Colorectal Cancer in Patient with Functional Gastrointestinal Symptoms

Aim. A clinical observation to highlight the importance of detailed examination in patients with functional gastrointestinal symptoms.Key points. A 28-yo female patient was admitted with complains of left ileal pain, abdominal distention and up to 4-day stool delay. The complaints had long been interpreted as clinical manifestations of irritable bowel syndrome. No significant abnormalities were revealed in outpatient check-up (general and biochemical blood panels, stool test, abdominal ultrasound, oesophagogastroduodenoscopy). Colonoscopy was performed on admission, with diagnosis of rectal adenocarcinoma. The patient had a prompt surgical intervention, repeated courses of polychemotherapy and is currently followed by an oncologist and coloproctologist. No relapse signs have been reported.Conclusion. Patients with the complaints satisfying the Rome Criteria Revision IV for functional gastrointestinal diseases should have a thorough examination as per recommendations of the Russian Gastroenterological Association and Russian Association of Coloproctologists

Determination of Probiotics Prescription Indications in Patients with Irritable Bowel Syndrome (Materials of the Expert Council and Literature Review)

Aim. To review the main indications for probiotics prescription in patients with irritable bowel syndrome and to present the materials of an Expert Council, which was held on 18 March 2022 in Moscow.Key points. Gut microbiota disturbance is an integral part of irritable bowel syndrome (IBS) pathogenesis. Changes of colonic microbiota composition are associated with its functional potential modification, which leads to an increasing of the pro-inflammatory immune response, as well as to an exacerbation of the disease symptoms and quality of life decreasing in patients with IBS. The novel coronavirus infection (COVID-19) is an independent risk factor for both exacerbation and onset of IBS, which predispose to increase IBS incidence. Correction of gut microbiota composition with probiotics seems to be a promising therapeutic target for IBS treatment optimizing. The optimal probiotic should be effective, safe, strain-specific, and its dose and duration of administration should be confirmed by the results of clinical studies. Some of the probiotics with proven efficacy in IBS are Alflorex® and Enterol®.Conclusion. Prescription of certain probiotics in IBS is advisable to normalize the frequency and consistency of stools, relieve abdominal pain and bloating, as well as improve patients’ quality of life

The Effectiveness of Add-on Treatment with Nutraceutical

Aim: evaluation of the effectiveness of the nutraceutical “Standard Zdorovia: Gastro” (“SZ Gastro”) in the treatment of patients with irritable bowel syndrome (IBS).Materials and methods. 52 patients (62 % women) diagnosed with IBS and IBS in combination with functional dyspepsia (FD) were included in the study and divided into two groups. Both groups received basic therapy according to the guidelines. The experimental group received as add-on the nutraceutical “SZ Gastro” (containing a standardized amount of menthol, gingerol and D-limonene); patients in the control group — placebo. The duration of the study was 30 days. The severity of somatic symptoms was assessed with the 7×7 questionnaire. Emotional state was assessed with the Four Dimensional Distress, Depression, Anxiety, and Somatization Questionnaire (4DSQ).Results. Patients of the experimental and control groups did not differ from each other either in terms of demographics, basic treatment, or in the severity of symptoms at the beginning of the study.The effectiveness of the treatment in the patients, who received add-on “SZ Gastro” was significantly higher than in the patients of the control group: in the control group the percentage of improvement of somatic symptoms was 22.35 %, in the experimental group it amounted to 49.18 % (χ2 = 15.9; p = 0.0001). The percentage of patients with significant decrease of emotional disturbances was also higher in the experimental group: distress (χ2 = 18.7; p = 0.0000), anxiety (χ2 = 6.9; p = 0.0097) and somatization (χ2 = 14.99; p = 0.0001). No significant side effects were registered in any of the groups.Conclusions. Add-on of nutraceutical “SZ Gastro” to basic treatment is safe and significantly increases effectiveness of the therapy in the patients with IBS and IBS in combination with PD

Modern Approaches to <i>H. pylori</i> Eradication Therapy in Adults (Literature Review and Resolution of Experts Council)

Aim: to analyze current approaches to H. pylori eradication therapy in adults and present the materials of Experts Council held on December 9, 2022 in Moscow.General statements. H. pylori infection is the main etiological factor of gastritis, peptic ulcer, and gastric cancer. Eradication of H. pylori is recognized as a necessary measure to reduce the incidence of these diseases. The approaches to selecting an eradication regimen should be optimized to take into account epidemiological trends and achieve better treatment outcomes. The updated Maastricht VI Consensus Report presents the means to overcome the difficulties in selecting an approach to the treatment of H. pylori infection. However, eradication therapy remains challenging due to adverse events (primarily antibiotic-associated diarrhea), poor treatment tolerance and patient compliance. Eradication therapy can be optimized by supplementing treatment regimens with strain-specific probiotics that reduce adverse events, improve patient compliance and eradication rates, such as Saccharomyces boulardii CNCM I-745 strain with established efficacy.Conclusion. The inclusion of certain probiotics in eradication regimens improves treatment tolerance, reduces the risk of adverse events, improves patient compliance and eradication rates

