Vol 22, No 8 (2020)
Articles
Gastroesophageal reflux disease in the practice of the therapist of the polyclinic: terra incognita
Abstract
Gastroesophageal reflux disease is one of the most common nosological forms in gastroenterology. The lecture sheds light on the pathogenesis of the disease, examines diagnostic and therapeutic approaches, gives algorithms for patient management and the differentiated use of drugs.
Consilium Medicum. 2020;22(8):9-26
9-26
The effectiveness of adding butyric acid to antispasmodic therapy regimens for irritable bowel syndrome: a meta-analysis of controlled studies
Abstract
Aim. Systematization of data on the effectiveness of adding butyric acid in the antispasmodic treatment regimens for irritable bowel syndrome (IBS) as a part of meta-analysis. Outcomes and methods. Searching for studies was performed using the MEDLINE / PubMed, EMBASE, Cochrane, Russian Science Citation Index electronic databases for a period till June 2020. All controlled studies comparing the effectiveness of abdominal pain relief in patients with IBS with a combination of butyric acid and standard antispasmodic therapy were included in the final analysis. Results. We selected 8 controlled studies (all from Russia) which included totally 708 patients (412 in the groups of butyric acid and antispasmodic drug combined therapy; 296 in the groups of antispasmodic drug monotherapy). The overall effectiveness of abdominal pain relief in the combined therapy groups was 76.31% (95% confidence interval -CI 71.947-80.298), while in the monotherapy groups - 33,58% (95% CI 28.294-39.199). A meta-analysis showed that adding butyric acid to antispasmodic therapy significantly increases the effectiveness of achieving a complete regression of abdominal pain in patients with IBS (odds ratio 5.995, 95% CI 4.282-8.395, p<0,001) compared with monotherapy. There was no significant heterogeneity between the data of studies (p=0.3335; I2=12.38%). Conclusions. This meta-analysis demonstrated that adding butyric acid to antispasmodic therapy regimens for IBS significantly increases the rate of abdominal pain relief.
Consilium Medicum. 2020;22(8):27-31
27-31
Endoscopic stenting for malignant esophago-respiratory fistulas
Abstract
More than 70% of all cases of malignant fistula occur in patients with advanced cancer of the esophagus. The frequency of their occurrence with inoperable cancer of the esophagus has increased over the past 30 years by more than 10%, due to the wider use of modern palliative treatment methods. Esophageal stenting in this severe group of patients is an effective method of choice with low rates of complications. The article presents the results of the implantation of esophageal stents under video endoscopic control in case of malignant esophago-respiratory fistula in the conditions of the Republican Clinical Oncology Dispensary for the period from 2011 to 2019. Stents were implanted in 22 patients with various malignant pathologies. The article analyzes the timing and factors of the occurrence of fistulas, as well as the complications that have arisen, methods of their prevention and methods of endoscopic correction. The analysis of life expectancy is performed depending on the age of the patients, underlying disease, localization and reporting of malignant fistulas. Successful implantation was achieved in 19 cases. Complications were noted in 5 cases. The average life expectancy of patients was 52 days. Esophageal stenting for malignant esophageal fistulas and esophageal anastomoses is an effective method of choosing palliative treatment.
Consilium Medicum. 2020;22(8):32-35
32-35
Analysis of the effectiveness of using crurorhaphy as a basic technique of laparoscopic plastics of hernia of the esophageal aperture of the diaphragm
Abstract
Based on the treatment provided to 406 patients diagnosed with hiatal hernia who underwent surgery as part of the pilot phase of the study from 2014 to 2017, data were collected that are presented in this article. Comparative results of cruraraphy of patients with pronounced small and large hernia of the alimentary opening of the diaphragm are shown.
