[Multicenter study of gastroesophageal reflux disease symptoms prevalence in outpatients in Russia].

BACKGROUND: Recently, there has been an increase in the prevalence of gastroesophageal reflux disease (GERD) in Northern Europe, North America and East Asia. However data on GERD prevalence in Russian population are very limited. AIM: To determine the prevalence of GERD among the population of Russia, the clinical spectrum of GERD symptoms, the main drugs used for GERD treatment, and the rate of their administration. MATERIALS AND METHODS: The study was conducted from November 2015 to January 2017 in 8 cities of Russia. A survey of patients over the age of 18 years old visiting outpatient medical institutions for any reason, including patients without gastrointestinal complaints was carried out using a short version of the Mayo Clinic questionnaire. RESULTS: In total, 6132 questionnaires of patients aged 1890 years were analyzed [2456 men (40.1%) and 3676 women (59.9%), mean age 46.615.4 years]. The GERD prevalence among the interviewed patients was 34.2%. The incidence of GERD increased depending on body mass index and the age of the patients. Medications used by the patients for heartburn relief included proton pump inhibitors 59.96%, antacids 67.92%, H2-histamine receptor blockers 11.42%, alginates 18.41% of patients. CONCLUSION: The results of this study indicate a high prevalence of GERD among residents of Russian cities applying for primary health care (34.2%). In comparison with previous studies, an increase in the proportion of GERD patients taking proton pump inhibitors was noted; in most cases the regimen of their intake was in accordance with the recommendations.

Effect of alginate in patients with GERD hiatal hernia matters.

Alginate-based formulations are frequently used as add-on proton pump inhibitor (PPI) therapy to help control of heartburn and regurgitation. There are limited data regarding the mechanisms and effects of alginate-based formulations. We aimed to evaluate the effects of the sodium alginate intake and its likely temporal relations on intraesophageal reflux events by MII-pH in patients with and without hiatal hernia (HH). Fifty GERD patients (18 with HH, 32 without HH) with heartburn or regurgitation once a week or more common were included. After combined multichannel intraluminal impedance and pH-metry (MII-pH) had been performed, all patients were asked to eat the same standard meal (double cheeseburger, 1 banana, 100 g regular yoghurt, and 200 mL water with total energy value of 744 kcal: 37.6% of carbohydrates, 21.2% of proteins, and 41.2% of lipids) during two consecutive days. On separate random two consecutive days, all patients took 10 mL of sodium alginate (GA; Gaviscon Advance; Reckitt Benckiser Healthcare, Hull, UK) or 10 mL of water, 30 minutes after the refluxogenic meal. After eating refluxogenic meal, patients were examined ½ hour for basal conditions, 1 hour in upright, and 1 hour in supine positions. Alginate significantly decreased acid reflux after intake at the first hour in comparison to water in patients with HH (6.1 vs. 13.7, P = 0.004) and without HH (3.5 vs. 5.5, P = 0.001). Weakly acid reflux were increased at the first hour in patients with HH (3.4 vs. 1.3, P = 0.019) and without HH (1.7 vs. 5, P = 0.02) compared to water. There was no distinctive effect of alginate on the height of proximal migration of reflux events in patients with HH and without HH. Alginate decreases acid reflux events within a limited time period, especially at the first hour both in patients with and without HH. Alginate has no effect on the height of reflux events along the esophagus both in patients with and without HH.

[Esophagus defeat in patients with scleroderma].

This article presents clinical case of scleroderma with affection of esophagus.

[Panum (pantoprazole) effectiveness in the treatment of patients with GERD].

There are demonstrated results of a prospective comparative study on clinical efficacy and tolerability of Panum (INN: pantoprazole) under the sponsorship of"Unique Pharmaceutical Laboratories (India)". Were evaluated the results of a 28-day course of treatment of 30 patients with GERD, including those with severe reflux esophagitis (erosive and ulcerative), who received 40 mg of pantoprazole as monotherapy. Was found an algorithm with an intermediate control efficacy to individualizing the approach to therapy. As a result 16,7% of patients with severe reflux esophagitis required increasing the dose of pantoprazole to 80 mg/day in two divided doses, and the rest (83,3%) patients to achieve clinical and endoscopic remission of GERD was sufficient single dose of 40 mg of the drug. The results of this study indicated the efficacy and safety of the Panum drug in the treatment of GERD, including its complicated forms.

[Esophageal lesions in Crohn's disease and ulcerative colitis].

This article reviews the literature about esophageal involvement of Crohn's disease and ulcerative colitis. The review highlights the incidence of IBD, clinical features and difficulties of diagnosis and treatment of patients with esophageal involvement of IBD.

[Pharmacokinetics of the proton pump inhibitors and psychological status in patients as factors that influence the efficiency of treatment of GERD with pantoprazole].

Was made an investigation of the effectiveness of pantoprazole (sanpraz, "SanFarma", India) at gastroesophageal reflux disease (GERD). 53 patients with GERD, including 20--with reflux esophagitis, received a daily dose of pantoprazole 40 mg to 28 days. To the 7 day of treatment heartburn was broke in 63.3%, regurgitation--in 65% of patients initially experiencing these symptoms. The 14-th day of treatment heartburn was broke in 83.7%, regurgitation--in 90%. Endoscopic remission in 28-th day of treatment was obtained in 85% of patients with reflux esophagitis. Broking of symptoms was accompanied by significant improvement in well-being and quality of life of patients. Treatment of a standard dose of pantoprazole was ineffective in 16.3% of patients. The reasons for the conservation of heartburn in 4.1% of the cases was an individual characteristics of the pharmacokinetics drug, in 12.2%--non-reflux mechanisms of symptoms in the face of mental status.

