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У вас в руках свежий номер журнала «Экспериментальная и клиническая гастроэнтерология», посвященный актуальным и нерешенным вопросам в гастроэнтерологии и адресованный широкому кругу врачей разных специальностей. Открывает номер передовая статья в которой описаны оригинальные исследования по проблемам коморбидности у современных пациентов. Так, статья Ткаченко Е. И., Орешко Л. С., Соловьева Е. А., Шабанова А. А., Журавлева М. С. посвящена ассоциации наиболее частых, генетически детерминированных заболеваний: целиакии и дисплазии соединительной ткани В разделе «клиническая гастроэнтерология» представлены: «Роль микробиоты кишечника в развитии ожирения в возрастном аспекте» (авторы М. Ю. Щербакова, А. В. Власова, Т. А. Роживанова), статья продолжает серию публикаций, о роли микробиоты при различных соматических заболеваниях. В актуальном обзоре содержатся сведения о популяционном и видом составе микроорганизмов у пациентов различного возраста, страдающих ожирением, представлен анализ публикаций о механизмах развития метаболического синдрома с учетом вклада кишечника и его значимой составляющей — микробиоты в каскад патологических реакций, приводящих к развитию ожирения. Приводятся данные о результатах комплексного лечения ожирения с включением пробиотиков. Работа Гриценко Т. А., Давыдкина И. Л., Осадчук А. М., Косталановой Ю. В. об особенностях ГЭРБ у пациентов с гемобластозами, получающих полихимиотерапию. Авторы отметили рефрактерность ГЭРБ к терапии ИПП, связанную с нарушениями процессов пролиферации и дифференцировки эпителоцитов на фоне агрессивной полихимиотерапии. Несомненный интерес и клиническую значимость представляет работа Л. П. Розумбаевой, И. В. Козловой, А. П. Быковой о коморбидности патологии печени, билиарного тракта и псориаза. Полученные авторами результаты необходимо учитывать при оценке эффективности и безопасности базисной терапии дерматоза. Ассоциация двух функциональных заболеваний — синдром раздраженного кишечника и функциональная диспепсия с анализом механизмов развития такой коморбидности с позиций нарушений нейрогуморальной регуляции описана в статье М. А. Осадчук, В. О. Бурдиной. Оригинальное исследование А. А. Марковой, Е. И. Кашкиной, Г. Н. Масляковой посвящено иммуногистохимической диагностике нарушений пролиферации кишечного эпителия у пациентов с язвенным колитом в сопоставлении с длительностью заболевания и активностью патологического процесса в кишке. В разделе «Хирургические аспекты гастроэнтерологии» публикуется статья О. И. Кита, Е. М. Франциянц с соавт., посвященная анализу тканевых факторов регуляции неоангиогенеза и фибринолиза при аденокарциноме прямой кишки, имеющих значимую роль в канцерогенезе. В разделе «Экспериментальная гастроэнтерология» — статья Жеребятьева А. С., Камышного А. М. о региональных различиях распределения популяции иммунных клеток в кишечнике, во многом определяющих специфику патологического процесса в эксперименте. В соответствующем разделе номера — две актуальные лекции, посвященные эозинофильному эзофагиту. В последнее десятилетие число публикаций по этой проблеме в зарубежной литературе возросло почти в 200 раз. Объединенными усилиями гастроэнтерологов, аллергологов и патоморфологов созданы международные согласительные и национальные документы, в которых рассмотрены современные клинико-диагностические критерии эозинофильного эзофагита. У российских пациентов разного возраста эозинофильный эзофагит диагностируют редко. Вниманию читателей представлены две взаимно дополняющие лекции «Особенности диагностики эозинофильного эзофагита» (авторы И. С. Садиков, Д. Ш. Мачарадзе, С. Г. Хомерики) и «Эозинофильный эзофагит у взрослых: особенности диетотерапии» (авторы И. В. Козлова, А. Л. Пахомова). Указанные публикации восполняют дефицит сведений по клиническим особенностям, методам диагностики и немедикаментозного лечения этой патологии. Всегда интересна и полезна врачам рубрика журнала «Случаи из практики». В этом номере представлены два клинических наблюдения. Материал Бабаевой А. И. с соавт. посвящен гемангиомам печени у ревматологических пациентов. Обобщая накопленный опыт, авторы трактуют выявленные при УЗИ гемангиомы печени у пациентов с ревматоидным артритом как системное проявление заболевания, отмечая при этом, что при остеоартрозе гемангиомы печени встречаются достоверно реже. В статье А. Ю. Рябовой с соавт. представлен случай острого холецистита под маской острого инфаркта миокарда. Данное клиническое наблюдение еще раз напоминает практикующим врачам, что холецисто-кардиальный синдром, впервые описанный С. П. Боткиным, часто встречается, но не всегда своевременно распознается у полиморбидных пациентов. В разделе «Материалы конференции» опубликованы материалы выездного пленума НОГР «Болезни органов пищеварения в 21 веке: мультидисциплинарный подход. Гастроэнтерология в возрастном аспекте». Пленум организован совместными усилиями научного общества гастроэнтерологов России и Саратовским государственным медицинским университетом им. В. И. Разумовского МЗ РФ. Саратовский государственный медицинский университет им. В. И. Разумовского — один из старейших медицинских вузов нашей страны. Он был основан более 100 лет назад — в 1909 году. За это время СГМУ преодолел огромный путь от единственного в составе университета факультета до солидного учебного заведения со сложившимися традициями, уникальным медицинским потенциалом и накопленным научным опытом. В университете на протяжении многих лет развивается, обогащаясь новыми идеями и результатами клинических наблюдений, научная гастроэнтерологическая школа, которую основали и продолжают развивать известные хирурги, терапевты, педиатры. В разделе история медицины — яркая и интересная статья об образцовой системе здравоохранения, созданной первым наркомом здравоохранения СССР Николаем Александровичем Семашко. В феврале 2015 года исполняется 80 лет со дня рождения профессора кафедры факультетской терапии Тверской государственной медицинской академии, видного ученого, заслуженного врача России, доктора медицинских наук, профессора Вячеслава Васильевича Чернина. От всего сердца Научное общество гастроэнтерологов России, редакция журнала и коллеги поздравляют Вячеслава Васильевича со славным юбилеем, желают здоровья, радости, интересной и плодотворной работы, творческих побед!
