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Issue. Articles

¹1(93) // 2017

 

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1. Original researches

 
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Gene-gene interaction of genes CFTR, PRSS1 and IL-4 polymorphism from the point of view of risk prediction for the edematous pancreatitis development

S. I. Ivashchuk, L. P. Sydorchuk

Bukovinian State Medical University, Chernivtsi
Objective — to establish the role of polymorphic variants combination of genes PRSS1 (rs 111033565), CFTR (rs 113993960) and IL-4 (rs 2243250) and their gene-gene interaction in the development of edematous pancreatitis.
Materials and methods. Genetic studies were performed for 123 patients with edematous pancreatitis. Molecular genetic studies included the determination of genes IL-4 (C-590T), PRSS1 (R122H) and CFTR (delF508) polymorphism by polymerase chain reaction using oligonucleotide primers of Metabion (Germany) company. The method of Multifactor Dimension Reduction with calculation of prediction potentials was used for investigation of gene-gene interactions of studied genes and constructing a model of its impact on the appearance of edematous pancreatitis in the sample of investigated persons.
Results. the reproducibility of single-factor model involving gene PRSS1 was 100 % (10/10), but permutation test did not confirm its probability and proved sufficient accuracy. The risk of edematous pancreatitis development was demonstrated by two- and three-component models (CFTR, IL-4 and CFTR, PRSS1, IL-4) with 90 % and 100 % reproducibility (the odds ratio (OR 19.76; p < 0.001 and OR 5.77; p = 0.045, respectively) and the high accuracy prediction of edematous pancreatitis risk (93.3 % and 83.62 %). This risk was confirmed for single-component model (with gene IL-4) for acute pancreatitis and the exacerbation of chronic pancreatitis (OR 9.09; p = 0.009 and OR 48.0; p < 0.001, respectively), and for the pancreatitis of alcoholic and biliary origin (OR 56.0, p < 0.001 and OR 68.0; p < 0.001, respectively). The models that included genes CFTR, PRSS1, IL-4 for the prediction of chronic pancreatitis exacerbation (OR 4.12; p = 0.048), alcoholic and biliary pancreatitis (OR 5.20; p < 0.05 and OR 18.33, p < 0.001, respectively) were the mist effective ones, with the accuracy of 88.93 %, 79.0 % and 49.26 % respectively. Cross-validation Testing T-statistic (CV-TT) was highly significant for the forecast of biliary pancreatitis for three-component model (CFTR, PRSS1, IL-4) (CV-TT = 11.32; p < 0.001) and for the acute pancreatitis according to single-component model for gene IL-4 (CV-TT = 9.24; p = 0.009).
Conclusions. The classification ability of the created models of gene-gene interactions confirmed with high reproducibility (90 % or 100 %) the significance of single-factor model, involving TT-genotype of IL-4 gene: for acute pancreatitis, the exacerbation of chronic disease, and for alcoholic and biliary pancreatitis with accuracy 70.68 %, 57.14 %, 70.71 % and 50.71 %, respectively. The inter-locus interactions for all types of pancreatitis was characterized by independent pronounced gene-gene link (from -21.65 % till -12.55 %) with the highest entropy level inherent for gene IL-4 (26.41 % — for acute pancreatitis, 54 60 % — for the exacerbation of chronic, 59.35 % — for alcoholic pancreatitis, 41.81 % — for biliary).

Keywords: pancreatitis, gene-gene interaction, polymorphism, CFTR, PRSS1, IL-4, prognosis.

