25 adult patients with NAFLD (steatosis only) were enrolled in the study. The quantitative real-time polymerase chain reaction (qRT-PCR) was used for fecal microbiota assessment. All patients were treated with oral lyophilized Saccharomyces boulardii for 90 days (3 capsules 250 mg per day). The count of Escherichia coli in patients with NAFLD steatosis was initially higher than the reference values obtained from healthy volunteers. Lyophilized S. boulardii for 90 days significantly reduced Bacteroides fragilis group and Escherichia coli. There were no significant changes in other fecal microbiota (total bacterial count, Lactobacillus group, Bifidobacterium spp., Faecalibacterium prausnitzii, etc.). Treatment with S. boulardii improved symptoms and quality of life in patients with NAFLD steatosis and significantly reduced VLDL and atherogenic index. Patients with overweight or obesity showed a decrease in body weight. In all patient steatosis showed no progression as assessed by FibroMax test, liver ultrasonography and telomere test Saccharomyces boulardii significantly reduced initially elevated fecal Escherichia coli in patients with NAFLD steatosis to normal values, thus reducing the risk of additional liver damage by endogenous ethanol and inhibiting the choline deficiency. S. boulardii significantly lowered Bacteroides fragilis group, thus reducing the risk of endotoxemia. The lack of progression of steatosis after 90 days suggests the effectiveness of S. boulardii in patients with NAFLD. Lyophilized Saccharomyces boulardii modulates the composition of the gut microbiota in patients with NAFLD steatosis and restores intestinal barrier integrity, thus preventing the progression of the disease.

It were examined 70 patients with non-alcoholic fatty liver disease and its combination with obesity, as well as 20 healthy individuals. The study was carried out using the following methods: clinical, laboratory and instrumental (including liver biopsy). It was found an inverse relationship between the level of resistin and the levels of the indices of lipid metabolism in both groups of patients. There was established the significant increase of plasma level of resistin, and also impairment of lipid metabolism indices in all groups in comparison with the controls, and most pronounced changes in patients with NAFLD and obesity. The established relationships suggests that the increase resistin may represent the presence of dyslipidemia in patients with NAFLD and its combination with obesity. In order to determination the disorder of the lipid metabolism is recommended to determine the level of resistin in patients with NAFLD, especially in presence of obesity. Patients with the level of resistin (>8,06±0,23 ng/ml) should refer to the risk of progression of dyslipidemia.

The results of 128 people’s study (average age - 46,3 ± 2,5 years) was analyzed Non-invasive ultrasound techniques for the study of the liver were used: TE (or single-stage pulse elastometry) on Fibroscan unit (Echo-Sens, France) and ESA on Aixplorer unit (Supersonic Imagine, France) with Elastometry (frequency range of 1.6 MHz). Average value (E_mean), the maximum value (E_max) and σ - standard deviation were taken into estimation. E_mean according to TE in healthy individuals was 4,8 kP, in patients with chronic viral hepatitis - 7,2 kPa (n1); in patients with steatohepatitis - 9,1 kPa (n2); group with cirrhosis - 43,8 kPa (n3). ESP indicators were slightly higher than the TE and showed the following results for n1 group - 8,3 kPa; n2-9,4 kPa; n3-55,3 kPa (in the group - 4,6 kPa). Efficiency of ESP was more successful, reaching 100% (all the procedures have been completed successfully), compared with TE with 84.6%, which indicated a higher diagnostic value of ESP in the diagnosis of diffuse liver disease.

