gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2020-30-5-63-83gastro-j-511Research ArticleКЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИ РОССИЙСКОЙ ГАСТРОЭНТЕРОЛОГИЧЕСКОЙ АССОЦИАЦИИCLINICAL GUIDELINES OF THE RUSSIAN GASTROENTEROLOGICAL ASSOCIATIONКлинические рекомендации Российской гастроэнтерологической ассоциации по диагностике и лечению инфекционного эзофагитаClinical Recommendations of the Russian Gastroenterological Association on Diagnosis and Treatment of Infectious Esophagitishttps://orcid.org/0000-0002-6815-6015ИвашкинВ. Т.IvashkinV. T.

Ивашкин Владимир Трофимович - академик РАН, профессор, доктор медицинских наук, заведующий кафедрой пропедевтики внутренних болезней, гастроэнтерологии и гепатологии Института клинической медицины им. Н.В. Склифосовского; директор клиники пропедевтики внутренних болезней, гастроэнтерологии и гепатологии им. В.Х. Василенко

119435, г. Москва, ул. Погодинская, д. 1, стр. 1

Vladimir T. Ivashkin - Full Member of the Russian Academy of Sciences, Prof., Dr. Sci. (Med.), Head of the Department of Internal Disease Propaedeutics, Gastroenterology and Hepatology, Sklifosovsky Institute of Clinical Medicine; Director, Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology; Chief Gastroenterologist, Ministry of Health of the Russian Federation

119435, Moscow, Pogodinskaya str., 1, bld. 1

 

 

v.t.ivashkin@mail.ruhttps://orcid.org/0000-0003-1928-4747ЮщукН. Д.YuschukN. D.

Ющук Николай Дмитриевич - академик РАН, доктор медицинских наук, профессор, заведующий кафедрой инфекционных болезней и эпидемиологии; президент

127473, г. Москва, ул. Делегатская, д. 20, стр. 1

 

Nikolay D. Yuschuk - Full Member of the Russian Academy of Sciences, Dr. Sci. (Med.), Prof., Head of the Chair of Infectious Diseases and Epidemiology; President

127473, Moscow, Delegatskaya str., 20, bld. 1

prof.uyshuk@gmail.comhttps://orcid.org/0000-0001-6114-564XМаевИ. В.MaevI. V.

Маев Игорь Вениаминович - академик РАН, профессор, доктор медицинских наук, заведующий кафедрой пропедевтики внутренних болезней и гастроэнтерологии

127473, г. Москва, ул. Делегатская, д. 20, стр. 1

Igor V. Maev - Full Member of the Russian Academy of Sciences, Prof., Dr. Sci. (Med.), Head of Chair of Internal Medicine Propaedeutics and Gastroenterology

127473, Moscow, Delegatskaya str., 20, bld. 1

https://orcid.org/0000-0003-3362-2968ТрухмановА. С.TrukhmanovA. S.

Трухманов Александр Сергеевич - доктор медицинских наук, профессор кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии Института клинической медицины им. Н.В. Склифосовского

119435, г. Москва, ул. Погодинская, д. 1, стр. 1

Alexander S. Trukhmanov - Dr. Sci. (Med.), Prof., Department of Internal Disease Propaedeutics, Gastroenterology and Hepatology, Sklifosovsky Institute of Clinical Medicine

119435, Moscow, Pogodinskaya str., 1, bld. 1

troukh@mail.ruhttps://orcid.org/0000-0002-0960-1166СтороноваО. А.StoronovaO. A.

Сторонова Ольга Андреевна - кандидат медицинских наук, врач отделения функциональной диагностики Клиники пропедевтики внутренних болезней, гастроэнтерологии и гепатологии им. В.Х. Василенко

119435, г. Москва, ул. Погодинская, д. 1, стр. 1

Olga A. Storonova - Cand. Sci. (Med.), Physician (functional diagnostics), Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology

119435, Moscow, Pogodinskaya str., 1, bld. 1

storonova@yandex.ruhttps://orcid.org/0000-0002-1390-2981МакушинаА. А.MakushinaA. A.

Макушина Анастасия Алексеевна - ординатор кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии Института клинической медицины им. Н.В. Склифосовского

119435, Москва, ул. Погодинская, д. 1, стр. 1

Anastasia A. Makushina - Clinical Resident, Department of Internal Disease Propaedeutics, Gastroenterology and Hepatology, Sklifosovsky Institute of Clinical Medicine

119435, Moscow, Pogodinskaya str., 1, bld. 1

 

makushinanast@gmail.comПироговС. С.PirogovS. S.

