Consilium Medicum

The treatment of patients with inflammatory bowel disease is an ever-evolving field of medicine. However, doctors often face difficulties in managing such patients. In this interview, E.A. Belousova shares her expert opinion on modern methods of diagnosis and treatment of inflammatory bowel disease, paying special attention to a multidisciplinary approach to the management of concomitant diseases and the prevention of complications caused by drug therapy.

Background. Currently, endoscopic vacuum therapy (EVT) with an efficiency of up to 90% or more is actively used in the treatment of esophageal injuries. At the same time, the economic assessment of the advantages of minimally invasive methods has not been studied enough.

Aim. To Analysis of the economic component of EVT for esophageal injuries in comparison with classical interventions (thoracotomy, esophageal extirpation) in a regional multidisciplinary hospital.

Materials and methods. The analysis of the economic component of EVT in comparison with classical interventions was carried out by retrospectively examining the medical records of 43 patients. The cost of treatment in the comparison groups was estimated by including the cost of the patient's stay in the hospital and the direct costs of intervention.

Results. The conducted statistical analysis showed significant differences in the groups with a strong dependence of the cost of treatment on the patient's stay in the intensive care units and the direct costs of open surgery.

Conclusion. The use of minimally invasive and modern EVT methods for esophageal injuries can significantly shorten the patient's hospital stay. Compared to traditional surgical approaches, this approach allows for a reduction in the financial aspect by more than two times.

Diseases of the digestive system are very common among the population around the world. Diagnosis of the diseases of this group is expensive and often invasive, which greatly limits its accessibility to the population. Increasing the time of disease development before diagnosis increases the risk of complications and adverse outcomes. The use of volatile organic compounds (VOC) as a biomarker is becoming increasingly popular due to the accuracy and ease of use. The article examines the available analytical platforms of VOCs for detecting changes in the state of the digestive system, assesses their strengths and weaknesses, provides examples of VOC assessment tool for the diagnosis of certain diseases of the digestive system – inflammatory bowel diseases, colorectal cancer, infectious diarrhea and celiac disease.

Aim. To optimise the curation of patients with a comorbid course of nonalcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD) to explore pathogenetically-based targets of high cardiovascular risk (CVR) formation.

Materials and methods. An open comparative study was conducted with the formation of a cohort of 126 patients with comorbid course of NAFLD and CVD with different stages of liver fibrosis, who were divided into comparison groups according to SCORE-2 and SCORE-2-OR. Collection of complaints, medical and life history, examination, general laboratory investigations and examination of hormonal status, abdominal ultrasound, EchoCG and liver elastometry to assess the severity of fibrosis were performed. Work with the study data and graphical analysis was performed using Microsoft Office 2019 software package statistical analysis using STATISTICA 12.0.

Results. SCORE-2 risk increased with increasing age of patients (z=-5.29; p<0.01). The most common non-cardiovascular co-morbidities in the study sample were cholelithiasis in 35 (66.78%) patients. Soluble leptin receptor levels were lower (z=-8.60; p<0.01) and leptin resistance index was higher (z=-5.95; p<0.01) in the higher cardiovascular group. Corresponding data were also obtained when the changes in insulin resistance index were calculated and analysed (z=-2.15; p<0.01). Fibrosis stage was higher, in patients with higher CVR (z=-3.488; p<0.01), while no statistically significant difference in steatosis level was recorded. According to transient elastometry, patients taking statins had lower levels of fibrosis (z=-3.747; p<0.01) and hepatic steatosis (z=-3.379; p<0.01).

Conclusions. The most common pathology is arterial hypertension. Gallstone disease and type 2 diabetes mellitus are often found in patients with a comorbid course. The risk of comorbid pathology and CVD increases with age. Formation of advanced stages of liver fibrosis, hyperinsulinaemia and leptin resistance phenomenon are associated with higher CVR according to SCORE-2 and SCORE-2-OR. The syndrome of increased intestinal permeability is a possible mechanism of increased CVD in patients with NAFLD.