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CLINICAL GASTROENTEROLOGY

    1. Kazan State Medical Academy — Branch Campus of the Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation, 420012, Kazan, Russia
    2. Federal State Budgetary Educational Institution of Higher Education “Kazan Medical University” of the Ministry of Healthcare of the Russian Federation, 420012, Kazan, Russia
    3. State autonomous health care institution “Republican Clinical Hospital Department of Health of the Republic of Tatarstan”, 420064, Kazan, Russia

    Keywords: infl ammatory bowel disease, ulcerative colitis, Crohn’s disease, fecal β-glucuronidase

    Abstract:The aim of research: to investigate the activity of β-glucuronidase in coprofi ltrates (OR feces) in patients with infl ammatory bowel diseases — UC and CD at diff erent severity levels (form of disease- mild, middle, severe) and to determine the signifi cance as a laboratory criterion in the diagnosis, treatment and prognosis of IBD. Materials and methods. In research was prospectively studied 105 patients — 82 patients with IBD (29 patients with CD, 53 patients with UC) and 23 healthy volunteers without clinical laboratory indicators of infl ammatory processes in the organism and diseases of the colon as the comparison group. The activity of β-glucuronidase in feces was determined using phenolphthalein glucuronide as a substrate. Results. The activity of β-glucuronidase in feces in patients with IBD did not diff er from the healthy group (comparison group): in patients with IBD — 86.81 ± 8.4 μM / g / hr, and in norm, healthy group (comparison group) 76.04 ± 10.13 μM / g / hr (p> 0.05). Also we did not fi nd signifi cant diff erences in the activity of β-glucuronidase in patients with CD and UC, in comparison with the norm (healthy group), or between groups of patients with IBD (CD and UC). In both forms of IBD, we did not fi nd signifi cant diff erences in the activity of β-glucuronidase in patients with severe, mild or middle severity level of disease, as in comparison with healthy group so as between group of severity level. Conclusion. We have established that the activity of fecal β-glucuronidase in patients with diff erent severity levels CD and UC did not diff er from in patients of healthy group. Determination of the activity of fecal β-glucuronidasecan not use as objective laboratory criteria for determining the severity of IBD and predicting the course of the disease and, apparently, does not have essential value in the pathogenesis of IBD.

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      8. Ivashkin V. T., Shely`ginYu.A., Abdulganieva D. I. i dr. Proekt klinicheskix rekomendacij po diagnostike i lecheniy u vzrosly`x pacientov s yazvenny`m kolitom [Draft clinical guidelines for the diagnosis and treatment of adult patients with ulcerative colitis]. Koloproktologiya – [Coloproctology], 2013, no. 3(45), – pp. 2–21.
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    Zinkevich O. D., Safi na N. A., Abdulganieva D. I., Korovina M. O., Mukhametova D. D., Odintsova A. Kh., Zimaleeva D. Е. Activity of fecal β-glucuronidase in patients with infl ammatory bowel diseases. Experimental and Clinical Gastroenterology. 2019;162(2): 14–18. (In Russ.) DOI: 10.31146/1682-8658-ecg162-2-14-18
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    1. Azerbaijan State Advanced Training Institute for doctors named after A.ALIYEV, Baku AZ1012, Azerbaijan
    2. National Center of Oncology, department of invasive diagnostics and treatments, Baku AZ1122, Azerbaijan

    Keywords: ulcerative colitis, Crohn’s disease, infl ammatory bowel disease, endothelial dysfunction, severity