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Original language: Ukrainian

2. Original researches

 
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Cytoprotective effects of hydrogen sulphide-releasing aspirin on esophageal mucosa compromised by stress injury

O. S. Zayachkivska1, N. S. Bula1, Ya. I. Pavlovskiy1, I. O. Pshyk-Titko1, E. M. Gavriluk1, O. I. Grushka1, J. L. Wallace2, 3

1 Danylo Halytsky Lviv National Medical University
2 University of Calgary, Calgary, Alberta, Canada
3 Camilo Castelo Branko University, San Paulo, Brazil
Objective — to compare effects of acetylsalicylic acid (ASA) and hydrogen sulphide-releasing aspirin (H2S‑ASA) on the esophageal mucosa (EM), compromised by stress injury.
Materials and methods. The rodents were injected either placebo (control), ASA (10 mg/kg) or H2S-ASA (ATB-340, 17.5 mg/kg) as a single injection and injections over 9 days with induction of stress or without it. The EM injury was assessed with the use of index of histological analysis EM injury. The serological levels of VCAM-1 and interleukin -6 were measured with immune enzymatic method.
Results. The use of H2S-ASA caused the protective effect on EM, confirmed by the reduction of histological injury index in comparison with the ASA at the one-time injection and injections over 9 days. Serological levels of VCAM-1 IL-6 in rats, injected ASA and induced stress, was higher than in controls. The use of H2S-ASA caused inflammatory effect due to the reduction of VCAM-1 and IL-6 levels, and this affect was not observed with ASA injections.
Conclusions. The cytoprotective effects of the new non steroid anti-inflammatory drug H2S-ASA on the esophageal mucosa manifested as reduction of inflammation and improvement of the functioning of the vascular endothelium.

Keywords: H2S, esophagus, aspirin, inflammation, cytoprotection, VCAM-1, IL-6.

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Original language: Ukrainian

3. Original researches

 
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The peculiarities of genetic profile in patients with inflammatory bowel disease in Ukraine and strategy for their management

À. E. Dorofeyev1, N. V. Kharchenko2, N. N. Rudenko1, Å. À. Kiryan3,
À. À. Dorofeyeva4, Î. P. Revko5, I. À. Derkach6

1 O. O. Bogomolets National Medical University, Kyiv
2 P. L. Shupyk National Medical Academy îf Postgraduate Education, Kyiv
3 Ukrainian Medical Stomatological Academy, Poltava
4 D. F. Chebotarev Institute of Gerontology of NAMS of Ukraine, Kyiv
5 Chernigiv Area Hospital Clinic
6 Truskavets City Hospital Clinic
Objective — to investigate the prevalence of certain single-nucleotide polymorphism (SNP) in patients with inflammatory bowel disease (IBD) in the Ukrainian population and to compare it with the group of healthy people.
Materials and methods. The observation involved 187 patients with IBD, the residents of Kyiv, Chernigiv, Donetsk, Lugansk, Poltava, Khmelnytsky, Vinnytza and Lviv regions. Among them, 28 (14.9 %) patients were resistant to standard therapy with mesalazine, glucocorticosteroids and cytostatics. These patients had a severe IBD course with advanced bowel lesions. Among these patients, 21 (75.0 %) patients suffered from ulcerative colitis, and 7 (25.0 %) from Crohn’s disease (CD). The latter  28 patients were undergone the in-depth genetic testing.
Results. The results showed that in patients with IBD, three single nucleotide polymorphisms, activating inflammation, were revealed significantly more frequently than in healthy individuals: Asp299Gly TLR4 gene; SNP Thr399Ile gene TLR4 and A-8202G MMP9 gene), and two, reducing the activity of anti-system (SNP C -592A gene IL-10, and allele SNP 915 G/C TGF-β1 gene).
Conclusions. For the treatment of IBD patients with genetic predisposition to more pronounced inflammatory response, the use of  vedolizumab is pathogenetically justified, due to its ability to inhibit the expression of pro-inflammatory genes in the intestinal mucosa.

Keywords: inflammatory bowel disease, genetics, treatment.

