1. Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk, Russia
2. Research Institute of Internal and Preventive Medicine — Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Science, Novosibirsk, Russia
3. Novosibirsk Regional Clinical Diagnostic Center, Novosibirsk, Russia
4. First Moscow State Medical University named after I. M. Sechenov, Moscow, Russia
5. Moscow Regional Research and Clinical Institute (“MONIKI”), Moscow, Russia

Keywords: gastroesophageal reflux disease, Barrett’s esophagus, hiatal hernia, extraesophageal manifestations of gastroesophageal reflux disease

Abstract: Over the years, Barrett’s esophagus doesn`t lose its relevance to clinicians and researchers. The problem is acute as the disease is considered as a precancerous condition associated with the risk of adenocarcinoma in the lower third of the esophagus. Knowledge of non-esophageal clinical “masks” of gastroesophageal reflux disease (GERD) and timely diagnosis is extremely relevant for Barrett’s esophagus patients with a high risk of its development as well as complex treatment and dynamic observation of these patients. The article describes a clinical case of a 10-year unsuccessful case of a 36-years old man with GERD complicated by Barrett’s esophagus. Different specialists who observed the patient didn`t evaluate patient’s cardiac and otorhinolaryngological complaints as extra-esophageal “masks” of GERD, although there was a bright clinical picture of the disease, repeated instrumental examination, including esophagogastroduodenoscopy. courses of antioxidants, metabolic drugs, vegetocorrectors, local treatment of laryngitis, intraperitoneal instillations were unjustifiably prescribed. This practice underlines the timeless relevance of assessing anamnestic data, clarifying the presence of comorbid conditions to ensure an adequate personalized drug approach.

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Full text is published :
Tsygankova O. V., Latyntseva L. D., Batluk T. I., Gaskina T. K., Starichkov A. A., Bueverov A. O. Gastroesophageal reflux disease with non-esophageal manifestations, the formation of Barrett’s esophagus on the background of a hiatal hernia. Experimental and Clinical Gastroenterology. 2019;163(3): 16–23. (In Russ.) DOI: 10.31146/1682-8658-ecg-163-3-16-23
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1. The Loginov Moscow Clinical Scientifi c Center, 111123 shosse Enthuziastov 86, Moscow, Russia

Keywords: chronic pancreatitis, pancreatic cancer, fibronectin, median of enhancement gradient

Abstract: Aim. To assess significance of serum fibronectin and new approaches of computed tomography for pancreatic cancer and chronic pancreatitis differential diagnosis. Material and methods. Data of 49 patients with pancreatic lesions who underwent multislice computed tomography (MSCT) with intravenous contrast enhancement and serum fibronectin (FN) evaluation in 2018 were analyzed. There were 29 (59.2%) males and 20 (40.8%) female patients, mean age 51.9+13.9 (30-82). All patients divided in 3 groups: 1 - with pancreatic ductal adenocarcinoma (PDAC) - 17 p., 34.6%, 2 - chronic pancreatitis with previous pancreonecrosis (CPPN) - 16 p., 32.7%, 3 - chronic calcifying pancreatitis (CCP) - 16 p., 32.7%. All cases of PDAC were pathologically proved. We calculated median of enhancement gradient between region of interest and intact parenchyma (Мgrad) based on MSCT results. Pearson’s correlation coefficient (rp) was calculated for correlation assessment. Results. We assessed mean Мgrad and mean serum FN rate in all three groups: PDAC - 28.1+2.6, р=0.0001, CPPN - 14.9+2.4, р=0.07, CCP - 13.3+0.7, р = 0.08 for Мgrad, and 239.8+30.1, p=0.8, 243.5+33.8, p=0.7, 227.2+34.3, p=0.8 for serum FN rate, respectively. There was statistically significant strong correlation of Мgrad in patients with PDAC (rp=0.63, p=0.0001). We revealed cut-off point of Мgrad value for PDAC that was 20 (p=0.001). There were no statistically significant correlations of serum FN rate in all groups (PDAC rp=0.04, p=0.8; CPPN rp=0.06, p=0.7; CCP rp= -0.03, p=0.8). Conclusion. Mgrad evaluation based on MSCT is an informative marker for differential diagnosis between PDAC and chronic pancreatitis, high rates of Мgrad positively correlate with PDAC existence. There was no correlation between serum FN rate and existence of PDAC, CPPN or CCP revealed.

