Rebamipide during chronic gastritis: <i>H. pylori</i> eradication therapy and restoration of gastric mucosa barrier function

Аim: to present evidence justifying prescription of rebamipide during chronic gastritis.Key points. Experimental and clinical studies have demonstrated that rebamipide increases concentration of prostaglandins (prostaglandin E2 and prostacyclin) and production of mucin, manages inflammation and oxidative stress, controls apoptosis and autophagy. Pleiotropic effects of rebamipide are aimed at restoration of epithelium barrier function and can be implemented during chronic gastritis for various indications. When added to the H. pylori eradication therapy, rebamipide increases its effectiveness and tolerability. During atrophic gastritis, long-term treatment with rebamipide has resulted in reduction of degree of atrophy and intestinal metaplasia. Effectiveness of rebamipide during erosive gastritis, for treatment and prevention of stomach and duodenum disorders associated with nonste- roidal anti-inflammatory drugs is proven. Rebamipide manages symptoms of dyspepsia during chronic gastritis and during functional dyspepsia.Conclusion. Prescription of rebamipide during chronic gastritis for various indications is proved from the perspective of evidence-based medicine during H. pylori eradication therapy and for restoration of mucosa barrier function

Modern aspects of diagnostics and treatment of <i>H. pylori</i> infection from standpoint of stomach cancer prophylaxis

The aim of review. To discuss modern aspects of diagnostics and treatment of H. pylori infection in relation of stomach cancer prophylaxis according to data of oral and poster presentations, delivered at XXVII International workshop of the European Helicobacter Study Group.Summary. The main attention has been given to relation of H. pylori infection to stomach cancer and eradications of infection as a mean of malignancy prevention. Data on relation of H. pylori to other diseases, including non-gastroenterological disorders are presented. Comparative estimation of efficacy of different modes of eradication therapy is given. According to conclusion of the majority of publications and data of meta-analyses, nowadays both bismuth-based and bismuth-free quadrotherapy are considered as the most effective treatment algorithms.Conclusion. For estimation of role of H. pylori infection in development of various diseases, and to improve management of patients further studies are required

Pathogenic and therapeutic role of bile acids at reflux-gastritis

The aim of review. To present data on pathogenic significance of bile acids for upper regions of gastrointestinal tract (GIT) and to describe medical properties ursodeoxycholic acid (UDCA) at reflux-gastritis.Summary. Reflux-gastritis is chemical type gastritis, morphologically manifested by foveolar hyperplasia, edema, proliferation of smooth-muscle fibres of lamina propria, insignificant chronic inflammation. There is evidences of relation of intestinal metaplasia to duodenogastric reflux (DGR). Bile acids at certain conditions possess damage effect on mucosa of the stomach and all GIT. They can increase endocellular concentration of calcium which is responsible for toxic effects of bile acids as a secondary messenger. Increase of endocellular calcium stimulates secretion of pepsinogen and acid production in the stomach,  that in the case of decreased cytoprotective factors by DGR can cause changes mucosal injury. According to the modern point of view bile acids are associated with a lot of neoplasms of digestive organs, including esophageal, stomach, small intestine, liver, pancreas and colorectal cancer. Exposition of bile acids results in formation of active forms of oxygen and nitrogen, damage of DNA, mutagenicity, induction of apoptosis in short-term prospect and resistance to apoptosis in long-term prospect. Gastric remnant gastritis is consideres to be a premalignant disease, thus bile acids play essential role in carcinogenesis. UDCA possesses choleretic effect and ability to displace toxic hydrophobic bile acids. It protects from oxydative stress, stabilizes cell membranes and inhibits apoptosis. At reflux-gastritis UDCA relieves clinical symptoms, improves of state of mucosa of the stomach and esophagus, and possess series of cytoprotective properties.Conclusion. Prescription of UDCA is pathogenicly proved in patients with reflux-gastritis and gastroesopha geal reflux disease (GERD) with non-acidic refluxes. Cytoprotective and antiapoptotic effects of UDCA at reflux-gastritis are especially significant from the point of view of smoothing cancerogenic potential of bile acids

Current Trends in Treatment for Acid-Dependent Diseases: Clinical Efficacy and Safety of Rabeprazole

