Terapevticheskii Arkhiv最新文献

Irritable bowel syndrome (IBS) is a widespread bowel disease, associated with a significant decrease in patients' quality of life. The etiology, pathogenesis, clinical symptoms and treatment strategies of IBS have not been studied sufficiently. Current clinical guidelines list antispasmodics as medications for abdominal pain management, the main symptom of IBS. Both in Russian and foreign clinical guidelines of IBS, among the antispasmodic drugs, hyoscine butylbromide is regarded as an effective and safe medicine for abdominal pain management. Hyoscine butylbromide has a broad spectrum of applications in gastroenterology. This fact determines its advantages in terms of drug choice for treating patients with comorbidities involving digestive system pathologies. The use of hyoscine butylbromide is especially relevant in light of the frequent occurrence of a combination of IBS and functional disorders of the biliary tract, since the antispasmodic is also recommended for biliary pain management.

Сase report of late radiation damage to the small intestine in a patient who underwent laparoscopic extirpation of uterine cancer and radiation therapy is presented. The article shows the clinical manifestations of chronic post-radiation enteritis with a long progressive course and the development of partial intestinal obstruction, demonstrating the importance of timely diagnosis and the implementation of a multidisciplinary approach in the treatment of patients with late radiation damage to the intestine.

Aim: To systematize data on the prevalence and risk of malnutrition in patients with chronic pancreatitis (CP).

Materials and methods: MEDLINE/PubMed, EMBASE, Cochrane, Google Scholar, Scopus, and the Russian Science Citation Index were searched for studies published between January 1, 1985, and October 23, 2024 (inclusive) based on an analysis of the titles and abstracts of articles in these databases. The study included relevant publications in peer-reviewed periodicals in English or Russian, publications with data on the prevalence of malnutrition in patients with CP and control subjects (if any), studies on adult patients with CP, and publications with detailed descriptive statistics that allow using the data in the meta-analysis.

Results: The final analysis included 13 studies involving 3,812 subjects (3,401 patients with CP and 411 controls). The overall prevalence of malnutrition in patients with CP was 43.43% (95% confidence interval [CI] 32.419-54.780), whereas in controls, it was 10.843% (95% CI 1.360-27.698). When analyzing the association in the overall pool of studies, a significant risk of malnutrition in CP patients compared to controls was shown (relative risk [RR] 3.635, 95% CI 1.409-9.373; p=0.008). The analysis used a random effect model, as there was high heterogeneity between the groups (I²=88.09%, 95% CI 74.76-94.38). A review of studies that used only validated instrumental methods for the diagnosis of malnutrition (criteria of the Global Leadership Initiative on Malnutrition) showed a total prevalence of malnutrition of 38.348% (95% CI 14.975-65.047) in patients with CP and 12.22% (95% CI 5.985-67.238) in control subjects.

Conclusion: This meta-analysis demonstrated that malnutrition is a common complication of CP and occurs in approximately 40% of CP patients. A modern clinician should promptly assess malnutrition markers in a CP patient and correct them using enzyme replacement therapy if detected.

The Russian Cross-disciplinary Consensus on the diagnositic and treatment of spondyloarthritis (SpA) in inflammatory bowel diseases (IBD) was prepared on the initiative of the Loginov Moscow Clinical Scientific Center, using the Delphic system. Its purpose was to consolidate the opinions of experts on the most actual issues of diagnosis and treatment of concomitant immuno-inflammatory diseases (SpA and IBD). An interdisciplinary approach is provided by the participation of leading gastroenterologists and rheumatologists. The working group analyzed domestic and foreign publications on the problem of curation of patients with SpA and IBD. There have been 17 statements and 2 treatment algorithms formulated. Statements 1-3 reflect the fundamental principles of management of patients with SpA and IBD. The principles of early diagnosis of SpA and IBD, including the diagnosis of complications of therapy, are described below. Eleven statements are devoted to current methods of treatment, on the basis of which 2 treatment algorithms have been developed. The statements of the Consensus were submitted to the Expert Council for consideration, edits were made, after which an online vote took place. This paper presents current recommendations for the management, diagnosis and treatment of patients with SpA and IBD.

