Vol 24, No 5 (2022)


Phenotypes of gastroesophageal reflux disease: classification, pathogenesis and diagnostic criteria: A review

Maev I.V., Barkalova E.V., Ovsepian M.A., Andreev D.N.


The literature review focuses on the current understanding of visceral hypersensitivity mechanisms in the esophagus. Mechanisms of peripheral and central sensitization and their relation to heartburn symptoms are covered in detail. Diagnostic criteria and algorithms for non-erosive reflux disease, functional heartburn, and esophagus hypersensitivity based on pH-impedance testing and high-resolution esophageal manometry data are presented.

Consilium Medicum. 2022;24(5):277-285
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Difficulties in differential diagnosis tuberculosis and Crohn's disease. Case report

Knyazev O.V., Kagramanova A.V., Fadeeva N.A., Pelipas I.G., Lishchinskaya A.A., Zvyaglova M.I., Parfenov A.I.


We present a clinical case of intestinal tuberculosis in a young patient with a clinical simulation of Crohn's disease. The article addresses clinical presentation, challenges of differential diagnostics of intestinal tuberculosis, and nonsurgical and surgical treatment approaches.

Consilium Medicum. 2022;24(5):287-290
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Somatic mutations in colorectal cancer: regional experience

Ognerubov N.A., Ezhova E.N.


Introduction. Colorectal cancer is one of the most common malignant neoplasms in economically developed countries, ranking 3rd and 2nd in the structure of morbidity and mortality, respectively. Current knowledge about the molecular features of colorectal cancer is necessary to implement the principle of personalized therapy.

Aim. To study regional features of tumor genomic landscape in colorectal cancer.

Materials and methods. The retrospective study from 2019 to 2022 included 153 patients with stage I–IV colorectal cancer aged 32 to 80 years, with a median of 63.8 years. DNA samples extracted from paraffin blocks of tumor tissue were analyzed using a real-time polymerase chain reaction. The study patients included 43.8% of males and 56.2% of females.

Results. Somatic mutations were detected in 48.4% of patients. The maximum number of mutations was detected in the KRAS gene – 60 (81%). The mutation rate was significantly higher in females versus males. KRAS mutations predominate in the colon compared to the rectum, accounting for 66.7 and 33.3%, respectively. In tumors of the right colon, these mutations were detected in 18.3% of cases, and in the left colon, 48.4%. NRAS mutations were found in 9.5% of cases, mainly in tumors of the left colon. BRAF mutations were diagnosed in 6 patients, 5 of them were women, and the tumors were localized in the right colon. The highest rate of KRAS mutations was observed in codons 12 and 13, accounting for 86.7% of cases. The G12V mutation occurred in the majority of patients (25%), followed by G12D (20%) and G12A (16.6%).

Conclusion. Somatic mutations in RAS and BRAF genes in colorectal cancer were detected in 48.4% of patients in the Tambov region. Among them, there is a predominance of KRAS mutations – 81% in females. KRAS oncogenic mutations are predictors of treatment response and prognosis.

Consilium Medicum. 2022;24(5):291-296
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Irritable bowel syndrome: current aspects of etiology, pathogenesis, clinic and treatment: A review

Trukhan D.I., Goloshubina V.V.


Among functional gastrointestinal disorders, Irritable bowel syndrome (IBS) rightfully continues to maintain its leading position. IBS is a kind of standard for understanding the pathogenetic essence of functional diseases of the digestive system, since it is the most common, studied and studied pathology. So, for the query "Irritable Bowel Syndrome" in the electronic database PubMed – as of July 30, 2022, 16 599 sources were found, and for the query "Irritable Bowel Syndrome" in the scientific electronic library eLIBRARY.RU – 6316. The first part of the review deals with topical aspects of the etiology, pathogenesis and clinical presentation of IBS. The urgency of the problem of IBS is associated with a significant decrease in the quality of life of patients. The review focuses on the role of psycho-emotional disorders, changes localized at the level of the intestinal wall; and a new coronavirus infection COVID-19 in the development of IBS. Abdominal pain as the leading manifestation of IBS is associated primarily with spasm. In this context, antispasmodic drugs can be considered not only as symptomatic agents, but also as pathogenetic therapy for IBS. In the second part of the review, the possibilities of one of the myotropic antispasmodics, mebeverine hydrochloride, in the treatment of IBS are considered in detail.

Consilium Medicum. 2022;24(5):297-305
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Clinical features and food preferences in persons with irritable bowel syndrome against the background of overweight and obesity

Fedorin M.M., Livzan M.A., Gaus O.V.


Aim. To identify the clinical features of the course and nutritional preferences of patients with irritable bowel syndrome (IBS) against the background of overweight and obesity in order to increase the effectiveness of therapy in this cohort of patients.

