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№ 09 (145) 2017

  • Глубокоуважаемые коллеги! !
    Перед Вами очередной номер журнала. Он посвящен самым разнообразным вопросам гастроэнтерологии, включая и вопросы коморбидности. Все статьи объединяет один немаловажный фактор – они написаны авторами из Сибири и в основном из Новосибирска, третьего по величине города России, являющего крупным научным центром.
    Передовая статья, выполненная М. А. Ливзан и М. Ф. Осипенко с соавторами посвящена вариантам непереносимости глютен- содержащих продуктов. Проблема актуальна, интересна тем, что наряду с неплохо известными состояниями – аллергическими реакциями на данный растительный компонент и глютеновую энтеропатию (целиакию) в ней рассматривается вопрос о новой форме непереносимости глютена – чувствительности к глютену не связанной с целиакией. Критерии данного состояния появились сравнительно недавно, механизмы формирования данного состояния пока изучены весьма условно. Публикации в отечественной литературе на данную тему практически отсутствуют. надеемся, что данная информация расширит Ваши представления о патологических состояниях связанных с глютеном и вы сможете ими воспользоваться в реальной клинической практике.
    В разделе клиническая гастроэнтерология представлены результаты исследования прогностической роли полиморфизма гена ИЛ-1B в отношении риска рака желудка в Сибирской популяции (Белковец А. В. с соавторами). Показано, что этот показатель также перспективен для включения его в рискометрию рака желудка, наряду с биомаркерами атрофии.
    Результаты исследования мутаций гена HFE у больных неалкогольной жировой болезнью печени представил коллектив авторов (Кондратова М. А. с соавторами). Показано, что наличие определенных мутаций (C 282Y и H63D) гена гемохроматоза HFE в сочетании с расстройствами порфиринового обмена являются факторами повышенного риска формирования фиброза печени у больных неалкогольной жировой болезнью печени.
    Статья Красновой Е. И. с соавторами посвящена вопросам норовирусного острого гастроэнтерита среди жителей города Новосибирска. Среди госпитализированных пациентов с острым гастроэнтеритом в 20.8 % была выявлена вирусная инфекция. При этом доминировали норовирусы второй группы NoV GII – в 13,6 %. Высокая заболеваемость вирусной инфекцией требует внедрения тест систем в рутинную практику врача инфекциониста и гастроэнтеролога.
    В исследовании Кулыгиной Ю. А. с соавторами при анализе регистра больных воспалительными заболеваниями кишечника города Новосибирска выявлена высокая частота синдрома избыточного бактериального роста, что может имитировать обострение (атаку) основного процесса и значительно снижает качество жизни. Поэтому коррекция данного состояния является самостоятельной клинической задачей.
    Оригинальное исследование Хрянина А. А. с соавторами посвещено социально значимой проблеме – половой передаче вируса гепатита С, Ситуация иллюстрирована конкретным клиническим примером. Приведены факторы риска, способствующие заражению вирусом гепатиат С, сто должно учитываться на практике.
    В статье Поздняковой О. Н. с соавторами представили данные о том, что на фоне диффузных заболеваний печени грибковые заболевания кожи могут иметь некоторые нетипичные клинические черты и требуют корректив в стандартных подходах к терапии.
    В обзорной статье Краснера Я. А. с соавторами показаны особенности течения некоторых иммуноопосредованных заболеваний у больных воспалительных заболеваний кишечника. Приведены данные о большой частоте желчнокаменной болезни и стеатоза печени, особенно у больных болезнью Крона, большая частота метаболических нарушений у больных язвенным колитом, а также выявленные факторы риска развития этих патологических состояний. Приведенные результаты многочисленных исследований надеемся, что помогут в реальной клинической практике при курации этой непростой группы больных.
    Особенностям нутритивного статуса у больных коморбидной патологией – артериальной гипертензией и хронической обструктивной болезнью легких посвящена работа Герасименко О. Н. с соавторами. Продемонстрировано, что своевременная коррекция нутритивного статуса, где важное место занимает показатель индекса окружности талии/окружности бедер, позволит улучшить течение обеих патологий.
    В исследовании Жук Е. А. с соавторами проанализированы различные причины синдрома диспепсии у больных Сахарным диабетом 2 типа. Показана ассоциация данного синдрома, не вызванного органическими заболеваниями желудочно-кишечного тракта, с уровнем компенсации и наличием осложнений сахарного диабета, что позволяет предположить функциональные расстройства желудка или начальные проявления моторных нарушений (гастропарез). Выявлена отрицательная ассоциативная связь между разными шкалами качества жизни и уровнем вегетативной дисфункции, общей тревожности во всех группах пациентов, что говорит о необходимости самостоятельной коррекции имеющихся нарушений. При анализе частоты, распространенности и нозологической структуру предопухолевых и опухолевых процессов в желудочно-кишечном тракте на основании морфологического исследования 1294 образцов биопсийного материала за 2014–2016 годы (исследование Надеева А. П. с соавторами) показано преобладание воспалительных заболеваний в структуре патологических процессов желудка (61,73 %) и тонкой кишки (71,8 %). Самой частой локализацией опухолей желудочно-кишечного тракта были толстая кишка (48,1 %), а самый распространенный гистологический вариант злокачественных опухолей – аденокарцинома (94 %). Данные результаты дают представление о преобладающем характере патологических процессов пищеварительного тракта.
    В разделе хирургическая гастроэнтерология первая статья, посвящена цитокиновому и микроэлементарному статусу при реконструктивных операциях на пищеводе (Пешкова И. В. со соавторами). Показана связь данных видов нарушений с алиментарной недостаточностью, вызванной основным заболеванием, что требует самостоятельной коррекции, а также наличием воспалительного процесса за счет перипроцесса вокруг пищевода.
    В работе Винник Ю. С. с соавторами показано, что ранняя визуализации поджелудочной железы с использованием КТ-ангиографии с болюсным контрастированием определяет прогноз и выбор тактики ведения больных с патологией данного органа.
    В статье Штофина С. Г. с соавторами показаны практические результаты 1990–2015 годов реконструктивных и восстановительных операций на внепеченочных желчных протоках после их повреждений и воспалительных поражений, из них у 115 больных (в 67,2 %) использованы никелид титановые стенты. Отражены основные результаты и осложнения высоко технологических оперативных вмешательств при коррекции рубцовых поражений внепеченочных желчных протоков и билиодигестивных анастомозов.
    Шестак И. С. с соавторами провели оценку влияния раннего эндоскопического гемостаза на частоту рецидивов при кровотечениях из варикозно расширенных вен пищевода и желудка, используя ретроспективный анализ 113 историй болезни. Наибольшая частота рецидивов кровотечений была выявлена в случае не обнаружения признаков кровотечения при первичном эндоскопическом исследовании, а также в случае отказа от раннего эндоскопического гемостаза. Работа имеет важное прикладное назначение, демонстрируя тактику ведения больных с кровотечением из варикозно расширенных вен пищевода.
    В разделе экспериментальная гастроэнтерология Мануйлов А. М. с соавторами анализировали временную зависимость метаболических показателей при частичной сосудистой изоляции печени в эксперименте. Установлено постепенное нарастание гепатоцитолиза, эндогенной интоксикации и интенсивности свободно-радикальных процессов с активацией в течение 10–15 минут компенсаторных систем организма и дальнейшим истощением их к 20 минуте ишемии раскрывают наши представления о необходимых сроках коррекции ишемических и перфузионных осложнений. В разделе лекции Маринкиным И. О. с соавторами приводят новейшие данные о редком осложнении беременности с вовлечением желудочно- кишечного тракта – HELLP-синдроме. Наряду гемолизом и тромбоцитопенией для синдрома характера гиперферментемия. Освещены подходы к диагнозу, прогнозу и тактике ведения беременных женщин с данным синдромом.
    Чеканов М. Н. с соавторами посвятили лекцию вопросам хирургического лечения редких форм колитов: коллагеновому, сегментарному и флебосклеротическому. Особенно интересен взвешенный взгляд на хирургические подходы к лечению (показания, прогноз, особенности оперативного вмешательства при трех формах патологии толстой кишки.
    В научном обзоре, посвященном факторам риска и протекции колоректального рака, представленном аспиранткой НИИ терапии и профилактической медицины Прудниковой Я. И. с соавторами, подробно, с позиций доказательной медицины, анализируется большое количество обсуждаемых в современной литературе факторов, с четкой градацией на доказанные, предполагаемые и только обсуждаемые факторы риска и протекции данного состояния. Полагаю, что обзор представит интерес для широкого круга гастроэнтерологов и терапевтов. В разделе клинических наблюдений в статье клинического ординатора НИИ терапии и профилактической медицины Воеводы С. М. представлен редкий клинический случай рецидивирующего внутрипеченочного холестаза на фоне идиопатической гиперпролактинемии, при годичном наблюдении. Роль пролактина в поддержании холестаза изучена мало (преимущественно на экспериментальных моделях). Возникают вопросы рационального ведения таких пациентов. Авторы надеются на отклики коллег, встречавшихся с подобными случаями.
    В разделе «Дискуссии» интересное и оригинальное исследование представлено д. м. н., в. н.с НИИ терапии и профилактической медицины Кручиной М. В. и соавторами. Оно посвящено новым возможностям дифференциальной диагностики алкогольной и неалкогольной жировой болезни печени (что является непростой задачей в клинике). Авторы изучали вязкоупругие и электрические характеристики эритроцитов в динамике абстинеции при алкогольной, и снижении ИМТ при неалкогольной жировой болезни печени. Оказалось, что отказ от алкоголя уже через 2,5–3 месяца привел к значимым позитивным сдвигам в характеристиках эритроцитов, в то время как снижение массы тела на 7 % не привело к улучшению эритроцитарных показателей. Таким образом, авторы постулируют, что эта доступная методика может быть использована как дифференциально-диагностическая, такт определены пороговые значения ряда эритроцитарных показателей. дискриминирующие жировую болезнь печени разного генеза.
    С наилучшими пожеланиями,
    Ответственный за выпуск редактор,

