Efficacy and safety of the use of rebamipide in the scheme of triple eradication therapy of Helicobacter pylori infection: a prospective randomized comparative study

Purpose of the study. To evaluate the effectiveness and safety of the use of rebamipide as part of the triple eradication therapy (ET) scheme of Helicobacter pylori infection. Materials and methods. A prospective, randomized comparative study included 94 patients with uncomplicated H. pylori-associated stomach / duodenal ulcer. In the process of randomization, patients are divided into three groups depending on the intended therapy. The first group (n=36) received a classical triple scheme of the first-line ET (omeprazole 20 mg twice a day, amoxicillin 1000 mg twice a day, clarithromycin 500 mg twice a day) for 10 days. Patients of the second group (n=33) were assigned a classical triple scheme of ET with the inclusion of rebamipide (omeprazole 20 mg twice a day, amoxicillin 1000 mg twice a day, clarithromycin 500 mg twice a day, rebamipide 100 mg 3 times a day day) for 10 days. Patients of the third group (n=25) were assigned a classical triple scheme of ET with the inclusion of rebamipide (omeprazole 20 mg twice a day, amoxicillin 1000 mg twice a day, clarithromycin 500 mg twice a day, rebamipide 100 mg 3 times a day) in for 10 days, with the prolongation of the administration of rebamipide for the next 20 days. The effectiveness of ET was determined by the respiratory test after 6 weeks after the end of treatment. Adverse events were recorded by patients in specially developed diaries. All patients with gastric ulcer at the 6th week underwent a histological examination of the biopsy specimens of the antrum and the body of the stomach, assessing the inflammatory activity of the process on a point system in accordance with the updated Sydney system. Results and discussion. Efficiency of H. pylori eradication in the first group was 77.7% (ITT), 82.3% (PP), in the second group - 81.8% (ITT), 84.4% (PP), and in the third group - 84% (ITT), 87.5% (PP). The use of rebamipide in the triple ET regimen was associated with an increase in H. pylori eradication efficiency, both with simultaneous use with the scheme [odds ratio (OR) 1.16; 95% confidence interval (CI) 0.32-4.24], and with subsequent prolonged admission (OR 1.5, 95% CI 0.34-6.7). A somewhat more pronounced dynamics of the epithelization of erosive and ulcerative changes in the mucous membrane of the stomach and duodenum to the 21st and 28th days in the third group of patients was noted. The incidence of adverse events between the groups was comparable: 22.2% in the first group, 24.2% in the second group and 20% in the third group. In the pathomorphological evaluation of biopsy specimens of patients with gastric ulcer at the 6th week after the treatment, significant differences were revealed between the first and third groups in terms of the inflammatory activity in the antrum stomach (2±0.63 vs. 1.4±0.52; p=0,0399). The conclusion. The inclusion of rebamipide in the classical triple scheme of H. pylori ET increases the effectiveness of treatment and does not affect the safety profile. In the post-eradication period, it is advisable to continue the use of rebamipide to potentiate the repair of the gastric mucosa and regress the inflammatory processes

Evaluation of the efficacy and safety of the hybrid scheme for eradication therapy of Helicobacter pylori infection

The aim is to conduct a comprehensive comparative study of the efficacy and safety of the hybrid scheme of eradication therapy (ET) in patients with peptic ulcer of the stomach or duodenum associated with Helicobacter pylori. Materials and methods. In a prospective, randomized comparative study, 180 patients were divided into three equal groups of 60 people, depending on the prescribed 10-day ET regimen. Group 1 - the standard triple scheme (omeprazole, amoxicillin and clarithromycin); group 2 - four-component therapy with preparations of bismuth (omeprazole, tetracycline, metronidazole, bismuth tricalium dicitrate); group 3 - hybrid scheme (first 5 days: omeprazole and amoxicillin, the next 5 days: omeprazole, amoxicillin, clarithromycin, metronidazole). The effectiveness of ET was determined with the help of a breath test a month after the end of therapy. Adverse events were recorded by patients in specially developed diaries. Pharmacoeconomic analysis was carried out using the "cost-effectiveness" method with calculation of the CER coefficient. Results and discussion. The effectiveness of standard triple therapy was 73.3% (ITT), 75.9% (PP); four-component therapy with bismuth preparations - 78.3% (ITT), 82.4% (PP); hybrid scheme - 85% (ITT), 91% (PP). Hybrid therapy proved to be significantly more effective than standard triple therapy with a odds ratio (OR) of 3.25; 95% confidence interval (CI) 1.08-9.73 (p=0.043, χ2=4.75, p-level=0.029298). The incidence of adverse events with the use of triple, four-component and hybrid ET regimens was 15; 18.3 and 28.3% respectively. The OR of at least one adverse event in patients receiving a hybrid ET regimen compared with triple therapy was 2.24 (95% CI 0.91-5.53, p=0.0823, χ2=3.14, p-level=0.076394), and compared with the four-component therapy - 1.76 (95% CI 0.74-4.17, p=0.2804, χ2=1.68, p-level=0.194924). According to the results of the pharmacoeconomic analysis, the most profitable from an economic point of view was a hybrid ET scheme with a CER of 20.1. The conclusion. Hybrid therapy showed the greatest effectiveness in comparison with the triple and four-component ET regimens, however, the incidence of side effects in patients receiving the hybrid ET scheme was higher, although it remained within the acceptable level for use in clinical practice. Pharmacoeconomic analysis also showed the advisability of designating a hybrid ET scheme. The obtained data allow to draw a conclusion about the necessity of further study of the efficiency and safety of the hybrid ET scheme

