Gastroenterological Pathology Research Articles

Episodic Hyponatremia in Acute Intermittent Porphyria: A Case Report

Episodic Hyponatremia in Acute Intermittent Porphyria: A Case Report

Epidemiological aspects of chronic diarrhea in children in the Samara region

The aim of the research: to study the structure and epidemiological features of chronic diarrhea in children in different age periods. Materials and methods: data on outpatient cases of children and inpatient care with diseases that are clinically manifested by chronic diarrhea syndrome were analyzed. A survey of 1509 children of different ages was also conducted at an outpatient appointment with a pediatrician on the day of a healthy child, in preschool and educational institutions in the city of Samara. Results of the study: as a result of the study, it was revealed that in the structure of gastroenterological pathology in children, diseases manifested by chronic diarrhea account for 1.8%, while at the outpatient stage, unspecified diseases are more common. Among the children surveyed, it was found that clinical manifestations of chronic diarrhea were observed in 53.4% of cases at the time of the survey, while among these children, only 8% had a gastroenterological diagnosis that explained chronic diarrhea. Slightly less than half of the children surveyed had the so-called causal nature of chronic diarrhea. Conclusion: The relevance of the problem of chronic diarrhea in childhood is confirmed by the data of its high prevalence. It has been shown that insufficient attention is paid to the problem of chronic diarrhea - the registered prevalence is at least 5 times lower than the real one. Particular attention should be paid to children with cause-related diarrhea, and restriction of the use of cause-significant products stops clinical manifestations and leads to a decrease in seeking medical help.

Functional disorders of the gastrointestinal tract in children of different age groups (a literature review)

In recent years, diseases of the gastrointestinal tract are becoming more common with economic and social impacts. It is believed that in terms of frequency, they rank second both among the adult and pediatric population, second only to respiratory system diseases. Due to significant morphological and physiological changes in individual organs and systems during the period of intensive development of a child, the formation of gastroenterological pathology occurs most often at the age of 5–6 or 9–12 years, that gives rise to various functional disorders of the gastrointestinal tract. There is an opinion that among older children, such functional disorders are often bordering on pathology, prompting pediatricians to an increased interest in their etiology, pathogenesis and current therapy. Aim. To highlight the state of the problem associated with the most frequent functional disorders of the gastrointestinal tract in children at the present stage. According to the recent recommendations, it has been recommended to consider functional changes as disorders of the interaction between the brain and the gastrointestinal tract (disorders of gut-brain interaction).The underlying disorders are abnormal motility, visceral hypersensitivity, the state of the gastrointestinal mucosa and local immune factors, intestinal microflora, activity of the central and autonomic nervous system. Most researchers tend to think about the key role of impaired autonomic regulation of sphincter activity in the pathogenesis of motor-evacuatory dysfunction of the alimentary canal in children, buoyed by the fact that often the lack of gastrointestinal organic lesions in motility disorders indicates their dysregulatory character. Conclusions. Functional disorders of the gastrointestinal tract have an extraordinary brightness of pain syndrome perception (no organic pathology would give such a wide array of symptoms as functional disorders) and a variable pattern of symptoms, so it becomes clear why these diseases impose a major economic burden, and it is this characteristic enables them to be classified as socially significant disorders. This requires a physician at various levels of medical care to provide timely diagnosis, differential diagnosis between organic gastrointestinal diseases, and timely correction of functional disorders.

Epidemiology of digestive diseases in children in modern conditions: regional data as a reflection of Russian trends

Introduction. Pathology of the digestive organs is one of the factors influencing the health indicators in children.
 Purpose of the work: to characterize current trends in the epidemiology of digestive diseases in children in the Udmurt Republic (UR).
 Materials and methods. The epidemiological features of digestive diseases in 0–14 and 15–17 years children were studied on the base on official statistics for the period from 2012 to 2022. The polynomial approximation method was used for forecasting.
 Results. There is a decrease in the prevalence of pathology of the digestive organs in 0–14 years children from 153.0 in 2012 to 75.0 in 2022 per 1000 children of the corresponding age, the average annual rate of decline was –6.3%. The predicted indicator will be 32.3 per 1000 children of the corresponding age in 2025. Similar trend in the prevalence of gastroenterological pathology were noted in the age group of 15–17 years: since 2012, this indicator has decreased by 1.9 times from 187.4 to 93.8 per 1000 children of the corresponding age with an average annual rate of decline of –6.3%. The predicted prevalence of gastroenterological pathology in 15–17 years children in the region will be 69.8 per 1000 children of the corresponding age in 2025. Since 2012, the trend in morbidity is characterized by a decrease in rates in both age groups with a higher rate of decline in the UR: from –10.6% in 0–14 years (Russia: –5.5%) to –7.7% in 15–17 years old (Russia: –3.0%). The predicted incidence rate in the UR will be 19.2 in 2025 for children 0–14 years old; 18.6 for children 15–17 years old.
 Conclusion. The established patterns indicate a decrease in the prevalence and morbidity of digestive organs among the child population of the UR.

