[The frequency and clinical aspects of extraesophageal syndromes in elderly patients with gastroesophageal reflux disease].

AIM: To investigate the frequency of extraesophageal syndromes in elderly patients with gastroesophageal reflux disease (GERD). MATERIALS AND METHODS: This cross-sectional study was conducted to compare the clinical manifestations of GERD in 1100 patients aged 60 to 75 years and in 453 patients aged 36 to 60 years. A control group consisted of 154 elderly patients without GERD and 178 mature-aged patients without this condition. GERD was diagnosed via analysis of its symptoms, esophagogastroduodenoscopy, and 24-hour pH monitoring on the basis of the Montreal consensus guidelines. Extraesophageal syndromes were detected actively using the current methods accepted to treat lung, heart, and ENT diseases and a simultaneous gastroesophageal examination. RESULTS: Chronic cough, asthma, chronic laryngitis, cardialgias and cardiac arrhythmias were much more common in elderly patients with GERD than in those without this condition and prevalent in patients with erosive esophagitis and Barrett's esophagus as compared with those with non-erosive reflux disease. The mature-aged patients were recorded to have similar but less pronounced trends. The authors proposed an algorithm for the management of patients with extraesophageal manifestations of GERD, the important aspect of which was two-month acid-suppressive therapy used as both diagnostic testing and empirical treatment for this pathology. CONCLUSION: The extraesophageal manifestations of GERD in elderly patients are a serious clinical problem calling for considerable attention.

[ESOPHAGITIS, CAUSED BY HERPES SIMPLEX VIRUS: CASE REPORT].

The clinical observation of the patient at the age of 56 years, with lesions of the esophagus by the herpes simplex virus has been presented. The patient complained of odynophagia and dysphagia. Treatment with proton pump inhibitors in outpatient stage was not effective. On endoscopic examination revealed multiple ulcers in all parts of the esophagus. Herpes simplex virus has been detected in biopsy specimens of esophageal mucosa by the PCR method. Treatment with acyclovir led to rapid and complete clinical recovery. Analysis of the literature allowed making the conclusion about the importance and actuality this demonstration.

[THE ROLE OF OXIDATIVE STRESS IN THE PATHOGENESIS OF GASTROESOPHAGEAL REFLUX DISEASE].

AIM: To study features of lipid peroxidation in patients with different types of gastroesophageal reflux disease (GERD). METHODS: We examined 120 patients with different clinical variants of GERD and 25 healthy individuals. It was determined the concentration of diene conjugates (DC) ketodienes (KD), conjugated trienes (CT) by biochemical methods in serum and mucosal biopsies of the lower third of the esophagus. RESULTS: In biopsies of esophagus mucosa the content of DK, CD, CT was increased in patients with complications of GERD (ulcerative esophagitis and Barrett's esophagus) in 2,2-5,3 times compared with healthy individuals. In blood serum registered similar but less pronounced regularities. CONCLUSION: It was revealed a significant intensification of free radical oxidation in the tissues of the esophagus and the blood of patients with GERD, which was exacerbated in proportion to the severity of the disease.

[Indicators of apoptosis in the gastric mucosa in patients with atrophic gastritis among the indigenous and nonindigenous dwellers of Evenkia].

AIM: To study the indicators of apoptosis in the gastric mucosa (GM) in relation to atrophy and the presence of CagA gene- containing Helicobacter pylori strains in the indigenous and nonindigenous dwellers of Evenkia. SUBJECTS AND METHODS: Clinical and morphological examinations and fibrogastroscopy of GM were performed in 159 Caucasians and 136 Mongoloids (Evenks). The TUNEL assay was used to determine GM apoptosis in 24 Caucasians and 22 Evenks and the H. pylori strains containing the CagA gene were detected in all the 295 patients. RESULTS: The extent of atrophic gastritis in the gastric antrum and body was higher in the Caucasians than in the Evenks. The total indicator of GM apoptosis in the gastric antrum was 5.19 ± 0.26% in the newcomers and 4.04 ± 0.28% in the aboriginals (p = 0.01). Apoptosis in both populations was associated with GM atrophy and the presence of H. pylori strains containing CagA gene. CONCLUSION: There were ethnic differences in the extent of atrophic gastritis, which may be attributable to differences in the rate of GM apoptosis and the spread of H. pylori strains containing CagA gene in the indigenous and non-indigenous dwellers of Evenkia.

