Pub Date : 2023-05-29DOI: 10.22416/1382-4376-2023-33-1-51-58
D. Akberova, A. Odintcova, D. Abdulganieva
Аim: to evaluate the state of small intestine permeability by the “double sugar test” in patients with overlap syndrome (autoimmune hepatitis / primary biliary cholangitis (AIH / PBC)).Materials and methods. Prospectively, 56 people were included in the study. Of these, 26 were diagnosed with AIH/PBC, 30 were in the control group. The diagnosis was made in accordance with the current recommendations. The average age of patients was 49.7 ± 13.8 years, healthy volunteers — 48.6 ± 9.2 years. The determination of the permeability of the small intestine was carried out by a “double sugar test” (the ratio of lactulose/mannitol in urine), using the method of high-performance liquid chromatography — mass spectrometry.Results. In patients with AIH/PBC, an increase in intestinal permeability was found — 0.20 [0.09; 0.30] (p < 0.001) compared with the control group 0.01 [0.01; 0.02]. We divided patients at the stage of liver damage. An increased small intestinal permeability was revealed: hepatitis stage — 0.19 [0.13; 0.30] (p < 0.001), liver cirrhosis stage — 0.18 [0.09; 0.30] (p < 0.05) compared with the control group. In the early stages of disease (1 month from the onset of the disease) had an increased lactulose/mannitol ratio — 0.13 [0.05; 0.26] (p < 0.001) compared to the control group. In the presence of portal hypertension (PH), small intestinal permeability was increased — 0.18 [0.09; 0.30] (p < 0.001) compared with the control group.Conclusions. An increase in small bowel permeability was found in patients with overlapping syndrome. All patients had increased intestinal permeability (regardless of the presence of extrahepatic manifestations).
{"title":"Evaluation of Small Intestinal Permeability in Patients with Overlap Syndrome (Autoimmune Hepatitis/Primary Biliary Cholangitis)","authors":"D. Akberova, A. Odintcova, D. Abdulganieva","doi":"10.22416/1382-4376-2023-33-1-51-58","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-1-51-58","url":null,"abstract":"Аim: to evaluate the state of small intestine permeability by the “double sugar test” in patients with overlap syndrome (autoimmune hepatitis / primary biliary cholangitis (AIH / PBC)).Materials and methods. Prospectively, 56 people were included in the study. Of these, 26 were diagnosed with AIH/PBC, 30 were in the control group. The diagnosis was made in accordance with the current recommendations. The average age of patients was 49.7 ± 13.8 years, healthy volunteers — 48.6 ± 9.2 years. The determination of the permeability of the small intestine was carried out by a “double sugar test” (the ratio of lactulose/mannitol in urine), using the method of high-performance liquid chromatography — mass spectrometry.Results. In patients with AIH/PBC, an increase in intestinal permeability was found — 0.20 [0.09; 0.30] (p < 0.001) compared with the control group 0.01 [0.01; 0.02]. We divided patients at the stage of liver damage. An increased small intestinal permeability was revealed: hepatitis stage — 0.19 [0.13; 0.30] (p < 0.001), liver cirrhosis stage — 0.18 [0.09; 0.30] (p < 0.05) compared with the control group. In the early stages of disease (1 month from the onset of the disease) had an increased lactulose/mannitol ratio — 0.13 [0.05; 0.26] (p < 0.001) compared to the control group. In the presence of portal hypertension (PH), small intestinal permeability was increased — 0.18 [0.09; 0.30] (p < 0.001) compared with the control group.Conclusions. An increase in small bowel permeability was found in patients with overlapping syndrome. All patients had increased intestinal permeability (regardless of the presence of extrahepatic manifestations).","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79594022","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 : 2023-05-29DOI: 10.22416/1382-4376-2023-33-1-15-23
T. Garmanova, D. Markaryan, E. Kazachenko, A. Lukianov, M. A. Kazachenko, M. Agapov
Аim: Evaluation of methods for pain prevention and pain reduction after anorectal surgery at all stages of treatment based on publications found in available databases.Key points. Most anorectal diseases are benign and do not affect life expectancy, meanwhile about 40 % of the population suffer from it. Mainly anorectal disorders affect middle-aged people reducing their life quality. At the same time many articles aimed at studying only postoperative anesthesia. 2 researchers independently searched for articles published in Medline, Scopus, Cochrane, Web of Science, E-library databases using keywords. A total of 54 publications were included. A multimodal approach should include the pain prevention during pre-, intra- and postoperative periods. Acetaminophen is recommended for pain reduction according to the dosing protocols. Acetaminophen combined with other systemic analgesics is advisable for patients with severe pain. The opioids use is justified only for moderate-severe postoperative pain. Metronidazole and lidocaine with nitroglycerin ointment/ nifedipine/сorticosteroids effectiveness has been proven for local postoperative anesthesia. Prophylactic use of antibiotics and bowel preparation do not reduce postoperative pain. Stool softeners are recommended for reducing postoperative pain severity. Additional local anesthesia such as nerve blockade or infiltration anesthesia is recommended for all patients. Modern minimally invasive treatment methods of hemorrhoid are associated with less severe postoperative pain.Conclusion. The recommended scheme of multimodal anesthesia for patients after anorectal surgery is shown on Fig.1. Further studies are needed to evaluate preoperative anesthesia effectiveness, the feasibility of the perioperative flavonoids use, as well as comparisons of various minimally invasive treatment methods of anorectal diseases.
