Role of video capsulе endoscopy in the diagnostic algorithm of small bowel Crohn's disease.

AIM: To evaluate the possibilities of video capsule endoscopy (VCE) for diagnosing small bowel Crohn's disease (SBCD). MATERIALS AND METHODS: The study included 25 patients (12 men, 13 women) diagnosed with Crohn's disease. The mean age of the patients was 31.84±10.5 years. The VCE was performed using the GivenImaging system (Yokneam, Israel), OMOM (China). After the end of each test, the data was analyzed at a rate of 8 to 10 frames per second using Rapid® Reader (version 7.0). RESULTS: The examination of patients in accordance with the diagnostic algorithm showed that for 11 patients (44%) the clinical assumption of SBCD was confirmed only with the help of VCE (1st group). Consequently, the use of VCE in these patients was crucial in the diagnosis of SBCD, since standard methods of analisys were insufficient to establish this diagnosis. For 14 patients (2nd group), the diagnosis of SBCD was established with the help of colonoscopy and/or diagnostic imaging modalities. The use of VCE allowed to confirm the diagnosis, to clarify the localization and extent of inflammation of the small intestine. CONCLUSION: VCE can be recommended for the diagnosis of SBCD during the period of early inflammatory manifestations in the small intestine mucosa.

[Helminths detection with video capsule endoscopy].

The article describes clinical observations of helminthiasis detection in 18 of 208 patients during video capsule endoscopy (VCE). Indications for the appointment of VCE were complex clinical situations associated with the search for inflammatory diseases of the small intestine and sources of small intestine bleeding. Because of the high cost of VCE the diagnosis of parasitic diseases should be based on laboratory techniques in clinical practice. Only in case of anemia of unknown etiology VCE demonstrates high efficiency.

Binding of Mucin by E. coli from Human Gut.

Cells of E. coli isolates from the gut of healthy volunteers (N=5) and patients with Crohn's disease (N=5) and laboratory E. coli strain DH5α bound mucin in vitro in similar amounts ranging from 0.02 to 0.12 mg/mg of bacterial dry weight. Binding was evaluated by the decrease in optical absorption of mucin solution at 214 nm after incubation with bacteria. Detailed analysis of mucin binding by one of isolates showed that during incubation of 0.09 mg/ml bacteria in 0.15 M NaCl containing 0.1 mg/ml mucin at 25oC, maximum binding was reached in 30 min, while in the presence of 14 mM α-methyl mannoside, mucin binding decreased by 46% (p<0.05). Confocal microscopy revealed intensive binding of FITC-labeled mucin to the surface of a small number of bacterial cells. Mucin binding did not significantly affect zeta potential of bacteria and their energetic status assessed by ATP content; at the same time, ATP content in the extracellular environment slightly increased.

Is it necessary to use capsular endoscopy to diagnose celiac disease?

AIM: To clarify the indications for capsular endoscopy (CE) in patients with celiac disease. MATERIALS AND METHODS: The study included 10 patients with celiac disease (6 women, 4 men) aged 22 to 69 years. The median age was 42.4±17.5 years. The diagnosis of celiac disease established on the basis of histological examination of the mucous membrane (MM) of the duodenum and detection of antibodies to diaminononane peptide gliadin and to tissue transglutaminase. In three patients celiac disease was diagnosed for the first time, in others - in terms of 3 months to 2 years. CE was performed using a Given Imaging systems (Yokneam, Israel), Olympus (Japan), the obtained data were analyzed using Rapidr® Reade (version 7.0). The results of the endoscopy were compared with the data of 78 patients examined by us, in which the indicators conformed to the normal CE criteria. RESULTS: All patients with celiac disease showed characteristic endoscopic markers of atrophy from the small intestine: scallop, nodularity, decrease in height and number of folds. Paid attention to the mosaic of defeat in the form of "atrophy fields" against a background of slightly modified MM. Erosive-ulcerative lesions of the small intestine were found in 4 patients. CONCLUSION: Indications for the appointment of CE in patients with celiac disease is the lack of response to treatment, which is based on strict adherence to gluten-free diet, the assumption of erosive and ulcerative lesions MM of the small intestine and refractory form of the disease. CE makes it possible to establish the extent of atrophy from the small intestine, which allows you to use it to evaluate the effectiveness of treatment.

