Nonalcoholic fatty liver disease (NAFLD) is one of the most common liver diseases, with pathogenetic mechanisms involving complex factors, in particular changes in the intestinal microbiota. The development and evaluation of the effectiveness of NAFLD treatment regimens, affecting intestinal microbiota disturbances, presents an urgent issue in modern medicine. Objective — to determine effects of combined therapy, including ursodeoxycholic acid (UDCA) and probiotic preparation (strains of Lactobacillus acidophilus, L. rhamnosus, Streptococcus salivarius subsp. thermophilus, L. delbrueckii subsp. Bulgaricus) on the metabolic disorders and inflammatory processes in liver tissue of patients with NAFLD. Materials and methods. The study included 108 patients with NAFLD with metabolic disorders and 30 people of the control group, who were examined on the basis of the Department of Gastroenterology and Therapy and outpatient department of the GI «L. T. Mala National Institute of Therapy of the NAMS of Ukraine». Women prevailed in both groups. The mean age of patients was 54.6 ± 11.7 years. The patients were randomized into two groups, comparable by gender and age ratio. Both groups received non‑drug therapy. The comparison group (48 patients) received UDCA preparation only, the main group (60 patients) received additional probiotic preparation «Yogurt capsules» (Pharmascience Inc., Canada). The treatment lasted 12 weeks. Patients were examined at the beginning and end of treatment with additional determination of pro‑inflammatory markers: C‑reactive protein CRP and TNF‑α. Statistical analysis was performed with the package Statistica 13.1 using nonparametric methods. Results. Patients’ examination in the dynamics of treatment showed an improvement in NAFLD course due to a decrease in the levels of alanine aminotransferase, aspartate aminotransferase and γ‑glutamyl peptidase (ALT, AST and GGT) in both groups. Moreover, against the background of treatment, the tendency was observed to the decrease of visceral fat percentage, as well as the visceral obesity index, which in group I significantly decreased in almost 1.6 times. In contrast to the carbohydrate metabolism indicators, the dynamics of which did not differ significantly between the groups, a significant effect of the developed therapy on the lipid profile was determined. The triglycerides (TG) levels in the main group decreased 1.3 times, and LDL cholesterol 1.6 times. In addition, the significant decrease in TNF‑alpha levels by 57.51 % was observed under the influence of treatment with the addition of probiotic yogurt. Conclusions. Combined therapy which includes lifestyle modification by means of non‑drug therapy, UDCA with the additional use of a complex probiotic preparation yogurt capsules, has a pathogenetic focus and proven effectiveness in the treatment of NAFLD.
Objective — to evaluate efficacy of potentiation of remission and safety of fecal microbiota transplantation (TFM) in patients with post‑infection irritable bowel syndrome with predominance of diarrhea (PI — IBS‑D), in whom standard therapy was ineffective. Materials and methods. The study involved 16 patients with patients with moderate to severe PI — IBS with diarrhea who did not respond to standard therapy and did not have any significant comorbidities. The diagnosis of IBS was made according to the Rome IV criteria. IBS severity was assessed with the use of Irritable bowel syndrome — Severity Scoring System, and the frequency of defecation and stool consistency according to the Bristol scale. Donor selection, preparation for TFM and the procedure itself were carried out in accordance with the recommendations of the European Consensus on TFM (2017). TFM was performed once with a colonoscope in the right part of the large intestine — 180 ml of a solution prepared from 50 g of donor feces. The total follow‑up period was 6 months after TFM. Efficacy was assessed by the level of score reduction of the IBS‑SSS questionnaire — a decrease of 50 points or more was considered a significant improvement. During the observation period, the patient did not take any additional drugs and procedures. Results. The obtained results showed a positive TFM effects on the clinical manifestations of post‑infection IBS, resistant to standard therapy. After 1 month post transplantation, the severity of symptoms decreased by more than 75 IBS‑SSS points in 75 % of patients and 3 of them had remission. The TFM procedure resulted in a significant decrease compared to baseline in the severity of abdominal pain (37 points) and its duration (31 points), bloating (41 points), dissatisfaction with defecation (40 points) against the background of almost twofold reduction in the frequency of defecation from 3.68 to 1.81 bowel movements/day) and improved stool consistency according to the Bristol scale (from 6.81 to 5.21 points). These rates remained unchanged until the end of the third month after TFM, they did not differ significantly compared to the end