No 33 (2014)

REVIEWS, LECTURES, CLINICAL RECOMMENDATIONS

PROGNOSTIC FACTORS IN CROHN’S DISEASE

Shchukina O.B.

Abstract

The paper contains a review of the literature data concerning the demographic, clinical, laboratory, genetic, immunohistochemical, endoscopic, and imaging features with a potential role of prognostic factors for clinical management of patients with Crohn’s
disease.

Almanac of Clinical Medicine. 2014;(33):3-14
pages 3-14 views

RUSSIAN GASTROENTEROLOGIC ASSOCIATION RECOMMENDATIONS FOR DIAGNOSIS AND TREATMENT OF CHRONIC PANCREATITIS (2014): A BRIEF OVERVIEW

Kucheryavyy Y.A., Andreev D.N.

Abstract

The paper provides a brief overview of the provisions of Russian Gastroenterologic Association recommendations for diagnosis and treatment of chronic pancreatitis dated 2014. The contemporary diagnostic criteria and stepwise clinical approach to patients
with chronic pancreatitis are described. Some critical aspects are identified.

Almanac of Clinical Medicine. 2014;(33):15-22
pages 15-22 views

TOPICAL ARTICLES

HEPATORENAL SYNDROME: DIAGNOSTIC AND THERAPEUTIC MANAGEMENT

Bakulin I.G., Varlamicheva A.A.

Abstract

The practical guidelines on diagnosis and management of hepatorenal syndrome, which could be useful for general medical practitioners, gastroenterologists, and hepatologists, are considered in this paper. Selected recommendations are based on integrated clinical data, international recommendations and results of clinical trials. Beginning from theoretical grounds of hepatorenal syndrome (its definition, diagnostic criteria, and classification), acute kidney injury, and spontaneous bacterial peritonitis, the paper contains diagnostic algorithms (in particular, in ascites, for early revealing hepatorenal syndrome), and main approaches to therapy and prevention. The efficacy criteria and monitoring rules for the terlipressin-based therapy are listed.

Almanac of Clinical Medicine. 2014;(33):23-31
pages 23-31 views

ANTIVIRAL THERAPY IN LIVER CIRRHOSIS

Bogomolov P.O., Matsievich M.V., Koblov S.V., Petrachenkova M.Y., Kokina K.Y.

Abstract

Management of patients with liver cirrhosis due to viral hepatitis is complicated; nevertheless, effective treatment is possible in the majority of diagnosed cases. Etiotropic treatment should be initiated as soon as liver cirrhosis is diagnosed. Antiviral therapy is the only evidence-based and justified treatment approach in such patients. Use of hepatoprotectors with doubtful efficacy significantly reduces chances of recovery and increases likelihood of poor outcomes. During the choice of antiviral regimen, considerations must be given to disease etiology and stage as well as liver functional status. Generally accepted scales for staging of liver cirrhosis (e.g. Child-Turcotte-Pugh and MELD) are helpful in the choice of up-to-date therapy regimen, assessment of the disease prognosis and planning of radical interventions.

Almanac of Clinical Medicine. 2014;(33):32-38
pages 32-38 views

ANTIBIOTIC-ASSOCIATED DIARRHEA AND ANTIBIOTIC-ASSOCIATED COLITIS

Belousova E.A.

Abstract

The article presents most recent data on antibiotic-associated intestinal disorders. The author reviews epidemiology and causative microorganisms in antibiotic-induced diarrhea and pseudomembranous colitis as well as clinical variants of antibiotic-associated disorders. Diagnosis methods are decribed at length with special attention to most sensitive and informative tests. Treatment of different clinical variants of antibiotic-induced disorders is discussed in detail.

Almanac of Clinical Medicine. 2014;(33):39-46
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FUNCTIONAL DISORDERS OF THE BILIARY TRACT IN CHILDREN AS A MULTIDISCIPLINARY PROBLEM

Ursova N.I.

