Актуальность обусловлена, с одной стороны, недостатком данных о распространенности в России Helicobacter pylori (HP), ассоцииро-ванного с риском развития язвенной болезни и рака желудка, и, с другой стороны, несоблю-дением врачами рекомендаций экспертов по диагностике этой инфекции и проведению эра-дикационной терапии. Цель -изучение распро-страненности НР у медицинских работников и их готовности пройти эрадикационную тера-пию. Материал и методы. Обследованы 315 ме-дицинских работников (61 мужчина и 254 жен-щины) в возрасте от 18 до 76 лет, в том числе в Москве -221, в Казани -94. Для определения инфицированности НР всем респондентам вы-полнен ¹³С-уреазный дыхательный тест с тест-на-бором «ХЕЛИКАРБ» по «четырехточечной» методике. Все участники заполнили анкеты, на основании анализа которых оценивалось вли-яние социальных и профессиональных факто-ров на распространенность НР. Результаты. НР выявлен у 54,9% обследованных: 45,9% мужчин и 57,1% женщин. Частота выявления НР в Москве существенно ниже (49,8%), чем в Казани (67%). Доля инфицированных НР нарастала с возрас-том: с 41,8% у лиц в возрасте до 25 лет до 76,9% в возрасте старше 60 лет. НР-позитивными были 60,2% состоящих в браке и 49% -не состоящих. В группе обследованных врачей наибольшая доля инфицированных наблюдалась среди эн-доскопистов (61,5%) и терапевтов (60,9%). Лишь 61,4% НР-позитивных медицинских работников выразили готовность к проведению эрадика-ционной терапии. Заключение. Проведенное исследование выявило высокую распростра-ненность НР у медработников, нарастающую с возрастом. Предположительно, это связано с гигиеническими условиями в детском возрасте каждого поколения, однако нельзя исключить возможность заражения в ходе профессиональ-ной деятельности. Ключевые слова:Helicobacter pylori, эпидемио-логия, инфицированность медицинских работ-ников, ¹³С-уреазный дыхательный тест, тест-на-бор «ХЕЛИКАРБ» Для цитирования: Бордин ДС, Плавник РГ, Невмержицкий ВИ, Буторова ЛИ, Абдулхаков РА, Абдулхаков СР, Войнован ИН, Эмбутниекс ЮВ. Распространенность Helicobacter pylori среди ме-дицинских работников Москвы и Казани по дан-ным ¹³С-уреазного дыхательного теста. Альманах клинической медицины. 2018;46(1):40-9.
Low patient compliance due to the development of adverse events in the form of antibiotic-associated diarrhea (AAD) is considered as the main reason for the failure of the eradication of optimized anti-Helicobacter therapy regimens. A key mechanism for the development of AAD is to reduce the number and species diversity of bacteria that form butyric acid. Aim. The purpose of this study was to study the comparative effect on the clinical effectiveness of eradication therapy (ET) of Helicobacter pylori infection and metabolic changes in the colon microbiota of additional inclusion in the optimized treatment regimen of the combined prebiotic Zakofalk (inulin + butyrate) with probiotics (lacto- and bifidobacteria in an amount of at least 1017 СFU). Materials and methods. 120 patients with chronic gastroduodenal diseases and infected H. pylori were еxamined. A comparative analysis of the effect of a combined prebiotic and lacto-bifid-containing probiotics on improving the effectiveness of the optimized ET scheme and improving its tolerability, as well as on the quantitative and qualitative content of short-chain fatty acids (SFA) in feces. The success of eradication was controlled by a 13C urease breath test. Results. According to the results of the study in randomized groups of patients, an excellent percentage of eradication (95%) was achieved in patients who performed ET with the addition of the prebiotic Zakofalk. In the same group of patients, there was an increase in the absolute content of SFA and a significant increase in the concentration of butyric acid. In the group of patients who received ET with the addition of probiotics, an acceptable level of eradication was achieved (85.7%), but no changes in SFA were found indicating an increase in the number or activity of the butyrate-producing flora. Patients who performed ET without the addition of pre-probiotics did not achieve the target percentage of successful eradication (83.3%), and a significant quantitative decrease in SFA was found with a significant decrease in the proportion of butyric acid. Conclusion. The inclusion of Zakofalk in the ET scheme, in comparison with probiotics, significantly increases the probability of successful eradication, more effectively restores the metabolic potential of the microbiota, and prevents the development of AAD.