Aim: To evaluate inflammatory cytokines, such as tumor necrosis factor α (TNF-α), interleukin (IL)-1β, 8, 6, soluble IL-6 receptors (sIL-6R) and fragmented cytokeratin-18 (FCK-18) as indicators of non-alcoholic steatohepatitis (NASH).

Materials and methods: 173 NASH patients aged 47.0±10.8 years were examined: 118 (68.2%) - men, 55 (31.8%) - women. The following markers were determined: TNF-α (Human TNFα Platinum ELISA, eBioscience, Austria), IL-1β, 8, 6 (Vector-Best, Russia), sIL-6R (Human sIL-6R ELISA, eBioscience, Austria), FCK-18 (TPS ELISA, Biotech, Sweden), insulin (Insulin TEST System, USA), HOMA-IR (Homeostasis Model Assessment of Insulin Resistance) and NAFLD fibrosis score (NFS) were calculated.

Results: The highest level in NASH patients compared with healthy individuals was observed for IL-6 - 8.4±1.6 pg/ml versus 2.8±0.9 pg/ml (p=0.001), FCK-18 - 295.3±56.3 U/l versus 110.5±30.2 U/l (p=0.0001), then IL-8 - 17.3±6.7 pg/ml vs 7.6±1.9 pg/ml (p=0.003), TNF-α - 6.3±0.4 pg/ml versus 4.1±0.8 pg/ml (p=0.0001), sIL-6R - 151.5±21.2 ng/ml vs 95.9±12.5 ng/ml (p<0.05); IL-1β did not change - 5.3±1.4 pg/ml versus 4.7±1.5 pg/ml (p=0.3) respectively. FCK-18 showed the highest correlations with TNF-α (r=0.73), HOMA-IR (r=0.73), alanine aminotransferase (r=0.71), erythrocyte sedimentation rate (r=0.23), IL-6 (r=0.22); p<0.05. TNF-α correlated with FCK-18 (r=0.73), cholesterol (r=0.61), albumin (r=-0.42), fibrinogen (r=0.21), leukocyte count (r=0.21); p<0.05. IL-8 correlated with triglycerides (r=0.79) and HDL (r=-0.77), IL-6 - with NFS (r=0.63) and FCK-18 (r=0.22), rIL-6R - with aspartate aminotransferase (r=0.62); p<0.05.

Conclusion: TNF-α, IL-8, 6, sIL-6R and FCK-18 should be used as non-invasive biomarkers of NASH.

Aim: To assess the muscle mass of patients with inflammatory bowel disease (IBD) using ultrasound.

Materials and methods: 102 IBD patients hospitalized in gastroenterology department of Republican Clinical Hospital (Kazan) were involved in the study. Among them, 49% of patients with ulcerative colitis, 51% with Crohn's disease, 10 people made up the control group (CG). The median age in the IBD group was 39.5 [28.5; 50] years, in the CG - 37 [26; 38] years. There were 52 (51%) women in the IBD group and 5 (50%) in the CG group. Patients were examined to assess body mass index (BMI), mid-upper arm circumference (MUAC, cm) and mid-thigh circumference (MTC, cm) of the dominant side; bioimpedance analysis of body composition using the ABC-02 "MEDASS" device; ultrasound examination of muscle thickness at two points on the leading side: ultrasound thickness of the middle of the shoulder (US-MUAC), ultrasound thickness of the middle of the thigh (US-MTC), dynamometry using a wrist dynamometer, assessment of nutritional status.