Consilium Medicum. 2020;22(8):36-40
36-40
Mechanisms of action of rebamipide: systematic review
Abstract
Rebamipide has been used in clinical practice for the treatment and prevention of various gastrointestinal diseases for 30 years. The principal mechanism of action of the drug is the induction of endogenous synthesis of prostaglandins and an indirect acceleration of ulcer healing. With that, fundamental experimental studies conducted over the past few years have significantly expanded our knowledge of the protective mechanisms of this molecule. This article summarizes the basic data on the mechanisms of action of rebamipide in gastroenterological diseases. The article provides literature data showing that the drug neutralizes lipid peroxidation, improves blood supply to the mucosa, maintains the epithelial barrier by repairing tight cell junctions, and has an antagonistic effect against the colonization activity of Helicobacter pylori.
Consilium Medicum. 2020;22(8):41-45
41-45
The role of bile acids in the pathogenesis of functional dyspepsia: an unfilled therapeutic niche
Abstract
Currently, the etiopathogenesis of functional dyspepsia (FD) is considered as a complex multifaceted and mosaic process, the cause-and-effect relationships of which are being actively studied. It is assumed that the genesis of FD-associated motor and sensory disorders of the stomach may involve complex mechanisms based on qualitative and quantitative changes in the composition of stomach and small intestine microflora caused by alterations in the motility of the lower parts of the gastrointestinal tract as well as changes in the composition and exposure time of bile components in the small intestine and stomach. Following alteration in the barrier function of the mucosal epithelium with the activation of effector resident immunocompetent cells (mast cells, eosinophils) in the lamina propria induces visceral hypersensitivity and/or motor-tonic disorders of the gastroduodenal region. The theoretical basis of the prospects for the use of ursodeoxycholic acid drugs in FD is emphasized not only by the frequent association of FD with biliary disorders, but also by data from recent controlled studies.
Consilium Medicum. 2020;22(8):46-50
46-50
Perspective for the use of metabiotics in the complex therapy of intestinal diseases
Abstract
Aim. To present modern data on the role of microbiota in the development of intestinal diseases, to consider methods for its maintenance and correction. Key points. The human microbiota plays an important role in maintaining homeostasis and the development of diseases, taking part in inflammatory signaling pathways, metabolic processes, digestion, regulation of the cellular and humoral immune response and gastrointestinal motility. The results of these studies demonstrate changes in the microbiota in patients with intestinal pathology. In this light, it seems relevant to correct the microbiota using metabiotics in order to increase the effectiveness of therapy in patients with irritable bowel syndrome, inflammatory bowel diseases, and acute intestinal infections. Conclusion. The inclusion of metabiotics in the complex therapy of intestinal diseases increases its effectiveness. Further study of the possibilities of correcting and/or maintaining the normal composition of microbiota using metabiotics as well as their effect on the pathogenetic links of irritable bowel syndrome, inflammatory bowel diseases is required.
Consilium Medicum. 2020;22(8):51-56
51-56
Probiotics in the treatment of gastrointestinal diseases: effectiveness from the standpoint of evidence-based medicine
Abstract
Probiotics are clinically important microorganisms which have beneficial effects on the gut microbiota and are able to affect the incidence of gastrointestinal diseases. The article provides a scientific review of a large number of meta-analyzes of studies (2004-2019) on assessing the effectiveness of the use of probiotics for the treatment of acute diarrhea, antibiotic-associated diarrhea, eradication therapy for Helicobacter pylori, and functional constipation. According to the data of 9 meta-analyzes (including 2 Cochrane meta-analyzes), the use of probiotics for the treatment of acute diarrhea in adults and children can reliably reduce the duration of diarrhea by more than 1 day and accelerate the achievement of cure in 3-4 days. The most pronounced effect of probiotics in acute diarrhea was noted in children under 5 years of age, and therefore probiotics are included in the European guidelines for the treatment of acute gastroenteritis in children. According to the data of 12 meta-analyzes (including 3 Cochrane meta-analyzes), probiotics have significant effectiveness in the prevention and treatment of antibiotic-associated