[All-Russian Consensus on Diagnosis and Treatment of Celiac Disease in Children and Adults]. / Vserossiiskii konsensus po diagnostike i lecheniyu tseliakii u detei i vzroslykh.

The paper presents the All-Russian consensus on the diagnosis and treatment of celiac disease in children and adults, which has been elaborated by leading experts, such as gastroenterologists and pediatricians of Russia on the basis of the existing Russian and international guidelines. The consensus approved at the 42nd Annual Scientific Session of the Central Research Institute of Gastroenterology on Principles of Evidence-Based Medicine into Clinical Practice (March 2-3, 2016). The consensus is intended for practitioners engaged in the management and treatment of patients with celiac disease. Evidence for the main provisions of the consensus was sought in electronic databases. In making recommendations, the main source was the publications included in the Cochrane Library, EMBASE, MEDLINE, and PubMed. The search depth was 10 years. Recommendations in the preliminary version were reviewed by independent experts. Voting was done by the Delphic polling system.

[Efficacy of adalimumab for Crohn's disease in real clinical practice]. / Effektivnost' adalimumaba pri bolezni Krona v real'noi klinicheskoi praktike.

AIM: To evaluate the efficacy and safety of adalimumab (ADA) in patients with Crohn's disease (CD) treated at the Department of Inflammatory Bowel Diseases, Moscow Clinical Research and Practical Center, and to determine the predictors of a therapy response. SUBJECTS AND METHODS: All the patients with CD treated with ADA were followed up for at least 6 months or until the drug was discontinued. Therapeutic effectiveness was evaluated at 4 weeks and 6 months after the initiation of treatment and at the end of a follow-up. Complete intestinal mucosal healing was assessed at 3 and 12 months following treatment initiation. Univariate and multivariate analyses were used to determine the predictors of treatment response. RESULTS: A clinical analysis covered 70 patients (57.1% male); the follow-up period averaged 112 weeks. Perianal fistulas were at baseline established in 22 (31.4%) patients with CD. 12 (17.4%) patients had been previously treated with infliximab (INF), 7 of them discontinued the drug for secondary loss of response and 5 for adverse reactions. 68 (97.1%) patients responded to an induction course of ADA. At 4 weeks, 6 months, and at the end of the follow-up, clinical remission occurred in 66.7, 80.4 and 67.4 % of patients with luminal CD and in 45.4, 36.5, and 36.4% of those with perianal CD, respectively. At 3 and 12 months and at the end of the follow-up, there was complete healing of the intestinal mucosa in 23.5, and 41.2 and 29.5% of cases, respectively. Six (8.8%) patients responding to the induction course needed to be optimized with ADA to 40 mg weekly. The time interval between treatment initiation and dose optimization averaged 30 weeks (range 12-120 months). There were 15 (21,4%) adverse events that were responsible for ADA discontinuation in 3 (4,2%) patients. CONCLUSION: The findings demonstrate the efficacy and safety of ADA used in clinical practice.

[Long-term infliximab therapy for ulcerative colitis in real clinical practice]. / Dlitel'naya terapiya yazvennogo kolita infliksimabom v real'noi klinicheskoi praktike.

