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CLINICAL GASTROENTEROLOGY

    1. Research Institute of Internal and Preventive Medicine - Branch of the Institute of Cytology and Genetics of SB RAS”; Novosibirsk State Medical University (Novosibirsk, Russian Federation)

    Keywords:atrophic gastritis,gastric cancer,pepsinogens,H. pylori,Caucasians

    Abstract:Background: atrophic gastritis (AG) associated with Helicobacter pylori (H. pylori-infection) is one of the precancerous lesions and associated with low level of serum pepsinogen I (PGI) and PGI/PGII ratio, which are also recognized like predictive markers for gastric cancer (GC) development. The aim of the study: to analyze the predictive value of biomarkers in the GC development in a prospective “case-control” study conducted in Caucasian population of Western Siberia (8 years follow-up). Material and Methods: GC cases and control were selected from population cohort of residents of Novosibirsk within the international HAPIEE project during 2003-2005 with inclusion of subjects (n=9360) of both sexes at the age of 45-69 years. Serum samples were stored at -700С. GC cases received from Population Cancer Registry until 2012 were compared with the database of HAPIEE with selection of appropriate on sex and age control in the ratio 1:2. Finally, 156 serum samples (52 - the main group and 104 - control) were available for analysis, and biomarkers were measured. The following criteria for biomarkers of atrophic gastritis were used: PGI < 30 µg/l, PGII < 3 µg/l, PGI/PGII < 3, G-17 < 1 pmol/l. Results: The mean levels of PGI and PgI/PgII ratio in the GC group was lower in comparison with the control (p < 0.005 and p< 0.0001, respectively); no difference was shown in respect to the other biomarkers. The cut-off values of atrophy have appeared above the recommended parameters: for PGI-55 µg/l (р=0.0001; OR=4.1; 95 % CI 2.0-8.4) and PGI/PGII ratio-5 (р=0.0001; OR =5.8; 95 % CI 2.7-12.4). Conditional (fixed effects) logistic regression analysis with inclusion into the model sex, age of the patients, and all biomarkers of test system showed PGI/PGII ratio as the most powerful indicator in the model (OR=2.9; 95 % CI: 1.0-8.0). Conclusions: for the first time the predictive value of low indicators of PGI and PGI/PGII ratio in GC risk development in Caucasian population for 8 years follow-up was demonstrated.

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    PROGNOSTIC VALUE OF THE ATROPHIA MARKERS IN GASTRIC CANCER RISK AT THE WEST SIBERIA POPULATION. Experimental and Clinical Gastroenterology Journal. 2017;147(11):13-21
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    1. Irkutsk State Medical Academy of Postgraduate Education - Branch Campus of the Federal State Budgetary Educational Institution of Further Professional Education «Russian Medical Academy of Continuing Professional Education» of the Ministry of Healthcare of the Russian Federation (Irkutsk, Russian Federation)
    2. Irkutsk Pathoanatomical Bureau (Irkutsk, Russian Federation)

    Keywords:antiplatelet therapy,acetylsalicilic acid,clopidogrel,ticagrelor,esophagitis,gastropathy,duodenopathy

    Abstract:The aim of the work is to estimate endoscopic and morphological peculiarities of the gastrointestinal tract proximal part against the background of acetylsalicilic acid intake, the acetylsalicilic acid in combination with clopidogrel and acetylsalicilic acid in combination with ticagrelor. Materials and methods. There were examined 65 patients taking the different variants of antiplatelet therapy. Data on fibroesophagogastroduodenoscopy and biopsy material were analyzed. Results. In the proximal parts of the gastrointestinal tract, various variants of antiplatelet therapy showed no endoscopic and morphological differences in the changes in the mucous tunic of the stomach and duodenum. In the group of patients taking acetylsalicylic acid and clopidogrel, esophagitis of varying severity, hyperplasia of basal layer, elongation of papillae and greatest polymorphocellular infiltration appeared to be more often.

