Modern Gastroenterology
Latest Publications


TOTAL DOCUMENTS

189
(FIVE YEARS 135)

H-INDEX

2
(FIVE YEARS 1)

Published By Publishing Company Vit-A-Pol

2521-649x, 1727-5725

Author(s):  
Y. Z. Dynia

Objective — to study the incidence and clinical and pathogenetic features of intestinal injury in patients with type 2 diabetes mellitus. Materials and methods. Examinations involved 138 patients with type 2 diabetes mellitus (DM 2), aged from 39 to 67 years (mean age 53 ± 5 years), including 82 women (59 %) and 56 men (41 %). In addition to general clinical methods, investigations included plasma levels of the transforming growth factor‑b1 (TGF‑b1) and vascular endothelial growth factor (VEGF), the hydrogen breath test with lactulose, endoscopic examination of the intestine with biopsy followed by staining with hematoxylin‑eosin, immunohistochemical determining of claudin‑1 and VEGF, and conduction of PAS‑reaction. Results. Diabetic enterocolopathy (DECP) was diagnosed in 72 (52.2 %) patients with DM 2. Clinical manifestations were nonspecific and similar to those of irritable bowel syndrome (IBS). It has been found that DECP correlates with the duration of the DM 2 course and was diagnosed more often in middle‑aged patients (52.1 ± 4.1 years). In patients with DECP, the increase in the proinflammatory cytokines TGF‑b1 and VEGF significantly exceeded those in IBS patients. Histologically the inflammatory cell infiltration in patients with DECP was more intense and diverse, there were signs of subatrophy of the glands with a relative decrease in the number of vacuoles in the goblet cells. The immunohistochemical study revealed that VEGF in the colon mucosa was visualized mainly in patients with DECP. Moreover, a tendency to a decrease in the claudin‑1 levels was established in these patients. Conclusions. Intestinal damage was revealed in 67.4 % of patients with type 2 diabetes mellitus, and DECP was diagnosed in more than half of patients. Diabetic enterocolopathy had nonspecific clinical symptoms, required differential diagnosis with IBS, and was not always accompanied with abdominal pain. The presence of DECP more often correlated with the bacterial overgrowth syndrome, and levels of proinflammatory cytokines in the blood plasma and intestinal mucosa of these patients was raised.  


Author(s):  
N. A. Nosko ◽  
O. M. Rud

Objective — to systematize literature data on the presence of 677C > T and 1298A > C polymorphisms in the MTHFR gene and homocysteine levels in patients with non‑alcoholic fatty liver disease (NAFLD); to calculate the frequencies 677C > T and 1298A > C polymorphisms combinations in the MTHFR gene and their impact on NAFLD development; to compare homocysteine levels in patients with and without NAFLD. Materials and methods. The analysis has been performed for the results of investigation of 49 patients, from them 17 subjects with NAFLD and 32 without it. Clinical, laboratory, statistical and ontological methods were used in the study. The MTHFR 677C > T and MTHFR 1298A > C polymorphisms in the MTHFR gene were investigated with the use of real time polymerase chain reaction (RT‑PCR) technique. Homocysteine levels were determined with chemiluminescent immunoassay with reference values 3.7 — 13.9 µmol/L. Multiple logistic regression method was used to evaluate the effects 677C > T and 1298A > C polymorphisms in the MTHFR gene on NAFLD development. Results. The variant of combination of 667С/С/1298А/А polymorphisms in the MTHFR gene (absence of mutation) was reveled in 6 (12 %) persons, that showed a widespread prevalence of variants with the presence of mutations. The correlation between variants of 677C > T and 1298A > C polymorphism in the MTHFR gene has been established (r = 0.429; p < 0.05). The results of multiple logistic regression demonstrated absence of the significant effects of 677C > T and 1298A > C polymorphisms in the MTHFR gen on NAFLD development (p > 0.05). Comparison of the homocysteine levels in patients with and without NAFLD didn’t reveal significant difference (р > 0.05), as well as comparison in the groups with combinations of 677C > T and 1298А > С polymorphisms in the MTHFR gen (р > 0.05). This can be explained by the fact that NAFLD group consisted of manly young patients without hypertension, type 2 diabetes mellitus and severe liver fibrosis. Conclusions. Ontological systematization of the scientific data on NAFLD revealed that 677C > T and 1298A > C polymorphisms in the MTHFR gen are pathogenetically associated with the significant increase in homocysteine levels as a marker of cardiovascular pathology. Giving the multifactorial nature of hyperhomocysteinemia and wide spread of 677C > T and 1298A > C polymorphisms in the MTHFR gen in population, it seems to be impractical to use genetic investigations for MTHFR gen polymorphism in NAFLD patients routinely, but only for the purpose of differential diagnosis of hyperhomocysteinemia.  


Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
K. Y. Linevska

For over a thousand years, Hippocrates and Galen have been the Alpha and Omega of medical knowledge. Despite the importance of their contributions to clinical and theoretical medicine, they lacked a true understanding of anatomy and physiology. Hippocrates is commonly associated with proposing the doctrine of «tissue fluids», or humoral pathology, and his book, «On the Nature of Man», promotes this point of view. Galen became inherited the knowledge of Hippocrates. Ultimately, he was recognized as one of the most influential physicians of all time. The number of his works was enormous: he wrote more than a hundred books, which were widely distributed. One of Galen’s main commandments was the rule of harmony: all body systems are balanced; disease is a result of an imbalance. As one might expect, some of his ideas, however, were erroneous. Aristotle considered the pancreas, due to its location in the abdominal cavity, as an organ which only task was to protect the adjacent vessels. In an era when unknown diseases wreaked havoc, the concept of known causes of diseases led to the fascination with the study of food poisons and their antidotes. This was common among aristocracy who felt particularly vulnerable to this kind of threats. According to legend, one of the most famous connoisseurs of poisons was Mithridates VI. Pedanius Dioscorides was a Greek who served in the Roman army during the reign of the emperor Nero. The wandering nature of life led him to study a large number of diseases and medicines. The catalogue of his medicinal herbs and plants became the basis for the study and understanding of the medicinal properties of plants. Liver was considered the source of divine prophecy in many ancient cultures. The anatomy of liver was well known in ancient Babylon: a huge number of clay tablets and objects were left, which testify to the importance of «hepatoscopy» in the Middle East as a form of prediction. Those who used the insides of animals for divination (e.g., haruspices — divine interpreters of the future, using the liver as a prediction tool), could be considered the first official anatomists, since the understanding of the future depended on accurate knowledge and interpretation of certain liver components. After the victory of the Assyrian king Sargon over the forces of Urartu and Zikirti in 718 BC, Sargon wanted to appease the gods by sacrificing animals; in doing so, he studied their livers for predictions. Although the concept of pancreas is rooted in ancient times, as evidenced by the comments of haruspices and priests, knowledge of the organ functions eluded humanity until the works by Danish physiologists Francis Sylvius and Regnier de Graaf. Prior to their studies of pancreatic secretion and the elucidation of the role of pancreas in digestion, described by van Helmont and Albrecht von Haller, most researchers focused on the anatomical description of the organ. If the ancient Assyrians and Mesopotamians did not believe that liver predicts the future, but believed that it was pancreas that did it, then pancreatology may have earlier origins. Maimonides, a Jewish scholar and humanist, was also influential in other fields: he condemned astrology and its attempts to calculate the time of the Messiah’s coming. In the field of medicine, he paid attention to prevention, and was interested in the treatment of diseases of the gastrointestinal tract. By the beginning of our era, ideas about digestion, diseases of the digestive tract and their treatment remained very vague. There was a long and difficult way ahead in this area.  


