Vol 23, No 5 (2021)


Microscopic colitis from the standpoint of modern gastroenterology

Andreev D.N., Maev I.V., Kucheryavyy Y.A., Cheremushkin S.V.


Microscopic colitis is a chronic inflammatory bowel disease of unknown etiology, characterized by chronic watery diarrhea, the absence of macroscopic signs of colon lesions in the presence of specific pathological changes. This review article presents the current view on microscopic colitis, including its definition, epidemiology, risk factors, clinical manifestations, diagnostic criteria and treatment tactics according to the last European clinical guidelines UEG/EMCG (2021).
Consilium Medicum. 2021;23(5):395-401
pages 395-401 views

Effect of adjuvant therapy with butyric acid on the safety profile of oral antibiotic therapy: a meta-analysis of controlled studies

Andreev D.N., Kucheryavyy Y.A., Kaziulin A.N., Maev I.V.


Aim. Systematization of data on the effect of adjuvant therapy with butyric acid (BA) on the safety profile of oral antibiotic therapy (ABT). Methods. Search of studies were carried out in MEDLINE/PubMed, EMBASE, Cochrane, Google Scholar, Russian Science Citation Index (RSCI) electronic databases until April 2021 inclusive. We analyzed titles and annotations in the named databases. The following combination of keywords was used for the search: "butyric acid" or "butyrate" + "antibiotic therapy" or "antibiotics" or "eradication" or "eradication therapy", as well as their analogs in English for searching in foreign databases. Results. The meta-analysis included 9 controlled studies (1 - Italy, 8 - Russia) involving 1409 patients (700 - in groups with BA; 709 - in comparison groups). Meta-analysis showed that the addition of BA to ABT regimens contributes to a significant reduction in the overall incidence of gastrointestinal Conclusion. A meta-analysis has shown that the inclusion of BA in ABT regimens significantly reduces the incidence of side effects (diarrhea, bloating, bitterness in the mouth).
Consilium Medicum. 2021;23(5):402-406
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Gastroesophageal reflux disease and alginates: diagnosis, treatment, prevention

Knorring G.J., Sediakina L.V.


Gastroesophageal reflux disease (GERD) remains a major problem in gastroenterology. GERD phenotypes have recently been identified, but a key mechanism of pathogenesis is the effect of acidic stomach contents on the esophageal mucosa due to reflux. The role of alginates in GERD is expanding in terms of diagnosis, improvement of treatment outcomes, and prevention of relapse.
Consilium Medicum. 2021;23(5):407-411
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Features of psychoemotional status and eating disorders in patients with gastroesophageal reflux disease and obesity

Yurenev G.L., Mironova E.M., Sirota N.A., Yureneva-Tkhorzhevskaya T.V.


Background. Eating disorders, as well as features of the psychoemotional status as risk factors for obesity, patients with comorbid gastroesophageal reflux disease (GERD) and obesity in the modern literature are not sufficiently disclosed. Further study of these aspects may be one of the additional ways to improve the prognosis of the course of GERD, as well as the correction of the psychoemotional status of patients. Aim. To study the features of the course of GERD in concomitant obesity in the context of the peculiarities of the psychoemotional sphere, as well as to identify the types of eating disorders in this cohort of patients. Materials and methods. The study included 130 patients aged 24 to 72 years with complaints characteristic of the pathology of the upper digestive tract, who, along with a detailed analysis of complaints in order to verify the diagnosis and identify the features of the course of the disease, were tested with the Dutch Eating Behavior Questionnaire (DEBQ) and the hospital scale of anxiety and depression (HADS). Results. It was found that obese patients who had GERD less than 8 years ago were more likely to suffer from external and emotionogenic eating disorders, and the external type was more often associated with the male, and the emotionogenic type with the female sex. Whereas, in patients with obesity and a history of GERD for more than 8 years, the restrictive and emotionogenic types of eating disorders were relatively more often recorded. An increased level of anxiety in patients with GERD was noted, both against the background of obesity and without it, but those with comorbid pathology had a relatively higher score on the anxiety scale. Conclusion. Correction of eating behavior and signs of anxiety-depressive states in patients can open up new prospects for the fight against obesity. And this, in turn, can improve the prognosis of patients with GERD.
Consilium Medicum. 2021;23(5):412-416
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Efficacy of esophagoprotection with short periods of withdrawal of maintenance therapy with proton pump inhibitors in patients with Barrett's esophagus

Kucheryavyy Y.A., Movtaeva P.R., Zayratyants O.V., Andreev D.N., Shaburov R.I., Barkalova E.V., Maev I.V.


