Aim of investigation. To estimate the effect of combined treatment by pinaverium bromide and itopride hydrochloride on clinical semiology and quality of life of patients with combination of constipation-predominant variant of irritable bowel syndrome (IBS-C) with postprandial distress syndrome (PDS).Material and methods. Overall 49 patients with IBS-C (Rome criteria III) were investigated, 31 of them also had accompanying PDS (Rome criteria III). Fourteen patients with combination of IBS-C and PDS (group I) for 4 wks received combined treatment by pinaverium bromide and itopride hydrochloride. Monotherapy by pinaverium bromide for 4 wks was carried out in 17 patients with combination of IBS-C and PDS (group II) and 18 patients with IBS-C (group III). Both symptoms and parameters of quality of life (SF-36) were estimated prior to onset of treatment and in 4 wks after its termination.Results. Combined therapy by pinaverium bromide and itopride hydrochloride for 4 wks in comparison to monotherapy by pinaverium bromide promoted more prominent reduction of abdominal pain intensity (p<0,001), meteorism (p<0,001), epigastric heaviness (p<0,001), complete disappearance of nausea and belching in many patients with combination of IBS-C and PDS. Treatment by pinaverium bromide in combination with itopride hydrochloride was characterized by absence of serious side effects and resulted in significant improvement of quality of life (p<0,001).Conclusions. Application of the combined therapy including spasmolytic drug pinaverium bromide and prokinetic agent itopride hydrochloride for patients combination of IBS-C and PDS significantly increased efficacy of relief of clinical symptoms of combined disease and improved quality of life of patients.

Aim: to analyze current approaches to H. pylori eradication therapy in adults and present the materials of Experts Council held on December 9, 2022 in Moscow.General statements. H. pylori infection is the main etiological factor of gastritis, peptic ulcer, and gastric cancer. Eradication of H. pylori is recognized as a necessary measure to reduce the incidence of these diseases. The approaches to selecting an eradication regimen should be optimized to take into account epidemiological trends and achieve better treatment outcomes. The updated Maastricht VI Consensus Report presents the means to overcome the difficulties in selecting an approach to the treatment of H. pylori infection. However, eradication therapy remains challenging due to adverse events (primarily antibiotic-associated diarrhea), poor treatment tolerance and patient compliance. Eradication therapy can be optimized by supplementing treatment regimens with strain-specific probiotics that reduce adverse events, improve patient compliance and eradication rates, such as Saccharomyces boulardii CNCM I-745 strain with established efficacy.Conclusion. The inclusion of certain probiotics in eradication regimens improves treatment tolerance, reduces the risk of adverse events, improves patient compliance and eradication rates.

Aim of review. To present management approach for acid-related diseases in patients with Helicobacter pylori (H. pylori) infection, under long-term proton pump inhibitor therapy. Summary. There is no relation of gastroesophageal reflux disease (GERD) symptom severity, the pattern of relapses and treatment efficacy to the presence or absence of H. pylori infection; successful H. pylori eradication does not cause relapse of pre-existing GERD and does not induce its development. At the same time it is impossible to neglect the data on potential induction or aggravation of GERD after H. pylori eradication in separate population groups, including those in Asia. The presence of GERD could not prevent infection eradication in the presence of other indications (e.g., peptic ulcer, chronic gastritis). Monotherapy by proton pump inhibitors (PPI) in H. pylori-positive patients with GERD may lead to progression of gastric corpus atrophy that can be regarded as risk factor for stomach cancer development. H. pylori infection eradication promotes reduction of gastritis-like changes severity irrespective of maintaining of acid-suppressive treatment. The choice of specific PPI for treatment of patients with GERD and other acid-related diseases, carrying out H. pylori eradication therapy or substitution of one PPI agent to another are individualized and depend on the indications registered in the drugs administration instructions, features of its pharmacokinetics and pharmacodynamics, possible drug-to-drug interactions. Conclusion. Testing for H. pylori infection and carrying out the subsequent eradication therapy could allow to prevent progression of corpus mucosa atrophy in patients with acid-related disorders, first of all those with GERD, who received long-term PPI treatment. Estimation of duration of PPI treatment at acid-related disorders, and terms of H. pylori eradication therapy should be evaluated according to clinical guidelines and treatment protocols of these diseases taking into account age of the patient, clinical features, course of disease, presence of complications.