Materials and methods. An open cohort cross-sectional study was conducted with the inclusion of 100 patients aged 18 to 44 years (mean age 30.63±6.37 years) with an established diagnosis of IBS. The main group included 50 overweight or obese people with IBS (mean age 31.67±5.99 years, BMI 31.31±4.16 kg/m2), among them: 16 men and 34 women. The comparison group included 50 people with normal weight (mean age 31.94±6.15 years, BMI 20.45±1.54 kg/m2), among them: 16 men and 34 women. IBS symptoms were assessed on a 10-point scale. Assessment of other gastroenterological complaints was carried out using a 4-point scale. The severity of anxiety and depression was assessed using the Hospital Anxiety and Depression Scale. The level of specific anxiety in relation to gastrointestinal symptoms was assessed using the VSI visceral sensitivity index. To assess the quality of life, a specific questionnaire for assessing the quality of life of patients with IBS IBS-QoL and a nonspecific questionnaire for assessing the quality of life SF-36 were used.

Results. IBS patients who are overweight or obese are characterized by a more severe course of the disease, more frequent formation of a mixed variant of stool disorders and a tendency to constipation, a more common clinically pronounced anxiety and depression, a more pronounced abdominal pain syndrome and a low level of quality of life, and as well as specific food preferences.

Conclusion. Studies are required to identify the relationship between the clinical features of the course of IBS and food preferences in overweight and obese individuals with leading pathogenetic mechanisms in order to correct the existing standard management regimens for overweight and obese patients suffering from IBS.

Consilium Medicum. 2022;24(5):306-311
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Prevention and treatment of some gastrointestinal complications after bariatric surgery: A review

Ilchishina T.A., Kucheryavyy Y.A., Sviridova T.N.


Globally, the incidence of overweight is increasing every year, and doctors around the world are talking about an epidemic of obesity. There has been a significant increase in bariatric surgery procedures as the only effective approach for morbid obesity. However, as the indications for bariatric surgery expand and the number of procedures increases, the number of publications on perioperative, postoperative, and late complications of surgery naturally increases.

Consilium Medicum. 2022;24(5):312-316
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Adipsin – summing up large-scale results: A review

Salukhov V.V., Lopatin Y.R., Minakov A.A.


Adipsin is one of the first discovered adipokines – hormones produced by adipose tissue. Adipsin performs the function of a regulator of carbohydrate and lipid metabolism and participates in the adaptation of metabolism to the real needs of the body, being a powerful stimulant of anabolic processes. A characteristic feature of adipsin is that it is also a complement factor D, which is necessary for the normal functioning of an alternative pathway of activation of the complement system. Due to this, adipsin is represented in the body as a link between the energy block of the endocrine system and the humoral block of the immune system. Adipsin is known as a regulator of the function of pancreatic beta cells, a stimulator of lipogenesis, a modulator of inflammation processes. Recently, there have been works indicating the effect of adipsin on the microbiota, as well as its role in non-alcoholic fatty liver disease. To date, there are a large number of publications describing the biochemical structure, functions of adipsin, mechanisms of regulation of its synthesis, as well as changes in the level of adipsin in various pathological conditions. Attempts are also described to pharmacologically influence adipsin in order to modulate its functions or use it as a biomarker for the diagnosis of diseases. However, there is currently no structured review that summarizes and systematizes all available information about this adipokine. This is exactly the task we set ourselves in this study. The paper contains the results of all available studies on adipsin. In some cases, they are contradictory in nature, which indicates the need for further research in detecting connections between the body's systems.

Consilium Medicum. 2022;24(5):317-323
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Metabolically associated fatty liver disease – a disease of the 21st century: A review

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


Metabolically associated fatty liver disease (MAFLD) is a widespread chronic disease characterized by increased accumulation of fat in the liver, which is based on metabolic dysfunction. The incidence of MAFLD is well over 20% in most regions of the world and is on an increasing trend. Current thinking considers the etiology and pathogenesis of MAFLD under the concept of "multiple parallel blows". According to this model, the development and progression of the disease are due to the interaction of multiple genetic, environmental and adaptive factors, which include specific genetic polymorphisms (e.g., the PNPLA3 gene) and epigenetic modifications, dietary patterns (e.g. high saturated fat and fructose intake), sedentary activity, obesity, insulin resistance, dysregulation of adipokines, lipotoxicity, oxidative stress, and gut microbiota dysbiosis (small intestinal bacterial overgrowth syndrome). The basis for the diagnosis of MAFLD is the presence of proven hepatic steatosis in combination with one of the following criteria: overweight/obesity, presence of type 2 diabetes mellitus, signs of metabolic dysregulation. Nonmedicamental therapies recommended for patients with MAFLD include weight loss (if overweight or obese), reduction of saturated fatty acid and fructose intake, and inclusion of adequate amounts of omega-3 polyunsaturated fatty acids and dietary fibre (psyllium) in the diet. Pharmacotherapy of MAFLD should be aimed at correcting insulin resistance, improving liver function and reducing the risk of associated diseases.

