Rising incidence of different variants of gluten intolerance associated with changes in eating behaviorin many countries, changes in the technology of growing and processing crops, new culinary technologies. Until recently, celiac disease, dermatitis herpetiformis and wheat allergy were the only known disease with a proven role of gluten in their pathogenesis. Non-celiac gluten sensitivity (NCGS)- a new syndrome of intolerance to gluten. This pathology can be suspected in patients with persistent intestinal and extra-intestinal symptoms clearly associated with the intake of foods containing gluten, the absence of serological markers of celiac disease or suspected allergy to wheat. The paper presents the current data on the epidemiology, etiology and pathogenesis, clinical features and diagnosis NCGS.

Background: Serum biomarkers of atrophic gastritis (pepsinogen I (PGI) and PGI/PGII ratio) are important for gastric cancer (GC) risk stratification. According to a number of researches IL1В gene polymorphisms are associated with risk of GC. The aim: to study the association of IL1В gene promoter polymorphism (-511C/T (rs16944) with GC in the prospective “case-control” study (8 years follow up). Materials and methods: the base of biomaterials received in 2003-2005 in population selection of residents of Novosibirsk within the international HAPIEE project (DNA samples and serums were stored at - 70⁰C) were compared with data of the population register of GC (in 2012). For each case of GC, an appropriate control case was selected at the ratio 1:2 matching the area of residence, sex and age. Finally 156 serum samples (52 - GC group and 104 - control) were available for the analysis using a panel of serum biomarkers “Gastropanel” (Biohit, Finland) and 141 DNA samples (49 - GC group and 92 - control) were genotyped according to the published method. Results: the frequency of T/T genotype of the IL1В was found significantly higher in the GC group (16.3 %) compared with the control (5.4 %) (p=0.03). The T/T genotype was associated with significantly increased risks of GC compared with the C/C genotype (OR=3.4; СI: 1.0-11.0, р=0.03). It was shown that rare T allele carriers have increased risk GC development (OR=1.69; CI: 1.01-2.81, р=0.04) in comparison with wild C allele carriers (OR=0.59; CI: 0.36-0.99, р=0.04). The mean level of PGI and PGI/II ratio in persons with T/T genotype were significantly lower in GC group (41.3 ±31.8 µg/l and 4.1±2.9 versus 131.0±57.2 µg/l and 7.0±2.8; p=0.0001 and p=0.05 respectively). Conclusion: IL1В polymorphism (rs16944) is associated with an increased risk of GC in the population of Western Siberia and can be discussed for inclusion in the GC riskometer.

Тhe purpose of the study. The determination of the frequency of polymorphism alleles C 282Y and H63D of the HFE gene in nonalcoholic fatty liver disease (NAFLD) in comparison to individuals from the General population and to identify the peculiarities in the metabolism of porphyrins. Materials and methods. Molecular genetic examination was performed in 454 people. We evaluated the frequency of polymorphism alleles C 282Y and H63D of the HFE gene in patients with NAFLD (major group 112) and compared with the results obtained in the examination of persons General population (comparison group, 342 people). Patients with NAFLD were determined excretory profile of indicators of porphyrin exchange. Results. Polymorphism of the alleles C 282Y and H63D of the HFE gene in patients with NAFLD and in patients the General population is recorded with the same frequency, respectively, at 32.1 % and 33.9 % of cases. In both groups, was often detected polymorphism for alleles С282У, respectively, 26.8 % and 28.1 % of cases. Disorders of porphyrin metabolism diagnosed in 77 (68,8 %) patients had NAFLD. Comparative analysis of detected disorders of porphyrin metabolism in patients with the identified polymorphisms C 282Y and H63D in HFE gene and without it did not reveal fundamental differences in the qualitative characteristics. Patients were recorded with identical violations. In patients with existing polymorphisms C 282Y and H63D in the HFE gene, the frequency of violations and their degree of severity were significantly higher (p < 0,05-0,001). Conclusion. The metabolism of porphyrins can be measured very sensitive “indicator” responsive to the diverse non-specific abnormalities under the wide range of metabolic disorders, including genetic disorders. Detection of the C 282Y and H63D polymorphisms of the HFE gene in combination with disorders of porphyrin metabolism allows us to consider such patients as a risk group who have not excluded an increased risk of formation of liver fibrosis.