      главный терапевт и главный гастроэнтеролог г. Новосибирска Министерства здравоохранения Новосибирской области,
    заведующая кафедрой пропедевтики внутренних болезней Новосибирского государственного медицинского университета,
    руководитель Департамента по науке, инновациям и информатизации НГМУ,
    доктор медицинских наук, профессор
      М. Ф. Осипенко.
       

    1. State budget institution of Higher Professional Education “Omsk State Medical University”, the Ministry of Health of the Russian Federation (Omsk, Russian Federation)
    2. State Educational Institution of Higher Professional Education “Novosibirsk State Medical University”, the Ministry of Health of the Russian Federation (Novosibirsk, Russian Federation)

    Keywords:gluten sensitivity is not associated with celiac disease (NCGS),gluten-related diseases,IBS-like symptoms,amylase- trypsin inhibitors (ATIs),antigliadinantibodies of class IgG (IgG-AGA),gluten-free diet,HLADQ2 and DQ8 genotypes

    Abstract:Rising incidence of different variants of gluten intolerance associated with changes in eating behaviorin many countries, changes in the technology of growing and processing crops, new culinary technologies. Until recently, celiac disease, dermatitis herpetiformis and wheat allergy were the only known disease with a proven role of gluten in their pathogenesis. Non-celiac gluten sensitivity (NCGS)- a new syndrome of intolerance to gluten. This pathology can be suspected in patients with persistent intestinal and extra-intestinal symptoms clearly associated with the intake of foods containing gluten, the absence of serological markers of celiac disease or suspected allergy to wheat. The paper presents the current data on the epidemiology, etiology and pathogenesis, clinical features and diagnosis NCGS.

