The semantic problem of designation of a set of diseases is a subject for wide discussion both in the world medical community and in Russia. The article analyzes and clarifies the definitions of “polymorbidity”, “comorbidity” and “multi-morbidity” proposed to refer to the plurality of diseases in one patient. This allows you to objectively look at such a complex and multifaceted problem, which is a multiple pathology.

Helicobacter pylori, an etiopathogenetic factor of gastritis and gastric and duodenal ulcer disease, is highly sensitive in vitro to antimicrobial photodynamic therapy with zinc octakis(cholinyl)phthalocyanine (o-PCZ). The photosensitizing activity of o-PCZ with molecules bearing eight positively charged substituents, is due to electrostatic binding with negatively charged surface of the cell walls of bacteria. In the bound state, when excited by light, o-PCZ generates singlet oxygen, which has a bactericidal effect. Intensive absorption of o-PCZ in the far-red region of the spectrum allows to use in photodynamic therapy light of wavelengths with high penetrating capacity in the biological environment from led sources.

Aim. In the article frequency of defeat of mucous membranes of organs of cavity of mouth and tissues of paradontium is examined at intensifying of chronic erosive gastritis associated with Helicobacter pylori and herpes viral infection. Result. As a result of the study in patients suffering from chronic erosive gastritis associated with Helicobacter pylori and herpesvirus infection, Helicobacter pylori was detected in 100% of cases in the gastric mucosa in the study of biopsies by PCR, urease test, microscopy of smears and in the oral cavity in the study by urease test and PCR method, while the degree of contamination was regarded as high and medium. All patients were divided into 2 groups depending on the severity of the disease. Significantly more often in the first group of studies compared with the second identified high and very high rate of the CPU (χ²=14,280 at p<0.01); the index of hygiene is very poor and unsatisfactory (χ²=11,752; χ²=11,509, at p<0.01, respectively); gingivitis severe (χ²=20,847 when p<0.01); severe inflammation of the gums (χ²=14,849, p<0.01); the third stage of periodontal disease (χ²=26,615 at p<0.05) in the assessment of dental status. No periodontitis was observed in the control group. Conclusions. The infection of Helicobacter pylori serves as the base-line factor of forming of inflammatory diseases of paradontium, initiating development of active erosive gastritis, nosotropic closely associated with gingivitis and periodontitis.

Dyskinesia of the upper digestivel tract is accompanied by the development of gastroesophageal reflux disease (GERD) in abdominal obesity. GERD occurs in the United States at 29.8% of men and 32.5% women and 30% of adults in Western Europe. However, clinical and instrumental characteristics of GERD in obesity are not well understood. The aim - to explore the clinical and instrumental characteristics of GERD in obesity. Methods. The survey included 52 patients with clinical, radiographic and electromyographic studies. The control group consisted of 36 patients. Results. Electromyographic marked increase in retrograde motility of the stomach and esophagus, as well as reduced motor function of duodenum. X-ray showed signs characteristic of GERD. Esophageal pH monitoring revealed the presence of alkaline reflux. Conclusions. The features of GERD in abdominal obesity is the prevalence of dyspepsia and heartburn absence, motor-evacuation disorders showing a decrease in evacuation function of the stomach and the presence of predominantly alkaline reflux.

Purpose of the study. To study the association between the gut microbiota composition and body mass index and abdominal obesity in participants without clinical chronic diseases. Materials and methods. The study included 92 residents from Moscow and the Moscow region, men and women aged 25 to 76 years without clinical chronic non-communicable diseases are not receiving medication, but with the possible presence of cardiovascular risk factors, including obesity. All participants underwent a thorough preliminary examination, including physical examination, clinical and biochemical blood tests, electrocardiography, treadmill test, evaluation of the presence of the cardiovascular risk factors, as well as the sequencing of the variable regions of the V3-V4 16S rRNA gene of the gut microbiota and diet analysis. Results. The study revealed that opportunistic bacteria of the genera Serratia and Prevotella were largely represented in overweight patients and / or patients with abdominal obesity. Amylolytic bacteria of the genus Oscillosipa were less represented in individuals with abdominal obesity. Probiotic bacteria of the genus Bifidobacterium producing SCFA were significantly less represented in people who consumed a lot of cholesterol or ethanol. Conclusion. Gut microbiota imbalance with an increase in opportunistic bacteria level and a decrease in strictly anaerobic amylolytic bacteria is associated with obesity.

