[Cholagenic diarrhea is a type of postcholescystectomy syndrome].

AIM: To study the role of biliary acids (BAs) in the pathogenesis of chronic diarrhea (CD) in patients undergoing cholecystectomy (CE). SUBJECTS AND METHODS: Twenty-five patients with post-CE diarrhea were examined. A comparison group consisted of 11 patients with diarrhea-predominant irritable bowel syndrome (IBS). The results of an examination of 15 healthy individuals were taken as normal values. Daily fecal BAs were determined by an enzyme spectrophotometric technique. RESULTS: In the patients after CE, daily fecal BA losses were found to be thrice as large as that in the healthy individuals. In the comparison group of patients with IBS, fecal bile excretion was not greater than the normal values. Stool normalization with a simultaneous decrease in fecal BA losses was seen in 92% of the post-CE patients receiving a course of therapy with adsorbents and astringents. CONCLUSION: Post-CE CD is a type of postcholescystectomy syndrome.

[The role of bile acids in the pathogenesis of chronic diarrhea].

Chronic diarrhea syndrome results from excess colonic bile acids. Fibroblast growth factor 19 (FGF19), produced in the ileum is response to bile acid absorption, regulates hepatic bile acids synthesis. Bile acid malabsorption can be found in various gastrointestinal conditions: the greatest losses bile acids with excrements were marked at patients with surgical resection of terminal ileum. The maintenance in daily colonic excess bile at patients with postholecystectomy exceed more than in three times the indicators noted at control subjects, but at the patients with irritable bowel sindrom did not exceed the norm. Effective remedies in treatment chologenic diarrhea were bile acid sequestran.

[Multipurpose psyllium monotherapy in patients with diverticular disease].

The purpose of the research was the study of the prebiotic and hypolipidemic effects of 12-week treatment by psillium of patients with uncomplicated diverticular disease and hyperlipidemia. It has been established that the examined medicine has not any by-effects, normalizes intestinal motility and lowers a pain syndrome and flatulence. Prebiotic effect has proved by higher concentration of short-chain fatty acids in faeces and reduction of anaerobic index. Psillium certainly reduces levels of hyperlipidemia and could be recommended as hypolipidemic remedy for monotherapy as long as base datum of cholesterol is less than 6,4 mmol/l.

[Spontaneous bacterial peritonitis in liver cirrhosis: optimization issues of prevention and treatment].

Research of features of a current of a spontaneous bacterial peritonitis (SBP) allows to allocate close interrelation between SBP, system inflammatory reaction and a sepsis to consider SBP, as one of stages in evolution of the difficult infectious process caused, as a rule, by resident flora, developing at patients with decompensated liver cirrhosis (LC), which demands timely preventive maintenance and adequate antibacterial therapy. In the present work therapy and preventive maintenance SBP questions are considered. In article the extensive review of the data of the literature and own supervision by efficiency of treatment SBP also is presented. For the purpose of optimization of pharmacotherapy of the sick LC, the complicated ascites, had been conducted pharmacokinetics research ciprofloxacin (CPF) according to dynamics of its maintenance in blood serum (BS) and ascitic fluid (AF) depending on presence and ascites size. Materials and methods. Researches are spent 18 sick decompensated liver cirrhosis (a class B and C on Ch-P), without signs SBP after unitary reception of 500 mg CPF per os on an empty stomach. All patients have been divided on two groups: I gr. (n = 10) with the expressed, intense ascites (> 10 1) and II gr. (n = 8) with the moderate, small ascites. Definition CPF in BS also was already carried out by a method of a highly effective liquid chromatography. On the basis of the received data for each patient counted the semidelucing period (T1/2), the area under pharmacokinetic curve (curve concentration - time) - (AUC), volume of distribution of a preparation (Avd), factor AUC(AF)\MIC (size of the relation of the area under pharmacokinetic curve to its minimum inhibitive concentration). Results of research have shown that concentration levels (C) (CPF in BS and AF for the given concrete patient are at one level, showing thus distinctions in dynamic behavior. Average value AUC(AF)\MIC (MIC - minimum inhibitive concentration) at patients II gr. has made 187,3 +/- 5,6 h that almost in 2 times more than necessary value, as has allowed not to recommend to patients increase in dose CPF. On the contrary, parity AUC(AF)/MIC at patients I gr. has made 43,8 +/- 3,6 h (less than 100 h) that it is not enough for therapeutic effect. Conclusions. The conducted research has allowed to make the conclusion that presence and ascites size make essential impact on pharmacokinetic parameters CPF and to recommend increase in dose CPF to 1000 mg/days for sick LC with sharply expressed ascites and safe nephritic function.

