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Digestive diseases, chronic gastritis with erosions being one of them, are common in elderly patients. Helicobacter pylori infection is one of the etiopathogenetic factors of chronic gastritis. Eradication therapy is currently considered one of the main treatments and prophylaxis of H. pylori infection. However, the increase in the duration of eradication therapy leads to an increase in the frequency of side effects, especially in the gastrointestinal tract, as well as the risk of cardiotoxicity which results in a decrease in the patient's compliance with therapy.The aim of the study was to evaluate the effectiveness of H. pylori eradication in the treatment of chronic gastritis with erosions using azithromycin and amoxicillin.Material and methods. A clinical and endoscopic examination of 134 patients with chronic gastritis with erosions associated with H. pylori was carried out. Depending on the treatment regimen, all patients were divided into 2 groups. The first group consisted of patients who received azithromycin for 5 days and amoxicillin for 10 days, omeprazole 2 times a day for 14 days, then once daily for 4 weeks, De-Nol for 28 days. In the second group, patients received clarithromycin and amoxicillin for 14 days, omeprazole 2 times a day for 14 days, then once daily for 4 weeks, De-Nol for 28 days. Control studies were conducted 6 weeks after the end of drug administration.Results. Abdominal and sternal pain, dysphagia, nausea, heartburn, vomiting, bloating, stool disorders — diarrhea or constipation — were the predominant complaints in the elderly patients. Assessment of the local effectiveness of the applied eradication regimens allows the select of the most effective and safe therapyregimens.Conclusion. Given the short course of administration of azithromycin (5 days) and (10 days), these drugs can be used in patients with low adherence to treatment, as well as for prevention of complications caused by antibiotics in elderly patients who are constantly taking medications for other diseases.

Objective. To compare efficacy and safety of 14-day triple eradication therapy with the addition of methylmethionine sulfonium chloride and a probiotic complex and 14-day triple eradication therapy boosted with bismuth tripotassium dicitrate and a probiotic complex in a prospective comparative randomized clinical trial. Materials and Methods. A total of 70 patients with confirmed H. pylori infection were enrolled into the study. The first group (n = 35) received esomeprazole 20 mg 2 bid, clarithromycin 500 mg bid and amoxicillin 1000 mg bid for 14 days, methylmethionine sulfonium chloride 300 mg once a day for 1 month, probiotic complex (bifidobacteria [Bifidobacterium longum CBT BG7, Bifidobacterium lactis CBT BL3, Bifidobacterium bifidum CBT BF3], lactobacilli [Lactobacillus acidophilus CBT LA1, Lactobacillus rhamnosus CBT LR5], Streptococcus thermophilus CBT ST3) 1 capsule once a day for 1 month. The second group (n = 35) received esomeprazole 20 mg 2 bid, clarithromycin 500 mg 2 bid, amoxicillin 1000 mg 2 bid and bismuth tripotassium dicitrate 240 mg 2 bid for 14 days, probiotic complex (bifidobacteria [Bifidobacterium longum CBT BG7, Bifidobacterium lactis CBT BL3, Bifidobacterium bifidum CBT BF3], lactobacilli [Lactobacillus acidophilus CBT LA1, Lactobacillus rhamnosus CBT LR5], Streptococcus thermophilus CBT ST3) 1 capsule once a day for 1 month. Eradication of H. pylori was assessed using stool antigen test. Results. Eradication rates for the first and second groups in the intent-to-treat (ITT) population were 77.1% and 88.6% (p = 0.205), respectively. In the per-protocol (PP) population, eradication rates were 81.8% and 96.9% (p = 0.051), respectively. Adverse events were reported in 34.3% of patients in the first group and 34.3% of patients in the second group (p = 1). Conclusions. 14-day standard triple therapy boosted with bismuth tripotassium dicitrate and a probiotic complex demonstrates high efficacy and safety profile, and therefore can be recommended as first-line therapy for H. pylori infection in adults.

Aim: to analyze current approaches to H. pylori eradication therapy in adults and present the materials of Experts Council held on December 9, 2022 in Moscow.General statements. H. pylori infection is the main etiological factor of gastritis, peptic ulcer, and gastric cancer. Eradication of H. pylori is recognized as a necessary measure to reduce the incidence of these diseases. The approaches to selecting an eradication regimen should be optimized to take into account epidemiological trends and achieve better treatment outcomes. The updated Maastricht VI Consensus Report presents the means to overcome the difficulties in selecting an approach to the treatment of H. pylori infection. However, eradication therapy remains challenging due to adverse events (primarily antibiotic-associated diarrhea), poor treatment tolerance and patient compliance. Eradication therapy can be optimized by supplementing treatment regimens with strain-specific probiotics that reduce adverse events, improve patient compliance and eradication rates, such as Saccharomyces boulardii CNCM I-745 strain with established efficacy.Conclusion. The inclusion of certain probiotics in eradication regimens improves treatment tolerance, reduces the risk of adverse events, improves patient compliance and eradication rates.

The purpose of the research is to test different dehelminthization schemes of laboratory rats infected with cestodes Rodentolepis nana and nematodes Syphacia muris and evaluate the significance of combined environment disinfection measures. The practical experience of eradication (helminth eradication) in animals in a conventional vivarium was described.Materials and methods. Experiments were conducted to study the efficacy of anthelmintics and administration schemes against cestode and nematode infections in laboratory rats. In the first experiment, praziquantel was used at a dose of 10 mg/kg to treat rats infected with R. nana. In the second experiment, the comparative efficacy of fenbendazole, albendazole, and pyrantel was evaluated against syphaciosis at the recommended dosages of 20, 10, and 12.5 mg/kg, respectively. Each drug was given orally, individually, twice with an interval of 7 days. The third experiment tested different schemes for treating syphaciosis with fenbendazole. One group of rats was given the drug orally individually using an esophageal tube at a dose of 20 mg/kg once a day for 7 consecutive days. Other groups were given fenbendazole daily with food for 7 days (150 mg fenbendazole per 1 kg of food). In all three experiments, all animals were divided into groups, and their cells underwent a complex of additional disinfection measures, and those kept in cages without disinfection.Results and discussion. Praziquantel showed 100% efficacy at a single dose of 10 mg/kg in R. nana therapy. In animals without additional disinfection procedures, cestode eggs were again recorded starting from day 14 after the drug administration. In the group of animals with disinfection measures, pathogens were not detected during the experiment. Double administration of fenbendazole, albendazole and pyrantel in the recommended dosages against syphaciosis did not result in eradicated nematodes in the animals. The disinfection did not affect the obtained results. Fenbendazole administered daily for 7 days ensured helminth eradication in animals. However, on day 7 after the therapy, Syphacia sp. eggs were again found in the groups that received the drug individually intragastrically through a tube, regardless of whether their cells were disinfected. The animals that received fenbendazole with food and were regularly disinfested remained free from nematodes throughout the experiment until the additional disinfection measures were cancelled. In the absence of disinfection, released helminth eggs were recorded on day 14 after therapy.

