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CLINICAL GASTROENTEROLOGY

    1. Moscow State University of Medicine and Dentistry named after A. I. Evdokimov
    2. Multidisciplinary Medical Center of the Central Bank of the Russian Federation

    Keywords:comorbid pathology, non-steroidal anti-inflammatory drugs, antithrombotic drugs, “Moscow classification”, risk of bleeding recurrence, risk of thromboembolic complications, multifocal lesions of the mucosa of the digestive tract

    Abstract:In order to develop an algorithm for managing patients receiving NSAIDs and anti-thrombotic therapy, as well as classification of lesions of the mucosa of the digestive tract, against the background of the treatment, we used the experience of foreign colleagues and information resources: PubMed, Cochrane Library, MDConsult, DynaMed, Google Scholar, TRIP Database, which today is the most comprehensive in terms of coverage by the public meta-search system, which has an advanced document sorting system, existing normative documents, as well as own experience. The algorythm for management of patients cured with NSAIDs or АТА included assessment of the patient’s condition before the start of treatment, dynamic monitoring of complications based on clinical and laboratory data, endoscopic diagnostic data, and a decision support system in the form of the “Russian classification” of esophagogastroduodenoenterocolatopathy. The developed “Moscow classification” of multifocal lesions of the mucosa of the digestive tract with nonsteroidal anti-inflammatory and antithrombotic agents is presented in the form of a cascade that includes a common scale, an expanded (specifying) scale, and a stratification of the risks of recurrence of bleeding and thromboembolic complications. The proposed “Moscow classification” of lesions of the mucosa of the digestive tract with non-steroidal anti-inflammatory drugs and drugs for lowering blood clotting (L. B. Lazebnik, G. V. Belova) is a testament to the medicine of “Three P” - personified, preventive and predictive, accounting for a significant number of gender, anamnesis, functional and clinical-laboratory indicators. The application of the Russian classification refers to the decision-support system for the tactics of conducting an extremely complex category of patients with severe comorbid pathology.

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    Full text is published :
    SYSTEMTIZING CLASSIFICATION OF MULTIFOCAL LESIONS OF THE MUCOSA OF THE DIGESTIVE TRACT BY NON-STEROIDAL ANTI-INFLAMMATORY AND ANTITROMBOTIC DRUGS (“MOSCOW CLASSIFICATION”). Experimental and Clinical Gastroenterology Journal. 2018;151(03):19-27
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    1. Tver State Medical University

    Keywords:acute gastroduodenal erosions, chronic heart failure, clinical and endoscopic features, changes of gastric secretion, local microcirculatory disorders

    Abstract:The study included 94 patients with CAD with CHF, which were divided into four groups, depending on the severity of CHF and the presence of acute erosions. The state of the gastroduodenal zone and terminal blood flow in its mucosa, the changes of gastric secretion were evaluated with methods, adapted to the severity of the patients’ condition and the peculiarities of the cardiac pathology. It was found that usually acute erosions in CHF I-IIa stage represented a few, small defects of tissues with localization in the body and (or) antral part of the stomach. Erosions in patients with CHF IIb-III stage were multiple, small or medium in size and occupied significant areas of the mucosa of the body and the antrum of the stomach and the bulb of the duodenum. Clinical presentation of acute erosions in CHF I-IIa stage was determined as unstable unsharply expressed epigastric pain and signs of gastric dyspepsia. In CHF IIb-III stage, stable dyspepsia dominated, while the symptoms of a mild pain syndrome receded into the background. The development of acute erosions in CHF was promoted by thrombohemorrhagic microcirculatory disorders in the gastroduodenal mucosa, the severity of which increased jointly to the severity of CHF. These changes were accompanied by abnormalities of gastric secretion, which were manifested by activation of the acid-peptic factor in combination with moderate suppression of the protective mucus components production in CHF I-IIa stage, and by increased pepsinogen and inhibition of protective mucus production, normal acid secretion - in CHF IIb-III stage. Acute gastroduodenal erosions in patients with CAD with CHF have a number of clinical, endoscopic and pathogenetic features, which are determined mainly by the severity of CHF.