Aim. To study the overlap syndrome of GERD and dyspepsia in a population study. Methods: A clinical and epidemiological study was performed, during which 1411 adult patients (506 indigenous and 905 alien inhabitants) were examined in an organized population with a coverage of 93%. Results. The prevalence of weekly heartburn was 12.2% in Caucasians and 8.3% in Khakassians (p = 0.03). Dyspepsia was detected in 20.2% of alien inhabitants and in 15.8% of indigenous people (p = 0.05). Dyspepsia was registered 7.1 times more often in Caucasians with weekly heartburn (p <0.001) and 6.3 times more often in the same group of Khakassians (p <0.001) compared to those without heartburn. Conclusions. It was concluded that there is overlap syndrome of GERD and dyspepsia in indigenous and alien inhabitants of Khakassia.

Aim. We aimed to determine possible interrelation between fecal calprotectin (FC) level, that small intestinal bacterial overgrowth (SIBO) and ileum mucosal inflammation in patients with irritable bowel syndrome (IBS). Methods. Based on Rome III criteria, 495 IBS patients (376 female, mean age 36,6±0,4 years) were included. All patients underwent FC levels, ileocolonoscopy with biopsies of the terminal ileum and H2 lactulose breath test to evaluate the presence of SIBO. Results. Among the 495 IBS patients 57% had reproducibly elevated calprotectin, including 17% with levels higher than 100 µg/g. SIBO was more frequent among IBS patients with elevated FC levels (>100 μg/g) than in those with normal FC levels (0-50μg/g) (77,1% vs 64,8%, р=0,011). We found a correlation between abnormal levels of FC and the presence of SIBO (Spearman r=0,153, p=0,001). Faecal calprotectin greater than 100 µg/g was predictive of ileum mucosal inflammation in IBS patients (OR6,19, 95%CI 3,99-9,61, р<0,0001). The abnormal calprotectin level was correlated with the grade ileum mucosal inflammation (Spearman r=0,399, p<0,0001). Conclusion. In IBS patients with SIBO the low-grade ileum mucosal inflammation was more frequent than in patients with IBS without SIBO (OR2.69, 95% CI 1.79-4.04, p <0.0001). Elevated FC levels (>100μg/g) were associated with low-grade ileum mucosal inflammation in IBS patients (OR6,19, 95%CI 3,99-9,61, р<0,0001).

Aim: The aim of this study was to assess the incidence, clinical and instrumental associations and prognostic value of cardiohepatic syndrome (CHS) phenotypes CHS in decompensated heart failure (DHF). Methods: CHS was diagnosed in 322 patients with DHF (190 male, 70±11 years (M±SD), arterial hypertension 87%, myocardial infarction 57%, atrial fibrillation 65%, type 2 diabetes mellitus 42%, left ventricular ejection fraction (EF) 38±13%, EF<40% 50%, NYHA IV 56%) when at least one liver function test (LFT) level exceeded upper normal limit on admission. Only alanine transaminase (ALT) and/or aspartate transaminase (AST) increase was considered as hepatocellular CHS, isolated increase of gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (AP), direct bilirubin (DB) and total bilirubin (TB) due DB increase - as cholestatic CHS, the simultaneous increase of markers of cytolysis and cholestasis - as mixed CHS. Mann-Whitney U, Kruskal-Wallis and Pearson’s chi-square tests were used. P <0.05 was considered significant for paired comparison, <0,017 - for comparison of 3 groups. Results: CHS occurs in 85,1% patients, predominantly mixed (66,8%) and moderate (LFT increase ≤ 3UNL). Patients with mixed vs cholestatic CHS had higher levels of LFT, incidence of cholestatic markers increase, NT-proBNP level, hypoperfusion (high heart rate, lower systolic blood pressure (BP) and pulse BP on admission), higher rate of incidence of EF<35% and vasopressor therapy. No significant differences in signs of congestion were observed between groups. Mixed CHS was associated with higher all-cause death in 6 months (30 vs 23%, p<0.05). Conclusions: Mixed CHS predominates in patients with DHF and is associated with more pronounced LFT increase, higher NT-proBNP levels, hypoperfusion (lower systolic and pulse BP, EF <35%, use of vasopressors and inotropes, worse prognosis.