Пирогов Сергей Сергеевич - доктор медицинских наук, заведующий отделом эндоскопии Московского научно-исследовательского онкологического института им. П.А. Герцена

125284, г. Москва, 2-й Боткинский пр., д. 3

Sergey S. Pirogov - Dr. Sci. (Med.), Head of the Endoscopy Department

125284, Moscow, Vtoroy Botkinskiy pr., 3

pirogov@mail.ruhttps://orcid.org/0000-0003-3606-3823ЗайратьянцО. В.ZayratyantsO. V.

Зайратьянц Олег Вадимович - доктор медицинских наук, профессор, заведующий кафедрой патологической анатомии

127473, г. Москва, ул. Делегатская, д. 20. стр. 1

Oleg V. Zayratyants - Dr. Sci. (Med.), Prof., Head of the Chair of Morbid Anatomy

127473, Moscow, Delegatskaya str., 20, bld. 1

ovzair@mail.ruhttps://orcid.org/0000-0002-1475-6584АлексееваО. П.AlekseevaO. P.

Алексеева Ольга Поликарповна - доктор медицинских наук, профессор кафедры госпитальной терапии и общеврачебной практики им. В.Г. Вогралика

603005, г. Нижний Новгород, пл. Минина и Пожарского, д. 10/1

Olga P. Alekseeva - Dr. Sci. (Med.), Prof., Chair of Hospital Therapy and General Practice named after V.G. Vogralik

603005, Nizhny Novgorod, Minina i Pozharskogo sq., 10/1

al_op@mail.ruhttps://orcid.org/0000-0002-4007-7112АндреевД. Н.AndreyevD. N.

Андреев Дмитрий Николаевич - кандидат медицинских наук, доцент кафедры пропедевтики внутренних болезней и гастроэнтерологии

127473, г. Москва, ул. Делегатская, д. 20, стр. 1

Dmitriy N. Andreyev - Cand. Sci. (Med.), Assoc. Prof., Chair of Internal Medicine Propaedeutics and Gastroenterology

127473, Moscow, Delegatskaya str., 20, bld. 1

dna-mit8@mail.ruhttps://orcid.org/0000-0003-4456-8725ЛапинаТ. Л.LapinaT. L.

Лапина Татьяна Львовна - кандидат медицинских наук, доцент кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии Института клинической медицины им. Н.В. Склифосовского

119435, г. Москва, ул. Погодинская, д. 1, стр. 1

Tatyana L. Lapina - Cand. Sci. (Med.), Assoc. Prof., Department of Internal Disease Propaedeutics, Gastroenterologyand Hepatology

119435, Moscow, Pogodinskaya str., 1, bld. 1

tatlapina@gmail.comhttps://orcid.org/0000-0002-5554-7084ТкачевА. В.TkachevA. V.

Ткачев Александр Васильевич - доктор медицинских наук, профессор, заведующий кафедрой пропедевтики внутреннихболезней

344022, г. Ростов-на-Дону, переулок Нахичеванский, д. 29

Alexander V. Tkachev - Dr. Sci. (Med.), Prof., Head of the Chair of Internal Disease Propaedeutics

344022, Rostov-on-Don, Nakhichevanskiy per., 29

tkachev@aaanet.ruhttps://orcid.org/0000-0001-6434-1267УспенскийЮ. П.UspenskiyYu. P.

Успенский Юрий Павлович - доктор медицинских наук, профессор, заведующий кафедрой факультетской терапииимени профессора В.А. Вальдмана; профессор кафедры внутренних болезней стоматологического факультета

194100, г. Санкт-Петербург, ул. Литовская, д. 2

 

Yuriy P. Uspenskiy - Dr. Sci. (Med.), Prof., Head of the Chair of Faculty Therapy named after Professor V.A. Valdman; Chair of Internal Medicine, Faculty of Dentistry

194100, St. Petersburg, Litovskaya str., 2.

 

uspenskiy65@mail.ruhttps://orcid.org/0000-0002-1395-9566ШептулинА. А.SheptulinA. A.

Шептулин Аркадий Александрович - доктор медицинских наук, профессор кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии Института Клинической Медицины им. Н.В. Склифосовского

119435, г. Москва, ул. Погодинская, д. 1, корп. 1

Arkadiy A. Sheptulin - Dr. Sci. (Med.), Prof., Department of Internal Disease Propaedeutics, Gastroenterology and Hepatology