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    Full text is published :
    ACUTE GASTRODUODENAL EROSIONS IN PATIENTS WITH CORONARY ARTERY DISEASE AND CHRONIC HEART FAILURE: CLINICAL AND ENDOSCOPIC FEATURES AND THE ROLE OF MICROCIRCULATORY AND GASTRIC SECRETION DISORDERS IN THEIR DEVELOPMENT. Experimental and Clinical Gastroenterology Journal. 2018;151(03):28-33
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    1. Kirov State Medical University

    Keywords:Helicobacter pylori, antibiotic sensitivity, eradication therapy, stable angina, gastroduodenal pathology

    Abstract:The study was conducted in two stages. At the first stage, 46 patients with stable angina with a combination of H. pylori-associated gastroduodenal pathology were consistently included in the study. During the endoscopic examination by esophagogastroduodenoscopy, a gastro-biopsy specimen was sampled for microbiological examination. The sensitivity of the analyzed isolates of H. pylori strains to antimicrobial agents (in vitro) was determined by bacteriological testing. In the second stage, patients (n = 46) underwent eradication therapy against the background of basic therapy: in group I (n = 25), taking into account the antibiotic susceptibility of H. pylori, in group II (n = 21) without antibiotic sensitivity. After eradication in all patients (n = 46), the effectiveness of therapy was tested by ELISA (determination of H. pylori antigen in the stool). In the first stage, resistance of H. pylori strains to metronidazole was found in 45.7% of patients, and levofloxacin in 4.4% of patients. The drugs of the standard triple line eradication resistance of strains of bacteria has not been established. Moderate and high sensitivity of H. pylori isolates to clarithromycin was detected in 56.5% and 39.1% of patients, respectively. Moderate and high sensitivity to amoxicillin was established in 73.9% and 8.7% of patients. At the second stage of the study, it was found that the effectiveness of eradication was 86.9% overall, while in the I group - 96%, in the II group - 76.2%. In 45.7% of patients with stable angina with concomitant gastroduodenal pathology, the resistance of H. pylori strains to metronidazole was revealed. The use of a bacteriological method for determining the sensitivity of H. pylori to antibiotics, makes it possible to improve the effectiveness of eradication therapy.

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    ASSESSMENT OF THE ANTIBIOTIC SUSCEPTIBILITY OF HELICOBACTER PYLORI IN PATIENTS WITH STABLE ANGINA WITH CONCOMITANT GASTRODUODENAL PATHOLOGY. Experimental and Clinical Gastroenterology Journal. 2018;151(03):34-40
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    1. Tver state medical university, department of faculty therapy

    Abstract:Taking into account the action of endogenous and exogenous risk factors, to discuss mechanisms for regulating the morphofunctional state of the esophagus and the pathogenesis of HE at the cellular, intercellular, organ and systemic levels. The work is based on the analysis of literature data and the results of long-term studies of the author and employees of the Department of faculty therapy, conducted in 689 patients with clinical and morphological manifestations of HE. 124 of them were treated for GERD with reflux esophagitis (re) associated with chronic gastritis (CG), 129 for GERD and re due to biliary pathology, 181 for exacerbation of CG, 223 for recurrence of peptic ulcer disease (NAF) and 32 for non-comorbidities. Among patients with GERD and re in Association with CG, there were 61 males and 63 females, aged 30-60 years, and with GERD and re in biliary pathology, 42 males and 87 females in 86% of cases. Pathogenesis of the disease in the detection of risk factors associated with the violation of the regulatory systems of the body and interaction at the cellular, intercellular, organ, organ and systemic levels, leading to a decrease in multi-level protection mechanisms and the development of morphofunctional changes in the esophagus.