    Abstract:Aim: to create a system for monitoring the condition of patients with infl ammatory bowel disease (IBD). Subjects and methods: In the period from August 2015 to December 2018, 246 patients with IBD were examined at the clinical base of the Department of Therapy Azerbaijan State Advanced Training Institute for doctors named after A.ALIYEV, the Department of Invasive Diagnostics and Treatment of the National Center of Oncology, Memorial Klinika Medical Center. The content of homocysteine, highly sensitive C-reactive protein (h/s CRP), vitamin D and the level of platelets in the blood, albumin in the urine, and calprotectin in the feces were determined in all subjects. Patients were retested if necessary (426 in total) Results: In the general group of patients with IBD, of the 426 studies conducted in 369 (86.6%) cases, there was an increased content of homocysteine i n the blood, in 405 (95.0%) — the level of h/s CRP, in 322 (75.5%) — thrombocytosis, in 411 (96.4%) — a decrease in the content of vitamin D, in 308 (72.3%) albumin was detected in the urine, and in 411 (96.4%) — an increased content of calprotectin was detected in the feces. When analyzing the identifi cation of each of these indicators separately in the UC and CD groups, no diff erence was found (p > 0.05). A correlation was found between some indicators of endothelial dysfunction and the severity of the clinical course in patients with infl ammatory bowel diseases. The proposed new approach to assessing the clinical status of patients with IBD, with the established diagnosis, does not resort to repeated costly studies and obtain real-time results that make it possible to assess the severity of the patient’s condition.

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      2. Th ird European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part1/2. J Crohns Colitis jjx008.DOI: https://doi.org/10.1093/ecco-jcc/jjx008
      3. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn’s Disease 2016: Part 1: Diagnosis and Medical Management. J Crohns Colitis (2017) 11 (1): 3–25.DOI: https://doi.org/10.1093/ecco-jcc/jjw168
      4. Edward L. Barnes et al. New Biomarkers for Diagnosing Infl ammatory Bowel Disease and Assessing Treatment Outcomes. Infl amm Bowel Dis. 2016 Dec; 22(12): 2956– 2965.doi: 10.1097/MIB.0000000000000903
      5. Norouzinia M., Chaleshi V. et al. Biomarkers in infl ammatory bowel diseases: insight into diagnosis, prognosis and treatment. Gastroenterol Hepatol Bed Bench. 2017 Summer; 10(3): 155–167. PMID: 29118930
      6. Derkacz A. et al. Diagnostic Markers for Nonspecifi c Infl ammatory Bowel Diseases. Disease Markers Volume 2018, Article ID7451946, 16 p. https://doi.org / 10.1155/2018/7451946
      7. Babayeva G. H., Babayev Z. M. Chastota viyavleniya nekotorix markerov endotelialnoy disfunksii u bolnix s vospalitelnimi zabolevaniyami kishechnika. Terapevticheskiy arxiv. 2018, no.4, pp.12–16. (In Russ.)
      8. Babayeva G. H., Samedova T. A., Babayev Z. M., Huseynova F. R. O roli defi sita vitamina D pri nekotorix patologicheskix sostoyaniyax.[About some vitamin D defi ciencies in certain pathological conditions]. Saglamliq. 2018, no. 2, pp.23–32. (In Russ.)
     


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    Babayeva G. H., Babayev Z. M. New approach to the estimation of a clinical fl ow in patients with ulceratıve colitis and Crohn's disease. Experimental and Clinical Gastroenterology. 2019;162(2): 19–23. (In Russ.) DOI: 10.31146/1682-8658-ecg-162-2-19-23
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    1. State Medical University, 644099, Omsk, Russia
    2. Regional Clinical Hospital, 644111, Omsk, Russia n

    Keywords: ulcerative colitis, nutritional factors, sugar, diet

    Abstract:The aim was to аssess the eff ect of nutritional factors on the risk of developing ulcerative colitis based on an analysis of food consumed. Assess the importance of consumption of certain nutrients in its development among the population of Western Siberia. Materials and methods: A survey of 81 patients with ulcerative colitis and 39 healthy volunteers was conducted. The profi le of the eating habits of patients with ulcerative colitis (before diagnosis) in relation to healthy respondents was investigated. Results. The diet of patients with ulcerative colitis before the fi rst signs of the disease is distinguished by the rare consumption of fresh and cooked vegetables and fruits in small portions, the consumption of more sugar with tea and / or coff ee compared to healthy ones. Also, patients poorly tolerated milk and dairy products before the debut of the disease. Conclusion. Our study confi rms the possible eff ect of a lack of dietary fi ber and excessive sugar intake on the onset of ulcerative colitis.

