Set out the basic problems of classification, diagnostics and differential diagnostics of chronic gastritis and functional dyspepsia in the context of the Kyoto global consensus

Introduction. Several meta-analyzes reported the effect of CYP2C19 genetic polymorphisms on the efficacy of proton pump inhibitor-based triple therapy for Helicobacter pylori eradication. Most of the studies which were included in these meta-analyzes were held on Asian population. Thus, there is lack of information about the effect of CYP2C19 genetic polymorphisms on the efficacy of proton pump inhibitor-based triple eradication therapy in Slavic patients with peptic ulcers. The aim of the study - to determine whether СYP2C19 affect the efficacy of proton pump inhibitor-based triple eradication therapy in Slavic patients with peptic ulcers. Methods. Data search was performed using Russian index of scientific citation database, Google Scholar and MEDLINE PubMed. Statistics was held in Review Manager v 5.3. The odds ratio (OR) and 95% confidence interval (95% CI) for eradication of H.pylori was estimated in a fixed-effect model when no heterogeneity across the studies was indicated. Results. Four articles published between 2008 and 2015 were included in meta-analysis (three Russian studies, one Polish study). Eradication rates were significantly lower in CYP2C19 extensive metabolizers of proton pump inhibitors than in a combined group of intermediate and poor metabolizers (OR = 1,90, CI-95% 1,08-3,34, p = 0,03; heterogeneity: I2= 0%, p = = 0,74). We also found that proton pump inhibitor-based triple eradication therapy achieved higher rates in poor metabolizers than in a combined group of intermediate and extensive metabolizers of CYP2C19 (OR= 5,48 CI-95% 1,51-19,93, р = = 0,01; heterogeneity: I2= 0%, p = 0,66). Conclusion. The impact of CYP2C19 genetic polymorphisms on the efficacy of proton pump inhibitor-based triple eradication therapy in Slavic patients appears significant.

The main aim of the study is to examine microbiocenosis of lower respiratory tract and intestine in patients with chronic obstructive pulmonary disease (COPD), lung cancer (LC), lung cancer with community-acquired pneumonia (CAP) and to determine their role in the etiological diagnosis of lower respiratory tract infections (LRTI), including those that develop during cancer chemotherapy (CC), to discuss the possibility of optimizing the treatment tactics. Materials and Methods: To solve this task were examined 147 patients and 30 healthy individuals were divided into 4 groups, according to nosology. The number of patients in the COPD group was 38 people, m / f -35/3, median age 63 (57; 69) years, in the LC group - 60 people, m / f - 56/4, with a median age of 65 (58; 71) year; LC group with CAP - 21 persons m / f - 17/4, with a median age of 73 (69; 75) years, in the LC group with CAP developed in the period up to 30 days after the end of chemotherapy (LC with CAP / CC) - 28 persons m / f - 22/6, with a median age of 70 (67; 73) years, the norm group - 30 healthy persons m / f - 26/4, median age 48 (40, 69) years. The spectrum of short-chain fatty acids (SCFA) sputum (in bronchoalveolar lavage standards group) and test groups of feces were studied by gas-liquid chromatographic analysis (GLC analysis). Results of the study. In the norm group: total absolute content of SCFA (Σ) in sputum was 0.032 mg / g, the relative content of acetic acid (pC2) 0.906 u, propionic acid (pC3) 0.085 u, butyric acid (pC4) 0.009 u, anaerobic index (AI) -0.104 units. According to the analysis the total absolute content of SCFA in the sputum may be expressed as follows: Σ SCFA (C2-C4) norm (0,032) <Σ SCFA (C2-C4) COPD (0,201) <Σ SCFA (C2-C4) RL (0,463) <Σ SCFA (C2-C4) LC with CAP (0.510) < RCMP Σ (C2-C4) LC with CAP / CC (0.612) (mg / g), the differences are statistically significant when compared with the norm. The findings of the relative content of C2-C4 show a statistically significant increase of the relative content of propionic and butyric acids: PC3 (0,085) pC4 (0.009) norm pC2 (0.846) COPD> pC2 (0.792) LC> pC2 (0.765) LC with CAP> pC2 (0.719) LC with CAP / CC (u) in patients of all study groups compared to the norm, and between groups. And the more pronounced changes in the content of SCFA in the sputum are ascertained in lung cancer with CAP during chemotherapy. The values of AI in the studied groups are displaced to more negative values: AI (- 0.104) rate> AI (- 0.190) COPD> AI (- 0.257) RL> AI (- 0.307) LC with CAP> AI (- 0.391) LC with CAP / CC (sing.) compared with the norm and between groups. The findings of SCFA in feces in the group norm: Σ SCFA 10.51 mg / g, 0.634 units pC2, pC3 0,189 units, 0,176 units pC4, -0.576 AI units. The total absolute content of SCFA in feces can be expressed as follows: Σ SCFA (C2-C4) LC (4,11) <Σ SCFA (C2-C4) COPD (4,81) <Σ SCFA (C2-C4) norm (10 51) (mg / g), the differences were statistically significant when compared with the norm; depending on the chemotherapy, preceding the development of the CAP: Σ SCFA (C2-C4) norm (10,51)> Σ SCFA (C2-C4) LC with CAP / chemotherapy (5,54)> Σ SCFA (C2-C4) LC CAP (4,96)> Σ SCFA (C2-C4) LC (4.11) (mg / g). Results of the study of the relative content of C4-C2 also demonstrate a statistically significant increase of the relative content of propionic and butyric acids: pC3 (0.189), pC4 (0.176) norm pC2 (0.590) COPD> pC2 (0,560) LC> pC2 (0.529) LC with CAP> pC2 (0.503) LC with CAP / chemotherapy (u) in patients of all study groups in comparison with the norm. And the more pronounced changes in the content of SCFA in feces are ascertained at LC with CAP during chemotherapy. The values of AI intestinal ecological community of all groups are displaced to more negative values when compared with the norm: AI (- 0.576) norm> AI (- 0.695) COPD> AI (- 0.786) LC> AI (- 0.890) LC with CAP> AI (- 0.988) LC with CAP / chemotherapy (u), with the most significant changes were observed in the group of LC with CAP during chemotherapy. Conclusion. Increased absolute SCFA concentration in patients with COPD, lung cancer, lung cancer with CAP, LC with CAP / CC in comparison with the norm indicates increased number and activity of anaerobic flora, the most significant changes observed in patients with lung cancer with CAP, developed in the period up to 30 days after the end of chemotherapy. The unidirectional changes in SCFA parameters in the sputum and stool demonstrate the dependence of microorganism biocenosis. The resulting information can be used in the etiological diagnosis of LRTI, as well as the development of therapeutic and preventive measures of the flow of infectious complications and treatment of these patients.

