[Use of probiotics and probiotic-based immunomodulators as adjuvant therapy for Helicobacter pylori eradication]. / Ispol'zovanie probiotikov i immunomoduliatorov na ikh osnove v kachestve ad''iuvantnoi terapii pri provedenii éradikatsii Helicobacter pylori.

At present, Helicobacter pylori (Нр) infection is the most common chronic bacterial infection in humans, the pathogen of which colonizes approximately 50% of the world's population. Hp eradication is required to control complications of Hp-related diseases (gastric and duodenal ulcers). Nevertheless, a number of investigations have demonstrated widespread antibacterial therapy inefficiency due to Hp antibiotic resistance and patient non-compliance with treatment regimens. Due to the growing need to elaborate alternative eradication regimens, some researchers have drawn their attention to probiotics and immunomodulators derived from Lactobacillus in particular for eradication therapy in Нp-positive patients to enhance the effect of antibacterial drugs. The review analyzes the results of 10 meta-analyses of randomized clinical trials with a similar design, which were published in 2007 to 2015, and other clinical trials assessing the role of probiotics and probiotic-based immunomodulators as an adjuvant therapy for Hp eradication. The results of the analysis have established that Lactobacillus strain-containing probiotics, both monocomponent probiotics and those as part of multicomponent ones, when used as an adjunct to anti-Hp therapy, significantly increase the level of Нp eradication by 8.1-20.0% (p<0.05; Level of Evidence, 1A; Recommendation Grade A). The use of N-acetylglucosaminyl-N-acetylmuramyl dipeptide (Licopid, a Lactobacillus bulgaricus-based immunomodulator) 0.001 and 0.01 g/day as an adjuvant to first-line triple anti-Hp therapy was shown to increase the level of Hp eradication by 7.1-8.9%. The intake of licopid 0.001 and 0.01 g/day during 7-day triple anti-Hp therapy results in the absence of recurrent Hp infection, as compared with 7- and 14-day treatment protocols without licopid, and leads to a significantly low incidence of Hp reinfection within 2-5 years after successful bacterial eradication, as compared with the 7-day protocol without adjuvant therapy with glucosaminylmuramyl dipeptide (p<0.05).

[Use of the immunopotentiator N-acetyl-glucosamine-N-acetylmuramyl dipeptide during triple anti-Helicobacter pylori therapy].

AIM: To evaluate the efficiency of first-line Helicobacter pylori eradication therapy with glucosaminylmuramyldipeptide (Licopid JSC "Peptek", Russia). SUBJECTS AND METHODS: Eradication therapy was performed in 128 patients (84 men and 34 women; mean age 44.1 +/- 13.5 years) with duodenal bulb ulcer associated with H. pylori. The latter was detected in the gastroduodenal mucosa by a morphological study and rapid urease test before and 6-8 weeks after treatment and discontinuation of all drugs. Gastric metaplasia areas in the duodenum were revealed by periodic acid-Schiff and Alcian blue staining. The patients were divided into 4 groups according to the treatment protocol: 1) omeprazole (O) 0.04 g/day, clarithromycin (C) 1 g/day, amoxicillin (A) 2 g/day for 7 days (OCA7; n = 33); 2) the above drugs for 14 days (OCA14; n = 34); 3) O 0.04 g/day, C 1 g/day, A 2.0 g/day for 7 days, and glucosaminylmuramyldipeptide (Licopid) (L) 0.001 g/day for a day (OCA7L1; n = 34) and 4) the above drugs and L 0.01 g/day for 10 (OCA7L10; n = 27). RESULTS: According to the data of intention-to-treat analysis and per protocol, the H. pylori eradication rate was 81.8 and 87.1% for OCA7; 82.4 and 93.3% for OCA14; 88.2 and 93.8% for OCA7L1; 88.9 and 96% for OCA7L10 after PT and RRT, respectively. The rate of side effects was as follows: 6.1% for OCA7; 17.6% for OCA14 (5.9% stopped treatment); 5.9% for OCA7L1; 7.4% for OCA7L10. The cost of the treatment protocols was $ 32 for OCA7; $ 64 for OCA14; $ 40 for OCA7L1; $ 67 for OCA7L10. The intake of glucosaminylmuramyldipeptide (licopid) 0.001 g/day during 7-day triple anti-Helicobacter pylori therapy increased eradication by 6.4% (ITT) and 6.7% (PP), without raising the rate of side effects. CONCLUSION: H. pylori-positive patients with duodenal bulb ulcer should be given glucosaminylmuramyldipeptide (Licopid) 0.001 g/day during 7-day first-line eradication therapy as alternative to the 14-day treatment regimen.

[Duodenal polyps: epidemiology, clinical picture, diagnostics].

This cross-sectional comparative study included 120 patients (68 men and 52 women, mean age 58.3 +/- 14.5 yr) with duodenal polyps (DP) diagnosed by fibroesophagogastroduodenoscopy. Morphological study was conducted in 118 patients. Gastric metaplasia (GM) areas in polyp mucosa (PM) were identified by alcian blue/PAS reaction at pH 1.0 and 2.5. A total of 82859 patients were examined. Endoscopy revealed DP in 0.15% of them. The pH value below 6.5 was documented in duodenal bulb polyps in 85% of the patients having them and in 20% of those with polyps of other localization. Biliary pathology was documented in 80% of the patient with DP in major duodenal papilla and in 2.0% of those with DP of different localization. 66.7% of the patients did not complain of pain in the upper part of the gastrointestinal tract. Erosion of polyp mucosa occurred in 21.2% of the patients (92% of erosions in duodenal bulbs and 56.5% in hyperplastic DP with GM areas). H. pylori was identified in GM areas of bulb DP in 30.4% of the patients. Endoscopic study of 120 patients revealed the following localization of DP: bulbs - 83.4%, postbulbar region - 8.3%, major duodenal papilla - 8.3%. The following morphological types of DP (n = 118) were identified: hyperplastic DP - 49.2%, epithelial tumours - 16.1%, non-epithelial tumours - 1.7%, inflamed mucosal areas - 33.0%.

