[Chronic gastrite: modern state of the problem].

AIM: Тo evaluate the modern view on the problem of chronic gastritis and the effectiveness of the drug ursodexic acid (UHC) Grinterol in the treatment of patients with chronic antral reflux-gastritis (biliar). MATERIALS AND METHODS: The work provides modern ideas about chronic gastritis, the issues of etiology and pathogenesis are considered. Contemporary classifications and the attitude of the authors of the work to them are presented. Clinical studies were conducted in 50 patients with chronic antral reflux-gastritis biliary (32 women and 18 men) between the ages of 20 and 80 years (average age 50.3 to 8.0 years). The treatment uses the drug Grinterol in a daily dose of 12.5 mg/kg of body weight for 4 weeks. RESULTS: Among patients with chronic antral gastritis isolated patients with reflux-gastritis biliary, the pathogenetic factor of which is the damaging property of aggressive bile acids. The main treatment for such patients are drugs UHC (in this study (this study uses Grinterol at a daily dose of 12.5 mg/kg of body weight); the duration of treatment is 4 years. The overall efficiency (according to endomorphological data) was 76%, according to clinical data 100%. DISCUSSION: Critical consideration of the classifications used and proposed for consideration indicates that the time has come for the adoption of a new classification with the allocation of reflux-gastritis biliary. Treatment of this form of antral gastritis is effective with UDHC drugs. CONCLUSION: the selection of a form of antral reflux-gastritis biliar in a separate classification group is scientifically justified. The results suggest that for the treatment of patients with chronic biliary refluxdrugs of choice are drugs UDHC.

[Efficiency and safety of generic Atorvastatine in patients at high cardiovascular risk].

Statines are first choice medications for hypercholesterolemia and combined hyperlipidemia of varying severity in wide population of patients. Atorvastatine is one of the most effective statines. In Russia, Atorvastatine is represented by nearly twenty drugs most of which are generics. The article covers data on efficiency, safety and good tolerance of Liptonorm--a generic Atorvastatine.

[Use of Verapamil and Dilthiasem in treating patients at high cardiovascular risk (review of literature)].

The article deals with usage of nondihydropiridine calcium antagonists--verapamil and dilthiasem--in treating patients with arterial hypertension, cardiomyopathy and arrhythmia, for secondary prevention of IHD. Data also concern cardio-, angio--and nephroprotective activity of the medications, their ability to prevent left ventricle hypertrophy, possible usage in patients after myocardial infarction. The authors also discuss problems of tolerance and safety of calcium antagonists with prolonged action vs. those with short-term action.

[Topical problems of empiric therapy of community-acquired pneumonia in outpatient practice].

Community-acquired pneumonia is one of prevalent infectious respiratory diseases. Adequate treatment of community-acquired pneumonia, with consideration of the disease severity and microbial resistence, remains extremely topical. The article covers contemporary views of community-acquired pneumonia treatment standards. The authors described results of personal research aimed to study antibacterial treatment for community-acquired pneumonia on outpatient basis over 2004-2012, evaluated correspondence of the treatment to the national clinical recommendations.

Functional state of sportsmen with mitral valve prolapse.

The study covered functional peculiarities in 541 professional sportsmen. Mitral valve prolapse (in 132 examinees) appeared to be associated with reliably lower levels of reticulocytes, leucocytes, lymphocytes CD4+, immunoglobulines G, magnesium, and higher cortisol level, in comparison with the sportsmen having no mitral valve prolapse. The athletes with mitral valve prolapse demonstrated more frequent changes in ECG, reliably lower performance in treadmill test, slower recovery of heart rate after exertion is over.

THE LONG - TERM RESULTS OF USEFUL ERADICAION PATIENTS WITH PEPTIC ULSERS (a five-year monitoring).

There was held an useful eradication of Helicobacter Pylon in 20 patients with peptic ulcers (Omeprazole, Clarithromycin and Amoxicillin in normal doses). A five - year monitoring period revealed clinical manifestations of relapse in 50% of cases and endoscopic manifestatiQns in 60% of cases (15% - ulcers and 45% - gastral erosions). Relapse of peptic ulcers was accompanied with change of clinical course, it became oligo- or asymptomatic in 83% of patients. Relapse of peptic ulcers was fixed in 45% of patients (15% - in patients with ulcer and 30% - in patients with gastral erosions), at that, erosions were caused by NSAIDs in a half of cases, accompanied with a weak degree of contamination and inflammation of gastral rnucosa.