The article presents the results of original research of the effectiveness and safety of natural mineral water “Borjomi” in patients with functional dyspepsia. Daily pH-metric study in dynamics showed that the positive effect of mineral water “Borjomi” depends on the leading symptom in patients with functional dyspepsia and may be connected with antacid and prokinetic effects.

Bile acids regulate glucose and lipid metabolism. Aim - determination of total serum bile acids in patients with NAFLD and in combination with type 2 diabetes. To determine the inflammatory markers (nitric oxide, endotoxin, phospholipase A2, malondialdehyde) effects role for the synthesis and transport of bile acids. NAFLD patients with type 2 diabetes observed decrease in synthesis and disruption of transport of bile acids, which is associated with the cell membrane damage by inhibition of enzyme systems, and inflammation.

Introduction. There are a lot of pathogenic factors involved in development of polyetiologic diseases. Acetylcholine is known as first-order mediator and plays important role in development and maintenance of pathological processes. In this article we provide data on concentration of acetylcholine (Ah) in blood serum of patients with stomach ulcer (SU), duodenal ulcer (DU), alcoholic chronic pancreatitis (ACP) and control group as well as activity of cholinesterase (Che). The aim of this study was to identify a role played by Ah in pathological process during a disease, that may complicate a course of the disease as poor prognostic factor. Results and discussion. We found that there are significant differences in Ah concentration and Che activity between SU, DU, ACP and control. In control group we divide concentration of Ah into three groups: low - 0.46 to 1.0 mlMol/l (60% of individuals), moderate - mlMol 02-1,5/l (30%) and high - more than 1.5 Ah mlMol/l (10%). Conclusion. We suppose that Che activity and Ah concentration depend on localization of pathological process. It is possible that there are hidden differences in Ah concentration and Che activity between GU and DU.

