[Epithelial protective therapy in comorbid diseases. Practical Guidelines for Physicians].

This document was produced with the support of the National Medical Association for the Study of Comorbidities (NASС). In 2021 the first multidisciplinary National Consensus on the pathophysiological and clinical aspects of Increased Epithelial Permeability Syndrome was published. The proposed guidelines are developed on the basis of this Consensus, by the same team of experts. Twenty-eight Practical Guidelines for Physicians statements were adopted by the Expert Council using the "delphic" method. Such main groups of epithelial protective drugs as proton pump inhibitors, bismuth drugs and probiotics are discussed in these Guidelines from the positions of evidence-based medicine. The clinical and pharmacological characteristics of such a universal epithelial protector as rebamipide, acting at the preepithelial, epithelial and subepithelial levels, throughout gastrointestinal tract, are presented in detail.

Implementation of specialised attention mechanisms: ICD-10 classification of Gastrointestinal discharge summaries in English, Spanish and Swedish.

Multi-label classification according to the International Classification of Diseases (ICD) is an Extreme Multi-label Classification task aiming to categorise health records according to a set of relevant ICD codes. We implemented PlaBERT, a new multi-label text classification head with per-label attention, on top of a BERT model. The model assessment is conducted on Electronic Health Records, conveying Discharge Summaries in three languages - English, Spanish, and Swedish. The study focuses on 157 diagnostic codes from the ICD. We additionally measure the labelling noise to estimate the consistency of the gold standard. Our specialised attention mechanism computes attention weights for each input token and label pair, obtaining the specific relevance of every word concerning each ICD code. The PlaBERT model outputs the computed attention importance for each token and label, allowing for visualisation. Our best results are 40.65, 38.36, and 41.13 F1-Score points on the English, Spanish and Swedish datasets, respectively, for the 157 gastrointestinal codes. Besides, Precision is the metric that most significantly improves owing to the attention mechanism of PlaBERT, with an increase of 44.63, 40.93, and 12.92 points, respectively, for the Spanish, Swedish and English datasets.

Manifestaciones gastrointestinales de la fibrosis quística en pediatría: una revisión general / Gastrointestinal features of cystic fibrosis in pediatrics: a general review

La Fibrosis Quística es una enfermedad genética que se caracteriza por el aumento de la densidad de las secreciones de los tejidos exocrinos, pudiendo afectar a múltiples órganos y sistemas dependiendo del genotipo de la enfermedad, el cual es variable. Uno de los sistemas que puede estar afectado es el gastrointestinal, manifestándose con varios signos y síntomas que pueden contribuir con la sospecha clínica de Fibrosis Quística. Es importante realizar precozmente el diagnóstico para llevar a cabo un manejo oportuno y tener un mejor pronóstico de la enfermedad. El diagnóstico definitivo se realiza con el test de sudor. Actualmente se está realizando un proyecto piloto de tamizaje neonatal para todos los recién nacidos de las regiones Metropolitana y de Valparaíso, incluyendo al Hospital Dr. Gustavo Fricke, con el fin de diagnosticar Fibrosis Quística precozmente

Cystic Fibrosis is a genetic disease characterized by an increase in secretion density of the exocrine tissues, which can affect multiple organs and systems, depending on the illness´s genotype which is variable. One of the systems that may be affected is gastrointestinal, showing various signs and symptoms which may contribute to the clinical suspicion of cystic fibrosis. An early diagnosis is important for timely management and a better prognosis. The definitive diagnosis is done by the sweat test. A pilot neonatal screening for early cystic fibrosis diagnosis is being carried out in the Metropolitan and Valparaíso regions, including Gustavo Fricke Hospital.