Results: According to BMI, patients were distributed as follows: normal in 57 (55.9%) patients; deficiency - in 12 (11.8%); overweight - 25 (24.5%); obesity - 8 (7.8%). Median MUAC in women with IBD was 28 [24.9; 31] cm, in CG - 28 [27; 28.5] cm (p>0.05); in men with IBD 29.8 [27; 32] cm, in CG - 33 [31; 34] cm (p<0.05). The median MTC in women with IBD was 54.25 [48.15; 58.10] cm, in CG - 61.5 [56; 67] cm (p<0.05); in men with IBD 48 [46; 51.4] cm, in GC - 54 [53; 54] cm (p<0.05). The median US-MUAC in women with IBD was 19.60 [18.23; 22.84] mm, CG 22.49 [20.41; 22.66] (p>0.05); in men with IBD 26.45 [22.87; 29.24] mm, in CG 21.54 [21.18; 25.13] mm (p>0.05). Median US-MTC in women with IBD was 31.05 [23.21; 37.11] mm, CG 41.30 [35.55; 41.74] mm (p<0.05), in men with IBD 30.90 [25.64; 39.99] mm, in CG 40.67 [39.10; 41.84] (p<0.05). According to the results of bioimpedansometry, the skeletal muscle mass index (SMI) was low in 32% of patients, normal in 65%, and above normal in 3%. US-MUAC correlated with MUAC (r=0.557; p<0.05), with BMI (r=0.448; p<0.05), with SMI (r=0.666; p<0.05). US-MTC correlated with MTC (r=0.505; p<0.05), with BMI (r=0.376; p<0.05), with SMI (r=0.373; p<0.05).

Conclusion: In patients with IBD, MTC was lower than in CG. US-MTC in women and men with IBD was lower than in CG, which correlated with MTC, BMI, skeletal muscle mass according to bioimpedance measurements and grip strength according to dynamometry.

Aim: To determine the trends of primary antibiotic resistance of Helicobacter pylori strains isolated from patients living in Moscow.

Materials and methods: As part of a clinical and laboratory study, 123 gastric biopsy specimens from H. pylori-infected patients were analyzed from 2015 to 2024. H. pylori infection was verified by a rapid urease test and a ¹³C-urease breath test. The anaerobic culture technique was used. After identifying a pure culture, its susceptibility to four antibacterial agents (amoxicillin - AMC, clarithromycin - CLR, metronidazole - MET, tetracycline - TET) was determined by the disc diffusion method.

Results: According to the data, the resistance in the overall pool (n=123) of the test samples to AMC was 4.88%, CLR 16.26%, TET 3.25%, and MET 46.34%. Dual resistance to CLR and MET was detected in 4.06% of strains. Among strains collected from 2015 to 2019 (n=28), resistance to AMC was 0.0%, CLR 10.71%, TET 0.0%, and MET 50.0%. The structure of antibiotic resistance of strains collected from 2020 to 2024 (n=95) was as follows: AMC - 6.32%, CLR - 17.89%, TET - 4.21%, MET - 45.26%.

Conclusion: There is a gradual tendency to increase the resistance of H. pylori to antibacterial agents such as AMC, CLR, and TET in Moscow, which is consistent with the data of other studies. This negative trend may eventually lead to decreased effectiveness of currently used eradication therapy regimens in Russia.

Aim: To evaluate the contribution of cardiometabolicfactors and PNPLA3 I148M (rs738409 C>G) gene polymorphism to the development of compensated advanced chronic liver disease (cACLD) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).

Materials and methods: 108 patients with MASLD were enrolled and formed the internal validation group; 30 patients with MASLD were selected for external validation. Anamnestic data, anthropometric and laboratory parameters and the presence of PNPLA3 gene polymorphism I148M (rs738409 C>G) were assessed. Steatosis was detected by assessing the controlled attenuation parameter. Liver elasticity was assessed by transient elastography. cACLD was detected when the liver stiffness was ≥8 kPa.

Results: Statistically significant difference was observed in the internal validation group during comparison of the incidence of cACLD depending on the presence of arterial hypertension (odds ratio - OR 5.58; 95% confidence interval - CI 1.21-25.71), type 2 diabetes mellitus - T2DM (OR 4.58; 95% CI 1.59-13.21), obesity (OR 3.13; 95% CI 1.1-8.9), dyslipidemia (OR 6.12; 95% CI 1.33-28.19) and the mutant G allele of the PNPLA3 gene (OR 3.9; 95% CI 1.28-11.88). Patients with cACLD had significantly higher mean values of waist circumference (WC), alanine aminotransaminase, aspartate aminotransaminase, gamma-glutamyl transferase and triglycerides, non-invasive markers of steatosis and fibrosis. The compiled prognostic model demonstrated a direct relationship between the likelihood of developing cACLD and the presence of T2DM (adjusted odds ratio - AOR 3.28; 95% CI 0.62-17.33), dyslipidemia (AOR 5.89; 95% CI 1.21-28.67) and WC value (AOR 1.05; 95% CI 1.01-1.11). PNPLA3 I148M gene polymorphism did not significantly affect the development of late stages of the disease. External validation of the model showed its moderate diagnostic ability.

