1. Non-government healthcare institution “Khabarovsk-1 Road clinical hospital, Open Society “Russian Railways” (Khabarovsk, Russia)
2. State educational government-financed institution of higher professional education “Far East state medical university”, Ministry of Healthcare of the Russian Federation (Khabarovsk, Russia)

Keywords:irritable bowel syndrome with or without diarrhea, small intestinal bacterial overgrowth, mebeverin, rifaximin, probiotics

Abstract:Aim. To assess the effect of therapy with mebeverine, rifaximin and probiotics on clinical symptoms, small intestinal bacterial overgrowth (SIBO) eradication, fecal calprotectin (FC) level and the quality of life in irritable bowel syndrome patients with (IBS-D) or without diarrhea (IBS without D). Material and methods. Patients with IBS-D (n=74) or IBS without D (n=127) were randomly divided into 2 subgroups homogeneous for sex, age, FC level and IBS severity. Patients of subgroup I received mebeverine 0,4 g/day for 1 month in combination with sequential therapy, including rifaximin 0,8 g/day 6 days followed by S. boulardii 0,5 g/day 10 days, and followed by probiotic “Bifiform” 2 capsules/day for 15 days. Patients of subgroup II received mebeverine 0,4 g/day for 3 months in combination with 3 courses of sequential therapy, without interruption, including rifaximin and probiotics in the same doses. IBS severity (IBS-SS), quality of life (SF-36), FC level and frequency SIBO eradication were estimated prior to onset of treatment and after its termination. Results. Differences between the 2 subgroups of IBS-D patients in clinical improvement and SIBO eradication after 1 or 3 months of therapy weren’t significant (р>0,05). Reduction of clinical symptoms and SIBO eradication were significantly more frequent in IBS patients without D after 3 months than 1 month (p<0.012). A significant decrease in the patient’s proportion with elevated FC levels occurred after 3 months (p <0.0001). Conclusions. The three-month therapy is significantly better than the monthly therapy in IBS patients without D in reducing the IBS severity, increasing the SIBO eradication frequency and the patient’s proportion with normal FC. Differences in clinical efficacy after 1 or 3 months of therapy in IBS-D patients with normal FC levels aren’t detected (p>0.05). Normalization of FC level in IBS-D patients with elevated FC levels (>100 μg/g) is significantly more likely to be detected after 3 months of therapy than in one (p <0.0001).

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Full text is published :
Krapivnaia O.V.Alexeenko S. A. EVALUATION OF THE EFFECTIVENESS OF COMBINATION THERAPY IN PATIENTS WITH DIFFERENT TYPES OF IRRITABLE BOWEL SYNDROME ASSOCIATED WITH SMALL INTESTINAL BACTERIAL OVERGROWTH.Experimental and Clinical Gastroenterology Journal. 2018;153(05):19-23
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1. Central State Medical Academy of the Administrative Department of the President of Russia (Moscow, Russian Federation)

Keywords:NAFLD, SIBO, intestinal microbiocenosis, endotoxemia, psyllium, rifaximin

