[Use of a controlled attenuation parameter for the diagnosis of non-alcoholic fatty liver disease].

AIM: To evaluate the efficacy of vibration-controlled transient elastography (VCTE) with a controlled attenuation parameter (CAP) in a population of patients with non-alcoholic fatty liver disease (NAFLD)and to compare to US and different non-invasive indices. MATERIALS AND METHODS: Single center NAFLD patients' database of 2021-2023 years was retrospectively analysed. Data of VCTE evaluation with CAP (FibroScan 530® and FibroScan 630 Expert®) as well as liver US examination results and values of HSI, FLI, BAAT and NAFLD-LFS were extracted. AUROCs for all methods used were constructed and sensitivity and specificity analysis was performed. RESULTS: The data of 1081 patients were available for analysis (385 with steatosis, 274 with NASH, 422 without NAFLD as a control). Ultrasound examination in the diagnosis of liver steatosis compared to VCTE with CAP showed sensitivity and specificity of 94.6 and 63.7%, respectively. Diagnosis of liver steatosis using indices and scales showed sensitivity and specificity of HSI: 97.9 and 60.1% (AUROC 0.90), FLI: 92.5 and 85.3% (AUROC 0.93), BAAT: 76.6 and 73.5% (AUROC 0.82), NAFLD-LFS: 56.7 and 81.8% (AUROC 0.85). CONCLUSION: The sensitivity of the US of the liver was consistent with previous studies, but the specificity was low. The HSI index had the best indicators of sensitivity and specificity in relation to the diagnosis of liver steatosis. Combination of liver US and HSI can be used in screening of liver steatosis, however, for the complete diagnosis better tools which can simultaneously evaluate liver steatosis and fibrosis should be used.

[Association of nutritional patterns and arterial hypertension in Russia: does it exist?]

AIM: To evaluate nutritional patterns in patient with arterial hypertension (AH) compared to the control group without elevated blood pressure. MATERIALS AND METHODS: Retrospective search for unique records of the patients aged 1875 y.o. with complete data on usual nutrition with food frequency methods who had no mentions of diabetes mellitus, food intolerance or allergies, and history of major abdominal surgery, as well as signs of secondary reasons of AH. Nutritional patterns were assessed with the use of healthy eating pyramid principles. Ststistical analysis was performed with the use of SPSS 13.0 for Windows software (SPSS Inc., USA). RESULTS: The data of 711 patients were available for the final analysis (595 of them in AH group). Both groups consumed lower compared to the recommended amounts of fruits, dairy and higher amounts of meat. Those with AH consumed larger amounts of vegetables (1.130.74 compared to the values of healthy eating pyramid vs 0.940.63 in the control group; p=0.004), fruits (0.800.66 vs 0.520.57; p=0.001), meat (1.851.05 vs 1.620.91; p=0.002) and fats (0.770.60 vs 0.490.55; p=0.001). On the other hand, there were lower rates of consumption of sugars, and confectionaries in the structure of nutritional patterns in patients with AH compared to the control group: (0.350.44 of the healthy eating pyramid in AH vs 1.930.98, in the control group; p=0.0001). CONCLUSION: Nutritional patterns of patients with arterial hypertension significantly differ compared to the control group. The obtained data may be used for diet modification in patients with arterial hypertension.

[Using a multicomponent functional food in IBS patients with constipation a comparative controlled study].

