GASTROENTEROLOGY 2021-06-23T07:03:45+00:00 Nina Gravirovska Open Journal Systems <table id="table1" border="0" width="100%"> <tbody> <tr> <td colspan="2" align="center" valign="top"><strong>The journal Gastroenterology (Gastroenterologìa) is the professional scientific-practical specialized peer-reviewed journal for gastroenterologists, internists, family physicians, covering the issues of the pathology of the gastrointestinal tract and related diseases.</strong></td> </tr> <tr> <td colspan="2" align="center" valign="top"><hr noshade="noshade" size="1" /></td> </tr> <tr> <td align="center" valign="top"><img src="" alt="Заголовок домашньої сторінки" width="250" height="366" hspace="10" /></td> <td valign="top" height="341"><strong>The founder:</strong> State Institution "Institute of gastroenterology of NAMS of Ukraine”, Dnipro, Ukraine.<br /><strong>Publisher:</strong> Zaslavsky O.Yu.<br /><strong>Language of edition:</strong> Ukrainian, English, Russian. <p><strong>Registration Certificate: </strong>КВ № 20330-10130ПР. Issued by the Ministry of Justice of Ukraine 22.08.2013.</p> <p>The journal is included in the new List of scientific publications of the Higher attestation Commission, which can publish results of dissertations on competition of scientific degrees of doctor and candidate of Sciences. Order of the MES from 24.09.2020 № 1188.</p> <p><strong>Founded:</strong> 1969<br /><strong>Publication frequency:</strong> 4 times per year.</p> <p>ISSN 2308-2097 (print)<br />ISSN 2518-7880 (online)</p> <p><strong>DOI: 10.22141/2308-2097</strong></p> <p><strong><a href="" target="_blank" rel="noopener"></a></strong><br /><strong><a href="" target="_blank" rel="noopener"></a></strong></p> </td> </tr> </tbody> </table> <hr /> <p><strong>The journal has official endorsement from the:</strong></p> <p> </p> <table border="0" width="100%"> <tbody> <tr> <td><img src="" alt="" height="200" /></td> <td><img src="" alt="" height="200" /></td> </tr> <tr> <td><strong>Public Union "Association for the Study and Treatment of Digestive Diseases"</strong></td> <td><strong>NGO "Ukrainian Gastroenterological Association"</strong></td> </tr> </tbody> </table> <hr /> <p><strong>The journal in its publication activity is guided by the recommendations of the following editorial associations:</strong></p> <p><br /><a href="" target="_blank" rel="noopener"><img src="" alt="" width="100" height="37" /></a> <a href="" target="_blank" rel="noopener"><img src="" alt="" width="100" height="37" /></a> <a href="" target="_blank" rel="noopener"><img src="" alt="" width="100" height="37" /></a> <a href="" target="_blank" rel="noopener"><img src="" alt="" width="100" height="37" /></a></p> <hr /> <p><strong>We endorse the following declarations:</strong></p> <p><a href="" target="_blank" rel="noopener"><img src="" alt="" width="100" height="37" /></a> <a href="" target="_blank" rel="noopener"><img src="" alt="" width="100" height="37" /></a></p> <hr /> <p> </p> Features of cytokine balance with the progression of structural changes in the gastric mucosa in patients with atrophic gastritis 2021-06-07T09:10:01+00:00 L.M. Mosyichuk O.M. Tatarchuk O.V. Simonova O.P. Petishko <p><em><strong>Background.</strong></em> Until now, the issue of the correlation between the cytokine balance and the progression of structural changes in the gastric mucosa remain completely uncertain. At the same time, the determination of the role of cytokine ba­lance as a component of gastric carcinogenesis will make it possible to substantiate new approaches to managing patients with atrophic gastritis. The purpose was to assess the level of pro- and anti-inflammatory cytokines, vascular endothelial growth factor (VEGF) at the stages of progression of structural changes in the gastric mucosa of patients with atrophic gastritis. <em><strong>Materials and methods.</strong> </em>The study included 79 individuals with atrophic gastritis who underwent narrow band imaging endoscopic examination. The patients were divided into groups taking into account the revealed structural changes in the gastric mucosa: group I — 7 people with gastric mucosal atrophy without intestinal metaplasia (IM); group II — 16 individuals with gastric mucosal atrophy with IM limited by the antrum; group III — 45 people with diffuse IM against the background of gastric mucosal atrophy; group IV — 10 individuals with gastric mucosal dysplasia. In all patients, we assessed the level of interleukins (IL-8, IL-10, IL-18), tumor necrosis factor alpha (TNF-α), VEGF. <em><strong>Results.