[European registry Helicobacter pylori (Hp-EuReg): how has clinical practice changed in Russia from 2013 to 2018 years].

The multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group (EHMSG) is conducted in 27 countries in Europe. The data from the Russian part of the European registry for the management of Helicobacter pylori infection (European Registry on the management of Helicobacter pylori infection, protocol: "Hp-EuReg") allows us to analyze the real clinical practice of diagnosis and treatment of H. pylori and compare it with international recommendations. MATERIALS AND METHODS: A comparative analysis of the data entered in the register by the Russian research centers "Hp-EuReg", in the period from 2013 to 2018, was conducted. RESULTS AND DISCUSSION: Invasive diagnostic methods prevail for the primary diagnosis of H. pylori [histology - 20.3% (in 2013 year) - 43.9% (in 2018 year), rapid urease test - 31.7% and 47.8% respectively]. The most popular mode of eradication therapy is a 10-day triple therapy (62.8-76.2%), the effectiveness of which does not exceed 79% (per protocol). Invasive tests (histology) are the leading method for control the effectiveness of therapy, however, there is a tendency towards a wider use of non-invasive methods (H. pylori stool antigen - from 17% in 2013 to 29.3% in 2018 and urea breath test from 6.9 to 18.3%, respectively). Serological test to control the effectiveness of eradication is still used from 8.2% (2013) to 6.1% (2018). Eradication therapy was not performed in 28% of patients throughout the entire observation period. CONCLUSION: In Russia, despite approved domestic and international recommendations, deviations in clinical practice persist, both during eradication therapy and in monitoring the effectiveness of eradication therapy.

European Registry on the management of Helicobacter pylori infection (Hp-EuReg): analysis of 2360 patients receiving first-line therapy in Russia.

AIM: European Registry on the management of Helicobacter pylori infection («Hp-EuReg¼) - a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group, conducted in 27 European countries in order to evaluate the real clinical practice of diagnosis and treatment of H. pylori and its comparison with international recommendations. MATERIALS AND METHODS: The analysis of 2360 patients entered in the register by the Russian centres of «Hp-EuReg¼ in 2013-2017, who were underwent 1st line eradication therapy. RESULTS: The most common methods of primary diagnosis of H. pylori are histological (37.7%), rapid urease test (29.2%) and serology (29.7%). The duration of eradication therapy in 9.4% of cases was 7 days, in 65.3% - 10 days, and in 25.3% - 14 days. To control the effec- tiveness of treatment, H. pylori antigen in feces (31.3%), urea breath test (23.4%) and histological method (23.3%) were used. In 3.6% cases was used serology by mistake. In 17.3% of patients control was not carried out. The effectiveness of triple therapy with a PPI, amoxicillin, clar- ithromycin (per protocol) was 67.6%, with 7-day course, 81.1% at 10-day and 86.7% at 14-day course. Eradication rate of triple therapy with addition of bismuth (per protocol) reached 90,6% in the group receiving 10-day scheme and 93.6% in the group receiving the 14-day treatment. CONCLUSION: Significant deviations of clinical practice from expert recommendations, most pronounced at the stage of monitoring the effectiveness of therapy, were noted. The suboptimal efficacy of triple therapy is shown.

[European Registry on the management of Helicobacter pylori infection (Hp-EuReg protocol): The first results of Russian centers].

AIM: To assess the clinical practice of diagnosis and treatment in patients with Helicobacter pylori infection and to compare this practice with the international guidelines in the European Registry on the management of Helicobacter pylori infection, Hp-EuReg protocol), a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group. MATERIALs AND METHODS: The data of 813 patients infected with H. pylori and entered in the Hp-EuReg register by the Russian centers in 2013-2015 were analyzed. RESULTS: The most common methods for the primary diagnosis of H. pylori infection are histology (40.3%), rapid urease test (35.7%), and serology (17.2%). The duration of H. pylori eradication therapy was 7, 10, and 14 days in 18.0, 49.3, and 25.1%, respectively. To monitor the effectiveness of treatment, the investigators used a histological examination (34%), a urea breath test (27.3%), H. pylori stool antigen (22.8%), and a rapid urease test (16.3%). A serological test was carried out in 2.5% of the cases. No monitoring was done in 13.5% of the patients. The average eradication efficiency was 82.6%. If the therapy was ineffective, 80% of physicians did not intend to prescribe a new cycle of treatment. CONCLUSION: Significant differences were found between clinical practice and the current guidelines.