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    Full text is published :
    Osipenko M.F., Zayakina N.V., Krolevec T.S. THE MANY FACES OF THE PROBLEM OF INTOLERANCE TO GLUTEN. Experimental and Clinical Gastroenterology Journal. 2017;145(09):4-9
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    1. Research Institute of Internal and Preventive Medicine - Branch of Institute of Cytology and Genetics SB RAN” (Novosibirsk, Russian Federation)
    2. Novosibirsk State Medical University (Novosibirsk, Russian Federation)

    Keywords: Atrophic gastritis,gastric cancer,pepsinogen I,PGI/PGII ratio,IL-1β polymorphism

    Abstract:Background: Serum biomarkers of atrophic gastritis (pepsinogen I (PGI) and PGI/PGII ratio) are important for gastric cancer (GC) risk stratification. According to a number of researches IL1В gene polymorphisms are associated with risk of GC. The aim: to study the association of IL1В gene promoter polymorphism (-511C/T (rs16944) with GC in the prospective “case-control” study (8 years follow up). Materials and methods: the base of biomaterials received in 2003-2005 in population selection of residents of Novosibirsk within the international HAPIEE project (DNA samples and serums were stored at - 700C) were compared with data of the population register of GC (in 2012). For each case of GC, an appropriate control case was selected at the ratio 1:2 matching the area of residence, sex and age. Finally 156 serum samples (52 - GC group and 104 - control) were available for the analysis using a panel of serum biomarkers “Gastropanel” (Biohit, Finland) and 141 DNA samples (49 - GC group and 92 - control) were genotyped according to the published method. Results: the frequency of T/T genotype of the IL1В was found significantly higher in the GC group (16.3 %) compared with the control (5.4 %) (p=0.03). The T/T genotype was associated with significantly increased risks of GC compared with the C/C genotype (OR=3.4; СI: 1.0-11.0, р=0.03). It was shown that rare T allele carriers have increased risk GC development (OR=1.69; CI: 1.01-2.81, р=0.04) in comparison with wild C allele carriers (OR=0.59; CI: 0.36-0.99, р=0.04). The mean level of PGI and PGI/II ratio in persons with T/T genotype were significantly lower in GC group (41.3 ±31.8 µg/l and 4.1±2.9 versus 131.0±57.2 µg/l and 7.0±2.8; p=0.0001 and p=0.05 respectively). Conclusion: IL1В polymorphism (rs16944) is associated with an increased risk of GC in the population of Western Siberia and can be discussed for inclusion in the GC riskometer.

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    Belkovets A.V., Kurilovich S.A., Maksimov V.N., Ragino Yu.I. et al. IL1В POLYMORPHISM IS ASSOCIATED WITH AN INCREASED RISK OF GASTRIC CANCER IN THE POPULATION OF WESTERN SIBERIA. Experimental and Clinical Gastroenterology Journal. 2017;145(09):10-17
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    1. Federal State budgetary educational institution of higher professional education “Novosibirsk state medical University” Ministry of healthcare of the Russian Federation (Novosibirsk, Russian Federation)
    2. Research Institutе of Internal and Preventive Medicine” -Branch of the Federal State Budget Scientific Institution “The Federal Research Center Institute of Cytology and Genetics of Siberian Branch of the Russian Academy of Sciences (Novosibirsk, Russian Federation)

    Keywords: Non-alcoholic fatty liver disease,the polymorphism of alleles C 282Y and H63D of HFE gene,porphyrin metabolism,HFE,H63D,282Y

    Abstract:Тhe purpose of the study. The determination of the frequency of polymorphism alleles C 282Y and H63D of the HFE gene in nonalcoholic fatty liver disease (NAFLD) in comparison to individuals from the General population and to identify the peculiarities in the metabolism of porphyrins. Materials and methods. Molecular genetic examination was performed in 454 people. We evaluated the frequency of polymorphism alleles C 282Y and H63D of the HFE gene in patients with NAFLD (major group 112) and compared with the results obtained in the examination of persons General population (comparison group, 342 people). Patients with NAFLD were determined excretory profile of indicators of porphyrin exchange. Results. Polymorphism of the alleles C 282Y and H63D of the HFE gene in patients with NAFLD and in patients the General population is recorded with the same frequency, respectively, at 32.1 % and 33.9 % of cases. In both groups, was often detected polymorphism for alleles С282У, respectively, 26.8 % and 28.1 % of cases. Disorders of porphyrin metabolism diagnosed in 77 (68,8 %) patients had NAFLD. Comparative analysis of detected disorders of porphyrin metabolism in patients with the identified polymorphisms C 282Y and H63D in HFE gene and without it did not reveal fundamental differences in the qualitative characteristics. Patients were recorded with identical violations. In patients with existing polymorphisms C 282Y and H63D in the HFE gene, the frequency of violations and their degree of severity were significantly higher (p < 0,05-0,001). Conclusion. The metabolism of porphyrins can be measured very sensitive “indicator” responsive to the diverse non-specific abnormalities under the wide range of metabolic disorders, including genetic disorders. Detection of the C 282Y and H63D polymorphisms of the HFE gene in combination with disorders of porphyrin metabolism allows us to consider such patients as a risk group who have not excluded an increased risk of formation of liver fibrosis.

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    Kondratova M.A., Kuimov A.D., Maksimov V.N., Aleschkina A.V. et al. THE FREQUENCY OF HFE GENE POLYMORPHISM IN PATIENTS WITH NONALCOHOLIC LIVER DISEASE AND IN PERSONS OF THE GENERAL POPULATION. FEATURES OF METABOLIC DISORDERS. Experimental and Clinical Gastroenterology Journal. 2017;145(09):18-24
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    1. Novosibirsk State Medical University” (Novosibirsk, Russian Federation)
    2. Institute of Chemical Biology and Fundamental Medicine of the SB RAS (Novosibirsk, Russian Federation)
    3. City Infectious Clinical Hospital No.1” (Novosibirsk, Russian Federation)

    Keywords: acute viral gastroenteritis,norovirus,rotavirus,astrovirus,polymerase chain reaction

    Abstract:The aim of this study was to determine the frequency and the clinical and laboratory features of norovirus acute gastroenteritis (AGE) in adult hospitalized patients, the residents of city Novosibirsk. Materials and methods: A total of 1047 patients aged 15 to 89 years who were hospitalized with AGE from January 2016 to April 2017 with no evidence of immunosuppression were examined. Together with conventional diagnostic methods, the polymerase chain reaction method with a set of original specific primers was also used to investigate feces for the presence of group A and group C rotaviruses, norovirus genogroup II (HNoV GII) and astroviruses. Results: Viral etiology was determined in 20.8 % of patients with AGE. HNoV GII was the dominant (13.6 %), followed by group A rotavirus (5.3 %) and astroviruses (2.0 %). HNoV GII dominance was observed in most months of the study period. For HNoV GII enteritis, a high incidence (p<0.05) of moderate fever and lymphocytosis is established in comparison with other AGE. Conclusion: The established frequency of viral AGE in adults shows the need to develop and implement in clinical practice universal test systems for detection of the most common viral pathogens. The predominance of HNoV GII in the structure of viral diarrhea aims further research on the genetic diversity of the isolates circulating in the Novosibirsk region.

