There is a huge amount of commensal bacteria and food antigens in the large intestine. At the same time, pathogenic microorganisms can enter the intestine. A macroorganism needs to maintain tolerance to the first and develop an effective immune response to the latter. The epithelial barrier of the colon plays the leading role in the realization of this task. Dysfunction of the epithelial barrier leads to the development of an inflammatory response to normal intestinal antigens, which, according to some authors, is the initial mechanism of ulcerative colitis development. This review is dedicated to modern concepts of the structure and function of the epithelial barrier of the colon and its alterations in ulcerative colitis.

The aim of research: to investigate the activity of β-glucuronidase in coprofiltrates (OR feces) in patients with inflammatory bowel diseases - UC and CD at different severity levels (form of disease- mild, middle, severe) and to determine the significance as a laboratory criterion in the diagnosis, treatment and prognosis of IBD. Materials and methods. In research was prospectively studied 105 patients - 82 patients with IBD (29 patients with CD, 53 patients with UC) and 23 healthy volunteers without clinical laboratory indicators of inflammatory processes in the organism and diseases of the colon as the comparison group. The activity of β-glucuronidase in feces was determined using phenolphthalein glucuronide as a substrate. Results. The activity of β-glucuronidase in feces in patients with IBD did not differ from the healthy group (comparison group): in patients with IBD - 86.81 ± 8.4 μM / g / hr, and in norm, healthy group (comparison group) 76.04 ± 10.13 μM / g / hr (p> 0.05). Also we did not find significant differences in the activity of β-glucuronidase in patients with CD and UC, in comparison with the norm (healthy group), or between groups of patients with IBD (CD and UC). In both forms of IBD, we did not find significant differences in the activity of β-glucuronidase in patients with severe, mild or middle severity level of disease, as in comparison with healthy group so as between group of severity level. Conclusion. We have established that the activity of fecal β-glucuronidase in patients with different severity levels CD and UC did not differ from in patients of healthy group. Determination of the activity of fecal β-glucuronidasecan not use as objective laboratory criteria for determining the severity of IBD and predicting the course of the disease and, apparently, does not have essential value in the pathogenesis of IBD.

Aim: to create a system for monitoring the condition of patients with inflammatory bowel disease (IBD). Subjects and methods: In the period from August 2015 to December 2018, 246 patients with IBD were examined at the clinical base of the Department of Therapy Azerbaijan State Advanced Training Institute for doctors named after A.ALIYEV, the Department of Invasive Diagnostics and Treatment of the National Center of Oncology, Memorial Klinika Medical Center. The content of homocysteine, highly sensitive C-reactive protein (h/s CRP), vitamin D and the level of platelets in the blood, albumin in the urine, and calprotectin in the feces were determined in all subjects. Patients were retested if necessary (426 in total) Results: In the general group of patients with IBD, of the 426 studies conducted in 369 (86.6%) cases, there was an increased content of homocysteine in the blood, in 405 (95.0%) - the level of h/s CRP, in 322 (75.5%) - thrombocytosis, in 411 (96.4%) - a decrease in the content of vitamin D, in 308 (72.3%) albumin was detected in the urine, and in 411 (96.4%) - an increased content of calprotectin was detected in the feces. When analyzing the identification of each of these indicators separately in the UC and CD groups, no difference was found (p > 0.05). A correlation was found between some indicators of endothelial dysfunction and the severity of the clinical course in patients with inflammatory bowel diseases. The proposed new approach to assessing the clinical status of patients with IBD, with the established diagnosis, does not resort to repeated costly studies and obtain real-time results that make it possible to assess the severity of the patient’s condition.

The aim was to аssess the effect of nutritional factors on the risk of developing ulcerative colitis based on an analysis of food consumed. Assess the importance of consumption of certain nutrients in its development among the population of Western Siberia. Materials and methods: A survey of 81 patients with ulcerative colitis and 39 healthy volunteers was conducted. The profile of the eating habits of patients with ulcerative colitis (before diagnosis) in relation to healthy respondents was investigated. Results. The diet of patients with ulcerative colitis before the first signs of the disease is distinguished by the rare consumption of fresh and cooked vegetables and fruits in small portions, the consumption of more sugar with tea and / or coffee compared to healthy ones. Also, patients poorly tolerated milk and dairy products before the debut of the disease. Conclusion. Our study confirms the possible effect of a lack of dietary fiber and excessive sugar intake on the onset of ulcerative colitis.