Author(s):  
A. V. Antonenko ◽  
T. V. Beregova

Non‑alcoholic fatty liver disease (NAFLD) takes the first place among liver diseases in the countries with developed economies. In the year 2020, the group of experts proposed a new term, metabolic‑associated fatty liver disease, that allows to specify the diagnosis, to divide different NAFLD phenotypes and to optimize its treatment. The course of metabolic‑associated liver disease can range from mild forms (simple nonalcoholic steatosis, characterized by the accumulation of triglycerides in liver cells) up to an aggressive course with the development of cirrhosis and hepatocellular carcinoma (HCC). Aggressive course of the disease is observed in patients with type 2 diabetes mellitus, high body mass index, abdominal obesity and histologically confirmed steatohepatitis. Epidemiological and genetic studies have shown an association between the morphological stage of metabolic‑associated liver disease and hereditary factors. Progression to HCC is common in patients with severe steatohepatitis, although recent literature data showed a significant increase in the proportion of patients with F1/F2 fibrosis and НСС. This is due to the presence of metabolic syndrome and gene polymorphism. Three main genes can be singled out, the polymorphism of which is associated with the development of metabolic‑associated liver disease, insulin resistance, dyslipidemia, and fibrogenesis: PNPLA3, TM6SF2 and GCKR. Recently, an MBOAT7 gene polymorphism has been also identified, it peculiarly increases the risk of steatohepatitis development in patients who are alcohol abusers and/or have chronic viral hepatitis C. Detection of polymorphisms in these genes is useful for identifying groups at high risk for disease progression. Early diagnosis of HCC and risk stratification will allow to diagnose the disease at an early stage and optimize its treatment.


2021 ◽  
Author(s):  
G. D. Fadieienko ◽  
O. E. Gridnyev ◽  
I. E. Kushnir ◽  
V. M. Chernova ◽  
T. A. Solomentseva ◽  
...  

Objective — to investigate endotoxin levels and to assess the relationship between endotoxemia and metabolic parameters and the degree of steatosis and fibrosis in patients with non‑alcoholic fatty liver disease (NAFLD) against the background of metabolic syndrome (MS). Materials and methods. The study included 68 patients with NAFLD with metabolic disorders and 20 people of the control group. Women prevailed in both investigational groups, the mean age was 49.34 ± 10.8 years. All patients underwent evaluation of their anthropometric parameters, investigation of body composition with determination of the percentage of visceral adipose tissue (VAT). To reveal VAT dysfunction, visceral adiposity index (VAI) was calculated with M. C. Amato method. Steatometry was performed by determining the wave attenuation coefficient and carrying out shear wave elastography. Endotoxin levels in blood serum were determined using a set of reagents «LAL Chromogenic Endpoint Assay» manufactured by «Hycult Biotech» (Netherlands). Results. Bacterial endotoxin levels in peripheral blood in the examined patients were almost three times higher in comparison with the control group (p < 0.05). Patients with overweight and obesity had significantly higher endotoxin levels compared with the control group (p < 0.05). The significant increase in endotoxin levels has been defined in obese NAFLD patients compared to the NAFLD patients with normal weight (p < 0.05). The direct correlation was found between endotoxin parameters and parameters of abdominal and visceral obesity. In the group of patients with high VAT activity, the maximal values of this indicator were observed, which significantly differed from the corresponding indicator in patients with low and medium VAI (p < 0.05). There was a direct correlation between moderate endotoxin and insulin resistance, a direct weak relationship between endotoxin and lipid profile parameters. In patients with grade 2 and 3 steatosis, significant differences in the level of endotoxemia were observed compared with the control group (p < 0.05) and patients with grade 1 steatosis (p < 0.05). At high grades of liver fibrosis (F3F4) there was a tendency to reduce endotoxemia compared with the low‑grade fibrosis (p < 0.05). Conclusions. The revealed relationships between endotoxemia level and metabolic factors of NAFLD development indicate the pathogenetic role of bacterial endotoxemia in triggering a cascade of metabolic reactions with the subsequent accumulation of lipids in the liver tissue and the progression of steatosis and fibrosis.  