Аim:基于现有数据库中发现的出版物，评估肛肠手术后所有治疗阶段预防和减轻疼痛的方法。要点。大多数肛肠疾病是良性的，不影响预期寿命，同时约有40%的人口患有这种疾病。肛肠疾病主要影响中年人的生活质量。同时，许多文章仅针对术后麻醉进行研究。2名研究人员使用关键词独立搜索Medline、Scopus、Cochrane、Web of Science、电子图书馆数据库中发表的文章。共包括54份出版物。多模式方法应包括术前、术中和术后的疼痛预防。根据给药方案，推荐使用对乙酰氨基酚来减轻疼痛。对乙酰氨基酚与其他全身性镇痛药合用适用于疼痛严重的患者。阿片类药物的使用仅适用于中度至重度术后疼痛。硝硝唑和利多卡因联合硝酸甘油软膏/硝苯地平/神经皮质激素用于术后局部麻醉的有效性已被证实。预防性使用抗生素和肠道准备不能减少术后疼痛。建议使用大便软化剂来减轻术后疼痛的严重程度。建议所有患者行局部麻醉，如神经阻滞或浸润麻醉。现代微创治疗痔术后疼痛减轻。肛肠术后患者多模式麻醉推荐方案如图1所示。术前麻醉效果的评价、围手术期黄酮类药物使用的可行性以及肛肠疾病各种微创治疗方法的比较，需要进一步的研究。
{"title":"A Multimodal Approach to Analgesia in Anorectal Surgery","authors":"T. Garmanova, D. Markaryan, E. Kazachenko, A. Lukianov, M. A. Kazachenko, M. Agapov","doi":"10.22416/1382-4376-2023-33-1-15-23","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-1-15-23","url":null,"abstract":"Аim: Evaluation of methods for pain prevention and pain reduction after anorectal surgery at all stages of treatment based on publications found in available databases.Key points. Most anorectal diseases are benign and do not affect life expectancy, meanwhile about 40 % of the population suffer from it. Mainly anorectal disorders affect middle-aged people reducing their life quality. At the same time many articles aimed at studying only postoperative anesthesia. 2 researchers independently searched for articles published in Medline, Scopus, Cochrane, Web of Science, E-library databases using keywords. A total of 54 publications were included. A multimodal approach should include the pain prevention during pre-, intra- and postoperative periods. Acetaminophen is recommended for pain reduction according to the dosing protocols. Acetaminophen combined with other systemic analgesics is advisable for patients with severe pain. The opioids use is justified only for moderate-severe postoperative pain. Metronidazole and lidocaine with nitroglycerin ointment/ nifedipine/сorticosteroids effectiveness has been proven for local postoperative anesthesia. Prophylactic use of antibiotics and bowel preparation do not reduce postoperative pain. Stool softeners are recommended for reducing postoperative pain severity. Additional local anesthesia such as nerve blockade or infiltration anesthesia is recommended for all patients. Modern minimally invasive treatment methods of hemorrhoid are associated with less severe postoperative pain.Conclusion. The recommended scheme of multimodal anesthesia for patients after anorectal surgery is shown on Fig.1. Further studies are needed to evaluate preoperative anesthesia effectiveness, the feasibility of the perioperative flavonoids use, as well as comparisons of various minimally invasive treatment methods of anorectal diseases.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89785262","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 : 2023-05-18DOI: 10.22416/1382-4376-2023-33-1-77-83
O. Samodova, G. Smirnova, E. Krieger
Аim: to describe clinical cases of Wilson – Konovalov disease in pediatric patients.Key points. The first clinical case demonstrates the manifestation of Wilson – Konovalov disease with unexplained mild elevation of aminotransferases at the age of 6 years. Despite the persistent hyperenzymemia, no additional laboratory tests were prescribed. At the age of 10, the patient showed signs of liver failure and neurological symptoms. Laboratory and instrumental examination enabled to diagnose Wilson – Konovalov disease at the stage of liver cirrhosis. The diagnosis was confirmed at the Federal medical center. The diagnosis was delayed and made 4 years after the hyperenzymemia was first revealed. The relief of clinical signs was observed after the orthotopic transplantation of the right lobe of the liver from a living related donor. The patient was under surveillance for 10 years after the transplantation.The second clinical case shows another variant of the course of the Wilson – Konovalov disease manifested as an acute hepatitis. To clarify the etiology of the disease, the patient was hospitalized. In 2 weeks, the patient developed symptoms of acute liver failure, progressive hemorrhagic syndrome, acute hepatic encephalopathy. Death from fulminant hepatitis occurred in 3 weeks after the disease onset after the disease onset.Conclusion. Healthcare workers should be aware of clinical signs of Wilson – Konovalov disease. Screening for the disease is recommended for children with an unexplained increase of liver transaminases, acute liver failure, chronic hepatitis and liver cirrhosis.
