[Effectiveness of empirical Helicobacter pylori eradication therapy with furazolidone in Russia: results from the European Registry on Helicobacter pylori Management (Hp-EuReg)].

BACKGROUND: First-line therapy does not always provide a high level of Helicobacter pylori eradication due to the increase of H. pylori resistance to antibiotics; therefore, it remains necessary to identify the most effective rescue treatments. The purpose of this study was to evaluate the efficacy and safety of empirical H. pylori furazolidone-containing regimens. MATERIALS AND METHODS: Adult H. pylori infected patients empirically treated with furazolidone-containing eradication regimens were registered in an international, prospective, multicenter non-intervention European registry on H. pylori management (Hp-EuReg). Data were collected at AEG-REDCap e-CRF from 2013 to 2021 and the quality was reviewed. Modified intention-to-treat (mITT) effectiveness analyses were performed. RESULTS: Overall 106 patients received empirical furazolidone-containing therapy in Russia. Furazolidone was prescribed in a sequential scheme along with amoxicillin, clarithromycin and a proton pump inhibitor in 68 (64%) cases, triple regimens were prescribed in 28 (26%) patients and quadruple regimens in 10 (9.4%). Treatment duration of 7 days was assigned to 2 (1.9%) patients, 10-day eradication therapy in case of 80 (75%) and 14 days - in 24 (23%) patients. Furazolidone was mainly used in first- (79%) and second-line (21%) regimens. The methods used to diagnose H. pylori infection were: histology (81%), stool antigen test (64%), 13C-urea breath test (6.6%), and rapid urease test (1.9%). The mITT effectiveness of sequential therapy was 100%; 93% with the triple therapy and 75.5% with quadruple therapy. Compliance was reported in 98% of cases. Adverse events were revealed in 5.7% of patients, mostly nausea (3.8%). No serious adverse events were reported. CONCLUSION: Furazolidone containing eradication regimens appear to be an effective and safe empirical therapy in Russia.

[Prospects for personalized Helicobacter pylori eradication therapy. Pro et contra].

The article is devoted to debatable aspects of Helicobacter pylori eradication therapy. The eradication cancer-preventive effects are considered. A negative comorbidity between H. pylori infection and such diseases as gastroesophageal reflux disease, inflammatory bowel disease and bronchial asthma has been described. The perspectives of populational, individualized and personalized strategies for H. pylori eradication therapy assessment are given. Recommendations for individualized H. pylori eradication strategy implementation in practical healthcare are proposed.

[Epithelial protective therapy in comorbid diseases. Practical Guidelines for Physicians].

This document was produced with the support of the National Medical Association for the Study of Comorbidities (NASС). In 2021 the first multidisciplinary National Consensus on the pathophysiological and clinical aspects of Increased Epithelial Permeability Syndrome was published. The proposed guidelines are developed on the basis of this Consensus, by the same team of experts. Twenty-eight Practical Guidelines for Physicians statements were adopted by the Expert Council using the "delphic" method. Such main groups of epithelial protective drugs as proton pump inhibitors, bismuth drugs and probiotics are discussed in these Guidelines from the positions of evidence-based medicine. The clinical and pharmacological characteristics of such a universal epithelial protector as rebamipide, acting at the preepithelial, epithelial and subepithelial levels, throughout gastrointestinal tract, are presented in detail.

[European registry Helicobacter pylori (Hp-EuReg): how has clinical practice changed in Russia from 2013 to 2018 years].

The multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group (EHMSG) is conducted in 27 countries in Europe. The data from the Russian part of the European registry for the management of Helicobacter pylori infection (European Registry on the management of Helicobacter pylori infection, protocol: "Hp-EuReg") allows us to analyze the real clinical practice of diagnosis and treatment of H. pylori and compare it with international recommendations. MATERIALS AND METHODS: A comparative analysis of the data entered in the register by the Russian research centers "Hp-EuReg", in the period from 2013 to 2018, was conducted. RESULTS AND DISCUSSION: Invasive diagnostic methods prevail for the primary diagnosis of H. pylori [histology - 20.3% (in 2013 year) - 43.9% (in 2018 year), rapid urease test - 31.7% and 47.8% respectively]. The most popular mode of eradication therapy is a 10-day triple therapy (62.8-76.2%), the effectiveness of which does not exceed 79% (per protocol). Invasive tests (histology) are the leading method for control the effectiveness of therapy, however, there is a tendency towards a wider use of non-invasive methods (H. pylori stool antigen - from 17% in 2013 to 29.3% in 2018 and urea breath test from 6.9 to 18.3%, respectively). Serological test to control the effectiveness of eradication is still used from 8.2% (2013) to 6.1% (2018). Eradication therapy was not performed in 28% of patients throughout the entire observation period. CONCLUSION: In Russia, despite approved domestic and international recommendations, deviations in clinical practice persist, both during eradication therapy and in monitoring the effectiveness of eradication therapy.

Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment.

The Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian "Pancreatic Club" on the Delphi method. His goal was to clarify and consolidate the opinions of specialists on the most relevant issues of diagnosis and treatment of exo- and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is provided by the participation of leading gastroenterologists and surgeons.

European Registry on the management of Helicobacter pylori infection (Hp-EuReg): analysis of 2360 patients receiving first-line therapy in Russia.

AIM: European Registry on the management of Helicobacter pylori infection («Hp-EuReg¼) - a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group, conducted in 27 European countries in order to evaluate the real clinical practice of diagnosis and treatment of H. pylori and its comparison with international recommendations. MATERIALS AND METHODS: The analysis of 2360 patients entered in the register by the Russian centres of «Hp-EuReg¼ in 2013-2017, who were underwent 1st line eradication therapy. RESULTS: The most common methods of primary diagnosis of H. pylori are histological (37.7%), rapid urease test (29.2%) and serology (29.7%). The duration of eradication therapy in 9.4% of cases was 7 days, in 65.3% - 10 days, and in 25.3% - 14 days. To control the effec- tiveness of treatment, H. pylori antigen in feces (31.3%), urea breath test (23.4%) and histological method (23.3%) were used. In 3.6% cases was used serology by mistake. In 17.3% of patients control was not carried out. The effectiveness of triple therapy with a PPI, amoxicillin, clar- ithromycin (per protocol) was 67.6%, with 7-day course, 81.1% at 10-day and 86.7% at 14-day course. Eradication rate of triple therapy with addition of bismuth (per protocol) reached 90,6% in the group receiving 10-day scheme and 93.6% in the group receiving the 14-day treatment. CONCLUSION: Significant deviations of clinical practice from expert recommendations, most pronounced at the stage of monitoring the effectiveness of therapy, were noted. The suboptimal efficacy of triple therapy is shown.

[The Russian consensus on the diagnosis and treatment of chronic pancreatitis: Enzyme replacement therapy]. / Rossiiskii konsensus po diagnostike i lecheniiu khronicheskogo pankreatita: zamestitel'naia fermentnaia terapiia.

Pancreatology Club Professional Medical Community, 1A.S. Loginov Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow; 2A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 3Kazan State Medical University, Ministry of Health of Russia, Kazan; 4Kazan (Volga) Federal University, Kazan; 5Far Eastern State Medical University, Ministry of Health of Russia, Khabarovsk; 6Morozov City Children's Clinical Hospital, Moscow Healthcare Department, Moscow; 7I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg; 8Siberian State Medical University, Ministry of Health of Russia, Tomsk; 9M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow; 10Maimonides State Classical Academy, Moscow; 11V.I. Razumovsky State Medical University, Ministry of Health of Russia, Saratov; 12I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow; 13S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, Saint Petersburg; 14Surgut State Medical University, Ministry of Health of Russia, Surgut; 15City Clinical Hospital Five, Moscow Healthcare Department, Moscow; 16Nizhny Novgorod Medical Academy, Ministry of Health of Russia, Nizhny Novgorod; 17Territorial Clinical Hospital Two, Ministry of Health of the Krasnodar Territory, Krasnodar; 18Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint Petersburg; 19Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don; 20Omsk Medical University, Ministry of Health of Russia, Omsk; 21Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 22Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk; 23Stavropol State Medical University, Ministry of Health of Russia, Stavropol; 24Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo; 25N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow; 26A.M. Nikiforov All-Russian Center of Emergency and Radiation Medicine, Russian Ministry for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters, Saint Petersburg; 27Research Institute for Medical Problems of the North, Siberian Branch, Russian Academy of Sciences, Krasnoyarsk; 28S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow; 29Tver State Medical University, Ministry of Health of Russia, Tver The Russian consensus on the diagnosis and treatment of chronic pancreatitis has been prepared on the initiative of the Russian Pancreatology Club to clarify and consolidate the opinions of Russian specialists (gastroenterologists, surgeons, and pediatricians) on the most significant problems of diagnosis and treatment of chronic pancreatitis. This article continues a series of publications explaining the most significant interdisciplinary consensus statements and deals with enzyme replacement therapy.

Acute cholestatic liver injury caused by polyhexamethyleneguanidine hydrochloride admixed to ethyl alcohol.

