Clinical variants of esophageal stenosis caused by infectious esophagitis in children

Infectious esophagitis (IE) is commonly seen in immunocompromised patients. IE may be the first symptom of immunodeficiency state, also can be complication of immunosuppressive therapy in patients with hematological and oncological diseases. Severe complication of IE is esophageal stenosis. Patient management tactics continue to be discussed. A purpose of our publication is to demonstrate our experience in the management of patients with infectious esophageal stenosis. The etiology, features of the clinical and endoscopic picture, as well as the effectiveness of drug therapy and endoscopic methods of treatment have been analyzed. The study was approved by the Independent Ethics Committee and the Scientific Council of the D. Rogachev NMRCPHOI. In each case, parents gave their consent to the use of their child’s data, including photographs, for research purposes and in publications.

Heterotopia of gastric mucosa and long segmental Barrett’ oesophagus complicated by cicatricial stricture of the upper third of the oesophagus

A 26-year-old patient with no symptoms of gastroesophageal reflux disease developed complaints of dysphagia. Endoscopic examination revealed a short grade 3 cicatricial stricture in the upper third of the oesophagus, and in the lower parts of the oesophagus mucosa was represented by a columnar epithelium for 16 cm. Histological examination verified the long segmental Barrett’ oesophagus. Above the stricture large areas of heterotopia of the gastric mucosa were determined among the regular oesophageal squamous epithelium. While taking proton pump inhibitors, the patient underwent a long course of endoscopic bougienage with intramural dexamethasone injections, which made it possible to stabilize the lumen in the stricture zone at a level of 12 mm. A precise examination of all parts of the oesophagus with the use of modern clarifying imaging techniques allows to correctly interpret the endoscopic picture and determine the further tactics of treatment and follow-up, taking into account the possible risks of neoplasia in the heterotoped area of the mucosa of the upper third of the oesophagus.

Clinical, endoscopic and histopathological correlation in gastro oesophageal reflux disease

Background: Gastroesophageal reflux disease (GERD) is a common burden on health care resources in the Western world and deteriorates the health-related quality of life of those affected, but its manifestations in the general population are as yet unclear.Methods: The present prospective study was conducted on 50 patients of acid peptic disease (APD) of both gender of age 15-75 were randomly selected. APD was diagnosed clinically in patients presenting the symptoms and were subjected to upper gastrointestinal (GI) endoscopy using Pentax FG29 gastroscope. The patients who had the classical symptoms of heart burn and reflux were diagnosed as GERD clinically and were examined for erosive changes by endoscopy.Results: Out of the 16 patients diagnosed as GERD, majority of them 10 (62.5%) were vegetarian and 62.50% had symptoms from 3 to 12 months. 12 (75%) had visible erosions on endoscopy. The remaining 4 (25%) had normal endoscopic picture, the biopsy taken from whom showed inflammatory changes on histopathology.Conclusions: The most common presenting complaint in patients of GERD was heartburn followed by regurgitation of gastric contents. Prevalence of GERD was found 32% in APD. In 12 (24%) of patients oesophagitis was seen on endoscopic examination. After medical treatment for 6-8 weeks, 37.5% of subjects become asymptomatic and 50% had partial symptomatic relief.