Abstract:Aim of investigation: to study the frequency of occurrence of small intestinal bacterial overgrowth (SIBO) and bacterial endotoxemia (BE) in patients with nonalcoholic fatty liver disease (NAFLD) of different stages. Material and methods: The survey included 100 patients (78 (78%) men, 28 (28%) women) with NAFLD of different stages (steatosis - 30 people, nonalcoholic steatohepatitis (NASH) of minimal activity - 30 people, NASH of moderate activity - 30 people, liver cirrhosis - 10 people) at the average age of 51,83±8,48 years old. SIBO was verified by hydrogen breath test with lactulose (LHBT). BE was diagnosed by method of activated particles with the use of test kits of “MAP-Endotox spp.”, Russia. According to the treatment type patients with NAFLD were divided in 3 groups. The first group of 36 people without SIBO (on the background of lifestyle modification) received a 6-month intake of psyllium. The second group of 35 people with SIBO in addition to lifestyle modification received a 7-day course of rifaximi(7 - days/800 mg/d) and psyllium during the period of observation (6 months). Comparison group to assess the prognosis of the disease consisted of 19 patients with NASH who refused therapy at different stages of the investigation. Results: SIBO was detected in 50% patients, including 38% people with recorded BE. In group of steatosis BE rate did not exceed normal values, in NASH groups it increased to 6.67% and 33.33%, respectively, in cirrhosis group - 70%. We analyzed the effectiveness of antibacterial (rifaximin) and prebiotic (psyllium) therapy in the course of 6 months. It is established that control LHBT and MAP-test after 6-months’ observation showed no SIBO and BE in all patients of two groups. The comparison group without therapy aimed at the normalization of intestinal microbiocenosis displayed negative dynamics in the course of the disease. According to the results of the control tests, the frequency of SIBO in this group increased by 20%. Conclusion: 1. Frequency of detection of intestinal microbiocenosis disorders, established by the results of LHBT and MAP-test, increases with the severity of pathological process that testifies the role of microbiota as one of the most important components in development and progression of NAFLD. 2. Combined course therapy of rifaximin and long-term intake of psyllium is effective for correction SIBO and BE as the control tests determine the normalization of their indicators.

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Full text is published :
Ardatskaya M.D,Garushyan G.V, Moysak R.P.EFFECT OF SMALL INTESTINAL BACTERIAL OVERGROWTH AND BACTERIAL ENDOTOXEMIA ON THE COURSE OF NONALCOHOLIC FATTY LIVER DISEASE Experimental and Clinical Gastroenterology Journal. 2018;153(05):24-31
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1. FSBI «A. N. Ryzhykh State scientific center of coloproctology» of Ministry of health of Russian Federation (Moscow, Russian Federation)

Keywords:Ultrasonography examination, ulcerative colitis, contrast enhancement, therapy effectiveness

Abstract:Aim of investigation: determination and selection of parameters of ultrasonography with contrast enhancement for evaluation of the effectiveness of the therapy in patients with ulcerative colitis (UC). Materials and methods: The study included 20 patients with active left-side UC or pancolitis. Before the treatment all patients underwent colonoscopy and ultrasonography in standard regimen and with contrast enhancement. All patients received systemic 5-aminosalicylic acid in granules at a dose of 4 g per day for 3 months. After treatment, patients were repeatedly underwent endoscopy and ultrasound. Based on the ultrasound obtained with a contrast enhancement curve, the contrast parameters were automatically calculated: the maximum intensity (Imax), the area under the contrast curve (AUC), rise time (RT), peak time (TTP) and mean transit time (mTT), time to half-wash (HTWo). Results: According to the results of the examination of patients before and after three months of treatment, it was established that the most informative US-parameter for assessing the activity of inflammation is the AUC. For this parameter, a positive correlation with the endoscopic activity of the UC was obtained. Conclusion: Ultrasonography with contrast enhancement may be a good alternative non-invasive method for assessing the efficacy of conservative therapy in patients with UC, but it is necessary to continue the study on a larger sample to identify the relationship between the other parameters and validate this technique.

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Full text is published :
Khalif I.L., Shapina M.V.,Orlova L.P., Evgrafov P.G.ULCERATIVE COLITIS TREATMENT EFFICIENCY ASSESSED BY ULTRASONOGRAPHY WITH CONTRAST ENHANCEMENT. Experimental and Clinical Gastroenterology Journal. 2018;153(05):32-37
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1. FSBEI Novosibirsk State Medical University of Ministry of Health of the Russian Federation (Novosibirsk, Russian Federation)
2. FSBI Novosibirsk Tuberculosis Research Institute of Ministry of Health of the Russian Federation (Novosibirsk, Russian Federation)

Keywords:abdominal tuberculosis, intestinal tuberculosis, mesenterial lymph node tuberculosis, disseminated pulmonary tuberculosis, HIV-infection, risk groups, diagnosis of abdominal tuberculosis