Aim. A comparative review of the rabeprazole properties vs. other PPIs, its efficacy and safety in treatment for aciddependent diseases.Key points. Rabeprazole provides a rapid proton pump blockade in parietal cells due to its high dissociation constant (pKa). A lower rabeprazole metabolic dependence on cytochrome P-450 enzyme system renders its antisecretory effect predictable and reduces the risk of interactions with other drugs metabolised through this system. A faster antisecretory effect and higher acid-suppressive activity of rabeprazole determine its better clinical efficacy in treatment for such acid-dependent diseases as gastroesophageal reflux disease and peptic ulcer. This makes rabeprazole (Pariet) a preferred drug in course and maintenance therapies for acid-dependent diseases, as well as in H. pylori eradication.Conclusion. The rabeprazole properties of high acid suppression potential, persistent antisecretory effect from first day of therapy, non-enzymatic metabolism and pleiotropic action determine its high efficacy in treatment for a wide range of acid-dependent diseases at a minimal risk of drug interaction

Investigating organic aerosol loading in the remote marine environment

Aerosol loading in the marine environment is investigated using aerosol composition measurements from several research ship campaigns (ICEALOT, MAP, RHaMBLe, VOCALS and OOMPH), observations of total AOD column from satellite (MODIS) and ship-based instruments (Maritime Aerosol Network, MAN), and a global chemical transport model (GEOS-Chem). This work represents the most comprehensive evaluation of oceanic OM emission inventories to date, by employing aerosol composition measurements obtained from campaigns with wide spatial and temporal coverage. The model underestimates AOD over the remote ocean on average by 0.02 (21 %), compared to satellite observations, but provides an unbiased simulation of ground-based Maritime Aerosol Network (MAN) observations. Comparison with cruise data demonstrates that the GEOS-Chem simulation of marine sulfate, with the mean observed values ranging between 0.22 μg m−3 and 1.34 μg m−3, is generally unbiased, however surface organic matter (OM) concentrations, with the mean observed concentrations between 0.07 μg m−3 and 0.77 μg m−3, are underestimated by a factor of 2–5 for the standard model run. Addition of a sub-micron marine OM source of approximately 9 TgC yr−1 brings the model into agreement with the ship-based measurements, however this additional OM source does not explain the model underestimate of marine AOD. The model underestimate of marine AOD is therefore likely the result of a combination of satellite retrieval bias and a missing marine aerosol source (which exhibits a different spatial pattern than existing aerosol in the model)

Issues of diagnostics and treatment of abdominal pain at irritable bowel syndrome at outpatient stage of the healthcare

The aim of review. To present the diagnostic and treatment algorithm for abdominal pain at out-patient/ polyclinic healthcare institutions and to demonstrate potential of hyoscine butylbromide application during diagnostic process and for relief of abdominal pain at irritable bowel syndrome.Summary. From 20% to 50% of all admissions to medical institutions are related to abdominal spasms and pain caused by irritable bowel syndrome (IBS). According to the Clinical guidelines of the Russian gastroenterological association and abdominal pain management algorithm at outpatient reception, the doctor on the basis of interviewing, inspection and physical data first of all should exclude acute abdominal diseases (acute pain, parietal pain) requiring urgent examination by the surgeon or gynecologist and subsequent hospitalization. In the case of visceral pain the minimal range of laboratory and instrumental tests is indicated. If the history of visceral pain is more than 6 months and there are no alarm symptoms, doctor should define specific features of clinical presentation already during outpatient visit, taking into account pain location, that provides formulation of preliminary diagnosis. Epigastric pain (dyspepsia), biliary pain, abdominal pain which can be accompanied by impaired frequency and consistency of stool determine the further investigation plan. Implementation of diagnostic algorithm allows to distinguish the organic disease or to establishthe diagnosis of functional disease. Hyoscine butylbromide at short-term treatment will relieve abdominal spasm as a symptomatic agent. Course treatment effectively reduces intensity and frequency of abdominal pain at IBS. The rate of adverse events and tolerability of hyoscine butylbromide are comparable to that of placebo.Conclusion. Symptomatic treatment by antispasmodic drugs is justified from the moment of referral for medical aid to outpatient department. Hyoscine butylbromide can be prescribed for relief of acute and chronic pain at any stage of diagnostic process. Course intake of antispasmodics has proved its efficacy for pain relief at IBS