Ответственный за выпуск редактор,
заведующая кафедрой терапии педиатрического и стоматологического факультетов ГБОУ ВПО «Саратовский государственный медицинский университет им. В. И. Разумовского» МЗ РФ доктор медицинских наук, профессор |
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И. В. Козлова | |
Keywords: cancer, gastrointestinal tract, incidence, risk factors, long-term trends
Abstract:A long-term monitoring of the incidence of digestive cancers was carried out according to the population cancer register in Novosibirsk in 1988–2012. Diff erent trends were established in the cancer incidence of indi vidual localizations: from a two-fold decrease in indicators for stomach cancer to a one-thir d increase in colorectal cancer. Cancer risk factors of diff e- rent localizations are discussed.
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Reshetnikov O.V., Openko T. G., Kurilovich S. A. EPIDEMIOLOGY OF DIGESTIVE CANCERS IN NOVOSIBIRSK OVER QUARTER OF CENTURY. Experimental and Clinical Gastroenterology Journal. 2018;155(07):03-08
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Keywords: CA-125, heart failure, ascites
Abstract:Purpose of the study . Assessment of the oncogene CA-125 as a laboratory parameter having non-gynecological genesis on the example of two clinical observations. Materials and methods . A literature review on the clinical signifi cance of the CA-125 oncogene and a description of two clinical observations Results . Oncogene CA-125 is considered as a laboratory indicator of gynecological oncology. The article presents the re- sults of studies of elevated levels of CA-125 in patients wi thout gynecological diseases. The authors give two observations of patients with anasarca and ascites and elevated level of CA-125. Сonclusion . The clinical observations presented by us indicate a vari ety of non-gynecological causes of an increase in the level of the oncoprotein CA-125.
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Osipenko M. F., Zhuk E. A., Sokolova T. M., Makarov K. Yu., Drobysheva V. P. Increased level of oncogene CA-125 in the practi ce of a general practitioner. . Experimental and Clinical Gastroenterology Journal. 2018;155(07):09-13
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Keywords: GERD, young age, night refl ux, obesity, adiponectin
Abstract:Aims : to investigate the eff ect of acidic night refl ux and seru m adiponectin level on the development of gastroesophageal refl ux disease (GERD) among young patients. Objectives : to compare the clinical manifestatio ns of GERD, the pH-metry data the frequency of pathological nocturnal acid refl ux and serum adiponectin level in young people with normal and overweight. Materials and methods : the study included 62 patients with GERD at the age from 21–44 years. The study group (SG) included 31 patients with a BMI of> 25 kg / m 2 and the group of clinical comparison (CCG) included 31 patients with GERD with a BMI
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Kozlova N. M., Kalinovskay I. Yu., Sayfutdinov R. G., Ryzhkova O. V., Fedorova S. O. Role of night refl uxes and serum adipone ctin level in develop- ment of the gastroesophageal refl ux disease in young patients with overweight. Experimental and Clinical Gastroenterology Journal. 2018;155(07):14-19
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Keywords: Helicobacter pylori, CagA antigen, population, prevalence.
Abstract:Aim . To study 20-year trends in the prevalence of antibodies to Helicobacter pylori and CagA antigen in the Novosibirsk population. Methods. Within the framework of population-bas ed studies over 1994–2015 random representative samples of adolescents and adults aged 25–69 years of both sexes in cluding 1,438 citizens (754 adults and 684 schoolchildren) were studied. Results. In adults, the infection rates of Helicobacter pylori did not change signifi cantly. In adolescents, the prevalence slightly decreased, but the dynamics of decline we re much less pronounced than in Eastern and, especially, Western Europe. Cytotoxic strains (CagA) were identifi ed approximately at the same frequency during this time. Conclusion. Interventions are needed to improve the sanitary and hygienic control of the quality of food and water.
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Reshetnikov O. V., Krotov S. A., Kurilovich S. A., Denisova D. V., Malyutina S. K. Prevalence of Helicobacter pylori in population-based studies in Novosibirsk (1994–2015) Experimental and Clinical Gastroenterology. 2018;155(07):20-24
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Keywords: diet, food behavior, inhibitors of vitamin-K-epoxide reductase, readiness for modifi cation, commitment
Abstract:The objective of this study was to determine whether feeding behavior and compliance with its modifi cation are diff erent between healthy respondents and those taking or potentially requiring of inhibitors of vitamin-K-epoxide reductase, con- sidering the geographical specifi city of diet. Material and methods . In open multicenter studies 196 respondents’ (88 men, 108 women) food preferences were assessed using questionnaires by NA Nikolaev (2015). Quantitati ve evaluation of compliance with lifestyle modifi cation was studied with questionnaire. Results . There were no signifi cant diff erences in consuming food either increasing (37,0 ± 19,5 points against 37,3 ± 17,98 points; Wald-Wolfowitz (Z), p = 0.16) or decreasing (62,2 ± 26,3 points against 63,4 ± 23,8 points; Wald-Wolfowitz (Z), p = 0.95) the effi ciency of inhibitors of vitamin-K-epoxide reductas e between the studied categories of respondents. The absence of diff erences persisted considering the geographical specifi city of diet (104,9 ± 45,6 points vs. 100,7 ± 43,9 points; Wald-Wolfowitz (Z), p = 0.78). There was no connection betwee n compliance with lifestyle modi fi cation and the actual diet modifi cation in patients taking inhibitors of vitamin-K-epoxide reductase. Conclusions . Doctors’ recommendations of modifying feeding behavior are shown to be ineff ective for patients taking inhibitors of vitamin-K-epoxide reductase. This may be an in dependent risk factor for complications either of proper treatment with these drugs or of underlying disease. Further clinical studies of patients’ compliance with feeding behavior modifi cation are required.
