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The key side effects of antiplatelet therapy are associated with the damage of the upper gastrointestinal tract (GIT) mucous that can lead to erosions or ulcers and specifically complicated by bleeding.To assess the upper gastrointestinal mucosal condition by endoscopic and histological methods in patients with stable coronary arteries disease receiving long-term antiplatelet therapy with gastrointestinal bleeding (GIB) history or with high risk of this complication.The study included patients from the single-center prospective registry of long-term antithrombotic therapy REGATTA-1. The gastric mucosa endoscopic examination with biopsy was performed in 20 patients with gastrointestinal bleeding history less than 1 year ago and in 24 patients without GIB, which have concomitant risk factors such as erosions and ulcers history and/or persistent dyspepsia clinical signs. The mucosal condition (erosions and ulcers) was estimated using a modified Lanz scale. The presence of Helicobacter pylori was determined by Histological verification. The inflammatory process characteristics were evaluated according to the modified Sydney classification. All participants received antithrombotic therapy at the time of esophagogastroduodenoscopy; 81.8% of patients received proton pump inhibitors.Chronic inflammation (93.2%), atrophy (59.1%), multiple erosions (45.5%) or ulcers (18.2%) were the most frequent endoscopic finding. H. pylori infection, found in mucosal samples in 90.9% of patients was one of the most important pathogenesis mechanism, which support the gastrointestinal mucosa damage.Mucosal damage endoscopic signs remains despite long-term proton pump inhibitors therapy in patients with coronary arteries disease and concomitant GIB risk factors, receiving antithrombotic therapy. H. pylori contamination may be the cause of these changes. Therefore, its active screening and eradication is necessary in such patients.Ключевые побочные эффекты антиагрегантов связаны с повреждающим действием на слизистую оболочку верхних отделов желудочно-кишечного тракта (ЖКТ) с развитием эрозий и язв, в том числе осложняющихся кровотечениями. Цель. Эндоскопическая и гистологическая оценка состояния слизистой оболочки верхних отделов ЖКТ у больных со стабильной ишемической болезнью сердца, длительно получающих антиагрегантную терапию и перенесших эпизод желудочно-кишечных кровотечений (ЖКК) либо имеющих высокий риск данного осложнения. Материалы и методы. Больные, включенные в исследование, являлись участниками одноцентрового проспективного регистра длительной антитромботической терапии РЕГАТА-1. Эндоскопическое исследование с биопсией слизистой оболочки желудка выполнено у 20 больных, перенесших эпизод ЖКК давностью менее 1 года, а также у 24 больных без ЖКК, но с сопутствующими факторами риска эрозивно-язвенным анамнезом и/или стойкими явлениями диспепсии. Оценивали состояние слизистой (эрозии и язвы) по модифицированной шкале Ланца. При гистологическом исследовании определяли наличие Helicobacter pylori, оценивали характеристики воспалительного процесса в соответствии с модифицированной Сиднейской классификацией. Все больные на момент эзофагогастродуоденоскопии получали антитромботические препараты, ингибиторы протонной помпы назначались в 81,8% случаев. Исходный скрининг и эрадикация не проводились. Результаты. Наиболее частыми эндоскопическими находками являлись: хроническое воспаление (93,2%), атрофия (59,1%), а также множественные эрозии (45,5%) либо язвы (18,2%). Важным патогенетическим механизмом, поддерживающим повреждение слизистой оболочки ЖКТ, являлась инфекция H. pylori, обнаруженная в образцах слизистой у 90,9% больных. Заключение. У больных со стабильной ишемической болезнью сердца, принимающих антитромботические препараты и имеющих сопутствующие факторы риска ЖКК, эндоскопические признаки повреждения слизистой оболочки сохраняются, несмотря на длительную терапию ингибиторами протонной помпы. В основе указанных изменений может лежать контаминация H. pylori, что указывает на необходимость активного скрининга и эрадикации возбудителя у данной категории больных.

