[Disorders of gut microflora in the pathogenesis of liver cirrhosis and complications of portal hypertension].

A total of 85 patients with alcoholic and viral cirrhosis were included in study to assess the prevalence of dysbiosis and its relationship with the severity of disease, and with development of dyspeptic disorders. Intestinal bacterial over-growth was measured by means of a lactulose breath test, fecal flora was cultured under aerobic and anaerobic conditions. Intestinal bacterial overgrowth and colon dysbiosis were determined in 82.4% of patients with equal prevalence in alcoholic and viral cirrhosis. Intestinal dysbiosis was found to be risk factor of increasing cirrhosis severity and liver dysfunction, as well as development of complications of portal hypertension. It was documented, that intestinal dyspepsia syndrome in cirrhotic patients is strongly associated with the presence of gut microflora disorders.

[The clinical manifestations and duodenal mucosa in the patients with chronic pancreatitis and bacterial overgrowth in the small intestine].

The current study was designed to test the role of bacterial overgrowth in the small intestine in the pathogenesis of chronic pancreatitis. It was established that the bacterial overgrowth in the small intestine is noted in the majority of patients with chronic pancreatitis. We found an association between clinical manifestations of chronic pancreatitis, active duodenitis, duodenal lymphangiectasia and papillitis and bacterial overgrowth in the small intestine.

[Meteospazmil for correction of motor disorders in functional colon diseases].

This article describes meteospazmil clinical effectiveness in problem of abdominal pain syndrome and flatulence reduction at IBS and gastrointestinal diseases that are attended with secondary colon motor disorders.

[The use of bismuth tripotassium dicitrate (De-Nol), a promising line of pathogenetic therapy for irritated bowel syndrome with diarrhea].

The aim of the study was to assess the expediency of prescription and efficiency of bismuth tri-potassium di-citrate in different therapeutic schemes for the management of irritable bowel syndrome (IBS) dominated by diarrhea. The open prospective study of de-nol efficacy and safety included 30 patients with this disorder allocated to 2 groups. Patients of the main group (n=20) were given 120 mg of de-nol thrice daily in combination with meteospasmyl (a spasmolytic and antifoaming agent). Control patients (n=10) received aluminium phosphate with meteospasmyl (1 capsule thrice daily). Duration of the treatment was 3 weeks. Therapeutic efficiency was assessed from the dynamics of abdominal pain syndrome, stool frequency, properties of faeces, results of their microscopic and microbiological studies, lactulose breath hydrogen test, rectoromanoscopy with rectal mucosal biopsy, and hepatic biochemical test. Before the study, all patients had abdominal pain, diarrhea, meteorism, altered composition of fecal bacteria, their excessive growth in the intestines, and morphological signs of chronic inflammation. Bacterial activity was recorded in 80 and 40% of the patients of the respective groups. By the end of therapy, abdominal pain was eliminated in 90 and 60%, meteorism was absent in 80 and 40%, diarrhea in 75 and 50%, excessive bacterial growth in small intestine in 75 and 30%, changes of fecal microflora persisted in 20 and 70%, histological signs of active mucosal inflammation remained in 40 and 85.7% of the patients of the main and control groups respectively. It is concluded that all patients with irritable bowel syndrome and diarrhea show altered composition of intestinal microflora, morphological signs of moderate chronic inflammation of intestinal mucosa. Most of them have apparent bacterial activity. Treatment with de-nol and spasmolytics for 3 weeks effectively eliminated clinical manifestations of the disease, restored normal composition of intestinal microflora, normalized faeces properties, and resolved active inflammation.

[Effects of probiotic bifiform on efficacy of Helicobacter pylori infection treatment].

