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По решению Всемирной гастроэнтерологической организации (WGO) 29 мая объявлен Днем воспалительных заболеваний кишечника (ВЗК), поэтому открывает наш майский выпуск большая статья авторов под руководством профессора Л. Н. Костюченко из Московского клинического научно-практического центра, в которой подробно освещены современные данные о распространенности язвенного колита и факторах патогенеза, представлены основные задачи, направления и схемы нутритивной поддержки в зависимости от активности заболевания, нутриционной недостаточности и иммунного статуса больного. Тему ВЗК продолжают оригинальная статья В. Э. Сагынбаевой и Л. Б. Лазебника о трансплантация мезенхимальных стромальных клеток костного мозга, способствующей повышению уровня инфликсимаба в сыворотке крови больных болезнью Крона и восстановлению утраченной ранее чувствительности к инфликсимабу, и экспериментальная статья из ФНКЦ ФХМ ФМБА России (генеральный директор — член-корреспондент РАН В. М. Говорун) о различных животных моделях болезни Крона, так как наиболее эффективным методом для изучения патогенеза заболевания и подбора подходящей терапии по-прежнему остается моделирование болезни Крона in vivo.
Украшением раздела «Клиническая гастроэнтерология» является материал академика РАН А. Л. Гинцбурга и соавторов из ФНИЦ эпидемиологии и микробиологии им. Н. Ф. Гамалеи, в которой авторы с помощью сканирующей электронной микроскопии изучали способность эталонных и свежевыделенных штаммов H. pylori к образованию биоплёнки при культивировании на абиогенных носителях и в естественных условиях существования. Показано, что штаммы обоих типов способны к образованию биоплёнки in vitro, причём по сравнению со свежевыделенными штаммами, эталонные штаммы H. pylori синтезируют менее выраженный экзоклеточный матрикс и обладают менее выраженным жгутиковым аппаратом.
В свете подготовке Клинических рекомендаций НОГР по функциональным заболеваниям ЖКТ у беременных большой кластер статей в этом номере журнала посвящен этой тематике. В совместной работе коллег из Тверского государственного медицинского университета и Московского клинического научно-практического центра показано, что у женщин, инфицированных H. pylori, достоверно чаще имеет место неразвивающаяся беременность в анамнезе, выше продолжительность и выраженность раннего токсикоза, частота и выраженность анемии беременных, а также частота развития кандидоза влагалища. Вместе с тем, не отмечено влияния наличия H. pylori на исход беременности, развитие плода и массо-ростовые показатели новорожденных.
Изжога является одним из самых частых и стойких симптомов, сопровождающих беременность. Перед практикующим врачом очень часто встают вопросы фармакотерапии у беременных. Профессор И. В. Козлова и соавт. из Саратовского государственного медицинского университета имени В. И. Разумовского в разделе «Лекции» рассматривают основные подходы к диагностике, немедикаментозному и медикаментозному лечению изжоги во время беременности.
Две статьи по заболеваниям печени у беременных представлены из Мордовского государственного университета им. Н. П. Огарева. В оригинальном исследовании Е. Ю. Еремина, И. В. Герасименко и О. В. Чернова на основании ретроспективного анализа обменных карт и историй родов 67 женщин сделали вывод о том, что лекарственный гепатит у беременных наиболее часто развивался на фоне приема комбинаций из 5 и более препаратов, в состав которых входили витаминно — минеральные комплексы, прогестагены, препараты фолиевой кислоты, препараты йода. При этом степень активности гепатита находилась в прямой зависимости от количества принимаемых препаратов. Профессор Е. Ю. Еремина в разделе «Обзоры» представила современные данные об аутоиммунном гепатите, вариантах его клинической симптоматики и течения во время беременности и в послеродовом периоде. Представлены современные российские и международные рекомендации по ведению беременных с аутоиммунным гепатитом, возможности базовой и альтернативной медикаментозной терапии заболевания во время беременности. Приведены собственные клинические наблюдения автора за течением беременности у пациенток с аутоиммунным гепатитом.
В разделе клинических наблюдений профессор Д. И. Абдулганиева и соавторы из Казани представили интереснейший случай ведения беременности на фоне сочетания синдрома Шерешевского-Тернера и цирроза печени в исходе аутоиммунного гепатита, завершившейся рождением здорового ребенка. По традиции мы предоставляем страницы нашего журнала для точки зрения оригинальных авторских идей с их последующим обсуждением. Доктор М. Д. Левин (Нетания, Израиль) предлагает теоретическое обоснование новой хирургической тактики при ГЭРБ.
