This review considers the data on Helicobacter pylori(H.pylori),which have been accumulated over 40 years since its description as an etiological factor in gastrointestinal diseases.The majority of modern publications...This review considers the data on Helicobacter pylori(H.pylori),which have been accumulated over 40 years since its description as an etiological factor in gastrointestinal diseases.The majority of modern publications are devoted to the study of the pathogenic properties of the microorganism in the development of chronic gastritis,peptic ulcer disease,and gastric cancer,as well as methods for its eradication.However,in recent years,there have been more and more studies which have suggested that H.pylori has a beneficial,or potentially positive,effect on the human body.The authors have attempted to objectively analyze the information accumulated in the literature on H.pylori.Some studies consider it as one of the recently identified human bacterial pathogens,and special attention is paid to the evidence suggesting that it is probably part of the composition of the human microbiome as a commensal(commensal from French to English is a table companion)or even a symbiont.The presented data discussing the presence or absence of the effect of H.pylori on human health suggest that there is an apparent ambiguity of the problem.The re-assessment of the data available on H.pylori infection is important in order to answer the question of whether it is necessary to create a program of mass H.pylori eradication or to apply a more personalized approach to treating patients with H.pylori-associated gastrointestinal diseases and to perform eradication therapy.展开更多
Primary biliary cholangitis(PBC)is a chronic cholestatic progressive liver disease and one of the most important progressive cholangiopathies in adults.Damage to cholangiocytes triggers the development of intrahepatic...Primary biliary cholangitis(PBC)is a chronic cholestatic progressive liver disease and one of the most important progressive cholangiopathies in adults.Damage to cholangiocytes triggers the development of intrahepatic cholestasis,which progresses to cirrhosis in the terminal stage of the disease.Accumulating data indicate that damage to biliary epithelial cells[(BECs),cholangiocytes]is most likely associated with the intracellular accumulation of bile acids,which have potent detergent properties and damaging effects on cell membranes.The mechanisms underlying uncontrolled bile acid intake into BECs in PBC are associated with pH change in the bile duct lumen,which is controlled by the bicarbonate(HCO3-)buffer system“biliary HCO3-umbrella”.The impaired production and entry of HCO3-from BECs into the bile duct lumen is due to epigenetic changes in expression of the X-linked microRNA 506.Based on the growing body of knowledge on the molecular mechanisms of cholangiocyte damage in patients with PBC,we propose a hypothesis explaining the pathogenesis of the first morphologic(ductulopenia),immunologic(antimitochondrial autoantibodies)and clinical(weakness,malaise,rapid fatigue)signs of the disease in the asymptomatic stage.This review focuses on the consideration of these mechanisms.展开更多
Helicobacter pylori(H.pylori)infection occurs in almost half of the world's population,most of whom are merely carriers of this microorganism.H.pylori is shown to be detected more frequently in patients with diabe...Helicobacter pylori(H.pylori)infection occurs in almost half of the world's population,most of whom are merely carriers of this microorganism.H.pylori is shown to be detected more frequently in patients with diabetes mellitus(DM)than in the general population,which is accompanied by a significantly increased risk of developing H.pylori-associated diseases.In addition,eradication therapy shows a low efficiency for H.pylori infection in patients with DM.There is a relationship between the level of chronic hyperglycemia and a higher detection rate of H.pylori as well as a lower efficiency of eradication therapy in patients with DM.The exact mechanisms of these phenomena are unknown.The authors make a hypothesis that explains the relationship between chronic hyperglycemia and the increased detection rate of H.pylori,as well as the mechanisms contributing to the improved survival of this bacterium in patients with DM during eradication therapy.展开更多
Primary biliary cholangitis(PBC)is a chronic cholestatic liver disease that is associated with impaired biliary excretion processes.Along with the development of cholestasis,there is a deficient flow of bile acids int...Primary biliary cholangitis(PBC)is a chronic cholestatic liver disease that is associated with impaired biliary excretion processes.Along with the development of cholestasis,there is a deficient flow of bile acids into the intestinal lumen causing malnutrition(MN)that is manifested in deficiencies of both macro-and micronutrients.The mechanism for development of trophological insufficiency is multifactorial.However,the trigger of MN in PBC is impaired enterohepatic circulation of bile acids.The ingress of bile acids with a detergent effect into the general bloodstream,followed by elimination via the kidneys and skin,triggers a cascade of metabolic disturbances,which leads to the gradual development and progression of calorie MN.The latter gradually transforms into protein-calorie MN(PСM)(as marasmus)due to the insufficient entry of bile acids into the duodenum,which is accompanied by a decrease in the emulsification,hydrolysis,and absorption of fats and fat-soluble vitamins,as well as disturbance of intestinal motility and bacterial overgrowth.Fat-soluble vitamin deficiencies complement PСM with vitamin and mineral MN.The development of hepatocellular failure enhances the progression of PСM due to the impaired protein synthetic function of hepatocytes in the advanced stage of PBC,which results in deficiency of not only the somatic but also the visceral pool of proteins.A mixed PСM form of marasmus and kwashiorkor develops.Early recognition of energy,protein,micronutrient,and macronutrient deficiencies is of great importance because timely nutritional support can improve liver function and quality of life in patients with PBC.In this case,it is important to know what type(energy,proteincalorie,vitamin,and vitamin-mineral)and form(marasmus,marasmuskwashiorkor)of MN is present in the patient and how it is associated with the stage of the disease.Therefore,it is recommended to screen all patients with PBC for MN,from the early asymptomatic stage of the disease in order to identify and avoid preventable complications,such as fatigue,malaise,performance decrement,sarcopenia,osteoporosis,and hepatic encephalopathy,which will be able to provide appropriate nutritional support for correction of the trophological status.展开更多
文摘This review considers the data on Helicobacter pylori(H.pylori),which have been accumulated over 40 years since its description as an etiological factor in gastrointestinal diseases.The majority of modern publications are devoted to the study of the pathogenic properties of the microorganism in the development of chronic gastritis,peptic ulcer disease,and gastric cancer,as well as methods for its eradication.However,in recent years,there have been more and more studies which have suggested that H.pylori has a beneficial,or potentially positive,effect on the human body.The authors have attempted to objectively analyze the information accumulated in the literature on H.pylori.Some studies consider it as one of the recently identified human bacterial pathogens,and special attention is paid to the evidence suggesting that it is probably part of the composition of the human microbiome as a commensal(commensal from French to English is a table companion)or even a symbiont.The presented data discussing the presence or absence of the effect of H.pylori on human health suggest that there is an apparent ambiguity of the problem.The re-assessment of the data available on H.pylori infection is important in order to answer the question of whether it is necessary to create a program of mass H.pylori eradication or to apply a more personalized approach to treating patients with H.pylori-associated gastrointestinal diseases and to perform eradication therapy.