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    Krasnova E.I., Kapustin D.V., Khokhlova N.I., Zhirakovskaia E.V. et al. ACUTE NOROVIRUS GASTROENTERITIS IN ADULTS. Experimental and Clinical Gastroenterology Journal. 2017;145(09):25-29
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    1. «Novosibirsk State Medical University», Ministry of Health of Russia (Novosibirsk, Russian Federation)

    Keywords: Crohn’s disease,ulcerative colitis,small intestinal bacterial overgrowth syndrome,quality of life

    Abstract:Patients with inflammatory bowel disease (IBD) are characterized by chronic recurrent course, frequent attacks, the presence of extraintestinal manifestations and the occurrence of complications, which leads to a decrease in the quality of life. One of the concomitant conditions in patients with IBD is the small intestinal bacterial overgrowth syndrome (SIBO), which has common clinical manifestations. There is practically no research on the effect of concomitant SIBO in patients with IBD on the quality of life (QOL). Therefore, the study of QOL in patients with IBD with SIBO is an important task for optimizing treatment. Purpose: to study the quality of life in patients with IBD, depending on the presence of SIBO. Material and methods of the study: patients from the registry of inflammatory bowel diseases in Novosibirsk who underwent a hydrogen respiratory test (HBT) on the device «Gastro+». The QOL indicators were determined using the Russian version of the SF-36 and IBDQ questionnaire. Results: in 152 patients with IBD, in whom HBT was carried out, the prevalence of SIBO was 48.0 % (with ulcerative colitis - 45.7 %, with Crohn’s disease - 50.7 %). In the scales of the SF-36 and IBDQ questionnaire significant decrease in QOL values was revealed in patients with IBD with positive results of HBT in comparison with patients with negative results of HBT. After a 2-week course of rifaximin intake, values increased in almost all scales of the SF-36 and IBDQ questionnaires. Conclusion: The obtained data confirm the necessity of correction of SIBO as an independent clinical task that significantly affects QOL of patients with IBD.

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    Kulygina Yu.A., Osipenko M.F. INDICATORS OF LIFE QUALITY IN PATIENTS WITH INFLAMMATORY DISEASES OF THE SMALL INTESTINAL BACTERIAL OVERGROWTH SYNDROME (ON THE DATA OF THE NOVOSIBIRSK REGISTER). Experimental and Clinical Gastroenterology Journal. 2017;145(09):30-34
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    1. Novosibirsk State Medical University (Novosibirsk, Russian Federation)
    2. IIPM - Branch of IC&G SB RA (Novosibirsk, Russian Federation)

    Keywords: Hepatitis C virus,sexual transmission,epidemiology of hepatitis C,risk factors

    Abstract:Data for the last and a half decade concerning the infection with hepatitis C virus in the population of Novosibirsk are presented. 173 patients infected with hepatitis C were questioned to find out the possibility of sexual transmission of the disease. Among the examined patients, 6.4 % were infected due to non-preserved sexual intercourse with partners using intravenous drugs. The risk factors have been estimated. The clinical example is given.

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    Khryanin A.A., Nemchaninova O.B., Lykova S.G., Reshetnikova T.B. et al. EPIDEMIOLOGY OF HEPATITIS C VIRUS AND SEXUAL TRANSMISSION. Experimental and Clinical Gastroenterology Journal. 2017;145(09):35-40
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    1. Novosibirsk State Medical University (Novosibirsk, Russian Federation)

    Abstract:Mycotic pathology was diagnosed clinically and confirmed with laboratory methods at 77,1 % from 368 patients with various forms chronic diffuse diseases of a liver, at the same time 817 cases of various nosological forms of fungic diseases are taped. Often mycoses proceeded is widespread and is combined, and also had a series of clinical features not inherent to them. The submitted data can be used both by gastroenterologists, and dermatologists.

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    Pozdnyakova O.N., Nemchaninova O.B., Lykova S.G., Reshetnikova T.B. et al. CLINICAL FEATURES OF FUNGAL INFECTIONS IN PATIENTS WITH CHRONIC DIFFUSE LIVER DISEASES. Experimental and Clinical Gastroenterology Journal. 2017;145(09):41-44
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    1. Novosibirsk State Medical University (Novosibirsk, Russian Federation)

    Keywords:Inflammatory bowel diseases,ulcerous colitis,Crohn’s disease,metabolic syndrome,arterial hypertension,obesity,steatohepatosis,GERD,gallstones,comorbid diseases

    Abstract:The purpose of the review: to observe prevalence and features of such comorbidities as gastroesophageal reflux disease, nonalcoholic fatty liver disease, metabolic syndrome and it’s components in patients with inflammatory bowel diseases (IBD). Methods: as literature sources databases Pubmed and Medscape were used, also data from monographies and Russian and foreign journal publications was included. Results: Higher frequency of steatohepatosis in IBD patients and higher frequency of gallstones in patients with Crohn’s disease (CD) are demonstrated. A risk factors of this comorbid diseases are described. Also lower frequency of arterial hypertension among IBD patients was shown. Higher frequency of metabolic syndrome in patients with ulcerous colitis vs. patients with CD was demonstrated. Higher severity of gastroesophageal reflux symptoms in IBD patients vs. patients with irritable bowel syndrome was shown. Article describes possible pathophysiological substrate of this clinical features. Conclusion. Frequency and clinical features of described comorbidities were analyzed. Literature analysis showed a lack of data about clinical features of gastroesophageal reflux disease and metabolic syndrome in IBD patients at this moment, so an additional studies on this subject are necessary.