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Vinokurova L. V., Lesko K. A., Bordin D. S., Dubtsova E. A., Tyulyaeva E. Yu., Varvanina G. G. Research of new approaches of differential diagnosis of pancreatic lesions. Experimental and Clinical Gastroenterology. 2019;163(3): 24–30. (In Russ.) DOI: 10.31146/1682-8658-ecg-163-3-24-30
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1. FSBEI HE SUSMU MOH Russia, 454092, Russian Federation, Ural Federal District, Chelyabinsk region, Chelyabinsk city, Vorovskogo street, 64

Keywords: chronic pancreatitis, Helicobacter pylori, gastrin, exocrine insuffi ciency

Abstract: Purpose of the study. To assess the state of the acid-producing function of the stomach in patients with varying degrees of functional insufficiency of the pancreas in the presence of Helicobacter pylori-associated gastritis. Materials and methods: 77 patients with chronic pancreatitis and concomitant Helicobacter pylori-associated gastritis were examined. The control group consisted of 56 patients with chronic pancreatitis without Helicobacter pylori-associated gastritis. Diagnosis of chronic pancreatitis was based on anamnestic, clinical data, instrumental studies (MSCT). The exocrine function of the pancreas was assessed by the content of pancreatic elastase in the feces. Diagnosis of H. pylori infection was carried out by the morphological method, urease respiratory test 13C, by immunoblotting. All patients underwent endoscopic examination of the stomach. In some patients, the level of gastrin 17 in the blood was determined. Statistical processing was carried out using SPSS Statistic 17.0 application software packages. Results. Pain syndrome was significantly more frequently observed in H.pylori- positive patients with chronic pancreatitis (93.2%, p = 0.045), while more often epigastric pain was observed (30.7% versus 12.5% of the control group, p = 0.48). In patients with chronic pancreatitis with an intense pain syndrome, in 66.7% of cases, the combination of proteins p26, p19 and p17 with CagA H.pylori was detected. In patients with chronic pancreatitis with concomitant Helicobacter pylori-associated gastritis, the level of gastrin was outside the normal range in 57.1% of cases (control group - 18.2%, p = 0.048) and was below normal in 42.9% of patients. The average value of gastrin in patients of the studied group was lower (3.140 ± 0.802 pmol / l) than in the control group (4.833 ± 1.594 pmol / l, p = 0.045). In patients with exocrine pancreatic insufficiency, the level of gastrin was reduced / increased in 75% of cases (p = 0.014). In patients with severe chronic pancreatitis, gastrin levels were significantly more often not normal (p = 0.041). CagA VacA - positive strains were statistically significantly more frequently detected in patients with chronic alcoholic pancreatitis and correlated with the severity of the disease. Conclusion. Helicobacter pylori infection contributes to a variety of clinical manifestations in patients with chronic pancreatitis. Helicobacter pylori - a positive status in patients with chronic pancreatitis is associated with more intense gastric acid-induced acid production in the stomach. The severity of morphological changes in chronic pancreatitis, as well as exocrine pancreatic insufficiency correlates with CagA- positive strains of Helicobacter pylori and fluctuations in gastrin levels in the digestive period.

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Domracheva E. V., Sarsenbaevа A. S. Clinical and functional features of patients with chronic pancreatitis and related helicobacter pylori-associated gastritis. Experimental and Clinical Gastroenterology. 2019;163(3): 31–37. (In Russ.) DOI: 10.31146/1682-8658-ecg-163-3-31-37
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1. Donetsk National Medical University Ministry of Health of Ukraine, 84404, Donetsk region, Liman, Ukraine
2. “Endotehnomed”, Dnepr, Ukraine

Keywords: pancreas, chronic pancreatitis, histostructure

Abstract: Aim - to study the morphological features of the pancreas in clinical and morphological forms of chronic pancreatitis. Materials and methods. Histological preparations of the pancreas were studied in 60 patients with various forms of chronic pancreatitis. Results. Scant inflammatory infiltration of the pancreatic parenchyma (represented by lymphocytes, plasma cells), atrophic and fibrotic changes, which were characterized by unidirection, were detected. The fibrosis was of two kinds - friable and dense fibrosis, that qualitative state of the connecting tissue at the different forms of chronic pancreatitis. Friable fibrosis has been revealed at patients for mild and moderate chronic pancreatitis and dense - for severe and complete fibrosis. Conclusion The morphological picture of fibrous changes of the pancreas does not depend on the form of the disease and is characterized by a mild degree of fibrosis in 6.6% of patients, moderate - in 20.0%, severe - 16.7%, full fibrosis - 56.7%.

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Full text is published :
Gubergrits N. B., Krylovа О. A., Opikhailo М. C. Features of the pancreatic histostructure in chronic pancreatitis. Experimental and Clinical Gastroenterology.2019;163(3): 38–42. (In Russ.) DOI: 10.31146/1682-8658-ecg-163-3-38-42
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