Терапевтический архив (Feb 2010)
On the occasion of the 50th anniversary of A. M. Ugolev's current theory of digestion
Abstract
In 1958, A. M. Ugolev (1926-1991) discovered parietal (membrane) digestion (MD) that differs fundamentally from cavity and intracellular digestion in the strictly directed arrangement of active centers of enzymes and in coupling to the membrane transport systems. The three-stage sequential triad: cavity digestion - MD - absorption has given an insight into the mechanism responsible for an extremely high food assimilation rate in the gastrointestinal tract and become as the basis of the current digestion theory stated by Academician A. M. Ugolev. Membrane maldigestion results from atrophic changes in the small bowel mucosa in gluten-sensitivity celiac disease, enteric infections, excessive small intestinal microflora growth, and intestinal damages induced by nonsteroidal anti-inflammatory drugs, some antibiotics, and antimetabolites. Clinically, it presents with poor tolerability of nutrients containing oligomers, whose digestion is impaired, and with malabsorption symptoms. Indirect (load) and direct (perfusion) tests, as well as biochemical and histological studies of the activity of membrane enzymes are proposed for the diagnosis of membrane maldigestion. The detection and elimination of agents that damage the intestinal mucosa (gluten, lactose, pathogenic microflora, and pharmacologicals) form the basis for the etiotropic treatment of patients with impaired MD. A. M. Ugolev's discovery has led not only to the major general biological generalization - the current theory of digestion, but also to the revision of the pathogenesis, clinical signs, and treatment of diseases accompanied by enteric food malassimilation.