Parameters of proliferation and apoptosis of epithelial cells in the gastric mucosa in indigenous and non-indigenous residents of Khakassia with Helicobacter pylori positive duodenal ulcer disease.

We evaluated parameters of apoptosis in the mucosa of the gastric antrum and body of indigenous and non-indigenous residents of Khakassia with duodenal ulcer disease associated with Helicobacter pylori infection. In the gastric antrum, apoptotic index was significantly increased in patients with ulcer disease in comparison with healthy individuals in both populations. The ratio of proliferation index to apoptotic index was lower in patients with ulcer disease in comparison with healthy individuals in both populations. Similar, but less pronounced processes were recorded in the body of the stomach. Significant changes in the parameters of proliferation and apoptosis were noted in the gastric antrum and body of the stomach in both populations, but they were more pronounced in Caucasians in comparison with Khakasses.

[Role of Helicobacter pylori eradication in the prevention of gastric cancer].

The review deals with the current aspects of prevention of non-cardia gastric cancer (GC). Helicobacter pylori is the most common cause of non-cardia GC. The Correa cascade remains a major pattern of the pathogenesis of non-cardia GC as before. The key moments in gastric carcinogenesis are H. pylori infection; genes associated with cell recognition of bacteria; an immune response and the activation of an inflammatory response. The prevention of GC requires H. pylori eradication as primary prevention in combination with screening for this pathology as secondary prevention of gastric malignancies. Standard three-component therapy is a first-line major regimen for H. pylori eradication.

[Clinical aspects of gastroesophageal reflux disease in elderly patients: results of a 5-year prospective study].

AIM: To evaluate the clinical manifestations and changes of non-erosive reflux disease, erosive reflux disease, and Barrett's esophagus (BE) in a cohort of elderly patients during a 5-year follow-up. SUBJECTS AND METHODS: A continuous method was used to compare the clinical manifestations of gastroesophageal reflux disease (GERD) in 950 patients aged 60 to 75 years and 453 patients aged 36 to 60 years. All the patients underwent clinical examination using the Mayo clinic questionnaire and fibroesophagogastroduodenoscopy. A prospective cohort study was performed in 950 patients aged 60 to 75 years for an average of 5 years. GERD was diagnosed on the basis of the Montreal Consensus guidelines (2006); the degree of esophageal mucosal injury was evaluated according to the Los-Angeles classification (1999). The diagnosis of BE was morphologically verified. RESULTS: The frequency of weekly heartburn was 10% higher in the mature-aged patients; but that of nocturnal heartburn, belching, and BE prevailed in the elderly patients. The 5-year prospective follow-up revealed a significant increase in the rate of erosive esophagitis and BE in the elderly patients with GERD. The risk factors of the latter were no maintenance therapy with proton pump inhibitors, as well as obesity and hiatal hernia. CONCLUSION: GERD shows clinical features and progression in the elderly patients.

[The influence of the oil and gas industry on environmental safety and population health in the Khanty-Mansiiskii Region - Iugra].

Production activities of oil and gas industry plants are related to technogenic impact on the environment, which has a high environmental risk. This is associated with low levels of environmental orientation of sheer technological processes of exploration and exploitation of hydrocarbons and also used in this technical means, materials and chemical reagents. The main pollutants that deteriorate the toxic characteristics of drilling waste, are the most likely drilling fluids, mud flush agents and chemicals, which enter into their composition. Existing methods of disposal of drilling wastes are not effective, the technology of their use is often violated. Dumping drilling waste into water bodies and burying toxic waste in water protection areas under the guise of processed waste has been observed. In the region there are significantly exceeded the national average values rate of morbidity of allergic, cardiovascular, pulmonary and cancer diseases, mediated by environmental factors and new monofactorial and multifactorial diseases appear.

[Helicobacter pylori eradication: current status].

The paper gives an update on the efficiency of Helicobacter pylori eradication. Triple therapy (a proton pump inhibitor + clarithromycin + amoxicillin) therapy is shown to hold top positions as first-line therapy for H. pylori eradication as before. The leading second-line therapy regimens are quadruple and 10-day triple schemes including levofloxacin. This point of view is supported by the Russian Gastroenterology Association. To reduce an increase in H. pylori resistance to clarithromycin, it is advisable to use Klacid (generic name: clarithromycin) in the eradication schemes.

[The prevalence and clinical aspects of Barrett's esophagus in the population of Eastern Siberia].

