Vol 19, No 8 (2017)


Diagnosis and treatment of non-alcoholic fatty liver disease: a review of European guidelines in 2016

Andreev D.N., Maev I.V., Dicheva D.T., Kuznetsova E.I.


Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases in the world. The review article deals with the approaches to diagnosis and treatment of patients with NAFLD from the perspective of evidence-based medicine and 2016 guidelines by the European Association for the Study of the Liver, the European Association for the Study of Diabetes and the European Association for the Study of Obesity.
Consilium Medicum. 2017;19(8):8-13
pages 8-13 views

Inflammatory diseases of the small intestine: undifferentiated and undifferentiable enteritis and enterocolitis

Vialov S.S.


The article discusses the diagnosis and treatment of inflammatory diseases of the small intestine, the differential diagnosis. There are practical difficulties in the diagnosis of pathology of the small intestine. Required routine screening of the intestinal pathology in patients with persistent symptoms. To identify inflammatory bowel disease it is advisable to use calprotectin, the passage of barium and capsule endoscopy.
Consilium Medicum. 2017;19(8):14-18
pages 14-18 views

Modern aspects of use of antacids in acid-related diseases

Butorova L.I., Osadchuk M.A., Tokmulina G.M.


Acid-related diseases (ARDs) are one of the most common disorders among of the digestive system diseases. Damaging action of hydrochloric acid is the main part of ARDs pathogenesis. The first pharmacological therapies that began to be used to treat ARDs several centuries ago were antacids. Antacids are included in all schemes and standards of ARDs treatment, nowadays. In the review we discuss the mechanisms of action and basic pharmacological characteristics of antacids, their classification and describe the characteristics of monocomponent drugs of this group. We show the facts about combined antacids and discuss the clinical pharmacology and the main indications for appointment of combined antacid - Antareit. The review stress that Antareit is an effective and safe antacid providing combined acid-neutralizing, cytoprotective, coating, adsorption, antifoaming capacity.
Consilium Medicum. 2017;19(8):19-26
pages 19-26 views

Safety of ursodeoxycholic acid: evidence or rumors about toxicity?

Yakovenko E.P., Vialov S.S.


The article studies the characteristics of ursodeoxycholic acid (UDCA) application in terms of safety and the risk of adverse effects. We have analyzed the instructions of medical application, the results of toxicological studies using animals, clinical trials of patients with different pathologies and meta-analysis of the results of the studies. This article deals with the actual results on the use of UDCA in pregnancy and childhood. We discuss the possibility of the usage the UDCA in pediatric patients, according to the characteristics of application of registered instruction in childhood. The instruction of medical application is an official document approved by the Ministry of Health, at the baseline of it are placed the results of the studies that confirm the safety of the usage of UDCA in pediatric practice. We have studied the therapeutic possibilities of UDCA usage and the safety and efficacy. As follows from the analysis of numerous studies we have found no evidence of toxicity or low-profile safety of the usage of UDCA. In contrast, the large number of studies are devoted to the categories of patients the so-called safety standard, confirm the absence of toxicity and high efficiency of UDCA. The reports of toxicity of UDCA should be considered incorrect and unfounded.
Consilium Medicum. 2017;19(8):27-31
pages 27-31 views

Helminthiases registered on the territory of the Russian Federation: epidemiological situation, parasite biology, pathogenesis, clinic, diagnostics, etiotropic therapy

Davydova I.V.


Helminthiases are widespread among all sections of the population. According to World Health Organization, more than half of the world's population is affected by helminths. On the territory of the Russian Federation, helminthiasis is monitored, however, the low alertness of medical personnel, the lack of diagnostic tools and drugs for the treatment of helminthiasis, the noncompliance with the rules for processing food products in industries and individuals, as well as the way of life of indigenous peoples and the low level of population education contribute to the retention of the morbidity level, and in some cases, its growth. The article contains information about the incidence of helminth invasions over the past few years and brief data on the features of parasite biology, the main points of pathogenesis, clinical manifestations of parasites, specific diagnostic methods and etiotropic treatments.
Consilium Medicum. 2017;19(8):32-40
pages 32-40 views

Prevention of venous thromboembolism in practice of coloproctologist: historical aspects and modern reality

Kudykin M.N.


