Acid-dependent Diseases Research Articles

Treatment specifics for sialadenosis of the parotid glands in patients undergoing eradication therapy

Relevance. Treating patients with comorbid pathologies of the parotid salivary glands (PSGs) and the gastrointestinal tract presents a significant clinical challenge. Sialadenosis commonly develops in acid-dependent diseases associated with H. pylori (HP) infection, often manifesting as complaints of dry mouth. This condition leads to a reduction in local immunological defense due to decreased levels of sIgA, which is predominantly sourced from parotid secretion. Gastroenterologists typically prescribe eradication therapy that includes a proton pump inhibitor (PPI), which, according to its pharmacodynamic properties, can cause drug-induced xerostomia.Material and methods. A total of 115 individuals with sialadenosis of the PSGs and HP infection, confirmed by a positive urease rapid test in parotid secretion, aged 46.42 ± 6.21 years, were examined. The participants were randomly assigned into groups based on the prescription of absorbable gingival collagen membranes and the dose of a complex immunoglobulin preparation (CIP). The groups were as follows: Group I – 35 individuals without local therapy; Group II – 40 patients receiving 30 mg CIP; Group III – 40 patients receiving 60 mg CIP. Additionally, a control group consisting of 20 healthy individuals aged 44.46 ± 4.12 years was included. Gastroenterologists prescribed a standard triple eradication regimen, which included a proton pump inhibitor (PPI) at double dosage, 1000 mg amoxicillin, and 500 mg clarithromycin, taken twice daily for 14 days. All participants underwent comprehensive dental examinations at various stages: diagnosis, day 14 of eradication, and days 21 and 28 of observation.Results. A significant increase in PSG sialometry and sIgA levels in parotid secretion was observed in patients using absorbable gingival collagen membranes and CIP in addition to standard treatment. At a CIP dose of 60 mg, a negative urease rapid test was determined in parotid secretion by day 14, while at 30 mg, this occurred by day 21, confirming the effectiveness of the therapy.Conclusion. Treating patients with PSG sialadenosis undergoing eradication therapy requires a comprehensive interdisciplinary approach. It is necessary to include absorbable gingival collagen membranes and CIP at a dose of 60 mg twice daily for 21 days.

Features of diagnostics of sialadenosis of parotid salivary glands in patients with gastrointestinal tract pathology associated with Helicobacter pylori

AIM: is improving the diagnostic efficiency of patients with sialadenosis of the parotid salivary glands and acid-dependent diseases associated with Helicobacter pylori.
 MATERIALS AND METHODS. At the clinical base of the Department of Dentistry of the Central State Medical Academy at the Department of Presidential Affairs of the Russian and the Department of Gastroenterology and Hepatology of the Polyclinic № 1 of the Office of the President, 40 people with sialadenosis of the parotid salivary glands and acid-dependent diseases associated with Helicobacter pylori-infection were examined. The mean age of the study patients was 47,03±6,33 years. The control group consisted of 20 practically healthy people aged 35-55 years.
 RESULTS. In the course of the work, data were obtained on a significant increase in IL-1β, 6 and TNFα indicators in patients with sialadenosis and a positive result for Helicobacter pylori, detected using a rapid urease test and PCR diagnostics in parotid saliva.