{"title":"Wilson – Konovalov Disease: Clinical Cases with Different Manifestations and Outcomes","authors":"O. Samodova, G. Smirnova, E. Krieger","doi":"10.22416/1382-4376-2023-33-1-77-83","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-1-77-83","url":null,"abstract":"Аim: to describe clinical cases of Wilson – Konovalov disease in pediatric patients.Key points. The first clinical case demonstrates the manifestation of Wilson – Konovalov disease with unexplained mild elevation of aminotransferases at the age of 6 years. Despite the persistent hyperenzymemia, no additional laboratory tests were prescribed. At the age of 10, the patient showed signs of liver failure and neurological symptoms. Laboratory and instrumental examination enabled to diagnose Wilson – Konovalov disease at the stage of liver cirrhosis. The diagnosis was confirmed at the Federal medical center. The diagnosis was delayed and made 4 years after the hyperenzymemia was first revealed. The relief of clinical signs was observed after the orthotopic transplantation of the right lobe of the liver from a living related donor. The patient was under surveillance for 10 years after the transplantation.The second clinical case shows another variant of the course of the Wilson – Konovalov disease manifested as an acute hepatitis. To clarify the etiology of the disease, the patient was hospitalized. In 2 weeks, the patient developed symptoms of acute liver failure, progressive hemorrhagic syndrome, acute hepatic encephalopathy. Death from fulminant hepatitis occurred in 3 weeks after the disease onset after the disease onset.Conclusion. Healthcare workers should be aware of clinical signs of Wilson – Konovalov disease. Screening for the disease is recommended for children with an unexplained increase of liver transaminases, acute liver failure, chronic hepatitis and liver cirrhosis.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84951728","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 : 2023-05-16DOI: 10.22416/1382-4376-2023-33-1-40-50
A. Turkina, M. Maevskaya, M. Zharkova, V. Ivashkin
Аim: to conduct a comparative analysis of serum albumin's structural and functional properties in decompensated cirrhotic patients by means of spin prob EPR spectroscopy.Materials and methods. The main study group included 70 patients with decompensated liver cirrhosis and ascites. The control group consisted of 12 healthy volunteers, comparable in gender and age, without liver diseases. To assess the structural and functional ability, serum albumin was analyzed by EPR spectroscopy.Results. Albumin levels within reference intervals were found in 37 patients (59.8 %). The native albumin index decrease in cirrhotic patients as the disease progressed with the lowest values in the Child – Pugh C group (p < 0.001). The binding efficiency of albumin decreased in accordance with the severity of cirrhosis with minimal albumin binding capacity in the Child – Pugh C (Me = 25.43 %; n = 30; p < 0.001). The transport activity of RTQ albumin decreased in patients with decompensated cirrhosis, the lowest transport ability was observed in the Child – Pugh C group (Me = 26.09 %). In patients with decompensated disease the detoxification potential was significantly reduced: Child – Pugh B — Me = 44.03 %; Child – Pugh C — Me =17.16 %. Despite the normal values of serum albumin in 72.5% of patients with cirrhosis B and in 26.7% in the cirrhosis C group, only 12.3% in the cirrhosis B group had normal albumin function and in cirrhosis C nо patients had normal albumin function.Conclusion. There were not only serum concentration depletion in cirrhotic patients, but also albumin physiological non-oncotic properties were violated. The severity of these changes increased with the progression of cirrhosis. Our data allow us to raise the question of the need to use the EPR test to determine indications for albumin replacement therapy in patients with cirrhosis and the presence of ascites, even at normal values of its serum concentration.
Аim:利用自旋探针EPR光谱对失代偿期肝硬化患者血清白蛋白的结构和功能特性进行比较分析。材料和方法。主要研究组包括70例失代偿性肝硬化和腹水患者。对照组由12名健康志愿者组成，性别和年龄相当，无肝脏疾病。用EPR谱分析血清白蛋白的结构和功能。37例(59.8%)患者白蛋白水平在参考区间内。肝硬化患者的天然白蛋白指数随着疾病的进展而下降，Child - Pugh C组最低(p < 0.001)。白蛋白结合效率随肝硬化严重程度降低，Child - Pugh C中白蛋白结合能力最低(Me = 25.43%;N = 30;P < 0.001)。失代偿性肝硬化患者RTQ白蛋白转运活性降低，Child - Pugh C组转运能力最低(Me = 26.09%)。失代偿性疾病患者的解毒潜能明显降低:Child - Pugh B - Me = 44.03%;儿童- Pugh C - Me = 17.16%。72.5%的B型肝硬化患者血清白蛋白正常，26.7%的C型肝硬化患者血清白蛋白正常，但B型肝硬化患者血清白蛋白功能仅12.3%正常，C型肝硬化患者血清白蛋白功能正常。肝硬化患者不仅血清浓度降低，而且白蛋白生理非肿瘤特性也被破坏。这些变化的严重程度随着肝硬化的进展而增加。我们的数据使我们提出了一个问题，即需要使用EPR试验来确定肝硬化和腹水患者白蛋白替代治疗的适应症，即使在其血清浓度正常的情况下。
