[MODERN PROKINETICS AND THEIR ROLE IN THE TREATMENT OF GASTROENTEROLOGICAL PATHOLOGY].

The importance of prokinetics (drugs stimulating motor function of the gastrointestinal tract) arises from the high prevalence of gastroenterological pathology associated with primary or secondary disturbances of this function in esophagus, stomach, and intestines. The main groups of prokinetics are beta-blockers of dopamine receptors, inhibitors of acetylcholine esterase (or their combination with dopamine receptor blockers), 5-HT4-receptor agonists. They find wide application for the treatment of gastroesophgeal reflux disease, functional dyspepsia and constipation, obstipational form of irritable bowel syndrome, and other conditions accompanied by motor function disorders of the gastrointestinal tract.

[NEWS IN ETIOLOGY AND PATHOGENESIS OF IRRITATED BOWEL SYNDROME].

The concept of irritated bowel syndrome as a complex of functional disorders that can not be explained by organic changes and are totally due to intestinal motility and visceral sensitivity needs revision. The development of this syndrome also depends on a number of pathogenetic and etiological factors, such as inflammation of intestinal mucosa, changes of its permeability, previous infection, altered microflora, gene polymorphism, and food hypersensitivity.

[HOW APPROACHES TO PHARMACOTHERAPY OF ULCER DISEASE CHANGED FOR THE LAST 30 YEARS].

Some 30-40 years ago, ulcer disease was treated with the use of a large amount of medications having different mechanisms of action. This approach is now substituted by a well-defined algorithm including courses of antisecretory therapy and eradication of Helicobacter pylori. Much attention is given to the optimization of the schemes of eradication therapy and prevention of erosive and ulcerative lesions of the stomach and duodenum associated with pharmacotherapy.

[Helicobacter pylori infection: what else besides gastric problems?].

The role of Helicobacter pylori infection (HPI) in the development of chronic gastritis, ulcer disease, MALT-lymphoma, stomach cancer, and other diseases is considered. HPI is directly or indirectluy associated with colon adenoma and colorectal cancer, hepatic disorders, coronary heart disease, idiopathic iron deficiency anemia and thrombocytopenia. The role of HPI in the development of gastroesophageal reflux disease remains to be elucidated. HPI is negatively related to bronchial asthma and chronic inflammatory intestinal diseases. Pathophysiological and clinical aspects of HPI and the aforementioned pathologies await further investigations.

[Effectiveness of pharmacotherapy of irritated bowel syndrome from the standpoint of evidence based medicine].

Evaluation of the action of various medicines used to treat irritated bowel syndrome from the standpoint of evidence based medicine indicates that most of them (spasmolytics, probiotics, loperamide, aperients) show but low effectiveness. The use of more efficacious preparations (alosterone, cisapride, tegacerode) is associated with serious adverse reactions whereas prucalopride is applied for unregistered indications. It necessitates the development of new drugs with enhanced effectiveness and tolerability.

[On the possibility of using prokinetics in gastroenterology].

This review is concerned with the main classes of medicines stimulating the motor activity of the gastrointestinal tract widely used in clinical practice and studied in clinical trials (dopamine receptor blockers, 5-HT4- and 5-HT1-receptor antagonists, agonists of motilin receptors, antagonists of A type cholecystokinin and opioid receptors, etc.). The necessity of developing new generations of prokinetics is emphasized in order to improve efficiency and safety of therapy with these preparations.

[Bad breath: causes, diagnostic and therapeutic practice].

Bad breath (BB) can be noted in various diseases of oral cavity, nasopharynx, upper gastrointestinal tract divisions (foetor ex ore) or be felt in expired air (halitosis) in various bronchopulmonary diseases, renal or hepatic failure, and diabetic ketoacidosis. BB requires interaction between different specialists making it possible to find the cause of this clinical symptom and the optimal therapeutic approach.

[Modern principles of the diagnostics and enzyme therapy of exocrine pancreatic insufficiency].

The author considers the main reasons for the development of exocrine pancreatic insufficiency, discusses the advantages and disadvantages of modern direct and indirect techniques of exocrine pancreatic insufficiency diagnostics, and states the main requirements pancreatic enzymes used as means of substitutive therapy should meet.