</strong></em> In patients of group IV, the concentration of IL-8 in the blood serum was 18.6 (11.3; 23.9) pg/ml that was significantly higher than in group I (by 5.0 times, p &lt; 0.05), group II (by 3.6 times, p &lt; 0.05) and group III (by 3.4 times, p &lt; 0.05). According to the results of the Kruskal-Wallis test, the probability of a difference in the IL-8 level between the groups was 0.0260. The level of VEGF in the blood serum of patients with gastric mucosal dysplasia was significantly increased compared to that in people with gastric mucosal atrophy without IM (by 1.8 times, p &lt; 0.05) and those with gastric mucosal atrophy with IM (by 1.7 times, p &lt; 0.05). Changes in the cytokine balance towards proinflammatory cytokines were most pronounced in patients of groups III and IV; according to the results of the Kruskal-Wallis test, the probability of a difference in the IL-8/IL-10 ratio between the groups was 0.0207. <em><strong>Conclusions.</strong></em> With the progression of structural changes in the gastric mucosa of patients with atrophic gastritis, an increase in the level of proinflammatory cytokines (IL-8, IL-18 and TNF-α) in the blood serum does not induce the secretion of anti-inflammatory cytokines (IL-10). According to the results of the ROC analysis, the diagnostic criteria for the formation of the risk group for detecting dysplastic changes in the gastric mucosa are VEGF level of more than 341.4 mU/ml (sensitivity — 90.0 %, specificity — 77.2 %) and the level of IL-8 above 14.4 pg/ml (sensitivity — 80.0 %, specificity — 78.3 %).</p> 2021-06-23T00:00:00+00:00 Copyright (c) 2021 Prevalence, clinical course and treatment of chronic gastritis at the present stage 2021-06-07T09:11:35+00:00 G.V. Osyodlo Y.Y. Kotyk M.A. Kalashnikov V.V. Osyodlo <p><em><strong>Background.</strong></em> The importance of the problem of chronic gastritis (CG) is determined by its high proportion in the structure of gastrointestinal pathology, reduced quality of life of patients, and possible complications. The study aimed at the investigation of the incidence and features of the clinical course of CG in servicemen at the present stage and pharmacoeconomic efficacy of bismuth and triple anti-helicobacter therapy (AHBT) in H. pylori (HP) — associated erosive gastritis with the use of domestic drugs. <em><strong>Materials and methods.</strong></em> At the first stage, the indicators of the admission rate of servicemen with CG and the peculiarities of the endoscopic picture of the gastric mucosa were analyzed. At the second stage, the features of the clinical course were studied and a pharmacoeconomic analysis of treatment regimens in servicemen with HP-associated erosive gastritis with proton pump inhibitors of different generations and domestic bismuth subcitrate, used in triple and bismuth-containing regimens, was performed. <em><strong>Results.</strong></em> An epidemiological, clinical, and pharmacoeconomic analysis of HP-associated CG in servicemen at the present stage has been conducted. It is reasonable to treat servicemen with HP-associated erosive gastritis with domestic drugs using bismuth-containing anti-helicobacter therapy, which will improve the efficiency and quality of treatment and avoid unjustified budget costs. <em><strong>Conclusions.</strong></em> Among the servicemen of the Armed Forces of Ukraine, starting from 2013, there is a tendency to increase the number of erosive gastroduodenal lesions with a predominant lesion of the antrum of the stomach. Pharmacoeconomic analysis of the treatment of HP-associated erosive gastritis showed the feasibility of switching to bismuth-containing AHBT with the use of domestic rabeprazole and bismuth subcitrate. This is justified by a higher anti-Helicobacter activity by 1.2 times (20 %), 1.6 times better (60 %) cost-effectiveness, and 1.4 times higher (40 %) cost-utility.</p> 2021-06-23T00:00:00+00:00 Copyright (c) 2021 Gastrointestinal disorders in patients with COVID-19: diagnoses and treatment during the pandemic 2021-06-07T09:13:09+00:00 I.G. Paliy S.V. Zaika I.V. Chernova I.M. Yevtodii D.V. Palii <p><em><strong>Background.