{"title":"Changes in the Structural and Functional Albumin Properties in Patients with Decompensated Liver Cirrhosis","authors":"A. Turkina, M. Maevskaya, M. Zharkova, V. Ivashkin","doi":"10.22416/1382-4376-2023-33-1-40-50","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-1-40-50","url":null,"abstract":"Аim: to conduct a comparative analysis of serum albumin's structural and functional properties in decompensated cirrhotic patients by means of spin prob EPR spectroscopy.Materials and methods. The main study group included 70 patients with decompensated liver cirrhosis and ascites. The control group consisted of 12 healthy volunteers, comparable in gender and age, without liver diseases. To assess the structural and functional ability, serum albumin was analyzed by EPR spectroscopy.Results. Albumin levels within reference intervals were found in 37 patients (59.8 %). The native albumin index decrease in cirrhotic patients as the disease progressed with the lowest values in the Child – Pugh C group (p < 0.001). The binding efficiency of albumin decreased in accordance with the severity of cirrhosis with minimal albumin binding capacity in the Child – Pugh C (Me = 25.43 %; n = 30; p < 0.001). The transport activity of RTQ albumin decreased in patients with decompensated cirrhosis, the lowest transport ability was observed in the Child – Pugh C group (Me = 26.09 %). In patients with decompensated disease the detoxification potential was significantly reduced: Child – Pugh B — Me = 44.03 %; Child – Pugh C — Me =17.16 %. Despite the normal values of serum albumin in 72.5% of patients with cirrhosis B and in 26.7% in the cirrhosis C group, only 12.3% in the cirrhosis B group had normal albumin function and in cirrhosis C nо patients had normal albumin function.Conclusion. There were not only serum concentration depletion in cirrhotic patients, but also albumin physiological non-oncotic properties were violated. The severity of these changes increased with the progression of cirrhosis. Our data allow us to raise the question of the need to use the EPR test to determine indications for albumin replacement therapy in patients with cirrhosis and the presence of ascites, even at normal values of its serum concentration.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"156 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73647872","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 : 2023-04-28DOI: 10.22416/1382-4376-2023-33-2-19-33
V. Ivashkin, I. Maev, D. Andreev, O. Goloshchapov, A. Derinov, O. Zolnikova, K. Ivashkin, O. Kiseleva, A. Kiryukhin, O. Lyashenko, E. Poluektova, A. S. Tertychnyy, A. S. Trukhmanov, A. Ulyanin, Arkadiy A. Sheptulin, O. Shifrin, Goloshchapov Andreev D.N., Derinov O.V., Zolnikova O.Yu, Kiseleva O.Yu, В.Т. Ивашкин, И. В. Маев, Д. Н. Андреев, О.В. Голощапов, А.А. Деринов, О. Ю. Зольникова, К.В. Ивашкин, О.Ю. Киселёва, А.П. Кирюхин, О.С. Ляшенко, Е.А. Полуэктова, А. С. Тертычный, А. С. Трухманов, А.И. Ульянин, А.А. Шептулин, О.С. Шифрин
Aim: to review the modern approaches to the diagnosis and treatment of C. difficile-associated disease in adults and present the resolution of the Expert Council held on March 25, 2023 in Moscow.General provisions. C. difficile is the most important nosocomial pathogen which spores are also commonly found in the environment. Microbiota impairment, primarily due to the use of antibacterial drugs, is a key stage in the development of C. difficile-associated disease. A search for an infection should be carried out only in patients with diarrhea, and it is advisable to use at least 2 laboratory methods. The drug of choice for first-line treatment is vancomycin. If drug treatment is ineffective or the patient has recurrent clostridial infection, fecal microbiota transplantation should be considered. The probiotic strain Saccharomyces boulardii CNCM I-745 has a direct inhibitory effect on C. difficile toxin A, promotes normalization of the intestinal microbiota composition, and decreases the inflammatory reaction in colonic mucosa colonized with a toxigenic strain of C. difficile.Conclusions. Addition of the probiotic strain Saccharomyces boulardii CNCM I-745 to antibacterial therapy promotes both primary and secondary prevention of C. difficile-associated disease.
{"title":"Modern Approaches to the Diagnosis and treatment of Clostridioides difficile (C. difficile)-associated Disease in Adults (literature Review and Expert Council Resolution)","authors":"V. Ivashkin, I. Maev, D. Andreev, O. Goloshchapov, A. Derinov, O. Zolnikova, K. Ivashkin, O. Kiseleva, A. Kiryukhin, O. Lyashenko, E. Poluektova, A. S. Tertychnyy, A. S. Trukhmanov, A. Ulyanin, Arkadiy A. Sheptulin, O. Shifrin, Goloshchapov Andreev D.N., Derinov O.V., Zolnikova O.Yu, Kiseleva O.Yu, В.Т. Ивашкин, И. В. Маев, Д. Н. Андреев, О.В. Голощапов, А.А. Деринов, О. Ю. Зольникова, К.В. Ивашкин, О.Ю. Киселёва, А.П. Кирюхин, О.С. Ляшенко, Е.А. Полуэктова, А. С. Тертычный, А. С. Трухманов, А.И. Ульянин, А.А. Шептулин, О.С. Шифрин","doi":"10.22416/1382-4376-2023-33-2-19-33","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-2-19-33","url":null,"abstract":"Aim: to review the modern approaches to the diagnosis and treatment of C. difficile-associated disease in adults and present the resolution of the Expert Council held on March 25, 2023 in Moscow.General provisions. C. difficile is the most important nosocomial pathogen which spores are also commonly found in the environment. Microbiota impairment, primarily due to the use of antibacterial drugs, is a key stage in the development of C. difficile-associated disease. A search for an infection should be carried out only in patients with diarrhea, and it is advisable to use at least 2 laboratory methods. The drug of choice for first-line treatment is vancomycin. If drug treatment is ineffective or the patient has recurrent clostridial infection, fecal microbiota transplantation should be considered. The probiotic strain Saccharomyces boulardii CNCM I-745 has a direct inhibitory effect on C. difficile toxin A, promotes normalization of the intestinal microbiota composition, and decreases the inflammatory reaction in colonic mucosa colonized with a toxigenic strain of C. difficile.Conclusions. Addition of the probiotic strain Saccharomyces boulardii CNCM I-745 to antibacterial therapy promotes both primary and secondary prevention of C. difficile-associated disease.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79075793","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 : 2023-04-28DOI: 10.22416/1382-4376-2023-33-2-87-94
