Clinico-functional status of the small intestine in patients with chronic opisthorchiasis

Examination of 110 patients with chronic opisthorchiasis lasting for over 5 years has revealed the syndrome of malabsorption by means of the d-xylose test, Kamer's method and radioindication. Dysbacteriosis, hypokinesia of the small intestine, reduction of the cholate-cholesterol ratio of the bile, structural alterations in the small intestine mucosa were found to be implicated in the genesis of malabsorption. The helminthologic recovery of the patients with protracted opisthorchiasis did not entail complete normalization of the function of the small intestine and thus required therapeutic correction.     

Morphofunctional changes in the small intestine in patients with chronic cardiac failure

AIM: To study morphological alterations in small intestinal wall in patients with chronic cardiac failure (CCF) of various severity and their relations with functional condition of the small intestine. MATERIAL AND METHODS: 63 patients (mean age 58.7 years) entered an open cohort study. By CCF and body mass index (BMI) the patients were divided into 4 groups. Estimation of ejection fraction (EF), BMI and lean body mass (LBM) was made in all the patients as well as functional intestinal activity was assessed by fat excretion and fecal protein. Small intestinal biopsies were made endoscopically for collagen quantitation. RESULTS: A rise in collagen content in the small intestine correlated with severity of CCF. In patients free of CCF relative area of collagen averaged 12.8%, in CCF FC I-II--16.5%, in CCF FC III-IV with cachexia--32.4%. Greater fibrosis of the small intestine corresponded to greater malabsorption. A 3-fold increase in collagen area led to a 2-3-fold growth in protein and fat loss with feces. In CCF, LBM was subnormal while body mass reduction correlated with relative collagen area. CONCLUSION: Morphofunctional changes of the small intestine developing in parallel with CCF severity lead to a significant loss in basic nutrients, regression of LBM and development of protein-energy insufficiency in patients with CCF.     

Morphofunctional changes in gastrointestinal tract in patients with psoriasis accompanied by chronic opisthorchosis

The paper covers clinical, morphological and functional aspects of gastrointestinal tract condition in patients with psoriasis accompanied by chronic opisthorchosis (CO). The authors examined 150 patients with psoriasis accompanied by CO, 100 patients having psoriasis without helminthiasis, 100 patients with CO and 30 healthy people. The gastric secretion was evaluated by means of the fractional test (both phases) with histamine stimulation; other diagnostic procedures included carbohydrate absorption evaluation (5-gram D-Xylose absorption test) and Kamer test of fat absorption. The morphological condition of the gastric and intestinal mucosa was investigated by means of light and electron microscopy. The study revealed gastric secretory dysfunction and malabsorption in small and large intestines in patients with psoriasis and CO, clarified the relation between the duration of psoriasis and opisthorchosis and gastric secretory dysfunction and determined dependence of small intestine malabsorption on such factors as stage, severity, degree of skin involvement and duration of psoriasis. The authors also established interrelation between the above malfunctions and gastric and intestinal structural abnormalities.     

Disorders of lipid metabolism in patients with chronic diseases of the small intestine

Lipid metabolism was evaluated in patients with chronic enteritis, celiac disease, general variable immunodeficiency (GVI), short-bowel syndrome. In chronic enteritis with malabsorption syndrome degree I and II changes in metabolism were characterized by hyperlipidemia due to high lipid fractions, mainly triglycerides; in malabsorption syndrome degree III (celiac disease, general variable immunodeficiency, short-bowel syndrome) by a drop of serum total lipids, phospholipids, cholesterol, beta-lipoproteins, free fatty acids, elevated concentrations of triglycerides. Changes in fatty acid composition of blood serum in patients with malabsorption syndrome degree III manifested by derangement of polyunsaturated fatty acids ratio. Arachidonic acid concentration was reduced in 100% of cases, linolenic acid in 45%. In all the patients with celiac disease and malabsorption syndrome degree III there was hypoactivity of lipolytic blood enzymes lipase and tributyrinase.     