[Dynamics of antipirin test at patients with alcoholic liver disease on the background of metadoksin drug receiving].

AIM: To study the effect of the drug metadoxin on drug-metabolizing liver function in patients with liver lesions alcoholic etiology (ALD). MATERIALS AND METHODS: 36 patients with ALD, of which 16 patients were diagnosed with hepatitis, while 20 - with the liver cirrhosis. All the patients underwent biochemical blood analysis and the study of drug-metabolizing liver function according to the pharmacokinetics of antipyrine in saliva before and after treatment with metadoxin. Metadoxin was administered at a dose of 500 mg once a day for 28 days. Concentrations of antipyrine in saliva samples were determined by HPLC. RESULTS. It was shown that of 36 patients examined in the 28-patients with ALD (group 2) there was a significant decrease in activity of liver enzymes according to the test with antipyrine (T1/2 = 28.7 +/- 3.4, CL = 17,9 +/- 5.2; p < 0,01 vs normal), whereas in 8 patients (group 1) was noted the typical for alcohol inductive influence on the activity of liver monooxygenases (T1/2 = 7.8 +/- 1.5, CL = 39.1 +/- 6.8; p < 0,05 vs normal). As a result of the 28-day therapy with metadoxin was a normalization of the pharmacokinetic parameters of AP in Gr. 1 (12.6 +/- 1.8; p < 0.05; NS vs normal) and a significant improvement of it in patients of Gr. 2 (17.9 +/- 5.2, vs N, p <0.05). Biochemical markers of ALD (AST/ALT, GGT, ALP) also demonstrated a positive dynamics in patients of both study groups. Correlation analysis of changes in CL and GGT (r1) and changes in AST/ALT and T1/2 (r2) showed a fairly high degree of correlation between these parameters (r1 = 0.58, r2 = 0.65). CONCLUSION: The results showed marked improvement of drug-metabolizing liver function according to the test with antipyrine in patients with ALD after treatment with metadoxin.

[Pre-and probiotics effectiveness in intestine microbiocenosis correction in patients after hemicolectomy].

Normal microflora plays a key role in ensuring and maintaining the health of human body. Currently, much attention is paid not only to rational, but the so-called optimal, or health nutrition, which includes individual selection of food, the most satisfying human needs for energy, plastic and regulatory components. The aim of our study was to evaluate the effectiveness of pre-and probiotics in correction of the intestine microbiocenosis, effect on the rate of the hyperendotoxemia and related functional changes in the liver and lipid metabolism. In our study, we identified changesof the intestine microbiocenosis, which led to endotoxemia to develop, and the associated changes in liver enzymes and lipid blood composition in patients after various variants of the hemicolectomy. During treatment were selected 50 patients with dysbiosis 2 - 4-th degree who underwent hemicolectomy. In the 1st groupwere patients (25 pat.) with the prevailing complaints of constipation that were performed therapy with lactulose prebiotics (Dyufalak) at 20 - 30 ml per day for 3 months. In the 2nd group were patients (25 pat.) with complaints of diarrhea and was conducted therapy with bifiform probiotic in a daily dose to 2 capsules 2 times a day for 3 months. The results of studies performed after treatment showed that the admission of pro-and prebiotics in patients after hemicolectomy, has a high efficiency in micro biocenosis restoring and had a positive effect not only on bacterial composition of the microflora, but also on the functional state of the liver and lipid levels in patients serum.