119435, Moscow, Pogodinskaya str., 1, bld. 1

arkalshep@gmail.comФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» (Сеченовский Университет) Министерства здравоохранения Российской ФедерацииРоссияSechenov First Moscow State Medical University (Sechenov University)Russian FederationФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Министерства здравоохранения Российской ФедерацииРоссияYevdokimov Moscow State University of Medicine and DentistryRussian FederationМосковский научно-исследовательский онкологический институт им. П.А. Герцена, филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Министерства здравоохранения Российской ФедерацииРоссияHerzen Moscow Oncology Research Center - Branch of the National Medical Research Radiology CenterRussian FederationФГБОУ ВО «Приволжский исследовательский медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияPrivolzhsky Research Medical University, Nizhny NovgorodRussian FederationФГБОУ ВО «Ростовский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияRostov State Medical UniversityRussian FederationФГБОУ ВО «Санкт-Петербургский государственный педиатрический медицинский университет» Министерства здравоохранения Российской Федерации; ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения Российской ФедерацииРоссияSaint-Petersburg State Pediatric Medical University; Pavlov First Saint-Petersburg State Medical UniversityRussian Federation2020300920203056383Copyright © Ивашкин В.Т., Ющук Н.Д., Маев И.В., Трухманов А.С., Сторонова О.А., Макушина А.А., Пирогов С.С., Зайратьянц О.В., Алексеева О.П., Андреев Д.Н., Лапина Т.Л., Ткачев А.В., Успенский Ю.П., Шептулин А.А., 20202020Ивашкин В.Т., Ющук Н.Д., Маев И.В., Трухманов А.С., Сторонова О.А., Макушина А.А., Пирогов С.С., Зайратьянц О.В., Алексеева О.П., Андреев Д.Н., Лапина Т.Л., Ткачев А.В., Успенский Ю.П., Шептулин А.А.Ivashkin V.T., Yuschuk N.D., Maev I.V., Trukhmanov A.S., Storonova O.A., Makushina A.A., Pirogov S.S., Zayratyants O.V., Alekseeva O.P., Andreyev D.N., Lapina T.L., Tkachev A.V., Uspenskiy Y.P., Sheptulin A.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/511

Цель представления клинических рекомендаций, предназначенных для врачей-гастроэнтерологов, врачей общей практики (семейных врачей), врачей-терапевтов, врачей-эндоскопистов, врачей-инфекционистов заключается в изложении современных методов диагностики и лечения инфекционного эзофагита.

Основное содержание

Основное содержание. Инфекционный эзофагит представляет собой заболевание пищевода, вызванное грибковыми, вирусными, бактериальными или паразитарными агентами. Пищевод может поражаться изолированно либо как часть распространенной инфекции желудочно-кишечного тракта. Всем пациентам с по дозрением на инфекционный эзофагит, при отсутствии противопоказаний, с целью подтверждения диагноза рекомендуется проведение эзофагогастродуоденоскопии со взятием биопсии. В ряде случаев пациентам с инфекционным эзофагитом с целью верификации инфекционного агента рекомендуется проведение гистологического исследования, иммуногистохимического исследования или анализа методом полимеразной цепной реакции. Пациенты с неосложненным течением инфекционного эзофагита подлежат консервативному лечению. В большинстве случаев оно проводится амбулаторно. Однако при выраженной одинофагии, дисфагии, выраженном болевом синдроме, высоком риске развития осложнений (например, риск развития кровотечения из язв пищевода у пациентов с тромбоцитопенией), тяжелой степени иммунодефицита, развитии генерализованных форм заболевания, тяжелых сопутствующих заболеваниях целесообразна госпитализация пациентов. Клинические рекомендации содержат критерии оценки качества оказания медицинской помощи, информацию для пациента.

Заключение

Заключение. Диагностика инфекционного эзофагита опирается на клиническую картину (одинофагия, дисфагия), наличие иммуносупрессии, данные эндоскопического и гистологического исследования. Всем пациентам с инфекционным эзофагитом с верифицированным возбудителем рекомендуется проведение соответствующей этиотропной терапии.

Aim

Aim. Current clinical recommendations aim to provide gastroenterologists, general practitioners (family doctors), endoscopists and infectionists with modern methods for diagnosis and treatment of infectious esophagitis.

Key points

Key points. Infectious esophagitis is an esophageal disease of fungal, viral, bacterial or parasitic origin. Esophagus may be affected per se or conjointly in a common gastrointestinal infection. All patients suspected for infectious esophagitis, unless contraindicated, are advised an esophagogastroduodenoscopy with biopsy to confirm diagnosis. Selected incidents of infectious esophagitis require a histological, immunohistochemical examination or polymerase chain reaction-based diagnosis to verify the infectious agent. Uncomplicated infectious esophagitis requires a conservative therapy, mostly on an outpatient basis. However, cases of severe odynophagia, dysphagia, severe pain syndrome, high complication risks (e.g., esophageal ulcer bleeding in thrombocytopenia), severe immunodeficiency, generalised forms of disease and severe concomitant disorders are considered for hospital care. The clinical recommendations outline criteria for the medical care quality assessment and provide relevant information to the patient.

Conclusion

Conclusion. Diagnosis of infectious esophagitis capitalises on the clinical picture (odynophagia, dysphagia), presence of immunosuppression, endoscopic and histological evidence. All patients with infectious esophagitis of verified origin are recommended a suitable etiotropic therapy.

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The authors declare that there are no conflicts of interest present.