Estado y rasgo de ansiedad en escolares y adolescentes colombianos con y sin desórdenes gastrointestinales funcionales / Anxiety status and trait in Colombian schoolchildren and adolescents with and without functional gastrointestinal disorders

Resumen Introducción: la fisiopatología de los desórdenes gastrointestinales funcionales (DGF) incluye un eje intestino-cerebro alterado. Objetivo: determinar la prevalencia y posibles asociaciones de ansiedad en niños con DGF. Metodología: estudio de prevalencia realizado en ciudades colombianas en niños entre 8 y 18 años a quienes se les identificaron DGF según los Criterios de Roma III y ansiedad por medio del State Trait Anxiety Inventory for Children. Se incluyeron variables sociodemográficas y familiares. El análisis estadístico incluyó medidas de tendencia central, análisis uni- y multivariados, y regresión logística, teniendo en cuenta una p < 0,05 como significativa. Resultados: se incluyeron 1496 niños, 12,7 ± 2,1 años, 50,5 % niñas, 79,9 % con ansiedad transitoria y 51,5 % con tendencia a experimentar estados de ansiedad. Hubo predominio para el estado-ansiedad en adolescentes masculinos y para el rasgo-ansiedad en adolescentes femeninas con algún DGF. Los posibles factores de riesgo fueron la edad y el sexo para estado-ansiedad, y la edad, el sexo y los DGF para el rasgo-ansiedad. Conclusiones: cerca de la mitad de los niños tuvo tendencia a presentar estados de ansiedad, con predominio de las adolescentes femeninas y con factores de riesgo como la edad, el sexo y tener algún DGF.

Abstract Introduction: The pathophysiology of functional gastrointestinal disorders includes alteration of the gut-brain axis. Objective: This study measures prevalence and of functional gastrointestinal disorders and discusses possible associations with anxiety in children with these conditions. Methodology: This is a prevalence study of children between 8 and 18 years of age diagnosed with functional gastrointestinal disorders as defined by the Rome III Criteria and anxiety as defined by the State-Trait Anxiety Inventory for Children in several Colombian cities. Sociodemographic and family variables were included. Statistical analyses included measures of central tendency, univariate and multivariate analysis, and logistic regression, with p <0.05 established as significant. Results: The study included 1,496 children of whom 50.5% were girls. The boys average age was 12.7 ± 2.1 years, 79.9% had suffered transitory anxiety, and 51.5% had tendencies to experience states of anxiety. State/anxiety predominated in male adolescents while trait/anxiety predominated in female adolescents with functional gastrointestinal disorders. Possible risk factors for state/anxiety were age and sex. Possible risk factors for trait/anxiety were age, sex, and functional gastrointestinal disorders. Conclusions: About half of the children tended to states of anxiety. Female adolescents predominated with risk factors of age, sex, and some functional gastrointestinal disorders.

Intrahepatic cholestasis of pregnancy and comorbidity: A 44-year follow-up study.

INTRODUCTION: Intrahepatic cholestasis of pregnancy (ICP) is a reversible liver disorder occurring during pregnancy. It has a typical genetic background with known genetic mutations and can be considered an expression of this genetic predisposition. The objective of this study was to determine whether ICP is associated with specific long-term comorbidity. MATERIAL AND METHODS: The study population comprised 571 women with ICP in at least one pregnancy who were compared with 1333 pregnant women without ICP during 1969-1988 at Tampere University Hospital, Finland. The cohort's follow-up time was 44 years. All ICD-10 classification discharge diagnoses were examined for the women in the ICP group from 1998 to 2013 and ICD-10 diagnoses from outpatient care from 1969 to 2013. RESULTS: At least one disease of the digestive system had been diagnosed in 50.4% (288/571) of the ICP mothers compared with 34.4% (459/1333) of the reference group (P < 0.001). In a more detailed analysis, women with a history of ICP had an increased risk for cholelithiasis and/or cholecystitis (odds ratio [OR] 2.88, 95% confidence interval [CI] 2.17 to 3.84), diseases of the pancreas (OR 2.26, 95% CI 1.20 to 4.27) and hypothyroidism (OR 2.38, 95% CI 1.27 to 4.46) compared with the reference group. Arterial diseases were less common in the ICP mothers than in the reference group (OR 0.38, 95% CI .15 to .99). Regarding other diseases, there were no statistically significant differences between the ICP mothers and reference group. CONCLUSIONS: Half of the women with a history of ICP were diagnosed with at least one disease of the digestive system compared with a third in the reference group. The risk of cholelithiasis, cholecystitis, diseases of the pancreas and hypothyroidism was increased compared with the reference group. These are important facts when counseling women after a pregnancy with ICP. Also, this is of importance for the general practitioners and other physicians who take care of these women.