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Skirdenko Yu.P., Nikolayev N. A., Livzan M. A., Krajcer A. P., Vasil’eva E.O., Zemljanov A. V., Orudzhova L. A. K., Ul’bashev D. S. Compelled feeding behavior: are patients ready to follow our recommendations? Experimental and Clinical Gastroenterology. 2018;155(7): 25–29.
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Keywords: cholelithiasis, postcholecystectomy syndrome, gastrointestinal symptoms after surgical treatment of gallstone disease
Abstract:Study of the conducted studies with the participation of ch ildren and adolescents during the 10-year observation of patients with cholelithiasis (CL). Materials and methods : The work is a fragment of a 10-year follow-up of patients with CL. Two groups were formed: the 1st group (1) (n = 113) patients with cholecystectomy who underwent cholecystectomy (CE) and were prospectively observed for 10 years; 2-nd- (2) (n = 92) — unoperated patients with SCI, a prescription of at least 10 years, the symptoms of which were retrospectively analyzed. Results : Heartburn frequency for the 10-year period increased in the 1st group by 47.8%, in the group (2) by 22.8% (p = 0.005). In the group (1), with the initially symptomatic course, the maximum increased — by 66.3% (p <0.001) and by 45.8% with the initially asymptomatic fl ow (p = 0. 001). In the group (2), in patients with initially asymptomatic course increased by 40% (p = 0.003). The symptom of «bitterness in the mouth» began to be detected more often in the fi rst group by 22.1% (p <0.001), almost independently of the or iginal version of the fl ow. The frequency of the symptom of «fatty food intoler- ance» (NFI) increased in the 2 nd group by 15.2% (p = 0.006), mainly due to the grou p with the initially symptomatic course. The frequency of diarrhea in the 1st group increased by 37.3% (p = 0.046), especially signifi cant in the group with baseline asymptomatic course 33.3% (p = 0.005).The frequency of consti pation increased in the 1st group by 25.6% (p <0.001), pre- dominantly in the symptomatic group with a 27% decrease ( p <0.001).The incidence of bitter mouth symptoms, diarrhea, constipation in group (2) has changed statistically insignifi cantly. Conclusions : During the 10-year follow-up of patients with CL, the frequency of symptoms increased, especially signifi - cantly: heartburn, bitterness in the mouth, diarrhea, constipation in patients after CE. Symptoms of heartburn and constipa- tion began to occur more often in groups with the initially symptomatic course. The symptom of NFI began to be detected more often in the group of unoperated patients with CL.
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Makarova Y. V., Osipenko M. F., Litvinova N. V., Voloshina N. B. Gastrointestinal symptoms in patients with gilt-patient dise ase in the dynamics of 10-year observation. Experimental and Clinical Gastroenterology. 2018;155(7): 30–36.
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Keywords: Cytokines of blood serum, excretory profi le of porphyrin metabolism, non-alcoholic fatty liver disease
Abstract:Purpose of the study . The study of the cytokine spectrum of blood seru m and its relationship with the index of porphyrin metabolism. Materials and methods . 84 patients (22 women and 62 men) aged from 26 to 69 years (mean age 49.6 ± 1.3 years) were examined. The cytokine spectrum of TNF-α, IL-1β, IL-1Ra, IL -6, IL-8, IL-10 and excretory porphyrins: δ-aminolevulinic acid, porphobilinogen, uroporphyrin, and coproporphyrin were determined by special methods. Results . In 59 people (70.2%), elevated concentrations of cyto kines in the serum were recorded. The deviations from the control values for IL-1Ra (39 people, 66.1%) and IL-6 (45 pe rsons, 76.3%) were recorded more often. Violations in the exchange of porphyrins were found in 58 patients (69.0%). On the totality of the disturbances, biochemical syndromes have been identifi ed: an increase in porphyrin precursors, uroporphyrinuria, coproporphyrinuria, urocoppororphyrinuria, combined disorders. A direct correlation was established between IL-6 (r = +0.409), IL-1Ra (r = + 0.478), IL-10 (r = + 0.456) with uroporphyrin fraction, as well as IL-1Ra and δ-pminolevulinic acid (r = + 0.501). The increase in porphyrin precursors and fractions is signifi cantly more often detected with violatio ns of the cytokine spectrum (χ2 = 5.6, at the critical value p = 3.8, p <0.05). Conclusion . Violations of the cytokine spectrum and porphyrin me tabolism are recorded in most patients with NAFLD. The reason for their occurrence at the moment rema ins unclear, which requir es additional research.
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Krivosheev A. B., Autenshlyus A. I., Boyko K. Yu., Mikhailova E. S., Ryzhikova S. L., Druzhinina Yu.G., Коndratovа M. A. The cytokine and porphy- rine spectrums in patients with non-alcoholic fatty lever disease. Experimental and Clinical Gastroenterology. 2018;155(7): 37– 42.