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    ENDOSCOPIC AND MORPHOLOGICAL DESCRIPTION OF THE GASTROINTESTINAL TRACT PROXIMAL PART AFFECTIONS AGAINST THE BACKGROUND OF ANTIPLATELET DRUGS. Experimental and Clinical Gastroenterology Journal. 2017;147(11):22-24
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    1. Novokuznetsk State Institute for Further Training of Physicians - Branch Campus of the Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation; Municipal Hospital N 29 (Novokuznetsk, Russian Federation)
    2. Municipal Hospital N 22

    Keywords:chronic erosive gastritis,gastroscopy

    Abstract:The article is devoted to the study of chronic gastric erosions in the normal course of gastritis and against the background of cardiac pathology requiring receiving of antiplatelet drugs. In cohort investigation of 1426 patients age characteristics, the frequency of chronic erosive gastritis, clinical manifestations, endoscopic findings and microscopic changes were studied. The proportion of cardiac patients with chronic erosive gastritis makes of 9.3 % from the 12.1 % of all identified chronic erosions. Significant differences in the structure of age groups with chronic erosive gastritis, significantly lower incidence of dysplasia and metaplasia at cardiac patients, the symptoms accompanying inactive gastritis in all cases of chronic asymptomatic erosions in cardiac patients, the same frequency of contamination HP are revealed. The conclusion about same course of chronic erosive gastritis irrespective of cardiac pathology is drawn.

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    CHRONIC GASTRIC EROSION IN CARDIAC PATIENTS: A SEPARATE FORM OR MANIFESTATION OF USUAL GASTRITIS? Experimental and Clinical Gastroenterology Journal. 2017;147(11):25-30
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    1. Non-state healthcare institution «Road clinical hospital at the station Irkutsk-Passenger JSC ”Russian Railways”» (Irkutsk, Russian Federation)
    2. Irkutsk State Medical Academy of Postgraduate Education - Branch Campus of the Federal State Budgetary Educational Institution of Further Professional Education «Russian Medical Academy of Continuing Professional Education» of the Ministry of Healthcare of the Russian Federation (Irkutsk, Russian Federation)

    Keywords:chronic pancreatitis,gastroesophageal reflux disease,daily 24-hour pH-metry,types of refluxes

    Abstract:The purpose of the study. To compare the type of reflux and endoscopic pattern of distal esophagus of patients with a combination of GERD-chronic pancreatitis and monopathology of GERD. Materials and methods: 155 patients with GERD were examined. The first group consisted of 75 patients with a combination of GERD and chronic pancreatitis, the second with 80 patients with monopathology. The analysis was applied to the data of fibroesophagogastroduodenoscopy with biopsy, daily 24-hour pH-metry of the esophagus and the stomach, multispiral computed tomography of the abdomen. Results. The combination of GERD and chronic pancreatitis increases the likelihood of reflux with pH >7 and independently on the type of reflux worsen clearance of the esophagus, characterizing by a higher frequency of erosive esophagitis and Barrett’s esophagus.

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    THE INFLUENCE OF CHRONIC PANCREATITIS ON THE TYPE OF REFLUX AND ENDOSCOPIC PICTURE OF DISTAL ESOPHAGUS. Experimental and Clinical Gastroenterology Journal. 2017;147(11):31-33
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    1. Federal public budgetary educational institution of higher education “Kursk State Medical University” of the Ministry of Healthcare of the Russia (Kursk, Russian Federation)

    Keywords:acute pancreatitis,genetic polymorphism,xenobiotics biotransformation enzymes

    Abstract:The aim of this study was to investigate the relationship between polymorphisms H139R and I462V of genes EPHX1 and CYP1A1 in the development of acute pancreatitis (AP) in the Russian population. Whole blood samples were collected from 299 patients with acute pancreatitis and 238 healthy controls. Genotyping of the SNPs (rs2234922) EPHX1 gene and (rs1048943) CYP1A1 gene accomplished using PCR with allele discrimination using TaqMan-probes. It has been found that the allele 139H (OR = 1.34 95 % CI 1.03-1.75) associated with a reduced risk of acute pancreatitis. I462V polymorphism association with development of acute pancreatitis detected. Conducted stratified analysis of smoking and genotypes of polymorphisms H139R and I462V genes EPHX1 and CYP1A1 in the development of acute pancreatitis also found no differences in the groups of patients and healthy controls.