Завершает номер раздел «История медицины», в котором на этот раз представлена статья профессора С. А. Кути и соавт., посвященная истории открытия и изучения поджелудочной железы. В материале приведены краткие сведения о жизни и деятельности ученых, чьи имена увековечены в эпонимах структур поджелудочной железы — И. Г. Вирсунга, Дж. Д. Санторини и П. Лангерганса.
Уважаемые коллеги! Мы постарались сделать выпуск максимально интересным как можно большему числу врачей всех специальностей.
Ждем ваши отзывы и пожелания.
Ответственный за выпуск редактор,
заведующая кафедрой пропедевтики внутренних болезней ФГБОУ ВО «Мордовский государственный университет им. Н. П. Огарева», главный гастроэнтеролог Минздрава Республики Мордовия доктор медицинских наук, профессор |
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Е. Ю. Еремина | |
Keywords:ulcerative colitis,prevalence,pathogenesis,immune status,nutritional support
Abstract:The article describes the modern data on the prevalence of ulcerative colitis, presents data on the factors of pathogenesis, main tasks, directions and scheme of nutritional support depending on the activity of the disease, nutritional deficiency and immune status of the patient.
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Smirnova O.A., Lychkova A.E., Kostyuchenko L.N., Puzikov A.M. ULCERATIVE COLITIS: A MODERN VIEW ON SOME PROBLEMS . Experimental and Clinical Gastroenterology Journal. 2017;141(05):04-13
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Keywords:Helicobacter pylori,biofilm,scanning electron microscopy
Abstract:Using scanning electron microscopy, the ability of reference and freshly isolated Helicobacter pylori strains to form biofilm under cultivation on abiotic surfaces and in natural conditions was studied. It was shown that both types of strains were capable of biofilm formation in vitro, although reference strains synthesized less pronounced exocellular matrix and flagella than freshly isolated strains. Bio-film also was detected in specimens of antral mucosa under duodenal ulcer. Most often Helicobacter pylori biofilms were detected near the mouths of the gastric glands. The structure of matrix surface of such biofilms looked inhomogeneous in different parts of the epithelial layer.
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Zhukhovitsky V.G., Smirnova T.A., Shevlyagina N.V., Korzheva I.Yu. et al. HELICOBACTER PYLORI BIOFILM IN VITRO AND IN VIVO. Experimental and Clinical Gastroenterology Journal. 2017;141(05):14-19
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Keywords:pregnancy,Helicobacter pylori,early toxicosis,vomiting of pregnancy,anemia
Abstract:Aim of the study. To investigate the effect of Helicobacter pylori infection on pregnancy and its outcome. Material and methods. An observational study involving 200 pregnant women divided into 3 groups. The first group included 100 women suffering from diseases associated with H. pylori, in the second - 50 pregnant women with digestive diseases, but H. pylori negative, a third - 50 healthy women. Results. It has been shown that women infected with H. pylori, significantly more likely to have the non-developing pregnancy in history, higher duration and severity of early toxicity, the frequency and severity of anemia in pregnant women, as well as the incidence of vaginal candidiasis. However, the presence of H. pylori had no effect on outcome of pregnancy, fetal development and weight and neonatal growth indicators.
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Burkov S.G., Bordin D.S., Sharapova E.I., Markina N.F. INFLUENCE OF HELICOBACTER PYLORI ON CLINICAL COURSE OF PREGNANCY. Experimental and Clinical Gastroenterology Journal. 2017;141(05):20-23
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Keywords:Crohn’s disease,infliximab,infliximab concentration in blood serum,infliximab pharmacokinetics,anticytokine therapy,mesenchymal stromal cells of the bone marrow
Abstract:The therapeutic effect of infliximab (INFL) in Crohn’s disease (CD) patients receiving anticytokine therapy depends on the concentration of the medication in the blood serum. When INFL concentration in the blood serum is high (more than 20 μg/ml) the clinical and endoscopic remission of CD is observed in the patients. Upon the second administration INFL is not accumulated in the organism. After the induction course of INFL the level of the medication in the blood serum increases (more than 45 μg/ml), further its serological concentration gradually decreases approaching the values below the minimum. The transplantation of mesenchymal stromal cells of the bone marrow contributed to the increase of INFL level in the blood serum and to the recovery of sensitivity to INFL.