Background. First-line therapy does not always provide a high level of Helicobacter pylori eradication due to the increase of H. pylori resistance to antibiotics; therefore, it remains necessary to identify the most effective rescue treatments. The purpose of this study was to evaluate the efficacy and safety of empirical H. pylori furazolidone-containing regimens. Materials and methods. Adult H. pylori infected patients empirically treated with furazolidone-containing eradication regimens were registered in an international, prospective, multicenter non-intervention European registry on H. pylori management (Hp-EuReg). Data were collected at AEG-REDCap e-CRF from 2013 to 2021 and the quality was reviewed. Modified intention-to-treat (mITT) effectiveness analyses were performed. Results. Overall 106 patients received empirical furazolidone-containing therapy in Russia. Furazolidone was prescribed in a sequential scheme along with amoxicillin, clarithromycin and a proton pump inhibitor in 68 (64%) cases, triple regimens were prescribed in 28 (26%) patients and quadruple regimens in 10 (9.4%). Treatment duration of 7 days was assigned to 2 (1.9%) patients, 10-day eradication therapy in case of 80 (75%) and 14 days in 24 (23%) patients. Furazolidone was mainly used in first- (79%) and second-line (21%) regimens. The methods used to diagnose H. pylori infection were: histology (81%), stool antigen test (64%), 13C-urea breath test (6.6%), and rapid urease test (1.9%). The mITT effectiveness of sequential therapy was 100%; 93% with the triple therapy and 75.5% with quadruple therapy. Compliance was reported in 98% of cases. Adverse events were revealed in 5.7% of patients, mostly nausea (3.8%). No serious adverse events were reported. Conclusion. Furazolidone containing eradication regimens appear to be an effective and safe empirical therapy in Russia.

The new Maastricht VI/Florence Consensus clarifies a number of provisions that were previously under discussion. It has been postulated that Helicobacter pylori infection always causes gastritis, regardless of symptoms or complications. Before making a convincing diagnosis of functional dyspepsia, it is necessary to exclude Helicobacters gastritis. Some provisions of the consensus, such as the test and treat tactic, require elements of a critical attitude, taking into account Russian regional conditions. About 90% of stomach cancers are due to H. pylori. Eradication of H. pylori makes it possible to prevent gastric cancer at any age in adulthood, but the effectiveness of such cancer prevention decreases with age. Bismuth quadruple therapy is preferred in the eradication therapy algorithm. Decreased value of triple treatment with clarithromycin. There is a rapid increase in H. pylori resistance to fluoroquinolones. Triple therapy with rifabutin is called the final eradication protocol.

The aim of our study was to evaluate the clinical performance of a monotherapy by Enterococcus faecium-based probiotics and indigenous autoprobiotics against H. pylori associated dyspepsia. Materials and methods. There were examined 95 patients with dyspepsia. The entire patient cohort underwent clinical evaluation including filling out the questionnaire to assess dyspepsia symptoms before and after treatment, gastric endoscopy as well as gastric multi-focal biopsy (gastric body and gastric antrum) and verification of H. pylori infection with the three clinical laboratory methods (biochemical, bacteriological and molecular detection). An antagonistic in vitro activity of probiotics against H. pylori was detected by drop plate method for probiotic strains Enterococcus faecium SF68 and Bifidobacterium bifidum (Bifiform), Enterococcus faecium L3 (Laminolact), and autoprobiotic strains combined with indigenous Enterococcus faecium. To examine an antagonistic activity of probiotics and autoprobiotics in clinical trials, we used a starter culture based on the Enterococcus faecium L3 strain and an autoprobiotic based on indigenous Enterococcus faecium. The probiotic or autoprobiotic were administered orally to patients with gastritis twice a day at dose of 50 ml (8.0 lgCFU/ml) for 20 days. H. pylori eradication was assessed by stool antigen test 1.52 months after the end of treatment. Results. Initially the H. pylori infection was confirmed with 49.4% of patients. The sensitivity of H. pylori to the probiotics was detected in 81% of individuals for indigenous Enterococci (the autoprobiotic), 76% for Laminolact, and in 62% for Bifiform. 22 patients with previous history of allergic reactions to antibiotics used in routine H. pylori eradication regimens were divided in two cohorts. One cohort (10 patients) received the autoprobiotic only, another cohort (12 patients) received only probiotic. Monotherapy with autoprobiotic resulted in 100% H. pylori eradication, single-agent therapy with probiotic led to 60% eradication of H. pylori. Dyspepsia symptoms were completely resolved in both groups of patients. Conclusion. Our research demonstrated the sensitivity of examined H. pylori strains to be similar for traditional eradication treatment agents (antibiotics) and the proposed intervention agents (probiotics and autoprobiotics). An autoprobiotic monotherapy with indigenous enterococci led to higher levels of H. pylori eradication than with E. faecium L3-based probiotic agent. Our work demonstrated advantage for application of probiotics in patients with antibiotic allergies or other obstacles for the standard eradication therapy. Nonetheless, further investigation to better understand underlying mechanisms of action, as well as larger observational and randomized studies, are necessary to determine the scope of therapeutic application for probiotics and autoprobitics to eradicate H. pylori infection.

Porcine Reproductive Respiratory Syndrome (PRRS) causes significant economic losses in pig production around the world. The virus is highly contagious and spreads both by aerosol and with all biological secretions, and the disease itself is characterized by fever, weight loss and abortion of fetuses. This swine disease is relatively new, for the first-time clinical signs were described in 1986, and in 1991 the pathogen was isolated. The main problems hindering the fight against the virus currently remain: the insufficient effectiveness of existing vaccines, the high genetic variability of the pathogen, the ability of PRRSV to suppress the host's immune system, and long-term virus carriers in recovered animals. The review on porcine reproductive and respiratory syndrome presents data on the genetic diversity of virus strains that differ in the degree of virulence and pathogenicity, sources of infection and ways of transmission of the virus. The article also contains data on the spread of PRRS in the world and in Russia. It is noted that the disease has been reported in many swine-producing countries, where, after a phase of active spread, the disease became endemic. And in 2021, according to the to the International Epizootic Bureau (OIE), outbreaks of PRRSV were detected in domestic pigs in Ecuador, Uruguay, Nepal, China, Bahrain, Switzerland and Ukraine, as well as in wild boars in Bahrain, Switzerland and Ukraine. According to the published data of monitoring studies conducted in the period from 2012 to 2017, only single territorially limited outbreaks were detected in Russia. Earlier studies indicate a wide distribution of the PRRS pathogen in Russia. The effectiveness of various variants of live and inactivated vaccines is described in detail, and it has been established that live attenuated vaccines are most effective against PRRS. The features of the protection of the territory of a number of states (Norway, Sweden, Finland, Switzerland) from the introduction of the pathogen, which by now remain free from PRRS, as well as the experience of Hungary in the eradication of the disease, are analyzed. All preventive measures in the pig farm in case of detection of the virus should include general, veterinary-sanitary and special measures, for diagnosis it is better to use modern RT-PCR test systems that allow distinguishing PRRS genotypes, in combination with serological tests, and for vaccination choose a registered and approved vaccine based on the genetic characteristics of the pathogen circulating in the area.

