[Lactose digestion and absorption in the jejunum of man: studies using the regional perfusion method]. / Perevarivanie i vsasyvanie laktozy v toshchei kishke cheloveka, izuchennye s pomoshch'iu metoda regional'noi perfuzii.

Continuous jejunal perfusion with 0.1, 1 and 10% lactose solutions was made in 9 patients with good milk tolerance and 25 patients with secondary hypolactasia. In normal tolerance lactose is assimilated in amounts of 30-60% along the 30 cm of the jejunal length. Hypolactasia results in inhibited hydrolysis and absorption of lactose whose activity rapidly diminishes. The phenomenon of substrate lactose induction is demonstrated available both in normal and hypolactasia conditions. In stepwise introduction of lactose in the intestine the tolerance to milk sugar noticeably rises. This fact should be allowed for when conducting enteral feeding.

[Gluten enteropathy]. / Glutenovaia énteropatiia.

The authors relate the results of 10 years of observations of 113 patients suffering from gluten enteropathy (GE) of the adults. In all the patients, the diagnosis was supported by the presence of hyper-regenerative atrophy of the small intestinal mucosa (total in 70% and subtotal in 30%). Metabolic disorders and cellular immunity were investigated. At the onset of the observations 70.7% of the patients demonstrated malabsorption, stage III gravity, and 29.3% stage II. It has been proved that permanent and strict adherence to the agluten diet and administration of corticosteroids in the most severe cases in combination with pathogenetic therapy of diarrhea and metabolic disorders permit attaining a steady clinical remission, improvement of normalization of the biochemical and immunological characteristics, a tendency toward normalization of the small intestinal mucosa, and even the recovery of its normal structure in part of the cases.

[Treatment of chronic diseases of the small intestine]. / Lechenie khronicheskikh zabolevanii tonkoi kishki.

Multimodality and differentiated treatment of small-intestinal diseases is to combine methods of etiological action with pathogenetic treatment of the main clinical syndromes: chronic diarrhea, malabsorption syndrome, hypercatabolic exudative enteropathy. Each nosological form should be treated specifically. Pathogenetic treatment involves diet therapy, chemotherapeutic correction of metabolic processes (vitamin administration, recovery of normal protein and lipid metabolism, water and electrolyte balance, anemia), management of chronic diarrhea. Treatment regimens are specified for gluten enteropathies, total variable immunodeficiency, Whipple disease, small-intestinal diverticulosis, Crohn's disease, amyloidoses, intestinal lymphoma and retroperitoneal lymph nodes. Clinical experience justifies the above methods as highly effective.

[Mechanisms of the development of the chronic phase of diseases of the small intestine]. / Mekhanizmy khronizatsii zabolevanii tonkoi kishki.

The results of studying mechanisms underlying chronicity of functional (chronic enteritis ) and severe organic (celiac disease) lesions of the small intestine have been analyzed. Mechanisms causing the diseases take a chronic course appeared very similar. They involve bacterial proliferation in the intestine with consequent impairment of the digestion, absorption and motility resultant in derangement of metabolism. Defects in protein and lipid metabolism proved most essential. Chronic enteritis is associated with a favorable outcome provided there are no grave malabsorption symptoms. Combined treatment as a rule produces good therapeutic response in chronic enteritis and celiac disease. Relevant schemes are presented.

[Current problems in the diagnosis and treatment of small intestinal diseases]. / Aktual'nye voprosy diagnostiki i lecheniia boleznei tonkoi kishki.

Based on the data obtained during clinical examination of 1,026 patients with small intestinal diseases the authors provide the portion of laboratory and instrumental methods employed in the diagnosis of different disease entities. The clinical picture of small intestinal diseases is mainly determined by the gravity of malabsorption. Histological examination of the small intestinal mucosa is a method of choice in the diagnosis of gluten enteropathy, Whipple's disease, primary lymphangiectasis and amyloidosis. Immunoassays play the key role in recognition of variable immunodeficiencies and disease of heavy alpha-chains. Meanwhile in differential diagnosis of Crohn's disease, small intestinal tumors, congenital abnormalities of rotation and in some others, the leading part is played by x-ray methods. The authors describe the treatment schedule based on the pathogenetic approach, that makes it possible to reach a stable clinical remission and recovery of the working capacity even in part of patients with stage III malabsorption.

[Disorders of lipid metabolism in patients with chronic diseases of the small intestine]. / Narusheniia lipidnogo obmena u bol'nykh khronicheskimi zabolevaniiami tonkoi kishki.