AIM: to retrospectively evaluate the efficiency of long-term infliximab (INF) therapy in patients with refractory ulcerative colitis (UC). SUBJECTS AND METHODS: The investigation enrolled 48 patients with refractory UC who had taken IFL in 2008 to 2014. Steroid-dependent or steroid-refractory UC was established in 40 (83.3%) patients; 8 (16.7%) were noted to be refractory to therapy with azathioprine or 6-mercaptopurine. Cytomegalovirus DNA was identified in the biopsy specimens of the large intestinal mucosa (LIM) from 7 patients. One patient received antiviral therapy. Induction therapy with IFL was in its administration in a dose of 5 mg/kg at 0, 2, and 6 weeks, then maintenance therapy was continued every 8 weeks. RESULTS: After an IFL induction cycle, 3 (6.3%) patients were unresponsive to therapy and were excluded from the investigation. At present, 25 (55.5%) of the 45 patients who have responded to the therapy continue to take IFL 5 mg/kg every 8 weeks and are in clinical remission; 4 (8.8%) patients receive intensified IFL therapy. Initially 23 patients received combined therapy with IFL + an immunosuppressive drug; 22 had IFL monotherapy. Escape from the effect of the performed therapy was observed in 5 (11.1%) patients, which required its intensification. The intensified therapy resulted in sustained remission in 4 (8.8%) patients; colectomy was carried out in one (2.2%) case. Secondary loss of response to IFL, its intolerance, development of severe infectious complications, which did not allow for further maintenance therapy with IFL, were seen in 11 (24.4%) patients; 5 (11.1%) stopped the therapy because they had been excluded from the additional drug subsidy list. Maintenance therapy with IFL proved successful during 64 months in 29 (64.4%) of the 45 patients and during 64 months if its intensity, when the occasion required, was enhanced. CONCLUSION: The long-term use of IFL in UC confirmed its high efficacy in achieving clinical response, in inducing a clinical remission and its capacity to heal LIM, and in sustaining remission.

[Current principles in the screening, diagnosis, and therapy of colorectal cancer].

The data available in the literature on the prevalence of colorectal cancer (CRC), its risk factors and genetic aspects are analyzed. Basic screening tests and their diagnostic value are described. The paper indicates the importance of methods (colonoscopy, occult blood feces analysis, fecal immunochemical test, determination of molecular genetic profile of fecal enterocytes) for the early primary diagnosis of colonic epithelial tumors and techniques (echography, computed tomography, magnetic resonance imaging, positron emission tomography) that are required to specify clinical TNM staging and enable one to choose an optimal treatment policy for CRC patients owing to the estimation of tumor volume and to the diagnosis of reginal and distant metastases. It also shows that new screening methods based on the detection of molecular markers for early (premorphological) tumor stages are promising. The role of primary CRC prevention aimed at molding and maintaining a healthy lifestyle in the population is demonstrated.

[Celiac disease detection rate in gastroenterological patients].

AIM: To determine celiac disease detection rate in patients with digestive disease. SUBJECTS AND METHODS: A total of 318 gastroenterological patients admitted to be treated at the Central Research Institute of Gastroenterology in September to October 2012 were examined. The patients' age was 18 to 74 years (mean 51.5±16.4 years). Immunoglobulin A (IgA) and immunoglobulin G (IgG) anti-gliadin antibodies (AGA), IgA anti-tissue transglutaminase (anti-tTG) antibodies and IgG anti-tTG antibodies were determined. When the antibodies were elevated, esophagogastroduodenoscopy with duodenal biopsy was performed. RESULTS: Forty-one of the 318 patients were found to have higher AGA (12.9%); out of them IgA AGA were in 17 (5.35%) patients and IgG AGA were also in 17 (5.35%). Elevated levels of both antibodies (IgA AGA and IgG AGA) were seen in 7 (2.2%) patients. Overall, the detection rate of increased AGA levels was 12.9%. The antibodies were more commonly higher in patients with liver diseases (21.8%) and in those with inflammatory bowel diseases (21.6%). Both IgA anti-tTG, IgG anti-tTG and IgA AGA, IgG AGA were detected in 6 (1.9%) of the 318 patients. The diagnosis of celiac disease was verified by duodenal histological examination in 3 (0.94%) of the 318 patients. CONCLUSION: The celiac disease detection rate in gastroenterological patients was 0.94%.

[Video capsule endoscopy is one more step towards improving the diagnosis of small intestinal diseases]. / Videokapsul'naia éndoskopiia - eshche odin shag na puti sovershenstvovaniia diagnostiki boleznei tonkoi kishki.