Abstract

Wide prevalence, multiplicity, great variety of etiological factors, diversity of clinical manifestations, and difficulties in registration of the gallbladder and bile ducts disorders and sphincter of Oddi dysfunction – all support the interest of internists to diagnosis
and treatment of functional biliary disorders. Taking into account clinically relevant anatomical interrelations between the organs of the choledochopancreatoduodenal zone, a possibility to develop a great variety of systemic diseases and conditions with long-term asymptomatic course it is advisable to conduct complex examination of pediatric patients with abdominal pain and dyspepsia signs. Exact syndromal diagnosis is of great importance in pediatric practice for it determines the necessity of treatment and its strategy. The tactic physician’s task is a choice of a drug which provide therapeutic effect with minimum risk of toxicity.

Almanac of Clinical Medicine. 2014;(33):47-56
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ORIGINAL STUDIES

GASTROESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH FUNCTIONAL DYSPEPSIA AND CONSTIPATION PREDOMINANT IRRITABLE BOWEL SYNDROME: CLINICAL FEATURES AND EFFICACY OF LACTULOSE AND ITOPRIDE HYDROCHLORIDE

Krapivnaya O.V., Alekseenko S.A.

Abstract

Background: The frequent coexistence of gastroesophageal reflux disease (GERD) with functional dyspepsia (FD) and an irritable bowel syndrome (IBS) has been described in the literature. Aim: To study the specific features of GERD clinical course and diagnosis in patients with GERD in combination with FD and constipation predominant IBS (IBS-C) in comparison to patients with isolated GERD; to assess the efficacy of lactulose and itopride hydrochloride. Materials and methods: A total of 60 patients with GERD, FD (Rome criteria III), and IBS-C (Rome criteria III) and 29 patients with isolated GERD were examined. GERD diagnosis was based on clinical, endoscopic, and pH-metric criteria. For 4 weeks 10 patients with combination of non-erosive reflux disease (NERD), FD and IBS-C received lactulose monotherapy and other 10 patients received combination of lactulose with itopride hydrochloride. Clinical symptoms and pH-metric parameters were assessed before and 4 weeks after treatment. Results: Combination of GERD, FD and IBS-C was noted more frequently in women under 40 with normal body mass index (р<0.05). Classic GERD symptoms were absent in 43.4% of patients with gastrointestinal comorbidity and in 10.3% of patients with isolated GERD (р=0.004). A higher prevalence of belching and nausea was found in patients, suffering from GERD, FD and IBS-C, than in those with isolated GERD (р<0.05). After 4-week lactulose and itopride hydrochloride treatment all the patients with GERD, FD and IBS-C showed a reduction of clinical symptoms (p<0.05) and normalization of pH-metric parameters (р<0.001). Conclusion: GERD course in patients with concomitant FD and IBS-C has the following peculiarities: predominance of women, absence of classic GERD-symptoms in almost half of these patients, and frequent combination with other functional symptoms. Combination therapy with lactulose and itopride hydrochloride enables successful control of GERD and FD symptoms as well as esophageal pH normalization.

Almanac of Clinical Medicine. 2014;(33):57-63
pages 57-63 views

TREATMENT COMPLIANCE AMONG PATIENTS WITH CHRONIC PANCREATITIS IN THE MOSCOW REGION

Beljakova S.V., Belousova E.A.

Abstract

Background: In the past decade, incidence of chronic pancreatitis among different age groups has been growing globally and in Russia. Chronic pancreatitis is a progressive disease characterized by development of complications and decrease of exocrine function of pancreas. Treatment should be initiated early, before the complications occur; therapy should account for international experience and established Russian guidelines. Continuous usage of high-dose enzyme preparations preferably in modern dosage forms (microgranules, minimicrospheres or microtablets) is one of the key principles in the management of chronic pancreatitis. Patient’s cooperative behavior and good compliance is crucial for achieving treatment targets. Aim: To assess treatment compliance among patients with chronic pancreatitis in the Moscow Region and to identify sources of information on the disease used by the patients. Materials and methods: One hundred patients with chronic pancreatitis in Moscow Region were questionnaired anonymously on their adherence to the medical recommendations for diet, alcohol consumption and medications, particularly enzyme preparations. Patients’ sources of information on the disease were also determined. Results: Poor compliance results were shown: only 28% of patients were fully adherent to medical recommendations; other patients took their medications irregularly, changed drug doses or preparations choosing less expensive and effective drugs. The majority of patients (89%) were aware of the main treatment principles, though, 53% didn’t adhere to them. Patients used varied sources of information on the disease including special literature and the web; nevertheless, the information could be incorrectly understood. Only some patients received disease-related information from their physician, and many of the patients described physician-derived information as insufficient. As a result, treatment was often inadequate. Conclusion:  Improved patients’ compliance is a crucial factor in achieving treatment targets in chronic pancreatitis. Two-way interventions are needed: 1. training of physicians in the disease field and in presenting clear and correct information to patients. 2. multimodal patients’ education.