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Original language: Russian

4. Original researches

 
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Investigation of seasonal factor in the development of oropharyngeal candidiasis in patients with gastroenterological diseases

I. V. Kushnirenko

SI «Institute of Gastroenterology of NAMS of Ukraine», Dnipro
Objective — to study seasonality of the exposure of oropharyngeal candidiasis, changes of the immunological parameters, and adhesive properties of buccal epithelial cells in patients of gastroenterological profile.
Materials and methods. The investigations which took place in the years 2009 to 2012 involved 638 patients. The quantitative evaluation of Candida albicans in tongue’s scrape was done; the presence of oropharyngeal candidiasis was established at the values of more than 300 colonies on the double dish. Immunological parameters (ÑD3+, ÑD4+, ÑD8+, ÑD16+, ÑD22+, ÍÑÒ-test) and cytochemical index of neutrophils’ activity were studied in 99 patients with oropharyngeal candidiasis. Buccal epithelial cells were taken from 66 subjects, and adhesive properties were determined of the reference strain Candida albicans that defines the average index of microorganism’s adhesion and the number of epithelial cells. All indices were analyzed according to the frequency of the definition of the season (autumn, winter, spring, summer).
Results. The frequency increase in 1.5 fold was as established in autumn vs winter (ð < 0.05) and in 1.6 times in comparison with spring (ð < 0.05). The frequency of oropharyngeal candidiasis definition was higher in autumn in 2.3 times in comparison with the absence of the growth of Candida albicans (95 % confidence interval (CI) 1.25 — 4.13). Lymphocytes activation was determined in summer and winter: their level was increased in 3.4 and 2.9 times more often than in autumn (ð < 0.05 in both cases). The probability of the increase of lymphocytes activity is low in autumn in comparison with other seasons, the odds ratio 0.3 (95 % CI 0.09 — 0.9). The probability of definition of the increased CD8+ levels is higher in autumn in comparison with other seasons and it contains 3.3 (95 % C² 1.1 — 9.9). The frequency of the decrease of neutrophils activity was higher in1.6 times in autumn in comparison with winter (F < 0.05) and in 1.4 in comparison with spring time (F < 0.05), odds ratio 5.4 (95 % C² 1.2 — 24.5). The probability of maximal stage of the index of buccal epithelial cells adhesiveness to Candida albicans was higher in autumn, odds ratio 4.4 (95 % C² 1.1 — 17.0), that defines the presence of seasonal ranges of buccal epithelial cells to adhesion of Candida albicans.
Conclusions. The increase of oropharyngeal candidiasis frequency in autumn is the result of the complex interaction of seasonal changes in the immunological provision to organism in this season and seasonal ranges of adhesive properties of epithelial cells to Candida albicans, The latter phenomena was revealed for the first time and requires further investigations.

Keywords: seasonality, oropharyngeal candidiasis, lymphocytes, neutrophils, CD8+, buccal epithelial cells, adhesiveness.

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Original language: Ukrainian

5. Original researches

 
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Evaluation of liver fibrosis progression in patients with stable coronary heart disease combined with non-alcoholic fatty liver disease