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    Full text is published :
    Krasner Ya.A., Osipenko M.F., Mamontova E.P., Bikbulatova E.A. INCIDENCE AND FEATURES OF CLINICAL COURSE OF UPPER GASTROINTESTINAL TRACT DISEASES AND METABOLIC SYNDROME IN IBD PATIENTS. Experimental and Clinical Gastroenterology Journal. 2017;145(09):45-51
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    1. Novosibirsk State Medical University (Novosibirsk, Russian Federation)

    Keywords:nutritional status,adipokines,arterial hypertension,chronic obstructive pulmonary disease,comorbidity

    Abstract:The state of nutritional status was studied in 161 patients with arterial hypertension (AH) in combination with chronic obstructive pulmonary disease (COPD), divided in three groups: 1st (54) - with AH, 2nd (52) - with COPD, 3rd (55) - with AH in combination with COPD. Based on the assessment of actual nutrition, anthropometric survey data, lipid, protein and carbohydrate metabolism, the level of adipokines and cytokines, it was determined that the nutritional features of patients with AH in combination with COPD are: high values of the index waist circumference / circumference of hips, increased fat mass and extracellular fluid, decrease in muscle component of the body, increased levels of total cholesterol and its atherogenic fractions, reducing the concentration of prealbumin, increased levels of leptin and resistin on the background of decreased adiponectin and leptin-binding receptor and increasing concentrations of the studied cytokines IL-1, IL-6, IL-18 and TNF-α. It was found that patients with AH in combination with COPD index waist circumference / circumference of hips for assessment of nutritional status has a greater diagnostic value than body mass index. Timely detection and correction of nutritional disorders will improve the effectiveness of treatment of patients.

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    Full text is published :
    Gerasimenko O.N., Drobyshev V.A., Shpagin I.S., Sukhoterina N.A. et al. FEATURES OF NUTRITIONAL STATUS IN PATIENTS WITH ARTERIAL HYPERTENSION IN COMBINATION WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE. Experimental and Clinical Gastroenterology Journal. 2017;145(09):52-55
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    1. Novosibirsk State Medical University (Novosibirsk, Russian Federation)

    Keywords:diabetes mellitus type 2,dyspepsia,functional dyspepsia,autonomic function,anxiety,quality of life

    Abstract:The research of 75 patients with diabetes mellitus type 2 and 33 patients with functional dyspepsia was conducted. The aim was to study relationship between dyspepsia and the level of autonomic function, general anxiety and quality of life in patients with diabetes mellitus type 2. The level of autonomic function was higher in patients with diabetes mellitus type 2 in the presence of dyspepsia, but did not reach indexes in patients with functional dyspepsia. The level of general anxiety in patients with diabetes mellitus type 2 was increased, did not depend on the presence of dyspepsia and did not differ from those with functional dyspepsia. Dyspepsia syndrome aggravated the reduced quality of life in patients with diabetes mellitus type 2, and its level was worser, than in patients with functional dyspepsia. Statistical analysis demonstrated negative correlation between the quality of life and the level of autonomic function and anxiety indexes.

      1. Tu H. P., Hsieh H. M., Liu T. L. et al. Prevalence of Depressive Disorder in Persons With Type 2 Diabetes: A National Population-Based Cohort Study 2000-2010 // Psychosomatics, 2017, vol. 58, no 2, pp. 151-163.
      2. Tu H. P., Lin C. H.,3, Hsieh H. M. et al. Prevalence of anxiety disorder in patients with type 2 diabetes: a nationwide population-based study in Taiwan 2000-2010 // Psychiatr Q, 2017, vol. 88, no 1, pp. 75-91.
      3. Feng X., Astell-Burt T. Impact of a type 2 diabetes diagnosis on mental health, quality of life, and social contacts: a longitudinal study // BMJ Open Diabetes Res Care, 2017, vol. 5, no 1, pp. 1-6.
      4. Schram M. T., Baan C. A., Pouwer F. Depression and quality of life in patients with diabetes: a systematic review from the European depression in diabetes (EDID) research consortium // Curr Diabetes Rev, 2009, vol. 5, no 2, pp. 112-119.
      5. Younis B. B., Arshad R., Yousuf H. et al. Impact of type 2 diabetes mellitus on quality of life in people with diabetes presenting to a specialist diabetes clinic // Turk J Med Sci, 2017, vol. 47, no 1, pp. 123-126.
      6. Harmon R. C., Peura D. A. Evaluation and management of dyspepsia // Therap Adv Gastroenterol, 2010, vol. 3, no 2, pp. 87-98.
      7. Tack J., Talley N. J., Camilleri M. et al. Functional gastroduodenal disorders // Gastroenterology, 2006, vol. 130, no 5, pp. 1466-1479.
      8. Tack J., Talley N. J., Camilleri M. et al. Functional gastroduodenal disorders // Gastroenterology, 2006, vol. 130, no 5, pp. 1466-1479.
     