Author(s):  
S. M. Tkach ◽  
N. V. Kharchenko ◽  
A. E. Dorofeev

Functional dyspepsia (FD) is one of the most common gastrointestinal functional diseases, occurring in an average of 10 % of the adult population. Recently, much attention is being paid to the infectious factor in FD pathophysiology. In addition to H. pylori infection and acute gastrointestinal infections, consideration is given to the syndrome of intestinal bacterial overgrowth (SIBO), in which the number of bacteria in the small intestine increases significantly. Objective — to establish the SIBO prevalence in patients with different FD subtypes and to establish the clinical and microbiological efficacy of rifaximin‑a (Alpha Normix®) at this pathology. Materials and methods. To refine the SIBO prevalence, 118 patients with FD were examined in three gastroenterological centers, including 45 men, 73 women aged 22 to 45 years (mean age — 35 ± 10 years). The control group consisted of 30 clinically healthy people with the mean age 33 ± 12 years. The diagnosis of FD and establishment of its subtype was performed according to Rome IV criteria. All patients underwent upper endoscopy with biopsy and H. pylori testing, which did not show any structural abnormalities. To diagnose SIBO, all patients underwent H2‑breath test with lactulose (H2‑LBT). All patients, depending on the FD subtype, received basic therapy with either a proton pump inhibitor (Omeprazole 20 mg once a day) at FD with epigastric pain syndrome (EPS) (group 1, n = 37), or prokinetic (Itopride in a dose of 50 mg three times a day) at FD with postprandial distress syndrome (PDS) (group 2, n = 36) for two weeks. Patients with positive H2‑LBT result, which predicted SIBO presence, were administered monotherapy with rifaximin‑a  (Alpha Normix®) in a dose of 1200 mg/day for 10 days. The effectiveness of the treatment was assessed after 2 and 4 weeks based on the dynamics of the scores of SAGIS (Structured Assessment of Gastrointestinal Symptom) scale. Results. According to the positive H2‑LBT results, SIBO presence was recorded in 45 of 118 patients with FD (38.1 %) and 2 (6.6 %) subjects from the control group. Positive H2‑LBT result was significantly more often recorded in patients with FD‑PDS (45.4 %) compared with patients with FD‑EPS (28.8 %, p < 0.01) and all patients with FD (38.1 %). Moreover, SIBO was significantly more common in patients with postinfectious FD (50 % of patients, p < 0.01). The use of rifaximin in a dose of 1200 mg/day for 10 days was accompanied by the clinical improvement in 28 of 45 patients (62.2 %) after 4 weeks of treatment. The clinical efficacy of rifaximin in FD patients on the SAGIS scale did not differ significantly from the efficacy of PPIs and prokinetics used in FD‑EPS and FD‑PDS, respectively. After 4 weeks, in 36 of 45 patients, repeated H2‑LBT was negative, which indirectly indicated the SIBO eradication and high antibacterial efficacy of rifaximin. Rifaximin treatment was safe, and minor side effects were observed in only 3 patients (6.6 %). Conclusions. SIBO is quite often associated with FD and is observed in more than every third patient. In patients with FD‑PDS, SIBO was found significantly more often than in patients with FD‑EPS, which emphasizes the important role of slowing gastric emptying in the development of SIBO. Also, SIBO is significantly more common in patients with postinfectious FD, which emphasizes the important role of the intestinal microbiome in maintaining the stability of the structural and functional state of the gastrointestinal tract. The obtained data allow to consider SIBO as a possible pathogenetic factor of FD, at least in some patients. This requires timely diagnosis and correction of SIBO in patients with FD, in particular with the use of rifaximin‑a.