Abstract:The goal of the study is determining of the prevalence and morbidity of tuberculosis (TB) lesions in organs of abdominal cavity in pulmonary TB patients during the period of unfavorable epidemic situation (2006-2008 years) and the period of reduction in TB incidence (2015-2017 years). Clinical records of patients with combined pulmonary and abdominal tuberculosis that underwent treatment in TB hospital during the periods of 2006-2008 and 2015-2017 years were analyzed. Despite a reduction in overall TB incidence from 2006-2008 to 2015-2017 years, the proportion of pulmonary TB patients with abdominal tuberculosis, treated in TB hospital, increased for this period almost twice (1,95±0,3% vs 3,5±0,6%). Abdominal tuberculosis is the result of generalization of TB. Abdominal TB was registered more often in 2015-2017 than in 2006-2008 (75,9±7,9% vs 20,5±6,1%, p=0,00001, Fischer exact test) and was less frequently associated with lung tissue destruction (27,4 and 81,8%, respectively, p=0,00001, Fischer exact test). Detection of Mycobacterium tuberculosis in feces increase significantly an efficiency of diagnosis of TB colitis (especially in patients without clinical intestinal symptoms).

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Full text is published :
Poddubnaya L.V.,Zyryanova T.V.,Petrenko T.I.,Kononenko V.G. et al. ABDOMINAL TUBERCULOSIS IN PULMONARY TUBERCULOSIS PATIENTS. Experimental and Clinical Gastroenterology Journal. 2018;153(05):38-43
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1. FSBI “SFSCC FMBA of Russia” (Novosibirsk, Russian Federation)
2. SBEI HPE “Siberian State medical University of Minzdrav of Russia” (Novosibirsk, Russian Federation)

Keywords:irritable bowel syndrome, psychovegetative status, drug-free rehabilitation, SMC-therapy, EHF-therapy

Abstract:Complex of rehabilitation measures at persons of young age with clinical signs of irritable bowel syndrome using SMC-therapy and EHF-therapy, which was prescribed based on the type of functional disorders, contributes to a significant improvement of clinical and laboratory parameters in the form of relief of complaints and symptoms against the background of increasing adaptive capacity and normalization of psycho-autonomic status. The direct effectiveness of non-pharmacological rehabilitation amounted to 94.4% of constipation and 93.3% in diarrhea. The obtained results were associated with the peculiarities of rehabilitation facilities (χ2=to 34.94; p=0,004; r=0,45;), while the maximum contribution to the total statistics Pearson correlations were “significant improvements” and “improvements” with the rehabilitation complexes, including SMT-therapy and EHF-therapy (with diarrhea - χ2=3,59 and χ2=1,51; constipation - χ2=2,85 and χ2=1,37, respectively).

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Full text is published :
Poddubnaya O.A.,Privalova N.I. THE EFFICIENCY OF THE COMPLEX NON-DRUG REHABILITATION OF YOUNG PATIENTS WITH IRRITABLE BOWEL SYNDROME. Experimental and Clinical Gastroenterology Journal. 2018;153(05):44-51
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1. Scientific Сentre for Family Health and Human Reproduction Problems (Moscow, Russian Federation)

Keywords:men, women, eubiosis, intestinal dysbiosis

Abstract:Aims. Analyze the structure of intestinal dysbiosis in adults, taking into account gender differences. Materials and methods: in the period from 2013 to 2017 the coprological material from 572 patients aged from 22 to 74 years (134 men and 438 women) was studied. Results: Long-term studies have shown that more than 90% of the adult population observed dysbiotic changes of varying severity. The structure was dominated by mild and moderate disorders (I and II degree of dysbiosis). In women, on average, more often than in men, there were dysbiotic changes of I degree (in 67,1±2,2% and 58,2± 4,2%, respectively), the proportion of men with dysbiotic disorders of II and III severity was higher than in women. It was revealed that in men in 2017 there was a decrease in the frequency of registration of the II degree of dysbiosis to 10,5± 7,0%, but the number of severe dysbiotic disorders of the III degree increased (to 10,6±7,0%) (p<0,05). In 2015 and 2017 men’s and, in 2016, the women there was not a single case eubioz intestine. This circumstance can be connected both with decrease in a standard of living, and with the ecological pressure on an organism of negative factors of environment continuing in our territory.

