1. Central State Medical Academy of the Administrative Department of the President of Russia, 121359, Moscow, Russia
2. Central Military Clinical Hospital of National Guard, Moscow region, Balashikha 143915, Russia

Keywords:intestinal microbiocenosis, NAFLD, short-chain fatty acids, rifaximin, psyllium

Abstract:Aim of investigation: to study the content and qualitative profi le of shot-chain fatty acids in feces and blood serum in patients with NAFLD of diff erent stages as indicators of intestinal microbiocenosis status and systemic lipid metabolism, and to evaluate the eff ectiveness of course antibacterial (rifaximin) and prebiotic (psyllium) therapy in the period of 6 months for the correction of gut microbiocenosis disorders. Material and methods: The survey included 115 patients (82 (71,3%) men, 33 (28,7%) women) with NAFLD of diff erent stages (steatosis — 40 people, nonalcoholic steatohepatitis (NASH) of minimal activity — 30 people, NASH of moderate activity — 30 people, liver cirrhosis class A Child-Pugh — 15 people) at the average age of 51,83±8,48 years old. All the patients were examined by research of short-chain fatty acids (SCFA) using gas-liquid chromatographic analysis in various biological substrates (blood serum and feces). According to the management scheme, the patients with NAFLD were divided into 3 groups. The fi rst group of 30 people (on the background of lifestyle modifi cation) received a 6-month intake of psyllium. The second group of 35 people in addition to lifestyle modifi cation received a 7-day course of rifaximin (7 — days/800 mg/d) and psyllium during the period of observation (6 months). The third group of 35 people received standard therapy of NAFLD without pharmacotherapy aimed to correction of gut microbiocenosis disorders. In the course of treatment the frequency and severity of clinical manifestations of intestinal bacterial overgrowth syndrome (SIBO) reduced in patients of groups 1 and 2 (in group 1 the complaints on abdominal pain and fl atulence decreased by 11%, in group 2 — by 37%, the normalization of stool occurred in both groups), SIBO was not detected according to the results of the hydrogen breath test with lactulose, the level of total endotoxin was determined within normal values. Negative dynamics was noted in group 3: the increase in the number of complaints of abdominal pain by 16%, fl atulence and unstable stool — by 10%, the frequency of registration of SIBO increased by 20%, increased level of total endotoxin was detected in 5.7% of patients. Results. The absolute concentration of SCFA in feces in patients with NAFLD (steatosis) is reduced, in patients with NASH of minimal activity, NASH of moderate activity and liver cirrhosis is increased, in the profi le of C2-C4 acids there was the increase in the share of propionic and butyric acids and the decline in the share of acetic acid, the anaerobic index (AI) defl ected in the region of strongly negative values, the total relative content of isoacids increased in all groups of patients, worsening with the severity of the pathological process (at normal Σ(С2-С6)=10.51±2.50 mg/g, С2=0.634±0.004, С3=0.189±0.001, С4=0.176±0.004, АI= –0.576(±0.012), Σ(isoСn)=0.068±0.004). The obtained results indicate marked changes in the qualitative and quantitative composition of the microfl ora, the decrease in the number and activity of obligate microorganisms and the increase in facultative and residual anaerobic bacteria. These changes in the microbial landscape lead to the marked disorders in the intestinal phase of lipid metabolism. The absolute concentration of SCFA in serum in patients with NAFLD (steatosis) is reduced, in patients with NASH of minimal activity, NASH of moderate activity is increased, in the profi le of C2-C4 acids there is the decrease in the share of propionic acid and the increase in the share of butyric acid, most pronounced in steatosis and NASH of minimal activity. In patients with liver cirrhosis, the absolute concentration of SCFA in serum is increased, in the profi le of C2-C4 acids, the share of acetic acid is sharply reduced with an increase in the share of propionic and butyric acids and the total relative content of isoacids. The content of caproic and isocaproic acids is increased in all groups (at normal Σ (C2-C6)=0.195±0.011 mg/g, C2=0.902±0.006, C3=0.071±0.004, C4 = 0.027±0.002, Σ (isoCn)=0.040±0.007, isoC6+C6=0.025±0.004). This fact can be explained by the changes in the functional state of hepatocytes, and, consequently, in the metabolic function of the liver (in particular with respect to lipid metabolism). The clinical effi cacy of therapeutic management with the use of drugs aimed at the relief of the intestinal microfl ora disorders (course of rifaximin (if SIBO is identifi ed) on the background of prolonged ingestion of psyllium) in patients with NAFLD of diff erent stages, is supported by the normalization of the content and profi le of SCFA in various biological substrates. In patients of group 3 there was noted the negative dynamics of estimated parameters SCFA. Thus, the results of the undertaken research of the parameters of SCFA in various biosubstrates indicate the marked changes in the intestinal microbiocenosis and their contribution to the development and enhancement of systemic metabolic processes. The inclusion of means aimed at correcting the microecological status disorders in the complex management of NAFLD is not only eff ective, but also pathogenetically necessary.

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Full text is published :
Ardatskaya M. D., Garushyan G. V., Moysak R. P., Topchiy T. B. Role of short chain fatty acids in evaluation of gut microbiocenosis disorders and their correction in patients with NAFLD of diff erent stages. Experimental and Clinical Gastroenterology. 2019;161(1): 106–116. (In Russ.) DOI: 10.31146/16828658-ecg-161-1-106-116
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1. Republican Specialized Scientifi c Practice Medical Center of Pediatrics, Tashkent, Uzbekistan
2. Tashkent pediatric medical institute (TashPMI), Tashkent 100140, Uzbekistan

Keywords: food protein-induced enterocolitis syndrome, vitamin D, defi ciency, insuffi ciency

Abstract:Aim of the study. To study the status of 25 hydroxyvitamin D in case of food proteins induced enterocolitis syndrome in young children and to determine the relationship between its level and clinical and laboratory manifestations of the disease. Materials and methods. 72 children with Food Proteins Induced Enterocolitis Syndrome aged from 3 months to 3 years were examined. To confi rm the diagnosis, clinical-anamnestic, paraclinical (general blood analysis, coprology, feces for latent bleeding, total protein), and immunological (IgE total, IgE-specifi c antigen-specifi c method, lymphoquin-producing ability of T-lymphocytes to food allergens) were used. For studying the status of vitamin D in the serum of sick children 25 (OH) D3 was determined. Results. The average values of vitamin D in children with gastrointestinal food allergies had marked diff erences in comparison with the norm. Thus, in children with FPIES, they were 20.0 ± 4.4 ng / ml, at a rate of 45.1 ±8.04 ng / ml. Lower vitamin D values occurred in children with more severe clinical manifestations of the disease and, in part, with association with Ig E. By criteria, vitamin D defi ciency was found in 41.6% of children with FPIES, insuffi ciency in 18% of children, in 29 (40.2%) cases, the rates were within the normal range. Conclusion. Thus, it was founded a decrease in the vitamin D values by 2.25 times in food protein induced enterocolitis syndrome, compared with the norm, which dictates the need for the children with FPIES to make aqueous solutions of vitamin D.

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Full text is published :
Kamilova A. T., Geller S. I., Dustmukhamedova D. Kh., et al. Status of vitamin D in the food protein induced enterocolitis syndrome in children. Experimental and Clinical Gastroenterology. 2019;161(1): 117–123. (In Russ.) DOI: 10.31146/1682-8658-ecg-161-1-117-123
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