The aim was a comparative analysis of clinical and laboratory parameters in carriers of different genotypes for the -174G>C IL6 gene polymorphic marker (rs1800795) in healthy donors and patients with NASH in the absence of hepatoprotective therapy and after therapy with UDCA. There were examined 50 patients with the diagnosis of NASH. NASH patients were treated with UDCA at a dose of 10-15 mg/kg for 8-10 weeks. The control group consisted of 50 donors without the clinical manifestations of NAFLD. Genotyping was carried out using the PCR-RFLP method. Functional liver tests, the level of cytokines IL6 and TNFα in the blood, the level of expression of the IL6 and TNF genes, the activity of caspases in peripheral leukocytes were estimated before the treatment and after UDCA monotherapy. In NASH patients with different alleles for the -174G>C IL6 gene polymorphic marker, there are significant differences in the level of the indicator of hepatic cell damage - AST, and the mRNA level of the TNF gene in PBL. In carriers of C allele, the effect of UDCA therapy on the level of AST and the TNF gene transcripts in PBL is less pronounced than in carriers of the GG genotype. This indicates a lower sensitivity to UDCA therapy in carriers of the mutant allele. The medians of decrease in the AST level and in the level of mRNA relative expression of the TNF gene in carriers of C allele are significantly lower than in carriers of the GG genotype, p<0.05. Significant differences in the effect of UDCA therapy on the level of other studied parameters depending on the genotype were not found. The presence of the -174G>C single nucleotide substitution in the IL6 gene (rs1800795), which is associated with the development of NASH, can determine not only the genetic predisposition to the development of this disease, but also the different sensitivity of patients with NAFLD to UDCA-based drugs.

Examined 65 patients with verified NASH. The age of the patients ranged from 23 to 67 years. Among them were 36 (55.4%) women and 29 (44.6%) men. The control group consisted of 20 healthy individuals. The effectiveness of complex therapy with the inclusion of the drug L-carnitine, deproteinized hemoderivat of calves and folic acid was studied. The presence of carnitine insufficiency, hyperhomocysteinemia, increase in the level of proinflammatory cytokines in all patients with NASH. After a month of treatment with complex therapy, the level of L-carnitine increased from 14.5 (13.1, 15.7) μmol/l to 31.1 (28.8, 34.1) μmol/l (p<0.001), homocysteine decreased to subnormal figures - 11.8 (11.0, 12.8) μmol/l (p<0.001). When studying the cytokine profile in the group after treatment, a significant decrease in the level of proinflammatory cytokines was revealed. The use of complex therapy with the inclusion of drugs L-carnitine, deproteinized hemoderevate blood of calves as an antihypoxant and folic acid has a positive effect on the clinical course of the disease, contributes to the elimination of L-carnitine deficiency, hyperhomocysteinemia, a decrease in the level of pro-inflammatory cytokines.

We examined 60 patients aged 38 ± 10.3 years who underwent cholecystectomy for cholelithiasis. According to ultrasonography, all patients did not have signs of non-alcoholic fatty liver disease. The observation period was 1 year. The patients were divided into 2 groups of 30 people each. Group 1 included patients assigned to: Ursofalk, Mukofalk and Hofitol. Group 2 included patients who received symptomatic therapy. All patients were examined: a biochemical blood test and ultrasonography of the abdominal organs, before surgery and 6 and 12 months after cholecystectomy. Of the 60 patients enrolled in the study, 21.6% by the end of the first year after cholecystectomy, ultrasonography from the liver showed signs of non-alcoholic fatty liver disease. In the first group of patients, by the end of the first year after cholecystectomy, signs of non-alcoholic fatty liver disease were found to be 6.6%. In the second group, the signs of non-alcoholic fatty liver disease appeared in 36.6% of patients. Against the backdrop of using the prophylaxis scheme developed by Ursofalk, Mukofalk and Hofitol, the incidence of non-alcoholic fatty liver disease in patients with cholelithiasis is lower by the end of the first year after cholecystectomy than in patients who did not use this scheme 6-fold.