[Apoptosis of peripheral blood mononuclears and evaluation of the effectiveness of antiviral therapy of chronic C hepatitis].

The effects of combined antiviral therapy on the apoptosis of peripheral blood mononuclears (PBM) were investigated in 54 patients with chronic hepatitis C (CHC), including patients with chronic viral-and-alcohol hepatitis (CVAH). Simultaneously, serum concentrations of cytokines (tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), and interleukins 10 and 12) using flow cytofluorimetry were taken. The results demonstrate an increase in the intensity of PBM apoptosis in patients with CHC and CVAH vs. controls; there was a tendency of lesser apoptosis intensity in the CVAH subgroup. In both groups IFN-gamma and TNF-alpha concentrations were increased, and there was a direct correlation between the level of apoptosis and TNF-alpha concentration. The study found an increase in the intensity of apoptosis in CHC patients with primary virological response to antiviral therapy with IFN-alpha and riboflavin, which can be considered an additional prognostic factor of the effectiveness of treatment.

[A comparative evaluation of the antacid properties of the preparations Maalox and Almagel]. / Sravnitel'naia otsenka antatsidnykh svoistv preparatov "Maaloks" i "Al'magel'".

Basic modes of action and indications for aluminium and magnesium-containing antacids are reviewed. Antacid properties of Maalox were studied versus those of Almagel in 24 duodenal ulcer patients by the following indices of pH-metry: time of pH response onset, "alkaline time", alkalification area and index. All the features were significantly different when assessed in the body of the stomach. Regular Maalox intake as a main medicine provided good results in the treatment of duodenal ulcer (25 responders), gastric ulcer (14 responders), erosive gastroduodenitis (14 responders), erosive reflux-esophagitis (9 responders). Maalox displayed high symptomatic efficacy, safety, insignificant side effects.

[Clinical aspects and diagnosis of peptic ulcer]. / Klinika i diagnostika iazvennoi bolezni.

The paper is concerned with clinical and diagnostic aspects of peptic ulcer interesting to practitioners. Atypical variants of ulcer course are considered as are criteria for differential diagnosis between ulcer and symptomatic gastroduodenal ulcer, between ulcers and infiltrative-ulcerative gastric cancer.

[Antisecretory effects of quamatel and gastrocepin in duodenal ulcer: comparison with intragastric pH-metry]. / Sravnitel'naia otsenka antisekretornogo deistviia kvamatela i gastrotsepina u bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kishki s pomoshch'iu vnutrizheludochnoi pH-metrii.

Antisecretory effect of intravenous quamatel (Q) and gastrocepin (G) was studied in 59 patients with duodenal ulcer. Mean maximal pH and delta-pH in antral portion of the stomach and its body were similar for Q and G, but pH responded to Q administration faster. The antisecretory effect of Q was more pronounced in males and young patients and was inversely proportional to initial acidity.

[Emotional-personality condition of patients with some gastroenterological diseases]. / Sostoianie emotsional'no-lichnostnoi sfery u bol'nykh nekotyrymi gastroenterologicheskimi zabolevaniiami.

Characteristics of personality and emotional condition were studied in 160 patients from Moscow (Russia) and Chardzhou (Turkmenistan) with various gastroenterological diseases: duodenal ulcer, chronic gastritis, chronic cholecystitis, irritable colon syndrome. Actual psychogenia occurred frequently in all the patients, children's psychogenia was more frequent in Moscow patients with duodenal ulcer. In patients with duodenal ulcer and chronic gastritis both from Moscow and Chardzhou the incidence of stress in everyday life was rather high. All the examinees suffered from mild or moderate depression found more frequently in Moscow patients with chronic gastritis.

[Comparative assessment of antacid agents with intragastric ph-metry]. / Sravnitel'naia otsenka éffektivnosti antatsidnykh preparatov s pomoshch'iu vnutrizheludochnoi ph-metrii.