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Full text is published :
Nemchenko U. M., Ivanova E. I., Grigorova E.V, Voropaeva N. M. et al. CHANGES IN THE STRUCTURE OF THE DYSBIOSIS OF THE INTESTINE IN THE ADULT POPULATION FOR LONG-TERM OBSERVATION PERIOD. Experimental and Clinical Gastroenterology Journal. 2018;153(05):52-56
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1. Moscow clinical scientific and practical center. A. I. Loginov (Moscow, Russian Federation)

Keywords:constipation, dolichosigma, electromyography, motor bowel function

Abstract:Irritable bowel syndrome (IBS) is a functional bowel disease in which recurrent abdominal pain is associated with defecation or a change in bowel function. Despite the numerous works devoted to the study of mechanisms of IBS development, intestinal motility in this disease has not been studied enough. The goal is to identify features of the motor function of the colon and small intestine in irritable bowel syndrome with constipation (IBS-C) and dolichosigma. Material and methods. The method of electromyography was used to study 84 patients with IBS-C in comparison with a group of 25 patients with dolichosigma and a group of 35 patients with functional constipation. The frequency of slow waves of the small and large intestine (patients with functional constipation) and left colon (patients with IBS-C and dolichosigma) was measured by the hardware-software complex “Conan-M”. Results and discussion. In electromyography patients with IBS-C showed a decrease in the frequency of slow waves to 5.4±0.2 V min (10%, p<0.05), the amplitude - to 0.09±0001 mV (46.6% p<0.05). The increase of spike activity was revealed: frequency 2.8±0.18 (40% p<0.05)., amplitude-0.13±0.02 mV (13.4% p<0.05). In patients with dolichosigma on electromyography revealed a decrease in the frequency of slow waves to 4.8±0.15 per minute (20%, p<0.05), the amplitude - to 0.07±0011 mV (53.3% p<0.05) with minimal spike activity. IBS-W is characterized by hypomotor dyskinesia of the left parts with pronounced spastic contractions of the smooth muscles of the circular layer of the intestine due to, perhaps, the activity of stimulating serotoninergic effects on the spastic activity of the circular muscle layer or inhibitory adrenergic neurons of the intermuscular (auerbachian) nerve plexus. When dolichosigma identified hypomotor dyskinesia of the left departments of the colon due to stretching of the mechanoreceptors in the afferent neurons of the intramural reflex arcs.

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Full text is published :
Lychkova A. E., Ruchkina I. N., Poleva N. I., Puzikov A. M. MOTOR FUNCTION OF THE INTESTINE IN IRRITABLE BOWEL SYNDROME WITH CONSTIPATION. Experimental and Clinical Gastroenterology Journal. 2018;153(05):57-60
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1. Acad. E. A. Wagner Perm State Medical University (Perm, Russian Federation)

Keywords:S. aureus, C. albicans. colonic biotope, antagonism, microbiota

Abstract:Intestinal microflora is considered as the main determinant of human health and disease. There is evidence that changes in the relationship between the composition of intestinal microbiota and the human body can be accompanied by the development of allergic and immunopathological conditions, as well as a number of diseases. The aim of the investigation was to assess changes in the lumen of the microbial composition of the large intestine in the case of isolation of S. aureus and C. albicans. Results. In the case of the presence of S. aureus a decrease in the frequency of isolation of typical variants of E. coli. This activity of S. aureus is suppressed by Candida, when the occurrence of E. coli corresponds to the level of the control group. In the presence of C. albicans alone, there is a slight decrease in the allocation of typical E. coli variants. Conclusion. The presence of C. albicans eliminates S. aureus antagonistic relationship with E. coli. On the other hand, the presence of S. aureus and C. albicans both individually and jointly contribute to the development of atypical variants of E. coli. Thus, the studies have shown that the detection of S. aureus and/or C. albicans in the large cell biotope can significantly change the composition of the microbiota, which may affect the functional activity of the colon mucosa and the whole human body.