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Keywords: non-alcoholic fatty liver disease, fi brosis, prognosis
Abstract:Objective : To increase the eff ectiveness of prediction and diagnosis of fi brosis in patients with non-alcoholic fatty liver disease. Materials and Methods : We conducted an open-type case-control study involving 149 patients with NAFLD and a diff erent stage of fi brosis determined with elastometry and hi stological examination of the liver biopsy specimen (group 1 — without signs of liver fi brosis (n = 40), group 2 — fi brosis 1 (n = 43), group 3–2 (n = 34) and group 4–3 stages (n = 32)). General clinical and laboratory methods of examination were co nducted. In addition, noninvasive markers of fi brosis in the blood serum were studied: the concentration of insulin, leptin, adiponectin, matrix metalloproteinase-9 (MMP-9) and its inhibitors — tissue inhibitor of matrix metalloproteinase-1 and 2 (TIMP-1, TIMP-2). The polymorphism PNPLA3 148M / I (rs738409) was studied by the PCR method as a potential marker of the progression of liver fi brosis in NAFLD. Results : We identifi ed clinical and laboratory signs demonstratin g informativeness in the form ation of progressive stages of fi brosis. It was studied that patients with NAFLD have hy perleptiemia and hyperinsulinemia. Evaluation of various types of leptinresistance allows to diff erentiate patients of high ri sk group for the progression of fi brosis. The nature of fat tiss ue distribution (abdominal obesity) is a highly informative criter ia of high-stage liver fi brosis. Polymorphism of the PNPLA3 gene 148M/I has prognostic signifi cance in the formation and progression of liver fi brosis in patients with NAFLD. The level of leptin, its soluble receptor in the serum, the bioche mical activity of the disease (N ASH), the waist are clinical and laboratory markers for the format ion and progression of liver fi br osis in patients with NAFLD. This markers were included in the mathematical model. Conclusion : Complex quantitative analysis of clinical, instrumental and laboratory indicators allows predicting the forma- tion and progression of liver fi brosis in individuals with non-alcoholic fatty disease.
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Krolevets T. S., Livzan M. A. Clinical and laboratory markers for predicting liver fi brosis in individuals with non-alcoholic fatty liver disease. Experimental and Clinical Gastroenterology. 2018;155(7): 43–51.
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Keywords: Elastometry, shear wave elastography, non-alcoholic fatt y liver disease, alcoholic liver disease, non-invasive diagnostic methods
Abstract:Diffi culties are known in the process of diff erential diagnosis between non-alcoholic fatty liver disease (NAFLD) and alco- holic liver disease (ALD), since the data of the main objective, laboratory and instrumental methods give similar results, not allowing to reliably speak about the etiology of the process. The most sensitive, specifi c, accurate, minimally invasive and accessible method for diagnosing chronic diff use liver diseases is the combined use of transient elastometry and shear wave elastography. The scientifi c novelty of the proposed work is the applicat ion of combined use of transient elastometry and shear wave elastography as a method of comparative evaluation of ALD (under conditions of abstinence more than 1 month) and NAFLD. The primary importance of abstinence in ALD therapy has been confi rmed. The aim of the study was to make a comparative evaluation of elastometric parameters of liver stiff ness in patients with NAFLD and in ALD under abstinence conditions. Materials and methods . The control group included 30 practically healthy persons with a body mass index (BMI) from 20–30 kg / m2, without pathological changes according to th e general, biochemical blood tests, when evaluating the echostructure of the abdominal cavity according to ultrasound , without any diseases of the liver and other organs in the history, voluntarily agreed to the study (group N). Two equal subgroups of subjects were included in the experimental group: 1. 30 patients with non-alcoholic fatty liver disease (F1), 60% of whom had a BMI> 25 kg / m2 and 40%
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Diomidova V. N., Tarasova L. V., Trukhan D. I., Tsyganova Yu. V. Comparative evaluation of elastometric indices of liver hard ness in alcoholic and non-alcoholic liver diseases. Experimental and Clinical Gastroenterology. 2018;155(7): 52–56.
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Keywords: E Infl ammatory bowel diseases, steatohepatosis, body mass index, platelets
Abstract:Purpose . To identify the factors associated with nonalcoholic steatohepatosis/steatohepatitis in patients with ulcerative colitis (UC) and Crohn’s disease (CD). Materials and methods . The study involved 47 patients diagnosed with ulcerative colitis (UC) or Crohn’s disease (CD) aged 24 to 64 years. The diagnosis of steatohepatosis/steatohepatitis was estimated according to the data of ultrasound diagnos- tic of liver. The study did not include alcohol abusers, as well as patients with viral and autoimmune hepatitis.Results . Patients with CD had a reliable association between plat elet count and the presence of nonalcoholic steatohepato- sis/steatohepatitis (median platelet count 287 × 10 9 /L, [192 × 10 9 /L; 420 × 10 9 /L] in patients with nonalcoholic steatohepatosis/ steatohepatitis and 250 × 10 9 /L, [180 × 10 9 /L; 379 × 10 9 /L] in patients without nonalcoholic steatohepatosis/steatohepatitis, p = 0.01). There were no signifi cant diff erences in the body ma ss index (BMI) and age between the groups with nonalcoholic steatohepatosis/steatohepatitis and without nonalcoholic stea tohepatosis/steatohepatitis among the patients with CD. Be- tween patients in the UC group with and without nonalcoholic steatohepatosis/steatohepatitis, signifi cant diff erences were found in the BMI (median BMI 28,7 kg/m 2 [26,2 kg/m2; 32,7 kg/m 2 ] and 20,9 kg/m 2 [18,4 kg/m 2 ; 22,7 kg/m 2 ], respectively, p=0.03), mean hospitalization rates (1,53 hospitalizations/year, [0,1 hospitalizations/year; 2,92 hospitalizations/year] and 0,83 hospitalizations/year, [0,36 hospitalizations/year; 1,46 hospitalizations/year] respecti vely, p=0,025) and age (median age 55,3 years [48 years; 62 years], and 30.4 years, [25 years; 35 years], respectively, р = 0,001). Conclusion . In patients with a CD factor associated with nonalcoholic steatohepatosis/steatohepatitis is the platelet count. In the case of the UC, steatohepatosis is associated with a high rate of hospitalization, BMI, and age.
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Krasner Ya. A., Osipenko M. F. Factors, associated with nonalcoholic steatohepatosis in patients with infl ammatory bowel dise ases. Experimen- tal and Clinical Gastroenterology. 2018;155(7): 57–61.
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Keywords: ulcerative colitis, treatment algorithm, budesonide-MMX
Abstract:The article outlines the basic principles of treatment of mi ld-to-moderate ulcerative colitis, according to Russian and international recommendations. Approaches to the treatment of ulcerative coliti s resistant to mesalamine therapy are considered. A review of clinical trials for the evaluation of the eff ectiveness of topical steroids is presented. The algorithm of patient selection for budesonide multimatrix treatment is proposed.
