Applicability of the Chronic Liver Failure-Consortium score in patients with cirrhosis and bacterial infections: a single-clinic experience

Background. The frequency and characteristics of acute-on-chronic liver failure (ACLF) are reported in numerous articles from different countries. The aim of the study was to assess the cirrhosis decompensation in patients with bacterial infections based on the Chronic Liver Failure-Consortium (CLIF-C) score in one of the city clinics in Belarus. Materials and methods. The patients underwent laboratory and instrumental studies during the hospitalization. The assessment of the syndrome of acute-on-chronic liver failure was performed using the CLIF-C score. Bacterial infections were diagnosed on the basis of standard criteria. Results. The study included 151 cirrhotic patients, 87 males and 64 females. Median age was 55 years (Q1 = 43; Q3 = 61). Cirrhosis was predominantly due to alcohol addiction — 83 patients (55 %). ACLF was diagnosed in 44 of 151 patients with cirrhosis (29.1 %; 95% confidence interval (CI) 22.0–37.1). Bacterial infections were detected in 67 people (44.4 %; 95% CI 36.3–52.7). Most often patients had liver failure that was detected by an increase in serum bilirubin level. Among individuals with upper gastrointestinal bleedings, number needed to harm for developing ACLF was 3.3 (95% CI 2.2–4.4). The risk of developing ACLF grade 2 and 3 in cirrhotic patients with infections was 8.2, with 95% CI 1.0–69.6 (number needed to harm was 12.9; 95% CI 10.7–15.0). Bacterial infections increase the risk of acute decompensation in patients with cirrhosis (odds ratio = 2.0, p = 0.048). Conclusions. The CLIF-C score is quite applicable in our cohort of patients with cirrhosis.

Gender features of the cytokine profile in patients with chronic atrophic gastritis

Background. Сhronic atrophic gastritis certainly remains an urgent problem of gastroenterology but data on sexual differences in the content of cytokines in this pathology are quite contradictory. The purpose of the study: to assess the gender chara­cteristics of the cytokine profile in patients with chronic atrophic gastritis. Materials and methods. The study included 120 patients with gastric atrophy, according to histological examination of biop­sies. The control group consisted of 20 healthy individuals, men and women equally. In all patients, we have evaluated the levels of interleukins (IL-8, IL-10, IL-18), tumor necrosis factor alpha (TNF-α), vasculoendothelial growth factor (VEGF) by enzyme-linked immunosorbent assay using appropriate reagent from Vector-BEST kits and the Stat Fax 303 Plus analyzer. Results. In men with chronic atrophic gastritis, there is a more pronounced imba­lance towards pro-inflammatory cytokines, in particular the level of IL-18 is 1.7 times higher (p < 0.05) than in women. In 46.2 % of cases, the content of IL-8 was also elevated in men by 1.3 times (p > 0.05) compared to women. The level of anti-inflammatory cytokine IL-10 does not have a significant gender difference in patients with precancerous conditions of the stomach. The median of IL-18/IL-10 ratio in men is 2 times higher than in women: 65.36 (21.67; 154.25) vs. 32.15 (12.76; 191.85) (p < 0. 05). In males, IL-8/IL-10 ratio is also 1.5 times higher, which is 2.25 (1.29; 7.68) vs. 1.49 (0.75; 9.78) but this difference was not statically significant. Serum content of VEGF in men exceeded the same indicator in women by 1.4 times (p < 0.05). Direct correlation between VEGF content and the levels of TNF-α (r = 0.47, p < 0.05), IL-8 (r = 0.42, p < 0.05), IL-18 (r = 0.58, p < 0.05) confirm the evidence of increased VEGF expression under the influence of many proangiogenic growth factors and proinflammatory cytokines. Conclusions. With an increase in the level of IL-18 and VEGF by more than 30 %, men require dynamic monitoring for early detection of precancerous structural changes in the gastric mucosa.