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    ETIOLOGY, MECHANISMS OF REGULATION OF THE MORPHOFUNCTIONAL STATE OF THE ESOPHAGUS AND PATHOGENESIS OF CHRONIC ESOPHAITIS. Experimental and Clinical Gastroenterology Journal. 2018;151(03):41-46
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    1. Tver state medical university, department of faculty therapy

    Keywords:gastroesophageal reflux disease, duodenogastroesophageal reflux, phenotypic and visceral signs of connective tissue dysplasia, developmental predictors

    Abstract:In 129 patients with DGER-associated GERD, aged 18-76 years, the presence and severity of phenotypic and visceral signs CTD were recorded using the original screening kit, which detects them in adult patients. Dysplastic-dependent phenotype was diagnosed in 59 people (15 men and 44 women), absence of signs of CTD - in 70 (27 men and 43 women). Among the phenotypic signs of CTD in patients with GERD predominate musculocutaneous (47,9%), osteoarticular (27,5%) and cranial (18,5%). Among visceral symptoms dominated cardia insufficiency (57,6%), hiatal hernia (HH) (54,2%), the structure anomalies of gallbladder (39,0%). Regardless of the sex of patients, the severity of CTD was moderate. Chance of developing DGER-associated GERD, in patients with dysplastic-dependent phenotype was 3,7 times higher compared with individuals with no evidence of CTD in the presence of HH; 1,4-1,6 times - with cardia insufficiency, abnormal forms of gallbladder and their combination; 4,3 times - with combination of HH and an abnormal forms of gallbladder. In the adult population of patients with DGER-associated GERD in 45,7% of cases it occurs on the background of the high frequency of phenotypic and visceral manifestations of CTD. Visceral manifestations (HH, cardia insufficiency, abnormal forms of the gallbladder, and others) at high frequency of phenotypic signs appear predictors of GERD associated with DGER.

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    PROGNOSTIC VALUE OF CONNECTIVE TISSUE DISPLASIA IN DUODENOGASTROESOPHAGEAL REFLUX-ASSOCIATED GASTROESOPHAGEAL REFLUX DISEASE. Experimental and Clinical Gastroenterology Journal. 2018;151(03):47-52
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    1. Ogarev Mordovia State University
    2. Mordovia Republican clinical hospital

    Keywords:tumor necrosis factor-α, gastritis, peptic ulcer disease, polyposis, gastric cancer, Helicobacter pylori

    Abstract:The aim of the study was to determine the serum level of tumor necrosis factor-α (TNF-α) with diseases of the stomach in correlation with the morphological changes of the gastric mucosa (GM). Examined with the informed consent of the 204 patients with precancerous diseases of the stomach, 40 patients with gastric cancer, and 40 healthy volunteers. The amount of TNF-α in serum was determined by enzyme immunoassay. The serum level of TNF-α in patients with chronic gastritis, peptic ulcer, polyposis, gastric cancer significantly exceeded the values of healthy individuals, correlated with the stage of atrophy, the degree of inflammation, colonization of GM Helicobacter pylori, severity ulcerative process, stage of tumor growth. Conclusion. Determining the number of TNF-α in serum can be used for immuno-laboratory assessment of severity and prognosis of the pathological process in the GM.

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    CHANGES OF THE SERUM LEVELS OF TUMOR NECROSIS FACTOR-Α AT DISEASES GASTRIC. Experimental and Clinical Gastroenterology Journal. 2018;151(03):53-57
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    1. Tver state medical university, department of faculty therapy