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Shchukina O. B., Kharitonov A. G. Budesonide MMX (cortiment) in treatment algorithm for mild-to-moderate ulcerative colitis. Experimental and Clinical Gastroenterology. 2018;155(7): 62–66. .
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Keywords: acute gastroenteritis, astroviruses, noroviruses, rotaviruses, clinical and epidemiological characteristics, poly- merase chain reaction, genotyping
Abstract:Objectives of the study : determination of clinical and epidemiological featur es of astrovirus infection in adult residents of Novosibirsk hospitalized with acute gastroenteritis (AGE), and genetic characteristics of the identifi ed isolates of astrovirus . Materials and methods : 1469 patients aged 15 to 91 years, hospitalized with a diagnosis of AGE in the period from January 2016 to February 2018 were examined. Along with the genera lly accepted methods of diagnosis, feces were examined by PCR for the presence of astroviruses, rotaviru ses o and noroviruses of the second genogroup. Results : Viral etiology of AGE was established in 311(21.2%) people. Astrovirus infection was diagnosed in 27 (1.8%), inferior in frequency to noroviruses (13.5%) and rotaviruses (5.7%). Astroviruses were detected throughout the year, mostly in patients under the age of 30 (88.9%). Half of the cases of astrovirus AGE (48.1%) showed consumption of seafood on the eve disease. Astrovirus AGE proceeded in a moderate form, characterized by fever from the fi rst day of the disease, in most patients with subfebrile (92.6%). In 81.4% of patients, watery diarrhea was observed, in the remaining 18.6% of patients the disease proceeded in the form of acute gastritis. Signifi cant diff erences of clinical sympto ms, indicators of a haemogram and coprogram in patients with astroviruses AGE from other vi ral OGE are not installed. Astroviruses of three genotypes, HAstV-4 (48%), HAstV-1 (44.5%) and HAstV-8 (7.5%) were circ ulating during the observation period. In 2016, HAstV-4 was dominant, and then HAstV-1 became dominant by the end of 2017. In two patients for the fi rst time in Novosibirsk, HAstV-8 was determined. Conclusion : The absence of specifi c manifestations of viral AGE of various etiologies, including astrovirus AGE, determines the need to introduce into clinical practice test systems for the verifi cation viral pathogens into clinical practice. The stud y of the genetic diversity of astroviruses reveals the change of the dominant geno type and is important for understanding the patterns of astrovirus circulation both in th e Novosibirsk region and in Russia as a whole.
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Kapustin D. V., Krasnova E. I., Zhirakovskaia E. V., Khokhlova N. I. et al. Clinico-epidemiological characteristic of astrovirus infection in hospitalized adults in Novos ibirsk. Experimental and Clinical Gastroenterology. 2018;155(7): 67–72.
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Keywords: Herbal Medicine. Hepatobiliary pathology. Standardized silymarin. Legalon
Abstract:Standardized original silymarin has a number of therapeutic eff ects: membrane stabilizing; antioxidant; metabolic; antiinfl am- matory; detoxifi cation; regenerative; antifi brotic; cytoprotective; reducing the severity of fatty liver disease; reduction of neutral fat in the liver; antiviral; immunomodulating; an tifi brotic; antiproliferative; normalizing the level of cholesterol in the blo od; antidepressant; diaphoretic; diuretic. The review pro vides data on clinical observations that testify to the effi cacy and safety of standardized silymarin in order to recommend its use for the prevention and treatment of a number of diseases of the hepa- tobiliary system. The hepatoprotector Legalon (MEDA, Germany) has a high degree of purifi cation according to Rottapharm | Madaus and meets the European standard for the content of silymarin in the preparation and is produced in accordance with GMP criteria. “Legalon” is a preparation, the quantitative det ermination of silymarin in which is carried out by a modern metho d of high-performance liquid chromatography. These factors allow us to treat Legalon as a “reference” preparation of silymarin.
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Kazyulin A. N., Shestakov V. A., Goncharenko A. Ju., Pavleeva E. E., Lubeznova I. Ju. Preparations of standardized silymarin. Mechanisms of action and prospects for clinical application. Experimental and Clinical Gastroenterology. 2018;155(7): 73–85.
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Keywords: stomach, morphology, hemoblastoses, cytostat ic therapy, clinical-hematological remission
Abstract:Purpose of the study . To study the morphofunctional state of the stomach in patients with hemoblastosis in the period of clinical-hematologic remission (GSR). Materials and methods . 164 patients with lymphomas were examined. The average number of courses of polychemo- therapy (PCT) is 9.4 + 0.9, the average duration of remission is 66.47 + 9.26 months. Comparison group — 72 patients with chronic HP-associated gastritis without hematologic disease. Results . During the period of GSR, the frequency of symptoms of gastric dyspepsia increased, with the pain syndrome being negligible, the frequency of pyloric Helicobacter (HP) de tection decreased signifi cantly . The relationship of HP and dysplasia of the epithelium of the gastric mucosa was noted, which was detected much more often than in patients with chronic HP-associated gastritis without hematological pathol ogy (OR = 319, (95% CI- (20.06–5073.5, p <0.0001), which suggests more a high risk of developing gastric cancer in patients with hemoblastosis in the GSR period. Сonclusion . Morphological changes in the stomach, including ulce rogenic and procancerogenic (erosion, atrophy, dyspla- sia) in patients with hematological diseases in the period of clinical and hematological remission are more frequent and expressed more than before treatment.
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Soldatova G. S., Ageeva T. A., Pospelova T. I., Kurilovich S. A., Kovynev I. B. Morphofunctional state of stomach in patients with haematological malignancies in the period of clinical and haematological remission. Experimental and Clinical Gastroenterology. 2018;155(7): 86–90.