Background. The novel coronavirus infection COVID-19 can be manifested by damage to the organs of the gastrointestinal tract (GIT). Damage to the gastrointestinal tract by the SARS-CoV-2 virus leads to a violation of the microbial-tissue complex of the mucous membrane of the digestive tract. A common gastroenterological manifestation of COVID-19 is diarrhea. Aim. Study of the clinical features of gastroenterological disorders and the possibility of optimizing the treatment of diarrheal syndrome in patients with COVID-19 with a mild form of viral infection. Materials and methods. The observation group consisted of 230 patients with mild COVID-19: K-group (n=115) with respiratory symptoms, I group (n=115) with gastrointestinal manifestations in combination and without signs of respiratory damage. In order to compare the effectiveness of treatment of diarrheal syndrome, patients of group I are randomized into 2 subgroups: Ia (n=58) prebiotic treatment (Zacofalk) and Ib (n=57) enterosorbents. Results. The development of gastrointestinal symptoms with SARS-CoV-2 infection is significantly more often noted in comorbid patients (67%). Gastrointestinal symptoms were dominated by diarrhea (93.9%) and flatulence (76.5%), in 1/3 of patients they were the first manifestos of infection. It was established that in 98.4% of patients of group I (against 42.6% of the K-group) signs of infectious intoxication were detected. In patients with gastrointestinal lesions, an elongation of the febrile period by 91.5 days was noted, a later (6 days) verification of the viral etiology of the disease. It was found that in patients of group I, the regression of clinical symptoms, the duration of viral disease, the dynamics of antibody formation, the prognosis for the development of IBS-like disorders in the post-infectious period depended on the treatment. In patients taking (Zacofalk), these indicators were significantly better. Conclusion. In mild cases, to reduce the severity of viral intestinal damage, for effective relief of intestinal symptoms, to reduce the risk of IBS-like symptoms, it is advisable to prescribe (Zacofalk) in an initial dose of 3 tablets per day.
Цель исследования-изучить терапевтическую эффективность препарата тримебутин (Тримедат) в купировании билиарной боли и поддержании ремиссии заболевания у пациентов с функциональными расстройствами желчного пузыря (ЖП) и сфинктера Одди (СО). Материал и методы. Обследованы 85 пациентов с синдромом билиарной боли, обусловленной нарушением функции ЖП (40 человек) или СО (45 человек), соответствующих критериям Римского консенсуса IV. При анализе эффективности терапии учитывались динамика болевого и диспепсического синдромов через 3 нед приема тримебутина и через 3 нед после завершения терапии, данные динамической ультразвуковой диагностики с проведением пробы с пищевым раздражителем, степень выраженности дуоденального рефлюкса. В первый и последний дни лечения проводились иммуногистохимические исследования биоптатов слизистой оболочки антрального отдела желудка с использованием моноклональных мышиных антител к мотилину и вазоинтестинальному пептиду. Результаты. После трехнедельного курса терапии Тримедатом купирование билиарной боли достигнуто у 81,2% больных с расстройствами ЖП и СО. Терапевтический эффект Тримедата сохраняется у 98,8% пациентов в течение последующих 3 нед. После завершения лечения отмечена статистически значимая нормализация сократительно-эвакуаторной функции ЖП и СО. Эффективность терапии существенно не различалась у пациентов с гипомоторной и гипермоторной дисфункцией билиарного тракта. Выявлено, что у больных с расстройствами ЖП и билиарного СО исходно отмечалось снижение уровня мотилина с последующим его достоверным повышением в результате лечения Тримедатом, что коррелировало с нормализацией моторной функции ЖП и СО, устранением дуоденогастрального рефлюкса. Заключение. Тримебутин эффективно купирует билиарную боль и оказывает модулирующее действие на моторику билиарного тракта, что позволяет рассматривать препарат Тримедат как лекарственное средство для инициальной терапии пациентов с синдромом билиарной боли, обусловленной функциональными расстройствами ЖП и СО.
COVID-19 infection may present with gastrointestinal lesions in up to 25% of patients. One of the target organs of the SARS-CoV-2 virus is the intestine. The pathogenesis of intestinal damage in a new coronavirus infection remains unclear and requires further in-depth study. Possible mechanisms include a direct cytotoxic effect of the virus, a persistent reduction in butyrate-producing bacteria, side effects of drugs, Clostridioides difficile infection, microvascular thrombosis, and the immune-mediated inflammatory reactions in the intestine. The most common symptom of intestinal damage during coronavirus infection, both in the acute phase and in the post-COVID period, is diarrhea. The impact of many aggressive factors on the intestines can form both long-term functional disorders and be the cause of the onset of organic diseases. Treatment should be aimed at possible causes of intestinal damage (Clostridioides difficile), as well as reducing inflammation, restoring intestinal permeability, cytoprotection of mucosal cells, replenishing butyric acid deficiency. When choosing a therapy for intestinal disorders, preference should be given to drugs with a pleiotropic effect in order to influence various possible pathogenetic mechanisms.