COVID-19 and gastroenterological pathology. Review

SARS‑CoV‑2 has led to numerous cases of coronavirus disease (COVID‑19) around the world. In addition to fever and respiratory symptoms, some COVID‑19 patients also have manifestations from digestive system. On the other hand, patients with chronic diseases of the gastrointestinal tract (GIT) also suffer from coronavirus disease.
 Objective — to provide an understanding of the characteristics, possible mechanisms and consequences of gastrointestinal damage caused by SARS‑CoV‑2 infection, in particular in patients with gastrointestinal tract pathology.
 Literature search was carried out using such databases as Scopus, Web of Science. Clinical studies of patients with COVID‑19 have shown that gastrointestinal (GI) symptoms such as anorexia, nausea, vomiting, abdominal pain and diarrhea precede or follow respiratory syndromes with a frequency of about 10 to 60%. Literary sources were studied regarding the relationship of COVID‑19 and such gastroenterological pathologies as gastrointestinal bleeding, hepatitis, pancreatitis and inflammatory bowel diseases. Lesions of the digestive system both in patients without chronic pathology and with existing diseases, apparently, are associated with a high concentration of angiotensin converting enzyme 2 (ACE2) throughout the entire GIT, including the intestine, liver, and pancreas. Some studies have shown that the spike (S) SARS‑CoV‑2 protein has a high affinity for human ACE2, while SARS‑CoV‑2 mainly enters cells through the ACE2 receptor. In addition, endothelial injury and thrombus inflammation and dysregulated immune responses may contribute to extrapulmonary manifestations of COVID 19. This requires an appropriate correction of the diagnostic search and therapy.

A clinical case of diverticular disease in a patient with COVID-19: features of the course against the background of comorbid pathology

As a consequence of the global pandemic of the coronavirus disease (COVID‑19), cases of combination of gastroenterological pathology with endocrinopathies, associated with this pandemic, occur sporadically. Therefore, reporting about a unique clinical case of post‑covid comorbidity of these diseases seems to be advisable.
 Patient K., 68 years old, who had been suffering from diabetes insipidus for five years and received appropriate treatment (desmopressin) daily, was hospitalized for 28 days at the lung disease center of the Regional Phthisiopulmonological Center due to a severe course of COVID‑19. Two months after discharge, due to prevailed gastrointestinal complaints (pain in the bowel areas, stool frequency up to 7 times a day, dryness mouth, urination up to 3 times at night (nocturia), general weakness), which required another thorough differential diagnosis, she was hospitalized in the Gastroenterology Department of Regional Clinical Hospital. The diagnosis of severe post‑covid complications has been established, including intestinal diverticular disease and type 2 diabetes mellitus, and patient was transferred to the surgical department.
 The problems of searching and improving methods for early diagnosis of post‑covid conditions that potentiate the development of polymorbidity are urgent. A pathogenetically based approach to the administration of therapy will promote reducing morbidity and mortality in patients with comorbid diseases. The coronavirus pandemic forces the medical and scientific community to join efforts for investigation of new comorbid condition. The timely diagnosis of relatively new and understudied post‑covid diseases should become the main task of multidisciplinary teams of doctors. Investigation of the diversity of the clinical courses, the development and improvement of algorithms for the treatment and prevention of severe complications of diverticular intestinal disease in combination with diabetes insipidus and diabetes mellitus are the important prospects of scientific research.