N. G. Virstyuk, I. I. Vakalyuk

Ivano-Frankivsk National Medical University
Objective — to assess the degree of liver fibrosis progression in patients with stable coronary heart disease (CHD) depending on the course of non-alcoholic fatty liver disease (NAFLD).
Materials and methods. The study involved 300 patients with CHD, divided in the groups depending on the NAFLD presence or absence. Patients with NAFLD were divided depending on the liver fibrosis stage. General clinical examination, ECG, coronary angiography, echocardiography, liver elastography, assessment of liver functional state, calculation of fibrosis indices FIB-4 and NFS were conducted to all patients.
Results. The results of elastography demonstrated the increased liver stiffness in all patients. In patients with F2 and F3 fibrosis stages, liver stiffness clearly depended on the NAFLD course. In particular, in Group IIIB shear wave velocity was on 54.3 % higher than in Group I, and on 19.7 % higher than in Group IIIA (p < 0.05). The most significant changes were observed in group with severe liver fibrosis of F4 stage, where shear wave velocity significantly exceeded as a measure of the patient of Group I in 2.9 times and those mentioned in Group IVB on 29.9 % (p < 0.05).The highest index FIB-4 value was observed in Group VB, that was greater in 2.5 times than in Group IIA; in 1.8 times compared with Group IIIB and on 33.6 % compared with Group IVB (p < 0.05). Negative values of NFS index were revealed in patients with F1 and F2 stage of liver fibrosis. In terms of NAFLD progression, index value was growing, reaching its highest value in the case of pronounced fibrotic liver changes of F4 stage. A direct correlations between the stage of liver fibrosis by shear wave velocity and FIB-4 index (r = 0.73; p = 0.0002); shear wave velocity and index NFS (r = 0.78; p = 0.0001) were found.
Conclusions. The progression of liver fibrosis in patients with stable CHD depends on the NAFLD course and is most prognostically unfavourable in the case of non-alcoholic steatohepatitis. The relationship between shear wave velocity and FIB-4 and NFS indices in patients with stable CHD combined with NAFLD suggests the multifactorial nature of the liver fibrosis progression. Determination of liver stiffness with elastography method, calculation of FIB-4 and NFS indices contributes the early detection of fibrotic changes in the liver parenchyma that generally causes the advisability of including these techniques to the protocol of examination of the patients with stable CHD combined with NAFLD.

Keywords: stable coronary heart disease, non-alcoholic fatty liver disease, elastography, fibrosis index.

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Original language: Ukrainian

6. Original researches

 
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Chronic pancreatitis and adipokines: pathogenetic relationship, effects on the inflammation and insulin resistance

O. I. Fediv, K. V. Ferfetska

Bukovinian State Medical University, Chernivtsi
Objective — to establish the role of adipokines in the development of metabolic disorders in patients with chronic pancreatitis (CP), combined with obesity and type 2 diabetes mellitus (DM 2).
Materials and methods. The study involved 97 patients with CP, divided into three groups: the first group included CP patients without comorbidity, the second group consisted of subjects with CP, combined with DM 2, and the third included patients with CP, combined with obesity and DM 2. The control group consisted of sex- and age-matched healthy subjects. The patients’ age was 23 to 65 years, the mean age 51.3 ± 0.9 years. Blood levels of leptin, adiponectin, resistin, immunoreactive insulin, triglycerides and reduced glutathione was determined in all patients.
Results. The significant increase of leptin and resistin levels against the background of adiponectin decrease was reveled in patients with chronic pancreatitis, combined with obesity and DM 2. The direct correlation was defined for the resistin and triglycerides’ level, and inverse correlation between adiponectin and immunoreactive insulin, adiponectin and C-reactive protein. These results showed the impact of obesity on the development of dyslipidemia, insulin resistance and inflammation.
Conclusions. In patients with chronic pancreatitis, combined with obesity and type 2 diabetes observed imbalance adypokins that support inflammation and insulin resistance.

Keywords: chronic pancreatitis, obesity, insulin resistance, leptin, resistin, adiponectin.

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Original language: Ukrainian

7. MEDICINES

 
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Replacement therapy of pancreatic exocrine insufficiency: the modern approaches

G. D. Fadieienko, T. A. Solomentseva

SI «L. T. Mala National Therapy Institute of NAMS of Ukraine», Kharkiv
Pancreatic exocrine insufficiency is a well-documented complication of chronic pancreatitis; however, results of its investigations are contradictory. Patients treated with both non-invasive and surgical methods, require the treatment of pancreatic exocrine insufficiency. This review article summarizes the relevant studies on pancreatic exocrine pancreatic insufficiency, with particular differentiation between non-surgical and surgical treatment of patients, as well as between the different operations. Moreover, the studies on pancreatic enzyme replacement therapy chronic pancreatitis have been summarized.

Keywords: chronic pancreatitis, exocrine pancreatic insufficiency, pancreatic enzymes lipase, Ermital.