Aim. Evaluation of the effectiveness of esophagoprotection in covering up short periods of withdrawal of maintenance therapy with proton pump inhibitors (PPIs) in patients with Barrett's esophagus (BE). Materials and methods. A retrospective analysis of the data of patients with histologically verified BE who received outpatient PPI therapy for at least 12 months was carried out. This cohort was divided into two groups to compare depending on the treatment regimen received. The first group included only patients who take PPIs constantly, while the second group included patients who had periodic interruptions in taking PPIs. In the second group, we analyzed only cases where to cover up the periods of PPI withdrawal the patients used the esophagoprotector Alfasoxx (10 ml 4 times a day, after each meal and at night). In the cohort, demographic data (age, gender), risk factors, length of the BE segment, degree of dysplasia, number of relapses of erosive esophagitis, and the data of high-resolution manometry on movement disorders of the thoracic esophagus (ineffective motility and lack of contractility) were analyzed. Results. The study included 39 patients (28 men and 11 women) with histologically verified BE. The average age was 57,1538 years (95% confidence interval 53.4269-60.8808). The gender structure was dominated by men (n=28). The duration of BE history in the analyzed cohort was 5.6769 years (95% confidence interval, 4.6161-6.7378). The first group consisted of 23 patients who take PPIs constantly. The second group consisted of 16 patients who had periodic interruptions in taking PPIs, which were covered by the esophagoprotector Alfasoxx. In the analyzed cohort, there were no significant differences between the groups in the average length of the BE segment, the number of patients with a long BE segment, the degree of dysplasia, the number of relapses of erosive esophagitis, and the rate of movement disorders of the thoracic esophagus. Conclusion. In routine practice, there are reasons for the temporary withdrawal of PPIs in patients with BE, which requires the administration of course esophagoprotection to cover up the risks. The results of this retrospective comparative study demonstrate the effectiveness of this strategy.
Consilium Medicum. 2021;23(5):417-421
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Increased epithelial permeability syndrome in organic diseases of the upper gastrointestinal tract: systematization of literature data

Andreev D.N., Ul'iankina E.V.


In 2021, the first Multidisciplinary national consensus was published in Russia. The document provides a comprehensive analysis of pathophysiological, clinical and pharmacotherapeutic aspects of the increased epithelial permeability syndrome (IEPS) as one of the main mechanisms of human diseases. A separate chapter of the consensus devoted to the role of IEPS in organic diseases of the upper gastrointestinal tract demonstrates the importance of this pathophysiological mechanism in the genesis of this group of diseases. This review aims to systematize the literature data on the role of IEPS in organic diseases of the upper gastrointestinal tract, including gastroesophageal reflux disease, chronic gastritis and gastric ulcer.
Consilium Medicum. 2021;23(5):422-427
pages 422-427 views

Dinical and immunological status of patients with chronic hepatitis С on the background of comorbidity

Basina V.V., Dzemova A.A., Arsent'eva N.A., Novak K.E., Esaulenko E.V., Totolyan A.A.


Aim. To study the clinical and immunological features of the course of chronic hepatitis C (CHC) in patients with an unfavorable comorbid background. Materials and methods. The study included 700 patients with CHC, followed up in the period from 2013 to 2019 in Botkin Clinical Infectious Diseases Hospital (St. Petersburg). A comparison of immunological features in 79 patients was carried out, depending on the presence or absence of comorbidity, the immunological profile (the concentrations of cytokines/chemokines were determined: tumor necrosis factor a, interferon y, CCL20/MIP-3a, CXCL9/MIG, CXCL10/IP-10, CXCL11/ITAC in blood plasma by multiplex analysis) was specifically studied in persons with diseases of the gastrointestinal tract and pancreas, pathology of the cardiovascular system and endocrine diseases, compared with the indicators of a group of conventionally healthy individuals. Results. Comorbidity was present in 63% of patients with CHC, among whom multimorbidity was found in 79.4%. The most common comorbidities were diseases of the gastrointestinal tract and pancreas - 49% of cases, diseases of the circulatory system - 15.4%, and pathology of the endocrine system and metabolism - 13.9%. In the group of patients with comorbidity, the concentrations of the chemokines CXCL9/MIG and CCL20/MIP-3a were determined, which were 2 and 1.6 times higher than those in the group without concomitant diseases (p=0.017). Also, both of these indicators significantly exceeded normal values (p<0.05). When analyzing the chemokine profile in patients in various subgroups, a significant excess of CCL20/MIP-3a concentration was revealed in the subgroup with endocrine diseases (p<0.05). Conclusion. Patients with CHC have a high prevalence of comorbidity and multimorbidity. The cytokine profile showed high concentrations of CCL20/MIP-3a and CXCL9/MIG chemokines in the group of patients with concomitant pathology in comparison with patients without it, and a predominance of the CCL20/MIP-3a chemokine concentration in patients with endocrine pathology, including diabetes 1 and 2 type.
Consilium Medicum. 2021;23(5):428-433
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New approaches to determining the nutritional treatment tactics in patients with malignant neoplasms