Features of the hemostasis system in patients with non-alcoholic fatty liver disease

Background. Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. In recent years, disorders in the hemostasis system, their role in the progression of liver diseases and the development of cardiovascular complications in NAFLD have been actively studied. The purpose was to investigate the features of the hemostasis system in patients with non-alcoholic fatty liver disease. Materials and methods. We examined 36 individuals with NAFLD (20 women and 16 men) aged 29–73 years. All patients underwent an anthropometric, general clinical, biochemical study of blood serum with the determination of platelets, prothrombin time ratio, international normalized ratio, fibrinogen, ultrasound examination of the abdominal cavity organs with elastometry, followed by statistical data processing. Results. Among patients with NAFLD, class 2 obesity and overweight (30.6 % each), class 1 obesity (27.8 %) prevailed. At the same time, according to the controlled attenuation parameter, 38.9 % of people had a severe degree of steatosis, 33.3 % — moderate and 27.8 % — mild. Regarding the indicators of hemostasis, a significant increase in the level of fibrinogen up to (4.9 ± 0.5) g/l was detected in 44.4 % of patients, its severity tended to grow with an increase in the degree of hepatic steatosis. Conclusions. In 44.4 % of NAFLD patients, with an increase in the degree of hepatic steatosis, the tendency to hypercoagulability has grown with an increase in fibrinogen content by 1.6 times (p < 0.001). Changes in the international normalized ratio, prothrombin time ratio and platelets were determined in isolated cases: more than 83.3 % of patients with NAFLD didn’t have violations of these parameters.

Chronic pancreatitis: about some complications and features of their pathogenesis and course

The review article provides up-to-date information on the complications of pancreatitis that are important for the tactics and strategy of patient management both at the inpatient and outpatient stages of observation. The purpose of the review was to emphasize the importance of complications for the course and life of patients with chronic pancreatitis. The authors draw the attention of internists to the course of such complications as pseudocysts, cysts, fistulas, thrombohemorrhagic, cholestatic syndromes, compression syndrome of adjacent organs, pancreatic encephalopathy (acute and chronic). The symptomatology of complications of chronic pancreatitis is discussed in detail, which is very important for differential diagnosis with the corresponding diseases. Such complications include the formation of erosive and ulcerative lesions, varicose veins of the esophagus and bleeding from varicose veins of the esophagus and stomach, portal hypertension syndrome with pancreatic ascites and chronic pancreatic encephalopathy, idio­pathic non-cirrhotic portal hypertension, pancreatic cancer. The authors emphasize the need to analyze the corresponding symptoms, indicating the possibility of complications, negative consequences with each recurrence or exacerbation of chronic pancreatitis, since it concerns the prognosis and life of the patient.

Peculiarities of the relationship between aggressive and protective factors of the gastric mucosa in patients with esophagogastroduodenal pathology with impaired adaptive potential and autonomic homeostasis (according to PRECISE-diagnostics)

Background. An imbalance of interaction between the sympathetic and parasympathetic links of the autonomic nervous system leads to autonomic dysregulation of the heart rate resulting in insufficient stress resistance, impaired adaptation and depletion of the protective mechanisms of the gastric mucosa. Therefore, the purpose of our research was to study adaptive potential of the body depending on the aggressive and protective factors of the gastric juice. Materials and methods. Seventy-one patients with esophagogastroduodenal pathology were examined using the method of PRECISE-diagnostics. The level of pH, pepsin, glycoproteins, fucose and sialic acids in the gastric contents was determined. The patients were divided into 3 representative groups: I — 30 individuals with hiatal hernia; II — 20 patients with achalasia cardia; III — 21 people with duodenal ulcer disease complicated by stenosis. Results. An imbalance of sympathetic and parasympathetic links of autonomic system was detected in 85.2 % of patients. The sympathetic mechanisms dominated in 71.3 % of cases. At the same time, most patients with achalasia cardia had vagotonia. The adaptive and compensatory mechanisms were identified after studying the relationship between the aggressive and protective factors of the gastric mucosa. When analyzing the correlation of aggressive and protective factors of gastric juice, the following adaptive and compensatory options were revealed: 1) hyperreactive, with simultaneous increase in the factors of both aggression and protection; 2) compensatory (an increase in the level of aggressive factors against the background of normal protective indicators); 3) decompensatory (an increase in the level of aggressive factors simultaneously with a decrease in protective factors). Conclusions. The adaptive potential of the body in 85.2 % of surgical patients, mostly those with hiatal hernia and achalasia cardia, according to PRECISE-diagnostics was defined as reduced, in the form of impaired adaptation in decompensatory type of the relationship between aggressive and protective factors of gastric juice.

