Новости, открытия и события.

Комбинированный гепатопротектор с пребиотическим действием.

Как помочь больному с функциональным оверлап-синдромом.

Proton pump inhibitors (PPI) are a class of drugs with the indisputably high effectiveness and a good safety profile. Taking into account the considerable distribution of acid-depending diseases in the modern world PPIs are applied quite widely; the modern practice is unthinkable without them. At the same time one can’t but admit that these drugs are often indicated in lack of justified indications, in unreasonably high dosages and for the excessively long time. In works of the recent time clinicians and pharmacists call on responsible attitude to use of PPIs, especially to “off-label” use – outside official indications; in these cases it’s necessary to prudently justify it the medical documentation. 

This article presents modern data devoted to etiology, clinical manifestations, diagnostics and therapy of chronic pancreatitis that are of interest to therapists and gastroenterologists. The review of the provided data testifies about the progress in understanding of the CP etiology, appearance of new informative diagnostics methods, certain revaluation of clinical data and therapeutic approaches. 

Currently the fact of the high prevalence rate of disturbance of motility of the upper departments of the gastrointestinal tracts doesn’t cause any doubts. The disturbed motility might be a leading pathogenic factor , for instance, in gastroesophageal reflux disease (GERD), duodenostasis, and might accompany other diseases with various pathogenesis (chronic gastritis, chronic cholecystisis, dyskinesia of bile ducts etc.). The most characteristics complaints at these states will be: heartburn, nausea, vomiting, postprandial heaviness, feeling of early satiety, belching. GERD – a disease related to disturbance of the motor function of GIT upper departments. The prevalence of the disease in adult population ranges from 40 to 60%. 

The article describes difficulties of the celiac syndrome diagnostics, causes of diagnostic errors in various clinical examples are specified. This helps to perceive certain diagnostics programs and to select similar nosologic entities between which the differential diagnostics should be conducted. 

The objective of the work is evaluation of effectiveness of Silimar drug in therapy of patients with drug-induced hepatitis (DIH) with cholestasis syndrome who received chemical therapy for oncologic pathology. Design: comparative non-randomized study. Materials and methods: results of a month-long therapy of 30 DIH patients with cholestasis syndrome who received chemical therapy for oncologic pathology were analyzed with evaluation of US study of the abdominal cavity organs US study, values of blood biochemistry and clinical manifestations. The criteria of effectiveness of Silimar action was the dynamics of the abovestated indicators (at the initial time point and in a month after the therapy). 

This article deals with the data on therapy of 130 patients who suffered chronic hepatic diseases (metabolic, viral) and by various reasons received the hepatoprotector and the immune modulator Laenneс. The high effectiveness of patients therapy by steatohepatites (alcoholic and non-alcoholic) was shown. In patients with chronic viral hepatitis B and C, who received antiviral therapy Leannec was used successfully to overcome antiviral therapy resistance, to reduce therapy side effects (high fever, muscular weakness, pancytopenia). Laennec allows overcoming these side effects and anemia therapy resistance in patients who suffered from chronic hepatitis at the hepatic cirrhosis stage. 

Essential phospholipids (Essentiale Forte N, Aventis, France-Germany) in alcohol-associated hepatic cirrhosis improve the subjective state of patients, reduce manifestations of asthenic and dyspeptic syndromes, intensity of jaundice, have a positive effect on biochemical indicators of cytolysis and cholestasis. The conducted clinical study showed effectiveness of use of essential phospholipids as hepatoprotective agents for hepatic diseases of alcoholic etiology. 

The article tells about the indications for use of ursodeoxycholic acid (UDCA). The most significant positive effects were demonstrated in primary biliary cirrhosis (PBC) and cholelithiasis (CL). The possibility of using UDCA for CL prophylaxis during biliary sludge (BS) and in risk groups -people of elderly and senile age - is discussed. The article presents the results of the authors’ study of UDCA administration in 32 patients with gallbladder deformity (GD) and BS. Grinterol (UDCA) demonstrated high clinical efficacy, safety and no side effects. 

