The Effectiveness of Add-on Treatment with Nutraceutical

Aim: evaluation of the effectiveness of the nutraceutical “Standard Zdorovia: Gastro” (“SZ Gastro”) in the treatment of patients with irritable bowel syndrome (IBS).Materials and methods. 52 patients (62 % women) diagnosed with IBS and IBS in combination with functional dyspepsia (FD) were included in the study and divided into two groups. Both groups received basic therapy according to the guidelines. The experimental group received as add-on the nutraceutical “SZ Gastro” (containing a standardized amount of menthol, gingerol and D-limonene); patients in the control group — placebo. The duration of the study was 30 days. The severity of somatic symptoms was assessed with the 7×7 questionnaire. Emotional state was assessed with the Four Dimensional Distress, Depression, Anxiety, and Somatization Questionnaire (4DSQ).Results. Patients of the experimental and control groups did not differ from each other either in terms of demographics, basic treatment, or in the severity of symptoms at the beginning of the study.The effectiveness of the treatment in the patients, who received add-on “SZ Gastro” was significantly higher than in the patients of the control group: in the control group the percentage of improvement of somatic symptoms was 22.35 %, in the experimental group it amounted to 49.18 % (χ2 = 15.9; p = 0.0001). The percentage of patients with significant decrease of emotional disturbances was also higher in the experimental group: distress (χ2 = 18.7; p = 0.0000), anxiety (χ2 = 6.9; p = 0.0097) and somatization (χ2 = 14.99; p = 0.0001). No significant side effects were registered in any of the groups.Conclusions. Add-on of nutraceutical “SZ Gastro” to basic treatment is safe and significantly increases effectiveness of the therapy in the patients with IBS and IBS in combination with PD

Modern Approaches to the Diagnosis and treatment of <i>Clostridioides difficile (C. difficile)</i>-associated Disease in Adults (literature Review and Expert Council Resolution)

Aim: to review the modern approaches to the diagnosis and treatment of C. difficile-associated disease in adults and present the resolution of the Expert Council held on March 25, 2023 in Moscow.General provisions. C. difficile is the most important nosocomial pathogen which spores are also commonly found in the environment. Microbiota impairment, primarily due to the use of antibacterial drugs, is a key stage in the development of C. difficile-associated disease. A search for an infection should be carried out only in patients with diarrhea, and it is advisable to use at least 2 laboratory methods. The drug of choice for first-line treatment is vancomycin. If drug treatment is ineffective or the patient has recurrent clostridial infection, fecal microbiota transplantation should be considered. The probiotic strain Saccharomyces boulardii CNCM I-745 has a direct inhibitory effect on C. difficile toxin A, promotes normalization of the intestinal microbiota composition, and decreases the inflammatory reaction in colonic mucosa colonized with a toxigenic strain of C. difficile.Conclusions. Addition of the probiotic strain Saccharomyces boulardii CNCM I-745 to antibacterial therapy promotes both primary and secondary prevention of C. difficile-associated disease

Метахронное развитие рака молочной железы и рака предстательной железы (клинический случай)

The formation of primary multiple malignant neoplasms, such as breast cancer and prostate cancer, in one patient is a rather rare combination. Treatment and diagnostic strategies in such cases require a multidisciplinary approach. Currently, there are no approved recommendations for the management of patients with a combination of these diseases. This manuscript presents a clinical case of diagnosis and treatment of breast and prostate cancer in one patient.Одновременное развитие первично множественных злокачественных новообразований, таких как рак молочной железы и рак предстательной железы, у одного пациента является редким случаем. Лечебно-диагностическая тактика в подобных ситуациях требует мультидисциплинарного подхода. В настоящий момент утвержденных рекомендаций по ведению пациентов с комбинацией этих заболеваний нет. В данной работе представлен клинический случай диагностики и лечения рака молочной железы и рака предстательной железы у одного пациента

Practical Recommendation of the Scientific Сommunity for Human Microbiome Research (CHMR) and the Russian Gastroenterological Association (RGA) on Small Intestinal Bacterial Overgrowth in Adults