[Age and eradication treatment of duodenal ulcer].

AIM: To study efficacy of Helicobacter pylori (Hp) eradication (different schemes) depending on the age of patients with Hp-associated duodenal ulcer (DU). MATERIAL AND METHODS: A total of 182 patients with Hp-associated exacerbated DU (101 males and 81 females) participated in the trial. The patients were divided into three groups according to their age: group 1 (18-39 years)--71 patients, group 2 (40-60 years)--71 patients, group 3 (61-74 years)--40 patients. Before and 4-6 weeks after treatment the patients were examined according to the standard scheme and with esophagogastroduodenoscopy (EGDS) including biopsy from the body and pyloric portion of the stomach. Seventy five patients received omeprasol+clarithromycin +moxicilline (scheme 1), 37 patients --eprasol+clarithromycin+tinidasol (scheme 2), 40 --eprasol+clarithromycin+furasolidon (scheme 3), 30 ---eprasol+clarithromycin+vicram (scheme 4). RESULTS: Hp dissemination in the pyloric stomach was independent of the age, nonatrophic and atrophic gastritis occurred with equal frequency. Contamination of the gastric body in the aged patients was moderate and mild. Atrophic gastritis incidence increased with age. After treatment according to scheme 1, Hp eradication was achieved in all the patients of group 3, 90%--group 1, 87%--group 2; according to scheme 2--100% patients of group 3, 90%--group 2 and 87%--group 1; according to scheme 3--all patients of groups 2 and 3, 90%--group 1; according to scheme 4--100% cases from groups 1 and 87% in group 2. CONCLUSION: Intensity of Hp dissemination in gastric mucosa does not depend on the age; it changes with deterioration of gastric mucosa atrophy and regress of acid production. Hp eradication efficacy in the same schemes of treatment is higher in presenile and senile patients who, therefore, can be treated with less doses of antibiotics.

[Outpatient clinic facilities for clinical-laboratory diagnosis of hepatic fibrosis].

AIM: To compare fibrosis stages estimated by histological data obtained at biopsy of hepatic tissue with fibrosis index (FI) calculated with the dominant calculation scale (DCS); to define diagnostic thresholds, sensitivity and specificity of FI estimation. MATERIAL AND METHODS: The trial included 75 chronic hepatitis (CH) patients (54 males and 21 females, mean age 37.4 +/- 9.5 years) with different activity of the disease and at different stages of CH: 51 (68%) with virus hepatitis C (VHC), 8 (10.7%) with virus hepatitis B (VHB), 11 (14.7%) with alcoholic hepatitis and 5 (6.7%) with non-alcohol steatohepatitis (NASH). Puncture hepatic biopsy specimens were obtained from all the examinees. Fibrosis stages were determined by METAVIR. FI by DCS was calculated by the score sum of prothrombin index, platelet count, ALT/AST. RESULTS: By METAVIR, F0 corresponded to FI 1.84 +/- 0.79, F4 (cirrhosis)--to 7.14 +/- 0.64; by ISHAK, F0 corresponded to FI 1.89 +/- 0.35, F6 (cirrhosis)--to 7.33 +/- 0.33. Sensitivity and specificity of FI estimation by DCS depending on fibrosis stage for METAVIR was 88% and 88%, for ISHAK--88% and 82.7%, respectively. In interferon therapy FI elevates due to iatrogenic thrombocytopenia.

[Pariet in eradication therapy plans]. / Pariet v skhemakh éradikatsionnoi terapii.

In the article the results of the eradication therapy by Pariet in the patients suffering from the duodenal ulcer disease, associated with Helicobacter pylori (HP), are estimated. Four schemas with use 40 and 20 mg of Pariet per day in a combination with two antibacterial preparations were evaluated. The therapy duration was 7 days. The ulcer cicatrisation has occurred in 100% of the patients. The eradication was achieved in 100% of cases at use of a dose 40 mg of Pariet per day. At use of the schemas with a dose 20 mg of Pariet per day the eradication was observed in 67% of patients. Pariet is considered as the high efficient preparation in the eradication and cicatrisation of the ulcer.

[Prognostic criteria in the course of duodenal ulcer]. / Prognosticheskie kriterii techeniia iazvennoi bolezni dvenadtsatiperstnoi kishki.