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Keywords: chronic diff usion diseases of a liver, skin itch, mycoses, seborrhea, xerodermiya, teleangiektaziya, Campbell de Morgan’s spots
Abstract:The purpose of the work was to study the characteristics of clinic of dermatoses and registration frequency of “extrahe- patic signs”, accompanying diseases of liver and biliary tract, a diagnosis which has already been verifi ed before resorting to Dermatologists. Materials and methods : the work is based on the aggreg ated results of clinical, laborato ry and instrumental examinations conducted during the 10 years of 368 patients with diseases of the liver and biliary tract. Results : in structure of nosological forms of dermatoses at 368 pa tients with various forms of the chronic diff use diseases of a liver (CDDL) most often were registered: an itch of a skin — 86,4%, mycoses of feet — 77,1%, a seborrhea — 60,9%, a superfi cial candidiasis of a skin and mucous — 50,8%, a chromophytosis — 41,0%, a human papillomavirus infection — 40,8%, a xerodermia — 31,5%. The prevalence and intensity of clinical implications of dermatologic symptoms depend on the nature of pathological process in a li ver and testify to its gravity and activity. Conclusion : considering the high frequency of registration at CDDL of onikhopatiya, teleangiectasias, trichopathies, Camp- bell de Morgan’s spots and high informat ional content of a symptom of “the become empty veins”, extension of the register of extrahepatic “signs”, and change of this term on more denotated — dermatologic symptoms of a dermal syndrome of CDDL is represented expedient. The submitted data can be used both by gastroenterologists, and dermatologists.
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Pozdnyakova O. N., Nemchaninova O. B., Spitsyna A. V., Lykova S. G., Reshetnikova T. B., Evstropov A. N. Nosologic structure and features of dermatoses in patients with diseases of the liver and biliary tract. Experimental and Clinical Gastroenterology. 2018;155(7): 91–96.
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Keywords: tuberculosis, viral hepatitis C, pathogenetic therapy, “Remaxol”, hepatotropic eff ect
Abstract:Purpose of the study . The study of the eff ectiveness of the domestic hepatoprotector “Remaxol” in the complex treatment of patients with pulmonary tuberculosis in combination with CHC on the background of drug and alcoholic liver damage. Materials and methods . 108 patient histories with diagnosis of pulmonary tuberculosis were analyzed, in which chronic hepatitis C (CHC) was defi ned as a concomitant pathology. The average age of the patients was 36.4 ± 10.5 years. Patients of the fi rst group (n = 37) with a diagnosis of pulmonary tuberculosis in combination with CHC on the background of chronic alcohol intoxication received complex chemotherapy for tuberculosis, and as a pa thogenetic therapy, Remaxol was intravenously dripped 400 ml once a day for 12 days. The comparison group (n = 23) with the same diagnosis were on complex antituberculous chemotherapy in combination with pa thogenetic and symptomatic th erapy. Patients of the sec- ond group (n = 25) with a diagnosis of pulmonary tuberculosis against the background of CHC in combination with drug damage to the liver received a complex ch emotherapy for tuberculosis, as well as a Remaxol intravenous drip 400 ml once a day for 12 days in quality of pathogenet ic therapy. Patients of the control group (n = 23) with the same diagnosis were on complex antituberculous chemotherapy in combinat ion with pathogenetic and symptomatic therapy. Results . Infusion therapy with the drug “Remaxol” led to the rapid disappearance of dyspeptic disorders and pain syn- drome, a signifi cant decrease in cytolysis. The pronounced hepatotropic eff ect of the drug “Remaxol” was confi rmed by the rates of decrease in the average indices of ALT and total bilirubin. The conclusion . The use of hepatoprotector “Remaxol” in the complex treatment of patients with pulmonary tuberculosis with concomitant pathology of HCV on the background of al cohol and drug damage contributes to the improvement of the functional state of the liver.
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Pritulina Yu.G., Fil G. V., Kornienko S. V., Plohotnyuk N. V. New approaches to pathogenetic therapy of patients suff ering wi th tuberculosis and viral hepatitis C. Experimental and Clinical Gastroenterology. 2018;155(7): 97–101.
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Keywords: erythrocyte membranes, fatty acids, colorectal cancer, chromatography-mass spectrometry
Abstract:With the aim of highly sensitive chromatography- mass spectrom etry (Agilent 7000B, USA) with triple quadrupole analyzer and electron ionization source). Followed by statistical proc essing of measurement results the fatty acid composition of erythrocyte membranes in patients with colorectal cancer (6 3,2+9,4 years; 57 men, 43 women) of diff erent stages and localizations and persons of comparison group (61,7+7,5 years; 14 men, 10 women) was studied. The study revealed signifi cant diff erences in fatty acid (FA) levels in erythrocyte membrane phospholipids in patients with colorectal cancer associated with the stage of disease and in control group. Patients with colorectal cancer (CRC) com- pared to the control group was set to increase level of polyunsaturated fatty acids, mainly due to the omega-3 (including docosapentaenoic, docosahexaenoic), since the early stages of CRC (p<0.001–0.05) and a decrease in the level of saturated C14:0, C15:0, C17:0 (p
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Kruchinina M. V., Osipenko M. F., Kruchinin V. N., Prudnikova Ya.I., Gromov A. A., Shashkov M. V., Sokolova A. S. Feature of composition of fatty acids of erythrocyte membranes in patients with colorectal cancer of diff erent stages. Experimental and Clinical Gastroenterolo gy. 2018;155(7): 102–111.
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Keywords: chronic pancreatitis, osteopenia, cytokines, dysbiosis
Abstract:Purpose of the study . To investigate the frequency and some mechan isms of osteopenia in chronic pancreatitis. Materials and methods . In a study of 161 patients with chronic pancreatitis included. Bone-turnover markers was mea- sured: osteocalcin, β-CrossLaps, dual-energy X-ray absorptiom etry was performed. The analysis of the content cytokines IL-2, IL-6, IL-8 in colonic biopsies, composition of the gut microbiota. Results . Bone disorders is associated with an increase in cytoki nes in colon biopsy and the altered intestinal microbiota.