[Characteristics of the intestinal dysbiosis and endotoxemia after hemicolectomy].

UNLABELLED: The normal intestinal microflora important for maintaining the optimum level of metabolic processes in the human body, the immune system, as well as to create a high colonization resistance against the pathogenic microbes. With aging, changes microbiocaenosis intestine, resulting in an increase in the total number of microbes in the gut and profound changes in the functional properties of microorganisms. Under physiological conditions, the main reservoir of endotoxin in the human body is the intestine. Endotoxins, penetrating through the intestinal mucosa, arrive first at the local (intestinal), and then through the portal system in the liver, are able to initiate it various lesions, including fatty degeneration of the parenchyma. OBJECTIVE: Based on clinical and laboratory studies to determine changes in gut microbiota and the level of endotoxemia in elderly patients in the remote period after undergoing surgery--hemicolectomy. RESULTS OF THE STUDY: Metabolic activity of microflora in the colon according to the concentrations of short chain fatty acids in the feces of elderly patients in distant periods after hemicolectomy revealed in various degrees of violation of the microbiota of the colon. Violation of gut microbiota leads to endotoxaemia, which has a toxic effect on liver function, level of endotoxin and protein that binds to endotoxin was significantly higher in patients who underwent left-sided hemicolectomy.

[Biochemical characteristics of operating bile composition in different types of cholecystolithiasis].

With a view to predicting the outcomes of surgical treatment of cholelithiasis, depending on the composition of concretions by high performance liquid chromatography was studied lipid composition and the spectrum of the operating bile acids in 10 patients with bile pigment cholelithiasis, 15--with cholesterol cholelithiasis, 15--with a combination of cholesterol cholelithiasis, and scab forms cholesterosis gallbladder, 6--to polypous-mesh form cholesterosis gallbladder. As a control, use the operating bile 6 patients with adenomatous and fibro-adenomatous polyps of the gallbladder. Based on the results of the study was proved the need for correction of biliary insufficiency in patients operated on for cholesterin associated pathology of the gallbladder. Spectrum of bile acids of operating bile helped justify holding litholytic therapy to prevent aggregation of bile.

[Fecal excretion of short-chain fatty acids as a marker of the severity of ulcerative colitis].

AIM: to determine the fecal excretion of short-chain fatty acids (SCFA) in patients with active ulcerative colitis (UC) depending on the duration, activity, and severity of the disease. SUBJECTS AND METHODS: The study enrolled 53 patients, including 9 patients with proctosigmoiditis, 18 with left-sided colitis, and 26 with total colonic lesion. The total levels of metabolites, the concentrations of acetic, propionic, and butyric acids in the feces were measured by gas liquid chromatography. RESULTS: Comparison of the excretion of bacterial metabolites with the clinical activity index (CAI) and the endoscopic activity index (EAI) revealed that the level of bacterial metabolites increased with an EAI of 21-30 scores and a CAI of 9-12 scores and then drastically decreased with excess of these values (a group of patients with total colonic lesion). With an EAI of less than 20 scores, the total level of metabolites was 8.91 +/- 1.027 mg/g. It rose steeply up to 17.12 +/- 1.55 mg/g in the activity range of 21 to 30 scores, but dropped up 5.291 +/- 0.916 mg/g when the EIA was more than 31 scores. The more severity of UC by the CAI resulted in a reduction in the total level of the metabolites from 12.84 +/- 2.039 to 5.114 +/- 1.186 mg/g. CONCLUSION: SCFA deficiency caused by impaired synthesis occurs only in severe total UC. In patients with UC, fecal SCFA excretion increases with the longer duration of an inflammatory process and with its higher activity.