AIM: To estimate the value of video capsule endoscopy (VCE) in the diagnosis of small intestine (SI) diseases.. SUBJECTS AND METHODS: A total of 134 patients, including 72 (53.7%) women and 62 (46.3%) men whose mean age was 41.48±9.33 years. Group 1 included 73 patients who were examined using an algorithm for the diagnosis of SI diseases, 61 patients underwent VCE by the referrals handed in other healthcare facilities. RESULTS: In the patients of Group 1, pathological SI changes were revealed by VCE by almost 4 times more frequently than in those of Group 2. VCE provides a possibility of establishing the sources of bleeding, Crohn's disease, and other inflammatory diseases, which are inaccessible to other diagnostic methods. SI arteriovenous malformations, polyps, and diverticula, parasitic infections, and nonsteroidal anti-inflammatory drug-associated enteropathy may be causes of obscure SI bleeding and anemia. In celiac disease, VCE may estimate the extent of SI mucosal atrophy and reveal its disintegration as erosions and ulcers, which are inherent in its refractory form. CONCLUSION: VCE is a highly informative method for examining the SI, but, in view of the specific features of its performance and the high cost of hardware, VCE is recommended to be performed in accordance with the proposed diagnostic algorithm.

[Common variable hypogammaglobulinemia: the author's observation].

The paper gives a case history of a patient with common variable hypogammaglobulinemia (CVHGG). Its clinical picture was characterized by frequent inflammatory airway diseases, pansinusitis, and periodic rises in temperature up to febrile ones. The diagnosis was established on the basis of the decreased serum concentrations of immunoglobulins (IG) A, M, and G, the unusual small intestinal (SI) wall relief created by large lymphoid follicles, as well as the characteristic sign of CVHGG, namely, the lack of plasma cells in the lamina propria of the SI mucosa. Antibacterial therapy was noted to have a good effect that confirmed the leading role of excessive bacterial growth in the pathogenesis of chronic diarrhea and fever, which are the major clinical manifestations of CVHGG in this patient.

[Small intestinal bacterial overgrowth as a cause of lactase deficiency].

AIM: To establish the rate of lactase deficiency (LD) in patients with post-infectious irritable bowel syndrome (PI-IBS), to define a role of enteric bacteria in the pathogenesis of hypolactasia, and to evaluate the efficiency of probiotic therapy. SUBJECTS AND METHODS: Examinations were made in 386 patients with PI-IBS, including 112 (79.4%) women; mean age 33.9 ± 9.1 years; disease duration 2.6 ± 1.4 years. Rapid tests of small intestinal mucosa (SIM) biopsy specimens obtained from the duodenal retrobulbar segment were used to diagnose LD. Bacterial growth was estimated by a hydrogen breath test using a H2 MICRO gas analyzer. RESULTS: The patients with PI-IBS were revealed to have moderate and severe LD in 25.6 and 10.9%, respectively. All the patients with LD were detected to have small intestinal (SI) bacterial overgrowth (BOG). An inverse correlation was found between LD and the degree of SI BOG (r = -0.53; p < 0.001). 73.7% of the patients with moderate LD showed a positive effect of probiotic therapy as regression of clinical symptoms of LD, a decrease of hydrogen levels in expired air from 72.4 ± 25.1 to 16.41 ± 3.2 ppm (p < 0.05), an increase of lactate activity in the SIM biopsy specimens and an improvement of quality of life from 2.69 ± 0.53 to 5.53 ± 0.64 scores according to the GCI scale. No improvement occurred in 73.8% of the patients with severe LD. CONCLUSION: LD was identified in 36.5% of the patients with PI-IBS. There was an inverse correlation between the degree of LD and SI BOG. The good therapeutic effect of probiotics in LD suggests that the symbiotic gut microflora positively affects the activity of lactase in the human SIM. No therapeutic effect of probiotics in patients with severe LN serves as the basis for a search for more active probiotic therapy.

[Holter monitoring data in children with gastroesophageal reflux disease].