The relationship of endocrine and gastroenterological pathology: dietary fiber as a mechanism of management

Gastroenterological manifestations of endocrine diseases are an additional factor that reduces the quality of life of patients. In some cases, gastroenterological symptoms are the reason for the patient’s coming to the doctor and the detection of endocrine disease. The pathogenetic aspects of the development of disorders of the gastrointestinal tract are diverse, and therefore, unfortunately, it is not always possible to eliminate gastroenterological symptoms by only compensating the underlying disease. The combination of pathology of the gastrointestinal tract and the endocrine system can mutually aggravate the course of each other. There are also cases when gastroenterological pathology can be the root cause of some metabolic diseases, in particular, malabsorption. Currently, the possibilities of correction of gastroenterological pathology are widely studied in order to achieve compensation for the patient’s endocrine pathology, as well as to improve the quality of life of patients. The main directions are measures aimed at restoring the passage of food contents, maintaining the integrity of the intestinal wall, eliminating the inflammatory factor, as well as restoring the gu microbiota (GM) and modulating its metabolism. The latter method of correcting violations seems to be the most promising today due to the constantly growing number of scientific publications, as well as a wide range of safe and effective ways to influence GM. In addition to dietary recommendations, the issue of prescribing dietary fiber (DF) to patients as a food substrate for GM and a mechanism for controlling the number and ratio of microorganisms is becoming increasingly relevant.

Сучасне розуміння етіопатогенезу гастроезофагеальної рефлюксної хвороби: висвітлення ключових аспектів та перспектив

Gastroesophageal reflux disease (GERD) is one of the most common diseases among gastroenterological pathologies. The relevance of GERD is due not only to medical aspects, but also to economic ones, since the vast majority of patients are young working-age people. The prevalence of GERD ranges from 20% to 30% of the adult population. GERD is associated with a significant decrease in quality of life and the development of Baretta’s esophagus and esophageal adenocarcinoma. GERD is a chronic disease with spontaneous repetitive spillage of gastric or duodenal-gastric contents into the esophagus, with typical complaints of heartburn and regurgitation. The pathogenesis is complex and includes the following aspects: decreased tone of the lower esophageal sphincter, diaphragmatic hernia, impaired protective function of the esophageal mucosa and esophageal motility, and increased intra-abdominal pressure. Obesity plays a significant pathogenetic role in the development of GERD. Weight loss is associated with symptom relief and a reduced risk of complications. Diagnosis of GERD is based primarily on typical clinical symptoms and empirical trial therapy with PPI. Treatment includes lifestyle changes, medications, and surgery. Еndoscopy and pH monitoring additionally contribute to the correct diagnosis. Further research on pathogenetic mechanisms is needed to implement effective strategies for diagnosis, treatment and prevention of complications.

Ways to optimize absorption processes as basis for nutritional treatment of gastroenterological pathology

Nutritional support is an important component of treatment in gastroenterology. This type of therapy is directly related to digestive and transport processes.The aim. To investigate the possibility of optimizing the absorption processes in the small intestine when using various natural formulations for enteral alimentation.Results. It is shown that the optimal degree of condensation of drugs is 4: 1. Inside the dry residue, you can change the ratio of proteins, lipids and carbohydrates. It is advisable to use hydrolytic digestive enzymes including the flokozim created by us. Antibacterial agents based on lactobacilli are also advisable.Conclusions. 1) The optimal medium for suction is chyme. 2) The mixture should contain no more than 80% water and about 20% dry residue. 3) Floccules are the basis for the creation of the drug flokozim 4) Lactotherapy based on optimized mixtures for enteral.

Abstract 17938: Identifying the Prevalence of Coronary Artery Disease Among Patients With Non-Alcoholic Fatty Liver Disease in the Adult US Population