Aim of review. To present management approach for acid-related diseases in patients with Helicobacter pylori (H. pylori) infection, under long-term proton pump inhibitor therapy. Summary. There is no relation of gastroesophageal reflux disease (GERD) symptom severity, the pattern of relapses and treatment efficacy to the presence or absence of H. pylori infection; successful H. pylori eradication does not cause relapse of pre-existing GERD and does not induce its development. At the same time it is impossible to neglect the data on potential induction or aggravation of GERD after H. pylori eradication in separate population groups, including those in Asia. The presence of GERD could not prevent infection eradication in the presence of other indications (e.g., peptic ulcer, chronic gastritis). Monotherapy by proton pump inhibitors (PPI) in H. pylori-positive patients with GERD may lead to progression of gastric corpus atrophy that can be regarded as risk factor for stomach cancer development. H. pylori infection eradication promotes reduction of gastritis-like changes severity irrespective of maintaining of acid-suppressive treatment. The choice of specific PPI for treatment of patients with GERD and other acid-related diseases, carrying out H. pylori eradication therapy or substitution of one PPI agent to another are individualized and depend on the indications registered in the drugs administration instructions, features of its pharmacokinetics and pharmacodynamics, possible drug-to-drug interactions. Conclusion. Testing for H. pylori infection and carrying out the subsequent eradication therapy could allow to prevent progression of corpus mucosa atrophy in patients with acid-related disorders, first of all those with GERD, who received long-term PPI treatment. Estimation of duration of PPI treatment at acid-related disorders, and terms of H. pylori eradication therapy should be evaluated according to clinical guidelines and treatment protocols of these diseases taking into account age of the patient, clinical features, course of disease, presence of complications.

Aim of review. To present data of clinical trials, systematic reviews and metaanalyses which allow to optimize eradication therapy of Helicobacter pylori (H. pylori) infection. Summary. Standard triple therapy including proton pump inhibitor (PPI), clarithromycin and amoxicillin is the first­line treatment for H. pylori eradication. At prescription of standard triple therapy various measures increasing its efficacy should be utilized. Classical fourcomponent bismuth tripotassium dicitrate­based treatment or quadrotherapy without bismuth including PPI, amoxicillin, clarithromycin and metronidazole may be alternative options for the first line eradication therapy. Quadrotherapy with bismuth tripotassium dicitrate is applied as the basic mode of second line therapy at failure of standard triple therapy. Alternative mode of the second line therapy includes PPI, levofloxacin and amoxicillin. Levofloxacin­based triple therapy can be prescribed only by specialist in gastroenterology at strict indications. Third line therapy is personalized according to the choice of the previous treatment modes. The choice of H. pylori eradication therapy in the Russian Federation is based on empirical approach. The rate of clarithromycin resistance of H. pylori strains in Russia does not exceed 15% in the majority of regional studies. There are data indicating absence of significant metronidazole resistance of H. pylori and low level of double clarithromycin and metronidazole resistance. Efficacy of H. pylori eradication therapy may be enhanced by increasing treatment duration to 14 days. Prescription of new generation PPI or increase of PPI dose are targeted to provide the maximum acid suppression, highly important for successful H. pylori infection eradication. Additional prescription of bismuth tripotassium dicitrate, probiotics or rebamipid increases efficacy of antihelicobacter therapy. Significant decrease of adverse events rate at H. pylori eradication treatment is reached at combined prescription of probiotics. Rebamipid may potentiate reparative processes in the stomach mucosa. Conclusion: Methods of H. pylori eradication optimization can be applied for enhancement of both standard triple therapy and other concomitant treatment modes, and the combination of these methods provides best result for the given patient.

The aim of publication. To present the modern concept of etiology and pathogenesis of exocrine pancreatic insufficiency to general practitioners as well as with the established approach to diagnostics and treatment of this syndrome. Summary. Exocrine pancreatic insufficiency (EPI) develops if activity of the enzymes in duodenal lumen in response to meal stimulation is insufficient to maintain normal nutrient digestion. This state can develop primarily, due to various pancreatic diseases (chronic pancreatitis, pancreatic cancer, cystic fibrosis), and secondarily, due to impaired stimulation of pancreatic secretion or non-physiological conditions for activity of digestive enzymes. Basic manifestations of EPN the syndromes of maldigestion and malabsorption leading to development of nutritional failure. At the present time there is no standardized diagnostic method for estimation of pancreatic exocrine function, therefore there are no standard diagnostic criteria for EPN. In clinical practice EPN is diagnosed according to decreased fecal elastase activity in patients with verified pancreatic disease, which can cause decrease of pancreatic exocrine function. The basic EPN treatment method is pancreatic enzyme replacement therapy (PERT). For last 50 years there was an significant progress in development of PERT, numerous pancreatin-containing preparations were developed. Treatment of PERT require prescription of capsules, containing pancreatin microparticles protected by enteric coating. The highest evidential base at EPN is accumulated for pancreatin mini-microspheres. The starting dose of pancreatic enzymes for adults is 25 000 units of lipase per meal, which should be subsequently increased up to achievement of complete response confirmed by both clinical and laboratory scores. Digestive enzymes should be taken at the beginning of food intake, to increase treatment efficacy PERT should be accompanied by prescription of proton pump inhibitors. Patient’s diet quantity and content should be adjusted with participation of nutritionist. Patient should intake at least normal daily amount of fat and divide daily ration to at least six meals. Patients should be motivated to restrain from alcohol consumption and smoking as they can lead to further progression of pancreatic exocrine insufficiency and symptoms of pancreatitis.

.

.