Vol 18, No 8 (2016)


Using rebamipide as a cytoprotective and anti-inflammatory agent in enteropathy induced by nonsteroidal anti-inflammatory drugs

Maev I.V., Kazyulin A.N.


The increase in the incidence of NSAID-induced enteropathy, which is associated with an extremely wide application of nonsteroidal anti-inflammatory drugs (NSAIDs) in almost all branches of medicine, multifactor developing NSAID-induced enteropathy (enteropathy induced by NSAIDs) is marked in the world today. Extremely alarming is the difficulty in diagnosing this disease and the possibility of its development since the 1, 2, 4 th week of reception. Accordingly, an important element in the prevention and treatment of NSAID-enteropathy is the use of funds that have a cytoprotective effect on the mucous membrane of the small intestine. Among these tools is a great therapeutic potential cytoprotector rebamipide. A large number of experimental and clinical studies suggests that taking rebamipide is reasonable and relatively healthy persons, if necessary, a short course of nonsteroidal anti-inflammatory drugs for patients who require long-term or lifelong them welcome, especially if you have risk factors for NSAID-induced enteropathy.
Consilium Medicum. 2016;18(8):8-12
pages 8-12 views

The use of combined drugs in the treatment of non-alcoholic fatty liver disease

Kazyulin A.N., Shestakov V.A., Babina S.M.


The prevalence of non-alcoholic fatty liver disease (NAFLD) is 10-40% in developed countries. In various regional and international guidelines for drug treatment there is no consensus on the effectiveness and safety of the use of certain drugs in NAFLD. Perhaps this is due to regional characteristics with the prevalence of NAFLD in the pathogenesis of a variety of factors listed in the theory of «multiple parallel strokes», the differences in the design of randomized clinical trials, the analysis of which is the basis of these recommendations. The use of essential phospholipids (EPL) in diseases of the liver, and in particular NAFLD is pathogenetically substantiated. However EPL are unstable substance, as they may be involved in lipid peroxidation processes with increasing levels of lipid peroxides, oxidants are active, and hence, increased oxidative stress. Accordingly, the actual improvement was a given dosage form by offering innovative solutions. An effective solution to this problem was the creation of a domestic combined hepatoprotective BAA Hepaguard Active®, one capsule that contains 222 mg of EPL, 93 mg of L-carnitine and 1.25 mg of tocopherol acetate (vitamin E). All these three biologically active substances act synergistically, providing of membrane, lipotropic, lipid-lowering and cholesterol-lowering effect. According to laboratory and instrumental studies, its effect is to reduce the severity of steatosis and nonalcoholic steatohepatitis with - and in the reduction of necroinflammatory and fibrosis of the liver. The drug helps normalize body weight, lipid profile, has a prebiotic effect, reduces the insulin resistance that is mechanisms not only impact on the manifestation of NAFLD, but also other components of the metabolic syndrome, has good portability.
Consilium Medicum. 2016;18(8):13-18
pages 13-18 views

Clinical efficacy and safety of treatment regimens for irritable bowel syndrome (a comparative study)

Maev I.V., Samsonov A.A., Yashina A.V., Andreev D.N., Shestakov V.A., Karaulov S.A.


The results of the comparative non - interventional observational study held to evaluate the efficacy and safety of Kolofort in the treatment of irritable bowel syndrome in comparison with trimebutine are given below.
Consilium Medicum. 2016;18(8):19-26
pages 19-26 views

Features of classical S-enantiomer of omeprazole molecules (esomeprazole) in the treatment of gastroesophageal reflux disease

Yurenev G.L., Partsvania-Vinogradova E.V., Lebedeva E.G., Zaborovskii A.V., Tararina L.A.


