[The role of the main risk factors and endocrine cells of the antrum of the stomach producing motilin in the occurrence of cholelithiasis].

AIM: To establish the role of the main risk factors and endocrine cells of the antrum of the stomach producing motilin (M-cells) in the occurrence of cholelithiasis. MATERIALS AND METHODS: The first group included 122 patients with cholelithiasis. The second group consisted of 30 healthy individuals who underwent medical examination. The groups were matched for gender and age. The work analyzed anamnestic, biochemical and anthropometric data. All patients underwent esophagogastroduodenoscopy with targeted biopsy of the mucous membrane from the antrum. Biopsies were subjected to cytological and immunohistochemical studies in order to verify Helicobacter pylori and estimate the number of M-cells. RESULTS: Patients with cholelithiasis more often belonged to the group of people of mental labor, had low physical activity, were committed to inappropriate nutrition and more often indicated the presence of aggravated heredity for cholelithiasis. Patients with gallstone disease had higher body mass index, waist volume, total cholesterol, low-density lipoprotein cholesterol, triglycerides, glucose, lower high-density lipoprotein cholesterol, H. pylori infection was more often verified and M-cell hypoplasia in the mucous membrane was established. stomach in comparison with the representatives of the second group. CONCLUSION: Our results suggest that certain external factors, nutritional characteristics of the metabolic syndrome components, hypoplasia of M-cells in the gastric mucosa are important factors in the formation of calculi in the gallbladder.

[The role of day hospital in optimization of medical care for patients of a therapeutic department of an outpatient clinic].

Day hospital (DH) provides consultations and treatment for all referred patients according to standards of medical care quality. DH has facilities for therapeutic and gastroenterological patients. Treatment in DH is performed according to current standards which cover basic treatment of the diseases (documented medicines, duration of treatment). Efficacy of DH's use of the Standards of Diagnosis and Therapy of Acid-Dependent Diseases associated with Helicobacter pylori (standards of Moscow consensus) is used as illustration. As a result of treatment in DH 93% outpatients resumed their jobs, improvement occurred in 96.7% patients, a complete response was seen in 23%, 1.9% cases failed treatment. Most DH patients (83%) were satisfied with treatment given in DH and think it a convenient replacement of hospital stay.

[Adaptation mechanisms of the gastric mucosa and factors that determine outcome of the therapy of acid-depended diseases associated with Helicobacter pylori on pre-hospital stage].

An efficiency of ambulant eradication therapy from patients with acid-dependent diseases was studied. The investigation was carried out in two stages. At the first stage the comparative efficiency of 4 schemes of the eradication therapy was found out of 180 patients. At the second stage the interrelation of an adaptable condition of the mucous membrane of stomach with the results of the eradication therapies and adaptor-vital characteristics of a lifestyle was investigated. The received facts allow to optimize outstationary medical care, and they can be a base for continuation of researches on adaptation of the Moscow standards "Diagnostics and therapy of acid-dependent diseases, including that ones, which are associated with a Hp-infection" to conditions of ambulant gastroenterology treatment.

[Optimization of approach to regular check-up of gastroenterological patients with acid-dependent diseases].

AIM: To optimize principles of gastroenterological care management in outpatient clinics and monitoring of medical service quality for patients with acid-dependent gastroenterological disease (ADGED) in the group of poor health patients for making decisions to optimize diagnosis, treatment and prophylaxis in outpatient setting. MATERIAL AND METHODS: Regulated standards were used in examination of 448 ADGED patients. Optimisation of outpatient medical care for poor health patients was conducted basing on the 3-level model of the consulting-diagnostic process. RESULTS: Among patients who suffer from ADGED most seriously 57.3% had H. pylori infection. Such patients benefited more from antihelicobacter treatment. CONCLUSION: Increasing number of patients with severe ADGED is explained by poor compliance with measures of prevention, healthy life style, treatment including antihelicobacter, low adaptation of gastric mucosa. Prophylaxis in ADGED patients should become a leading direction in medical care for such patients.

[Mechanism of action of Nizhne-Ivkinskaya 2K sulfate-calcium mineral water in combined treatment of acid-dependent gastrointestinal diseases].

