[Epithelial protective therapy in comorbid diseases. Practical Guidelines for Physicians].

This document was produced with the support of the National Medical Association for the Study of Comorbidities (NASС). In 2021 the first multidisciplinary National Consensus on the pathophysiological and clinical aspects of Increased Epithelial Permeability Syndrome was published. The proposed guidelines are developed on the basis of this Consensus, by the same team of experts. Twenty-eight Practical Guidelines for Physicians statements were adopted by the Expert Council using the "delphic" method. Such main groups of epithelial protective drugs as proton pump inhibitors, bismuth drugs and probiotics are discussed in these Guidelines from the positions of evidence-based medicine. The clinical and pharmacological characteristics of such a universal epithelial protector as rebamipide, acting at the preepithelial, epithelial and subepithelial levels, throughout gastrointestinal tract, are presented in detail.

Effect of Prebiotic Complex on Gut Microbiota and Endotoxemia in Female Rats with Modeled Heart Failure.

We studied the levels endotoxin and microbial markers in the blood of female rats with experimental heart failure and the effects of preliminary treatment with a prebiotic complex based on fermented wheat bran and inactivated Saccharomyces cerevisiae culture on these parameters. The concentrations of endotoxin, markers of lactobacilli, and opportunistic microorganisms were found to increase in rats with experimental heart failure and significantly decreased against the background of treatment with prebiotic complex. The dynamics of markers of bifidobacteria, eubacteria, and propionibacteria were reciprocal. The observed effect of the prebiotic complex effect on gut microbiota in rats with experimental heart failure suggests that this complex can be used for the correction of intestinal dysbiosis and endotoxemia in this clinical condition.

[Gut microbiota and systemic inflammation in patients with chronic heart failure].

Aim To study the interrelationship between intensity of chronic systemic inflammation (CSI) with severity of the condition and intestinal microbiocenosis parameters in patients with chronic heart failure (CHF).Material and methods 47 hospitalized patients with symptomatic CHF were evaluated. The following parameters were determined: clinical condition; N-terminal pro-B-type natriuretic peptide (NT-proBNP). C-reactive protein (CRP); serum interleukins (IL) 6 and 10; and intestinal microbiocenosis composition by mass-spectrometry of microbial markers in whole blood. Microbiocenosis indexes were compared in the main group and in 38 outpatient patients with arterial hypertension and ischemic heart disease without CHF.Results Direct, medium-power correlations were found between CRP and IL-6 concentrations and severity of clinical condition (NT-proBNP, ХСН stage, and edema severity) in patients with CHF. Most patients with CHF had lower numbers of bifido-, lacto-, propionic-, and eubacteria, and Clostridium (С.) ramosum and higher numbers of aspergillus. Among CHF patients, the highest indexes of endotoxemia, gram (-) bacteria, cocci, actinomycetes, and microfungi were observed in the group with NT-proBNP from 400 to 2000 pg/ml. Direct correlations were observed for amounts of C. hystolyticum, Pseudonocardia spp., and Aspergillus spp. with IL-6 and IL-10 and unidirectional inverse correlation were observed for these cytokines with Propionibacterium acnes and jensenii, Streptomyces spp., and Nocardia asteroides. In addition, IL-6 concentration was negatively correlated with contents of Staphylococcus aureus, C. difficile, C. ramosum, Eggerthella lenta, and Corynebacterium spp. and was positively correlated with C. propionicum, Moraxella spp. and Flavobacterium spp. Concentration of IL-6 directly correlated with the number of Eubacterium spp. and inversely correlated with numbers of Ruminicoccus spp. and Streptomyces farmamarensis. The amount of Streptomyces farmamarensis negatively correlated with CRP concentrations.Conclusion The study results evidence the significance of intestinal microbial-tissue complex in the pathogenesis of CSI in CHF and allow suggesting this complex as a promising target for therapy.

Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment.

The Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian "Pancreatic Club" on the Delphi method. His goal was to clarify and consolidate the opinions of specialists on the most relevant issues of diagnosis and treatment of exo- and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is provided by the participation of leading gastroenterologists and surgeons.

[The Russian consensus on the diagnosis and treatment of chronic pancreatitis: Enzyme replacement therapy]. / Rossiiskii konsensus po diagnostike i lecheniiu khronicheskogo pankreatita: zamestitel'naia fermentnaia terapiia.

