Results of non-interventional observational study of ursodeoxycholic acid in primary biliary cirrhosis

Aim of investigation. To estimate clinical efficacy and safety of ursodeoxycholic acid («Livodexa®») in a dose of 15 mg/kg/day for 3 months in the treatment of primary biliary cirrhosis (PBC) of the I to III stage. Material and methods. Open single center clinical trial included 30 patients with PBC of the I-III stage. All patients received «Livodexa®» in the daily dose of 15 mg/kg taken two times per day for 3 months. Efficacy and safety investigation of the drug was carried out at the day 30 (visit 2) and at the day 90 (visit 3) according to the laboratory tests results, quality of life assessment by SF-36 questionnaire, registration of frequency and severity of the adverse events (AE). Results. The median age (interquartile range) of PBC patients enrolled in the original study was 53 (48-61) years, the women prevailed: 29 (96,6%). The majority (43,2%) of patients had PBC of the histological grade II according to the Ludwig system. Treatment with «Livodexa®» in a dose of 15 mg/kg/day resulted in a statistically significant decrease of biochemical marker levels: alanine transaminase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyltranspeptidase, total and conjugated bilirubin at the 30th day of treatment (visit 2;

Irritable bowel syndrome concept from the gut microbiom point of view

Aim of review. To present data on integration of nutritional pattern and intestinal microbiom spectrum, to estimate the role of each of the listed factors in development of irritable bowel syndrome (IBS) symp­ toms. Summary. In spite of the fact, that IBS is one of the most common gastrointestinal functional disease, etiol­ ogy of disease is substantially unknown. Among factors which promote IBS development specific features of the patient and environmental factors, first of all nutritional stereotype and dietary pattern are considered nowa­ days. These in turn exert direct impact on quantitative and qualitative spectrum of gastrointestinal microbiota which changes, as it was demonstrated in the recent original studies, is an integral part of IBS pathogenesis and is the cornerstone of symptom origin of this func­ tional disorder. Conclusion. Pattern of intestinal microbiome, nutrition­ al stereotype and dietary pattern should be taken into account at management of IBS and planning of clinical or pilot studies in this area

Short bowel syndrome: pathogenesis, clinical presentation and treatment

Aim of review. To present basic information on the short bowel syndrome (SBS) Summary. Patients with the SBS are quite rare in practice of a clinician and, as a rule, require multidisciplinary approach. Most frequently disease manifests by malabsorption signs: diarrhea, weight loss, macro - and micronutrients deficiency, meteorism and abdominal pain. Nevertheless the spectrum and severity of signs considerably vary among patients. The aim of review was to highlight features of pathogenesis, clinical manifestations and treatment of SBS after small intestinal resection for various reasons. Localization and volume of resection, presence of the background affection of the small intestine and other abdominal organs involved in digestion process and also adaptation capacity of the remaining part of the gut fragment are the basic factors that determine severity of SBS and prognosis of patients. Conclusion. SBS prophylaxis is feasible and, taking into account of high disability and mortality rates of such patients, is essential both at preoperative stage, and during surgical intervention. Even at following of all modern guidelines only stabilization of the state is available in part of the SBS patients, while improvement of remaining small intestinal segment function will be impossible. Small intestinal transplantation may be considered as alternative treatment approach in these patients. Key words: short bowel syndrome, malabsorbtion syndrome, diarrhea, rehabilitation, parenteral nutrition

Possible Mechanisms Linking Obesity, Steroidogenesis, and Skeletal Muscle Dysfunction

Increasing evidence suggests that skeletal muscles may play a role in the pathogenesis of obesity and associated conditions due to their impact on insulin resistance and systemic inflammation. Skeletal muscles, as well as adipose tissue, are largely recognized as endocrine organs, producing biologically active substances, such as myokines and adipokines. They may have either beneficial or harmful effects on the organism and its functions, acting through the endocrine, paracrine, and autocrine pathways. Moreover, the collocation of adipose tissue and skeletal muscles, i.e., the amount of intramuscular, intermuscular, and visceral adipose depots, may be of major importance for metabolic health. Traditionally, the generalized and progressive loss of skeletal muscle mass and strength or physical function, named sarcopenia, has been thought to be associated with age. That is why most recently published papers are focused on the investigation of the effect of obesity on skeletal muscle function in older adults. However, accumulated data indicate that sarcopenia may arise in individuals with obesity at any age, so it seems important to clarify the possible mechanisms linking obesity and skeletal muscle dysfunction regardless of age. Since steroids, namely, glucocorticoids (GCs) and sex steroids, have a major impact on the amount and function of both adipose tissue and skeletal muscles, and are involved in the pathogenesis of obesity, in this review, we will also discuss the role of steroids in the interaction of these two metabolically active tissues in the course of obesity

Which Comes First, Nonalcoholic Fatty Liver Disease or Arterial Hypertension?

