medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-6-100-108medsovet-6818Research ArticleГАСТРОЭНТЕРОЛОГИЯGASTROENTEROLOGYЯзвенная болезнь: современное состояние проблемыPeptic ulcer: the current state of the problemhttps://orcid.org/0000-0001-6114-564XМаевИ. В.MaevI. V.

академик РАН, д.м.н., профессор, заслуженный деятель науки РФ, лауреат премии Правительства РФ в области науки и техники, заведующий кафедрой пропедевтики внутренних болезней и гастроэнтерологии,

127473, Москва, ул. Делегатская, д. 20, стр. 1

Acad. RAS, Dr. Sci. (Med.), Professor, Honored Scientist of the Russian Federation, Laureate of the Prize of the Government of the Russian Federation in the Field of Science and Technology, Head of the Department of Propaedeutics of Internal Diseases and Gastroenterology,

20, Bldg. 1, Delegatskaya St., Moscow, 127473

igormaev@rambler.ruhttps://orcid.org/0000-0002-4007-7112АндреевД. Н.AndreevD. N.

к.м.н., доцент, лауреат премии Правительства РФ в области науки и техники, доцент кафедры пропедевтики внутренних болезней и гастроэнтерологии, 

127473, Москва, ул. Делегатская, д. 20, стр. 1

Cand. Sci. (Med.), Laureate of the Prize of the Government of the Russian Federation in the Field of Science and Technology, Associate Professor of the Department of Propaedeutics of Internal Diseases and Gastroenterology, 

20, Bldg. 1, Delegatskaya St., Moscow, 127473

dna-mit8@mail.ruhttps://orcid.org/0000-0001-5617-7110СамсоновА. А.SamsonovA. A.

д.м.н., профессор, профессор кафедры пропедевтики внутренних болезней и гастроэнтерологии,

127473, Москва, ул. Делегатская, д. 20, стр. 1

Dr. Sci. (Med.), Professor, Professor of the Department of Propaedeutics of Internal Diseases and Gastroenterology, 

20, Bldg. 1, Delegatskaya St., Moscow, 127473

aleksey.samsonov@gmail.comhttps://orcid.org/0000-0002-1089-4322ЧерёмушкинаА. С.CheryomushkinaA. S.

студентка 6-го курса,

127473, Москва, ул. Делегатская, д. 20, стр. 1

6th Year Student of the Faculty of General Medicine, 

20, Bldg. 1, Delegatskaya St., Moscow, 127473

sashasche@yandex.ruМосковский государственный медико-стоматологический университет имени А.И. ЕвдокимоваРоссияYevdokimov Moscow State University of Medicine and DentistryRussian Federation20222404202206100108Copyright © Маев И.В., Андреев Д.Н., Самсонов А.А., Черёмушкина А.С., 20222022Маев И.В., Андреев Д.Н., Самсонов А.А., Черёмушкина А.С.Maev I.V., Andreev D.N., Samsonov A.A., Cheryomushkina A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6818

Язвенная болезнь  (ЯБ) – это хроническое полиэтиологическое рецидивирующее заболевание гастродуоденальной зоны, патогенез большинства случаев которого обусловлен дисбалансом между факторами агрессии и факторами защиты слизистой оболочки желудка и двенадцатиперстной кишки. Инфекция Helicobacter pylori (H. pylori) и использование нестероидных противовоспалительных препаратов  (НПВП), включая аспирин, являются ведущими каузативными факторами развития ЯБ. Показано, что 65% случаев язвенных поражений желудка и 80% случаев язвенных поражений двенадцатиперстной кишки ассоциировано с инфекцией H. pylori. В свою очередь, на долю НПВП приходится 30% случаев язвенных поражений желудка и 15% случаев поражений двенадцатиперстной кишки. Около 0,1–1% всех случаев ЯБ обусловлено синдромом Золлингера – Эллисона. Ведущим симптомом в клинической картине больных с обострением ЯБ является абдоминальная боль. Диспепсический синдром  (рвота, тошнота, отрыжка, нарушения стула) у  больных ЯБ встречается значительно реже. Эндоскопическое исследование верхних отделов желудочно-кишечного тракта в настоящее время является золотым стандартом диагностики ЯБ и  рекомендуется всем пациентам с  подозрением на  наличие этого заболевания  (при отсутствии противопоказаний). Антисекреторная терапия с применением ингибиторов протонной помпы является основной тактикой лечения ЯБ, а также профилактики ее осложнений. Неотъемлемой частью лечения пациентов с H. pylori ассоциированной ЯБ является эрадикационная терапия инфекции. В рамках фармакотерапии ЯБ целесообразно использовать цитопротектор ребамипид, ускоряющий заживление язвенных дефектов и  способствующий улучшению качества образующегося рубца. Помимо этого, применение ребамипида в схемах эрадикационной терапии H. pylori способствует увеличению эффективности элиминации микроорганизма. 

Peptic ulcer disease (PUD) is a chronic polyetiological recurrent disease of gastroduodenal region. In most cases, the pathogenesis of PU is caused by imbalance between the aggressive factors and protective factors of the gastric or duodenal mucosa. Helicobacter pylori (H. pylori) infection and the use of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, are the major causative factors leading to PUD development. 65% of gastric ulcers and 80% of duodenal ulcers were found to be associated with H. pylori infection. In turn, NSAIDs account for 30% of gastric ulcers and 15% of duodenal ulcers. About 0.1–1% of  all PUs are caused by Zollinger-Ellison syndrome. Abdominal pain is the leading symptom in the clinical findings of patients with exacerbation of PUD. Dyspeptic syndrome (vomiting, nausea, belching, abnormal bowel pattern) is much less common in   patients with PUD. Endoscopic examination of the upper gastrointestinal tract is currently the gold standard test used in   the  diagnosis of PUD and is recommended for all patients suspected of having this disease (unless contraindicated). Antisecretory therapy including proton pump inhibitors is the main approach to the treatment of PUD, as well as the prevention of its complications. Integral to the treatment of patients with H. pylori-associated PU is the eradication therapy of the infection. It is  reasonable to use a cytoprotector rebamipide, which accelerates ulcer healing and improves the resulting scar quality, as part of the pharmacotherapy of PUD. In addition, the use of rebamipide in H. pylori eradication therapy regimens contributes to increased efficiency of elimination of the microorganisms. 

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The authors declare that there are no conflicts of interest present.