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CLINICAL GASTROENTEROLOGY

    1. The Federal State Budgetary Institution “Privolzhsky Federal Medical Research Center” of the Ministry of Health of the Russian Federation (PFMTS “PFMTS” of the Ministry of Health of Russia) (Nizhny Novgorod, Russian Federation)

    Keywords:Crohn’s disease,children,fistula prognosis,stenoses,morphological signs,complications of the disease

    Abstract:The aim of the study was to identify early morphological changes in the IA of the ileum and large intestine, which are of prognostic significance in stenosing and fistulous forms of Crohn’s disease (BC) in children. Materials and methods: A retrospective analysis of the case histories in 59 children with BC on the age of 3 to 17 years with their primary hospitalization to the formation of phenotypic forms of the disease for at least 8 years of follow-up. Three groups of patients were compared: group A (infiltrative form) - 39 people, group B (stenosing form) - 12 people, group C (fistula form) - 8 people. Results: early morphological signs of variants of the development of the disease were revealed. Prognostic morphological criteria of complicated forms of BC were revealed, the detection of which will allow changing the tactics of treatment to a more aggressive variant, which will allow avoiding complications and thereby surgical intervention. Conclusion: Based on the identified criteria, it is possible to predict complicated forms of BC in children during the initial treatment of the patient, along with the diagnosis of BC, it is possible to predict the course of the disease and determine the tactics of managing the patient with a view to preventing the development of complications.

      1. Потапов А. С., Алиева Э. И., Габрусская Т. В. и соавт. Клиническая картина, диагностика и лечение язвенного колита у детей: Российский педиатрический консенсус // Вопросы современной педиатрии, 2013, 12 (3), 18-30.
      2. Яблокова Е. А., Горелов А. В., Ратникова М. А. и соавт. Воспалительные заболевания кишечника у детей // Педиатрия, 2006, № 5, 99-104.
      3. Громов М. С., Чиж А. Г., Исламова Е. А. и соавт. Маркеры метаболизма соединительной ткани и серотонинсекретирующие клетки в диагностике и оценке динамики неспецифического язвенного колита // Современные наукоемкие технологии, 2007, № 7, 85-87.
      4. Ботина А. В., Майоров Е. Е., Чистякова Н. Я. и соавт. Морфологические изменения при синдроме раздраженного кишечника и воспалительных заболеваний кишечника // Гастроэнтерология Санкт-Петербурга, 2010, № 4,10.
      5. Scaldaferri F., Correale C., Gasbarrini A. et al. Mucosl biomarkers in inflammatory bowel disease: Key pathogenic players or disease predictos? // World. J. Gastroenterol., 2010, Vol. 16, 2616-2625.
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    Fedulova E.N., Shumilova O.V., Shirokova N.Ya. EARLY MORPHOLOGICAL CRITERIA FOR COMPLICATED CROHN FORMS IN CHILDREN. Experimental and Clinical Gastroenterology Journal. 2017;146(10):15-19
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    1. The Federal State Budgetary Institution “Privolzhsky Federal Medical Research Center” of the Ministry of Health of the Russian Federation (PFMTS “PFMTS” of the Ministry of Health of Russia) (Nizhny Novgorod, Russian Federation)

    Keywords:Crohn’s disease,children,prognosis of the disease course,diagnostic algorithm

    Abstract:The aim of the study was to optimize the diagnosis and treatment of Crohn’s disease in children on the basis of the use of the revealed prognostic criteria for various forms of the disease. Materials and methods: A retrospective analysis of the case histories in 59 children with Crohn’s disease aged 3 to 17 years with their primary hospitalization to the formation of phenotypic forms of the disease for at least 8 years of follow-up. Three groups of patients were compared: group A (infiltrative form) - 39 people, group B (stenosing form) - 12 people, group C (fistula form) - 8 people. Clinico-anamnestic, laboratory-instrumental and morphological signs of variants of the development of the disease have been revealed. Results: An algorithm for predicting various forms of Crohn’s disease based on the identified criteria was developed. Conclusion: at the primary treatment of the patient, along with the diagnosis of BC, it is possible to predict the course of the disease and determine the tactics of managing the patient with a view to preventing the development of complications.

