Gastrointestinal Tract In Patients Research Articles

The effect of mebeverine in extended-release capsules on intestinal motor function in patients with functional gastrointestinal pathology

Purpose of the study. Evaluation of the clinical effectiveness of combination therapy for FGID with overlap syndrome – gastroesophageal reflux disease (GERD), functional dyspepsia (FD) and irritable bowel syndrome (IBS) using the PPI omeprazole and the myotropic antispasmodic mebeverine hydrochloride in extended-release capsules (Meberin ML, Micro Labs Limited, India) on clinical manifestations and motor-evacuation function of the gastrointestinal tract in patients with FGID with overlap syndrome – GERD, FD with gastric hypersecretion and IBS.Materials and methods. We examined 27 patients with FGID with overlap syndrome of GERD, FD with gastric hypersecretion of hydrochloric acid and IBS.Results and conclusion. It has been established that combination therapy with these drugs for two weeks in 97 % of cases eliminates the clinical symptoms of the syndromes, improves the quality of life of patients, normalizes intestinal motility and myoelectric activity of the gastrointestinal tract.

A review on increasing risk for gastrointestinal bleeding associated with dabigatran

Dabigatran, a reversible direct thrombin inhibitor, is widely used in clinical practice as a therapeutic option due to its unique mechanism of action in comparison to other anticoagulants. Although patients taking dabigatran experience a reduced risk of fatal bleeding, a higher risk of gastrointestinal bleeding (GIB) is associated with dabigatran, and its rational use between anticoagulation and bleeding is challenging for clinicians. To prevent GIB, it is imperative for clinicians to understand the pharmacological characteristics of dabigatran to ensure that its prescription should be avoided in patients with bleeding. In this review, we summarize the mechanism of action and pharmacokinetics of dabigatran and bleeding sites in the gastrointestinal tract in patients treated with dabigatran, as well as discuss the factors that increase the risk of dabigatran-induced GIB, including dose, age, drug interactions, race, genetics and past medical history. Finally, the treatment and prevention of GIB with dabigatran is also discussed. This review will help clinicians choose their drugs and doses more carefully for treating GIB.

Патоморфологічні та морфометричні особливості гострого апендициту в дітей з цукровим діабетом І типу

Metabolic disorders caused by chronic hyperglycemia in the gastrointestinal tract of patients with type I diabetes mellitus (T1DM) not only affect natural course of this disease but also modify clinical course of concomitant abdominal purulent-inflammatory diseases in children due to changes of the internal intestinal wall. Purpose - to analyze pathomorphological and morphometric features of acute appendicitis in children with T1DM. Materials and methods. We carried out a pathomorphological and morphometric case-control study of the surgical specimens (appendices and fragments of the peritoneum). Two groups were created: the Group I (n=11) - patients with acute appendicitis, peritonitis and T1DM; the Group II (n=24) - patients with acute appendicitis, peritonitis but without T1DM. Statistical analysis was performed using software package STATISTICA v.10.0 (StatSoft, USA). Results. There were signs of diabetic angiopathy in the Group I and a significant number of inflammatory cells, represented by a large number of segmented nuclear leukocytes - 431±18.2 in 1 mm2, plasma cells - 146±11.13 in 1 mm2, lymphohistiocytic elements - 196±23,32 in 1 mm2. The density of the inflammatory cell infiltrate was 773±36.2 cells in 1 mm2. Morphometric features of the Group II are as follows, number of segmented nuclear leukocytes - 228±15,7 in 1 mm2, plasma cells - 112±10,41 in 1 mm2, lymphohistiocytic elements - 132±21,2 in 1 mm2. The density of the inflammatory cell infiltrate was 773±36.2 cells in 1 mm2. Conclusions. There is an increase in the density of the inflammatory cell infiltrate, the number of neutrophils, plasma cells, and lymphohistiocytic elements in samples of appendices and peritoneum in children with acute appendicitis and T1DM in comparison with the Group II (p˂0.001). Furthermore, those specimens feature presence of hyalinosis, thickening of the vascular wall and partial obliteration of small caliber vessels. In the Group II (patients without T1DM), the parietal and visceral peritoneum had a large number of inflammatory elements and presence of macrophage elements upon normal histological structure of the microcirculatory vessels. 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 participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

Endoscopic Submucosal Dissection for Treatment of Early-Stage Cancer or Precancerous Lesion in the Upper Gastrointestinal Tract in Patients with Liver Cirrhosis.