Objective: To evaluate structural and functional cardiac changes in patients with alcoholic cirrhosis in relation to the severity of liver disease. Methods: Study included 80 patients with alcoholic liver cirrhosis (LC) without history of cardiovascular and respiratory disease. ECG, echocardiography were performed. Plasma values of NT-proBNP were evaluated in 60 patients. Results: Left ventricular ejection fraction was normal in all patients (mean value 65,3 ± 5,8%). Left ventricular hypertrophy (LVH) (LVMI 149,8 ± 20 g/m 2) and LV diastolic dysfunction were observed in 33 (40,7%) and 58 (71,6%) patients, respectively. Median NT-proBNP value was 621,5 pg/ml (min 33 pg/ml; max 3849 pg/ml), NT-proBNP elevation (> 125 pg/ml) was observed in 47 (58%) patients. NT-proBNP level positively correlated with the number of points on the Child-Pugh score (R =0,27, p < 0,05). There was no relationship between the severity of cirrhosis and structural and functional cardiac changes. Conclusion: Patients with alcoholic LC frequently demostrate structural and functional cardiac changes such as left ventricular hypertrophy, diastolic dysfunction. NT-proBNP elevation was observed in more than half of the patients and directly correlated with the severity of cirrhosis.

The aim was to improve and optimize the management tactics of women of reproductive age with somatic diseases on the basis of a comprehensive assessment of the main structural and functional characteristics of the hepatobiliary system at various stages of physiological gestation in the presence or absence of somatic pathology, as well as in the process of complex dynamic observation and examination for three years after delivery. Materials and methods: there were examined 535 outpatient and inpatient patients aged 16 to 45 years (mean age 27.9 ± 4.7 years, m 28, Mo 25) was conducted, including 383 patients with somatic pathology during pregnancy: group 1 (n=183) with gestational hypertension (GAG), group 2 (n=66) with chronic arterial hypertension (HAG), group 3 (n=134) of obese pregnant women. The control group consisted of 152 pregnant women without somatic pathology. Results: Analysis of structural and functional parameters of the hepato-biliary system showed that pregnant women with obesity have a moderate increase in one share of the liver (42.11% of cases), moderate hyperechogenicity of parenchyma (36.84%), difficulty in visualization of the diaphragm contour (26.31%). In gestational and chronic hypertension without obesity, these changes are expressed slightly. Conclusion: Linear and estimated the ultrasonic parameters of the liver (distal attenuation of the echo signal, hepatomegaly, hyperechogenicity, increased ehoplotnosti of the liver parenchyma and disruption of its calibre in conjunction with the expansion of the vena portae) correlated with hemodynamic, nutritional parameters and periods of gestation and are biomarkers of hypertension and obesity in women of reproductive age.

The aim of this study was to investigate the association of polymorphism of the glutathione-S-transferase genes with the risk of occupational liver diseases in workers of petrochemical plants. Materials and Methods. 544 DNA samples of petrochemical workers and 322 healthy persons DNA sample were used for genotyping by polymerase chain reaction and restriction fragment length polymorphism. Results. It was found that the genotype Val/Val of polymorphic locus rs1695 of GSTP1 gene is less common in patients with toxic hepatitis (χ²=4,405, р=0,036) than in healthy workers. Analysis of the association of polymorphic loci GSTM1 and GSTT1 with the development of occupational liver lesions revealed no statistically significant results. Conclusion. The data obtained suggest that the homozygous genotype Val/Val of polymorphic locus rs1695 of the GSTP1 gene is protective of the development of occupational toxic hepatitis.

