Pub Date : 2023-09-11DOI: 10.22416/1382-4376-2023-33-3-7-15
M. O. Pyatchenkov, A. A. Vlasov, E. V. Sherbakov, S. P. Salikova
А im: to analyze the significance of microbial-derived uremic toxins (MDUT) in the pathogenesis of comorbidities in patients with chronic kidney disease (CKD). Key findings. Increased excretion of nitrogen metabolism products into the intestines of patients with CKD is associated with uremic dysbiosis; changes in the metabolic activity of the gut microbiota and the leaky gut syndrome; which largely cause the accumulation of MDUT in the internal environment of the body: indoxyl sulfate; p-cresyl sulfate; trimethylamine-N-oxide; etc. The results of recent studies allow to consider these metabolites as an independent risk factor for adverse outcomes in people with CKD due to the progression of renal dysfunction to the terminal stage; as well as frequent cardiovascular; neurological; bone mineral; nutritional and other complications. Conclusion. MDUT are one of the key modulators of the pathogenetic relationship between the gut and kidneys. Therapeutic manipulations with intestinal microbiota can be considered a promising strategy for preventing complications associated with uremia.
{"title":"Microbial-Derived Uremic Toxins: Role in the Pathogenesis of Comorbidities in Patients with Chronic Kidney Disease","authors":"M. O. Pyatchenkov, A. A. Vlasov, E. V. Sherbakov, S. P. Salikova","doi":"10.22416/1382-4376-2023-33-3-7-15","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-3-7-15","url":null,"abstract":"А im: to analyze the significance of microbial-derived uremic toxins (MDUT) in the pathogenesis of comorbidities in patients with chronic kidney disease (CKD). Key findings. Increased excretion of nitrogen metabolism products into the intestines of patients with CKD is associated with uremic dysbiosis; changes in the metabolic activity of the gut microbiota and the leaky gut syndrome; which largely cause the accumulation of MDUT in the internal environment of the body: indoxyl sulfate; p-cresyl sulfate; trimethylamine-N-oxide; etc. The results of recent studies allow to consider these metabolites as an independent risk factor for adverse outcomes in people with CKD due to the progression of renal dysfunction to the terminal stage; as well as frequent cardiovascular; neurological; bone mineral; nutritional and other complications. Conclusion. MDUT are one of the key modulators of the pathogenetic relationship between the gut and kidneys. Therapeutic manipulations with intestinal microbiota can be considered a promising strategy for preventing complications associated with uremia.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136025586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-26DOI: 10.22416/1382-4376-2023-33-4-38-57
Yu. P. Uspenskiy, A. M. Sarana, L. N. Melentyeva, A. V. Yazenok, S. V. Petrov, Yu. A. Fominykh, S. V. Ivanov, A. V. Shotik, A. M. Segal, T. V. Gorbacheva, S. D. Plotnikova, K. V. Dronov
Aim: to present the principles of functioning of the regional registry of inflammatory bowel disease (IBD) patients in Saint Petersburg on the basis of the City Health Information System (Saint Petersburg IBD Registry). Key points. The Saint Petersburg IBD Registry consists of General Statistical Module and Clinical Module. The General Statistical Module is intended to analyze the prevalence of ulcerative colitis and Crohn's disease, the number of patient visits to medical institutions; to assess the burden on the healthcare system, demographic characteristics, routing and mortality for the whole region. The Clinical Module allows to assess the IBD features in prospective observation. The register case report form is integrated into the patient's status in the Medical Information System of the medical institution. Saint Petersburg IBD Registry operates on the basis of the Saint Petersburg Medical Center of Information and Analysis within the framework of the Regional Medical Data Collection System of the Russian state information system “Regional Fragment of the Unified State Information System in the Healthcare Branch”. The accumulation of prospective data in the Clinical Module continues, which in the near future will make it possible to test and configure the automated analytical block of the registry. Conclusion. The functioning of the Saint Petersburg IBD Registry allows to achieve following primary goals within region: assessment of the epidemiological features of IBD in Saint Petersburg; dynamic assessment of the disease features; assessment and planning of health care resources required to provide care to IBD patients; improvement of approaches to the treatment taking into account the specifics of the region; assessment of the effectiveness and tolerability of specific treatment including biologics.
