OVERDIAGNOSIS OF COELIAC DISEASE IN A PATIENT WITH ASCARIASIS AND GIARDIASIS.

There are many errors in the diagnosis of celiac disease. The most common errors are following: underestimation of the importance of comprehensive laboratory and instrumental studies (histological study of biopsy specimens of the duodenal mucosa, molecular- genetic HLA typing and serological markers of celiac disease); the positive clinical dynamics after a strict gluten-free diet is not always confirm the diagnosis of celiac disease; insufficient or incorrect orientation of biopsy specimens of the mucous of the duodenum; illiterate description and interpretation of histopathological data; neglecting to identify possible IgA deficiency, the use of serological tests with low specificity for the diagnosis of celiac disease.

THE VALUE OF THE REGISTER WITH INFLAMMATORY BOWEL DISEASE TO ASSESS THE EFFECTIVENESS OF DIAGNOSTIC AND TREATMENT ACTIVITIES.

Inflammatory bowel diseases (IBD) are chronic recurrent immune-mediated inflammation of the gastrointestinal tract. Now it is not unified system of monitoring patients with IBD in Russia, but there is information from different regions about the prevalence of disease. There are the registers in few big cities. From 2003 the registers of IBO have been done in Novosibirsk. The register data can give us the possibility to estimate the various real-time data of the disease, to analyze the effect of the treatment, to evaluate risk factors for the disease in real clinical practice. Among the patients with ulcerative colitis decreased the number ofpatients with recurrent and continuous increase in the number of patients with distal forms, which is probably due to the more skillful conduct of patients. in general, it decreased the number of patients with Crohns disease with continuously relapsing course option, reflecting, perhaps, improved treatment. Decline in the proportion of persons with the localization process, only in the colon, which is associated with greater availability of diagnostic methods for destruction of the small intestine. The registry was created in April 2012 and includes patients registered up to October 2015.

[Patient compliance as one of the factors determining the efficiency of eradication therapy].

AIM: To improve the quality of eradication therapy (ET), by increasing patient compliance. SUBJECTS AND METHODS: An open-label cohort multicenter randomized study was conducted. A total of 350 patients with Helicobacter pylori infection-associated diseases and indications for ET were examined. Work was done to improve compliance in a study patient group before treatment. RESULTS: In the study group of patients motivated for treatment, the efficiency of ET was significantly higher than in the control group. The factors influencing treatment adherence were identified and methods to optimize compliance during H. pylori eradication were developed. CONCLUSION: Awareness of the essence of the disease in a patient and his higher motivation for compliance are one of the components of successful H. pylori eradication.

[Evaluation of the efficacy of prucalopride (resolor) in the treatment of patients with chronic constipation].

AIM: To evaluate the efficacy of the enterokinetic prucalopride (resolor) in patients with chronic constipation. SUBJECTS: The effect of treatment with prucalopride (resolor) in 109 patients with chronic constipation was analyzed. RESULTS: The effect was noted in 82% of the patients; 61 patients were fully satisfied with treatment results. Among the adverse reactions, headache that was particularly significant on the first days of use, diarrhea, and cramping abdominal pain were reported by 35, 17, and 13% of the included patients, respectively. The authors' experience with prucalopride demonstrated that the patients with chronic constipation displayed the good efficacy of the drug in both the frequency of stool and the elimination of all other constipation symptoms (straining effort, incomplete bowel emptying sensation, solid stool, bloating), and its good tolerability. CONCLUSION: Prucalopride (resolor) exerts a predictable effect, can extend a physician's capacity to arrest chronic constipation, and, when the drug is used, requires no long-term dose adjustment.

[Lanzoptol efficiency for heartburn alleviation in patients with NERD].

Now you can find a growing interest in modern proton pump inhibitors. This article presents results of Lanzoptol (lansoprazol company "Krka", Slovenia) drug study. This study involved 30 people including 13 women and 17 men. Study included patients with NERD aged from 18 to 65 years with clinical manifestations like pyrosis, regurgitation, epigastrium pain and in with absence of esophageal ulcers and erosions at endoscopic study. Duration of disease ranged from 2 months to 20 years. Results of the therapy: completely stopped heartburn for 4 weeks of treatment at 26 people (87%), partly--at 4. 9 patients got acute pharmacological test with 48-hour pH meter. The average time percentage at pH <4 decreased in 2 times, amount of acid esophageal reflux at pH <4--decreased in 4,5 times, the number of long-Esophageal Reflux decreased in 1,5 times. De Meester combined ratio decreased in 2 times. According to the daily pH meter speed of antisecretory effect on the average was 135 minutes. Lanzopotol portability is good, side effects hasn't been identified. So, Lanzoptol demonstrated a high rate of antisecretory effect and high clinical efficacy with an excellent portability.

[Splenic flexure and irritable colon syndromes: conjugate conditions].