Non-alcoholic fatty liver disease (NAFLD) and arterial hypertension (AH) are widespread noncommunicable diseases in the global population. Since hypertension and NAFLD are diseases associated with metabolic syndrome, they are often comorbid. In fact, many contemporary published studies confirm the association of these diseases with each other, regardless of whether other metabolic factors, such as obesity, dyslipidemia, and type 2 diabetes mellites, are present. This narrative review considers the features of the association between NAFLD and AH, as well as possible pathophysiological mechanisms

Clinically Meaningful Fatigue and Depression Are Associated with Sarcopenia in Patients with Non-Alcoholic Fatty Liver Disease

Background: Sarcopenia is thought to be related to an increased risk of non-alcoholic steatohepatitis and advanced liver fibrosis. Our cross-sectional single-center study was designed to analyze the prevalence of sarcopenia in patients with NAFLD and possible influencing factors. Methods: A survey on the presence of sarcopenia, fatigue, anxiety, and depression, along with a quality-of-life (QoL) assessment, was forwarded by email to 189 outpatients. Demographics, anthropometric and clinical data (laboratory test results and abdomen complete ultrasound protocol), performed within 2–4 weeks prior to the enrollment, were obtained. Results: Sarcopenia (defined as SARC-F score ≥ 4) was identified in 17 (15.7%) patients, all of them (100%) females, with median age (interquartile range) 56 (51–64) years. These patients had a poorer metabolic state (greater values of waist and hip circumferences, body mass index, and HOMA-IR) and significantly poorer QoL, specifically, regarding the physical component of health, compared with NAFLD patients without sarcopenia. Multivariate analysis showed that depression (OR = 1.25, 95% CI: 1.02–1.53, p = 0.035) and clinically meaningful fatigue (OR = 1.14, 95% CI: 1.04–1.26, p = 0.008) were the factors independently associated with sarcopenia in patients with NAFLD. Conclusion: Sarcopenia is associated with depression and fatigue rather than with the severity of liver disease alone and may negatively affect QoL in patients with NAFLD

Reduced Quality of Life in Patients with Non-Alcoholic Fatty Liver Disease May Be Associated with Depression and Fatigue

Non-alcoholic fatty liver disease (NAFLD) is often thought of as clinically asymptomatic. However, many NAFLD patients complain of fatigue and low mood, which may affect their quality of life (QoL). This may create a barrier to weight loss and hinder the achievement of NAFLD therapy goals. Our study aimed to evaluate the QoL in NAFLD patients vs. healthy volunteers, and to analyze likely influencing factors. From March 2021 through December 2021, we enrolled 140 consecutive adult subjects (100 NAFLD patients and 40 controls). Overall, 95 patients with NAFLD and 37 controls were included in the final analysis. Fatty liver was diagnosed based on ultrasonographic findings. We employed 36-Item Short Form Health Survey (SF-36) to evaluate QoL, Hospital Anxiety and Depression Scale (HADS) to identify anxiety and/or depression, and Fatigue Assessment Scale (FAS) to measure fatigue. NAFLD patients had significantly lower physical component summary scores, as well as significantly higher HADS-D scores, compared with the control group (Mann-Whitney U criterion = 1140.0, p = 0.001 and U = 1294.5, p = 0.022, respectively). Likewise, fatigue was more common in NAFLD patients (χ2 = 4.008, p = 0.045). Impaired QoL was significantly associated with fatigue (FAS score ≥ 22, p p < 0.001). In conclusion, NAFLD patients had significantly poorer QoL vs. controls, in particular with respect to the physical component of health. Impaired QoL may be associated with fatigue and depression, and together they may interfere with increased physical activity and lifestyle modifications in patients with NAFLD

Diversities in the Gut Microbial Patterns in Patients with Atherosclerotic Cardiovascular Diseases and Certain Heart Failure Phenotypes

To continue progress in the treatment of cardiovascular disease, there is a need to improve the overall understanding of the processes that contribute to the pathogenesis of cardiovascular disease (CVD). Exploring the role of gut microbiota in various heart diseases is a topic of great interest since it is not so easy to find such reliable connections despite the fact that microbiota undoubtedly affect all body systems. The present study was conducted to investigate the composition of gut microbiota in patients with atherosclerotic cardiovascular disease (ASCVD) and heart failure syndromes with reduced ejection fraction (HFrEF) and HF with preserved EF (HFpEF), and to compare these results with the microbiota of individuals without those diseases (control group). Fecal microbiota were evaluated by three methods: living organisms were determined using bacterial cultures, total DNA taxonomic composition was estimated by next generation sequencing (NGS) of 16S rRNA gene (V3&ndash;V4) and quantitative assessment of several taxa was performed using qPCR (quantitative polymerase chain reaction). Regarding the bacterial culture method, all disease groups demonstrated a decrease in abundance of Enterococcus faecium and Enterococcus faecalis in comparison to the control group. The HFrEF group was characterized by an increased abundance of Streptococcus sanguinus and Streptococcus parasanguinis. NGS analysis was conducted at the family level. No significant differences between patient&rsquo;s groups were observed in alpha-diversity indices (Shannon, Faith, Pielou, Chao1, Simpson, and Strong) with the exception of the Faith index for the HFrEF and control groups. Erysipelotrichaceae were significantly increased in all three groups; Streptococcaceae and Lactobacillaceae were significantly increased in ASCVD and HFrEF groups. These observations were indirectly confirmed with the culture method: two species of Streptococcus were significantly increased in the HFrEF group and Lactobacillus plantarum was significantly increased in the ASCVD group. The latter observation was also confirmed with qPCR of Lactobacillus sp. Acidaminococcaceae and Odoribacteraceae were significantly decreased in the ASCVD and HFrEF groups. Participants from the HFpEF group showed the least difference compared to the control group in all three study methods. The patterns found expand the knowledge base on possible correlations of gut microbiota with cardiovascular diseases. The similarities and differences in conclusions obtained by the three methods of this study demonstrate the need for a comprehensive approach to the analysis of microbiota