The frequency of intestinal microbiota disorders in patients with chronic pancreatitis (CP) is extremely high and can reach 97%. The bacterial overgrowth syndrome (SIBO) and the syndrome of increased epithelial permeability (SPEP), developing against the background of excretory insufficiency of the pancreas, affect the severity of the clinical picture of the disease, reduce the effectiveness of enzyme replacement therapy and generally contribute to the further progression of CP.The article presents a modern view on the mechanisms of the formation of SIBO and SPEP in CP. There is their aggravating effect on the course of the disease and the aggravation of disorders of the digestive and absorption processes that accompany them is shown and analyzed in the article.For decontamination of conditionally pathogenic and pathogenic flora, increasing the number and metabolic activity of indigenous microflora in patients with CP, the use of a non-absorbable broad-spectrum antibiotic rifaximin is effective. In order to restore the barrier function of the gastrointestinal mucosa, the drug of choice is rebamipid, a universal cytoprotector that affects all three levels of epithelial tissue protection (preepithelial, epithelial and subepithelial).Conclusion. CP is characterized by the complexity of its etiology and pathogenesis. Bacterial factors, in particular, SIBO and SPEP, play an essential role in the development of inflammatory changes in the pancreas. In the complex therapy of CP, it is advisable to take measures aimed at correcting disorders of the intestinal microbiota.
Aim. Тo evaluate the modern view on the problem of chronic gastritis and the effectiveness of the drug ursodexic acid (UHC) Grinterol in the treatment of patients with chronic antral reflux-gastritis (biliar). Materials and methods. The work provides modern ideas about chronic gastritis, the issues of etiology and pathogenesis are considered. Contemporary classifications and the attitude of the authors of the work to them are presented. Clinical studies were conducted in 50 patients with chronic antral reflux-gastritis biliary (32 women and 18 men) between the ages of 20 and 80 years (average age 50.3 to 8.0 years). The treatment uses the drug Grinterol in a daily dose of 12.5 mg/kg of body weight for 4 weeks. Results. Among patients with chronic antral gastritis isolated patients with reflux-gastritis biliary, the pathogenetic factor of which is the damaging property of aggressive bile acids. The main treatment for such patients are drugs UHC (in this study (this study uses Grinterol at a daily dose of 12.5 mg/kg of body weight); the duration of treatment is 4 years. The overall efficiency (according to endomorphological data) was 76%, according to clinical data 100%. Discussion. Critical consideration of the classifications used and proposed for consideration indicates that the time has come for the adoption of a new classification with the allocation of reflux-gastritis biliary. Treatment of this form of antral gastritis is effective with UDHC drugs. Conclusion. the selection of a form of antral reflux-gastritis biliar in a separate classification group is scientifically justified. The results suggest that for the treatment of patients with chronic biliary refluxdrugs of choice are drugs UDHC.
This review of the literature is devoted to the importance of nutritional support in the treatment and prevention of diseases of the gastrointestinal tract associated with Helicobacter pylori. Modern data on the biological properties of H. pylori and the mechanisms of colonization of the microorganism in the gastrointestinal mucosa are presented. Information is provided on the virulence factors and factors that promote adhesion, depolymerization and dissolution of protective mucus, damage and circulatory disorders of the gastrointestinal mucosa, secreted by H. pylori (lipopolysaccharides and proteins of the outer shell of the bacterium, enzymes – mucinase, protease, phospholipase, urease, VacA cytotoxin). The article pays special attention to the issues of diet therapy, the role of various foods and their components in the dietary correction of disorders in gastrointestinal diseases associated with H. pylori. The causes of nutritional disorders in patients with gastrointestinal diseases are described and a detailed description of food products and their biologically active components with anti-Helicobacter activity is given. A special section is devoted to the use and effectiveness of specialized dietary products for therapeutic and preventive nutrition of domestic production (LLC “Leovit nutria”) and the features of use in diseases of the gastrointestinal tract mediated by H. pylori. The authors provide information on the composition of dietary products, their anti-inflammatory, antioxidant, immunotropic and other activities that underlie clinical efficacy. The article provides detailed recommendations on the use of specialized dietary foods for this pathology.