Introduction. Video capsule endoscopy (VCE) is relatively new, informative and minimally invasive endoscopic diagnostic method for assessment of the small bowel mucosa. Objective. To evaluate the clinical significance of ten years’ experience of VCE in Latvia. Materials and methods. A retrospective review of patients who underwent VCE between July 2006 and July 2016 was conducted. All patients had undergone previous negative endoscopic examinations before VCE. Special original study protocol with more than 370 parameters was fulfilled for each patient. All the data was entered into the database with consecutive statistical analysis using SPSS ver.19. Results. In total out of 530 VCE were performed, due to technical reasons 421 patients’ data were entered into the database. Out of these, 245 (58,2%) patients were females and 176 (41,8%) - males. Patients’ age was varied from 13 to 82 (mean 44.39 ± 16.36) years. VCE most common indications were: Crohn’s disease (26.1%), unclear iron deficiency anemia (22.8%), chronic unexplained abdominal pain (20.4%) and obscure bleeding from the digestive tract (17.1%). VCE findings were justified as clinically significant in 255 (60.57%) of cases. In 152 (36.10%) - findings were doubtful, and in 14 (3.33%) - clinically insignificant. Bowel preparation prior to capsule endoscopy was performed using one of the four schemes. Bowel cleanliness was statistically significantly better (p = 0.03) using 2 liters or 4 liters of polyethylene glycol-based electrolyte solution. Regional transit abnormalities (RTA) in 55 (13.1%) cases. Positive statistically significant correlation was observed between presence of RTA without changes / defects in the small bowel mucosa and patients age (p = 0.028). Conclusions: VCE is clinically significant examination in patients with Crohn’s disease, obscure bleeding from the digestive tract, unexplained anemia and chronic unexplained abdominal pain, which also allows changing the patient’s further treatment tactics. 2 liters and 4 liters of polyethylene glycol-based electrolyte solution are by far the most efficient bowel preparation schemes prior VCE. RTA is more common in the elderly patients.

Aim of the study. To analyze the reasons of failed transpapillary interventions in malignant obstructive jaundice. Material and methods. Single-center retrospective study of results of treatment of patients with malignant obstructive jaundice, in which an attempt of transpapillary endoscopic decompression (n=433) was done. We analyzed cases of clinical and technical failure (n=89) of endoscopic retrograde cholangiopancreatography (ERCP), demanded antegrade biliary drainage. Results. Analysis of cases of technical failure of endoscopic transpapillary decompression revealed following causes: inability to reach major duodenal papilla (MDP) due to stenosis of the gastric outlet - 10 (11.2%); inability to visualize MDP - 3 (3.4%); unsuccessful cannulation of the common bile duct - 26 (29.2%); high biliary stricture - 20 (22.5%); tumor proliferation in the area of MDP - 10 (11.2%); previously performed Billroth-2 gastrectomy - 5 (5.6%). Clinical failure of transpapillary stenting was detected in 15 (16.9%) patients. Conclusion. Transpapillary intervention in malignant obstructive jaundice had technical success rate 82.9%, with clinical failure in 20.6% of patients. High biliary stricture was significantly more frequent in group of failed ERCP (χ²=47.448, p<0.001) in comparison to the group of successful transpapillary decompression (n=8; 5.2%). Frequency of failed endoscopic biliary decompression in patients with previous Billroth-2 gastrectomy was significantly greater than in successful ERCP group (n=1; 0.29%, p=0.002). Despite this, impaired gastroduodenal anatomy and high biliary strictures are not a contraindication for endoscopic transpapillary decompression. Failed ERCP was associated with higher mortality (χ²=4.574; p=0.032). Unit providing treatment of patients with malignant obstructive jaundice should have alternative methods of biliary drainage.

Aim of the study was to analyze the dynamics of thyroid hormones in the pituitary gland, thyroid gland (TG) and blood serum (BS) in liver metastases to reveal thyroid profile of metastasis and to find thyroid markers of metastasis in BS. Material and methods. The experiment included 44 white male rats weighing 180-250 g. Sarcoma 45 (S-45) was transplanted intrasplenically after the spleen was brought under the skin. Levels of thyroid hormones: thyroid stimulating hormone (TSH) in the pituitary gland, TG, BS; free (FT4) and total (T4) thyroxine and free (FT3) and total (T3) triiodothyronine in TG and BS were studied by radioimmunoassay (Immunotech, Czech Republic; Arian analyzer, Russia). Results. From the first days of the tumor development, pituitary gland strain with TSH hyperproduction was observed, and later TG hypofunctioning developed. Quantitative changes of thyroid hormones in organs did not correspond to their dynamics in BS. First diagnostic signs of experimental liver metastases, under the absence of formed metastases in the organ, were hyper-TSH-emy and the tendency to FT3 decreasing in BS. Typical characteristics of the “climax” of liver metastasis included formation of a marked “low T3” syndrome which transformed into a more severe “lowT3/lowT4” syndrome in secondary metastasis to the lungs. Conclusions. Thus, primary tumor growth and development of metastases are accompanied by the strain and imbalanced functioning of the thyroid system. Analysis of dynamics of the thyroid axis hormones in BS allows prognosis of liver metastases, as well as contributes to identifying the point of no return for the disease development which leads to secondary metastasis and irreversible progression of the process.