</strong> </em>The pandemic caused by the coronavirus disease 2019 (COVID-19) is a topic that is currently in the spotlight of the world community. The use of non-steroidal anti-inflammatory drugs (NSAIDs) in combination with new oral anticoagulants (dabigatran, rivaroxaban, apixaban, etc.) and acetylsalicylic acid by the significant number of patients during the pandemic, caused by COVID-19, raises the question about the safety of the influence of each drug on the occurrence of gastrointestinal complications. The development of algorithms to prevent damage to the gastrointestinal mucosa on the background of these drugs is becoming a priority. The purpose was to examine the presence of gastrointestinal disorders using the Gastrointestinal Symptom Rating Scale (GSRS) in convalescents after COVID-19 and to evaluate the effectiveness of esomeprazole for correction of these disorders. <em><strong>Materials and me­thods.</strong></em> We surveyed 92 (48 men and 44 women) convalescents after COVID-19. The mean age of individuals was (49.2 ± 2.0) years. To conduct a survey of patients who had COVID-19, we developed a questionnaire which included patient’s passport data, age, gender. In addition, patients reported how COVID-19 was diagnosed, what drugs they were taking during treatment, and whether they nee­ded oxygen therapy. Subsequently, convalescents after COVID-19 ­answered questions from the GSRS. Information was collected and the questionnaire was completed by telephone survey. Depending on the data of GSRS, esomeprazole (Ezonexa) was prescribed to patients at a dose of 20 mg 1 time per day, 30 minutes before meals, for 30 days. During the follow-up survey on day 30 of esomeprazole intake, patients re-answered the GSRS questions. <em><strong>Results.</strong></em> Thirty days after starting esomeprazole intake at a dose of 20 mg 1 time per day, 92 convalescents after COVID-19 showed a significant reduction (p &lt; 0.001) in the manifestations of reflux, abdominal pain and dyspeptic syndromes compared to the results before treatment ((2.3 ± 0.1), (4.3 ± 0.2), (5.7 ± 0.3) versus (4.3 ± 0.3), (9.3 ± 0.4), (8.6 ± 0.6), respectively). Esomeprazole was equally effective (p &gt; 0.05) in influencing the severity of reflux, abdominal pain, dyspeptic, diarrheal and constipation syndromes in both men and women: (2.3 ± 0.1), (4.3 ± 0.2), (5.7 ± 0.3), (3.9 ± 0.3), (3.0 ± 0.1) versus (2.4 ± 0.1), (4.2 ± 0.2), (6.0 ± 0.4), (4.0 ± 0.4), (3.1 ± 0.1), respectively. Esomeprazole was also equally effective (p &gt; 0.05) in the impact on the severity of reflux, abdominal pain, dyspeptic, diarrheal and constipation syndromes among patients receiving acetylsalicylic acid and those treated with rivaroxaban: (2.5 ± 0.2), (4.2 ± 0.2), (5.6 ± 0.2), (3.9 ± 0.4), (3.1 ± 0.1) versus (2.2 ± 0.1), (4.4 ± 0.3), (6.4 ± 0.6), (4.2 ± 0.4), (3.0 ± 0.1), respectively. Esomeprazole at a dose of 20 mg 1 time per day was equally effective (p &gt; 0.05) in relation to the dynamics of the severi­ty of syndromes in patients receiving paracetamol and one NSAID and in those receiving paracetamol and 2 NSAIDs. In particular, in people receiving paracetamol and one NSAID, on the background of esomeprazole administration, the severity of reflux, abdominal pain, dyspeptic, diarrheal and constipation syndromes were (2.4 ± 0.1), (4.3 ± 0.2), (5.8 ± 0.3), (4.1 ± 0.3), (3.1 ± 0.1) and in patients taking paracetamol and 2 NSAIDs — (2.1 ± 0.2), (4.5 ± 0.4), (6.7 ± 0.7), (4.4 ± 0.7), (3.0 ± 0.1), respectively. <em><strong>Conclusions.</strong></em> Esomeprazole (Ezonexa) effectively reduces (p &lt; 0.001) the severity of reflux, abdominal pain and dyspeptic syndromes in convalescents after COVID-19. The use of Esomeprazole (Ezo­nexa) demonstrates the same efficacy (p &gt; 0.05) in men and women when receiving both ASA and rivaroxaban and during the treatment with both paracetamol and one NSAID and paracetamol and 2 NSAIDs.</p> 2021-06-23T00:00:00+00:00 Copyright (c) 2021 Markers of progression of liver fibrotic changes in patients with chronic toxic drug-induced hepatitis 2021-06-07T09:14:15+00:00 V.I. Didenko O.M. Tatarchuk O.P. Petishko I.S. Konenko S.L. Melanich <p><em><strong>Background.