Модуляция интестинального микробиома в формировании и прогрессировании язвенного колита

In recent decades, an increase in the incidence of ulcerative colitis has been observed throughout the world. The purpose of this review is to generalize the available information on the influence of environmental factors and intestinal microbiome on the occurrence and development of ulcerative colitis, the role of bacteria metabolism products in the pathogenesis of the disease. Studied literature, we came to the conclusion that lifestyle in the era of post-industrial society has a significant impact on the microbial composition of the intestine and leads to changes in its diversity in patients suffering from ulcerative colitis. The changes include a decrease in the number of residential flora with anti-inflammatory activity, which synthesize short-chain fatty acids, and an increase in the number of potentially pathogenic and pathogenic microorganisms. Within the phylums Firmicutes and Proteobacteria, the proportional ratio changes. The combination of aggression factors (deterioration of the intestinal microbiome composition, the presence of aggressive intestinal metabolites) leads to intestinal mucosa permeability disfunction, impairing its barrier function. Food and bacterial agents can penetrate deeper layers of the intestinal wall through mucosal defects, which then stimulate the development of inflammatory and immune responses.Целью подготовки обзора является обобщение имеющейся информации о влиянии факторов окружающей среды и микробиома кишечника на возникновение и развитие язвенного колита, роли продуктов метаболизма бактерий в патогенезе этого заболевания. Изучив литературные источники, мы пришли к выводу, что образ жизни в эпоху постиндустриального общества оказывает существенное влияние на микробный пейзаж кишечника и приводит к изменению его разнообразия у больных, страдающих язвенным колитом, в частности к уменьшению числа резидентной флоры с противовоспалительной активностью, синтезирующих короткоцепочечные жирные кислоты, и увеличению числа условно-патогенных и патогенных микроорганизмов. Внутри филумов Firmicutes и Proteobacteria изменяется пропорциональное соотношение. Совокупность факторов агрессии (нарушения состава кишечного микробиома, наличия агрессивных кишечных метаболитов) приводит к нарушению проницаемости слизистой оболочки кишки, снижается ее барьерная функция. Через дефекты слизистой оболочки в более глубокие слои стенки кишки могут проникать пищевые и бактериальные агенты, которые затем стимулируют развитие воспалительных и иммунных реакций

Готовы ли врачи первичного звена соблюдать протоколы диагностики и лечения заболеваний, ассоциированных с Helicobacter pylori: результаты опроса 2020–2021 годов