Alexandra S.Silaeva, E. Bueverova, Y. Shulpekova
Aim: to present observation of a patient diagnosed with functional dyspepsia based on current guidelines, and having increased eosinophil counts in the biopsy specimen of duodenal mucosa. To consider possible causes of duodenal eosinophilia in the light of present-day concepts.Highlights. Patient K., 40 years old, complained of dyspeptic phenomena, the first appearance of which she had noted at the age of 18. The patient noted poor tolerance to canned and fermented foods, which provoked an increase in dyspepsia and sometimes caused watery diarrhea. The examination excluded “symptoms of concern”. Successful antihelicobacter eradication therapy was carried out. Morphological examination of the stomach showed phenomena of mild chronic inflammation without intestinal metaplasia or glandular atrophy. A biopsy of the mucosa of the descending part of the duodenum showed a moderate increase in the levels of mononuclears and eosinophils in its lamina propria without penetration into the epithelium of the villi or formation of clusters. The patient suffers from pollinosis; sensitization to birch pollen was diagnosed by a skin prick test. However, she has no oral allergy symptoms, which does not allow linking duodenal eosinophilia to food allergy. Based on current guidelines, the patient was diagnosed with functional dyspepsia. In addition to dietary restrictions, treatment courses with a proton pump inhibitor, itopride, and S-methylmethionine sulfonium chloride, which has an antihistamine effect, were recommended for periods of worsening dyspepsia.Conclusion. The clinical significance of duodenal eosinophilia and local histamine production in patients with a clinical diagnosis of functional dyspepsia deserves special attention. Triggering factors provoking the worsening of symptoms should be analyzed; in particular, a food diary and exclusion of food allergies are recommended. Histamine-neutralizing drugs may play a role in the treatment of FD with duodenal eosinophilia in the future.
{"title":"Duodenal Eosinophilia in Functional Dyspepsia","authors":"Alexandra S.Silaeva, E. Bueverova, Y. Shulpekova","doi":"10.22416/1382-4376-2023-33-2-87-94","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-2-87-94","url":null,"abstract":"Aim: to present observation of a patient diagnosed with functional dyspepsia based on current guidelines, and having increased eosinophil counts in the biopsy specimen of duodenal mucosa. To consider possible causes of duodenal eosinophilia in the light of present-day concepts.Highlights. Patient K., 40 years old, complained of dyspeptic phenomena, the first appearance of which she had noted at the age of 18. The patient noted poor tolerance to canned and fermented foods, which provoked an increase in dyspepsia and sometimes caused watery diarrhea. The examination excluded “symptoms of concern”. Successful antihelicobacter eradication therapy was carried out. Morphological examination of the stomach showed phenomena of mild chronic inflammation without intestinal metaplasia or glandular atrophy. A biopsy of the mucosa of the descending part of the duodenum showed a moderate increase in the levels of mononuclears and eosinophils in its lamina propria without penetration into the epithelium of the villi or formation of clusters. The patient suffers from pollinosis; sensitization to birch pollen was diagnosed by a skin prick test. However, she has no oral allergy symptoms, which does not allow linking duodenal eosinophilia to food allergy. Based on current guidelines, the patient was diagnosed with functional dyspepsia. In addition to dietary restrictions, treatment courses with a proton pump inhibitor, itopride, and S-methylmethionine sulfonium chloride, which has an antihistamine effect, were recommended for periods of worsening dyspepsia.Conclusion. The clinical significance of duodenal eosinophilia and local histamine production in patients with a clinical diagnosis of functional dyspepsia deserves special attention. Triggering factors provoking the worsening of symptoms should be analyzed; in particular, a food diary and exclusion of food allergies are recommended. Histamine-neutralizing drugs may play a role in the treatment of FD with duodenal eosinophilia in the future.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83154142","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 : 2023-04-28DOI: 10.22416/1382-4376-2023-33-2-34-44
O. Gaus, M. Livzan, О.В. Гаус, М.А. Ливзан