Introduction in practice of therapeutic establishments in the RF of antiviral therapy of chronic viral hepatitis in the form of interferon-free schemes led to considerable increase of the frequency of the stable virologic response. Study objective: determination of virologic response predictors in CVHC patients when various therapeutic schemes are used. Materials and methods: Group 1 of CVHC 52 patients with genotype 1 of HCV received standard anti-viral therapy, Group 2 (21 subject) – interferon-free scheme (Viekira Pak+ Ribavirin). Genetic polymorphisms IL-28В rs12979860 (С>Т) and rs8099917 (Т>G) and blood interferon-γ induced protein – IP-10 were determined. Results: standard anti-viral therapy in Group 1 resulted in SVR (sustained viral response) in 29 patients (55.7%). In Group 2 that received Viekira Pak 100% SVR was achieved in spite of more frequent F3 and 4 stage of fibrosis, unsuccessful anti-viral therapy (9 persons), contraindications to IFN-α drugs (6 persons). Unfavorable genotypes IL-28B ТТ (rs12979860) and GG (rs8099917) were associated in Group 1 with lack of SVR, level of IP-10 in patients with SVR was lower than the one in non-respondents. The therapy by Viekira Pak was well tolerated and resulted in SVR despite presence of grave hepatic fibrosis/ cirrhosis, concomitant pathology, unfavourable options of IL-28B, high IP-10 protein levels. Conclusion: choice of optimal anti-viral therapy schemes for each patient with CVHC must be done taken into account all possible predictors, which allows optimizing the therapy and preventing the necessity of repeated therapy. 

Objective of review: to present new approaches to therapy of patients with chronic NCV-infection based on the clinical use of the direct antiviral action drug Sofosbuvir.

Major provisions: until recently a standard approach to therapy of HCV-infection included prescription of schemes on the basis of the pegylated interferons (PEG-IFN) in combination with Ribavirin. Drugs of focused action at functional proteins of the virus – direct antiviral drugs – have become drugs of choice, which significantly increases effectiveness and safety of treatment. Drugs of direct antiviral action are classified by the type of viral proteins that serve as the target of their action: protease inhibitors (names of the drugs end with - previr), polymerase inhibitors (names of the drugs end with –buvir), NS5A inhibitors (names of the drugs end with – asvir).

Sofosbuvir is an analogue of the uridine nucleotide, a powerful NS5B inhibitor, a key enzyme of HCV-RNA replication, it is widely used in various scheme of antiviral therapy.

Conclusion: Sofosbuvir is one of the most promising drugs for therapy of chronic NCV-infection. Its indisputable advantages: it can be used at various viral genotypes, decompensated liver function. Sofosbuvir stands out for its good tolerability and low possibility of development of viral resistance. 

Chronic liver diseases (CKD) are located on one of the first places on the incidence and are currently the fifth most common cause of mortality in many developed countries. One of the manifestations caused by hepatic insufficiency, hepatic encephalopathy is a syndrome which is a violation of the functions of the brain, which manifests a wide range of neurological or psychiatric disorders of subclinical changes to coma. This article examines current aspects of diagnosis and treatment of hepatic encephalopathy, taking into account the recommendations of the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD). 

The article is devoted to one of the current issues of the internal medicine – to issues of diagnostics and therapeutic correction of the excessive bacterial growth syndrome (EBGS) in the small intestine. Consistent patterns of microflora dissemination in various departments of the gastrointestinal tract are provided, the “excessive bacterial growth syndrome” in the small intestine is defined. The most significant factors leading to small intestine microbiocoenosis disturbance are set forth. Possibilities of a number of diagnostic methods and their place for EBGS verification are determined. Major principles are therapeutic and preventive measures (treatment of pathology that led to its development; diet correction; decontamination of opportunistic flora, restoration of eubiosis; supporting therapy of the major disease and prevention of microbe contamination of the small intestine (in the period of remission)) are described. Taking into account current requirements presented to “ideal antibacterial drugs”, special place is given to rifaximin-α (Alfa Normix®) due to its high effectiveness and safety of use. 