[The gastroprotective action of acidic mineral water from the Azhyg-Sug source on the stress-induced injuries to the stomach of white rats]. / Gastroprotektivnoe deistvie kisloi mineral'noi vody istochnika Azhyg-Sug pri stress-indutsirovannom povrezhdenii zheludka u belykh krys.

BACKGROUND: The relevance of this study is determined by the need for the scientifically sound substantiation of the possibility for the use of acidic mineral waters in the treatment of digestive diseases taking into consideration their widespread application in ethnomedicine, in particular in the Republic of Tuva. AIM: The objective of the present study was to elucidate the gastroprotective action of acidic mineral water from the Azhyg-Sug source (Republic of Tyva) on the experimental animals as exemplified by the model of ulcerogenesis under the conditions of immobilization stress. MATERIAL AND METHODS: The experimental studies were carried out with the use of 32 white rats of the Wistar line. Ulcerogenesis was initiated by means of immobilization stress. We evaluated the pathomorphological characteristics of the gastric mucosa and the number of destructions based on the Pauls index. The state of the lipid peroxidation system and antioxidative protection were determined from the content of malon dialdehyde and reduced glutathione, extracellular catalase and superoxide dismutase activities in erythrocytes. RESULTS: The study has demonstrated that the mineral water from the Azhyg-Sug source slows down the development of the inflammatory and destructive necrotic processes in the mucosa of the stomach of albino rats. The depth of erosion in the animals receiving mineral water was 2.3 and 3.4 times lower than in the control animals (p≤0.05). The antioxidant effect of mineral water was confirmed by the 14-20% decrease of the MDA concentration as well as by the increase of the catalase and superoxide dismutase (SOD) activities by 21-25% and 20-30% respectively in comparison with the control animals. CONCLUSION: The Azhyg-Sug mineral water has the strong gastroprotective influence on the experimental animals having the induced neurogenic ulcer. One of the mechanisms underlying the gastroprotective action of the investigated mineral water arises from its ability to inhibit the processes of lipid peroxidation with the simultaneous enhancement of the activity of the antioxidant system of the organism.

Review of the application and mechanism of Chaihu-Shugan powder for digestive system / 国际中医中药杂志

This review summarizes the clinical and functional mechanisms of Chaihu-Shugan powder in the treatment of digestive system diseases. This prescription shows good curative effect on peptic ulcer, functional dyspepsia, chronic gastritis, nonalcoholic fatty liver, chronic hepatitis B, chronic pancreatitis and ulcerative colitis. The main mechanism is to reduce the immune inflammatory response, improve lipid metabolism, regulate the level of gastrointestinal hormones, and affect Cajal interstitial cells (ICC).

Epidemiological aspects of morbidity in the class of digestive organs in Kazakhstan.

AIM: To study epidemiological aspects of disease, class of diseases of the digestive system in the region of the relative risk in Kazakhstan. MATERIALS AND METHODS: Studied epidemiological parameters are first identified in the incidence and prevalence of class XI ICD in regions of Kazakhstan with the identification of risk relative to the average national level. In a dysfunctional region Kyzylorda region analyzed the performance of its regions and compared with data from medical examination of the population and the survey. RESULTS: A significant excess of the average national incidence rate between 1990 and 2015, was noted for 3 of the 14 regions of Kazakhstan (West-Kazakhstan, Kyzylorda, Mangystau). According to the dynamics of the unfavorable situation on the high level of incidence currently is in the Kyzylorda region (COA). From the areas of the COA maximum, the incidence of diseases of the digestive system registered in Kazalinsk district which exceeded the level at RK 4.8 times. The data on examination and survey of the complaints of the population exceeded the epidemiological indicators. In the area identified as the leading neoplasms of the digestive system in the structure of cancer incidence and exceeded the national average on the related class of blood diseases. Unfavorable situation on the incidence of the digestive system in Kyzylorda region of Kazakhstan is associated with the cancer and blood diseases, this is partly due to the presence of pollutants in the environment.