(1) Background: Endoscopic submucosal dissection (ESD) has been widely accepted as the standard method for treating early-stage cancer or precancerous lesions in the upper gastrointestinal tract; however, it may be difficult in patients with liver cirrhosis due to clinical challenges such as coagulation dysfunction, presence of gastroesophageal varices, etc. We aimed to demonstrate the safety and efficacy of ESD in these populations. (2) Methods: The clinical data of patients were retrospectively collected and analyzed. Inclusion criteria of the study were: a. patients with liver cirrhosis; b. patients who underwent ESD; c. patients who were diagnosed with early-stage cancer or precancerous lesions in the upper gastrointestinal tract. (3) Results: Eight patients were enrolled from April 2019 to April 2023, of whom three were male and five were female, with ages ranging from 43 to 70 years old. Seven lesions were located in the stomach and one other lesion was in the esophagus. ESD was performed successfully in all eight patients, and the resected lesion size ranged from 2 to 6 cm. Only one patient encountered postoperative complications, namely, chest pain and fever. No recurrence was noticed during a follow-up of 3 to 45 months. (4) Conclusions: ESD may serve as a safe and effective method for treating upper gastrointestinal early-stage cancer or precancerous lesions in patients with liver cirrhosis.

Navigating the complexities of medicating paediatric patients: Insights from an enteral feeding tube workshop

Enteral feeding tubes (EFT) are used to administer nutrition into the gastrointestinal tract of patients who are unable to take nutrition via mouth. A wide range of children may require enteral feeding through EFT which are also used to administer medication. However, many medicines are not licensed for administration via this route. Numerous factors can impact EFT medicine administration, including for example, dosage form properties and composition, EFT size, design and material, and operational aspects such as tube flushing. As a result, the risk of sub-optimal dosing and medication error is much higher in patients with EFT compared to those without. EuPFI organised a preconference workshop to review the current state of knowledge around aspects to be considered in the verification of EFT administration of medications to children, and considerations for EFT use, and to highlight the areas that remain challenging. Healthcare professional, pharmaceutical industry and regulatory agency perspectives were shared, and case studies discussed. It was agreed that simple and clear standardised global procedures are required for the evaluation and administration of medicines via EFT, and collaboration between all key stakeholders is recommended.

Laparoscopic observations of adhesions between peritoneal dialysis catheters and intraperitoneal organs: A retrospective, observational study.

Laparoscopy provides extensive data for the decannulation of a peritoneal dialysis catheter and is being increasingly used to diagnose encapsulating peritoneal sclerosis. However, there are few reports on the methods of decannulation of peritoneal dialysis catheters. In this study, we examined the laparoscopic findings and postoperative complications of patients undergoing peritoneal dialysis catheter removal. A total of 119 laparoscopic decannulations of peritoneal dialysis catheters were performed between 2003 and 2018 at the Juntendo University Hospital and Juntendo University Nerima Hospital. Laparoscopy was performed during peritoneal dialysis catheter removal by a gastrointestinal surgeon. Patient characteristics such as age, sex, duration of peritoneal dialysis, history of peritonitis and age at the time of peritoneal dialysis termination were assessed. Of these 119 cases, 19 (16.0%) showed adhesion between the peritoneal dialysis catheter and intraperitoneal organs. There were 13 (10.9%) cases involving a tangled omentum, 4 (3.4%) cases involving the small intestine and 2 (1.7%) cases of adhesions extending from the bowels to the abdominal wall. No postoperative complications were associated with the laparoscopic surgery. In these cases, blind decannulation of the peritoneal dialysis catheter may result in injury to the gastrointestinal tract in patients with adhesions. Therefore, we need to pay attention to adhesions between peritoneal dialysis catheters and intraperitoneal organs, and laparoscopy could be a valuable tool in detecting such adhesions and ensuring patient safety.