Pancreatology Club Professional Medical Community, 1A.S. Loginov Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow; 2A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 3Kazan State Medical University, Ministry of Health of Russia, Kazan; 4Kazan (Volga) Federal University, Kazan; 5Far Eastern State Medical University, Ministry of Health of Russia, Khabarovsk; 6Morozov City Children's Clinical Hospital, Moscow Healthcare Department, Moscow; 7I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg; 8Siberian State Medical University, Ministry of Health of Russia, Tomsk; 9M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow; 10Maimonides State Classical Academy, Moscow; 11V.I. Razumovsky State Medical University, Ministry of Health of Russia, Saratov; 12I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow; 13S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, Saint Petersburg; 14Surgut State Medical University, Ministry of Health of Russia, Surgut; 15City Clinical Hospital Five, Moscow Healthcare Department, Moscow; 16Nizhny Novgorod Medical Academy, Ministry of Health of Russia, Nizhny Novgorod; 17Territorial Clinical Hospital Two, Ministry of Health of the Krasnodar Territory, Krasnodar; 18Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint Petersburg; 19Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don; 20Omsk Medical University, Ministry of Health of Russia, Omsk; 21Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 22Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk; 23Stavropol State Medical University, Ministry of Health of Russia, Stavropol; 24Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo; 25N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow; 26A.M. Nikiforov All-Russian Center of Emergency and Radiation Medicine, Russian Ministry for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters, Saint Petersburg; 27Research Institute for Medical Problems of the North, Siberian Branch, Russian Academy of Sciences, Krasnoyarsk; 28S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow; 29Tver State Medical University, Ministry of Health of Russia, Tver The Russian consensus on the diagnosis and treatment of chronic pancreatitis has been prepared on the initiative of the Russian Pancreatology Club to clarify and consolidate the opinions of Russian specialists (gastroenterologists, surgeons, and pediatricians) on the most significant problems of diagnosis and treatment of chronic pancreatitis. This article continues a series of publications explaining the most significant interdisciplinary consensus statements and deals with enzyme replacement therapy.

[Chronic pancreatitis: microbe-intestinal tissue complex and systemic inflammatory response].

Today in Russian Federation, we observe significant growth of the chronic pancreatitis incidence with the depression of its therapy efficiency (more than 20% of the patients) and complications rate growth. In many respects given tendency is associated with the inefficiency of traditional medications combination in the context of inflammation process reduction, gut dysbiosis correction and chronic inflammation reaction depression. Present-day studies indicates, that the grade and character of inflammation in the pancreas depends on the pro- and anti-inflammatory cytokines balance, which is associated with the elevation of the pathogenic microbiota concentration and permeability of the gut. We estimate clinical efficacy of complex treatment regimen (PPI, spasmolytic, multienzyme and prebiotic therapy) in the patients with chronic pancreatitis and its effect on chronic system inflammation. We established that efficacy of modern complex treatment regimen depends on its influence on chronic system inflammation and that prebiotics addition potentiates correction of dysbiotic changes in the gut microbial-tissular complex and reduces grade of system inflammation.

[Mast cells as a criterion of repair process activity in ulcerative stomach lesions]. / Tuchnye kletki kak kriterii aktivnosti reparativnykh protsessov pri iazvnenykh porazheniiakh zheludka.

Histochemical and morphometric examinations of mast cells were carried out in 215 patients with peptic ulcer and 23 patients with gastric carcinoma. A control group included 30 normal subjects. An increase in the number of mast cells at the edge of the scarring ulcer as compared with that in the surrounding mucous membrane was found. Slowly scarring and callous ulcers are characterized by a significant decrease in the number of mast cells in the edge of the ulcer and beyond the zone of the periulcerous process. A specific feature of carcinoma-ulcer and malignant ulcer was a local (only in the ulcer zone) decrease in the number of mast cells and disappearance of mature granulated cell forms. It is concluded that the histochemical analysis and morphometry of mast cells may be used in the evaluation of the activity of reparative processes as well as in the diagnosis of the slowly scarring ulcer, malignant ulcer, and carcinoma-ulcer.

[The dynamic functional-morphological changes in the small intestine of obese patients undergoing weight-reducing diet therapy]. / Dinamika funktsional'no-morfologicheskikh izmenenii tonkoi kishki u bol'nykh ozhireniem pri provedenii razgruzochno-dieticheskoi terapii.

