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CLINICAL GASTROENTEROLOGY

    1. Kharkiv National Medical University (Kharkiv, Ukraine)

    Keywords:Non-alcoholic fatty liver disease,obesity,resistin

    Abstract:It were examined 70 patients with non-alcoholic fatty liver disease and its combination with obesity, as well as 20 healthy individuals. The study was carried out using the following methods: clinical, laboratory and instrumental (including liver biopsy). It was found an inverse relationship between the level of resistin and the levels of the indices of lipid metabolism in both groups of patients. There was established the significant increase of plasma level of resistin, and also impairment of lipid metabolism indices in all groups in comparison with the controls, and most pronounced changes in patients with NAFLD and obesity. The established relationships suggests that the increase resistin may represent the presence of dyslipidemia in patients with NAFLD and its combination with obesity. In order to determination the disorder of the lipid metabolism is recommended to determine the level of resistin in patients with NAFLD, especially in presence of obesity. Patients with the level of resistin (>8,06±0,23 ng/ml) should refer to the risk of progression of dyslipidemia.

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    Full text is published :
    THE INFLUENCE OF RESISTIN ON LIPID METABOLISM IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE IN PATIENTS WITH NORMAL BODY WEIGHT AND OBESITY. Experimental and Clinical Gastroenterology Journal. 2018;150(02):19-23
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    1. FSEBI of HE “The Ulianov Chuvash State University” (Cheboksary, Russian Federation)
    2. BI “City clinical hospital № 1” of the Ministry of Нealthcare of the Chuvash Republic (Cheboksary, Russian Federation)
    3. SAI SVE “The Postgraduaute Doctor' Training Institute” of the Ministry Healthcare of the Chuvash Republic (Cheboksary, Russian Federation)
    4. BI “Chuvash Republic clinical hospital“ of the Ministry of Нealthcare of the Chuvash Republic (Cheboksary, Russian Federation)

    Keywords:elastography,elastometry, shear wave, stiffness, liver, diffuse disease

    Abstract:The results of 128 people’s study (average age - 46,3 ± 2,5 years) was analyzed Non-invasive ultrasound techniques for the study of the liver were used: TE (or single-stage pulse elastometry) on Fibroscan unit (Echo-Sens, France) and ESA on Aixplorer unit (Supersonic Imagine, France) with Elastometry (frequency range of 1.6 MHz). Average value (Emean), the maximum value (Emax) and σ - standard deviation were taken into estimation. Emean according to TE in healthy individuals was 4,8 kP, in patients with chronic viral hepatitis - 7,2 kPa (n1); in patients with steatohepatitis - 9,1 kPa (n2); group with cirrhosis - 43,8 kPa (n3). ESP indicators were slightly higher than the TE and showed the following results for n1 group - 8,3 kPa; n2-9,4 kPa; n3-55,3 kPa (in the group - 4,6 kPa). Efficiency of ESP was more successful, reaching 100% (all the procedures have been completed successfully), compared with TE with 84.6%, which indicated a higher diagnostic value of ESP in the diagnosis of diffuse liver disease.

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    Full text is published :
    MODERN POSSIBILITIES OF THE SEVERITY OF LIVER FIBROSIS. Experimental and Clinical Gastroenterology Journal. 2018;150(02):24-30
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    1. Institute of Biology of Karelian Research Centre Russian Academy of Sciences (Petrozavodsk, Russian Federation)
    2. Petrozavodsk State University, the Department of Internal Medicine Propaedeutics and hygiene (Petrozavodsk, Russian Federation)

    Keywords:nonalcoholic steatohepatitis (NASH),interleukin-6polymorphism,ursodeoxycholic acid (UDCA)

    Abstract:The aim was a comparative analysis of clinical and laboratory parameters in carriers of different genotypes for the -174G>C IL6 gene polymorphic marker (rs1800795) in healthy donors and patients with NASH in the absence of hepatoprotective therapy and after therapy with UDCA. There were examined 50 patients with the diagnosis of NASH. NASH patients were treated with UDCA at a dose of 10-15 mg/kg for 8-10 weeks. The control group consisted of 50 donors without the clinical manifestations of NAFLD. Genotyping was carried out using the PCR-RFLP method. Functional liver tests, the level of cytokines IL6 and TNFα in the blood, the level of expression of the IL6 and TNF genes, the activity of caspases in peripheral leukocytes were estimated before the treatment and after UDCA monotherapy. In NASH patients with different alleles for the -174G>C IL6 gene polymorphic marker, there are significant differences in the level of the indicator of hepatic cell damage - AST, and the mRNA level of the TNF gene in PBL. In carriers of C allele, the effect of UDCA therapy on the level of AST and the TNF gene transcripts in PBL is less pronounced than in carriers of the GG genotype. This indicates a lower sensitivity to UDCA therapy in carriers of the mutant allele. The medians of decrease in the AST level and in the level of mRNA relative expression of the TNF gene in carriers of C allele are significantly lower than in carriers of the GG genotype, p<0.05. Significant differences in the effect of UDCA therapy on the level of other studied parameters depending on the genotype were not found. The presence of the -174G>C single nucleotide substitution in the IL6 gene (rs1800795), which is associated with the development of NASH, can determine not only the genetic predisposition to the development of this disease, but also the different sensitivity of patients with NAFLD to UDCA-based drugs.

