[Results of a multicenter trial "Epidemiology of Gastroesophageal Reflux Disease in Russia" (MEGRE)].

AIM: To assess prevalence of gastroesophageal reflux disease (GERD) in Russia in MEGRE trial in 6 cities of the Russian Federatiion (Kazan, Kemerovo, Krasnoyarsk, Ryazan, St-Petersburg, Saransk). MATERIAL AND METHODS: Mayo Clinic questionnaire (USA) adapted for Russia was used to question 7812 people over 18 years of age from of random population sample. The symptoms (heartburn and regurgitation) were classified as frequent if they arose once a week and more often for the last 12 months, rare symptoms arose less often than once a week. The responders with frequent heartburn and/or regurgitation were regarded as persons with epidemiological quantitative criteria of GERD. RESULTS: Heartburn occurred in 47.5% responders: frequent in 9%, rare in 38.5%. Regurgitation occurred in 42.9%: frequent in 7.6%, rare in 35.3%. GERD prevalence was 13.3% (city range 11.3-14.3%). Frequent GERD symptoms are associated with frequent gaseous eructation (24.3%), chronic cough (22.9%), chest pain (15.1%), dysphonia (11.4%.). To stop heartburn, 88% responders took antacids, 32%--blockers of histamine H2-receptors and only 23%--inhibitors of proton pump. Only 52.8% responders with frequent chest pain and 29.3% those with frequent heartburn visited a doctor. CONCLUSION: The population-based trial MEGRE conducted by international methodology in 6 cities of Russia demonstrated that GERD prevalence is 13.3%. Most of the patients pay little attention to the symptoms, do not seek medical advice and, therefore, receive no adequate treatment.

[Of the article intraliver pregnancy cholestasis].

The article includes the contemporary information about prevalence, clinical history, the methods of diagnostics and treatment of the intraliver pregnancy cholestasis, and about the tactics of the supervision of the pregnant women with intraliver cholestasis.

[From the results of the "MEGRE" study to the "Society against heartburn" project].

This article presents the results of studies "MEGRE" and "VIA APIA", that were made by the Research Institute of Gastroenterology and the Scientific Society of Gastroenterologists of Russia in recent years and a new test for the diagnosis of GERD with a single intake of alginate, which was based on the concept of educational development "Society against heartburn" project.

[Surgical treatment of neuromuscular diseases of the esophagus].

Surgical treatment of patients with neuromuscular diseases of the esophagus is a separate issue, and the approach to antireflux surgery they differ from fundoplication for gastroesophageal reflux disease. At the Central Research Institute of Gastroenterology in 2010 yr were 17 patients with neuromuscular diseases of the esophagus laparoscopic fundoplication. Analysis of results showed the effectiveness of laparoscopic fundoplication in patients with severe esophageal motility.

[Panum (pantoprazole) effectiveness in the treatment of patients with GERD].

There are demonstrated results of a prospective comparative study on clinical efficacy and tolerability of Panum (INN: pantoprazole) under the sponsorship of"Unique Pharmaceutical Laboratories (India)". Were evaluated the results of a 28-day course of treatment of 30 patients with GERD, including those with severe reflux esophagitis (erosive and ulcerative), who received 40 mg of pantoprazole as monotherapy. Was found an algorithm with an intermediate control efficacy to individualizing the approach to therapy. As a result 16,7% of patients with severe reflux esophagitis required increasing the dose of pantoprazole to 80 mg/day in two divided doses, and the rest (83,3%) patients to achieve clinical and endoscopic remission of GERD was sufficient single dose of 40 mg of the drug. The results of this study indicated the efficacy and safety of the Panum drug in the treatment of GERD, including its complicated forms.

[Clinical variants of chronic urticaria associated with Helicobacter pylori].

INTRODUCTION: Chronic urticaria (CU) is one of the toughest problems. The main difficulty is the search for an etiological factor in 70-90% of cases the cause of chronic urticaria remains unclear. In the development and persistence of CU recently paid great importance to the role of Helicobacter pylori infection (HP), which is the most common bacterial infection in humans. However, the influence of HP eradication on the course of CU is poorly understood. AIM: to improve the diagnosis and treatment of urticaria patients with Helicobacter-associated diseases of the upper gastrointestinal tract. MATERIALS AND METHODS: The study included 184 patients with clinical manifestations of urticaria and HP-associated gastroduodenal pathology in the age of 18. RESULTS: Infection with HP was more frequently detected in patients with chronic idiopathic urticaria in comparison with patients with allergic urticaria (73% and 56% respectively, p < 0.05). In patients with allergic and chronic idiopathic urticaria HP-associating chronic gastritis were detected respectively in 90% and 81% of cases, gastric ulcer (4% and 11%) and duodenal ulcers (6% and 13%) in the first and second groups, respectively (p < 0.05). HP eradication was achieved in 69.2% of patients in the group with AU and 61.8% of patients with CU, while in 20.5% of patients with CU didn't recur in the year. The influence of HP eradication on the course of allergic urticaria isn't established. In order to achieve stable remission CU by HP eradication in patients with diseases of the digestive tract of prognostically important is the combination of the following factors: the initial elevated levels of antibodies to HP (IgG-AP) in the range of 1:360 to 1:900, serum cytokines: interleukin 1beta in the range (68-22 pg/ml) and TNF alpha (84-50 pg/ml), reduced levels of total IgE from 0 to 38 IU/ml. CONCLUSION: To patients with HP-associated gastrointestinal diseases, combined with idiopathic urticaria is shown holding Helicobacter therapy, because it leads to remission of allergies at 20.5% of patients remaining--to reduce the frequency of exacerbations. To patients with allergic urticaria an HP eradication for the treatment and prevention of AK is not reasonable.