    Abstract:84 patients with recurrent peptic ulcer disease and simtomatic gastroduodenal ulcers associated with nonsteroidal anti-inflammatory drugs (NSAIDs) were examined. The first group consisted of patients with relapse of UX, the second - patients with SRS. Groups did not differ in age, sex and localization of ulcers. Each included 7 men, with an average age of 49.4±3.6 years, and 7 women aged 51.2±2.2 years. 9 examined ulcers were located in the stomach, 5 - in the duodenum. All patients of these two groups, except for complex therapy, including diet, protective regime, cytoprotectors, anti-secretory agents, according to indications, preparations of eradication HP-therapy of the I line, received bmkk nifedipine 0.01 three times during the course of treatment (2-4 weeks). To clarify the effectiveness of the use of nifedipine in the treatment of relapse of gastric ulcer and duodenal ulcer and gastric ulcer and duodenal ulcer, a third group was formed, including 56 patients (42 men and 14 women) with relapse of gastric ulcer and duodenal ulcer (12 patients with ulcers of the stomach, 44 - duodenum), the average age of 33.9±11.7 years, who received similar therapy to the two main groups only without nifedipine. A study of blood calcium found that gastroduodenal ulcers are accompanied by a significant (p<0.05) increase compared to healthy individuals (2.04±0.05 mmol/l) in all groups. In the study of regional microcirculation in biopsies WITH periulcerous zone all patients with recurrent of gastric ulcer and duodenal ulcer and SGDU identified violations, characterized by congestion and enlargement of the capillaries and venules, arterioles spasm, microthrombuses, edema and hemorrhage in the perivascular tissue. However, SRS and a more significant increase in blood calcium levels were accompanied by more pronounced vascular and intravascular disorders, and relapse of gastric ulcer and duodenal ulcer - perivascular changes in the final blood flow. Comparing the presented data with the results of our studies presented in previous works, we can assume that the SRS as well as the recurrence of gastric ulcer and duodenal ulcer occurs against the background of dysfunction of the calcium regulating system with an increase in blood calcium levels, which contributes to the formation of such mechanisms of ulcerogenesis as violation of regional microcirculation, activation of the acid-peptic factor and the development of hypermotor dyskinesia of the stomach. Symptomatic gastroduodenal ulcers, as well as the recurrence of peptic ulcer disease, are accompanied by an increase in blood calcium levels, reflecting the dysfunction of the calcium regulating system and contributing to the formation of the main mechanisms of ulcerogenesis. The inclusion in the complex therapy of symptomatic gastroduodenal ulcers associated with NSAIDs and recurrence of peptic ulcer of slow calcium channel blockers is pathogenetically justified and clinically effective.

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    CALCIUM IMBALANCE IN THE PATHOGENESIS OF SYMPTOMATIC GASTRODUODENAL ULCERS ASSOCIATED WITH NONSTEROIDAL ANTIINFLAMMATORY DRUGS, AND EFFECTIVENESS OF BLOCKERS OF SLOW CALCIUM CHANNELS IN THEIR TREATMENT. Experimental and Clinical Gastroenterology Journal. 2018;151(03):58-63
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    1. Federal State Budgetary Educational Institution of Higher Education “Rostov State Medical University” of the Ministry of Healthcare of the Russian Federation

    Keywords:total immunoglobulin E, IgE, violation of carbohydrate metabolism, blood groups, diabetes mellitus, specific immunoglobulin E, insulin

    Abstract:The following are determined: total IgE; specific IgE; The level of glucose and the percentage of glycosylated hemoglobin (HbA1c) in the serum; insulin in different blood groups 0(I), A(II), B(III) (n = 110). At the expressed infringement of a carbohydrate exchange representatives 0 (I) and And (II) groups of a blood had indicators of the general IgE43,61±15,12 kIU/l and 86,2 ± 42,61 kIU/l accordingly, that on the average in 4 times lower than blood group B(III), whose total IgE in type 2 diabetes increased 2 times the upper limit of normal and was 209,65 ± 52,5 kIU/l. It is also shown that individuals with different blood groups and glucose levels have individual reactions of induction of IgE to insulin. In B(III) blood group with glucose below 4 mmol/l, the lowest induction of insulin was observed - 0,85±0,05 μE/ml, and the production of IgE to insulin increased 80 times, amounting to 113,0±56,0 kU/l. It can be assumed that the outbreak of total IgE in people with a border glucose level (6,2-7,8 mmol/l), glycosylated hemoglobin (5,9-6,9%) in O(I) and A(II) blood groups may be a predictor of the onset of diabetes mellitus, and also reflect the state of compensation mechanisms for impaired glucose tolerance, as demonstrated in the B(III) blood group, which has high levels of total IgE with marked glucose tolerance. All three groups of blood to increase the level of glucose and insulin in the blood, as well as with expressed type 2 diabetes, react with a decrease in the production of specific IgE to insulin.

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    REAGIN SPECIFIC REACTION OF REPRESENTATIVES OF DIFFERENT BLOOD GROUPS AS A SYSTEM OF INDIVIDUAL TYPICAL DISEASE OF PANCREAS DISEASES WITH HYPOTHERMAL EXCHANGER DISTURBANCES. Experimental and Clinical Gastroenterology Journal. 2018;151(03):64-70
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