Modern Approaches to the Diagnosis and treatment of <i>Clostridioides difficile (C. difficile)</i>-associated Disease in Adults (literature Review and Expert Council Resolution)

Aim: to review the modern approaches to the diagnosis and treatment of C. difficile-associated disease in adults and present the resolution of the Expert Council held on March 25, 2023 in Moscow.General provisions. C. difficile is the most important nosocomial pathogen which spores are also commonly found in the environment. Microbiota impairment, primarily due to the use of antibacterial drugs, is a key stage in the development of C. difficile-associated disease. A search for an infection should be carried out only in patients with diarrhea, and it is advisable to use at least 2 laboratory methods. The drug of choice for first-line treatment is vancomycin. If drug treatment is ineffective or the patient has recurrent clostridial infection, fecal microbiota transplantation should be considered. The probiotic strain Saccharomyces boulardii CNCM I-745 has a direct inhibitory effect on C. difficile toxin A, promotes normalization of the intestinal microbiota composition, and decreases the inflammatory reaction in colonic mucosa colonized with a toxigenic strain of C. difficile.Conclusions. Addition of the probiotic strain Saccharomyces boulardii CNCM I-745 to antibacterial therapy promotes both primary and secondary prevention of C. difficile-associated disease

Practical Recommendation of the Scientific Сommunity for Human Microbiome Research (CHMR) and the Russian Gastroenterological Association (RGA) on Small Intestinal Bacterial Overgrowth in Adults

Aim. To optimize the choice of treatment strategies by physicians and gastroenterologists to improve treatment and prevention of small intestinal bacterial overgrowth (SIBO) in adults.Key points. SIBO is a condition characterized by an increased amount and/or abnormal composition of the microbiota in the small intestine. Clinically, the syndrome is manifested by nonspecific gastroenterological complaints and the development of malabsorption syndrome. Most often, SIBO is associated with various chronic non- infectious diseases (both diseases of the gastrointestinal tract, and the cardiovascular system and the neuromuscular apparatus) and can affect the severity of their symptoms. Specific methods for diagnosing SIBO are the culture method and breath tests. The main approaches to the treatment of SIBO include the elimination of the underlying cause of its occurrence, the use of antibacterial drugs and adherence to dietary recommendations (elemental diet).Conclusion. Small intestinal bacterial overgrowth is common in patients with various diseases, but has non-specific manifestations, so proper diagnosis of this condition is required. SIBO therapy involves prescription of antibacterial agents, the most studied of which is the non-absorbable antibiotic rifaximin-α

Метахронное развитие рака молочной железы и рака предстательной железы (клинический случай)

The formation of primary multiple malignant neoplasms, such as breast cancer and prostate cancer, in one patient is a rather rare combination. Treatment and diagnostic strategies in such cases require a multidisciplinary approach. Currently, there are no approved recommendations for the management of patients with a combination of these diseases. This manuscript presents a clinical case of diagnosis and treatment of breast and prostate cancer in one patient.Одновременное развитие первично множественных злокачественных новообразований, таких как рак молочной железы и рак предстательной железы, у одного пациента является редким случаем. Лечебно-диагностическая тактика в подобных ситуациях требует мультидисциплинарного подхода. В настоящий момент утвержденных рекомендаций по ведению пациентов с комбинацией этих заболеваний нет. В данной работе представлен клинический случай диагностики и лечения рака молочной железы и рака предстательной железы у одного пациента

Potential of nutraceutical products for irritable bowel syndrome remission maintenance

Aim of review. To summarize the modern data on pathogenesis of symptoms irritable bowel syndrome (IBS) symptoms, to present nutraceutical product «Standart zdorovya: GASTRO» as an agent for IBS remission maintenance. Summary. Recent data indicate essential changes of intestinal microbiota in IBS in comparison to healthy population. These changes may be associated to development of inflammatory processes of intestinal wall. Long-term inflammation may result in nociceptor hypersensitivity i.e. peripheral sensitization that in turn, lead to the central sensitization and indirectly - to gastrointestinal tract (GIT) motility disorders. Besides, change of intestinal microbiota may impact the development of emotional disorders (e.g.: impaired capacity of affected intestinal microbiota to produce neurotransmitters). Therefore, according to the results of available studies, intestinal microbiota changes in IBS is a key factor for the cascade of events including intestinal wall inflammation, changes of gastrointestinal motility, decreased threshold of gastrointestinal receptor sensitivity, as well as emotional disorders resulting in development of disease symptoms. Medical preparation for IBS remission induction and remission maintenance should possess probiotic/prebiotic and anti-inflammatory properties, reduce visceral sensitivity, normalize intestinal motility and modulate patients’ emotional sphere. Due to capacity of «Standart zdorovya: GASTRO» components to deliver above-listed effects it can be promising for administration in patients with IBS