[Pharmacokinetics of the proton pump inhibitors and psychological status in patients as factors that influence the efficiency of treatment of GERD with pantoprazole].

Was made an investigation of the effectiveness of pantoprazole (sanpraz, "SanFarma", India) at gastroesophageal reflux disease (GERD). 53 patients with GERD, including 20--with reflux esophagitis, received a daily dose of pantoprazole 40 mg to 28 days. To the 7 day of treatment heartburn was broke in 63.3%, regurgitation--in 65% of patients initially experiencing these symptoms. The 14-th day of treatment heartburn was broke in 83.7%, regurgitation--in 90%. Endoscopic remission in 28-th day of treatment was obtained in 85% of patients with reflux esophagitis. Broking of symptoms was accompanied by significant improvement in well-being and quality of life of patients. Treatment of a standard dose of pantoprazole was ineffective in 16.3% of patients. The reasons for the conservation of heartburn in 4.1% of the cases was an individual characteristics of the pharmacokinetics drug, in 12.2%--non-reflux mechanisms of symptoms in the face of mental status.

[Combination therapy of arterial hypertension combined with liver pathology. The place of angiotensin converting enzyme inhibitors].

It is necessary to take into account presence of concomitant pathology while prescribing hypotensive therapy to patients with arterial hypertension (AH). Hydrophilic angiotensin converting enzyme inhibitors (ACEI) (lisinopril) which are not metabolized in the liver are theoretically safest in liver cirrhosis. We have examined and treated 180 patients with AH and assessed efficacy and tolerability of ACEI lisinopril and enalapril with consideration of their pharmacokinetic peculiarities in patients with various severity of involvement of the liver (steatosis or cirrhosis). Advantage of hypotensive effect of lisinopril (which required no biotransformation in the liver) over enalapril based on its pharmacokinetic properties has been demonstrated.

[Metabolic activity of intestinal microflora and its role in determination of nutritional support tactic after gastrectomy].

Nutrition recommendations in symptoms of postgastrectomy syndroms is very different. The calculation of regimen using the parenteral and enteral alimentation may be established in the control test of definition of fecal short-chain fatty acids and microflora in such patients. Probiotics attach to the intestinal wall and protect it from the attacks of pathologic microorganisms. Probiotics are especially useful in the complex treatment of postgastrectomy syndroms.

[Pharmacokinetics of enalapril and metoprolol in hypertensive patients with hepatic pathology].

AIM: To examine characteristics of pharmacokinetics and pharmacodynamics of enalapril and metoprolol in hypertensive patients with gastrointestinal diseases to make relevant corrections in the treatment. MATERIAL AND METHODS: The study included 36 hypertensive patients with steatosis, hepatic cirrhosis and ulcer. All the patients received metoprolol or enalapril. Concentrations of metoprolol and enalaprilate (active enalapril metabolite) were determined with high performace liquid chromatography. The findings gave grounds for calculation of mean drug retention time (MRT) and area under curve "concentration-time" (AUC). Efficacy of the drugs was estimated by the data of 24-h blood pressure monitoring. RESULTS: Hypertensive patients with hepatic diseases given enalapril exhibited lowering of maximal concentration (C(max)) of enalaprilate and prolongation of time of its reaching (T(max)) compared to ulcer patients. MRT and AUC were increased in hepatic cirrhosis patients treated with enalapril and metoprolol. Metoprolol C(max) in this group of patients was higher than in the controls. Blood pressure monitoring showed that enalapril therapy was more effective in ulcer patients vs patients with liver diseases. Metoprolol treatment of hypertensive patients with hepatic cirrhosis resulted in development of bradycardia. CONCLUSION: In hypertensive patients with liver diseases on enalapril therapy its metabolite production may appear insufficient for therapeutic effect and higher dose may be needed. Metoprolol in the treatment of hypertensive patients with hepatic cirrhosis should be used with caution because of disturbance of its metabolism and possible cumulative effects.