[Pharmacoeconomic analysis of treatment of certain diseases of the digestive system].

The article provides data of the pharmacoeconomic analysis (cost/effectiveness) of treatment of peptic ulcer, ulcerative colitis, Crohn's disease, gastroesophageal reflux disease, biliary sludge and cholelithiasis. It was shown that the most appropriate treatment scheme is one that characterized by lower costs per unit of effectiveness. Analysis of cost/effectiveness can give an economic assessment of clinical efficacy, compare alternative treatments and help to choose the method by which the efficiency increases faster than the level of costs.

[Gastroesophageal reflux disease in the elderly patients: epidemiology, clinical features, therapy].

AIM: Was made a multicenter study of the GERD prevalence in Russia--MEGRE--that revealed quantitative criteria for GERD in 13.3% of respondents but in Moscow it was 23.6%. Also was detected an increasing prevalence with age, and respondents noted a higher prevalence of GERD in groups of older age (over 60) compared with persons younger than 60 years--accordingly 26.5% and 20.2%. We studied the course and treatment of elderly patients with GERD and assessed the results of surgical treatment of patients with short esophagus syndrome. METHODS: Was made a prospective study of 500 patients with GERD (241--age 60 years) that were treated with PPI and 95 patients were operated with an axial HH (42 of them with shortening of the esophagus 1-2-th power), mean age 65.7 +/- 17.4 years. We used endoscopic techniques (endoscopy), daily pH monitoring, esophageal manometry. RESULTS: Results of a prospective clinical study in elderly patients allocated two clinical variants of the flow of GERD, predicting a more severe course of disease in patients with a short history (up to 5 years) (the second "adult type") and suggests a differentiated approach to diagnosis and treatment. The expediency of extension to 12 weeks in elderly patients with GERD, the duration of the basic course of PPI therapy in full doses, which increased the effectiveness of therapy in 14.1%. after ending of this protocole, elderly patients with a second type of disease showed maintenance treatment in continuous operation since the regime "on demands from them ineffective. A reasonable approach to therapy in elderly patients, including STIs, can benefit and make a minimal risk of treatment. 24 months after performed fundoplication were observed excellent and good results in 96% of cases. In this case, patients with ineffective esophageal motility observed improvement in esophageal manometry, indicating that nature reflux of these disorders at baseline. CONCLUSIONS: Course and treatment of GERD in the elderly has its own characteristics, which dictate the need for an integrated approach to diagnosis and treatment of these patients. Older patients with esophageal shortening, 1 st degree possible to perform laparoscopic surgery, and shortening of the esophagus, 2 nd degree is the most secure laparotomic access.

[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.

[Functional methods of the esophagus examination].

Manometry of the esophagus is the "gold standard" in diagnosing diseases of the esophagus associated with motor disorders. The combination of manometry with impedance gives an indication of violation of bolus transport along the esophagus. High resolution manometry is new method that provides the most accurate information about the functional anatomy of the esophagus and its sphincters, as well as accurately characterizes the esophageal-gastric junction. We can increase the diagnostic value of daily pH-monitoring by analyzing communication with reflux symptoms. The combination of pH and impedance can identify different types of reflux (acid, sour, gas, liquid and mixed) in patients with symptoms of GERD and related Ahil, after gastric resection in children and infants, to evaluate the effectiveness of antireflux therapy.

[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.

[Lanzoptol efficacy at gastroesophageal reflux disease: results of multicenter study leader].