Purpose. To analyze the features of formation of comorbidity and age-related patterns of distribution of risk factors (RF) in patients with diseases of the gastrointestinal tact (GIT) living in rural areas. Materials and methods. In 2015-2017.d. a retrospective analysis of the database of 2500 patients at two sites of General practitioners of Konakov district of Tver region was conducted. Of these, 350 (14% of all the studied out-patient charts) out-patient charts of patients aged 44-53 years (164 men and 186 women) were selected, which contained more complete information about the annual medical examination of the population. In addition, a survey of this population group was conducted for a more detailed retrospective analysis of the incidence and presence of PD during life depth up to 25-35 years. Results. Gastrointestinal diseases were detected in 42 patients (12% of the total group of patients studied); dorsopathy - in 84 patients (24%); arterial hypertension (AH) in 178 patients (50,86%); chronic kidney disease in 12 (3,4%), diabetes in 10 (2,9%) people; other diseases accounted for no more than 3% and 35 (10%) patients had no registered diseases. Basic FRENCH men for life was Smoking. Despite the high percentage of Smoking women aged 18-23 years (47.52%), almost all patients left a bad habit of 34 years. In an additional survey, 97% of women who had smoked earlier explained Smoking cessation to 34 g of children in their family and only 3% of respondents attributed Smoking cessation to deterioration of their health. It is important to note that although the prevalence of overweight in men increased slightly more than in women (40.3% and 36.6%, respectively) with age to 53 years, differences in the increase in the incidence of associated GC increased disproportionately (48.05% and 22.77%, respectively) Conclusion. Thus, the formation of comorbidity in rural areas occurs mainly at the age of 44-53 years. Among the features of comorbidity in these patients, it should be noted the frequent combination of gastrointestinal diseases with hypertension and dorsopathy, and relatively rare-with chronic obstructive pulmonary disease and cerebrovascular diseases. The “diagnostic failure” observed at the age of 24-43 dictates the need to pay special attention to this age category for the purpose of timely examination and early detection of the initial stages of diseases.

Aim of the study. Determination of the potential opportunity of immune protease cathepsin G (Cat G) to participate in the regulation of homeostasis and protective reactions in the intestinal epithelium by interacting with cell adhesion proteins (cadherins). Materials and methods. Biopsies of the human duodenal mucosa were examined by confocal immunofluorescence microscopy using specific antibodies to desmogleins 1-3 (DSGs 1-3), E-cadherin and Cat G of human. Results. The presence of DSG 2 in the contact area of the basolateral membrane of epitheliocytes of intestinal villi and intestinal glands (crypts) with the basal membrane was demonstrated. DSGs 1 and 3 were not detected in the test samples. E-cadherin is located in the zone of the basolateral membrane of enterocytes, goblet cells and Paneth cells. E-cadherin-specific fluorescence is also found between the secretory granules of Paneth cells, which indicates the synthesis of this protein by Paneth cells and/or E-cadherin role in intracellular signaling. In inflammation (duodenitis II-III degree) Cat G-containing granules are localized near the basal membrane of villi and intestinal glands. Conclusions. The catalytic properties of Cat G and its close proximity to the cell adhesion proteins (DSG 2 and E-cadherin) indicate the possibility of interaction of these proteins and their role in the regulation of tissue metabolism, modification and maintenance of the barrier properties of the epithelium during the development of protective and / or pathological processes.

The aim is to study the electromotor activity of the gastrointestinal tract in patients with GERD with concomitant functional constipation Material and methods. A study was made of the electromotor activity of the gastrointestinal tract in 70 patients with GERD with concomitant functional constipation and 64 patients with GERD with normal stool. Electromotor activity (EMA) was recorded with the help of skin electrodes in the area of the projection of the stomach and sigmoid colon on the anterior abdominal wall. The amplitude-frequency characteristics of slow-wave and spike activity on the electromyogram curve were measured. Results. EMA of the stomach in patients with endoscopically confirmed GERD and the presence of constipation was characterized by increased slow-wave and spike activity. Thus, the frequency of slow waves of the EMA of the stomach exceeds the norm by 78%. The amplitude of slow waves exceeds the norm by half. EMA of the sigmoid colon in patients with endoscopically confirmed GERD and the presence of constipation was characterized by a decrease in slow-wave activity: the frequency of slow waves of the sigmoid colon EMA was 70% of the norm; The amplitude of the slow wave activity is only 0.13 ± 0.06 mV. Conclusion. In patients with GERD and concomitant functional constipation, the incidence of gastroesophageal reflux is high, the gastrointestinal tract EMA was characterized by a more pronounced motor activity of the smooth muscles of the stomach and reduced motor activity of the sigmoid colon, which creates the conditions for an increase in intestinal pressure.

