[Antibiotic resistance of Helicobacter pylori in the European part of the Russian Federation: first results].

AIM: Determine the primary antibiotic resistance of Helicobacter pylori (H. pylori) strains isolated from patients living in the European part of the Russian Federation. MATERIALS AND METHODS: As part of a clinical laboratory study, from 2015 to 2018, 27 gastrobiopsy samples obtained from H. pylori-infected patients were analyzed. H. pylori infection was verified using a rapid urease test or a 13C-urea breath test. The values of the minimum inhibitory concentration (MIC) of antibiotics were determined by the diffusion method using E-test strips (BioMerieux, France) according to the recommendations of the manufacturer. The sensitivity of the isolates was determined for 6 antibacterial drugs (amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, rifampicin). RESULTS: According to the data obtained, resistance to amoxicillin was 0%, clarithromycin 11.1%, metronidazole 59.3%, levofloxacin 3.7%, tetracycline 0%, and rifampicin 14.8%. Dual resistance to clarithromycin and metronidazole was recorded in two isolates (7.4%). CONCLUSION: Thus, the first results of the evaluation of H. pylori antibiotic resistance in the European part of the Russian Federation indicate a low resistance of the microorganism to clarithromycin and quite high to metronidazole.

[Ultrasound elastography of the liver for assessing the risk of complications of its cirrhosis of different etiologies]. / Otsenka riska razvitiya oslozhnenii tsirroza pecheni razlichnoi etiologii pri ispol'zovanii ul'trazvukovoi elastografii pecheni.

AIM: To study the results of dynamic liver ultrasound elastography (LUE) in assessing the risk of complications of liver cirrhosis (LC) of different etiologies and to elaborate a monitoring program for estimation of the predictive value of elastography in patients with LC. SUBJECTS AND METHODS: A total of 194 patients with LC of different etiologies, including 56 patients with alcoholic cirrhosis, 48 with LC and an outcome of nonalcoholic fatty liver disease, 53 with LC and an outcome of chronic hepatitis C, 23 with LC and an outcome of chronic hepatitis B, and 14 with an outcome of coinfection with hepatitis B and D viruses, were examined. An analysis was made between the presence of a number of LC complications and the results of LUE, by constructing the receiver operating characteristic (ROC) curves to select LUE threshold values, in which there was a high risk for LC complications (esophageal varices, bleeding esophageal varices, hepatic encephalopathy, and ascites). RESULTS: The investigation could obtain liver elastography threshold values expressed in kilopascals (kPa), which were proposed for use as a prognostic sign of the presence of complications caused by LC and assessed liver elastography threshold values for its mortality prediction. The predictive value of positive LUE results in determining the risk of different complications was 75.7 to 92.5%; that of negative results was 70 to 92.9%. An algorithm for individualized diagnostic and treatment policy was elaborated in relation to the liver elastography results obtained during the primary examination of a patient. CONCLUSION: The dynamic LUE findings in patients with LC of different etiologies suggest that the proposed LUE threshold values are efficient and may be used in practical healthcare, which will be able to timely correct management tactics for a patient and to monitor his treatment.

[CLINICAL FEATURE OF NONALCOHOLIC STEATOHEPATITIS, ASSOCIATED WITH CHRONIC CONSTIPATION].

THE AIM OF THE STUDY: to conduct a comprehensive assessment of features of combined course NASH and functional constipation using laboratory parameters, the data of instrumental methods, indicators of quality of life in comparison with patients with Nash without proven pathology of the intestine. MATERIALS AND METHODS: In the cross-sectional comparative study involving 102 patients with NASH, among which identified patients with functional constipation, there were formed two groups: study group (patients with NASH and functional constipation) and comparison group (patients with NASH without pathology of the intestine). All patients underwent a comprehensive assessment of laboratory data (markers of cytolysis, cholestasis, lipid and carbohydrate metabolism), results of instrumental methods (hydrogen breath test), quality of life (questionnaire SF-36). RESULTS: All patients with NASH, regardless of the presence of functional bowel pathology was characterized by hyperlipidemia with a tendency to lower HDL and raise LDL with normal levels of triglycerides, fasting hyperglycemia, increased postprandial glucose, glycated hemoglobin and HOMA--IR higher than normal values and the availability of the SIBO. NASH is often associated with functional constipation (68.6%). Patients with functional constipation and NASH have a significantly higher average level of ALT (127.3 ± 58.4 U/I in the control group and to 103.5 ± 74.6 U/I in the comparison group, p = 0.02), more frequent association with the SIBO (65.7% in the main group opposed to 43.7% in the comparison group, p = 0.014) and a lower quality of life compared with patients without pathology of the intestine. CONCLUSION: NASH has frequent association with functional constipation, worsens its course, resulting in a significant increase in the level of the marker of cytolysis (ALT), the more expressed SIBO and a palpable decline in the quality of life of patients, therefore the impaired intestinal function in these patients requires close attention.