[Drug therapy's new options in the treatment of the severe irritable bowel syndrome].

BACKGROUND: Stress, individual characteristics of each patient, visceral hypersensitivity and intestinal motility have the key importance in the pathogenesis of irritable bowel syndrome (IBS). In recent years, there has been growing interest in the use of selective serotonin and norepinephrine reuptake inhibitors (SNRIs) in the complex therapy of IBS patients with somatoform disorders. AIM: To examine the effectiveness of the SNRIs antidepressant therapy in the treatment of patients with IBS and diarrhea (IBS-D) with extraintestinal manifestations. MATERIALS AND METHODS: 42 patients with severe IBS and diarrhea (IBS-D) were examined, among them 22 female with a median age of 32 years old (22; 38), and 20 male with a median age of 31 years old (25; 35). Treatment with duloxetine 60 mg/day was prescribed. The effectiveness of the therapy was assessed after eight weeks. The IBS clinical symptoms dynamics were assessed by the intensity of pain syndrome and bloating, which were determined using Visual Analogue Pain Scale (VAS), stool frequency and shape based on the Bristol stool scale; Visceral sensitivity threshold was assessed according to the Balloon dilatation test. There was studied the effect of the duloxetine on the extraintestinal manifestations of IBS. The psycho-emotional state was assessed using the Beck scale of anxiety and depression and the Spielberger-Khanin scale by psychiatrist, neurologist-vegetol. RESULTS: All patients showed positive dynamics after eight weeks duloxetine treatment: the decrease of pain syndrome from 9 (9; 10) to 2 (2; 3) points, bloating from 8 (8; 9) points to 2,5 (1; 3) points according to VAS, and defecation frequency from 10 (9; 12) to 2 (1; 2) times a day; the change of stool consistency from 6th (6; 7) to 3rd (3; 4) type. The visceral sensitivity threshold increased: the time of appearance of the first urge to defecate increased from 56 (34; 74) ml to 95 (80; 98) ml. Significantly decreased extraintestinal manifestations of IBS. In reassessing each patient's individual characteristics there were the decrease of the depression level according to the Beck scale from 26 (23; 32) to 11.5 (10; 13) points and personal personal anxiety level according to the Spielberger-Khanin scale from 42.5 (35; 53) to 22 (20; 24) points, as well as the decrease of situational anxiety from 40 (37; 49) to 22 (21; 36) points. CONCLUSION: The severe course of IBS-D is mainly associated with the patients' individual characteristics and anxiety or anxiety-depressive syndromes. The positive impact of duloxetine therapy in severe IBS-D with extraintestinal manifestations is associated with the regulation of serotonergic and noradrenergic activity of the central.

[Visceral sensitivity in diagnostics and treatment of severe irritated bowel syndrome].

