Diagnosis and Treatment of Irritable Bowel Syndrome: Clinical Recommendations of the Russian Gastroenterological Association and Association of Coloproctologists of Russia

Aim. Current clinical recommendations accentuate current methods for the diagnosis and treatment of irritable bowel syndrome (IBS).Key points. IBS is a functional bowel disorder manifested with recurrent, at least weekly, abdominal pain with the following attributes (any two leastwise): link to defecation, its frequency or stool shape. The symptoms are expected to persist for at minimum three months in a total six-month follow-up. Similar to other functional gastrointestinal (GI) disorders, IBS can be diagnosed basing on the patient symptoms compliance with Rome IV criteria, provided the absence of potentially symptom-causative organic GI diseases. Due to challenging differential diagnosis, IBS can be appropriately established per exclusionem, with pre-examination as follows: general and biochemical blood tests; tissue transglutaminase IgA/IgG antibody tests; thyroid hormones test; faecal occult blood test; hydrogen glucose/ lactulose breath test for bacterial overgrowth; stool test for enteric bacterial pathogens and Clostridium difficile A/B toxins; stool calprotectin test; abdominal ultrasound; OGDS, with biopsy as appropriate; colonoscopy with biopsy. The IBS sequence is typically wavelike, with alternating remissions and exacerbations often triggered by psychoemotional stress. Treatment of IBS patients includes dietary and lifestyle adjustments, various-class drug agents prescription and psychotherapeutic measures.Conclusion. Adherence to clinical recommendations can facilitate timely diagnosis and improve medical aid quality in patients with different clinical IBS variants

Diagnosis and Treatment of Irritable Bowel Syndrome: Clinical Recommendations of the Russian Gastroenterological Association and Association of Coloproctologists of Russia

Aim. Current clinical recommendations accentuate current methods for the diagnosis and treatment of irritable bowel syndrome (IBS).Key points. IBS is a functional bowel disorder manifested with recurrent, at least weekly, abdominal pain with the following attributes (any two leastwise): link to defecation, its frequency or stool shape. The symptoms are expected to persist for at minimum three months in a total six-month follow-up. Similar to other functional gastrointestinal (GI) disorders, IBS can be diagnosed basing on the patient symptoms compliance with Rome IV criteria, provided the absence of potentially symptom-causative organic GI diseases. Due to challenging differential diagnosis, IBS can be appropriately established per exclusionem, with pre-examination as follows: general and biochemical blood tests; tissue transglutaminase IgA/IgG antibody tests; thyroid hormones test; faecal occult blood test; hydrogen glucose/ lactulose breath test for bacterial overgrowth; stool test for enteric bacterial pathogens and Clostridium difficile A/B toxins; stool calprotectin test; abdominal ultrasound; OGDS, with biopsy as appropriate; colonoscopy with biopsy. The IBS sequence is typically wavelike, with alternating remissions and exacerbations often triggered by psychoemotional stress. Treatment of IBS patients includes dietary and lifestyle adjustments, various-class drug agents prescription and psychotherapeutic measures.Conclusion. Adherence to clinical recommendations can facilitate timely diagnosis and improve medical aid quality in patients with different clinical IBS variants

Кадаверный курс в системе подготовки ургентного хирурга

Introduction. In our country, severe concomitant injury is one of the main causes of death among people of working age. This poses an urgent task for the national health care and education system in the form of training qualified emergency surgeons.Purpose of the study. To improve the quality of practical training of specialists in the delivery of urgent surgical care for concomitant injury.Material and methods. The “Cadaver course of operative surgery for severe concomitant injury” was developed. The participants of the cadaver course were senior students of the Ryazan State Medical University. At the stages of the course, theoretical training was carried out, work in a cadaver operating room with mentors and independently was performed, as well as a comparative assessment of learning outcomes with the results of similar tests of clinical residents of the 2nd year of study.Results. Statistically significant differences were obtained in terms of indicators reflecting the level of practical training of students who completed the developed course. The level of theoretical training in the compared groups did not differ significantly.Conclusion. New opportunities have been opened for the widespread introduction of the developed training course into the educational process. It is necessary to further improve the proposed methodology and study the results of its use.Введение. В нашей стране тяжелая сочетанная травма является одной из основных причин смерти среди лиц трудоспособного возраста. Это ставит перед отечественной системой здравоохранения и образования актуальную задачу в виде подготовки квалифицированных экстренных хирургов.Цель исследования. Повысить качество практической подготовки специалистов по оказанию ургентной хирургической помощи при сочетанной травме.Материал и методы. Разработан «Кадаверный курс оперативной хирургии при тяжелой сочетанной травме». Участниками кадаверного курса стали студенты старших курсов ФГБОУ ВО РязГМУ. На этапах курса проводилась теоретическая подготовка, работа в кадаверной операционной с наставниками и самостоятельно, а также сравнительная оценка результатов обучения с результатами аналогичных испытаний клинических ординаторов 2-го года обучения.Результаты. Получены статистически значимые различия по показателям, отражающим уровень практической подготовки студентов, прошедших разработанный курс. Уровень теоретической подготовки в сравниваемых группах статистически значимые не различался.Заключение. Открыты новые возможности по широкому внедрению в учебный процесс разработанного курса подготовки. Необходимо дальнейшее совершенствование предложенной методики и изучение результатов ее использования

Immediate and long-term results of laparoscopic hernioplasty in inguinal hernias with and without mesh endoprosthesis fixation

The objective of this study was to conduct comparative analysis of the immediate and long-term results of laparoscopic inguinal hernioplasty performed with and without fixation of the mesh endoprosthesis.Methods and materials. The base group included 77 patients who underwent laparoscopic inguinal hernioplasty without fixation of the mesh by herniostepler. The control group included 76 patients who underwent laparoscopic inguinal hernioplasty with mesh fixation by herniostepler. To assess the postoperative period, the following criteria were studied: the severity of postoperative pain on a Visual Analog Scale; postoperative complications on the Clavien-Dindo scale; an early recurrence of inguinal hernias determined by ultrasound.Results. In both groups, the severity of postoperative complications did not exceed grade I. Among the entire list of complications, there were observed: pain in the area of surgery, an increase in body temperature above 38.5 °C, acute urinary retention, swelling and hematoma of the scrotum, seroma. There were no cases of conversion, intraoperative damage to internal organs and vascular structures. Complications in both groups do not differ significantly and do not depend on the method of laparoscopic inguinal hernioplasty: with fixation of the endoprosthesis by herniostepler or without fixation. The level of pain in the early postoperative period in patients operated by laparoscopic inguinal hernioplasty with mesh fixation was significantly higher. During control examinations of patients on the day after surgery, at the time of discharge and 6 months after surgery, no cases of dislocation of mesh endoprosthesis and relapse of inguinal hernia were detected.Conclusion. The obtained data indicate the effectiveness of laparoscopic hernioplasty in inguinal hernias with polypropylene mesh without fixing with herniostepler