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    Full text is published :
    -174g>c polymorphism (rs1800795) of il6 gene and its impact on the effectiveness of treatment with ursodeoxycholic acid in patients with nonalcoholic steatohepatitis. Experimental and Clinical Gastroenterology Journal. 2018;150(02):31-36
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    1. Kharkov Medical Academy of Postgraduate Education (Kharkiv, Ukraine)

    Keywords:non-alcoholic fatty liver disease,non-alcoholic steatohepatitis,L-carnitine,homocysteine,hyperhomocysteinemia

    Abstract:Examined 65 patients with verified NASH. The age of the patients ranged from 23 to 67 years. Among them were 36 (55.4%) women and 29 (44.6%) men. The control group consisted of 20 healthy individuals. The effectiveness of complex therapy with the inclusion of the drug L-carnitine, deproteinized hemoderivat of calves and folic acid was studied. The presence of carnitine insufficiency, hyperhomocysteinemia, increase in the level of proinflammatory cytokines in all patients with NASH. After a month of treatment with complex therapy, the level of L-carnitine increased from 14.5 (13.1, 15.7) μmol/l to 31.1 (28.8, 34.1) μmol/l (p<0.001), homocysteine decreased to subnormal figures - 11.8 (11.0, 12.8) μmol/l (p<0.001). When studying the cytokine profile in the group after treatment, a significant decrease in the level of proinflammatory cytokines was revealed. The use of complex therapy with the inclusion of drugs L-carnitine, deproteinized hemoderevate blood of calves as an antihypoxant and folic acid has a positive effect on the clinical course of the disease, contributes to the elimination of L-carnitine deficiency, hyperhomocysteinemia, a decrease in the level of pro-inflammatory cytokines.

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    THE ROLE OF MITOCHONDRIAL DYSFUNCTION IN THE DEVELOPMENT OF NON-ALCOHOLIC FATTY LIVER DISEASE. Experimental and Clinical Gastroenterology Journal. 2018;150(02):37-43
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    1. North-Western State Medical University named after I. I. Mechnikov (St. Petersburg, Russian Federation)

    Keywords:non-alcoholic fatty liver disease,cholelithiasis,cholecystectomy,Ursofalk,prophylaxis

    Abstract:We examined 60 patients aged 38 ± 10.3 years who underwent cholecystectomy for cholelithiasis. According to ultrasonography, all patients did not have signs of non-alcoholic fatty liver disease. The observation period was 1 year. The patients were divided into 2 groups of 30 people each. Group 1 included patients assigned to: Ursofalk, Mukofalk and Hofitol. Group 2 included patients who received symptomatic therapy. All patients were examined: a biochemical blood test and ultrasonography of the abdominal organs, before surgery and 6 and 12 months after cholecystectomy. Of the 60 patients enrolled in the study, 21.6% by the end of the first year after cholecystectomy, ultrasonography from the liver showed signs of non-alcoholic fatty liver disease. In the first group of patients, by the end of the first year after cholecystectomy, signs of non-alcoholic fatty liver disease were found to be 6.6%. In the second group, the signs of non-alcoholic fatty liver disease appeared in 36.6% of patients. Against the backdrop of using the prophylaxis scheme developed by Ursofalk, Mukofalk and Hofitol, the incidence of non-alcoholic fatty liver disease in patients with cholelithiasis is lower by the end of the first year after cholecystectomy than in patients who did not use this scheme 6-fold.

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    Full text is published :
    PREVENTION OF NON-ALCOHOLIC FATTY LIVER DISEASE IN PATIENTS WITH CHOLELITHIASIS AFTER CHOLECYSTECTOMY. Experimental and Clinical Gastroenterology Journal. 2018;150(02):44-50
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    1. Moscow Clinical Scientific and Practical Center of the Moscow City Health Department (Moscow, Russian Federation)

    Abstract:Six patients with right-sided hemihepatectomy were observed. In the preoperative period, along with clinical and laboratory, CT, ultrasound, gastroscopy, the functional reserve of the liver was assessed before and after the operative increase in the volume of the left lobe of the liver. We estimated not only the increase in volume, but also the functional preservation of liver functions. The criterion of nutritional consistency was the well-known alimentary-vollemic diagnosis. Given the high nutritional risk, a nutritional correction included a mixed nutrition (sparing diet + sipping with a mixture of hepatoprotective composition, enzyme therapy and parenteral correction with electrolyte solutions, vitamins and albumin). Against the background of the correction, the patient’s state was satisfactory with positive dynamics.