diarrhea by reducing the risk of diarrhea by 40% or more in different patient populations (adults, the elderly, children). Two Cochrane metaanalyzes have shown the efficacy of probiotics in preventing diarrhea caused by Clostridioides difficile infection via reducing the risk by 60% or more. Fourteen meta-analyzes have demonstrated the effectiveness of probiotics when taking in addition to different regimens of H. pylori eradication therapy, by increasing the rate of eradication and reducing the risk of side effects of antibiotics by 40-50%, which gained significance in the Maastricht V clinical guidelines. In 10 meta-analyzes, the effectiveness of probiotics in influencing intestinal transit in functional constipation was established, in addition, probiotics contributed to the improvement of constipation. Two types of probiotics have the greatest clinical significance for the treatment and prevention of gastrointestinal diseases, they are Lactobacillus and Saccharomyces, namely strains of Lactobacillus rhamnosus GG and Saccharomyces boulardii, for the treatment of functional constipation -probiotics of the genus Bifidobacterium lactis. In addition, a dose-dependent effect of probiotics has been established, and the greatest effect is manifested when using high dosages - at least 109-1010 CFU / day. The evidence for the use of probiotics in the treatment of gastrointestinal diseases in adults and children is also defined in the 2017 Guidelines of the World Gastroenterological Organization.
Consilium Medicum. 2020;22(8):57-64
57-64
Transabdominal intestinal ultrasound in inflammatory and tumor bowel diseases: new opportunities for oral contrasting with polyethylene glycol
Abstract
The purpose of the work is to review current data on the possibilities of transabdominal ultrasound (US) in the diagnosis of intestinal diseases, as well as to present our own results on improving the echographic visualization of the wall of the small and large intestine. The following main options for transabdominal bowel US exist: 1) without any special preparation, and the study is best done on an fasting, but in emergency gastroenterology US may be possible after eating; 2) ente-roclysis; 3) small intestine contrast ultrasonography; 4) bowel hydrosonography; 5) US of the bowel that was emptied from the contents of the intestine after cleaning the colon with a solution of polyethylene glycol (PEG), taken orally (as for colonoscopy); 6) contrasting of the small and large intestine contrast ultrasonography with a PEG solution taken orally The best visualization of the intestinal wall was observed when using two-stage PEG application, when half dose of PEG was taken in the evening, then an US scan was performed in the morning, and next the second half of PEG was taken and an US scan was performed in 30-120 min depending on the zone of interest. The best visualization of the wall of the small intestine is observed 30-60 minutes after the morning intake of PEG. For the diagnosis of protruding tumors of the colon, it is proposed to carry out the above technique of US of the colon approximately 2 hours after taking the second dose of PEG. US should be the first-line imaging method in the medical care of patients with inflammatory bowel disease.
Consilium Medicum. 2020;22(8):65-70
65-70
Iron deficiency anemia in the practice of a gastroenterologist and surgeon: current aspects of diagnostics and treatment
Abstract
Anemia is a group of diseases characterized by a decrease in the number of circulating erythrocytes and/or hemoglobin per unit of blood volume below normal for a given age and gender. Chronic iron deficiency anemia (IDA) occurs more often (80-95% of all anemias) in real clinical practice. IDA is often found in the practice of a gastroenterologist and in patients of surgical departments. This review discusses the most significant aspects of the diagnosis and treatment of IDA in the practice of a gastroenterologist and surgeon. Parenteral iron preparations are indicated in cases where there are contraindications to the use of oral preparations or they are ineffective. In surgical practice (if it is necessary to quickly replenish iron in the body) and in gastroenterology (peptic ulcer and duodenal ulcer, a history of surgical interventions in the gastrointestinal tract, Crohn's disease, ulcerative colitis, malabsorption syndrome), parenteral iron preparations are considered as drugs of choice. The results of numerous international and Russian studies indicate the efficacy and safety of iron (III) hydroxide oligoisomaltosate as the drug of choice for the treatment of absolute or functional iron deficiency states in the absence of the effectiveness of oral iron preparations and, if necessary, rapid iron replacement.
