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

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

Clinical significance of Helicobacter pylori infection in iron-deficiency anemia: features of comprehensive treatment approach

Aim of investigation. To study pathogenic and clinical role of Helicobacter pylori infection at irondeficiency anemia (IDA). To present the diagnostic and treatment guidelines for these patients taking into account their specific requirements. Material and methods. Overall 120 H. pylori-positive patients of different age (from 18 to 70 years), which were subdivided into two groups were studied. The main group included 70 H. pylori-positive patients with chronic iron-deficiency anemia of unknown etiology. Patients of this group have been randomized in two homogeneous subgroups (according to severity of anemia). Patients of the subgroup 1a underwent eradication therapy for 10 days (amoxicillin 1000 mg b.i.d., clarithromycin 500 mg b.i.d.; esomeprazole 20 mg b.i.d.) followed by the course of treatment by ferrous iron combined to ascorbic acid. Subgroup 1b patients received only iron supplementation therapy. The group of comparison included 50 H. pylori-positive patients without coexistent iron deficiency who received the first line eradication therapy for 10 days as well. Presence of H. pylori infection and eradication control were carried out by urea breath test (Helic-test system). Efficacy of IDA treatment was evaluated by hemoglobin level, RBC color index, total iron-binding capacity (TIBC), serum ferritin and iron levels. Results. Patients were monitored with examination on the 14th, 28th and 56th days of treatment. Mean laboratory scores prior to onset of treatment in the subgroup 1a were: Нb 88,5 g/l, RBC 3,0×1012, RBC color index 0,74, serum iron 6,7 µmol/l, TIBC 89,4 µmol/l, transferrin saturation rate 9,3 %, ferritin 10,1 µg/l; in the subgroup 1B: 89,6 g/l, 3,1×1012, 0,75; 7,3 µmol/l, 88,6 µmol/l, 9,8%, 10,8 µg/l. At control examination in 28 days after iron supplementation onset positive changes were observed, that were more prominent in the subgroup 1a: Hb 117,8 g/l, RBC 3,9×1012, RBC color index 0,83, serum iron 17,7 µmol/l, TIBC 74,4 µmol/l, transferrin saturation percent 20,8 %, ferritin of 20,7 µg/l; in the subgroup 1B: 104,2 g/l, 3,6×1012, 0,81, 12,6 µmol/l, 79,2 µmol/l, 16,6 %, 17,9 µg/l respectively. Is also noticed that regression of anemia symptoms was more rapid than improvement of the laboratory scores especially in subgroup 1A patients. To 56th day of treatment all patients have reached target hemoglobin levels, that corresponded to a normal range. Conclusions. Eradication therapy in patients with iron deficiency anemia, allows to achieve improvement of both physical signs and the laboratory scores in shorter terms, as well as more rapid symptom relief. According to Maastricht IV consensus statements, all H. pylori-positive patients with idiopathic iron deficiency anemia require eradication therapy before onset of iron supplementation

Pleiotropic effects of rabeprazole at acid-related diseases

Aim of investigation. To study association interleukin-1 (IL-1) gene (rs16944), interleukin-6 (IL-6) gene (rs1800795), interleukin-10 (IL-10) gene (rs1800896) polymorphisms with development of acute pancreatitis (AP) in the Russian population. Material and methods. Whole blood samples were received from 297 AP patients and 238 healthy controls. Genotyping of IL-1 gene (rs16944) polymorphisms, IL-6 gene (rs1800795), IL-10 gene (rs1800896) was carried out by polymerase chain reaction with allele discrimination by TaqMan-probes. Results. The genetic polymorphism combination 511СТ×174GC of IL-1 and IL-6 genes was associated to high risk of AP development (OR=2.25, 95%-CI 1.45-3.49; p=0.0018). According to stratification analysis smoking patients with 511CT genotype had higher AP risk, then the patients with other genotypes (OR=2.22, 95%-CI 1.3-3.79; p=0.003). Paired combination of genotypes to disease risk analysis demonstrated that at 511СT×174GС genotype combination the AP risk is highest at alcohol abuse history for over 10 years (OR=2.88, 95%-CI 1.59-5.23; p=0.0004). Conclusion. Interleukin genetic polymorphism investigation may be useful at assessment of cytokine status in AP patients to predict the outcomes and to develop the personalized approach to treatment and prophylaxis

Evaluation of the functional gastrointestinal diseases concept from standpoints of Rome IV (2016) diagnostic criteria (review)

Aim of review. To present the modern concept of functional gastrointestinal diseases (FGID) and to analyze the basic clinically relevant changes made in Rome IV criteria (2016) in comparison to the previous edition. Summary. According to the due definition that was proposed by the Rome IV advisory council, FGID are the brain-gut axis interaction disorders. It was proposed to exclude the term «functional» from the definition. The new nosological entities with known causative factor (opioid-induced gastrointestinal hyperalgesia, opioidinduced constipation, cannabinoid induced hyperemesis syndrome), hypersensitive reflux syndrome, nausea and vomiting syndrome (that encompasses previously separate nosological forms: chronic idiopathic nausea and functional vomiting) were added to the new version of the classification. In the new edition of Rome criteria the management approach to patients with sphincter of Oddi dysfunction is specified, along with diagnostic criteria of functional dyspepsia and irritable bowel syndrome. Conclusion. The classification of FGID is revised in updated Rome criteria, diagnostic features of several nosological entities were specified

Esophageal adenocarcinoma: risk factors and modern screening strategy

Aim of review. To present the modern concepts on epidemiological pattern and risk factors of esophageal adenocarcinoma (EAC) and analyze the modern screening approach. Summary. In developed countries EAC is characterized by rapid increase of mobidity, as well as by high mortality level. As a rule, EAC is diagnosed at the late stage: diagnosis is often made at the 3rd or 4th stage of the tumor that is a major contributing factor for high mortality as treatment options at these stages are significantly limited. The basic established risk factor for EAC is the gastroesophageal reflux disease (GERD). EAC develops usually as a complication of the Barret's esophagus (BE) being a consequence of the long-standing GERD. Male gender, Caucasian race, obesity and metabolic syndrome, tobacco smoking, and series of genetic markers are considered to be significant EAC risk factors. A main goal of EAC screening programs is the early diagnosis that allows to improve patient survival. Conclusion. Only GERD patients develop EAC, with the highest risk in males, Caucasians, smokers, overweight patients and those with uncontrolled symptoms. Timely diagnosis of GERD, its effective treatment and follow-up of BE cases can prevent EAC development

Challenges of the Klatskin tumor diagnosis in a patient suffering from cirrhosis of the liver

The clinical example demonstrates several stages of diagnostic search in patients admitted to hospital with severe manifestations of cholestatic syndrome. Due to the presence of alimentary liver cirrhosis and absence of cholelithiasis, cholestasis was evaluated with regard to the underlying disease. However, progressive jaundice against a background of adequate treatment and deterioration of the general condition of the patient forced the doctors to extend the range of diagnostic search. Heterogeneity of results of diagnostic imaging was the major obstacle to the detection of Klatskin tumor

The effectiveness of H. pylori therapy in patients with helicobacter pylori related functional dyspepsia

The article presents the results of a study aimed to evaluate the efficacy and tolerability of eradication schemes with macrolides and bismuth in the treatment of patients with Helicobacter pylori related functional dyspepsia (postprandial distress syndrome)