</strong></em> In recent years, as a result of the growing expansion of the pharmaceutical market, there has been a clear trend towards an increase in the incidence of chronic toxic drug-induced hepatitis of drug genesis (TDIH). The appearance of fibrosis is considered the most important histological change that determines the further course of the disease. Therefore, the search for non-invasive or minimally invasive markers for assessing fibrotic changes in the liver remains an urgent issue in clinical practice. The purpose was to determine the diagnostic value of immunological parameters for stratification of the severity of liver fibrosis in patients with TDIH. <em><strong>Materials and methods.</strong></em> The study included 41 patients with TDIH, who were divided into three groups: group I consisted of 12 people without liver fibrosis (F0), group II — 22 patients with moderate fibrosis (F1-F2), group III — 7 individuals with severe liver fibrosis (F3-F4). Shear wave elastography was performed using a Soneus P7 system (Ukraine-Switzerland). All patients underwent a biochemical blood test with the determination of alanine aminotransferase (ALT), aspartate aminotransferase (AST). The subpopulation composition of lymphocytes, circulating immune complexes (CIC), the level of interleukins (IL-6, IL-10) and tumor necrosis factor α were assessed. <em><strong>Results.</strong></em> The progression of liver fibrosis is accompanied by an increase in cytolytic syndrome: patients with severe fibrosis have a 3.3-fold increase in the ALT (p &lt; 0.05) compared to the controls and a 2.1-fold (p &lt; 0.05) compared to that in patients with moderate fibrosis. The AST level is significantly higher — by 4.6 times (p = 0.023) in patients with severe fibrosis than in those with moderate fibrosis. With the progression of liver fibrosis, there is a significant decrease in cellular immunity, an increase in the level of CIC and pro-inflammatory cytokines with a simultaneous decrease in the content of anti-inflammatory cytokines, which is confirmed by correlations between the liver stiffness index according to shear wave elastography data and the level of T-helpers (r = –0.466; p = 0.03), IL-6 (r = 0.364; p = 0.01), IL-10 (r = –0.331; p = 0.039) and CIC (r = 0.381; p = 0.017). <em><strong>Conclusions.</strong></em> Markers of the diagnosis of severe liver fibrosis in patients with TDIH are indicators such as the ratio of IL-6/IL-10 higher than 0.83 (sensitivity 81.8 %, specificity 78.9 %), CIC level more than 4.3 optical density units (sensitivity 77.3 %, specificity 72.2 %), the ratio of T-helpers/T-suppressors is less than or equal to 1.6 (sensitivity 72.7 %, specificity 57.9 %).</p> 2021-06-23T00:00:00+00:00 Copyright (c) 2021 Evaluation of the intestinal microbiota and short-chain fatty acids content in patients with chronic inflammatory bowel diseases 2021-06-07T09:17:34+00:00 M.V. Stoykevich N.S. Fedorova N.V. Nedzvetskaya I.A. Klenina O.M. Tatarchuk <p><strong><em>Background.</em></strong> The pathogenesis of chronic inflammatory bowel disease (IBD) is still not fully clarified. It is known that disorders of the intestinal microbiota lead to an increased intestinal permeability, activation of mucous and adaptive immunity, impaired production and intestinal absorption of short-chain fatty acids (SCFA). The ratio of acetic, propionic, butyric acids is an important indicator of the integrity of the intestinal microbial community. Thus, the study of the composition of the intestinal microbiota and the concentrations of fecal SCFA is a very promi­sing approach to broadening the understanding of IBD pathoge­nesis. The purpose of our study was to determine the features of the production of fecal SCFA and the composition of colon microbiota in patients with IBD. <em><strong>Materials and methods.</strong></em> The study, which was carried out at the Department of Intestinal Diseases of the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine, involved 74 patients with IBD with an average age of (43.2 ± 1.8) years, who according to nosology were divided into 2 groups: group I — those with ulcerative colitis (UC) (n = 66), group II — individuals with Crohn’s disease (CD) (n = 8). The diagnoses of CD and UC were established accor­ding to generally accepted diagnostic standards in gastroenterology. Determination of fecal SCFA was carried out by chromatographic method with the use of hardware-software complex for medical researches on the basis of the gas chromatographer Chromateс Crystal 5000. The intestinal microflora was evaluated using a microbiological study of the colon content. <em><strong>Results.