Combined Therapy of Gastroesophageal Reflux Disease

Objective: to evaluate the benefits of co-administration of the esophagoprotector Alfazox and the proton pump inhibitor (PPI) for the relief of symptoms and epithelialization of esophageal mucosal erosions in patients with gastroesophageal reflux disease (GERD). Material and methods. 40 patients with GERD with reflux esophagitis were examined. Patients were randomized into two groups: 19 patients of the first group (8 men and 11 women, age 48,0 [39,0;60,5] years) received combination therapy: pantoprazole 40 mg per day and Alfazox 10 ml four times a day; 21 patients from the second group (13 men and 8 women, age 47,0 [33,0; 64,0] years) received pantoprazole 40 mg per day. The duration of therapy was 28 days. The dynamics of the frequency and severity of symptoms of the disease were evaluated on the Likert scale. According to the EGDS data, the effectiveness of the treatment of erosive esophagitis was evaluated. Results. The advantages in reducing the severity of symptoms in the first group were noted. On the first day of combined treatment, heartburn was stopped in 64% of patients (χ2 p < 0.05). By the fourth day of treatment in this group, heartburn persisted in 11% of patients and in 42% of patients receiving pantoprazole monotherapy (χ2 p < 0.05). Combination therapy was more effective in reducing the severity and frequency of belching and dysphagia (Wilcoxon p < 0.01, χ2 p < 0.05). Against the background of combined therapy, endoscopic remission of reflux esophagitis was achieved in all patients, and erosion of the esophageal mucosa persisted in 25% of patients in the control group (χ2 p = 0.033). Conclusions. The study showed the advantages of combination therapy (PPI + Alfazox) both in achieving the symptomatic response and in improving the endoscopic picture in patients with erosive reflux esophagitis.

Prevalence, clinical course and treatment of chronic gastritis at the present stage

Background. The importance of the problem of chronic gastritis (CG) is determined by its high proportion in the structure of gastrointestinal pathology, reduced quality of life of patients, and possible complications. The study aimed at the investigation of the incidence and features of the clinical course of CG in servicemen at the present stage and pharmacoeconomic efficacy of bismuth and triple anti-helicobacter therapy (AHBT) in H. pylori (HP) — associated erosive gastritis with the use of domestic drugs. Materials and methods. At the first stage, the indicators of the admission rate of servicemen with CG and the peculiarities of the endoscopic picture of the gastric mucosa were analyzed. At the second stage, the features of the clinical course were studied and a pharmacoeconomic analysis of treatment regimens in servicemen with HP-associated erosive gastritis with proton pump inhibitors of different generations and domestic bismuth subcitrate, used in triple and bismuth-containing regimens, was performed. Results. An epidemiological, clinical, and pharmacoeconomic analysis of HP-associated CG in servicemen at the present stage has been conducted. It is reasonable to treat servicemen with HP-associated erosive gastritis with domestic drugs using bismuth-containing anti-helicobacter therapy, which will improve the efficiency and quality of treatment and avoid unjustified budget costs. Conclusions. Among the servicemen of the Armed Forces of Ukraine, starting from 2013, there is a tendency to increase the number of erosive gastroduodenal lesions with a predominant lesion of the antrum of the stomach. Pharmacoeconomic analysis of the treatment of HP-associated erosive gastritis showed the feasibility of switching to bismuth-containing AHBT with the use of domestic rabeprazole and bismuth subcitrate. This is justified by a higher anti-Helicobacter activity by 1.2 times (20 %), 1.6 times better (60 %) cost-effectiveness, and 1.4 times higher (40 %) cost-utility.

P195 Predictors of colectomy in patients with acute severe ulcerative colitis: single-center retrospective analysis

Background Acute severe ulcerative colitis is observed in 25% of patients1. Near 40% of this severe patients might undergo surgery2 and the mortality rate in this group of patients reaches 6.3%3. Untimely surgery leads to severe metabolic disorders, infectious postoperative complications, and increases the risk of death4,5. Eventually, the purpose of this study is identify predictors of colectomy in patients with acute severe ulcerative colitis. Methods A retrospective study included 74 patients with acute severe ulcerative colitis, who were treated at the clinic in 2017(Fig. 1). The patients were divided into the groups: group of colectomy - 54/74 (73%) and group of conservative treatment 20/74 (27%) (Fig 1). The predictors, like serum albumin, C-reactive protein, hemoglobin, endoscopic picture of «extensive ulcers», and clinical data were analyzed. The statistical analysis was performed using the software«Statistica 13.3» and «RStatistica». Results There were no difference by gender, age and duration of the disease in the groups. Mean of albumin and hemoglobin levels were significantly lower in the colectomy group. The endoscopy «extensive ulcers» was significantly more common in the operated patients (Tab 1). Also univariate, multivariate and ROC analyses were performed (Tab 2), (Fig 2). The risk of colectomy when endoscopy «extensive ulcers» combined with an albumin level&lt;31 g/l and hemoglobin&lt;107 g/l, was 100%. A nomogram for predicting the probability of colectomy was constructed (Fig 3). This logistic model has a statistically significantly high predictive value (AUC=0.93, p=0.006). Conclusion The endoscopic picture of «extensive ulcers» in combination with an albumin level of less than 31 g/l and hemoglobin less than 107 g/l are predictors of colectomy with high predictive value.