Irritable bowel syndrome (IBS) is highly prevalent functional gastrointestinal disorder associated with decrease in quality of life and a high social cost. Diet is one of several therapeutic options in IBS treatment; therefore the development and clinical evaluation of innovative functional food for IBS patients are actual. Instant drink containing 4 g inulin, 4 mg menthol and 2 mg of pyridoxine (in daily dose) has been evaluated. 49 patients 18-68 (41.5±16.5) years old fulfilling the Rome III criteria for IBS-C were randomly assigned into two groups: one received standard diet plus two drinks per day for 2 weeks and control group received standard diet. Response to therapy was recorded daily using Likert scale of abdominal pain, bloating and feeling of incomplete bowel emptying, frequency of bowel movement, Bristol stool scale, and quality of life was assessed by IBSQoL questionnaire before and after the treatment. The consumption of the drink with inulin and menthol contributed to a significant positive effect on the stool parameters (from 0.91±0.73 to 1.12±0.45 bowel movements per day in stool frequency, p=0.05, from 2.68±1.63 to 3.43±1.27 index Bristol scale, p=0.05), reduced the severity of abdominal pain (from 1.78±0.58 to 1.47?0.61 Likert scale points, p=0.05), bloating (from 2.22±0.83 to 1.53±0.71 points ofLikertscale,p= 0.01) and a sense of incomplete bowelemptying (from 2.22 ± 0.88 to 1.61± 0.81 points of Likert scale, p=0.001), as well as increased the quality of life (from 75.3± 12.0 to 83.3±6.7%, p=0.05), but a significant part of patients (10 of 25) complained the appearance of heartburn after the start of the treatment. In conclusion, the consumption of the functional drink containing inulin, menthol and pyridoxine is associated with improve in stool parameters, abdominal pain, Bristol scale index and increase in quality of life in patients with IBS-C, but produce noticeable heartburn. Changes in functional drink composition are needed to reduce adverse effects.

[Nutritional status in patients after gastrectomy due to gastric cancer].

UNLABELLED: Aim of the study was to evaluate nutritional status in patients after gastrectomy due to gastric cancer. METHODS: In 55 (26 males and 29 females) gastric cancer patients after gastrectomy body composition (bioimpedansometry method); resting energy expenditures and home actual nutrition (frequency analysis method) were evaluated. Blood levels of major nutrients and metabolites were assessed. RESULTS: Both men and women suffered from weight loss after gastrectomy (mean BMI was 19,8+/-4,7 kg/m2 in men and 20,5+/-1,9 in women). Higher BMI was positively correlated with age in women (R=0,45; p<0,03), but not in men, however there was no difference in mean age and mean time after gastrectomy between men and women. Mean body fat mass significantly decreased in men (7,4+/-5,0 kg) and in women (12,0+/-7,1 kg) in compare to normal values (18,2 and 22,5 correspondingly) (p<0,001). Resting energy expenditure variably decreased (for 13-53%) in half of the patients, mainly due to decrease in lipid oxidation rate. Mean daily energy intake was lower than normal in short-term (1359 kcal in period of 12 months) and long-term (1814 kcal in 1-5 years period) after gastrectomy, due to decrease consumption of proteins, carbohydrates and fat. Mean blood total protein, hemoglobin and hematocrit levels were lower than normal values in 40% of patients. CONCLUSION: In gastric cancer patients low BMI, low fat mass and energy consumption are observed even long period of time after gastrectomy. Dietary counseling and support are badly needed in patients short-term as well as long-term period after gastrectomy in men and younger women.

[The role of gastroesophageal reflux in malignization of post-burn and peptic esophageal strictures].

The subjects of the study were 221 patients with cicatrical esophageal strictures. 62 (28.5%) patients had peptic strictures, and 159 (71.9%)--post-burn strictures. 67 (30.3%) patients underwent esophageal resection with one-stage intrapleural esophagoplasty with the stomach, 152 (68.8%) patients--gullet bougienage in combination with surgical intervention or as an only treatment. The study revealed 8 cases of squamous cell carcinoma in patients with post-burn strictures, and 3 cases of squamous cell carcinoma in patients with peptic strictures. In 2 cases the researchers found early stage of esophageal cancer (verrucose carcinoma)--in 1 patient with post-burn stricture and 1 patient with peptic stricture. The results suggest an important role of chronic gastroesophageal reflux in the oncogenesis of esophageal squamous cell carcinoma in patients with post-burn and peptic strictures.

[Esomeprasol and rabeprasol effects on esophageal acidification in patients with gastroesophageal reflux disease, intensively metabolizing inhibitors of proton pump].