    Full text is published :
    Zhuk E.A., Medvedeva O.V., Shakaliter Yu.D., Voroncova E.S. DYSPEPSIA SYNDROME, LEVELS OF AUTONOMIC FUNCTION, ANXIETY AND QUALITY OF LIFE IN PATIENTS WITH DIABETES MELLITUS TYPE 2. Experimental and Clinical Gastroenterology Journal. 2017;145(09):56-59
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    1. Novosibirsk state medical University (Novosibirsk, Russian Federation)

    Keywords:gastrointestinal tract,tumors,precancerous conditions,inflammatory diseases,biopsy

    Abstract:The aim of the study was to study the frequency, prevalence and nosological structure of pre-tumoral and tumor processes in the gastrointestinal tract on the basis of morphological study data. Materials and metods: 1294 specimens of biopsy specimens from the stomach and intestines were studied for the period 2014-2016. Results. Of the 1,294 specimens examined, the stomach accounted for 58 % of the small and large intestine - 42 %. Of 750 stomach biopsies, inflammatory diseases were detected in 61.7 %, hyperplastic processes in 19.6 %, tumors in 10 %, biopsy from gastroanastomoses - 7.73 %. Of the 544 biopsies of the intestine, 20.2 % of cases of small intestinal disease, 78.2 % of the large intestine, and 1.6 % of intestinal anastomoses. In biopsies of the small intestine, inflammatory processes prevailed (71.8 %), hyperplastic processes - 18.2 %, tumors - 6.4 %. When studying the nosological structure of the lesion of the large intestine: inflammatory diseases of the large intestine - 24.9 %, hyperplastic processes -17.5 %, tumors - 48.1 %, other processes -7.4 % and biopsies from intestinal anastomoses -2.1 %. Conclusions. Inflammatory diseases prevailed in the structure of pathological processes of the stomach (61.73 %) and the small intestine (71.8 %). The most frequent localization of tumors of the gastrointestinal tract was the large intestine (48.1 %), and the most common histological variant of malignant tumors was adenocarcinoma (94 %). Tumors of the stomach accounted for 10 % of the total number of pathological processes, and among the histological variants the most common was adenocarcinoma (64.1 %).

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    Nadeev A.P., Kozaev M.A., Porotnikova E.V., Sadykova A.M. NOSOLOGICAL STRUCTURE OF THE GASTRO-INTESTINAL TRACT DISEASES ACCORDING TO BIOPSY STUDIES. Experimental and Clinical Gastroenterology Journal. 2017;145(09):60-64
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    1. Novosibirsk State medical university; Novosibirsk State regional clinical hospital (Novosibirsk, Russian Federation)

    Keywords: benign diseases of esophagus,enteral nutrition,extirpation of esophagus,microelements,cytokines concentration,system inflammatory reaction

    Abstract:The aim of the study was to study the dynamics of the concentration of cytokines and certain trace elements within the framework of nutritional insufficiency and the course of operational stress, depending on nosology. Materials and methods. The concentration of cytokines and microelements in the blood plasma was measured in patients with benign stenosing diseases of the esophagus (aсhalasia of the esophagus - 10, cicatrical after-burn constriction - 10) before the operation, on the 1st, 3rd and 7th day of the postoperative period. All patients underwent extirpation of the esophagus with esophagoplasty of the gastric stalk. Results. High concentrations of proinflammatory cytokines (IL-1β, IL-2, IL-6) were detected throughout the perioperative period. The pre-operative nutritional deficiency in this category of patients led to a deficiency of nutritional elements, in particular, zinc deficiency and micro-nutrient balance disorders (zinc-copper). Conclusion. The causes of disturbances in the balance of microelements are due to alimentary deficiency and increased demand for trace elements due to the peculiarities of the disease itself, in particular, the presence of scar periprocess around the esophagus. Causes of increased cytokine concentration in the preoperative period is a slow inflammatory reaction associated with the underlying disease.

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    Peshkova I.V., Drobjazgin E.A., Vereshagin I.E., Chikinev Yu.V. et al. DYNAMICS OF CYTOKINE AND MICROELEMENT STATUS IN RECONSTRUCTIVE OPERATIONS ON THE ESOPHAGUS. Experimental and Clinical Gastroenterology Journal. 2017;145(09):65-70
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    1. Krasnoyarsk State Medical University named after Prof. V. F. Voino-Yasenetsky (Krasnoyarsk, Russian Federation)

    Keywords: severe acute pancreatitis,integral hematological indexes,chemiluminescence

    Abstract:Research aim to estimate possibility of maximum early visualization of pathological focus at pancreatic gland by the use CT angiography with Bolus tracking. Materials and methods: 30 patients, who were admitted to this hospital before 72 hours from the begin of disease, with severe necrotizing acute pancreatitis Maximum early visualization was made after 72 hours from the begin of disease on multispiral 4 multislice tomograph «Lightspeed», with program Bolus tracking. We estimateв volume of perfusion’s disorder of pancreatic glandular tissue. For finale estimation of formed necrotic affection we repeated CT at the third week of disease. Results: 2 (6,67 %) patients hadn’t signs of perfusion’s disorder of pancreatic glandular tissue. 15 (50,00 %) patients had perfusion’s disorder volume less than 30 % of pancreatic gland’s volume. 8 (26,67 %) patients had perfusion’s disorder volume from 30 % to 50 %, 4 (13,33 %) patients had perfusion’s disorder volume from 50 % to 75 % and 1 patients had perfusion’s disorder volume more than 75 %. At the third week of disease patients, who hadn’t signs of perfusion’s disorder, hadn’t signs of pancreatonecrosis. 17 (56,67 %) patients had small-focal pancreatonecrosis, 7 (23,33 %) patients had large-focal pancreatonecrosis, 3 (10 %) patients had subtotal pancreatonecrosis. Affection more than 75 % of pancreatic gland’s volume also was confirmed. Sensitivity of estimation of perfusion’s disorder for prognostication of necrotizing affection of pancreatic gland was 100 %, specificity 33,33 %, accuracy - 100 %, positive and negative predictive value - 87,50 % and 100 %, AUC - 0,944.

      1. Дюжева Т. Г., Джус Е. В., Рамишвили В. Ш. и соавт. Ранние КТ-признаки прогнозирования различных форм панкреонекроза. Анналы хирургической гепатологии. - 2009. - Т. 14. № 4. - С. 54-63.
      2. Винник Ю. С., Дунаевская С. С., Антюфриева Д. А. Риск развития осложнений при остром алкоголь-ассоциированном панкреатите. Новости хирургии. - 2012. - Т. 20, № 4. - С. 38-41.
      3. Китаев В. М., Бардаков В. Г., Бронов О. Ю. и соавт. Компьютерная томография в диагностике острого панкреатита. Вестник Национального медико-хирургического центра им. Н. И. Пирогова. - 2016. - Т. 11. № 1. - С. 94-100.
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      5. Винник Ю. С., Дунаевская С. С., Антюфриева Д. А. Возможности компьютерной ангиографии в диагностике деструктивного панкреатита. Вестник хирургической гастроэнтерологии. - 2013. - № 1. - С. 35-37.
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      10. Yadav A. K., Sharma R., Kandasamy D. et al. Perfusion CT: can it predict the development of pancreatic necrosis in early stage of severe acute pancreatitis? Abdom Imaging. - 2015. - vol. 40(3). - P. 488-499.
     