The aim of research is to estimate the functional state of the cardiovascular system in children with gastroesophageal reflux disease (GERD) with the help of Holter monitoring. 117 children of school age were examined: 69 children with GERD and 48 children with chronic gastroduodenitis. All children passed esophagogastroduodenoscopy, 24-hour pH-monitoring, electrocardiography and Holter monitoring. According to Holter monitoring data it was revealed that children with GERD had increased low-frequency components of frequency domain analyses, increased number of nocturnal PVCs and increased time of enhanced dispertion periods. Holter monitoring in patients with GERD can be used to detect preclinical ectopic rhythm, to evaluate autonomic dysfunction by frequency domain analyses, to predict nocturnal symptoms.

[Gastroesophageal reflux disease in children: the role of endoscopy].

The article deals with the problem of modern diagnosis of gastroesophageal reflux disease in children with the use of modern techniques used in endoscopy. This article provides an analysis of the current literature on the efficacy of diagnosis of various manifestations of gastroesophageal reflux disease in children of different ages. The data on the benefits of the various diagnostic techniques and endoscopic techniques. Article illyustrirovavana endofotografiyami original authors.

[Clinical efficacy of functional nutrition in patients with gastrointestinal disorders].

AIM: To identify micronutrient deficiencies in patients with functional bowel diseases (FBD) and to reveal their correction with functional foods and probiotics. SUBJECTS AND METHODS: The health status was evaluated in 90 patients aged 18 to 67 years with FBD. All the patients were randomized into 3 groups according to the treatment regimen. Group 1 took Amaltea goat's milk 200 ml/day during basic therapy; Group 2 received multispecies and multistrain RioFlora Balance probiotics in addition to the above components; Group 3 (a control group) had traditional basic dietary therapy. All the groups continued their treatment for 14 days. RESULTS: The performed examinations have demonstrated that diet-based treatment fortified with goat's milk and multispecies probiotics makes it possible to more promptly achieve remission and to level off clinical manifestations than in the control group. The patients using multispecies probiotics versus the control group showed a reduction in fat-soluble vitamin deficiencies and a considerable improvement in quality of life. CONCLUSION: FBD lacks a specific clinical picture and may be masked as lactase deficiency, which commonly leads to noticeable limitations in patients' diet and favors the development of vitamin deficiency. Of particular concern is the development of vitamin D deficiency in young patients, which may result in the early development of osteoporosis in the future. To specify the composition of enzymes in the patients gives grounds to refuse restricted diets, and the dietary addition of functional foods (goat's milk fortified with vitamins and minerals), particularly in combination with multistrain probiotics, produces a pronounced clinical effect and eliminates fat-soluble vitamin deficiencies.

Pacemakers in extrahepatic biliary ducts.

Pacemaker cells in the biliary system were studied by using electromyographic and histological methods. The pacemaker cells of the duodenal-biliary complex are located in the bile duct (predominantly, in its proximal part). They are characterized with enhanced spontaneous spike and slow-wave electrical activity. The pacemaker cells organize the sequential motor activity of the proximal and distal portions of ductus choledochus, with subsequent involvement of the duodenum into this activity.

[Value of adhesion molecules for evaluating the efficiency of therapy for ulcerative colitis and Crohn's disease].