Six patients with right-sided hemihepatectomy were observed. In the preoperative period, along with clinical and laboratory, CT, ultrasound, gastroscopy, the functional reserve of the liver was assessed before and after the operative increase in the volume of the left lobe of the liver. We estimated not only the increase in volume, but also the functional preservation of liver functions. The criterion of nutritional consistency was the well-known alimentary-vollemic diagnosis. Given the high nutritional risk, a nutritional correction included a mixed nutrition (sparing diet + sipping with a mixture of hepatoprotective composition, enzyme therapy and parenteral correction with electrolyte solutions, vitamins and albumin). Against the background of the correction, the patient’s state was satisfactory with positive dynamics.

The group under study consisted of 387 patients with LC. The levels of prostaglandins (Pg) I₂ and F_2α, their dynamics in patients with LC were studied depending on the differentiated method of correction of ascites and (HRS) in these patients. In all patients with LC a statistically significant increase in serum levels of Pg I₂ and F_2α was observed. Our studies indicate the presence of regularity in the dynamics of serum Pg I₂ levels in patients with ascites and HRS with LC, namely: in patients with LC and ascites class B, an increase in the level of Pg I₂ was observed, which tends to normalize in class C in these patients, whereas in patients LC and HRS class B level of Pg I₂ in the blood serum is within normal range, and in class C in these patients, is decreased in 2-2.5 times than normal. 1. In patients with LC, ascites and HRS there is a violation of serum prostaglandins levels, namely, an increase in Pg F_2α, and decrease in Pg I₂, which indicates the formation of refractory ascites and HRS in these patients. 2. An effective method of correction prostaglandins levels in patients with LC is the use of symbiotic and combined drugs “Gepadif” in the early stages of ascites formation, which contributes to the prevention of resistance to treatment of ascites and HRS.

The importance of the HCV-infection is determined by the wide spread, progressive course, the formation of liver cirrhosis (LC) and hepatocellular carcinoma. The mechanisms of the effect of the virus on hepatic cells and regeneration of hepatocytes, the processes of fibrogenesis and fibrolysis, mechanisms of the reverse development of the LC remain unexplored. There is no effective pathogenetic therapy, which contributes to the regress of the formed fibrosis in the liver tissue. A patient with HCV-LC who has a secondary hemorrhagic vaculities who underwent autologous MSC transplantation into the liver tissue. The liver biopsy specimens were studied in dynamics by light and electronic microscopy and by immunohistochemistry. The procedure of transplantation and posttransplantation period proceeded without complications. After the introduction of MSC from the data of the morphological study, the features of the formed micronodular LC remained. In some parts of the samples, the septa looked thin, sometimes perforated, indicating a resorption in this place of fibrous tissue. There was a decrease in the degree of transdifferentiation of stellate cells into myofibroblasts, a decrease in the number of fibroblasts and fibroblasts, there were no immune reactions in the form of deposition of amorphous and fibrous masses of moderate electron density along the sinusoidal capillaries that were significantly expressed in the primary biopsy. These changes were combined with the appearance of hepatocyte heterogeneity in the density of the cytoplasmic matrix, the state and quantity of organelles and inclusions, and the structural improvement of intracellular organelles Autologous transplantation of mesenchymal bone marrow stem cells reduces the degree of destructive changes in hepatocytes, the severity of fibrosis and contributes to the improvement of the morpho-functional state of the liver, and therefore, it can be recommended as an important component of medical interventions.

Materials and methods of research. To study the effect of liver pathology on the pharmacokinetics of everolimus, the concentration of the drug in whole blood was determined by HPLC-MS/MS in 16 patients (men - 10, women - 6) after heart transplantation, observed in the fgbi “NMITS im. V. A. Almazova“ of the Ministry of health of the Russian Federation in the period 2016-2017, aged from 25 to 67 years (average age - 55.5 years). The average time after heart transplantation is 4.5 years. Patients received everolimus at a dose of 1.25 mg / day to 5.4 mg/day (average dose of everolimus - 2.5 mg / day).). In accordance with the distribution of nafr symptoms, the patients were divided into 2 groups (table.1): 1-4 patients with signs of nonalcoholic fatty liver disease (NAFLD), group 2 without evidence of NAFLD. The proposed method implemented using the method of high performance liquid chromatography combined with tandem mass spectrometry is straightforward, reproducible, rapid and reliable for the determination of everolimus in human whole blood with the aim of pharmacokinetic studies. Non-alcoholic fatty liver disease in patients after heart transplantation, receiving immunosuppressive therapy inhibitor mTOR everolimus, significantly affects the pharmacokinetics of the drug, achieving the target values, which can worsen the disease prognosis and quality of life.