Introduction. In recent years, diarrheal syndrome is the most common clinically significant negative effect of the antibiotic therapy (ABT), which constitutes a first-priority medical and social problem. The prescription of any antibiotic for any duration of treatment may cause a potential risk of developing antibiotic-associated diarrhea (AAD). In that regard, there is a need for the systematization of the main pathogenetic aspects of the deveopment of AAD and the rationale for the use of probiotics to prevent its development and treatment. Aim. To conduct a comparative evaluation of the efficacy, adherence and tolerability of a synbiotic Floriosa containing Bifidobacterium lactis Bl-04, Lactobacillus acidophilus La-14, Lactobacillus rhamnosus Lr-32, inulin, B vitamins, and an eubiotic Bifiform containing Enterococcus faecium, Bifidobacterium longum for the prevention of the development of AAD during and after the use of ABT in inpatients. Materials and methods. A total of 60 patients, which was used for the ABT in the hospital settings, were included in the study: the 1st group (30 patients) received a synbiotic, the 2nd group (30 patients) received an eubiotic. The efficacy of the preventive administration of drugs was assessed by Day 12 and 28 of the therapy. The methods included the patients’ assessment of the efficacy and satisfaction with treatment, an assay of short-chain fatty acids (SCFAs) in feces via gas-liquid chromatography and a Clostridium difficile Toxin A + B rapid test. Results. No cases of AAD were detected in both groups. The study drugs were comparable in terms of their efficacy assessment by the doctor and patients. A trend towards a higher assessment of the therapeutic effect and satisfaction with synbiotic therapy was observed. Changes in the absolute and relative content of SCFAs in the patients’ feces from the baseline level were established. More pronounced positive changes in the quantitative and qualitative composition of acids due to the treatment were identified in the patients who received the synbiotic and had more than 3 risk factors. Conclusions. The synbiotic Floriosa and probiotic Bifiform are effective drugs to prevent AAD. The synbiotic has advantages in terms of the overall assessment of the efficacy of the treatment and patient satisfaction, provides a pronounced protective effect on the intestinal microbiocenosis status during and after the ABT (as evidenced by the changes in SCFAs level in the feces), can be the drug of choice for the prevention of AAD, including AAD associated with C. difficile in individuals with more than 3 risk factors for the development of AAD.
In the clinical classification of cholelithiasis, biliary sludge (BS) is distinguished as the pre-stone stage. Ursodeoxycholic acid (UDCA) is a drug with an evidence base for effective and safe effects on BS. The therapeutic equivalence of various UDCA drugs remains an important issue for clinical practice. Aim. To conduct a comparative analysis of the effectiveness of the use of UDCA: Ursofalk with other UDCA drugs for the treatment of BS in a fixed dose of 10 mg/kg of body weight. Material and methods. The observation group consisted of 225 patients with various types of BS. In randomized groups, the comparison of the effectiveness of UDCA drugs in the dissolution of BS was determined by the data of ultrasound of the gallbladder. Dynamic ultrasound cholecystography using a standardized technique was performed to study the effect of the compared drugs on the contractile function of the liver. When analyzing the impact of ursotherapy on the clinical manifestations of BS, the dynamics of biliary pain syndrome and dyspeptic disorders were evaluated. Results. A comparative analysis of the effectiveness of UDCA drugs for BS lysis with a high degree of confidence established the advantage of Ursofalk: after 3 months in 80%, and after 6 months of therapy in 95.65% of patients, a regression of BS was detected. In the group of patients who took other UDCA, the corresponding indicators were 46.36% and 67.27%. The greatest effectiveness of ursotherapy was demonstrated in the BS variant by the type of suspension of hyperechogenic particles, the lowest in the variant by the type of putty-like bile in the form of mobile or fixed clots. In the last variant of BS, the relationship between the success of lysis with the extension of the UDCA intake period to 6 months and the preferred choice of Ursofalk was traced. Normalization of the contractile function of the gallbladder was noted in patients who took Ursofalk. Conclusion. From the standpoint of therapeutic effectiveness, the drug of choice for the treatment of BS, regardless of its type, is Ursofalk, which has proven the best dynamics of BS litolysis, recovery of the contractile function of the gastrointestinal tract, and relief of clinical symptoms.
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