Introduction/Background: In the twenty-first century, new findings have helped unravel the outstanding significance of contributory roles of the different pathologies in the proper regulation of physiologic and metabolic homeostasis. NAFLD is presently considered one of the emerging gastroenterological pathologies in the world. In our research study, we describe the contributory potential of NAFLD to cardiovascular disease. We also examined the patterns of NAFLD and identified specific emerging subgroups to improve our understanding of intertwined mechanisms between NAFLD and the pathogenesis of systemic atherosclerotic diseases. Aims and Objective: The primary outcome of the study was to identify the prevalence of NAFLD. The secondary outcome was to evaluate the prevalence of CAD in people with NAFLD and to describe the association between these two processes. Methods: We performed a retrospective cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) database from 2015 to 2018. Adults with a secondary diagnosis of NAFLD were identified. Univariate analysis was performed using Mann Whitney U test and chi-square test. A multivariable logistic regression analysis was performed to describe the association between NAFLD and CAD. Results: Among a total of 275,968 people in this selected NHANES cohort, 0.26 were identified to have NAFLD. In the cohort, NAFLD was more prevalent in older (median: 62 years), males, Mexican Americans and Hispanics, and people with median household income >$100,000. People with NAFLD had an early onset of CAD (47 vs 60 years) with higher prevalence of CAD in NAFLD compared to the group without NAFLD (15.90% vs 4.64%). People with NAFLD had a significantly higher association of having CAD (prevalence odds: 9.78 [95% CI: 9.76-9.80]). Conclusion: In a select NHANES cohort, positive correlations were identified between groups with NAFLD and the early onset of CAD. Additional findings include positive correlations for ethnicity, social economic status, and gender. Prospective studies and long-term clinical follow-up will be required to further characterize specific populations with NAFLD in an attempt to mitigate the burden of CAD within the population of NAFLD patients.

A clinical case of edematous syndrome: diagnostic search and treatment tactics of a complex patient in compliance with the internarial and domestic recommendations

Edematous syndrome is quite common in modern clinical practice. Swelling is one of the most common complaints that cause the patient to consult a doctor and often become the first clinical manifestation of many diseases. Fluid makes up approximately 3/5 of the human body weight, 70% of which is located in cells, and about 30% is extracellular. There is a constant exchange of electrolytes and other substances involved in metabolism between the cell and the extracellular fluid. Subcutaneous connective tissue under normal conditions contains a minimal amount of fluid. Edema fluid formed from blood plasma, which in pathological conditions under the influence of various factors is unable to retain water in the vascular bed, and water accumulates in excessive amounts in the tissues. Often, a patient refers to a doctor with the main complaint — the appearance of edema, and the correct interpretation of the origin of edema is important at this stage, because they are often a marker that reflects the severity and/or decompensation of the disease. Therefore, a detailed and comprehensive differential diagnosis of the edematous syndrome allows choosing the optimal tactics of the patient’s treatment.
 The authors present a clinical case of diagnostic search and treatment tactics for edematous syndrome based on global and national recommendations. Patient V., 1983 year of birth, on May 8th, 2023, visited a nephrologist at the L. T. Mala National Therapy Institute. She believed that kidney disease caused swelling of her face and lower limbs. However, considering the long history of intestinal dysfunction, protein loss and edema, the case was revised as a manifestation of gastroenterological pathology. The patient was referred to a gastroenterologist. An extensive diagnostic search was conducted, which allowed not only to establish the correct diagnosis, but also to administer an effective therapy.

Anemic Syndrome and Molecular Mechanisms and Regulation of Iron Absorption in Gastroenterological Diseases

In this review, we tried to combine and systematize the accumulated information on the problem of anemic syndrome in the pathologies of the gastrointestinal tract. Anemic syndrome is the most frequent extraintestinal complication in patients with gastrointestinal tract pathology, which can significantly impair the quality of life. Depending on the combination of pathogenitic mechanisms, the iron deficiency, anemia of chronic diseases, B12-deficiency, and folate deficiency anemia are distinguished. Other types of anemia are less common. It is necessary to conduct a comprehensive laboratory examination to reveal the leading factor in the development of anemia and select adequate therapy. Anemia is one of the most common complications in patients with inflammatory bowel disease. In clinical practice, the intravenous iron is frequently administered. However, this therapy can lead to excess iron and cause exacerbation of the disease. Understanding the pathogenesis of anemia is important for the selection of therapy and minimizing the risk of complications. Parenteral forms of iron and vitamin preparations are more preferable for this category of patients due to their higher bioavailability, low safety profile, and minimal negative effect on the gastrointestinal tract. Erythropoietin preparations and inhibitors of proinflammatory cytokines are used mainly for the correction of anemia of chronic diseases. The latter showed themselves well in the treatment of patients with anemic syndrome on the background of severe inflammatory bowel diseases. Various clinical trials are being conducted to introduce new drugs to correct anemia. However, today, there is practically no experience of their application. Further study of patients with gastroenterological pathology complicated by anemia is required to form a final conclusion on the effectiveness and appropriateness of the intravenous iron administration in these categories of patients.