Examination and long-term follow-up covered 95 patients with duodenal ulcer (DU). Mean age of the patients was 32 +/- 1.67 years. The patients were divided into two groups: with rare DU recurrences (n = 36) and with frequent recurrences (n = 59). Diagnostic criteria for development of rarely recurrent DU were the following: blood group A(II), exacerbations in winter, weak symptoms at DU onset, weak abdominal pains, solitary surface ulcers. For development of frequently recurrent DU, diagnostic criteria include O(I) blood group, spring exacerbations, marked symptoms of the exacerbation, severe abdominal pains, multiple deep ulcers.

[The prognostic criteria of the course in newly detected duodenal peptic ulcer]. / Kriterii prognoza techeniia vpervye vyiavlennoi iazvennoi bolezni dvenadtsatiperstnoi kishki.

AIM: Elucidation of the significance of various factors in prognosis of duodenal ulcer (DU) severity. MATERIALS AND METHODS: The observational study entered 18 new cases of DU and 13 healthy controls. All the patients were followed up for 7 years with annual esophagogastroduodenoscopy. RESULTS: 10 patients (group 1) had annual exacerbations of DU, 8 patients had rare exacerbations (group 2). Group 1 was characterized by basal acid hyperproduction, hyperpepsinogenemia, hypergastrinemia, marked contamination with Helicobacter pylori. Patients of group 2 had normal basal and pentagastrin-stimulated acid production, normopepsinogenemia, normogastrinemia, mild Helicobacter pylori infection. CONCLUSION: The 7-year follow-up of new DU cases allowed demonstration of functional-morphological prognostic criteria for frequently and rarely recurrent DU courses.

[Helicobacter pylori, endocrine cells of the gastric mucosa, and their function in duodenal ulcer]. / Helicobacter pylori, éndokrinnye kletki slizistoi obolochki zheludka i ikh funktsiia pri iazvennoi bolezni dvenadtsatiperstnoi kishki.

Antral biopsies of 33 duodenal ulcer patients (15 with hypergastrinemia, group 1 and 18 with normal fasting serum gastrin, group 2) and also 13 healthy volunteers were studied for D- and G-cell density and HP-status. Basal acid output (BAO), maximal acid output (MAO) and serum somatostatin were also evaluated. G- and D-cell density was measured by PAP-immunostaining technique. Serum gastrin and somatostatin levels were studied by radioimmunoassay. HP-status was evaluated histologically with the use of semiquantitative enhanced method. Both groups of patients had decreased D-cell density compared with control (p < 0.05). Patients from group 1 had significantly increased BAO, MAO, G-cell density, index of infective load of HP, index of adherence of HP, comparing with group 2 (p < 0.05), and decreased serum somatostatin level and D-cell density compared with group 2. There were no significant differences found in serum somatostatin level, BAO, G-cell density, serum gastrin level between group 2 and control (p > 0.05). Hyperfunction of G-cells arose from impaired paracrine secretion of somatostatin, that strongly associated with increased index of infective load and increased index of adherence of HP to epitheliocytes of gastric antrum.

[Levels of gastrin and somatostatin in blood and gastroduodenal gastrin and somatostatin cells in the differentiation of treatment of patients with duodenal ulcer]. / Urovni gastrina i somatostatina v krovi, gastroduodenal'nye gastrinovye i somatostatinovye kletki pri differentsirovannom lechenii bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kishki.

Radioimmunoassay and immunomorphological methods were used in the study of pepsinogen 1, basal and food-stimulated gastrin and somatostatin blood levels, the number of gastroduodenal G- and D-cells as well as gastric secretion during routine-dose treatment with gastrozepin and ranisan of 45 gastroduodenal ulcer patients versus 15 controls. The patients were divided into 2 types according to blood gastrin levels and the number of pyloric G-cells: with hypergastrinemia and/or hyperplasia of the G-cells, with normogastrinemia and normal number of G-cells. A course treatment with gastrozepin of type 1 patients brought about normalization of serum gastrin and the number of the G-cells with elevation of blood somatostatin levels. In patients of type 2 the above parameters did not change. The same picture in them remained after ranisan treatment, though they developed hypergastrinemia. In patients of type 1 after ranisan treatment the above parameters did not change. The data obtained demonstrate once more heterogeneity of duodenal ulcer.

[The differentiated treatment of patients with duodenal peptic ulcer]. / Differentsirovannoe lechenie bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kishki.