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    THE INVESTIGATION OF ASSOCIATION POLYMORPHISMS OF XENOBIOTICS BIOTRANSFORMATION ENZYMES GENES EPHX1 AND CYP1A1 TO THE DEVELOPMENT OF ACUTE PANCREATITIS IN RUSSIANS. Experimental and Clinical Gastroenterology Journal. 2017;147(11):34-37
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    1. Moscow clinical scientific practical center named after A. S. Loginov (Moscow, Russian Federation)
    2. Pirogov Russian National Research Medical Universityv (Moscow, Russian Federation)

    Keywords:oncology,palliative care,nutritional treatment,personification of programs

    Abstract:The aim is to develop recommendations for the use of nutritional schemes for palliative care for cancer patients. Material and methods. The severity of the condition, the degree of protein-energy deficiency and organ deficiency (according to the method of alimentary-vollemic diagnosis), the degree of nutritional risk, the stage of the process, the assessment of the intensity of intoxication, the state of the immune system and genomic prognosis were assessed in cancer patients. Criteria for assessment of homeostasis in all patients with oncopathology are divided into 3 main groups: 1) patients who could performed radical surgery and/or comprehensive treatment; 2) patients receiving at the time of providing support to various regimens; 3) patients requiring only palliative care. With this gradation, the use of information, literature data and own observations, we proposed for each group a specialized nutritional program. Results and discussion. Patients in need of palliative care were diagnosed with asthenia, early satiety, progressive weight loss, anorexia, tissue protein deficiency, the growth of pro-inflammatory cytokines and tumor-specific cachexia factors. For such patients, a program is proposed that includes a diet, sipping with the use of a caliper; In the case of probe alimentation, partially disintegrated formulations are recommended (for example, nutrihim). In severe patients, the nutritional effect was enhanced by progestogen preparations (megas, ondasetron), anti-catabolic agents (indomethacin, ibuprofen, EPA), anabolics (retabolil). Conclusions. The composition of the sipping rations should include nutrients that affect the molecular mechanisms of survival, apoptosis of tumor cells, proliferation, angiogenesis and invasion of tumor cells.

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    PERSONIFICATION OF NUTRITIVE TREATMENT PROGRAMS IN THE STRUCTURE OF PALLIATIVE AID TO PATIENTS OF THE ONCOLOGICAL PROFILE. Experimental and Clinical Gastroenterology Journal. 2017;147(11):38-41
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    1. Izhevsk State Medical Academy (Izhevsk, Russian Federation)

    Keywords:Metabolic syndrome,small intestine,small intestinal bacterial overgrowth,microbiota,digestion,absorption,intestinal motility

    Abstract:Objective. Investigation of the importance of microbiota in the violation of digestive, absorption and motor function of the small intestine (SI) in the metabolic syndrome (MS). Materials and methods. 58 patients with MS were examined. To assess the processes of digestion and absorption in the intestine, stress tests were carried out with mono-, di- and polycarbohydrates. The motor-evacuator function of SI was studied with the help of gastroenteromonitor “Gastroscan-GEM”. In the definition of small intestinal bacterial overgrowth (SIBO) in the SI, a hydrogen breathing test with lactulose was used. The state of the colon’s microbiocenosis was determined by sowing feces on various selective nutrient media. Results. In MS, there was a violation of all stages of the hydrolysis-resorption process in the SI. Depression of cavity and parietal hydrolysis of carbohydrates, increased absorption of glucose in the proximal part of the SI was noted. When conducting peripheral electrogastroenterocolography in most patients with MS there was a violation of the motor function of the intestine, aggravated in the postprandial period. In 40 % of patients, SIBO was detected, and in 72 % of cases it is localized in the distal part of the SI against the background of insufficient ileocecal valve and impaired propulsive motility of the intestine. A regularity is established between the severity of SIBO and the violation of digestion, absorption and motor functions of the SI. The conclusion. A new information on the conjugation of the functional state of SI and intestinal microbiocenosis in patients with MS has been obtained.

