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"Helicobacter pylori" (Electronic educational course of 18 hours)

Category of students: doctors-specialists in the field of training: "Therapy" "Gastroenterology", "Endoscopy", " General medical practice (family medicine)", "Pathological anatomy", " Pediatrics»

The complexity of the program: 18 academic hours.

Form of training: distance learning by means of an electronic educational environment with the use of interactive communication technologies.

 

Relevance.

Helicobacter pylori (H. pylori) is a widespread pathogenic bacterium worldwide. In all infected individuals, H. pylori causes chronic active gastritis, yavlit is one of the leading factors in the development of peptic ulcer disease, atrophic gastritis, gastric adenocarcinoma and MALT- lymphoma.

Chronic gastritis is characterized by the presence of inflammatory and dystrophic processes in the gastric mucosa, its progressive atrophy, functional and structural restructuring. Atrophic gastritis is considered as the first stage of the cascade of changes in the gastric mucosa leading to cancer (Correa cascade). The" gold standard " for the diagnosis of gastric pathology associated with H. pylori is currently esophagogastroduodenoscopy with biopsy. .Morphological examination is one of the key and reliable methods for detecting atrophic, inflammatory, and precancerous changes in the gastric mucosa, but only if high-quality morphological diagnostics are performed. For the morphological diagnosis of chronic gastritis, a system for evaluating the OLGA morphological integral criteria has been developed.

It has been proven that H. pylori eradication inhibits the progression of inflammatory changes in the gastric mucosa, prevents the development of H. pylori-associated peptic ulcer disease, reduces the risk of precancerous changes in the gastric mucosa, and is a strategy for the primary prevention of gastric cancer, up to 90% of cases of which are caused by H. pylori. The latest international and domestic consensus recommends the implementation of eradication therapy in all infected patients in the absence of contraindications.

For the primary diagnosis of H. pylori and control of eradication, there are invasive and non-invasive diagnostic methods Invasive methods, such as histology, rapid urease test, microbiological cultivation and polymerase chain reaction, require esophagogastroduodenoscopy and examination of the obtained biopsies. Non-invasive tests include a test for the H. pylori antigen in the feces, serology, and urease respiratory tests. Due to its high sensitivity and specificity, modern non-invasive tests provide high reliability in detecting H. pylori. All of these methods have their limitations, and the choice of a specific testing strategy will depend on the sensitivity, specificity, clinical circumstances, and cost-effectiveness of the study.

Principles of treatment of H infection. pylori is defined by international agreements (the Maastricht Consensus) and domestic recommendations based on the principles of evidence-based medicine. Experts have developed the principles of eradication therapy and proposed standard treatment regimens. As a first-line therapy, it is recommended to use standard triple therapy (proton pump inhibitor (PPI) + clarithromycin and amoxicillin or metronidazole), with a level of resistance to clarithromycin not exceeding 15%. The addition of bismuth tricalium dicitrate to this regimen helps to increase the level of eradication and overcome the possible resistance of H. pylori to clarithromycin and levofloxacin

Cause atrophy of the gastric mucosa can be not only H. pylori, but also autoimmune gastritis (AIG), which is accompanied by Hypo-and then achlorhydria is the result of atrophy of the parietal cells In turn leads to hypergastrinemia hyperplasia enterochromaffin cells of the stomach and subsequent dysplasia, which is considered a precancerous lesion and may eventually progress to type 1 carcinoid. Patients with AIH may have a concomitant H. pylori infection, which will exacerbate the progression of gastric mucosal atrophy. The determination of antibodies to the parietal cells of the stomach is considered the optimal screening test for AIG, and the determination of antibodies to the internal factor is a backup method to confirm the diagnosis. Pathogenetic therapy of AIG has not been developed. The symptomatic treatment of AIH depends on the clinical manifestations, the results of laboratory tests.

 

As part of the course, we:

- we will master the morphological picture of chronic atrophic gastritis.

- we will master diagnostic tests for the detection of H. pylori.

- we will master the methods of treatment of patients with HP-associated diseases.

- we will master the methods that allow us to increase the effectiveness of eradication therapy.

- we will master autoimmune gastritis.

- learn the principles of diagnosis and treatment of autoimmune gastritis.

- we will master the technique of a full-fledged examination during the EGDS

- learn the endoscopic signs of gastritisassociated with H. pylori

- there are endoscopic signs of early forms of cancer and precancerous changes in the gastric mucosa.

- we will master the pathogenesis of diffuse stomach cancer and its diagnosis (linitis plastica). 

Number of possible cycles: 2 times a week

Maximum number of listeners per cycle: no number limit

Speakers of the professional development cycle:

  1. Bordin Dmitry Stanislavovich, Chief freelance specialist gastroenterologist, Head of the Department of Pathology of the pancreas, bile ducts and pathology of the upper digestive tract of the State Medical Institution " MCSC named after A. S. Loginov DZM, MD.
  2. Khomeriki Sergey Germanovich, Head of the Department of Pathological Anatomy of the State Medical Institution " MCSC named after A. S. Loginov DZM, MD, Professor.
  3. Embutnieks Yulia Viktorovna, Head of the Department of Pathology of the upper digestive tract of the State Medical Institution " MCSC named after A. S. Loginov DZM, MD.
  4. Bystrovskaya Elena Vladimirovna, Head of the Department of Diagnostic Endoscopy of the State Medical Institution " MCSC named after A. S. Loginov DZM, MD.
  5. Irina N. Voynovan, Junior researcher of the Department of Pathology of the Upper Digestive Tract of the State Medical Institution " MCSC named after A. S. Loginov DZM

 

Working program of the course

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