Vol 23, No 5 (2021)

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).

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.

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.

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.

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.

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.