The aim of this study was to determine the frequency and the clinical and laboratory features of norovirus acute gastroenteritis (AGE) in adult hospitalized patients, the residents of city Novosibirsk. Materials and methods: A total of 1047 patients aged 15 to 89 years who were hospitalized with AGE from January 2016 to April 2017 with no evidence of immunosuppression were examined. Together with conventional diagnostic methods, the polymerase chain reaction method with a set of original specific primers was also used to investigate feces for the presence of group A and group C rotaviruses, norovirus genogroup II (HNoV GII) and astroviruses. Results: Viral etiology was determined in 20.8 % of patients with AGE. HNoV GII was the dominant (13.6 %), followed by group A rotavirus (5.3 %) and astroviruses (2.0 %). HNoV GII dominance was observed in most months of the study period. For HNoV GII enteritis, a high incidence (p<0.05) of moderate fever and lymphocytosis is established in comparison with other AGE. Conclusion: The established frequency of viral AGE in adults shows the need to develop and implement in clinical practice universal test systems for detection of the most common viral pathogens. The predominance of HNoV GII in the structure of viral diarrhea aims further research on the genetic diversity of the isolates circulating in the Novosibirsk region.

Patients with inflammatory bowel disease (IBD) are characterized by chronic recurrent course, frequent attacks, the presence of extraintestinal manifestations and the occurrence of complications, which leads to a decrease in the quality of life. One of the concomitant conditions in patients with IBD is the small intestinal bacterial overgrowth syndrome (SIBO), which has common clinical manifestations. There is practically no research on the effect of concomitant SIBO in patients with IBD on the quality of life (QOL). Therefore, the study of QOL in patients with IBD with SIBO is an important task for optimizing treatment. Purpose: to study the quality of life in patients with IBD, depending on the presence of SIBO. Material and methods of the study: patients from the registry of inflammatory bowel diseases in Novosibirsk who underwent a hydrogen respiratory test (HBT) on the device «Gastro+». The QOL indicators were determined using the Russian version of the SF-36 and IBDQ questionnaire. Results: in 152 patients with IBD, in whom HBT was carried out, the prevalence of SIBO was 48.0 % (with ulcerative colitis - 45.7 %, with Crohn’s disease - 50.7 %). In the scales of the SF-36 and IBDQ questionnaire significant decrease in QOL values was revealed in patients with IBD with positive results of HBT in comparison with patients with negative results of HBT. After a 2-week course of rifaximin intake, values increased in almost all scales of the SF-36 and IBDQ questionnaires. Conclusion: The obtained data confirm the necessity of correction of SIBO as an independent clinical task that significantly affects QOL of patients with IBD.

Data for the last and a half decade concerning the infection with hepatitis C virus in the population of Novosibirsk are presented. 173 patients infected with hepatitis C were questioned to find out the possibility of sexual transmission of the disease. Among the examined patients, 6.4 % were infected due to non-preserved sexual intercourse with partners using intravenous drugs. The risk factors have been estimated. The clinical example is given.

Mycotic pathology was diagnosed clinically and confirmed with laboratory methods at 77,1 % from 368 patients with various forms chronic diffuse diseases of a liver, at the same time 817 cases of various nosological forms of fungic diseases are taped. Often mycoses proceeded is widespread and is combined, and also had a series of clinical features not inherent to them. The submitted data can be used both by gastroenterologists, and dermatologists.

The purpose of the review: to observe prevalence and features of such comorbidities as gastroesophageal reflux disease, nonalcoholic fatty liver disease, metabolic syndrome and it’s components in patients with inflammatory bowel diseases (IBD). Methods: as literature sources databases Pubmed and Medscape were used, also data from monographies and Russian and foreign journal publications was included. Results: Higher frequency of steatohepatosis in IBD patients and higher frequency of gallstones in patients with Crohn’s disease (CD) are demonstrated. A risk factors of this comorbid diseases are described. Also lower frequency of arterial hypertension among IBD patients was shown. Higher frequency of metabolic syndrome in patients with ulcerous colitis vs. patients with CD was demonstrated. Higher severity of gastroesophageal reflux symptoms in IBD patients vs. patients with irritable bowel syndrome was shown. Article describes possible pathophysiological substrate of this clinical features. Conclusion. Frequency and clinical features of described comorbidities were analyzed. Literature analysis showed a lack of data about clinical features of gastroesophageal reflux disease and metabolic syndrome in IBD patients at this moment, so an additional studies on this subject are necessary.