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Original language: Russian

8. MEDICINES

 
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The long-lasting stomach acid suppression with proton pump inhibitors: potential risks, the choice of an optimal drug

M. B. Shcherbinina

Oles Honchar Dnipro National University
Objective — to organize and analyze data pertaining to the peculiarities of the clinical profile of proton pump inhibitors (PPIs), presented in the scientific literature. The PPIs proved to be the most effective drugs that provide the acid suppression in stomach. The short treatment PPI courses hardly accompanied by clinically significant side effects. However, the long-term therapy may cause undesirable effects in a form of class-specific effects of PPIs, requiring patients’ monitoring, as well as the effects associated with the peculiarities of the chemical structure and pharmacokinetics of each representative of the group. Among the PPIs, Pantoprazole favorably distinguished by a number of advantages: it has the lowest probability of systemic effects on the body due to its high pH selectivity of activation. It provides the most long-lasting effect of acid suppression, gives clinically significant cross-reactivity with other drugs, does not depend on the genetic polymorphism of CYP2C19 and does not require increasing doses in patients’ fast “metabolizers”, which constitute the majority of the European population. The number of recorded side effects was minimal during its administration. In case if PPIs intake required, it is recommended to give preference to pantoprazole as the most safe PPI. Zolopent is a domestic generic drug of pantoprazole. A number of studies conducted in Ukrainian hospitals in the treatment of acid-related diseases in adult and pediatric patients confirmed its high efficiency, good tolerability and safety.

Keywords: acid disorders, proton pump inhibitors, the mechanism of action, omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole, dexlansoprazole class-specific effects, drug-drug interactions, side effects, Zolopent.

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Original language: Ukrainian

9. MEDICINES

 
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Peculiarities of the gastroesophageal reflux disease treatment with lack of effectiveness of proton pump inhibitors

S. M. Tkach

Ukrainian Research and Practical Centre of Endocrine Surgery,
Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukrain, Kyiv
The article describes the main reasons for the lack of effectiveness of proton pump inhibitors (PPIs) in patients with gastroesophageal reflux disease (GERD) and basic methods to improve their effectiveness. To optimize the GERD treatment, especially in case of the insufficient efficacy of the PPI standard doses, it is advisable to use extensively the combined drugs, capable to ensure effective and prolonged control of intragastric pH, such as proton pump PPIs with immediate release (Ezolong), which also provides more rapid symptomatic effect.

Keywords: gastroesophageal reflux disease, proton pump inhibitors, combined drugs.

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Original language: Russian

10. MEDICINES

 
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The small intestine bacterial overgrowth syndrome at chronic pancreatitis: causes and consequences

N. B. Gubergrits1, O. M. Agibalov2, N. V. Byelyayeva1, A. Ye. Klotchkov1, K. Yu. Linevska3, P. G. Fomenko1

1 Donetsk National Medical University, Lyman
2 VitaCenter, Zaporizhzhya
3 O. O. Bogomolets National Medical University, Kyiv
The article presents analysis of incidence and pathogenesis of bacterial overgrowth syndrome at chronic pancreatitis. The data of own researches and results of evidence-based investigations of this problem have been presented. A special attention is paid to the treatment. Rifaximin (Alfa Normix) proved to be the most effective drug in the treatment of bacterial overgrowth syndrome. The advantages of this medicinal product have been described, and reasonability of its administration have been grounded.

Keywords: bacterial overgrowth syndrome, chronic pancreatitis, frequency, diagnosis, treatment, rifaximin.