The incidence of gastroesophageal reflux disease (GERD), as well as the number of patients with complications of this disease (Barrett's esophagus, adenocarcinoma) has been steadily growing. Not only gastorenterologists but other medical specialists face the need of treating GERD patients. The article presents the modern methods of diagnosis and various therapeutic approaches in the management of patients with GERD. In many clinical situations, the drug of choice in the treatment of this disease is esomeprazole due to its high efficiency and safety.
Consilium Medicum. 2016;18(8):27-31
pages 27-31 views

Optimization of Helicobacter pylori therapy in modern clinical practice

Kazyulin A.N., Partsvania-Vinogradova E.V., Dicheva D.T., Lebedeva E.G., Golovkina N.L.


The review indicated ways of optimizing the Helicobactor pylori therapy. Performance indicator eradication therapy (ET) is correlated with the prevalence of antibiotic resistance strains in the population. One factor influencing the efficiency of ET, is a gene polymorphism (CYP2C19, MDR1), which is a defining feature of drug metabolism. Doubling unit dose of proton pump inhibitor ensures a more pronounced antisecretory effect for a longer time, which increases the efficiency of ET. In the view of the need to achieve the intragastric pH>4 for 90% of the time the use of an inhibitor of the proton pump of the new generation is justified.The introduction of bismuth drugs in the main ET scheme demonstrates a positive impact on the eradication rate and is regulated in modern Russian recommendations.
Consilium Medicum. 2016;18(8):32-36
pages 32-36 views

The role of the antihomotoxic medications in treatment of diseases of the gastrointestinal tract

Grishchenko E.B.


Current knowledge about the human body and the nature of the proceeding in its disease provides a new approach to the physiology and pathophysiology of the processes taking place in order to ensure recovery of the underlying disease by systemic exposure to the entire affected network, not only due to the relief of the primary symptoms. Researching the dysregulation of affected systems and their mechanisms allows us to understand the complex nature of the diseases, their pathophysiology, and to assess autoregulatory capabilities of the organism and to maintain homeostasis in the face of changing conditions of external and internal environment. Established by H-H.Reckeweg, the theory of homotoxicology has much in common with modern advanced scientific and medical concepts of the medical system. Antihomotoxic drugs smoothly integrated into the system and bioregulatory medicine and can be used as ba-sic therapy or in combination with classical allopathic therapy.
Consilium Medicum. 2016;18(8):37-41
pages 37-41 views

Use of aceclofenac (Aertal) in early stages arthrosis of the knee joint

Zagorodniy N.V., Ivashkin A.N., Zakirova A.R., Skipenko T.O.


The purpose of this study was in the assessment of the efficacy and safety of Aertal® in patients with knee OA in its early stages. The study group consisted of patients with gonarthrosis stage I-II. Representative group consisted of 80 patients (43 women and 37 men), mean age was 58 years. All subjects were randomized to conservative treatment groups (A and B). Patients received either Aertal® 100 mg 2 times a day, or diclofenac 75 mg 2 times a day for 6 weeks. The average value of the visual analogue scale (VAS) for pain intensity estimates in group A was 7.4, group B - 7.6. After 6 weeks of conservative therapy VAS index fell to 3.8 in group A and 5,4 - in group B, showing a significant reduction in pain intensity. The Western Ontario McMaster (WOMAC) index in group A was 31,68±12,41 (>40), in the group B 36,17±10,32 (>40). Similarly, the WOMAC index fell to 6.28 in group A and to 19.42 - in group B, which shows a significant decrease of difficulty in daily physical activities, including improving the quality of life of patients. The results of this study showed a favorable safety profile in the group B (Aertal®) compared with group A (diclofenac), against the background of almost equivalent efficacy of both groups. Thus Aertal® has much better gastrointestinal tolerability than diclofenac. Based on the data, it can be stated that the key issue in choosing NSAID orthopedic surgeon is its high clinical efficacy, safety, and well-tolerated.
Consilium Medicum. 2016;18(8):42-45
pages 42-45 views

Nonalcoholic fatty liver disease and type 2 diabetes mellitus

Rodionova S.V., Zvenigorodskaya L.A., Biryukova E.V.


