Pathogenesis of Functional Biliary Pain and Pharmacology of Trimebutin

Aim: to provide data on the pathogenesis of functional biliary pain and provide rationale for the use of trimebutine for this indication.Key points. Biliary pain is one of the most frequent reasons for patients to see a doctor. The diagnosis of functional disorder of the gallbladder and Oddi's sphincter is legitimate only after the exclusion of organic causes from both the gastrointestinal tract and other organs and systems. The initial appeal to surgeons with a complaint of pain in the epigastrium or right hypochondrium may lead to unjustified surgical intervention that does not bring relief to the patient's suffering. The consequences of cholecystectomy also have an anatomical and physiological justification for the occurrence or preservation of biliary pain. Currently, two main hypotheses are being considered to explain its cause: increased intraluminal pressure due to morphological and functional obstacles to bile outflow and visceral hypersensitivity. In the multilevel system of regulation of the gallbladder and sphincter apparatus, the opioid system occupies a special place. The agonist of peripheral receptors of the enkephalinergic system, trimebutine, in clinical studies led to the relief of biliary pain in more than 80 % of patients with functional biliary disorders, while a significant decrease in the severity of diarrhea, dyspeptic, and constipation syndromes was revealed.Conclusion. The prescription of the peripheral receptor agonist of the enkephalinergic system, trimebutine, is pathogenetically justified for functional biliary pain

Dexamethasone in Treatment of Comorbid SARS-CoV-2 Patients Aged over 50 Years with Lung Injury over 50 %

Aim. An efficacy assessment of steroid therapy in SARS-CoV-2 patients aged over 50 years with lung damage over 50 % (grade 3–4).Materials and methods. A retrospective study of 158 SARS-CoV-2 patients hospitalised in April—June 2020 was conducted under the inclusion criteria: age over 50 years, chest computed tomography (CT) for COVID-19-asso-ciated pneumonia, C-reactive protein (CRP) >50 mg/L, anticoagulant therapy, no contraindications to steroids, no biologic therapy. Cohort 1 patients (n = 96) received dexamethasone 4–12 mg/day, cohort 2 (n = 62) — a standard non-dexamethasone therapy.Results. Dexamethasone treatment associated with a significant alleviation of COVID-19-associated pneumonia in CT score (p = 0.001), reduced fibrinogen (p = 0.001), a trend to CRP reduction by day 8–10 and lower demand for oxygen therapy, including ventilatory support (p = 0.001). Mortality rate was 19.8 and 75.8 % in cohorts 1 and 2, respectively (p = 0.001).Conclusion. Dexamethasone therapy 4–12 mg/day in SARS-CoV-2 patients aged 50+ years with grade 3–4 CT changes receiving LMWH from start of hospitalisation significantly improved CT scores and reduced mortality

To the Anniversary of Vladimir Ivashkin. Clinical diagnosis at the bedside always was, still is and always will be a criterion of a doctor's professionalism

In 2019, on the eve of Vladimir Ivashkin’s 80th birthday, we conducted our first interview with him. Now, on the eve of his 85th birthday, Professor Ivashkin again kindly agreed to talk with us and share his thoughts, emotions and impressions about the key events of the past five years

Small Bowel Bacterial Overgrowth Syndrome in Patients with Bronchial Asthma

Aim.  This work is aimed at studying the role of the small bowel bacterial overgrowth syndrome (SBBOS) in the pathogenesis of bronchial asthma (BA).Materials and methods.  The study included 80 BA patients (45 and 35 patients allergic and non-allergic BA forms, respectively). Conventional laboratory and instrumental studies were conducted. SBBOS was confirmed by a hydrogen breath test with lactulose. Patients received conventional basal therapy with combined drugs (long-acting β2-adrenomimetics, and inhaled glucocorticoids). For SBBOS treatment, rifaximin (23 patients) or rifaximin followed by probiotic (B. bifidum, B. longum, B. infantis, L. rhamnosus) for 1 month (22 patients) was administered. Control studies were conducted on the 14th day and following 1 month of treatment.Results. A frequent combination of the small bowel bacterial overgrowth syndrome and bronchial asthma was revealed. 67 % and 43 % of the patients with the allergic form and non-allergic asthma form, respectively, are shown to suffer from SBBOS, p = 0.028. High levels of IgE (p < 0.01) and eosinophils in sputum (p < 0.001), combined with severe impairment of the function of external respiration (p < 0.01) in the case of SBBOS with allergic asthma reflect a more pronounced degree of sensitization of these patients. The correction of composition disorders of the intestinal microflora is accompanied by a statistically significant decrease in the immune response (p < 0.01) and improvement in the function of external respiration (p < 0.001).Conclusion.  SBBOS is a significant factor, aggravating the course of bronchial asthma and playing an important role in the development and maintenance of sensitization of patients