THE FOCUS ON INCREASED RISK OF FRACTURES IN THEIR PROLONGED USE

Proton pump inhibitors are the most effective drugs for the treatment of acid-dependent diseases. For a long time, proton pump inhibitors have been considered to be completely safe drugs both for short-term and long-term use. A number of modern clinical studies note that when prescribing proton pump inhibitors in high doses for a long time, the possibility of side effects should be taken into account. The purpose of the review is to study the effect of prolonged use of proton pump inhibitors on the condition of bone tissue and the risk of osteoporotic fractures. Materials and methods. A search was conducted in the PubMed and Scopus information databases for publications on the safety of using proton pump inhibitors, including sources published before December 1, 2023, with an emphasis on the influence of proton pump inhibitors on bone tissue and the possible risk of fractures. Results. According to numerous studies, prolonged use of proton pump inhibitors is associated with an increased risk of fractures of the hip, vertebrae and the wrist. An increased risk of fractures may be associated with hypergastrinemia and hypochlorhydria (due to inhibition of acid secretion by proton pump inhibitors), and electrolyte disorders (hypocalcemia). Conclusions. All the pros and cons of prescribing proton pump inhibitors in patients with a history of fractures associated with osteoporosis should be carefully considered. In the curation of comorbid/multimorbid patients, proton pump inhibitors should be used if medically required for as short duration as possible and at the minimum effective dose to relieve symptoms.

Gastroesophageal reflux disease: Clinical variants and therapeutic tactics

Gastroesophageal reflux disease (GERD) is currently one of the most common nosologies, which affects people of different ages, but mostly able-bodied ones, patients of 40–60 years of age. Without effective or appropriate treatment, people with this disease can expect many complications, including severe ones: bleeding, distal oesophageal stenosis, electrolyte abnormalities associated with cardiac and conduction disorders, and the development of severe anaemia. These factors significantly complicate medical treatment and increase economic costs in the ensuing time. The disease is classified as an acid-dependent disease, although the acid-induced damage is not indicated in the definition and consideration of pathogenesis, as the primary diagnosis of diseases begins with an assessment of the clinical variant of the disease course, which also forms an adequate examination program. We proposed for discussion a new classification of GERD course variants, which will help facilitate diagnosis, find adequate pharmacological targets and increase the effectiveness of treatment. Acid-dependent and acid-independent variants are the main GERD course variants according to the proposed classification. Given this, we examined a group of 60 patients treated with the combination of guaiazulene with dimethicone, which impacts the protection of esophageal mucosa from aggressive reflux, reduces the number of refluxes (duodenoesophageal) and has a local anti-inflammatory effect. The overall effectiveness was 87%, and it halved the treatment time, which confirmed the very concept of the clinical classification of GERD course variants. We hope that the proposed classification of GERD course variants will be favourably accepted by the gastroenterology community, discussed and will serve as an effective tool for the treatment of this severe group of patients.

Эффективность и безопасность пантопразола в лечении пациентов с кислотозависимыми заболеваниями в России: многоцентровое наблюдательное исследование

The aim – evaluate the clinical effect and adherence to pantoprazole (Nolpaza®) therapy in patients with acid-dependent diseases in real clinical practice. Pantoprazole occupies a special place among various representatives of proton pump inhibitors (PPI) due to the peculiarities of its pharmacokinetics and pharmacodynamics. Thus, the area under the curve (AUC), correlating with the severity of acid-suppressive effect, is significantly higher for pantoprazole than for other PPIs. In addition, pantoprazole has a longer-lasting antisecretory effect because it is the only PPI that binds to both cysteine 813 and deep-lying cysteine 822. Of all PPIs, pantoprazole least blocks the CYP2C19 isoenzyme involved in multidrug metabolism, ensuring minimal drug interactions. Material and methods. Data collection for further analysis was performed using specially designed electronic individual registration cards of two groups of patients: the first – patients with gastroesophageal reflux disease (GERD), receiving therapy with Nolpaza®; the second – patients with peptic ulcer disease (PU) / erosive gastritis and patients with an indication for Helicobacter pylori eradication, receiving therapy with Nolpaza® as part of the eradication therapy regimen. Conclusion. According to the results of the conducted study it was possible to evaluate the clinical effect and tolerability of Nolpaza® therapy using the data of more than 14 thousand patients with GERD, gastritis, duodenitis, gastric and duodenal ulcer, drug-induced gastropathy, 98% of whom had gastrointestinal complaints before the beginning of treatment, while by the end of therapy the complaints remained in full in less than 1% of patients. The results of esophagogastroduodenoscopy at the end of therapy with Nolpaza® confirmed positive dynamics in 99.8% of cases, and the vast majority of patients achieved complete endoscopic remission. Positive dynamics was also observed in the majority of patients who were tested for H. pylori infection. The efficacy of eradication therapy with Nolpaza® amounted to 88.2%. The study provided a high assessment of patient adherence throughout the follow-up period.

