In this review we discuss the problem of polymorbidity and polypharmacy in the elderly patient, particularly the mutual influence of cardiovascular and gastroenterological diseases, presents algorithms for timely diagnostics and adequate selection of treatment in combined pathology.

Aim. The study of the qualitative and quantitative characteristics of microbiocenosis of the oral cavity and esophagogastroduodenal zone in patients with gastroesophageal reflux disease (GERD), associated with duodenogastroesophageal reflux (DGER) as a manifestation of biliary pathology. Materials and methods. In 83 GERD patients with symptoms of reflux esophagitis and DGER we studied the microbial landscape of the oral fluid and biopsy samples from visually unaltered sections of the mucosa of the lower third of the esophagus, antrum and duodenum by the classical bacteriological methods. Results. Biopsy specimens from the esophagogastroduodenal zone mucosa in patients with GERD indicated high content of staphylococci (92 %) and streptococci (85 %) in amount of from 4,8 to 6,1 lg CFU/g. Bacteria of the Enterobacteriaceae family were defined in 61 % of cases in an amount of 3,1-5,4 lg CFU/g. Fungi of the genus Candida were detected in 59 % of the samples in the amount of 10⁴-10⁷ CFU. Bacteria characterized by cytotoxic, hemolytic and lecithinase activity were often detected in comparison with healthy people. Conclusion. The study revealed pathological microbiocenosis of upper gastrointestinal tract with opportunistic pathogens presence with factors of pathogen and cytotoxicity in patients with GERD associated with DGER, that define chronic inflammatory changes in the mucous membranes.

A comparative evaluation of the «morning load» of blood pressure and the hemostatic system in patients with peptic duodenal ulcer associated with arterial hypertension after acute gastrointestinal bleeding had been done. The study included 45 patients with hypertension who underwent gastrointestinal bleeding and 63 patients with gastrointestinal bleeding without hypertension. The combination of the activation of blood coagulation in the morning with an excessive morning rise of systolic blood pressure in hypertensive patients with duodenal ulcer complicated by acute bleeding, may be an important and a predisposing factor for the development threatening cardiovascular events: sudden death, stroke and / or myocardial infarction.

Purpose. The aim of the study was to analyze the vegetative status, personal and situational anxiety and quality of life in patients with peptic ulcer disease with associated chronic duodenal insufficiency (CDI), as well as the contingency of their changes with indicators of the functional state of duodenum. Materials and methods. The complex study conducted 106 patients with ulcer disease with associated CDI (observation group) and 30 patients without CDI (group of comparison). Verification of ulcer disease was performed clinically and by fibrogastroduodenoscopic researches. In determination of chronic duodenal insufficiency there were used the cavitary manometry. We have studied motor performance of the stomach and gastroduodenal ulcer with a help of peripheral electrogastrograph EGG-4М. The study of the state of the autonomic nervous system was conducted by autonomic tone (AT), autonomic reactivity (AR) and software vegetative (SV). In determining the type of temperament was used the test Eysenck questionnaire, in the assessing of trait anxiety (TA) and situational anxiety (SA) - test questionnaire Spielberg Hanina. In definition of quality of life (QL) was performed by using the SF-36 questionnaire. Results. The majority of patients from observation group was haved sympathicotonia with enhanced indicators of SA and IN. The level of coefficient of correlation power of the stomach/ duodenum was reduced postprandial against the comparison group. The vegetative status of patients with gastric ulcer without CDI was characterized by eutoniya with high AR and normal SV. The vegetative status of patients with duodenal ulcer without CDI was characterized by parasympathikotoniya, reduced AR, excess SV. In the comparison group the levels of TA and SA were reduced in relation to the observation group, the levels of the coefficient of correlation power of the stomach / duodenum have normokinetic values. The patients with ulcer disease with associated CDI have significant changes in quality of life, manifested in the reduction of the mental and physical well-being. Conclusion. Chronic duodenal insufficiency in patients with ulcer disease have a functional character, resulting from infringements of the vegetative regulation and psycho-emotional status.

