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CLINICAL GASTROENTEROLOGY

    1. Central state medical Academy (Moscow, Russian Federation)

    Keywords:microflora,of low molecular weight metabolites of the intestinal microbiota,short chain fatty acids (SCFA),colon cancer,butyric acid (butyrate),psyllium,butyrate+inulin

    Abstract:The purpose of the study is to examine the content of short chain fatty acids (SCFA) in patients with colon cancer (CC) in the mucosa of the colon (CM) and feces by GLC-analysis: to assess their significance. Material and methods: the Study was performed in 52 patients operated on for colon cancer. Patients ranged in age from 61 to 81 years, 32 women and 20 men. In 14 cases the tumor was localized in the blind and ascending Department of the colon, 6 - in descending, 26- in the sigmoid colon, in 6 - in rectosigmoid part. In this regard, in 14 cases, the right hemicolectomy, 14 left hemicolectomy, 16 resection of the Sigma, 8 - anterior resection of the rectum. Histological examination revealed colon adenocarcinoma varying degrees of differentiation (high difference-25, moderate - -20, low of -7). Distribution of patients according to prevalence of tumor process was as follows: -2 I, IIA -4, -36 IIIA, IIIB -10. By GLC analysis to determine the content SCFA in CM and feces. Results: the Absolute contents SCFA in CM, the group of patients with CC tends to decrease compared to the control group. The total absolute concentration SCFA when the tumor in the right departments is higher in comparison with the concentration of SCFA when left-sided localization (0,420±0,110 mg/g and of 0.350±0.001 mg/g, respectively). In the study profiles in samples of tumor and feces when left localization of the significantly elevated level of propionic and butyric acids (up to 0,159±0,001 ed and 0,105±0,002 units, respectively, at a rate of 0,134±0,001 ed and 0,087±0,004 units, respectively, in CM; to 0,241±0,001 0,221 and u of±0.002 units, respectively, at a rate 0,189±0,001 ed and 0,176±0,004 units, respectively, in the feces), when right - level of isolated oil acid (0,093±0,011 u, at a rate of up to 0,067±0,01 IU per CM; to 0.281±0,002 units, at a rate of up to 0,176±0,004 ed feces). Among CC patients with increasing tumor stage marks an increase in the level of butyric acid (0,099±0,021 ed at T 1-3, to 0,110±0,030 ed at T4 in SOTK, 0,201±0,002 ed at T 1-3, to 0,220±0,002 ed at T4 in the feces) and increasing the ratio of isocyclic to acids in CM and feces (1,929±0,010 u at T 1-3, to 2,217±0,019 ed at T4 in CM, with 2,432±0,120 ed at T 1-3, to 4,327±0,110 units at T4 in feces). By reducing the degree of tumor differentiation (highly, moderately -, poorly-differentiated) in CM marked increase in the proportion of propionic (of 0.152±0,010 u, 0,209±0,01 units, 0,224±0,010 u, respectively) and mainly oil acid (of 0.085±0,010 units, 0,120±0,010 units, 0,168±0,010 units, respectively). The ratio of isocyclic forms to acids do not differ. Conclusion: in CC patients revealed specific changes SCFA in CM, depending on the localization, differentiation grade and depth of germination by the tumor of the intestinal wall is comparable to the change in feces. Changes SCFA in the stool can be used as a non-invasive test that allows indirectly to judge the presence of tumor, its localization and extent of germination of the bowel wall by the tumor. The use of preparations containing precursors of butyric acid (psyllium) or itself butyric acid, is a promising direction of CC canceroprevention.

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    Full text is published :
    Ardatskaya M.D. THE ROLE OF LOW MOLECULAR WEIGHT METABOLITES OF THE INTESTINAL MICROBIOTA IN THE PATHOGENESIS, DIAGNOSIS AND PREVENTION OF COLORECTAL CANCER. Experimental and Clinical Gastroenterology Journal. 2017;139(03):13-21
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    1. Saratov State Medical University n. a. V. I. Razumovsky (Saratov, Russian Federation)

