Use of Bismuth in Irritable Bowel Syndrome

Aim. An evidence review on use of bismuth in irritable bowel syndrome.Key points. Irritable bowel syndrome (IBS) is a common functional disorder significantly impacting the quality of life and social status, i.a., through frequent manifestations of diarrhea. Postinfectious IBS emerges after a bacterial, pro-tozoan or viral intestinal disease. The new coronavirus pandemic supposedly affects most factors involved in functional disorder developments and may serve a fuelling cause of postinfectious IBS. Bismuth salts accumulate cytoprotective, anti-inflammatory and antibacterial properties. Therapeutic efficacy of bismuth compounds has been demonstrated in treatment of diarrhea-accompanied diseases of   various etiology, including postinfectious IBS. The use of therapeutic-dosed bismuth preparations is safe and well tolerated by patients.Conclusion. Use of bismuth may be considered a treatment and prevention approach in diarrhea-predominant IBS, both in monotherapy and combined regimens

Role of proton pump inhibitors dosage and duration in Helicobacter pylori eradication treatment: Results from the European Registry on H. pylori management

Background: Management of Helicobacter pylori (H. pylori) infection requires co-treatment with proton pump inhibitors (PPIs) and the use of antibiotics to achieve successful eradication. Aim: To evaluate the role of dosage of PPIs and the duration of therapy in the effectiveness of H. pylori eradication treatments based on the ‘European Registry on Helicobacter pylori management’ (Hp-EuReg). Methods: Hp-EuReg is a multicentre, prospective, non-interventionist, international registry on the routine clinical practice of H. pylori management by European gastroenterologists. All infected adult patients were systematically registered from 2013 to 2022. Results: Overall, 36,579 patients from five countries with more than 1000 patients were analysed. Optimal (≥90%) first-line-modified intention-to-treat effectiveness was achieved with the following treatments: (1) 14-day therapies with clarithromycin-amoxicillin-bismuth and metronidazole-tetracycline-bismuth, both independently of the PPI dose prescribed; (2) All 10-day (except 10-day standard triple therapy) and 14-day therapies with high-dose PPIs; and (3) 10-day quadruple therapies with clarithromycin-amoxicillin-bismuth, metronidazole-tetracycline-bismuth, and clarithromycin-amoxicillin-metronidazole (sequential), all with standard-dose PPIs. In first-line treatment, optimal effectiveness was obtained with high-dose PPIs in all 14-day treatments, in 10- and 14-day bismuth quadruple therapies and in 10-day sequential with standard-dose PPIs. Optimal second-line effectiveness was achieved with (1) metronidazole-tetracycline-bismuth quadruple therapy for 14- and 10 days with standard and high-dose PPIs, respectively; and (2) levofloxacin-amoxicillin triple therapy for 14 days with high-dose PPIs. None of the 7-day therapies in both treatment lines achieved optimal effectiveness. Conclusions: We recommend, in first-line treatment, the use of high-dose PPIs in 14-day triple therapy and in 10-or 14-day quadruple concomitant therapy in first-line treatment, while standard-dose PPIs would be sufficient in 10-day bismuth quadruple therapies. On the other hand, in second-line treatment, high-dose PPIs would be more beneficial in 14-day triple therapy with levofloxacin and amoxicillin or in 10-day bismuth quadruple therapy either as a three-in-one single capsule or in the traditional scheme

MALT lymphoma and erosive and ulcerative lesions of the stomach: modern diagnostic approaches and own clinical observation

Due to the pronounced polymorphism of stomach MALT-lymphoma endoscopic manifestations, often mimicking inflammatory changes of various etiologies, difficulties arise in the timely diagnosis of this disease. The alertness of the endoscopist and the use of integrated approaches to endoscopic diagnosis, taking into account the existing criteria for differential diagnosis, will undoubtedly improve the results of treatment