Results of multicenter study "Efficacy of Lansoptol (lansoprazole, KRKA) and its influence on the Dynamics of GERD symptoms" (LIEDER) are presented. The impact of 56-days treatment with lansoprazole 30 mg once daily on symptoms relief, a quality of life of 121 patients with gastroesophageal reflux disease (GERD) and healing of esophageal lesions of 30 patients with reflux esophagitis were investigated. Rapid acid inhibition effect of first dose of lansoptol was shown by 48-hr pH-monitoring. At the first day of the treatment 43.1% of patients reported decreasing of intensity of heartburn and 36.5%--of regurgitation. It were shown that the treatment with lansoptol provided symptoms relief in 25% patients at day 3, in 50% of patients at day 5 and in 75% at day 8 for heartburn, and at days 2, 6 and 9--for regurgitation. It was conducted improvement of quality of life. Healing rate of esophagitis at 28 day was 83.3%.

[Prevention of intestinal dysbiosis in patients after anti-Helicobacter therapy].

This article presents a literature review of side effects of antihelikobakter therapy, as well as survey data, whose goal was to determine the efficacy and safety of normoflorins at patients after eradication therapy of peptic ulcer. It was shown that the frequency of occurrence of side effects during antihelikobakter therapy varies widely and can reach, according to different authors, from 30 to 50% of patients. In addition to allergic and toxic PE, with antibacterial agents allocate their influence on the microflora of the colon, which often leads to development of a scarce and dysbacteriosis of antibioticassociated colitis. Appointment of biodiesel of normoflorin after eradication therapy effectively suppresses clinical signs of dyspepsia as a side effect of antihelikobakter therapy enhances the effectiveness of treatment of patients and improve their quality of life.

[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.

[Multicentre study "Epidemiology of gastroesophageal reflux disease in Russia"(MEGRE): first results].

We aimed to determine the prevalence and clinical spectrum of GERD in the urban population of 6 cities in different parts of Russia (St. Petersburg, Ryazan, Kazan, Kemerovo, Krasnoyarsk and Saransk). A previously validated reflux questionnaire developed at the Mayo Clinic was translated into Russian, culturally adapted and administered. Data was collected from 7812 randomly selected subjects greater than 18 years old with the assistance of the yellow pages. 'Frequent symptoms' were defined as a major symptom (heartburn and/or regurgitation) occurring at least once a week or more. "Occasional symptoms" were defined as an episode of one of the major symptoms occurring less than once a week within the past 12 months. Patients were defined as having GERD if they reported frequent heartburn and/or regurgitation. The average prevalence of frequent and occasional GERD symptoms in Russia was 9% and 38.5% for heartburn and 7.6% and 35.3% for regurgitation respectively within the last 12 months. The average prevalence of GERD in Russia was 13.3% (11.3-14.3%). The prevalence of frequent heartburn decreased with age (r = -0.3); however, frequent regurgitation increased (r = 0.7) with age. As a result, we found that prevalence of GERD increased with age. The average prevalence of GERD was statistically the same in men (12.5%) and in women (13.9%). This prevalence didn't change with age in men but did increase with age in elderly women to 24%. Frequent heartburn and regurgitation (GERD) were significantly associated with frequent belching (24.3%), chronic cough (22.9%), dyspepsia (19.8%), non-cardiac chest pain (15.1%), nausea (14.9%), hoarseness (11.4%), dysphagia (8.1%), odynophagia (7.3%) and constipation (37.8%). Alcohol consumption (prevalence of 60.4% among respondents) and smoking (prevalence of 25.4% among respondents) didn't yield any significant difference in subjects with frequent symptoms. Importantly, we also found that only 52.8% of subjects with frequent chest pain and 29.3% of respondents with frequent heartburn had seen a physician for these symptoms.

[Prevalence of gastroesophageal reflux disease in Moscow: results of a population study].

AIM: To study prevalence of the principal symptoms of gastroesophageal reflux disease (GERD) in Moscow. MATERIAL AND METHODS: A total of 1065 respondents aged 15-85 years (a random representative sample of population of one of the typical Moscow districts) participated in a questionnaire survey using the international questionnaire for detection of GERD incidence. RESULTS: Epigastric burning (EB) occurs in 39.6% examinees. GERD prevalence is 14.2%. Subjects with EB have the following symptoms of GERD: regurgitation (66.3%), epigastric pain (discomfort) (53.0%), nausea (43.6%), vomiting (23.2%), dysphagia (20.6%), chest pain (18.0%), odinophagia (5.5%), singultus (4.6%). There is a direct correlation between incidence rate of EB, height, body mass index, number of alcohol excesses and smoked cigarettes. CONCLUSION: EB occurs in both young and aged men and women with similar frequency. Significant differences were detected only in the age group 45-59 years in which EB is more frequent in women. All the symptoms excluding cough and singultus were seen in women significantly more frequently. With age, these differences disappeared but noncardial pain in the chest that was less frequent in the elderly. Muscovites with GERD symptoms are older (61.26 +/- 13.47 years) than those without such symptoms (58.44 +/- 16.28, p < 0.0001).