Consilium Medicum. 2020;22(8):71-77
71-77
Autoimmune gastritis: from symptom to diagnosis
Abstract
There are 4 clinical cases of autoimmune gastritis in this article. We examined clinical and laboratory-instrumental dates to determine the indicators to this disease. The leading symptoms, the principles of diagnosis and treatment of autoimmune gastritis were discussed. The gold standard for the diagnosis of autoimmune gastritis is esophagogastroduodenoscopy with biopsy according to the OLGA system to focus not only the stage and degree of atrophy of the gastric mucosa, but also the presence of precancerous lesions. During morphological examination the signs of metaplastic and non-metaplastic atrophy of the glands of the gastric body with the neuroendocrine cell hyperplasia are the most important for the diagnosis. Serological diagnosis (autoantibodies IgG to parietal cells and to Castle internal factor) also helps to confirm the diagnosis.
Consilium Medicum. 2020;22(8):78-84
78-84
Ulcerative colitis: description, genetics, manifestation (familial case of ulcerative colitis)
Abstract
A burdened familial history is an important risk factor for inflammatory bowel disease. This factor occurs in 8-12% of patients and more often with Crohn's disease, than with ulcerative colitis. In this article, we present an example of the hereditary nature of the ulcerative colitis course and the features of the history, diagnosis and clinical picture in the family (mother, daughter and grandson). Clinical observation demonstrates the presence of both similar and distinctive features in patients with the familial form of the disease. The ulcerative colitis manifested in the observed patients at 38, 30 years and at 8 months. The mother had the onset of the disease with extraintestinal manifestations in the form of arthropathy, erythema nodosum, episcleritis and iron deficiency anemia. The manifestation of ulcerative colitis in daughter started with the use of antibacterial drugs and resulted in spontaneous miscarriage. Later she had repeated miscarriage. In the younger patient, the features of the clinical picture represent the early onset of the disease and its severe course. With each generation in this family, the course of ulcerative colitis became more severe and required the inclusion of glucocorticosteroids and immunosuppressants in the child's therapy to achieve remission. Considering the po-lygenetic pathophysiology of ulcerative colitis, currently, it is not possible to carry out genetic mapping in every patient. In the long term, the creation of a gene panel will help to develop and implement personalized management strategies, timely preventing, diagnosing and treating inflammatory bowel disease.
Consilium Medicum. 2020;22(8):85-89
85-89
Leser-Trelat sign in patients with colon cancer: clinical case
Abstract
Leser-Trelat sign that manifests as eruption of multiple seborrheic keratoses is a rare but valuable for diagnostics paraneoplastic syndrome. We present a clinical case of Leser-Trelat sign in a patient with colon cancer. Our opinion s that all patients with sudden onset and rapid progression of seborrheic keratoses should be included in diagnostic screening for undetected malignant process.
Consilium Medicum. 2020;22(8):90-92
90-92
Anomalies of rotation and fixation of the intestine in combination with the Crohn’s disease and tumors of the thin and thick bowel. Clinical observation
Abstract
Anomalies of the rotation and fixation of the intestine is one of the congenital defects of the position of the intestine in the abdominal cavity due to incomplete or improper rotation, it belongs to the group of intestinal development disorders, that can occur at any stage of intestinal tube formation. Anomalies of the position of the colon are often accompanied by functional disorders, could be the reason of complications and the occurrence of inflammatory diseases and tumor processes. Nonspecificity or lack of symptoms greatly complicate clinical and instrumental diagnosis. Clinical observations demonstrate the combination of abnormalities of rotation and fixation of the intestine with non-specific inflammatory and tumor diseases, primarily detected by computed tomography using various techniques for contrasting the lumen of the small and large intestine. The issues of clinical manifestations and the main radiological signs characteristic of Crohn's disease, tumor lesions of the small and large intestine are considered.
Consilium Medicum. 2020;22(8):93-98
93-98