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      7. Chan S. S., Luben R., van Schaik F. et al. Carbohydrate intake in the etiology of Crohn’s disease and ulcerative colitis // Infl amm Bowel Dis. 2014, № 20, pp.2013–2021.
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    Bikbavova G. R., Livzan M. A., Sovalkin V. I., Turchaninov D. V., Tretyakova T. V., Lopatina O. E., Panova T. Yu. The effect of nutritional factors on the development of ulcerative colitis. Experimental and Clinical Gastroenterology. 2019;162(2): 24–27. (In Russ.) DOI: 10.31146/1682-8658-ecg-162-2-24-27
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    1. Clinical Hospital № 122 L. G. Sokolova, St. Petersburg, Russia
    2. St. Petersburg State Healthcare Institution Children’s City Hospital № 2 Holy Mary of Magdalene, St. Petersburg, Russia
    3. St. Petersburg State Pediatric Medical University, Ministry of Health of the Russian Federation, St. Petersburg, Russia
    4. Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, Moscow, Russia

    Keywords: diet for ulcerative colitis, prevention of exacerbations of ulcerative colitis, specifi c diet, food sensitization, ulcerative colitis, new methods of selection of the diet

    Abstract:There is a new principle of preparing diet for a patient with ulcerative colitis (UC). Within 4 years, we observed and comprehensively examined 60 patients UC who received standard treatment. In group 1(n=30) was used as a dietary therapy specifi c individual elimination hypoallergenic diet (ISEH diet), picked up in vitro and composed by exclusion from the diet of those products, which can be a source of food sensitization. To identify the immunopathological reactions I, III and IY types of food allergens used a range of methods — ELISA (IgE-specifi c) and the reaction of inhibition migration of leukocytes(RIML), modifi ed by NN Matyshevа and LS Kositskаyа. Group 2(n = 30) received a standard mechanically and chemically sparing diet. Patients with UC showed a high degree of sensitization to food antigens. Usage of the ISEН diet promoted a more rapid onset and prolonged maintenance of clinical and endoscopic remission, more than in the standard diet group, without the use of corticosteroids and thiopurins, as well as a signifi cant decrease in the number of disease relapses. Diet of patients with UC should be hypoallergenic. The best results are observed in the preparation of a diet based on a comprehensive individual screening-testing of food allergens using laboratory diagnostic methods based on cell-type reactions and methods for detecting specifi c antibodies to food antigens. Results of a 4- year follow-up for patients with UC show high effi cacy ISEH diet in the treatment and maintaining remission of these patients.

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    Kryukova O. A., Matysheva N. N., Drygin A. N., Khavkin A. I. Use of a customized hypoallergenic diet in treatment of patients with the infl ammatory bowel diseases. Experimental and Clinical Gastroenterology. 2019;162(2): 28–35. (In Russ.) DOI: 10.31146/1682-8658-ecg-162-2-28-35
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    1. Institute of Osteopathy, 191024, Degt’arnaya str.1A, St. Petersburg, Russian Federation
    2. North-Western State Medical University named after I. I. Mechnikov, Ministry of Health of Russian Federation, 191015, Kirochnay street, 41, Saint-Petersburg, Russian Federation
    3. St. Petersburg State University, 199034, University emb, 7/9, Saint-Petersburg, Russian Federation

    Keywords: osteopathic methods, somatic dysfunction, motor-evacuation functions of the digestive tract, celiac disease

    Abstract:The article presents the results of clinical eff ectiveness of osteopathic correction methods in the treatment of motor-evacuation disorders of the digestive tract in celiac patients based on a comparison of clinical and instrumental data. Materials and methods: 26 patients with celiac disease aged from 18 to 35 years old, in which General clinical, endoscopic and PEGEG studies revealed disorders of motor activity of the digestive tract. The examined patients had been carried out 5 sessions of osteopathic procedures to correct their motor-evacuation disorders of the gastrointestinal tract (GI). Results: the examined patients were observed to have osteopathic disorders, indicating regional somatic dysfunction and combined motility disorders of the upper and lower digestive tract in both phases of the PEGEG. The use of osteopathic correction, aimed at mobilizing the compensatory-adaptive mechanisms of the body, was eff ective for discontinuing gastroenterological symptoms, normalization of propulsive and tonic activity of the gastrointestinal tract. Conclusion: osteopathic correction can be used in the treatment of patients with motility disfunction of the digestive tract.