Proton pump inhibitor (PPI) administration and Clostridioides difficile infection - is this a real clinical problem? A critical review of the literature

Background: Proton pump inhibitors (PPIs) are widely used drugs that reduce gastric acid secretion. In recent years, there has been a gradual increase in their use. The safety of prolonged PPI therapy and the potential for cumulative side effects of these drugs raise legitimate concerns. An association between PPI administration and the risk of Clostridioides difficile infection has been suggested. The findings regarding this phenomenon require further unequivocal verification.
 Material and methods: A review of publications obtained from the PubMed database and published between 2016-2023. Based on the keywords "proton pump inhibitor", "PPI" and "Clostridium", 132 articles were selected. Finally, 6 meta-analyses were included in the analysis.
 Results: Studies conducted in recent years have shown a statistically significant increase in the risk of C. difficile infection in patients taking PPIs compared to those who avoid this therapy. The aforementioned relationship was observed in both adults and pediatric patients. One study proved that the risk remained high even up to 1 year after the end of treatment. The described relationship is still a matter of debate due to the fact that patients using antacids are usually elderly, have several comorbidities and a higher risk of developing C. difficile infection regardless of PPI use.
 Conclusions: The relationship between the use of PPIs and the risk of developing C. difficile infection is still controversial, which justifies the need for continued clinical trials to objectively resolve this issue. PPIs exert high efficacy in the treatment of acid-dependent diseases, but due to the many ambiguities surrounding possible side effects, caution in their administration seems warranted, especially for long-term therapy in elderly patients with polypharmacy.

Development of a comorbidity phenotype of acid-dependent diseases and arterial hypertension syndrome for a personalized approach to diagnosis and treatment

Purpose of the study. The prevalence of diseases of the gastroduodenal zone and cardiovascular pathology among the working population is alarming. In order to develop phenotypes of comorbidity of acid-dependent diseases of the gastroduodenal zone and the syndrome of arterial hypertension in hazardous workers, a study of the state of health was carried out. Materials and methods. 4 observation groups were formed, aged 40 to 60 years, with work experience of more than 10 years. The first group consisted of 51 patients with arterial hypertension, the second - 26 patients with acid-dependent diseases, the third - 25 workers with comorbid pathology. The fourth group consisted of 24 workers without this pathology. The clinical examination was carried out as part of clinical examinations in the conditions of the departmental clinical hospital of Russian Railways. To clarify the psycho-emotional status, psychometric testing was carried out using the Stilberger-Khanin anxiety scale and the SANT test. A biochemical blood test included the determination of the level of alanine aminotransferase, aspartate aminotransferase, glucose, creatinine, lipid spectrum, antibody titer to Helycobacter pylori, the amount of endothelin-1, monocytic chemoattractant protein-1. Instrumental studies: fibrogastroduodenoscopy, daily monitoring of blood pressure. Results and conclusions. Indicators of general morbidity among employees of locomotive crews are higher than those of the industry. In the structure of chronic diseases, the prevalence of isolated arterial hypertension and erosive and ulcerative lesions of the gastroduodenal zone exceeds 60%, and the calculated probability coefficient of the combination is 6 times higher than the population one. The development of comorbidity of arterial hypertension and erosive and ulcerative lesions of the gastroduodenal zone under conditions of long-term exposure to a complex of production factors in trained workers was accompanied by the prevalence of personal and situational anxiety as a reflection of the maladjustment syndrome. The main pathophysiological determining modules in each group of patients were identified: the dyscirculatory-inflammatory module was identified as a phenotype of the comorbidity of the studied pathologies. The data obtained allow us to form a personalized approach to the prevention and treatment of comorbid pathology.