BACKGROUND: Irritable bowel syndrome (IBS) is a biopsychosocial model based on the malfunction of "brain-intestinal linking". AIM: To improve diagnostics of the severe IBS accompanied with somatoform disorders by using balloon dilatation test (BDT) and optimize the therapy by using antidepressants from the serotonin and noradrenaline reuptake inhibitor type. MATERIALS AND METHODS: 61 patients with severe IBS and diarrhea were examined, among them 29 female with a median age of 31 years old (24; 36), and 31 male with a median age of 31 (24; 36) years old. All patients were randomized into two groups, group 1 consisted of 30 patients (15 female, 15 male), group 2 consisted of 31 patients (15 female, 16 male). The symptoms of all patients were assessed using the Visual Analogue Pain Scale (VAS Pain), visceral sensitivity index (VIS) was assessed according to the J. Labus questionnaire (2007) and visceral sensitivity threshold was assessed according to the BDT, the psycho-emotional state was assessed using the Beck scale of anxiety and depression and the Spielberger-Khanin scale. Both group patients underwent a comparative effectiveness evaluation between the therapy based on the use of Trimebutine at a dose of 600 mg per day and the SNRI-Duloxetine therapy at a dose of 60 mg per day for 8 weeks. RESULTS: Patients from group with severe IBS and diarrhea who had undergone the antidepressant therapy showed the decrease of pain syndrome from 7 (5; 7) to 2.5 (2; 3) points according to VAS Pain; normalization of stool frequency from 7 (6; 9) to 2 (1; 2) times a day; normalization of stool consistency from 6 (6; 7) to 3 (3; 4) type; and decrease of VIS: first urge from 56 (34; 74) to 95 (80; 98) ml.; as well as the decrease of the depression level (Beck scale) from 26 (23; 32) to 11.5 (10; 13) points and anxiety according to Beck scale from 38 (31; 45) to 11 (10; 12), the decrease of personal anxiety level (Spielberger-Khanin scale) from 42.5 (35; 53) to 22 (20; 24) points, and the decrease of situational anxiety from 40 (37; 49) to 22 (21; 36) points. During the trimebutine therapy in group 1, the clinical symptoms of IBS have persisted. According to the BDT, the visceral sensitivity (HF) threshold remained at a low level. And the indicators of anxiety and depression remained at a high level according to the psychometric scales. CONCLUSION: The insufficient effect of the trimebutine therapy can be explained by the somatoform disorders persistence in patients from group 1. Meanwhile SNRI-duloxetine therapy in group 2 showed a clinical remission of IBS: such as a reliable relief from pain and diarrheal syndrome, as well as an increase in the HF threshold. Thus, Duloxetine is a promising treatment for severe IBS with somatoform disorders. BDT can be used as an objective criterion to diagnose and evaluate the effectiveness of therapy in patients with IBS.

[New opportunities for non-drug treatment of insomnia using sleep normalization medical device SONYA]. / Novye vozmozhnosti nelekarstvennoi korrektsii insomnii s pomoshch'yu apparata dlya normalizatsii sna SONYa.

OBJECTIVE: To study the effectiveness and safety of the sleep normalization medical device SONYA in the treatment of insomnia. MATERIAL AND METHODS: The effectiveness and safety of the SONYA device was studied in 32 subjects randomized into two groups - those who received stimulation using this device and those who received false stimulation (placebo). The indicators of subjective sleep characteristics, polysomnography, and emotional state were evaluated. RESULTS: The SONYA device exerts the positive effect on the main characteristics of night sleep and the emotional state of patients. The overall sleep efficiency, the total duration of delta sleep in its 1st and 2nd cycles, the delta sleep index significantly increased, while the time of falling asleep and the time of onset of delta sleep as well as the number and duration of night awakenings decreased. The severity of emotional and motivational disorders significantly decreased in the form of a decrease in the level of state anxiety, an increase in the background mood, the level of cheerfulness and well-being. No adverse events and side-effects from the use of the SONYA device have been recorded. CONCLUSION: According to the results of clinical studies, the SONYA device was registered as a medical device of the 2nd safety class for the treatment of insomnia of inorganic nature (F51.0) and sleep-wake disorders of inorganic nature (F51.2).

[Chronic intestinal pseudoobstruction: difficulties in diagnosis and treatment. Case report].

The article presents a clinical case of a 23-year-old patient with an extremely severe congenital form of chronic intestinal pseudoobstruction coupled with a neuromyopathy,colon malrotation, malabsorption, bacterial overgrowth syndrome, cholelithiasis and gastrostasis, which excluded bowel transplantation. Long-term treatment in the intensive care unit with combined, mainly parenteral nutrition for 6 months, using antibiotics, prokinetics, intestinal decompression allowed to achieve partial stabilization of the patients condition and transfer to home treatment with the continuation of adequate complex therapy.

[Multidisciplinary treatment of the patient with a severe irritable bowel syndrome].

The patient E., aged 39, was described with a severe form of the irritable bowel syndrome that developed after the stress. In addition to the clinical manifestations of IBS, the patient got the somatoform disorders, which manifested itself with a large number of extraintestinal symptoms and led to a disability. According to the recommendations of the Rome Criteria IV 2016, the main medicines for the treatment of biopsychosocial model of IBS are antidepressants. The remission of the disease with a complete recovery of the patients disability was achieved by duloxetine, an antidepressant from the group of serotonin and noradrenaline reuptake inhibitors.