Feasibility of Flow Cytometry Analysis of Gastrointestinal Tract-Residing Lymphocytes in Hematopoietic Stem Cell Transplant Recipients.

The feasibility of lymphocyte isolation and flow cytometry using a single endoscopic biopsy specimen from the gastrointestinal tract of patients who have undergone hematopoietic stem cell transplantation has not been investigated. We acquired 51 endoscopic biopsy specimens from the gastrointestinal tract of 35 patients. We divided the flow cytometry samples into two groups: group A, successful lymphocyte isolation (n=24), and group B, incomplete isolation (n=27). We compared the backgrounds of the samples between the groups to reveal crucial elements in the successful isolation of lymphocytes residing in the gastrointestinal tract. Comparison between the groups revealed lymphocyte isolation success rates differed between biopsy sites. Isolation was most successful in samples from the duodenum (8/9, 88.9%), followed by the ileum (4/8, 50.0%), large intestine (4/11, 36.4%), and stomach (8/23, 34.8%). Tacrolimus was used more frequently in group B (92.6%) than in group A (62.5%) (p=0.015). Logistic regression analysis revealed that isolation from the duodenum or ileum was a significant factor for successful isolation, while tacrolimus use was not statistically significant. In conclusion, the duodenum and ileum are more suitable sites than the stomach and colorectum for acquiring samples for flow cytometry.

THE IMPACT OF FIXED DENTURES ON THE TISSUES OF THE ORAL CAVITY AND THE COURSE OF GASTROINTESTINAL DISEASES

The article presents the results of scientific research on the negative impact of fixed denture structures on the tissues of the oral cavity and gastrointestinal tract in patients with chronic gastritis.
 The relevance of the work lies in the fact that orthopedic treatment not only eliminates aesthetic defects, restores the impaired function of the dentoalveolar system, but also has a significant preventive value for the prevention of gastrointestinal diseases.
 The aim of our research was to study the effect of fixed dentures made of different structural materials on the tissues of the oral cavity and gastrointestinal tract in chronic gastritis.
 Objects and methods of the study. We examined patients of the gastroenterological department who were inpatients with chronic gastritis and used fixed dentures.
 The examination took into account complaints of burning sensation, itching, redness of the gingival mucosa, gingival swelling, increased salivation or dryness in the oral cavity, heightened perception of acidity and the presence of microcurrents in the oral cavity; type of denture and visually determined the material from which it is made; compliance of the denture with clinical and technological requirements, the period of its use, diagnosis of the underlying disease for which the patient is undergoing inpatient treatment.
 Study results and conclusions. According to the results of the study, it was found that out of 86 patients examined, 44 patients (51.16%) of both groups used soldered bridges, 42 (48.84%) full-cast bridges. Pathological manifestations of the negative effects of soldered dentures in the oral cavity and gastrointestinal tract were detected in 41 of 44 patients, which is 47.7% of the total number of patients examined. Out of 42 patients (48.84%) in both groups, 11 (12.8%) had full-cast bridges.
 Soldered bridges cause 35% more complications in the oral cavity and digestive system than full-cast dentures. Negative manifestations and exacerbation of somatic pathology when using fixed dentures are observed 3 times more often in patients with hyperacid gastritis.

Intestinal Permeability in Patients Early after Kidney Transplantation Treated with Two Different Formulations of Once-Daily Tacrolimus.