Alkalizing effects of maalox, renni and tams were compared in 63 patients (27 males and 36 females) aged 19-56 with endoscopically confirmed superficial gastroduodenitis using intragastric pH-metry. Liquid antacids (maalox) began their action quicker (1.3-1.7 times) than tablets (renni and tams) but the tablets had longer alkalizing effects. Maximal and minimal alkalizing effects were achieved with maalox and renni, respectively. It is inferred that rapid intragastric pH-metry can be used for comparative assessment of different antacid drugs. Of the drugs studied the highest antiacid effect was exhibited by maalox.

[Effectiveness of lecedil (famotidine) in the therapy of patients with peptic ulcer]. / Effektivnost' primeneniia letsedila (famotidina) v lechenii bol'nykh iazvennoi bolezn'iu.

A total of 30 patients (29 with peptic ulcer and 2 with erosive gastroduodenitis) received lecedil, a new famotidine blocker of histamine H2-receptors. The effect of the drug was not related to the dose regimen (20 mg twice or 40 once a day). In good tolerance side effects were not reported. Healing of duodenal ulcer occurred within 4 and 5 treatment weeks in 17 (85.0%) and 19 (95.0%) out of 20 patients, respectively, within 6 and 8 treatment weeks ulcer healed in 5 and 6 out of 8 gastric ulcer patients, respectively.

[Indicators of cellular and humoral immunity during the process of healing of stomach ulcer]. / Pokazateli kletochnogo i gumora'lnogo immuniteta v protsesse zazhivleniia iazvy zheludka.

Cellular and humoral immunity parameters in the process of healing of ulcer were studied in 47 patients with gastric ulcer. Changes in the immune status in these patients depended on the stage of healing of an ulcerous defect (active exacerbation, the beginning of cicatrization, "red" or "white" scar) and were most pronounced at the initial period of ulcer cicatrization. They were manifested by the signs of the immune system activation (primarily by increase in the relative content of theophylline-resistant T-lymphocytes). In patients with more prolonged terms of ulcer healing these changes appear later to indicate one of the factors of slow ulcer cicatrization.

[Role of 24 hour intraesophageal pH monitoring in diagnosis of gastroesophageal reflux and assessment of drug effectiveness]. / Znachenie sutochnogo monitorirovaniia vnutripishchevodnogo pH v diagnostike gastroézofageal'noi refliuksnoi bolezni i otsemke éffektivnosti lekarstvennykh preparatov.

58 patients with gastroesophageal reflux (GER) and 18 patients with chronic gastroduodenitis (CGD) were examined using 24-h monitoring of intraesophageal pH. GER patients exhibited changes in all the readings of 24-h pH-gram of the esophagus which strongly correlated with severity of clinical symptoms (heartburn, metasternal pain), reflux-esophagitis (endoscopical picture), data of esophagotonocimography. 24-h monitoring of intraesophageal pH provided an adequate estimation of the drugs used to treat GER. As to effect on intraesophageal pH, domperidon had no effect, famotidine had a moderate positive effect, omeprasol returned pH to normal.

[Clinical manifestations, diagnosis and conservative treatment of slowly healing stomach ulcers]. / Osobennosti klinicheskikh proiavlenii, diagnostiki i konservativnogo lecheniia trudnorubtsuiushchikhsia iazv zheludka.

The paper presents the analysis of examination and treatment data on 80 patients with long-healing gastric ulcer (12 weeks or longer), of contributing factors (sex, age, ulcer site and size, smoking, alcohol abuse, associated diseases), of changes in the antral and fundal gastric mucosa as well as in immune system, of conservative treatment results.

[Peptic ulcer localized in the stomach: conservative therapy or surgical treatment?]. / Iazvennaia bolezn' s lokalizatsiei v zheludke--konservativnaia terapiia ili khirurgicheskoe lechenie?

Most authors advocate surgery for peptic ulcer because of the high frequency of malignancy of the ulcers. The literature data and personal observations provide evidence, however, that true malignant degeneration of the ulcer is a quite rare complication of the disease. Of greater importance in examination of the patients is differential diagnosis between benign ulcers and the infiltrative-ulcerous form of gastric ulcer which may take the "mask" of a benign ulcer in the early stages. Patients with an uncomplicated form of peptic gastric ulcer must be given nonoperative treatment. An operation should be considered only in formation of poorly cicatrizing ulcers with due regard for the poor efficacy of their nonoperative management.