Objective: To assess compliance of physicians with diagnostic and management guidelines for H. pylori-associated diseases with a question-naire-based survey.Materials and methods: We conducted an anonymous voluntary online survey of 775 physicians of the following specialties: internal medicine 459 (59.2%), gastroenterology 279 (36%), and endoscopy 34 (4.4%). The respondents expressed their level of agreement with the questionnaire items as follows: 0 – I do not know, 1 – disagree, 2 – partially agree, and 3 – fully agree.Results: 613 (79.4%) of the physicians fully agreed to diagnose and treat H. pylori in patients with chronic atrophic gastritis, 602 (78.0%) in the 1 st degree relatives of gastric cancer patients, 525 (68.0%) in patients with chronic superficial gastritis, 423 (54.8%) in peptic ulcer at remission, and 336 (43.4%) in those with dyspepsia syndrome. The physicians were equally compliant with eradication therapy in the patients, for whom long term use of proton pump inhibitors (PPI) or non-steroid anti-inflammatory drugs (NSAID) is being planned (386 (50.0%) and 397 (51.4%), respectively). Internists were less compliant with diagnosis and management of H. pylori in patients taking both PPI (χ2 = 66.525, p = 0.004) and NSAID (χ2 = 103.354, p = 0.003). Among the primary diagnostic tools for H. pylori the physicians preferred 13/14С-urease breath test (545 physicians, or 70.6%) and gastric bioptate morphology (574, or 74.4%), and among the control diagnostic methods they chose fаeces analyses (enzyme-linked immunosorbent assay and polymerase chain reaction). The respondents considered bismuth-enhanced standard triple therapy with clarithromycin to be the most effective regimen for the 1 st line eradication therapy (606, 78.5%). To increase the efficacy of eradication therapy, the physicians were more prone to administer esomeprazole or rabeprazole (70.6%), bismuth-based agents (79.4%), than to use rebamipid (35%), probiotics (44.9%) and/or to double PPI doses (44.2%). The respondents expressed their concerns with low patient compliance to treatment (59.4%) and limited diagnostic capabilities (49.4%).Conclusion: Physician's compliance with the guidelines on diagnosis and management of H. pylori-associated diseases is adequate and might depend on both their awareness and availability of the proposed diagnostic and therapeutic methods.Цель – оценка комплаентности врачей первичного звена в отношении выполнения рекомендаций по диагностике и лечению Helicobacter pylori-ассоциированных заболеваний на основании проведенного анкетирования.Материал и методы. Проведено анонимное добровольное онлайн-анкетирование 775 врачей: 459 (59,2%) врачей по специальности «терапия», 279 (36%) – «гастроэнтерология», 34 (4,4%) – «эндоскопия». Уровень согласия респонденты выражали в баллах: «0» – не знаю, «1» – не согласен, «2» – согласен не полностью и «3» – полностью согласен.Результаты. Полностью согласными диагностировать и лечить H. pylori у больных хроническим атрофическим гастритом были 613 (79,4%) врачей, у родственников 1-й линии родства больных раком желудка – 602 (78,0%), у пациентов с хроническим поверхностным гастритом – 525 (68,0%), у больных язвенной болезнью в период ремиссии – 423 (54,8%), при синдроме диспепсии – 336 (43,4%). В равной степени врачи были привержены к эрадикационной терапии у пациентов, которым планируется длительный прием ингибиторов протонной помпы (ИПП) или нестероидных противовоспалительных препаратов (НПВП) – 386 (50,0%) и 397 (51,4%) соответственно. Терапевты выражали меньшую приверженность к лечению и диагностике H. pylori при приеме как ИПП (χ2 = 66,525, p = 0,004), так и НПВП (χ2 = 103,354, p = 0,003). Среди методов первичной диагностики H. pylori врачи предпочитали использовать 13/14С-уреазный дыхательный тест (545 (70,6%) врачей) и морфологическое исследование гастробиоптата (574 (74,4%)), а в качестве контрольных – анализы кала (иммуноферментный анализ и полимеразная цепная реакция). Наиболее эффективной схемой эрадикационной терапии первой линии респонденты считали стандартную тройную терапию с кларитромицином, усиленную висмутом (606 (78,5%)). В качестве способов достижения большей эффективности эрадикационной терапии врачи чаще были готовы использовать в схемах эрадикации эзомепразол или рабепразол (70,6%), добавлять препараты висмута (79,4%), чем применять в схеме эрадикации ребамипид (35%), пробиотики (44,9%) и/или удваивать дозу ИПП (44,2%). Респонденты продемонстрировали обеспокоенность низкой приверженностью пациентов к лечению (59,4%) и ограниченностью диагностических возможностей (49,4%).Заключение. Комплаентность в отношении соблюдения рекомендаций по диагностике и лечению H. pylori-ассоциированных заболеваний достаточна и может зависеть как от осведомленности врачей, так и от доступности предлагаемых диагностических и лечебных методов

The need to strengthen measures for the diagnosis and treatment of Helicobacter pylori infection in Russia. Memorandum

Leonid B. Lazebnik, PhD, Doctor of Medical Scienses, Professor, Department of Polyclinic Therapy; President of Gastroenterological Scientific Society of Russia; Vise President of Russian Scientific Medical Society of Therapists; Scopus Author ID: 7005446863, ORCID: 0000-0001-8736-5851 Dmitry S. Bordin, MD, PhD, Head of the Department of Pancreatic, Biliary and upper digestive tract disorders; professor of the department of general practice (family medicine); professor of the department of propaedeutics of internal diseases and gastroenterology; ORCID: 0000-0003-2815-3992 Nataliya N. Dekhnich, Doctor of Medical Sciences, Associate Professor at the Department of Faculty Therapy; ORCID: 0000-0002-6144-3919 Roman S. Kozlov, Professor, Corresponding member of the Russian Academy of Science, Director, Institution of Antimicrobial Chemotherapy; chief freelance specialist-therapist of the Ministry of Health of Russia for the Siberian Federal District, professor Mariya A. Livzan, D. Sci. (Med.), Professor, Rector, Head of the Department of Faculty Therapy, Occupational Diseases; ORCID: 0000-0002-6581-7017, Scopus Author ID: 24341682600 Elena A. Lyalyukova, PhD, MD, Professor of the Department of additional postgraduate education in internal and family medicine, Associate Professor; WoS Research ID: AAB -5416-2021, Scopus Author ID: 56657486600, ORCID: 0000-0003-4878-0838 Svetlana V. Luzina, Deputy Chief physician for Medical Part Galina V. Belova, MD, PhD, Professor, Deputy chief physician; Scopus Author ID: 57198379175 Rustem A. Abdulkhakov, Doctor of Medicine, Professor of the Department of Hospital Therapy, Kazan State Medical University, Ministry of Health of Russia, Professor; ORCID: 0000-0002-1509-6776, Scopus Author ID: 6506615710 Sayyar R. Abdulkhakov, Candidate of Medical Sciences, Associate Professor, Head of the Department of Fundamental Foundations of Clinical Medicine; Institute of Fundamental Medicine and Biology; Associate Professor, Department of General Medical Practice and Polyclinic Therapy; assistant professor