Enterite granulomatosa associada a larvas de ciatostomíneos em eqüinos no Rio Grande do Sul / Granulomatous enteritis associated with larval cyathostomiasis in horses in Rio Grande do Sul, Brazil

São descritos cinco casos de enterite granulomatosa associada a larvas de ciatostomíneos em eqüinos provenientes de três propriedades rurais do Rio Grande do Sul. Os casos ocorreram entre janeiro de 1999 e dezembro de 2007. A evolução clínica nos dois casos cujo seguimento clínico foi acompanhado foi de 10 e 14 dias. Os sinais clínicos apresentados por três eqüinos foram semelhantes e consistiam de diarréia (3/3), emagrecimento (2/3), pirexia (1/3), taquicardia (1/3) e taquipnéia (1/3). Os achados macroscópicos incluíram espessamento da parede do cólon maior e ceco por edema e ocorrência de numerosos pontos marrom-escuros com 1-4mm, levemente salientes, disseminados pela mucosa. A incisão desses pontos revelou pequenas larvas de nematódeos marrom-avermelhadas de 1-2mm. Numerosos parasitas, compatíveis morfologicamente com pequenos estrôngilos, foram observados na luz intestinal ou aderidos à mucosa do cólon maior e ceco. Histologicamente, na mucosa e submucosa do cólon maior e ceco, foram observados múltiplos granulomas constituídos por moderado ou acentuado infiltrado inflamatório, composto por macrófagos, macrófagos epitelióides e eosinófilos circundados por linfócitos e plasmócitos. No centro desses granulomas, observaram-se cortes transversais de parasitas com morfologia compatível com ciatostomíneos. Adicionalmente, havia edema e infiltrado inflamatório linfo-histioplasmocitário e eosinofílico, leve ou moderado na submucosa e mucosa do cólon maior e ceco; necrose e proliferação linfo-histiocítária em folículos linfóides na submucosa e hiperplasia de células caliciformes na mucosa. O diagnóstico de enterite granulomatosa associada a ciatostomíneos foi realizado com base nos achados epidemiológicos, clínicos e macroscópicos e confirmado pela histologia.

Five cases of granulomatous enteritis associated with cyathostomes are described in horses from three farms in Rio Grande do Sul, Brazil. The cases occurred from January 1999 to December 2007. The clinical course in two cases in which clinical follow-up was available was 10-14 days. Clinical signs presented by two horses were similar and included diarrhea (3/3), weight loss (2/3), pyrexia (1/3), tachycardia (1/3), and tachypnea (1/3). Gross changes consisted of thickening of the wall of large colon and cecum by edema and the occurrence of numerous 1-4mm, dark-tan, slightly raised multifocal pinpoints disseminated throughout the mucosa. Up on the incision of these pinpoints, brown-reddish, small (1-2mm) nematode larvae emerged. Large numbers of parasites with morphology compatible with small strongyles were observed in the lumina of large colon and cecum or adhered to the mucosae of these organs. Histologically, multiple granulomas were seen in the mucosa and submucosa of large colon and cecum. These granulomas consisted of moderate to severe inflammatory infiltrate of macrophages, epithelioid macrophages, and eosinophils surrounded by fewer lymphocytes and plasma cells. In the center of these granulomas, transversal cut sections of parasites with morphology compatible with cyathostomes larvae were observed. Additionally, there was edema and moderate to marked lymphohistioplasmacytic and eosinophilic inflammatory infiltrate throughout the mucosa and submucosa of the large colon and cecum; necrosis and lymphohistiocytic proliferation in the submucosal lymphoid follicles, with hyperplasia of goblet cells in the epithelial lining of these organs were also observed. The diagnosis of granulomatous enteritis associated with larval cyathostomiasis was made based on epidemiological, clinical, and gross findings which were confirmed by histopathology.