Kostiuchenko L.N., Varvanina G.G., Dobrovol'skaia N.l., Kruglov A.D., Lychkova A.E.


Aim. To determine personalized approaches to the choice of nutritional support (NS) tactics in oncopathology, depending on the stage of carcinogenesis. Materials and methods. Nutritionists consulted 96 patients with oncopathology (colorectal cancer, pancreatic adenocarcinoma) over the period 2018-2019. The stage of carcinogenesis was determined mainly by the morphogenetic signs according to V.S. Turusov. Nutritional status was assessed according to the parameters of the known alimentation-volemic diagnosis and basic metabolic syndromes characteristics in cancer patients. The effectiveness of NS was assessed by the change in lysosomal metabolism. Statistical analysis was performed using Statistica 10 software. Results. Based on such clinical and biochemical analysis, 3 groups of patients were identified: 1) subject only to surgical treatment; 2) subject to combined treatment; 3) palliative. Corresponding to the selected groups, the concept of nutritional extinction was formulated and 3 treatment regimens were proposed, which differ in the use of additional correction of endotoxicosis, analgesic pharmaconutrients, or low-calorie diets. The effectiveness of the nutritional correction was assessed with testing lysosomal metabolism by cathepsins L using enzyme-linked immunosorbent assay. It has been shown that cathepsin L can serve as an early marker of nutritional dysfunction and nutritional prognosis. Conclusion. When determining nutritional treatment tactics in cancer patients, it is advisable to distinguish the stages of nutritional extinction. It is advisable to carry out the assessment of NS effectiveness and nutritional prognosis according to cathepsin L levels. Nutritional counseling allows to determine the tactics of neoadjuvant NS, and in some cases to make adjustments in the choice of surgical aid.
Consilium Medicum. 2021;23(5):434-439
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Interdisciplinary approach is a key of efficient treatment in patients with immunoinflammatory diseases. Case report

Kagramanova A.V., Knyazev O.V., Kulakov D.S., Vinnitskaya E.V., Sandler L.G., Savenkova N.A., Lukina G.V., Parfenov A.I.


The article is devoted to clinical case of concomitant immune-inflammatory diseases: Crohn disease, ankylosing spondylitis, primary sclerosing cholangitis. Chronic immunoinflammatory diseases (CID) caused disability, characterized by similar genetic and immunological factors. The emergence of genetically engineered biological drugs has changed the prognosis for both musculo-skeletal diseases and inflammatory bowel disease (IBD). The intersection of the therapeutic spectrum in CID is a very important point in choosing the tactics of management of patients with these pathologies. This clinical case demonstrates the importance of early diagnosis of immunoinflammatory diseases and application of genetically engineered biological drugs, that contributes to prevention disability and enhancement of quality of life of IBD patients. It is concluded that treatment of immunoinflammatory diseases should be carried out taking into account the course of the IBD and the multidisciplinary approach, which requires close cooperation of doctors of various specialties.
Consilium Medicum. 2021;23(5):440-443
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A case of long-term staged treatment of a patient suffering from a peptic ulcer of the gastroduodenal zone. Case report

Semenov D.Y., Did-Zurabova E.S., Osmanov Z.K., Pankova P.A., Kulikov D.V., Polevaya E.V.