Adequate tacrolimus blood exposure is crucial in the early post-renal transplant period and a gut epithelial barrier integrity may play a role. We prospectively investigated several markers of intestinal permeability in recent kidney transplant recipients (KTRs) treated with different tacrolimus extended-release formulations. Within each of the 49 KTR pairs that received grafts from the same donor, an early randomized conversion was performed from twice-daily (Prograf) to once-daily tacrolimus formulation: Advagraf or Envarsus. Plasma zonulin, calprotectin, circulating lipopolysaccharide (LPS), LPS-binding protein (LBP), intestinal fatty acid binding protein (FABP-2), and CD-14 levels were measured. There was no difference in the recipient age, dialysis vintage, BMI, and residual diuresis between Advagraf and Envarsus groups. FABP-2 and LPS levels were significantly associated with tacrolimus trough level, 3-h level, and area under the curve (AUC) in the Envarsus but not in the Advagraf group. AUC was independently increased by LPS and decreased by age, FABP-2 concentration, and the use of Envarsus formulation as compared with Advagraf. Functional changes of gastrointestinal tract in patients treated with Envarsus may influence intestinal tacrolimus absorption to a greater extent than in Advagraf-treated KTRs and may lead to inadequate variability of tacrolimus exposure early after kidney transplantation.

Analysis of the Morphology of the Gastroduodenal Zone Mucous Membrane in Chronic Pancreatitis in Comorbidity with Chronic Viral Hepatitis C Under the Influence of Combined Hepatoprotection

Recently, in medicine, the influence of infectious, hepatobiliary, gastric and duodenogenic factors for the formation and course of chronic pancreatitis (CP) and chronic hepatitis C virus (CHCV) which was treated etiotropically is increasingly being studied. Hepatitis C virus (HCV) is an important infectious factor in CP, for which the ability to chronic course has been proven. The condition of the mucous membrane of the organs in the gastroduodenal zone (GDZ) in the combined course of CP and HCV is important for the patient’s quality of life, as well as for assessing the safety of the performed and planned restorative complex treatment of such patients. The objective: to analyze the dynamics of morphological changes of the mucous membrane in the gastrointestinal tract of patients with CP in comorbidity with etiotropically treated HCV under the influence of a protocol therapeutic complex with the additional inclusion of hepatotrophic drugs. Materials and methods. We analyzed the data of 55 patients with CP in comorbidity with HCV after etiotropic treatment of HCV, who were examined according to generally accepted algorithms and received a generally accepted complex of treatment according to the CP protocol. The patients were divided into two groups: the 1st group – 20 patients who received a generally accepted complex of treatment according to the protocol (PC) for 3 months; the 2nd group – 35 patients who received treatment according to the PC with the additional inclusion of a hepatotrophic agent for 3 months. In all the patients before and after treatment a morphological study of biopsies of the mucous membrane of the stomach and duodenum was performed. Results. In the course of the study, a significant improvement in the mucous membrane morphology of the GDZ of patients with a combination of CP and HCV was established after a course of treatment with the use of hepatoprotectors, namely: a decrease in lymphohistiocytic infiltration – by 3.97 times, restoration of the gland structure that did not undergo complete non-metaplastic atrophy – by 5,13 times, increased proliferation of the glandular epithelium as a sign of morphological restoration of the epithelium – 3.9 times, decrease in signs of epithelial dysplasia – 10.35 times, decrease in the number of erosions of the mucous membrane of the organs of the gastrointestinal tract – 2.6 times. Conclusions. The higher efficiency and safety of the complex treatment with the additional inclusion of a combination of hepatotrophic agents on the morphological condition of the mucous membrane of the organs of the gastroduodenal zone have been substantiated.

Features of the upper gastrointestinal tract mucous membrane state in patients with atherosclerosis of the mesenteric arteries