Acute intestinal infections (AII) are important for clinical practice. Many experts shows that there are the change in the etiological structure of AII in children. There is a dominance of pathogens of viral etiology, primarily rotavirus. However, in recent years there is growing importance of combined forms of viral AII. This requires the establishment of the characteristics of their clinical manifestations. In the article there are results of own long-term observations, showing the peculiarities of the clinical appearances of rotavirus infection and its combined form (with a norovirus infection, salmonellosis and antibioticassociated diarrhea) in children.

The results of the study of morpho-functional state of the upper gastrointestinal tract in children with congenital anomalies of the heart and small development. The study involved 324 child with congenital heart and small anomaly of development between the ages of 1 month to 15 years. Boys 170, girls 154 children were divided into groups: 138 children with congenital malformations, the second 186 children with minor heart anomalies. It was found that children with congenital frequently detected erosive and ulcerative diseases in children with small heart-surface anomalies gastroduodenitis, reflux disorders. On the morphological and functional state of the upper gastrointestinal traktau children with congenital anomalies of the heart and small influence the state of chronic hypoxia.

Introduction. ABCB 1 gene localized on seventh chromosome encodes ABC-transporter P-glycoprotein. Proton pump inhibitors are known to be substrates of P-glycoprotein. Studies showed that C 3435T genetic polymorphism of ABCB 1 might influence proton pump inhibitors-based acid suppression and Helicobacter pylori eradication rates. From this point of view, studying the relation between C 3435T polymorphism of ABCB 1 and clinical and demographic features of peptic ulcer patients taking proton pump inhibitors may have clinical relevance. The aim of the study - to find the connection between C 3435T polymorphism of ABCB 1 and clinical and demographic features of patients with peptic ulcer taking omeprazole. Methods. Fifty peptic ulcer patients (19 men, 31 women), who were on treatment with omeprazole in Moscow clinics, aged 18-77 years (mean age 51.5±14.9 years) were enrolled. Six milliliters of venous blood were taken from patients in K2-EDTA tubes. C 3435T polymorphism of ABCB 1 gene was analyzed using real-time polymerase chain reaction (PCR). Results. CC genotype of ABCB 1 was found in 11 (22 %) patients, CT genotype - in 26 (52 %) patients, TT genotype - in 13 (26 %) patients. All genotypes were in Hardy-Weinberg equilibrium (p=0.77). There were no statistically significant differences in distribution of CC, CT, TT genotypes of ABCB 1 gene in patients depending on stomach or duodenum ulcer localization (6,8 %, 15,9 %, 9,1 % vs. 13,6 %, 34,1 %, 20,5 %, respectively), existence or absence of family history of peptic ulcer (14,3 %, 33,3 %, 9,6 % vs. 4,7 %, 23,8 %, 14,3 %, respectively), existence or absence of exacerbation after diagnosed peptic ulcer (14,8 %, 18,6 %, 3,7 % vs. 11,1 %, 37 %, 14,8 %, respectively), existence or absence of ulcer complications (15,1 %, 9,1 %, 9,1 % vs. 12,1 %, 45,5 %, 9,1 %, respectively), less than 1 cm or 1 cm and more ulcer according to gastroscopy (7,1 %, 28,6 %, 28,6 % vs. 7,1 %, 7,1 %, 21,5 %, respectively), less than 30 or 30 and more total score of GSRS scale (10 %, 30 %, 30 % vs. 5 %, 15 %, 10 %, respectively), Fisher’s Exact test, p>0.05. Conclusion. There is a high prevalence of C 3435T polymorphisms of ABCB 1 gene in peptic ulcer patients of Moscow region. There were no statistically significant differences between ABCB 1 genotype and clinical and demographic features of peptic ulcer patients.

The work describes the results of a study of gene endothelial NO-synthase (eNOS) polymorphism in patients with gastroesophageal reflex disease (GERD) combined with obesity. It is shown that even isolated GERD course occurs against changes in gene polymorphism. GERD and obesity in 48.8 % of cases occurs at a polymorphic variant of the eNOS gene (pathological genotype CC), that allows to speak about increased risk of endothelial and hemostatic disorders, in particular, the development of cardiac symptoms. These factors may contribute to the development of atypical forms of the disease, its progression and the appearance of complications.

