No 40 (2015)

Rationale: According to prognosis made by World Health Organization experts, by mid-21st century gastrointestinal disorders will be among the leaders, partially due to lifestyle of a modern man (stress, unhealthy diet, lack of physical exercise, unhealthy habits), environmental pollution, genetically modified and low quality foods.
Aim: To provide informational support of activities aimed at improvement of organization of medical care to patients with gastrointestinal disorders and at further development of specialized gastroenterological care to the population of the Moscow Region, its better availability and higher efficacy and quality.
Materials and methods: We calculated and analyzed gastrointestinal morbidity in 2014 (according to referrals) among the main age categories (children, adolescents, adults) of the population of the Moscow Region, as well as hospitalization rates and in-hospital mortality. The information was taken from the Federal Statistical Surveillance report forms # 12 and # 14.
Results: In 2014, the highest prevalence of gastrointestinal disorders was registered in adolescents, being by 42.7% higher than that in adults and by 11.7% higher than that in children. The leading causes of referrals in all age categories were gastritis and duodenitis, as well as gall bladder and bile tract disorders. The structure of morbidity was characterized by a high proportion of pancreatic disorders, stomach and duodenal ulcers in adults. The rate of hospitalizations due to gastrointestinal disorders was 17.8 cases per 1000 patients, being 17.4‰ in adults and 19.8‰ in children and adolescents. The main reasons for hospitalization in adults were diseases of pancreas (23.9% of all hospitalization due to gastrointestinal disorders), gall bladder and bile tract disorders (16.3%). In children and adolescents, the main reasons for hospitalizations were intestinal disorders (36.4%), gastritis and duodenitis (17.9%). In-hospital mortality from gastrointestinal disorders in adults was 3.3%, in children, 0.02%.
Conclusion: The statistical data obtained, as well as the results of the analysis of organization, quality and efficacy of medical care to patients with gastrointestinal disorders can be used for improvement of gastroenterological care at all levels and further development of this service in the region.

Background: Chronic pancreatitis is characterized by an imbalance of pro-inflammatory and anti-inflammatory cytokines, reflecting the presence of chronic systemic inflammation. The functional state of microbial-tissue complex of the intestine determines the severity of chronic systemic inflammation. Restoration of normal microbial-tissue complex functioning of the intestine reduces the severity of inflammatory changes in the pancreas.
Aim: To study clinical efficacy of combination of chronic pancreatitis through correction of the functional state of intestinal microbial-tissue complex.
Materials and methods: The analyzed patient sample included 117 patients with uncomplicated chronic pancreatitis and moderate pain syndrome, moderate exocrine and endocrine, with their mean age of 43.9 ± 11.6 years (men, 40.9 ± 13.5 years and women, 48.6 ± 11.7 years). Patients with chronic pancreatitis were divided into 2 groups, with the Results: After combination therapy of chronic pancreatitis with the agent for correction of the functional state of intestinal microbial-tissue complex, there was a significant (p < 0.05) reduction in the representation of pathogenic and conditionally pathogenic microflora, with a significant increase in the primary intestinal flora, as well as a decrease in cytokines TNF-α (74.32 ± 11.22 ng/ml before treatment, 31.34 ± 8.92 ng/ml after treatment) and IL-1β (25.32 ± 4.36 ng/ml before treatment, 10.52 ± 3.52 ng/ml after treatment), a significant decrease in cortisol (456.53 ± 68.99 nmol/ml before treatment, 382.61 ± 60.24 nmol/ml after treatment). The significant improvement of metabolic abnormalities was associated with positive clinical dynamics and improvement of quality of life.
Conclusion: Treatment strategies in chronic pancreatitis should include agents restoring the functioning of intestinal microbial-tissue complex and positively affecting metabolic and hormonal milieu.

