Mesalazine use tactics in the ulcerative colitis patients

Aim of the lecture. To specify indications for the administration of the 5-aminosalicylic acid (5-АSA) in the patients with ulcerative colitis (UC) and to discuss the possibility of correlation between the body mass index, the disease activity and reasonability for the prescription of the mesalazine (Pentasa) as a monotherapy.Key points. 5-АSA is the first line drug for the UC patients. The efficacy has been demonstrated in a huge number of studies, the indications for the administration have been determined and are dependent on the disease activity index. 5-АSA are used in moderate rate of the inflammatory activity. This article discusses the question of the possible relation between the body mass loss during the disease, www.m-vesti.ru and the body mass index as the additional factors for the determining of the pathological process activity and the indications for the prescription of the 5-АSA drugs. The article points out the possibility of the mesalazine rectal suppositories use for proctitis in the patients with UC that increases the adhesion of the patients to the treatment.Conclusion. Mesazaline is efficient in the UC patients with both distal as well as extended forms of the disease. The additional factor which determines the disease activity is probably the patients’ nutritional status which is expedient to be taken into account while selecting the therapy

Modern methods of studying of human gastro-intestinal microflora

The aim of review. To discuss modern concepts on the structure and functions of intestinal microflora and its possible effect on development of certain diseases, as well as the basic methods of diagnostics of disorders of its qualitative and quantitative structure.Key points. Intestinal microflora plays important role in maintenance of normal ability to live of a human body. Its qualitative and quantitative pattern can vary under effect of environmental factors, in relation to age, gender and climatic geographical conditions. New data on relation of disorders of microflora with diseases of cardio-vascular system, disorders of metabolism, autoimmune and allergic diseases have appeared. From the middle of XX century bacteriological method of investigation based on obtaining of pure culture was widely applied in rating of microflora pattern. However, during the last decade modern methods of diagnostics which allow to investigate structure and functions of microorganisms at a genetic level, even at the presence of single bacterial cell in a sample.Conclusion. Application of modern methods of diagnostics allows to receive the unwrapped representation of microbic landscape of small and large intestine, and also to estimate character of metabolism of the defined microorganisms

Substantiation of application and estimation of efficacy of probiotics at inflammatory bowel diseases

The aim of review. To prove competency of application of probiotics and to analyze data of the original studies of efficacy of various probiotic agents in treatment of inflammatory bowel diseases (IBD).Summary. The role of microflora in pathogenesis of this group of diseases becomes more and more obvious. At patients with IBD the intestinal microbiome have quantitative and qualitative differences from microbiome of healthy patients aside of increase in contents of opportunistic and pathogenic microorganisms. Microbiome changes result in initiation of cascade of pathological immune reactions of the host in related to presence of genetical defects, that, in turn, promotes development of clinical symptoms and morphological changes in intestinal wall. Potential of probiotic agents effect on microflora is actively studied in the last years, including patients with IBD.Conclusion. The highest efficacy the Bifidum and Lactobacilli-containing probiotics, possess at advance and maintenance of remission of reservoir ileitis (pouchitis). Addition of probiotics in mode of treatment significantly increases probability of clinical improvement and, at level of the statistical trend, achievement of clinical remission at ulcerative colitis. In remission maintenance efficacy of the studied probiotic drugs is comparable to efficacy of maintenance dozes of mesalazine. Efficacy of probiotics is not proved at their addition in the mode of standard therapy used for achievement and maintenance of remission of a Crohn's disease

Efficacy of mesalazine at ulcerative colitis with nutritional failure

Aim of investigation. To specify relation between trophological status, severity of relapse of ulcerative colitis (UC) and efficacy of 5-aminosalicylic acid (5-ASA) for achievement of clinical remission.Summary. Nutritional status plays important role for body recovery at relapse of chronic diseases, including UC. At patients with nutritional failure remission achievement time becomes longer, bed-stay duration is increased. On the other hand, overweight patients often have more severe course of UC, as it affects important pathogenic processes. This article discusses possible links between trophological status and achievement of clinical remission, as well as between nutritional failure at UC and efficacy of mesalazine monotherapy.Conclusion. More severe course of UC, long bedstay, lower mesalazine efficacy are marked at patients with nutritional failure in comparison with those scores at patients with normal trophological status. At over-weight patients in comparison with patients with normal nutritional status no significant differences in specified parameters is observed

