[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.

[Multicenter study of gastroesophageal reflux disease symptoms prevalence in outpatients in Russia].

BACKGROUND: Recently, there has been an increase in the prevalence of gastroesophageal reflux disease (GERD) in Northern Europe, North America and East Asia. However data on GERD prevalence in Russian population are very limited. AIM: To determine the prevalence of GERD among the population of Russia, the clinical spectrum of GERD symptoms, the main drugs used for GERD treatment, and the rate of their administration. MATERIALS AND METHODS: The study was conducted from November 2015 to January 2017 in 8 cities of Russia. A survey of patients over the age of 18 years old visiting outpatient medical institutions for any reason, including patients without gastrointestinal complaints was carried out using a short version of the Mayo Clinic questionnaire. RESULTS: In total, 6132 questionnaires of patients aged 1890 years were analyzed [2456 men (40.1%) and 3676 women (59.9%), mean age 46.615.4 years]. The GERD prevalence among the interviewed patients was 34.2%. The incidence of GERD increased depending on body mass index and the age of the patients. Medications used by the patients for heartburn relief included proton pump inhibitors 59.96%, antacids 67.92%, H2-histamine receptor blockers 11.42%, alginates 18.41% of patients. CONCLUSION: The results of this study indicate a high prevalence of GERD among residents of Russian cities applying for primary health care (34.2%). In comparison with previous studies, an increase in the proportion of GERD patients taking proton pump inhibitors was noted; in most cases the regimen of their intake was in accordance with the recommendations.

[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.

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.

Diagnosis of Helicobacter pylori infection in clinical practice.

Diagnostic tests used to detection Helicobacter pylori are divided into invasive (requiring endoscopy) and non-invasive, direct (bacteriological, histological or molecular detection of the bacterium) and indirect (detection of urease activity of the bacterium or antibodies to it). The choice of the test is determined by the clinical situation, as well as by its availability and cost. The sensitivity of most tests is affected by the use of antisecretory drugs and antibiotics.

[European Registry on the management of Helicobacter pylori infection (Hp-EuReg protocol): The first results of Russian centers].

AIM: To assess the clinical practice of diagnosis and treatment in patients with Helicobacter pylori infection and to compare this practice with the international guidelines in the European Registry on the management of Helicobacter pylori infection, Hp-EuReg protocol), a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group. MATERIALs AND METHODS: The data of 813 patients infected with H. pylori and entered in the Hp-EuReg register by the Russian centers in 2013-2015 were analyzed. RESULTS: The most common methods for the primary diagnosis of H. pylori infection are histology (40.3%), rapid urease test (35.7%), and serology (17.2%). The duration of H. pylori eradication therapy was 7, 10, and 14 days in 18.0, 49.3, and 25.1%, respectively. To monitor the effectiveness of treatment, the investigators used a histological examination (34%), a urea breath test (27.3%), H. pylori stool antigen (22.8%), and a rapid urease test (16.3%). A serological test was carried out in 2.5% of the cases. No monitoring was done in 13.5% of the patients. The average eradication efficiency was 82.6%. If the therapy was ineffective, 80% of physicians did not intend to prescribe a new cycle of treatment. CONCLUSION: Significant differences were found between clinical practice and the current guidelines.

[Severity of anxiety and depressive disorders and their relationship with cerebral and hemodynamic impairment in patients with arterial hypertension in the practice of general practitioner]. / Vyrazhennost' trevozhno-depressivnykh rasstroistv i ikh sootnoshenie s tserebral'nymi i gemodinamicheskimi narusheniyami u bol'nykh arterial'noi gipertoniei v praktike vracha obshchego profilya.

AIM: To determine the relationship of anxiety and depressive disorders with cerebral and hemodynamic impairment in arterial hypertension (AH). MATERIAL AND METHODS: The study involved 97 patients with AH, stage II, who were followed up by a general practitioner. The severity of anxiety and depression assessed with the HADS, severity of cerebral disorders and a set of hemodynamic parameters were evaluated. RESULTS AND CONCLUSION: It was found that psycho-emotional disorders were combined with an increase in the frequency of modifying risk factors (smoking, high salt intake, overweight and obesity), severe cerebral disorders and significant changes in the elastic-tonic properties of a vascular wall. Significant correlations between depression and vascular age were found.