{"title":"The First Saint Petersburg Regional Inflammatory Bowel Diseases Registry on the Basis of the Regional Health Information System: Principles of Functioning, Testing Results, Plan of Development","authors":"Yu. P. Uspenskiy, A. M. Sarana, L. N. Melentyeva, A. V. Yazenok, S. V. Petrov, Yu. A. Fominykh, S. V. Ivanov, A. V. Shotik, A. M. Segal, T. V. Gorbacheva, S. D. Plotnikova, K. V. Dronov","doi":"10.22416/1382-4376-2023-33-4-38-57","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-4-38-57","url":null,"abstract":"Aim: to present the principles of functioning of the regional registry of inflammatory bowel disease (IBD) patients in Saint Petersburg on the basis of the City Health Information System (Saint Petersburg IBD Registry). Key points. The Saint Petersburg IBD Registry consists of General Statistical Module and Clinical Module. The General Statistical Module is intended to analyze the prevalence of ulcerative colitis and Crohn's disease, the number of patient visits to medical institutions; to assess the burden on the healthcare system, demographic characteristics, routing and mortality for the whole region. The Clinical Module allows to assess the IBD features in prospective observation. The register case report form is integrated into the patient's status in the Medical Information System of the medical institution. Saint Petersburg IBD Registry operates on the basis of the Saint Petersburg Medical Center of Information and Analysis within the framework of the Regional Medical Data Collection System of the Russian state information system “Regional Fragment of the Unified State Information System in the Healthcare Branch”. The accumulation of prospective data in the Clinical Module continues, which in the near future will make it possible to test and configure the automated analytical block of the registry. Conclusion. The functioning of the Saint Petersburg IBD Registry allows to achieve following primary goals within region: assessment of the epidemiological features of IBD in Saint Petersburg; dynamic assessment of the disease features; assessment and planning of health care resources required to provide care to IBD patients; improvement of approaches to the treatment taking into account the specifics of the region; assessment of the effectiveness and tolerability of specific treatment including biologics.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"95 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135236329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-26DOI: 10.22416/1382-4376-2023-33-3-43-48
A. A. Turkina, M. V. Maevskaya, M. S. Zharkova, V. T. Ivashkin
А im: to study the structural and functional characteristics of albumin in patients with decompensated cirrhosis, their relationship with ascites; to identify the relationship between improvement in albumin characteristics and regression of ascites. Materials and methods. Fifty patients with decompensated liver cirrhosis and ascites were divided into groups. The first group received standard treatment for cirrhosis, the second — standard treatment and replacement therapy with 20 % human albumin solution at a dose of 200 mL per week for 3 months. Results. The value of the native conformation of albumin and the functional parameters of albumin were significantly lower than in the group of healthy individuals ( p < 0.001). With the severity of ascites, the native conformation index (DR), which characterizes the structural usefulness of the albumin molecule, decreased. Median DR for ascites stage I (IAC) was –1.69, II grade — –2.28, III grade — –2.42 ( p < 0.05). Replacement therapy with albumin allowed to achieve regression of ascites in 48.4 % of patients, compared with 7.1 % in the standard treatment group. Along with clinical improvement, restoration of albumin structural and functional properties was observed in the albumin group. The mean serum albumin level at which ascites remained in remission for 3 months was 42.11 g/L ( p < 0.001). Conclusions and discussion. The structural and functional characteristics of albumin were impaired in patients with decompensated cirrhosis and ascites. The severity of changes in the structural and functional properties of albumin depended on the severity of ascites. The regression of ascites was accompanied by the restoration of the functional and structural usefulness of albumin against the backdrop of albumin replacement therapy. The criterion for stopping transfusion therapy with albumin can be the achievement of a serum albumin level of 42.11 ± 7.04 g/L, DR — 1.05, BE — 73.51 %, RTQ — 75.10 %, DTE — 72.71 %.
{"title":"The Role of Correcting Structural and Functional Albumin Properties in Ascites Control in Decompensated Cirrhotic Patients","authors":"A. A. Turkina, M. V. Maevskaya, M. S. Zharkova, V. T. Ivashkin","doi":"10.22416/1382-4376-2023-33-3-43-48","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-3-43-48","url":null,"abstract":"А im: to study the structural and functional characteristics of albumin in patients with decompensated cirrhosis, their relationship with ascites; to identify the relationship between improvement in albumin characteristics and regression of ascites. Materials and methods. Fifty patients with decompensated liver cirrhosis and ascites were divided into groups. The first group received standard treatment for cirrhosis, the second — standard treatment and replacement therapy with 20 % human albumin solution at a dose of 200 mL per week for 3 months. Results. The value of the native conformation of albumin and the functional parameters of albumin were significantly lower than in the group of healthy individuals ( p < 0.001). With the severity of ascites, the native conformation index (DR), which characterizes the structural usefulness of the albumin molecule, decreased. Median DR for ascites stage I (IAC) was –1.69, II grade — –2.28, III grade — –2.42 ( p < 0.05). Replacement therapy with albumin allowed to achieve regression of ascites in 48.4 % of patients, compared with 7.1 % in the standard treatment group. Along with clinical improvement, restoration of albumin structural and functional properties was observed in the albumin group. The mean serum albumin level at which ascites remained in remission for 3 months was 42.11 g/L ( p < 0.001). Conclusions and discussion. The structural and functional characteristics of albumin were impaired in patients with decompensated cirrhosis and ascites. The severity of changes in the structural and functional properties of albumin depended on the severity of ascites. The regression of ascites was accompanied by the restoration of the functional and structural usefulness of albumin against the backdrop of albumin replacement therapy. The criterion for stopping transfusion therapy with albumin can be the achievement of a serum albumin level of 42.11 ± 7.04 g/L, DR — 1.05, BE — 73.51 %, RTQ — 75.10 %, DTE — 72.71 %.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"169 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135236917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-26DOI: 10.22416/1382-4376-2023-33-3-76-84
R. V. Ischenko, Yu. V. Ivanov, A. V. Smirnov, V. N. Antipov
А im: to present two clinical cases of successful surgical treatment of patients with a combination of complete transposition of internal organs and cancer of the biliopancreatoduodenal zone. Key points. A 65-year-old man underwent gastropancreatoduodenal resection for cancer of the large duodenal papilla. In addition to the situs vicserum inversus , this patient revealed a special variant of vascular anatomy, namely: separate separation of the left and right hepatic arteries from the ventral trunk. A 70-year-old man, in addition to complete transposition of internal organs, had a combination of cancer of the terminal part of the common bile duct and heterotaxy syndrome in the form of polysplenia, aplasia of the hepatic segment of the inferior vena cava, agenesis of the dorsal pancreatic rudiment (“short” pancreas), intrapancreatic course of the right hepatic artery extending from the superior mesenteric arteries, rotational abnormalities of intestinal development. This patient underwent a total pancreatectomy. In both cases, the main difficulties in mobilizing the pancreatoduodenal complex arose due to anatomical disorientation and the absence of standard (familiar) topographic and anatomical landmarks for the surgeon. Conclusion. In all patients with tumors of the biliopancreatoduodenal zone, a detailed assessment of the vascular anatomy of this area is required before surgery, with the study of the course of the main visceral vessels and their large branches using multispiral computed tomography in vascular mode. If heterotaxy syndrome is suspected, additional examination is necessary to identify hidden developmental anomalies, which allows surgeons to be prepared for an unusual situation. Gastropancreatoduodenal resection or total pancreatectomy in situs viscerum inversus is a technically complex intervention and should be performed in large multidisciplinary medical institutions, and the operating team should have extensive experience in operations on the organs of the biliopancreatoduodenal zone.