Morphological features of autoimmune gastritis

Aim of investigation. To estimate presence of classical morphological signs of autoimmune gastritis (AIH) in patients with high titer of antiparietal cells antibodies.Material and methods. Overall 15 patients (3 men and 12 women, 28 to 72 years old) have been included in original study. Clinical symptoms in the study group varied and included both severe В12-deficient anemia and normal levels of pepsinogen I, gastrin-17 and cyanocobalamine. In 4 patients Helicobacter pylori infection has been detected. According to guidelines of the Russian Society of Pathologists in all cases multiple biopsies have been taken at esophagogastroduodenoscopy. Biopsy specimens were processed by the standard technique, sections were stained by hematoxyline and eosine.Results. Classical signs of AIH i.e. atrophy of mucosa of body of the stomach and intestinal metaplasia were not revealed. The signs of feeble inflammation in body of the stomach were found in 6 patients. In 4 cases biopsy specimens had no inflammatory or atrophic changes. Pseudo-hypertrophy of parietal cells was the unique morphological feature found out in these cases. At all patients involvement of antral region of the stomach was marked. Atrophic gastritis with intestinal metaplasia was diagnosed in 4 patients. In 3 cases non-metaplastic variant of patchy atrophic gastritis was present, the rest revealed superficial gastritis with signs of activity in 4 cases. No Н. рylori was found out morphologically.Conclusion. In our investigation in patients with AIG no metaplastic atrophic lesions was found in body of the stomach, while metaplastic atrophy had patchy pattern. The pseudo-hypertrophy of parietal cells as well as dilation of main glands lumen can be the earliest and unique sign found in biopsy specimens. Involvement of antral region was revealed in all patients, in 4 cases it has been related to presence of H. pylori infection at the moment of investigation. Thus, the diagnosis of AIG was based mainly on elevated level antiparietal cells antibodies at blood serum test

Efficacy of Topical Corticosteroid Monotherapy in Inducing and Maintaining Clinical and Histologic Remission in Adolescent and Adult Patients with Eosinophilic Esophagitis: a Systematic Review and Meta-Analysis

Background: Eosinophilic esophagitis (EoE) is the second most common cause of esophagitis. Topical steroids represent a promising group of drugs for inducing and maintaining clinical and histological remission in these patients.Objective. To evaluate the effectiveness of topical steroids in inducing and maintaining clinical and histological remission in adolescent and adult patients with EoE.Methods. A systematic literature search using defined keywords was performed up to March 20, 2021 in the MEDLINE / PubMed, EMBASE (Excerpta Medica), and Cochrane Central Register of Controlled Trials, ClinicalTrial.gov databases.Results. 390 patients from 5 studies were included in this systematic review with meta-analysis. The meta-analysis showed that topical steroids, compared with placebo, was more effective in inducing (odds ratio (OR) 75.77; 95 % confidence interval (CI): (21.8; 263.41), p &lt; 0.001) and maintaining complete histological remission (OR 103.65; 95 % CI: (36.05; 298.01), p &lt; 0.001) in patients with EoE. Also, topical steroids significantly relieved disease symptoms compared with placebo in inducing and maintaining clinical remission (OR 4.86; 95 % CI: (1.4; 16.86), p = 0.01) and (OR 11.06; 95 % CI: (4.62; 26.45), p &lt; 0.001) respectively.Conclusions. Topical steroids represent an effective group of drugs for inducing and maintaining histologic and clinical remission in adolescent and adult patients with EoE

Gut Microbiota and its Metabolites in Pathogenesis of NAFLD

Aim: to provide information on the results of recent scientific research in the field of non-alcoholic fatty liver disease (NAFLD) metabolomic profiling.Key points. Metabolites of microbial origin are important biological molecules involved in many specific reactions of the human body. This literature review presents the results of recent studies in the field of metabolomics in patients with NAFLD. A more detailed understanding of the role of individual metabolites or their combinations in the NAFLD pathogenesis will allow us to determine the vector of further diagnostic and therapeutic approaches for this nosology. The research results of the probiotics effect on the levels of certain metabolites are currently being discussed.Conclusion. New research data in the field of studying the human metabolomic profile are presented. The results allow us to summarize the effects of microbial agents and their metabolites in the formation of changes in the liver parenchyma in the context of NAFLD. Changes in the level of endogenous ethanol, secondary bile acids, aromatic amino acids, branched chain amino acids, etc. have been described. Correlation between metabolites and certain bacterial strains has been established. A correlation between the ratio of bacteria types and clinical/laboratory parameters was noted in patients taking prebiotics