In the study, two groups of patients were compared: 31 patients operated with a single-step minimally invasive surgical method and 28 patients who were operated with a two-stage surgical procedure. To study the long-term results of treatment in patients with cholecystocholangiolithiasis who underwent surgical treatment, a questionnaire survey (questionnaire SF-36) and a survey including clinical (complaints, examination), laboratory tests (blood and urine test, bilirubin level, ALAT, ACAT, AF) and instrumental (ultrasound, fibrogastroduodenoscopy) research methods. The obtained results of the conducted study testify to the undoubted advantage of one-stage minimally invasive surgical treatment of patients with cholecystocholangiolithiasis. Quality of life indicators in patients taking UDCA drugs at the postoperative stage of smoking were better in comparison with patients who did not take UDCA, which may serve as an additional reason for prescribing UDCA drugs after cholecystectomy. The received results of the conducted research testify to an undoubted advantage of one-stage minimally invasive surgical treatment of patients with cholecystocholangiolithiasis.

The hemostasis system indicators of rats with acetaminophen-induced hepatitis under the conditions of alimentary deprivation of protein were assessed in the research. Research was conducted on 4 groups of animals: 1 - control; 2 - rats maintained on low-protein diet; 3 - rats with acute acetaminophen-induced hepatitis, maintained on full-value ration, 4 - rats with acute acetaminophen-induced hepatitis, maintained under the conditions of alimentary deprivation of protein. The activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT) and fibrinogen concentration were determined by optical method on a semi-automated coagulometer HUMACLOT Junior (Human GmbH, Germany). The content of soluble fibrin-monomer complexes (SFMC) was assessed using the “RFMK test” test system; the serum D-dimer concentration was determined by enzyme immunoassay. Our study established an increase of prothrombin time in protein-deficient animals, while in other parameters of the hemostasis system significant changes were not detected. Meanwhile, a significant increase of APTT, prothrombin and thrombin time is established in animals with acetaminophen-induced hepatitis. At the same time, the results of this study suggest that the accumulation of blood fibrinogen and SFMC is higher in almost 3 and 1.5 times respectively compared to control values, on the background of maintaining of the D-dimer concentration at the control level. The most pronounced changes of hemostatic system are observed in animals with toxic liver damage, which contained on a low protein diet. A decrease of procoagulant blood potential was established in rats of this group that was shown by increase of APTT, prothrombin time and also of hyperfibrinogenemia on the background of the accumulation of SFMC. In conclusion, acetaminophen-induced liver damage is accompanied by disorders of the hemostasis system, which are most pronounced in protein-deficient animals. The established elongation of APTT, PT, TT and the increasing of fibrinogen and SFMC contents indicate the formation of the hypocoagulation state and risk of hemorrhage. The results of the research can be used for biochemically substantiate and the development of optimal strategy for the correction of coagulopathies as consequences of toxic liver damage.

