History of study of peptic ulcer, evolution of ideas about its etiology and pathogenesis are set out in this review. The precedingtheories of the formation of peptic ulcer and the current provisions explaining the development of this disease are described. Special attention is paid to the role of the bacterium Helicobacter pylori put forwardin the occurrence of peptic ulcer and the formation of its recurrence; the microbiological and genetic features of helicobacteria are described in detail, giving them unique pathogenic properties. The genetic, immune, psychogenic mechanisms of the pathogenesis of peptic ulcer are described, the significance of oxidative stress and local factors in the formation of the ulcerative defect of the mucous membrane is revealed. A thorough critical analysis of some of the provisions of the dominant theory of ulcerogenesisis carried out. The inconsistency of helicobacteria, which are considered the main etiological factor of peptic ulcer, to the requirements of the Koch Triad, is emphasized: this pathogen does not always provoke the development of erosive-ulcerative mucosal lesions and is frequently not detected in many patients with peptic ulcer. Own data illustrating the dysbiotic nature of the violation of the microbial landscape of the stomach, and not the prevalence of helicobacteria in patients with peptic ulcer, are presented. Clinical features of peptic ulcer disease are properly described. Statements of the Maastricht consensus are strongly criticized for contradicting the basic principles of evidence-based medicine and not allowing the use of clinical thinking, analysis and synthesis of evidence. There is a doubt about the feasibility of the eradication of helicobacteria using the systemic broad-spectrum antibiotics. The rationale for further comprehensive study of peptic ulcer and the development of new, more effective therapeutic agents is put forward.
The authors propose the definition of chronic gastritis with a brief overview of the history of investigation of this diseases and its prevalence with special reference to (1) the bacterial profile and its role in the development of infectious and inflammatory process in gastric mucosa, (2) the modern state of and new trends in the classification of chronic gastritis including their advantages and disadvantages, (3) the relationship between chronic gastritis and functional gastroduodenal dyspepsia syndrome. It is concluded that mucous microflora plays an important factor in the development ofpathology but H.pylori is not its predominant component. Modern classifications of chronic gastritis provide a basis for a deeper insight into evolution of chronic gastritis and its transformation into cancer. The diagnosis of ‘chronic gastritis with functional gastroduodenal dyspepsia syndrome‘ is invalid.
The review presents modern information on such an actual clinical problem as hepatic encephalopathy syndrome upon acute and chronic hepatic insufficiency: its definition, etiology, detailed description of pathogenesis factors, clinical features, classification, diagnostic methods (clinical and laboratory-instrumental). The possibilities of treatment are fully highlighted: dietotherapy and pharmacotherapy of hepatic encephalopathy upon acute and chronic hepatic insufficiency.
List of medical terms has been recently supplemented with relatively new notions of compliance (adherence), which means “consent, compliance with your wishes” in English. They are used to denote the patient’s strict adherence to medical recommendations, especially with regard to pharmacotherapy (use of the drug at the recommended dose with the necessary frequency and duration), correction of lifestyle, rationalization of dietary habits, getting rid of bad habits. High compliance is very important in the treatment of acid-related diseases: organizing a lifestyle, following advice on dietary restrictions and habits, avoiding stressful situations and physical exertion significantly affect the effectiveness of therapeutic measures in gastroesophageal reflux disease, gastric ulcer and duodenal ulcer, non-atrophic gastritis, Zollinger-Ellison syndrome, chronic gastritis induced by nonsteroidal anti-inflammatory drugs. Optimization of compliance (adherence), control over the implementation of prescriptions, elimination of factors that impede the realization of medical recommendations will improve the effectiveness of treatment of acid-related diseases. The key to successful treatment of any pathology is an active involvement of a patient in the treatment process.
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.