RESUMO
BACKGROUND: Reduction of cardiovascular risk (CVR) is based on the correction of risk factors, especially dyslipidemia. Due to the limiting factors of conventional lipid-lowering medications, the investigation of alternative approaches is necessary. METHODS: The present open, comparative, randomized, and parallel investigation was conducted on 77 patients. Participants were of both sexes, 40-74 years-of-age, and had dyslipidemia. The participants were divided into 2 groups; the treatment group (n = 41) received a combination of Lactobacillus plantarum and simvastatin 20 mg once a day, and the control group (n = 36) received simvastatin 20 mg once a day. The trial included 5 visits; screening on the first 2, and treatment on the next 3 (on weeks 4, 8, and 12). On visits 1, 3, 4, and 5, the lipid profile was evaluated and CVR was calculated using 5 tools. RESULTS: The combination treatment led to a more pronounced decrease in total cholesterol (TC) and low-density lipoproteins (LDL) after 8 weeks (P = 0.002 and 0.016, respectively), that persisted after 12 weeks (P < 0.001 and 0.002, respectively). Reduction in TC and LDL by ³ 20% was observed more predominantly in the treatment group. A significant reduction was observed in CVR in the treatment group according to the Prospective Cardiovascular Münster (ýPROCAM) score (P = 0.004). Reduction of CVR by ³ 20% was mostly observed as a result of prescribing combination therapy according to the Framingham Risk Score ý(70.7%; P = 0.003), 2013 ACC/AHA ASCVD Risk Calculator ý(51.2%; P = 0.035), PROCAM (65.9%; P < 0.001), and WHO CVD risk chart (56.1%; P = 0.012). CONCLUSION: Additional supplementation with Lactobacillus plantarum was more effective in the reduction of TC, LDL, and CVR according to PROCAM and the attainment of treatment goals regarding lipid profile and CVR levels.
RESUMO
INTRODUCTION: Motility disorders can be an important factor in the occurrence of symptoms of dyspepsia that consequently require evaluation of clinical significance of noninvasive diagnostic approaches when observing patients with functional dyspepsia (FD), gastroesophageal reflux disease (GERD), and Helicobacter pylori-associated diseases of the stomach and duodenum. AIM: To determine the relationship between various motility disorders and to improve the diagnostics and treatment with the use of 13C-urea (UBT) and 13C-octanoic breath tests (OBT). MATERIAL AND METHODS: A total of 591 patients, aged 18-83 years, who underwent upper gastrointestinal endoscopy at our department were evaluated. Age, sex, and duration of symptoms of dyspepsia were recorded. UBT and OBT were examined in patients with dyspepsia, GERD, and H. pylori-associated diseases. RESULTS: Patients with dyspepsia syndrome had H. pylori infection in 70 ±1.3% of cases. The strategy of "test-and-treat" using UBT can be applied in 76.5% of cases of unexplained dyspepsia in the Ukrainian population. In patients with GERD, slowing down of the gastric emptying (GE) prevails (overall 79.7 ±4.4%), which is a reliable predictor of early relapse of GERD symptoms (OR = 4.9, 2.4-7.0). In the case of H. pylori-associated diseases, the slowing down of GE according to OBT data is a prognostic sign of the return of the symptoms of dyspepsia after successful eradication of H. pylori (OR = 2.1, 1.9-2.3). In H. pylori-associated diseases with a slow GE, recurrence of dyspeptic syndrome after H. pylori-eradication therapy is observed in 33.1% of cases; the appointment of prokinetics reduces this probability to 9.2% (p = 0.0074). CONCLUSIONS: Investigations into the clinical use of new facilities of 13C-breath tests in gastroenterology are shown. The clinical efficacy of urea and octanoic breath tests in FD, GERD, and H. pylori-associated diseases was proven experimentally among patients of the Ukrainian population. New simplified diagnostic and treatment approaches were proposed for certain groups of patients with gastric dyspepsia syndrome, based on the results of the UBT and the OBT.