Guality eradication anti-helicobacter therapy increases the effectiveness of treatment of patients with stable angina pectoris

Aim. On the basis of the complex analysis, to evaluate the efficiency of eradication therapy at patients with stable stenocardia with a combination of chronic gastritis. Material and methods. 46 patients with stable stenocardia with a combination of chronic H. pylori-associated gastritis were included in the open prospective clinical study. Two groups of patients were formed during the study. Patients of group I (n = 25) received eradication therapy in accordance with antibiotic sensitivity of H. pylori strains, patients of group II (n = 21) - without antibiotic sensitivity. In all patients before and after treatment were performed: evaluation of clinical status, laboratory indicators, EGDS with biopsy sampling, diagnosis of H. pylori. Results. The effectiveness of eradication therapy was 86.9%, at the same time, 96% -in group I and 76.2% - in group II. It is established: stabilization of clinical status of patients, improvement of morphological and endoscopic picture of gastroduodenal zone, improvement of laboratory indices. Conclusions. The inclusion of antibiotic-sensitive erication therapy in the algorithm of treatment of patients with stable stenocardia in combination with chronic gastritis allows to achieve high effectiveness of killing the infection Helicobacter pylori. At the same time stabilizes clinical status of patients, laboratory indices, has a positive effect on morphological and endoscopic picture of gastroduodenal zone, preventing progression of metaplastic changes.

The effectiveness of hepatosplanchnic ischemia treatment monitored with intramucosae pH in polytrauma

The study aimed to substantiate and introduce the empirical oxygenation of general and local action into intensive care for heptosplanchnic ischemia during polytrauma. The study included 85 patients with polytrauma with the brain injury of mild to moderate severity according to the modern clinical classification. The conditions for inclusion in the study were as follow: Injury Severity Score (ISS) more than 32 points, Acute Physio­logy and Chronic Health Evaluation (APACHE II) — 25 points or more. Clinical and biochemical studies were carried out at the following stages: upon admission (stage 1), 12–24 hours after the start of intensive care (stage 2), in 3, 5, 7 days (stages 3, 5, 7, respectively). The clinical observation was carried out up to 32 days from the time of the injury. The manifestations showed certain differences depending on the outcome of the disease. Victims with a subsequent fatal outcome had higher blood loss (by 27.65 %, p < 0.05), blood volume deficiency (by 33.42 %, p < 0.05), more severe hypotension, tachycardia; increased arterial hypoxemia; the indicator of venous blood shunting in the lungs significantly exceeded the normal values and those of the group of survivors. With sigmoidal gas tonometry in survivors, the intramucosal pH ranged 6.88–7.0; pCO2 from 85.6 to 118.38 mmHg. In the dead, the intramucosal pH ranged from 6.79 to 6.9 units; pCO2 from 95.61 to 121.71 mmHg. In 85 % of cases of endoscopic visuali­zation, erosive-ulcerative changes in the mucous membrane of the antrum were determined. Gastrointestinal insufficiency in patients with subsequent fatal outcome clinically corresponded to II–III stages; according to the manifestations of histological changes in the mucous membrane of the antrum of the stomach to the III–IV stages. The described features are based on the prevalence of 11.77 % ISS scales in deceased victims, APACHE II by 20.78 %, and SOFA by 71.52 %, which determines the severity of the damage, the condition of the victims, and the severity of organ damage. Starting from the 1st day of intensive care, the differences between the studied parameters in survivors and deceased victims continued to worsen. In surviving patients, oxygenation of arterial blood was restored from the first day to the physiological values due to the elimination of venous bypass blood in the lungs, and the transition to normodynamic blood circulation. Then on the 3rd day, the intramucosal pH was 99.59 % of the norm. In the dead, the restoration of the oxygenation index on the 1st day was combined with a decrease in tissue oxygen extraction, hypovolemic shock, refractory to vasopressor therapy from the 3rd day of the study. The pH values exceeded 7.35 only by the 5th day, while clinically the digestive function did not recover on the 7th day of the study. The data of the clinical evaluation of gastroenteric insufficiency were confirmed in the endoscopic picture, the data of histological and histochemical studies of the mucous membrane of the antrum. High, positive, reliable correlations between intramucosal pH and the outcome of the disease have been established. The actual mortality rate at the intermediate points was 20 %: 3 victims died on the 3rd day, 2 victims — on the 5th day. Before the 28th day of clinical observation, the actual mortality rate was 44 % (the rest 6 victims died from the 7th day to the 28th day). After 28 days to 32 days, death was not registered.