To evaluate the clinical and endoscopic features of diseases of the upper gastrointestinal tract (GIT) in patients with atherosclerosis of the mesenteric arteries (MA). The study included 48 patients with atherosclerosis of MA and 43 patients without atherosclerosis of MA, who were hospitalized in the department of vascular surgery of the Chelyabinsk Regional Clinical Hospital in the period from 2019 to 2021. All patients underwent multispiral computed tomoangiography of the visceral and lower limb arteries, esophagogastroduodenoscopy. Assessment of lesions of the upper gastrointestinal tract revealed a higher incidence of erosive and ulcerative gastroduodenopathies among patients with atherosclerosis of MA (60.4%), compared with patients without atherosclerosis MA (39.5%); p=0.047. Signs of severe atrophy according to the data of histological examination were statistically significantly more frequent among patients with atherosclerosis of MA (29.2 and 11.6%; p=0.031). According to the results of logistic regression, the following predictors of erosions and ulcers of the upper gastrointestinal tract were revealed: the severity of stenosis of the superior mesenteric artery (SMA) is more than 35%, the body mass index (BMI) is less than 25.9 and the total score on the HADS scale is more than 6.5 points for depression (p=0.008). Erosive-ulcerative gastroduodenopathies and atrophy of the gastric mucosa are significantly more common in the group of patients with MA atherosclerosis. The main risk factors for erosions and ulcers of the upper gastrointestinal tract in patients with MA atherosclerosis are: the severity of SMA stenosis is more than 35%, a decrease in BMI is less than 25.9 and an increase in the HADS score is more than 6.5 points.

The Gut Dysmotility Questionnaire for Parkinson's disease: Insights into development and pretest studies.

A total of 48% of patients with Parkinson's disease (PD) present symptoms of gastrointestinal dysfunction, particularly constipation. Furthermore, gastrointestinal tract (GIT)-related non-motor symptoms (NMSs) appear at all stages of PD, can be prodromal by many years and have a relevant impact on the quality of life. There is a lack of GIT-focused validated tools specific to PD to assess their occurrence, progress, and response to treatment. The aim of this study was to develop and evaluate a novel, disease- and symptom-specific, self-completed questionnaire, titled Gut Dysmotility Questionnaire (GDQ), for screening and monitoring gastrointestinal dysmotility of the lower GIT in patients with PD. In phase 1, a systematic literature review and multidisciplinary expert discussions were conducted. In phase 2, cognitive pretest studies comprising standard pretests, interviews, and evaluation questionnaires were performed in patients with PD (n = 21), age- and sex-matched healthy controls (HC) (n = 30), and neurologists (n = 11). Incorporating these results, a second round of cognitive pretests was performed investigating further patients with PD (n = 10), age- and sex-matched HC (n = 10), and neurologists (n = 5). The questionnaire was adapted resulting in the final GDQ, which underwent cross-cultural adaptation to the English language. We report significantly higher GDQ total scores and higher scores in five out of eight domains indicating a higher prevalence of gastrointestinal dysmotility in patients with PD than in HC (p < 0.05). Cognitive pretesting improved the preliminary GDQ so that the final GDQ was rated as relevant (100/100%), comprehensive (100/90%), easy to understand concerning questions and answer options (100/90%), and of appropriate length (80/100%) by neurologists and patients with PD, respectively. The GDQ demonstrated excellent internal consistency (Cronbach's alpha value of 0.94). Evidence for good construct validity is given by moderate to high correlations of the GDQ total score and its domains by intercorrelations (r s = 0.67-0.91; p < 0.001) and with validated general NMS measures as well as with specific items that assess gastrointestinal symptoms. The GDQ is a novel, easy, and quick 18-item self-assessment questionnaire to screen for and monitor gastrointestinal dysmotility with a focus on constipation in patients with PD. It has shown high acceptance and efficacy as well as good construct validity in cognitive pretests.

Mucosal healing and inflammatory bowel disease: Therapeutic implications and new targets.

Mucosal healing (MH) is vital in maintaining homeostasis within the gut and protecting against injury and infections. Multiple factors and signaling pathways contribute in a dynamic and coordinated manner to maintain intestinal homeostasis and mucosal regeneration/repair. However, when intestinal homeostasis becomes chronically disturbed and an inflammatory immune response is constitutively active due to impairment of the intestinal epithelial barrier autoimmune disease results, particularly inflammatory bowel disease (IBD). Many proteins and signaling pathways become dysregulated or impaired during these pathological conditions, with the mechanisms of regulation just beginning to be understood. Consequently, there remains a relative lack of broadly effective therapeutics that can restore MH due to the complexity of both the disease and healing processes, so tissue damage in the gastrointestinal tract of patients, even those in clinical remission, persists. With increased understanding of the molecular mechanisms of IBD and MH, tissue damage from autoimmune disease may in the future be ameliorated by developing therapeutics that enhance the body's own healing response. In this review, we introduce the concept of mucosal healing and its relevance in IBD as well as discuss the mechanisms of IBD and potential strategies for altering these processes and inducing MH.