of the first month: 75 % of patients experienced adequate relief of abdominal pain, satisfaction with defecation, reduced bloating and reduced impact on quality of life. However, by the end of 6th month, the symptoms of PI — IBS began to increase: the average score of IBS‑SSS increased to 169 points, including indicators of the intensity of abdominal pain and its duration, severity of bloating, dissatisfaction with defecation and defecation frequency, thus PI — IBS increasingly affected the quality of life of patients. Despite the increased PI — IBS severity by the end of 6th month after TFM, its symptoms remained significantly lower than before treatment and still 62.5 % of patients reported adequate relief of abdominal pain and satisfaction with defecation, reduction of diarrhea and bloating. None of patients reported about serious adverse events. During the first hours after procedure, only 31.25 % trial participants noticed insignificant adverse events (abdominal discomfort, flatulence and stomach growling) that disappeared on their own during the day. Conclusions. Colonoscopy‑delivered fecal microbiota transplantation proved to be effective and safe procedure in patients with PI — IBS who have not responded to standard therapy.
The article presents the results of studies on humans showing the association between the use of specific drugs and changes in the microbial composition of the intestinal microbiome and its functional profile. It was found that the intestinal microbe directly or indirectly affects metabolism and effectiveness of a large number of drugs, causing variability in their activation, inactivation and toxicity. On the other hand, more than 800 non‑antibiotic drugs have also been shown to have significant effects on dozens of major species of bacteria that colonize the gastrointestinal tract. It is also noted that regardless of the route of administration, some drugs will spend considerable time in the intestine and contact the microbiome (parenterally administered drugs and their metabolites may enter the intestine through bile secretion), so the intestine is an important participant in drug metabolism. Data on the main taxonomic changes of PPI users are presented and it is shown that their severity was associated with higher doses of PPIs and that such changes in the microbiome may potentiate the development of diseases, as they are similar to those that reduce colonization resistance and intestinal infections. Much attention is paid to the presence of the association of intestinal microbiome — sugar‑lowering drugs. The data on the role of the intestinal microbiome as the main target of metformin are presented. In addition, metformin has been shown to increase Akkermansia muciniphila, which is known to be correlated with obesity, type 2 diabetes mellitus, cardiovascular diseases, and inflammation, and to increase lactobacilli in the upper small intestine, which will undoubtedly contribute to its antidiabetic effect. Metformin has been shown to regulate numerous metabolic pathways by interacting with the intestinal microbiota and partially eliminate dysbacteriosis caused by type 2 diabetes, and changes in the population of microorganisms that multiply with metformin are closely related to its efficacy and tolerability. With regard to other antidiabetic drugs (glitazones, alpha‑glucosidase inhibitors, DPP‑4 inhibitors, glucagon‑like peptide‑1 receptor agonists), it has also been shown that one of their main effects is the elimination of dysbacteriosis by including bacterial nutrient changes. and the length of stay of carbohydrates in the intestine, which also emphasizes their relationship with the intestinal microbiome. It is also noted that lactobacilli have inhibitory activity against DPP‑4 inhibitors. In this aspect, measures aimed at modifying the microbiome and especially probiotics, prebiotics and antibiotics may be of particular interest, as their use can significantly change the pharmacokinetics of drugs. It is noteworthy that the pattern of intestinal microbiome observed during treatment with liraglutide is the complete opposite of what is characteristic of the metabolic syndrome. The article shows that statin intake is also associated with changes in the intestinal microbiome and hypothesizes that the response of low‑density lipoprotein cholesterol to statins may be due to the activity of bacteria containing bile hydrolases. It is also noted that the intestinal microbiota can have a significant effect on the metabolism of psychoactive drugs by modulating intestinal permeability with subsequent effects on their absorption, and on the other hand taking this group of drugs leads to significant changes in intestinal microbiome. As a result, it is concluded that today it is very important and promising to study the interaction of intestinal microbiome and the most widely used drugs for the application of methods of modulation of intestinal microbiome to optimize the effectiveness of treatment of many diseases.