Bicyclol in the treatment of patients with chronic diffuse liver diseases

Introduction. The increase in serum transaminases (ALT and AST) and the persistence of their high values is associated with morbidity and mortality from liver diseases. Bicyclol has anti-inflammatory and antioxidant effects, which formed the basis for this study.Materials and methods. The study enrolled 51 patients (MELD < 19); hepatitis stage – 84.4%, cirrhosis – 15.6%. Treatment: Bicyclol 75 mg/day for 12 weeks. Criteria of efficacy: dynamics of ALT, AST, CRP; general well-being (D-FIS scale).Results. After 4 weeks of treatment the share of patients with ALT normalization was 50,9% (p < 0,001); with AST normalization – 62.7% (p < 0.001); after 12 weeks - 79,5% and 89,7% respectively (p < 0,001). CRP decreased statistically significantly after 2 and 4 weeks from the beginning of treatment. The D-FIS questionnaire was filled in by 36 patients at the beginning of the study, in 4 weeks - by 35 patients, in 12 weeks – by 32 patients. Median D-FIS decreased from 12 (8.2; 32.2) to 8 (5; 29) points (p < 0,001) after 4 weeks of treatment, after 12 weeks – to 6.5 (3; 28.5) points (p < 0.001). The CRP was positively correlated with the D-FIS value. Fibrosis (“Fibromax”, “Fibroscan”) was studied in 10 additional patients, the dose of Bicyclol was 150/75 mg/day during 6 months, the result was statistically significant (p < 0.001).Conclusion. Application of Bicyclol leads to reduction of fatigue, local and systemic inflammation, fibrosis in chronic diffuse liver diseases regardless of etiology

The Role of Motility Impairment in the Pathogenesis of Functional Disorders of the Gastrointestinal Tract and Modern Possibilities for Their Treatment (Resolution of an Expert Council and Literature Review)

Aim. To present the materials of an Expert Council, which was held on September 23, 2019 in Istanbul (Turkey) under the auspices of a World Gastroenterology Organisation congress and the support of the Abbott company.General provisions. During the work of the Expert Council, the role of motility disorders of the stomach and duodenum, intestines, gall bladder and the sphincter of Oddi in the development of functional diseases of the digestive system, such as functional dyspepsia (FD), irritable bowel syndrome (IBS), biliary dyskinesia (BD) was discussed, and the effectiveness of antispasmodics and prokinetics in their treatment was shown. At the same time, the advantages of the mebeverin antispasmodic drug, as well as the high efficiency and safety of the itopride hydrochloride prokinetic drug were noted. It is emphasized that, at the stage of a diagnostic search in the absence of “alarm symptoms” in patients with suspected FD, IBS, and BD, these drugs can be prescribed empirically.Conclusions. When selecting pharmacotherapy for patients with motor impairment, it is extremely important to consider the nature of these disorders. The use of modern medical preparations, which are characterized by a high level of safety and the targeted action towards a specific motility disorder, allows optimal therapy results to be achieved with minimal risks for the patient

European registry Helicobacter pylori (Hp-EuReg): How has clinical practice changed in Russia from 2013 to 2018 years

© 2019 Consilium Medikum. All rights reserved. The multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group (EHMSG) is conducted in 27 countries in Europe. The data from the Russian part of the European registry for the management of Helicobacter pylori infection (European Registry on the management of Helicobacter pylori infection, protocol: “Hp-EuReg”) allows us to analyze the real clinical practice of diagnosis and treatment of H. pylori and compare it with international recommendations. Materials and methods. A comparative analysis of the data entered in the register by the Russian research centers “Hp-EuReg”, in the period from 2013 to 2018, was conducted. Results and discussion. Invasive diagnostic methods prevail for the primary diagnosis of H. pylori [histology - 20.3% (in 2013 year) - 43.9% (in 2018 year), rapid urease test - 31.7% and 47.8% respectively]. The most popular mode of eradication therapy is a 10-day triple therapy (62.8-76.2%), the effectiveness of which does not exceed 79% (per protocol). Invasive tests (histology) are the leading method for control the effectiveness of therapy, however, there is a tendency towards a wider use of non-invasive methods (H. pylori stool antigen - from 17% in 2013 to 29.3% in 2018 and urea breath test from 6.9 to 18.3%, respectively). Serological test to control the effectiveness of eradication is still used from 8.2% (2013) to 6.1% (2018). Eradication therapy was not performed in 28% of patients throughout the entire observation period. Conclusion. In Russia, despite approved domestic and international recommendations, deviations in clinical practice persist, both during eradication therapy and in monitoring the effectiveness of eradication therapy

European registry Helicobacter pylori (Hp-EuReg): How has clinical practice changed in Russia from 2013 to 2018 years