The aim was to investigate the influence of the peptide complex from pork kidney tissues on indicators of free radical oxidation and the expression of COX-1,2 in experimental Indometacine-induced gastropathy. Materials and methods: There were examined 67 male Wistar rats. Experimental peptic ulcer disease was reached by the injection into the stomach of 60mg/kg Indometacine. The experimental group had got 75mg/kg for 7 days up to the Indometacine injection. The concentration of enzymes COX-1, 2 in blood plasma and gastric homogenate were determined by the method of enzyme immunoassay. The activity of free radical oxidization processes was evaluated by the coloring intensity of the products of the corresponding biochemical reactions. Results: In the experimental group the concentration of COX-2 in the gastric mucosa was reduced by 26.5% comparing to the intact group. Thiobarbituric acid-reactive substances concentration was redused in 2,3 times comparing to the control group. Increased under the effect of indomethacin, the concentrations of superoxide dismutase and glutathione peroxidase were equal the concentrations of healthy rats. Conclusion: The injection of a peptide complex from pork kidney tissues for 7 days is accompanied by reducing of the inflammatory process in the gastric mucosa, as evidenced by a decrease in the concentration of COX-2 in the stomach homogenate, as well as reducing of oxidative damage to gastric cells and strengthening their enzyme antioxidant protection.

Objective: To study the qualitative and quantitative composition of microflora in the jejunum and the cecum in acetaminophen administration. Materials and methods: The experiments were carried out on 30 rats male Wistar rats weighing 400-450 g. The influence of intragastric administration of acetaminophen (500 mg/kg) on the microflora in the jejunum and cecum has been studied. Results: It is shown that administration of acetaminophen within 21 days no changes composition of the jejunal microbiota, but leads to decrease species composition and to significant inhibition of lactobacillus and bifidobacterium in the cecum.

Purpose. Experimentally determine the volume and time stages of damage formation associated with the use of low-alcohol (SAN) and energy drinks (EN) in rats. Material and methods. 45 white Wistar rats were used, the experimental animals were divided into three series consisting of three groups. The first a series of age - 1.5 month; the second a series of - 12 months. The third series-24 months. In each series of 3 groups: 1-I control (intact), animals had the free access to clean water and customary food. 2nd experimental group rats with free access to water and food was added to the drinking bowl with AL “Red Bull” or SAN “Black Russian”. Autopsy after 14 and 45 days, or if necessary, when the animals died from drinking. After the autopsy, the abdominal and thoracic cavities were examined. To assess the revealed injuries, the damage index (di) was calculated, which was calculated by the number of organs with injuries and divided by the number of animals in the group. Conclusion. Experimental animal studies have established a single pathogenetic mechanism and cause-and-effect relationship between blood flow disorders associated with alcohol and multiple (polymorbidity) internal injuries. Low-alcohol drinks (cocktails) are not harmless drinks, they cause multiple toxic damage to the internal organs in the “young” rats appear damage characteristic of the “old” animals. In this case, aging is not age, but disease. Low-alcohol and energy drinks are conducive to the use of stronger drinks (“Rare” - Red bull + vodka). Decrease in the instinct of self-preservation-refusal of food and drink in combination with polymorbidity of lesions of internal organs leads to death of animals. Easy access for young people and the widespread availability of low-alcohol and energy drinks (cocktails) are a subject of discussion and attention for educators and doctors.