AIM: To define the value of adhesion molecules (sVCAM-1 integrin, P-selectin, E-selectin, and L-selectin) for the prediction and evaluation of the efficiency of treatment in patients with ulcerative colitis (UC) and Crohn's disease. SUBJECTS AND METHODS: Twenty-six patients with UC and 14 patients with CD were examined. Of them, 16 patients took infliximab (INF) in a dose of 5 mg/kg of body weight according to the standard scheme; 14 patients received cultured mesenchymal stem stromal cells (MSSCs) in a quantity of 150 x 10(8) cells, and 10 had azathioprine (AZA) 2 mg/kg and glucocorticosteroids (GCS) 1 mg/kg of body weight. Enzyme immunoassay was used to determine the serum concentration of the adhesion molecules (L-selectin, E-selectin, P-selectin, and sVCAM-1 integrin) before and 2 months after treatment. RESULTS: The signs of bowel inflammatory disease activity and the elevated levels of adhesion molecules whose synthesis did not occur under normal conditions remained in the patients receiving GCS and AZA. INF treatment caused a decrease in P-selectin, E-selectin, and sVCAM-1 levels to 8.9 +/- 1.0, 5.5 +/- 1.7, and 9.5 +/- 4.4 ng/ml, respectively (p < 0.001). Incorporation of MSSCs was followed by a reduction of the concentrations of P-selectin and E-selectin to 6.9 +/- 1.1 and 5.7 +/- 1.3 ng/ml, respectively (p < 0.001). The level of integrin (cVCAM-1) fell to 12.2 +/- 2.2 ng/ml (p > 0.1); that of L-selectin did not drop after MSSC administration and INF induction therapy. CONCLUSION: P-selectin, E-selectin, L-selectin, and sVCAM-1 integrin are current inflammatory markers and may be used to evaluate the efficiency of standard and biological therapies for inflammatory bowel diseases and to predict disease course.

[Combination biological therapy for fistular Crohn's disease: clinical demonstration].

Perianal fistulas are the most common and frequently encountered types of fistulas in Crohn's disease (CD). They are incurable, may worsen quality of life in a patient and increase the risk of total bowel resection. Despite the significant impact of biological (anticytokine) therapy for fistular CD, treatment in this category of patients remains a difficult task with the high risk of recurrent CD. Mesenchymal stromal cells (MSCs) having immunomodulatory properties and a great regenerative potential are currently also used to treat fistulas in CD and perianal fistulas of another etiology. The given clinical case demonstrates that complete fistula healing could be achieved only after a few local administrations of MSCs in combination with infliximab and azathioprine. World and our experiences indicate that there is a need for randomized controlled trials with a sufficient number of patients to prove the efficacy of MSCs in the combination therapy of fistulas in CD.

[Mesenteric inflammatory veno-occlusive disease is a rare nosological entity: Literature review and the authors' clinical observation].

Mesenteric inflammatory veno-occlusive disease (MIVOD) is a rare disease. Its basis is inflammation of the small and medium-sized mesenteric veins, which is generally complicated by thrombosis and intestinal ischemia. Arteries are not therewith involved in the process. According to the location, either ischemic jejunitis (ileitis) or segmental colitis develops. The etiology and incidence of MIVOD are unknown. Only a few tens of descriptions of clinical cases have been published. MIVOD is differentially diagnosed with Crohn's disease and vasculitides (Behçet's syndrome, Buerger's syndrome, rheumatoid arthritis, and systemic lupus erythematosus). The paper presents a MIVOD patient with partial thrombosis of portal, superior mesenteric and splenic veins, pylephlebitis, extrahepatic portal hypertension and with ischemic jejunitis complicated by fistulas, subcompensated stenosis, and seropurulent peritonitis. At laparotomy, an infiltrate with multiple interintestinal abscesses and a 40-cm jejunal segment with 4 fistular openings up to 1.5 cm in diameter and necrotic walls were removed and an interintestinal anastomosis was applied. A morphological examination of the operative material detected thrombi, stases, and pronounced plethora of the veins with fibrinoid changes in their walls. The lumen of arterial vessels of different diameters was free. No signs of systemic vasculitis and Crohn's disease were found. The postoperative period was uncomplicated.

[Clinicopathologic and endoscopic characteristics of chronic gastritis in flight personnel].

Surveyed 119 men in flight personnel. All were performed esophagogastroduodenoscopy and morphological study of biopsy material. Level of specific antibodies to Helicobacter pylorus (Hp) by enzyme immunoassay was determined, performed breathing Helika-test; Hp was determined by cytological method. Performed acidogastrometry. In 8 patients revealed erosive antral gastritis, 99--chronic gastritis, 12 patients have no stomach or duodenal ulcers. All patients with erosive gastritis were infected with Hp. antibodies to Hp were detected in all patients with chronic gastritis, and Helika-test and cytology for Hp were negative in 18.2% of patients in this group.