© 2019 Consilium Medikum. All rights reserved. The multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group (EHMSG) is conducted in 27 countries in Europe. The data from the Russian part of the European registry for the management of Helicobacter pylori infection (European Registry on the management of Helicobacter pylori infection, protocol: “Hp-EuReg”) allows us to analyze the real clinical practice of diagnosis and treatment of H. pylori and compare it with international recommendations. Materials and methods. A comparative analysis of the data entered in the register by the Russian research centers “Hp-EuReg”, in the period from 2013 to 2018, was conducted. Results and discussion. Invasive diagnostic methods prevail for the primary diagnosis of H. pylori [histology - 20.3% (in 2013 year) - 43.9% (in 2018 year), rapid urease test - 31.7% and 47.8% respectively]. The most popular mode of eradication therapy is a 10-day triple therapy (62.8-76.2%), the effectiveness of which does not exceed 79% (per protocol). Invasive tests (histology) are the leading method for control the effectiveness of therapy, however, there is a tendency towards a wider use of non-invasive methods (H. pylori stool antigen - from 17% in 2013 to 29.3% in 2018 and urea breath test from 6.9 to 18.3%, respectively). Serological test to control the effectiveness of eradication is still used from 8.2% (2013) to 6.1% (2018). Eradication therapy was not performed in 28% of patients throughout the entire observation period. Conclusion. In Russia, despite approved domestic and international recommendations, deviations in clinical practice persist, both during eradication therapy and in monitoring the effectiveness of eradication therapy

Room for Improvement in the Treatment of Helicobacter pylori Infection: Lessons from the European Registry on H. pylori Management (Hp-EuReg)

Background: Managing Helicobacter pylori infection requires constant decision making, and each decision is open to possible errors. Aim: The aim was to evaluate common mistakes in the eradication of H. pylori, based on the "European Registry on Helicobacter pylori management". Methods: European Registry on Helicobacter pylori management is an international multicentre prospective noninterventional registry evaluating the decisions and outcomes of H. pylori management by European gastroenterologists in routine clinical practice. Results: Countries recruiting more than 1000 patients were included (26,340 patients). The most common mistakes (percentages) were: (1) To use the standard triple therapy where it is ineffective (46%). (2) To prescribe eradication therapy for only 7 to 10 days (69%). (3) To use a low dose of proton pump inhibitors (48%). (4) In patients allergic to penicillin, to prescribe always a triple therapy with clarithromycin and metronidazole (38%). (5) To repeat certain antibiotics after eradication failure (>15%). (6) Failing to consider the importance of compliance with treatment (2%). (7) Not to check the eradication success (6%). Time-trend analyses showed progressive greater compliance with current clinical guidelines. Conclusion: The management of H. pylori infection by some European gastroenterologists is heterogeneous, frequently suboptimal and discrepant with current recommendations. Clinical practice is constantly adapting to updated recommendations, although this shift is delayed and slow

Empirical Second-Line Therapy in 5000 Patients of the European Registry on Helicobacter pylori Management (Hp-EuReg)

Background & Aims: After a first Helicobacter pylori eradication attempt, approximately 20% of patients will remain infected. The aim of the current study was to assess the effectiveness and safety of second-line empiric treatment in Europe. Methods: This international, multicenter, prospective, non-interventional registry aimed to evaluate the decisions and outcomes of H pylori management by European gastroenterologists. All infected adult cases with a previous eradication treatment attempt were registered with the Spanish Association of Gastroenterology–Research Electronic Data Capture until February 2021. Patients allergic to penicillin and those who received susceptibility-guided therapy were excluded. Data monitoring was performed to ensure data quality. Results: Overall, 5055 patients received empiric second-line treatment. Triple therapy with amoxicillin and levofloxacin was prescribed most commonly (33%). The overall effectiveness was 82% by modified intention-to-treat analysis and 83% in the per-protocol population. After failure of first-line clarithromycin-containing treatment, optimal eradication (>90%) was obtained with moxifloxacin-containing triple therapy or levofloxacin-containing quadruple therapy (with bismuth). In patients receiving triple therapy containing levofloxacin or moxifloxacin, and levofloxacin–bismuth quadruple treatment, cure rates were optimized with 14-day regimens using high doses of proton pump inhibitors. However, 3-in-1 single capsule or levofloxacin–bismuth quadruple therapy produced reliable eradication rates regardless of proton pump inhibitor dose, duration of therapy, or previous first-line treatment. The overall incidence of adverse events was 28%, and most (85%) were mild. Three patients developed serious adverse events (0.3%) requiring hospitalization. Conclusions: Empiric second-line regimens including 14-day quinolone triple therapies, 14-day levofloxacin–bismuth quadruple therapy, 14-day tetracycline–bismuth classic quadruple therapy, and 10-day bismuth quadruple therapy (as a single capsule) provided optimal effectiveness. However, many other second-line treatments evaluated reported low eradication rates. ClincialTrials.gov number: NCT02328131