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    NUTRITIOUS ACCOMPANIMENT OF EXTENSIVE LIVER RESECTIONS. Experimental and Clinical Gastroenterology Journal. 2018;150(02):51-54
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    1. State Higher Educational Institution “Uzhhorod national university” (Uzhgorod, Ukraine)

    Keywords:liver cirrhosis,ascites,hepatorenal syndrome,prostaglandines,treatment

    Abstract:The group under study consisted of 387 patients with LC. The levels of prostaglandins (Pg) I2 and F2α, their dynamics in patients with LC were studied depending on the differentiated method of correction of ascites and (HRS) in these patients. In all patients with LC a statistically significant increase in serum levels of Pg I2 and F2α was observed. Our studies indicate the presence of regularity in the dynamics of serum Pg I2 levels in patients with ascites and HRS with LC, namely: in patients with LC and ascites class B, an increase in the level of Pg I2 was observed, which tends to normalize in class C in these patients, whereas in patients LC and HRS class B level of Pg I2 in the blood serum is within normal range, and in class C in these patients, is decreased in 2-2.5 times than normal. 1. In patients with LC, ascites and HRS there is a violation of serum prostaglandins levels, namely, an increase in Pg F2α, and decrease in Pg I2, which indicates the formation of refractory ascites and HRS in these patients. 2. An effective method of correction prostaglandins levels in patients with LC is the use of symbiotic and combined drugs “Gepadif” in the early stages of ascites formation, which contributes to the prevention of resistance to treatment of ascites and HRS.

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    Full text is published :
    DYNAMICS OF INDICATORS OF PROSTAGLANDINS IN PATIENTS WITH LIVER CIRRHOSIS WITH ASCITES AND HEPATORENAL SYNDROME. Experimental and Clinical Gastroenterology Journal. 2018;150(02):55-60
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    1. Belarusian stat medical university, Department of Infectious Diseases (Minsk, Belarus)
    2. Belarusian research center for pediatric oncology, hematology and immunology (Minsk, Belarus)
    3. Grodno stat medical university, Department of Infectious Diseases (Grodno, Belarus)
    4. Grodno stat medical university, Research Laboratory (Grodno, Belarus)

    Keywords:Cirrhosis,hepatitis C virus,liver damage,mesenchymal bone marrow stem cells

    Abstract:The importance of the HCV-infection is determined by the wide spread, progressive course, the formation of liver cirrhosis (LC) and hepatocellular carcinoma. The mechanisms of the effect of the virus on hepatic cells and regeneration of hepatocytes, the processes of fibrogenesis and fibrolysis, mechanisms of the reverse development of the LC remain unexplored. There is no effective pathogenetic therapy, which contributes to the regress of the formed fibrosis in the liver tissue. A patient with HCV-LC who has a secondary hemorrhagic vaculities who underwent autologous MSC transplantation into the liver tissue. The liver biopsy specimens were studied in dynamics by light and electronic microscopy and by immunohistochemistry. The procedure of transplantation and posttransplantation period proceeded without complications. After the introduction of MSC from the data of the morphological study, the features of the formed micronodular LC remained. In some parts of the samples, the septa looked thin, sometimes perforated, indicating a resorption in this place of fibrous tissue. There was a decrease in the degree of transdifferentiation of stellate cells into myofibroblasts, a decrease in the number of fibroblasts and fibroblasts, there were no immune reactions in the form of deposition of amorphous and fibrous masses of moderate electron density along the sinusoidal capillaries that were significantly expressed in the primary biopsy. These changes were combined with the appearance of hepatocyte heterogeneity in the density of the cytoplasmic matrix, the state and quantity of organelles and inclusions, and the structural improvement of intracellular organelles Autologous transplantation of mesenchymal bone marrow stem cells reduces the degree of destructive changes in hepatocytes, the severity of fibrosis and contributes to the improvement of the morpho-functional state of the liver, and therefore, it can be recommended as an important component of medical interventions.

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    EFFECTS OF AUTOLOGICAL MESENCHIMAL STEM CELLS, TRANSPLANTED IN LIVER WITH VIRUS CYRROSIS. Experimental and Clinical Gastroenterology Journal. 2018;150(02):61-67
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