The state of nutritional status was studied in 161 patients with arterial hypertension (AH) in combination with chronic obstructive pulmonary disease (COPD), divided in three groups: 1st (54) - with AH, 2nd (52) - with COPD, 3rd (55) - with AH in combination with COPD. Based on the assessment of actual nutrition, anthropometric survey data, lipid, protein and carbohydrate metabolism, the level of adipokines and cytokines, it was determined that the nutritional features of patients with AH in combination with COPD are: high values of the index waist circumference / circumference of hips, increased fat mass and extracellular fluid, decrease in muscle component of the body, increased levels of total cholesterol and its atherogenic fractions, reducing the concentration of prealbumin, increased levels of leptin and resistin on the background of decreased adiponectin and leptin-binding receptor and increasing concentrations of the studied cytokines IL-1, IL-6, IL-18 and TNF-α. It was found that patients with AH in combination with COPD index waist circumference / circumference of hips for assessment of nutritional status has a greater diagnostic value than body mass index. Timely detection and correction of nutritional disorders will improve the effectiveness of treatment of patients.

The research of 75 patients with diabetes mellitus type 2 and 33 patients with functional dyspepsia was conducted. The aim was to study relationship between dyspepsia and the level of autonomic function, general anxiety and quality of life in patients with diabetes mellitus type 2. The level of autonomic function was higher in patients with diabetes mellitus type 2 in the presence of dyspepsia, but did not reach indexes in patients with functional dyspepsia. The level of general anxiety in patients with diabetes mellitus type 2 was increased, did not depend on the presence of dyspepsia and did not differ from those with functional dyspepsia. Dyspepsia syndrome aggravated the reduced quality of life in patients with diabetes mellitus type 2, and its level was worser, than in patients with functional dyspepsia. Statistical analysis demonstrated negative correlation between the quality of life and the level of autonomic function and anxiety indexes.

The aim of the study was to study the frequency, prevalence and nosological structure of pre-tumoral and tumor processes in the gastrointestinal tract on the basis of morphological study data. Materials and metods: 1294 specimens of biopsy specimens from the stomach and intestines were studied for the period 2014-2016. Results. Of the 1,294 specimens examined, the stomach accounted for 58 % of the small and large intestine - 42 %. Of 750 stomach biopsies, inflammatory diseases were detected in 61.7 %, hyperplastic processes in 19.6 %, tumors in 10 %, biopsy from gastroanastomoses - 7.73 %. Of the 544 biopsies of the intestine, 20.2 % of cases of small intestinal disease, 78.2 % of the large intestine, and 1.6 % of intestinal anastomoses. In biopsies of the small intestine, inflammatory processes prevailed (71.8 %), hyperplastic processes - 18.2 %, tumors - 6.4 %. When studying the nosological structure of the lesion of the large intestine: inflammatory diseases of the large intestine - 24.9 %, hyperplastic processes -17.5 %, tumors - 48.1 %, other processes -7.4 % and biopsies from intestinal anastomoses -2.1 %. Conclusions. Inflammatory diseases prevailed in the structure of pathological processes of the stomach (61.73 %) and the small intestine (71.8 %). The most frequent localization of tumors of the gastrointestinal tract was the large intestine (48.1 %), and the most common histological variant of malignant tumors was adenocarcinoma (94 %). Tumors of the stomach accounted for 10 % of the total number of pathological processes, and among the histological variants the most common was adenocarcinoma (64.1 %).