AIM: To compare action of different esomeprasol and rabeprasol doses on esophageal acidification in patients with gastroesophageal reflux disease (GERD). MATERIAL AND METHODS: A cross-over study was made in 27 GERD patients (12 males and 15 females). It included esophagoduodenoscopy with biopsy for detection of H-pylori and 24-h pH-metry of esophageal content. Rabeprasol and esomeprasol efficacy was compared for daily doses 20 mg of each (stage I) and rabeprasol 20 mg and esomeprasol 40 mg (stage II). RESULTS: All the patients proved H-pylori positive. Before the treatment mean daily time of marked esophageal acidification was 29-36%. At stage I significant differences between the drugs were absent. At stage If esomeprasol was more effective from the first day of therapy both in relation to time to effect and its intensity. CONCLUSION: Esomeprasol provided a fast and noticeable correction of esophageal acidification. This relieves symptoms of GERD and accelerates esophageal mucosa epithelization.

[Antisecretory therapy for prevention of stenoses of bougienage after-burn of esophageal strictures]. / Antisekretornaia terapiia v profilaktike stenozov posle buzhirovaniia ozhogovykh striktur pishchevoda.

The purpose of the research was to study the efficacy of the bougienage of after-burn esophageal strictures against the background of long-term treatment with proton pump inhibitors of H2-blockers. 100 patients with after-burn esophageal strictures were divided into 3 groups in a random way: 1) only bougienage--53 patients; 2) bougienage and omeprazole, 20 mg per day during 12 months--20 patients; 3) bougienage and ranitidine, 300 mg per day during 12 months--27 patients. Bougienage was efficient in 83 patients (83%). 17 patients underwent esophagoplasty due to inefficiency of bougienage. Repeated bougienage was necessary for 35% of patients who were taking omeprazole (p = 0.04), 48.1%--ranitidine (p = 0.2), and 60.4% of patients who underwent only bougienage. Bougienage of the esophagus is efficient in treatment of after-burn strictures. Twelve-month treatment of these patients with omeprazole reduces the number of repeated bougienage courses significantly.

[Results of an open multicenter study of the efficiency of one-week anti-helicobacter therapy using omeprazole, clarithromycin, and amoxicillin in patients with duodenal peptic ulcer]. / Rezul'taty otkrytogo mnogotsentrovogo issledovaniia éffektivnosti odnonedel'noi antikhelikobakternoi terapii s primeneniem omeprazola, klaritromitsina i amoksitsillina u bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kishki.

AIM: To study the efficiency of one-week antihelicobacter therapy using omeprazole, clarithromycin, and amoxycillin in patients with duodenal peptic ulcer during its recurrence. MATERIALS AND METHODS: 105 patients with recurrent peptic ulcer and a not less than 0.5-cm ulcer in the duodenal bulb was given triple therapy: omeprazole, 20 mg twice daily, amoxycillin, 1000 mg twice daily, and clarithromycin, 500 mg twice daily for 7 days. Then the patients were allowed to take antacids if they were required to abolish the symptoms of recurrent peptic ulcer. H. pylori was detected in the mucosal biopsy specimens taken from the anthral part and body of the stomach at gastroduodenascopy, by using the rapid urease test and histology. Gastroduodenoscopy was performed before and 4-6 weeks after the triple therapy. RESULTS: The major symptoms of recurrent peptic ulcer were eliminated in 90% of the patients by the end of a course of therapy, i.e. on its day 7. By the control time, the rate of ulcer cicatrization was 99.05% (104/105). The coincidence of results of the two tests has indicated that H. pylori eradication was 81.9% (86/105) 4-6 weeks after termination of treatment. Adverse reactions during therapy were observed in 20% of the patients; however, treatment had to be discontinued only in 2.9% of the patients. CONCLUSION: One-week triple therapy using omeprazole, clarithromycin, and amoxycillin in highly effective in treating duodenal peptic ulcer during its recurrence.

[Current possibilities of X-ray diagnosis of small intestine diseases using the agent Entero-view]. / K voprosu o sovremennykh vozmozhnostiakh rentgenologicheskoi diagnostiki zabolevanii tonkoi kishki s pomoshch'iu preparata "Entero-v'iu",

The paper analyzes the current capacities of routine (classical) X-ray study in the diagnosis of organ diseases of the small bowel. The distinctive feature of the paper is that in addition to routine barium passage through the small bowel, the new barium contrast agent Entero-view specially designed for its exploration is used. Of the 115 examined patients with various gastroenterological diseases, 76 underwent Entero-view examination that revealed different organ pathology of the small bowel in 28 cases (Crohn's disease in 18, tuberculosis in 3, lymphomas in 5, and cancer in 2). A normal X-ray pattern of the small bowel was diagnosed in 48 cases. The authors highly appreciate this agent. In their opinion, it is essentially helpful in solving one of the most difficult problems in X-ray gastroenterology--present-day X-ray diagnosis of small bowel pathology. The paper describes a procedure for using this agent. It gives a normal X-ray pattern of the small bowel, the agent's use has provided a particularly vivid image of both a normal part of the ileum and its different organ pathology-associated changes.