Aim: to assess the level of stress hormones (cortisol in saliva), neurotransmitters (serotonin in blood serum, dopamine in blood plasma) in relation to eating habits, anxiety and depression levels in patients with IBS.Materials and methods. An open cohort prospective study was conducted with the inclusion of 263 patients with an established diagnosis of IBS, among them 189 (71.9 %) women and 74 (28.1 %) men. The average age of patients with IBS was 29 [25; 35] years. The control group included 40 healthy volunteers. All individuals included in the study were assessed for diet and eating habits using the WHO CINDI program questionnaire, “Information on Nutrition and Eating Behavior”, the severity of anxiety and depression according to the HADS questionnaire, the level of specific anxiety in relation to gastrointestinal symptoms according to the VSI questionnaire, quality of life according to the IBS-QoL questionnaire. In addition, the enzyme immunoassay method was used to assess the levels of cortisol in the morning and evening portions of saliva, serotonin in the blood serum and dopamine in the blood plasma.Results. Among patients with IBS there is a statistically significantly higher level of cortisol in the morning and evening portions of saliva (U = 19.5, p < 0.001 and U = 111.5, p < 0.001, respectively), serotonin in blood serum (U = 269.0, p = 0.042) and lower plasma dopamine levels (U = 93.5, p = 0.0002) compared with controls. The mean salivary cortisol level among patients with IBS was 45.39 [29.86; 70.10] ng/ml in the morning and 19.21 [13.98; 23.50] ng/ml in the evening, while in the group of healthy individuals it was 19.0 [16.5; 21.7] and 9.7 [8.5; 10.5] ng/ml, respectively. The average content of serotonin in blood serum in patients with IBS was 188.78 [150.41; 230.32] ng/ml, among healthy individuals — 142.80 [130.52; 154.15] ng/ml. The average content of dopamine in blood plasma in patients with IBS was 28.83 [20.08; 41.54] ng/ml, in healthy individuals — 58.20 [48.15; 66.62] ng/ml.Conclusion. In patients with IBS the secretion of the stress hormone (cortisol) and neurotransmitters (serotonin, dopamine) is closely related to the nature of nutrition, the level of anxiety and depression, and is also associated with the clinical variant and severity of the course of the disease.
目的:评估肠易激综合征患者的应激激素(唾液中的皮质醇)、神经递质(血清中的血清素、血浆中的多巴胺)水平与饮食习惯、焦虑和抑郁水平的关系。材料和方法。一项开放队列前瞻性研究纳入263例确诊为肠易激综合征的患者，其中189例(71.9%)为女性，74例(28.1%)为男性。IBS患者的平均年龄为29岁[25岁;35年。对照组包括40名健康志愿者。使用WHO CINDI项目问卷、“营养和饮食行为信息”评估所有参与研究的个体的饮食和饮食习惯，根据HADS问卷评估焦虑和抑郁的严重程度，根据VSI问卷评估与胃肠道症状相关的特定焦虑水平，根据IBS-QoL问卷评估生活质量。此外，采用酶免疫分析法评估了唾液早晚部分的皮质醇水平、血清中的血清素和血浆中的多巴胺水平。与对照组相比，IBS患者唾液早晚部分皮质醇水平(U = 19.5, p < 0.001)、血清血清5 -羟色胺水平(U = 269.0, p = 0.042)、血浆多巴胺水平(U = 93.5, p = 0.0002)均显著升高。IBS患者的平均唾液皮质醇水平为45.39 [29.86;上午为70.10 ng/ml, 19.21 ng/ml [13.98;夜间为23.50]ng/ml，健康组为19.0 [16.5;21.7]和9.7 [8.5];10.5] ng/ml。IBS患者血清血清5 -羟色胺平均含量为188.78 [150.41;230.32] ng/ml，健康人142.80 [130.52;154.15 ng / ml。IBS患者血浆多巴胺平均含量28.83 [20.08;41.54] ng/ml，健康人- 58.20 [48.15;66.62 ng / ml.Conclusion。IBS患者的应激激素(皮质醇)和神经递质(血清素、多巴胺)的分泌与营养的性质、焦虑和抑郁的水平密切相关，也与病程的临床变异和严重程度有关。
{"title":"Eating Habits, Anxiety and Depression in Patients with Irritable Bowel Syndrome: Clinical and Laboratory Comparisons","authors":"O. Gaus, M. Livzan, О.В. Гаус, М.А. Ливзан","doi":"10.22416/1382-4376-2023-33-2-34-44","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-2-34-44","url":null,"abstract":"Aim: to assess the level of stress hormones (cortisol in saliva), neurotransmitters (serotonin in blood serum, dopamine in blood plasma) in relation to eating habits, anxiety and depression levels in patients with IBS.Materials and methods. An open cohort prospective study was conducted with the inclusion of 263 patients with an established diagnosis of IBS, among them 189 (71.9 %) women and 74 (28.1 %) men. The average age of patients with IBS was 29 [25; 35] years. The control group included 40 healthy volunteers. All individuals included in the study were assessed for diet and eating habits using the WHO CINDI program questionnaire, “Information on Nutrition and Eating Behavior”, the severity of anxiety and depression according to the HADS questionnaire, the level of specific anxiety in relation to gastrointestinal symptoms according to the VSI questionnaire, quality of life according to the IBS-QoL questionnaire. In addition, the enzyme immunoassay method was used to assess the levels of cortisol in the morning and evening portions of saliva, serotonin in the blood serum and dopamine in the blood plasma.Results. Among patients with IBS there is a statistically significantly higher level of cortisol in the morning and evening portions of saliva (U = 19.5, p < 0.001 and U = 111.5, p < 0.001, respectively), serotonin in blood serum (U = 269.0, p = 0.042) and lower plasma dopamine levels (U = 93.5, p = 0.0002) compared with controls. The mean salivary cortisol level among patients with IBS was 45.39 [29.86; 70.10] ng/ml in the morning and 19.21 [13.98; 23.50] ng/ml in the evening, while in the group of healthy individuals it was 19.0 [16.5; 21.7] and 9.7 [8.5; 10.5] ng/ml, respectively. The average content of serotonin in blood serum in patients with IBS was 188.78 [150.41; 230.32] ng/ml, among healthy individuals — 142.80 [130.52; 154.15] ng/ml. The average content of dopamine in blood plasma in patients with IBS was 28.83 [20.08; 41.54] ng/ml, in healthy individuals — 58.20 [48.15; 66.62] ng/ml.Conclusion. In patients with IBS the secretion of the stress hormone (cortisol) and neurotransmitters (serotonin, dopamine) is closely related to the nature of nutrition, the level of anxiety and depression, and is also associated with the clinical variant and severity of the course of the disease.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82934138","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 : 2023-04-28DOI: 10.22416/1382-4376-2023-33-2-95-104
