European registry on the management of helicobacter pylori infection (HP-EUREG protocol): The first results of Russian centers

Aim: To assess the clinical practice of diagnosis and treatment in patients with Helicobacter pylori infection and to compare this practice with the international guidelines in the European Registry on the management of Helicobacter pylori infection, Hp-EuReg protocol), a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group. Materials and methods: The data of 813 patients infected with H. pylori and entered in the Hp-EuReg register by the Russian centers in 2013-2015 were analyzed. Results: The most common methods for the primary diagnosis of H. pylori infection are histology (40.3%), rapid urease test (35.7%), and serology (17.2%). The duration of H. pylori eradication therapy was 7, 10, and 14 days in 18.0, 49.3, and 25.1%, respectively. To monitor the effectiveness of treatment, the investigators used a histological examination (34%), a urea breath test (27.3%), H. pylori stool antigen (22.8%), and a rapid urease test (16.3%). A serological test was carried out in 2.5% of the cases. No monitoring was done in 13.5% of the patients. The average eradication efficiency was 82.6%. If the therapy was ineffective, 80% of physicians did not intend to prescribe a new cycle of treatment. Conclusion: Significant differences were found between clinical practice and the current guidelines

Effectiveness of empirical <i>Helicobacter pylori</i> eradication therapy with furazolidone in Russia: results from the European Registry on <i>Helicobacter pylori</i> Management (Hp-EuReg)

Background. First-line therapy does not always provide a high level of Helicobacter pylori eradication due to the increase of H. pylori resistance to antibiotics; therefore, it remains necessary to identify the most effective rescue treatments. The purpose of this study was to evaluate the efficacy and safety of empirical H. pylori furazolidone-containing regimens. Materials and methods. Adult H. pylori infected patients empirically treated with furazolidone-containing eradication regimens were registered in an international, prospective, multicenter non-intervention European registry on H. pylori management (Hp-EuReg). Data were collected at AEG-REDCap e-CRF from 2013 to 2021 and the quality was reviewed. Modified intention-to-treat (mITT) effectiveness analyses were performed. Results. Overall 106 patients received empirical furazolidone-containing therapy in Russia. Furazolidone was prescribed in a sequential scheme along with amoxicillin, clarithromycin and a proton pump inhibitor in 68 (64%) cases, triple regimens were prescribed in 28 (26%) patients and quadruple regimens in 10 (9.4%). Treatment duration of 7 days was assigned to 2 (1.9%) patients, 10-day eradication therapy in case of 80 (75%) and 14 days in 24 (23%) patients. Furazolidone was mainly used in first- (79%) and second-line (21%) regimens. The methods used to diagnose H. pylori infection were: histology (81%), stool antigen test (64%), 13C-urea breath test (6.6%), and rapid urease test (1.9%). The mITT effectiveness of sequential therapy was 100%; 93% with the triple therapy and 75.5% with quadruple therapy. Compliance was reported in 98% of cases. Adverse events were revealed in 5.7% of patients, mostly nausea (3.8%). No serious adverse events were reported. Conclusion. Furazolidone containing eradication regimens appear to be an effective and safe empirical therapy in Russia

ORGANIZATION OF IN-DEPTH PREVENTIVE CONSULTING AND EVALUATION OF ITS EFFECTIVENESS OF ARTERIAL HYPERTENSION PATIENTS IN THE AREA OF RESPONSIBILITY OF GENERAL PRACTITIONER

83 arterial hypertension patients of Stage II with the achieved eutonia who were on the dispensary observation by the general practitioner were studied. Risk factors, clinical signs of cerebral disturbances, rigidity of the vascular were evaluated in all patients. During a year of observation in-depth individual preventive consulting was provided to patients two times. It turned out that active dispensary observation of arterial hypertension patients with implementation in the area of responsibility of the general practitioner of individual consulting allowed not only achieving target values of arterial pressure, improving elastic and tonic properties of the vascular wall, reducing intensity of the endothelial dysfunction but reducing intensity of such modified risk factors as excessive consumption of salt with food, sedentary lifestyle, hyperglycemia, hypercholesterolemia, excessive body weight and obesity. The experience shows that to reinforce the educational skills in arterial hypertension patients with cerebral disturbances it’s necessary to perform in-depth preventive consulting (no less than 2-3 times per year), which finally increases compliance with performance of medical recommendations