Aim. To optimize the choice of treatment strategies by physicians and gastroenterologists to improve treatment and prevention of small intestinal bacterial overgrowth (SIBO) in adults.Key points. SIBO is a condition characterized by an increased amount and/or abnormal composition of the microbiota in the small intestine. Clinically, the syndrome is manifested by nonspecific gastroenterological complaints and the development of malabsorption syndrome. Most often, SIBO is associated with various chronic non- infectious diseases (both diseases of the gastrointestinal tract, and the cardiovascular system and the neuromuscular apparatus) and can affect the severity of their symptoms. Specific methods for diagnosing SIBO are the culture method and breath tests. The main approaches to the treatment of SIBO include the elimination of the underlying cause of its occurrence, the use of antibacterial drugs and adherence to dietary recommendations (elemental diet).Conclusion. Small intestinal bacterial overgrowth is common in patients with various diseases, but has non-specific manifestations, so proper diagnosis of this condition is required. SIBO therapy involves prescription of antibacterial agents, the most studied of which is the non-absorbable antibiotic rifaximin-α

Treatment of autonomous intestinal neuropathy in critical care by prucalopride and multistrain probiotic

The aim of clinical case presentation. To analyze the options of autonomous intestinal neuropathy treatment in critical state patients. Key points. The clinical cases of autonomous intestinal neuropathy of various etiology are presented. Patient A., 19-year-old patient presented with constipation for up to 3 days, progressive feeling of abdominal distention and general weakness. In the past history patient underwent surgery for chronic left-side achillobursitis. In postoperative period antibacterial treatment was prescribed that included first-generation cephalosporin. At the 4thday after onset of antibiotic treatment the patient developed chronic abdominal pain that increased progressively, diarrhea up to 10 times per day and fever of 39 °C. Subsequent investigation revealed positive stool test for C. difficile toxins A and B. Urgent colonoscopy detected pseudomembranes at colonic mucosa. Histological examination of biopsy specimens from affected sites demonstrated focal cystic dilation of crypts with epithelium desquamation, severe edema of lamina propria. Pseudomembranous colitis was diagnosed and vancomycin 125 mg qid in combined to metronidazole 500 mg tid for 10 days were prescribed. At the background of treatment stool frequency gradually decreased up to 2 times per day, hematochezia stopped. However at the 7-8th days patient developed constipation, feeling of abdominal distention and progressive general weakness. The state was regarded as development of C. difficile toxin-associated autonomous intestinal neuropathy. Patient I., 54 year-old admitted to the hospital; presenting complaints included flatulence, constipation for up to three days and severe general weakness. According to the past history in 2014 patient was diagnosed to have adenocarcinoma of the right breast gland with subsequent right-sided radical mastectomy followed by radiation therapy and chemotherapy. In May 2017 patient developed boring pain in the right lumbar area, frequent small-volume urination, febrile fever and progressive general weakness. Laboratory and instrumental investigation revealed obstructive right-sided abscessing pyelohephritis with development of sepsis; antibacterial therapy included meropenem in daily dose of 3.0 g along with correction of hypoalbuminemia and detoxication therapy. At the 3rd day of treatment patient noticed improvement in the state of health: decrease in right-sided lumbar pain and general weakness, decrease in body temperature up to subfebrile level. Catheter-collected urine sample contained no admixture of pus. However in the same day patient developed constipation along with progressive abdominal distention. The most likely cause for development of ileus in this case is development of autonomous intestinal neuropathy associated to severe intoxication. Basic mechanisms for development of autonomous intestinal neuropathy are discussed: suppression of smooth muscular contractility by C. difficile toxins A and B (in the first of presented cases) and combined autoimmune neuronal damage by immune cells due to expression of proteins by neoplastic cells (in the second case). Therapeutic approaches including prescription of prokinetic drug prucalopride and multistrain probiotic containing bifido-and lactobacilli are presented (Bifidobacterium bifidum, B. longum, B. infantis, Lactobacillus rhamnosus). Prescription of prucalopride and multistrain probiotic provided resolution of neuropathy and recovery of adequate intestinal motility due to resumption neuromuscular intestinal complex activity and correction of intestinal microbiota spectrum. Conclusion. Combination of prokinetic drug (prucalopride) and multistrain probiotic medication (Bifidobacterium bifidum, B. longum, B. infantis, Lactobacillus rhamnosus) can be effective in the treatment of autonomous intestinal neuropathy in critical care

