[Clinical and pathogenetic features of esophageal spasm].

AIM: To comparatively analyze clinical manifestations in patients with primary esophageal spasm (ES) and its concurrence with gastroesophageal reflux disease (GERD) and the results of their instrumental examinations and psychodiagnostic tests. SUBJECTS AND METHODS: A total of 104 patients with the clinical and manometric signs of ES were examined and divided into two groups: 1) 42 patients with primary ES; 2) 62 patients with ES concurrent with GERD. The examination encompassed esophageal manometry, esophagogastroduodenoscopy, 24-hour pH metry, and an interview using a questionnaire to identify autonomic disorders, and the Mini-Mult test. RESULTS: The patients with primary ES compared to those with ES concurrent with GERD significantly more frequently showed severe pain syndrome (p = 0.009) and a paradoxical dysphagia pattern (p = 0.03); manometry revealed an incoordination in the motility of the entire esophagus (p = 0.001). Comparison of the statistical series of values for contraction amplitude and duration in the distal esophagus found no significant difference in the patients of both groups. Autonomic disturbances were detected in 76.0% of the patients with ES; but the intergroup differences were insignificant. Mental maladaptation was observed in 81.7% of the patients in the absence of intergroup differences. CONCLUSION: The etiopathogenetic factor of ES is a psychoautonomic response to chronic stress in both primary ES and its concurrence with GERD. The reflux of gastric contents into the esophagus does not appear to be one of the leading causes of ES. In primary ES, esophageal motor function is generally impaired to a much greater extent than that in ES concurrent with GERD. The degree of motor disorders is embodied in the specific clinical features of the disease.

[Nutricional support in the complex treatment of a patient with esophageal spasm].

In the presented clinical case the theme of the need for an integrated therapeutic intervention has been disclosed, including nutritional support on the various links of the pathogenesis of esophagospasm to the effectiveness of the patient's treatment.

[Psychological respond to the disease and treatment devotion].

THE PURPOSE OF THE STUDY: To evaluate the degree of adherence to treatment in comparison with the psychological reactions to the disease in patients with chronic diseases of the digestive system. MATERIAL AND METHODS: We examined 106 patients with chronic diseases of the upper gastrointestinal tract. Psychological reactions to the disease were studied using personality questionnaires of the Bekhterev Institute (the St. Petersburg V.M. Bekhterev Psychoneurological Research Institute), adherence to treatment--using a specially designed questionnaire. 52 patients were polled again at 6 months after discharge from hospital. RESULTS: High adherence was diagnosed in 47.2%, satisfactory--in 44.3%, and lower--in 8.5% of cases. Hypernosognosia reaction to the disease in patients with low levels of compliance were more frequent than in patients with a high level of compliance (77.8 and 12.0%, respectively). The obtained result suggests that excessive emotional tension, high levels of anxiety and the stress response prevent adequate inclusion of patients in the treatment process. A similar situation persists in 6 months after discharge from hospital. This is confirmed by clinical observations indicating that this type of reaction to a disease peculiar to the mature person who knows how to extract the experience of adverse life situations. CONCLUSIONS: The results confirm the absence of an adequate level of adherence to treatment in patients with chronic diseases of the digestive system. In particular this applies to patients with inadequate emotional response to diseases. In this regard, in terms of improving adherence increases the importance of timely diagnosis of anxiety and depression with subsequent correction of the violations.

[Dysmotility of the esophagus in patients after stomach resection].

The aim of the work was to evaluate the esophageal motility in patients after distal gastrectomy of different sizes. It was found that in patients after gastrectomy with erosive and ulcerative lesions of the esophagus innofective esophageal motility often registered and this correlates with the reduction clearance indicator of the esophagus according to the pH-impedance monitoring.

[Diagnostic criterion for anorexia nervosa].

Article presents a case of anorexia in 29 years old patient. Described the clinical symptoms of anorexia, the manifestations of the disease in patient; the premorbid characteristics of personality, the formation of which influences on relationships with parents.

[Endoscopic negative GERD: psychogenic nature of somatic complaints].

The aim is to study the characteristics of the operation of psychological defenses in patients with endoscopically negative gastroesophageal reflux disease. On the example of a survey of 60 patients showed that the actual mental status of patients, being an inpatient at the endoscopically negative GERD, characterized by a high degree of neuroticism in comparison with GERD patients under reflux esophagitis. This fact is considered in terms of imperfect mental protection, among which the most common in these patients is the suppression of the negative emotional experiences. As one of the possible causes of resistance to therapy is considered the psychological phenomenon of "secondary gain from illness".

[Adherence to treatment patients with the digestive system chronic diseases].

The purpose of study is to expand notions of personal factors of adherence to treatment chronic diseases of digestive system. The article presents data on the patients accuracy of performing medical recommendations on pre-hospital and in the delayed period. Analyzed the influence of socio-demographic characteristics (gender, age, educational level), the characteristics of the disease (duration of history, the frequency of hospitalizations, complications) to the compliance of patients. The psychological aspect of the formation of adherence to treatment was considered in the interactions of personality and disease. Was underlined the role of the doctor's deontological work aimed on the involving of the personality of patient in therapeutic process as an active subject of the therapeutic interaction.