AIM: To investigate phenotypical and clinical characteristics in individuals with high fixation of the splenic angle (HFSA). MATERIAL AND METHODS: The study group included 82 patients with HFSA, the comparison group--76 patients with irritable colon syndrome (ICS), control group--19 patients without colon pathology. the results of the following examinations were analysed: the disease history, detailed intestinal investigation, rectal sensitivity, constitution, connective tissue weakness, vegetative dysfunction and regulation. RESULTS: HFSA is encountered mainly in persons with hyperstenic constitution. Some HFSA patients have pain on the left side--splenic flexure syndrome (SFS). The pain corresponds most to clinical criteria of irritable colon syndrome diagnosis and is accompanied with reduced threshold of pain sensitivity to balloon extension. Provoking factors of the symptoms are stress situations in childhood. CONCLUSION: SFS can be considered as a variant of ICS arising in HFSA. The treatment should be based on the principles of ICS treatment.

[Colon diverticula: origin, prevalence, clinical manifestations].

AIM: To study prevalence of colon diverticula (CD) and phenotypical features of patients with this anomaly. MATERIAL AND METHODS: At the first stage of the study we analysed colon x-ray evidence for 3 years to assess prevalence of CD. At the second stage we examined 59 patients with CD. Sixty patients with idiopathic constipation and 48 patients with irritable colon syndrome served control. RESULTS: We discovered the following independent factors associated with a high CD risk: history of CD in the relatives of the patients (OR 24.6; 95% CI 5.23-116.23; p = 0.0001) and age of the patient (OR 2.5; 95% CI 1.03-1.13; p = 0.0010). Age-dependent CD occurrence, similar anomalies in the relatives, other structural gastrointestinal anomalies in them, hyperaminociduria suggest that CD represent a metabolic involutionary process with hereditary predisposition. CD manifested clinically with abdominal pain and problems with colon passage. Abdominal pain related to defecation occurred with low pain threshold to extension. Abdominal pain risk in CD patients is significantly associated with intestinal infections (OR 4.56; 95% CI 1.09-18.97; chi-square = 4.34; p = 0.0372) and connective tissue dysplasia syndrome (OR 2.21; 95% CI 1.23-3.95; chi-square = 7.08; p = 0.0078). Independent risk factors of constipation in CD are non-morning defecation (OR 8.68; 95% CI 1.55-48.51; chi-square = 6.06; p = 0.0138), connective tissue dysplasia syndrome (OR 1.77; 95% CI 1.0-3.20; chisquare = 3.65; p = 0.0501), sedentary life style (OR 7.42; 94% CI 1.24 - 44.57; chi-square = 4.81; p = 0.0284). CONCLUSION: Incomplete CD reflect colon involution. Abdominal pain associated with defecation has much in common with irritable colon syndrome.

[Cirrhotic cardiomyopathy].

Modern studies have shown that hepatic cirrhosis (HC) is accompanied by moderate cardiac dysfunction. The character and degree of these changes do not depend on the etiology of HC and manifest by an increased ventricular wall thickness and diastolic dysfunction, which deteriorate with ascite and physical labor, as well as basal hyperdynamic systolic dysfunction with pathologic response to physical stress. The latter decreases physical tolerance, which contributes to the development of chronic fatigue syndrome and lowered working ability in HC patients. Cardiovascular changes get reversed in 6 to 12 months after hepatic transplantation.

[Clinical manifestations of vegetative dysfunction in patients with irritated bowel syndrome].

The purpose of the study was to evaluate interrelations between clinical manifestations of irritated bowel syndrome (IBS) and vegetative dysfunction (VD). The subjects were 153 patients with gastroduodenal pathology: 120--with IBS, and 23--with inflammatory bowel diseases (IBD). The study found that vegetative dysfunction was associated with IBS more often than with IBD. Clinical manifestations of IBS were associated with VD syndrome (VDS), including high intensivity and frequency of abdominal pain, feeling of abdominal swelling, elevated anxiety level, and low rectal sensitivity threshold. VDS is probably one of the links of its pathogenesis. VDS is not associated with a type of intestinal passage disorder. VDS in IBS patients is often of constitutional character and is associated with lower life quality.

[Medico-economic efficacy of eradication schemes in helicobacter infections in patients with duodenal ulcers]. / Mediko-ékonimicheskaia éffektivnos' éradikatsionnykh skhem pri khelikobakternoi infektsii u bol'nykh s iazvennoi bolezn'iu dvenadtsatiperstnoi kishki.

The purpose of the study was to make a comparative medical and economic analysis of the application of Rabeprazole (Pariet) and Omeprazole generic in a seven-day eradication therapy.

[The experience of the use of Ursosan in the differential diagnosis of gall bladder's polypoid formations]. / Opyt ispol'zovaniia ursosana dlia differentsial'noi diagnostiki polipovidnykh obrazovanii zhelchnogo puzyria.

Prevalence of gall bladder's polipoid formations is 4.3% by ultrasonographic (US) examinations of gastroenterological patients. So tactics of such patients management is necessary. Usual US examination doesn't always allow differentiate real polips and cholesterol's polips. The real ones demand active surgery. The positive reactions to ursosan's treatment testifies to cholesterol gall bladder's formations.