Author(s):  
O. I. Hrabovska ◽  
O. M. Tatarchuk ◽  
N. Y. Zavhorodnia

Objective — to evaluate functional activity of the immune system, carbohydrate and lipid metabolism in children with biliary dysfunction against the background of overweight and obesity. Materials and methods. At the SI «Institute Gastroenterology of the National Academy of Medical Sciences of Ukraine» observations were performed on 108 children with the mean age 12.5 ± 2.51 years. Based on the results of investigation of motor and evacuator gallbladder (GB) function and body mass index, the pediatric patients were divided into three groups: group I included 52 overweight children with gallbladder hypofunction and obesity; group II consisted of 42 overweight children with normal gallbladder function and obesity; group III (comparison group) included 14 children with normal weight and biliary normokinesia. Investigations included anthropometric measurements and ultrasound imaging of the abdomen. ELISA was used to determine blood serum levels of insulin, interleukin‑6 (IL), IL‑10, tumour necrosis factor‑a (TNF‑a). Results. The following augmentation of the median levels was established when compared with group III: IL‑6 in 2.2 times (p < 0.05) and TNF‑a in 4.5 times (p < 0.05) in patients of group I, levels of IL‑6 in 2.3 times (p < 0.05) and TNF‑a in 4.3 times (p < 0.05) in patients of group II. The IL‑10 level in group I patients was lower in 2.5 times than in group II patients (p < 0.05), and in 4.4 times vs group III patients (p < 0.05). The serum insulin levels in children of groups I and II were in 2.2 times (p < 0.05) and 1.5 times (p < 0.05) lower, and HOMA‑IR index in 2.3 times (p < 0.05) and in 1.8 times (p < 0.05), respectively, in comparison with group III patients. The following blood serum levels vs group III were established: triglycerides (TG) increased in group I in 1.4 times (p < 0.001) and in group II in 1.5 times (p < 0.001); low density lipoproteins (LDL) and very low density lipoproteins (VLDL) were increased both in I and II groups in 1.2 times, (p < 0.01) and 1.5 times, (p < 0.001), respectively. The atherogenic index (AI) raised in 1.6 times (p < 0.001) in group I patients and in 1.5 times (p < 0.05) in group II patients compared to group III, whereas high density lipoprotein (HDL) levels were decreased in the I and II groups in 1.2 times (p < 0.01) in comparison with group III patients. Conclusions. Regardless of the gallbladder functional state in overweight and obese pediatric patients, the abnormalities of the immune system indices have been established and, consequently, carbohydrate metabolism disorders (increased levels of insulin and index HOMA‑IR). The lipid metabolism disturbances have been established in the overweight and obese children with gallbladder hypofunction (significant increase in the levels of TG, LDL, VLDL, AI and decreased HDL levels). Correlation analysis in the groups of overweight and obese children with gallbladder hypofunction showed the presence of significant relationships between biliary sludge and IL‑6, TNF‑a levels, gallbladder volume and insulin and glucose levels, gallbladder hypofunction and levels of total cholesterol, HDL, LDL and as well as between the gallbladder dimensions and atherogenic index.  


Author(s):  
A. O. Rozhdestvenska

Objective — to determine the effects of concomitant hypertension on the quality of life (QOL) of patients with non‑alcoholic fatty liver disease (NAFLD) using the Medical Outcomes Study Short Form (SF‑36) and The Chronic Liver Disease Questionnaire (CLDQ). Materials and methods. Examinations involved 115 patients with NAFLD at the stage of non‑alcoholic steatohepatitis. The patients were divided into two groups: the main group included 63 patients with NAFLD and hypertension (32 men and 31 women, the mean age 48.4 years) and comparison group consisted of 52 patients with NAFLD (25 men and 27 women, the mean age 48.3 years). The control group consisted of 20 practically healthy people (12 women and 8 men, the mean age 47.1 years). The NAFLD duration did not significantly differ between the groups of comorbid course (6.6 years (95 % confidence interval (CI) — 5.8; 7.3)) and isolated NAFLD (7.8 years (95 % CI 6.7; 8.8)) (p = 0.086). Hypertension duration was 8.4 years (95 % CI 7.3; 9.5). Assessments included body mass index calculation (BMI) and measurements of systolic (SBP) and diastolic (DBP) arterial pressure. The Medical Outcomes Study Short Form (SF‑36) and Chronic Liver Disease Questionnaire (CLDQ) were used to assess the QOL of NAFLD patients. Results. In comparison with the control group and regardless of the presence of concomitant pathology, the significant decrease in QOL scores of almost all SF‑36 scales was established in NAFLD patients. In NAFLD patients with hypertension, decrease in the QOL indicators was observed for all components of health, except for the results on the scale of physical functioning («PF»). Indicators of the total physical («PCS») and mental («MCS») health components were also significantly lower in the group with NAFLD and hypertension and amounted to 25.00 % (95 % CI 21.20; 29.60) and 44.00 % (95 % CI 42.23; 50.47) out of the maximum possible 100 %. There was a significant decrease in indicators for all domains of the CLDQ questionnaire in patients with NAFLD and hypertension compared to the isolated NAFLD and the control group. Significant inverse correlations were determined between the QOL indicators according to both questionnaires and the diseases duration, SBP, DBP levels and BMI. Conclusions. NAFLD is associated with significant deviant changes in patients’ quality of life indicators according to the SF‑36 and CLDQ questionnaires. The presence of concomitant hypertension, the duration of fatty changes in the liver, the experience of hypertension, the levels of SBP, DBP and BMI significantly worsen the QOL of patients with NAFLD. The quantitative variability of QOL components in patients with NAFLD and hypertension can negatively affect the course of the disease and reduce the effectiveness of therapeutic and rehabilitation measures.  