    Full text is published :
    Vinnik Y.S., Dunaevskaya S.S., Antufrieva D.A. EFFECTIVENESS OF MAXIMUM EARLY VISUALIZATION FOR ESTIMATION PANCREATIC GLAND’S AFFECTION VOLUME AT NECROTIZING PANCREATITIS. Experimental and Clinical Gastroenterology Journal. 2017;145(09):71-73
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    1. Novosibirsk State Medical University (Novosibirsk, Russian Federation)
    2. FGBU “Research Institute of Clinical and Experimental Lymphology” (Novosibirsk, Russian Federation)

    Keywords: extrahepatic biliary tract,cicatric lesions,stenting,titanium nickelide

    Abstract:From 1990 to 2015 171 reconstructive and reconstructive surgery on extrahepatic bile ducts after their injuries and inflammatory lesions were performed in the clinic, of which 115 (67.2 %) using nickel-titanium stents. The average age of patients was 48.6 years. Complications after operations of constant stenting arose in 6 patients (8.3 %), lethal outcome in 2 (2.7 %). Long-term results of this group, traced from one year to seven years, were found to be good at 88.4 % at the time of the study, satisfactory - at 8.4 %, unsatisfactory - in 3.2 % of patients. In the group of patients, after application of replaceable transhepatic drainage and a precision seam of the ducts: good - in 58.5 %, satisfactory - in 22.0 %, unsatisfactory - in 19.5 %. Long-term results after endobiliary stenting with nitinol stents with round stent filaments were considered good In 41.8 %, satisfactory in 58.2 % of patients.

     


    Full text is published :
    Shtofin S.G., Anishchenko V.V., Shtofin G.S., Nalbandyan A.G. CHOICE OF A METHOD OF CORRECTION OF CICATRICIAL LESIONS OF EXTRAHEPATIC BILE DUCTS AND BILIODIGISTIVE ANASTOMOSES. Experimental and Clinical Gastroenterology Journal. 2017;145(09):74-77
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    1. Municipal Hospital № 29 (Novosibirsk, Russian Federation)

    Keywords: esophageal and gastric varices,bleeding,portal hypertension,rebleeding,early endoscopy hemostasis

    Abstract:Aim of study. To assess the influence of the early endoscopy hemostasis for rebleeding rate in variceal bleeding. Methods. Retrospective analysis of 113 medical cards of patients with variceal bleeding. Results and conclusions. The most rebleeding rate had been revealed in patients who had not any signs of bleeding on primary endoscopy (75 %). We had not got statistically significant differences in rebleeding rate between groups of patients who had undergone the early endoscopy hemostasis and who had not (24,5 % vs 26,7 %). We compared the rebleeding rate depending on combination of the bleeding activity on primary endoscopy and the fact of performing the early endoscopy hemostasis and revealed certain differences which are indicating to higher rebleeding rate if the early endoscopy hemostasis had not performed.

      1. Roberto de Franchis. Expanding consensus in portal hypertension Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. Journal of Hepatology. 2015. Vol. 63; P. 743-752.
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    Full text is published :
    Shestak I.S., Korotkevich A.G., Mariniich Ya.Ya. EARLY ENDOSCOPY HEMOSTASIS AND REBLEEDING RATE AT VARICEAL BLEEDING. Experimental and Clinical Gastroenterology Journal. 2017;145(09):78-81
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    1. State Educational Institution of Higher Professional Education “Kuban State Medical University” Ministry of Health Care of the Russian Federation (Krasnodar, Russian Federation)
    2. Federal State-funded Educational Institution of Higher Professional Education “Kuban State Agrarian University” Ministry of Agriculture of the Russian Federation (Krasnodar, Russian Federation)

    Keywords:vascular liver isolation,hepatocytolysis,endogenous intoxication,antioxidant system,oxidative stress

    Abstract:Object. To study the temporal dependence of metabolic indicators experimentally by simulating the liver ischemia in rats in conditions of the partial vascular liver isolation. Materials and methods. The partial vascular liver isolation was simulated in nonlinear male rats by means of cross-clamping of the hepatoduodenal ligament for 10, 15 and 20 minutes. The markers of cytolysis, the prooxidant-antioxidant system and the functional detoxification system were detected on the local level as well as on the systemic one. Results. The gradual increase of hepatocytolysis, endogenous intoxication and the intensity of free-radical processes were detected as well as the activation of bodily compensatory systems within 10-15 minutes and their further emaciation by the 20th minute of ischemia. Conclusion. The demonstrated data open the prospects to the metabolic correction of ischemic and reperfusive complications; they also may be useful by forming the conception of reasonable temporal limitation of the vascular liver isolation.

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    Full text is published :
    THE TEMPORAL DEPENDENCE OF METABOLIC INDICATORS BY THE PARTIAL VASCULAR LIVER ISOLATION IN CONDITIONS OF EXPERIMENT. Experimental and Clinical Gastroenterology Journal. 2017;145(09):82-86
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    1. Federal State Budget Educational Foundation of the High Education «Novosibirsk State Medical University» of the Health Ministry of Russia (Novosibirsk, Russian Federation)

    Keywords:HELLP syndrome,diagnostics,treatment

    Abstract:The article presents data concerning the prevalence, clinical manifestations, methods of diagnostics, treatment and prevention of HELLP syndrome, as well as the case management.