Features of the blood cytokine profile in gastroesophageal reflux disease in schoolchildren with gastritis and family history of peptic ulcer

Gastroesophageal reflux disease (GERD) is a common acid-dependent disease among the population, including children, with multifactorial genesis. It, like many other acid-dependent diseases (peptic ulcer, etc.) is associated with a family predisposition to the disease. Of interest is the study of the role of cytokines in the regulation of pathology in childhood, depending on the severity of a family history of peptic ulcer disease. Aim: to evaluate the levels of cytokines in the blood serum in case of family history of ulcerative diseases in schoolchildren with gastritis associated with GERD. In the course of a scientific study, 142 children with gastroenterological complaints aged 7-17 years were examined. The diagnosis of GERD was made in the presence of weekly heartburn in accordance with the global consensus on pathology in children. All subjects underwent gastroscopy with taking biopsy material from the gastric mucosa and morphological confirmation of their diagnosis of gastritis in accordance with the Sydney classification. The concentration of cytokines in blood serum (IL-2, IL-4, IL-6, IL-8, IL-10, IL-18, IL-1β, IFNα, TNFα) was obtained by enzyme immunoassay. During statistical processing, the χ2 and Mann–Whitney tests were used. The studies were approved by the ethics committee and informed consents of patients and their parents were obtained prior to the start of the study. The results of the study did not show significant differences in the concentration of cytokines in schoolchildren depending on the presence of GERD. In children with a family burden of peptic ulcer, GERD was detected more often (p = 0.054), which is probably a consequence of their increased acid formation. Changes in the cytokine profile of the blood were noted. During GERD, with aggravation of peptic ulcer, there was an increase in the replication of IL-4 (p = 0.027) and IFNα (p = 0.001). The increase in blood IFNα in children with GERD with family burden is obviously aimed at enhancing immune responses involving the whole body to damage. This is due to its functional role – participation in the immune response. Increased replication of IL-4, obviously, provides an increase in metabolic, immune processes in the body aimed at optimizing the course of proliferative processes in the esophageal mucosa under conditions of increased secretion of hydrochloric acid in the stomach. Thus, when a family history of peptic ulcer is aggravated in schoolchildren with gastritis associated with GERD, a number of links in the cytokine network (IL-4, IFNα) move to the systemic level of regulation.

Особливості перебігу та функціональний стан підшлункової залози в підлітків із гастроезофагеальною рефлюксною хворобою

Chronic acid-dependent diseases and, in particular, gastroesophageal reflux disease (GERD), are urgent problems in pediatric gastroenterology. However, the clinical features and functional state of the pancreas in adolescents with reflux disease remain not fully understood. Purpose - to investigate the main parameters of quality of life, clinical features, and functional state of the pancreas in adolescents with GERD. Materials and methods. We examined 100 inpatients aged 13-17 years who were hospitalised in the period between 2016 and 2022. The diagnosis was verified according to modern protocols of diagnosis and treatment, and the results were statistically processed using the Statistica for Microsoft 7.0 software package. Results. Of the children we examined, 80.0% had endoscopically positive (non-erosive form) GERD, with 50.0% having concomitant functional pancreatic disorders. The most significant changes in blood amylase were noted in patients with comorbidity (120.5±0.1 g/(hr×L) and 33±0.3 g/(hr×L), p<0.05) and in patients with the erosive form of GERD (98.1±0.2 g/(hr×L) and 25±0.1 g/(hr×L), p<0.05). Serum lipase levels were also more pronounced in patients with comorbid GERD (70±0.1 U/L and 35±0.2 U/L, χ2=32, p<0.0001). In these teenagers, there was a violation of the quality of life according to the main parameters: heartburn, regurgitation, sleep disorders (the sum of points on three scales was 14.95±0.36 (95% confidence interval: 14.85-15.05) in combination with the appearance of pathology. 11.25±0.65 (95% confidence interval: 11.02-11.48) points - in patients with an isolated course of the disease, erosive form (р˂0.001). Conclusions. The clinical features of GERD in combination with functional pancreatic disorders include severe abdominal pain localized in the pyloric duodenal zone and left hypochondrium. In adolescents with comorbid GERD, the levels of organ-specific enzymes were more often increased compared to the control group. Quality of life was significantly changed in them too. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