Selective myotropic spasmolytics are the most effective modern correction means for pain at irritable bowel syndrome. Currently various drugs of mebeverine hydrochloride are represented in the domestic market, the dosage of the active substance in which is identical but they are produced by various technologies. We established that in patients with the irritable bowel syndrome administration of the drug Niaspam (Sun Pharmaceutical Industries Ltd.) at standard dosages for 2 weeks showed high effectiveness in arresting pain syndrome and intestinal dyskinesias. Niaspam statistically reliably reduces the relative intensity of intestinal contractions, normalizes the contraction rythmicity but effective predominantly in lower parts of the gastrointestinal tract. Peculiarities of the production technology allow gradual mebeverine release from the capsule, which is extremely important in therapy of intestinal dyskinesias. 

A randomized, placebo-controlled, double-blind trial

Objective. The present randomized placebo-controlled double-blind trial was conducted to examine whether natural mineral water with a high content of magnesium sulfate and sodium sulfate (Donat Mg) contributes to improvement of the bowel function.

Methods. A total of 106 healthy subjects with functional constipations were randomized in groups to receive 500 ml natural mineral water for the 6-week course and a comparison group who took placebo water. Trial participants recorded in a diary each complete spontaneous bowel movement, the number of spontaneous bowel movements per week overall, consistency of stool, gastrointestinal symptoms and general wellbeing. The change in the number of complete spontaneous bowel movements was defined as the primary outcome of the trial.

Results. In 75 trial participants in groups that took 500 ml the change in the number of complete spontaneous bowel movements per week after 6 weeks., as a rule, was higher in the active treatment group compared with the placebo group (T2 = 1.8; P-value= 0.036; one-sided criterion). The average number of complete spontaneous bowel movements significantly increased during the trial, with significant differences between trial groups, taking into account the duration of the trial in general (F-criterion = 4,743; R time × group = 0,010, a two-sided criterion). Intake of mineral water, compared with placebo considerably improved the stool consistency at spontaneous bowel movements (p < 0.001), subjectively perceived signs of constipation significantly decreased (p = 0.005).

Conclusion. Daily intake of natural mineral water, rich in magnesium sulfate and sodium sulfate, has increased frequency of bowel movements and improved stool consistency in people with functional constipations. In addition, assessment of the participants in the trial of quality of life associated with the condition improved. Clinical trial registration number in the EudraCT database: No. 2012-005130-11. 

Возможности современной фармакотерапии при заболеваниях органов пищеварения с использованием отечественных препаратов.

Отчет о научно-практической конференции «Гастроэнтерология и эндоскопия – междисциплинарные подходы к диагностике и дифференциальной диагностике редких болезней пищевода и кишечника».

When administered to patients with pathology of the gallbladder and biliary tract, doctors often resort to a passive diagnostic and treatment tactics, which leads to the progression of diseases of the biliary tract and the development of clinical situations where the possibility of conservative treatment are minimal, and the patient requires surgical treatment. The leading role in the prevention of gallstone disease belongs to a doctor of first contact. Diagnosis of gallstone before the stone - stage and active conservative therapy is effective for the prevention of formation of gallstones and other complications of biliary sludge. An important place in the framework of the active surveillance of patients with pathology of the biliary tract, takes therapy with ursodeoxycholic acid as a result of the multifaceted actions pathogenetic justification and evidence-based. 

The article analyzes the causes of recurrent abdominal pain and dyspeptic phenomena in 657 patients after cholecystectomy. The authors found out that after gall bladder resection 48% of patients complain of pain and dyspepsia. Postcholecystectomy syndrome (dysfunction of Oddi’s sphincter) is diagnosed in 15.2% of the patients. The proportion of diseases of the esophagus and organs of the gastroduodenal zone is 36.4%, of the hepato-pancreato-biliary one is 38.3 per cent. Diagnostic errors at the preoperative stage and/or tactical ones during cholecystectomy amounted to 7.8%.