Aim. To perform a meta-analysis of the data on Rebamipide efficacy and safety as a part of Helicobacter pylori eradication therapy in Russian patients. Materials and methods. A search for original studies was conducted in the electronic database of the Russian Science Citation Index (RSCI) on the Scientific Electronic Library (SEL Elibrary.ru). Google (Google.com) was used for the "grey" search. All Russian controlled studies comparing the efficacy and/or safety of Rebamipide as a part of the regimen of H. pylori eradication therapy were included in the final analysis. Results. In 6 included controlled trials with a cumulative population (considering double comparisons between multiple groups) of 531 patients (273 in Rebamipide groups and 258 in groups without Rebamipide), the pooled eradication effectiveness was 90.376% (95% confidence interval CI 86.31193.560) in patients receiving Rebamipide and 81.681% (95% CI 76.49986.141) in patients receiving eradication regimens without Rebamipide. The meta-analysis showed that the Rebamipide addition to eradication regimens significantly improved efficacy (odds ratio 2.162, 95% CI 1.2683.685; p=0.005). No significant heterogeneity was found between study results (p=0.863; I2=0.00%); therefore, a fixed effects model was used in the resulting analysis. In addition, the meta-analysis of included studies showed a reduction of adverse events (odds ratio 0.569, 95% CI 0.3330.970) in the groups receiving Rebamipide; p=0.038). This effect of Rebamipide deserves special attention and requires additional study, as the result was at the border of statistical significance in the subanalysis of three studies with a large margin of risk reduction in one of them (with the largest sample of patients). Conclusion. The present meta-analysis demonstrated that the Rebamipide addition to H. pylori eradication regimens significantly improves the treatment effectiveness in the Russian patient population.

In this review, current methods of treating Helicobacter pylori bacterial infection are discussed. H. pylori is one of the most common pathogens causing gastrointestinal discomfort. It is considered a major cause of peptic ulcer disease, stomach and duodenal cancer, and MALT lymphoma. The authors analyzed the results of clinical studies regarding the efficacy of various treatment regimens, such as quadruple therapy, triple therapy, therapy with probiotics, therapy with the addition of phytochemical compounds, and therapy with a single drug. In addition, indications for eradication therapy were discussed. The conclusions of the review indicate the need for an individualized approach to the treatment of H. pylori infection, taking into account the rapidly increasing antibiotic resistance and patient risk factors for eradication.

The purpose of the research is identifying patients with helicobacteriosis and opisthorchosis, and determining regular features of the course of combined diseases.Materials and methods. The study involved 50 patients in the Gastroenterology Department with helicobacteriosis diagnosed. Helicobacter pylori was confirmed by the HP test during fibrogastroduodenoscopy. Opisthorchis felineus was detected in patients using the study of feces by the Kato technique and enrichment method. The patients were divided into 2 groups of 25 people each. The first group only consisted of patients with H. pylori. The second group consisted of patients in whom H. pуlori and O. felineus were identified. Initially, the levels of aminotransferases and bilirubin were assessed using a biochemical blood test on a MIURA 200 apparatus. The manifestation of such clinical symptoms as abdominal pain was assessed using a visual analogue scale (VAS). Further, the eradication of H. pylori during therapy was assessed based on the Maastricht V recommendations for 14 days, including the use of three drugs: omeprazole at a dose of 20 mg 2 times a day, clarithromycin – 500 mg 2 times a day, amoxicillin – 1000 mg 2 times a day, and the effectivity of treatment of patients of the second group with opisthorchosis with the use of praziquantel at a dose of 60 mg/kg of body weight during the day three times every 4 hours.Results and discussion. In the second group of patients with combined pathology, pain intensity was estimated at 4–5 scores in 20 people (80%), and at 2–3 scores in 25 people (100%) in the first group. The severity of nausea was also higher in 100% of patients in the second group. Values for AST and ALT in blood were higher in patients of the second group – by an average of 50–100% in 18 people (72%); increase in the level of bilirubin by 15% in 23 people (92%). Combined pathology (opisthorchosis and helicobacteriosis) is accompanied by more pronounced clinical symptoms (abdominal pain and nausea). In patients with opisthorchosis and H. pуlori, aminotransferases increased up to three reference values and bilirubin increased by 15% were noted. For helicobacteriosis and opisthorchosis, longer treatment was required. The presence of H. pylori at the same time with opisthorchosis did not affect the efficacy of antiparasitic therapy.

Aim. Systematization of data on the efficacy and safety of butyric acid inclusion in eradication therapy (ET) regimens for Helicobacter pylori infection. Methods. Research searches were carried out in the electronic databases MEDLINE/PubMed, EMBASE, Cochrane, Google Scholar, the Russian Science Citation Index (RSCI) until November 2020. All controlled studies comparing the efficacy and/or safety of including butyric acid in ET regimens for H. pylori infection were included in the final analysis. Results. The meta-analysis included 6 controlled studies (1 Italy, 5 Russia) involving 736 patients (381 in the ET groups with butyric acid; 355 in the comparison groups). The pooled eradication efficiency in the butyric acid groups was 90.23% (95% confidence interval CI 86.73493.069), while in the comparison groups it was 65.69% (95% CI 60.44170.669). Meta-analysis showed that the addition of butyric acid to ET regimens significantly increased the eradication efficiency (odds ratio OR 5.355, 95% CI 3.5048.184; p0.001). There was no significant heterogeneity between results (p=0.1408; I2=42.1%). The addition of butyric acid to ET regimens significantly reduces the risk of diarrhea (OR 0.225, 95% CI 0.09230.549; p=0.001; I2=34.21%) and abdominal distention (OR 0.357, 95% CI 0.1550.818; p=0.015; I2=80.13%) by the end of the 1st week of treatment. Conclusion. The present meta-analysis demonstrated that the inclusion of butyric acid in ET regimens for H. pylori infection significantly increases the effectiveness of treatment and reduce the incidence of side effects. Apparently, the increase in the effectiveness of eradication is due to an increase in patient compliance with treatment due to an improvement in the safety profile of therapy.

Helicobacter pylori infection is a common bacterial infection in humans and is associated with peptic ulcer disease and chronic gastritis. The presence of natural resistance to some antibiotics in bacteria, as well as the appearance of primary and secondary resistance to antibacterial agents, complicates treatment and determines the search for new methods of therapy. The aim of this study was to evaluate the efficacy and safety of 10-year complex treatment of patients with duodenal ulcer associated with H.pylori , 136 patients (96 men, 40 women; mean age 45.8 14.8 years; 18-65 years). H.pylori was determined morphologically and by rapid urease test one day before the start of therapy, after 1, 6, 12 months, 2 years, 5 and 10 years. Patients of the first group received basic therapy: omeprazole 0.02 g 2 times a day, clarithromycin 0.5 g 2 times a day, amoxicillin 1 g 2 times a day, for 10 days (OCA group 1; n = 98). Patients of the second group, in addition to the basic therapy, took 1 mg per day drug Liсopid (group 2 OСAL; n = 38). At the 1st stage of the clinical study, 130 patients completed eradication therapy. Tracking completeness was 96 %. The frequency of H.pylori eradication after per protocol treatment: OCA - 83 % (95 % CI: 75 %-91 %), OCAL - 97 % (95 % confidence interval (CI): 92 %-100 %). The incidence of adverse reactions after treatment (per protocol): OCA - 26 % (95 % CI: 17-35 %; nausea; n = 24), discontinued treatment - 5 % (95 % CI: 0.8 %-10 %; diarrhea; n = 5); OCAL - 3 % (95 % CI: 0.01 %-8 %; nausea; n = 1), all were treated. Taking the drug Liсopid 1 mg (glucosaminyl muramyl dipeptide, JSC Peptek, Russia) as part of complex therapy contributed to the elimination of H.pylori and the absence of relapses for 2 years. Observation of patients in the next 5 and 10 years also showed the advantage of including the immunomodulator in therapy: a significant 15 % decrease in H.pylori reinfection (P 0.05), a 23 % decrease in the frequency of gastrointestinal adverse reactions (P0.01), compared with a 10-day standard triple regimen without immunomodulatory therapy with glucosaminylmuramyl dipeptide. When using several antibiotics in H.pylori eradication therapy, not only pathogenic, but also commensal microorganisms are destroyed, the waste products of which are vital and maintain immune homeostasis, including through the NOD2 receptors of innate immunity. The effectiveness of the complex therapy of H.pylori infection can be explained by the fact that the drug Liсopid compensates for the signal for innate immunity receptors that is missing due to the absence of commensals, providing an adequate immune response and preventing chronicity and recurrence of infection.

