scholarly journals Features of therapeutic correction of GERD: focus on cytoprotection (with a clinical case)

2022 ◽  
pp. 87-92
Author(s):  
I. G. Pakhomova
Keyword(s):  
Combination Therapy ◽  
Mucous Membrane ◽  
Clinical Case ◽  
Barrier Properties ◽  
Esophageal Mucosa ◽  
Free Oxygen Radicals ◽  
Protective Properties ◽  
Inflammatory Drugs ◽  
Mucous Barrier ◽  
Endothelial Growth Factor

Тo date, the possible links of the pathogenesis of this disease have been well studied and described, which predetermine certain approaches to the treatment of various variants of gastroesophageal reflux disease (GERD). Effective drug therapy for GERD includes proton pump inhibitors (PPI). However, PPI monotherapy is not always effective. One approach is to increase the PPI dose. At the same time, combination therapy with the addition of drugs that affect the protective properties of the esophageal mucosa seems to be more rational. It is known that in the development of GERD, the violation of cytoprotection of the esophageal mucosa is one of the key links in pathogenesis. Consequently, the issue of combination therapy of PPIs with drugs that increase the protective properties of the mucous barrier along with acid suppression becomes relevant. An example of such an approach is the  appointment of  rebamipide, the  action of  which is to regulate the  synthesis of  prostaglandins through COX-2  mediated mechanisms, influence on endothelial growth factor, increase the expression of tight intercellular contact proteins in epithelial cells of the mucous membrane, reduce the level of interleukin-8 and free oxygen radicals, directed to protect the mucous membrane of  the  gastrointestinal tract and restore its natural barrier properties. The  effectiveness of  the  combination of  PPI and rebamipide contributes to a greater regression of complaints in patients with GERD and a lower frequency of disease relapses than with PPI monotherapy. This article provides a review of the literature on the features of GERD therapy, primarily with an emphasis on the correction of the cytoprotective properties of the esophageal mucosa, including against the background of the use of nonsteroidal anti-inflammatory drugs (NSAID), and a clinical case analysis with a discussion of rational pharmacological correction.

Primary dysmenorrhea: strategy and tactics of treatment

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (1) ◽  
pp. 31-34
Author(s):  
Yu E Dobrokhotova ◽  
E I Borovkova ◽  
S A Zalesskaia
Keyword(s):  
Clinical Case ◽  
Primary Dysmenorrhea ◽  
Therapeutic Result ◽  
Randomized Studies ◽  
Effect Of Therapy ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

The article summarizes the results of numerous randomized studies and structured the approach to the tactics of managing patients with primary dysmenorrhea. The starting therapy is the administration of non-steroidal anti-inflammatory drugs and/or estrogen-progestational drugs. In the absence of the effect of therapy for 3 months, it is advisable to switch to a drug of another group or a combination of drugs. Failure to achieve the desired therapeutic result within 6 months is the basis for clarifying the diagnosis. The article is illustrated by the clinical case of a patient with primary dysmenorrhea.

scholarly journals COMPARISON OF PAIN SCORE IN OSTEOARTHRITIS PATIENTS TREATED WITH A COMBINATION OF DIACEREIN AND MELOXICAM AND MELOXICAM ALONE

2017 ◽  
Vol 9 (6) ◽  
pp. 69
Author(s):  
Ni Made Oka Dwicandra ◽  
Antonious Adji Prayitno Setiadi
Keyword(s):  
Randomized Controlled Trial ◽  
Articular Cartilage ◽  
Combination Therapy ◽  
Pain Intensity ◽  
Pain Score ◽  
Controlled Trial ◽  
Area Under The Curve ◽  
Randomized Controlled ◽  
Pain Outcome ◽  
Inflammatory Drugs

Objective: Osteoarthritis (OA) is a progressive chronic disease with the loss of articular cartilage. In managing OA, inadequate pain relief (IPR) often occurs, particularly with a single non steroidal anti-inflammatory drugs (NSAIDs) therapy. In this research, pain outcome of OA patients treated with a combination of diacerein and meloxicam vs meloxicam alone was evaluated.Methods: This research was conducted at rumah sakit umum daerah (RSUD) Dr. Mohammad Soewandhie Surabaya by using randomized controlled trial (RCT) design. Pain outcome was evaluated by pain intensity and area under the curve (AUC) of pain score in week 0-4th.Results: There were a significantly different (p<0.05) in pain intensity seen in 3rd and 4th weeks after treated with a combination of diacerein and meloxicam, and with meloxicam only. However, there were no different in AUC pain score between combination and single therapy.Conclusion: Combination therapy of diacerein and meloxicam was more effective than meloxicam alone. A significant effect of a combination therapy of diacerein and meloxicam occurred at 3rd weeks. The prolong study in order to get the differences in AUC pain score are needed.

scholarly journals Xantomatosis. Xanthomas of the stomach

2021 ◽  
Vol 1 (5) ◽  
pp. 86-91
Author(s):  
O. B. Dronova ◽  
E. V. Kolesnikova ◽  
A. N. Neverov ◽  
S. V. Petrov ◽  
S. V. Miroshnikov
Keyword(s):  
Gastric Mucosa ◽  
Mucous Membrane ◽  
Clinical Case ◽  
Point Of View ◽  
Age Related