Acromegaly is a severe neuroendocrine disease caused by increased production of somatotropic hormone by adenohypophysis tumor. The somatotropic hormone is indirectly, via insulin-like growth factor-1, acts on all organs and systems of the body, causing a large number of complications, including those of the gastrointestinal tract. Numerous cases of diagnosing both benign and malignant neoplasms have been described in the literature in this group of patients. About 15% of patients with acromegaly die from cancer, especially colon cancer, which frequency varies from 2 to 14 times the increase in comparison with the general population. However, there is an extremely low amount of studies of the upper part of the digestive tract in patients with acromegaly. The article reflects the results of various domestic and foreign studies on the upper and lower divisions of the gastrointestinal tract of patients with acromegaly, malignant and benign neoplasms of the stomach and colon, diverticular disease in patients with acromegaly, as well as possible prerequisites for their development, based on the pathogenesis of the underlying disease.

Goal. To study the effects of complex therapy with Remaksol on the reparative process of a laparotomic wound in the early postoperative period in patients with mechanical jaundice. Material and methods of investigation. We performed clinical and laboratory studies in 40 patients with mechanical jaundice of a non-tumoral nature, 22 patients received Remaxol in their early postoperative period (daily intravenous infusion of 400.0 ml for 5 days). The control group consisted of 18 patients with chronic calculous cholecystitis. Patients underwent cholecystectomy, choledochotomy with choledocholithoextraction or the formation of choledochoduodenoanastomosis. Results. Under mechanical jaundice the reparative potential of tissues is significantly reduced. One of the most important mechanisms of inhibition of tissue regeneration is the deterioration of their bioenergetics. Membrane destabilizing phenomena of regenerating structures are also of great importance due to excessive activity of peroxide oxidation of membrane lipids and activation of phospholipases. Negative factors, aggravating regeneration, in patients were hypoxia, endotoxemia and hypoalbuminemia. Application in the early postoperative period in the complex therapy of Remaxol leads to a significant correction of factors detrimental to the reparative process, which is responsible for the improvement of tissue healing in conditions of cholestasis. Correction of endogenous intoxication and hypoalbuminemia is associated with the hepatoprotective effect of the drug. Conclusion. The Remaxol use increases the reparative potential of laparotomic wounds in patients with mechanical jaundice.

The article analyzes the results of recent studies on the relationship of iron deficiency, iron deficiency anemia and H. Pylori infection. The results of recent epidemiological studies of the combination of these diseases and the proposed theory of the pathogenesis of iron deficiency in infection with HP, including the role of chronic inflammation supported by HP in the formation of anemia of chronic diseases.

The available numerous literature data indicate that Helicobacter pylori infection (HP) plays an important role in the etiology and pathogenesis of diseases that are not related to the digestive system (atherosclerosis, diabetes, thrombocytopenic purpura, Sjogren’s disease), including skin diseases (chronic urticaria, atopic dermatitis, itching, psoriasis, red flat lichen, focal alopecia, rosacea, etc.). The role of Helicobacter pylori infection during these diseases is described in detail and the need for eradication therapy is proved. The importance of studying gastrointestinal lesions in patients with this pathology for the purpose of complex pathogenetic therapy is confirmed

The article is devoted to the problem of the emetic syndrome. Details are presented etiology, basic variants and diagnostic criteria for the disease. The article focuses on the aspects of treatment of patients with an emetic syndrome.

The development and introduction of high-performance molecular genetic methods into practice allowed us, in recent years, to increase our knowledge of the epigenome and microbiome, which shed light on the mechanisms of development of various pathologies, such as cancer, immune-mediated, metabolic and cardiovascular diseases. It was found that the dysbiosis of gut microbiota (GM), which often accompanies these diseases, can affect the epigenetic mechanisms of the regulation of the activity of individual genes either directly through a change in the composition of GM, or indirectly, through changes in metabolites, which are various biologically active substances (short-chain fatty acids, biotin, folic acid and other biologically active molecules). Indeed, correlations between epigenetic mechanisms regulating the activity of host genes, on one hand, and changes in the composition of its gut microbiota or metabolites produced by intestinal microorganisms, on the other, have been established in certain diseases. It served as the basis for assuming that GM can become a diagnostic marker for certain diseases, and that treating the intestinal dysbiosis by transplanting healthy microflora is an effective therapeutic strategy. In this article, we discuss the relationship between dysbiosis of the gut microbiota and the host’s epigenome, as well as the possibility of using the microbiome and epigenome as diagnostic and therapeutic targets.

