The role of nutritional fiber deficiency in the pathogenesis and course of gastroesophageal reflux disease

Aim of the Review. To analyze current data about possible influence of nutritional fiber on the course of GERD.Key points. Systematic review in PubMed/Medline databases was performed with keywords food, dietary fiber in combination with gastroesophageal reflux, GERD. The review contains data concerning influence of nutritional fiber on the pathogenetic mechanisms of GERD and illuminates results of epidemiological studies suggesting positive correlation between quantities of nutritional fiber in the patient’s diet and manifestations of the disease. The main features of pathogenesis caused by the lack of nutritional fiber include slow gastric emptying, increased gastric volume, increased risk of obesity and hiatal hernia, reduced lower esophageal sphincter pressure. The epidemiological studies suggest the higher incidence of GERD symptoms, higher prevalence of Barrett’s esophagus and esophageal adenocarcinoma in patients who consume low quantity of nutritional fiber.Conclusion. Despite the lack of interventional studies the literature data about impact of nutritional fiber on the manifestations of GERD show probable approach for the correction of diet in GERD patients. There is a need for prospective studies evaluating correction of diet on the course of the disease

Zollinger–Ellison syndrome: modern aspects of diagnostics and treatment

The aim of review. To reflect modern concepts on clinic, diagnostics and treatment of Zollinger–Ellison syndrome (ZES).Key points. ZES is rare disease related to intragastric hyperacidity. Phenomenon of hyperacidity in ZES patients is caused by hypergastrinemia associated with ectopic gastrin production. Disease frequently develops in patients with multiple endocrine neoplasia syndrome of the 1-st type. Clinical presentation of ZES directly reflects hypersecretion of hydrochloric acid with development of erosive — ulcerative lesions of esophagus, stomach and duodenum, resistant to standard dozes of proton pump inhibitors (PPI). One of basic methods of ZES diagnostics is assessment of serum gastrin level and intragastric acid production. Conservative treatment includes prescription of high PPI dozes, and octreotide analogues.Conclusion. ZES is not a common disease, anyhow knowledge of its clinical course is important for duly recognition. ZES should be considered at differential diagnostics in patients with frequently relapsing upper gastro-intestinal erosive-ulcerative lesions and in patients resistant to standard dozes of PPI

The impact of the ursodeoxycholic acid as monotherapy and in the combination with the lactulose on the biochemical blood tests values of the nonalcoholic steatohepatitis patients

Aim of the Study. The administration of ursodeoxycholic acid (UDCA) as monotherapy or in combination with lactulose for the treatment of the patients with nonalcoholic steatohepatitis (NASH) has been studied insufficiently. The aim was to assess the impact of the 90-day therapy with Ursoliv® drug (20 mg/kg per day of the UDCA and 25 mg/kg per day of the lactulose) on the biochemical blood tests values of the NASH patients in comparison with the Ursosan® drug (20 mg/kg per day of UDCA).Мaterials and methods. 60 patients with the NASH were included into the open randomized prospective comparative study without applying control. The patients were separated into 2 equal groups. The 1st group was administered Ursoliv®, and the 2nd group – Ursosan®. The baseline laboratory tests – markers of cytolysis and cholestasis, lipid profiles – and after 45 and 90 days of the treatment were assessed.Results. The credible dynamic of the biochemical tests values of the cytolysis as compared with the baseline (the reducing of the activity of the alanine transaminase and the aspartate transaminase) and of the cholestasis (gamma-glutamyl transpeptidase) was observed; the positive changes in the lipid profile (the increase in the concentration of the high density lipoproteins and the reduction in the total cholesterol, the low density lipoproteins, the very low density lipoproteins and triglycerides ) were seen during the treatmet in both groups. The tendency towards the more expressed impact of the combination of UDCA and lactulose (Ursoliv®) in comparison to the monotherapy by UDCA (Ursosan®) on the biochemical parameters were discovered. However, the statistical credibility was not reached, which, probably, can be explained by the peculiarities of the sampling.Conclusions. The administration of the UDCA in the dosage of 20 mg/kg per day as monotherapy as well as in the combination with the lactulose (25 mg/kg per day) in the patients with NASH is characterized by the expressed positive impact on the laboratory markers of cytolysis, cholestasis and the lipid profile. The higher dosages of the UDCA and of the UDCA in combination with the lactulose can be recommended for the treatment of the NASH patients