Current trends in the treatment of H. pylori infection in Ukraine: results of the European Registry on Helicobacter pylori Management (Hp EuReg) The European Registry on Helicobacter pylori Management (Hp EuReg) was established to evaluate the efficacy and safety of the different eradication H. pylori treatments, as well as to audit H. pylori infection consensus and clinical guidelines implementation. The current study presents data from a sample of patients from Ukraine who were registered in the Hp EuReg until February 2022. The aim was to assess the frequency, effectiveness and safety of treatment against H. pylori infection in Ukraine. Materials and methods. The Hp EuReg, an international multicenter prospective non‑interventional registry, was launched in 2013 and is promoted by the European Helicobacter and Microbiota Study Group (www.helicobacter.org). The Hp EuReg protocol was approved by the Ethics Committee of La Princesa University Hospital (Madrid, Spain) and registered with Clinical Trials.gov under the code NCT02328131. The effectiveness analysis included mainly a modified intention‑to‑treat (mITT) analysis, aiming to mimic the clinical practice outcomes and including all records with a confirmatory test after the eradication treatment, regardless of compliance. Given that some treatment regimens were used only in a small number of patients, only regimens with a relevant number of patients were selected for analyses. Results. Overall 841 patients (54 % women, 46 % men), whose average age (SD) was 48.35 (± 15.52) were included in the register. The main method for diagnosing on‑going H. pylori infection was histology, and the use of urea breath tests and stool antigen tests was low — (approximately 6 % of cases). Assessment of bacterial antibiotic resistance was performed in 13 % of patients, with less than 1 % reporting a positive result. More than half of the patients received quadruple therapy and 40 % triple therapy. Over 90 % of patients were treatment‑ naïve. Almost all patients received low‑dose proton pump inhibitors (PPIs), and a smaller proportion received standard (7.2 %) or high‑dose PPIs (1.2 %). Low‑doses PPI prescriptions negatively affected the effectiveness of therapy: in treatment‑naïve patients’ overall effectiveness was below 85 %, while the use of standard‑ and high‑doses of PPIs achieved 100 % eradication rates in all patients. Despite the fact that the duration of therapy in the vast majority of patients was at least prescribed for 10 days, there were cases (12 %) of administration of 7‑day therapy with the reported suboptimal (< 90 %) effectiveness. In those prescribed with a first‑line treatment of 7 — 10 days, the eradication rate was 82 %, while therapy for 14 days provided 100 % treatment eradication success. In the overall mITT analysis, the use of therapy in naïve patients resulted in the eradication of H. pylori in more than 90 % of patients. It is noteworthy that effectiveness with PPI+ amoxicillin + levofloxacin was below 84 %, suboptimal according to the most up‑to‑date consensus. The administered therapy was well tolerated, which allowed to complete the treatment of more than 90 % of patients, and the incidence of adverse events was less than 4 % in naïve patients, while in patients with repeated courses of therapy it was more than 3 times higher. Conclusions. In Ukraine, the frequency of use of validated non‑invasive methods (urea breath tests and stool antigen test) to detect H. pylori infection is very low. However, Ukrainian doctors often use methods to assess the antibiotic resistance of Helicobacter pylori, which certainly helps to increase the rate of therapy‑guided eradication. The vast majority of eradication therapies administered to patients in the Ukrainian population corresponds to the current guidelines, but very often PPIs were administered in low doses and there were still some cases of regimens lasting 7 days, even in those patients receiving a second‑line therapy, which reduced the treatment effectiveness. Even though overall effectiveness of eradication therapy was over 90 %., there is a need to closely monitor treatment management. Prescribed first‑line therapy was well tolerated by patients — more than 98 % of patients completed treatment.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.