Vol 20, No 8 (2018)

The literature review addresses a modern diagnostics method - high-resolution esophageal manometry as one of the advances in up-to-date gastroenterology for esophageal tonus and motility disorders assessment. Esophageal manometry allows to estimate the esophageal motor function in detail along its entire length, including the upper esophageal sphincter, thoracic esophagus and lower esophageal sphincter through the use of highly-sensitive multilumen catheters and evaluation of the results with the use of computerized polychrome image data. The parameters of manometry study on the basis of which clinical conclusion is made according to Chicago classification version 3.0 are presented. The issues of etiology, pathogenesis, clinical presentation, as well as diagnostic criteria and treatment approaches to lower esophageal sphincter dysfunction, main and minor thoracic esophagus motility disorders are covered.

A clinical case of combination of ulcerative colitis and рrimary sclerosing cholangitis is presented in the article. Data on clinical manifestations of disease, changes in laboratory and tool methods of examination, differential diagnosis, and tactics of further examination of a patient are also described. The combination of ulcerative colitis and рrimary sclerosing cholangitis increases the risk of colorectal cancer. Therefore treatment should be directed both on prevention of relapse of the disease and of colorectal cancer occurrence. Besides such medications as 5-aminosalicylic acid and ursodeoxycholic acid should be prescribed.

The problem of comorbidity becomes pressing in the context of demographic population ageing. The influence of comorbid pathology on diseases clinical manifestations, diagnostics, prognosis and treatment is complicated and controversial. The article discusses the challenges of gastro-esophageal reflux disease diagnostics and treatment in multimorbid patients. According to the existing standards and clinical guidelines on this disorder treatment antisecretory agents lie in the basis for these patients pharmacotherapy. Of these the leading role belongs to proton pump inhibitors, a class of medications with high effectiveness and good safety profile.

Study objective - to evaluate taurin effect on liver fibrosis severity, structural and functional liver characteristics in patients with nonalcoholic fatty liver disease (NAFLD). Materials and methods. The prospective comparative randomized study included 60 patients with NAFLD diagnosed according to liver ultrasound results (using SIEMENS SONOLINE G50, Germany system with doppler sensor for liver parenchymal echogenicity, vascular pattern, and echoed signal decrement evaluation) and liver fibrosis index NFS>0.675 (F3-4 fibrosis). With the use of simple randomization patients were divided into 2 groups: group 1 (study group) included patients with NAFLD who received taurin in total daily dose 1000 mg (500 mg twice a day) in addition to comorbid conditions (diabetes mellitus type 2, ischemic heart disease, hypertension) treatment; group 2 (control group) included patients with NAFLD who received only comorbid conditions treatment. Type IV collagen serum level, fatty liver index (FLI), and NAFLD fibrosis score (NFS) were evaluated at baseline and after 24 weeks of treatment. Сarbohydrate metabolism parameters were monitored by fasting plasma glucose level, basal insulin level and insulin resistance index (HOMA-IR) evaluation. For lipid metabolism monitoring total cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein levels were evaluated. For damage and functional liver markers assessment alanine and aspartate aminotransferase, g-glutamyl transpeptidase activity was evaluated. Results. After 24 weeks of treatment with taurin a statistically significant decrease in type IV collagen level, and NFS decrease on all stages of fibrotic changes that was statistically significant on early fibrosis stages (NFS≤0.675) were observed in patients with NAFLD and liver fibrosis. A significant metabolic activity of the drug was shown that presented with hypoglycemic and lipid-lowering effects as well as significant insulin resistance reduction.

Pancreatic ductal adenocarcinoma (PDA) accounts for 90% of all pancreatic neoplasms and is the fourth leading cause of cancer-related death in the western world and sixth - in Russia. PDAs may demonstrate intratumoral cystic features or accompany peritumoral non-neoplastic cystic lesions. We present the clinical case of the patient with cystic-solid lesion of pancreas, the use of contrast-enhanced harmonic EUS (CH-EUS) helped in determining the tactics of treatment. CH-EUS significantly increases the informativeness of the method, extends the possibilities of differential diagnostics of the pancreatobiliary diseases. Now assessment of diagnostic accuracy and determining the place of contrast enhancement in the diagnostics pancreatic diseases are considered the most relevant tasks.

The article presents evidential base which served as the basis for including probiotics in gastroenterology practical guidelines. Also existing practical guidelines on probiotics use in acute diarrhea, for antibiotic-associated diarrhea prevention and as adjuvant therapy for Helicobacter pylori eradication effectiveness increase are discussed.

Antareit is a combination of magaldrate (new generation antacid) with simeticone (anti-foaming agent used to reduce bloating). Magaldrate anti-acid effect develops quickly (in 1-2 minutes) and preserves for a long time (up to 3 hours). Magaldrate is a multitarget antacid that has adsorbing, enveloping and significant cytoprotective effect on gastric mucosa. When magaldrate dissolves in hydrochloric acid its crystal structure provides forming of tightly-packed hexaaquaaluminium particles. These particles envelop the ulceration area and their size (2 µm) enables epithelial cells and fibroblasts migration in gastric wall reparation process. As a result prostaglandin metabolism is modulated, nitrogen oxide vasodilatator level increases, tissue microcirculation improves and antihistamine effects manifest. These processes are important components of multitarget magaldrate effect.

Thromboangiitis obliterans is a chronic inflammatory disorder that mostly manifests in young patients. The primary vessel wall lesion leads to further necrosis without affecting elastic vessel membrane. Generally thromboangiitis involves peripheral arteries resulting in typical clinical presentation of limb ischemia. Veins are involved as well as arteries whereas no signs of atherosclerosis are found in these patients. Thromboangiitis may be acute as well as it may have relapsing-remitting course causing thromboses and limb ischemia that may result in limb loss. Patients’ survival is higher than corresponding survival rates in patients with atherosclerosis even despite unfavorable outcome of limb revascularization. It is explained by absence of coronary atherosclerosis in these patients. Taking into account the ongoing research on pathogenesis, treatment of such patients still remains a subject of discussion and is a promising area for further scientific developments.