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    HELLP-SYNDROME: HEMOLYSIS, ЕLЕVATED LIVER ENZYMES ACTIVITY (еL - еlеvated liver enzymes), THROMBOCYTOPENIA (LP - 1оw рlаtelet соunt) IN PREGNANCY. Experimental and Clinical Gastroenterology Journal. 2017;145(09):87-89
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    1. Novosibirsk State Medical University (Novosibirsk, Russian Federation)

    Keywords:collagenous colitis,segmental colitis associated with diverticulosis

    Abstract:This review focuses on three diseases of the colon: collagenous colitis, segmental colitis, associated with diverticulosis and phlebosclerotic colitis. These diseases are quite rare in practice and can cause serious difficulties. The article reflects modern views on the diagnosis and treatment of such diseases from the point of view of the surgeon.

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    SURGICAL ASPECTS OF SOME RARE COLITIS (review). Experimental and Clinical Gastroenterology Journal. 2017;145(09):90-95
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    1. Research Institute of Internal and Preventive Medicine - Banch of the Institute of Cytology and Genetics RAN (Novosibirsk, Russian Federation)
    2. Novosibirsk Regional Oncology Center (Novosibirsk, Russian Federation)

    Abstract:The scientific review is devoted to the discussion of risk factors for colorectal cancer (CRC) morbidity and mortality which remains high and growing, especially in the civilized world. Factors are considered taking into account the degree of proof or the likelihood of their impact on morbidity and mortality. Risk factors related to the CRC proven include the geographical area and level of socio-economic development of the country of residence, race, hereditary a family history of bowel cancer, long current inflammatory bowel disease (IBD), primary sclerosing cholangitis (PSC) associated with ulcerative colitis and Crohn’s disease and heavy smoking. Probable risk factors for CRC are physical inactivity, obesity (including in combination with diabetes mellitus type 2), high-dose consumption of alcohol, cholecystectomy, a history of frequent consumption of red meat and deficient in some nutrients (Ca, folate, selenium). As protective factors are discussed high physical activity and salicylates. Protective role of other factors against CRC requires additional research.

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    Prudnikova Ya.I., Kruchinina M.V., Svetlova I.O., Kurilovich S.A. et al. COLORECTAL CANCER: FACTORS OF RISK AND PROTECTION. Experimental and Clinical Gastroenterology Journal. 2017;145(09):96-105
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    1. Research Institute of Internal and Preventive Medicine - Branch of the Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences (Novosibirsk, Russian Federation)
    2. Federal Budgetary Research Institution “State Research Center of Virology and Biotechnology «Vector»”, Federal Service for Surveillance on Consumer Rights Protection and Human Well-being (Novosibirsk, Russian Federation)

    Keywords:fatty liver disease,alcoholic,nonalcoholic genesis,erythrocytes,electrical,viscoelastic parameters,dynamics of withdrawal

    Abstract:The purpose of the work was to study the electrical and viscoelastic parameters of erythrocytes in patients with fatty liver disease of alcoholic and non-alcoholic genesis in the dynamics of withdrawal symptoms and weight loss. Materials and methods. The electrical and viscoelastic parameters of erythrocytes have been studied by the method of dielectrophoresis in 22 men (56,4 ± 2,2 years) with nonalcoholic and 24 with fatty liver of alcoholic genesis (57,2 ± 2,7 years) in the dynamics of withdrawal syndrome and weight loss (within 2,5-3 months). Results. In the dynamics of the abstinence syndrome in patients with fatty liver disease of alcoholic genesis a significant decrease in the diameter of erythrocytes, summarized viscosity, rigidity, electrical conductivity, indexes of destruction, aggregation and increase of the amplitude of cell deformation, polarizability, magnitude of the dipole moment, cell capacitance were determined; the crossover frequency was shifted to the low-frequency range (p<0,001-0,05). The revealed changes correlated with a decrease of the transaminase activity, de Ritis coefficient, GGTP, the average corpuscular volume of erythrocytes. In patients with fatty liver disease of non-alcoholic genesis at the background of weight loss (5-7 % of the initial body weight) there was no significant change in erythrocyte parameters. Conclusion. Differences in the dynamics of erythrocyte parameters at the background of abstinence and weight loss in patients with fatty liver disease can be used for differential diagnosis of alcoholic and non-alcoholic genesis of the disease.

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    Kruchinina M.V., Parulikova M.V., Kurilovich S.A., Gromov A.A. et al. CHANGE OF ERYTHROCYTE, S PARAMETERS IN PATIENTS WITH FAT LIVER DISEASE OF ALCOHOL AND NON-ALCOHOL GENESIS IN THE DYNAMICS OF ABSTENTINE SYNDROME AND DECREASE OF BODY MASS. Experimental and Clinical Gastroenterology Journal. 2017;145(09):106-115
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    1. Research Institute of Internal and Preventive Medicine - Banch of the Institute of Cytology and Genetics RAN (Novosibirsk, Russian Federation)
    2. Novosibirsk State Medical University (Novosibirsk, Russian Federation)

    Keywords:idiopathic hyperprolactinemia,intrahepatic cholestasis,clinical case

    Abstract:A clinical case of a female patient 25 years old with intrahepatic cholestasis and idiopathic hyperprolactinemia diagnosed at age 17 years is presented. Intrahepatic cholestasis manifested for the first time in the third trimester of pregnancy in the classic version, and regressed immediately after delivery. However, within 3 months after birth and established lactation the clinical and laboratory signs of cholestasis reappeared. After exclusion of organic liver and biliary tract diseases, the therapy with UDCA was initiated but without clinical and laboratory improvement. Due to lack of the effect of standard treatment the decision was made about medical suppression of lactation with cabergoline. After suppression of lactation all signs of cholestasis disappeared. Afterwards episodes of intrahepatic cholestasis repeated again with typical clinical and laboratory manifestations. They were treated by elevated doses of cabergoline. The observation time was 12 months.

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    Full text is published :
    Voevoda S.M., Rymar O.D., Kurilovich S.A. SYNDROME OF RECURRENT INTRAHEPATIC CHOLESTASIS IN A FEMALE PATIENT WITH IDIOPATHIC HYPERPROLACTINEMIA. Experimental and Clinical Gastroenterology Journal. 2017;145(09):116-120
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