А im:介绍两例成功手术治疗胆胰十二指肠区肿瘤合并脏器完全性移位的临床病例。要点。一位65岁男性，因大十二指肠乳头癌行胃胰十二指肠切除术。除了副血清逆位外，该患者还表现出一种特殊的血管解剖变异，即:左、右肝动脉与腹侧干分离。70岁男性，除内脏完全移位外，合并胆总管末端癌及多脾异位综合征，下腔静脉肝段发育不全，胰腺背侧基底发育不全(“短”胰腺)，右肝动脉从肠系膜上动脉延伸至胰腺内走行，肠道旋转发育异常。该患者接受了全胰腺切除术。在这两种情况下，调动胰十二指肠复合体的主要困难是由于解剖定向障碍和外科医生缺乏标准(熟悉的)地形和解剖标志。结论。在所有胆胰十二指肠区肿瘤患者中，术前需要对该区域的血管解剖进行详细的评估，使用血管模式下的多螺旋计算机断层扫描研究主要内脏血管及其大分支的走向。如果怀疑异位综合征，则需要进行额外的检查以确定隐藏的发育异常，这使外科医生能够为异常情况做好准备。胃胰十二指肠切除术或内脏逆位全胰切除术是一项技术复杂的干预手术，应在大型多学科医疗机构进行，手术团队应具有丰富的胆胰十二指肠区脏器手术经验。
{"title":"Surgical Strategy in Patients with Complete Transposition of Internal Organs in Cancer of the Biliopancreatoduodenal Zone","authors":"R. V. Ischenko, Yu. V. Ivanov, A. V. Smirnov, V. N. Antipov","doi":"10.22416/1382-4376-2023-33-3-76-84","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-3-76-84","url":null,"abstract":"А im: to present two clinical cases of successful surgical treatment of patients with a combination of complete transposition of internal organs and cancer of the biliopancreatoduodenal zone. Key points. A 65-year-old man underwent gastropancreatoduodenal resection for cancer of the large duodenal papilla. In addition to the situs vicserum inversus , this patient revealed a special variant of vascular anatomy, namely: separate separation of the left and right hepatic arteries from the ventral trunk. A 70-year-old man, in addition to complete transposition of internal organs, had a combination of cancer of the terminal part of the common bile duct and heterotaxy syndrome in the form of polysplenia, aplasia of the hepatic segment of the inferior vena cava, agenesis of the dorsal pancreatic rudiment (“short” pancreas), intrapancreatic course of the right hepatic artery extending from the superior mesenteric arteries, rotational abnormalities of intestinal development. This patient underwent a total pancreatectomy. In both cases, the main difficulties in mobilizing the pancreatoduodenal complex arose due to anatomical disorientation and the absence of standard (familiar) topographic and anatomical landmarks for the surgeon. Conclusion. In all patients with tumors of the biliopancreatoduodenal zone, a detailed assessment of the vascular anatomy of this area is required before surgery, with the study of the course of the main visceral vessels and their large branches using multispiral computed tomography in vascular mode. If heterotaxy syndrome is suspected, additional examination is necessary to identify hidden developmental anomalies, which allows surgeons to be prepared for an unusual situation. Gastropancreatoduodenal resection or total pancreatectomy in situs viscerum inversus is a technically complex intervention and should be performed in large multidisciplinary medical institutions, and the operating team should have extensive experience in operations on the organs of the biliopancreatoduodenal zone.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135236914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-22DOI: 10.22416/1382-4376-2023-33-3-61-65
A. A. Sheptulin, S. S. Kardasheva, A. A. Kurbatova
А im: to analyze publications devoted to the study of the role of food in the occurrence of functional dyspepsia (FD), as well as the possibilities of using dietary nutrition in its treatment. Key findings. Many studies have shown that spicy food, food with a high content of saturated fats, coffee, carbonated drinks can lead to symptoms of FD. Intolerance to certain foods (in particular, wheat) may be associated with their ability to act as allergens. A number of studies have noted that elimination diets (a diet with a low content of FODMAP products and a gluten-free diet) reduce the severity of dyspeptic disorders, however, there is no convincing evidence of the effectiveness of these diets. Conclusion. The role of nutrition in the occurrence of FD and the possibility of using various diets in its treatment have not been sufficiently studied and require further research.