The study of tissue IgG4 in the mucous membrane of the colon in patients with inflammatory bowel disease

Background. Inflammatory bowel disease (IBD) is a global problem today, with a growing prevalence in the world. It significantly increases the economic burden on the health care system. Recently, many studies indicate the important role of immunoglobulin G4 (IgG4) in the formation of chronic inflammation in IBD and the possibility of using it as a biomarker of the inflammatory process. The purpose was to improve the diagnosis of chronic inflammatory bowel diseases by studying the status of IgG4-positive plasma cells in the mucous membrane of the colon in patients with ulcerative colitis (UC) and Crohn’s disease (CD). Materials and methods. We have examined 34 patients with IBD, 25 with UC and 9 with CD, of them 20 women and 14 men, with an average age of (38.8 ± 3.0) and (38.2 ± 3.7) years, respectively. Patients were divided into groups depending on the noso­logy and severity of the disease. All patients underwent endoscopic examination of the colon to establish or clarify the diagnosis, and biopsy specimens were taken for histological and immunohistochemical examination. Results. In 13 (38.3 %) of 34 examined patients, a positive result for the presence of tissue IgG4 (≥ 10 cells in the field of view) was found. Among patients with UC, 48 % have a positive result of immunohistochemical examination of tissue IgG4, in people with CD, this figure is 11.1 %. This gives us reason to say that in UC, elevation of tissue IgG4 levels occurs 4.4 times more often. Positive tissue IgG4 in patients with moderate UC was found 1.1 times more often than in severe UC. Among patients with mildly active disease, tissue IgG4 was not detected. Conclusions. In UC, IgG4-positive cells in the mucous layer of the colon are more common than in CD, which makes it possible to use this indicator for the differential diagnosis of ulcerative colitis and Crohn’s disease. Positive tissue IgG4 is more common in moderate form than in severe one.

Professor Leon Padlewski — director of the bacteriological institute

The article presents the life path of an epidemiologist, professor Leon Padlewski, a native of Poland. He became the first director of the bacteriological institute in Yekaterinoslav. Information about his wife Nadieżda (nee Berestnieva), a well-known pianist, the founder of the Belarusian piano school, was provided. A tragic fate befell Padlewski sons, who died in the fight against the Nazis. The elder son Jerzy was an architect, and the younger son Roman was a composer.

The role of endoscopic ultrasound investigation in the diagnosis of submucosal neoplasms of the stomach and duodenum (literature review and our clinical observations)

Submucosal neoplasms of the stomach and duodenum include a group of diseases with different etiology, clinical symptoms, diagnosis and management. Conventional gastroduodenoscopy helps detect submucosal formations in 0.36–4 % of cases, while the stomach is the most common site of submucosal lesions (up to 60 %). Endoscopy and ultrasound endoscopic examination are important tools for the diagnosis of submucosal tumors of the esophagus, stomach, duodenum, both benign (polyps, submucosal formations, extraorganic compression, cysts) and malignant neoplasms of the gastrointestinal tract, especially small and accidentally detected. It is important not only to diagnose the tumor, but also to determine from which layers it comes, what level germinates, whether there is damage to regional lymph nodes. Only endoscopic ultrasonography (EUS) can answer these questions. EUS combines the capabilities of two studies: endoscopic and ultrasound, which significantly increased the informativeness of endoscopic examination, as it was possible to determine the site of the pathological process and the degree of intramural invasion, and also made it possible to carry out the differential diagnosis of submucosal tumors and pathological processes in organs adjacent to the esophagus, stomach, duodenum. The article presents examinations of patients with submucous formations of the stomach and duodenum at the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine. With the help of EUS, the diagnosis was confirmed in one patient, and in another one, the submucosal neoplasms was excluded.