      1. Потапов А. С., Алиева Э. И., Габрусская Т. В. и соавт. Клиническая картина, диагностика и лечение язвенного колита у детей: Российский педиатрический консенсус // Вопросы современной педиатрии, 2013, 12 (3), 18-30.
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      3. Федулова Э. Н., Жукова Е. А., Тутина О. А. и соавт. Некоторые морфологические критерии прогнозирования степени тяжести течения болезни Крона у детей // Вопросы современной педиатрии, 2013, Т. 12, № 5, 108-111.
      4. Allez M., Lemann M. Role of endoscopy in predicting the disease course in inflammatory bowel disease // World. J. Gastroenterol., 2010, Vol. 16, 2626-2632.
      5. Lewis J. D. The utility of biomarkers in the diagnosis and therapy of inflammatory bowel disease // Gastroenterology, 2011, Vol. 140, 1817-1826.
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    Full text is published :
    Fedulova E.N., Shumilova O.V., Tutyna O.A. THE ALGORITHM OF PREDICTING THE COURSE OF CROHN’S DISEASE IN CHILDREN. Experimental and Clinical Gastroenterology Journal. 2017;146(10):20-25
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    1. Saint-Petersburg state pediatric medical University of Ministry of healthcare of the Russian Federation (St. Petersburg, Russian Federation)

    Keywords:inflammatory bowel disease (IBD),bone mineral density (BMD),Crohn’s disease,ulcerative colitis,risk factors of low BMD

    Abstract:Aim of this study was to evaluate clinical and laboratory criteria which can help to identify patients with inflammatory bowel disease (IBD) with high risk of low bone mineral density (BMD). 91 patients (2-17 years old) were included in the study. Bone mineral density (BMD) of lumbar spine (DEXA) was assessed, level of serum osteocalcin (OC), C-terminal telopeptides (CTT), parathyroid hormone (PTH), serum calcium, alkaline phosphatase and 25 (OH) vitamin D was measured to evaluate bone metabolism. All patients have been divided in two groups: with normal and low BMD. Comparison of different clinical and laboratory factors have been made between those two groups. Statistics have been performed using Statistica 6.0 и MicrosoftExcel. According to our data high laboratory activity (clinical indices of activity, high CRP, low albumin and haemoglobin), extraintestinal manifestation and complicated form of disease, long course of steroids, low height and weight and also low level of calcium and 25(OH) vitamin D can be considered as risk factors of low BMD. Differences in bone metabolism markers between patients with low and normal BMD were no observed. Presence of risk factors of low BMD in patients with IBD leads to necessity of further radiological evaluation in order to identify low-energy fractures of vertebrae in this group of patients.

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    Full text is published :
    Gabrusskaya T.V., Revnova M.O., Kostyk M.M. PREDICTORS OF LOW BONE MINERAL DENSITY IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE. Experimental and Clinical Gastroenterology Journal. 2017;146(10):26-32
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    1. Scientific and Educational Center of Gastroenterology and Hepatology, Saint-Petersburg University (St. Petersburg, Russian Federation)
    2. Saint-Petersburg State Pediatric Medical University, Department of Gastroenterology (St. Petersburg, Russian Federation)
    3. Russian Scientific Center of Radiology and Surgical Technologies (St. Petersburg, Russian Federation)

    Keywords:primary sclerosing cholangitis,inflammatory bowel disease,ulcerative colitis,Crohn’s disease,cholangiocarcinoma

    Abstract:Characteristics of primary sclerosing cholangitis in combination with inflammatory bowel diseases were studied. Materials and methods. We have performed comprehensive laboratory and instrumental examination, and retrospective analysis of outpatient charts of 62 patients with confirmed diagnosis of primary sclerosing cholangitis (PSC), including 47 cases of PSC combined with inflammatory bowel diseases (IBD). We carried out morphological study of liver biopsy specimens in 26 (55.3 %) patients with PSC/IBD and 13 (81,3 %) with PSC only. Biopsy specimens of the colon of 26 patients with PSC/IBD were analyzed as well. Results. Combination of PSC with IBD has been detected in 47 (75.8 %) patients. At the time of the PSC onset, patients with PSC/IBD were significantly younger than those in the control group (patients with PSC only). They were characterized with asymptomatic onset of the disease with higher activity of laboratory markers of cholestasis. Pronounced leukocytosis, thrombocytosis, activity of cytolysis markers were significantly higher in PSC/IBD comparatively to PSC-only patients. Morphological examination in patients with isolated PSC revealed initial stages of the disease more often: J. Ludwig portal (I) stage in 8 (61.5 %) patients, F0 by METAVIR in 3 (23,1 %) patients, (p<0,05). Correlations were not detected between the morphological activity of IBD and the activity and stage of fibrosis of PSC. Strictures of ducts were diagnosed mainly in patients with combined pathology (p = 0,04). Malignancy was revealed only in PSC/IBD group (11 (23.4 %) people, p<0,02). The most common tumor was cholangiocarcinoma [5 (45 %) patients, p<0,05]. Conclusions. Patients with PSC in combination with IBD mostly had early onset and asymptomatic course of the disease with higher markers of cholestasis, due to the frequent development of strictures of the ducts and malignancy.

