According the background of increasing consumption of gluten-containing products by the population increase in the prevalence and expanding the range of gluten-related diseases was marked. Gluten proteins and other cereals have been recognized as a possible cause of allergies to wheat, and non-celiac gluten sensitivity has been described as a new syndrome (NCGS). The article presents a modern view on the problem of gluten-related diseases, definition of NCGS, approaches to the diagnosis and recommendations for management of patients with this pathology

Background: Corpus atrophic gastritis (СAG) may be the outcome of Helicobacter pylori (H.pylori) - infection or autoimmune damage of the parietal system, affecting the risk of gastric cancer and requiring different approaches in the treatment and observation. Aim: To study the prevalence and peculiarity of CAG in population with high prevalence of H.pylori infection. Materials and methods: Prevalence of CAG was studied in the representative group of Novosibirsk citizens (246 subjects aged 45-69, 117 males and 129 females) using serology for noninvasive testing of gastritis phenotype GastroPanel. Pepsinogen I (PgI) level < 30 µg/l and/or PgI/PgII ratio < 3.0 were interpreted as sever atrophy. In addition, a clinical group with serologically proven corpus atrophy was studied: 39 females and 8 males aged 38-79. Upper endoscopy and morphological examination was performed in 38 patients. As a pilot project, in 19 patients with suspicion on autoimmune gastritis (AIG) (low PgI + high Gastrin-17) parietal cells antibodies (PCA) and vitamin B12 level were determined. Conclusion: In Novosibirsk population prevalence of both H.pylori infection and CAG (10.2%) is high. AIG is often associated with H.pylori infection (in 47.4% of cases); however, its role demands a further evaluation. Autoimmune phenotype of gastritis which was found using noninvasive diagnostic was confirmed with the presence of PCA. In all cases of AIG atrophy was confirmed morphologically with the presence of intestinal metaplasia in 52.6% and dysplasia in 10.5% of cases.

The aim of this study was to determine the frequency and the clinical and laboratory features of acute viral gastroenteritis in adult patients the residents of Novosibirsk. Materials and methods: A total of 363 patients aged 16 to 82 years hospitalized with a diagnosis of “acute gastroenteritis” in the winter-spring season 2016 and with no evidence of immunosuppression were examined. In addition to generally accepted diagnostic techniques faeces were investigated using polymerase chain reaction for the detection and differentiation group A and C rotaviruses (HRVA and HRVC), II norovirus genogroup II (HNoV GII) and astroviruses (HAstV) with applying the original set of specific primers. Results: Viral etiology has been set at 19,6% of patients with acute gastroenteritis. Noroviruses were predominant (10,2%), the proportion of rotavirus was 7,7%, astroviruses - 1,7%. The proportion of viral gastroenteritis was higher in the winter months and decreased in spring months. The moderate form of the disease dominated (99.4%). No significant differences in clinical symptoms, blood count and coprogram parameters were revealed in patients with different etiology of viral gastroenteritis, except the higher frequency of lymphocytosis in norovirus infection (p < 0,05). Conclusion: Set frequency of viral gastroenteritis in adults, no significant differences in the clinical picture of viral gastroenteritis of various etiologies determine the necessity of elaboration and introduction into clinical practice of universal test systems for the detection of common viral pathogens.

Objective: To study for gastroesophageal reflux disease (GERD) in patients with overweight and obesity, and to choose treatment approaches in this group of individuals. Materials and Methods: Group of 131 patients suffering from GERD was formed. Patients completed questionnaires. We had performed a physical examination, laboratory and instrumental examination, measuring the level of leptin and its receptor. Cohort was divided into two groups: primary (n = 104) - persons with obesity and excess weight, and the comparison group (n = 27) - people with normal body weight. All patients had been appointed drug Pantoprazole. Additionally we were recruited 20 patients followed by randomization to monotherapy with proton pump inhibitors (PPIs), or a combination with ursodeoxycholic acid (UDCA). Results: Individuals both group often complained of regurgitation «bitter» (2I = 8,03; p < 0,001), the nature of biliary pain (2I = 17,17; p < 0,05). In this group non-erosive form of GERD, as well as Step C of reflux esophagitis most significantly were observed (φ = 2,28; p < 0,05). It was found that among the indicators of the main group of persons higher pH and cardia gastric body were identified. In the group of obese higher levels of leptin had identified (U = 67,0; Z = 4,35; p = 0,000), having a significant negative relationship with its receptor levels (rs = -0,452; p = 0,0004). Leptin was independent of BMI due to the pH-meter. In monotherapy PPIs in the study group the persistence of clinical symptoms was noted by the 28th day of therapy (82 (62,6 ± 4,2) of the patient), as well as the less significant increase in quality of life. In combination therapy (PPI + UDCA) symptoms (heartburn, bitter regurgitation) could more fully to stop and this data were statistically significant: (φ = 2,07; p < 0,05) and (φ = 3,51; p < 0,001), respectively. Conclusion: The features of the clinical course of GERD in patients with obesity and overweight were found, UDCA in the treatment of GERD in this category of persons can improve treatment outcomes.