Multidisciplinary Approach to Recurrent Upper Respiratory Tract Diseases in Children. Intermediate Study Results

The issue of recurrent upper respiratory tract diseases in children is common and relevant. Commonly this pathology is associated with other diseases that lead to the prolonged, complicated, or chronic course of the inflammatory process in the upper respiratory tract. Objective. The aim of the study is to improve management principles for children with recurrent upper respiratory tract diseases according to the developed multidisciplinary and personalized approach (modern methods of diagnosis and health monitoring) for achieving long-term remission. Methods. The study included 65 children aged from 3 to 17 years 11 months with recurrent upper respiratory tract diseases. Examination: nasal, nasopharynx and larynx endoscopy, abdominal ultrasound with aqueous-siphon test, tympanometry, and laboratory tests (complete blood count, evaluation of total and specific IgE levels, antistreptolysin O, nasopharynx and oropharynx microbiological study, enzyme-linked immunosorbent fecal analysis for Helicobacter pylori). Results. 88% of examined children showed allergic pathology according to our study results. Clinical signs of gastroesophageal reflux disease (GERD) were revealed in 30% of children with chronic oropharynx inflammation. GERD signs were revealed both via abdominal ultrasound with aqueous-siphon test and via fiberoptic laryngoscopy and later confirmed by esophagogastroscopy in 8.7% of patients. Obtained data indicates high prevalence of allergic and gastroenterological pathology in children with recurrent upper respiratory tract diseases. Conclusion. Obtained results allow us to establish scientifically multidisciplinary and personalized approach for the management of children with recurrent upper respiratory tract disease. This approach shall include key diagnostic methods required for improvement of comorbid conditions revealing, and achieving and maintaining control over the disease symptoms. The study is currently ongoing.

Ефективність та безпечність підготовки до вакцинації проти вірусу SARS-COV-2 у пацієнтів із хронічною рецидивуючою кропив’янкою

Abstract. The aim: to develop a personalized algorithm for vaccination against COVID-19 for patients with severe chronic urticaria and to evaluate its effectiveness and safety. Methods. Patients with severe (according to the UAS7 scale) chronic spontaneous urticaria and concomitant gastroenterological pathology, who were observed at the City Allergology Center, were included in a prospective single-center clinical study. All patients underwent a complete physical examination, evaluation of complaints, history of life and illness, presence of concomitant pathology. Patients with a history of COVID19 or complete or partial vaccination against COVID-19 were excluded from the study. Blood tryptase level was determined before vaccination using immunofluoroenzymatic analysis (ImmunoCAP). Total serum IgE was determined using an immunochemical method. Preparation for vaccination against the SARS-COV-2 virus was carried out according to the developed algorithm: the appointment of 5 mg of desloratadine orally 30 minutes before vaccination with a normal level of tryptase (< 11 ng/l); and 20 mg of desloratadine 30 minutes before vaccination at an elevated level of tryptase (≥ 11 ng/L) with further observation of the condition of patients during the day after vaccination. Results. The study included 30 patients aged 24 to 63 years, median age 52 (39-59) years, of which 66.7 % were women. The duration of the disease was, on average, 6 years, and 63.3 % of patients suffered from urticaria for five or more years. All 100 % of patients had a severe course of chronic urticaria: from 28 to 42 points on the UAS7 scale, median 42 (42-42) points. Among patients with severe chronic urticaria and concomitant gastrointestinal pathology included in the study, 60 % had elevated serum tryptase levels, were older and had a higher prevalence of H. pylori infection, but a lower prevalence of concomitant allergic pathology. The level of tryptase did not correlate with the level of total IgE. Conclusions The developed individual algorithm for pre-vaccination preparation of patients with severe chronic urticaria has shown its effectiveness and safety in preparing such a difficult category of patients for vaccination against SARS-CoV-2 infection, which is vital today.