    Keywords:chronic pancreatitis,colon,colonoscopy,cytokines

    Abstract:Purpose of the study. To investigate the clinical and morphological characteristics of the intestine in patients with chronic pancreatitis with the assessment of the quantitative determination of proinflammatory cytokines in the mucosa of the colon. Material and methods. In a study of 113 patients with chronic pancreatitis included. The analysis of intestinal dysfunction symptoms, endoscopic, morphological changes of the colon, the quantitative content of proinflammatory cytokines in colonic biopsies: IL-2, IL-6, IL-8, a more pronounced when toxic-metabolic chronic pancreatitis. Results. It has been established that chronic pancreatitis functionally associated with structural changes of the colon. In colonic biopsies increased content of IL-2, IL-6, IL-8. Morphological picture of colon mucosa in patients with normal excretory function of the pancreas and moderate exocrine insufficiency of pancreas (EIP) as a whole was normal. Revealed lymphoplasmacytic infiltration of the mucosa - 47 (68 %) patients, a decrease in the number of glands. Proliferation of the capillaries of the mucosa was observed in 21 (30,4 %) patients, in 16 (23.2 per cent) of the observed decrease in the number and size of crypts. A number of patients - 19 (40,4 %) with moderate EIP showed a growth of connective tissue fibers in the lamina propria that were regarded as early signs of fibrosis of the colon wall. In patients with severe EIP infiltration of the mucosa and submucosa by lymphocytes and plasma cells were observed more frequently in 85 %. For this group of patients was characterized by the abundance of connective-tissue elements of the mucosa and marked reduction of crypts in the tissue of the colon.

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    Full text is published :
    Bykova A.P., Kozlova I.V. CLINICAL-ENDOSCOPIC AND MORPHOLOGICAL FEATURES OF THE COLON IN CHRONIC PANCREATITIS. Experimental and Clinical Gastroenterology Journal. 2017;139(03):22-27
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    1. Federal State Budget Educational Institution of High Education «Saratov State Medical University named after V. I. Razumovsky» of the Ministry of Public Health of Russia (Saratov, Russian Federation)

    Keywords:ulcerative colitis,pain syndrome,alexithymia

    Abstract:Purpose of the study: to investigate the relationship between the index of alexithymia and severity of pain in patients with ulcerative colitis and comparable severity of the next attack. Materials and methods: the study included 59 patients with acute exacerbation of ulcerative colitis who were hospitalized in the gastroenterological department of the Saratov Regional Hospital. On admission to the hospital for all patients was determined the level of alexithymia using the Toronto alexithymia scale (1985), adapted in the Institute named after VM Bekhterev (2005). The severity of the next attack of ulcerative colitis was evaluated according to the criteria of Truelove-Witts (1955). Results: with comparable severity of the next attack of ulcerative colitis patients with high alexithymia significantly more often reported higher levels of pain than at low values one. Conclusion: in the choice of optimal tactics analgesic drug therapy in patients with ulcerative colitis in the period of exacerbation it is necessary to consider psychological characteristics of their personality.

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    Full text is published :
    Fedosova M.A., Kashkina E.I., Kunitsuna M.A. CORRELATION BETWEEN SEVERETY OF PAIN SYNDROME AND ALEXITHYMIA IN PATIENTS WITH ULCERATIVE COLITIS. Experimental and Clinical Gastroenterology Journal. 2017;139(03):28-31
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    1. State scientific center of coloproctology (Moscow, Russian Federation)

    Keywords:rectal motility,gastrocolic reflex,irritable bowel syndrome (IBS),constipation,diarrhea,rectal manometry

    Abstract:Background and aims: the article presents the results of the study rectal motility in patients with IBS. Our aim was to investigate the possibility of using balloon manometry to assess the locomotor activity of the rectum in patients with IBS. Material and methods: The investigation was conducted on total 168 patients in the clinical pathophysiology laboratory for the period June 2014 - September 2015. Male - 41 (24.4 %), mean age was 40,1 ± 17,2 years, female - 127 (75.6 %), mean age - 44,1 ± 15,3 years. The average age of patients older than 60 years was 69,4 ± 7,7 years. All patients fulfilling the Rome III criteria for IBS, and the prevalence of constipation was observed in 109 (64.9 %), diarrhea - in 29 (17.3 %), unstable stool (alternating diarrhea and constipation) - 30 (17.8 %).Rectal motility was evaluated by using air-filling catheters with manometry system Solar GI (MMS/Laborie, The Netherlands). We studied the background activity of the rectum and meal stimulated motility in both phases of gastrocolic reflex in patients with different clinical manifestations of IBS. Results: We diagnosed “irritable colon” type of motor activity in 56 (33.3 %) of 168 patients by analyzing the background motility. Irritable colon was found in 25 (22.9 %) of 109 patients with constipation, in 12 (41.4 %) of 29 patients with diarrhea and in 19 (63.3 %) of 30 patients with unstable stool. Remaining patients had hypokinetic background motility of the rectum, regardless of clinical manifestations (even in patients with diarrhea). Irritable bowel syndrome after eating was diagnosed in 111 (66.1 %) of 168 patients. They are 63 (57.8 %) patients with constipation, 20 (68.9 %) patients with diarrhea and 28 (96.6 %) patients with an unstable chair. The response to stimulation was not expressed in the remaining patients. They preserved hypokinetic motility type. Conclusions: Balloon manometry reveals a certain correlation between the clinical picture of IBS (the prevalence of constipation, diarrhea, or an unstable chair) and rectal motility type. This allows recommending balloon manometry as method of functional studies in patients with IBS.