Purpose Plasma von Willebrand factor (VWF) and D-dimer levels have been proposed as markers of endothelial damage, coagulation activation and subsequent cardiovascular events. Thrombotic and hemorrhagic burdens are closely related. However, the association of coagulation markers with bleeding complications in pts with atherosclerosis remains unclear. We aimed to assess the predictive value of D-dimer and VWF levels for upper gastrointestinal bleeding (UGIB) in patients with chronic coronary syndromes (CCS) receiving long-term antithrombotic therapy. Patients and methods Single center prospective Registry of Long-term AnTithrombotic TherApy (REGATTA-1 NCT04347200) included 934 pts with CCS (78.6% males, age 61±10.7 yrs, 76% after elective PCI). The UGIB annual incidence was 1.9 events per 100 patient-years. VWF was determined in 28 pts with UGIB and 141 controls, matched for age, sex and main clinical risk factors. D-dimer was determined from 28 and 380 pts respectively Results The median for VWF was 139 [interquartile range 107–168]%. The median for D-dimer was 443,8 [interquartile range 272.5–702.4] ng/ml. ROC analysis revealed acceptable discriminatory ability for VWF (cut off >105%; AUC=0.67, 95% CI: 0.59–0.74, p=0.001) and for D-dimer (cut off >928 ng/ml; AUC=0.63, 95% CI: 0.59–0.68, p=0.002). High levels of coagulation markers remained significant in regression model adjuster for ESC panel of UGIB risk factors. OR for D-dimer = 3.4, 95% CI: 1.09–10.66; p=0.03). OR for VWF = 11.74, 95% CI: 1.19–116.18; p=0.03). Conclusion VWF and D-dimer should be considered as valuable prognostic biomarkers to improve the prediction of UGIB in addition to well-known scoring systems in CCS patients receiving long-term antithrombotic therapy. Funding Acknowledgement Type of funding sources: None.

The article presents the results of using a combination of PPI (pantoprazole) and UDCA for the treatment of erosive esophagitis induced by mixed reflux in patients with coronary artery disease.A total of 62 patients with EGDS-proven erosive esophagitis were enrolled in the study. The patients were divided into two groups: the active treatment group (ATG) which included 34 patients with erosive reflux esophagitis and control group (CG), which included 28 patients with erosive reflux esophagitis without CAD. The patients of both groups received IPP (pantoprazole) 80 mg/day and UDCA at a dosage of 15 mg/kg/day for 12 weeks. (84 days).The study showed that complete epithelialization of esophageal mucosa defects was detected in 100% of ATG patients by Day 84 of therapy, the same was achieved in CG patients by Day 56 of the basic course of therapy.The treatment of EE induced by mixed reflux with a combination of PPI (pantoprazole) at a dose of 80 mg/day and UDCA at a dosage of 15 mg/kg/day was efficient in patients with GERD and CAD as a basic course of therapy for not less than 84 days. An effective dose of UDCA for maintenance therapy is 5 mg/kg/day in combination with PPI at a daily dose of 40 mg for not less than 2 months.

MATERIALS AND METHODS. The investigators examined 30 patients (16 men, 14 women) after gastrectomy (n = 15) or gastric resection (n = 15) who had anacidity as shown by pH-metry and the clinical and/or endoscopic signs of RE. During 4 months, Groups 1 and 2 patients received the drug in doses of 10 and 15 mg/kg/day, respectively. Maintenance treatment was performed for 2 months. The maintenance therapy group included 25 patients, including 12 patients who took Livodexa in a dose of 2.5 mg/kg/day (Group 1) and 13 patients who had 5 mg/kg/day (Group 2) during 2 months. RESULTS. Treatment with ursodeoxycholic acid (Livodexa) resulted in the significantly reduced frequency and intensity of the major symptoms of the disease (heartburn, retrosternal pain, bitter eructation), by achieving a maximum effect at 4 months of therapy. Endoscopic remission was observed in 63.3 and 83.3% of the patients at 4 and 6 months of treatment, respectively. There was a significant and steady rise in the quality of life as evidenced by a visual analogue scale. The ursodeoxycholic acid dose of 10 mg/kg was effective in patients with grade 1 RE (single erosions) while it should be increased up to 15 mg/kg in those with more significant esophageal mucosal injury (grades 2-3 RE). Some patients receiving a maintenance dose of 2.5 mg/kg/day were recorded to have recurrent reflux disease with a relapse of clinical manifestations and a morphological substrate as catarrhal esophagitis. The group of patients receiving maintenance therapy (5 mg/kg/day) retained the achieved clinical and morphological remission. CONCLUSION. The findings suggest that Livodexa is effective in patients of this category.

The analysis of combined endoscopic diagnostics with catheter confocal laser endomicroscopy (CCLE) for detection of gastric neoplasia in 103 patients is presented in the article. It was described the main principles of catheter confocal laser endomicroscopy by using of Cellvizio-system ("Mauna Kea Technologies", France). All patients underwent esophagogastroduodenoscopy before catheter confocal laser endomicroscopy. Such modes as HRE-endoscopy, NBI-endoscopy and Zoom-endoscopy were used. It was revealed different neoplastic changes of stomach mucous coat and early cancer forms of stomach in 185 cases. It was noted expediency and high informational content of CCLE which leads to detect the foci of intestinal metaplasia by colonic type, foci of dysplasia and early cancer of stomach mucous coat. The role of conventional morphological study for verification of changes detected with CCLE was shown.