New achievements of pharmacology for practical medicine in prevention and therapy of acid-dependent diseases

The prevalence of GERD in most European countries and the Russian Federation is at the level of 15–20%. Hydrochloric acid plays a significant and sometimes major role in damage to the mucosa of the upper gastrointestinal tract (GIT) in patients with various acid-related diseases. Despite the presence of various classes of drugs that reduce the damaging effect of hydro-chloric acid on the mucous membrane of the upper gastrointestinal tract, acid-related diseases continues to be an urgent medical problem. The review article discusses the issues of pharmacological treatment of acid-related diseases. Such classes of drugs as antacids, H2-histamine blockers, gastroprotectors, potassium-competitive blockers of hydrochloric acid secretion are described in detail. Particular attention is paid to the group of proton pump inhibitors (PPIs). The paper evaluates the merits of each class of drugs, their significance in the treatment of acid-related diseases. One of the most popular PPIs in the Russian Federation is omeprazole. The effectiveness of the drug is determined by pharmacokinetic parameters, in particular bioavailability. The bioavailability of omeprazole of various trade names varies widely. To increase the rate and completeness of dissolution, and hence the bioavailability of poorly soluble molecules in the modern pharmaceutical industry, various disintegrants are used as excipients. The addition of sodium superdisintegrant carboxymethyl starch to the new Omez® dosage form with MiniCaps technology promotes an accelerated and more complete intake of omeprazole into the systemic circulation, helping to increase bioavailability. In addition, the innovative dosage form has a volume that is 30% smaller than the classic capsule, which improves ease of use and adherence to treatment.

How to Make the Right Choice of Proton Pump Inhibitor for Patients with Gastroesophageal Reflux Disease?

Аim: to analyze the main pharmacokinetic properties of proton pump inhibitors (PPIs) and their significance in the treatment of gastroesophageal reflux disease (GERD).Key points. Pantoprazole has a high bioavailability, the absolute bioavailability of pantoprazole at a dose of 40 mg is 77 % from the first dose and does not change with repeated use. Pantoprazole shows a faster onset of action than omeprazole. Simultaneous food intake does not change the bioavailability of pantoprazole. Suppression of hydrochloric acid production while taking pantoprazole accompanies by the achievement of endoscopic remission of GERD by day 28 in 91 % of patients with reflux esophagitis and by day 56 in all patients in the PANSTAR studies. Pantoprazole has little effect on CYP2C19 compared to other PPIs, minimizing the risk of drug-drug interactions. Pantoprazole is the most pH-selective PPI, which determines the specificity of action only in the parietal cells of the stomach and the greatest safety of long-term use in patients with comorbid pathology.Conclusion. PPIs form the basis of the therapy of acid-dependent diseases, and, in particular, gastroesophageal reflux disease. Pantoprazole is distinguished from other PPIs by its persistent high bioavailability, long-term antisecretory effect, and very low affinity for cytochrome P450.

Proton pump inhibitors in the treatment of gastroduodenal ulcer bleeding: optimization of drug therapy methods

Currently, peptic ulcer disease remains the most common disease of the digestive system. Ulcerative bleeding is a terrible complication. The main condition for the successful conservative treatment of gastrointestinal bleeding that occurs against the background of acid-dependent diseases is adequate acid-reducing therapy. We conducted a study comparing the different modes of administration of proton pump blockers. To this end, three groups of the study were formed: the first group: the drug Rabeprazole was obtained as an antisecretory therapy. The dosing regimen consisted in the introduction of a bolus of 80 mg, then a constant infusion of the drug at a rate of 8 mg per hour for the first 72 hours, after which the transfer to the oral form of 20 mg ×2 times a day; the second group: received the drug rabeprazole intravenously in a dosage of 40 mg 2 times a day; the third group: received the drug rabeprazole intravenously in a dosage of 20 mg 2 times a day for the first 72 hours, then transfer to the oral form of 20 mg ×twice a day. The use of PPIs in various dosages in the study groups significantly reduced the risk of bleeding relapses and deaths. We have shown that the use of PPIs in reduced dosages is also an effective method of treating patients with ulcerative gastroduodenal bleeding.