CLINICAL AND STATISTICAL ASPECTS OF THE DEVELOPMENT AND COURSE OF BLEEDING FROM VARICOSE VEINS OF THE ESOPHAGUS IN PATIENTS WITH PORTAL HYPERTENSION

Summary. The aim of the study was to identify the main etiological factors that led to the development of portal hypertension — the leading cause of varicose bleeding, to analyze the clinical aspects of the course and methods of treatment of bleeding from varicose veins of the esophagus (EVV). Materials and methods. We collected, processed and analyzed the results of treatment of 95 patients with bleeding from varicose veins of the esophagus hospitalized in the Dnipro Clinical Emergency Hospital, DGS “for 2017. The leading factor was established liver cir-rhosis — 92 cases (96.8 %). Moreover, in 42 cases (44.2 %), cirrhosis of the liver developed against the background of chronic viral hepatitis C. The endoscopic picture of this category of patients and the degree of blood loss were also assessed. Results and its discussion. It was found that the most frequently detected VRV II–III st. — in 42 (44.2 %), III st. — in 27 (28.4 %), while 52 (54.7 %) patients showed dilatation of the venous trunks in all parts of the esophagus, in 29 (30.5 %) — in the mid-lower parts. Analysis of concomitant pathology helped to establish against the background of which diseases portal hypertension most often develops: viral hepatitis C was detected in 46 cases (48.4 %), coronary artery disease (diffuse cardiosclerosis) — in 29 (30.5 %), ischemic heart disease (atherosclerotic cardiosclerosis) — in 15 (15.8 %), hypertension II Art. — 26 (27.4 %), diabetes mellitus — 10 (10.6 %). All patients received conservative therapy, which was combined with mechanical methods of hemostasis (Sengstaken – Blakemore probe) in 24 cases (25.3 %), endoscopic hemostasis (ligation with latex rings) — in 3 cases (3.2 %), partial embolization of the splenic artery — in 3 cases (3.2 %), suturing of veins — in 1 (1.1 %). In 70 cases (73.7 %) a favorable outcome was noted, 25 cases (26.3 %) were fatal. Conclusions. The main cause of bleeding from varicose veins of the esophagus is liver cirrhosis developed against the background of viral hepatitis C. Despite the widespread use of local endoscopic hemostasis techniques, recurrent bleeding occurs in 9.5 % of cases. The mortality rate for bleeding from varicose veins of the esophagus is 26.3 %, which corresponds to the world average trend.