The article presented complex assessment of intestinal permeability in patients with autoimmune hepatitis (AIH) and overlap syndrome (OS). The study included 82 people: 26 patients with AIH, 26 - with OS and 30 healthy controls. All included into the study underwent a triple sugar test. There was increasing of small intestinal permeability in patients with AIH 0,11 [0,075; 0,18] (p<0,001) and OS 0,2 [0,088; 0,3] (p<0,001), comparing with control group 0,013 [0,01; 0,025]. In patients with cirrhosis, portal hypertension and liver failure intestinal permeability changes were more prominent - increasing small bowel and colonic permeability.

Preamble and aim of the study: Irritable bowel syndrome (IBS) affects health-related quality of life (QоL). The purpose of this study is a comparative analysis of the mental and physical indicators of health conditions IBS patients depending on age, gender of patients and type of IBS. Materials and methods: In a specialized gastroenterology clinic 245 patients with IBS were investigated QoL using a questionnaire MOS SF-36. The analysis was conducted in 2 groups of patients with IBS: up to 45 years (n=125) from 45 years and older (n=120). The results of the study: IBS рatients have low rates of both physical and mental components health. With age significantly reduced QoL, due to the physical component health (PH), p<0.05. QoL by physical (FF), emotional (RE) and role functioning (RP), in the women older age subgroup is lower than in men, p<0.05. QoL indicators of IBS-C patients are lower than in IBS-D and IBS-CM patients, p<0.05. Conclusion: QOL in patients with IBS reduced in younger and older age, predominantly in women and with age even more reduced. IBS-C patients QoL is lower than at IBS-D and IBS-CM.

The aim of the study was to evaluate the representation of the microbial community in patients with ulcerative colitis. Materials and methods. The study included 46 patients with ulcerative colitis (25 men and 21 women, aged 42,4±13.8 years, duration of the disease - 5,42 ±8.21 years). Results of sequencing of ulcerative colitis patients stool samples as well as samples from 96 healthy volunteers were used for analysis. Whole genome sequencing was carried out on the SOLiD 5500W platform (LifeTechnologies, FosterCity, CA, USA). Results. Metagenomic analysis allowed us to detect 29 classes of bacteria, including: 73 families, 154 genera, 437 species of microbes in intestinal microbiota of patients with ulcerative colitis. The prokaryotic part of microbiota formed 99.5 % (98,2 % - Bacteria, 1,8 % - Archaea), viruses - 0.5 %, eukaryotes - 0,004 % of all intestinal microbiota. Taxonomic analysis revealed changes in the relative representation of bacterial families: we observed decrease in Lachnospiraceae, Rikenellaceae, Acidaminococcaceae, Enterococcaceae, Desulfovibrionaceae, Verrucomicrobiaceae, Clostridiaceae and increase in Enterobacteriaceae. Only the number of Escherichia genus, particularly Escherichia coli species was significantly abundant among the members of Enterobacteriaceae family. In ulcerative colitis patients the fraction of Escherichia was (3,74±8,01)% which was greater than in the control group (1,49±of 5.23)%, whereas the fraction of Clostridium (1,15±3,35)% was significantly lower in patients with ulcerative colitis than in the control group (2,33±4,26)%. The alpha-diversity index which characterizes richness of the microbial community was decreased in stool samples of patients with ulcerative colitis in comparison with the control group. Conclusions. The metagenomics analysis revealed significant changes in intestinal microbiota in ulcerative colitis patients comparing with the control group.

This article is devoted to studying the long-term results of surgical treatment of patients with chronic pancreatitis. Studied personality traits, social and psychological characteristics and the quality of life of patients with chronic pancreatitis. The results indicate that the disease is multidisplinarnoy problem and requires the attention not only on the part of health professionals, but also long-term observations of psychologists, sociologists and social workers.