Assessing the Burden of Choledochian Lithiasis and Cholangiocarcinoma in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography, Using Disability-Adjusted Life Years

Exact estimates of the current and future burden of gastroenterological pathology can support the national public health policy. In order to have a possible comparison between the impact and burden of some diseases, a series of health measurements were developed, simultaneously including morbidity and mortality. The aim of the study was to evaluate the burden of gastrointestinal pathology that requires therapeutic endoscopy, such as choledochian lithiasis and cholangiocarcinoma in a tertiary centre between 2019 and 2020. The scientific research was carried out as a retrospective study, intending to analyze the macroeconomic indicator-Disability-Adjusted-Life Year (DALY) in patients who underwent endoscopic retrograde cholangiopancreatography (ERCP), for the diagnosis of choledochian lithiasis or cholangiocarcinoma. The study included the cases diagnosed based on clinical, biological and imaging criteria. Our study showed that the values of DALY indicator are higher in men than in women. The DALY approach has a strong methodological framework and a firm theoretical grounding. It has been widely accepted by public health experts and employed to measure the global and regional burdens of the disease.

A family case of giardiasis manifested as allergic urticaria in the joint practice of a family doctor and a pediatrician

To date, giardiasis remains an urgent disease in the practice of family doctors, internists and pediatricians. Family cases of giardiasis are quite common. If one case of giardiasis is detected in the family, it is necessary to examine all family members. Currently, giardiasis remains relevant, especially in pediatrics. The difficulty of detecting giardiasis in children is primarily due to the fact that its manifestations are often disguised as various clinical variants of gastroenterological pathology (functional disorders of the gastrointestinal tract, syndrome of excessive growth of microflora in the small intestine, malabsorption syndrome) and often occur with the clinic of allergic diseases recurrent urticaria, atopic dermatitis, gastrointestinal forms of food allergies and others forms.
 The article presents a clinical case of familial giardiasis, in which the primary diagnosis of the disease in a child caused the greatest difficulty due to its allergic manifestations by the type of severe urticaria in the presence of possible allergens at home, which led to a long diagnosis and two emergency hospitalizations in childrens hospitals, where despite the examination and treatment, the correct diagnosis was not suspected timely. Differential diagnosis at the first stages of patient management was carried out between allergic urticaria, infectious mononucleosis and streptococcal infection, the possibility of giardiasis was not considered. Difficulties in diagnosis led to the appointment of systemic glucocorticosteroids and unjustified antibacterial therapy. Indirectly, prolonged diagnosis and untimely start of treatment led to a decrease in motivation for examination and treatment of the patients parents due to distrust of doctors.

Comorbidity of indeterminate colitis with celiac disease and extra-intestinal manifestations

The article presents a clinical case of a combination of celiac disease with diagnosis in the adult period and infl ammatory bowel disease, which had the phenotype of ulcerative colitis in its debut and transformed into indeterminate colitis during observation. Gastroenterological pathology was accompanied by adrenal insufficiency and demyelinating disease of the central nervous system, which can be considered as extra-intestinal manifestations of autoimmune intestinal diseases according to literature data.

Gastroenterological masks of chronic yersiniosis in children: comprehension of experience

Chronic yersinioses are “therapeutic” infections with predominant symptoms of a somatic pathology while the typical manifestations of the infectious process are absent. Рurpose . Тo analyze the features of clinical manifestations of chronic yersinioses in children and to evaluate the eff ectiveness of diagnostic methods for detecting the disease. Characteristics of children and research methods. Laboratory confi rmation of the diagnosis of yersiniosеs was the criterion for including patients in the study group. As a result the group of patients with chronic yersiniosis infection included 131 children, 68 boys and 63 girls aged 2 years 8 months to 17 years 11 months (the average age of the group was 10 years) with typical gastroenterological pathology Laboratory confi rmation of the diagnosis of pseudotuberculosis and intestinal yersiniosis was carried out using the PCR to detect pathogenic yersinia in feces, specifi c antibodies were determined by a set of methods. Results . The article describes the clinical variants of chronic yersiniosis infections in children caused by Yersinia pseudotuberculosis and pathogenic Yersinia enterocolitica. Мost organs of the gastrointestinal tract (stomach, pancreas, liver, small and large intestines, mesenteric lymph nodes) can be aff ected in the course of chronic yersiniosis infection in children. A recurrent course of chronic yersiniosis infection is possible in children with hypogammaglobulinemia A. Conclusion . The chronic yersinioses can be suspected in the absence or insignifi cant eff ect of standard therapy of somatic pathology (gastritis, pancreatitis, irritable bowel syndrome, functional dyspepsia, etc.). The irritable bowel syndrome and functional dyspepsia are most common clinical variants of chronic yersiniosis infection in children. The immunoblotting is the most effective method to confi rm the diagnosis of chronic yersinioses.