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    Pazenko E.V., Raikhelson K.L., Gabrusskaya T.V., Kondrashina E.A., Gerasimova O.A. CHARACTERISTICS OF PRIMARY SCLEROSING CHOLANGITIS CONCOMITANT WITH INFLAMMATORY BOWEL DISEASE. Experimental and Clinical Gastroenterology Journal. 2017;146(10):33-39
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    1. Republican Clinical Hospital of the Ministry of Healthcare of the Republic of Tatarstan (Kazan, Russian Federation)
    2. Kazan State Medical University (Kazan, Russian Federation)

    Keywords:Inflammatory bowel disease,thromboembolic complications,hemostasis,Crohn’s disease,ulcerative colitis,Thrombodynamics test

    Abstract:Aim. To study changes in hemostasis system in patients with inflammatory bowel diseases (IBD). Materials and methods. 127 patients with IBD (80 patients with ulcerative colitis, 47 Crohn’s disease) and 20 healthy volunteers were included into the study. The hemostatic system was studied using standard coagulation tests and the global method of thrombodynamics. Results. Shifting of the hemostasis system into the hypercoagulation was observed in IBD patients according to the parameters of the Thrombodynamics test, due to the increased procoagulant plasma features of these patients. This contributes to the formation of a denser clot, in comparison with the control group, and promotes the formation of spontaneous thrombus. Conclusion. The Thrombodynamic test reveals the hypercoagulable potential of plasma in patients with IBD, which not diagnosed by routine methods of hemostasis study. More pronounced changes in the blood coagulation system were observed in Crohn’s disease patients.

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    Ramazanova A.Kh., Mustafin I.G., Odintsova A.Kh., Nabiullina R.M. et al. HEMOSTASIS CHANGES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE. Experimental and Clinical Gastroenterology Journal. 2017;146(10):40-45
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    1. Northwestern State Medical University (St. Petersburg, Russian Federation)
    2. Institute of Obstetrics, gynecology and reproductology (St. Petersburg, Russian Federation)

    Keywords:Crohn’s disease,recurrent aphthous stomatitis,genetic research

    Abstract:The aim of the study. The aim was to reveal the relationship between gene polymorphism and phenotypic features of Crohn’s disease (CD) in the form of recurrent aphthous stomatitis and extraintestinal manifestations. Materials and methods. 210 patients with CD had clinical, instrumental and genetic studies with the determination of polymorphisms of the genes NOD 2 / CARD 15 (Gly908Arg, Arg702Trp, Leu3020finsC), TNF-α (-308G / A), ATG16L1 (841 * A/G), JAK2 (1358 * C / A). Results. Aphthous stomatitis occurs more often in the lesions of the proximal parts of the gastrointestinal tract. The polymorphism of the NOD 2 / CARD 15 gene (Gly908Arg) was found to correlate with the frequency of aphthous stomatitis and the development of perianal lesions. Conclusion. The frequency of occurrence of aphthous stomatitis depends on the localization of the CD. The association of the Gly908Arg polymorphism of the NOD 2 / CARD 15 gene with recurrent aphthous stomatitis makes it possible to consider aphthae in the oral cavity as a phenotypic manifestation of Crohn’s disease.

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    Full text is published :
    Shchukina O.B., Robakidze N.S., Nasykhova J.A. ASSOCIATION OF POLYMORPHISM OF THE NOD 2/ CARD 15 GENE WITH APHTHOUS STOMATITIS IN CROHN’S DISEASE. Experimental and Clinical Gastroenterology Journal. 2017;146(10):46-49
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    1. The Rostov State Medical University (Rostov-on-don, Russian Federation)

    Keywords:irritable bowel syndrome,ulcerative colitis,proteolysis,matrix metalloproteinase-9,tissue inhibitor of matrix metalloproteinase

    Abstract:The objective of the our study - to investigate the components of proteolysis in patients with irritable bowel syndrome (diarrheal variant) (IBS-D), and in patients with ulcerative colitis (UC) in the different stages of the disease. Materials and methods. The study included 17 patients with IBS-D, as the comparison groups were 7 patients with mild UC and 16 - remission of UC. Proteolysis system evaluated by production of matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of metalloproteinase 1 (TIMP-1) in the mucosa of the sigmoid and rectum with the use of immunohistochemical analysis (rabbit polyclonal antibodies to MMP-9 and mouse monoclonal antibodies to TIMP-1). The results of morphological investigation of colon mucosa in patients with IBS-D showed cellular infiltration, which gives opportunity to doubt the functional nature of the disease. Furthermore production of MMP-9 and TIMP-1 in patients with IBS-D and UC in remission had similar values. Conclusion: The results of our study indicate on presence of the morphological substrate of functional diseases, as evidenced by studies of the ultrastructure of mucosa in patients with IBS-D. We can suggest that one of the mechanisms influencing on the development of mild inflammation in the colon mucosa is the increasing of the production of MMP-9 and decreasing of the production of TIMP-1 in IBS-D, which probably explain the development of a surface inflammation of the colon mucosa.

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    Tkachev A.V., Mazovka K.E., Mkrtchyan L.S. IBS: FUNCTIONAL OR ORGANIC PATHOLOGY?. Experimental and Clinical Gastroenterology Journal. 2017;146(10):50-53
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