Alpha-1 antitrypsin deficiency is a frequent metabolic, genetically-associated disease in which the liver is affected, primarily in patients with a ZZ phenotype. However, according to the literature to 20 years of life, only 10-15% of patients retain or develop clinical signs of the disease. We observed 7 children with the ZZ phenotype of α₁-antitrypsin, who had a severe neonatal cholestasis, a neonatal liver syndrome, and asymptomatic moderate hyperfermentemia in young children at the initial examination. In the course of further follow-up, a tendency toward weakening of the manifestations of the disease or normalization of liver laboratory tests was observed in all, no one showed signs of progression of liver fibrosis for a period of up to 3 years. However, in children among genetic diseases in this disease, most often there is a need for a liver transplant. Diagnosis of α₁-antitrypsin deficiency is to determine its level in the blood and phenotyping. Genetic diagnosis is possible. Treatment of liver damage with α₁-AT deficiency is an unresolved problem, but in recent years new strategies have been applied when it is possible to influence individual pathological mechanisms that cause liver damage.

The article presents literature data of recent years on the relevance of the problem of non-alcoholic fatty liver disease. The data on the role of physical activity, decrease in body weight upon this pathology are analyzed. Peculiar attention is paid to nutrition recommendations with variants of hypocaloric diets. An algorithm for changing lifestyle, increasing physical activity and dietary nutrition is presented, aimed at reducing body weight and treating non-alcoholic fatty liver disease.

The article presents data on the prevalence, clinical manifestations of cholelithiasis. The connection between the pathology of the biliary tract and changes in the activity of the cardiovascular system was noted. A clinical picture of cholecystocardial syndrome (CCS) and tactics of disease management with this pathology are described. The case of own clinical observation of a patient with CCS illustrates the published literature data.

This review focuses on the clinical picture, approaches to diagnosis and therapy of Caroli’s disease and Caroli’s syndrome

Incidence of non-alcoholic fatty liver disease (NAFLD) is growing rapidly throughout the world and has recently become the most common liver pathology. NAFLD's pathogenetic basis, which is insulin resistance, makes it similar to the metabolic syndrome diseases (visceral obesity, dyslipidemia, arterial hypertension and disorders of carbohydrate metabolism). High prevalence of NAFLD determines the importance of non-invasive predictors of its development and, particularly, of its progression to cirrhosis. Level of adipose tissue hormones (adipocytokines) is directly related to severity of insulin resistance and to high degree determines inflammation and fibrosis in liver. These hormones are good candidates both for predictors of NAFLD development and progression, and for markers of metabolic effects of therapy. Hormones involved in food behavior regulation (leptin, ghrelin, glucagon-like peptide type 1) have significant effects on adipose-tissue metabolism as well as adipose and liver tissue insulin sensitivity. Dynamics of these hormones in course of NAFLD treatment can also be an important marker of its effectiveness. This review explores the role of adipocytokines and other hormones in the insulin sensitivity, inflammation and fibrosis regulation in predicting development, progression and response to the therapy of NAFLD.

Irritable bowel syndrome (IBS) is a functional disorder of digestive organs, which manifests itself as abdominal pain and accompanied by disorders of defecation [2]. The prevalence of IBS ranges from 3% to 28% in different countries [2, 4]. The pathogenesis of IBS is still not completely clear, and now relation found with genetic, immune factors, impaired functioning axis the “brain-gut”, changes in the microbiota and psychosocial factors [3-12]. The ability of intestinal microbiota to produce neurotransmitters that change intestinal secretion and motility, as well as visceral sensitivity threshold [8, 9] was established in the studies. The data of observations in the world as a whole on the efficacy and safety of probiotic B. longum infantis (longum) 35624 in patients with IBS and some other gastrointestinal diseases.

The review presents mechanisms, clinical manifestations, methods of diagnostics and pharmacotherapy of portal hypertension syndrome with β-blockers in patients with liver cirrhosis. In addition, the article describes pharmacogenetic major aspects of cytochrome P450 2D6 activities and the influence of CYP2D6 polymorphism on the hemodynamic response to non-selective β-blockerpropranolol.