Almanac of Clinical Medicine. 2014;(33):64-70
pages 64-70 views

PREVALENCE OF CLOSTRIDIUM DIFFICILE INFECTION IN HOSPITALIZED PATIENTS

Volchkova E.V., Belousova E.A., Makarchuk P.A., Rusanova E.V., Velikanov E.V.

Abstract

Background: Over the past decade, the epidemiology of Clostridium difficile infection has shown a remarkable increase in incidence in both hospital and community settings. Up to the last time, inappropriate antibiotic usage was considered as the main cause of the infection. The growth of morbidity and mortality rate of C. difficile infection is partly due to the worldwide dissemination of new and more virulent C. difficile strains, and is associated with increase in severity and related health care costs. Aim: To study the prevalence of C. difficile infection in the department of gastroenterology. Materials and methods: The prevalence of C. difficile infection in patients with gastrointestinal diseases with diarrheal syndrome who has not received antibiotics within the previous 6 months was investigated. The studied group included 238 diarrheal patients with an inflammatory bowel disease, chronic pancreatitis with excretory pancreas insufficiency, and several other diseases. To identify C. difficile infection, A and B toxins in patients’ stool were determined using immunochromatography method. Results: The prevalence of C. difficile infection in the group studied was found to be 39.1% and didn’t significantly differ from that of patients with different diseases (ulcerative colitis – 37.2%, Crohn’s disease – 31.6%, chronic pancreatitis – 36.2%). After etiotropic therapy, complete resolution of diarrhea was obtained in majority of patients, none of them tested positive for A and B toxins. Conclusion: Taking into account high frequency of C. difficile infection in diarrheal patients in department of gastroenterology authors recommend mandatory detection of C. difficile toxins in all hospitalized patients with diarrhea in gastroenterology, therapeutic, surgical departments. 

Almanac of Clinical Medicine. 2014;(33):71-76
pages 71-76 views

METHOD OF EXTRAHEPATIC BILE DUCTS RECONSTRUCTION WITH FORMATION OF AN ACCESS FOR MINIMALLY INVASIVE INTERVENTIONS

Filizhanko V.N., Lobakov A.I., Sidorenko A.B.

Abstract

Background: Methods of repair for iatrogenic extrahepatic bile ducts injuries are still under discussion. Aim: To improve surgical outcomes in patients with diseases and iatrogenic injuries of extrahepatic bile ducts. Materials and methods: The new surgical method for treatment of the diseases and traumatic injuries of extrahepatic bile ducts improves immediate and long-term outcomes in patients with iatrogenic injuries and diseases of bile ducts. The method provides a direct endoscopic access allowing for minimally invasive biliodigestive anastomosis interventions (balloon dilation, endoprothesis positioning and change, etc.) under direct vision. Results:  The new method is associated with less surgical trauma, reduced intra-/postoperative complications, better quality of life and no impact on patients’ life-style. Conclusion:  In our study, endoscopic repair of biliodigestive anastomoses through persistent gastroenteroanastomosis was a simple, available and safe method. The procedure may be performed by surgeon-endoscopist under local anesthesia. If needed, multiple procedures are possible.

Almanac of Clinical Medicine. 2014;(33):77-80
pages 77-80 views

CLINICAL CASES

DIFFICULT DIAGNOSIS OF CROHN’S DISEASE: A CLINICAL CASE

Nikolaeva N.N., Grishchenko E.G., Nikolaeva L.V., Baykova O.A., Topol’skaya N.V.

Abstract

The paper presents a case of Crohn’s disease with isolated jejunum involvement, which exemplifies the difficulty in diagnosing this condition. The clinical picture was characterized by iron-deficiency anemia and hypoproteinemia, while other typical symptoms were absent. The late diagnosis, delayed pathogenetic therapy administration led to multiple jejunum stenosis, complicated by partial small bowel obstruction.

Almanac of Clinical Medicine. 2014;(33):81-84
pages 81-84 views

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