文摘Primary biliary cholangitis(PBC)is a chronic cholestatic progressive liver disease and one of the most important progressive cholangiopathies in adults.Damage to cholangiocytes triggers the development of intrahepatic cholestasis,which progresses to cirrhosis in the terminal stage of the disease.Accumulating data indicate that damage to biliary epithelial cells[(BECs),cholangiocytes]is most likely associated with the intracellular accumulation of bile acids,which have potent detergent properties and damaging effects on cell membranes.The mechanisms underlying uncontrolled bile acid intake into BECs in PBC are associated with pH change in the bile duct lumen,which is controlled by the bicarbonate(HCO3-)buffer system“biliary HCO3-umbrella”.The impaired production and entry of HCO3-from BECs into the bile duct lumen is due to epigenetic changes in expression of the X-linked microRNA 506.Based on the growing body of knowledge on the molecular mechanisms of cholangiocyte damage in patients with PBC,we propose a hypothesis explaining the pathogenesis of the first morphologic(ductulopenia),immunologic(antimitochondrial autoantibodies)and clinical(weakness,malaise,rapid fatigue)signs of the disease in the asymptomatic stage.This review focuses on the consideration of these mechanisms.
文摘Helicobacter pylori(H.pylori)infection occurs in almost half of the world's population,most of whom are merely carriers of this microorganism.H.pylori is shown to be detected more frequently in patients with diabetes mellitus(DM)than in the general population,which is accompanied by a significantly increased risk of developing H.pylori-associated diseases.In addition,eradication therapy shows a low efficiency for H.pylori infection in patients with DM.There is a relationship between the level of chronic hyperglycemia and a higher detection rate of H.pylori as well as a lower efficiency of eradication therapy in patients with DM.The exact mechanisms of these phenomena are unknown.The authors make a hypothesis that explains the relationship between chronic hyperglycemia and the increased detection rate of H.pylori,as well as the mechanisms contributing to the improved survival of this bacterium in patients with DM during eradication therapy.
文摘Primary biliary cholangitis(PBC)is a chronic cholestatic liver disease that is associated with impaired biliary excretion processes.Along with the development of cholestasis,there is a deficient flow of bile acids into the intestinal lumen causing malnutrition(MN)that is manifested in deficiencies of both macro-and micronutrients.The mechanism for development of trophological insufficiency is multifactorial.However,the trigger of MN in PBC is impaired enterohepatic circulation of bile acids.The ingress of bile acids with a detergent effect into the general bloodstream,followed by elimination via the kidneys and skin,triggers a cascade of metabolic disturbances,which leads to the gradual development and progression of calorie MN.The latter gradually transforms into protein-calorie MN(PСM)(as marasmus)due to the insufficient entry of bile acids into the duodenum,which is accompanied by a decrease in the emulsification,hydrolysis,and absorption of fats and fat-soluble vitamins,as well as disturbance of intestinal motility and bacterial overgrowth.Fat-soluble vitamin deficiencies complement PСM with vitamin and mineral MN.The development of hepatocellular failure enhances the progression of PСM due to the impaired protein synthetic function of hepatocytes in the advanced stage of PBC,which results in deficiency of not only the somatic but also the visceral pool of proteins.A mixed PСM form of marasmus and kwashiorkor develops.Early recognition of energy,protein,micronutrient,and macronutrient deficiencies is of great importance because timely nutritional support can improve liver function and quality of life in patients with PBC.In this case,it is important to know what type(energy,proteincalorie,vitamin,and vitamin-mineral)and form(marasmus,marasmuskwashiorkor)of MN is present in the patient and how it is associated with the stage of the disease.Therefore,it is recommended to screen all patients with PBC for MN,from the early asymptomatic stage of the disease in order to identify and avoid preventable complications,such as fatigue,malaise,performance decrement,sarcopenia,osteoporosis,and hepatic encephalopathy,which will be able to provide appropriate nutritional support for correction of the trophological status.