[Polyneuropathies in intestinal diseases]. / Polineiropatii pri zabolevaniiakh kishechnika.

Different aspects of polyneuropathies (PN) developed due to the deficit of group B vitamins in intestinal diseases are considered. Neurological disturbances related to intestinal diseases are caused by malabsorption that leads to the deficit of some compounds extremely important for normal cell metabolism, pathological changes of mucous coat of the stomach and intestine and higher sensitivity to the plant protein gluten. Vitamin B12 deficit can lead to a number of neurological disturbances; patients with pernicious anemia most often develop myelopathy and PN. An increase in serum vitamin B1 concentration is identified in 30-80% of patients with alcoholism. However, vitamin B1 deficit is seen also in ulcer disease, chronic gastritis, acute pancreatitis, esophageal metastatic lesions as well as in primary tumors of the stomach and intestine. Demyelinating as well as axonal PN may develop in patients with enteropathy. Gluten intolerance is the most often cause of PN in pathological changes in the intestine Possibilities of clinical and paraclinical diagnosis of these disorders are analyzed.

[Neurological disorders associated with gluten sensitivity]. / Nevrologicheskie rasstroistva, assotsiirovannye s chuvstvitel'nost'iu k gliutenu.

The review considers the pathogenetic, clinical, and therapeutic aspects of neurological disorders associated with gluten sensitivity. Gluten ataxia and polyneuropathy are most common. The clinical features of neurological disorders in patients with gluten sensitivity and the effects of a gluten-free diet are described.

[A rare complication of bariatric surgery: Polyradiculoneuropathy as a type of Guillain-Barré syndrome].

The number of bariatric (weight loss) surgeries have increased steadily in the past decade. Along with the tangible benefit of this treatment, there is a risk for postoperative complications, the main cause of which is impaired absorption of nutrients. The paper describes polyradiculoneuropathy running as a type of Guillain-Barré syndrome.

[Navigated transcranial magnetic stimulation as a method of early motor activity disorders rehabilitation after stroke].

UNLABELLED: The objective of the present study was to compare the safety and effectiveness of navigated and non-navigated rhythmic transcranial magnetic stimulation rTMS in the patients presenting with post-stroke hemiparesis. METHODS: Group 1 consisted of 31 patients with post-stroke hemiparesis treated by navigated rTMS. Thirty comparable patients treated without navigation were included in Group 2. The patients were examined 3.2 +/- 1.1 month after stroke. Their mean age was 42 +/- 10.1 years. The average NIHSS score declined from 15.9 +/- 3.5 to 10.2 +/- 3.9 in Group 1 and from 15.8 +/- 3.0 to 13.1 +/- 3.4 in Group 2 (p=0.05). The Barthel index characterizing the degree of functional independence increased from 14.5 +/- 4.4 to 25.7 +/- 6.8 in Group 1 and from 14.3 +/- 4.2 to 18.1 +/- 5.9 in Group 2 (p=0.07). Navigated rTMS should be preferred as a method for locomotor rehabilitation after stroke.

[Differential diagnosis of lymphadenopathy in HIV/AIDS].

AIM: To determine the role of histological diagnosis of lymphadenopathy (LAP) associated with clinico-laboratory picture in patients with HIV infection/AIDS. MATERIAL AND METHODS: Target biopsy of the peripheral lymph node was made in 80 HIV-infected patients from 2002 to 2005. Histological diagnosis was made in all the patients with light microscopy, in some patients at immunohistological examination. RESULTS: Most of the patients had peripheral blood CD4 lymphocytes under 200 cell/mcl. Viral load was hundred thousands copies in mcl. Tuberculosis was diagnosed in 33 (41%) patients, lymphomas--in 23(29%), lymphogranulomatosis--in 5 (6%), reactive lymphadenopathy--in 15 (19%), germinogenic tumors--in 3 (4%), sarcoidosis--in 1 (1%). Histologically, LAP was represented by follicular hyperplasia (n = 9), involution (n = 2), bacterial lymphadenitis with necrosis (n = 4). CONCLUSION: Biopsy of peripheral lymph nodes is an early, safe, reliable and cost-effective method of LAP diagnosis in patients with AIDS.