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Bykova A. P., Kozlova I. V., Tsareva E. E. Some mechanisms of osteopenia in chronic pancreatitis. Experimental and Clinical G astroenterology. 2018 ;155 ( 7 ) : 112 –117.
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Keywords: gallbladder diseases, cholelithiasis, gallbladder stones , X-ray microtomography, powder diff raction, electron microscopy, elemental analysis
Abstract:The aim . The study of morphology and composition of gallbladder st ones in the search for the po ssibility of diff erentiation of cholesterol type stones by X-ray tomography technique. Materials and methods . In-vitro investigation of gallstones were performed by the X-ray microtomography, X-ray phase analysis and electron microscopy methods. Results . The phase and element composition of gallstones were determined in our experiments. Cholesterol monohy- drate, cholesterol anhydrous and calcium carbonate were discov ered in the gallstones composition. 3D-distributions of linear attenuation coeffi cients of gallstones were obtained from X-ray microtomography measurements. The agreement of experimentally measured linear attenuation coeffi cients with the calculation based on tabular data for pure cholesterol is demonstrated. The cavities of diff erent morphological stru cture formed in the process of growth were found in the gallstones. On the basis of X-ray, electron microscopic and opti cal measurements the possibility of formation of thin layers of bilirubin on the surface of cholesterol stones is demonstrated.
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Asadchikov V. E., Buzmakov A. V., Voloshin A. E., Dyachkova I. G. et al. Studies of the morphology, phase and elemental composition of gall stones by instrumental methods. Experimental and Clinical Gastroenterology. 2018;155(7): 118–123.
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Keywords: rocuronium, obesity, body surface area
Abstract:The qualitative indicators of the neuromuscular block were compared and evaluated the heart rate variability, using a variety of the methods of dosing of rocuronium bromide in th e female patients with BMI more than 40 kg∙m-2, who were operated by laparoscopic cholelithiasis. It has been determined that the dosage of rocuronium bromide 30 mg / m² on the body surface area has an advantage over dosing on the ideal body weight, reduces sympathotony, the temporary ranges of the block duration and the need for re peated administration of rocuronium bromide. There was an expressed correlation between the amount of the entered rocuro nium and the stress index of heart rate in the calculation on the body surface area than on the body weight. It allows to suggest more security on the dosing on the surface area than on the weight.
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Shmakov A. N., Elizareva N. L., Kolosov A. N., Kokhno V. N., Loktin E. M. Dosage of rocurony to the surface of the body surfa ce of patients with morbid obesity. Experimental and Clinical Gastroenterology. 2018;155(7): 124–127.
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Keywords: ileocecal valve, endoscopic anatomy
Abstract:Objective : to improve the diagnosis and treatment of diseases of the ileocecal section. To improve the diagnosis and possible operative and endosc opic treatment of the ileocecal section, knowledge of normal anatomy and clinical anatomy is necessary. Much attent ion is paid to the state of the valvular apparatus of the gastrointestinal tract in normal and with various pathologies, an d in particular, the ileocecal section, both in adults and in children. The following intravital methods for diagnosing the condition of the ileocec al section are available: X-ray, endo- scopic, functional — peripheral computer electrogastroenterography. Conclusions . The presented literature data testify to the gr eat functional signifi cance of the ileocecal section both for the gas- trointestinal tract and for the entire human body as a whole. But the available endoscopic data is fragmentary, illuminates the individual elements of the transition, is not systematized. Thus, the infor mation presented in the review of the literature ind icates the relevance and expediency of studying the endoscopic anatomy of the ileocecal section both in normal and in some diseases.
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Shepelev A. N., Dronova O. B., Fateev I. N., Petrov S. V., Ne verov A. N. Endoscopic anatomy of the ileocectal department and its clinical value. Experimental and Clinical Gastroenterology. 2018;155(7): 128–134.
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Abstract:The aim of the study was to evaluate the eff ectiveness and safety of sodium phosphate (NaP) for colon cleaning in clinical practice. Patients and methods : 63 patients were under observation. Of these, 32 took the tablet form of Na P. The control group consisted of 31 patients who were preparing for colonoscop y using the standard method using a two-regimen for prepa- ration of polyethylene glycol 4000. Conditions for the use of th e NaP-tablet form were evaluated using a scale of criteria for compliance with the recommended treatment regimen. Results . Adequate use of the tablet form of NaP was noted in 84% of patients. The main reasons for the inadequate training were non-compliance with the intake of 1 person (3.1%), no n-compliance with the diet be fore preparation for the study — 3 people (9.4%).Evaluation of the quality of preparat ion for the study was carried out accord ing to the Boston scale [1–3]. When esophagogastroduodenoscopy was carried out, 34.3% (11 patien ts) of patients showed changes in gastric mucosae of the stomach, of which possible association with the reception of th e tablet form of NaP in 1 (3.1%). Drug withdrawal and prepa- ration for study 1 (3.1%) were stopped. The compliance with the use of the tablet form of NaP was high, especially among patients who previously used other prep arations for intestinal preparation. Conclusions : the use of the tablet form of NaP in preparing the colon for colonoscop y when compared with other methods of purifi cation showed good results both in the quality of th e patient’s preparation and in th e continuity of the patients with this preparation in preparation and in the safety of its use, which coincides wi th the data of other randomized research.
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Shcherbakov P. L., Kalachnyuk T. N., Ivanova O. I., Arkhipov A. A.et al. The fi rst clinical expe rience of using the tableted form of sodium phosphate (NAP) colokit, when preparing for colonoscopy in Russia. Experimental and Clinical Gastroenterology . 2018;155(7): 135–141.
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Keywords:hyperemesis gravidarum, diagnostics, treatment
Abstract:Hyperemesis gravidarum — one of the common diseases in during I and II trimesters of pregnancy. The review presents data concerning the prevalence, clinical manifestations, methods of diagnostic s and treatment, as prevention of hyperemesis gravidarum. The literature of 2015–2018 is analyzed.