Venous thromboembolic complications (VTEC) may occur after any surgical treatment and may complicate any kind of pathology. Pulmonary artery thromboembolism (PATE) is known as the most common identifiable cause of death in hospitalized patients around the world. The risk for deep vein thrombosis and PATE is higher in colorectal surgical procedures compared with general surgical procedures. The incidence of PATE in this population is estimated to be 0.2 to 0.3%. The measures for prevention of VTEC include mechanical methods (graduated compression stocking, intermittent pneumatic compression devices on lower-extremity) and pharmacologic agents. A combination of mechanical and pharmacological methods shows the best results. Patients underwent surgery should be stratified according to their risk of VTEC based on patient risk factors, disease-related risk factors, and procedure-related risk factors. The type of prevention should be commensurate with the risk of VTEC based on the risk profile of patient.
Consilium Medicum. 2017;19(8):41-47
pages 41-47 views

Radiologic technology in gastroenterology: "old" and "new" in the diagnosis

Koroleva I.M.


The history of the development of methods of radiologic imaging in gastroenterology decades and represents, basically, the evolutionary transformation of contrasting methods of study of the digestive tract. Classical research methods of the stomach, colon and small intestine with contrast still remain relevant to the present time, as represent the most simple and physiological way of obtaining information on the morphology and function of the digestive tract, both in normal and in pathological conditions, including postoperative changes. Fluoroscopy of the stomach and duodenum ulcer, barium enema was initially performed using only barium suspension. Then, techniques have improved through the use of double contrast techniques. To improve imaging of the digestive tract significantly contributed to the improvement of x-ray equipment, namely, the appearance of electron-optical image converters. Absolutely new stage in development of radiation technology in gastroenterology has become computerized tomography that provides a revolutionary leap forward not only in diagnostic systems, but also in all clinical disciplines that use the information to determine the optimal tactics of conservative treatment and selection of adequate operative approaches in various clinical situations.
Consilium Medicum. 2017;19(8):48-53
pages 48-53 views

The possibilities of phytotherapy in the treatment of patients with functional disorders of the digestive tract

Bakulin I.G., Skazyvaeva E.V., Avalueva E.B., Skalinskaya M.I., Oganezova I.A.


In recent years there has been an increase in the number of patients with functional diseases of the gastrointestinal tract, and often there is a combination of various variants of functional disorders, as well as their combination with other diseases of the gastrointestinal tract. In this regard, there is a need to find new effective approaches in the treatment of this group of patients, which will help to avoid the simultaneous administration of several medicines. One of these therapeutic approaches is the appointment of a combined herbal preparation STW 5 (Iberogast®), which affects various pathogenetic mechanisms of functional disorders. The components included in the formulation have a synergistic effect, potentiating the actions of each other. In patients with functional disorders, the drug can be used both in the form of monotherapy, and the composition of complex treatment. The efficacy and safety of STW 5 in the treatment of functional disorders of the digestive tract has been demonstrated in a large number of clinical studies and corresponds to a level of evidence of IA.
Consilium Medicum. 2017;19(8):54-61
pages 54-61 views

Ulcerative colitis: case report of recurrence on the background of biological therapy

Kliaritskaia I.L., Maksimova E.V., Stilidi E.I.


Aim of review - to present our readers a clinical case of ulcerative colitis, in which the recurrence of the disease has developed on the background of biological therapy Summary. Inflammatory bowel disease, which includes ulcerative colitis and Crohn's disease, has been and remains one of the most serious problems in modern gastroenterology. According to severity, frequency of complications and mortality, inflammatory bowel diseases in the world occupy one of leading places in the structure of diseases of the gastrointestinal tract. The article presents a clinical case of ulcerative colitis, which has manifested in a patient aged 30 years with the development at first hormonal dependence, then - hormone resistance, and then - a relapse of disease on the background of biological therapy with adalimumab. In this connection it is planned to appoint the patient another biological agent - vedolizumab. The vedolizumab is anti-a4b7-integrinhumanized class IgG1 antibodies which suppresses migration of leukocytes in intestinal tissue, interfering thereby with development of pathologic inflammation.
Consilium Medicum. 2017;19(8):62-64
pages 62-64 views

Optimizing therapy of Helicobacter pylori infection in the light of the recommendations of the Maastricht

Baeva T.A., Partsvania-Vinogradova E.V., Kuznetsova E.I., Golovkina N.L., Gulenchenko Y.S.


In clinical practice of gastroenterologist the large part of patients, requiring therapy of Helicobacter pylori. In the scheme of treatment a certain patient the doctor is guided by both international and russian recommendations. However, the frequent detection of drug-resistant strains of H. pylori to within the recommended schema therapy of H. pylori to antibiotics, forcing researchers to address questions about its optimization. The result of the discussion of the optimization problems of modern schemes of H. pylori therapy was the material of the consensus Maastricht V, developed by leading experts in the diagnosis and treatment of H. pylori infection. This article examines the provisions of the consensus Maastricht V, as well as options of therapeutic tactics depending on regional resistance of H. pylori.
Consilium Medicum. 2017;19(8):65-68
pages 65-68 views

Main hepatic syndromes in practice of internist

Makarova M.A., Baranova I.A.