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Full text is published :
Godovalov A. P., Antonyan A. A., Gorbunova E. A. PECULIARITIES OF MICROFLORA OF THE COLONIC BIOTOPE COLONIZED BY S. AUREUS AND C. ALBICANS. Experimental and Clinical Gastroenterology Journal. 2018;153(05):61-65
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1. The Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia (Moscow, Russian Federation)

Keywords:microbiota, gerontology, gas chromatography-mass spectrometry, microbial markers

Abstract:Purpose of research. To study the characteristics of the wall of the intestinal microbiota of elderly persons with multiple organ pathology. Materials and methods. 94 patients aged from 55 to 65 years with various somatic pathology were examined. Results. The study of mass spectrometry of microbial markers in blood plasma (near-wall microbiota) in elderly compared to young allowed to establish the following: total number of microbial markers reduced by 40%; good microbiota reduced by 46%; the proportion of opportunistic pathogenic bacteria significantly increased (older people 48%, and in young only 34%); the share of anaerobic microorganisms localized mainly in the large intestine has decreased; the relationship between individual representatives of the microflora has changed.

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Rodionov G. G., Shantyr I. I., Kolobova E. A., Svetkina E. V. FEATURES OF THE PARIETAL INTESTINAL MICROBIOTA OF THE ELDERLY MEN OF SAINT-PETERSBURG. Experimental and Clinical Gastroenterology Journal. 2018;153(05):66-72
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1. Federal research center “Krasnoyarsk scientific center” Siberian branch of the Russian Academy of Sciences Research Institute of Medical Problems of the North (Krasnoyarsk, Russian Federation)
2. Krasnoyarsk regional clinical cancer center named. A. I. Kryzhanovsky (Krasnoyarsk, Russian Federation)

Keywords:neutrophilic granulocytes; chemiluminescence; rectal cancer

Abstract:The purpose of our work is to study the spontaneous and induced chemiluminescent activity of neutrophilic granulocytes (NG) in patients with rectal cancer in dynamics. Materials and methods. The study included 56 patients with rectal cancer. At the first stage there were 9 people, in the II stage 19 people, on the III 17 and at the IV stage 11 patients. The object of study are neutrophilic granulocytes isolated from venous blood. The control group consisted of 112 healthy blood donors. The intensity of synthesis of active oxygen species of NG was determined by the method of chemiluminescence analysis. Results. The study showed a significant increase in the intensity of spontaneous and induced luminescence and the area under the curve of spontaneous chemiluminescence in the II-IV stages of the disease. When studying zymosan-induced chemiluminescence, the area under the curve is increased in all groups of patients, while in patients at stage IV the total production of reactive oxygen species (ROS) is significantly higher than in stages I and II. On the 7th day after the surgical treatment, the intensity of spontaneous chemiluminescence remains elevated only in patients at the IV stage of the rectal cancer. The intensity of induced chemiluminescence and the area under the curve of spontaneous and induced luminescence are increased at all stages of the disease with respect to control. The activation index was increased in patients at all stages of with rectal cancer both before and after surgery. Сonclusion. As a result of the study, an increase in the intensity of ROS synthesis in patients with rectal cancer was revealed. The total production of reactive oxygen species is higher in the late stage of the disease. An increase in the activation index of neutrophils in all stages of the RPC characterizes the metabolic capabilities of neutrophils to the enhanced synthesis of ROS in functional activation.

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Full text is published :
Smirnova O. V., Kasparov E. V., Perepechay Ya.I., Versenev A. A., Laletin I. A. THE FEATURES OF NONSPECIFIC IMMUNITY IN THE PROGRESSION OF COLORECTAL CANCER. Experimental and Clinical Gastroenterology Journal. 2018;153(05):73-77
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1. Federal state budgetary institution “national medical and surgical Center. N. And. Pirogov” Ministry of health of the Russian Federation in Moscow (Moscow, Russian Federation)
2. State budget educational institution of higher professional education “Moscow State medical and dental University. A. I. Evdokimov” (Moscow, Russian Federation)

Keywords:Yersinia enterocolitica, infliximab, adalimumab, Crohn’s disease, immunosuppressive therapy, mesenchymal stromal bone marrow cells, ulcerative colitis