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Sagynbaeva V.E., Lazebnik L.B., Golovanova E.V. THERAPEUTIC CONCENTRATION OF INFLIXIMAB IN THE BLOOD SERUM OF CROHN’S DISEASE PATIENTS RECEIVING ANTICYTOKINE THERAPY. Experimental and Clinical Gastroenterology Journal. 2017;141(05):24-28
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Keywords:drug-induced hepatitis,pregnancy,medicines,biochemical activity of drug-induced hepatitis
Abstract:Purpose of the study. To characterize drug-induced hepatitis in pregnant women. Materials and methods: a clinical examination, a retrospective analysis of the exchange of cards and 67 birth stories of women. Results. Drug-induced hepatitis often diagnosed at 39 weeks of gestation. Overweight and comorbidities biliary system increases the biochemical activity of drug-induced hepatitis. The clinical picture is dominated by asymptomatic version of the flow, but monosemeiotic option complaining of itchy skin, accompanied by higher rates of liver transaminases. Among biochemical syndromes prevailed cytolytic and cholestatic options, and the degree of activity of transaminases usually defined as the minimum and reasonable. Drug-induced hepatitis in pregnant women developed in patients receiving combinations of 5 or more drugs, which included vitamin - mineral complexes, progestogens, folic acid preparations, iodine preparations. The degree of hepatitis activity was in direct proportion to the number of drugs taken.
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Gerasimenko I.V., Chernova O.V. DRUG-INDUCED HEPATITIS IN PREGNANT WOMEN. Experimental and Clinical Gastroenterology Journal. 2017;141(05):29-32
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Keywords:Escherichia coli,Crohn’s disease,experimental animal models,Escherichia coli
Abstract:Crohn’s disease (CD), a member of inflammatory bowel disease group (IBD), is a chronic relapsing disease of unknown origin. It is considered, that the pathogenesis of CD involves aberrant immune reactions in response to the pathogenic intestinal microflora, in particular opportunistic E. coli, but the exact cause of the disease still remains unknown. Therefore, the CD therapy depends on the stage of the disease and remains symptomatic. The most effective method for pathogenesis study of the CD and the selection of appropriate treatment is in vivo CD models. Today, there are more than sixty different animal models of CD, conventionally divided into four groups: chemical induction of the disease, the introduction of specific pathogen into model object, spontaneous occurrence of the disease in genetically modified animals and transplantation of immune system cells into immunodeficient animals.
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Baykova Yu.P., Rakitina D.B., Shcherbakov P.L., Govorun V.M. EXPERIMENTAL ANIMAL MODELS OF CROHN’S DISEASE. Experimental and Clinical Gastroenterology Journal. 2017;141(05):33-38
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Keywords:liver,pancreas,free radical oxidation,obstructive cholestasis,ozone
Abstract:Objective: The goals of this investigation is to study experimentally the effectiveness of intravenous infusions of ozonated 0.9 % sodium chloride solution for the correction of free-radical oxidation processes in acute obstructive cholestasis. Materials and methods: In 40 dogs under thiopental sodium (0.045-0.050 g / kg body weight) anesthesia was simulated a mechanical jaundice with the applying a loop on the common bile duct. Animals were divided into 4 series. In the first and second series after the simulation of cholestasis the common bile duct was decompressed on the third day. In the 3rd and 4th series after the decompression of the common bile duct for 4 days it were 0.9 % chloride and ozonized isotonic sodium chloride solution (OIS) infused. The pro- and antioxidant status were measured with the help of the luminescence induced plasma chemiluminescence intensity (Imax, S) in homogenates of the pancreas, the determination of the level of malondialdehyde (MDA) and catalase. Results. When ligation common bile duct the total bilirubin level was 40.3 times higher on the 3rd day of the experiment than in baseline. Imax index was increased by 2.7 times, chemiluminescence light sum - by 2.6 times of the original value. When ozone intravenous infusion for 7 days the maximal chemiluminescence intensity was decreased by 1.7 times and S parameter - by 68 %. Conclusion. Progressive obstructive jaundice in animals was accompanied by an increase in the intensity of free radical processes. But the infusions OIS followed by a significant decrease in the intensity of free radical processes that expressed by the decreasing in the amount of lipid peroxidation and was accompanied by increasing of antioxidant enzymes activity.