Ischaemia of the small intestine in patients with systemic sclerosis: Raynaud's phenomenon or chronic vasculopathy?

We investigated duodenal and gastric mucosal blood flow by endoscopiclaser Doppler flowmetery (LDF) in ten patients with systemicsclerosis (SSc) and in ten healthy volunteers. In addition,we tested for the presence of small bowel bacterial overgrowthby jejunal aspiration. Jejunal aspiration and LDF were doneconsecutively, via a gastroscope, using a flexible catheterand laser Doppler probe. Following these procedures, two duodenalbiopsies were obtained for light and electron microscopy. Meanduodenal and gastric blood flow were significantly lower inpatients with SSc than in normal subjects (516 flux units vs.240, 521 vs. 202, both p < 0.001). There was no correlationbetween age and blood flow in patients or volunteers. Four ofthe ten patients had evidence of significant bacterial overgrowthon jejunal aspiration (>10⁵ colony-forming units/ml). Thesefindings support the hypothesis that within the small intestineof patients with SSc, factors independent of bacterial overgrowthmay be responsible for malabsorption. The observed reductionin small-intestine mucosal blood flow may play an importantcontributary role. Further studies are required to determinewhether this represents reversible or chronic progressive ischaemia,and its effect on nutrient absorption.     

Pathogenesis of steatorrhea in chronic diseases of the small intestine

Altogether 150 patients with chronic enteritis and celiac disease with a history of resection of a part of the ileum were examined. It was established that in patients with chronic enteritis, of importance for the pathogenesis of steatorrhea was the deficiency of bile acids during digestion because of hypokinesia of the gallbladder and partial deconjugation of bile acids in the presence of bacterial dissemination of the small intestine. During celiac disease, steatorrhea was caused by the decreased enzymatic function of the pancreas, asynchronism of the food and bile supply to the intestinal lumen, disorders of absorption of lipolysis products. In patients with large resection of the ileum, steatorrhea was associated with abnormality of the enterohepatic circulation of bile acids, bacterial dissemination of the small intestine and reduction of the absorption surface. A schedule of differentiated therapy is offered.     

Treatment of chronic diseases of the small intestine]

Multimodality and differentiated treatment of small-intestinal diseases is to combine methods of etiological action with pathogenetic treatment of the main clinical syndromes: chronic diarrhea, malabsorption syndrome, hypercatabolic exudative enteropathy. Each nosological form should be treated specifically. Pathogenetic treatment involves diet therapy, chemotherapeutic correction of metabolic processes (vitamin administration, recovery of normal protein and lipid metabolism, water and electrolyte balance, anemia), management of chronic diarrhea. Treatment regimens are specified for gluten enteropathies, total variable immunodeficiency, Whipple disease, small-intestinal diverticulosis, Crohn's disease, amyloidoses, intestinal lymphoma and retroperitoneal lymph nodes. Clinical experience justifies the above methods as highly effective.     

The course of chronic glomerulonephritis in chronic opisthorchiasis

AIM: To characterize clinical, functional and morphological features of chronic glomerulonephritis (CGN) running with chronic opisthorchiasis (CO) and to justify dehelminthization. MATERIAL AND METHODS: Clinical, functional and morphological examinations of the kidneys, immunological characteristics were studied in 100 patients with primary CGN and CO (group 1), 30 patients with CGN free of CO (group 2) and 40 patients with long-term CO. RESULTS: CGN in CO runs with frequent rise of creatinine, glomerular filtration and canal reabsorption fall. Pathogenetic therapy with addition of pulse cyclophosphamide in a dose 10 mg/kg and conduction of dehelminthization a year later lead to long-term remission and inhibition of nephrosclerosis development. CONCLUSION: Clinicofunctional and morphological characteristics of the kidneys in mixed pathology necessitate addition of immunosuppressor cyclophosphamide in a dose 10 mg/kg and dehelminthization in combined treatment of patients with glomerulonephritis and opisthorchiasis.