The aim of this study was to identify the effect of seasonal changes of carbachol and Gly-Pro on secretor function of the stomach in rats with actively-search behavior, intermediate and passive-defensive behavior in the “open field”. The experiment was carried out on male rats of Wistar, the reactivity of the nervous system was assessed during the winter and summer solstice. Rats were imposed ligature on the pyloric section of the stomach, after that carbachol, Gly-Pro and saline were injected in various combinations. In 45 minutes of secretion, rats were decapitateв, gastric juice was collected, and its volume, acidity and proteolytic activity were identified. Statistical procedures were performed using STATISTICA 8.0, used the criterion of Mann-Whitney, cluster analysis. When comparing rates of gastric secretion after administration of carbachol, assessed in summer and winter periods, certain specific secretion features were detected only in rats with the passive-defensive type. This group demonstrated the smaller volume and greater proteolytic activity of gastric juice in summer compared to winter. Greater variety of secretion features was identified in thegroups of rats receiving the peptide cholinomimetic depending on the reactivity of the nervous system and season. In the summer the introduction of сholinomimetiс and Gly-Pro were accompanied with decreasing proteolytic activity of gastric juice in the rats with active search behavior; decrease in the volume of secretion, and in rats with an intermediate type of behavior; increase in volume of juice and decreased digestive ability in rats with passive-defensive type of behavior. In winter Gly-Pro on the background of carbachol increased only the acidity of gastric juice in rats with active search behavior in the “indoor field”, without affecting the levels of gastric secretion of two other groups of animals. Thus specific response of the secretory cells of the rats’ stomach after administration of carbachol solely, and together with Gly-Pro are determined by the reactivity of the central nervous system of animals and season of the year.

The article presents data concerning the determination of acetylcholine (Ah) and cholinesterase activity (HAE) in the serum of patients with PUD, chronic pancreatitis of alcoholic etiology (AKHP) and inflammatory bowel disease (ulcerative colitis, Crohn’s disease), IBD. Established that healthy individuals can be divided into three groups with different levels of the concentration of acetylcholine - low, medium and high. The aim of the research was to identify how the concentration of Oh in response to the disease (primary or secondary). The concentration of Oh is associated with the disease and depends on the localization of the pathological process. The change in concentration of the mediator of the parasympathetic nervous system can influence the course of the disease is prognostically significant factor.

Aim: to investigate changes in the composition of fecal microbiota, serum metabolome and some clinical parameters following oral calcium butyrate plus inulin (Zacofalk NMX) in patients with ulcerative colitis (UC) and celiac disease (CD). Methods: 40 mild-to-moderate active left-sided UC patients and 43 CD patients in remission on a gluten-free diet were enrolled in the study. The quantitative real-time polymerase chain reaction (qRT-PCR) was used for fecal microbiota assessment. Serum metabolomic assays were conducted using the GC-MS. Study design: an open, randomized, parallel-group study. UC patients were randomized into A₁ and A₂ groups and CD patients were randomized into B ₁ and B ₂ groups. Patients enrolled in the groups A₁ (UC) and B ₁ (CD) received Zacofalk NMX (Dr. Falk Pharma GmbH, 3 tablets per day) for 28 days as supplement to oral mesalazine (standard treatment) in UC or gluten-free diet (GFD) in CD. Patients from group A₂ (UC) received standard treatment for 28 days. Patients from group B ₂ (CD) were on a gluten-free diet. Results: Oral butyrate plus inulin (as supplement for 28 days) significantly enhanced fecal butyrate-producing bacteria (with a butyryl coenzyme A: acetate-CoA transferase gene, but) and significantly reduced elevated baseline Bacteroides fragilis / Faecalibacterium prausnitzii ratio in both (A₁ and B ₁) groups. Significant changes in gut microbiota in both UC and CD were accompanied by changes in serum levels of some microbial metabolites (reduced levels of anti-inflammatory caproate and glycolate, elevated levels of pro-inflammatory metabolites such as lactate, 2-hydroxyisovalerate, succinate, fumarate, benzoate, p-hydroxyphenylacetate and 3-indoleacetate). Butyrate plus inulin significantly lowered serum levels of pro-inflammatory succinic acid (in both UC and CD patients) and 2-hydroxyisovaleric acid (in CD). In total, 85 % of UC patients in group A₁ (Zacofalk NMX) demonstrated significant improvement in both rectal bleeding and stool frequency by day 14, compared to 55 % in group A₂ (p=0.048; Fisher’s exact test). Consumption of Zacofalk NMX for 28 days in CD patients (group B ₁) improved perception of some clinical syndromes (indigestion and abdominal pain) evaluated by the GSRS: there was a significant decrease in related subscores (from 3.8 to 2.1 for indigestion; from 3.2 to 1.7 for abdominal pain; p<0.05 for both). Butyrate plus inulin significantly improved bloating in CD patients (group B ₁) compared with those from group B ₂ with GFD only (73 % vs. 29 %; p = 0.006; Fisher’s exact test). Conclusions: In addition to anti-inflammatory and immunomodulatory effects, butyric acid is probably able to exert a prebiotic (butyrogenic) effect, restoring butyrate-producing bacteria in patients with gut dysbiosis associated with chronic inflammation (IBD) or in patients with dysbiosis due to a decrease in dietary fiber intake (GFD). A significant reduction in the Bacteroides fragilis / Faecalibacterium prausnitzii ratio and the lowering of serum level of pro-inflammatory microbial metabolites confirm the effectiveness of metabiotics such as butyrate plus inulin in UC- or CD-associated taxonomic/metabolic dysbiosis. Clinical data also support the use of butyrate plus inulin as supplement to standard treatment in UC or gluten-free diet in CD patients to more rapid improvement in gastrointestinal symptoms.

