[Gallbladder polyps: modern approaches to diagnostics and treatment].

Gallbladder polyps are an elevation of the mucous membrane that protrudes into the lumen of the gallbladder cavity. Their prevalence in the general population varies from 0.3 to 13.8%. According to the modern classification, polyps of the gallbladder are divided into benign non-tumor, benign tumor and malignant tumor polyps. A review of modern literature presents cohort and randomized controlled trials, including those summarized in meta-analyzes and systematic reviews, suggesting that the dominant form of polypoid formations of the gallbladder are cholesterol pseudo-polyps with no malignant potential associated with impaired cholesterol metabolism, often combined with gallbladder cholesterosis, metabolic syndrome and cardiovascular morbidity. Evidence is building up on the effectiveness of ursodeoxycholic acid for controlling components of the metabolic syndrome and cardiovascular risks. Ursodeoxycholic acid preparations may become promising for the management of cholesterol polyps.

Effectiveness of mebeverine in patients with post-cholecystectomy gastrointestinal spasm: results of prospective observational program "odyssey".

AIM: To assess the effectiveness of mebeverine 200 mg BID in patients with post-cholecystectomy gastrointestinal spasm not requiring surgical treatment. MATERIALS AND METHODS: 218 patients were included in 16 clinical centers in 14 cities in Russia. All patients had post-cholecystectomy gastrointestinal spasms, not requiring surgical treatment and received mebeverine (Duspatalin®) 200 mg BID. The observational assessment period lasted from the moment of their inclusion into the study up to 6 weeks post inlusion. The therapy results were evaluated using visual analog scales (GPA and 11-point numeric rating scale) by patient self-assessment of the dynamics of spasm/discomfort and other post-cholecystectomic gastrointestinal symptoms after 2 and 6 weeks of treatment. Gastrointestinal Quality of Life Index (GIQLI) was used to assess patient quality of life. RESULTS: All 218 patients completed the 2-week mebeverine treatment course, 101 of them finished the 6-week course ("prolonged population"). Significant positive changes in the relief of abdominal pain and dyspepsia were noted as well as normalization of stool frequency and consistency. A more marked change in values was observed during prolonged (up to 6 weeks) therapy. Both 2-week and 6-week mebeverine courses led to a normalization of patient quality of life. After 6 week therapy, an effect of mebeverine on the quality of life 91% of patients was observed comparable to cholecystectomy itself, speficially related to the quality of life subscore 'symptoms'. CONCLUSION: The results of our study demonstrate that mebeverine (Duspatalin®) therapy leads to an effective elimination of clinical symptoms associated with post-cholecystectomy GI-spasm disorders, like abdominal pain, symptoms of dyspepsia and stooldisorders. A more marked change in values was observed during prolonged (up to 6 weeks) therapy.

A new look at dietary fibers in metabolic syndrome.

Metabolic syndrome (MS) is a cluster of factors associated with high risk of initiation of cardiovascular diseases, of diabetes of the 2nd type, total and cardiovascular mortality. The prevalence of MS in the general population averages 10-25%, varying depending on the region of the world from 3 to 71.7%. Two recent large meta-analysis found an inverse relationship between risk of MS and consumption of dietary fiber. Great prospects have dietary fiber for the maintenance of individual MS components. The review of modern literature presents cohort studies and randomized controlled trials, including generalized meta-analyses and systematic reviews, indicating the impact of soluble high-viscosity gel-forming, non-fermentable dietary fiber-psyllium on the weight of visceral fat, achieving metabolic control, including correction of disorders of carbohydrate, lipid, purine metabolism and regulation of blood pressure.

[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.

[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.

[ESPECIALLY CHRONIC RHINOSINUSITIS ASSOCIATED WITH GASTROESOPHAGEAL REFLUX DISEASE].