А im:分析专门研究食物在功能性消化不良(FD)发生中的作用的出版物，以及在其治疗中使用膳食营养的可能性。关键的发现。许多研究表明，辛辣食物、饱和脂肪含量高的食物、咖啡、碳酸饮料都会导致FD的症状。对某些食物(特别是小麦)的不耐受可能与它们作为过敏原的能力有关。许多研究指出，消除饮食(低含量FODMAP产品的饮食和无麸质饮食)可以降低消化不良疾病的严重程度，然而，没有令人信服的证据表明这些饮食的有效性。结论。营养在FD发生中的作用以及使用不同日粮治疗FD的可能性尚未得到充分研究，需要进一步研究。
{"title":"Diet in the Management of Functional Dyspepsia: Controversial and Unresolved Issues","authors":"A. A. Sheptulin, S. S. Kardasheva, A. A. Kurbatova","doi":"10.22416/1382-4376-2023-33-3-61-65","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-3-61-65","url":null,"abstract":"А im: to analyze publications devoted to the study of the role of food in the occurrence of functional dyspepsia (FD), as well as the possibilities of using dietary nutrition in its treatment. Key findings. Many studies have shown that spicy food, food with a high content of saturated fats, coffee, carbonated drinks can lead to symptoms of FD. Intolerance to certain foods (in particular, wheat) may be associated with their ability to act as allergens. A number of studies have noted that elimination diets (a diet with a low content of FODMAP products and a gluten-free diet) reduce the severity of dyspeptic disorders, however, there is no convincing evidence of the effectiveness of these diets. Conclusion. The role of nutrition in the occurrence of FD and the possibility of using various diets in its treatment have not been sufficiently studied and require further research.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135717085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-22DOI: 10.22416/1382-4376-2023-33-3-34-42
T. V. Sapozhnikova, S. A. Parfenov, T. E. Yesina, K. V. Sapozhnikov, A. N. Smirnov, A. A. Paulov, D. M. Rizakhanov, O. A. Rizakhanova
А im: development of an algorithm for the use of antioxidant cognitive-behavioral therapy in adult patients with functional dyspepsia. Material and methods. The study included 112 adult patients with functional dyspepsia receiving the antioxidant drug Cytoflavin containing succinic acid, inosine, nicotinamide and riboflavin, and cognitive behavioral therapy according to the method of Beck and Jacobson in addition to the main therapy (prokinetics, proton pump inhibitors, psychotropic drugs). Results. Of the total group, 74 patients had an optimal response to the inclusion of an antioxidant and psychotherapy in the treatment regimen (increased quality of life and reduced anxiety) and 38 patients had the insignificant response. It has been established that the main predictors of the successful use of an extended treatment regimen are the patient's disadaptation in relation to the disease, a recent stress factor, the duration of functional dyspepsia, the presence of an overlap syndrome (combination with other functional gastrointestinal disorders). Conclusions. Based on the collection of a small amount of anamnestic information (the duration of functional dyspepsia, the presence of an acute stress factor in the anamnesis), the assessment of the presence of an overlap syndrome and disadaptation in relation to the patient to his illness, the value of the discriminant function is calculated. After comparing it with a threshold, the probability of a positive response to a combination of antioxidant and cognitive-behavioral therapy is estimated. The developed prediction algorithm is valid (sensitivity — 91 %, specificity — 73 %, accuracy — 84.8 %) and allows to optimize the definition of treatment tactics for a patient with functional dyspepsia.
А im:在功能性消化不良的成年患者中使用抗氧化认知行为疗法的算法开发。材料和方法。本研究纳入112例成年功能性消化不良患者，在主要治疗方法(前动力学、质子泵抑制剂、精神药物)的基础上，给予含有琥珀酸、肌苷、烟酰胺、核黄素的抗氧化药物Cytoflavin，并按Beck和Jacobson方法进行认知行为治疗。结果。在整个组中，74名患者对治疗方案中包含抗氧化剂和心理治疗(提高生活质量和减少焦虑)有最佳反应，38名患者的反应不显著。已经确定，延长治疗方案成功使用的主要预测因素是患者对疾病的不适应、最近的压力因素、功能性消化不良的持续时间、重叠综合征的存在(与其他功能性胃肠道疾病合并)。结论。基于收集少量的记忆信息(功能性消化不良的持续时间，记忆中是否存在急性应激因素)，评估重叠综合征的存在以及患者对其疾病的不适应，计算出判别函数的值。在将其与阈值进行比较后，估计抗氧化剂和认知行为治疗相结合的积极反应的概率。开发的预测算法是有效的(灵敏度- 91%，特异性- 73%，准确性- 84.8%)，并允许对功能性消化不良患者的治疗策略进行优化定义。
{"title":"Antioxidants and Cognitive-Behavioral Therapy in Patients with Functional Dyspepsia","authors":"T. V. Sapozhnikova, S. A. Parfenov, T. E. Yesina, K. V. Sapozhnikov, A. N. Smirnov, A. A. Paulov, D. M. Rizakhanov, O. A. Rizakhanova","doi":"10.22416/1382-4376-2023-33-3-34-42","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-3-34-42","url":null,"abstract":"А im: development of an algorithm for the use of antioxidant cognitive-behavioral therapy in adult patients with functional dyspepsia. Material and methods. The study included 112 adult patients with functional dyspepsia receiving the antioxidant drug Cytoflavin containing succinic acid, inosine, nicotinamide and riboflavin, and cognitive behavioral therapy according to the method of Beck and Jacobson in addition to the main therapy (prokinetics, proton pump inhibitors, psychotropic drugs). Results. Of the total group, 74 patients had an optimal response to the inclusion of an antioxidant and psychotherapy in the treatment regimen (increased quality of life and reduced anxiety) and 38 patients had the insignificant response. It has been established that the main predictors of the successful use of an extended treatment regimen are the patient's disadaptation in relation to the disease, a recent stress factor, the duration of functional dyspepsia, the presence of an overlap syndrome (combination with other functional gastrointestinal disorders). Conclusions. Based on the collection of a small amount of anamnestic information (the duration of functional dyspepsia, the presence of an acute stress factor in the anamnesis), the assessment of the presence of an overlap syndrome and disadaptation in relation to the patient to his illness, the value of the discriminant function is calculated. After comparing it with a threshold, the probability of a positive response to a combination of antioxidant and cognitive-behavioral therapy is estimated. The developed prediction algorithm is valid (sensitivity — 91 %, specificity — 73 %, accuracy — 84.8 %) and allows to optimize the definition of treatment tactics for a patient with functional dyspepsia.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135717087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-22DOI: 10.22416/1382-4376-2023-33-3-66-75