Practical Recommendations of Scientific Society for the Study of Human Microbiome and Russian Gastroenterological Association (RGA) for Probiotics in Treatment and Prevention of Gastroenterological Diseases in Adults

Aim. To provide practical recommendations on the use of probiotics for the treatment and prevention of gastroenterological diseases in adults.General provisions. Probiotics are living microorganisms that benefit the health of the host when administered in adequate amounts. The main functions of probiotics include the support for colonisation resistance, the metabolism of food substrates and utilisation of end metabolites, the production of substrates necessary for the macro-organism, as well as the regulation of local and adaptive immune responses. Probiotics can be registered in the Russian Federation as biologically active food additives (BAFA) or as pharmaceutical products (drugs) in accordance with the microbiological standards and legislative requirements of the Russian Federation. The probiotics registered in the Russian Federation as BAFA for adults include bacteria of the Lactobacillus, Bifidobacterium, Enterococcus, Pediococcus, Lactococcus, Streptococcus, Bacillus, and Escherichia genera, and fungi of the Saccharomyces genus; probiotics registered as drugs — bacteria of Lactobid, Lactobacid, Escherichia and Enterococcus genera and fungi of the Saccharomyces genus. Some probiotics registered in the Russian Federation include probiotic strains that have proved to be effective for the prevention and treatment of antibiotic-associated diarrhea, the prevention of C. difficile-associated disease, the eradication of H. pylori infection, as well as for the treatment of irritable bowel syndrome and functional constipation.Conclusions. The clinical efficacy of probiotics depends on the probiotic strains included in their composition and is confirmed by a comparative analysis of the results of appropriate clinical studies. Not all probiotics registered in the Russian Federation as BAFA or drugs contain bacterial or fungal strains; as a result, the expected clinical effect may not be achieved

Practical Recommendations of Scientific Society for the Study of Human Microbiome and the Russian Gastroenterological Association on Use of Probiotics, Prebiotics, Synbiotics and Functional Foods in Treatment and Prevention of Gastroenterological Diseases in Children and Adults

Aim. The practical guidelines are intended for primary care physicians, general practitioners, paediatricians, gastroenterologists and general internists to advance the treatment and prevention of gastroenterological diseases in adults and children in therapies with probiotics, prebiotics, synbiotics and their enriched functional foods.Key points. Probiotics are live microorganisms that sustain health of the host when supplied in adequate amounts. Prebiotics include human-indigestible but accessible to gut microbiota substances expediting specific changes in the composition and/or activity of gastrointestinal microbiota that favour the host health. The mechanism of probiotic action comprises the quorum resistance maintenance, nutrient substrate metabolism and end metabolite recycling, macroorganism-sustaining substrate production, as well as the mediation of local and adaptive immune responses.The Russian Federation regulates market differently for biologically active food additives (BAFA), medicinal products (drugs) and functional food products (FFP). We overview the probiotic strains regulated in Russia as BAFAs, drugs and FFPs and provide recommendations on the use of these strains in treatment and prevention of gastroenterological diseases in children and adults.Conclusion. The clinical efficacy of probiotics, prebiotics, synbiotics and fortified functional foods depends on the prebiotic and strain properties and is verified in appropriate comparative clinical trials. Not all probiotics registered in Russia as BAFAs, drugs and FFPs have a strain identity, which provides no warranty of the clinical effect expected. The FFP legislation demands improved regulation mechanisms and control for therapeutic efficacy