Russian consensus on exo-and endocrine pancreatic insufficiency after surgical treatment

The Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian Pancreatic Club using the Delphi method. Its goal was to consolidate the opinions of national experts on the most relevant issues of diagnosis and treatment of exo- and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is ensured by the participation of leading gastroenterologists and surgeons

The first Russian consensus on quantitative assessment of treatment outcome

The first Russian Consensus on the quantitative evaluation of treatment results was approved by the XIII National Congress of therapists (Moscow, November 21-23, 2018). © 2019, Stavropol State Medical University. All rights reserved

ПЕРВЫЙ РОССИЙСКИЙ КОНСЕНСУС ПО КОЛИЧЕСТВЕННОЙ ОЦЕНКЕ РЕЗУЛЬТАТОВ МЕДИЦИНСКИХ ВМЕШАТЕЛЬСТВ

The first Russian Consensus on the quantitative evaluation of treatment results was approved by the XIII National Congress of therapists (Moscow, November 21-23, 2018).Первый Российский консенсус по количественной оценке результатов медицинских вмешательств одобрен XIII Национальным конгрессом терапевтов (г. Москва, 21-23 ноября 2018 года)

Management of adherence-based treatment. Consensus document – Clinical guidelines. English version [упРАВЛЕНИЕ ЛЕЧЕНИЕМ НА ОСНОВЕ пРИВЕРЖЕННОСТИ. КОНСЕНСуСНЫй ДОКуМЕНТ – КЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИ. АНГЛОЯзЫЧНАЯ ВЕРСИЯ]

Consensus Document «Management of adherence-based treatment» developed based on clinical guidelines of Russian Scientific Medical Society of Internal Medicine approved by the XIV National Congress of physicians (Moscow, 20 November 2019). The document is intended primarily to assess adherence to drug therapy, adherence to lifestyle modification, and adherence to medical support for patients who need long-term or permanent treatment. The document’s authors considered the treatment adherence unanimously as the compliance of the patient’s behavior with the recommendations received from the Doctor regarding medication, dieting, and other measures of lifestyle modifications. Insufficient adherence to treatment is a global problem. Assessing adherence as a basis for making medical decisions is an essential element of improving the quality of the healthcare system. Predictions of treatment outcomes cannot be considered effective if individualized levels of adherence are not used to justify project planning and evaluation. In medical practice, quantitative assessment of adherence is preferred, suitable for patients with various diseases, and with the possibility of automated data entry and processing. Therefore, sections on medical interventions based on the assessment of treatment adherence should be reflected in national clinical guidelines. These Joint Recommendations are based on these provisions. © Group of authors, 202

Treatment management based on adherence: Patient recommendation algorithms. Cross-disciplinary guidelines [УПРАВЛЕНИЕ ЛЕЧЕНИЕМ НА ОСНОВЕ ПРИВЕРЖЕННОСТИ: АЛГОРИТМЫ РЕКОМЕНДАЦИЙ ДЛЯ ПАЦИЕНТОВ. МЕЖДИСЦИПЛИНАРНЫЕ РЕКОМЕНДАЦИИ]

The algorithms (sample templates) of recommendations for patients, which are an integral part of adherence-based treatment management technologies, were developed by an interdisciplinary Working Group coordinated by the Treatment Adherence Section of the Russian Scientific Medical Society of Physicians. The Working Group includes opinion leaders and experts in the therapeutic, gastroenterology, cardiology, preventive medicine, gerontology, oncology, hematology, immunology, phthisiopulmonology, infectious diseases, oncohematology, neurology, intensive care, rehabilitation and other specialties, both involved by the section of RSMSIM, and recommended by the Gastroenterological Scientific Society of Russia, National Association of experts in Thrombosis, Clinical Hemostasiology and Hemorheology, Gerontological Society of the Russian Academy of Sciences, Russian Oncohematologists Society, Russian Society of Phthisiatrists, Society of Evidence-based Neurology. The algorithms are based on the materials of «The First Russian Consensus on Quantitative Assessment of adherence to treatment», approved by the XII National Congress of Internal Medicine (2017) and Clinical Guidelines «Treatment Management on the Basis of adherence», approved by the XIV National Congress of Internal Medicine (2019), taking into account the Consenting Document - Interdisciplinary Guidelines of RSMSIM, GSSR, NATH, SEN, GSRAS, ROHS, RSP «Treatment Management on the Basis of Adherence» (2020). The algorithms of treatment strategies are recommended by the Working Group to be used as a basis for inclusion into relevant sections of clinical guidelines and clinical handbooks developed by professional medical communities, as well as for use by practitioners in medical practice. © 2020 Stavropol State Medical University. All rights reserved