Efficacy of Esophageal Protector in Treating Gastroesophageal Reflux Disease with Extraesophageal Symptoms: a Multicenter, Open-Label, Observational Study

Aim: to assess effects of esophageal protector Alfasoxx on extraesophageal symptoms in patients with GERD.Materials and methods. A prospective open multicenter post-registration observational study was conducted. The study included 546 patients aged 6 to 85 years (the average age of patients is 42.4 ± 16.9 years) with a verified diagnosis of GERD (endoscopically and/or pH-metrically), the presence of extraesophageal symptoms of the disease (according to the results of an objective examination and consultations of specialists), to whom the attending physician prescribed a course of treatment with a medical device Alfasoxx in accordance with the instructions for medical use. The patients were recruited by 51 researchers in 26 cities of Russia. The study in chronological order consisted of a screening visit and two recorded visits (the observation period within the framework of the use of the Alfasoxx esophagoprotector). The screening visit was conducted on the day of the patient's admission. Visit 1 could be conducted on the same day as the screening visit, whereas visit 2 was conducted 4–5 weeks after visit 1 at the end of the course of treatment.Results. According to the results obtained, at the end of the study, 42.7 % (95 % CI: 38.5–46.9) had complete disappearance of extraesophageal GERD symptoms (questionnaire RSI = 0 points). When comparing the average values of the total RSI score before and after treatment, there was also a statistically significant regression from 13.8 points (95 % CI: 13.2–14.4) at visit 1 to 2.0 points (95 % CI: 1.8–2.2) at visit 2. Thus, the decrease in the total score was significant and exceeded 80 % of the initial value. When analyzing the dynamics of individual indicators of the RSI scale before and after treatment, a significant regression in the severity of all symptoms of the disease was noted. In addition, the results showed that the proportion of patients taking antacid-containing drugs at visit 1 significantly decreased from 58.2 % (95 % CI: 54.0–62.4) to 15.2 % (95 % CI: 12.1–18.3) by visit 2. The average score on the Likert scale of satisfaction with treatment was 4.8 (95 % CI: 4.8–4.9), whereas the convenience of using Alfasoxx is 4.7.Conclusion. This prospective observational multicenter study demonstrated that the addition of Alfasoxx to standard GERD therapy contributes to a significant regression of both esophageal and extraesophageal symptoms, as well as a decrease in the need for antacid medications

Diagnosis of Functional Gastrointestinal Disorders and Choice of Treatment Regimen in Constipation Patients

Aim. A practical review of functional gastrointestinal disorder diagnosis in constipation patients and the rationale for opting treatment.Key points. Functional constipation commonly afflicts different ages and negatively impacts the quality of life. The current diagnostic algorithm in chronic constipation includes the disease identification according to Rome Criteria IV, red-flag symptom detection and instrumental laboratory examination. Functional constipation is notably often associated with anorectal abnormalities that bear a diagnostic value to elaborate an apt treatment strategy. Anorectal manometry, rectal sensation and balloon expulsion tests are the well-studied and significant probing techniques for objective anorectal zone sensorimotor function assessment in patients with functional constipation. The article reviews modern diagnostic methods in functional defecation disorders.Conclusion. The examination and treatment algorithms presented will help improve diagnosis and apply the most suitable management in a constipation-associated functional digestive pathology

Clinical Guidelines of the Russian Society of Surgeons, the Russian Gastroenterological Association, the Association of Surgeons-Hepatologists and the Endoscopic Society “REndO” on Diagnostics and Treatment of Chronic Pancreatitis