The Utilization Evaluation of Intravenous Pantoprazole for Stress Ulcer Prophylaxis in a Major Teaching Hospital

Background: Proton pump inhibitors (PPIs) are one of the first-line drugs for acid-dependent diseases. Inappropriate use of PPIs, especially the Intravenous (IV) formula of pantoprazole, can result in excessive cost. This study aimed to evaluate IV pantoprazole usage's appropriateness and optimize its use in accordance with guidelines at Razi educational and remedial center, Rasht, Iran.
 Methods: This cross-sectional study was executed in five months among 344 patients of Razi hospital who received IV pantoprazole for stress ulcer prophylaxis (SUP). Demographic data, route and doses of pantoprazole, risk factors for stress ulcer, and other related medical data were recorded. In addition, the appropriate use of IV pantoprazole was measured according to recommendations arranged by this center and the American Society of Health-System Pharmacists.
 Results: Out of 197 patients who received SUP with an appropriate indication, 183 patients (92.9%) were able to tolerate the drug orally, and only 14 patients (7.1%) had an indication for receiving IV pantoprazole. There was a significant difference between patients who received SUP with an indication regarding having or not having an indication for IV pantoprazole (P = 0.007). 5029 vials (96.5%) with a cost of 17,822 US dollars were used inappropriately and imposed an additional cost on the health care system.
 Conclusion: This study presented that the majority of IV pantoprazole use in this center was not well-matched with guidelines in most cases, containing appropriate indication and right dosing. In order to prescribe this drug as SUP, it is necessary to be more careful about the criteria for prescribing and conforming the prescribed drug and the prescribed dose to the relevant instructions.

The influence of CYP2C19 polymorphism on the effectiveness of the treatment of acid-dependent diseases

Introduction. In modern systematic reviews, there is a point of view that CYP2C19 polymorphism affects the results of treatment of peptic ulcer, erosive esophagitis and eradication of Helicobacter pylori.Оbjective. To evaluate the effect of CYP2C19 polymorphism on the effectiveness of treatment with rabeprazole at a dose of 20 mg once a day in patients with GERD during 2 and 4 weeks of treatment.Materials and methods. In total, the study included 75 patients with GERD (36 men and 39 women, mean age 41.7 ± 1.5 years). A clinical examination with the completion of standard questionnaires took place during three visits: before the start of treatment, after 2 and after 4 weeks of therapy. Esophagogastroduodenoscopy was performed in all patients before treatment and in patients with esophagitis after 4 weeks of therapy. All patients received rabeprazole at a dose of 20 mg once a day. Genotyping of single nucleotide polymorphisms of CYP2C19 metabolizer genes was carried out by real-time polymerase chain reaction. Ultrarapid, rapid, normal, intermediate and poor CYP2C19 metabolizers have been isolated.Results. Of the 75 patients examined, 8.0% of patients were ultrarapid metabolizers, 30.7% of people were rapid, 49.3% of individuals were normal, 10.7% of persons were intermediate, and 1.3% of patients were poor CYP2C19 metabolizers. Response after 4 weeks of treatment with rabeprazole 20 mg once daily was 94.4% for NERD and 90.5% for erosive esophagitis. In ultrarapid and rapid metabolizers of CYP2C19, a complete response to rabeprazole therapy was registered in 81.3% of NERD patients and in 84.6% of patients with erosive esophagitis.Conclusion. Based on the results of the study, we obtained high efficacy of Razo® at a dose of 20 mg 1 time per day for the treatment of GERD in a group of patients with a predominance of rapid and normal metabolizers of CYP2C19.