Irritable bowel syndrome: extra- intestinal comorbidity, psychological, morphometric and genetic predictors of variants of the course of the disease

Purpose of the study. To determine clinical, morphometric, genetic predictors of non-refractory and refractory variants of the course of irritable bowel syndrome (IBS).Materials and methods. We examined 148 patients with non-refractory (41 people) and refractory (107 people) the course of irritable bowel syndrome. The control group consisted of 36 healthy volunteers. The analysis of the symptoms of the current exacerbation of the disease, verifi cation of comorbid gastroenterological pathology (taking into account the Roman criteria- IV and Russian recommendations), assessment of signs of psychological maladaptation (The Four-D imensional Symptom Questionnaire), fi brocolonoscopy, immunohistochemical, morphometric study of colobiopts, determination of the expression area of colonocytes immunopositive to motilin and sirtuin-1, determination of genotypes of polymorphic marker rs4680 of the СOMT gene by polymerase chain reaction.Results. The intensity of abdominal pain, the severity of “intestinal” symptoms was higher in refractory IBS compared with non-refractory. Functional comorbidity (functional dyspepsia, functional disorder of the gallbladder) was more common in the refractory variant of the course of the disease, mainly with diarrhea. Indicators of distress, depression, anxiety, somatization in the refractory course of the disease were higher compared to non-refractory, did not diff er signifi cantly in IBS with constipation and diarrhea. The indicators of the expression area of motilin-p ositive colonocytes were reduced in IBS with constipation, increased in IBS with diarrhea (the maximum changes were in the refractory variant of the course of the disease). The expression area of sirtuin-1-positive colonocytes was reduced in IBS with diarrhea compared to IBS with constipation and with the control group. Associations of genotypes of the polymorphic marker rs4680 of the СOMT gene with a refractory variant of the course of IBS, as well as with the severity of abdominal pain syndrome and signs of psychological maladaptation were found.Conclusion. Patients with irritable bowel syndrome are characterized by functional comorbidity, signs of psychological maladaptation, more pronounced in the refractory variant of the course of the disease. Patients with IBS, in comparison with the control group, are characterized by a change in the expression area of motilin- and sirtuin-1-positive colonocytes, correlating with the variant of intestinal dysfunction and maximally expressed in the refractory course of the disease. Variants of the course of irritable bowel syndrome are associated with polymorphic markers rs4680 of the gene of the enzyme СOMT.