Abstract: The authors have analyzed research works, both by domestic and foreign researchers that dwell on frequency of H.pylori being resistant to antibacterial medications, the reasons for its occurrence, methods applied to determine it and ways to overcome it. Over the last 15 years there has been a growth in frequency of detecting H.pylori that was resistant to basic antibiotics used to eradicate the pathogen. The authors have established geographical diversity in resistance related to antibiotics intake by population. Bacteriological technique is the most valid for determining H.pylori sensitivity; however, it is rather difficult to apply it due to complicated procedures for the microorganism cultivation. Therefore, molecular-genetic techniques are widely used. H.pylori resistance to Clarithromycin has great practical significance as this antibiotic is able not only to produce antibacterial effects but also to destroy biofilms. Helicobacter that was resistant to Clarithromycin was the least frequently detected in northern European countries (1–3%); it was the most frequently detected in Southern Europe, Asia, and South America (30–40%). Research performed in several Russian regions revealed significant variations in frequency of detecting H.pylori resistant to Clarithromycin (5–40%) and a growth in dynamics of this detection (from 5 to 15%). Frequency of detecting helicobacter resistance to another widely used medication, Metronidazole, is also different in different geographic regions; it amounts to 17% in Europe, 24% in Russia, and 92% in Africa. H.pylori still has low resistance to Amoxicillin and another reserve medication, Rifabutin. The article also dwells on probable ways to overcome non-sensitivity of the pathogen to antibiotics and the necessity to develop procedures for treating H.pylori infection based on the results of examining the pathogen sensitivity with standardized techniques performed in different regions. Efficient H.pylori eradication reduces inflammation in the gastric mucosa, prevents ulcer formation and atrophy and reducers risks of stomach cancer.

A significant mortality rate from infectious diseases is largely mediated by the widespread and uncontrolled use of antibiotics, which has led to the emergence of drug-resistant strains of bacteria. The rapid evolution of bacterial resistance to antimicrobials is a serious challenge for modern health care, mediates the need to create new antibiotic agents, as well as to intensify the study of molecular mechanisms underlying the formation of microorganism resistance. One of these mechanisms is bacterial persistence, manifested by the formation of persistent cells in the culture, which are a phenotypic variant of the isogenic population. The persistence of bacteria can occur spontaneously, regardless of exposure to antimicrobials or environmental reasons, such as lack of nutrients, oxidative stress or hypoxia. This small cell subpopulation is able to maintain viability even in the presence of antimicrobial agents at concentrations many times higher than therapeutic. The presence of persistent cells of pathogenic bacteria in the host organism reduces the effectiveness of antibiotic treatment, not due to the genotypic drug resistance of the microorganism, but due to the presence of phenotypic resistance of persister cells. The difference is fundamental, since cell-persisters are insensitive to any antibiotics and the development of fundamentally new antimicrobial strategies is necessary for their eradication. Persister cells are phenotypic variants of the maternal culture of bacteria that are present in all populations of microorganisms, and after the onset of favorable conditions, they are able to reclaim and form a new generation of vegetative bacteria. This review discusses modern concepts of the molecular genetic mechanisms of bacterial persistence with an emphasis on their clinical significance for the occurrence of persistent infections, and discusses innovative technologies for the eradication of resistant cell forms of microorganisms.

European recommendations for eradication of Helicobacter pylori are presented. The increase of the resistance to clarithromycin requires the necessity of rational use of quadritherapy as the first line treatment and sequential therapy including drugs active against the pathogen with low resistance. New treatment regiments for patients with allergy to penicillin are recommended.

Objective. To assess efficacy and safety of 14-day triple nifuratel-based therapy compared to 14-day standard triple therapy in adult patients with symptomatic H. pylori infection. Materials and Methods. A total of 70 patients with dyspepsia and microbiologically confirmed H. pylori infection were enrolled into the open-label, randomized, comparative clinical trial. The study group (n = 35) received a 14-day triple nifuratel-based therapy: esomeprazole (20 mg BID), nifuratel (400 mg BID) and amoxicillin (1000 mg BID). The comparator group (n = 35) received 14-day conventional clarithromycinbased triple therapy: esomeprazole (20 mg BID), clarithromycin (500 mg BID) and amoxicillin (1000 mg BID). Eradication of H. pylori was assessed using stool antigen test. Results. Eradication rates for 14-day nifuratel-based triple therapy and 14-day clarithromycin-based triple therapy in the intent-to-treat (ITT) population were 82.9% and 74.3% (p = 0.561), respectively. In the per-protocol (PP) population, eradication rates were 90.6% and 89.7% (p = 1.00), respectively. Adverse events were reported in 17.1% of patients in the study group and 34.3% of patients in the comparator group (p > 0.05). Conclusions. The 14-day triple nifuratel-based therapy has demonstrated a high H. pylori eradication rate (above 90%). Nifuratel triple therapy may be considered as an alternative to clarithromycin-based triple therapy for patients with a history of the prior macrolide exposure or macrolide intolerance.

Low patient compliance due to the development of adverse events in the form of antibiotic-associated diarrhea (AAD) is considered as the main reason for the failure of the eradication of optimized anti-Helicobacter therapy regimens. A key mechanism for the development of AAD is to reduce the number and species diversity of bacteria that form butyric acid. Aim. The purpose of this study was to study the comparative effect on the clinical effectiveness of eradication therapy (ET) of Helicobacter pylori infection and metabolic changes in the colon microbiota of additional inclusion in the optimized treatment regimen of the combined prebiotic Zakofalk (inulin + butyrate) with probiotics (lacto- and bifidobacteria in an amount of at least 1017 СFU). Materials and methods. 120 patients with chronic gastroduodenal diseases and infected H. pylori were еxamined. A comparative analysis of the effect of a combined prebiotic and lacto-bifid-containing probiotics on improving the effectiveness of the optimized ET scheme and improving its tolerability, as well as on the quantitative and qualitative content of short-chain fatty acids (SFA) in feces. The success of eradication was controlled by a 13C urease breath test. Results. According to the results of the study in randomized groups of patients, an excellent percentage of eradication (95%) was achieved in patients who performed ET with the addition of the prebiotic Zakofalk. In the same group of patients, there was an increase in the absolute content of SFA and a significant increase in the concentration of butyric acid. In the group of patients who received ET with the addition of probiotics, an acceptable level of eradication was achieved (85.7%), but no changes in SFA were found indicating an increase in the number or activity of the butyrate-producing flora. Patients who performed ET without the addition of pre-probiotics did not achieve the target percentage of successful eradication (83.3%), and a significant quantitative decrease in SFA was found with a significant decrease in the proportion of butyric acid. Conclusion. The inclusion of Zakofalk in the ET scheme, in comparison with probiotics, significantly increases the probability of successful eradication, more effectively restores the metabolic potential of the microbiota, and prevents the development of AAD.