Introduction. Recently, more and more attracted the attention of cell therapy, which requires a study of the efficacy and safety of allogeneic MSCs transplantation in acute and chronic inflammatory reactions. The aim of our study was to examine the effectiveness of transplantation of allogeneic mesenchymal bone marrow stromal cells for the healing of surgical wounds the glandular stomach in rats. Material and methods. Using white Wistar rats. Producing cell transplantation mononuclear fraction derived from rat bone marrow aspirate. Injected cells 8 and 9 th passage. The dose of cells administered to 3-th and / or 7-th days 3,5h106 cells / ml twice or 5,0h106 cells / ml dose. Autopsy on day 10-th and 17-th. The serum ELISA determined the content of the pro- and anti-inflammatory cytokines IL1β, TNFα, IFNγ, IL-4. Results and discussion. Introduction MSCs contributed to the decline of the immune mediators of inflammation IL1β, TNFα, IFNγ, increase anti-inflammatory IL4. Quality improved healing. Conclusion. Rapid curative effect of stem cells may be associated with the formation of blood immune cells (macrophages) that produce substances that restore damaged tissue. They restore the balance between Th1 and Th2.

Aim: An improvement of the stomach through the development of reconstructive operations results of anatomical - the experimentally study and clinical testing of a series of new microsurgical areflux gastrointestinal anastomosis with sphincter properties. Materials and methods: The study was performed on 60 animals (dogs) and 52 organocomplexes people dead. 4 A series of experiments, developed new ways to 4 gastro-intestinal anastomosis with sphincter properties gastroduodenostomii way to “end to end” (patent number 2,197,903); pilorosohranyayuschey gastrectomy method (patent number 2,201,714); gastronesteostomy way to “end to side” (patent number 2,201,716); gastroduodenostomii way to the formation of artificial pyloric sphincter (patent number 2,212,195). Results: Anatomical studies on cadaveric organocomplexes installed, but that the use of the formation of the gastro-intestinal anastomosis of microsurgical techniques and a separate cross-linking methods of internal and external casings of hollow organs without entrainment into the joint mucosa anastomosis gives high impermeability and durability, retains histotopography linkable tissues. Gastric resection methods developed to form microsurgical gastrojejunal anastomosis and gastro used in clinical practice in 20 patients. Operated patients were examined after 1-6 years after surgery. When gastroscopia they celebrated, good function Form-balanced, the sphincter, the absence of duodenal reflux. Conclusion: The use of microsurgical techniques with gastric resection with the formation of functionally active gastroduodenal and gastrojejunal anastomosis can create gastrointestinal anastomosis with anti-reflux properties and save the porter, without violating its contractile function, ensures minimum trauma to the tissues, the exact adaptation of the histologic homogeneous layers of the walls of bound bodies.

The review deals with the mechanisms of the clinical features and pathology of the gastrointestinal tract in chronic pancreatitis.

The review presents comparative characteristics of domestic and foreign clinical guidelines for the diagnosis and treatment of nonalcoholic fatty liver disease

Recently the rate of successful H. pylori eradication while using existing treatment regimens continues to decline, primarily due to the appearance of antibiotic-resistant strains of the microorganism. Recent studies confirm the fact that the standard triple therapy becomes ineffective method of H. pylori eradication, due to the increase of drug-resistant strains of H. pylori. H. pylori resistance level to antibacterial agents is not the same in different countries, as well as in certain regions within the same country. Thus, studing the regional features of H. pylori resistance to certain antibiotics with subsequent development of eradication regimens that are effective in particular region becomes extremely actual. Still bismuth containing quadruple therapy remains an effective method of H. pylori eradication, allowing to achieve good results. In recent years, several alternative schemes of H. pylori eradication were proposed, such as sequential, concomitant, hybrid therapy including three antimicrobial agents. Currently, these regimens allow to achieve quite high H. pylori eradication level.