Two groups of pathogenetic mucosal changes peculiar to fasting period were revealed in 28 obese patients: a structural rearrangement of mucosa with inhibition of mitotic activity of epithelial crypts, and the inflammatory responses manifested by increased cellular infiltration of stroma and compensatory-adaptive changes of capillary bed structures. The adequate dietotherapy provided full recovery of the mucosa tissue parameters on the 26th day.

[Gastric mucosal mast cells and precancerous states]. / Tuchnye kletki slizistoi obolochki zheludka i predrakovye sostoianiia.

Mast cells of the gastric mucous membrane were assayed in 30 gastric cancer patients and in 190 patients with pretumor lesions of the stomach. For the control 208 patients were taken with functional gastric disturbances, chronic gastroduodenitis, of hypersthenic type, ulcerous disease of the duodenum and 30 practically healthy persons. It was stated that the development of chronic atrophic gastritis with the mucous membrane degeneration of intestinal type, a tendency to malignization of callous and persistently unhealed ulcers are preceded by degradation of mast cells, manifested in their reduction, considerable "rejuvenescence" and practically complete disappearance of mucopolysaccharide saturated mast cells. Analogous changes in mast cells were revealed in the mucous membrane of gastric cancer patients. It is suggested to use the morphometric criteria of mast cells as the criteria of pretumor lesions.

[The course of the reparative process in patients with gastric and duodenal peptic ulcers (a clinico-statistical study)]. / Techenie reparativnogo protsessa u bol'nykh iazvennoi bolezn'iu zheludka i devnadtsatiperstnoi kishki (kliniko-statisticheskoe issledovanie).

Clinico-statistical evaluation of reparative process in 332 gastric ulcer and 294 duodenal ulcer patients revealed factors of objective value to its course. In order of significance the factors rank as follows: area of ulcer, localization, combination with certain mucosal erosions, total fasting acidity, free fasting hydrochloric acid, basal gastric secretion, cardial function, duodenogastric reflux, sex, age, number of cigarettes smoked daily. When studying treatment effects on regeneration in ulcer patients in is necessary to take into consideration basal clinico-endoscopic parameters.

[A comparative evaluation of the efficacy of sucralfate and H2-histamine blockaders in treating peptic ulcer]. / Sravnitel'naia otsenka éffektivnosti sukral'fata i H2-gistaminovykh blokatorov pri lechenii iazvennoi bolezni.

Sucralfate (55 patients), cimetidine (25 patients), ranitidine (30 patients), antacids and cholinolytics (32 patients) were studied and compared in open clinical trials for the efficacy in the treatment of ulcer disease of the stomach and duodenum. During 5 weeks, ulcers completely healed in 100% of the patients given sucralfate (in 94.5% for 4 weeks), in 90% of the patients treated with ranitidine, in 84% on cimetidine, and in 78% of the patients undergoing treatment with antacids and cholinolytics.

[Characteristics of non-Helicobacter pylori ulcer disease]. / Osobennosti iazvennoi bolezni, ne sviazannoi s Helicobacter pylori.

AIM: To characterize clinicomorphological and psychosomatic manifestations of ulcer disease (UD) with reference to Helicobacter pylori (HP) contamination of gastric mucosa. MATERIAL AND METHODS: Out of 411 UD patients HP invasion was diagnosed in 338. RESULTS: Patients with UD having no HP in gastric mucosa showed clinical peculiarities related to changes in psychological and vegetative status. CONCLUSION: The addition of psychopharmacological drugs to conventional antiulcer therapy promoted induction of clinicoendoscopic remission of UD within optimal time and improved quality of life in patients without HP infection in the stomach.

[Erosive changes of the gastroduodenal mucosa--is it a pre-ulcer state?]. / Erozivnye izmeneniia gastroduodenal'noi slizistoi obolochki--pred''iazvennoe sostoianie?

The evidence obtained on 280 ulcer patients, 107 of whom have preulcer erosive gastritis, duodenitis or gastroduodenitis, suggest the conclusion on ulcerogenesis dependence on the type and site of erosions, response of blood germs, characteristics of protein, carbohydrate and electrolyte metabolism. Erosive processes in the gastroduodenal mucosa seem a facultative preulcer state.

[Acute and chronic gastroduodenal erosions: characteristics of etiology, pathogenesis, clinical aspects and diagnosis]. / Ostrye i khronicheskie gastroduodenal'nye érozii: osobennosti étiologi, patogeneza, kliniki i diagnostiki.