Russia is a country with a high prevalence of Helicobacter pylori (HP) infection, a high incidence of gastric cancer, and its late diagnosis. HР infection has been recognized as the leading manageable risk factor for gastric cancer. Accurate diagnostic tests must be used to identify and control the effectiveness of HP eradication, and effective schemes must be implemented for HP eradication. The aim of this article was to analyze the latest consensus documents, systematic reviews and meta-analyzes that reflected the role of HP as a risk factor for the development of gastric cancer, as well as measures for the risk reduction. We describe in detail the diagnostic methods for HP infection, provide data on their use in the Russian Federation, and analyze the efficacy of eradication regimens. In all HPinfected individuals, HP leads to chronic inflammation in the gastric mucosa and launches a precancerous cascade (Correa's cascade). The risk of gastric cancer increases with severe atrophy, intestinal metaplasia and dysplasia. Primary prevention of gastric cancer is most effective if the eradication is performed before atrophic gastritis develops. The available consensus documents underline the importance of HP infection identification by accurate diagnostics at this stage of chronic gastritis. In Russia, the primary HP diagnosis is based on histology (37.7%), rapid urease test (29.2%), and serology (29.7%). HP stool antigen test (31.3%), 13C-urea breath test (23.4%) and the histological method (23.3%) are most often used to control eradication. Currently, the first line of eradication therapy is recommended as triple therapy with clarithromycin prescribed for 14 days. It is recommended to use double dose of proton pump inhibitors and bismuth to increase the effectiveness of this scheme. A 14-days triple regimen enhanced by bismuth has been recommended as the first-line therapy in the Russian Federation.

Effective eradication of Helicobacter pylori infection is an important means to reduce the risk of precancerous changes in the gastric mucosa and prevention of gastric cancer. A search for non-invasive diagnostic tools for Helicobacter pylori infection, evaluation of the effectiveness of eradication remains of high importance.The aim of the study was to assess an informative value of detecting pepsinogen I and II as well as serum antibodies to Helicobacter pylori while assessing an efficacy of treated chronic Helicobacter gastritis and identifying preneoplastic changes in the stomach mucosa. There enrolled 113 male patients with chronic gastritis aged 41 to 76, average age- (56.7±0.7) years. Examination of patients was carried out at admission to the clinic, as well as at 2 and 12 months after administering a standard eradication therapy. It was found that Helicobacter pylori infection was detected in 101 (89.4%) patients. Groups of patients with effective eradication therapy were noted. A time-dependent level of antibodies to Helicobacter pylori, as well as measured concentration of pepsinogen I and II after the onset of eradication treatment were determined. Which were analyzed in connection with the results of histology examination of gastric mucosa biopsy specimens and expression of oncoproteins Ki-67, Bcl-2, c-erbB-2, p16 in the gastric mucosa depending on efficacy of eradication therapy. It is shown that effective eradication therapy was characterized by significantly decreased serum level of IgG antibodies to Helicobacter pylori 2 months after the onset of treatment. Moreover, a significantly decreased pepsinogen II and serum IgG antibodies to Helicobacter pylori during eradication therapy were accompanied by a significant decrease in Ki-67 expression in the gastric epithelium. Decreased concentration of pepsinogen II within the first year after Helicobacter pylori eradication therapy was due to a greater decrease in activity of inflammatory changes in the gastric mucosa than to dynamic changes in gastric atrophy and metaplasia. An inverse relation between the serum level of pepsinogen I and atrophy as well as intestinal metaplasia within the gastric mucosa were found.

Aim. To evaluate an association of genetic polymorphisms CYP2C19, MDR1, and IL-1β on the eradication rate by 10-day modified therapy in patients with H. pylori - associated diseases. Materials and methods. In this study was conducted a prospective, randomized trial, included 89 patients with H. pylori - associated diseases. They were divided into 2 groups depending on therapy: clarithromycin 500 mg, b.i.d., amoxicillin 1000 mg, b.i.d., bismuth subcitrate 240 mg, b.i.d. rabeprazole 20 mg or 40 mg, b.i.d. for 10 days. All subjects underwent pharmacogenetic testing of CYP2C19, MDR1, and IL-1β. Results and discussion. Per - protocol (PP) eradication rates in group with rabeprazole 40 mg were 97.6% (41/42; 95% CI 87.7-99.6), in group with rabeprazole 20 mg were 82.1% (32/39; 95% CI 67.3-91.0). Intention - to - treat analysis in group with rabeprazole 40 mg eradication rates were 89.1% (41/46; 95% CI 77.0-95.3), in group with standard dose rabeprazole - 74.4% (32/43; 95% CI 59.8-85.1). No significant differences in eradication rates between the groups of ultrarapid, rapid, normal and intermediate CYP2C19 metabolizers (PP: 93.5%/90.3%/84.6% respectively; χ2=0.87, p=0.65). Eradication rates in group with IL-1β CC genotype there was no difference among the IL-1β CT and TT genotype groups (PP: 92.9%/85.7%/94.7% respectively; χ2=1.34; p=0.51). The cure rate among MDR1 TT genotype was significantly lower than among subjects in the MDR1 CC/CT genotype groups (PP: 76.2% vs 96.3%: χ2=5.04; p=0.025; OR=8.13). Conclusion. Ten - day modified triple therapy with high dose rabeprazole significantly high eradication rates in patients with H. pylori - associated diseases. Independent factor for treatment failure is MDR1 CC/CT genotype status.

Functional dyspepsia (FD) is one of the most common gastroenterological diseases. The article presents modern views on the pathogenesis of the disease. It is shown that disorders of motor skills (retardation of voiding function, disturbance of relaxation accommodation) and stomach sensitivity (visceral hypersensitivity to stretching) are considered to be one of the main pathophysiological mechanisms of FD. The authors present a modern algorithm of treatment of patients with FD, based on the clinical recommendations of the Rome Consensus IV revision (2016) and the Russian Gastroenterological Association (2017). The strategy of differentiated use of pharmaceuticals for different variants of FD is considered.