AIM: To study effects of the probiotic bifiform on efficacy of Helicobacter pylori (HP) eradication in patients with chronic gastritis and ulcer disease. MATERIAL AND METHODS: A total of 98 patients with verified HP infection were divided into two groups. The study group received a week three-component anti-HP therapy+a probiotic. The control group received the same treatment without the probiotic. All the patients were tested for HP before the treatment and one month after the end of the treatment. Cell composition of duodenal mucosa (DM), tissue proinflammatory cytokines, secretory immunoglobulin A (sIgA) in coprofiltrates, serum IgA, IgM, IgG, phagocytic parameters and copromicrobiology were studied. RESULTS: HP eradication rate in the study group was higher than in the control group (89.1 vs 63.5, respectively, p < 0.05). After the treatment, patients of the study group had lower rates of side effects, impaired intestinal biocenosis, tissue cytokines levels but higher concentration of plasmatic cells in CO and cIgA in coprofiltrates. CONCLUSION: The addition of probiotic bifiform to the standard three-component antihelicobacter scheme of the treatment raises its efficacy and is promising treatment of HP. Mechanisms of a potentiating action of the probiotic are related to enhancement of antibacterial activity of local immune reactions.

[Effect of H2-blockers and proton pump inhibitors on intragastric acidity and intraesophageal pH in patients with gastroesophageal reflux disease]. / Vliianie H2-blokatorov i ingibitorov protonnoi pompy na intragastral'nuiu kislotnost' i intrapishchevodnyi pH u bol'nykh gastroézofageal'noi refliuksnoi bolezn'iu.

We investigated 53 patients with GORD symptoms and a various grade (A-C according to the Los Angeles classification) of reflux oesophagitis diagnosed in the course of upper endoscopy. By using 24-hour gastric and esophageal pH-metry we investigated the antisecretory effect of single-dose morning or evening administration of famotidine, omeprazole and rabeprazole. We revealed essential superiority of single-dose morning omeprazole and rabeprazole administration in daily gastric acid release suppression and gastro-esophageal reflux prevention as compared with morning famotidine and evening omeprazole and rabeprazole administration in GORD patients.

[Methods to optimize the management of Helicobacter pylori infection. The comparative efficacy of the triple and quadruple therapy used as a first line therapy]. / Puti optimizatsii lecheniia Helicobacter pylori-infektsii. Sravnitel'naia éffektivnost' troinoi i kvadroterapii, ispol'zuemykh v kachestve skhem pervoi linii.

The study involved a dynamic comparative efficacy survey of the standard triple and quadruple therapies recommended by the Maastricht Consensus as first line therapies for eradication of Helicobacter pylori infection with the time period of 5 years. The study included 199 Hp-positive patients with stomach ulcer; 101 of them were under examination in 1997 and 98 in 2002. Depending on the therapy type, patients were assigned to one of two groups: the OCM/A group (48 and 53 patients in 1997 and 2002, respectively) was treated with Omeprazole, Clarithromycin and Metronidazole for 7 days and ODTM group (46 and 52 patients in 1997 and 2002, correspondingly) was treated with Omeprazole, De-Nol, Tetracycline and Metronidazole. To discover and confirm Hp eradication, cytological, histological and rapid urease tests were used. Hp eradication was considered as successful when all the tests were negative. The eradication frequency was assessed with the help of ITT and PP analyses. In the OCM/A group Hp was eradicated in 81.3% and 62.3% (p<0.05) of patients when analyzed by the intention-to-treat and in 88.6% and 66.0% (p<0.01) of patients when analyzed by per-protocol in 1997 and 2002, respectively. In the ODTM group Helicobacter pylori was eradicated in 89.1% and 88.5% (p<0.05) of patients when analyzed by intention-to-treat and 95.3% and 93.9% (p<0.05) when analyzed by per-protocol in 1997 and 2002, respectively. The frequency of ulcer cicatrisation and cuticularization of erosions did not depend on the type of the treatment. There was no significant difference between the compliance and side effects of the triple and quadruple therapies. Taking into account the decrease in the efficacy of the triple anti-Hp therapy, the need to use the quadruple therapy as a first line therapy for Hp infection eradication was substantiated.

[Current methods of ulcer therapy and their efficacy and cost]. / Sovremennye metody terapii iazvennoi bolezni, ikh éffektivnost' i stoimost'.

