Status and prospects of acid-suppressive and gastrocytoprotective therapy of the esophageal, gastric & duodenal disorders among servicemen

Abstract

Introduction. In the conditions of the Russian-Ukrainian war, it is extremely important for the medical service of the Armed Forces of Ukraine to conduct clinical and pharmacoeconomic studies on common diseases among servicemen, which, together with high quality standards of medical care, should ensure the rational use of financial resources to achieve maximum therapeutic effectiveness.

The purpose is the study of literary sources of information and a critical analysis of one's own research on the peculiarities of the clinical course of diseases of the esophagogastroduodenal zone in military personnel during the ATO/OS and under martial law conditions in order to outline the most pharmaco-effective and risk-oriented treatment schemes for the mentioned pathology.

Materials and methods. Using the methods of systematic, bibliosemantic, and retrospective analysis, scientific publications were studied to identify the prevalence, structure, and features of the clinical course of diseases of the esophagogastroduodenal zone among military personnel during ATO/JFO and under martial law conditions, with the inclusion in treatment regimens of drugs of a domestic manufacturer with high clinical and pharmacoeconomic efficiency. For this, a search was made for available sources of information from 2009 to 2022, which related to the purpose of the work and terminological phrases: acid-dependent diseases, colloidal bismuth, pharmacoeconomic analysis, gastroesophageal reflux disease, chronic gastritis and peptic ulcer of the stomach and duodenum, anti-Helicobacter therapy, acid-suppressive and gastrocytoprotective therapy. On the basis of a thoughtful analysis of modern sources of information, various approaches to the perspective of research on the use of new domestic cytoprotective drugs in the treatment schemes of diseases of the esophagogastroduodenal zone and the use of a gastrointestinal risk calculator were summarized.

Results. The article reviews the literature and data of our own research on the prevalence, structure, and features of the clinical course of diseases of the esophagogastroduodenal zone in servicemen during ATO/JFO and under martial law conditions with the inclusion in the treatment regimen of drugs of a domestic manufacturer with high clinical and pharmacoeconomic efficiency. The relevance of conducting a pharmacoeconomic analysis of anti-helicobacter, acid-suppressive and cytoprotective therapy schemes for acid-dependent diseases in military personnel was determined, which will contribute to the optimization of budget costs. The implementation of two versions of the "Calculator of gastrointestinal risks of NSAIDs-associated injuries of the gastroduodenal zone and their prevention" was announced for the prevention and treatment of drug-induced gastroduodenopathy. Prospects for conducting research on the use of new domestic cytoprotective drugs in treatment schemes for diseases of the esophagogastroduodenal zone were analyzed.

Conclusions. Acid-dependent diseases of the esophagogastroduodenal zone lead among diseases of the digestive organs in military personnel with an increasing share of erosive-ulcerative lesions during combat operations. PPI antisecretory therapy occupies a leading place in the treatment of this pathology, in connection with which the questions of not only its effectiveness, but also its pharmacoeconomic feasibility become relevant. Our studies have shown the clinical and pharmacoeconomic advantages of using in clinical practice proton pump inhibitors of the domestic manufacturer of the latest generations (esomeprazole and rabeprazole) compared to omeprazole. The decrease in the effectiveness of H. pylori eradication in military personnel dictates the need to switch from triple antihelicobacter therapy (with an eradication rate of up to 70%) to other schemes (with an eradication level of more than 85% according to international standards), which in turn actualizes the conduct of clinical and pharmacoeconomic studies of the effectiveness of schemes anti-helicobacter therapy. Our studies have shown the clinical and pharmacoeconomic advantages of using in clinical practice bismuth-containing (based on rabeprazole and colloidal bismuth) and sequential schemes of anti-helicobacter therapy (based on esomeprazole) compared to omeprazole. To prevent the occurrence of erosive-ulcerative lesions of the gastroduodenal zone against the background of taking NSAIDs, the "Calculator of gastrointestinal risks of NSAIDs-associated lesions of the gastroduodenal zone and their prevention" is recommended for widespread use, which can be used to determine the gastrointestinal risk of negative events in a specific patient with defined functional reserves and on on the basis of this, make decisions about the need for prophylaxis with PPI drugs.