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Belyaev A.N., Kostin S.V., Belyaev S.A., Zakhvatov A.N. EFFECTS OF OZONE ON FREE RADICAL OXIDATION IN ACUTE OBSTRUCTIVE CHOLESTASIS. Experimental and Clinical Gastroenterology Journal. 2017;141(05):39-42
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Keywords:pregnancy,heartburn,GERD
Abstract:Heartburn is one of the most frequent and resistant symptoms in pregnancy. Although complications are rare, heartburn may reduce the quality of life, and forces to use pharmacotherapy. The lecture describes the main approaches to the diagnostic, non-drug and drug treatment of heartburn in pregnancy.
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Kozlova I.V., Pakhomova A.L., Lekareva L.I. DIAGNOSTIC AND THERAPEUTIC APPROACHES TO HEARTBURN IN PREGNANT WOMEN. Experimental and Clinical Gastroenterology Journal. 2017;141(05):43-47
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Keywords:liver,pregnancy,autoimmune hepatitis,diagnosis,treatment
Abstract:Presents recent data on autoimmune hepatitis, variants of its clinical symptoms and course. Special attention is paid to the disease during pregnancy and in the postpartum period. Presents current local and international guidelines on the management of pregnant women with autoimmune hepatitis, the possible basic and alternative drug treatment of the disease during pregnancy. The authors present their clinical observations of the author over the course of pregnancy in patients with autoimmune hepatitis.
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Eremina E.Yu. AUTOIMMUNE HEPATITIS AND PREGNANCY. Experimental and Clinical Gastroenterology Journal. 2017;141(05):48-56
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Abstract:Objective: a prospective, open, observational study to assess the tolerability and efficacy of multicomponent probiotics containing Lactobacillus acidophilus, Lactobacillus reuteri, Bifidobacterium lactis and Lactobacillus acidophilus LA-14, Lactobacillus plantarum LP-115, Bifidobacterium longum BB 536 with functional gastrointestinal disorders in early aged children and in frequently ill children. Methods: the first part of the study included 35 infants with functional gastrointestinal disorders during the onset of intestinal colic, dentition, transition from breast to artificial feeding: 25 children received a multicomponent probiotic, 10 children made up a control group. The second part of the study included 40 patients aged 18-24 months during and after taking antibiotics due to virus-bacterial diseases: 20 children received a probiotic and 20 children with similar problems and diseases made up a control group. The study design included 2 visits with an assessment of clinical signs, a coprological study, a quantitative microbiological seeding of feces for the maintenance of microorganisms. The levels of sIgA and lysozyme in coprofiltrates were determined. Results: as a result of assessing the tolerability and clinical effectiveness of the multicomponent probiotic usage in children of the first group with functional gastrointestinal disorders, a good tolerance of the probiotic was established. The improvement of the gastrointestinal tract with its dysfunction associated with dentition, transition from breast to artificial feeding was noted. The probiotic usage in a standard dosage and duration of 2 weeks resulted in clinical (normalization of stool frequency and consistency and other characteristic manifestations: regurgitation, flatulence, frequency and intensity of colic) and laboratory improvement. In the group of children who received the multicomponent probiotic in combination with an antibiotic, an active immunological reaction of the children’s organism to the viral-bacterial disease was noted the increasing concentration of sIgA and lysozyme in coprofiltrates. Conclusion: The multicomponent probiotic containing Lactobacillus acidophilus, Lactobacillus reuteri, Bifidobacterium lactis and Lactobacillus acidophilus LA-14, Lactobacillus plantarum LP-115, Bifidobacterium longum BB 536, can be recommended for widespread usage in early aged children with functional gastrointestinal disorders including disturbance of the stool, flatulence, intestinal colic, as well as in unfavorable conditions, which are associated with a risk of microbiocenosis and immunological intestinal tolerance disorders. Preparations should be used from the first day of antibiotic therapy and continue for 2-3 weeks after the end of admission. The study showed good tolerability of the probiotic, there were no side and undesirable effects.