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    Оrеshkо A. Yu., Mokhov D. E., Tregubova E. S., Оrеshkо L. S., Seliverstov P. V., Semenova Е. A. Functional disorders of motor activity of the digestive tract and their osteopathic correction in patients with celiac disease. Experimental and Clinical Gastroenterology. 2019;162(2): 36–44. (In Russ.) DOI: 10.31146/1682-8658-ecg-162-2-36-44
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    1. Kemerovo State Medical University, 650056, Kemerovo, Russia
    2. Research Institute for Complex Issues of Cardiovascular Diseases, 650002, Kemerovo, Russia

    Keywords: rectal cancer, TP53, rs1042522, Arg72Pro

    Abstract:The aim was to investigate the prevalence of genetic variants of marker rs1042522 (Arg72Pro) of TP53 among individuals without cancer and patients with colon cancer. Materials and methods. Using allele specifi c PCR we performed genotyping of rs1042522 marker with subsequent comparing of alleles and genotypes frequencies in two studied groups: the comparison group (n=119) and the group of patients with rectal cancer (n=105). Results. Proportion of the minor allele Pro with the expected pathological eff ect in the comparison group was 26,9%, and among patients with rectal cancer — 26,7%. The frequency of the Pro/Pro genotype in the two groups was 6,7% and 5,7%, respectively. The distinction in indicators was not statistically signifi cant.

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    Volkov A. N., Padukova A. D., Zinchuk P. V., Kutikhin A. G. Polymorphysm of tumor supressor gene tp53 among healthy donors and patients with rectal cancer. Experimental and Clinical Gastroenterology. 2019;162(2): 45–49. (In Russ.) DOI: 10.31146/1682-8658-ecg-162-2-45-49
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    1. Federal State Funded Edication Institution of Higher Education “Khakass State University named after N. F. Katanov”, 655000, Abakan, Russian Federation
    2. Federal state autonomous educational institution of higher education “Crimean Federal University named after V. I. Vernadsky” Medical Academy named after S. I. Georgievsky, 295051, Simferopol, Crimea, Russian Federation

    Keywords: colorectal cancer, anamnesis of life, factors risk

    Abstract:Aim to study the frequency, expression and simultaneity of risk factors for colorectal cancer in hospital patients. Materials and methods. The statistics of 1690 colorectal cancer (CRC) patients were retrospectively studied. Clinical signs were assessed according to the case histories of 180 patients with colorectal cancer, selected by random sampling and systematic sampling (every tenth of the total population of all patients with CRC). Questioning patients with CRC, based on their informed consent, studied risk factors in 80 people (random sample; every second of the average annual number of patients with CRC). Results. The share of women was 52.5%, men — 47.5%. The average age of patients is 69 (61–77) years. Before the manifestation of colorectal cancer, patients had an overweight in 40.9% of cases, obesity in 39.4% of cases. Women with colorectal cancer more often than men had type 2 diabetes mellitus 4 times (p = 0.015), cholecystectomy 2.5 times (p = 0.09), combined pathology 3 times (p = 0.24) and prolonged history of IBD 5 times (p <0.05). In men with colorectal cancer, hypodynamia (5 times, p = 0.003) and smoking (2 times, p = 0.23) occurred more often than in women. Conclusion. Risk factors for colorectal cancer were, 55 years of age, overweight or obesity, type 2 diabetes.