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1.    Ambrosova T. M. Metabolichnyi syndrom: adypokinova teoriia patohenezu // Aktualni problemy suchasnoi medytsyny: Visnyk ukrainskoi medychnoi stomatolohichnoi akademii. — 2013. — T. 13, ¹ 4. — S. 215 — 220 (³n Ukr).
2.    Babak O.Ya., Kolesnikova O. V., Shut I. V. Vzaiemozviazok mizh vmistom adyponektynu, vistseralnoho zhyru ta polimorfnym henom ADIPOR1 u khvorykh na nealkoholnu zhyrovu khvorobu pechinky // Suchasna hastroenterolohiia. — 2012. — ¹ 5. — S. 7 — 12 (³n Ukr).
3.    Babak O.Ya., Fadieienko H. D., Frolov V. M. ta in. Pokaznyky syndromu «metabolichnoi» intoksykatsii u khvorykh na nealkoholnyi steatohepatyt, poiednanyi z khronichnym nekalkuloznym kholetsystytom, pry zastosuvanni kombinovanoi terapii // Suchasna hastroenterolohiia. — 2012. — ¹ 1. — S. 19 — 24 (³n Ukr).
4.    Bychkova N. A., Gorelova L. A., Dymova O. I. i dr. Rol’ duodenal’nogo zondirovaniya v diagnostike patologii gepatobiliarnoi sistemy // Vestnik sovremennoi klinicheskoi meditsiny. — 2011. — T. 4, prilozhenie 1. — S. 13 — 15 (³n Rus).
5.    Horbatiuk I. B., Khukhlina O. S., Rusnak-Kaushanska O. V. ta in. Klinichna ta morfolohichna kharakterystyka khronichnoho kholetsystytu ta kholesterozu zhovchnoho mikhura u khvorykh na ishemichnu khvorobu sertsia ta ozhyrinnia // Ukrainskyi medychnyi almanakh. — 2012. — T. 15, ¹ 2 — S. 39 — 42 (³n Ukr).
6.    Huberhrits N.B, Fomenko P. H., Lukashevych H. M. ta in. Efektyvnist «Kholiveru» v likuvanni khvorykh z kholesterozom zhovchnoho mikhura na tli ozhyrinnia // Suchasna hastroenterolohiia. — 2012. — ¹ 1. — S.48 — 67 (³n Ukr).
7.    Zhuravleva L. V. Bobronnikova L. R. Mekhanizmy formirovaniya metabolicheskikh narushenii u patsientov s khronicheskim beskamennym kholetsistitom i nealkogol’noi zhirovoi degeneratsiei pecheni / L. V. Zhuravleva, L. R. Bobronnikova // Suchasna gastroenterolog³ya. — 2012. — ¹ 2: — S. 49 — 56 (³n Rus).
8.    Il’chenko A. A., Dolgasheva G. M. Ozhirenie kak faktor riska nealkogol’noi zhirovoi bolezni zhelchnogo puzyrya (kholetsistosteatoza, steatokholetsistita) // Eksperiment. i klin. gastroenterol. — 2010. — ¹ 8. — S. 80 — 93 (³n Rus).
9.    Isaeva E. N. Rasprostranennost’ metabolicheskogo sindroma v neorganizovannoi populyatsii s uchetom razlichnykh kriteriev ego diagnostiki // Kazanskii meditsinskii zhurnal. — 2012. — T. 92, ¹ 3:– S. 517 — 519 (³n Rus).
10.    Kovalenko V. M., Talaieva T.V, Kozliuk A. S. Metabolichnyi syndrom: mekhanizmy rozvytku, znachennia yak faktora sertsevo-sudynnoho ryzyku, pryntsypy diahnostyky ta likuvannia // Ukrainskyi kardiolohichnyi zhurnal. — 2013. — ¹ 5. — S. 80 — 87 (³n Ukr).
11.    Korneeva E. V. Rol hrelyna y leptyna v rehuliatsyy massû tela u patsyentov s metabolycheskym syndromom // Vestnyk novûkh medytsynskykh tekhpolohyi. — 2014. — T. 21, ¹ 1. — S. 36 — 39 (³n Rus).
12.    Stepanov Yu.M. Hastroenterolohichna dopomoha naselenniu Ukrainy: Osnovni pryntsypy zdorovia ta resursy zabezpechennia u 2011 rotsi // Hastroenterolohiia. — 2013. — ¹ 1 (48). — S. 8 — 11 (³n Ukr).
13.    Tytov V. N. Leptyn y adyponektyn v patoheneze metabolycheskoho syndroma // Klynycheskaia medytsyna. — 2014. — ¹ 4. — S. 20 — 29 (³n Rus).
14.    Kharchenko N. V. Na puti ser’eznykh preobrazovanii gastroenterologicheskoi sluzhby v Ukraine // Zdorov’ya Ukra¿ni. — 2008. — ¹ 19. — S. 7 (³n Rus).