P15 Acupuncture treatment of Costochondritis, a case series

Introduction/BackgroundI had been practising acupuncture for 30 years and noticed while working in the rheumatology clinic that costochondritis had a particular response to acupuncture. As this condition is extremely debilitating and often misdiagnosed, a case series of 8 cases is presented, the majority of whom were seen in primary care.Description/MethodCostochondritis is characterised by anterior chest pain associated with painful tender costochondral (CC) joints felt on palpation. These mainly affect the 2nd to 5th costochondral junctions, either unilateral or bilateral. Other areas of the anterior and lateral chest wall can also be affected. The pain is often severe and nocturnal, of sudden onset and can be associated with shock, nausea and dyspnoea, causing patients to call for an ambulance. Tietze's syndrome is a rare variant of this, usually affecting younger patients.Patients with persistent chest wall pain were offered acupuncture. Details of age, duration of symptoms, number of treatments and VAS pain scores were recorded day and night, (Table 1) pre and post treatment Patients with thoracic pain were excluded.0.25*25mm and 0.25*30mm needles were used with silicon tips and a guide tube, to help prevent painful insertion. An infra-red lamp (Bio-lamp) was used + electro-acupuncture (EA) if insufficient improvement after two close treatments, sessions were continued weekly.Acupuncture points used were local tender/trigger points + distal Chinese points P6 and LI4. Other points used were CV 17, GB 34, SI6, GB39 or Sp 6 and St36. An average of 4.7 sessions were needed.Audit of Acupuncture Treatment Table 1P15 Table 1PATIENTAGEDURATION OFNUMBER OFVAS INITIAL (0-10)VAS FINALYEARSPROBLEMTREATMENTSDAYNIGHTDAYNIGHT1375 MTHS410100022618 MTHS8 (1 EA)5.57.5023653 WEEKS5 (+EA)79114584 DAYS4972256210 WEEKS7 (+EA)68026346 WEEKS447227289 MTHS314008255 YEARS38700Recurrence of pain3651 WEEK4 (+EA)88126345 WEEKS228227282 WEEKS11311Six patients took daily analgesia which was rapidly reduced to nil. All completed their treatment until their pain stabilised. There were no adverse events.Average improvement in the day was 89% and night 85%. Recurrences of pain improved by 11% in the day and 72% at night. The attacks of severe chest pain and dyspnoea stopped, abating anxiety.Discussion/ResultsCostochondritis is a highly debilitating condition and I had noticed that acupuncture could be a dramatic treatment for this[i]. It can affect up to a third of patients attending emergency departments with atypical chest pain[ii] and 1-3% of patients in primary care[iii].It seems to be a missed diagnosis by Accident and Emergency (A&E) doctors and GPs, perhaps because the chest wall was not carefully palpated. One patient had ankylosing spondylitis (AS) and another had systemic lupus erythematosus but attributed her pain to prolonged laughter. Five patients attended cardiology clinics including one who had a coronary angiogram. Another had tests for upper abdominal pain which also were normal.All the patients were female although quoted F:M ratio is 7:3Differential diagnoses include: acute coronary syndromes, lung problems, trauma, upper gastroenterology pathology or neoplasiaPathogenesis is unclear but the onset can be acute and follow:Respiratory tract infection Extreme sneezing, coughing or laughterChest wall trauma Micro trauma from costovertebral dysfunctionFibromyalgia Inflammation from inflammatory joint disease.[i] Alexander R; White A. Acupuncture in a Rheumatology Clinic. Acupuncture in Medicine; Dec 2000 vol.18 (no.2): 100-103[ii] Disla E; Rhim HR; Reddy A; Karten I; Taranta A. A prospective analysis in an emergency department setting. Arch Intern Med. 1994; 154(21):2466-2469[iii] Ayloo A; Cvengros T; Marella S. Evaluation and treatment of musculoskeletal chest pain. Prim Care (Review) Dec 2013 40(4): 863-87Key learning points/ConclusionNormal management of costochondritis includes analgesia, physiotherapy, steroid injections and occasionally surgery[i]. 30% can have protracted pain. There are isolated reports of acupuncture for this condition, integrated with conventional medicine[ii] [iii]. Acupuncture also has been used for myofascial trigger points including costochondritis[iv].Acupuncture is now an accepted modality of pain management and in 2021 was recommended in NICE guidelines for the treatment of Chronic Primary Pain alongside exercise programmes and CBT ahead of analgesic medication[v]. It has also been recommended in the management of low back pain in patients aged 60 years and over as a non-drug treatment[vi].This paper highlights the fact that acupuncture appears to be a safe effective treatment for costochondritis, with further research and more access needed for this therapeutic modality.Increased awareness of this condition would make complex invasive investigations less necessary.[i] Gologorsky R; Hornik B; Velotta J. Surgical Management of Medically Refractory Tietze's Syndrome. Annals of Thoracic Surgery; Dec 2017; vol. 104 (no. 6)[ii] Jonkman FAM.; Jonkman-Buidin M.L; Stolwijk P.W.J. Surprise after successful treatment of a patient with noncardiac chest pain using acupuncture. Medical Acupuncture; Feb 2015; vol.27(no 1):83-90[iii] Lin, Katerina; Tung, Cynthia. Integrating Acupuncture for the Management of Costochondritis in Adolescents. Medical Acupuncture; Oct 2017; vol.29(no 5): 327-330[iv] Baldry P. Cardiac and non-cardiac chest wall pain. Acupuncture in Medicine;1997; vol.15(no.2): 42-45[v] NICE guideline; Chronic Pain (primary and secondary) in over 16s (NG 193 April 2021)[vi] Traeger A; Underwood M;Ivers R; Buchbinder R. Low back pain in people aged 60 years and over. BMJ 2022 vol. 376: e066928