OBJECTIVE: to study the clinical and laboratory features of chronic rhinosinusitis (CRS) associated with gastroesophageal reflux disease (GERD). MATERIALS AND METHODS: The study involved 87 patients with complaints of difficulty in nasal breathing and 30 healthy volunteers with no pathology ENT and GERD. The diagnosis of CRS met the criteria EPOS 2012. Diagnosis of GERD was performed based on the recommendations of the Montreal consensus. All investigated conducted a survey for the presence of esophageal and extraesophageal manifestations of GERD, fibroesophagogastroduodenoscopy, LOR examination with the use of endoscopes, rhinoscopy, laryngoscopy, computed tomography of the paranasal sinuses, pH-metry mucous secretions of the nose and pharynx using visual test - strips, microbiological examination of discharge from the middle of the nose stroke. Association of CRS with GERD with GERD compared with impaired nasal breathing inflammatory and non-inflammatory genesis in the absence of GERD and healthy volunteers accompanied by a large variety and frequency of symptoms, endoscopic signs of laryngitis back, reducing the pH of the pharynx, the change in quantitative and qualitative characteristics of the microflora of the nasal mucosa and paranasal sinuses.

[pH values in the pharynx of the patients presenting with compromised nasal breathing of inflammatory and non-inflammatory genesis concomitant with gastroesophageal reflux disease].

The objective of the present study was to estimate the influence of gastroesophageal reflux disease (GERD) on the pH values in the pharynx and nose. It included 87 patients at the age varying from 18 to 81 years admitted to the Irkutsk-based Railway Clinical Hospital and allocated to four groups. Group 1 was comprised of 25 patients presenting with gastroesophageal reflux disease and chronic rhinosinusitis (CRS), group 2 consisted of 29 patients with CRS in the absence of GERD, group 3 included 22 patients with nasal septum deformations (NSD) and GERD, group 4 included 11 patients with NSD and motor rhinitis without GERD. The control group was formed from 10 volunteers. pH was measured by the contact method with the use ofEkokhim indicator paper. Gastroesophageal reflux disease was diagnosed following the recommendations of the Montreal consensus. It was shown that pH values in the pharynx of the patients with compromised nasal breathing of any origin in combination with GERD were lower than in the absence of GERD and in the healthy volunteers. The study groups did not differ in terms of pH values in the nasal cavity. It is concluded that pH values 4 or lower may serve as the criterion for pharyngo-laryngeal reflux (PLR) concomitant with HERD while pH 5 occurs more frequently in the patients with compromised nasal breathing of any etiology, regardless of the presence or absence of GERD.Disordered nasal breathing of any genesis in the patients presenting with gastroesophageal reflux disease was associated with the feeling of the lump in the throat, congestion of the respiratory tract and the nose, pain in the ears, cardialgia, and irregular heartbeat. It isrecommended to use pH measurements as a criterion for diagnostics of pharyngo-laryngeal reflux in the patients presenting with gastroesophageal reflux disease.

[STUDY OF THE VARIABILITY OF THE CARDIAC RHYTHM IN RAILROAD EMPLOYEES, WHO SUFFER BY STOMACH ULCER AND DUODENUM, ASSOCIATED AND NONASSOCIATED WITH THE INFECTION HELICOBACTER PYLORI].

AIM OF INVESTIGATION: To estimate the Heart rate variability (HRV), by the method of daily kholterovskogo monitoring in the workers of rail transport (RT). MATERIALS AND METHODS: A total of 93 persons working in the East Siberian Railway. The main group (CG) consisted of 27 patients with gastric ulcer (GU) and duodenal ulcer (DU) contamination without Helicobacter infection. The first group of clinical comparison (GCS 1) included 36 patients with gastric ulcer and duodenal with contamination of infection H. pylori. The second group of clinical comparison (GCS 2) consisted of 30 employees VT held preventive medical examination, without contamination of Helicobacter infection is not suffering from gastric ulcer and duodenum. RESULTS: With the analysis of spectral and time characteristics HRV in Haug is revealed the explicit displacement of vegetative homeostasis with the prevalence of the sympathetic component of regulation, which is restored against the background of treatment. Meanwhile in GKS1 the indices of vegetative regulation had parasympathetic directivity, they were more close to the standard and did not change after conducting of the eradikatsionnoy therapy. CONCLUSION: The greatest unbalance of sympathetic and parasympathetic nervous system is observed in patients, workers (RT), who suffer SU and UD in the absence of the contamination of H. pylori. The use of a method of study VCR in the conditions of the absence of H. pylori infection can make it possible to form the group of risk of development SU and UD in workers RT.