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Marinkin I. O., Sokolova T. M., Kiseleva T. V., Kuleshov V. M.et al . Hyperemesis gravidarum. Experimental and Clinical Gastroenterology. 2018;155(7): 142–145.
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Keywords:pregnancy, organic and functional dyspepsia
Abstract:A research objective was assessment of a current and the result of pregnancy at women with various types of dispepsia. 175 pregnant women are examined: 73 — with dyspepsia during pregnancy, but without that before a gestation, 46 pregnant women — with chronic gastrointestinal diseases before pregnancy and 56 pregnant women who had no dyspepsia as pregnancies in time, and in the anamnesis. The conducted research refl ects negative impact of gastrointestinal disorders of functional and organic genesis on a current of a gestation: increase in frequency of an early gestoz, placentary insuffi ciency, infections of urinary tract, anemias, deterioration in indicators of health of newborns on a scale Apgar. Dyspepsia also lead to increase in complications of childbirth and the postnatal period — epiziotomiya, postnatal endometritis. Thus, dyspepsia during pregnancy should be considered as risk factor of the complicated course of pregnancy, childbirth and the postnatal period demanding adequate correction.
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Zhukovskaya I. G., Sandakova E. A., Khlynova O. V., Sadovniche nko E. A. Peculiarities of the current and prediction of the pr egnancy in women with diff erent types of dyspeptic disorders. Experimental and Clinical Gastroenterology. 2018;155(7): 146–150.
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Keywords:thyroid peroxidase antibodies, thyroglobulin antibodie s, thyroid status, atopy, children, gastroduodenitis
Abstract: The aim was to investigate the thyroid status in children with chronic gastroduodenitis in combination with such atopic diseases as bronchial asthma and atopic dermatitis. Materials and мethods . 39 children of pre-pubertal age that have a morphologically confi rmed diagnosis of chronic gas- troduodenitis-CGD were examined with an ELISA. The children were divided into 2 groups: 1 — a group of 16 children with HGD only; the second is 23 children with CGD and atopy. Results . In both groups, the mean T3, T4, T4cb, TTG levels and the number of patients with normal levels of thyroid hormones in the blood serum were the same . A higher level of antibodies to thyrog lobulin was found in patients with CGD and atopy and a higher level of antibodies to thyroid peroxidase in patients with CGD only. The mechanism of the revealed diff erences requires additional study.
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Listopadova A. P., Zemskova Е. А., Zamyatina Yu.E., Tyrtova L. V. et al. Thyroid status in children with chronic gastroduodenitis and related atopic diseases. Experimental and Clinical Gastroenterology. 2018;155(7): 151–154.
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Keywords:Klippel- Trenaunay syndrome, rectal bleeding, angiodysplasia
Abstract: Purpose of the study . Description of the case of the Klippel-Trenone syndrome. Materials and methods . A short review of the literature on the problem of the Klippel-Trenone syndrome and a description of the clinical observation is presented. Results . The abdominal form of the Klippel-Trenone syndrome is a rare variant of this type of pathology. This report describes the observation of a 65-year-old patient, with the abdominal form of the Klippel- Trenone syndrome, manifesting rectal bleeding Сonclusion . Thus, the study of literature and our observation shows that in the pr esence of typical manifestations of the Klippel-Trenone syndrome, bleeding from the organs of the gastrointestinal tract can have the same vascular- malformational nature.
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Chekanov А. M., Chekanov M. N., Osipenko M. F., Shtofi n S. G. , Shamray A. B., Blagitko E. M. Abdominal form of Klippel-Trenau nay syndrome (case report). Experimental and Clinical Gastroenterology. 2018;155(7): 155–157.
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Keywords: viral hepatitis C, antiviral therapy, resistance
Abstract: A clinical case of a virologic breakthrough in a patient with a 1b genotype after a 12-week therapy with ombitasvir + pari- trapeprivir / ritonavir + dasabuvir, due to signifi cant mutations in the NS3, NS5a, and NS5b region of the virus is presented.
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Voloshinа N. B., Voloshina I. O., Cholin S. I. Virological breakthrough after therapy with ombitasvir + paritaprevir / ritona vir + dasabuwir in a patient with the 1B genotype of viral hepatitis C. Experi mental and Clinical Gastroenterology. 2018;155(7): 158–160.
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Keywords: damage of bile duct, bowel fi stul as, reconstuctive surgery, nitinol
Abstract: The study describes a case of a two-stage reconstructive surgical reconstruction in a patient with with damage of common bile duct and unformed bowel fi stu las.
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Shtofi n S. G., Atamanov K. V., Shtofi n G. S., Shumkov O. A., Egorov V. A. Surgical reconstruction in patient with damage of c ommon bile duct and unformed bowel fi stulas. Experimental and Clinical Gastroenterology. 2018;155(7): 161–162.
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Keywords: Infl ammatory bowel disease, ulcerative colitis, Crohn’s disease, bacterial overgrowth syndrome
Abstract: Infl ammatory bowel diseases (IBD) — ulcerative colitis (UC) and Cr ohn’s disease (CD) are characterized by a specifi c clinic: diarrhea, the presence of blood in the stool, abdominal pain, general weakness. However, IBD can be combined with other bowel diseases, for example, with the bacterial overgrowth syndrome (BOS). BOS may not be suspected due to the similarity of symptoms with manifestations of exacerbation of CD or UC, the symptoms of BOS can be regarded only as a manifesta- tion of IBD, which leads to incorrect treatment tactics. In this article, we demonstrate the clinical case of such a combinatio n.
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Kulygina Y. A., Osipenko M. F., Bikbulatova E. A. Bacterial overgrowth syndrome in 34-year-old patient with Crohn’s disease. Experimental and Clinical Gastroenterology. 2018;155(7): 163–165.
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