K. S. Nezhdanov, E. N. Shirokova, Yu. O. Shulpekova, A. S. Ostrovskaya, M. S. Zharkova, V. T. Ivashkin
А im: to highlight the importance of broad differential diagnosis and possibility of conversion of benign recurrent intrahepatic cholestasis type 2 into more aggressive clinical phenotype. Key points. A 19-year-old female patient was admitted to the Clinic with skin pruritus, jaundice, dark urine, clay-colored stool, and general fatigue. Past medical history was significant for recurrent aforementioned symptoms since 3 years old, that relapsed every 1–2 years and were usually ameliorated with conservative therapy. During recent years, frequency of relapses and recovery period increased, at the same time effectiveness of medical therapy decreased. Blood chemistry results revealed an elevation of total bilirubin (up to 634 μmol/L), direct bilirubin (up to 354 μmol/L), bile acids (up to 510 μmol/L) and normal gamma glutamyl transferase level. Workup was negative for viral hepatitis, autoimmune liver diseases, obstructive choledochal lesions, storage diseases, although mutation in gene ABCB11 was found. Benign recurrent intrahepatic cholestasis type 2 was diagnosed. Following conservative therapy and plasmapheresis, jaundice and skin pruritus significantly diminished, levels of bilirubin and bile acids normalized. Regular follow up, liver biopsy and measures for relapse prevention given clinical features of aggressive phenotype were recommended. Conclusion. Identification of etiology of cholestatic liver diseases requires broad differential diagnosis. Clinical course of patients with benign recurrent intrahepatic cholestasis may transform into aggressive phenotype, reminiscent of progressive familial intrahepatic cholestasis.
А im:强调广泛鉴别诊断的重要性和良性复发型肝内胆汁淤积2型转化为更具侵袭性临床表型的可能性。要点。19岁女患者因皮肤瘙痒、黄疸、尿色深、大便泥色、全身乏力而入院。上述症状自3岁起复发，既往病史显著，每1-2年复发一次，通常通过保守治疗得到改善。近年来，复发频率和恢复期增加，同时药物治疗的有效性下降。血液化学结果显示总胆红素(高达634 μmol/L)、直接胆红素(高达354 μmol/L)、胆汁酸(高达510 μmol/L)升高，谷氨酰转移酶水平正常。尽管发现ABCB11基因突变，但检查结果显示病毒性肝炎、自身免疫性肝病、梗阻性胆总管病变、储存性疾病均为阴性。诊断为良性复发性肝内胆汁淤积2型。保守治疗和血浆置换后，黄疸和皮肤瘙痒明显减轻，胆红素和胆汁酸水平恢复正常。根据侵袭性表型的临床特点，建议定期随访，肝活检和预防复发的措施。结论。胆汁淤积性肝病的病因鉴定需要广泛的鉴别诊断。良性复发性肝内胆汁淤积症患者的临床过程可能转变为侵袭性表型，使人联想到进行性家族性肝内胆汁淤积症。
{"title":"A 19-year-old Patient with Recurrent Pruritus and Jaundice","authors":"K. S. Nezhdanov, E. N. Shirokova, Yu. O. Shulpekova, A. S. Ostrovskaya, M. S. Zharkova, V. T. Ivashkin","doi":"10.22416/1382-4376-2023-33-3-66-75","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-3-66-75","url":null,"abstract":"А im: to highlight the importance of broad differential diagnosis and possibility of conversion of benign recurrent intrahepatic cholestasis type 2 into more aggressive clinical phenotype. Key points. A 19-year-old female patient was admitted to the Clinic with skin pruritus, jaundice, dark urine, clay-colored stool, and general fatigue. Past medical history was significant for recurrent aforementioned symptoms since 3 years old, that relapsed every 1–2 years and were usually ameliorated with conservative therapy. During recent years, frequency of relapses and recovery period increased, at the same time effectiveness of medical therapy decreased. Blood chemistry results revealed an elevation of total bilirubin (up to 634 μmol/L), direct bilirubin (up to 354 μmol/L), bile acids (up to 510 μmol/L) and normal gamma glutamyl transferase level. Workup was negative for viral hepatitis, autoimmune liver diseases, obstructive choledochal lesions, storage diseases, although mutation in gene ABCB11 was found. Benign recurrent intrahepatic cholestasis type 2 was diagnosed. Following conservative therapy and plasmapheresis, jaundice and skin pruritus significantly diminished, levels of bilirubin and bile acids normalized. Regular follow up, liver biopsy and measures for relapse prevention given clinical features of aggressive phenotype were recommended. Conclusion. Identification of etiology of cholestatic liver diseases requires broad differential diagnosis. Clinical course of patients with benign recurrent intrahepatic cholestasis may transform into aggressive phenotype, reminiscent of progressive familial intrahepatic cholestasis.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135717088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-22DOI: 10.22416/1382-4376-2023-33-3-85-119
V. T. Ivashkin, O. S. Lyashenko, O. M. Drapkina, O. P. Alexeeva, S. A. Alekseenko, D. N. Andreev, A. Yu. Baranovsky, O. V. Goloshchapov, N. V. Zheleznova, O. Yu. Zolnikova, I. L. Kliaritskaia, N. V. Korochanskaya, T. L. Lapina, I. V. Maev, R. V. Maslennikov, R. G. Myazin, P. V. Pavlov, M. V. Perekalina, N. A. Pisarenko, A. V. Povtoreyko, E. A. Poluektova, L. A. Sekretareva, A. V. Tkachev, Yu. M. Troshkina, A. S. Trukhmanov, A. I. Ulyanin, S. G. Filatova, V. V. Tsukanov, O. S. Shifrin