The article presents data on non-alcoholic fatty liver disease and chronic viral hepatitis C in combination with opisthorchosis invasion. With the system approach considers the specific features of the clinical, laboratory and functional data in patients with combined pathology. Observed frequency of the pain, asthenic and allergic cholestatic syndromes, the latter as part of the triad Paltsev. The high efficiency of the placenta hydrolisat - laennec, as means of pathogenetic therapy.

Non-alcoholic fatty liver disease (NAFLD) is one of the most urgent problems of modern medicine - is the subject of numerous studies, causing interest of different medical specialists This paper presents our own experience of supervision of patients with fatty degeneration of liver on the background of the application of human placenta extract - Laennec. We treated 11 patients with fatty degeneration of the liver and examined the motor-evacuation function of the hepatobiliary tract before and after treatment. The control group consisted of 50 healthy subject aged between 19 to 21 years. Laennec was administered intramuscularly to 2 ml a day, a course of 20 injections. Usage of placental drug Laennec has a stimulating influence on the processes of choleresis and bile secretion in patients with fatty degeneration of the liver, and normalizes the motility of the sphincter and contractility of the gall bladder

The mammalian isoprenoid synthesis pathway (also known as the mevalonate pathway) is fundamental to the metabolism and health of organisms, with products such as cholesterol (sterol isoprenoid), ubiquinone (coenzyme Q) and dolichol (non-sterol isoprenoids) having great importance to mammalian biology and physiology. Targeting the isoprenoid pathway results in novel therapeutic options for a diverse range of conditions. Plant polyprenols are biologically active molecules that affect the isoprenoid pathway - toxic side effects have never been observed during treatment with our pharmaceutical-grade polyprenols (Ropren®). Statins and bisphosphonates also act on this pathway but have the disadvantage of causing numerous side effects. Our unique ability to produce Ropren® containing not less than 95% pure polyprenols has enabled their clinical use in Russia for around eight years and has also enabled researchers to conduct trials into other therapeutic uses. Although polyprenols can treat conditions such as viral, bacterial and fungal infections, inflammation and other immune conditions, this paper focuses on the new pre-clinical and clinical effects of polyprenols in hepatic and neurological conditions. Recent pre-clinical studies have shown treatment with polyprenols from conifers had a range of neurological and cognitive effects, including improved cognitive performance in a rat model relevant to Alzheimer’s disease and healthy levels of myelination in mice with an experimental model of multiple sclerosis. Early clinical data has shown Ropren® treatment improved antioxidant levels in people with diabetes and improved liver function in patients on chemotherapy treatment. Ropren® also had positive effects on electroencephalograms of people with alcohol-induced cirrhosis and Alzheimer’s disease and significantly decreased symptoms in people with depression. These results pave the way for larger clinical trials and show how Ropren® is a valuable clinical tool to treat a wide range of liver and neurological conditions.

The aim of the study was to estimate clinical efficiency of the interactive automatic program of digestive system diseases diagnostics “Electronic policlinic”. Material was presented by 22 patients with different gastroenterological diseases (duodenal ulcer, chronical gastritis, chronical pancreatitis) and the comparative group consisted of 20 healthy people. The plan of the research included the interactive questionnaire using diagnostic module digestive system diseases of the digestive system of the automated program “Electronic policlinic” (Certificate No. 2012614202 from 12.05.12) posted on the Internet (http://klinikcity.ru). For the purpose of verification of diagnosis patients underwent fibrogastroduodenoscopy, ultrasound examination of abdominal cavity organs, CT scan, sigmoidoscopy, colonoscopy, barium enema. As the result of the study there were showed that interactive automated system was able to reveal 85,7% of patients with chronical gastritis, duodenal ulcer and chronical pancreatitis and 75% of patients with colonopathy. The specify of diagnostic procedure was 80% in the first case and 100% in the second. Prevalence of digestive system diseases basic symptoms was studied too. The conclusion of the study demonstrated interactive questionnaire good ability in preliminary digestive problem patient examination procedure for individual diagnostic plan making.

Alveolar echinococcosis is a rare parasitic disease, especially of the liver, caused by the larval stage of the tapeworm Echinococcus multilocularis. At the end of the last century France, Germany, Austria and Switzerland were the regions where this disease most often manifested itself, these days this infection is diagnosed also in our territory. We describe the case of the disease of a twenty-five-year-old male with nonspecific signs and hepatomegaly, who was diagnosed on the basis of imaging and laboratory sampling. Due to inoperability the patient is now in infectologist follow-up on long-term treatment with Albendazole. He is clinically stable, included on the waiting list for liver transplantation.