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Khavkin A.I., Komoarova O.N. THE EFFECTIVENESS OF POLYCOMPONENT PROBIOTICS INCLUDING STRAINS OF LACTOBACILLUS ACIDOPHILUS LA-14, LACTOBACILLUS REUTERI AND BIFIDOBACTERIUM LACTIS IN FUNCTIONAL GASTROINTESTINAL DISORDERS IN EARLY AGED CHILDREN: THE RESULTS OF A PROSPECTIVE, OPEN, OBSERVATIONAL STUDY. Experimental and Clinical Gastroenterology Journal. 2017;141(05):57-64
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Keywords:gastroesophageal reflux disease,lower esophageal sphincter,operation,plication,cardia,scheme
Abstract:Surgical treatment of gastroesophageal reflux disease (GERD) is performed in cases where severe symptoms cannot be controlled by conservative methods. Laparoscopic Nissen Fundoplication (LNF) has become the gold standard surgical procedure for management of GERD, which causes a narrowing of the gastroesophageal junction. Several modifications have been proposed to original technique since the results of LNF are not always as good as expected. Often it is not a complicated operation transformed into the kit of manipulations. The relapses ranging from 0.98 % to 42 %. The aims article to substantiate the new tactics of treatment of the GERD. Theoretical foundations: 1) manometric and radiological studies have shown that the failure of the lower esophageal sphincter (LES) is attributable of the weakness of its intra-abdominal portion (2.1 cm from 3.5 cm); 2in the previous study we have shown that in the patients with GERD the LES is not displaced; 3) it was found that the surgical plication of the external anal sphincter and puborectalis muscle increases its sarcomere length and increases anal canal pressure that can be true also for the LES. Conclusion. The scheme of the surgical plication of the intraabdominal part of the LES is offered. This procedure leads to a mechanical narrowing of the cardia, to the narrowing of the LES ring, as well as increases its wall thickness, which implies the ability to restore of its antireflux function.
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Levin M.D. THE THEORETICAL JUSTIFICATION OF A NEW SURGICAL TECHNIQUE IN GASTROESOPHAGEAL REFLUX DISEASE. RESTORATION FUNCTION OF THE LOWER ESOPHAGEAL SPHINCTER (CARDIOPLICATION). Experimental and Clinical Gastroenterology Journal. 2017;141(05):65-69
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Keywords:Turner’s syndrome,mosaic,pregnancy,cirrhosis,autoimmune hepatitis
Abstract:The clinical case of pregnancy in patient with mosaic Turner’s Syndrome and cirrhosis in the outcome of Autoimmune Hepatitis is presented in the article.
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Abdulganieva D.I., Odintsova A.Kh., Mukhametova D.D., Ramazanova A.Kh. et al. PREGNANCY IN PATIENT WITH MOSAIC TURNER’S SYNDROME AND CIRRHOSIS IN THE OUTCOME OF AUTOIMMUNE HEPATITIS TYPE 1. Experimental and Clinical Gastroenterology Journal. 2017;141(05):70-73
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Abstract:The article is devoted to the history of discovery and study of one of the most important organs of the digestive and endocrine system of the body - the pancreas. Chronologically, key discoveries in pancreatic anatomy, histology, physiology and biochemistry are presented. Brief data about life and activity of scientists, whose names immortalized in pancreatic eponyms (J. G. Wirsung, G. D. Santorini, P. Langerhans) are given. Circumstances of their discoveries are described.
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Kutia S.A., Sataieva T.P., Kriventsov M.A., Polishchuk E.A. PANCREAS: HISTORY IN A TIMELINE. Experimental and Clinical Gastroenterology Journal. 2017;141(05):74-78
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Abstract: Yury Borisovich Belousov is rightly called the founder of clinical pharmacology in the Russian Federation. Yu. B. Belousov was the Chief Clinical Pharmacologist and Deputy Chairman of the Pharmacological Committee of the Ministry of Health of the Russian Federation, Chairman of the Interdepartmental Council on Antibiotic Policy at the Ministry of Health of the Russian Federation, Deputy Chairman of the Scientific Organizing Committee and Chairman of the Council of Experts of the “Federal Manual for Doctors on Drug Use”. Yuri Borisovich was one of the founders and vice-president of the Russian National Congress "Man and Medicine". Thanks to him, congresses and congresses of the Russian Scientific Medical Society of Therapists acquired a new sound. The article is in Russian.
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Lazebnik L.B. OF THE MEMORY OF YURI BORYSOVICH BELOUSOV. Experimental and Clinical Gastroenterology Journal.2017;141(05):79-79
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