The purpose of the review. To highlight the state of arterial stiffness problem of the metabolic syndrome and generalized periodontitis with clinical, laboratory and instrumental and morphological and functional positions. Recent data on the problem indicate the conjugation of the metabolic syndrome and generalized periodontitis with characteristic changes in arterial stiffness. It is assumed, on the one hand, a fundamental role of generalized periodontitis in the development of immunological processes in the body with the development of atherosclerotic cardiovascular diseases including metabolic disorders with the formation of the insulin resistance syndrome and on the other hand, indicates that hyperinsulinemia, hyperglycemia, dyslipidemia and microcirculatory disturbances increase arterial stiffness. According to the authors, the trigger generalized periodontitis progression of the metabolic syndrome, inflammation appears closely paired with an increase in arterial stiffness. Conclusion. Changes in generalized periodontitis, including vascular stiffness characteristic of the metabolic syndrome, secondary, not only on the background, but also contribute to the progression of the syndrome and the development of complications, closing circle of pathogenesis.

The article contains an overview of modern recommendations for the management of patients with Clostridium difficil infection, one of the urgent and unsolved problems of modern medicine, the risk of developing it increases in elderly patients with various concomitant diseases. The prevalence of this disease in is not known in Russia. The diagnosis of Cd-I is based on a combination of clinical symptoms and the results of microbiological studies confirming the presence of toxins and toxin-producing strains, the absence of another cause or histopathological or colonoscopic signs of pseudomembranous colitis. The choice of the anti-clostridial therapy regimen for patients is based on the severity of the patient’s condition and the probability of relapse.

It is well known that in the structure of total mortality in Russia more than 57 % are cardiovascular disease (CVD). From the point of view of pathophysiology the basis of premature cardiovascular death in almost half the cases lies with atherothrombosis: the situation when the tyre is destroyed atherosclerotic plaque is formed thrombus, covering partially or totally the lumen of the vessel, and depending on the location of the lesion, the patient develops a myocardial infarction, ischemic atherothrombotic stroke, or gangrene of the lower extremities. Since the completion of the famous Framingham study, the notion of “risk factor” and therefore the concept of secondary and primary prevention of CVD. Among the drugs that have the ability to reduce CVD risk include antiplatelet agents and statins. It was during the administration of these drugs in some cases can cause serious problems.

Saccharomyces boulardii CNCM I-745 (Saccharomyces cerevisiae HANSEN CBS 5926) - strain of yeast, used widely in clinical evidence as probiotic. It’s positive effect of immune system, pathogenic agents adsorption and toxins blocking, influence on digestive ferments had proved. As a result S. boulardii allow for microbiota development, provides mucosa caring. Additional, Saccharomyces boulardii action brings stability to microbiota for risk groups patients.

