Objective. To evaluate the efficacy of combination therapy with a proton pump inhibitor (PPI) and rebamipide compared to PPI monotherapy in controlling nocturnal gastroesophageal reflux (GER) in patients with non-erosive reflux disease (NERD), based on 24-hour pH-impedance monitoring in the nocturnal supine position. Patients and methods. This prospective randomized study included 39 patients with NERD. All patients were divided into two groups: the study group (n = 22) received omeprazole 20 mg/day and rebamipide 300 mg/day; the comparison group (n = 17) received omeprazole 20 mg/day. The duration of treatment was 4 weeks. Efficacy was assessed functionally using 24-hour pH-impedance monitoring before and after treatment, with analysis of nocturnal parameters in the supine position. Results. In the study group, the duration of the longest nocturnal GER episode decreased by 78% (p = 0.016), and there was a notable positive trend in the percentage of time with pH <4, which decreased by 62% (p = 0.064). No significant improvement was observed in the comparison group. Intergroup analysis revealed a difference in the change in the number of GER episodes lasting >5 minutes (p = 0.039) and a trend toward a difference in the change in the percentage of time with pH <4 (p = 0.051). Conclusion. Combination therapy with rebamipide and PPI demonstrated both statistically significant and clinically meaningful superiority over PPI monotherapy in controlling nocturnal GER in patients with NERD, as evidenced by a substantial reduction in acid exposure and the number of pathologically prolonged reflux episodes in the supine position. These findings support the inclusion of rebamipide in the treatment regimen for NERD to improve control of nocturnal symptoms. Key words: proton pump inhibitors, rebamipide, non-erosive reflux disease, epithelial protective therapy
Celiac disease (CD) is a chronic autoimmune disorder that requires lifelong adherence to a gluten-free diet, which significantly impacts quality of life. The lack of validated Russian-language tools for assessing quality of life in CD patients limits the ability to provide comprehensive care for this population. Objective. To perform a comprehensive linguistic and psychometric validation of the Russian-language version of the CD-QOL (Celiac Disease Quality of Life) questionnaire for assessing quality of life in CD patients. Patients and methods. The procedure of linguistic validation was conducted in accordance with international standards (ISPOR, WHO) and involved a multistage process, including forward translation, reverse translation, expert review, cognitive testing, and a pilot study. Psychometric validation was performed on a sample of 599 patients with CD aged 0 to 18+ years, using principal component factor analysis with varimax rotation, assessment of internal consistency (Cronbach’s alpha), correlation analysis, group comparisons via t-tests and analysis of variance (ANOVA), as well as linear regression. Results. Factor analysis confirmed a two-factor structure of the questionnaire: “Social and emotional limitations” (9 items, α = 0.904) and “Health-related anxiety and fear” (6 items, α = 0.874), jointly explaining 60.2% of the variance. Mean scores for these factors were 3.39 (SD = 0.96) and 3.16 (SD = 1.07), respectively. Correlation analysis revealed a moderately strong positive association between the factors (r = 0.649, p < 0.001). Anxiety levels decreased with age (r = -0.14, p < 0.001), whereas the perception of social limitations remained stable (r = -0.06, p = 0.143). No sex-related differences were observed for the identified factors. Regression analysis showed that the perception of social limitations was a key predictor of anxiety (β = 0.636, p < 0.001), explaining 44.4% of the variance in the dependent variable in combination with age. Conclusion. The Russian-language version of the CD-QOL questionnaire demonstrated high linguistic and psychometric validity, supporting its use in both research and clinical practice for assessing quality of life in CD patients within Russianspeaking populations. These findings indicate that the instrument can be effectively applied for monitoring quality of life, evaluating the efficacy of therapeutic interventions, and developing individualized psychological support programs for patients with CD. Key words: celiac disease, quality of life, linguistic validation, CD-QOL, translation and adaptation, psychometric properties, Russian-language version