EVIDENCE BASE OF LACTOBACILLUS REUTERI EFFICACY IN THE TREATMENT OF DISEASES ASSOCIATED WITH HELICOBACTER PYLORI.

Helicobocterpylori (HP) - the human infection that persists for a long time in the stomach and can cause chronic gastritis, gastric and duodenal ulcer, MALT-lymphoma, gastric adenocarcinoma. There is a well-adapted niche-specific microbial community in the stomach represented by Lactobocillus, Streptococcus ahd other bacteria. Use of probiotics is considered to be an alternative or supplement to eradication therapy Among the Lactobacillus the most promising is Loctobocillus reutert who are able to have the anti-HP activity L. reureri produces powerful antimicrobial compounds such as reuterin, reuteritsin 6, reutetsiklin and metabolites that inhibit the growth of I-/P (volatile fatty acids, lactic acid, hydrogen peroxide, etc.). These compounds could reduce the adhesion of HP to gastric epithelial cells, inhibit growth HP, which leads to a significant reduction in the degree of contamination of HP and the severity of gastric mucosal inflammation. The data on the effectiveness of L. re uteri as monotherapy in patients with HP without absolute indications for eradication, and as an additional component, which increase the effectiveness of eradication are presented.

[Clinical characteristics of hypertensive encephalopathy in the perimenopausal period].

OBJECTIVES: To study correlations between symptoms of hypertensive encephalopathy (HE), structural MRI changes of the brain and affective disorders in the perimenopausal period. MATERIALS AND METHODS: A study included 150 women who have been through natural menopause (group 1) and 100 women in the premenopausal (group 2). Somatic and neurological examination, MRI and psychometric scales for anxiety and depression were used. RESULTS AND CONCLUSIONS: Women with hypertensive encephalopathy in the postmenopausal period had signs of persistent psycho-emotional disorders (higher anxiety, depression of different severity) combined with structural changes in the brain, with their severity increasing with the progression of HE.

[The degree of cognitive disorders and related psychovegative and hemodynamic impairments in patients with essential hypertension].

AIM: to study the specific features of clinical, hemodynamic, and psychovegetative impairments in patients with essential hypertension (EH) in relation to the degree of cognitive disorders (CD). SUBJECTS AND METHODS: Seventy-five patients with EH were examined and, according to the presence and degree of CD were divided into 3 groups: 1) 17 patients without cognitive deficit; 2) 35 patients with mild CD; 3) 23 patients with moderate CD. Risk factors, clinical manifestations, and hemodynamic and autonomic regulation features were assessed. RESULTS: In EH patients without cognitive deficit, blood pressure (BP) corresponded to grade 1; among cerebral disorders, there was a preponderance of early signs of dyscirculatory encephalopathy (DEP) that were accompanied by subclinical anxiety disorders, preserved autonomic adaptation, and symmetrical blood flow in the common carotid artery (CCA) bed. Sympathetic autonomic tone and the occurrence of anxiety-depressive disorders were noted in EH patients with mild CD along with progression of cerebral disorders and impairments in the 24-hour BP profile and hemodynamics in the CCA bed. In patients with EH and moderate CD, the 24-hour BP profile corresponded to grade 2 and the significant cerebral symptoms were associated with the significantly impaired elastotonic properties of the vascular wall in the CCA bed and with the presence of signs of its stenosis, with the increased sympathetic and central effects on cardiac rhythm, and with moderate anxiety-depressive disorders. CONCLUSION: In EH patients, moderate CD is attended by significant BP circadian rhythm disturbances, the functional and structural changes in the vascular wall of the CCA bed, which are combined with autonomic disregulation and anxiety-depressive disorders. The severity of the cardiac-cerebral syndrome in patients with EH should be borne in mind on elaborating individual and preventive programs.