The article highlights laboratory and clinical laboratory syndromes associated with the diffuse liver lesions, which are most commonly occur in everyday practice of primary care physician.
Consilium Medicum. 2017;19(8):69-74
pages 69-74 views

Nonsteroidal anti-inflammatory drugs during the provision of primary health care through the prism drug safety and comorbidity: in focus aceclofenac

Trukhan D.I.


One of the most common symptoms in modern clinical practice and one of the most common reasons for which patients seek medical help, is a pain. The most promising and effective remedy pathogenetic peripheral pain receptors are nonsteroidal anti-inflammatory drugs (NSAIDs). However, NSAID-associated a range of different events. Drug safety and comorbidity are closely intertwined with the use of NSAIDs. The results of numerous domestic and foreign researches allow to consider aceclofenac as the drug of choice for the treatment of pain in primary health care in comorbid patients with gastrointestinal and cardiovascular risk.
Consilium Medicum. 2017;19(8):75-83
pages 75-83 views

Differential diagnosis and treatment of hepatic encephalopathy

Viuchnova E.S., Babina S.M.


In the article the main ways of differential diagnosis of hepatic encephalopathy (HE) is one of the earliest clinical manifestations of hepatocellular failure in chronic liver diseases. Diagnostic search is considered in the framework not only of the etiological factors of brain damage, but also at all stages of development of the HE, given the difficulties in establishing minimal clinical manifestations of the latent HE, with the use of psychometric tests for the detection of hidden functional disorders of brain activity and instrumental methods of diagnostics, allowing to determine the structural changes of the brain. From the perspective of the pathogenesis of HE represented a leading direction in the choice of therapy and the role of medicines L-ornithine-L-aspartate, acting on ornithology cycle, representative of which is a new domestic drug Ornilatex having pronounced hypoazotemic action.
Consilium Medicum. 2017;19(8):84-88
pages 84-88 views

Proctologic incidence and the standards of specialized service

Rivkin V.L.


Widespread diseases of the colon and rectum make actually the task of further study and optimization of parameters of the specialized assistance.
Consilium Medicum. 2017;19(8):89-92
pages 89-92 views

Nonalcoholic fatty liver disease and cardiovascular risk

Kliaritskaia I.L., Maksimova E.V.


Objective: to provide data corroborating the relationship between non-alcoholic fatty liver disease - NAFLD (in particular, non-alcoholic steatohepatitis - NASH) and diseases of the cardiovascular system and to study the prevalence of NAFLD in patients with cardiovascular disease in Republic of Crimea and to compare the effectiveness of different strategies of treatment of NAFLD. Materials and methods. The study included 100 patients with essential hypertension stage II 2 degree, of which 65% patients had also hypercholesterolemia. All patients underwent ultrasound of the abdomen, biochemical blood analysis, blood tests for markers of viral hepatitis, 13C-metathetin breath test. Frequency of NAFLD in the studied population was 54%, in the group with hypercholesterolemia - 45 persons (69.2%). Among them, the patients were divided into 2 groups: 1 group (n=22) with NASH received atorvastatin 20 mg at bedtime, essential phospholipids 2 caps. × 3 t/d; 2 group (n=23) without NASH received only atorvastatin 20 mg at night, for 6 months. Results of the study. After 6 months of treatment comparable results were obtained in both groups: normal levels of transaminases and decreased total cholesterol and lipid profile parameters in 90.9% of patients 1 group vs. 91.3% of patients 2 group, as well as improvement in the 13C-metathetin breath test that indicates the increase in mass of functioning hepatocytes. Conclusions. Considering the high incidence of NAFLD in patients with cardiovascular disorders, especially in combination with hypercholesterolemia, it is useful in complex survey of patients include abdominal ultrasound, 13C-metathetin breath test, as well as determining of the level of transaminases, bilirubin, alkaline phosphatase and GGT. In the presence of NASH it is advisable to include essential phospholipids in therapy, which will reduce mortality.
Consilium Medicum. 2017;19(8):94-96
pages 94-96 views

Alcoholic liver disease and non-alcoholic fatty liver disease. Similarities and differences. Peculiarities of treatment

Zvenigorodskaia L.A., Shinkin M.V.