Consilium Medicum. 2022;24(5):325-332
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Effectiveness of Rebamipide as a part of the Helicobacter pylori eradication therapy in Russia: a meta-analysis of controlled trials

Andreev D.N., Maev I.V., Bordin D.S., Lyamina S.V., Dicheva D.T., Fomenko A.K., Bagdasarian A.S.


Aim. To perform a meta-analysis of the data on Rebamipide efficacy and safety as a part of Helicobacter pylori eradication therapy in Russian patients.

Materials and methods. A search for original studies was conducted in the electronic database of the Russian Science Citation Index (RSCI) on the Scientific Electronic Library (SEL — Elibrary.ru). Google (Google.com) was used for the "grey" search. All Russian controlled studies comparing the efficacy and/or safety of Rebamipide as a part of the regimen of H. pylori eradication therapy were included in the final analysis.

Results. In 6 included controlled trials with a cumulative population (considering double comparisons between multiple groups) of 531 patients (273 in Rebamipide groups and 258 in groups without Rebamipide), the pooled eradication effectiveness was 90.376% (95% confidence interval – CI 86.311–93.560) in patients receiving Rebamipide and 81.681% (95% CI 76.499–86.141) in patients receiving eradication regimens without Rebamipide. The meta-analysis showed that the Rebamipide addition to eradication regimens significantly improved efficacy (odds ratio 2.162, 95% CI 1.268–3.685; p=0.005). No significant heterogeneity was found between study results (p=0.863; I2=0.00%); therefore, a fixed effects model was used in the resulting analysis. In addition, the meta-analysis of included studies showed a reduction of adverse events (odds ratio 0.569, 95% CI 0.333–0.970) in the groups receiving Rebamipide; p=0.038). This effect of Rebamipide deserves special attention and requires additional study, as the result was at the border of statistical significance in the subanalysis of three studies with a large margin of risk reduction in one of them (with the largest sample of patients).

Conclusion. The present meta-analysis demonstrated that the Rebamipide addition to H. pylori eradication regimens significantly improves the treatment effectiveness in the Russian patient population.

Consilium Medicum. 2022;24(5):333-338
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Visceral sensitivity index of patients with irritable bowel syndrome after COVID-19 infection

Feklina I.Y., Mnatsakanyan M.G., Pogromov A.P., Tashchyаn O.V.


Aim. To perform comparative analysis of visceral sensitivity index (VSI) of patients with previously diagnosed irritable bowel syndrome (IBS) and of patients with IBS symptoms after COVID-19 infection.

Materials and methods. The study was carried out on the basis of University Clinical Hospital №1; 200 patients with COVID-19 infection were examined. Selection criteria were the recommendations of the Rome Consensus IV (2016). Fourteen patients met the criteria for IBS (Rome IV). Forty patients with a verified diagnosis of IBS before the COVID-19 pandemic (Group 2) were selected as a comparison group. The control group included 50 healthy respondents (group 3). Group 1 included 14 patients; Group 2 included 40 patients (54 patients in total): 37 women and 17 men. The control group included 50 patients: 23 men and 27 women. VSI was estimated in the studied groups.

Results. No statistically significant difference of VSI index (p>0.05) was revealed while comparing two studied groups (group 1 and group 2). In group 1 and group 2 the mean values of VSI were 24.57±5.47 and 33.98±2.55 respectively. Absence of significant differences allows to assume from the position of biopsychosocial model that the patients were initially predisposed to IBS development.

Conclusion. A new coronavirus infection is one of the triggers for the development of IBS 6 months after COVID-19 infection.

Consilium Medicum. 2022;24(5):339-342
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Jaundice as an atypical manifestation of the new coronavirus infection. Case report

Pichugina I.M., Ogoltsova I.M.