The purpose of this study is to assess the efficiency of the anti-ulcer therapy taking into account the economic aspects of treatment. We have examined 708 HP-positive(+) patients with stomach ulcers (SU) and duodenal ulcers (DU). Various schemes of anti-helicobacter and anti-secretory therapy were administered to them. Positive dynamics of some clinical data (local palpatory tenderness and abdominal wall resistance) and gastritis (gastroduodenitis) activity was discovered in all groups of patients. The cost of the treatment was determined with the help of marketing studies by taking the lowest price of drugs. There were no statistically reliable differences found groups of traditional treatment regimens by both results of HP eradication and the cost of eradicative and anti-secretory therapy. All drugs under study are highly effective for rapid relief of symptoms at an exacerbation of stomach ulcer associated with HP as well as the decrease of gastritis (gastroduodenitis) activity. It is possible to recommend them for both eradicative therapy and prolonged treatment.

[Status of the upper parts of the digestive tract and Helicobacter pylori infections in patients with chronic kidney failure after kidney transplantation]. / Sostoianie verkhnikh otdelov pishchevaritel'nogo trakta i Helicobacter pylori-infektsiia u bol'nykh khronicheskoi pochechnoi nedostatochnost'iu posle transplantatstii pochki.

The purpose of the study was to examine the state of upper parts of the digestive tract, prevalence of Helicobacter pylori infection and its relation to the pathology revealed in patients with chronic renal insufficiency after kidney transplantation.

[The effectiveness of 7-day combined Helicobacter eradication therapy in patients with peptic ulcer and chronic gastritis]. / Effektivnost' semidnevnogo kombinirovannogo kursa éradikatsionnoi gelikobakternoi terapii u bol'nykh iazvennoi bolezn'iu i khronicheskim gastritom.

Epidemiological and clinical findings suggest that the spread of Helicobacter pylori (H.p.) infection as an etiological and pathogenetic agent is of prime importance for patients with pelvic ulcer and chronic gastritis. However, there are relatively scanty papers on the impact of therapy against H.p. on its eradication rate, symptom arrest, and the course of diseases. A great deal of drug combinations have been proposed to eradicate H.p. infection and some of them are even classical (omeprazole in combination with 2-3 antibiotics). The H.p. eradication with this combination for 7 days is as high as 85-90%. These regimens are recommended for practical application in Europe and Russia. The authors' studies in 90 patients (34 with duodenal ulcers, 34 with gastric ulcers, and 28 with chronic duodenitis) indicate that lansofed used in 7-day combined therapy is highly effective in suppressing acid production, abolishing symptoms during an exacerbation of peptic ulcer (gastroduodenitis) and in eradicating H.p. infection. There is evidence for that the use of the agent in combination with 2 and 3 anti-H.p. drugs rapidly arrest the symptoms of a disease, frequently diminishes an inflammatory process and lead to a remission.

[Stages in the improvement of drug therapy at a polyclinic]. / Etapy sovershenstvovaniia medikamentoznoi terapii v usloviiakh polikliniki.

Within 1968-1997 the authors studied the steps of introduction of the achievements of the medical science, technology and pharmacology to therapy of exacerbations and complications of peptic ulcer (PU). The scientific and practical value of endoscopic, histological, biochemical and bacteriological examinations in the improvement of the methods of pharmacotherapy of exacerbations and complications of PU was shown. Three phases of the PU development were indicated by the clinical signs and results of esophagogastroduodenoscopy, target biopsy and histological examinations. These data and available scientific achievements were assumed as a basis for the design of optimal drug combinations and their introduction to the medical practice. The use of such combinations made it possible to prevent relapses and life-threatening complications of the disease in the overwhelming majority of the patients. The best results of the pharmacotherapy were recorded in the years (1988-1997) when the drug combinations began to be used. The combinations provided eradication of Helicobacter pylori in the gastroduodenal mucosa and it was proved that in all the patients with PU and the relapsing lesions in the duodenum and in the overwhelming majority of the patients with gastric ulcer the disease developed at the background of chronic active gastroduodenitis associated with H.pylori. The success of the pharmacotherapy in the patients with PU was due to the use of the rational combinations of antibacterial and antisecretory agents.