Russian consensus on exoand 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" on the Delphi method. His goal was to clarify and consolidate the opinions of specialists on the most relevant issues of diagnosis and treatment of exo - and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is provided by the participation of leading gastroenterologists and surgeons

RUSSIAN GASTROENTEROLOGIC ASSOCIATION RECOMMENDATIONS FOR DIAGNOSIS AND TREATMENT OF CHRONIC PANCREATITIS (2014): A BRIEF OVERVIEW

The paper provides a brief overview of the provisions of Russian Gastroenterologic Association recommendations for diagnosis and treatment of chronic pancreatitis dated 2014. The contemporary diagnostic criteria and stepwise clinical approach to patients with chronic pancreatitis are described. Some critical aspects are identified

Chronic acalculous cholecystitis and biliary dysfunction: how does clinical diagnosis affect management?

Similar abdominal pain of biliary type in functional disorders of biliary tract and chronic acalculous cholecystitis causes objective difficulties to differentiate not only between each other, but also with other diseases of gastrointestinal tract. The  clinical picture is so homogeneous and difficult to distinguish from cholelithiasis that some patients undergo unreasonable surgical interventions for CAC and FDBT. Individual publications pushing for such an aggressive strategy are sporadic and need to be clarified in larger studies. The first choice drugs for treatment of FDBT are spasmolytics; ursodeoxycholic acid drugs are used as adjuvant agents. In CAC, the initial therapy will be similar, but the treatment regimen can be expanded with targeted etiotropic (if the cause of cholecystitis is identified – giardiasis, opisthorchiasis, etc.) or empirical antimicrobial/antiparasitic therapy. The greatest interest today is caused by hymecromone – a drug with proven by both experimental and controlled studies combined choleretic, selective spasmolytic action, mediated effect of reducing bile lithogenicity and possible anti-inflammatory action. Hymecromone effectively relieves biliary pain without causing gallbladder contractions, which determines the possibility of its wide application both in CAC and FDBT, both in monotherapy and in combination with other agents, primarily with UDCA. In this article the issues of optimization of diagnostic and therapeutic strategy of management of patients with biliary pain to avoid unreasonable cholecystectomies in acalculous diseases of the biliary tract are considered

The revised pancreatitis etiology-based classification system TIGAR-O, version 2: adaptation for the Russian clinical practice

The discoveries in molecular genetics and breakthrough visualization techniques in the last 20 years have changed our understanding of the pancreatitis causes and biomarkers, expanded our knowledge on the pathophysiology of the disease, and promoted the development of new additional conservative treatments. From the practical perspective, the physician's comprehension of the etiology is of particular importance. It is for this reason that the activities to elaborate an etiology-based classification of pancreatitis have been already started since long ago. The first internationally acknowledged system was TIGAR-O checklist, introduced in 2001. Being innovative at the time, it structured our understanding of the etiology of chronic pancreatitis. The revised version (version 2) was published in 2019 and is less known to the Russian medical community, although from the authors' point of view, it has been substantially extended and structured to be maximally convenient and useful for physicians in routine medical practice. The review presents key provisions of the TIGAR-O, version 2 and recommendations for its adaption to the Russian clinical setting

Prevalence of small bowel bacterial overgrowth in patients with functional dyspepsia: a meta-analysis

Aim.Systematization of data on the frequency of detection of the syndrome of bacterial overgrowth in the small intestine (SIBO) in patients with functional dyspepsia (FD). Materials and methods.MEDLINE/PubMed, EMBASE, Cochrane, Google Scholar, the Russian Science Citation Index (RSCI) through July 2020 were searched to identify studies evaluating the prevalence of SIBO in FD. In addition, a search for relevant abstracts was carried out in the electronic databases of the United European Gastroenterology Week (UEG), American College of Gastroenterology (ACG), International Conference on Nutrition and Food (ICNF). For the final analysis, publications were selected that used validated tests for the assessment of SIBO (hydrogen breath test using glucose or lactulose) with detailed descriptive statistics, allowing the resulting data to be included in the meta-analysis. Results.The final analysis included 7 studies with 1248 patients with FD. Overall pooled prevalence of SIBO in patients with FD was 34.73% (95% CI 24.80745.383). There was significant heterogeneity between the results (p0.0001; I2=89.91%). When excluded from the meta-analysis of a study in which the incidence of SIBO was studied in patients with refractory FD, the pooled prevalence was 38.98% (95% CI 28.96449.490). Conclusion.This meta-analysis has demonstrated that SIBO is often associated with FD and is observed in about every third patient with this functional gastrointestinal tract disease