Grain-based products are widely used in nutrition throughout the life of a person, beginning with early childhood. When choosing the first type of complementary foods, priority is given to the cereal, since it has a high energy value and enriches the diet of the baby with vegetable proteins, fats, carbohydrates and other important biologically active compounds. Thus, it has been shown, during the period of active growth and development of the brain, hypoglycemic conditions that can lead to disruption of its functioning are unacceptable. To maintain normoglycemia, especially after an overnight fast, consumption of breakfast, including dishes from cereals, is important. This is important for the maturation of the brain in children and has a long-term effect on cognitive development. Cereals, rich in tryptophan, can be useful for correcting the sleep-wake cycle in children, middle-aged and elderly people, and also having a positive effect on mood. In addition, the consumption of whole grains reduces the risk of cardiovascular diseases, diabetes, obesity and colon cancer in adult patients.

The article considers expediency of application of cycloferon in patients with chronic erosive gastritis, associated with Helicobacter pylori and herpes infection.

The aim of this work was the demonstration of a clinical case of complications during cystic fibrosis with the development of the syndrome of pseudo-Bartter reflecting the difficulties of differential diagnosis of the disease. Presents a clinical case of late diagnosis of a severe form of cystic fibrosis have an infant with clinical manifestations of congenital herpes virus infection.

The purpose of the study. To present the history of differential diagnosis of jaundice in the Perm region. Materials and methods. The study used narrative, historical-genetic, comparative and structural methods. Results. The number of patients with diseases of the liver and biliary tract, manifested by obstructive jaundice syndrome is steadily increasing. Indirect methods of contrast enhancement turned out to be untenable in the presence of hypertension in the biliary tract. Direct opacification of the biliary tract originally performed by intraoperative cholangiography via the cystic duct stump. The method of percutaneous transhepatic cholangiography (transparietal cholangiography), promoted in the 60-ies of the several hospitals of the Soviet Union, is not widely spread due to the lack of imaging punchthrough ducts. Head of Department of hospital surgery, Perm medical Institute Professor S. Y. Minkin on 27m all-Union Congress of surgeons in 1960 first reported cholestatic jaundice without mechanical barriers to the outflow of bile. The use of electron microscopy made it possible to develop universally accepted diagram of the structure of the biliary tract. On the basis of the pathogenetic classification of Professor E. N. Ter-Grigorova algorithm of differential diagnosis, which can be used for computer calculation of the characteristics manually, or simply in the form of visual diagrams (L. F. Pulatova, 1977). In order to diagnose the functional state of the liver was applied isotope hepatography. Significantly advanced diagnosis using endoscopic techniques, laparoscopic cholecystocholangiography, endoscopic retrograde cholangiopancreatography. Distal levels of obstruction of the biliary tract were identified using the relaxation of duodenography, ultrasound and endomicroscope research. Computer and magnetic resonance imaging, especially magnetic resonance-cholangiography has virtually solved the problem. Invasive methods are mainly used for diabeticheskoi techniques, the research also serves as the first stage of surgical treatment for relief of biliary tree and the elimination of biliary hypertension. Advances in diagnosis have led to the progress in surgical treatment. If in the middle of the twentieth century, the most frequent operation was palliative cholecystojejunostomy, and high tumor - tunnelization of the tumor, it is now in daily clinical practice included pancreatoduodenectomy, liver resection for tumors of the gate as a portal, and navalnyj. Wide application of mini-invasive methods (endoscopic cholangiopancreatography, percutaneous transhepatic cholangiography, mini-accesses, puncture under ultrasound control) allows to reduce operational risk and prevent the development or progression of liver failure, which greatly improves treatment results Conclusion. Evolution of morphological and clinical methods for differential diagnosis of jaundice has enabled the optimization of surgical tactics, which currently contains a whole spectrum of interventions, from minimally invasive diabeticheskoi methods to extensive radical surgery.