Diabetes mellitus type 2 (DM 2) is often associated with non - alcoholic fatty liver disease (NAFLD). The combination of type 2 diabetes and NAFLD is associated with a high risk of developing liver cirrhosis and hepatocellular carcinoma in patients with data. All aspects of the pathogenesis of NAFLD is unknown until the end, but a key role for insulin resistance. A new class of oral antidiabetic drugs - inhibitors of sodium - glucose cotransporter type 2 (inhibitors of SGLT2) - reduce the level of blood glucose independent of insulin manner. SGLT2 inhibitors lead to a decrease in body weight, thereby reducing insulin resistance, hyperinsulinemia, and glucose normalization synthesis and its utilization in the liver. This class of antidiabetic drugs may have positive effects on NAFLD and be used to treat patients with a combination of type 2 diabetes and NAFLD.
Consilium Medicum. 2016;18(8):46-50
pages 46-50 views

Functional, clinical and morphological transformations of the pancreas and metabolic syndrome

Zvenigorodskaya L.A., Khachaturyan N.E.


This article discusses a close relationship of the endo - and exocrine functions of the pancreas (pancreatic), and the development of pancreatic steatosis in patients with metabolic syndrome (MS). It is shown that in patients with disorders of the endocrine pancreas function observed marked changes in exocrine function of the pancreas. The trigger mechanism of the progression of pancreatic pathology in MS inflammation appears closely paired with fatty infiltration of the body on the background of obesity. With pancreatic steatosis in patients with MS the b-cell dysfunction with subsequent formation of impaired glucose tolerance and development of diabetes mellitus (DM) type 2 develops. As part of the diagnosis of pancreas besides ultrasound, computed and magnetic resonance imaging is currently used by fine - needle aspiration biopsy pancreas that allows you to get a more accurate picture of the morphological RV with steatosis in patients with the metabolic syndrome and diabetes type 2. Given the contingency MS with steatosis RV, it is important to clarify the state of the pancreas in patients with MS.
Consilium Medicum. 2016;18(8):51-58
pages 51-58 views

Eating disorders in the light of clinical guidelines for the diagnosis and treatment of nonalcoholic fatty liver disease

Maev I.V., Gegel N.V., Dicheva D.T., Mironova E.M., Andreev D.N., Kazyulin A.N., Kudriashova K.O.


Both Russian and international clinical guidelines on the treatment of non-alcoholic fatty liver disease (NAFLD) have important modifications to give the image of the patient's life, such as weight loss. That body mass correction in many ways is a basic method of treatment of NAFLD, which allows to slow down the progression of the pathological process and the complications of the disease prophylaxis. However, patients with NAFLD are extremely difficult in implementing this recommendations due to the formed dietary habits. With this in mind the practical skills of GPs and gastroenterologists in this area allow to identify and take the first steps for the correction of eating disorders in this group of patients.
Consilium Medicum. 2016;18(8):59-63
pages 59-63 views

Metabolic syndrome and metabolically healthy obesity in young men

Goncharova E.V., Petunina N.A., Bokeriia O.L., Arkhipkin A.A.


A retrospective and cross - sectional study evaluated the prevalence of metabolic syndrome and metabolically healthy obesity in young men with obesity debut with adolescence. There was a significant reduction in the phenotype of the metabolically healthy obese when compared to adolescence, as well as taking into account additional risk factors for subclinical: HOMA-IR index, and high - sensitivity C-reactive protein.
Consilium Medicum. 2016;18(8):64-67
pages 64-67 views

Non-alcoholic fatty liver disease associated with obesity: therapeutic opportunities

Trukhan D.I., Ivanova D.S.