Aim. The study of the clinical course and metabolic disorders in patients nonalcoholic fatty liver disease (NAFLD) elderly. Subjects and methods. 153 patients with NAFLD was investigated, including 97 men and 56 women. In comparative terms we studied clinical manifestations of NAFLD. All patients NAFLD was verified for the first time. We studied the functional state of the liver function, lipid, carbohydrate and porphyrin metabolism, insulin resistance. Results. Revealed comorbid pathology, which is predominantly observed in elderly patients. Disturbances in lipid metabolism and insulin resistance hyperinsulinemiya and proved to be more significant in young patients. Disorders of porphyrin metabolism observed in most patients. Disorders are variable. Do young people have dominated the initial disorder, on the other hand more often in elderly patients were observed faction (later) porphyrin metabolism disorders. Conclusion. Studies suggest that the main pathophysiologic and pathogenetic processes of formation of NAFLD (insulin resistance and dyslipidemia) significantly more pronounced in younger patients. This fact suggests that NAFLD is mainly formed at a young age. Elderly patients have comorbid pathology.

The aim: to evaluate the clinical manifestations and data of instrumental methods in patients with Gilbert's syndrome and different genotype UGT1A1. Materials and methods: Clinical manifestations and results of instrumental methods were studies in 104 patients with Gilbert's syndrome (UGT1A1 gene mutation rs8175347), including 75 with the homozygous variant (genotype 7ТА*7ТА) and 29 - with heterozygous variant (genotypes 6ТА*7ТА or 6ТА*8ТА). Results: The most frequent clinical manifestation was asthenovegetative syndrome. The promoter of the appearance/intensification of jaundice were physical activity, stress and viral infections. Homozygotes exhibit an earlier manifestation of the disease, higher rates of bilirubin (sometimes not only due to deconjugating), a greater variety of stigmas undifferentiated dysplasia of connective tissue, more frequent detection of biliary sludge or gallstones. The clinical observation of a family case of Gilbert's syndrome where the mother is a homozygote, and the son - heterozygotes on UGT1A1 mutation is presented, which shows the above differences associated with genotype. Conclusion: Patients with asthenic constitution and the stigma dysplasia of connective tissue have to be examined by the presence of mutations rs8175347 gene UGT1A1. The carrier not only homozygous but with the heterozygous variant mutations may require changes in the interpretation of symptoms, lifestyle, medication, etc.

Aim. Frequency Estimation of registration of various skin changes in patients with chronic diffuse liver diseases (CDDL). Subjects and methods. A cross-sectional observational study in patients with CDDL and dermatological changes. The basis of this study - the results of clinical and laboratory findings 468 patients with various liver diseases (viral, toxic, parasitic). Results. A detailed analysis of dermatological manifestations of "dermal signs" in the studied group has allowed both to expand their roster, and refine clinical description of some of them. Specifically, that patients can simultaneously generate multiple dermatological stigmata. Conclusion. The results suggest that skin extrahepatic "marks" is very variable. Their various combinations available to patients is a high screening signs of liver disease. The data can be used by physicians gastroenterologists and dermatologists.

Inflammatory bowel diseases (IBD) are chronic recurrent immune-mediated inflammation of the gastrointestinal tract. Now it is not unified system of monitoring patients with IBD in Russia, but there is information from different regions about the prevalence of disease. There are the registers in few big cities. From 2003 the registers of IBD have been done in Novosibirsk. The register data can give us the possibility to estimate the various real-time data of the disease, to analyze the effect of the treatment , to evaluate risk factors for the disease in real clinical practice. Among the patients with ulcerative colitis decreased the number of patients with recurrent and continuous increase in the number of patients with distal forms, which is probably due to the more skillful conduct of patients. In general, it decreased the number of patients with Crohn's disease with continuously relapsing course option, reflecting, perhaps, improved treatment. Decline in the proportion of persons with the localization process, only in the colon, which is associated with greater availability of diagnostic methods for destruction of the small intestine. The registry was created in April 2012 and includes patients registered up to October 2015.

