Chronic atrophic gastritis: patient manage

Patient management in chronic atrophic gastritis (CAG) in real clinical practice is a difficult task for a clinician. It is mainly due to the lack of reliable clinical stigmas that allow suspecting the presence of gastric mucosal atrophy. The diagnosis of chronic atrophic gastritis is valid only after a morphological assessment of gastrobiopaths taken during an endoscopy. According to a contemporary view, regardless of the inflammatory process etiology, CAG can progress to stomach cancer. At the same time, the point of no-return (at which the risk of inflammatory changes progression in the gastric mucosa and carcinogenesis preserves) is the CAG formation with the presence of intestinal metaplasia, even after the etiological factor is eliminated. Patients of this group, depending on the severity of inflammatory changes and atrophy, require constant dynamic follow-up and timely implementation of necessary measures for cancer prevention. To inhibit the progression of gastric mucosal precancerous changes, it is necessary to include the regimen using gastroprotective drugs for patients with CAG. Patients with autoimmune gastritis (in addition to the gastroprotective drugs) need to conduct regimens of cyanocobalamin therapy to prevent hematological and neurological disease manifestations. KEYWORDS: chronic atrophic gastritis, intestinal metaplasia, gastric cancer, Helicobacter pylori, autoimmune gastritis, gastroprotection, carcinoprevention, eradication therapy, rebamipide. FOR CITATION: Livzan M.A., Gaus O.V., Mozgovoi S.I. Chronic atrophic gastritis: patient management. Russian Medical Inquiry. 2021;5(6):427–432 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-427-432.

Non-steroidal anti-inflammatory drugs and gastroprotection in primary health care users

Objective: The aim of this study is to assess the prevalence of gastroprotection and identify the main factors that influence the taking of protective drugs among the adult population, who are treated with non-steroidal anti-inflammatory drugs (NSAID). Material and Methods: This study was cross-sectional, conducted by including a contingent of 800 users of primary health care services (n=369, 46% males and n=431, 54% females). Included in the study were individuals of both sexes aged 18+ who sought counselling or treatment during the three-month period. The data collection of this study was based on the completion of a structured questionnaire, which included questions related to the use of NSAID and the modalities for the description and application of these drugs, and simultaneous taking of gastroprotective drugs. Results: The prevalence of the gastroprotective drugs use was higher among the elderly, individuals living in urban areas, those with higher education, those with daily use of NSAID, individuals receiving prescriptions from their own doctors, and those suffering side effects from the use of NSAID, as well as subjects that had a longer duration of NSAID use. Conclusion: This paper demonstrates the need to improve the quality of primary health care service through informing and educating patients regarding the need to take gastro-protective drugs for those in high risk of adverse effects manifested by the use of NSAID.

Do NSAIDs and ASA Cause More Upper Gastrointestinal Bleeding in Elderly than Adults?

Purpose. NSAIDs and ASA may cause upper gastrointestinal bleeding (UGIB) both in adults and in elderly. There is no study that compares this increased bleeding risk between adult and elderly subjects.Methods. A total of 524 patients with UGIB were included in this study. The data of patients were, respectively, analyzed.Results. NSAIDs and ASA-associated UGIB rates were similar between <65 years (345 patients) (group 1) and ≥65 years (179 patients) (group 2) (28.4% versus 23.5%,p=0.225and 13% versus 19%,p=0.071, resp.). Warfarin-associated UGIB was found significantly higher in group 2 than group 1. Elderly patients with NSAID-associated UGIB had significantly higher length of stay (LoS) and CoH than adult patients with NSAID-associated UGIB (p=0.002and 0.001, resp.). Elderly patients with ASA-associated UGIB had significantly higher CoH than adult patients with NSAID-associated UGIB.Conclusions. Using NSAIDs without gastroprotective drugs or using ASA with gastroprotective drugs in elderly patients is as safe as in adult patients. Not only should adding gastroprotective drugs to ASA or NSAID be based on their risk of UGIB, but the cost of hospitalization of ASA or NSAID-associated UGIB should be considered.

Influence of the dual COX-2/5-LOG inhibitor on the activity of L-arhinin/NO system in rat's blood with experimental ulcer of the stomach

A large spread of stomach ulcer causes the search for new effective gastroprotective drugs, which would possess antioxidant properties. It is established that the disease is accompanied by the imbalance in the system L-arhinin/NO. This is manifested by the activation of the NO-synthase pathway of L-arginine and is accompanied by excessive formation of nitric oxide. It is proved that the use of dual inhibitor COX-2/5-LOG normalizes deviation in the L-arhinin/NO system. This shows antioxidant and cytoprotective properties of the substance.