[Pharmacokinetics and pharmacodynamics of rebamipide. New possibilities of therapy: A review].

The MedLine database contains 570 publications, including 71 randomized clinical trials and 6 meta-analyses on the rebamipide molecule in 2022. Indications for the use of rebamipide are gastric ulcer, chronic gastritis with hyperacidityin the acute stage, erosive gastritis, prevention of damage to the gastrointestinal mucosa while taking non-steroidal anti-inflammatory drugs, eradication of Helicobacter pylori. Currently trials are studying the efficacy and safety of the drug in gouty and rheumatoid arthritis, osteoarthritis, Sjögren's syndrome, bronchial asthma, vitiligo, atherosclerosis, diseases of the kidneys and liver; using in traumatology to accelerate bone regeneration; in ophthalmology to improve the regeneration of corneal epithelium; in oncology to reduce inflammatory changes in the oral mucosa after chemoradiotherapy. The review article is about the main pharmacokinetic and pharmacodynamic characteristics of rebamipide. A detailed understanding of pharmacodynamics and pharmacokinetics allows for individual selection of therapy based on the characteristics of the patient's body - gender, age, comorbidities; choose the optimal route of administration and dosing regimen; predict adverse effects and drug interactions; be determined with new clinical indications.

[Esophagoprotective therapy in patients with erosive esophagitis].

AIM: To evaluate the advantages of using combined therapy of proton-pump inhibitors (PPIs) and esophagoprotector in comparison with basic therapy of PPIs for 4 weeks based on the results of changes in the endoscopic picture.To compare the effectiveness of 4-week PPI therapy and 4-week combination therapy with PPI and esophagoprotector Alfasoxx (sodium hyaluronate, chondroitin sulfate, poloxomer 407) in patients with erosive esophagitis (EE) of any degree according to the Los Angeles Endoscopic Classification. MATERIALS AND METHODS: 81 patients with EE AC according to the Los Angeles endoscopic classification (1994) was enrolled in the study on the basis of the clinic of Peter the Great, Mechnikov North-Western State Medical University. By computer randomization, patients were divided into the control group 40 patients (pantoprazole 40 mg 1 time per day) and the intervention group 41 patients (pantoprazole 40 mg 1 time per day + Alfasoxx 1 sachet qid). The therapy was carried out for 4 weeks. In all patients before and after therapy, the frequency and severity of the main symptoms of gastroesophageal reflux disease (GERD) were assessed, esophagogastroduodenoscopy was performed. RESULTS: The advantage of combination therapy over standard PPI monotherapy in patients with EE was revealed. According to the results of the control endoscopy, healing of erosions of the esophageal mucosa was observed in 39 out of 41 (95.1%) patients in the intervention group and 32 out of 39 (82.1%) in the control group. The proportion of patients who showed an improvement in the endoscopic picture before and after treatment for 4 weeks by at least 1 level according to the Los Angeles classification was significantly higher in the comparison group 41 patients (100%), while in the control group 33 patients (85%); p0.009. After treatment, the combination therapy group had a lower incidence (p0.01) and severity of heartburn (p0.01). The same results are demonstrated by combination therapy regarding the symptom belching of air: in the study group after treatment, this symptom occurred less frequently (p=0.014), its severity was significantly less than in the control group (p0.01). There was a statistically significant decrease in the need for on-demand antacid therapy in the study group. CONCLUSION: In this study involving 81 patients with erosive GERD, the benefits of combination therapy were demonstrated. The addition of Alfasoxx medical device to PPI therapy increases the clinical and endoscopic efficacy of therapy. This positive effect is associated with the esophagoprotective properties of the drug, based on unique pharmacodynamic characteristics. Combination therapy for GERD is preferred in patients with EE. Studies have shown the expediency of using Alfasoxx in case of insufficient effectiveness of classical acid-suppressive therapy for GERD.

[The eosinophilic esophagitis and IgG4-related disease involving the esophagus].

The study of eosinophilic esophagitis has become a dynamic field with an evolving understanding of the pathogenesis, diagnosis, and treatment. Immunoglobulin G4 (IgG4)-related disease exhibits systemic involvement but very rarely involves the esophagus. The article presents a clinical case: the history of ulcer and stricture of the esophagus in a young man of 17 years. The patient was finally diagnosed with IgG4-related and eosinophilic esophagitis and showed a good response to corticosteroid therapy. We herein report a rare case of dysphagia associated with IgG4-related disease and eosinophilic. We presented a review of modern data on the relationship of eosinophilic esophagitis and pathological IgG4-response.

[Clinical observation experience of a pediatric patient with primary progressive multiple sclerosis in the Moscow office for the treatment of children and adolescents with multiple sclerosis]. / Opyt kuratsii pediatricheskogo patsienta s pervichno-progressiruyushchim rasseyannym sklerozom v usloviyakh kabineta po lecheniyu detei i podrostkov s rasseyannym sklerozom Departamenta zdravookhraneniya goroda Moskvy.