Comprehensive investigation of 2620 patients with general somatic diseases revealed acute gastroduodenal erosions in 252 of them and chronic gastroduodenal erosions in 178 patients. Principal differences between clinical, endoscopic and morphological features of those two types of erosion due to etiological and pathogenetic character of their formation were established as the changes in the immune response, disorders in the protein and lipid metabolism. Almost 75% of chronic erosions correlated with circulation disorders, the diseases of hepatobiliary system and were their local morphological equivalents.

[Device laboratory and postmortem parallels in alcoholic hepatitis during combined therapy using thioctic (alpha-lipoic) acid]. / Laboratorno-instrumental'nye i patomorfologicheskie paralleli pri alkogol'nom gepatite na fone kompleksnoi terapii s ispol'zovaniem tioktovoi (alfa-lipoevoi) kisloty.

The absence of clinical, biochemical, and instrumental signs that characterize the morphological pattern of the liver presents an urgent problem in the diagnosis of alcoholic hepatitis (AH). Sixty-one patients (mean age 41.7 +/- 8.7 years) were examined to study relationships between the histomorphological parameters and laboratory and instrumental findings in patients with AH on combined treatment including alpha-lipoic acid (Berlition). Indirect assessment of the histological activity of the disease may use the parameters of the serum activity of aspartate aminotransferase and gamma-glutamine aminotransferase, the stages of hepatic fibrosis-ultrasound symptoms: the splenic index at the early stages of the disease, the diameter of the splenic vein in moderate and severe fibrosis. The supplementation of Berlition in the combined therapy for AH decreases the severity of fatty hepatocytic dystrophy, hepatic inflammatory and necrotic changes, no increase or a decrease in the stage of fibrotic changes in the liver tissue.

[Pharmacotherapy of non-associated with Helicobacter pylori ulcer]. / Farmakoterapiia iazvennoi bolezni, ne assotsiirovannoi s Helocobacter pylori.

Examination and pharmacotherapy were performed in 77 patients with ulcer disease (48 patients with duodenal ulcer, 29 patients had gastric ulcer). The disease was not associated with Helicobacter pylori. Ulcer disease free of Helicobacter pylori was treated with famotidine within 5 days since the recurrence onset (in acute phase of ulcer defect) followed by intake of phosphalugel (in duodenal ulcer) or de-nol (in gastric ulcer). Such treatment appeared more effective than ranitidine therapy as it consolidates stable remission and produced minimal side effects.

[Dyspepsia of a nonulcerous nature in servicemen under conditions of ecological-occupational stress]. / Dispepsiia neiazvennoi prirody u voennosluzhashchikh v usloviiakh ékologo-professional'nogo napriazheniia.

In the result of complex examination of servicemen with non-ulcer dyspepsia in the conditions of ecological-professional tension it was found out that clinical manifestations of this pathology were the following: existence of morphological substrate as erosive--acute or chronic--and follicular changes of gastroduodenal mucosa. As a rule the non-ulcer dyspepsia in patients with intact mucosa is accompanied by isolated motor-evacuative disorders of stomach and duodenum.

[Acid-base blood balance in patients with ulcer under treatment by the gastric secretion inhibitors and antacids]. / Kislotno-osnovnoe sostoianie krovi u bol'nykh iazvennoi bolezn'iu na fone lecheniia ingibitorami zheludochnoi sekretsii i antatsidami.

There was an analysis of the results of the study of intragastric acidity and acid-base balance (ABB) of the blood in 25 patients with duodenal ulcer. The patients were examined before and against the background of the 14-day monotherapy with one of the following preparations: Losec, 40 mg (omeprazole), famotidine, 80 mg (Quamatel), Phosphalugel, or placebo.

[New prospects in treating chronic pancreatitis (clinico-pharmacoeconomic study)]. / Novye vozmozhnosti v lechenii khronicheskogo pankreatita (kliniko-farmakoékonomicheskoe issledovanie).

The argument about advantages of certain herniotomy methods has not been settled up to now. Some authors believe that it is reasonable to perform a Shouldice's operation for all inguinal hernias, while others think that it is optimum to use synthetic materials. Certain surgeons prefer endoscopic techniques for recurrent inguinal hernias, etc. In all fairness, it should be acknowledged that none of the currently available hernioplasty methods can ultimately secure against a recurrence of hernia one hundred per cent. Only a differentiated approach to the selection of surgery methods, sufficient surgeon's experience in this field, thorough analysis of remote results of his own operations as well as the use of up-to-date plastic materials, all taken in the aggregate, can considerable improve the results of herniotomy.