[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.

[Antiplatelet therapy with acetylsalicylic acid: approaches to reducing the frequency of gastrointenstinal adverse reactions].

Acetylsalicylic acid (ASA) is highly effective in preventing cardiovascular events, but associated with increased risk for digestive adverse reactions. The paper provides an update on the epidemiology, mechanisms, and risk factors of esophagogastroduodeno- and enteropathies during long-term low-dose ACA therapy. It outlines the key principles of their prevention.

[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.

[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.

[Using gaviscon preparation for relief of esophageal, extraesophageal syndromes and functional dyspepsia in elderly patients with GERD].

OBJECTIVE: To compare the clinical efficacy of alginate drug Geviskon and aluminum-magnesium antacids to relieve symptoms of esophageal, extraesophageal syndrome and functional dyspepsia at 3 and 7 days of study in patients with GERD elderly. MATERIALS AND METHODS: An open, longitudinal, randomized, parallel-group. The study included 60 patients with "A" degree of ERD, consistently received in-patient treatment in the Municipal KGVV, mean age 79.0 +/- 6.8 years. During the first 12 hours of hospital stay by "sealed envelopes" them randomly divided into equal groups of comparison, given 3 times a day: alginate product--Geviskon forte dose of 10 ml and aluminum-magnesium antacid drug at a dose of 1 sachet. Assess the frequency and severity of esophageal symptoms, extraesophageal syndrome, functional dyspepsia at 3 and 7 days of study on 5-point scale Likert. The degree of esophageal mucosal injury was determined during endoscopy before the study. RESULTS: The technique of alginate compared with antacids provided significantly more complete and earlier effect on the relief of heartburn, regurgitation, chronic cough, sore throat, and EBS. Only Geviskon influenced the symptoms of PPD in patients with GERD. CONCLUSION: The clinical features Geviskon the frequency and timing of relief of symptoms of esophageal, extraesophageal syndrome, functional dyspepsia with GERD in the older age groups is higher than that of antacids. Suspension Geviskon may be recommended in patients with middle and old age as an effective and safe symptomatic funds in the first days of exchange rate earlier generations of PPI therapy, as well as monotherapy--to maintain remission.

[Drug UDCA (Ursosan) in therapeutic management of patients Barrett's esophagus].

OBJECTIVE: to evaluate the five-year prospective study the possibility of using the drug UDCA (Ursosan) for the therapeutic management of patients with BE older. MATERIALS AND METHODS: A prospective open randomized, parallel-group 62 patients of BE with a length of metaplasia less than 3 cm in average age 72.8 +/- 2.8 years. Method of "sealed envelopes" were divided into two equal groups. Patients first--received omeprazole at a daily dose of 40 mg, the second--to combine the same dose of omeprazole drug-Ursosan a daily dose of 10 mg/kg. At baseline and after 4.8+1.2 years assessed the frequency of esophageal, extraesophageal and dyspeptic complaints, endoscopic and morphological pattern of esophageal-gastric junction and lower third of the esophagus. Confirm or exclude the diagnosis of BE during follow-up study was performed after a two-fold endoscopy upper GIT using subdivision techniques for sampling biopsy material and subsequent analysis of biopsy samples pathomorphology of various medical institutions. RESULTS: The combination therapy with omeprazole and drug UDCA contributed to the positive dynamics is the lack of intestinal metaplasia in 32.3% of patients with Barrett's esophagus, whereas monotherapy with omeprazole in a daily dose of 40 mg possible to achieve a similar result in 6.5% of patients (p = 0,01). The frequency of diagnosis of erosive esophagitis decreased after 5 years of therapy with 80.6% to 51.6% (p = 0.016) in the omeprazole group and 86.7% to 16.7% (p < 0.001) in the group receiving omeprazole and the preparation of UDCA. CONCLUSION: This study suggests the possibility of combined therapy with omeprazole and the preparation of UDCA (Ursosan) as a promising means for hemopreventciya Barrett's esophagus in the elderly.