The aim is to study the impact of Retinol Palmitate in combinative anti-ulcer therapy in the treatment of reflux esophagitis as a preoperative preparation for hiatal hernia surgery (HH). 40 patients were observed, including 27 men, women 13. All patients were divided into two groups. The first group of 20 patients received anti-ulcer therapy, the second group 20 - anti-ulcer therapy and retinol palmitate. Anti-ulcer therapy included assignments of proton pump inhibitors, antacids and preparations that improve the evacuation function of the stomach. Retinol palmitate patients took 16-18 drops of 50,000 IU once a day at night, dripping it on bread or breadcrumbs. All patients underwent esophagogastroduodenoscopy (EGDS) before and after the 14-day course of treatment. Our study reliably demonstrated the efficacy of prescribing retinol palmitate for 14 days in combination with anti-ulcer therapy in most patients with mild to moderate reflux esophagitis. This treatment restores the oxidation-reduction process in the mucosa of the esophagus and stomach, facilitating the rapid epithelialization of erosions with the formation of a little noticeable elastic scar. Clinical manifestations of the disease were not observed in patients of the 2nd group within 3 months after the termination of anti-ulcer therapy. Patients with severe reflux esophagitis require a longer-term intake of retinol palmitate (up to 6 months) without anti-ulcer therapy. The absence of retinol palmitate in the complex anti-ulcer treatment of reflux esophagitis showed a short-term improvement in the endoscopic and clinical picture of the disease only in patients with mild and moderate reflux esophagitis. The combined use of retinol palmitate together with proton pump inhibitors and antacid preparations significantly improves the results of treatment of patients with reflux esophagitis with mild, moderate and severe degree. Rapid rapid epithelialization of erosions in reflux esophagitis under the influence of retinol palmitate contributes to the adequate preparation of patients for surgical treatment.

Available data are suggestive that modified version of frequency scale for the symptoms of gastrointestinal reflux disease (mFSSG) consists specific questions reflecting symptoms of reflux and dyspepsia which can be measured in form of Reflux Score (RS) and Dyspepsia Score (DS). By calculating this individual score, it has high positive effect on the pre-investigational identification of Gastrointestinal Reflux Disease and Dyspepsia syndrome respectively. Beyond the significant sensitivity and specificity, mFSSG tool is very convenient for practical use. When DS score is ranged between 6 and 8, the greatest correlation is observed with the fact that clinical criteria for functional dyspepsia are met by patient: lower DS scores are not indicative for starting empirical treatment of dyspepsia. DS score of 8 and above should be regarded as sufficient for the initiation of empirical treatment of uninvestigated dyspepsia. This review recommends using mFSSG questionnaire in the complex diagnostic examinations of patients who have symptoms of gastroesophageal reflux and/or dyspepsia. Those patients with uninvestigated dyspepsia who have mFSSG dyspepsia score of 8 and above can be recommended empiric treatment with fixed dose combination of omeprazole 20mg and domperidone suspended release 30mg. Russian version of the questionnaire yet to be validated in Russian patients population. This review provides practical recommendations on using mFSSG questionnaires by GPs and primary care physicians for making preliminary diagnostic decisions, identify laboratory examinations to be required, and to decide empiric treatment administration for patients with upper gastrointestinal symptoms. mFSSG questionnaire is meant to assist with, not dictate, decision making in conjunction with patients.

The article provides our own observation of the use of autologous mesenchymal stem cells for the treatment of a patient with cirrhosis of the liver. In this observation, the possibility of visualization in the human body of the introduced autologous mesenchymal stem cells is presented. Changes in biochemical blood parameters are also presented one month after the introduction of cellular structures into the arterial bed of the liver.

The presented clinical observation reflects the key issues of the drug-induced chronic liver disease (DICLD): the complexity of the interpretation of the cause-and-effect relationship. The drug-liver, the severity of the flow, the diagnostic concept, as an exclusion method, the lack of treatment standards and the difficulty of finding an effective therapy.