AIM: To study the prevalence and clinical aspects of Barrett's esophagus (BE) in natives and newcomers in East Siberia. SUBJECTS AND METHODS: Clinical examinations and esophagogastroduodenoscopy were performed in 12975 Caucasoids and 1489 Khakases in Abakan (Khakasia), 1861 Caucasoids and 5829 Tuvinians in Kyzyl (Republic of Tuva), and 1177 Caucasoids in Dudinka (Taimyr). The diagnosis of BE was verified by morphological study. RESULTS: Among the Caucasoids, the total prevalence of BE was 1.6% (2.4% in men and 0.8% in women; odds ratio (OR) was 3.21 with 95% CI 2.40-4.29; p < 0.001); among the Mongoloids, that was 3.1% (4.5% in men and 2% in women; OR, 2.3 with 95% CI 1.75-3.04; p < 0.001). Heartburn and other typical symptoms was more prevalent in patients with BE. The risk factors of BE in all the examined populations were male sex, age over 40 years, smoking more than 20 cigarettes a day for 10 years or more in men, and obesity. CONCLUSION: There were ethnic differences in the prevalence of BE, which were prevalent in East Siberia in the Mongoloids as compared to the Caucasoids.

[Peculiarities of relationship between atrophic gastritis and stomach cancer in the population of Eastern Siberia].

The authors studied the prevalence of atrophic gastritis, H.pylori strains carrying the CagA gene, seeding and apoptosis indices of gastric mucosa in indigenous and newcomer residents of Evenkia. A total of 136 Evenks and 159 newcomers were examined using fibrogastroscopy and biopsy of antral gastric mucosa. Morphological study included light microscopy of hematoxylin and eosin-stained biopsies and their analysis using a visual-analog scale to reveal signs of inflammation, apoptosis, intestinal metaplasia and the degree of insemination by P. pylori. Urease and morphological tests were used to identify H. pylori and the TUNEL technique (Mebstain Apoptosis kit direct, France) to determine apoptosis index; serum anti-Helicobacter and CagA antibodies were detected by an immunoenzyme assay in 22 Evenks and 24 newcomers with chronic H. pylori-associated gastritis. The prevalence of atrophic gastritis in these groups was estimated at 13.2 and 23.9% respectively, seeding density 45.37 +/- 2.01 and 214 +/- 8.75 (p < 0.001). H. pylori strains carrying the CagA gene were identified in 59.6 and 43.6% of the newcomers and Evenks (p = 0.01), total apoptosis index in greater curvature mucosa was 4.99 +/- 0.23 and 3.19 +/- 0.28 (p < 0.01) respectively. These ethnic difference in the prevalence of atrophic gastritis appear to be attributable to different intensity of apoptosis in greater curvature mucosa.

[Lipid peroxidation and antioxidant protection in patients with different variants of gastro-esophageal reflux disease].

UNLABELLED: AIM. To study features of lipids peroxide oxidation and function of antioxidant protection in patients with various variants of gastro-esophageal reflux disease (GERD). MATERIAL AND METHODS: 120 patients with GERD and 20 healthy persons were examinated. Diene conjugates, ketodienes, connected trienes, concentration of intermediants of peroxide oxidation, catalase activity and general antioxidizing activity index were investigated in blood serum and esophageal biopsy specimens by biochemical methods. RESULTS: The level of peroxide oxidation products in esophageal biopsy specimens in esophagitis and complicated GERD was 1.8-4.5 times higher then in control group. The level of catalase activity and general antioxidizing activity was 2-5 times lower in patients with the pathology in comparison to healthy persons. CONCLUSION: Patients with GERD had activation of lipids peroxide oxidation accompanied by deficiency of antioxidants in esophageal mucosa and blood serum proportionally to esophagus damage degree.

[Features of prevalence and risk factors of GERD in different age-gender groups].

AIM: To study prevalence and risk factors of gastroesophageal reflux disease in different age-gender groups. MATERIAL AND METHODS: 506 men of military age, in 375 men in age 40-60 years old, 296 women in age 18-30 years old were investigated. The research included clinical examination with standard questionnaires filling and endoscopy. RESULTS: Prevalence of heartburn in men of military age was 30.4%; in men in age 40-60 years old--46.9%, (p(1-2) < 0.001), in women--24.6% (p(1-3) = 0.8). Prevalence of esophagitis in men of military age was 2.4%; in men in age 40-60 years old--4.3%, (p(1-2) = 0.1), in women--0.7% (p(1-3) = 0.07). CONCLUSION: Features of clinical manifestations and risk factors action in three different age-gender groups were established.