Vol 20, No 8 (2018)
Articles
Modern gastroenterology advances in esophageal tonus and motility disorders assessment
Abstract
The literature review addresses a modern diagnostics method - high-resolution esophageal manometry as one of the advances in up-to-date gastroenterology for esophageal tonus and motility disorders assessment. Esophageal manometry allows to estimate the esophageal motor function in detail along its entire length, including the upper esophageal sphincter, thoracic esophagus and lower esophageal sphincter through the use of highly-sensitive multilumen catheters and evaluation of the results with the use of computerized polychrome image data. The parameters of manometry study on the basis of which clinical conclusion is made according to Chicago classification version 3.0 are presented. The issues of etiology, pathogenesis, clinical presentation, as well as diagnostic criteria and treatment approaches to lower esophageal sphincter dysfunction, main and minor thoracic esophagus motility disorders are covered.
Consilium Medicum. 2018;20(8):8-13
8-13
Possibilities of multi-slice computed tomography in colitis diagnosis
Abstract
Nowadays multislice computed tomography is widely used as a primary radiological method of diagnosis of acute abdominal syndrome. One of possible causes for abdominal pain, that as a rule doesn’t present with any specific clinical symptoms is colitis. Clinical use of wide spectrum antibiotics leads to changes in normal microflora of the digestive system, causing growth of Clostridium difficile, which is the main pathogen of pseudomembranous colitis. Multislice computed tomography allows us to evaluate the inflammatory process in the bowel wall, that considering laboratory data and colonoscopy gives the ability to estimate the prevalence and the extent of pathological changes.
Consilium Medicum. 2018;20(8):14-16
14-16
Clinical case of a combination of ulcerative colitis and рrimary sclerosing cholangitis
Abstract
A clinical case of combination of ulcerative colitis and рrimary sclerosing cholangitis is presented in the article. Data on clinical manifestations of disease, changes in laboratory and tool methods of examination, differential diagnosis, and tactics of further examination of a patient are also described. The combination of ulcerative colitis and рrimary sclerosing cholangitis increases the risk of colorectal cancer. Therefore treatment should be directed both on prevention of relapse of the disease and of colorectal cancer occurrence. Besides such medications as 5-aminosalicylic acid and ursodeoxycholic acid should be prescribed.
Consilium Medicum. 2018;20(8):17-19
17-19
Modern aspects of nonalcoholic fatty liver disease patients treatment
Abstract
The review article presents the principles of patients with nonalcoholic fatty liver disease (NAFLD) treatment. It is outlined that lifestyle and diet modification are the basis for the disease treatment. Modern methods of NAFLD pharmacotherapy are analysed.
Consilium Medicum. 2018;20(8):20-23
20-23
Multimorbid patient: gastro-esophageal reflux disease in focus
Abstract
The problem of comorbidity becomes pressing in the context of demographic population ageing. The influence of comorbid pathology on diseases clinical manifestations, diagnostics, prognosis and treatment is complicated and controversial. The article discusses the challenges of gastro-esophageal reflux disease diagnostics and treatment in multimorbid patients. According to the existing standards and clinical guidelines on this disorder treatment antisecretory agents lie in the basis for these patients pharmacotherapy. Of these the leading role belongs to proton pump inhibitors, a class of medications with high effectiveness and good safety profile.
Consilium Medicum. 2018;20(8):24-31
24-31
Radiodiagnosis of abdominal trauma on clinical examples of penetrating wounds from the practice of the first level hospital
Abstract
The analysis of radiodiagnosis of 15 patients admitted to a first-level hospital with penetrating wounds of the abdomen was carried out. All the victims were examined by ultrasound, multislice computed tomography of the abdomen, part of them was made plan radiography. It has been established that multidetector computed tomography has shown high efficiency in assessing the consequences of penetrating abdominal trauma. With the help of this method, it was possible both to confirm and to exclude damage to the internal organs. An important factor is the ability to trace the progress of the wound channel. The effectiveness of ultrasound is significantly lower and this method is recommended only for dynamic monitoring of patients. Plan radiography is of little informative and can not be used for timely diagnosis.
Consilium Medicum. 2018;20(8):32-36
32-36
Nonalcoholic fatty liver disease pharmacotherapy: accent on fibrosis
Abstract
Study objective - to evaluate taurin effect on liver fibrosis severity, structural and functional liver characteristics in patients with nonalcoholic fatty liver disease (NAFLD). Materials and methods. The prospective comparative randomized study included 60 patients with NAFLD diagnosed according to liver ultrasound results (using SIEMENS SONOLINE G50, Germany system with doppler sensor for liver parenchymal echogenicity, vascular pattern, and echoed signal decrement evaluation) and liver fibrosis index NFS>0.675 (F3-4 fibrosis). With the use of simple randomization patients were divided into 2 groups: group 1 (study group) included patients with NAFLD who received taurin in total daily dose 1000 mg (500 mg twice a day) in addition to comorbid conditions (diabetes mellitus type 2, ischemic heart disease, hypertension) treatment; group 2 (control group) included patients with NAFLD who received only comorbid conditions treatment. Type IV collagen serum level, fatty liver index (FLI), and NAFLD fibrosis score (NFS) were evaluated at baseline and after 24 weeks of treatment. Сarbohydrate metabolism parameters were monitored by fasting plasma glucose level, basal insulin level and insulin resistance index (HOMA-IR) evaluation. For lipid metabolism monitoring total cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein levels were evaluated. For damage and functional liver markers assessment alanine and aspartate aminotransferase, g-glutamyl transpeptidase activity was evaluated. Results. After 24 weeks of treatment with taurin a statistically significant decrease in type IV collagen level, and NFS decrease on all stages of fibrotic changes that was statistically significant on early fibrosis stages (NFS≤0.675) were observed in patients with NAFLD and liver fibrosis. A significant metabolic activity of the drug was shown that presented with hypoglycemic and lipid-lowering effects as well as significant insulin resistance reduction.