</strong></em> Patients with IBD had significant changes in the spectrum of SCFA, which were similar in both UC and CD: a decrease in acetic acid in the UC group by 5.7 times, in the CD group by 10.5 times (p &lt; 0.05), butyric acid in the UC group by 1.6 times, in the CD group by 1.5 times (p &lt; 0.05), and an increase in propionic acid in the UC group by 4 times and in the CD group by 3.3 times (p &lt; 0.05) compared with the control group. There was also a significant increase in the anaerobic index in patients with IBD. Microbiological study of feces showed a significant decrease in Lactobacillus, which was observed in all patients with IBD, as well as a decrease in Bifidobacterium in 19.7 % of those with UC and in 37.5 % with CD. There was a decrease of other representatives of the normal microflora: Enterococci (in 15.2 % in the UC group and 25 % in the CD group) and Escherichia coli (in 15.2 % in the UC group and 12.5 % in the CD group). Excessive growth of opportunistic flora was also detected: hemolytic Escherichia coli was increased in 19.7 % of patients with UC and in 12.5 % of those with CD; Proteus was detected in 12.1 % of people with UC and in 37.5 % with CD. The excessive growth of Candida was found in 43.9 % of patients in the UC group and in 87.5 % of indivi­duals with CD. <em><strong>Conclusions.</strong></em> Quantitative and qualitative deviations of the intestinal microbiota, such as a decrease in the number of major symbionts and an increase in the number of opportunistic pathogens, were observed in all examined patients with IBD. The obtained results showed that changes in SCFA concentrations in both nosologies of IBD differed significantly from those in the control group, which in combination with primary genetic defects of the barrier function of the epithelium and its regenerative abi­lity can lead to deterioration in the course and prognosis of IBD. Evalua­tion of the ratio of SCFA fractions with the calculation of the anaerobic index may be useful for the diagnosis of intestinal dysbiosis in patients with IBD.</p> 2021-06-23T00:00:00+00:00 Copyright (c) 2021 A rational approach to the prevention of thromboembolic complications in the surgical treatment of complicated forms of cholelithiasis in patients with liver cirrhosis 2021-06-07T09:18:43+00:00 S.D. Khimich F.T. Muraviov <p><em><strong>Background.</strong> </em>It is known from scientific sources that a significant proportion of complications of liver cirrhosis is associated with negative impact of this pathology on the coagulation system. According to many scientists, liver cirrhosis in most cases poses a risk of developing both thrombotic and hemorrhagic complications. Objective: to identify a rational approach to the prevention of thromboembolic complications in the surgical treatment of complicated forms of cholelithiasis in patients with cirrhosis. <em><strong>Materials and methods.</strong></em> We retrospectively analyzed the hospital records of 62 patients who were treated for complicated forms of cholelithiasis with verified liver cirrhosis for the period from 2005 to 2018. The distribution of patients by nosology was as follows: acute calculous cholecystitis — 48 patients, Mirizzi syndrome — 7, choledocholithiasis — 7. <em><strong>Results.</strong> </em>Based on a comparative analysis of two groups, the risk of intraoperative bleeding in patients with preoperative prophylaxis was higher (3 cases — 8.1 %), with a blood loss of more than 400 ml. Hematomas of postoperative wounds were observed in 5 cases in group 1 and in one case in group 2. In the group of preoperative prophylaxis, portal vein thrombosis (n = 1), thrombosis of small branches of the pulmonary artery (n = 1), and deep vein thrombosis of the leg (n = 1) developed. No such complications were observed in the group with postoperative prophylaxis. <em><strong>Conclusions.