Sensitivity of pathogenic and opportunistic microorganisms to probiotic strains in the light of personalized probiotic therapy

BACKGROUND: Resistance of microorganisms to antimicrobial drugs (AMP) is one of the global problems of modern medicine, which poses a serious threat to human health. The formation of the resistance of pathogens to AMP forces us to look for new ways to combat them. Probiotic therapy is one of the promising and safe methods of treating many infectious diseases.&#x0D; AIM: This study assesses the sensitivity of clinical strains of pathogenic and opportunistic bacteria and fungi to microorganisms that are part of probiotic preparations.&#x0D; MATERIALS AND METHODS: The sensitivity of 93 cultures of pathogenic and opportunistic microorganisms (UPM) isolated from the feces of patients with intestinal dysbiosis to strains of probiotic bacteria isolated from commercial probiotic preparations was studied: Lactobacillus plantarum 8RA-3, Escherichia coli M-17, Bacillus subtilis strain VKPM B-10641, Enterococcus faecium SF-68, Saccharomyces boulardii CNCM I-745 by the delayed antagonism method.&#x0D; RESULTS: Pathogenic microorganisms showed low and moderate sensitivity to the probiotic strain of L. plantarum. Sensitivity to the probiotic strain of B. subtilis was detected in Staphylococcus aureus strains, low or completely absent in Pseudomonas aeruginosa, Klebsiella spp., Serratia marcescens. The most sensitive to the probiotic strain were clinical strains of E. coli.&#x0D; CONCLUSION: UPM and pathogenic microorganisms isolated from the gastrointestinal tract of patients with dysbiosis have different sensitivity to probiotic strains: from high to several probiotics to its complete absence. The empirical approach to prescribing a probiotic does not guarantee a therapeutic effect, which makes it prudent to individualize the selection of a probiotic based on an assessment of its antimicrobial activity against isolated pathogens.

Microbial Dynamics in Newly Diagnosed and Treatment Naïve IBD Patients in the Mediterranean.

Microbial communities have long been suspected to influence inflammatory processes in the gastrointestinal tract of patients with inflammatory bowel disease. However, these effects are often influenced by treatments and can rarely be analyzed in treatment-naïve onset cases. Specifically, microbial differences between IBD pathologies in new onset cases have rarely been investigated and can provide novel insight into the dynamics of the microbiota in Crohn's disease (CD) and ulcerative colitis (UC). Fifty-six treatment-naïve IBD onset patients (67.3% CD, 32.7% UC) and 97 healthy controls were recruited from the Maltese population. Stool samples were collected after diagnosis but before administration of anti-inflammatory treatments. Fecal microbial communities were assessed via 16S rRNA gene sequencing and subjected to ecological analyses to determine disease-specific differences between pathologies and disease subtypes or to predict future treatment options. We identified significant differences in community composition, variability, and diversity between healthy and diseased individuals-but only small to no differences between the newly diagnosed, treatment-naïve UC and CD cohorts. Network analyses revealed massive turnover of bacterial interactions between healthy and diseased communities, as well as between CD and UC communities, as signs of disease-specific changes of community dynamics. Furthermore, we identified taxa and community characteristics serving as predictors for prospective treatments. Untreated and newly diagnosed IBD shows clear differences from healthy microbial communities and an elevated level of disturbance, but only the network perspective revealed differences between pathologies. Furthermore, future IBD treatment is to some extent predictable by microbial community characteristics.