Wirsungectomy for pancreatic hypertension in chronic pancreatitis

Background. Pain in chronic pancreatitis (CP) can occur as a consequence of mechanical factors — pancreatic ductal hypertension, interstitial pressure, inflammatory and neuropathic pathological changes in the pancreas. The purpose was to evaluate a novel modification of the classic Partington-Rochelle procedure via comparing functional results of conventional surgery group and wirsungectomy group. Materials and methods. A retrospective analysis of the case histories of patients with CP and an enlarged (≥ 4 mm) main pancreatic duct was carried out for the period from 2003 to 2009, which underwent surgical treatment of CP. The SF-36 and EORTC QLQ-C30 questionnaires, and visual analogue scale of pain were used for the assessment. The first group included five patients with wirsungectomy with lateral pancreaticojejunostomy (PEA + WE); the second group consisted of 20 patients after the lateral pancreaticojejunostomy (PEA) only. Cross-tabulation analyses were performed to compare PEA and PEA + WE groups as well as those groups in different time points using a two-sided Student’s t-test. The significance level was set to p < 0.05. Results. The groups were compared in terms of VAS and the EORTC QLQ-C30 questionnaire before and 2 years after surgery using Student’s t-test for unrelated values: statistically significant differences between the groups according to VAS as before (p = 0.757) and after surgery (p = 0.696) were not obtained. There were no significant differen­ces (p > 0.05) between the PEA and PEA + WE groups before and after surgery according to the EORTC QLQ-C30 questionnaires, except for some items (p < 0.05) Within the groups according to VAS and EORTC QLQ-C30 (pain severity), in the PEA group (p = 0.000001, p = 0.000109) and the PEA + WE group (p = 0.018, p = 0.017) after surgery, there was a statistically significant decrease in pain. Conclusions. Longitudinal pancreaticojejunostomy with wirsungectomy is justified in patients with long-term CP, severe fibrosis of the pancreas with multiple calcifications of the periphery pancreatic ducts to decompress pancreatic ducts, and parenchyma. In the long-term period after 2 years, the proposed method of longitudinal pancreaticojejunostomy with wirsungectomy in patients with CP with dilation of main pancreatic duct according to the VAS scale and EORTC QLQ questionnaires C30 and SF-36 is accompanied by a significant reduction in pain.

Assessment of mental health in patients with irritable bowel syndrome

Background. The study of mental health in patients with irritable bowel syndrome (IBS) is a promi­sing area of medicine not only in terms of determining the psychological profile, but can also serve as an alternative in terms of further management and treatment of this group of patients. The purpose of the study was to examine mental health of IBS patients. Materials and methods. 54 patients with IBS were examined in the psychiatric clinic of Gǟvle Hospital in 2019–2021. They were included in group I of the examined patients. The control group (group II) included 40 healthy individuals. Assessment of the psychological status was determined using the following methods: 1) Psychological Stress Measure PSM-25 by Lemyr-Tessier-Fillion; 2) The Holmes and Rahe Stress Scale; 3) Health Assessment 36-Item Short Form Survey (SF-36 Health Assessment). Results. Despite the fact that physical symptoms (abdominal pain, intestinal spasm, defecatory dysfunction) were the main complaints in the clinical picture of our patients with IBS, it was found that the key factor in exacerbating and maintaining IBS physical symptoms are psychosocial (cognitive and emotional) factors. We evaluated the quality of life and psychological state of the examined patients with IBS. Analyzing the PSM-25 questions answered by patients from group I with IBS (n = 54) and from control group II (n = 40) on the level of psychological stress, the following results were obtained with gender distribution: 42.9 % of female patients of group I had a high level of stress, and 50.0 % a medium level of stress; low levels of stress were found in only 7.1 % of female patients of group I. After analyzing the level of stress, we assessed stress resistance, as a significant proportion of patients showed high and medium levels of stress. The level of stress was significantly higher in patients with IBS compared with the control group II. According to the survey on the psychological and physical component of health, these scores were also reduced in patients with IBS compared with the control group. Conclusions. High and medium levels of stress, as well as reduced stress resistance, were found in IBS patients, which is more pronounced in male patients. Decreased psychological and physical components of health have been found in IBS patients, indicating a reduction in the quality of life of these patients.