Abstract:In patients with ulcerative colitis and Crohn’s disease long-term appointment of biological therapy in combination with GCS/CT increases the frequency of development of yersiniosis infection, which worsens the clinical course of the disease and increases the period of exacerbation. Yersiniosis in inflammatory bowel diseases (IBD), often accompanied by extra-intestinal manifestations of the disease (polyarthritis, erythema nodosa and uveitis). However, the question remains: is yersiniosis a cause of the development of an extra-intestinal manifestation or a sign of reactivation of opportunistic infections against the background of immunosuppressive therapy or an etiological factor of inflammatory bowel diseases? This issue requires further research. According to the literature with inflammatory bowel diseases among the extraintestinal manifestations predominate articular lesions to 42.7% [36]. Although yersiniosis plays a leading role in the pathogenesis of arthritis, clinical and diagnostic studies on yersiniosis were not carried out in IBD. Until now, there are no clear diagnostic and prognostic criteria for the development of adverse outcomes of yersiniosis, in connection with which clinicians do not conduct examinations for the presence of yersiniosis.

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Full text is published :
Sagynbaeva V. E., Golovanova E. V., Lazebnik L. B., Fighters S. A. YERSINIOSIS - THE REASON FOR THE DEVELOPMENT OF EXTRAINTESTINAL INFLAMMATORY BOWEL DISEASE, OR SYMPTOM OF REACTIVATION OF OPPORTUNISTIC INFECTIONS AGAINST THE BACKGROUND OF BIOLOGICAL THERAPY?. Experimental and Clinical Gastroenterology Journal. 2018;153(05):78-85
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1. State budgetary institution of high professional education “Moscow State University of Medicine and Dentistry named after A. I. Evdokimov” of the Ministry of Healthcare of the Russian Federation, Department of outpatient therapy (Moscow, Russian Federation)

Keywords:diverticular disease of the colon conservative therapy, antispasmodics, probiotics, intestinal antiseptics, butyrat

Abstract:The article presents the results of long-term monitoring of patients diverticular disease of the colon to study the effectiveness of different groups of medicines on the basis of which the proposed rational scheme of treatment according to age of patients, duration of anamnesis of disease and presence of comorbidities. In the period 2003-2016 the study included 396 patients aged 24 to 89 years (mean age 61,4±9.3 years) with instrumental confirmed diverticula of the colon. A big problem in the elderly is polymorbidity and, as a result, forced polypragmasia. In our study of 295 patients over 60 years of age at the time of inclusion in the study had 4.7-5.2 diseases per 1 person. The most common were systemic atherosclerosis, constipation and hyperlipidemia. Constipation was detected in 193 patients (65.4%), hyperlipidemia - in 170 (57.6%). Drugs psillium and lactulose have long been widely known as effective laxatives with prebiotic properties and safe with long-term use. In our study, 120 patients took psyllium and 116-lactulose. For two years, we estimated the number of relapses of NSC (resumption of pain and symptoms of intestinal dyspepsia). It was found that in the psyllium group during the two-year follow-up period the number of recurrences was 20% less than in the lactulose group. Summary. The most effective drug for relief of abdominal pain syndrome in patients with diverticular disease of the colon in all age groups is trimebutin In the treatment of symptomatic diverticular disease of the colon in patients younger than 45 years, it is advisable to prescribe intestinal antiseptics (rifaximin, nifuroxazide) for at least 7 days from the moment of treatment. Patients over 75 years of age need normalization of the stool with the predominant use of laxatives with prebiotic action. When combined with diverticular disease and constipation hyperlipidemia drug of choice is psyllium (mukofalk, vibrolux). At presence at patients of senile age concomitant cardiovascular pathology with the purpose of correction of possible ischemia of the bowel wall at the microscopic level should be provided citoprotected drug of butyric acid.

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Boytsov S. A., Lazebnik L. B., Levchenko S. V., Komissarenko I. A. RATIONAL PHARMACOTHERAPY OF THE SYMPTOMATIC UNCOMPLICATED COLON DIVERTICULAR DISEASE. Experimental and Clinical Gastroenterology Journal. 2018;153(05):86-92
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