INTRODUCTION: Polyhexamethyleneguanidine hydrochloride (PHMG) is an antimicrobial biocide of the guanidine family. In the period from August 2006 to May 2007, more than 12500 patients were admitted to hospital with a history of drinking illegal cheap "vodka" in 44 different regions in Russia, of whom 9.4% died. In reality, the "vodka" was an antiseptic liquid composed of ethanol (≈93%), diethyl phthalate, and 0.1-0.14% PHMG (brand name "Extrasept-1"). MATERIAL AND METHODS: We performed an analysis of the clinical features and outcome in four poisoning treatment centers in the cities of Perm, Ekaterinburg, Irkutsk, and Khabarovsk. A total of 579 patients (215 females and 364 males) with similar symptoms were included. RESULTS: The main symptoms on admission included jaundice (99.7%), skin itch (78.4%), weakness (96%), anorexia (65.8%), dizziness (65.3%), nausea (54.8%), vomiting (22.6%), stomach ache (52.7%), diarrhea (32%), and fever (50%). Mild symptoms were found in 2.5% of cases, moderate in 63%, and severe in 34.5%. Laboratory results were (mean ± SD): total bilirubin 249 ± 158 µmol/L, direct bilirubin 166 ± 97 µmol/L, cholesterol 14 ± 8 mmol/L, alanine aminotransferase 207 ± 174 IU/L, aspartate aminotransferase 174 ± 230 IU/L, alkaline phosphatase 742 ± 751 IU/L, and gamma-glutamyltranspeptidase 1199 ± 1095 IU/L. Patients generally recovered over a period of 1-5 months, although high levels of alkaline phosphatase and gamma-glutamyltranspeptidase were still found in all patients examined after 6 months. Sixty-one patients (10.5%) died between 23 and 150 days after poisoning. Local cholestasis, inflammatory infiltration, and fibrosis developing into cirrhosis were found by liver biopsy. CONCLUSION: Acute liver injury caused by PHMG-hydrochloride or PHMG in combination with either ethanol or diethyl phthalate can be characterized as cholestatic hepatitis with a severe inflammatory component causing high mortality.

[Effect of enalapril, lisinopril, and amlodipine on the course of chronic gastrititis in patients with arterial hypertension]. / Vliianie énalaprila, lizinoprila i amlodipina na techenie khronichskogo gastrita u bol'nykh arterial'noi gipertoniei.

A hundred and thirty-six patients with mild and moderate arterial hypertension (AH) who had received angiotensin-converting enzyme inhibitors (ACEIs) (enalapril and lisinopril) and the calcium channel blocker amlodipine were examined. The use of the above ACEIs promoted the normalization of proliferative processes in the epithelium of the gastric mucosa (GM) in patients with AH and concomitant chronic gastritis. This effect ofACEIs is not related to an antihypertensive effect since the antihypertensive agent amlodipine fails to exert such an effect on GM. The revealed fact of the positive effect ofACEIs not only on the morphological characteristics of GM, but also on the severity of the dyspeptic syndrome is important from the clinical point of view.

[Dynamics of clinical symptoms, indices of quality of life, and the state of motor function of the esophagus and rectum in patients with functional dyspepsia and irritable bowel syndrome after Helicobacter pylori eradication]. / Dinamika klinicheskoi simptomatiki, pokazatelei kachestva zhizni, sostoianiia motornoi funktsii pishchevoda i priamoi kishki u bol'nykh s funktsional'noi dispepsiei i sindromomrazdrazhennogo kishechnika posle éradikatsii HP.

94 patients with irritable bowel syndrome and functional dyspepsia were included in the study. To confirm the diagnosis of H. pylori infection, all patients underwent fibroesophagogastroduodenoscopy with histological and urea tests before and 5 weeks after treatment. Standard eradication was performed. 25 patients underwent intraesophageal and anorectal manometry using the Polygraf device, Sweden. The dynamics of clinical symptoms, life quality (SF-36), manometry data and data of the histological examination of the stomach mucous coat was assessed. 63.5% of patients had clinical improvements following the eradication. The threshold of rectal sensitivity rose in 40% of patients. The esophageal motor function normalized in 48% of patients. An improvement of the morphological picture of chronic gastritis was recorded in 58.7% of patients.

[Ways to optimize therapy of acid-dependent diseases]. / Puti optimizatsii terapii bol'nykh kisloto-zavisimymi zabolevaniiami.

The range of antisecretory preparations used by a gastroenterologist now includes a new reliable preparation. Nexium, which allows solving the problem of optimization of treatment of patients with acid-dependent diseases.

[The effect of histamine H2 receptor blockers on reparative processes in the gastric mucosa of patients with gastric peptic ulcer]. / Vliianie blokatorov gistaminovykh H2-retseptorov na reparativnye protsessy v slizistoi obolochke zheludka u bol'nykh iazvennoi bolezn'iu zheludka.

