Papers by Alexander Nijevitch
Èksperimentalʹnaâ i kliničeskaâ gastroènterologiâ, Mar 7, 2024
Pathophysiology, Jun 1, 1998
Journal of Nepal Paediatric Society, Oct 7, 2013
Peripheral μ-, k-and δ-opioid agonist trimebutine maleate is considered to be an effective therap... more Peripheral μ-, k-and δ-opioid agonist trimebutine maleate is considered to be an effective therapeutic drug for the treatment of functional gastrointestinal disorders. Ninety-two paediatric outpatients (12-17 year-old) suffering from functional dyspepsia (epigastric pain and meal-induced dyspeptic symptoms) were enrolled in a prospective openlabel study. For ethical reasons, no placebo group was included. Patients were treated with trimebutine maleate (200 mg three times daily). After a 3-week treatment there was a significant decrease in scores of epigastric pain (p<0.05), postprandial fullness (p<0.05), early satiety (p<0.05), nausea (p<0.05) and belching (p<0.05). The treatment regimen was well tolerated and demonstrated a good compliance. In conclusion, we postulate that trimebutine maleate is an effective medication for relief of main symptoms associated with functional dyspepsia syndrome in childhood. Because of the limited data on therapeutic interventions in functional dyspepsia in childhood and increasing demand for therapies to treat this disorder, further evaluation of the efficacy of trimebutine treatment for children is certain.
Alimentary Pharmacology & Therapeutics, Nov 1, 2005
Background: Failures of Helicobacter pylori eradication in children are common. Aim: To evaluate ... more Background: Failures of Helicobacter pylori eradication in children are common. Aim: To evaluate the efficacy of amoxicillin, bismuth subcitrate and omeprazole and nifuratel or furazolidone for H. pylori eradication in children who failed initial treatment with a standard triple therapy. Methods: Seventy-six consecutive H. pylori-positive paediatric outpatients (aged 12-16 years; mean age 13.7 ± 1.4) with chronic abdominal complaints who had failed one attempt of eradication of H. pylori using metronidazole-containing triple therapy were enrolled. It was an open prospective study. Patients were randomized to receive a 2-week course of bismuth subcitrate (8 mg/kg/day, q.d.s.), amoxicillin (50 mg/ kg/day, q.d.s.), with either nifuratel (15 mg/kg/day, q.d.s.) or furazolidone (10 mg/kg/day, q.d.s.), plus omeprazole (0.5 mg/kg, once daily). Results: There were 37 patients in the nifuratel group and 39 in the furazolidone group. Helicobacter pylori was eradicated in 33 of 37 (89%; 95% CI: 74.5-96.9; intention-to-treat) in nifuratel group and in 34 of 39 (87%; 95% CI: 72.5-95.7) in furazolidone group, respectively. Frequency of severe side-effects was greater with furazolidone (21%) than with nifuratel (3%; P ¼ 0.0289). Conclusions: Nitrofuran-containing therapies consisting of a proton-pump inhibitor, amoxicillin and bismuth citrate plus either nifuratel or furazolidone produced good cure rates even among those who had failed prior therapy. Nifuratel is preferred because of the lower frequency of side-effects.
The American Journal of Gastroenterology, Jul 1, 2002
Pediatrics International, Apr 1, 1998
The objective of the present work was to study the relationship between intragastric urea hydroly... more The objective of the present work was to study the relationship between intragastric urea hydrolysis generated by Helicnhricter pylori urease and acid-peptic disease in childhood. Intragastric urease activity was examined by urea and ammonia concentration measurement in gastric juice in 91 children with upper abdominal complaints. Hrlicobrrctrr pylori infection was detected from 70 (76.9%) of 9 1 patients, including all of the 15 subjects with peptic ulcer disease. Helicobacrer pvlori-related gastritis in children was associated with a decrease of urea and an incrcase of ammonia in gastric juice (P < 0,001) in comparison with H. pylori-negative children. The gastritis score was correlated with the concentrations of urea and ammonia in the gastric juice of patients infected with H. pylori. There was a significant correlation between the histologically detected dissemination of organisms and gastric ammonia levels. Similar results were obtained concerning correlation between gastric juice ammonia and anti-H. pylori specific immunoglobulin G versus highly purified antigen of H. pylori containing urease. Present findings prove that H. pylori plays an essential role in the pathogenesis of gastritis and that ammonia is one of the main pathogenic factors of acidpeptic disease.