Structure of risk factors, comorbid conditions and emotional disorders in patients with myocardial infarction with atrial fibrillation

Introduction: the majority of patients with cardiovascular diseases in real medical practice are characterized by a combination of two or more diseases and conditions, that is, comorbidity. This places additional demands on the observation and treatment of this category of patients. Objective: to assess risk factors, the structure of comorbid conditions and the severity of psychoemotional disorders in patients with myocardial infarction with various forms of atrial fibrillation. Materials and methods: 138 patients (63 men, 75 women) who were hospitalized in the cardiology department of the City Clinical Hospital No. 7 GBUZ with a diagnosis of myocardial infarction with atrial fibrillation were examined. Depending on the form of atrial fibrillation, the patients were divided into 2 groups: the 1st consisted of 83 (60,1%) patients with a paroxysmal form, the 2nd group – 55 (39,9%) with a constant form. The examination was carried out in the first three days of hospitalization of patients. Results: in patients with myocardial infarction with a paroxysmal form of atrial fibrillation, the structure of risk factors is dominated by an average degree of nicotine addiction, dangerous alcohol consumption, high salt intake and excess body weight, and with a constant form of atrial fibrillation, a mostly weak and high degree of nicotine addiction, harmful alcohol consumption and obesity. Conclusion: in patients with myocardial infarction with a paroxysmal form of atrial fibrillation, the predominant risk factors are: dangerous alcohol consumption, high salt intake and overweight combined with depressive disorders in the form of subclinical and clinical depression, and with a constant form of atrial fibrillation, a high degree of nicotinic dependence and mild anxiety disorders: subclinically and clinically severe anxiety, which must be taken into account when carrying out preventive, rehabilitation measures and the solution of expert issues

Helicobacter pylori as a risk factor for gastric cancer: the evidence and primary prevention strategy

Russia is a country with a high prevalence of Helicobacter pylori (HP) infection, a high incidence of gastric cancer, and its late diagnosis. HР infection has been recognized as the leading manageable risk factor for gastric cancer. Accurate diagnostic tests must be used to identify and control the effectiveness of HP eradication, and effective schemes must be implemented for HP eradication. The aim of this article was to analyze the latest consensus documents, systematic reviews and meta-analyzes that reflected the role of HP as a risk factor for the development of gastric cancer, as well as measures for the risk reduction. We describe in detail the diagnostic methods for HP infection, provide data on their use in the Russian Federation, and analyze the efficacy of eradication regimens. In all HPinfected individuals, HP leads to chronic inflammation in the gastric mucosa and launches a precancerous cascade (Correa's cascade). The risk of gastric cancer increases with severe atrophy, intestinal metaplasia and dysplasia. Primary prevention of gastric cancer is most effective if the eradication is performed before atrophic gastritis develops. The available consensus documents underline the importance of HP infection identification by accurate diagnostics at this stage of chronic gastritis. In Russia, the primary HP diagnosis is based on histology (37.7%), rapid urease test (29.2%), and serology (29.7%). HP stool antigen test (31.3%), 13C-urea breath test (23.4%) and the histological method (23.3%) are most often used to control eradication. Currently, the first line of eradication therapy is recommended as triple therapy with clarithromycin prescribed for 14 days. It is recommended to use double dose of proton pump inhibitors and bismuth to increase the effectiveness of this scheme. A 14-days triple regimen enhanced by bismuth has been recommended as the first-line therapy in the Russian Federation

Functional pancreatic insufficiency after surgical treatment in the light of the latest international recommendations

Exocrine  and  endocrine   insufficiencies  are  frequent complications of surgical treatment for pancreatic diseases. The presence  and  extent  of the insufficiency depend on the underlying  disorder, type of surgical procedure, extent of pancreatic resection, and anatomical reconstruction. Increased surgical  activity  determines  the  importance  of the  evidence-based guidelines  for management of patients  after  pancreatic  surgery. The article presents  an  overview of international Evidence-based Guidelines for the Management of Exocrine Pancreatic  Insufficiency after  Pancreatic  Surgery (2016) and United European Gastroenterology evidence-based guidelines  for the  diagnosis  and therapy of chronic pancreatitis (HaPanEU, 2017)