[Peculiarities of nervous/mental state and hemodynamic disturbances in patients with arterial hypertension in relation to the level of total cholesterol in the blood plasma].

To investigate peculiarities of the clinical picture, nervous/mental state, indices of cognitive functions and extracranial hemodynamics in patients with arterial hypertension in relation to the level of total cholesterol in the blood plasma, 130 patients (69 males, 61 female) were examined. Patients were divided into 3 groups by the level of total cholesterol: the first group (n = 46) contained the patients with the desirable level of total cholesterol, the second group (n = 40)--with the borderline level and the third one (n = 44)--with the elevated level. The results show that, with the increase of total cholesterol in the blood plasma from desirable to higher level, patients with arterial hypertension develop signs of discirculatory encephalopathy; elastic/tonic characteristics of the vascular wall of extracranial arteries changed with the increase of blood flow asymmetry that correlated with neurasthenic disturbances of anxious-depressive type and significant reduction of mental capacity.

[Clinical, vegetative and cognitive disorders in hypertensive postmenopausal women in relation to menopause causes].

AIM: To specify clinical, vegetative and cognitive disorders in hypertensive women depending on the type of menopause. MATERIAL AND METHODS: A total of 195 hypertensive women were divided into three groups: group 1 (n = 50, age 45.6 +/- 4.5 years) consisted of premenopausal women, group 2 (n = 100, age 57.4 +/- 4.7 years) - of women with natural menopause, group 3 (n = 45, age 55.1 +/- 5.9 years)--with early and/or surgical menopause. Severity of the menopausal syndrome, anxiety, depression, alexitimia, mental performance, vegetative regulation of heart rhythm were examined. RESULTS: The premenopausal women were characterized by cardial and cerebral disorders, unaffected psychovegetative function and initial symptoms of lowering mental performance. Hypertensive women with natural menopause showed combination of cardial and cerebral symptoms with moderate anxio-depressive disorders, alexitimia, subnormal parasympathetic activity of the autonomic nervous system in high centralization of heart rhythm regulation and attention disturbances. Patients with surgical and/or early menopause had marked cardial and cerebral symptoms, moderate anxiodepressive disorders, alexitimia, inhibition of mental performance, vegetative dysfunction, overcentralization of heart rhythm control. CONCLUSION: With development of postmenopausal metabolic symptom complex, severity of hypertension grows with emergence of anxiodepressive disorders which combine with vegetative regulation disorders and attenuation of mental performance.

[Circular disorders in the common carotid artery bed and associated psychovegetative and hemodynamic disturbances in hypertensive patients]. / Vyrazhennost' tsirkuliatornykh rasstroistv v basseine obshchei sonnoi arterii i sviazannye s nimi psikhovegetativnye i gemodinamicheskie narusheniia u bol'nykh arterial'noi gipertenziei.

AIM: To specify circulatory disorders in the bed of common carotid artery (CCA) in hypertensive patients and these disorders influence on psychovegetative and hemodynamic disturbances. MATERIAL AND METHODS: Ultrasonic dopplerography of the region of common carotid artery, ECG, examinations of central hemodynamics, vegetative regulation of cardiac rhythm and psychic status were performed in 200 patients with arterial hypertension (AH). RESULTS: AH patients with unaffected CCA circulation have common central and cerebral hemodynamics, hyperkinetic circulation, retain psychovegetative adaptation. Left ventricular myocardial hypertrophy is absent. In impaired elasticity and tonicity of the vascular wall there was hypokinetic circulation, left ventricular hypertrophy, anxiohypochondria in high sympathetic activity. In stenotic CCA the patients have hypokinetic circulation, left ventricular hypertrophy and dilation and resultant asthenodepressive disorders and vegetative dystonia. CONCLUSION: Aggravation of cerebrovascular insufficiency goes in parallel with AH progression and arterial atherosclerosis. Changes of circulation variant, left ventricular cardiodynamic rearrangement are accompanied with changes in psychovegetative homeostasis.