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11. MEDICINES

 
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Clinical efficacy of ursodeoxycholic acid at non-alcoholic steatohepatitis

S. M. Tkach1, A. E. Dorofeev2

1 «Ukrainian Research and Practical Centre of Endocrine Surgery,
Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine, Kyiv»
2 O. O. Bogomolets National Medical University, Kyiv
Non-alcoholic fatty liver disease (NAFLD) is probably the most common chronic liver disease (CLD) in the world, which, moreover, has a strong tendency to increase in prevalence. An open, randomized, comparative trial with concurrent control group was performed to investigate the effectiveness of UDCA treatment (Ursofalk) in patients with non-alcoholic steatohepatitis (NASH) of various origins. The study involved As a whole, 60 patients were examined and treated (36 men, 24 women) with obesity (body mass index > 30 kg/m2, 42 patients) and/or type 2 diabetes (18 patients) aged 26 to 62 years (mean age 48 ± 13 years); BMI 33.6 ± 5.2 kg/m2, with non-alcoholic steatohepatitis due to NAFLD. The diagnosis of NASH was established on the basis of identification of patients at multimodal ultrasound (routine ultrasound + doppler + elastography + liver steatometriya), held on the ultrasonic apparatus Sonius P7 company Ultrasign, hepatic steatosis and its extent, moderate hepatomegaly, biochemical signs of cytolysis (hypertransaminasemia with primary increase in ALT, increasing the ratio ALT/AST above 1.0) and/or cholestasis with negative serological markers of viral hepatitis B, C, D, and autoimmune hepatitis, alcohol abuse and lack of receiving hepatotoxic drugs. NAFLD is frequent pathology, and the cause of the the majority chronic diffuse liver diseases, the relevance of this problem is not in doubt. If the simple hepatic steatosis has a benign course in the most cases, NASH is characterised with hepatocytes injury, liver inflammation and fibrosis, that can result in liver cirrhosis, insufficiency and hepatocellular cancer. «Ursofalk» is an effective, safe and pathogenetically grounded hepatoprotective preparation, providing significant clinical and biochemical effects at NASH (decrease of steatosis, hepatomegaly, hyperenzymemia) as well as cholesterol-lowering effect. With the continuation of the «Ursofalk» administration, its clinical and biochemical course increases, testifying the necessity of its more prolonged intake in combination with the constant modifying effects on the risk factors of NFALD.

Keywords: non-alcoholic steatohepatitis, ursodeoxycholic acid.

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Original language: Russian

12. Reviews

 
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Mechanisms of damage in patients with gastroesophageal reflux disease and concomitant coronary heart disease

T. A. Solomentseva, I. E. Kushnir, V. M. Chernova

SI «L.T. Mala National Therapy Institute of NAMS of Ukraine», Kharkiv
The article presents basic mechanisms of inflammatory and destructive lesions of the esophageal mucosa in patients with GERD in conjunction with coronary artery disease (CHD). The pathophysiological role of endothelial dysfunction in the progression of GERD in patients with CHD has been considered. The expediency of inclusion of drugs, improving endothelial function, in the standard schemes of GERD treatment in patients with comorbid pathology as the promotes reducing of the damage of esophageal mucosa endothelium, thus preventing the disease progression and development of GERD complications.