Consilium Medicum. 2018;20(8):37-41
37-41
Gallstone disease treatment: challenges and perspectives
Abstract
The article presents primary ethiopathogenetic aspects of a common biliary tract pathology - gallstone disease. The main goals and objectives of different treatment methods of the disease are outlined. Wide range of ursodeoxycholic acid use effects is described and data of Urdoxa - Russian medication on its basis clinical studies are presented.
Consilium Medicum. 2018;20(8):42-52
42-52
Difficulties in differential diagnosis of cystic pancreatic neoplasm: clinical case
Abstract
Pancreatic ductal adenocarcinoma (PDA) accounts for 90% of all pancreatic neoplasms and is the fourth leading cause of cancer-related death in the western world and sixth - in Russia. PDAs may demonstrate intratumoral cystic features or accompany peritumoral non-neoplastic cystic lesions. We present the clinical case of the patient with cystic-solid lesion of pancreas, the use of contrast-enhanced harmonic EUS (CH-EUS) helped in determining the tactics of treatment. CH-EUS significantly increases the informativeness of the method, extends the possibilities of differential diagnostics of the pancreatobiliary diseases. Now assessment of diagnostic accuracy and determining the place of contrast enhancement in the diagnostics pancreatic diseases are considered the most relevant tasks.
Consilium Medicum. 2018;20(8):53-57
53-57
The new guideline of the American college of gastroenterologists on alcoholic liver disease: the hepatitis is in the spotlight
Abstract
Authors of the guideline have defined the heavy alcohol-use or alcohol-use disorder as consumption of more than 42 g of alcohol per day in males and more than 28 g of alcohol per day in females. These doses during 5 years should be counseled that they are at increased risk for alcoholic liver disease. It is believed that alcoholic hepatitis is layered on any stage of liver disease, i.e. on existing alcoholic steatosis with fibrosis or on cirrhosis of the liver. Clinical diagnosis of alcoholic hepatitis is determined in a patient with rapid development or worsening of jaundice and liver-related complications, with serum total bilirubin >3 mg/dL (51.3 μmol/l); alanine aminotransferase and aspartate aminotransferase elevated >1.5 times the upper limit of normal but <400 U/L with the aspartate aminotransferase/alanine aminotransferase ratio >1.5; documentation of heavy alcohol use until 8 weeks prior to onset of symptoms; and exclusion of other liver diseases. Specific pharmacological therapies with proven efficacy for management of alcoholic hepatitis include nutritional supplementation and corticosteroids.
Consilium Medicum. 2018;20(8):58-66
58-66
Probiotics in gastroenterology practical guidelines: reality and nearest perspectives
Abstract
The article presents evidential base which served as the basis for including probiotics in gastroenterology practical guidelines. Also existing practical guidelines on probiotics use in acute diarrhea, for antibiotic-associated diarrhea prevention and as adjuvant therapy for Helicobacter pylori eradication effectiveness increase are discussed.
Consilium Medicum. 2018;20(8):67-72
67-72
74-79
Characteristic property of molecular and biological mechanisms of Antareit antacid: multiplicity of therapeutic effects
Abstract
Antareit is a combination of magaldrate (new generation antacid) with simeticone (anti-foaming agent used to reduce bloating). Magaldrate anti-acid effect develops quickly (in 1-2 minutes) and preserves for a long time (up to 3 hours). Magaldrate is a multitarget antacid that has adsorbing, enveloping and significant cytoprotective effect on gastric mucosa. When magaldrate dissolves in hydrochloric acid its crystal structure provides forming of tightly-packed hexaaquaaluminium particles. These particles envelop the ulceration area and their size (2 µm) enables epithelial cells and fibroblasts migration in gastric wall reparation process. As a result prostaglandin metabolism is modulated, nitrogen oxide vasodilatator level increases, tissue microcirculation improves and antihistamine effects manifest. These processes are important components of multitarget magaldrate effect.
Consilium Medicum. 2018;20(8):80-84
80-84
Patient with abdominal pain at an outpatient physician visit
Abstract
The article discusses the problem of abdominal pain at an outpatient visit: the most common causes and diagnostic approaches, including differential diagnosis, which will allow outpatient physicians to define indications for emergency hospital admission or refer the patient to other specialized doctors, are presented. The material is presented in tables, that allows to structure it and make it easy to use. Therapeutic approaches to abdominal pain treatment, such as the use of combination drugs including non-steroid anti-inflammatory drugs and spasmolytics are described.
Consilium Medicum. 2018;20(8):85-90
85-90
Thromboangiitis obliterans (Buerger's disease)
Abstract
Thromboangiitis obliterans is a chronic inflammatory disorder that mostly manifests in young patients. The primary vessel wall lesion leads to further necrosis without affecting elastic vessel membrane. Generally thromboangiitis involves peripheral arteries resulting in typical clinical presentation of limb ischemia. Veins are involved as well as arteries whereas no signs of atherosclerosis are found in these patients. Thromboangiitis may be acute as well as it may have relapsing-remitting course causing thromboses and limb ischemia that may result in limb loss. Patients’ survival is higher than corresponding survival rates in patients with atherosclerosis even despite unfavorable outcome of limb revascularization. It is explained by absence of coronary atherosclerosis in these patients. Taking into account the ongoing research on pathogenesis, treatment of such patients still remains a subject of discussion and is a promising area for further scientific developments.
Consilium Medicum. 2018;20(8):91-95
91-95