Non-alcoholic fatty liver disease as well as alcoholic liver disease is important medical and social problem, because, despite the apparent beneficial course - these diseases are associated with the development of liver inflammation in an outcome of cirrhosis and liver failure.
Consilium Medicum. 2017;19(8):97-102
pages 97-102 views

Chronic gastritis: clinical variants and treatment

Vialov S.S.


The article discusses the diagnosis and treatment of chronic gastritis differential diagnosis. There are practical difficulties in the diagnosis of pathology of the stomach, limiting the granularity of the diagnosis. Required routine screening of atrophy and dysplasia in patients with pathology of the stomach. To identify inflammatory diseases of the stomach, it is advisable to use the gastropanel. To improve the effectiveness of relief of symptoms, it is possible to add prokinetic in the scheme of therapy, to reduce the frequency of relapses, the application of gastroprotectia of rebamipide.
Consilium Medicum. 2017;19(8):103-109
pages 103-109 views

New understanding about gastropathy associated with using of nonsteroidal anti-inflammatory drugs

Maev I.V., Andreev D.N., Dicheva D.T., Zhilyaev E.V.


More than 30 million people take nonsteroidal anti-inflammatory drugs (NSAIDs). Regular use of NSAIDs is associated with a number of side effects and risks, the leader which are inflammatory, erosive and ulcerative changes of the mucous membrane of the gastrointestinal tract (GIT). NSAIDs can induce lesions of the GIT throughout its length from the esophagus to the rectum, but the lesion of the upper GIT develops in 6 times more often. NSAID gastropathy is a topical problem of modern clinical medicine, given the high prevalence and frequency of complications. Risk of NSAID-gastropathy is influenced by as factors as patient age, infection with Helicobacter pylori, the presence of complications of gastrointestinal diseases in the anamnesis, concomitant use of other drugs. Currently the most common of the strategies used for the prevention of NSAID-gastropathy is a combination therapy of NSAIDs with a proton pump inhibitor, and the use of selective cyclooxygenase-2 inhibitors. The introduction into clinical practice of new gastroprotective drug with proven effect - rebamipide - opens new prospects for the management of this difficult group of patients.
Consilium Medicum. 2017;19(8):110-115
pages 110-115 views

Chronic constipation: actuality, problems and modern treatment options

Kucheriavyi Y.A., Andreev D.N., Cheremushkin S.V.


Chronic constipation is the greatest global medical social health problem, and rational therapy of this disorder is one of the most topical themes in modern gastroenterology. Therapeutic approaches in the treatment of chronic constipation should be characterized by the stage of sequence. The treatment should started lifestyle changes of the patients, increase of water intake to over 1.5-2 liters per day, include a diet rich in dietary fiber, in particular wheat bran, or the use of psyllium. In case of inefficiency of these activities, it is important to use pharmacotherapy, and the priority should be given to the non-absorbable disaccharides, in particular the next generation drug - lactitol (Exportale®). This drug within the framework of the treatment of chronic constipation is characterized by an equivalent and in some cases more effective, in comparison with first generation non-absorbable disaccharides (lactulose) and has a better safety profile (decrease the frequency of side effects by 1.5-2 times), as well as that drug has the best taste, that allows to consider this drug as first-line therapy in the treatment of chronic constipation.
Consilium Medicum. 2017;19(8):116-120
pages 116-120 views

Primary sclerosing cholangitis: review of recommendations for diagnosis and treatment of disease

Raikhelson K.L., Pazenko E.V., Marchenko N.V.


Primary sclerosing cholangitis (PSC) is a chronic progressive cholestatic liver disease with unknown etiology. In recent years, there is steady increase in the incidence of PSC. However, this disease is poorly known to practitioners still. Within last 10 years, leading hepatological associations have developed or updated the current recommendations on PSC. That allowed to standardize approaches to diagnosis and treatment of the disease. However, there are still more questions than answers in the understanding of PSC, and it remains a scientific and clinical problem. Primary diagnosis and treatment of the disease are the sharpest issues. The purpose of this review was to summarize current and advanced concepts in the diagnosis and treatment of the disease. We analyzed recommendations of the leading gastroenterological (hepatological) associations on PSC. As a result, we have received the most complete comprehension on the features of diagnosis and treatment modalities for PSC at the present stage of the development of medicine. Currently, none of the medicinal products are proved to be effective on patient's survival rate, and liver transplantation remains the only treatment that improves prognosis of the patients with PSC. At the same time, there are many observations on effectiveness of ursodeoxycholic acid in PSC, which explains its wide use in this group of patients. We also presented our own experience in diagnosing and treating of a patient with PSC.
Consilium Medicum. 2017;19(8):121-130
pages 121-130 views

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