Keywords: gastroesophageal reflux disease, coronary heart disease, endothelial dysfunction, inflammatory mediators, approaches to therapy.

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13. Original researches

 
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Non-alcoholic fatty liver disease and physical activity: the effects of exercise training on intrahepatic lipid content

V. A. Chernyshov1, L. V. Bogun2

1 SI «L. T. Mala National Therapy Institute of NAMS of Ukraine», Kharkiv
2 Vasyl Karazin Kharkiv National University
The review is devoted to the problem of relationship between physical activity and one of the most common liver disorders in western society, non-alcoholic fatty liver disease, from the standpoint of the effects of exercise training on the intrahepatic lipid levels. The pathological conditions and factors promoting the lipids’ accumulation in liver have been considered. Methods of modulation of the intrahepatic fat levels, including the long-term physical exercise training and acute physical exertion have been discussed. The mechanisms involved in the hepatic lipid metabolism as well as effects of exercise training on them have been summarized, and data of the clinical and experimental researches to investigate these mechanisms have been presented.

Keywords: exercise training, insulin tissue sensitivity, lipid metabolism, non-alcoholic fatty liver disease.

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Original language: Russian

14. CLINICAL CASE STUDIES

 
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Endocrine masks of abdominal syndrome: the visceropathic form of primary hyperparathyroidism (case study)

N. S. Havrylyuk

Ivano-Frankivsk National Medical University
This case study shows a rare isolated visceropathic form of primary hyperparathyroidism (PHPT) caused by parathyroid adenoma, with a predominance in the clinical picture of abdominal syndrome with an acute and chronic abdomen. The acute abdomen was manifested by severe attacks of acute pancreatitis, strangely enough recurring without any provoking food-related factors. Under the guise of acute pancreatitis, which was difficult to discern from severe renal colic, hypercalcemic crisis developed. The chronic abdomen was manifested by persistent painful continuously recurrent pancreatitis progressing abnormally in association with micro nephrolithiasis with primary signs of kidney failure. This observation was considered as peculiar due to the diagnosis establishment at the primary examination of a patient: absence of typical bone injury and preserved mineral bone density, confirmed by densitometry. The article contains a detailed analysis of diagnostic markers of the visceropathic PHPT form  and the differential diagnosis of common conditions with similar clinical picture and accompanied by hypercalcemia.
Significance of the case study and obtained data. 1. The symptomatic visceropathic PHPT form can occur in isolation without typical bone lesions (osteoporosis, cysts, epulis). 2. The main indicators of the presumed visceropathic PHPT form are: a) combined co-morbid gastroenterological pathology in association with kidney damage; b) atypical and progressive pancreatitis, urolithiasis or peptic ulcer; c) rapid and severely progressive anamnesis. 3. The diagnostic attempts of a medical practitioner in case of hypercalcemia should proceed from the understanding that its main cause is neoplasia of various origins. This involves the following steps: a) the revision of the amount of calcium preparations, administered to patient,  including antacids; b) determining parathyroid hormone and gastrin levels; c) PHPT (parathyroid adenoma) exclusion; d) MEN-syndrome exclusions; d) exclusions of carcinoid or endocrine cancer of different localization (breast, prostate, intestine). 4. Hypercalcemic crisis can occur under the mask of acute pancreatitis and/or severe protracted renal colic. 5. Early diagnosis and prompt treatment of PHPT lead to rapid reversibility of the clinical picture, prevent the occurrence of complications and early disability and significantly improve the quality of life of patients. 6. Determination of calcium level in the blood in patients over 45 years old  should be added to mandatory screening examinations like cholesterol or C-reactive protein. This will increase awareness and alertness of physicians and significantly change the epidemiology of PHPT, increase the chances for the timely diagnostics and treatment of PHPT on its early stage.

Keywords: primary hyperparathyroidism, hypercalcemia, hypercalcemic crisis, pancreatitis, abdominal syndrome.

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Original language: Ukrainian

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