Aim of publication. To present indications for antihelicobacter therapy, methods and sequence of diagnostics and eradication treatment of Helicobacter pylori (H. pylori) infection to general practitioners. Key points. Chronic gastritis caused by H. pylori infection, including that in «asymptomatic» patients can be considered to be an indication for H. pylori eradication therapy both as etiological treatment and opportunistic screening diagnostics for gastric cancer prevention. Indications for obligatory antihelicobacter therapy include stomach and a duodenum peptic ulcer (PU), stomach MALT-lymphoma, early gastric cancer with endoscopic resection. Breath test with 13 С-labeled urea, laboratory test for assessment of anti-H. pylori antibodies in feces, rapid urease test and serological method can be recommended for primary diagnostics of infection. Serological test is not applicable after antihelicobacter therapy. According to the bulk of regional studies clarithromycin resistance level of H. pylori strains in Russia does not exceed 15%. Obtained data indicate the absence of high metronidazole-resistance of H. pylori as well as double resistance to clarithromycin and metronidazole. Standard triple therapy including proton pump inhibitor (PPI), clarithromycin and amoxicillin is recommended Цель публикации. Ознакомить практикующих врачей с показаниями к проведению антигеликобактерной терапии, методами и порядком проведения диагностики и эрадикационной терапии инфекции Helicobacter pylori (H. pylori). Основные положения. Хронический гастрит, вызванный инфекцией Н. pylori, в том числе у «бессимптомных» лиц, можно рассматривать как показание к проведению эрадикационной терапии инфекции Н. pylori в качестве этиотропного лечения и оппортунистического скрининга для профилактики рака желудка. Показаниями к обязательному проведению антигеликобактерной терапии служат язвенная болезнь желудка и двенадцатиперстной кишки, MALT-лимфома желудка, ранний рак желудка с эндоскопической резекцией. В качестве методов первичной диагностики инфекции H. pylori используют дыхательный тест с мочевиной, меченной 13 С, определение антигена H. pylori в кале лабораторным способом, быстрый уреазный тест и серологический метод. После проведения антигеликобактерной терапии серологический метод не применяют. Согласно результатам большинства региональных исследований, показатели устойчивости штаммов H. pylori к кларитромицину в России не выше
Aim. Current clinical recommendations are intended to supply gastroenterologists, physicians and general practitioners with modern methods for the diagnosis and treatment of constipation.Key points. Constipation is defined as primary (functional) and secondary form, the latter comprising a manifestation of another illness. The causes of constipation are diagnosed with colonoscopy, especially in patients aged over 50 having “anxiety symptoms” and hereditary colorectal oncological predisposition. Indications may also include the bowel transit time estimation with radiopaque markers, balloon expulsion test, anorectal manometry, defecography and electromyography. Therapy for constipation should be comprehensive and concern lifestyle, diet recommendations and use of medications (psyllium, macrogol, lactulose, lactitol, contact laxatives, prucalopride). Patients with a less effective conservative therapy and largely reduced quality of life should be considered for surgical intervention.Conclusion. An effective therapy for constipation requires a correct diagnosis of its causes.
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