D. E. Okonskaya, Khachik H. Ayvazyan, Yuliia A. Stepanova, A. Zhao, E. A. Sokolova, Д.Е. Оконская, Х.А. Айвазян, Ю. А. Степанова, А.В. Чжао, Евгения Александровна Соколова
Aim: the reason for the publication was the rare occurrence, as well as the non-specificity of symptoms of the cystic form of duodenal dystrophy. The listed features of this disease lead to difficulties in its differential diagnosis and the choice of the optimal method of treatment.General statements. The report is devoted to the description of a case of successful treatment of a cystic form of duodenal dystrophy — a chronic inflammation of the pancreatic tissue, ectopic in the wall of the duodenum. A 47-year-old patient was admitted to the clinic with complaints of persistent abdominal pain, periodic vomiting, general weakness, weight loss of 20 kg in three months. With the help of computed tomography, the diagnosis was established, the tumor process was rejected, and chronic pancreatitis was detected in the orthotopic pancreas. Due to the presence of changes in the main pancreas, the patient underwent pancreatoduodenal resection. The features of the operation were pronounced infiltrative changes and pronounced vitreous tissue edema, which made it difficult to mobilize the hepatic flexure of the colon and duodenum.Conclusion. Pancreatoduodenal resection is the optimal surgical intervention for the combination of cystic form of duodenal dystrophy with sub-/decompensated duodenal stenosis.
{"title":"Cystic Form of Duodenal Dystrophy (Clinical Case)","authors":"D. E. Okonskaya, Khachik H. Ayvazyan, Yuliia A. Stepanova, A. Zhao, E. A. Sokolova, Д.Е. Оконская, Х.А. Айвазян, Ю. А. Степанова, А.В. Чжао, Евгения Александровна Соколова","doi":"10.22416/1382-4376-2023-33-2-95-104","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-2-95-104","url":null,"abstract":"Aim: the reason for the publication was the rare occurrence, as well as the non-specificity of symptoms of the cystic form of duodenal dystrophy. The listed features of this disease lead to difficulties in its differential diagnosis and the choice of the optimal method of treatment.General statements. The report is devoted to the description of a case of successful treatment of a cystic form of duodenal dystrophy — a chronic inflammation of the pancreatic tissue, ectopic in the wall of the duodenum. A 47-year-old patient was admitted to the clinic with complaints of persistent abdominal pain, periodic vomiting, general weakness, weight loss of 20 kg in three months. With the help of computed tomography, the diagnosis was established, the tumor process was rejected, and chronic pancreatitis was detected in the orthotopic pancreas. Due to the presence of changes in the main pancreas, the patient underwent pancreatoduodenal resection. The features of the operation were pronounced infiltrative changes and pronounced vitreous tissue edema, which made it difficult to mobilize the hepatic flexure of the colon and duodenum.Conclusion. Pancreatoduodenal resection is the optimal surgical intervention for the combination of cystic form of duodenal dystrophy with sub-/decompensated duodenal stenosis.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"232 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72751535","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 : 2023-04-28DOI: 10.22416/1382-4376-2023-33-2-7-18
V. Ivashkin, M. Zharkova, Natalya V. Korochanskaya, I. Khlynov, Y. Uspensky, В.Т. Ивашкин, М. С. Жаркова, Н.В. Корочанская, И.Б. Хлынов, Ю.П. Успенский
Aim: to present data on the prevalence of various phenotypes of non-alcoholic fatty liver disease (NAFLD), the features of its diagnosis and treatment in various regions of the Russian Federation following a meeting of chief gastroenterologists.Key points. Non-alcoholic fatty liver disease (NAFLD) holds the leading position among non-infectious liver diseases in the Russian Federation, its prevalence is 37.3 % and does not tend to decrease.To get information on various aspects of NAFLD diagnosis and treatment, opinion of 18 chief external regional gastroenterologists and leading specialists in the field of liver diseases was studied by analyzing the responses to questions specially formulated for them. Information on the situation in the Ural, Privolzhsky, Southern, Central and North-western Federal Districts was obtained. Regional statistics on the prevalence of NAFLD and its certain phenotypes (steatosis, steatohepatitis, cirrhosis), diagnostic instruments and treatment approaches which are used in clinical practice, as well as on the most common associated conditions was presented.Conclusions. The collected information allows to improve both administrative and treatment and diagnostic-related activities in managing patients suffering from this disease.