This article is devoted to the clinical picture, approaches to diagnosis and treatment of Oddi´s sphincter dysfunction.

It is believed that gallstone formation in the biliary tree is a disease associated with alterations of the normal functioning of the organism, and often accompanied by metabolic dysfunction. Recent scientific data allow us to take a fresh look at the problem by proposing an original hypothesis about gallstone formation as a protective immunological reaction of the biliary three cells aimed to isolate exogenous microorganisms and to stop overexpression of toll-like receptors (TLR). In this paradigm, the cholelithiasis appears to be an autoimmune cholangiopathy, therapy of which is associated with the normalization of the immune status of cholangiocytes and down-regulation of its membrane receptors.

Neuroendocrine tumors (NET) are a rare, but dangerous disease, and often have malignant character. The frequency is about 35 cases at 100.000 population, with 2-5 new cases on 100.000 people a year. The majority of NET produce the active substances in various degree influencing exocrine function and motility of the gastrointestinal tract (GIT). The frequent clinical manifestation of NET is diarrhea. It is necessary to carry out a differential diagnosis of NET in patients with the persistent not stopped diarrhea and/or ulcer damage of a GIT. The purposes of treatment of NET are the elimination of primary tumor (and its metastasizes - if they are) and normalization of a hormonal background that leads to a regress of clinical symptoms. The randomized controlled studies PROMID and CLARINET with a high degree of substantiality have shown symptomatic improvement and significant anti-proliferative effect of somatostatin analogs in the treatment of NET. In the CLARINET study, the lanreotide Autogel was effective at a wide range of patients with highly - and moderate differentiated NET (Ki-67 <10%), including with primary tumor in a small intestine and pancreas, with a primary tumor of unknown localization, and with metastatic damage of a liver. Now somatostatin analogs are considered as the first line of drug treatment of patients with highly - and moderate differentiated NET of digestive tract regardless of the extent of metastatic damage of a liver.

The influence of therapy with ursodeoxycholic acid Grinterol® on the clinical and biochemical parameters of patients with hepatobiliary pathology under conditions of real polyclinic practice was studied. The study involved 300 centers in 25 cities of the Russian Federation. The number of participants was 10213 patients. The study included patients with non-alcoholic fatty liver disease, alcoholic liver disease, chronic viral hepatitis, drug damage to the liver, cirrhosis, сholecystitis with biliary sludge. An assessment of the dynamics of clinical symptoms and biochemical markers of hepatic cytolysis and cholestasis demonstrated the high clinical effectiveness of therapy with Grinterol®, safety and the minimum side effects in all the examined groups. According to the results of the study, the use of the medicinal preparation Grinterol® seems very appropriate for the treatment of diseases of the hepatobiliary system.

The clinical situation in which the dependence of the result of Н. pylori eradication therapy on the genotype СYР2С19 controlling the metabolism rate of proton pump inhibitors is described. When carrying the allele variant СUR2С19 * 17 (homo-, heterozygote), a person refers to the “fast metabolizers” of this group of drugs. In view of this anti-Helicobacter therapy can not be achieved in the proper amount.

The present study demonstrates severe course of glomerulonephritis with underlying nephrotic and acute nephritic syndrome with rapidly progressing kidney failure and skin lesion associated with chronic viral hepatitis C. Unfortunately despite the combined immunosuppressive therapy the patient still had azotemia and the nephrotic syndrome was progressing. It was impossible to conduct antiviral therapy because of acute kidney damage, as the clearance of the pegylated interferon decreases under kidney failure. The therapy by monoclonal antibodies to CD20 was not discussed. Kidney damage remains the main cause of death of patients with mixed cryoglobulinemia. The presented clinical case emphasizes the urgency of the problem of extrahepatic aspect of chronic viral hepatitis C and proves the role of lymphotropic chronic viral hepatitis C in the mechanism of the development of rapidly progressing glomerulonephritis. The development of the scheme of modern antiviral therapy and relapse prevention is needed.

In the article are collected “gastronomic” Russian- and the English-speaking medical metaphors connected with digestive system. Terms are grouped on nozologic and organic sign. The diseases having “gastronomic” symptoms are shortly outlined.