Mechanism of action of gastroprotective agent rebamipide

Among the diseases of the digestive system, a significant place is occupied by acid-dependent diseases caused by excessive secretion of hydrochloric acid secreted by the parietal cells of the gastric mucosa. Due to their high prevalence and risk of complications, these pathologies represent a serious medical and social problem. Gastroprotective agents have a protective effect on the mucous membrane of the stomach and intestines. This group of medicines includes a range of drugs that differ in principle and mechanism of action, such as misoprostol, bismuth salts, as well as some herbal preparations, etc.

Syntropia – acid-dependent diseases and hypertension

Introduction. With syntropy of CVD and AH, the pathology of the digestive system can exacerbate the course of AH and develop special conditions for increasing the risk of cardiovascular complications. Pharmacotherapy of HD may affect the course and progression of gastroesophageal reflux disease.
 Material and methods. The study was conducted using the PubMed, Z-library, NCIB, Medscape, Mendeley databases using the keywords: “syntropy”, “comorbidity”, “arterial hypertension”, “acid-dependent diseases”, “gastric ulcer”, “gastroesophageal reflux disease”.
 Results. AH and CVD are quite often observed together, having, moreover, a conditioned commonality of the mechanisms of formation. The proximity of the location with the heart, the commonality of innervation, in the pathology of the esophagus, can create viscero-visceral reflexes and provoke arrhythmias, imitate coronary heart disease. Pathology of the upper gastrointestinal tract can lead to functional disorders of the cardiovascular system, manifested through the autonomic nervous system. The combined course of AH and CVD, observed, according to various sources, from 11.6% to 50%, is not just random, but may have pathogenetic and etiological patterns. Comorbidity of CVD and AH can enhance the development of the main pathological process and lead to disruption of adaptive mechanisms.
 Conclusions. The syntropy of AH and CVD requires thorough scientific studies to discover and elucidate the pathogenetic features of the course and methods of better drug therapy.

Interrelation: gastric microbiota - acid-dependent diseases, and more….

The relationship between gastric microbiota and acid-dependent diseases is currently not fully studied. The study is based on a review of the literature to analyze and reflect the available data on the interaction of gastric microbiota and acid-dependent diseases, as well as brain-gut diseases. The survey was performed by analyzing data from Medscape, PubMed, Elsevier. The articles analyzed are in English, Romanian, Russian, published in the last 10 years. Data on the composition (landscape) of the gastric microbiota and their influence on acid-dependent diseases and digestive diseases in general were reflected. The research reflected that in addition to Helicobacter pylori infection, the landscape of the gastric microbiota in the acid stomach (with low pH) is not sterile and includes other types such as: Proteobacteria, Firmicutes, Actinobacteria, Bacteroidetes, Fusobacteria. At the same time, current methods document a bacterial load of 1010-1012 CFU/mL in the colon, which is much higher than in the stomach, where it reaches 102-104 CFU/mL. H. pylori influences the diversification of the non-H.pylori gastric microbiota; Decreased diversification increases the risk of carcinogenesis. The aspects of the role of H. pylori in functional dyspepsia, named after the Maastricht Consensus V - H. pylori dyspepsia, were also demonstrated. The taxonomic profiles (Philum-level, Genus-level) of the gastric microbiota require the study of the interrelationships with acid-dependent diseases, as well as the feedback. The study shows that the stomach is not a sterile organ and in addition to H. pylori there are 5 other types of gastric microbiota, which are interrelated with acid-dependent diseases and digestive disorders and vice versa. This issue requires a comprehensive approach.