Aim: To evaluate retrospectively the efficacy and safety of entecavir in treatment-naïve patients with hepatitis B viral infection.
Materials and methods: Based on patient medical documentation, we analyzed the results of clinical, virologic and instrumental assessment of 36 patients with chronic hepatitis B, 6 of whom were HBeAg-positive, and 1 had a highly active progression of acute hepatitis B. Duration of entecavir therapy (at a dose of 0,5–1 mg daily) was 48 weeks.
Results: In most patients with chronic hepatitis B, treatment with entecavir, regardless of the HBeAg status, promoted a virologic response (94.4%) and HBeAg serum conversion with anti-HBe formation (83.3%), which was associated with a clinical improvement, normalization of liver enzyme activity, reduction of liver fibrosis by 1 point (assessed by fibroelastometry). There were no changes in serum HBsAg during the antiviral therapy. A clinical case of successful entecavir therapy of hepatitis B viral infection is presented.
Conclusion: Entecavir is a highly effective and reliable agent that can suppress viral replication in various forms of acute and chronic hepatitis B viral infection. A relatively rapid recurrence of viral replication after withdrawal of the drug justifies further research to optimize treatment of chronic hepatitis B.

The article describes opportunities and results of laparoscopic oesophagocardiomiotomy and laparoscopic transhiatal oesophagus removal without hand assistance in esophageal achalasia (cardiospasm). In total, such operations were performed in 196 and 31 of cases (of 423 patients), respectively. There were minimal numbers of relapses (below 2.3%) after laparoscopic oesophagocardiomiotomy done by the proposed technique. All cases of reflux esophagitis were diagnosed after esophagocardiomiotomy with Dor fundoplication.
After cardiodilatation, disease relapses were registered in 57% of patients. The advantages of a laparoscopic access for oesophagectomy are shown and technical particular of this intervention are analyzed based on a case history. The principles of Fast track surgery in this patient category are discussed that allow for reduction of the length of hospital stay by 40%.

Background: Optimization of the size of the surgical access exerts a positive effect on recovery dynamics. The size of median laparotomy in operations for small bowel obstruction is usually determined without consideration of specifics of the abdominal cavity anatomy of the patient. Aim: To improve the results of treatment of patients with acute small bowel obstruction by adapting the parameters of the median laparotomy to constitutional characteristics of the patient.
Materials and methods: The results of treatment of 101 patients with acute small bowel obstruction were analyzed. In 49 patients of the group I, laparotomy was performed with the newly developed method to determine the size of laparotomy. Fifty two patients of the group II were treated at the time when the method was still in the process of development. To identify optimal parameters of the laparotomy, we performed anatomical experiments in 90 cadavers with dolicho-, mesoand brachymorphic constitution. Results: During the anatomical experiments, we found that in individuals with dolychomorphic constitution, the average depth of the abdominal cavity amounted to 58.07% of the distance between the upper anterior iliac spines, in those with mesomorphic body build, this parameter was 42%, and in individuals with brachymorphic constitution, 37.67% of this distance. Based on the analysis of surgical accessibility parameters, we found that the optimal length of median laparotomy in individuals with dolichomorphic body build was 63.877% of the distance between the front upper iliac spines, in mesomorphic ones, 46.2%, and in brachymorphic, 41.437% of this distance. The described method of determination of the surgical incision length was applied in 49 patients from the group I. The average size of laparotomic incision was 121.74 ± 10.4 mm. The use of the proposed method for determination of the length of surgical incision allowed for reduction of the mean duration of hospitalization from 13.32 ± 3.4 to 10.02 ± 2.1 hospital days. On average, patients from group I could defecate without stimulation one day earlier than those from group II, with abdominal pain intensity being much lower.
Conclusion: A differentiated approach to laparotomy depending on the constitution of a patient with acute small bowel obstruction allows to reduce operational trauma and improve the recovery dynamics.

Until now, surgery is a standard  treatment strategy in liver trauma. However, continuous evolution and  improvement of imaging  and  interventional techniques open  a wide perspective  for conservative  management of liver trauma  patients. In the recent years, this method is getting  more and   more widely used  and becomes  a component of the standard  care protocols for patients  with liver trauma in tertiary centers.