Mechanisms of bacterial-to-host interaction and their disorders at inflammatory bowel diseases

The aim of review. To discuss modern concepts on interaction of bacterial cells with human body, and disorders of micro-and macroorganism interaction at inflammatory bowel diseases (IBD).Summary. Quantitative and qualitative changes of intestinal microflora are revealed in patients with IBD, with tendency to increase of opportunistic and pathogenic microorganisms contents. The capability of bacteria contact with immune cells is provided by capacity of bacterial cells to adhesion and invasion, competence of mucus layer covering mucosa of gastro-intestinal tract, detaining and fixing microbic cells, competence of intercellular epithelial contacts function, density of signal receptors, level of antimicrobic peptides expression, completeness of autophagy process. Disorder of barrier function of intestine at IBD patients, in combination to prevalence of opportunistic and pathogenic microorganisms in intestinal biome, results in essential overload of innate and adaptive immune system.Conclusion. At IBD, all mechanisms providing interaction of bacterial cells with the host body are malfunc tioning to some extent, that, in combination to genetic predisposition to this disease, results in development of clinical symptoms and morphological changes

Management of a Female Patient with Irritable Bowel Syndrome and Somatoform Disorder

Aim: to demonstrate the management of a patient with somatization disorder and irritable bowel syndrome.Key points. A 41-yo female patient was admitted with complains of spastic lower abdomen pain, hard stool once every 1–2 days under laxative treatment (macrogol), bloating, anxiety, waiting for confirmation of a life threatening illness, internal stress, difficulty in falling asleep, shallow sleep. Has a long history of disease, characterized by the appearance of a variety of somatic symptoms (headache, tachycardia, joint pain, stool disorders, abdominal pain, etc.) during periods of emotional tension, lack of data suggesting organic disease. No abnormal changes were detected in examination at the clinic (complete blood count, serum chemistry tests, urinalysis or fecal tests, hydrogen and methane breath tests with lactulose, abdominal ultrasound, esophagogastroduodenoscopy, colonoscopy). With the prior agreement of patient, she was consulted by a psychiatrist and diagnosed with somatization disorder and mild anxiety disorder. On discharge from hospital recommended cognitive-behavioral therapy, continue taking macrogol, as well as treatment with Kolofort. After 3 months of complex treatment, there was a significant decrease in the severity of both the symptoms of irritable bowel syndrome and anxiety disorder.Conclusion. For patients whose complaints meet the diagnostic criteria for IBS, a two-stage differential diagnosis may be justified: at the first stage, differentiation of IBS and organic diseases of the gastrointestinal tract is carried out; at the second stage - IBS and somatization disorder. Kolofort can be the drug of choice both in patients with IBS and the pharmacological part of therapy in patients with somatization disorder

Pathogenic role of intestinal microflora changes in patients with irritable bowel syndrome and treatment options

The aim of review. To analyse of publications on qualitative and quantitative changes in pattern of intestinal microflora in patients with irritable bowel syndrome (IBS) and options of its treatment by pre-, pro-, and symbiotic drugs.Key points. In the last years more and more data appear on changes in qualitative and quantitative spectrum of intestinal microflora in combination to low degree inflammation of colonic mucosa at IBS that allowed to reconsider standard concepts on pathogenesis of this functional disorder. Agents restoring intestinal microflora balance are effective for symptom relief of this disease.Conclusion. The analysis of the information concerning disorder of qualitative and quantitative structure of intestinal microflora at IBS, mechanisms of action of pre-, pro- and synbiotics, allows to expand essentially treatment options of this disease