Conclusion: T2DM, dyslipidemia and WC values are the determining factors in the development of cACLD in patients with MASLD. The PNPLA3 I148M gene polymorphism has no leading importance for the development of the progressive course of MASLD in the studied cohort.

Aim: To collect and analyze real-world data on long-term enzyme replacement therapy with Glurazyme® in patients with type I Gaucher disease (GD).

Materials and methods: The study included 31 patients with type I GD (21 patients with intact spleen and 10 patients with a history of splenectomy) over 18 years. Efficacy was assessed by the change in hemoglobin level (primary endpoint), platelet count, spleen and liver volumes, prevalence of bone marrow infiltration, and the number of patients with quiet hip disease according to magnetic resonance imaging (secondary endpoints). Safety was assessed by the incidence of treatment-related adverse events and serious adverse events, as well as by the incidence of production of imiglucerase binding and neutralizing antibodies (IgG, IgE). The mean follow-up duration was 54 weeks.

Results: The study did not show a statistically significant change in hemoglobin levels, platelet count, or spleen and liver volumes. There was an upward tendency in platelet count in the overall group (p=0.1) and patients after splenectomy (p=0.08). The prevalence of specific bone marrow infiltration and the number of patients with quiet hip disease remained unchanged. During the safety analysis, one adverse reaction, a mild increase in alanine aminotransferase, was reported, which resolved spontaneously by the end of the study. The immunogenicity analysis showed the initial presence of anti-drug antibodies (ADAs) in 5 (16.7%) of the 30 examined patients. At the end of the study, ADAs were detected in only 3 (10%) patients. The detected ADAs had a low titer and no neutralizing activity, and they did not affect the treatment effectiveness.

Conclusion: Long-term therapy with the imiglucerase biosimilar was associated with a stable course of GD without progression. It was characterized by a good safety profile and low immunogenicity.

Aim: To study the interaction of hormonal factors and indicators of vegetative homeostasis in violation of the motor evacuation function of the duodenum in chronic duodenal insufficiency (CDI).

Materials and methods: 70 patients with CDI were under observation. The average age of patients was 35.7±11.4 years, women were 32 (45.7%), men - 38 (54.3%). The control group included 31 healthy individuals [average age 39.1±12.3 years; there were 15 women (48.3%), 16 men (51.7%)]. Cardiorhythmographic examination and analysis of heart rate variability with the "Varicard 2.51" complex were used to study the ANS. To study the intramural nervous apparatus of the duodenum, a biopsy piece of its wall from the lower horizontal section was examined. Electrochemiluminescence analysis made it possible to determine the content of gastrin, insulin, cortisol, and somatostatin in the blood. To diagnose motor disorders of the gastroduodenal zone, peripheral electrogastroenterography was performed using the gastroenteromonitor GEM-01 "Gastroscan-GEM".

Results: In patients with CDI, in addition to changes in the clinical and electrophysiological picture, changes in the vegetative status were revealed. This condition correlates with the following electrophysiological signs in CDI - hypomotor duodenum leads to a greater increase in the ratio P_i/P_{i + 1} stomach / duodenum after food stimulation (17.43±2.46) in this group of patients (p=0.000). The study of the basal hormone content in CDI showed a significant increase in gastrin, cortisol and a decrease in insulin and somatostatin in comparison with the control group. The relationship between them and vegetative-electrophysiological indicators is revealed.

Conclusion: Comprehensive studies of myoelectric activity, the functional state of the autonomic nervous system and hormonal regulatory factors, followed by the analysis of multidimensional statistics data, revealed new pathophysiological patterns in duodenal motility disorders in CDI.