Г астроэзофагеальная рефлюксная болезнь (ГЭРБ) является частой патологией ЖКТ, конкурирую-щей с язвенной болезнью и холециститом. ГЭРБ определяют как полисимптомное заболевание, развива-ющееся вследствие нарушения двигательной функции пищевода, ослабления антирефлюксного барьера нижне-го пищеводного сфинктера (НПС) и опорожнения желуд-ка, что ведет к длительному контакту слизистой оболочки пищевода с кислым желудочным или щелочным кишеч-ным содержимым. Значение ГЭРБ определяется не только ее растущей распространенностью, но и утяжелением течения: увеличением числа осложненных форм (язвы, кровотечения и стриктуры пищевода), развитием пище-вода Барретта (ПБ) как предракового состояния [1].Осложнениями РЭ являются кровотечения и рубцовые стриктуры пищевода, при которых нередко требуется хирургическое вмешательство.В классическом представлении рефлюкс-эзофагит (РЭ) связан с забросом кислого содержимого в пищевод. Этот вариант РЭ наиболее изучен, однако гастроэзофаге-альному рефлюксу (ГЭР) может предшествовать рефлюкс дуодено-гастральный, что приводит к так называемому смешанному рефлюксу.В случае если у пациента имеется «кислый» рефлюкс, целесообразно назначение ИПП [2,3]. Однако высокая частота рецидивов подталкивает к поиску новых препара-тов и схем. Одним из последних (2014 г.) в России зареги-стрирован препарат декслансопразола (Дексилант) с эффектом двойного (отсроченного) высвобождения [4,5]. Отдельные исследования говорят о высокой эффектив-ности препарата у пациентов с тяжелым и среднетяже-лым эрозивным эзофагитом, которые, по данным литера-туры, составляют до 23,1% среди пациентов с эрозивной формой ГЭРБ [8-10].Напротив, если у пациента выявляется рефлюкс желчи, так называемый «щелочной» рефлюкс, показан прием препаратов урсодезоксихолевой кислоты (УДХК), что продемонстрировано в исследованиях у пациентов, пере-несших операции на желудке [6,7].Сочетание слабокислого и слабощелочного компо-нентов рефлюктата определяет выбор терапии в сторону комбинации препаратов групп ИПП и УДХК, но опыт при-менения недостаточен и требует изучения.Цель исследования: оценить эффективность комбина-ции препаратов декслансопразола и УДХК в лечении эрозивного эзофагита у пациентов, имеющих смешанный характер рефлюктата. Выбрать оптимальную дозу УДХК для курсового и поддерживающего лечения. МАТЕРИАЛЫ И МЕТОДЫВ исследование были включены 214 пациентов, у которых при эзофагогастроскопии (ЭГДС) выявлен эро-зивный эзофагит, что являлось критерием включения их в исследование. Данное исследование проводилось в рам-ках диссертационной работы.Пациенты включались в исследование после подпи-сания информированного согласия на участие в иссле-довании -рандомизированное контролируемое испыта-ние. Количественные данные представлены в виде сред-него значения ± стандартное отклонение (М ± δ). Качественные признаки представлены в виде абсолют-ных значений с указанием частоты встречаемости в про-центах. Для сравнения цифровых данных в двух выбор-ках пользовались t-критерием Стьюдента. Также для оценки достоверности различий качественных призна-ков...
Introduction. Dietary nutrition is one of the most important and physiological therapeutic and preventive approaches for chronic reflux gastritis (CRG), not associated with HP infection. Aim. To analyze the effectiveness and safety of the use of specialized therapeutic nutrition (produced by LEOVIT) in chronic reflux gastritis (CRG), not associated with HP infection, in the acute phase. Materials and methods. A comparative randomized study included 40 patients with CRG, not associated with HP infection, in the acute phase. During the one-month course, standard diet therapy was used in the control group (20 patients), and in the patients of the main group (20 patients), diet therapy was carried out using specialized dietary products. The dynamics of clinical manifestations, changes in esophagogastroduodenoscopy (EGDS), blood test parameters, and the severity of dysbiosis were studied. Statistical processing of the research results was carried out with the determination of the significance of the mean values using the Student’s t-test. Results. It was found that the studied specialized therapeutic nutrition (oatmeal porridge with herbs and flax seed, vegetable soup with herbs and oatmeal, gastric jelly LEOVIT) have pleasant organoleptic properties, do not cause intolerance and allergic manifestations, restore digestion, improve the state of intestinal microflora, improve the quality of life of patients. According to endoscopic studies in the esophagus of patients in the main group, compared with patients in the comparison group, “normal” mucosa was statistically significantly more common (95 vs. 60% of cases) and catarrhal esophagitis was less common (5 vs. 40% of cases). The number of patients with an admixture of bile in the lumen of the stomach in patients of the main group compared with patients of the control group was found significantly less frequently in 20% of cases versus 75% of cases. Conclusion. The investigated approach to diet therapy with the use of specialized therapeutic nutrition in CRG is completely safe and recommended by the authors for long-term use in patients with this pathology.
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