In many cases, the clinical presentation of SARS-CoV-2, seeking to the epithelium of the respiratory tract, was typical and affected only the respiratory system, but if we look at the statistics, other clinical findings were also encountered. In particular, the virus can also affect the gastrointestinal tract. There was an outbreak of SARS in 2002, and more than 70% of patients had dyspeptic disorders. In 2012, there was an outbreak of the Middle East respiratory syndrome and a quarter of patients had similar symptoms. And there were cases in which it was dyspepsic phenomena that came to the forefront and respiratory phenomena only afterwards. Already in 2012, this «behavior» of coronavirus made it difficult to make a correct diagnosis. SARS-CoV (2002), MERS-CoV (2012), and the new SARS-CoV-2 (2019) belong to the genus Betacoronavirus, and the genome sequence of SARS-CoV-2 is similar at 82% to that of severe acute respiratory syndrome coronavirus. The kinship of the viruses should alert physicians and always warn that an atypical clinical picture of the disease is possible, as has been the case in the past. This article describes a clinically interesting patient. Jaundice is the only symptom, a symptom that confuses doctors, because no one could think of a coronavirus infection in this case. The purpose of this article is to show on the example of a patient that it is difficult to diagnose the main diagnosis in case of atypical symptomatology of COVID-19. Therefore, also in cases of liver damage it is necessary to collect the anamnesis qualitatively, to make differential diagnosis not only within the framework of gastroenterology, but also in present conditions suspecting a new coronavirus infection.

Consilium Medicum. 2022;24(5):343-348
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Changes in the organs and tissues of the oral cavity in the new coronavirus infection (COVID-19): A review

Trukhan D.I., Sulimov A.F., Trukhan L.Y.


SARS-CoV-2 infection can cause changes in the organs and tissues of the oral cavity, which is associated with a wide distribution of angiotensin-converting enzyme type 2 in the oral cavity, mainly epithelial cells of the oral mucosa, gums and fibroblasts of the periodontal ligament. Thus, the oral mucosa is susceptible to SARS-CoV-2 infection and may act as a gateway for the virus, as well as a reservoir for SARS-CoV-2. We searched the literature for the period from the beginning of the pandemic until May 30, 2022, devoted to the study of changes in the organs and tissues of the oral cavity with a new coronavirus infection (COVID-19) in the electronic search engines PubMed/MEDLINE and Scopus. A special place in the study of changes in the organs and tissues of the oral cavity with a new coronavirus infection (COVID-19) is occupied by periodontal pathology. A number of reviews and clinical studies conclude the importance of good oral hygiene and periodontal health as an important aspect of COVID-19 prevention and management. Oral probiotics can be considered as a promising direction for correcting changes in organs and tissues of the oral cavity in COVID-19.

Consilium Medicum. 2022;24(5):349-357
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Topical issues of prevention of stomach cancer: A review

Uspenskiy Y.P., Baryshnikova N.V., Krasnov A.A., Petlenko S.V., Apryatina V.A.


Prevention of gastric cancer, both primary and secondary, is an extremely important component of the management of gastroenterological patients. The correct collection of anamnesis with an assessment of the hereditary (family) cancer risk, the action of risk factors (eating disorders, habitual/chronic intoxication, obesity, Helicobacter pylori infection, etc.), as well as the use of gastroprotectors (in particular, the drug Regastim Gastro), especially in persons with potentially precancerous the condition is chronic atrophic gastritis. According to the data of a double-blind placebo-controlled randomized study Regastim Gastro (active ingredient – alpha-glutamyl tryptophan) in the treatment of chronic atrophic gastritis, it was found that this drug has a powerful anti-inflammatory effect and regenerative activity. Taking the drug Regastim Gastro, compared with placebo, statistically significantly contributed to a decrease in the number of inflammatory infiltration cells per 1 mm2 of the gastric mucosa. Regastim Gastro decreases in eosinophilic (3 times) and neutrophilic (4 times) infiltration of the gastric mucosa and also reduced the number of macrophages, lymphocytes and plasmocytes. In addition to anti-inflammatory properties, the drug also had a pronounced regenerative effect. Taking of Regastim Gastro statistically significant (p=0.028) increases in the number of glands per 1 mm2 of the gastric mucosa – by 26.1% compared with the initial screening indicators. In the group of patients taking placebo, on the contrary, there was a further progression of the pathological process, accompanied by a decrease in the number of glands per 1 mm2 of the gastric mucosa after the end of treatment in comparison with the initial indicators. After the course of therapy, the number of glands per 1 mm2 of the gastric mucosa in patients taking the drug Regastim Gastro was statistically significantly higher in comparison with the results in the placebo group (p=0.013). After the course of Regastim Gastro, there was an improvement in acid production: a shift in the acidic side of the average pH value (1.6 times) and an increase in the value of the acidity index, both when compared with the initial values (5.4 times) and in comparison with the placebo group (2.9 times). The intake of Regastim Gastro to patients with gastritis, both H. pylori (+) and H. pylori (-) before the development of atrophy of the gastric mucosa can reduce the inflammatory factor, prevent the occurrence of atrophy and may have maximum anti-carcinogenic action.

Consilium Medicum. 2022;24(5):358-364
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