Aim: to present modern methods of diagnosis and treatment of chronic pancreatitis for gastroenterologists, general practitioners and physicians.Chronic pancreatitis (CP) is a long-term inflammatory disease of the pancreas, manifested by irreversible morphological changes in the parenchyma and pancreatic ducts, which cause pain and/or persistent impairment of function. Current concept on the etiology of CP is reflected by the TIGAR-O classification. The criteria for establishing the diagnosis of CP include typical attacks of abdominal pain and/or clinical and laboratory signs of exocrine, endocrine insufficiency with the mandatory detection of characteristic morphological changes (calcifications in the parenchyma and pancreatic ductal stones, dilatation of the main pancreatic duct and its branches). CT, MRCP, and pancreatobiliary endosonography are recommended as the methods of choice to verify the diagnosis of CP. Conservative treatment of patients with CP is provided for symptom relief and prevention of complications. Individual cases with severe non-interactable abdominal pain, as well as a complicated course of the disease (development of ductal hypertension due to main pancreatic duct stones or strictures, obstructive jaundice caused by compression of the common bile duct, symptomatic postnecrotic cysts, portal hypertension due to compression of the portal vein or thrombosis of the splenic vein, persistent duodenal obstruction, pseudoaneurysm of the celiac trunk basin and the superior mesenteric artery) serve as an indication for endoscopic or surgical treatment. The Guidelines set out modern approaches to the diagnosis, conservative, endoscopic and surgical treatment of CP, and the prevention of its complications.Conclusion. The implementation of clinical guidelines can contribute to the timely diagnosis and improve the quality of medical care for patients with chronic pancreatitis

Treatment of patients with erosive esophagitis. A modern view on the problem

Gastroesophageal reflux disease is one of the most common diseases of the gastroenterological profile. There are several forms of illness, including non-erosive forms, erosive esophagitis, Barrett esophagus. The article provides an overview of the drugs used to treat the erosive form of GERD and long-term supportive therapy from the perspective of evidence-based medicine. The main objectives of the treatment of erosive esophagitis are to heal esophagus mucosa lesions, achieve long-term remissions, and normalize the patients’ life quality. The proton pump inhibitors (PPIs) have steadily become the mainstay in treatment of erosive esophagitis. These drugs are used at all stages of treatment, both for the relief of symptoms and healing of oesophagus mucosa lesions, and as the long-term supportive therapy. Due to the need for long-term use of IPI, their safety are open to question. The recent publications reported an increased risk of chronic kidney disease, myocardial infarction, pneumonia, calcium, magnesium, iron, vitamin B12 deficiency. At the same time, the analysis of studies underlying the risks of long-term PPI use detected some significant disadvantages that reduce their evidence-based value. This paper provides data on the most frequently discussed risks and critical assessment of them

High-resolution manometry in the diagnosis of oesophageal motility disorders

Esophageal high-resolution manometry is a modern method of diagnosis performed worldwide as the gold standard for assessing esophageal motility. The Chicago classification is applied to interpret the manometric findings. It provides a standardized approach to the analysis and classification of motility disorders, which facilitates a diagnosis of esophageal motility disorders and helps select a tactic for treatment. There are four major categories of motility disorders: 1. Disorders with esophagogastric junction outflow obstruction (types I, II, III achalasia, esophagogastric junction outflow obstruction). 2. Major disorders of peristalsis (distal esophageal spasm, jackhammer esophagus, absent contractility). 3. Minor disorders of peristalsis (ineffective motility, fragmented peristalsis) 4. Normal esophageal motility. Only primary esophageal motility disorders are addressed in the Chicago Classification. Motility disorders of the upper esophageal sphincter, motility abnormalities after surgical esophagus interventions do not have classification criteria. However, in the future the Chicago classification is expected to be improved and expanded to cover these disorders