А im: the clinical practice guidelines intended for gastroenterologists, internal medicine specialists, infectious disease specialists, general practitioners (family doctors), coloproctologists, surgeons and endoscopists present modern methods of diagnosis, prevention and treatment of C. difficile -associated disease. Key points. C. difficile -associated disease is a disease that develops when the diversity of the intestinal microbiota decreases and C. difficile excessively colonizes the colon, the toxins of which damage the intestinal muco-epithelial barrier, followed by the development of inflammation in the colon wall, with diarrhea being a characteristic clinical manifestation. The clinical presentation of the disease can vary from asymptomatic carriage, mild to moderate diarrhea that resolves on its own, to profuse watery diarrhea and pseudomembranous colitis with development of life-threatening complications. The diagnosis of C. difficile -associated disease is based on an assessment of the clinical presentation, medical history, an objective examination of the patient and laboratory stool tests. The disease severity is determined by clinical symptoms and laboratory findings. Additional diagnostic methods that are used according to indications and contribute to the assessment of severity include endoscopy of the colon and abdominal cavity imaging methods. Treatment should be initiated in cases of characteristic clinical presentation of C. diffi cile -associated disease and positive laboratory stool testing. The choice of drug and treatment regimen depends on the severity of the episode, the presence of complications, and whether the episode is initial, recurrent, or reinfection. Conclusion. Determination of target groups of patients for the diagnosis of clostridial infection is important in preventing overdiagnosis and subsequent unnecessary treatment. Timely diagnosis and treatment of C. difficile -associated disease help avoiding the development of life-threatening complications and improve the prognosis and quality of life of patients.
А im:针对胃肠病学家、内科专家、传染病专家、全科医生(家庭医生)、肛肠科医生、外科医生和内窥镜医生的临床实践指南，介绍了诊断、预防和治疗艰难梭菌相关疾病的现代方法。要点。难辨梭菌相关疾病是指肠道菌群多样性减少，难辨梭菌在结肠内过度定植，其毒素破坏肠黏膜上皮屏障，继而发生结肠壁炎症，以腹泻为特征性临床表现的疾病。该病的临床表现各不相同，从无症状携带，轻度至中度腹泻自行消退，到大量水样腹泻和假膜性结肠炎，并发危及生命的并发症。艰难梭菌相关疾病的诊断是基于对临床表现、病史、患者客观检查和实验室粪便检查的评估。疾病的严重程度取决于临床症状和实验室结果。根据适应症使用的其他诊断方法有助于评估严重程度，包括结肠内窥镜检查和腹腔成像方法。当出现难辨梭菌相关疾病的特征性临床表现和实验室粪便检测呈阳性时，应开始治疗。药物和治疗方案的选择取决于发作的严重程度、并发症的存在以及发作是初次、复发还是再感染。结论。确定诊断梭状芽孢杆菌感染的目标人群对于防止过度诊断和随后的不必要治疗具有重要意义。及时诊断和治疗艰难梭菌相关疾病有助于避免危及生命的并发症的发生，改善患者的预后和生活质量。
{"title":"Clinical Practice Guidelines of the Scientific Society for the Clinical Study of Human Microbiome, of the Russian Gastroenterological Association and the Russian Society for the Prevention of Noncommunicable Diseases on the Diagnosis and Treatment of <i>Clostridioides difficile</i> (<i>C. difficile</i>)-associated Disease in Adults","authors":"V. T. Ivashkin, O. S. Lyashenko, O. M. Drapkina, O. P. Alexeeva, S. A. Alekseenko, D. N. Andreev, A. Yu. Baranovsky, O. V. Goloshchapov, N. V. Zheleznova, O. Yu. Zolnikova, I. L. Kliaritskaia, N. V. Korochanskaya, T. L. Lapina, I. V. Maev, R. V. Maslennikov, R. G. Myazin, P. V. Pavlov, M. V. Perekalina, N. A. Pisarenko, A. V. Povtoreyko, E. A. Poluektova, L. A. Sekretareva, A. V. Tkachev, Yu. M. Troshkina, A. S. Trukhmanov, A. I. Ulyanin, S. G. Filatova, V. V. Tsukanov, O. S. Shifrin","doi":"10.22416/1382-4376-2023-33-3-85-119","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-3-85-119","url":null,"abstract":"А im: the clinical practice guidelines intended for gastroenterologists, internal medicine specialists, infectious disease specialists, general practitioners (family doctors), coloproctologists, surgeons and endoscopists present modern methods of diagnosis, prevention and treatment of C. difficile -associated disease. Key points. C. difficile -associated disease is a disease that develops when the diversity of the intestinal microbiota decreases and C. difficile excessively colonizes the colon, the toxins of which damage the intestinal muco-epithelial barrier, followed by the development of inflammation in the colon wall, with diarrhea being a characteristic clinical manifestation. The clinical presentation of the disease can vary from asymptomatic carriage, mild to moderate diarrhea that resolves on its own, to profuse watery diarrhea and pseudomembranous colitis with development of life-threatening complications. The diagnosis of C. difficile -associated disease is based on an assessment of the clinical presentation, medical history, an objective examination of the patient and laboratory stool tests. The disease severity is determined by clinical symptoms and laboratory findings. Additional diagnostic methods that are used according to indications and contribute to the assessment of severity include endoscopy of the colon and abdominal cavity imaging methods. Treatment should be initiated in cases of characteristic clinical presentation of C. diffi cile -associated disease and positive laboratory stool testing. The choice of drug and treatment regimen depends on the severity of the episode, the presence of complications, and whether the episode is initial, recurrent, or reinfection. Conclusion. Determination of target groups of patients for the diagnosis of clostridial infection is important in preventing overdiagnosis and subsequent unnecessary treatment. Timely diagnosis and treatment of C. difficile -associated disease help avoiding the development of life-threatening complications and improve the prognosis and quality of life of patients.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135715861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-22DOI: 10.22416/1382-4376-2023-33-3-49-60
