The article discusses various approaches for probiotic treatment of Helicobacter pylori (H. pylori) infection: Probiotics as an adjuvant treatment in the standard eradication therapy; probiotic strains as a monotherapy; and autoprobiotics as a monotherapy. Autoprobiotics refer to indigenous bifidobacteria, lactobacilli, or enterococci isolated from a specific individual, intended to restore his/her microbiota and improve his/her health. The potential mechanisms of probiotic action against H. pylori include correction of the gut microbiota, immunological effects (enhancement of humoral and cellular immunity, and reduction of oxidative stress), direct antagonistic effects against H. pylori (such as colonization resistance and bacteriocin synthesis), and stimulation of local immunological protection (strengthening of the mucous protective barrier and reduction of gastric mucosa inflammation). The incorporation of probiotics into comprehensive eradication therapy shows promise in optimizing the treatment of H. pylori infection. Probiotics can enhance the eradication rates of H. pylori, reduce the occurrence and severity of side effects, and improve patient compliance. Probiotic or autoprobiotic monotherapy can be considered as an alternative treatment approach in cases of allergic reactions and insufficient effectiveness of antibiotics. We recommend including probiotics as adjunctive medications in anti-H. pylori regimens. However, further randomized multicenter studies are necessary to investigate the effects of probiotics and autoprobiotics against H. pylori, in order to gain a better understanding of their mechanisms of action.

The multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group (EHMSG) is conducted in 27 countries in Europe. The data from the Russian part of the European registry for the management of Helicobacter pylori infection (European Registry on the management of Helicobacter pylori infection, protocol: “Hp-EuReg”) allows us to analyze the real clinical practice of diagnosis and treatment of H. pylori and compare it with international recommendations. Materials and methods. A comparative analysis of the data entered in the register by the Russian research centers “Hp-EuReg”, in the period from 2013 to 2018, was conducted. Results and discussion. Invasive diagnostic methods prevail for the primary diagnosis of H. pylori [histology – 20.3% (in 2013 year) – 43.9% (in 2018 year), rapid urease test – 31.7% and 47.8% respectively]. The most popular mode of eradication therapy is a 10-day triple therapy (62.8–76.2%), the effectiveness of which does not exceed 79% (per protocol). Invasive tests (histology) are the leading method for control the effectiveness of therapy, however, there is a tendency towards a wider use of non-invasive methods (H. pylori stool antigen – from 17% in 2013 to 29.3% in 2018 and urea breath test from 6.9 to 18.3%, respectively). Serological test to control the effectiveness of eradication is still used from 8.2% (2013) to 6.1% (2018). Eradication therapy was not performed in 28% of patients throughout the entire observation period. Conclusion. In Russia, despite approved domestic and international recommendations, deviations in clinical practice persist, both during eradication therapy and in monitoring the effectiveness of eradication therapy. Keywords: Hp-EuReg, Helicobacter pylori diagnosis, eradication efficiency, expert recommendations

The formation of metabolic changes is based on many factors. In particular, the infectious theory of the development of metabolic “breakdowns” has not lost its relevance. In this regard, many scientists are investigating the role of various microorganisms in the pathogenesis of metabolic syndrome. The review provides the results of current research on the role of Helicobacter pylori (as one of the most well-known and widespread bacterial pathogens) in the pathogenesis of metabolic syndrome. However, the results of scientific work are sometimes contradictory, which dictates the need for novel further research to clarify the characteristics of the influence Helicobacter pylori on the formation of various components of the metabolic syndrome.

Despite great advances in the treatment of oncological diseases, the development of medical technologies to prevent or reduce complications of therapy, in particular, those associated with surgery and the introduction of antibiotics, remains relevant. The aim of this study is to evaluate the effectiveness of the use of autoprobiotics based on indigenous non-pathogenic strains of Enterococcus faecium and Enterococcus hirae as a personalized functional food product (PFFP) in the complex therapy of colorectal cancer (CRC) in the early postoperative period. A total of 36 patients diagnosed with CRC were enrolled in the study. Study group A comprised 24 CRC patients who received autoprobiotic therapy in the early postoperative period, while the control group C included 12 CRC patients without autoprobiotic therapy. Prior to surgery and between days 14 and 16 post-surgery, comprehensive evaluations were conducted on all patients, encompassing the following: stool and gastroenterological complaints analysis, examination of the gut microbiota (bacteriological study, quantitative polymerase chain reaction, metagenome analysis), and analysis of interleukins in the serum. Results: The use of autoprobiotics led to a decrease in dyspeptic complaints after surgery. It was also associated with the absence of postoperative complications, did not cause any side effects, and led to a decrease in the level of pro-inflammatory cytokines (IL-6 and IL-18) in the blood serum. The use of autoprobiotics led to positive changes in the structure of escherichia and enterococci populations, the elimination of Parvomonas micra and Fusobacterium nucleatum, and a decrease in the quantitative content of Clostridium perfringens and Akkermansia muciniphila. Metagenomic analysis (16S rRNA) revealed an increase in alpha diversity. Conclusion: The introduction of autoprobiotics in the postoperative period is a highly effective and safe approach in the complex treatment of CRC. Future studies will allow the discovery of additional fine mechanisms of autoprobiotic therapy and its impact on the digestive, immune, endocrine, and neural systems.