Introduction. The prevalence of H. pylori infection has declined in recent years. However, the processes of population migration offset this difference, and the decline in the rate of distribution of H. pylori has recently slowed down. In addition, the frequency of unsuccessful eradication has sharply increased in many countries due to the resistance to antibiotics. In Ukraine, according to the Center of Medical Statistics of Ukraine, the incidence of peptic ulcer over the same period has increased by 38.4% and has no tendency to decrease, and the prevalence of the duodenal peptic ulcer has reached 150 cases per 100 thousand population. Even the intensive introduction of new treatment programs, despite their benefits, does not significantly change the general rates of morbidity and hospitalization of this patient’s contention. Aim. To find out the effectiveness of treatment of the patients with duodenal peptic ulcer and the need for their retreatment since the introduction of the Maastricht Consensus. Materials and methods. A retrospective analysis of the efficacy of treatment of the duodenal ulcer of the patients (age – 17-72 years, average age 43.9 ± 1.3 years, 2 191 (63.60%) men and 1 255 (36.40%) women), has been carried out over the 10 years since the introduction of the Maastricht Consensus provisions into the clinical practice. Results. It was showed that the re-hospitalisation frequency among the patients with duodenal peptic ulcer did not change. The frequency of repeated referrals due to the unsuccessful eradication in this category of patients increased significantly (20.72 % in 1996 vs. 38.82 % in 2006; p < 0.01) as well as the percentage of the reinfected patients (5.80 % in 1996 vs. 24.71 % in 2006). An analysis of the age composition of patients showed that the percentage of reinfecting in individuals aged 60 and over was recorded in 11.50% of cases, at the age of 20-59 (the most able-bodied age) 16.20% of the patients were reinfected. The smallest number of reinfected was recorded in the group of the patients under the age of 19 (5.62%). No difference was noticed in gender composition between the reinfected patients and the patients who requested the treatment repeately after the unsuccessful eradication. In the most working capable part of Lviv region population every third patient with duodenal peptic ulcer requested the repeated treatment during a year. Conclusions The prevalence among the patients of working age of the duodenal peptic ulcer and the resistance of the helicobacteric infection to antibacterial agents requires a comprehensive study and the adoption of appropriate management decisions in various spheres of life.

Purpose of the study. To evaluate the effectiveness and safety of the use of rebamipide as part of the triple eradication therapy (ET) scheme of Helicobacter pylori infection. Materials and methods. A prospective, randomized comparative study included 94 patients with uncomplicated H. pylori-associated stomach / duodenal ulcer. In the process of randomization, patients are divided into three groups depending on the intended therapy. The first group (n=36) received a classical triple scheme of the first-line ET (omeprazole 20 mg twice a day, amoxicillin 1000 mg twice a day, clarithromycin 500 mg twice a day) for 10 days. Patients of the second group (n=33) were assigned a classical triple scheme of ET with the inclusion of rebamipide (omeprazole 20 mg twice a day, amoxicillin 1000 mg twice a day, clarithromycin 500 mg twice a day, rebamipide 100 mg 3 times a day day) for 10 days. Patients of the third group (n=25) were assigned a classical triple scheme of ET with the inclusion of rebamipide (omeprazole 20 mg twice a day, amoxicillin 1000 mg twice a day, clarithromycin 500 mg twice a day, rebamipide 100 mg 3 times a day) in for 10 days, with the prolongation of the administration of rebamipide for the next 20 days. The effectiveness of ET was determined by the respiratory test after 6 weeks after the end of treatment. Adverse events were recorded by patients in specially developed diaries. All patients with gastric ulcer at the 6th week underwent a histological examination of the biopsy specimens of the antrum and the body of the stomach, assessing the inflammatory activity of the process on a point system in accordance with the updated Sydney system. Results and discussion. Efficiency of H. pylori eradication in the first group was 77.7% (ITT), 82.3% (PP), in the second group - 81.8% (ITT), 84.4% (PP), and in the third group - 84% (ITT), 87.5% (PP). The use of rebamipide in the triple ET regimen was associated with an increase in H. pylori eradication efficiency, both with simultaneous use with the scheme [odds ratio (OR) 1.16; 95% confidence interval (CI) 0.32-4.24], and with subsequent prolonged admission (OR 1.5, 95% CI 0.34-6.7). A somewhat more pronounced dynamics of the epithelization of erosive and ulcerative changes in the mucous membrane of the stomach and duodenum to the 21st and 28th days in the third group of patients was noted. The incidence of adverse events between the groups was comparable: 22.2% in the first group, 24.2% in the second group and 20% in the third group. In the pathomorphological evaluation of biopsy specimens of patients with gastric ulcer at the 6th week after the treatment, significant differences were revealed between the first and third groups in terms of the inflammatory activity in the antrum stomach (2±0.63 vs. 1.4±0.52; p=0,0399). The conclusion. The inclusion of rebamipide in the classical triple scheme of H. pylori ET increases the effectiveness of treatment and does not affect the safety profile. In the post-eradication period, it is advisable to continue the use of rebamipide to potentiate the repair of the gastric mucosa and regress the inflammatory processes.

The article presents a current algorithm for treating patients with functional dyspepsia, which is based on the clinical guidelines of the Rome IV Revision (2016), the Russian Gastroenterological Association (2017), and the American and Canadian Associations of Gastroenterologists (2017). It provides evaluation of the options for eradication of Helicobacter pylori infection as one of the stages of management of patients with this functional disorder. It also discusses the strategy for differentiated use of proton pump inhibitors and prokinetics for various variants of functional dyspepsia.

The article presents the results of a pilot prospective randomized study aimed at evaluating the efficacy and safety of rebamipide (Rebagit, PRO.MED.CS Praha a.s., Czech Republic) as part of the triple therapy for helicobacter pylori (H. Pylori) eradication. 54 patients with H. pylori-associated gastric ulcer/duodenal ulcer were enrolled to the study. All patients were randomized to two therapeutic groups depending on the eradication therapy to be received. Group 1 received the standard triple therapy, Group 2 received the standard triple therapy plus rebamipide. The efficacy of H. pylori eradication in Group 1 amounted to 78,2% (ITT), 81,8% (PP), and in Group 2 to 83,8% (ITT), 86,6% (PP). Odd ratio of efficient eradication with the use of rebamipide as part of standard triple therapy for helicobacter pylori eradication was 1,44 (95 CI: 0,36–5,72). The side effect rates between the groups were comparable

Helicobacter pylori is the most common human infection. H. pylori is known to cause chronic gastritis and gastric and duodenal ulcers. However, the H. pylori-host interaction is not confined to the gastric mucosa, the mechanism responsible for the adaptation of this bacterium to the living conditions in the human body, can cause systemic immune imbalance, provoking various autoimmune reactions. The paper considers the investigations demonstrating the possible role of H. pylori as a trigger or aggravating factor in rheumatic diseases, such as rheumatoid arthritis (RA), Sjögren's syndrome and disease, systemic lupus erythematosus, and progressive systemic sclerosis. The relationship between H. pylori and autoimmune diseases is confirmed by the higher frequency of more aggressive strains of this microorganism in rheumatic diseases. There are also clinical trials showing the positive impact of H. pylori eradication on RA activity.

The article presents the results of a study aimed to evaluate the efficacy and tolerability of eradication schemes with macrolides and bismuth in the treatment of patients with Helicobacter pylori related functional dyspepsia (postprandial distress syndrome).

The aim of this work is investigation of H. pylori eradication on heart structural and geometry parameters and myocardial function at patients with coronary artery disease (CAD) and gastroenterological pathology. We studied 147 patients with CAD and gastroenterological pathology. It was stated, that H. pylori infection causes negative effect on intracardial hemodynamics and myocardial function at patients with combined pathology. We also fixed, that helicobaceriosis led to more clear myocardium remodeling and finally to cardiac insufficiency. It was shown, that eradication therapy optimized CAD symptoms by intracardial hemodynamics normalization.