Aim: To evaluate gastrointestinal symptoms during 10 years after cholecystectomy in patients with symptomatic and asymptomatic gallstone disease and to identify predictors of them. Materials and Methods: The work is the part of a prospective long-term monitoring of patients with symptomatic (1) and asymptomatic (2) gallstone disease after cholecystectomy (CE). The study included 145 patients: 115 (80.7%) with initially symptomatic disease (1) and 30 (21.5%) asymptomatic (2) disease. Results: The frequency of heartburn increased from 15.9% to 63.7% during 10 years (p = 0.015) after CE especially in the group (1) (from 2.24% to 68.53% (p = 0.037). The frequency of "bitter taste in the mouth” raised from 46.9% before the CE to 69.02% after CE (p < 0.001). The frequency of diarrhea increased from 0.88% to 38.2% in both groups. (p = 0.046). Conclusion: The frequency of heartburn, "bitter taste in the mouth", diarrhea increased in patients after 10 years in patients with symptomatic and asymptomatic gallstone disease after CE. A common risk factors are presence symptomps at baseline and the presence of these symptoms at the first years after CE.

The aim of the study was the study of ten-year trends (1999-2009) of GERD symptoms and risk factors in schoolchildren in Novosibirsk from 14 to 17 years. Materials and methods: The comparison of the results of the screenings performed at 1999 and 2009 was analyzed. Anthropometry, the survey to identify the symptoms of GERD and eating habits, smoking and alcohol consumption, determination of IgG and CagA antibodies to Helicobacter pylori were included at the program of screenings. Results: No significant dynamics of GER symptoms in adolescents, except weekly heartburn among boys. Among the factors associated with dyspepsia and GER, there have been some mixed changes: the frequency of smoking significantly reduced, but the proportion adolescents with excess body weight have increased. Violations of the regime and diet, and Helicobacter pylori-infection has not changed significantly. Conclusion: The frequency of GERD in adolescents remains high but does not reach the prevalence of GERD in adults.

Aim. Refining pathogenesis factors and the role of disorders of gastric secretion in the formation of the syndrome of malnutrition in patients with connective tissue dysplasia patients. Materials and methods: In a cross-sectional comparative cohort study 83 patients were included: 59 patients with signs of connective tissue dysplasia (study group) and 24 patients with no signs of connective tissue dysplasia (control group). In all patients the gastrointestinal symptoms were evaluated using a questionnaire GSRS, esophagogastroduodenoscopy, 24-hours pH monitoring, diagnostics H.pylori infection. Results. In patients with connective tissue dysplasia the higher scores were recorded at body pH 1.2 (1.0; 2.8) and antral stomach 8.9 (6.6; 10.0). According to the morphological study the mucosal damage prevalents as pangastritis (20%), fundic gastritis (4%). Changes of intranagastric pH were associated with high rates of duodeno-gastric reflux in 74.5% patients. The severity of symptoms of dyspepsia (postprandial distress syndrome) and the degree of malnutrition correlated with indicators of intragastric pH in the body and antrum. Conclusion. The changes revealed intragastric pH may significantly alter the digestive conditions in all parts digestive tract contributing desynchronization receipt chyme and enzymes disrupting the normal regulation of pancreatic secretion, promoting the development of maldigestion syndromes, malabsorption and, consequently aggravate genetically determined disorders trophological status.

72 patients with pulmonary fibrosis were examined with ultrasound method. Some of them have also gastroesophageal reflux. Changes in amplitude of diaphragm motion during intensified breathing were informative. Diaphragm level in patients with gastroesophageal reflux was lower than without reflux

Objectives. New and effective drugs to improve liver function and fibrosis are urgently needed for patients with nonalcoholic steatohepatitis (NASH). This study examines the effectiveness of treatment of patients with NASH with the registered hepatoprotector, Ropren®. Methods. This observational study used Ropren® in a post-registration setting to treat 20 females (38-56 years) with chronic NASH unresponsive to standard treatment. Ropren® is a biopolymer made up of polyprenols (analogue of dolichol) isolated from the green verdure of spruce (Picea abies (L) Karst). Ropren® was given orally, three times a day (54 mg/day). Measurements before and after treatment included symptoms and blood biochemistry (triglycerides, high-density lipoproteins, low-density lipoproteins, alanine transaminase, aspartate transaminase, alkaline phosphatase and gamma-glutamyl-transpeptidase). Liver fibrosis was measured with indirect ultrasound elastometry. Results. After 12 weeks of Ropren® treatment, improvements were found for blood lipids and clinical and biochemical signs, including reductions in total cholesterol and triglycerides (p < 0.05). Ropren® also significantly decreased the liver fibrosis index (p < 0.05). No side effects were observed. Conclusions. Ropren® treatment increased the elasticity of the liver and might be useful to reduce the risk of cirrhosis. Although the sample size in this study was small, the results demonstrated that a randomised-controlled trial of Ropren® for NASH is warranted.