Prevention of gastrointestinal bleeding in patients operated on the arteries of the lower extremities for critical ischemia

The purpose of the study. To determine the frequency of occurrence and prevention measures of erosive and ulcerative lesions of the proximal gastrointestinal tract in patients operated for critical ischemia with a diagnosis of obliterating atherosclerosis of the arteries of the lower extremities. Materials and methods. The examination included patients with lower limb ischemia - III-IV stage of ischemia according to the Fontaine-Pokrovsky classification. The patients were divided into 2 groups: the control group, where treatment was carried out according to the recommendations: HP diagnosis (express test) was carried out only with an endoscopic picture of gastric ulcer and duodenal ulcer, as well as the main group, in which HP diagnosis was carried out totally with fibrogastroduodenoscopy and a standard three-component eradication scheme was prescribed for at least 14 days when bacterial contamination of the gastric mucosa was detected. Results. In all cases, endoscopic changes characteristic of gastritis were registered in patients of the first group. Of the eight patients (100%), two (25%) were diagnosed with single erosions in the distal parts of the stomach, one patient (12.5%) had atrophic gastritis, and the remaining 5 (62.5%) patients had hyperemia of the antral and prepiloric mucosa. In patients of the second group, there were no changes in FGDS in one patient (25%), foci of mucosal atrophy were diagnosed in two patients (50%), and single erosions in one (25%). Conclusion. Among patients with peripheral artery diseases accompanied by critical ischemia, by the time they seek specialized medical care, there are no healthy or close to such persons with unchanged mucous membrane of the proximal parts. In the high-risk groups for the occurrence of gastrointestinal bleeding, a complex effect on aggression factors is necessary

Status of the mucosa of the upper gastrointestinal tract in patients with acute viral hepatitis B

Introduction. Patients with acute viral hepatitis B (AVHB) during the peak may develop erosions and ulcers of the mucous membrane of the upper gastrointestinal tract, which are difficult to diagnose clinically. Aim. The differences in clinical and laboratory manifestations of acute viral hepatitis B, depending on the presence or absence of erosive and ulcerative defects of the mucous membrane of the upper gastrointestinal tract has studied. Materials and methods. The work used clinical and laboratory data and the results of endoscopic examination of 44 patients with AVHB. All patients underwent a comprehensive clinical and laboratory examination, supplemented by fibroesophagogastroduodenoscopy (FEGDS). Results. Among 44 patients with AVHB, complaints of a dyspeptic character occurred in 79.6% (35 patients) and did not depend on the severity of the course of AVHВ. FEGDS of patients with AVHB revealed various pathological changes in the mucous membrane from superficial gastritis and gastroduodenitis (61.4%) to erosive gastroduodenitis and acute ulcers of the mucous membrane of the duodenal bulb (38.6%). Erosive and ulcerative defects of the mucous membrane of the upper gastrointestinal tract (ММUGIT) were more often diagnosed in the first 9 days from the onset of AVHB and was acute. Еrosions and ulcers of the GIТ tract with AVHB were less often than non-erosive gastritis/gastroduodenitis accompanied by such dyspeptic complaints as epigastric pain, nausea, and vomiting, which excludes dyspeptic syndrome as an evidence-based clinical landmark in diagnosing the degree of damage to the mucous membrane of the upper gastrointestinal tract. However, patients with AVHB with erosive and ulcerative defects of the ММUGIT had a significantly higher level of ALT at admission than patients with EVHV with gastritis/gastroduodenitis (1860 U/l (1030.2889) vs. 910 U/l (325.1749), p< 0 .05). Conclusion: In order to identify erosive-ulcerative defects of the mucous membrane of the upper gastrointestinal tract in patients with AVHB the FEGDS should be performed in the first 9 days of the disease in the presence of high ALT activity, which will allow to correct the tactics of managing patients with AVHВ earlier.