Pediatrics International, Oct 1, 1995
Seventy-five children (aged 9-14 years) infected with Helicobacter pylori were studied endoscopic... more Seventy-five children (aged 9-14 years) infected with Helicobacter pylori were studied endoscopically and morphologically for the signs of infection and immune response by ELISA technique (total IgE and specific IgG against H. pylori); a control group of 36 children (not infected with H. pylori) were studied simultaneously. Helicobacter pylori positive children examined endoscopically revealed a number of mucous membrane changes including erythema, erosions, lymphoid nodular hyperplasia and ulcers. Gastritis was confirmed by histology in 58 children; 6% were termed 'active', others were 'non-active'. When studying the concentrations of anti-H. pylori IgG in children from the control group they were considered to be seronegative but in children infected with H. pylori a considerable increase was noted. An evaluation of the interaction between anti-H. pylori IgG titers and age, endoscopic signs and histology was carried out. Suppositions were made about the presence of links between these characteristics. Children with H. pylori infection showed a considerable increase of total IgE titers in comparison with the control group, The role of IgG and IgE in the development of chronic gastroduodenal diseases associated with H. pylori is discussed.
Current Pharmaceutical Design, Jul 24, 2014
Helicobacter pylori is a gram-negative, microaerophilic spiral bacillus that is associated with l... more Helicobacter pylori is a gram-negative, microaerophilic spiral bacillus that is associated with lifethreatening diseases such as gastric cancer, gastric MALT lymphoma, and peptic ulcer disease. The definition of an effective therapy is one that achieves at least a 90% eradication rate on a perprotocol basis with the first attempt. Eradication rates of H. pylori have declined to unacceptable levels worldwide, mostly due to antibiotic resistance and standard triple therapy gradually has lost its efficacy in most counties. However, bismuth quadruple therapy, when prescribed properly, has maintained its effectiveness. Alternative first-line regimens such as sequential and concomitant therapy were developed to substitute for standard triple therapy and were highly effective in the countries where they were developed, but proved susceptible to failure in regions with high rates of antibiotic resistance. Antibiotic resistance rates in Russia are high, however there is lack of data regarding comparative efficacy of first-line eradication options. The authors of this review extrapolate the knowledge of H. pylori first-line eradication options in Russia based on data from other countries, as well as from domestic studies. The available data support use of 14-day regimens with concomitant therapy, bismuth quadruple therapy, or furazolidone quadruple therapy for empiric use in adults. In addition, 14-day levofloxacin-containing therapies could be used if resistance is relatively low or lacking as triple therapy or possibly as a 5-day concomitant levofloxacin therapy.
Journal of Clinical Gastroenterology, Mar 1, 2001
Journal of Gastroenterology and Hepatology, May 1, 2004
Background and Aims: Helicobacter pylori is considered to be the major cause of chronic gastritis... more Background and Aims: Helicobacter pylori is considered to be the major cause of chronic gastritis and duodenal ulcer disease recurrence in childhood. However, the association between H. pylori and recurrent abdominal pain (RAP) syndrome is still controversial. Therefore, the spectrum of clinical variants of gastrointestinal symptoms associated with H. pylori-positive status was studied in consecutive symptomatic children who were undergoing diagnostic endoscopy. Methods: A consecutive series of 225 school children from the Ural area of Russia (mean age 11.1 + 1.4 years, age range 7-15 years) who presented with RAP were investigated using esophagogastroduodenoscopy, including three antral biopsies for histology and polymerase chain reaction. Helicobacter pylori immunoglobulin G antibodies were found using a second-generation enzyme immunoassay. Information about the clinical symptoms was collected using a special questionnaire. Results: The authors found a high incidence of H. pylori infection (80%) and peptic ulcers (16%) in 225 school children from the Ural area of Russia who were referred for upper gastrointestinal (UGI) endoscopy for chronic abdominal pain. Of the overall 225 symptomatic children who underwent endoscopy, 182 (80,8%) were found to be H. pylori-positive. Duodenal ulcers were detected in 36 H. pyloripositive children. A family history of peptic ulcers was significantly more frequent in the children infected with H. pylori (P < 0.001). Symptom score and duration of symptoms were similar, but nighttime pain (P < 0.0001) and fasting pain relieved by food (P < 0.001) were more frequent in the H. pyloripositive children as compared with the H. pylori-negative children. Conclusions: The present results provide further evidence for a significant association between H. pylori and some patterns of gastrointestinal symptoms in children who underwent UGI endoscopy in order to exclude an organic cause of severe chronic gastrointestinal disorders.