Children with severe neurological disorders frequently experience gastrointestinal problems, including dysphagia, constipation, and gastroesophageal reflux disease, which often lead to protein-energy undernutrition (PEU). Effective management of nutritional disorders is not possible without assessment of actual dietary intake. The available literature provides limited data on dietary intake in children with neurological disorders, particularly in those with cerebral palsy (CP). Objective. To perform a comprehensive assessment of actual dietary intake among children with CP according to the severity of motor impairment, disease type, and physical development. Patients and methods. This cross-sectional analytical study included 175 children aged 1–18 years with spastic forms of CP and all levels of motor impairment according to the Gross Motor Function Classification System (GMFCS). Physical development was evaluated, and dietary intake was analyzed using a questionnaire survey and a 3-day dietary record. Results. The analysis of dietary intake revealed a monotonous diet in 41% of children with CP, inadequate intake of fresh vegetables and greens in 39%, low fiber intake in 32%, and a significantly low red meat intake in 16%. Meal duration exceeding 30 minutes was observed in 31% of children. The average daily energy intake was comparable to the total energy expenditure (TEE) calculated using the Krick formula but differed significantly from age-specific requirements (p < 0.001). Overall, 81% of children had energy intake below age-specific requirements; carbohydrate intake was inadequate in 89% of cases, fat intake in 66%, and protein intake in 60%. Regarding TEE, children assigned to GMFCS levels I–II had excess energy intake (>100%) compared to those with GMFCS levels III–V (81–90% of TEE). Children with hemiparetic CP had a more optimal dietary intake than those with spastic tetraparesis (p = 0.001 for protein and carbohydrate; p = 0.012 for fat). In children with GMFCS level V, macronutrient intake was lower than in children with GMFCS levels I and II for protein (pV–I = 0.045; pV–II = 0.029) and carbohydrates (pV–I = 0.015; pV–II = 0.09). Fat intake in children with GMFCS level V was lower than in those with GMFCS level II (p < 0.001) and level III (p = 0.041). Conclusion. Most children with CP exhibited inadequate intake of energy, carbohydrates, fat, and protein. Children with spastic/ hyperkinetic CP, spastic tetraparesis, and severe motor impairments (GMFCS level V) represent a high-risk group for developing PEU. In contrast, children with hemiparetic CP and/or preserved motor function (GMFCS levels I–II) are at risk of overweight and obesity. Key words: children, cerebral palsy, energy intake, nutritional status, dietary intake, physical development
Childhood and adolescent obesity represents a significant medical and public health challenge, particularly in the northern and Arctic regions of Russia, where the combination of extreme environmental and climatic conditions, shifts in dietary patterns, and high genetic homogeneity of the population contributes to increased metabolic risk. Objective. To examine the associations between five polymorphisms in genes involved in the regulation of lipid and carbohydrate metabolism (PPARG rs1801282, FABP2 rs1799883, ADRB2 rs1042713 and rs1042714, ADRB3 rs4994) and the presence of obesity in the pediatric population of Yakutia. Patients and methods. The study included 410 children and adolescents aged 7–18 years permanently residing in Yakutia. Genotyping was performed using a quantitative real-time polymerase chain reaction (qPCR). Dominant, recessive, heterozygous, homozygous, and allelic genetic models were evaluated. Results. A significant association with obesity was observed for the rs1042713 polymorphism of the ADRB2 gene. The AG genotype (heterozygous model) was linked to an increased risk of obesity compared to the AA genotype: OR = 1.82 (95% CI: 1.07–3.11). The recessive model also demonstrated a significant correlation (GG vs. AG+AA): OR = 1.81 (95% CI: 1.10–2.98). In the allelic model, carriage of the G allele was associated with more than a two-fold increase in obesity risk: OR = 2.22 (95% CI: 1.19–4.14). The remaining polymorphisms showed no statistically significant correlation with this phenotype. Conclusion. The rs1042713 polymorphism of the ADRB2 gene may contribute to the pathogenesis of obesity in children and adolescents living in northern and Arctic regions, possibly reflecting adaptive metabolic responses to extreme climatic conditions. The lack of statistically significant associations for other genes examined supports the polygenic nature of obesity and highlights the importance of integrative strategies combining genetic, nutrigenetic, and digital approaches for early diagnosis and prevention. Key words: children, adolescents, nutrigenetics, obesity, personalized nutrition, gene polymorphisms, Arctic
Cow’s milk protein allergy (CMPA) remains the most common cause of food allergies in children. The limited efficacy of traditional elimination diets and the presence of infectious comorbidities in children with CMPA necessitate the search for new approaches to improve the immune control of allergies. A promising strategy for remodulating the immune response is to influence the gut microbiota. This article provides a review of preclinical and clinical studies, real-world clinical experience, and economic benefits for the healthcare system regarding 2FL Neocate Syneo, a new amino acid-based formula with synbiotics and human milk oligosaccharides. Key words: cow’s milk protein allergy, gut microbiota, synbiotics, Neocate Syneo