Endoscopic findings in the upper gastrointestinal tract in patients with Crohn’s disease are common, highly specific, and associated with chronic gastritis

Crohn’s disease (CD) may affect the entire gastrointestinal tract including its upper part. However, this aspect is poorly addressed in scientific literature and considered a rare finding. Here we aimed to prospectively investigate the prevalence, characteristics and clinical significance of upper gastrointestinal tract involvement in patients with CD, with particular focus on stomach bamboo joint-like appearance (BJA), Helicobacterpylori status and presence of microscopic changes. 375 prospectively recruited patients were included. In CD patients the prevalence of gastric and duodenal, but not esophageal, mucosal lesions, such as gastric mucosal inflammation, duodenal edema, ulcerations, and duodenal bulb deformation was significantly higher (at least p < 0.01 for all). Similar results were found when only H.pylori negative individuals were analyzed. Moreover, BJA of the stomach and in case of H.pylori negative patients also duodenal bulb deformation were detected exclusively in CD patients. Presence of BJA lesion was not significantly associated with neither duration of the disease nor use/history of biologic treatment. Despite absence of H.pylori infection microscopic features of chronic gastritis were found in almost all (93.5%) patients, and in 31% of controls (p < 0.00001). Our analysis outlines that upper gastrointestinal tract involvement in CD is a very common event and frequently manifests with a highly specific BJA lesion. Furthermore, our study reveals that in almost all CD patients features of H.pylori negative gastritis are present.

Pathological changes in the gastrointestinal tract in patients with diabetes mellitus

Autonomic neuropathy in patients with diabetes mellitus (DM) is the leading cause of damage to the digestive tract. As a result of chronic hyperglycemia and high glucose variability, the esophagus, stomach, small intestine, and large intestine are most often affected. The most common disorder of the digestive system in diabetes is gastroparesis. Clinical symptoms of gastroparesis have similarities with other functional disorders of digestive tract, which complicates differential diagnosis with other diseases. Quality of life of these patients is worsened because of significant difficulties in managing postprandial glycemia. Since patients with diabetes are quite often affected by cholelithiasis, this review also considers the need for surgical intervention and the subsequent effect of cholecystectomy on the development of gastroparesis in these patients. It is important to remember that after gallbladder removal patients need more careful monitoring of glucose levels. This will allow timely prescription of antidiabetic therapy and reduce the risk of developing gastroparesis in the future. In addition, the effect of coronavirus infection on functional damage of the digestive tract in patients with diabetes is discussed. A special diet is important in the therapy of gastroparesis. Exclusion of hard-to-digest fiber, fatty foods, inclusion of vitamin complexes and normalization of microbiota contribute to slower glucose absorption after meals and better compensation of disease. The main therapeutic value is the timely diagnosis of gastroparesis and normalization of glucose levels.

Pathology of the Gastrointestinal Tract in Patients with Primary Hyperparathyroidism

Aim. To present data of Russian and foreign studies on the prevalence, pathogenesis and clinical picture of gastrointestinal tract (GIT) pathology in patients with primary hyperparathyroidism (PHPT).Key point. At the beginning of the 20th century PHPT was considered a severe endocrine disease with specific bone and kidney complications, however in 1957 W.T. St Goar proposed a mnemonic triad to recognize this pathology as “diseases of stones, bones and abdominal groans”. A high frequency of gastrointestinal complaints, peptic ulcer, pancreatitis, cholelithiasis in patients with PHPT has been reported. Hyperparathyroidism has been shown to cause smooth muscle atony with specific upper and lower GI symptoms such as nausea, heartburn and constipation. The prevalence of peptic ulcer in patients with PHPT, according to studies of the 50s–60s of the last century, ranged from 10 to 25 %. However, studies linking PHPT to peptic ulcer development were performed before the advent of proton 1). On the other hand, the development of pancreatitis in PHPT is one of the most studied pathologies. In developing countries its frequency can reach 10–20 % due to the absence of routine screening for blood calcium. Some authors report the impact of elevated parathyroid hormone levels on the formation of gallbladder stones by inhibiting of gallbladder emptying, hepatic bile secretion and mobility of the sphincter Oddi, and changing of the bile composition. A number of studies have found an increased risk of developing malignant neoplasms of the intestine, especially the colon, in patients with PHPT.Conclusion. The digestive manifestations of parathyroid dysfunction in patients can often be overlooked, and serum calcium levels should be included in the routine examination in the presence of abdominal symptoms.