</strong></em> The decision on the prevention of thromboembolic complications in this category of patients should be balanced and include an assessment of the risks of developing both hemorrhagic disorders and complications associated with thrombosis.</p> 2021-06-23T00:00:00+00:00 Copyright (c) 2021 Abstracts of the Research-to-Practice Conference with International Participation “IX Scientific Session of the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine. The Latest Technologies in Theoretical and Clinical Gastroenterology” (June 17–18, 2021, Dnipro, Ukraine) 2021-06-07T09:25:23+00:00 No authors <p>No abstract</p> 2021-06-23T00:00:00+00:00 Copyright (c) 2021 Zemstvo doctor Vasyl Leontovych — the father of the dynasty of scientists 2021-06-07T20:17:52+00:00 M.P. Chaban Z.I. Shevtsova V.V. Gaponov <p>The article describes the life and professional acti­vity of zemstvo doctor, a descendant of the Zaporozhian Cossacks Vasyl Fedorovych Leontovych (1842–1888). The young man was a graduate of the Yekaterynoslav Classical Gymnasium in 1862. The doctor managed to start a dynasty of outstanding domestic scientists. His son Oleksandr became a physiologist, academician. His grandson Mykhailo is a physicist and academician; granddaughter Tatiana and great-granddaughter Natalia are doctors of medical sciences. The Leontovych family is an example of the medical dynasty of Cossacks.</p> 2021-06-23T00:00:00+00:00 Copyright (c) 2021 A multidisciplinary approach to the management of inflammatory bowel diseases: surgical complications — how not to miss by therapist 2021-06-07T09:23:47+00:00 T.B. Nechypurenko <p>The article deals with a condition that is complex for diagnostic search — inflammatory bowel diseases (IBD). Frequent complication of IBD by acute surgical manifestations, the possibility of the onset of diseases from surgical lesions determines the practical need for physicians to be aware of the management of IBD with complicated pathology. The article presents a clinical case — the complication of ulcerative colitis by multiple colonic perforations, which were not detected in time. The diagnostic search allowed us to find out intraoperatively the causes of acute surgical manifestations, to diagnose complications, and the prescribed ade­quate postoperative treatment stabilized the patient’s state.</p> 2021-06-23T00:00:00+00:00 Copyright (c) 2021 Morphological manifestations of irritable bowel syndrome 2021-06-07T09:20:31+00:00 Yu.M. Stepanov I.Ya. Budzak Yu.A. Gaidar <p>The article presents modern data on morphological changes in the intestinal mucosa in patients with irritable bowel syndrome. There were analyzed the studies of different years on the morphological manifestations of irritable bowel syndrome. It has been shown that this pathology has an unusual low-grade inflammation. Mast cells play an important role in these inflammatory disorders, they have an effect on motility disorders, visceral hypersensitivity and other pathogenetic factors of irritable bowel syndrome. Disorders of intercellular tight junctions in this category of patients were also analyzed. The role of proteins involved in intercellular contacts (occludin, claudin, ZO) has been characterized. An analysis of the studies investigating these disorders has been carried out. The article provides examples of the analysis of biopsies in patients with irritable bowel syndrome using various methods of their assessment.</p> 2021-06-23T00:00:00+00:00 Copyright (c) 2021 Pleiotropic effects of ursodeoxycholic acid 2021-06-07T09:22:10+00:00 Yu.М. Stepanov А.V. Salenko <p>The article summarizes the literature data on the expansion of the range of application of ursodeoxycholic acid due to its various mechanisms of action. Almost 50-year history of the study of its properties has proven choleretic, litholytic, antiapoptotic, anti-inflammatory, immunomodulatory, cytoprotective, antifibrotic and hypocholesterolemic effects. In addition to the well-known functions of bile acids, their role has been shown as signa­ling, endocrine molecules that regulate glucose, lipids, and energy metabolism through pathways mediated by the activation of the nuclear receptor of the farnesoid X receptor and the cell surface G protein-coupled receptor, TGR5. The variety of nosological forms in which this substance can be successfully used is substantiated.</p> 2021-06-23T00:00:00+00:00 Copyright (c) 2021