{"title":"Phenotypes of Non-Alcoholic Fatty Liver Disease in Different Regions of the Russian Federation, Diagnostic and Therapeutic Approach in Clinical Practice","authors":"V. Ivashkin, M. Zharkova, Natalya V. Korochanskaya, I. Khlynov, Y. Uspensky, В.Т. Ивашкин, М. С. Жаркова, Н.В. Корочанская, И.Б. Хлынов, Ю.П. Успенский","doi":"10.22416/1382-4376-2023-33-2-7-18","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-2-7-18","url":null,"abstract":"Aim: to present data on the prevalence of various phenotypes of non-alcoholic fatty liver disease (NAFLD), the features of its diagnosis and treatment in various regions of the Russian Federation following a meeting of chief gastroenterologists.Key points. Non-alcoholic fatty liver disease (NAFLD) holds the leading position among non-infectious liver diseases in the Russian Federation, its prevalence is 37.3 % and does not tend to decrease.To get information on various aspects of NAFLD diagnosis and treatment, opinion of 18 chief external regional gastroenterologists and leading specialists in the field of liver diseases was studied by analyzing the responses to questions specially formulated for them. Information on the situation in the Ural, Privolzhsky, Southern, Central and North-western Federal Districts was obtained. Regional statistics on the prevalence of NAFLD and its certain phenotypes (steatosis, steatohepatitis, cirrhosis), diagnostic instruments and treatment approaches which are used in clinical practice, as well as on the most common associated conditions was presented.Conclusions. The collected information allows to improve both administrative and treatment and diagnostic-related activities in managing patients suffering from this disease.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75285177","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 : 2023-04-28DOI: 10.22416/1382-4376-2023-33-2-105-119
Y. Stepanova, Kh. A. Ayvazyan, D. Kalinin, O. Zhavoronkova, V. S. Shirokov, A. Zhao, Ю. А. Степанова, Х.А. Айвазян, Д. В. Калинин, О.И. Жаворонкова, Владимир Степанович Широков, А.В. Чжао
Aim: to present a clinical case of pancreatic PEComa with liver metastases with an emphasis on morphological features, radiology diagnostic methods and features of treatment tactics, allowing practitioners to get an idea about this rare mesenchymal tumors composed of “perivascular epithelioid cells”, and a review of literature data on pancreatic PEComa, including 32 author's cases.General statements. A 22-year-old woman who was surgically treated for pancreatic head PEComa with infiltration of the duct of Wirsung, common bile duct, duodenal wall, focal invasion into the blood and lymphatic vessels, and perineural space infiltration. Synchronously, metastases were detected in both liver lobes, for which she took Everolimus for 6 years under the control of radiology methods with dose adjustment and frequency of administration. At the A.V. Vishnevsky National Medical Research Center of Surgery, the patient underwent right-sided hemihepatectomy and atypical resection of II-III liver segments.Conclusion. To determine clearer criteria for the diagnosis and differential diagnosis of PEComa, to identify criteria for the malignancy of these tumors, to develop treatment tactics and further dynamic monitoring, a set of statistical data of significant group and randomized clinical trials are needed. Pancreatic PEComas in this group are extremely rare and often have a benign course. The presented clinical case demonstrates the most malignant form of this tumor with localization in the pancreas and liver metastases.
{"title":"Pancreatic Perivascular Epithelial Cell Tumor (PEComa) with Liver Metastasis: a Case Report and Literature Review","authors":"Y. Stepanova, Kh. A. Ayvazyan, D. Kalinin, O. Zhavoronkova, V. S. Shirokov, A. Zhao, Ю. А. Степанова, Х.А. Айвазян, Д. В. Калинин, О.И. Жаворонкова, Владимир Степанович Широков, А.В. Чжао","doi":"10.22416/1382-4376-2023-33-2-105-119","DOIUrl":"https://doi.org/10.22416/1382-4376-2023-33-2-105-119","url":null,"abstract":"Aim: to present a clinical case of pancreatic PEComa with liver metastases with an emphasis on morphological features, radiology diagnostic methods and features of treatment tactics, allowing practitioners to get an idea about this rare mesenchymal tumors composed of “perivascular epithelioid cells”, and a review of literature data on pancreatic PEComa, including 32 author's cases.General statements. A 22-year-old woman who was surgically treated for pancreatic head PEComa with infiltration of the duct of Wirsung, common bile duct, duodenal wall, focal invasion into the blood and lymphatic vessels, and perineural space infiltration. Synchronously, metastases were detected in both liver lobes, for which she took Everolimus for 6 years under the control of radiology methods with dose adjustment and frequency of administration. At the A.V. Vishnevsky National Medical Research Center of Surgery, the patient underwent right-sided hemihepatectomy and atypical resection of II-III liver segments.Conclusion. To determine clearer criteria for the diagnosis and differential diagnosis of PEComa, to identify criteria for the malignancy of these tumors, to develop treatment tactics and further dynamic monitoring, a set of statistical data of significant group and randomized clinical trials are needed. Pancreatic PEComas in this group are extremely rare and often have a benign course. The presented clinical case demonstrates the most malignant form of this tumor with localization in the pancreas and liver metastases.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86429478","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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