We investigated 97 patients with chronic viral hepatitis В и C, 30- nonalcoholic and alcoholic steatohepatitis with liver fibrosis 0-1stage. For the estimation of liver microcirculation we used non-invasive method polyhepatography (modificated liver impedansometry). Activation of HSCs was determined by expression of SMA-alfa in liver bioptate. Endothelial function was estimated by peripheral arterial tonometry (EndoPAT-2000), by expression of eNOS, iNOS in liver bioptate (immunohystochemical reactions) and by determination of NO metabolits in blood. For correction of hepatic blood flow disorders we used L-ornithine-L-aspartate, test with nitrates and deep respiration. we revealed the disorders of intrahepatic microcirculation on presinusoidal level (in-flow) at the viral patients and on sinusoidal level (out-flow) at steatohepatitis with increase of basic resistance and decrease of blood filling of the liver. The endothelial disfunction was identified: disorders od endothelia-depended vasodilatation, increased NO metabolits in blood, presence of iNOS expression and moderate decreased eNOS in liver. In liver bioptate we revealed the signs of activation of HSCs - expression of SMA-alfa. L-ornithine-L-aspartate improved liver microcirculation in all patients. at the chronic liver diseases patients with fibrosis 0-1 we detected the hepatic microcirculation disorders in different levels in depending on the ethiology of the disease. Functional tests with nitrates confirmed functional character of this disorders in cases of fibrosis 0. Endothelial dysfunction and activation of HSCs are important pathogenetic factors of increased hepatic resistance. L-ornithine-L-aspartate can improve liver microcirculation.

Gallstone disease has been known since ancient times. In the XIX century, two theories of the appearance of gallstones were proposed: the primary pathology of the liver and stagnation in the gallbladder. Later, they were supplemented by ideas of participation of a microbial agent and violation of cholesterol metabolism. In the XX century, cholestotomy, cholecystostomy and cholecystectomy were performed. Differences in the quality of stones have been noted for a long time. Elemental composition of different stones in the form was the same. By the 1980s of the twentieth century there were three main theories of the pathogenesis of gastrointestinal tract: infectious, bile stagnation and lipid metabolism disorders. None of them solved the problem. Pathogenesis remained at the level of assumptions. The results of surgical treatment of calculous cholecystitis did not always match the expected results. The term “postcholecystectomy syndrome” was proposed to characterize pathological conditions after surgical treatment of gallbladder diseases. In the Perm State Medical Institute, a number of works appeared at the Department of Hospital Surgery, in which the correlation of clinical, biochemical and morphological changes in the liver with cholelithiasis was investigated. L. F. Palatova laid the direction of studying the relationship of standing of the liver and the course of cholelithiasis. L. P. Kotelnikova, based on the spectral study of concrements, it was suggested that they are formed as a result of a lipid distress syndrome, where the liver and biliary tract serve as the target organ. The peculiarities of ultrastructural changes were discovered by T. I. Subbotin in persons with SCI who had previously suffered hepatitis B. Disturbances of blood supply and microcirculation in stenoses of the fat nipple and choledocholithiasis are studied in the candidate’s thesis by V. M. Rusinov. A. V. Popov and D. V. Shvarev investigated the polymorphism in CHD, indications for surgery and the results of treatment and rehabilitation, including resort. L. B. Guschensky shows the relationship of pathological processes in HDB and pancreatitis. Complications of choledocholithiasis, in particular, cholangitis, are covered in the work of D. I. Dremin. The role of the intestinal microbiota in the course of pathological processes in the biliary tract was studied by NA. Zubareva. The influence of pre-operative dispensary, surgical tactics on the outcomes of treatment is shown in doctoral dissertations. Kotelnikova and P. Ya. Sandakova. The idea of the pathogenesis and course of CSF has come a long way, and there are still unresolved issues in this problem, and surgical treatment has also evolved from large surgical interventions to stage manipulations from small accesses, which allows the patient to escape from extensive operational trauma, shortens treatment time and improves the quality of life.