Author(s):  
N. Y. Emelyanova ◽  
T. E. Kozyrieva ◽  
O. V. Stepanova ◽  
N. V. Zorenko

Dryness of the mucous membranes (in mouth, nose, genitals in women) and skin are the most common complaints of patients with Sjogren’s disease — a multisystem immune‑mediated disorder that causes anxiety and concern associated with the difficulties of initial diagnosis. The authors present a clinical case of a patient with primary Sjogren’s syndrome, a large number of symptoms of digestive diseases, complaints of dryness of mucous membranes, in particular the oral cavity. The diagnosis was confirmed by allied specialists such as ophthalmologist, gynecologist, rheumatologist, dentist. Detailed dental examination revealed the main dental complaints (constant dry mouth, galitos, changes in taste), clinical condition (dryness of the red border of the lips, swelling of the oral mucosa, changes in the relief of the gums), decreased secretory activity and significant reduction of unstimulated salivation with a moderate level of stimulated salivation. It is noted that a significant decrease in sialometry (0.01 ml per minute) and functional activity of the small salivary glands (up to 18) confirms the presence of true xerostomia. Micro‑crystallization of saliva revealed disorganization of irregularly shaped structures, as well as a significant number of organic inclusions, which indicates a violation of homeostasis in the oral cavity. Given the results of ultrasound examination of the large salivary glands and the absence of enlargement and swelling of the glands during clinical examination, we can assume that the destructive damage to the glands is not so pronounced, evacuation function of the gland is not reduced, but the amount of secretion is significantly reduced. To provide medical aid to patients with Sjogren’s syndrome, the accessibility of the qualified consultation is important and required, with conduction of comprehensive examinations by allied specialists, including a dentist.  


Author(s):  
G. D. Fadieienko ◽  
O. Y. Gridnyev

Objective — to perform analysis of the literature data as regards the efficacy of the use of fecal microbiota transplantation (FMT) in patients with the irritable bowel syndrome (IBS). Materials and methods. The systematic review of the literature (PubMed, MEDLINE, Cochrane Library) has been performed to assess the results of investigation on the use of FMT in adult IBS patients. Results. Currently, FMT is a safe and highly successful method of treatment for recurrent Clostridium difficile infection, and possibility to use FMT in the treatment of other diseases is under investigation. The results of FMT treatment of patients with IBS are contradictory. A number of authors outline fairly high FMT efficacy when used for the treatment of patients with IBS, refractory to the standard methods: it varies from 36 % to 70 % with a duration of adequate symptoms’ relief up to 1 year. However, other authors indicate that the positive FMT clinical effect lasted from 8 weeks to 3 months, after which there was a gradual recovery of symptoms. At the same time, the researchers noted that mostly often the positive outcome was reached after FMT from donors with a higher number of streptococci in the feces. Still others point out that there was no sustained, at least 50‑point reduction in the severity of IBS symptoms from baseline. Some authors did not reveal the advantages of FMT over placebo control and even reported about the higher placebo efficacy. After data generalization no significant difference was revealed in the global improvement in IBS symptoms in patients receiving donor FM versus placebo. However, the attention is drawn to the relationship between the results of FMT with methodology. Indeed, several studies have shown that placebo capsules were more effective than capsules containing donor feces, whereas FMT from donor stool delivered by colonoscopy was superior to FMF from autologous stool. This may be due to the excipients, containing in the capsulated FMT. A number of researchers also indicated that the use of a super donor is necessary for successful FMT and that the response to FMT is dose dependent. Conclusions. To resolve the issue of the expediency of using FMT in routine clinical practice in patients with IBS, more qualitative controlled studies, involving large cohorts of IBS patients and long‑term follow‑up, are required.  


Sign in / Sign up

Export Citation Format

Share Document