AIM: To study efficacy of drinking mineral water (MW) nizhne-ivkinskaya 2K in combined sanatorium treatment of gastrointestinal acid-dependent diseases (ADD) and the role of endogenic modulators of M-cholinoreactivity in pathogenesis of ADD. MATERIAL AND METHODS: General condition of the patients, gastric pH and peristalsis (computer system Gastrolog-M), gastric and gall bladder motility (Aloka SSD 1100), hepatic function (by bilirubin and AST and ALT activity), lipid spectrum (including LDLP and HDLP) and M-cholinomodulating activity of the blood serum (by biomethod) were examined in 134 subjects: 20 healthy subjects and 114 patients with ADD. RESULTS: In ADD, gastric juice acidity is high, gastric and gall bladder motility is low, total cholesterol and LDLP cholesterol are elevated, M-cholinoblocking activity of the blood serum is reduced 10-fold. Intake of nizhne-ivkinskaya 2K mineral water for 21 days improved the patients' health, normalized gastric pH, motility of the stomach and gall bladder, reduced content of LDLP and restored M-cholinoblocking serum activity. CONCLUSION: ADD development is thought to result from excessive vagus effect due to elevated blood level of lysophosphatidylcholine (LPC). In certain concentrations it can enhance efficacy of M-cholinergic impacts on gastric cells. Reduction of LDLP content due to intake of the mineral water leads to normalization of M-cholinergic impacts on gastric cells.

[Efficacy of sulfate calcium mineral water in disorders of motor evacuatory function of the stomach and gallbladder]. / Effektivnost' sul'fatnoi kal'tsievoi mineral'noi vody pri narushenii motorno-évakuatornoi funktsii zheludka i zhelchnogo puzyria.

Patients with disorders of motor-evacuatory gastric function and those of the gallbladder received sanatorium spa treatment with Nizhneivkinskaya 2K mineral water. It was found that both course and single intake of the above mineral water induce clinical remission of the disease, normalization of the echoscopic picture of the stomach and gallbladder, their motor function, tesiocrystalloscopic characteristics of the saliva. Therefore, spa treatment with mineral water Nizhneivkinskaya is effective in rehabilitation of patients with gastric and gallbladder motor-evacuatory dysfunction.

[Current methods of ulcer therapy and their efficacy and cost]. / Sovremennye metody terapii iazvennoi bolezni, ikh éffektivnost' i stoimost'.

The purpose of this study is to assess the efficiency of the anti-ulcer therapy taking into account the economic aspects of treatment. We have examined 708 HP-positive(+) patients with stomach ulcers (SU) and duodenal ulcers (DU). Various schemes of anti-helicobacter and anti-secretory therapy were administered to them. Positive dynamics of some clinical data (local palpatory tenderness and abdominal wall resistance) and gastritis (gastroduodenitis) activity was discovered in all groups of patients. The cost of the treatment was determined with the help of marketing studies by taking the lowest price of drugs. There were no statistically reliable differences found groups of traditional treatment regimens by both results of HP eradication and the cost of eradicative and anti-secretory therapy. All drugs under study are highly effective for rapid relief of symptoms at an exacerbation of stomach ulcer associated with HP as well as the decrease of gastritis (gastroduodenitis) activity. It is possible to recommend them for both eradicative therapy and prolonged treatment.

[Stages in the improvement of drug therapy at a polyclinic]. / Etapy sovershenstvovaniia medikamentoznoi terapii v usloviiakh polikliniki.

Within 1968-1997 the authors studied the steps of introduction of the achievements of the medical science, technology and pharmacology to therapy of exacerbations and complications of peptic ulcer (PU). The scientific and practical value of endoscopic, histological, biochemical and bacteriological examinations in the improvement of the methods of pharmacotherapy of exacerbations and complications of PU was shown. Three phases of the PU development were indicated by the clinical signs and results of esophagogastroduodenoscopy, target biopsy and histological examinations. These data and available scientific achievements were assumed as a basis for the design of optimal drug combinations and their introduction to the medical practice. The use of such combinations made it possible to prevent relapses and life-threatening complications of the disease in the overwhelming majority of the patients. The best results of the pharmacotherapy were recorded in the years (1988-1997) when the drug combinations began to be used. The combinations provided eradication of Helicobacter pylori in the gastroduodenal mucosa and it was proved that in all the patients with PU and the relapsing lesions in the duodenum and in the overwhelming majority of the patients with gastric ulcer the disease developed at the background of chronic active gastroduodenitis associated with H.pylori. The success of the pharmacotherapy in the patients with PU was due to the use of the rational combinations of antibacterial and antisecretory agents.