Aim. To study the possibility of using a combination of dexmedetomidine with nefopam for postoperative analgesia in patients with morbid obesity after bariatric surgery in anesthesia quality aspects and the impact of the study on the combination during the inflammatory response to surgical trauma. Subjects and methods. A prospective cohort study of 48 patients with obesity. Results. Based on the analysis of hemodynamic parameters, evaluation of pain using a numeric rating scale pain concluded that selective agonist of α-2 adrenergic dexmedetomidine in combination with nefopam provides effective postoperative pain relief in patients who underwent bariatric surgery, and is not a factor for suppression of postoperative inflammatory response Unlike the effects of ketorolac tromethamine, do not always provide a sufficient level of analgesia and reduce the rate of growth in the level of IL-6. Conclusion. The combination of dexmedetomidine with nefopam provides sufficient analgesic effect after bariatric surgery, with noted a more rapid onset of analgesia than with ketorolac. Postoperative analgesia and dexmedetomidine nefopam, unlike the use of ketorolac tromethamine, are not violated ratio of interleukins 1 and 6 was not a factor and suppression of postoperative acute phase inflammatory response.

The article presents data concerning the prevalence, clinical manifestations, methods of diagnostics, treatment and prevention of cholestasis of pregnancy, as well as the case management depending on the gestation and the cholestasis severity. A clinical case of a typical course of cholestasis of pregnancy is presented

Sarcoidosis is a multisystemic disease of unknown origin characterized by the formation of non caseating granulomas. Thoracic involvement is the most common presentation; however, sarcoidosis can involve almost any other organ. Liver is one of the most frequently affected organs after lungs and lymph nodes. Microscopic hepatic involvement is common in these patients but is mostly clinically silent. specific symptoms include jaundice and pruritus, mostly from chronic cholestasis. In a significant portion of these patients, macroscopic findings can be detected by ultrasound examination , abdominal CT or magnetic resonance imaging and these findings may easily be confused with other benign and malignant conditions of the liver. Liver biopsy is usually required to confirm the diagnosis. Not all cases of hepatic sarcoidosis require treatment. For symptomatic patients, the first line treatment includes corticosteroids or ursodeoxycholic acid.

The purpose of the review is to summarise the current data on chronic and acute pancreatitis with the goal to improve the diagnostics and treatment of women during pregnancy, which complicates differential diagnosis of hepatopancreatobiliary system pathology. The features of the incidence, etiology, pathogenesis and evaluation of the severity of the clinical manifestations of acute pancreatitis in pregnant women are given. It is emphasis that the most frequent its reason is the gallstones following by the biliary pancreatitis. The experience of use in pregnant patients imaging methods - endoscopic ultrasound, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography, as well as treatments that include endoscopic sphincterotomy, stone extraction from the common bile duct and laparoscopic cholecystectomy. The recommendations are based on expert opinions and are not supported by randomized controlled trials. Nevertheless more active clinical management allows to diagnose and treat effectively pancreatitis, including biliary etiology, which contributes to a sharp decline in maternal and perinatal mortality.

Purpose of the study. Pay attention endoscopists doctors, oncologists surgeons, gastroenterologists on the ability to detect mioblastoma in the esophagus, as well as to present its endoscopic semiotics. Material and methods. 32583 A primary esophagogastroduodenoscopy and only one patient S., 39 years old (0.0031%) showed polypoid masses in the lower third of the esophagus. Esophagogastroscopy underwent endoscopy XP 150N system Exera II. Patients underwent clinical evaluation and morphological study of endoscopically resected of education. Results. Patient 39 years old 20.01.2012, in the lower third of the esophagus revealed polypoid formation with a flat, smooth surface covered with a mucous membrane, not different from the surrounding mucosa. Morphologic study after endoscopic resection of the tumor - grainycly cell mioblastoma. When viewed within four years of changes in the mucosa and not detected change in the esophageal wall. Conclusion. Abrikosov tumor in the esophagus is extremely rare localization has exophytic growth after endoscopic removal requires regular endoscopic surveillance.

This article describes a clinical case of fulminant paracetamoly hepatitis a young woman of 33 years. Fulminant hepatitis has developed as a consequence of uncontrolled reception paracetamol-containing medicines for acute viral infection. Paracetamol poisoning confirmed at autopsy.

There are many errors in the diagnosis of celiac disease. The most common errors are following: underestimation of the importance of comprehensive laboratory and instrumental studies (histological study of biopsy specimens of the duodenal mucosa, molecular- genetic HLA typing and serological markers of celiac disease); the positive clinical dynamics after a strict gluten-free diet is not always confirm the diagnosis of celiac disease; insufficient or incorrect orientation of biopsy specimens of the mucous of the duodenum; illiterate description and interpretation of histopathological data; neglecting to identify possible IgA deficiency, the use of serological tests with low specificity for the diagnosis of celiac disease.