Gastric cancer screening in selected population of Moscow region: retrospective evaluation.

The aim of the study was to evaluate the efficacy of photofluorographic gastric cancer screening in selected population of Moscow Region (Russia) during a 15-year period. Thirty-five thousand patients were examined annually with photofluorography (tight filling and double contrast) of the stomach. Gastroscopy with multiple biopsies was performed in suspicious or inconclusive cases. Dynamic CT scan with air distention of the stomach was made before the operation for precise determination of tumor size as well as in some inconclusive cases. The final diagnosis was made by histologic examination of resected stomach. A total of 4286 patients dropped out of the study. In 25,392 patients no pathology was found. Gastric cancer was diagnosed in 680 (1.94%) of patients. In the study 170 (25%) "early" gastric cancers and 510 (75%) advanced gastric cancers were found. Among 170 early gastric cancers 120 (70%) were type-IIb (flat carcinoma) lesions in which endoscopy had low positive predictive value due to nonspecific picture and negative biopsy. On the contrary, dynamic CT scan with air distention of the stomach revealed local thickening of stomach wall in 118 of 120 (98.3%) of the tumors and correctly determined their sizes in 106 of 120 (89.9%). Gastric cancer screening by means of photofluorography in selected groups of patients is efficient and cost-effective. In doubtful cases with negative biopsies and nonspecific endoscopic image, dynamic CT scan with air distention of the stomach can be a method of choice.

[The diagnosis of stomach cancer: the status of the problem, the outlook for improvement and the clinico-morphological aspects]. / Diagnostika raka zheludka: sostoianie problemy, perspektivy sovershenstvovaniia, kliniko-morfologicheskie aspekty.

Having analysed 3000 verified cases of cancer of the stomach, the authors have made the conclusion that current x-ray investigations and computed tomography are effective tools in diagnosis of gastric carcinoma especially in intramural carcinomas, propose the term "intramural blastomatous infiltrate" (IBI) syndrome characterizing initial manifestations of squamous cell carcinoma of the stomach. Morphologically, x-ray symptoms corresponded either to infiltrative growth of gastric cancer or growth of connective tissue under the tumor. Such morphological changes in gastric cancer are likely to result from molecular-genetic polymorphism of the tumors. To make the diagnosis of gastric cancer as early as possible it is necessary to combine updated x-ray, endoscopic and morphological techniques.

[Liver damage caused by HIV infection]. / Porazhenie pecheni u infitsirovannykh virusom immunodefitsita cheloveka.

Hepatic status was studied in 7 HIV-infected patients at the stage of generalized lymphadenopathy. Intravital needle biopsy obtained from the livers characterizes the latter as enlarged, showing signs of protein-synthesis dysfunction, morphological evidence of mild cytolysis, cholestasis, moderate mesenchymal-inflammatory syndrome. The study of autopsy specimens obtained from hepatic tissue of the woman who had died of AIDS disclosed more advanced lesions: hepatocytes dystrophy, intralobular and periportal infiltration. The conclusion is made on the necessity of liver function examination entailing due therapeutic measures when following up patients with HIV infection and AIDS.

[A method of determining Campylobacter pylori in the gastric mucosa in peptic ulcer and chronic gastritis]. / Metod opredeleniia Campylobacter pylori v slizistoi obolochke zheludka pri iazvennoi bolezni i khronicheskom gastrite.

An original method is described for the detection of Campylobacter pylori in gastric mucosa biopsy specimens in chronic gastritis and gastroduodenal ulcers. The method is based on the detection (by a special test) of extremely high urease activity of C. pylori. The method has been employed in examinations of 211 patients. The results and prospects for the use of this technique for the detection of C. pylori in patients with gastroduodenal diseases are discussed.