[Results of dynamic observation of patients with polyps in the stomach].

This work is based on the analysis of data doing 409 patients with polyps in the stomach. Among them 200 men (48.9%) and 209 women (51.1%) aged 18 to 91 years. The average age of men was 67.4 years, and women 66.8 years. All these patients were find 1034 neoplasms of various sizes. At all of this patients polyps were identified on a background of chronic gastritis, as a rule, has the character of atrophic process. Histological research was conducted 775 (74.6%) polyps, of which focal hyperplasia and hyperplastic polyps detected in 49% of cases, and adenomas in 51% (including adenomas with varying degrees of dyspiasia, and prostatic adenocarcinoma cells). Endoscopic polypectomy performed 367 patients, and the remaining 42 was merely the dynamic monitoring of the identified entities. In 79 (28.8%) patients after polypectomy noted relapse formations and in 10 cases (3.65%) diagnosed with cancer in the intervention area. 4 (0.98%) patients from 409 cancer in polyps detected during the initial survey and in 4 patients the cancer originated in the not associated with polyps of stomach. As a result of the research of the dependence of the size of neoplasms on the nature of destruction and histological structure. For most existing polyps characteristic of the stability of their morphological structure and the absence of its transformation.

[Pancreatitis in pregnant women].

Regardless of the fact, that pancreatitis during pregnancy is rare; this disease is characterized by high indices of maternal and perinatal mortality. Among variety of etiological and pathogenetic aspects of pregnant women's acute pancreatitis, leading role in its development belongs to bile-excreting system diseases, conditioned by physiological processes in women's organism during gestational period. Also there is a genetic theory of acute pancreatitis genesis in pregnant women, based on dislipoproteinemia development caused by lipoprotein lipase insufficiency, when severity of pancreatitis course is correlated with morphotype of this enzyme gene mutation. Chronic pancreatitis is conditioned by the same causes and can develop and recur during pregnancy and right after parturition. Diagnostics of pregnant women's pancreatitis is complicated because of limitation of the use of some methods (radiation and endoscopic). Pancreatitis clinical course does not differ from the one in nonpregnant women and is manifested by pain abdominal and dyspeptic syndromes, and also by syndromes of exocrine and endocrine pancreatic insufficiency. The main clinical feature of pregnant women's pancreatitis is high occurrence of painless forms. Approaches to treatment include pain relief disintoxication, use of pancreatic secretion blockers, multienzyme complexes, glycemia correction.

[Rabeprazole test and comparison of the effectiveness of course treatment with rabeprazole in patients with gastroesophageal reflux disease and non-coronary chest pain].

Proton pump inhibitors (PPI) are efficient for ex juvantibus diagnostics of non-coronary chest pain (NCCP) of gastroesophageal reflux origin as well as for its course treatment. The aim of this randomized cross-over study was to compare the efficiency of rabeprasol and omeprasol as means of both diagnostics and long-term treatment. In rabeprasol group the symptoms disappeared more quickly, and the maximum effect was achieved by day three, while in omeprasol group the best results were achieved only by day six (p < or = 0.05). The sensitivity and specificity of rabeprasol test was 81.6% and 80.6%, respectively, while those of omeprasol test were 73.5% and 77.4%, respectively. By the end of the 12th week of treatment pain syndrome had been completely or partly coped with in 92% of rabeprasol patients, and 76% of omeprazol patients (p < 0.05). Thus, response to rabeprasol takes place twice as quick as response to omeprasol, which makes it possible to shorten the time of NCCP diagnostics. Furthermore, rabeprasol test is more sensitive and specific. Course treatment with high doses of PPI increase the number of patients with eliminated pain syndrome, and rabeprasol here is more efficient than omeprasol.

[Oral cavity manifestations of gastroesophageal reflux disease].

