Russian Consensus “Hyperammonemia in Adults” (Version 2021)

Justification Given the large number of reports on the peculiarities of liver lesions during the Sars-Cov-2 infection [1], a team of experts who participated in the 23rd Congress of the Scientific Society of Gastroenterologists of Russia and 15 National Congress of Therapists of November 19, 2020 decided to make additions to the Russian Consensus of “Hyperammonemia in Adults” published early 2020 [2, 3].

European Registry on the management of Helicobacter pylori infection (Hp-EuReg): analysis of 2360 patients receiving first-line therapy in Russia

AIM

European Registry on the management of Helicobacter pylori infection («Hp-EuReg») - a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group, conducted in 27 European countries in order to evaluate the real clinical practice of diagnosis and treatment of H. pylori and its comparison with international recommendations.

MATERIALS AND METHODS

The analysis of 2360 patients entered in the register by the Russian centres of «Hp-EuReg» in 2013-2017, who were underwent 1st line eradication therapy.

RESULTS

The most common methods of primary diagnosis of H. pylori are histological (37.7%), rapid urease test (29.2%) and serology (29.7%). The duration of eradication therapy in 9.4% of cases was 7 days, in 65.3% - 10 days, and in 25.3% - 14 days. To control the effec- tiveness of treatment, H. pylori antigen in feces (31.3%), urea breath test (23.4%) and histological method (23.3%) were used. In 3.6% cases was used serology by mistake. In 17.3% of patients control was not carried out. The effectiveness of triple therapy with a PPI, amoxicillin, clar- ithromycin (per protocol) was 67.6%, with 7-day course, 81.1% at 10-day and 86.7% at 14-day course. Eradication rate of triple therapy with addition of bismuth (per protocol) reached 90,6% in the group receiving 10-day scheme and 93.6% in the group receiving the 14-day treatment.

CONCLUSION

Significant deviations of clinical practice from expert recommendations, most pronounced at the stage of monitoring the effectiveness of therapy, were noted. The suboptimal efficacy of triple therapy is shown.

[European registry Helicobacter pylori (Hp-EuReg): how has clinical practice changed in Russia from 2013 to 2018 years]

The multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group (EHMSG) is conducted in 27 countries in Europe. The data from the Russian part of the European registry for the management of Helicobacter pylori infection (European Registry on the management of Helicobacter pylori infection, protocol: "Hp-EuReg") allows us to analyze the real clinical practice of diagnosis and treatment of H. pylori and compare it with international recommendations.

MATERIALS AND METHODS

A comparative analysis of the data entered in the register by the Russian research centers "Hp-EuReg", in the period from 2013 to 2018, was conducted.

RESULTS AND DISCUSSION

Invasive diagnostic methods prevail for the primary diagnosis of H. pylori [histology - 20.3% (in 2013 year) - 43.9% (in 2018 year), rapid urease test - 31.7% and 47.8% respectively]. The most popular mode of eradication therapy is a 10-day triple therapy (62.8-76.2%), the effectiveness of which does not exceed 79% (per protocol). Invasive tests (histology) are the leading method for control the effectiveness of therapy, however, there is a tendency towards a wider use of non-invasive methods (H. pylori stool antigen - from 17% in 2013 to 29.3% in 2018 and urea breath test from 6.9 to 18.3%, respectively). Serological test to control the effectiveness of eradication is still used from 8.2% (2013) to 6.1% (2018). Eradication therapy was not performed in 28% of patients throughout the entire observation period.

CONCLUSION

In Russia, despite approved domestic and international recommendations, deviations in clinical practice persist, both during eradication therapy and in monitoring the effectiveness of eradication therapy.

Gastroesophageal reflux disease: current views and prospects

This review presents a detailed definition of gastroesophageal reflux disease (GERD) and data on its prevalence, etiological and pathogenetic factors. The clinical picture of the disease, its clinical “masks” and complications including Barrett’s oesophagus and oesophageal carcinoma are discussed. Various diagnostic methods, such as oesophagofibroscopy, targeted biopsy, morphological studies, multichannel 24 hr pH-metry, etc. are considered. Classifications of GERD is presented with special reference to the original clinico-pathogenetic classification developed by one of the authors. The effectiveness of modern methods of GERD pharmacotherapy and surgical treatment is discussed.

[Gastroesophageal reflux disease: current views and prospects]

This review presents a detailed definition of gastroesophageal reflux disease (GERD) and data on its prevalence, etiological and pathogenetic factors. The clinical picture of the disease, its clinical “masks” and complications including Barrett’s oesophagus and oesophageal carcinoma are discussed. Various diagnostic methods, such as oesophagofibroscopy, targeted biopsy, morphological studies, multichannel 24 hr pH-metry, etc. are considered. Classifications of GERD is presented with special reference to the original clinico-pathogenetic classification developed by one of the authors. The effectiveness of modern methods of GERD pharmacotherapy and surgical treatment is discussed.

[Characteristics of a combined course of duodenal ulcer and gastroesophageal reflux disease]

Duodenal ulcer (DU) and gastroesophageal reflux disease (GERD) are often combined. A combination of these wide-spread diseases invariantly effects their pathogenesis, clinical manifestations, diagnostics, and requires correction of methods of their treatment. The authors observed 41 patients suffering from DU combined with GERD (main group) and 25 patients with DU alone (control group). A higher level of intragastral acidity with cardial "acidification", more prominent disturbances in duodenal, gastral and esophageal motor activity leading to duodenal spasm, duodenogastral and gastroesophageal reflux (DGR; GER) were found in the main group. Heartburn as the main clinical sign of GERD appears, as a rule, only in the presence of reflux-esophagitis (RE) confirmed by morphological study of bioptats from the lower part of esophagus independently of an endoscopic form of GERD, positive or negative. In cases of combined duodenal ulcer and GERD certain signs of disturbances in psychoemotional and vegetative spheres were revealed, such as hypochondrial changes, moderate changes in cerebral hemodynamics (vertebrobasilar basin). Administration of eglonil, an atypical neuroleptic with prokinetic activity, as part of complex treatment leads to reduction and/or disappearance of heartburn, DGR, GER, morphological signs of RE, and improvements in the psychoemotional and vegetative status in patients with combined DU and GERD, as well as improvement in quality of life.

[Efficacy of the drinking magnesium-calcium sulfate mineral water in the combined treatment of duodenal ulcer comorbid with gastroesophageal reflux]

Thirty patients with duodenal ulcer in remission running in combination with gastroesophageal reflux disease (GERD) were divided into two groups. Patients of group 1 received medication (omeprasol 20 mg twice a day, motilium 10 mg 3 times a day) and mineral water Klyuchi (200 ml 3 times a day). Patients of group 2 received the same medication but no mineral water. The efficacy of the treatment was assessed by the data obtained at esophagogastroduodenofibroscopy, morphological study of gastric and esophageal biopsies, 24-h pH-metry of the esophagus and the stomach. The results suggest that the addition of mineral water Klyuchi to standard medication of GERD shortens correction of clinical, endoscopic and morphological manifestations of the disease.