[The prognostic value of gastric metaplasia in the duodenal mucosa in patients with Helicobacter pylori positive duodenal bulb ulcer].

The predictive value of gastric metaplasia in the duodenal mucosa in patients Helicobacter pylori-positive patients with duodenal bulb ulcer (DBU) was investigated. One hundred and twenty four randomly selected patients with DBU were included in this prospective study. The detection of Helicobacter pylori (HP) in the stomach and duodenum was carried out with Giemsa (using standard visual analogue scale), rapid urease test (standard Jatrox-HP test, Rohm Pharma, Germany), and polymerase chain reaction (PCR) to detect the specific fragment of ureC HP gene (Helicopol II, Lytech, Russia). Regions of gastric metaplasia of the duodenum were confirmed by periodic acid-Schiff and alcian blue (Serva) staining (pH 1.0; 2.5) Duodenal ulcer (DU) complications were registered within 8 to 10 years. Estimation of the predictive factor (gastric metaplasia in the duodenum) was carried out in patients with non-complicated DU (Group 1; n = 73), and with such complications as bleeding, perforation, penetration, pyloroduodenal stenosis (Group 2; n = 51) which were revealed within the 8 to 10 years of observation. Gastric metaplasia in the duodenum was found in 64 or 87.7% of the 73 patients with non-complicated DU and in 5 or 9.8% of the 51 patients with complicated DU within 8 to 10 years of observation. The following facts about the predictive factor for the prognosis of DU complication were found: the sensitivity of 83.6%, the specificity of 92.8%, the predictive accuracy of 88.7%, the relative risk of the predicted outcome of 7.5, the relative risk of a different outcome of 0.11, the odds ration of 65.4. The study revealed a high and significant (p < 0.001) predictive value of gastric metaplasia in the duodenum as a marker of non-complicated clinical course of DU in HP-positive patients within an 8 to 10-year period.

[Principles of current classification of duodenitis]. / Printsipy sovremennoi klassifikatsii duodenitov.

The paper considers the principles of classification of chronic duodenitis. The current classification of chronic duodenitis may be divided into three parts: endoscopic, histological, and etiological. The characterizing terms of the endoscopic part are as follows: erythema, hemorrhages, atrophy, erosions, follicles. The endoscopic localization of duodenitis is as follows: proximal and distal portions (panduodenitis, including bulbitis in the proximal portion and postbulbitis in the distal portion, palpilitis). The nonspecific terms of the histological part are as follows: activity, inflammation, and atrophy. Its specific terms are: ventricular metaplasia, ventricular heterotopia, Helicobacter pylori, granulomas, lymphatic follicles, eosinophilic infiltration, lymphocytic infiltration. The following morphological categories of duodenitis are: nonatrophic, nodular, granulomatous, eosinophilic, and lymphocytic. The morphological localization of duodenitis is as follows: proximal and distal portions (panduodenitis, including bulbitis in the proximal portion and postbulbitis in the distal portion). The following degrees of its severity are: none changes, mild, moderate, and sever. The types (etiological factors) of duodenitis are as follows: acid-associated, drug-dependent, toxic (eliminating), and isolated nonspecific (idiopathic). Its special forms are: H. pylori-induced, granulomatous (Crohn's disease, sarcoidosis), nodal (Crohn's disease, sarcoidosis, acid-associated diseases), eosinophilic (unspecified allergens), lymphocytic (gluten-induced).

[Identification of Helicobacter Pylori in stomach contents]. / Obnaruzhenie Helicobacter pylori v zheludochnom soderzhimom.

Development of noninvasive methods for the diagnosis of Helicobacter pylori infection is an important problem. We investigated the possibility of detecting the bacterium in gastric juice. Noninvasive methods (bacteriological and urease test) for detection of H. pylori in gastric aspiration biopsy specimens are proposed.

[Antibody enzymes in Helicobacter pylori-associated infection]. / Antitela-fermenty pri Helicobacter pylori-assotsiirovannoi infektsii.

The amidase activity of a fraction of IgG antibodies to H. pylori in cases of bacterial persistence in the antral section of the stomach and the duodenal bulb and the role of enzyme antibodies in the pathogenesis of this infection were evaluated. 113 patients were examined under clinical conditions. Diagnosis was made with the use of the morphological method, the rapid urease test (Jatrox-H.p.-Test, Germany) and ELISA (Diagnostic Automation Inc., USA). The amidase activity of serum IgG was determined. As proteolytic substrate benzoylarginine-p-nitroanilide (BAPNA) was used. The study revealed that in the blood serum of patients with chronic gastritis and/or duodenitis, caused by H. pylori, and the active persistence of H. pylori in the mucous membrane IgG antibodies to H. pylori having BAPNA-amidase activity could be detected.