The review deals with the epidemic situation for poliomyelitis in the world. It describes the strategy and tactics of the World Health Organisation aimed at realisation of Global Polio Eradication Initiative and the main phases of the Initiative. The review shows the dynamics of poliomyelitis incidence over the years in the world and in different WHO regions. The events connected with the importation of wild poliovirus of type 1 to the countries of the WHO European region (Tajikistan, Turkmenistan, Kazakhstan and Russian Federation) which had been previously certified as polio free countries are treated in detail. The review also includes the data concerning the outbreaks of acute flaccid paralysis provoked by the circulating vaccine-derived polioviruses in certain countries. These events cause serious problems on the way of Global Polio eradication.

The review deals with the current aspects of prevention of non-cardia gastric cancer (GC). Helicobacter pylori is the most common cause of non-cardia GC. The Correa cascade remains a major pattern of the pathogenesis of non-cardia GC as before. The key moments in gastric carcinogenesis are H. pylori infection; genes associated with cell recognition of bacteria; an immune response and the activation of an inflammatory response. The prevention of GC requires H. pylori eradication as primary prevention in combination with screening for this pathology as secondary prevention of gastric malignancies. Standard three-component therapy is a first-line major regimen for H. pylori eradication.

The literature review gives current views on the treatment of Helicobacter pylori infection. The rising antibiotic resistance of H. pylori in the first decade of the 21st century entailed the decreased efficiency of common eradication therapy (ET) regimens, by determining the higher interest in this problem. The paper summarizes data on the efficiency of current ET regimens in different regions of the world in the past 3 years. The prospects of alternative ET regimens are considered. The existing and promising ways of optimizing the current ET regimens are presented.

AIM: To improve the quality of eradication therapy (ET), by increasing patient compliance/MATERIAL AND METHODS: An open-label cohort multicenter randomized study was conducted. A total of 350 patients with Helicobacter pylori infection-associated diseases and indications for ET were examined. Work was done to improve compliance in a study patient group before treatment/RESULTS: In the study group of patients motivated for treatment, the efficiency of ET was significantly higher than in the control group. The factors influencing treatment adherence were identified and methods to optimize compliance during H. pylori eradication were developed/CONCLUSION: Awareness of the essence of the disease in a patient and his higher motivation for compliance are one of the components of successful H. pylori eradication.

The aim of review. To summarize and analyze main causative factors determining inefficacy of modern algorithms of antihelicobacter therapy.Key points. Efficacy of eradication therapy (ET) can depend on a lot of factors which generally can be divided in three main groups in relation to origin: factors determined by microorganism (bacteria); factors determined by macroorganism (patient); the factors determined by doctor. Hence, in clinical practice cases a single patient may have combination of several independent factors determining failure of provided treatment.Conclusion. Efficacy ET depends upon wide spectrum of heterogeneous mechanisms. For the present moment, the primary factor determining inefficacy of treatment, is increase of H. pylori antibiotic resistance to the basic drugs, applied in modes of the first line of ET.

The literature review tells about current views on the clinical and molecular aspects of antibiotic resistance of Helicobacter pylori (H. pylori). Today, the growing number of H. pylori strains resistant to the first-line regimens is considered to be the main reason of treatment failure. In the total global population, incidence of drug-resistant strains of H. pylori varies greatly across different geographic areas and correlates with the total frequency of antibiotics intake by the corresponding population. Latest global consensus recommendations regulate a differential choice strategy in selecting eradication therapy. The choice should take into account the level of resistance of H. pylori to clarithromycin, as this type of resistance has greatest clinical significance.

The article tells about current diagnostic criteria for the syndrome of functional dyspepsia; major clinical variants of the disease and the process; modern algorithm revealing the main stages of diagnosis and treatment of patients with functional dyspepsia in clinical practice. The role of eradication of Helicobacter pylori infection in multimodal treatment of functional dyspepsia is highlighted.

AIM: To evaluate the efficiency of first-line Helicobacter pylori eradication therapy with glucosаminylmuramyldipeptide (Licopid JSC "Peptek", Russia). /MATERIAL AND METHODS: Eradication therapy was performed in 128 patients (84 men and 34 women; mean age 44.1±13.5 years) with duodenal bulb ulcer associated with H. pylori. The latter was detected in the gastroduodenal mucosa by a morphological study and rapid urease test before and 6-8 weeks after treatment and discontinuation of all drugs. Gastric metaplasia areas in the duodenum were revealed by periodic acid-Schiff and Alcian blue staining. The patients were divided into 4 groups according to the treatment protocol: 1) omeprazole (O) 0.04 g/day, clarithromycin (C) 1 g/day, amoxicillin (A) 2 g/day for 7 days (ОCА7; n=33); 2) the above drugs for 14 days (ОCА14; n=34); 3) O 0.04 g/day, C 1 g/day, A 2.0 g/day for 7 days, and glucosаminylmuramyldipeptide (Licopid) (L) 0.001 g/day for a day (ОCА7L1; n=34) and 4) the above drugs and L 0.01 g/day for 10 (ОCА7L10; n=27) /RESULTS: According to the data of intention-to-treat analysis and per protocol, the H. pylori eradication rate was 81.8 and 87.1% for ОCА7; 82.4 and 93.3% for ОCА14; 88.2 and 93.8% for ОCА7L1; 88.9 and 96% for ОCА7L10 after PT and RRT, respectively. The rate of side effects was as follows: 6.1% for ОCА7; 17.6% for ОCА14 (5.9% stopped treatment); 5.9% for ОCА7L1; 7.4% for ОCА7L10. The cost of the treatment protocols was $ 32 for ОCА7; $ 64 for ОCА14; $ 40 for ОCА7L1; $ 67 for ОCА7L10. The intake of glucosаminylmuramyldipeptide (licopid) 0.001 g/day during 7-day triple anti-Helicobacter pylori therapy increased eradication by 6.4% (ITT) and 6.7% (PP), without raising the rate of side effects /CONCLUSION: Н. рylori-positive patients with duodenal bulb ulcer should be given glucosаminylmuramyldipeptide (Licopid) 0.001 g/day during 7-day first-line eradication therapy as alternative to the 14-day treatment regimen.

Pharmacological effects of immunomodulators produce normalization of immunochemical function of homeostasis. This phenomenon determines optimization of Helicobacter pylori eradication. The combination of immunomodulators with antibiotics has a double effect. Antibiotics destress the functional activity of microorganisms and increase it’s sensitivity to the effect of phagocytes. On the other hand immunomodulators increase functional activity of phagocytes to eliminate microorganizms Оptimization of Helicobacter pylori eradication by using of immunomodulators is necessary for clinical practice. It includes prophylaxis of recurrences and complications caused by drugs action on immune system in patients with chronic diseases.

The paper gives an update on the efficiency of Helicobacter pylori eradication. Triple therapy (a proton pump inhibitor + clarithromycin + amoxicillin) therapy is shown to hold top positions as first-line therapy for H. pylori eradication as before. The leading second-line therapy regimens are quadruple and 10-day triple schemes including levofloxacin. This point of view is supported by the Russian Gastroenterology Association. To reduce an increase in H. pylori resistance to clarithromycin, it is advisable to use Klacid (generic name: clarithromycin) in the eradication schemes.