The American Journal of Gastroenterology, Mar 1, 2001
superior sedation when administered by the gastroenterologists with training in intravenous sedat... more superior sedation when administered by the gastroenterologists with training in intravenous sedation. Our results showed that propofol use caused deeper sedation, had better objective, and similar subjective comfort scores. The ease of endoscopy, amnesia score, recovery from sedation, drop in blood pressure, and oxygen saturation were similar in both groups. The following are the answers to the questions raised:
Pediatrics International, Aug 1, 1999
... Plasmogastric passage of urea and ammonia in children with Helicobacter pylori infection. Ale... more ... Plasmogastric passage of urea and ammonia in children with Helicobacter pylori infection. Alexander A Nijevitch,; Zulfira M Yelitcheva,; IRINA Z OUSMANOVA, RINAT SH Khasanov,; ShamilM Khusnutdinov,; Svetlana V Khamidullina. Article first published online: 2 MAY 2002. ...
Journal of Clinical Gastroenterology, 2004
Background: Reflux esophagitis is uncommon in countries in which most people are colonized by H. ... more Background: Reflux esophagitis is uncommon in countries in which most people are colonized by H. pylori infection and is extremely rare in persons with reflux esophagitis, although esophagitis is detected in almost 50% of children with recurrent lower respiratory tract symptoms. Hypothesis: Failure to acquire H. pylori can enhance esophagitis risk in children with chronic asthma. Patients and Methods: Forty-two pediatric out patients with chronic asthma (mean age 13.2 ± 1.18 years, range 12-15 years, 23 boys and 19 girls) were included in the study. They had undergone endoscopy with gastric and esophageal biopsies for upper dyspeptic complaints. H. pylori positivity was confirmed by positive Giemsa staining. Esophagitis was diagnosed by standard histologic procedure (presence of intraepithealial leukocytes or basal cell hyperplasia). Results: H. pylori colonization was detected histologically in 22 of 42 patients (52.4%) enrolled in the study. Histology demonstrated that in asthmatic children with evidence of H. pylori infection esophagitis was a dramatically rare finding than in the patients without the infection (P < 0.001). It was an unexpected finding, that lung function parameters (FEF 50 , FEF 75) were significantly lower in asthmatics infected with H. pylori (P < 0.05). Conclusion: The present findings suggest inverse association between esophagitis and H. pylori in course of asthma in pediatric patients.
Journal of Pediatric Gastroenterology and Nutrition, Nov 1, 2001
Background: The relation of between Helicobacter pylori and the symptoms in children is still con... more Background: The relation of between Helicobacter pylori and the symptoms in children is still controversial. Determination of specific immunoglobulin (Ig) G antibodies to H. pylori may represent a useful test to screen the patients with acid peptic disease in childhood. The aim of this study was to investigate the spectrum of clinical symptoms, endoscopic and histologic lesions, and clinical value of serum IgG response to H. pylori in school-aged children residing in the Ural area of Russia for the identification of Helicobacter-related acid-peptic disease. Methods: During 1998, 129 pediatric outpatients (mean age, 12.1 ± 2.3 years; age range, 10-15 years; 41 boys, 88 girls) were undergoing gastroduodenal endoscopy for evaluation of chronic abdominal pain. H. pylori colonization was determined by histology, urease test, and polymerase chain reaction. H. pylori IgG antibodies were found by using an enzyme-linked immunosorbent assay. Results: There was a high prevalence of H. pylori infection (80%) and peptic ulcers (24%) among the study group. Duo-denal ulcers were detected in 31 of the children; all of them were H. pylori positive. Family history of peptic ulcers, nighttime pain associated with nocturnal awakening, fasting pain relieved by food, pain associated with meals, postprandial pain, bitter taste, and heartburn were the clinical signs that helped to distinguish the ulcer-positive children from the ulcer-negative H. pylori group. Duodenal ulcer patients had higher anti-H. pylori IgG titers compared with the levels of IgG antibodies in the infected children without ulcers (P < 0.001). Peptic ulcer disease was a more common finding in the Ural ethnic group of Asians (Bashkirs) compared with the pediatric population of Russian origin. Conclusions: These results provide further evidence for a causal relation between H. pylori-associated peptic ulcer disease in childhood and relevant clinical symptoms. High titers of anti-H. pylori IgG might serve as a useful noninvasive indicator of ulcer disease.