OBJECTIVE: To demonstrate the experience of a personalized approach to the treatment of pediatric patients with multiple sclerosis using the example of the Moscow patient population. MATERIALS AND METHODS: The authors describe the clinical follow-up of 79 pediatric patients with demyelinating diseases of the nervous system during 2019, including 39 patients with multiple sclerosis, including one patient with a primary progressive course of the disease (clinical case). RESULTS: The experience of the Moscow office for the treatment of multiple sclerosis in children and adolescents demonstrates the effectiveness of the personalized approach to the treatment of pediatric cases confirmed by the case report of biological therapy by recombinant humanized monoclonal antibody directed against CD20-expressing B-cells for early treatment of the adolescent patient with primary progressive multiple sclerosis. CONCLUSION: The identification of patient's groups with different levels of disease activity and different risks of disability progression is highly relevant in the pediatric population of patients with multiple sclerosis, especially in the context of expanding therapeutic opportunities.

[Differentiation therapy for non-acidic gastroesophageal reflux disease]. / Differentsirovannaia terapiia 'nekislykh' form gastroézofageal'noi refliuksnoi bolezni.

AIM: To investigate the clinical and pathogenetic features of the non-acidic types of gastroesophageal reflux disease (GERD) and to evaluate the impact of combined therapy versus monotherapy on the course of this disease. SUBJECTS AND METHODS: The investigation enrolled 62 patients with non-acidic GERD. The follow-up period was 6 weeks. The patients were divided into 2 groups: 1) weakly acidic gastroesophageal refluxes (GER); 2) weakly alkaline GER. Then each group was distributed, thus making up 4 groups: 1) 19 patients with weakly acidic GER who received monotherapy with rabeprazole 20 mg/day; 2) 21 patients with weakly acidic GER had combined therapy with rabeprazole 20 mg and itopride; 3) 8 patients with weakly alkaline GER who received ursodeoxycholic acid (UDCA) monotherapy; and 4) 14 patients with weakly alkaline GER who had combined therapy with UDCA and itopride, The clinical symptoms of the disease, the endoscopic pattern of the upper gastrointestinal tract (GIT) mucosa, histological changes in the esophageal and gastric mucosa, and the results of 24-hour impedance pH monitoring were assessed over time. RESULTS: During differentiation therapy, the majority of patients reported positive clinical changes and an improved or unchanged endoscopic pattern. Assessment of impedance pH monitoring results revealed decreases in the overall number of GERs, the presence of a bolus in the esophagus, and the number of proximal refluxes. These changes were noted not only in patients taking proton pump inhibitors (PPIs), but also in those treated with UDCA monotherapy or combined PPI and prokinetic therapy. CONCLUSION: A differentiated approach to non-acidic GER treatment contributes to its efficiency. Adding the prokinetic itomed (itopride hydrochloride) to PPI therapy in a patient with weakly acidic GER enhances the efficiency of treatment, by positively affecting upper GIT motility. The mainstay of therapy for GERD with a predominance of weakly alkaline refluxes is UDCA, the combination of the latter and the prokinetic can exert a more pronounced effect on the clinical and endoscopic pattern and upper GIT motility.

CLINICAL STUDY OF THE EFFICACY OF NATURAL MINERAL WATER "BORJOMI" IN PATIENTS WITH FUNCTIONAL DYSPEPSIA.

The article presents the results of original research of the effectiveness and safety of natural mineral water "Borjomi" in patients with functional dyspepsia. Daily pH-metric study in dynamics showed that the positive effect of mineral water "Borjomi" depends on the leading symptom in patients with functional dyspepsia and may be connected with antacid and prokinetic effects.

[Rebamipide: New opportunities of gastroenteroprotection].

This review paper deals with the prevention and therapy of nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal mucosal injuries in patients with disease of the cardiovascular and locomotor systems. Particular emphasis is laid on the new Russian drug rebamibide that is a stimulant of prostaglandin and glycoprotein synthesis and an inhibitor of the synthesis of oxidative stress products, inflammatory cytokines, and chemokines in the gastrointestinal mucosa. The advantage of rebamipide over classical gastroprotectors is its proven additional effect on the small and large intestinal mucosa. This drug has been registered and is actively used in a number of countries, including Japan, South Korea, and China.

The use of tenoten preparation in complex therapy of hypomotoric biliary dyskinesia.

A positive effect of tenoten on the course of biliary dyskinesia in patients with anxiety and depressive disorders was demonstrated. Tenoten can be recommended for the treatment of functional cholangio-pancreatoduodenal motility disturbances.