Aim. To assess efficiency of esomeprazole in the treatment of duodenal ulcer (DU) associated with Hpylori in various eradication regimens. Material and methods. 80 patients with duodenal ulcer at least 0.5 cm in diameter were randomized into three groups. 23 patients of group 1, 28 patients of group 2 received esomeprazole for 7 days in a dose 20 mg twice a day, in a single morning dose 40 mg, respectively. 29 patients of group 3 received omeprazole 20 mg twice a day for 7 days and further 3 weeks 20 mg twice a day. All the patients were also given amoxicillin 1000 mg twice a day and clarithromycin 500 mg twice a day for a week. Results. An antisecretory effect of esomeprazole as shown by 24-h monitoring of gastric secretion was longer and more stable than that of omeprazole: a latent period averaged 1.5 ± 0.6 h in a pharmacological test with 20 mg esomeprazole, 1.2 ± 0.4 h in intake of 40 mg esomeprazole and 2.1 + 0.3 h in intake of 20 mg omeprazole. Overall duration of the antisecretory effect averaged 16.8 ± 1.9, 20.3 ±1.7 and 12.5 ± 1.9 h, respectively. The time of intragastric pH > 4 was 13.1 ± 1.6, 2 ± 1.6 and 9.8 ± 1.5 hours, respectively. Eradication of H.pylori in group 1, 2 and 3 was 91.3, 3 and 89.6%, respectively. Complete epithelization of ulcer occurred in 95.6, 92.8 and 93.1% cases, respectively. In 77 patients who finished the treatment according to the protocol the treatment resulted in eradication in 95.6, 92.5 and 92.8%, respectively; in epithelization - in 100, 96.3 and 96.4% patients of groups 1, 2 and 3, respectively. Side effects were mild or moderate but not causing changes of the regimen or treatment discontinuation. Conclusion. Esomeprazole in three-component treatment was highly effective in eradication of H. pylori and epithelisation of duodenal ulcer defects in various regimens of administration. Esomeprazole in combination with amoxicillin and clarithromycin reduces the time of treatment of DU associated with H. pylori to 1 week without further monotherapy with antisecretory drugs.

Background: First-line therapy does not always provide a high level of Helicobacter pylori eradication due to the increase of H. pylori resistance to antibiotics; therefore, it remains necessary to identify the most effective rescue treatments. The purpose of this study was to evaluate the efficacy and safety of empirical H. pylori furazolidone-containing regimens., Materials and Methods: Adult H. pylori infected patients empirically treated with furazolidone-containing eradication regimens were registered in an international, prospective, multicenter non-intervention European registry on H. pylori management (Hp-EuReg). Data were collected at AEG-REDCap e-CRF from 2013 to 2021 and the quality was reviewed. Modified intention-to-treat (mITT) effectiveness analyses were performed., Results: Overall 106 patients received empirical furazolidone-containing therapy in Russia. Furazolidone was prescribed in a sequential scheme along with amoxicillin, clarithromycin and a proton pump inhibitor in 68 (64%) cases, triple regimens were prescribed in 28 (26%) patients and quadruple regimens in 10 (9.4%). Treatment duration of 7 days was assigned to 2 (1.9%) patients, 10-day eradication therapy in case of 80 (75%) and 14 days - in 24 (23%) patients. Furazolidone was mainly used in first- (79%) and second-line (21%) regimens. The methods used to diagnose H. pylori infection were: histology (81%), stool antigen test (64%), 13 C-urea breath test (6.6%), and rapid urease test (1.9%). The mITT effectiveness of sequential therapy was 100%; 93% with the triple therapy and 75.5% with quadruple therapy. Compliance was reported in 98% of cases. Adverse events were revealed in 5.7% of patients, mostly nausea (3.8%). No serious adverse events were reported., Conclusion: Furazolidone containing eradication regimens appear to be an effective and safe empirical therapy in Russia.

Aim: Systematization of data on the efficacy and safety of butyric acid inclusion in eradication therapy (ET) regimens for Helicobacter pylori infection., Methods: Research searches were carried out in the electronic databases MEDLINE/PubMed, EMBASE, Cochrane, Google Scholar, the Russian Science Citation Index (RSCI) until November 2020. All controlled studies comparing the efficacy and/or safety of including butyric acid in ET regimens for H. pylori infection were included in the final analysis., Results: The meta-analysis included 6 controlled studies (1 Italy, 5 Russia) involving 736 patients (381 in the ET groups with butyric acid; 355 in the comparison groups). The pooled eradication efficiency in the butyric acid groups was 90.23% (95% confidence interval CI 86.73493.069), while in the comparison groups it was 65.69% (95% CI 60.44170.669). Meta-analysis showed that the addition of butyric acid to ET regimens significantly increased the eradication efficiency (odds ratio OR 5.355, 95% CI 3.5048.184; p0.001). There was no significant heterogeneity between results (p=0.1408; I2=42.1%). The addition of butyric acid to ET regimens significantly reduces the risk of diarrhea (OR 0.225, 95% CI 0.09230.549; p=0.001; I2=34.21%) and abdominal distention (OR 0.357, 95% CI 0.1550.818; p=0.015; I2=80.13%) by the end of the 1st week of treatment., Conclusion: The present meta-analysis demonstrated that the inclusion of butyric acid in ET regimens for H. pylori infection significantly increases the effectiveness of treatment and reduce the incidence of side effects. Apparently, the increase in the effectiveness of eradication is due to an increase in patient compliance with treatment due to an improvement in the safety profile of therapy.

Low patient compliance due to the development of adverse events in the form of antibiotic-associated diarrhea (AAD) is considered as the main reason for the failure of the eradication of optimized anti-Helicobacter therapy regimens. A key mechanism for the development of AAD is to reduce the number and species diversity of bacteria that form butyric acid., Aim: The purpose of this study was to study the comparative effect on the clinical effectiveness of eradication therapy (ET) of Helicobacter pylori infection and metabolic changes in the colon microbiota of additional inclusion in the optimized treatment regimen of the combined prebiotic Zakofalk (inulin + butyrate) with probiotics (lacto- and bifidobacteria in an amount of at least 1017 СFU)., Materials and Methods: 120 patients with chronic gastroduodenal diseases and infected H. pylori were еxamined. A comparative analysis of the effect of a combined prebiotic and lacto-bifid-containing probiotics on improving the effectiveness of the optimized ET scheme and improving its tolerability, as well as on the quantitative and qualitative content of short-chain fatty acids (SFA) in feces. The success of eradication was controlled by a 13C urease breath test., Results: According to the results of the study in randomized groups of patients, an excellent percentage of eradication (95%) was achieved in patients who performed ET with the addition of the prebiotic Zakofalk. In the same group of patients, there was an increase in the absolute content of SFA and a significant increase in the concentration of butyric acid. In the group of patients who received ET with the addition of probiotics, an acceptable level of eradication was achieved (85.7%), but no changes in SFA were found indicating an increase in the number or activity of the butyrate-producing flora. Patients who performed ET without the addition of pre-probiotics did not achieve the target percentage of successful eradication (83.3%), and a significant quantitative decrease in SFA was found with a significant decrease in the proportion of butyric acid., Conclusion: The inclusion of Zakofalk in the ET scheme, in comparison with probiotics, significantly increases the probability of successful eradication, more effectively restores the metabolic potential of the microbiota, and prevents the development of AAD.