To evaluate the efficiency and safety of Livodexa monotherapy in patients with reflux esophagitis (RE) after gastric resection or gastrectomy.The investigators examined 30 patients (16 men, 14 women) after gastrectomy (n = 15) or gastric resection (n = 15) who had anacidity as shown by pH-metry and the clinical and/or endoscopic signs of RE. During 4 months, Groups 1 and 2 patients received the drug in doses of 10 and 15 mg/kg/day, respectively. Maintenance treatment was performed for 2 months. The maintenance therapy group included 25 patients, including 12 patients who took Livodexa in a dose of 2.5 mg/kg/day (Group 1) and 13 patients who had 5 mg/kg/day (Group 2) during 2 months.Treatment with ursodeoxycholic acid (Livodexa) resulted in the significantly reduced frequency and intensity of the major symptoms of the disease (heartburn, retrosternal pain, bitter eructation), by achieving a maximum effect at 4 months of therapy. Endoscopic remission was observed in 63.3 and 83.3% of the patients at 4 and 6 months of treatment, respectively. There was a significant and steady rise in the quality of life as evidenced by a visual analogue scale. The ursodeoxycholic acid dose of 10 mg/kg was effective in patients with grade 1 RE (single erosions) while it should be increased up to 15 mg/kg in those with more significant esophageal mucosal injury (grades 2-3 RE). Some patients receiving a maintenance dose of 2.5 mg/kg/day were recorded to have recurrent reflux disease with a relapse of clinical manifestations and a morphological substrate as catarrhal esophagitis. The group of patients receiving maintenance therapy (5 mg/kg/day) retained the achieved clinical and morphological remission.The findings suggest that Livodexa is effective in patients of this category.

Endoscopic procedures were used for diagnosis and treatment of cancer of major duodenal papilla (MDP) at 31 patients. Gastroduodenoscopy (with visual assessment) and endoscopic retrograde cholangiopancreatography were performed at all the patients. Morphological study of tissue sampling permitted to confirm preliminary visual diagnosis only in half of patients. Detection of x-ray symptoms and bile passage disorders at retrograde cholangiopancreatography were high informative. All the patients underwent endoscopic papillosphincterotomy which was effective at 26 (83.9%) patients.

To study efficacy of Helicobacter pylori (Hp) eradication (different schemes) depending on the age of patients with Hp-associated duodenal ulcer (DU).A total of 182 patients with Hp-associated exacerbated DU (101 males and 81 females) participated in the trial. The patients were divided into three groups according to their age: group 1 (18-39 years)--71 patients, group 2 (40-60 years)--71 patients, group 3 (61-74 years)--40 patients. Before and 4-6 weeks after treatment the patients were examined according to the standard scheme and with esophagogastroduodenoscopy (EGDS) including biopsy from the body and pyloric portion of the stomach. Seventy five patients received omeprasol+clarithromycin +moxicilline (scheme 1), 37 patients --eprasol+clarithromycin+tinidasol (scheme 2), 40 --eprasol+clarithromycin+furasolidon (scheme 3), 30 ---eprasol+clarithromycin+vicram (scheme 4).Hp dissemination in the pyloric stomach was independent of the age, nonatrophic and atrophic gastritis occurred with equal frequency. Contamination of the gastric body in the aged patients was moderate and mild. Atrophic gastritis incidence increased with age. After treatment according to scheme 1, Hp eradication was achieved in all the patients of group 3, 90%--group 1, 87%--group 2; according to scheme 2--100% patients of group 3, 90%--group 2 and 87%--group 1; according to scheme 3--all patients of groups 2 and 3, 90%--group 1; according to scheme 4--100% cases from groups 1 and 87% in group 2.Intensity of Hp dissemination in gastric mucosa does not depend on the age; it changes with deterioration of gastric mucosa atrophy and regress of acid production. Hp eradication efficacy in the same schemes of treatment is higher in presenile and senile patients who, therefore, can be treated with less doses of antibiotics.

In the article the results of the eradication therapy by Pariet in the patients suffering from the duodenal ulcer disease, associated with Helicobacter pylori (HP), are estimated. Four schemas with use 40 and 20 mg of Pariet per day in a combination with two antibacterial preparations were evaluated. The therapy duration was 7 days. The ulcer cicatrisation has occurred in 100% of the patients. The eradication was achieved in 100% of cases at use of a dose 40 mg of Pariet per day. At use of the schemas with a dose 20 mg of Pariet per day the eradication was observed in 67% of patients. Pariet is considered as the high efficient preparation in the eradication and cicatrisation of the ulcer.

Examination and long-term follow-up covered 95 patients with duodenal ulcer (DU). Mean age of the patients was 32 +/- 1.67 years. The patients were divided into two groups: with rare DU recurrences (n = 36) and with frequent recurrences (n = 59). Diagnostic criteria for development of rarely recurrent DU were the following: blood group A(II), exacerbations in winter, weak symptoms at DU onset, weak abdominal pains, solitary surface ulcers. For development of frequently recurrent DU, diagnostic criteria include O(I) blood group, spring exacerbations, marked symptoms of the exacerbation, severe abdominal pains, multiple deep ulcers.