The aim of the study was to investigate changes in the oral cavity and the gastroesophageal zone of the patients receiving rabeprazol, a proton pump inhibitor (PPI). The subjects were 88 patients with gastroesophageal reflux disease (GERD), who had changes in the oral cavity typical of this disease. The patients were divided into four groups. Group I included patients with non-erosive reflux disease; the other three groups were formed according to the degree of the severity of reflux esophagitis in accordance with Los Angeles classification of GERD: A, B, and C. The patients were administered rabeprazol as a PPI. The study found that oral cavity changes are associated with the degree of the gastroesophageal reflux. The study demonstrated high efficacy of rabeprazol in GERD patients with oral cavity changes.

[A case of the successful treatment of the esophageal leukoplakia with rabeprazole]. / Sluchai uspeshnogo lecheniia leikoplakii pishchevoda rabeprazolom.

This clinical endoscopic study is of interest because clinical and endoscopic remission of the disease with a torpid course was achieved in a patient with gastroesophageal reflux disease with a continuously recurrent course complicated with leukoplakia under the condition of regular combination of preparations of the base course PPIs (Pariet) + prokinetic agent (Motilium) + antacid (Magalphil), conduction of continuous treatment during 12 weeks and subsequent supporting therapy (Pariet, 20 mg) during 6 months in the weekend treatment mode, as well as adherence to recommendations for changing the lifestyle.

[Hyperplastic processes of the gastric mucosa in helicobacter infections]. / Giperplasticheskie protsessy slizistoi obolochki zheludka i gelikobakternaia infektsiia.

The investigation of possible H.p. role in the development of stomach mucous changes, promoting to arising of hyperplasiogenic polypus is the purpose of this study. Gastro-duodenal endoscopy with biopsy of stomach mucous from the antral part, body and bottom for H.p. diagnosis and morphological changes was made in 85 patients (at the age of 43-82 years) with hyperplasmiogenic polypus. The H.p. associated chronic gastritis was determined in 47.6% of the patients. H.p. intensity (prevailed weak and moderate--69.2%) correlated with the inflammation activity degree (1st and 2nd--80.3%) and with dystrophic changes (initial and moderate mucous atrophy--74.4%). The obtained data indicate the possible relation to H.p. infection frequency, degree and character of stomach mucous morphological changes. It allows to examine the expedience of the eradiction therapy for the patients with hyperplasiogenic polypus, infected by helicobacterial infection.

[Interrelations of hyperplasia of gastric mucosa and helicobacter infection (based on data from a polyclinic center]. / O vzaimosviazi giperplasticheskikh protsessov v slizistoi obolochke zheludka i khelikobakternoi infektsii (po dannym poliklinicheskogo tsentra).

AIM: To examine a relationship of hyperplastic processes in the gastric mucosa (GM) to Helicobacter infections. MATERIAL AND METHODS: A hundred patients aged 44 to 86 years who had gastric polyps [Group 1, foveolar hyperplasia (n = 21); Group 2, hyperplasiogenic polyps (n = 65), Group 3, adenomas (n = 14)] underwent esophagogastroduodenoscopy with biopsy of the mucosa from the athrum, body, and fundus of the stomach to reveal Helicobacter pylori (Hp) and GM morphological changes. RESULTS: Hp-associated chronic gastritis was detected in 56% of the patients (66.7, 52.3, and 57.1% in Groups 1, 2, and 3, respectively). The rate of Hp seeding correlated with the magnitude of inflammatory and dystrophic changes. As the regulation of epithelial growth and differentiation impairs, the magnitude of GM structural alterations increase. CONCLUSION: The findings indicate that there may be a relationship between the frequency, degree of Hp infection and the pattern of GM morphological changes, which makes it expedient to use eradication therapy in this group of patients.

[The efficacy of flonivin BS in the treatment of intestinal dysbacteriosis]. / Znachenie flonivina BS v lechenii disbakterioza kishechnika.

The paper presents results of intestinal dysbacteriosis (ID) treatment with flonivin in 25 patients. The diagnosis was made clinically and bacteriologically (fecal examinations). Flonivin BS proved to be an effective biological preparation for management of ID stage I and II. It is composed of bacteria which do not conflict with macroorganism, contribute to normalisation of intestinal biocenosis, is especially beneficial in ID induced by long-term administration of antibiotics.