Особенности артропатии при болезни Уиппла

The authors describe a case of Whipple's disease (WD) in a 56-year-old male patient followed up for 2 years. The diagnosis was established on the evidence that there was a low-density retroperitoneal or mesenteric infiltrate at computed tomography and PAS-positive macrophages in the biopsy specimens of the duodenal retrobulbar mucosa. Arthropathy had developed within 10 years before the occurrence of intestinal symptoms, subsided with their progression, and recurred after their regression. On the basis of this observation and the data available in the literature, the authors discuss the relationships of arthropathy to the abdominal manifestations of WD.Описано двухлетнее клиническое наблюдение мужчины 56 лет с болезнью Уиппла (БУ). Диагноз был установлен на основании обнаружения при компьютерной томографии расположенного за брюшиной и в брыжейке тонкой кишки инфильтрата низкой рентгеновской плотности и выявления в биоптате слизистой оболочки залуковичного отдела двенадцатиперстной кишки PAS-позитив-ных макрофагов. Артропатия развилась за 10 лет до появления кишечной симптоматики, стихла с ее развитием и возобновилась после достижения клинической ремиссии. На основании данного наблюдения и данных литературы обсуждаются взаимоотношения артропатии и абдоминальных проявлений БУ

Clinical Guidelines of the Russian Gastroenterological Association on the Diagnostics and Treatment of Eosinophilic Esophagitis

Aim. This paper presents guidelines on the diagnostics and treatment of eosinophilic esophagitis, which can be used by practitioners in their everyday practice.Summary. Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized by the symptoms of esophageal dysfunction and a pronounced eosinophilic infiltration of the esophageal mucosa. The EoE diagnostics is based on the clinical manifestations of the disease (dysphagia, food impaction, chest pain regardless of swallowing), as well as on the combination of endoscopic and histological signs. The diagnostic criterion is the eosinophilic infiltration of the esophageal mucosa with an eosinophil density of ≥ 15 per high power field (×400) in at least one of the biopsy specimens (about 60 eosinophils in 1 mm2). Total IgE levels, peripheral blood eosinophilia and skin allergy tests are considered to be additional diagnostic means. Several approaches are used for the treatment of EoE, including proton pump inhibitors (PPIs) and topical glucocorticosteroids (GCS), as well as elimination diets. The choice of therapy should be individualized, with the mandatory assessment of the treatment efficacy after 6–12 weeks using esophagogastroduodenoscopy with biopsy sampling. Endoscopic dilatation should be considered in patients suffering from severe dysphagia due to esophagus stricture.Conclusion. Increased incidence of EoE predominantly among children and young people, as well as its chronic character requiring long-term maintenance therapy, make EoE a significant issue to the practice of gastroenterology

Overcoming the novelty effect in online gamified learning systems: an empirical evaluation of student engagement and performance

Learners in the Higher Education context who engage with computer-based gamified learning systems often experience the novelty effect: a pattern of high activity during the gamified system’s introduction followed by a drop in activity a few weeks later, once its novelty has worn off. We applied a two-tiered motivational, online gamified learning system over two years to a total number of 333 students. In a mixed methods research design, we used three-years’ worth of longitudinal data (333 students for the treatment group and 175 in the control group) to assess students’ engagement and performance in that period. Quantitative results established that students engaged and performed better in the gamified condition vis-à-vis the non- gamified. Furthermore, students exhibited higher levels of engagement in the second year compared to the first year of the gamified condition. Our qualitative data suggests that students in the second year of the gamified delivery exhibited sustained engagement, overcoming the novelty effect. Thus, our main contribution is in suggesting ways of making the engagement meaningful and useful for the students thus sustaining their engagement with computer-based gamified learning systems and overcoming the novelty effect

Optimizing the treatment of patients with irritable bowel syndrome: focus on increased compliance

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that is characterized by periodic abdominal pain associated with altered bowel habits and/or changes in stool consistency. The chronic course of the disease marked by alternating periods of exacerbation and remission necessitates the long-term use of non-drug and pharmacological methods for the treatment of IBS, which is extremely negative for the patient’s compliance. A strategy for improving compliance of a patient with IBS is the cornerstone that allows a physician to ensure the optimal level of effectiveness of the prescribed therapy and minimize the risk of disease recurrence

A breach in the intestinal permeability as a factor of etiopathogenesis of functional gastrointestinal diseases

To date the mechanisms of etiopathogenesis of functional gastrointestinal diseases continue to be actively studied. By now, alteration of the components of the intestinal epithelial tight junctions supporting the intestinal barrier integrity has been identified in several studies in patients with irritable bowel syndrome and functional dyspepsia (FD). Characteristic changes in patients with IBS compared with healthy controls include decreased expression of ZO-1 protein and occludin in mucosal biopsy specimens from various parts of the colon. On the other hand, the analysis of duodenal biopsy specimens shows similar changes in patients with FD. The causative factor of these changes continues to be studied. In fact, experimental and clinical studies conducted to date have demonstrated that there are factors that affect adversely the structural and functional stability of intestinal tight junctions. Regardless of the initiating factor, the compromise of tight junctions results in the breach of permeability of the intestinal mucosa and the entry of various intraluminal factors into the proper mucous plate, contributing to the activation of resident immunocompetent cells. Due to the production of cytokines and other biologically active substances, the latter lead to sensitization of nerve endings, thereby inducing the development of visceral hypersensitivity phenomenon and alteration of the motor behaviours of the gastrointestinal tract. The literature describes the phenomenon of activation of a local inflammatory response in patients with functional gastrointestinal diseases as “low-grade inflammation”. These data update the need to consider restoration of the intestinal mucosal barrier in patients with diseases in question as a therapeutic target. This review article systematizes data on this problem