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    Shtygasheva O. V., Ageeva E. S., Guzar Ya. R. Anamnestic predictors of colorectal cancer. Experimental and Clinical Gastroenterology. 2019;162(2): 50–54. (In Russ.) DOI: 10.31146/1682-8658-ecg-162-2-50-54
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    1. GBUZ Moscow Clinical Research Center named after A. S. Loginov DZM, 111123, Moscow, Russia
    2. Federal State Budgetary Educational lnstitution of Further Professional Education «Russian Medical Academy of Postgraduatc Educatioп» of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
    3. Pirogov Russian National Research Medical University, Moscow, Russia
    4. Moscow State University of Medicine and Dentistry named after A. I. Evdokimov, 127473, Moscow, Russia

    Keywords: nutritional drugs

    Abstract:In the literature there is little information about the occurrence of dielectrolytes with inadequately selected parenteral-enteral correction. This fully applies to the correction of iron defi ciency in colorectal cancer (CRC). Material and methods. On examination were 51 patients with CRC (T3N1M0 and T4N0M1) and iron defi ciency of various severity. Nutritional status was assessed by the parameters of a known alimentary-volemic diagnosis (AED). Iron defi ciencies resulting from chronic blood loss were assessed by the content of serum iron, ferritin, transferrin, the level of Hb and Ht, the number and average volume of red blood cells, and the average content of Hb in the red blood cell. The control group consisted of 10 patients with iron-defi cient anemia. Results. One of the components of the AVD is the determination of electrolyte defi ciencies, including gland. With a defi cit of free iron in plasma up to 11%, a decrease in hemoglobin level and Ht, a slight decrease in the number of erythrocytes and normal parameters of ferritin, the average volume of erythrocyte and the content of Hb in it were suffi cient nutritive correction mixtures containing 3.0–3.5 mg of iron in 100 g dry product. With a higher iron defi ciency, additional parenteral administration of its drugs was required: as part of the nutritional correction, as a pharmacological supplement, supplements were injected with non-sorbed or sorbed iron on a special matrix (ironMatrix), which guaranteed the stability of the iron complex and its controlled release in the body. At the same time, sorbed iron provided a higher safety (no complications were observed in any of the studies. with the administration of non-sorbed iron in 2 cases, there were unpleasant sensations in the heart area, in the right hypochondrium, resembling signs of iron overload (ferritin could increase to 1340 mg), stopped, however, only by the administration of a hepatoprotector and 0.9% of the sodium chloride solution without the additional use of an antidote. Conclusion. For the sake of safety of iron defi ciency correction (prevention of toxic-metabolic complications) when conducting a comprehensive nutritional correction in patients with CRC complicated by mild chronic anemia with iron defi ciency not more than 11%, it is advisable to use drugs containing iron (3–3.5 mg per 100 g of dry product), and in case of a pronounced shortage of it, supplement the nutritional support with parenteral preparations of sorbed iron under the control of the parameters of iron metabolism.

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    Kostyuchenko L. N., Mikhaylyants G. S., Danilov M. A., Atroshchenko A. O., Kruglov A. D., Kuzmina T. N., Noskova K. K., Kostyuchenko M. V., Zhu-kova L. D., Lychkova A. E., Govaleshko A.Yu. Management of Iron defi ciency syndromes and their correction with nutritional drugs Experimental and Clinical Gastroenterology. 2019;162(2): 55–67. (In Russ.) DOI: 10.31146/1682-8658-ecg-162-2-55-67
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    1. Saratov State Medical University n. a. V. I. Razumovsky of the Ministry of Healthcare of the Russian Federation, Saratov, Russia
    2. “Мedical Di center” LLC, Saratov, Russia

    Keywords: Irritable bowel syndrome, refractoriness to treatment, genetic polymorphism, psychological factors.

    Abstract:Purpose of the study. Тo determine predictors of refractory course of irritable bowel syndrome with consideration for genetic markers and psychological peculiarities of patients. Materials and methods. 101 patients with irritable bowel syndrome (73 with refractory form of irritable bowel syndrome, 28 with non-refractory form of the same) have been examined. We analyzed the triggers of the disease, assessed the levels of distress, depression, anxiety, somatization, and aggression, and we have determined polymorphic variants of genes COMT Val158Met, TLR9 G2848A, TLR9 T-1237C. Results. Refractory variant of irritable bowel syndrome is associated with the onset at an earlier age, social and psychological triggers, extraintestinal manifestations and non-gastroenterological symptoms, high levels of distress, depression, anxiety, somatization, and aggression. We have revealed that refractoriness and some clinical forms of irritable bowel syndrome are associated with polymorphic variants of certain genes. Conclusion. Refractory variant of irritable bowel syndrome is associated with certain genetic and psychological factors.