Lipid metabolism was evaluated in patients with chronic enteritis, celiac disease, general variable immunodeficiency (GVI), short-bowel syndrome. In chronic enteritis with malabsorption syndrome degree I and II changes in metabolism were characterized by hyperlipidemia due to high lipid fractions, mainly triglycerides; in malabsorption syndrome degree III (celiac disease, general variable immunodeficiency, short-bowel syndrome) by a drop of serum total lipids, phospholipids, cholesterol, beta-lipoproteins, free fatty acids, elevated concentrations of triglycerides. Changes in fatty acid composition of blood serum in patients with malabsorption syndrome degree III manifested by derangement of polyunsaturated fatty acids ratio. Arachidonic acid concentration was reduced in 100% of cases, linolenic acid in 45%. In all the patients with celiac disease and malabsorption syndrome degree III there was hypoactivity of lipolytic blood enzymes lipase and tributyrinase.

[General variable immunologic deficiency with malabsorption syndrome]. / Obshchaia variabel'naia immunologicheskaia nedostatochnost' s sindromom narushennogo vsasyvaniia.

Twenty-two patients with general variable immunodeficiency (GVI) and malabsorption syndrome (MS) were followed up for 2-12 years. III degree MS was found in 17 cases. Serum immunoglobulins concentration and T-lymphocyte count were reduced, the latter at the expense of theophylline-resistant and active E-RFC. With casein and milk albumin as the antigens, lymphokine-producing capacity of the mononuclear cells appeared elevated. MS treatment with adjuvant gamma-globulin produced a positive trend in clinical manifestations of the disease, content of T lymphocytes and relevant subpopulations. Long-term results were less favourable: partial compensation with recurrences persisted in 15 patients only. Seven patients died: two of pneumonia, five of cardiac failure and visceral dystrophy. All MS patients are recommended to undergo serum immunoglobulins diagnosis of GVI and in case of its verification to receive life-time gamma-globulin replacement therapy.

[Diagnosis and treatment of psychogenic intestinal dyskinesia]. / Diagnostika i lechenie psikhogennykh diskinezii kishechnika.

Intestinal dysfunction resulting from psychological factors associated with vegetative disorders were found in 79% of relevant patients. It is stated that comprehensive program of screening persons suffering from psychosomatic intestinal diseases should involve diagnosis of psychopathologic syndromes, analysis of personal traits, factors of psychic trauma, internal pattern of the disease. The treatment technique affecting all the levels of the disease (central, vegetative and somatic) provides good therapeutic effect and normal psychological profile in the majority of patients.

[The effect of an agluten diet on cellular immunity in adult patients with celiac disease]. / Vliianie agliutenovoi diety na pokazateli kletochnogo immuniteta u bol'nykh tseliakiei vzroslykh.

A total of 45 patients with Gee's disease of adults were followed up in the time course of 6 months to 3 years. In untreated patients the number of T-lymphocytes was decreased both at the expense of T-helpers and, especially, of T-suppressors. Lymphokine-producing activity of T-lymphocytes, according to the production degree of the mediator, inhibiting monocyte adherence, increases after gliadin-treatment of the immuno-competent cells, that leads to monocyte adhesion decrease. In patients strictly keeping the agluten diet the cellular immunity parameters return to normal. Decreased monocyte adhesion remains up to a year. In those who do not strictly keep the agluten diet the cellular immunity disorders are retained and become more pronounced than in the untreated patients.

[Gastrointestinal biorhythms in chronic intestinal diseases]. / Zheludochno-kishechnye bioritmy pri khronicheskikh zabolevaniiakh kishechnika.

Gastric and intestinal bio-electrical activity (BEA) was assessed from body surface by means of a modified electrogastrograph, EGS-4M, in 387 patients with various intestinal conditions and 39 normal subjects. The method is simple, atraumatic and rather inexpensive. It revealed qualitative and quantitative BEA changes (uncoordination in half the cases, and increased amplitudes of waveforms I, IV and V) in patients with mild disorders, which were chiefly functional and involved no organic gastro-intestinal lesions (i.e., signs of gastric or colonic irritation). In cases of chronic small-intestinal conditions, involving impaired absorption syndrome, reduced waveform II and III amplitudes showed correlation to the severity of the latter. BEA normalization in the course of treatment provides an objective indicator of the degree of patient rehabilitation and the efficiency of treatment at large. BEA parameters cannot be used for nosologic or differential diagnosis. BEA measurements, combined with other techniques, can be useful for the assessment of motor/evacuatory activity of the digestive system.

[Importance of amino acid mixtures in the supplementary nutrition of patients with chronic diseases of the small intestine]. / Znachenie aminokislotnykh smesei v dopolnitel'nom pitanii bol'nykh s khronicheskimi zabolevaniiami tonkoi kishki.

The clinical effectiveness of alvesin, a mixture of pure amino acids, balanced by the amino acid composition, was studied in the treatment of patients with chronic diseases of the small intestine. The drug was well tolerated by the patients after its parenteral administration. A high clinical effect of alvesin was recorded in 98 patients suffering from chronic enteritis, celiac disease, general variable immunodeficiency. The optimal dose of the drug was determined.