Primary liver lymphoma: review of the literature and clinical case presentation

Aim of the case presentation. To demonstrate the rare case of extranodal lymphoma with primary extensive liver involvement which caused difficulties at diagnosis verification. Despite of rapid disease progression with development of severe liver failure, that resulted in poor prognosis, patient demonstrated significant response to high-dose chemotherapy and achieved long-term remission. Summary. Male 38-year-old patient developed acute symptoms: sweating, general weakness, febrile fever, weight loss (50 kg for 4 months), abdominal pain combined to hepatomegaly and multiple focal lesions in the liver according to abdominal US, with 5 unsuccessful attempts for 6 months to receive informative tissue sample. Laboratory tests revealed progressive signs of liver failure at normal level of alpha-fetoprotein and carcino-embryonic antigen; clinical signs included progressive manifestations of liver encephalopathy, skin hemorrhages, severe edema, ascites, pruritis and excoriations. Empirical therapy by prednisolon resulted in no responce and was complicated by development of steroid diabetes. The diagnosis of diffuse B-macrocellular lymphoma was established only via open liver biopsy. Four sessions of high-dose polychemotherapy according to mNHL-BFM-90 program resulted in rapid reduction of liver size, recovery of consciousness, resolution of encephalopathy signs, however the liver and the spleen remained enlarged with focal parenchimatous lesions that required laparoscopy with biopsy of the pathological foci, the latter revealed no remaining neoplastic cells. During 10 years of patient follow-up liver function remains compensated, focal lesions in the liver and the spleen are undetectable, that indicates achievement of 113-months complete tumor remission. Conclusion. Presence of multiple focal lesions in the liver and signs of progressive liver failure at normal level of tumor markers requires taking into account primary liver lymphoma in the spectrum of possible etiologies. Potentially poor life prognosis in similar clinical situations at detection of primary liver lymphoma can flip to favorable due to high efficacy of modern chemotherapeutic agents

Esophageal adenocarcinoma: risk factors and modern screening strategy

Aim of review. To present the modern concepts on epidemiological pattern and risk factors of esophageal adenocarcinoma (EAC) and analyze the modern screening approach. Summary. In developed countries EAC is characterized by rapid increase of mobidity, as well as by high mortality level. As a rule, EAC is diagnosed at the late stage: diagnosis is often made at the 3rd or 4th stage of the tumor that is a major contributing factor for high mortality as treatment options at these stages are significantly limited. The basic established risk factor for EAC is the gastroesophageal reflux disease (GERD). EAC develops usually as a complication of the Barret's esophagus (BE) being a consequence of the long-standing GERD. Male gender, Caucasian race, obesity and metabolic syndrome, tobacco smoking, and series of genetic markers are considered to be significant EAC risk factors. A main goal of EAC screening programs is the early diagnosis that allows to improve patient survival. Conclusion. Only GERD patients develop EAC, with the highest risk in males, Caucasians, smokers, overweight patients and those with uncontrolled symptoms. Timely diagnosis of GERD, its effective treatment and follow-up of BE cases can prevent EAC development

Postcholecystectomy syndrome: the modern approach: resolution of Advisory council

Aim of publication. To present proceedings of Advisory council on postcholecystectomy syndrome (August 25, 2017; Prague, Czech Republic) with support of the Adamed Group company. Summary. The Advisory council proposed algorithm for investigation and management of patients with postcholecystectomy syndrome (PCS). Gallstone disease (GSD) is diagnosed in 10-25% of the population of various age, with obvious trend to involvement of the younger patient categories in the last decades. The total number of GSD patients increases every decade no less than twice. Cholecystectomy remains the basic method of surgical treatment of symptomatic GSD. Nowadays laparoscopic cholecystectomy became universally popular and earned the status of the «gold standard» of surgical treatment. At the same time at asymptomatic GSD the watchful waiting approach avoiding active treatment is considered to be the most expedient. Biliary sludge and microlithiasis including cases undiagnosed at routine investigation can be one of important factors for development of the PCS. Pharmacological treatment of sphincter of Oddi dysfunction that develop at GSD/PCS include following of dietary recommendations, intake of selective spasmolytics, digestive enzymes and ursodeoxycholic acid. Conclusions. Follow-up program for the patient of the cholecystectomy should include regular assessment of clinical symptoms for duly diagnostics of acute and/or severe complications and associated diseases, that may require surgical treatment. Treatment has to include regular courses of selective antispasmodics, the presence of indications - prescription of bile acid supplements, when required - methods of endoscopic surgery