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    Tikhonova T. A., Kozlova I. V., Fedotov E. A. Genetic and psychological prerequisites for development of refractory variant of irritable bowel syndrome. Experimental and Clinical Gastroenterology. 2019;162(2): 68–74. (In Russ.) DOI: 10.31146/1682-8658-ecg-162-2-68-74
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    1. GBUZ Moscow Clinical Research Center named after A. S. Loginov DZM, 111123, Moscow, Russia

    Keywords: irritable bowel syndrome, constipation, intestinal motility

    Abstract:Irritable Bowel Syndrome (IBS) is a functional bowel disease in which relapsing abdominal pain is associated with bowel movements or bowel movements. Despite the numerous works devoted to the investigation of the mechanisms of IBS development, the intestinal motility in this disease has not been studied enough. The aim is to reveal the features of the motor function of the large and small intestine in irritable bowel syndrome with constipation (IBS-C) and in the case of dolichosigma. Material and methods. 84 patients with IBS-C by electromyography in comparison with a group of 25 patients with dolichosigma and a group of 35 patients with functional constipation were examined. The frequency of slow waves of the small and large intestine (patients with functional constipation) and the left parts of the colon (patients with IBS-3 and dolichosigma) by the Conan-M hardware and software complex were measured Results and discussion. IBS-C is characterized by hypomotor dyskinesia of the left divisions with pronounced spastic contractions of the smooth muscles of the circulatory layer of the gut, possibly due to the activity of stimulating serotonergic eff ects on the spastic activity of the circular muscle layer or inhibitory adrenergic neurons of the intermuscular (Auerbach) nerve plexus. With dolichosigma, hypomotor dyskinesia of the left parts of the colon was revealed due to stretching of the mechanoreceptors of the aff erent neurons of the intramural refl ex arcs.

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    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. 2019;162(2): 75–78. (In Russ.) DOI: 10.31146/1682-8658-ecg-162-2-75-78
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    1. Bashkir state medical University of the Ministry of health of Russia, 450008, Ufa, Lenin street, 3, Russia

    Keywords: personality-oriented educational program, biliary pathology, young age, psychosomatic examination

    Abstract:Purpose of the study. Show the eff ectiveness of training for young people with chronic non-calculous cholecystitis on the example of a personality oriented educational program. Materials and methods. A total of 64 patients with chronic non-calculous cholecystitis in the remission phase were examined. They determined the levels of anxiety, indicators of quality of life, types of attitudes towards the disease. The obtained data were compared before and after training in a person-centered program. Results. In the course of dynamic management of patients with biliary pathology, a decrease in high anxiety levels, an increase in persons with a low level of anxiety, an increase in ergopathic, mixed types of attitudes towards the disease, a decrease in anxiety and hypochondriacal types was noted. In terms of quality of life, an increase in self-satisfaction along with a scale of health status was reliably detected. Positive changes in the behavior of patients in terms of adherence to the implementation of the recommendations of the doctor according to the person-oriented program are identifi ed. Individual approach, familiarity of patients with the basics of the disease, risk factors, self-help, mutual aid, non-drug, urgent measures contribute to the primary and secondary prevention of the disease. Conclusion. In the course of this study, positive results were obtained in the psychosomatic status of patients. Due to the development of this trend now, increasing the level of education of certain groups of the population, individual approach to each patient, resolving issues together with the doctor in class, discussing emerging issues, getting advice — all this allows you to increase the patient’s participation in resolving issues of self-, mutual assistance, control the state of the main indicators of the level of health, monitor the levels of anxiety, depression and promptly contact specialists; therefore, this technique is relevant to and Use at the outpatient stage for people of all ages.

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    Full text is published :
    Volevach L. V., Sarsenbaeva A. S., Gabbasova L. V., Demidovа N. A., Garipova R. A., Guriyev R. D., Kamalova A. A. The personal oriented educational program in the management of patients with biliary pathology. Experimental and Clinical Gastroenterology. 2019;162(2): 79–83. (In Russ.) DOI: 10.31146/1682-8658-ecg-162-2-79-83
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