Clinical Significance of Cytochrome P4502C19 (681G/A) Gene Polymorphism in Residents of the Trans-Baikal Territory in Treatment of Acid-Dependent Diseases

Aims . To study the CYP2C19(681A/G) polymorphism among the population of the Trans-Baikal Territory in comparison with data in other regions of Russia and the world. Materials and methods. The study involved 132 people (81 women and 53 men). The median age was 47 (18; 72) years. Genotyping of the 681G/A polymorphic locus of the CYP2C19 gene was performed by polymerase chain reaction. Results. The prevalence of CYP2C19(681G/G) was 105 people (79.6%), CYP2C19(681G/A) — 25 people (18.9%) and CYP2C19(681A/A) — 2 participants (1.5%). Allele A of the CYP2C19 gene in position 681 was found in 14.2%. Allele A is less common in the population of the Trans-Baikal Territory, compared with Asians (China, p <0.001; Japan, p = 0.015) and did not differ in prevalence from Native Americans, Hispanics, African Americans, residents of Moscow, Voronezh, Irkutsk regions and Sakha-Yakutia. CYP2C19(681A/A) was more common in the Asian population than among the Transbaikalians, p = 0.003. The prevalence of the CYP2C19(681A/A) genotype did not differ between the population of the Trans-Baikal Territory, African Americans, Caucasians, and the population of the Moscow and Voronezh regions. Conclusions. The prevalence of the allele A in the population of the Trans-Baikal Territory was 14.2% and was comparable to the Caucasians, but less common than in the Asian population. The prevalence of the CYP2C19(681A/A) was 1.5%, which was consistent with world data among Caucasoid populations and was less common than in Asians.

Dynamics of inflammatory changes of the gastric mucosa in children with duodenal ulcer

Background. The problem of gastrointestinal diseases in children remains quite relevant due to the high prevalence and presence of atypical symptoms and comorbidities pathogenetically associated with acid-dependent diseases. The purpose was to study the dynamics of inflammatory changes of the mucous membrane in children with duodenal ulcer (DU). Materials and methods. One hundred and six children aged 10 to 18 years with DU were examined. To verify the diagnosis, all children underwent endoscopy, pH-metry, morphological examination of gastrobiopsy samples, examination for Helicobacter pylori (H.pylori). Results. 49.1 % of children with DU were diagnosed with impaired motor-evacuatory function in the form of duodenogastric and/or gastrooesophageal reflexes, 81.1 % of patients presented with H.pylori was determined. Erythematous changes of the gastric and duodenal mucosa predominated. 92.4 % of patients were diagnosed with chronic non-atrophic gastritis and/or gastroduodenitis with varying degrees of inflammation, 7.6 % of children — chronic atrophic gastritis. There was a decrease in height and signs of desquamation of the superficial epithelium, in 72.3 % — the development of granular dystrophy, in 6.9 % of patients without H.pylori infection and in 57.5 % of H.pylori infected — neutrophilic infiltration of the mucous membrane. In the dynamics after 3 months, the height of the superficial epithelium and the frequency of desquamative changes decreased, and the proliferation of the glandular epithelium 12.4 % increased. Conclusions. Morphological changes in biopsies of the gastric mucosa differ depending on the presence of H.pylori infection and partially persist for 3 months after treatment.

Current Trends in Treatment for Acid-Dependent Diseases: Clinical Efficacy and Safety of Rabeprazole

Aim. A comparative review of the rabeprazole properties vs. other PPIs, its efficacy and safety in treatment for aciddependent diseases.Key points. Rabeprazole provides a rapid proton pump blockade in parietal cells due to its high dissociation constant (pKa). A lower rabeprazole metabolic dependence on cytochrome P-450 enzyme system renders its antisecretory effect predictable and reduces the risk of interactions with other drugs metabolised through this system. A faster antisecretory effect and higher acid-suppressive activity of rabeprazole determine its better clinical efficacy in treatment for such acid-dependent diseases as gastroesophageal reflux disease and peptic ulcer. This makes rabeprazole (Pariet) a preferred drug in course and maintenance therapies for acid-dependent diseases, as well as in H. pylori eradication.Conclusion. The rabeprazole properties of high acid suppression potential, persistent antisecretory effect from first day of therapy, non-enzymatic metabolism and pleiotropic action determine its high efficacy in treatment for a wide range of acid-dependent diseases at a minimal risk of drug interaction.