The article presents some information about xanthomatosis, as well as about xanthomas of the stomach, which are benign formations, but their etiopathogenesis is unknown. Some believe that there is a relationship between xanthomas of the stomach and hyperlipidymia, diabetes, preneoplastic changes in the mucous membrane, age-related features of the gastric mucosa.The clinical case described in this report confi rms the existing point of view about xanthomas as markers of preneopastic changes in the gastric mucosa and its precancerous diseases.

scholarly journals Intestinal epithelial dysplasia

2020 ◽  
pp. 91-94
Author(s):  
T. E. Taranushenko ◽  
E. M. Vasilyeva ◽  
E. V. Antsiferova ◽  
L. N. Karpova ◽  
Y. S. Shamova
Keyword(s):  
Small Intestine ◽  
Rare Disease ◽  
Histological Examination ◽  
Mucous Membrane ◽  
Clinical Case ◽  
Clinical Presentation ◽  
Epithelial Dysplasia ◽  
Intestinal Epithelial ◽  
Electronic Microscopy

The article presents a clinical case of intestinal epithelial dysplasia (tufting enteropathy), a rare disease which relates to congenital diarrheas, has a particular clinical presentation and is life-threating. The diagnosis was confirmed by histological examination and electronic microscopy of mucous membrane of small intestine. Additional evidence is substantiated for the existence of prenatal markers of intestinal epithelial dysplasia represented as polyhydramnios and intrauterine dilatation of fetal intestinal loops. These symptoms are considered to be a clinical hallmark of sodium and chloride diarrheas and are described in single cases in enteropathy called a microvillus inclusion disease.

scholarly journals Gastroesophageal reflux disease: new approaches to optimizing pharmacotherapy

2021 ◽  
pp. 30-37
Author(s):  
D. N. Andreev ◽  
A. V. Zaborovsky ◽  
E. G. Lobanova
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Barrier Properties ◽  
Nerve Fibers ◽  
Esophageal Mucosa ◽  
Mucosal Permeability ◽  
Other Substances ◽  
Maintenance Of Remission

Proton pump inhibitors (PPIs) are baseline drugs for induction and maintenance of remission in gastroesophageal reflux disease (GERD). PPIs have proven to be highly effective in healing esophageal mucosal lesions and relieving the symptoms of the disease in most cases. However, according to the literature data, the incidence rate of clinical ineffectiveness of PPIs in the form of partial or complete persistence of current symptoms during administration of standard doses of PPIs ranges from 10 to 40%. Optimization of GERD therapy in PPI refractory patients is a significant challenge. In most cases, experts advise to increase a dose / dosage frequency of PPIs, switch to CYP2C19-independent PPIs (rabeprazole, esomeprazole, dexlansoprazole), add an esophagoprotective or promotility agents to therapy. At the same time, these recommendations have a limited effect in some patients, which opens up opportunities for looking for new solutions related to the optimization of GERD therapy. Today there is growing evidence of the relevance of the role of disruption of the cytoprotective and barrier properties of the esophageal mucosa in the genesis of GERD and the formation of refractoriness. Intercellular contacts ensure the integrity of the barrier function of the esophageal mucosa to protect it from various exogenous intraluminal substances with detergent properties. Acid-peptic attack in patients with GERD leads to alteration of the expression of some tight junction proteins in epithelial cells of the esophageal mucosa. The latter leads to increased mucosal permeability, which facilitates the penetration of hydrogen ions and other substances into the submucosal layer, where they stimulate the terminals of nerve fibers playing a role in the induction and persistence of the symptoms of the disease. The above evidence brought up to date the effectiveness study of the cytoprotective drugs with tropism to the gastrointestinal tract, as part of the combination therapy of GERD.

scholarly journals Current advances in the treatment of gastroesophageal reflux disease: a focus on esophageal protection

2019 ◽  
Vol 91 (8) ◽  
pp. 4-11 ◽  
Author(s):  
I V Maev ◽  
D N Andreev ◽  
Yu A Kucheryavyy ◽  
R I Shaburov
Keyword(s):  
Molecular Weight ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Mucous Membrane ◽  
Reflux Disease ◽  
Barrier Function ◽  
Poloxamer 407 ◽  
Low Molecular Weight ◽  
Esophageal Mucosa ◽  
Refractory Gerd

Gastroesophageal reflux disease (GERD) is characterized by high morbidity and a significant decrease in the quality of life of patients, and is a major risk factor for esophageal adenocarcinoma. Nowadays, antisecretory therapy with proton pump inhibitors (PPI) is the "gold standard" of conservative treatment of GERD, but in some cases this therapy is unsuccessful. According to various studies, the prevalence of refractory GERD can reach 30-40%. The latest scientific data in the field of genetics and pathophysiology of GERD demonstrate that a disruption of the barrier function of the esophageal mucosa and an increase of its permeability can be the leading causes of refractoriness. Thus, the optimal therapy for patients with GERD should not only suppress the secretion of hydrochloric acid, but also restore the barrier function of the mucous membrane, providing an esophagoprotective effect. To achieve these goals, Alfasoxx was developed, which consists of a mixture of low molecular weight hyaluronic acid and low molecular weight chondroitin sulfate dissolved in a bioadhesive carrier (poloxamer 407). The clinical efficacy of this product has been confirmed by three prospective, randomized, placebo - controlled trials. Alfasoxx has a healing and restorative effect towards the esophageal epithelium and due to high ability for bioadhesion provides long - term protection of the mucous membrane of the esophagus. Combination therapy for GERD with the use of PPI and an esophagoprotector offers new perspectives for the treatment of patients with GERD.

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