[Treatment of tobacco dependence in patients with chronic diseases of digestive system].

The purpose of this study was to increase the effectiveness of tobacco control by improving the treatment of tobacco dependence. The article presents the data results of different methods of treatments of tobacco dependence among 135 patients with digestive diseases. As the most effective is a comprehensive approach combining psychotherapy and physiotherapy methods is designated. The possible reasons of due treatment effect absence are separately analysed: a sharp severity of tobacco withdrawal syndrome, inadequate primary motivation of smoking refusal, premorbid personality characteristics, a pathological variant of response to disease.

[Restoration of the quality of life by eliminating and prevention of heartburn by alginate: results of multicenter study "VIA APIA"].

Was conducted a muIticenter study VIA APIA, in which the impact of gaviscon forte (suspension) on symptoms, general state and quality of life of 148 patients (male 53, female 95, age 42.9 +/- 15.6) with gastroesophageal reflux disease (GERD) were investigated. The patients had undergone clinical evaluation of dynamics of GERD symptoms (Likert scale), general state (Visual Analogue Scale, questionnaire SAN) and quality of life (SF-36). It was shown that 14-days treatment with gaviscon forte provided symptoms relief in 84.5% patients and conducted improvement of general state and quality of life. Gaviscon forte recommended as drug of choice in initial treatment for the first time visited patient with heartburn before endoscopy and for pathogenetic treatment of typical reflux syndrome.

[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.

[Smoking in elderly patients with chronic diseases of the digestive system].

The purpose of this study was to examine the features of smoking in elderly patients with chronic diseases of the digestive system. Results are based on an analysis of 762 questionnaires of patients were receiving hospital treatment in the Central Research Institute of Gastroenterology. The article presents data on the frequency and intensity of smoking in patients with digestive diseases in the age and gender. To increase the effectiveness of tobacco dependence treatment in elderly patients suggested treatment strategy targeting the early stages to reduce the daily dose of nicotine, rather than a one-time and full cessation of smoking tobacco.

[Diagnostic value of alginate test in gastroesophageal reflux disease].

AIM OF STUDY: To evaluate the diagnostic accuracy of single dose of gaviscon (the alginates test) in detecting gastroesophageal reflux disease (GERD) in patients with heartburn symptoms. MATERIAL AND METHODS: 123 patients (male 46, female 77, age 43.6 +/- 15.5 years) with symptoms suggestive of GERD were investigated. Symptom response to the alginates test compared in GERD positive and GERD negative patients according traditional diagnostic criteria of GERD (upper endoscopy, 24-hr pH-monitoring, esophageal manometry, response to treatment with PPIs). RESULTS: Of 91 (78.9%) patients with positive alginates test, 87 were classified as GERD positive and 4 as GERD negative. Of 32 (26%) patients with negative alginates test, 29 were GERD negative and 3 GERD positive. The results providing a sensitivity of alginates test of 96.7% and a specificity of 87.7%. CONCLUSIONS: The alginates test is sensitive and specific for diagnosing GERD in patients with typical GERD symptoms.

[Cardial achalasia in a 77-year-old man].

In the article the case of achalasia of cardia and diagnostic algorithm of this pathology are presented.

[Complex treatment of tobacco dependence by means of psychotherapeutic correction in combination with mesodiencephalic modulation in patients with chronic diseases of digestive organs].

This paper deals with the problem of tobacco dependence and its medical treatment. Various methods available for this purpose are considered with special reference to their clinical efficiency. A scheme for combined treatment of the given pathology is proposed.

[Evaluation of action, efficacy, and onset dynamics of a single dose of alginates in patients with heartburn and GERD].

We conducted a crossover study, in which the efficacy and the onset of action of a single dose of Gaviscon (suspension) and Gaviscon forte (suspension) in 52 patients with heartburn of moderate intensity and gastroesophageal reflux disease (GERD) have been investigated. The average age of the patients was 44.0 +/- 17.3-years-old. The patients have undergone clinical evaluation of intensity of GERD symptoms and psychological assessment (questionnaires SF-36, SMOL, LOBI). Alginates' effects and qualities were evaluated using stopwatch technique, clinical examination, and organoleptic assessment. Primary sensation of a cooling (soothing) effect after use of a single dose of Gaviscon has been reported in 65.7 seconds (on average), and Gaviscon forte--in 66.1 seconds. Fourty three (82.7%) patients with heartburn have described the effects of both medications as "instant" cooling effects. Heartburn was relieved in 3.3 minutes in all patients after a single dose of Gaviscon, and in 3.6 minutes in 51 (98.1%) patients who have received a single dose of Gaviscon forte. Organoleptic qualities averaged at 3.6 points (on a scale of 1-5) for Gaviscon, and at 3.5 points for Gaviscon forte. Assessment of mental status of the patients suggested that a "delayed" effect of the medications in relieving heartburn in some patients may have occurred due to possible physical disadaptation.