No 33 (2014)

The paper contains a review of the literature data concerning the demographic, clinical, laboratory, genetic, immunohistochemical, endoscopic, and imaging features with a potential role of prognostic factors for clinical management of patients with Crohn’s
disease.

The practical guidelines on diagnosis and management of hepatorenal syndrome, which could be useful for general medical practitioners, gastroenterologists, and hepatologists, are considered in this paper. Selected recommendations are based on integrated clinical data, international recommendations and results of clinical trials. Beginning from theoretical grounds of hepatorenal syndrome (its definition, diagnostic criteria, and classification), acute kidney injury, and spontaneous bacterial peritonitis, the paper contains diagnostic algorithms (in particular, in ascites, for early revealing hepatorenal syndrome), and main approaches to therapy and prevention. The efficacy criteria and monitoring rules for the terlipressin-based therapy are listed.

The article presents most recent data on antibiotic-associated intestinal disorders. The author reviews epidemiology and causative microorganisms in antibiotic-induced diarrhea and pseudomembranous colitis as well as clinical variants of antibiotic-associated disorders. Diagnosis methods are decribed at length with special attention to most sensitive and informative tests. Treatment of different clinical variants of antibiotic-induced disorders is discussed in detail.

Background: The frequent coexistence of gastroesophageal reflux disease (GERD) with functional dyspepsia (FD) and an irritable bowel syndrome (IBS) has been described in the literature. Aim: To study the specific features of GERD clinical course and diagnosis in patients with GERD in combination with FD and constipation predominant IBS (IBS-C) in comparison to patients with isolated GERD; to assess the efficacy of lactulose and itopride hydrochloride. Materials and methods: A total of 60 patients with GERD, FD (Rome criteria III), and IBS-C (Rome criteria III) and 29 patients with isolated GERD were examined. GERD diagnosis was based on clinical, endoscopic, and pH-metric criteria. For 4 weeks 10 patients with combination of non-erosive reflux disease (NERD), FD and IBS-C received lactulose monotherapy and other 10 patients received combination of lactulose with itopride hydrochloride. Clinical symptoms and pH-metric parameters were assessed before and 4 weeks after treatment. Results: Combination of GERD, FD and IBS-C was noted more frequently in women under 40 with normal body mass index (р<0.05). Classic GERD symptoms were absent in 43.4% of patients with gastrointestinal comorbidity and in 10.3% of patients with isolated GERD (р=0.004). A higher prevalence of belching and nausea was found in patients, suffering from GERD, FD and IBS-C, than in those with isolated GERD (р<0.05). After 4-week lactulose and itopride hydrochloride treatment all the patients with GERD, FD and IBS-C showed a reduction of clinical symptoms (p<0.05) and normalization of pH-metric parameters (р<0.001). Conclusion: GERD course in patients with concomitant FD and IBS-C has the following peculiarities: predominance of women, absence of classic GERD-symptoms in almost half of these patients, and frequent combination with other functional symptoms. Combination therapy with lactulose and itopride hydrochloride enables successful control of GERD and FD symptoms as well as esophageal pH normalization.

Background: Over the past decade, the epidemiology of Clostridium difficile infection has shown a remarkable increase in incidence in both hospital and community settings. Up to the last time, inappropriate antibiotic usage was considered as the main cause of the infection. The growth of morbidity and mortality rate of C. difficile infection is partly due to the worldwide dissemination of new and more virulent C. difficile strains, and is associated with increase in severity and related health care costs. Aim: To study the prevalence of C. difficile infection in the department of gastroenterology. Materials and methods: The prevalence of C. difficile infection in patients with gastrointestinal diseases with diarrheal syndrome who has not received antibiotics within the previous 6 months was investigated. The studied group included 238 diarrheal patients with an inflammatory bowel disease, chronic pancreatitis with excretory pancreas insufficiency, and several other diseases. To identify C. difficile infection, A and B toxins in patients’ stool were determined using immunochromatography method. Results: The prevalence of C. difficile infection in the group studied was found to be 39.1% and didn’t significantly differ from that of patients with different diseases (ulcerative colitis – 37.2%, Crohn’s disease – 31.6%, chronic pancreatitis – 36.2%). After etiotropic therapy, complete resolution of diarrhea was obtained in majority of patients, none of them tested positive for A and B toxins. Conclusion: Taking into account high frequency of C. difficile infection in diarrheal patients in department of gastroenterology authors recommend mandatory detection of C. difficile toxins in all hospitalized patients with diarrhea in gastroenterology, therapeutic, surgical departments. 

The paper presents a case of Crohn’s disease with isolated jejunum involvement, which exemplifies the difficulty in diagnosing this condition. The clinical picture was characterized by iron-deficiency anemia and hypoproteinemia, while other typical symptoms were absent. The late diagnosis, delayed pathogenetic therapy administration led to multiple jejunum stenosis, complicated by partial small bowel obstruction.