I. N. Grigor’eva, O. V. Efimova, N. L. Tov, T. S. Suvorova, D. L. Nepomnyashchikh
А im: to evaluate metabolic risk factors and their impact on quality of life in patients with pancreatic cancer (PC) and in patients with acute or exacerbated chronic pancreatitis. Materials and methods. Forty-five patients with PC (group 1) and 141 patients with acute pancreatitis or exacerbated chronic pancreatitis (group 2) in an observational multicenter clinical cross-sectional uncontrolled study were examined. Clinical, laboratory and instrumental examination of patients and assessment of risk factors (lipid profile, blood plasma glucose, obesity, arterial hypertension) were carried out in accordance with clinical recommendations. Patients completed the SF-36 questionnaire once to assess quality of life at hospital admission before treatment. Results. In group 1, indicators of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) in blood serum (3.7 ± 0.2; 2.2 ± 0.2 and 0.8 ± 0.1 mmol/L) were lower than in group 2 (5.1 ± 0.1; 3.1 ± 0.1 and 1.2 ± 0.1 mmol/L; p < 0.05). Arterial hypertension was more common in group 1 (55.6 %) than in group 2 (34.8 %; p = 0.013). The presence of arterial hypertension increases the chance of having PC by 2.7 times ( p < 0.05). Body mass index parameters, including obesity, as well as parameters of triglycerides, and fasting plasma glucose, did not differ between the groups. Logistic regression analysis revealed a direct relationship with PC HDL hypocholesterolemia (Exp B = 4.976; p < 0.001) and arterial hypertension (Exp B = 2.742; p = 0.027) and an inverse relationship — with hypercholesterolemia (Exp B = 0.204; p = 0.002). The chance of having PC was not associated with age, fasting plasma glucose ³ 7.0 mmol/L, obesity. Quality of life indicators were higher in group 1 than in group 2 on four SF-36 scales: bodily pain (68.1 ± 5.1 and 36.8 ± 2.0; p < 0.001), general health (51.1 ± 2.5 and 38.0 ± 1.7 points; p < 0.001), social functioning (74.7 ± 3.0 and 64.5 ± 2.2 points; p = 0.007), role emotional functioning (28.2 ± 5.2 and 12.5 ± 3.1 points; p = 0.007) and in the general domain “physical component of health” (40.2 ± 1.0 and 33.6 ± 0.8 points; p < 0.001). In group 1 with HDL hypocholesterolemia compared with its absence, the indicators of role emotional functioning (22.2 ± 5.1 and 51.9 ± 13.7 points; p = 0.020) were lower, with arterial hypertension compared with its absence — role physical functioning (5.0 ± 4.0 and 25.5 ± 7.5 points; p = 0.036) and role emotional functioning (16.0 ± 5.1 and 43.3 ± 8.8 points; p = 0.007) were lower. Conclusions. In patients with PC arterial hypertension was more common and the levels of total cholesterol, LDL-C and HDL-C were lower than in patients with acute or exacerbated chronic pancreatitis. The chance of having PC is directly associated with HDL hypocholesterolemia, with arterial hypertension, inversely — with hypercholesterolemia, and is not associated with age, fasting plasma glucose ³ 7 mmol/L, or obesity.
{"title":"Metabolic Risk Factors and Their Impact on Quality of Life in Patients with Pancreatic Cancer, Acute or Exacerbated Chronic Pancreatitis","authors":"I. N. Grigor’eva, O. V. Efimova, N. L. Tov, T. S. Suvorova, D. L. Nepomnyashchikh","doi":"10.22416/1382-4376-2023-33-3-49-60","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-3-49-60","url":null,"abstract":"А im: to evaluate metabolic risk factors and their impact on quality of life in patients with pancreatic cancer (PC) and in patients with acute or exacerbated chronic pancreatitis. Materials and methods. Forty-five patients with PC (group 1) and 141 patients with acute pancreatitis or exacerbated chronic pancreatitis (group 2) in an observational multicenter clinical cross-sectional uncontrolled study were examined. Clinical, laboratory and instrumental examination of patients and assessment of risk factors (lipid profile, blood plasma glucose, obesity, arterial hypertension) were carried out in accordance with clinical recommendations. Patients completed the SF-36 questionnaire once to assess quality of life at hospital admission before treatment. Results. In group 1, indicators of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) in blood serum (3.7 ± 0.2; 2.2 ± 0.2 and 0.8 ± 0.1 mmol/L) were lower than in group 2 (5.1 ± 0.1; 3.1 ± 0.1 and 1.2 ± 0.1 mmol/L; p < 0.05). Arterial hypertension was more common in group 1 (55.6 %) than in group 2 (34.8 %; p = 0.013). The presence of arterial hypertension increases the chance of having PC by 2.7 times ( p < 0.05). Body mass index parameters, including obesity, as well as parameters of triglycerides, and fasting plasma glucose, did not differ between the groups. Logistic regression analysis revealed a direct relationship with PC HDL hypocholesterolemia (Exp B = 4.976; p < 0.001) and arterial hypertension (Exp B = 2.742; p = 0.027) and an inverse relationship — with hypercholesterolemia (Exp B = 0.204; p = 0.002). The chance of having PC was not associated with age, fasting plasma glucose ³ 7.0 mmol/L, obesity. Quality of life indicators were higher in group 1 than in group 2 on four SF-36 scales: bodily pain (68.1 ± 5.1 and 36.8 ± 2.0; p < 0.001), general health (51.1 ± 2.5 and 38.0 ± 1.7 points; p < 0.001), social functioning (74.7 ± 3.0 and 64.5 ± 2.2 points; p = 0.007), role emotional functioning (28.2 ± 5.2 and 12.5 ± 3.1 points; p = 0.007) and in the general domain “physical component of health” (40.2 ± 1.0 and 33.6 ± 0.8 points; p < 0.001). In group 1 with HDL hypocholesterolemia compared with its absence, the indicators of role emotional functioning (22.2 ± 5.1 and 51.9 ± 13.7 points; p = 0.020) were lower, with arterial hypertension compared with its absence — role physical functioning (5.0 ± 4.0 and 25.5 ± 7.5 points; p = 0.036) and role emotional functioning (16.0 ± 5.1 and 43.3 ± 8.8 points; p = 0.007) were lower. Conclusions. In patients with PC arterial hypertension was more common and the levels of total cholesterol, LDL-C and HDL-C were lower than in patients with acute or exacerbated chronic pancreatitis. The chance of having PC is directly associated with HDL hypocholesterolemia, with arterial hypertension, inversely — with hypercholesterolemia, and is not associated with age, fasting plasma glucose ³ 7 mmol/L, or obesity.