Vol 25, No 5 (2023): Gastroenterology

Over the last 10 years, the incidence of chronic pancreatitis (CP) has increased 4 times and nowadays is about 27.4–50 cases per 100 000 adults. In the outpatient gastroenterologist practice, patients with CP account for about 35–45%, in the hospital gastroenterology department – up to 20–45%. CP criteria according to imaging methods – fibrosis, duct dilatation and deformation, calcifications in the pancreatic parenchyma or its atrophy – are formed at a late stage of the disease. Simultaneously, diagnosis at the early stage with potentially reversible changes remains difficult, due to the lack of clear instrumental and laboratory findings confirming minimal changes in the pancreas. However, some methods in combination with a detailed history taking, risk factors identification in comparison with the clinical features are of interest for the early diagnosis of chronic pancreatitis.

Aim. To reveal and evaluate predictors of infectious complications in the postoperative period after pancreatoduodenectomy.

Materials and methods. An analysis was made of 790 articles that dealt with the subject of complications after pancreatoduodenectomy.

Results. Seventy five articles met the inclusion criteria. Studies with small samples (less than 20 patients) were not considered. Based on the multifactorial nature of the problem of preventing infectious complications in the postoperative period, the results of the review are divided into several sections. PBD is highly effective in obstructive jaundice syndrome at the preoperative stage, but is associated with the risk of bile infection and complications in the postoperative period. These circumstances should be taken into account when determining the indications for PBD, choosing the method of decompression, in cases where stenting is used, attention should also be paid to the choice of material. Bacteriobilia is an independent predictor of surgical site infections (SSI) after PDR.

Conclusion. Changing the approach to antibiotic prophylaxis based on the antibiotic sensitivity of the microflora can lead to a decrease in the incidence of SSI, a reduction in the duration of hospitalization, the number of complications associated with long-term antibiotic therapy, a decrease in the rate of spread of antibiotic resistance and a decrease in the financial costs of the institution for a completed case of medical care.

Aim. To identify the role of impaired motor function of the gastrointestinal tract (GIT) in the overlap of functional disorders (FD).

Materials and methods. Thirty-two abdominal FD patients were followed up, with a predominance of women aged 33.7±6.1 years (75%). Men aged 31.8±5.6 years were 25%. All patients had symptoms of GIT FD established according to the Rome IV criteria, endoscopy, and abdominal ultrasound. In addition, patients underwent 2-hour pH-metry and electromyography of the abdominal organs using bipolar silver electrodes with a surface area of 0.5–0.6 cm². The amplitude-frequency characteristics of slow waves and spikes and the power of phase and tonic contractions were analyzed using the Canon M hardware and software complex with a transmission frequency of 0.1 to 10 Hz and a noise level of 1–5 W.

Results. Overlapping clinical symptoms of motor disorders in gastrointestinal tract functional disorders are observed at a young age, mainly in women. The abnormal ratio of the gallbladder and common bile duct motility in overlapping GIT FD was 1:1.08, with a pronounced increase in contractions of the common bile duct, which could lead to an increase in pressure in the biliary system, pain, and insufficient flow of bile to the duodenum, disrupting the digestion and worsening the dyspepsia.

Conclusion. The study showed a tendency for higher incidence of functional disorders in young women. Patients with overlapping disorders also have more severe pain than those with isolated disorders.

Aim. To study the opinions of gastroenterologists about drugs affecting the intestinal microflora.

Materials and methods. A qualitative survey was conducted in focus groups to study the patterns of prescribing drugs that regulate intestinal microflora in chronic gastrointestinal diseases. The survey included only outpatient gastroenterologists who managed patients with irritable bowel syndrome, an uncomplicated diverticular disease with clinical manifestations and excessive bacterial growth in the small intestine for at least 3 years.

Results. Physicians perceive the non-absorbable antibiotic rifaximin alpha as the drug of choice for treating these diseases; they are aware of its low bioavailability and suitability for repeated use. However, with severe clinical symptoms, some doctors tend to use systemic antibiotics before infectious or inflammatory complications are confirmed. It is due to the erroneous perception of systemic antibiotics as obviously more effective drugs than non-absorbable antibiotics. When choosing a drug, it is essential to consider the risk of antibiotic-associated diarrhea, adverse changes in the microflora, and the patient's comorbidities.

Conclusion. Surveyed gastroenterologists consider rifaximin alfa (Alfa Normix) the most suitable drug that helps in routine practice achieve the desired result with a minimum risk of adverse events. Many study participants are skeptical about the effect of probiotics due to the lack of evidence but emphasize their safety and the request for probiotics from patients. Not all doctors are aware of metabiotics. Prebiotics and dietary fibers are perceived as agents that affect both the intestinal microflora and the stool frequency. Some healthcare professionals are concerned about prebiotics and probiotics registered as dietary supplements, which can cause patient misunderstandings. Identified opinions about such agents can be used in training gastroenterologists and developing clinical guidelines.

Perforated duodenal ulcer is a common pathology with fairly high postoperative mortality, especially in late diagnosis. In some cases, timely diagnosis of a perforative ulcer may be difficult and the results of the survey may be contradictory. The classical triad of clinical signs of perforative ulcers is not always observed in patients, sometimes the clinical picture is so unclear that the final diagnosis can only be made intraoperative. The article presents an analysis of the clinical case of difficult diagnosis and treatment of perforative duodenal ulcer in a patient in an acute period of ischemic stroke. In addition, the patient had severe concomitant somatic pathology with a high risk of systemic thromboembolism and at the same time a high risk of bleeding.

Prevention of thromboembolic complications is the main goal in patients with atrial fibrillation. Anticoagulant therapy is used as prophylaxis, and direct oral anticoagulants are preferred. However, this therapy is associated with a risk of bleeding, among which gastrointestinal bleeding takes a leading place. Proton pump inhibitors are now widely used as prophylaxis for upper gastrointestinal bleedings, but when used long-term, may be associated with a number of adverse drug reactions, including an increased risk of adverse cardiovascular events. Long-term use of these drugs may suppress the action of antiplatelet drugs, disrupt the function of the vascular endothelium, and at the same time cause hypomagnesemia, iron deficiency, vitamin D and K deficiency. At the same time, monotherapy with proton pump inhibitors does not protect against the risk of bleeding from the lower gastrointestinal tract. Thus, as an effective gastro- and enteroprotection, it is necessary to prescribe drugs that protect the gastrointestinal tract throughout its entire length. Such a drug is rebamipide, which has a complex protective effect on the gastrointestinal tract, protecting the mucous membrane at all its levels (pre-, post-epithelial and directly epithelial level), and ensures the restoration of tight contacts in the epithelium of the intestinal tube throughout its entire length. It should be noted that the current consensus documents of the leading experts on the problem of decreasing the risk of gastrointestinal bleedings during direct oral anticoagulant treatment recommend the use of rebamipide for the entire duration of therapy.