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    THE ROLE OF BACTERIAL OVERGROWTH SYNDROME IN VIOLATION OF THE DIGESTIVE, ABSORPTIVE AND MOTOR FUNCTIONS OF THE SMALL INTESTINE IN PATIENTS WITH METABOLIC SYNDROM. Experimental and Clinical Gastroenterology Journal. 2017;147(11):42-48
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    1. Moscow clinical scientific practical center named after A. S. Loginov (Moscow, Russian Federation)

    Keywords:serotonin,acetylcholine,intestinal motility,inflammatory bowel diseases

    Abstract:Introduction. It is known that biologically active substances (serotonin, acetylcholine) participate in the regulation of motor activity of the intestine in patients with inflammatory bowel diseases (IBD). The aim of the study was to determine the concentration of neurotransmitters of acetylcholine and serotonin in the serum at IBD. Material and methods. 69 patients with IBD were examined. The control group consisted of 30 volunteers regularly undergoing a prophylactic check-up. The concentration of Ach and serotonin in serum was determined. Statistical processing of the results was carried out using a nonparametric analog of the variance analysis. Result and discussion. The concentration of 5-HT in the blood of patients with IBD: 0.39 ± 0.05 μg. So, it is established that the presence of the disease promotes an increase in the concentration of Ac and serotonin. There is a violation of the neuronal regulation of the functional activity of the digestive system as a vicious circle. In patients, in contrast to the control group, there is a high initial level of neurotransmitter concentration. Conclusion. In the chain of cause-effect relationships, the main link is identified, this is the level of concentration of neurotransmitters. Patients have a high quantitative composition of neurotransmitters. Perhaps the determination of the concentration of BAS will allow us to find the line between adaptation and disease.

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    PECULIARITIES OF REGULATION OF ENGINE ACTIVITY OF THE TOLSTOUS PIGS IN INFLAMMATORY DISEASES OF THE INTESTINE. Experimental and Clinical Gastroenterology Journal. 2017;147(11):49-54
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    1. I. Metchnikov North-West State Medical University (St. Petersburg, Russian Federation)

    Keywords:actinomycetes,actinomycosis,anaerobic infection,drugs penicillin group

    Abstract:The results of the single-center study of the intestinal actinomycosis patients, treated at the Research Institute of mycological clinic in 2005-2016. Age of patients from 8 to 81 year, median - 42 (36,5÷52). Risk factors for intestinal actinomycosis were acute appendicitis with perforation (OR= 3.857[1.527-28.242]). Appendix (64 %), omentum (64 %) are the most common abdominal sites of actinomycosis. Patients may present with non-specific symptoms such as fever (100 %), abdominal pain (91 %), weight loss (36 %). The formation of spontaneous draining of purulent material was in 27 % cases. The time from onset to diagnosis varied from a few weeks to two years (median - 27 +/- 2 days). Surgical resection of infected tissue and long-term antibiotic therapy will be effective in the treatment of abdominal actinomycosis - 94 %

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    FEATURES INTESTINAL ACTINOMYCOSIS. Experimental and Clinical Gastroenterology Journal. 2017;147(11):55-59
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    1. FGBI Federal scientific-clinical center of physico-chemical medicine FMBA Russia (Moscow, Russian Federation)

    Keywords:type 2 diabetes mellitus,NETosis,glycated haemoglobin,purulent necrotic complications,neutrophil extracellular traps

    Abstract:Objective of the Paper: Quantitative comparison of neutrophil extracellular traps (NETs) in blood between type 2 diabetes mellitus patients with purulent necrotic complications at various locations and healthy volunteers. Key Points: NETs concentration in patient blood was, on average, higher than that for healthy subjects. NETs blood concentration in the latter and in patients (n = 5) with high levels of NETs increased as HbA1c increased. For other patients, NETs concentration decreased as HbA1c increased, indicating the existence of a compensatory mechanism to inhibit NETosis in conditions of inflammation in type 2 diabetes mellitus. High NETs levels and a positive correlation between this parameter and HbA1c were observed in patients with phlegmon, vast infected wound, gangrene of lower leg, purulent pyogenic mediastinitis. Infected wounds, abscess, gangrene of finger were predominant among other patients. Analysis of the two clinical examples shows the relationship between inflammation severity, including wound healing speed, and NETs concentration in patient blood. Conclusion: This study suggests that monitoring blood levels of NETs alongside HbA1 levels in healthy subjects and type 2 diabetes mellitus patients with allow more accurate assessment of the risk of various complications, the disease severity and the duration of post-surgical treatment

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    CIRCULATING NEUTROPHIL EXTRACELLULAR TRAPS IN TYPE 2 DIABETES MELLITUS PATIENTS WITH SUPPURATIVE COMPLICATION. Experimental and Clinical Gastroenterology Journal. 2017;147(11):60-63
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