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    Fomenko O.Yu., Halif I.L., Aleshin D.V., Belousova S.V. RECTAL NONPERFUSION MANOMETRY AS A WAY OF RECTAL MOTILITY ASSESSMENT IN PATIENTS WITH IRRITABLE BOWEL SYNDROME. Experimental and Clinical Gastroenterology Journal. 2017;139(03):32-37
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    1. Moscow state medical dental University named A. I. Evdokimov Ministry of health of the Russian Federation (Moscow, Russian Federation)

    Keywords:comorbid pathology,functional constipation,non-alcoholic steatohepatitis,treatment,psyllium,lactulose

    Abstract:The aim of the study was to Evaluate the effectiveness of long-term therapy dietary fiber (DF) or lactulose on the course of functional constipation when combined with nonalcoholic steatohepatitis (NASH) Material and methods. Was conducted an open prospective comparative study in parallel groups with the inclusion of 102 patients with NASH, among whom were allocated to patients with symptoms of functional constipation. The main group consisted of 70 people (NASH and functional constipation), a comparison group of 32 people with just NASH. The main group patients were randomized into two equal subgroups of 30 people IA and IB, differentiated by the treatment of functional constipation: patients of subgroup IA in addition to modification of lifestyle was prescribed the drug lactulose, patients IB - preparation of dietary fiber (psyllium). All patients 1 time per 3 months was carried out dynamic assessment of specific markers of functional constipation, frequency of defecation, stool type, indicators of quality of life, check bacterial overgrowth syndrome. The observation period of the patients was 6 months. Results. For the period 6-month observation the most significant regression of markers of functional constipation (natureline, frequency of defecation), better tolerance of therapy, including less pronounced side effects significantly greater reduction of bacterial overgrowth syndrome (p < 0.05) was achieved only in the subgroup of dietary fiber, which is reflected in a statistically more significant improvement in quality of life than in the subgroup of lactulose. Conclusion: long-term treatment of functional constipation with psyllium is characterized by a more pronounced laxative effect, better tolerated, reduces the severity bacterial overgrowth syndrome that regularly impact on improving the quality of life compared with lactulose.

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    Full text is published :
    Maevskaya E.A., Cucheryavy Y.A., Cheremushkin S.V., Shestakov V.A. et. al. THE EFFECTIVENESS OF PSYLLIUM AND LACTULOSE IN TREATMENT OF FUNCTIONAL CONSTIPATION WHEN COMBINED WITH NONALCOHOLIC STEATOHEPATITIS. Experimental and Clinical Gastroenterology Journal. 2017;139(03):38-47
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    1. Volgograd state medical University (Volgograd, Russian Federation)
    2. First Moscow state medical University. I. M. Sechenov, the Ministry of health of the Russian Federation (Moscow, Russian Federation)

    Keywords:irritable bowel syndrome,systemic inflammation,cytokines

    Abstract:In the presented article the data gained from recent publications and our original investigations conducted in term to determine the role of low grade systemic inflammation in the pathogenesis and clinical manifestation of irritable bowel syndrome (IBS) were analyzed. It was shown that in patients with IBS levels of circulating key pro-inflammatory cytokines (TNFα, IL-1, IL-6, IL-8) were increased while the levels of anti-inflammatory IL-10 tends to decrease. Revealed cytokine imbalance correlated with severity of the intestinal symptoms such as abdominal pain and changes in bowel habits. The raised levels of pro-inflammatory cytokines were detected in 30-40 % pts with IBS and in 60-85 % pts with ulcerative colitis (UC) versus 2-6 % in controls. In pts with active UC pro-inflammatory cytokines raised much more prominent than in IBS, nevertheless in IBS group levels of these cytokines were significantly higher than in controls. The results of randomized placebo controlled study had demonstrated the efficacy and safety of combination of affinity purified release-active antibodies (RAAT) to histamine, TNFα and brain-specific S-100 protein with anti-cytokine property in the treatment of IBS. In pts treated with combination of affinity purified RAAT to histamine, TNF-α and brain-specific S-100 protein the significant improvement in intestinal and non-intestinal systemic symptoms was registered. These data support the concept of relationship between cytokine imbalance and functional GI disorders and suggest the recommendation to include combination of affinity purified RAAT to histamine, TNF-α and brain-specific S-100 protein as disease modifying drug in IBS treatment.

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    Babaeva A.P., Osadchuk M.A., Vidiker R.V., Kalinina E.V. et. al. MARKERS OF SYSTEMIC INFLAMMATION IN PATHOGENESIS AND OPTIMIZATION OF PHARMACOTHERAPY OF IRRITABLE BOWEL SYNDROME. Experimental and Clinical Gastroenterology Journal. 2017;139(03):48-55
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