Aim: European Registry on the management of Helicobacter pylori infection («Hp-EuReg») - a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group, conducted in 27 European countries in order to evaluate the real clinical practice of diagnosis and treatment of H. pylori and its comparison with international recommendations. Materials and methods: The analysis of 2360 patients entered in the register by the Russian centres of «Hp-EuReg» in 2013-2017, who were underwent 1st line eradication therapy. Results: The most common methods of primary diagnosis of H. pylori are histological (37.7%), rapid urease test (29.2%) and serology (29.7%). The duration of eradication therapy in 9.4% of cases was 7 days, in 65.3% - 10 days, and in 25.3% - 14 days. To control the effec- tiveness of treatment, H. pylori antigen in feces (31.3%), urea breath test (23.4%) and histological method (23.3%) were used. In 3.6% cases was used serology by mistake. In 17.3% of patients control was not carried out. The effectiveness of triple therapy with a PPI, amoxicillin, clar- ithromycin (per protocol) was 67.6%, with 7-day course, 81.1% at 10-day and 86.7% at 14-day course. Eradication rate of triple therapy with addition of bismuth (per protocol) reached 90,6% in the group receiving 10-day scheme and 93.6% in the group receiving the 14-day treatment. Conclusion: Significant deviations of clinical practice from expert recommendations, most pronounced at the stage of monitoring the effectiveness of therapy, were noted. The suboptimal efficacy of triple therapy is shown.

ЦЕЛЬ ИССЛЕДОВАНИЯ Изучить влияние стимулятора репарации альфа-глутамил-триптофана на морфологические характеристики слизистой оболочки желудка и экспрессию CXCL-12 и CDX-2 при хроническом атрофическом гастрите, ассоциированном с Helicobacter pylori. МАТЕРИАЛ И МЕТОДЫ Проанализированы образцы биопсийного материала 116 пациентов с верифицированным диагнозом хронического атрофического гастрита, ассоциированного с Helicobacter pylori, в рамках многоцентрового двойного слепого рандомизированного плацебо-контролируемого исследования. При морфологическом исследовании оценивали параметры, характеризующие процесс атрофии: количество желез на 1 мм² слизистой оболочки желудка, глубину желез слизистой оболочки желудка, количество обкладочных клеток на 100 эпителиальных клеток слизистой оболочки желудка, наличие признаков кишечной метаплазии. Для постановки иммуногистохимических реакций для верификации экспрессии CXCL-12 и CDX-2 использовали первичные антитела Anti-CXCL-12 (MA5-23759) и Anti-CDX-2 (EP25). Морфологический анализ и иммуногистохимическое исследование биоптатов проводили до начала терапии и после окончания приема исследуемого препарата/плацебо. РЕЗУЛЬТАТЫ На фоне терапии у пациентов, принимавших исследуемый препарат, выявлено статистически значимое увеличение количества желез на 1 мм² слизистой оболочки желудка при сравнении с исходными показателями скрининга на 26,1% (p=0,028) и с группой плацебо (p=0,026), определена тенденция к уменьшению кишечной метаплазии. Отмечено статистически значимое увеличение относительной площади экспрессии CXCL-12 у пациентов, принимавших плацебо, при сравнении с параметрами исходных данных (p=0,045) и отсутствие статистически значимых изменений в основной группе. Выявлено статистически значимое увеличение относительной площади экспрессии CDX-2 в группе принимавших альфа-глутамил-триптофан в сравнении с исходными данными (p=0,015), статистически значимой динамики данного показателя в группе плацебо не обнаружено. ЗАКЛЮЧЕНИЕ Установлено статистически значимое в сравнении с контролем исходного состояния и плацебо положительное влияние исследуемого препарата на регенераторные механизмы, приводящие к стабилизации и/или улучшению гистологической картины слизистой оболочки желудка. Результаты иммуногистохимического исследования по повышению экспрессии CDX-2 на фоне приема исследуемого препарата также можно расценить как показатель улучшения репаративных процессов.