Recent decades have seen a marked increase in the prevalence of diseases associated with a change in the nature of power and way of life. One of the most often associated with pathological conditions of obesity is a metabolic syndrome (MS). Almost all patients with MS there is fatty degeneration of hepatocytes, and nearly half found steatohepatitis, which can be considered non - alcoholic fatty liver disease (NAFLD) as the hepatic component of MS. A promising drug in NAFLD associated with obesity and impaired metabolic processes in the body, is taurine.
Consilium Medicum. 2016;18(8):68-74
pages 68-74 views

Diet therapy with a reduced content of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) for the irritable bowel syndrome

Kazyulin A.N., Dicheva D.T., Russ I.S., Andreev D.N., Partsvania-Vinogradova E.V.


In the treatment of irritable bowel syndrome (IBS) it is extremely important to create new schemes of diet therapy. The most recommended today is a diet with a reduced content of fermentable oligosaccharides (fructans and galactans), di- (lactose), monosaccharides (fructose) and polyols (FODMAP). Exclusions of various food in the diet of patients with different clinical variants of IBS diet for FODMAP scheme reduces the gassing process and normalization of contractile activity of the intestine, which greatly relieves the frequency of exacerbations and improves the quality of life of these patients.
Consilium Medicum. 2016;18(8):75-78
pages 75-78 views

Irritable bowel syndrome. Rome criteria IV

Maev I.V., Cheremushkin S.V., Kucheryavy Y.A., Cheremushkina N.V.


The following review of the literature is devoted to the publication of the next Rome criteria for the diagnosis and treatment of functional disorders of the digestive system. IV review focuses on the most frequently encountered and difficult curable pathology - Irritable bowel syndrome (IBS). We present the new diagnostic criteria, observed important differences from the previous version. The attention of readers to the peculiarities of the pathophysiology of IBS and related misunderstanding in this area frequent errors in the conduct of such patients. Submitted by the modern view of the IBS drug therapy based on evidence - based clinical trials, a brief critical analysis of the most common mistakes in choosing drugs and other agents in the treatment of this disease.
Consilium Medicum. 2016;18(8):79-85
pages 79-85 views

Nutrition support in treatment of complicated chronic pancreatitis

Kostyuchenko L.N., Kostyuchenko M.V.


We compared 2 groups of patients: standard treatment of chronic pancreatitis in the preand postoperative periods and the modified correction (with on the background of the traditional scheme of active nutritional support with the participation of the nutritionist). On the basis of the alimentation-volemic diagnosis adjusted data treatment algorithm taking into account the functional reserve of limiting the absorption of bodies, rehabilitation potential, bowel readiness to assimilate nutrients, etc. It is shown that nutritional support in the treatment of complicated chronic pancreatitis is one of the main components of treatment.
Consilium Medicum. 2016;18(8):86-88
pages 86-88 views

The possibilities of modern nutraceuticals in the service fast track surgery ulcerogenic peritonitis

Simutis I.S., Boyarinov G.A., Malinovskkaya I.A., Mukhin A.S.


Objective. To study the effect of early enteral nutritional balanced mixtures containing glutamine in patients with ulcerative general fibrinous-purulent peritonitis in the docking compartment syndrome in the early postoperative period. Materials and methods. The study included 43 patients with perforated gastric ulcer, complicated by diffuse purulent peritonitis. All patients underwent an emergency surgical resection guide in the form of perforated ulcer. We used the technique of programmed (24-48 hours) rehabilitation of the abdominal cavity. In the main group, which includes 30 people, patients received in the structure of the above indicated basic treatment 500 ml of the product Intestamin. Results and its discussion. The use of a standard protocol of nutritional support, without a high content of glutamine resulted in the comparison group to almost two - fold increase in complications is an average of 38.5% and an increase in mortality in the group to 30.7%, while in the basic group the above figures were 20.0% and 16.6%, respectively. One of the significant reasons for the above difference was pronounced and the long - term cropped compartment syndrome in the control group, as well as the speed of its resolution on the background of Intestamin. Conclusions. Application Intestamin in the perioperative period in patients with peritonitis ulcerogenic justified by the possibility of full implementation of ERAS protocol, which in turn significantly affects the speed of the correction compartment syndrome and leads to a significant reduction in such important indicators as the number of complications, length of hospital stay, mortality.
Consilium Medicum. 2016;18(8):89-92
pages 89-92 views

Possibilities of optimization of transfusion therapy in gastrosurgery

Simutis I.S., Boyarinov G.A., Mukhin A.S., Otdelnov L.A.