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135717086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-04DOI: 10.22416/1382-4376-2023-33-1-84-124
V. Ivashkin, V. Chulanov, N. Mamonova, M. Maevskaya, M. Zharkova, I. Tikhonov, P. Bogomolov, E. Volchkova, A. S. Dmitriev, O. O. Znojko, E. Klimova, K. Kozlov, I. E. Kravchenko, E. Malinnikova, R. Maslennikov, M. Mikhailov, K. E. Novak, I. Nikitin, V. Syutkin, E. Esaulenko, A. Sheptulin, E. Shirokova, N. D. Yushchuk
Аim: diagnosis and treatment algorithms in the clinical recommendations intended for general practitioners, gastroenterologists, infectious disease specialists, hepatologists on the of chronic hepatitis C are presented.Summary. Chronic viral hepatitis C is a socially significant infection, the incidence of which in the Russian Federation remains significantly high. Over the past 10 years, great progress has been made in the treatment of hepatitis C — direct acting antiviral drugs have appeared. The spectrum of their effectiveness allows to achieve a sustained virological response in more than 90 % of cases, even in groups that were not previously considered even as candidates for therapy or were difficult to treat — patients receiving renal replacement therapy, after liver transplantation (or other organs), at the stage of decompensated liver cirrhosis, HIV co-infected, etc. Interferons are excluded from the recommendations due to their low effectiveness and a wide range of adverse events. The indications for the treatment have been expanded, namely, the fact of confirmation of viral replication. The terms of dispensary observation of patients without cirrhosis of the liver have been reduced (up to 12 weeks after the end of therapy). Also, these recommendations present approaches to active screening of hepatitis in risk groups, preventive and rehabilitation measures after the end of treatment.Conclusion. Great success has been achieved in the treatment of chronic hepatitis C. In most cases, eradication of viral HCV infection is a real task even in patients at the stage of cirrhosis of the liver, with impaired renal function, HIV co-infection, after solid organs transplantation.
{"title":"Clinical Practice Guidelines of the Russian Society for the Study of the Liver, the Russian Gastroenterological Association, the National Scientific Society of Infectious Disease Specialists for the Diagnosis and Treatment of Chronic Hepatitis C","authors":"V. Ivashkin, V. Chulanov, N. Mamonova, M. Maevskaya, M. Zharkova, I. Tikhonov, P. Bogomolov, E. Volchkova, A. S. Dmitriev, O. O. Znojko, E. Klimova, K. Kozlov, I. E. Kravchenko, E. Malinnikova, R. Maslennikov, M. Mikhailov, K. E. Novak, I. Nikitin, V. Syutkin, E. Esaulenko, A. Sheptulin, E. Shirokova, N. D. Yushchuk","doi":"10.22416/1382-4376-2023-33-1-84-124","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-1-84-124","url":null,"abstract":"Аim: diagnosis and treatment algorithms in the clinical recommendations intended for general practitioners, gastroenterologists, infectious disease specialists, hepatologists on the of chronic hepatitis C are presented.Summary. Chronic viral hepatitis C is a socially significant infection, the incidence of which in the Russian Federation remains significantly high. Over the past 10 years, great progress has been made in the treatment of hepatitis C — direct acting antiviral drugs have appeared. The spectrum of their effectiveness allows to achieve a sustained virological response in more than 90 % of cases, even in groups that were not previously considered even as candidates for therapy or were difficult to treat — patients receiving renal replacement therapy, after liver transplantation (or other organs), at the stage of decompensated liver cirrhosis, HIV co-infected, etc. Interferons are excluded from the recommendations due to their low effectiveness and a wide range of adverse events. The indications for the treatment have been expanded, namely, the fact of confirmation of viral replication. The terms of dispensary observation of patients without cirrhosis of the liver have been reduced (up to 12 weeks after the end of therapy). Also, these recommendations present approaches to active screening of hepatitis in risk groups, preventive and rehabilitation measures after the end of treatment.Conclusion. Great success has been achieved in the treatment of chronic hepatitis C. In most cases, eradication of viral HCV infection is a real task even in patients at the stage of cirrhosis of the liver, with impaired renal function, HIV co-infection, after solid organs transplantation.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91182033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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