Experimental & clinical gastroenterology, May 21, 2023
The aim of the present study was to evaluate exocrine pancreatic function in children with type 1... more The aim of the present study was to evaluate exocrine pancreatic function in children with type 1 diabetes mellitus during the course of the disease. Fecal elastase varied between 24.4 and 169.6 μg /g (median 134.5 μg /g) in children with type 1 DM and concomitant PEI. Number of children with diarrhea was not signifi cantly diff erent between children with low pancreatic elastase levels and those with normal levels (43.0% versus 35.5%, p=0.359). The remainder of the children with type 1 DM had fecal elastase-1 levels between 201.4 and 810.5 μg /g stool (median 650.7 μg /g). Diff erences between the type 1 DM patients without PEI and the comparison group were not signifi cant (p=0.112). Median daily fecal fat excretion in type 1 DM patients with PEI was 8.31 g/day (min-mах 7.81-9.21 g/day), which was signifi cantly higher than in type 1 DM children without PEI (3.87 g/day; min-mах 2.97-6.33 g/day; р= 0.0003). There was no signifi cant diff erence in daily fecal fat excretion between children with type 1 DM without signs of PEI and children in the control group (2.91 g/d; min-max: 2.31-5.74 g/d; р= 0.091). The results of this study demonstrate PEI in children with long-standing type 1 DM. Fecal elastase-1 concentration signifi cantly correlates with duodenal exocrine elastase output. Fecal elastase-1 levels have a good correlation with fecal fat excretion, which was measured by employing the acid steatocrit test.
Gut 49(Suppl, May 11, 2001
В обзоре рассмотрена взаимосвязь анти-Cag IgG иммунного ответа с распространенностью язвенной бол... more В обзоре рассмотрена взаимосвязь анти-Cag IgG иммунного ответа с распространенностью язвенной болезни у детей. CagA (Cytotoxine assotiated gene A) – ген, кодирующий иммунодоминантный протеин, определяемый у штаммов хеликобактерий с цитотоксическими свойствами. Гены H. Pylori, входящие в состав островка патогенности Cag, ответственны за развитие воспалительного иммунного ответа в слизистой оболочке желудка. Продемонстрирована связь между наличием IgG к CagA антигену с повышением уровня пепсиногена I, предопределяющим высокий риск развития язвенной болезни. Проведенные исследования в популяциях России, Восточной и Западной Европы, Латинской Америки показали значимость данного теста в диагностике наиболее тяжелых клинических форм гастродуоденальной патологии. Определение анти-CagA антител является высокоспецифичным методом диагностики ульцерогенных штаммов H. Pylori. Обсуждается необходимость включения серологических тестов на определение анти-CagA антител в перечень обязательных метод...
Journal of Gastroenterology and Hepatology, 2000
bismuth subsalicylate) with nitroimidazoles (tinidazole or metronidazole) and antibiotics (amoxic... more bismuth subsalicylate) with nitroimidazoles (tinidazole or metronidazole) and antibiotics (amoxicillin or clarithromycin). Unfortunately, bismuth salts lack significant antisecretory activity. 13 In children, elevated gastric acid secretion is considered a major factor in the pathogenesis of peptic ulcer disease 14 and is shown by the rapid healing of ulcers after treatment, which includes antisecretory drugs (e.g. H 2-blockers). 4 However, the use of H 2-receptor antagonists alone is not effective against H. pylori. 15 At the same time, H 2-blockers improve the bactericidal effect of antibiotics. 16 Thus, the first line of treatment for H. pylori infection is triple
Alimentary Pharmacology and Therapeutics, 2005
Background: Failures of Helicobacter pylori eradication in children are common. Aim: To evaluate ... more Background: Failures of Helicobacter pylori eradication in children are common. Aim: To evaluate the efficacy of amoxicillin, bismuth subcitrate and omeprazole and nifuratel or furazolidone for H. pylori eradication in children who failed initial treatment with a standard triple therapy. Methods: Seventy-six consecutive H. pylori-positive paediatric outpatients (aged 12-16 years; mean age 13.7 ± 1.4) with chronic abdominal complaints who had failed one attempt of eradication of H. pylori using metronidazole-containing triple therapy were enrolled. It was an open prospective study. Patients were randomized to receive a 2-week course of bismuth subcitrate (8 mg/kg/day, q.d.s.), amoxicillin (50 mg/ kg/day, q.d.s.), with either nifuratel (15 mg/kg/day, q.d.s.) or furazolidone (10 mg/kg/day, q.d.s.), plus omeprazole (0.5 mg/kg, once daily). Results: There were 37 patients in the nifuratel group and 39 in the furazolidone group. Helicobacter pylori was eradicated in 33 of 37 (89%; 95% CI: 74.5-96.9; intention-to-treat) in nifuratel group and in 34 of 39 (87%; 95% CI: 72.5-95.7) in furazolidone group, respectively. Frequency of severe side-effects was greater with furazolidone (21%) than with nifuratel (3%; P ¼ 0.0289). Conclusions: Nitrofuran-containing therapies consisting of a proton-pump inhibitor, amoxicillin and bismuth citrate plus either nifuratel or furazolidone produced good cure rates even among those who had failed prior therapy. Nifuratel is preferred because of the lower frequency of side-effects.
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Papers by Alexander Nijevitch