Objective. To develop techniques pretransfusion rehabilitation canned red blood cells in patients with perioperative blood loss, severe. Materials and methods. The object of the study served as the red cells of various human blood storage time, stable preservative CPDA-1. Ozonation red blood cells was carried out by mixing it with ozonated solution NaCl 0.9% in an equivalent volume containing various concentrations of ozone, discrete increases of up to 20 mg/l. After 30 minutes of exposure to the slurry obtained erythrocyte suspension was determined concentration of malondialdehyde, adenosine triphosphate (ATP), 2,3-diphosphoglycerate (2,3-DPG), catalase activity in erythrocytes and their electrophoretic mobility. Results of the study. Under the influence of different ratios of ozone and erythrocytes detected ozone concentration range of 0.5-2 mg/l, causing an equivalent mixing restoration of ATP levels and 2,3-DPG in red blood cells to near normal values during the shelf life of 7 to 21 days. In terms of storage of packed red blood cells to 30 days, an increase 2,3-DPG content in red blood cells was observed on the background of the depletion of ATP pools in the cells. Thus inside the erythrocytes catalase activity in the basic group increases, resulting in 30 minutes after treatment, a significant reduction of malondialdehyde, without disturbing the electrophoretic mobility of treated erythrocytes. Conclusion. The work demonstrated the potential effects of ozone at low concentrations on key factors such as the system of oxygen transport and energy metabolic status of erythrocytes, as well as their morphological and functional properties (primarily deformability) at pretransfusion processing.
Consilium Medicum. 2016;18(8):93-95
pages 93-95 views

Unresolved issues of surgical treatment of liver echinococcosis (review of literature)

Cherkasov M.F., Melikova S.G., Starcev Y.M., Cherkasov D.M.


The article presents a literature review on one of the actual problems of surgery concerning liver echinococcosis. Discusses some of the controversial and unresolved problems of surgical treatment of liver echinococcosis. Today, in addition to traditional operations, in cases of liver echinococcus widely used videoendosurgical and minimally invasive surgery, which cause a lot of mixed opinions. Despite the improvement of methods of surgical intervention with the use of modern technologies, the introduction of various chemical and physical methods of influence on the parasite, the recurrence rate of hydatid cyst of the liver remains high. Challenges the effective treatment of liver echinococcosis and a high likelihood of recurrence due to the lack of generally accepted optimal variant of surgical treatment depending on the size and localization of cyst, fibrous cap thickness, the qualitative characteristics of the parasite, the lack of unified methods of processing the bed of the cyst and a small selection of highly effective germicidal solutions. This shows the relevance of the problem and makes the search for new solutions to improve the efficiency of surgical treatment of liver echinococcosis.
Consilium Medicum. 2016;18(8):96-100
pages 96-100 views

Effects of metabolic activity of the intestinal microflora on the nutritional status of patients with combined bowel resection

Kostyuchenko L.N., Kuzmina T.N., Smirnova O.A., Silvestrova S.Y.


There are changes in the intestinal microflora of the syndrome of a short small intestine and postcolectomy syndrome. However, information obtained for the first time with a combination of extensive resection of the small intestine and colon. It is shown that the condition of the intestinal microbiota is one of the essential components of diagnosis of nutritional status in combined bowel and colonic resections. Determination of the activity of its various representatives of the program allows you to select the optimal enteral nutritional correction.
Consilium Medicum. 2016;18(8):101-104
pages 101-104 views

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