The aim of the study was to study the dynamics of the concentration of cytokines and certain trace elements within the framework of nutritional insufficiency and the course of operational stress, depending on nosology. Materials and methods. The concentration of cytokines and microelements in the blood plasma was measured in patients with benign stenosing diseases of the esophagus (aсhalasia of the esophagus - 10, cicatrical after-burn constriction - 10) before the operation, on the 1st, 3rd and 7th day of the postoperative period. All patients underwent extirpation of the esophagus with esophagoplasty of the gastric stalk. Results. High concentrations of proinflammatory cytokines (IL-1β, IL-2, IL-6) were detected throughout the perioperative period. The pre-operative nutritional deficiency in this category of patients led to a deficiency of nutritional elements, in particular, zinc deficiency and micro-nutrient balance disorders (zinc-copper). Conclusion. The causes of disturbances in the balance of microelements are due to alimentary deficiency and increased demand for trace elements due to the peculiarities of the disease itself, in particular, the presence of scar periprocess around the esophagus. Causes of increased cytokine concentration in the preoperative period is a slow inflammatory reaction associated with the underlying disease.

Research aim to estimate possibility of maximum early visualization of pathological focus at pancreatic gland by the use CT angiography with Bolus tracking. Materials and methods: 30 patients, who were admitted to this hospital before 72 hours from the begin of disease, with severe necrotizing acute pancreatitis Maximum early visualization was made after 72 hours from the begin of disease on multispiral 4 multislice tomograph «Lightspeed», with program Bolus tracking. We estimateв volume of perfusion’s disorder of pancreatic glandular tissue. For finale estimation of formed necrotic affection we repeated CT at the third week of disease. Results: 2 (6,67 %) patients hadn’t signs of perfusion’s disorder of pancreatic glandular tissue. 15 (50,00 %) patients had perfusion’s disorder volume less than 30 % of pancreatic gland’s volume. 8 (26,67 %) patients had perfusion’s disorder volume from 30 % to 50 %, 4 (13,33 %) patients had perfusion’s disorder volume from 50 % to 75 % and 1 patients had perfusion’s disorder volume more than 75 %. At the third week of disease patients, who hadn’t signs of perfusion’s disorder, hadn’t signs of pancreatonecrosis. 17 (56,67 %) patients had small-focal pancreatonecrosis, 7 (23,33 %) patients had large-focal pancreatonecrosis, 3 (10 %) patients had subtotal pancreatonecrosis. Affection more than 75 % of pancreatic gland’s volume also was confirmed. Sensitivity of estimation of perfusion’s disorder for prognostication of necrotizing affection of pancreatic gland was 100 %, specificity 33,33 %, accuracy - 100 %, positive and negative predictive value - 87,50 % and 100 %, AUC - 0,944.

From 1990 to 2015 171 reconstructive and reconstructive surgery on extrahepatic bile ducts after their injuries and inflammatory lesions were performed in the clinic, of which 115 (67.2 %) using nickel-titanium stents. The average age of patients was 48.6 years. Complications after operations of constant stenting arose in 6 patients (8.3 %), lethal outcome in 2 (2.7 %). Long-term results of this group, traced from one year to seven years, were found to be good at 88.4 % at the time of the study, satisfactory - at 8.4 %, unsatisfactory - in 3.2 % of patients. In the group of patients, after application of replaceable transhepatic drainage and a precision seam of the ducts: good - in 58.5 %, satisfactory - in 22.0 %, unsatisfactory - in 19.5 %. Long-term results after endobiliary stenting with nitinol stents with round stent filaments were considered good In 41.8 %, satisfactory in 58.2 % of patients.

Aim of study. To assess the influence of the early endoscopy hemostasis for rebleeding rate in variceal bleeding. Methods. Retrospective analysis of 113 medical cards of patients with variceal bleeding. Results and conclusions. The most rebleeding rate had been revealed in patients who had not any signs of bleeding on primary endoscopy (75 %). We had not got statistically significant differences in rebleeding rate between groups of patients who had undergone the early endoscopy hemostasis and who had not (24,5 % vs 26,7 %). We compared the rebleeding rate depending on combination of the bleeding activity on primary endoscopy and the fact of performing the early endoscopy hemostasis and revealed certain differences which are indicating to higher rebleeding rate if the early endoscopy hemostasis had not performed.