[Gastrointestinal Bleeding in Patients with Coronary Heart Disease: Preventive Options].

Extensive use of antithrombotic drugs (ATD) in patients with ischemic heart disease (IHD), on the one hand, provides a considerable decrease in the risk for development of life-threatening cardiovascular complications but on the other hand, is associated with a risk of gastrointestinal bleedings (GIB), which may develop in 0.5-1.0 % of patients. In such cases, the major measures for prevention of GIB are strict adherence to indications for the ATD treatment, detection and analysis of risk factors for GIB and their elimination as far as feasible. For evaluation of GIB risk in patients with IHD, the PRECISE-DAPT and DAPT, HAS-BLED scales should be used. If the risk factors are non-modifiable the therapeutic tactics for further management of these patients should be strictly individual with determining the nature of damage, degree of a risk for present and possible complications, and the range of required therapeutic and diagnostic measures. The use of ATD requires monitoring of the patient's condition to timely detect and treat GI complications.

[Anxious depressive conditions in patients with gastroesophageal reflux disease].

The authors objectively evaluated the presence of anxious depressive conditions in patients with gastroesophageal reflux disease (GERD) and studied associations between them and the clinical picture of the disease. Ninety-one patients with GERD were examined. The diagnosis was based on clinical and anamnestic data as well as the results of esophagogastroduodenoscopy and rabeprazole test. Gastrointestinal Symptom Rating Scale (GSRS) was used to assess the severity of GERD symptoms and quality of life. Beck Scale was applied to assess the level of depression. Spielberg test was used to assess reactive and personal anxiety. The psychological status of GERD patients was studied before the beginning of the treatment. Tests and questionnaires were filled by patients on their own. Spielberg test and Beck Scale revealed a high prevalence of psychopathic syndromes among GERD patients. Forty-three per cent of patients had anxious syndrome, while 57% of patients suffered from anxious depressive syndrome; the anxiety level and depression level were clinically significant in 70% of cases and in 23%, respectively. The presence of a direct correlation between the severity of the psychopathological syndromes (according to Spielberg test and Beck Scale) and GSRS data demonstrate that anxiety and depression intensify GERD symptoms and lower the quality of life of these patients. There is no doubt that concomitant anxious and anxious-depressive disturbances need psychotherapeutic and drug correction. Tranquilizers have the priority in neurotic anxious disturbances. In some situations antidepressants are indicated to treat a combination of anxious disturbances and depressive ones.