[Anxiety and hemodynamics: correlations in hypertensive patients]. / Vyrazhennost' trevozhnykh rasstroistv i sostoianie krovoobrashcheniia u bol'nykh gipertonicheskoi bolezn'iu.

AIM: Syndrome analysis of functional relationships between personality disorders, autonomic regulation and psychic performance in relation to hemodynamic condition of hypertensive patients. MATERIALS AND METHODS: MMP1, Tailor's anxiety scale, Burdon and Schulte tables, variation pulsometry, tetrapolar chest rheography were used in examination of 86 patients with stage I and II hypertension. RESULTS: In early hypertension, weak anxiety and subclinical emotional disturbances, dominant was a parasympathetic trend of the vegetative tone without central control of the cardiac rhythm in hyperkinetic circulation. Changes in cortical neurodynamics manifested with minor attenuation of the ability to focus attention. Progression of angiospasticity and anxiety gave rise to psychic maladjustment in the form of anxiety-depression disorders with autonomic dysfunction in hypokinetic circulation, overcentralization of cardiac rhythm control. This was associated with a decline in mental performance. CONCLUSION: Systemic investigations of the emotional sphere, central hemodynamics and autonomic regulation of cardiac rhythm enable assessment of multilevel structure and severity of psychocardiac syndrome in hypertensive patients which is important both for therapeutic and expert practice.

[The emotional status and indices of cortical neurodynamics in hypertension patients]. / Emotsional'noe sostoianie i nekotorye pokazateli korkovoi neirodinamiki u bol'nykh gipertonicheskoi bolezn'iu.

At early stages of essential hypertension (EH) clinical psychological examinations of 96 EH patients revealed predominance of anxiety-hypochondriac responses controlled by will. Changes in cortical neurodynamics were evident from a decline in attention concentration. At EH stage II persistent hypertension and prolonged psychogenias gave rise to psychic disadaptation occurring as anxious-depressive conditions. Damage to cortical neurodynamics brought about mnestic and thinking disorders.

[The use of graded walking with hypertension patients]. / Primenenie dozirovannoi khod'by u bol'nykh gipertonicheskoi bolezn'iu.

Different walking regimens adjusted in duration and intensity to the circulation functional class were prescribed to patients with essential hypertension (EH) stage I and II. Functional class of the circulation was determined at bicycle exercise, the motor regimen was under the control of ECG Holter monitoring. Regular walking improved the patients' health, lowered blood pressure, enhanced physical performance. The authors advocate graded walking as one of nonpharmacological forms of outpatient EH therapy.

[The possibilities of preventing hypertension and the characteristics of the psychological set for its management in rural inhabitants]. / Vozmozhnosti profilaktiki gipertonicheskoi bolezni i osobennosti psikhologicheskoi ustanovki na ee povedenie u sel'skikh zhitelei.

At examination of 360 hypertensive subjects living in rural areas it was found that the examinees were quite indifferent to their health. This is explained by poor knowledge of hypertension and its complications, inadequacy of the patients psychophysical condition, lack of medical prevention activity. A questionnaire survey of the physicians-in-charge revealed that 24% of them were unaware of the risk factors, 68% did not care for relevant correction, though they had diagnosed the risk factors in themselves. In self-rating the physicians were not confident, showed indifference to own health and future. The authors believe that the condition of the patients was in many respects due to social and psychological dysadaptation of their physicians who had lost their interest in preventive medicine.

[New approaches to the polyclinic assessment of physical work capacity in hypertension patients]. / Novye podkhody k otsenke v usloviiakh polikliniki fizicheskoi rabotosposobnosti bol'nykh gipertonicheskoi bolezn'iu.

By using up-to-date mathematical methods, the authors studied exercise tolerance in 324 hypertensive patients. New approaches are validated to estimation of motor activity and its intensity in hypertensive subjects. The mathematical model provides reliable orientation in physical performance in the above patients as well as in their reference to the functional classes. The model is thought appropriate for wide introduction into outpatient clinical practice.