AIM: To investigate effects of histamine H2-receptor antagonists (cimetidine, famotidine) on proliferative activity of gastric mucosa of patients with acute gastric ulcer. MATERIALS AND METHODS: We treated 74 patients (54 men and 20 women) with acute benign mediogastric ulcer at the age of 28-56 years. Group 1 consisted of 24 patients who received antacid; group 2--of 26 patients on 1 g/day cimetidine; group 3--24 patients who received famotidine 40 mg qPM. We assessed clinical efficiency of three-week therapy, grade of ulcer healing, proliferative activity of antral and fundic gastric epithelium and ulcer margin epithelium using autoradiography with 3H-thymidine. RESULTS: Clinical efficiency of histamine H2-receptor antagonists was significantly higher than of antacid. Cimetidine and famotidine stimulate proliferative activity in the epithelium of ulcer margins. CONCLUSION: The ability to stimulate proliferative activity of gastric mucosa makes H2-receptor antagonists an effective modality in acute gastric ulcer with low acid secretion.

[Effects of histamine H2-receptor blockers and dalargin on reparative processes gastroduodenal mucosa in patients with duodenal ulcer]. / Vliianie blokatorov H2-retseptorov gistamina i dalargina na reparativnye protsessy v slizistoi obolochke gastroduodenal'noi sistemy u bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kiski.

The effect of synthetic opiate peptide dalargin, histamine H2-receptors blockers (cimetidin, famotidin) and combination of dalargin with famotidin on proliferative activity of gastroduodenal mucosal epithelium has been studied autoradiographically (3H-thymidine) in 75 patients with duodenal ulcer. Compared to spasmolytics and antacids, the studied drugs (dalargin, cimetidin and famotidin) significantly increased the number of DNA-synthetizing cells in the epithelium of fundal stomach, duodenal cap and ulcer borders. Maximal effect was noticed in combined use of dalargin and famotidin. A correlation existed between clinical and stimulating reparative effect of the drugs.

[Effect of dalargin on repair capacity of gastroduodenal mucosa in patients with duodenal ulcer]. / Vliianie dalargina na reparativnuiu sposobnost' gastroduodenal'noi slizistoi obolochki u bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kishki.

Changes in the number of DNA-synthesizing nuclei of gastroduodenal mucosa in duodenal ulcer were monitored for patients treated with dalargin versus standard therapy (spasmolytics and antacids). In contrast to the standard treatment, dalargin 20-day administration produced a significant increase in the index of 3H-thymidine-labelled epithelial nuclei in fundal and duodenal bulb mucosa. The capacity for activating DNA synthesis in gastroduodenal mucosa may represent an essential mechanism of dalargin therapeutic action.

[Disturbance of epithelial proliferation of the gastro-intestinal tract mucosa in ulcers and erosion]. / Narusheniia protsessov proliferatsii épiteliia slizistoi obolochki zheludochno-kishechnogo trakta pri iazvakh i éroziiakh.

Epithelial proliferation in the mucosa of the gastro-intestinal tract was studied autoradiographically with 3H-thymidine under the following conditions: acute gastric ulcers as complication of acute pancreatitis; exacerbation of duodenal ulcer; ulcers and erosions in bacterial dysentery. Mucosa of practically healthy persons as well as mucosa of patients with the same diseases not complicated with ulcers and erosions served as control. Biopsies of mucosa were taken 2 cm from ulcers and erosions. The decrease of DNA-synthesizing nuclei number in the mucosa epithelium at early stages of ulcer formation was observed in all these conditions.

[Reverse diffusion of hydrogen ions and its correlation with acid secretion and proliferative activity of gastric mucosal epithelium in patients with variants of chronic gastritis and peptic ulcer]. / Obrataia diffuziia ionov vodoroda i sopostavlenie ee s kislotovydeleniem i proliferativnoi aktivnost'iu épiteliia slizistoi zheludka u bol'nykh s razlichnymi variantami khronicheskogo gastrita i iazvennoi bolezni.

Eighty-one patients with chronic gastritis and 124 patients with peptic ulcer were examined. It was discovered that in chronic gastritis, the concomitant gastritis included, in patients with peptic ulcer, the degree of enhancement of reverse diffusion of hydrogen ions depended on the intensity of atrophy of the fundal and antral mucosa as well as on the extent of gastric lesions. The duodenogastral reflux promoted the increase of reverse diffusion of hydrogen ions. In mediogastral ulcer site, reverse diffusion of hydrogen ions was, at the height of exacerbation, enhanced to a greater degree than in the stage of ulcer healing. In atrophic variants of chronic gastritis and in peptic ulcer patients with an ulcer sited in the stomach, a close positive correlation was noted between reverse diffusion of hydrogen ions and proliferative activity of the gastric mucosa epithelium and a negative correlation between the diffusion and hydrochloric acid secretion. In patients with peptic ulcer of the duodenum without gastritis or the duodenogastral reflux, the characteristics of reverse diffusion of hydrogen ions did not differ from those seen in normal subjects.