[Functional methods of the esophagus examination].

Manometry of the esophagus is the "gold standard" in diagnosing diseases of the esophagus associated with motor disorders. The combination of manometry with impedance gives an indication of violation of bolus transport along the esophagus. High resolution manometry is new method that provides the most accurate information about the functional anatomy of the esophagus and its sphincters, as well as accurately characterizes the esophageal-gastric junction. We can increase the diagnostic value of daily pH-monitoring by analyzing communication with reflux symptoms. The combination of pH and impedance can identify different types of reflux (acid, sour, gas, liquid and mixed) in patients with symptoms of GERD and related Ahil, after gastric resection in children and infants, to evaluate the effectiveness of antireflux therapy.

[Gastroesophageal reflux disease in the elderly patients: epidemiology, clinical features, therapy].

AIM: Was made a multicenter study of the GERD prevalence in Russia--MEGRE--that revealed quantitative criteria for GERD in 13.3% of respondents but in Moscow it was 23.6%. Also was detected an increasing prevalence with age, and respondents noted a higher prevalence of GERD in groups of older age (over 60) compared with persons younger than 60 years--accordingly 26.5% and 20.2%. We studied the course and treatment of elderly patients with GERD and assessed the results of surgical treatment of patients with short esophagus syndrome. METHODS: Was made a prospective study of 500 patients with GERD (241--age 60 years) that were treated with PPI and 95 patients were operated with an axial HH (42 of them with shortening of the esophagus 1-2-th power), mean age 65.7 +/- 17.4 years. We used endoscopic techniques (endoscopy), daily pH monitoring, esophageal manometry. RESULTS: Results of a prospective clinical study in elderly patients allocated two clinical variants of the flow of GERD, predicting a more severe course of disease in patients with a short history (up to 5 years) (the second "adult type") and suggests a differentiated approach to diagnosis and treatment. The expediency of extension to 12 weeks in elderly patients with GERD, the duration of the basic course of PPI therapy in full doses, which increased the effectiveness of therapy in 14.1%. after ending of this protocole, elderly patients with a second type of disease showed maintenance treatment in continuous operation since the regime "on demands from them ineffective. A reasonable approach to therapy in elderly patients, including STIs, can benefit and make a minimal risk of treatment. 24 months after performed fundoplication were observed excellent and good results in 96% of cases. In this case, patients with ineffective esophageal motility observed improvement in esophageal manometry, indicating that nature reflux of these disorders at baseline. CONCLUSIONS: Course and treatment of GERD in the elderly has its own characteristics, which dictate the need for an integrated approach to diagnosis and treatment of these patients. Older patients with esophageal shortening, 1 st degree possible to perform laparoscopic surgery, and shortening of the esophagus, 2 nd degree is the most secure laparotomic access.

[Impairment of humoral regulation of exocrine pancreatic function in chronic pancreatitis].

AIM: To elicit the role of cholecistokinin (CCK), biogenic amines, bile acids (BA) in development of functional pancreatic insufficiency (PI) in chronic pancreatitis (CP). MATERIAL AND METHODS: Blood concentrations of CCK, serotonin and acetylcholin, fecal concentration of elastase (E-1), BA spectrum in the blood and duodenal content were studied in 46 CP patients (20 patients with alcoholic pancreatitis--AP and 26 patients with biliary pancreatitis--BP) and 15 healthy controls. RESULTS: In AP patients E-1 fell to 78.4 +/- 6.3 mcg/g (severe exocrine PI), while in BP patients E-1 was 170.0 +/- 28.9 mcg/g. CCK in AP and BP decreased to 0.33 +/- 0.03 and 0.45 +/- 0.03 ng/ml, respectively (control--1.60 +/- 0.02 ng/ml, respectively, p < 0.05). AP and BP patients had a rise in the absolute concentration and percentage of the total fraction of the taurodioxicholanic acids to 10.2 +/- 1.6 and 15.0 +/- 2.3%, respectively, (control 9.5 +/- 1.2%) in duodenal bile. The concentration of glycocholic acid fell to 24.1 +/- 1.6 and 23.7 +/- 3.7%, respectively, (control--36.4 +/- 2.4%, p < 0.05). AP patients had more significant decrease of taurocholic acid--to 4.5 +/- 0.7% (control--9.2 +/- 0.7%, p < 0.05). In the peripheral blood of AP patients there was an elevated basal level of serotonin and acetylcholine in the presence of low cholinesterase activity. After meal, acetylcholine concentration lowered in high secretion of serotonin. CONCLUSION: Depending on severity of destructive changes in the pancreas, AP and BP patients had different degree of exocrine insufficiency which may be secondary to the absence of acetylcholine rise in the blood after meal. Alterations in the composition of the conjugates of cholic and taurodioxicholanic BA lead to alterations of CCK blood concentration and, therefore, to changes in exocrine pancreatic secretion. Imbalance between serotonin and acetylcholine levels after meal evidences for defects in conventional regulatory interrelations. Decreased threshold of nociceptors activation in simultaneous enhancement of afferent nociceptive flows may entail pain syndrome in CP.