There were 45 patients suffering from duodenal ulcer in the stage of exacerbation and 15 subjects who served as control. Radioimmunoassay and immunomorphological PAP methods were used to examine the blood PGI and gastrin levels, the number of gastroduodenal G and D cells, the characteristics of basal and stimulated acid production in gastric juice in the treatment with gastrozepin (22 persons) and ranisen (23 persons). Depending on the concentration of gastrin in the blood and the number of pyloric G cells, the patients were distributed into two groups: with hypergastrinemia and/or hyperplasia of G cells (48%) and with normogastrinemia and the normal number of these cells (52%). It has been shown that the continuous treatment with gastrozepin of the patients with hypergastrinemia and/or hyperplasia of pyloric G cells was followed by the normalization of blood gastrin concentration and of the number of pyloric G cells; on the contrary in the patients with normogastrinemia and the normal amount of these cells, the analogous characteristics remained unchanged. After the treatment with ranisan the patients with normogastrinemia and the normal amount of pyloric G cells manifested hypergastrinemia without any changes in the amount of G cells; meanwhile in the patients with hypergastrinemia and/or hyperplasia of G cells, the analogous characteristics were unchanged. In these groups patients, the rate and the times of the relapse occurrence were different throughout the whole year. The data obtained support the nonuniformity of duodenal ulcer.

[Assessment of criteria for forming follow-up groups of patients at high risk for ulcerogenesis in ambulatory care]. / Otsenka kriteriev formirovaniia grupp nabliudeniia sredi lits s faktorami vysokogo riska ul'tserogeneza v usloviiakh polikliniki.

A method of clinico-laboratory examinations to reveal persons at high risk for the development of duodenal ulcer, suitable for wide use during prophylactic medical screenings was devised. The rise of the levels of serum pepsinogen-I, pepsin and hexosamines in the urine, being of prognostic importance as applicable to ulcerogenesis, was the most significant indicator in screening risk group patients. During 3 to 5 years of the screened group follow-up and carrying out health measures, peptic ulcer was ascertained in 8.4% of the patients with chronic gastroduodenitis. Of these, 66.6% had initially suffered from pylorobulbitis. It is shown that there is a real opportunity of preventing ulcer formation in patients with chronic primary gastroduodenitis under outpatient conditions.

[Disorders of humoral regulation of the digestive organ functions in children with malabsorption syndromes]. / Narusheniia gumoral'noi reguliatsii funktsii organov pishche- vareniia pri sindrome mal'absorbtsii u detei.

The authors provide the data obtained during examination of 36 children with celiac disease and 18 children with lactase deficiency. The children's age ranged from 8 months to 15 years. All the children underwent spot biopsy of the gastric and duodenal mucosa followed by immunomorphological PAP-staining of the biopsy specimens and count of the number of gastrin- and somatostatin-producing cells. Gastrin in the blood serum was measured by radioimmunoassay. The children with celiac disease manifested an increase of the number of somatostatin-producing cells in the duodenum and decrease of their number in the pyloric part of the stomach, seen in the acute phase of the disease. The number of gastrin-producing cells remained unchanged. The level of gastrin declined in the acute phase and increased during a remission. The alterations described were found to be related to the atrophic processes in the small intestinal mucosa. In lactase deficiency, no significant alterations were established in the number of pyloric and duodenal endocrine cells or in blood gastrin level.

[Cellular and humoral immunity in duodenal peptic ulcer with gastrin cell hyperplasia]. / Kletochnyi i gumoral'nyi immunitet pri iazvennoi bolezni dvenadtsatiperstnoi kishki s giperplaziei gastrinovykh kletok.

A total of 61 patients with frequently relapsing duodenal ulcer were examined. Of these, 18 patients were in the acute phase and 43 experienced remission. Using 1 mm2 of the mucosa, measurements were made of the counts of duodenal and pyloric G-cells (by immunomorphologic assay), of the absolute and relative counts of T and B lymphocytes, the content of IgA, IgM and IgG, histamine and serotonin (by fluorometry) in the blood, and of the concentration of uropepsin in the urine. In the stages of exacerbation and remission, the patients suffering from duodenal ulcer with hyperplasia of G-cells manifested, as compared with the analogous patients without hyperplasia, a decrease of the absolute and relative counts of T cells, especially of those of B cells, combined with a rise of the content of IgM and IgG during exacerbation, followed by its returning to normal in the phase of remission. Over one year part of the duodenal ulcer patients with hyperplasia of G-cells received preventive treatment with ranitidine, which resulted in a tendency towards the lowering of the count of pyloric G-cells and the rise of the absolute and relative counts of T cells.