Comparative assessment of <i>Bifidobacterium bifidum, Bifidobacterium longum, Bifidobacterium infantis, Lactobacillus rhamnosus</i> and <i>Saccharomyces boulardii</i> efficacy at diarrheal variant of irritable bowel syndrome

Aim of investigation. To estimate effect of probiotics on severity of clinical symptoms, presence of bacterial overgrowth syndrome (BOS) and quality of life at diarrheal variant of irritable bowel syndrome (IBS-D).Material and methods. In 47 patients with diagnosis of IBS-D, confirmed by conformity of symptoms to Rome-III criteria and absence of organic diseases according to carried out investigation comparative analysis of effect of probiotics and placebo on development of main clinical symptoms, state of intestinal microflora and quality of life was applied. Efficacy of probiotics containing microorganisms Bifidobacterium bifidum, Bifidobacterium longum, Bifidobacterium infantis, Lactobacillus rhamnosus (Florasan-D); yeast Saccharomyces boulardii (Enterol) was studied. Overall 25 men (53,2 %) and 22 women (46,8 %) with mean age 33 year (31,5; 37,8) were investigated. Probiotics Florasan-D, Enterol and placebo were prescribed in a doze of 250 mg bid. Intensity of abdominal pain and meteorism was estimated by visual analog scale (VAS), consistency of stool – by Bristol stool form scale, defecation rate — by calculation of number of bowel movements during every week of treatment. Besides that presence of BOS was investigated by hydrogen breath test with lactulose, quality of a life was determined using The Short Form-36 (SF-36) questionnaire prior to treatment onset and its termination. Treatment lasted for 28 days.Results. In group of the patients who received Florasan-D and Enterol, in contrast to as placebo group improvement in relation to severity of main clinical symptoms was marked, quality of a life score increased. Besides that, according to hydrogen breath test with lactulose results on a background of Florasan-D it was possible to eliminate BOS in all patients

Comparative efficacy of <i>Bifidobacterium bifidum, Bifidobacterium longum, Bifidobacterium infantis, Lactobacillus rhamnosus</i> composition and prucalopride in treatment of constipation variant of irritable bowel syndrome

Aim of investigation. To estimate effect of probiotics and enterokinetic agents on severity of clinical symptoms, presence of bacterial overgrowth syndrome (BOS) and quality of life of patients with constipation variant of irritable bowel syndrome (IBS-C).Material and methods. Comparative analysis of effect of probiotics, enterokinetic agents and placebo on dynamics of main clinical symptoms, intestinal microflora state and quality of life in IBS-C patients was carried out. Investigation of Florasan-D probiotic, composed of Bifidobacterium bifidum, Bifidobacterium longum, Bifidobacterium infantis, Lactobacillus rhamnosus, enterokinetic agent Resolor (prucalopride) and placebo was carried out in 50 patients with IBS-C, conforming Rome III criteria without organic diseases according to results of present investigation. Overall 8 men (16%) and 42 women (84%) with mean age of 35 years [33,7; 41,1 years] were investigated. Patients received probiotic Florasan-D 250 mg bid, placebo — in a similar mode; patients received Resolor 2 mg as a single-dose in the morning. Intensity of abdominal pain and meteorism were estimated by visual analog scale (VAS), stool consistency — by Bristol stool form scale, frequency of defecation — by calculation of number of defecations for every week of treatment. BOS was assessed by lactulose hydrogen breath test, quality of life — by The Short Form-36 (SF-36) questionnaire. Treatment was carried out for 28 days. Results. In the group of IBS-C patients efficacy of Florasan-D probiotic in relation to basic symptoms reduction, improvement of quality of life, normalization of hydrogen breath test scores was comparable to those at Resolor application. Conclusions. Probiotic of Florasan-D and enterokinetic Resolor at application in patients with IBS-C for 4 wks possess similar efficacy in main symptom reduction, relief of BOS, improvement of quality of life. Florasan-D is better tolerated by patients due to gradual increase of stool frequency during treatment course