First Russian Gastroenterology Olympiad

On October 21, 22, 23, 2022, within the framework of the 122nd International Session of the National School of Gastroenterology, Hepatology (NSGH) of the Russian Gastroenterological Association (RGA), the First Russian Gastroenterology Olympiad was held

Small Bowel Bacterial Overgrowth Syndrome in Patients with Bronchial Asthma

Aim.  This work is aimed at studying the role of the small bowel bacterial overgrowth syndrome (SBBOS) in the pathogenesis of bronchial asthma (BA).Materials and methods.  The study included 80 BA patients (45 and 35 patients allergic and non-allergic BA forms, respectively). Conventional laboratory and instrumental studies were conducted. SBBOS was confirmed by a hydrogen breath test with lactulose. Patients received conventional basal therapy with combined drugs (long-acting β2-adrenomimetics, and inhaled glucocorticoids). For SBBOS treatment, rifaximin (23 patients) or rifaximin followed by probiotic (B. bifidum, B. longum, B. infantis, L. rhamnosus) for 1 month (22 patients) was administered. Control studies were conducted on the 14th day and following 1 month of treatment.Results. A frequent combination of the small bowel bacterial overgrowth syndrome and bronchial asthma was revealed. 67 % and 43 % of the patients with the allergic form and non-allergic asthma form, respectively, are shown to suffer from SBBOS, p = 0.028. High levels of IgE (p < 0.01) and eosinophils in sputum (p < 0.001), combined with severe impairment of the function of external respiration (p < 0.01) in the case of SBBOS with allergic asthma reflect a more pronounced degree of sensitization of these patients. The correction of composition disorders of the intestinal microflora is accompanied by a statistically significant decrease in the immune response (p < 0.01) and improvement in the function of external respiration (p < 0.001).Conclusion.  SBBOS is a significant factor, aggravating the course of bronchial asthma and playing an important role in the development and maintenance of sensitization of patients

Clinical Traits of SARS-CoV-2 Infection

Aim. Analysis of clinical manifestations, laboratory and instrumental examination data in SARS-CoV-2 patients with taking into account the disease severity and outcome.Materials and methods. The study included 92 patients with confirmed coronavirus infection, including 15 lethal cases, hospitalised at the Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology of the Sechenov University in April 2020. The analysis included demographic data, the presence of concomitant diseases, chest computed tomography (CT) results, laboratory tests (including SARS-CoV-2-diagnostic PCR, general and metabolic blood panels, coagulogram) and the duration of disease.Results. Patients infected with SARS-CoV-2 usually exhibit lymphopenia (p ≤ 0.001), leucocytosis, the elevated neutrophils (p ≤ 0.05), neutrophil-lymphocyte ratio (p ≤0,05), C-reactive protein (p ≤ 0.05), ferritin (p ≤ 0.05), D-dimer (p ≤ 0.05) and fibrinogen (p ≤ 0.05), altered prothrombin time (p ≤ 0.05) and INR (p ≤ 0.05). In a critical coronavirus infection, the pulmonary lesion exceeds 50% (corresponds to CT3 — CT4). The risk of critical SARS-CoV-2 infection increases with elder age (p ≤ 0.001), associates with the male gender and presence of concomitant diseases, such as obesity (p < 0.01), diabetes mellitus (p < 0.001), hypertension (p ≤ 0.001), CHD (p ≤ 0.001) and atrial fibrillation (p <0.05).Conclusion. The risk of severe and adverse coronavirus infection is significantly higher in elder comorbid patients