Currently, a unified approach to the treatment of peptic ulcer of the upper gastrointestinal tract has been developed, based on knowledge of the pathogenesis of the disease. However, standard methods of conservative and surgical treatment do not bring positive results to a number of patients. The reason may lie in the impossibility of establishing the true etiological factor of this pathology. It must be remembered that patients with of the gastroduodenal zone are not a homogeneous group and require a differentiated approach to diagnosis and treatment. The article describes a clinical case of successful of complicated ulcerative lesions of the gastric and duodenal mucosa, resistant to various methods of conservative and surgical treatment.
Consilium Medicum. 2021;23(5):444-447
pages 444-447 views

Endoscopic stenting of refractory benign esophageal strictures (review)

Ivanov A.I., Popov V.A., Burmistrov M.V., Chugunov A.N., Nazmeev M.A., Gatin I.T., Rahmatullin V.B.


Despite the fact that the overwhelming majority of benign esophageal strictures, although long-term, but effectively stop with the help of endoscopic recanalization, 10% of them recur. Such strictures are a major problem in thoracic surgery. Disabled surgical methods of treatment are associated with a sufficiently high mortality rate and do not guarantee the formation of new anastomotic strictures. Esophageal stenting against the background of a limited endoscopic arsenal of methods for recanalization of benign strictures is the last option. A lot of different models of esophageal stents with their own individual characteristics and features have appeared since the introduction of the first stents in clinical practice. All were investigated in an attempt to identify the optimal stent type and design for the treatment of refractory benign strictures. The review is devoted to the current state of stenting in recurrent benign esophageal stenosis. The review reflects the efficacy and disadvantages of various types of stents and their comparison with a focus on new biodegradable stents used in the treatment of benign esophageal strictures.
Consilium Medicum. 2021;23(5):448-452
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Plastic and cruroraphy for chiatal hernia

Rozenfel'd I.I.


Aim. The article discusses the results of a study using a patented method of two-layer laparoscopic repair of large and giant hiatal hernias using a biocarbon implant in comparison with other surgical techniques. Materials and methods. 716 patients were divided into 3 study groups based on the area of the size of the esophageal hernia defect: group I (314 patients) - with small (less than 5 cm2) and medium (5-10 cm2) hiatal hernias, that is, up to 10 cm2, which hernioplasty was performed only by the method of posterior cruraphy; group II (323 patients) - with large hernias 10-20 cm2: subgroup 1 (92 patients) underwent posterior cruraphy, subgroup 2 (231 patients) - alloplasty. Depending on the alloplasty technique, subgroup 2, in turn, was divided: subgroup A (89 people) - hernioplasty with a polypropylene implant and subgroup B (142 people) - hernioplasty with a medical biocarbon construction. Study group III (79 patients) -patients with giant diaphragmatic hernias of more than 20 cm2 using alloplasty: subgroup A (29 people) - hernioplasty with a polypropylene implant and subgroup B (50 patients) - alloplasty with a medical biocarbon construction. Results. When comparing group I with subgroup 1 of group II, the following results were obtained. Statistically significant differences were found in the degrees and types of diaphragmatic hernias. The average age of patients and statistical differences for it were insignificant. When comparing subgroup 1 with subgroup 2 of group II, statistically insignificant differences were found in the degrees and types of hiatal hernias. The difference in the average age of patients was also statistically insignificant. The difference in the average age of patients was also statistically insignificant. When comparing subgroup A with subgroup B of group II, statistically insignificant differences were found among themselves in the degrees and types of hiatal hernias. When comparing subgroup 2 of group II with group III, the difference turned out to be statistically significant in the distribution of patients by types and degrees of diaphragmatic hernias. When comparing subgroup A with subgroup B of group III by degrees and types of hiatal hernias, statistically insignificant differences were revealed. Conclusion. Posterior cruraphia in small and medium diaphragmatic hernias had significant statistical differences in types and degrees compared to that in large hernias, as well as in the average area of the hernial defect. Posterior cruraphia with hernioplasty in large hiatal hernias did not differ statistically significantly according to any of the criteria. Plastic surgery with a polypropylene implant with alloplasty of a biocarbon implant for large hernias did not differ significantly according to any of the criteria. Hernioplasty for large hiatal hernias, when compared with giant hernias, differed significantly only in the degree and type, as well as in the area of the hernial defect. Onlay plastic surgery with a polypropylene implant with alloplasty of biocarbon structures for giant hernias did not differ significantly according to any of the criteria, except for gender distribution, which did not have significant fundamental significance, which made it possible to make a more correct comparison of the results of surgical interventions in these research subgroups.
Consilium Medicum. 2021;23(5):453-456
pages 453-456 views

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