There is a new principle of preparing diet for a patient with ulcerative colitis (UC). Within 4 years, we observed and comprehensively examined 60 patients UC who received standard treatment. In group 1(n=30) was used as a dietary therapy specific individual elimination hypoallergenic diet (ISEH diet), picked up in vitro and composed by exclusion from the diet of those products, which can be a source of food sensitization. To identify the immunopathological reactions I, III and IY types of food allergens used a range of methods - ELISA (IgE-specific) and the reaction of inhibition migration of leukocytes(RIML), modified by NN Matyshevа and LS Kositskаyа. Group 2(n = 30) received a standard mechanically and chemically sparing diet. Patients with UC showed a high degree of sensitization to food antigens. Usage of the ISEН diet promoted a more rapid onset and prolonged maintenance of clinical and endoscopic remission, more than in the standard diet group, without the use of corticosteroids and thiopurins, as well as a significant decrease in the number of disease relapses. Diet of patients with UC should be hypoallergenic. The best results are observed in the preparation of a diet based on a comprehensive individual screening-testing of food allergens using laboratory diagnostic methods based on cell-type reactions and methods for detecting specific antibodies to food antigens. Results of a 4- year follow-up for patients with UC show high efficacy ISEH diet in the treatment and maintaining remission of these patients.

The article presents the results of clinical effectiveness of osteopathic correction methods in the treatment of motor-evacuation disorders of the digestive tract in celiac patients based on a comparison of clinical and instrumental data. Materials and methods: 26 patients with celiac disease aged from 18 to 35 years old, in which General clinical, endoscopic and PEGEG studies revealed disorders of motor activity of the digestive tract. The examined patients had been carried out 5 sessions of osteopathic procedures to correct their motor-evacuation disorders of the gastrointestinal tract (GI). Results: the examined patients were observed to have osteopathic disorders, indicating regional somatic dysfunction and combined motility disorders of the upper and lower digestive tract in both phases of the PEGEG. The use of osteopathic correction, aimed at mobilizing the compensatory-adaptive mechanisms of the body, was effective for discontinuing gastroenterological symptoms, normalization of propulsive and tonic activity of the gastrointestinal tract. Conclusion: osteopathic correction can be used in the treatment of patients with motility disfunction of the digestive tract.

The aim was to investigate the prevalence of genetic variants of marker rs1042522 (Arg72Pro) of TP53 among individuals without cancer and patients with colon cancer. Materials and methods. Using allele specific PCR we performed genotyping of rs1042522 marker with subsequent comparing of alleles and genotypes frequencies in two studied groups: the comparison group (n=119) and the group of patients with rectal cancer (n=105). Results. Proportion of the minor allele Pro with the expected pathological effect in the comparison group was 26,9%, and among patients with rectal cancer - 26,7%. The frequency of the Pro/Pro genotype in the two groups was 6,7% and 5,7%, respectively. The distinction in indicators was not statistically significant.

Aim to study the frequency, expression and simultaneity of risk factors for colorectal cancer in hospital patients. Materials and methods. The statistics of 1690 colorectal cancer (CRC) patients were retrospectively studied. Clinical signs were assessed according to the case histories of 180 patients with colorectal cancer, selected by random sampling and systematic sampling (every tenth of the total population of all patients with CRC). Questioning patients with CRC, based on their informed consent, studied risk factors in 80 people (random sample; every second of the average annual number of patients with CRC). Results. The share of women was 52.5%, men - 47.5%. The average age of patients is 69 (61-77) years. Before the manifestation of colorectal cancer, patients had an overweight in 40.9% of cases, obesity in 39.4% of cases. Women with colorectal cancer more often than men had type 2 diabetes mellitus 4 times (p = 0.015), cholecystectomy 2.5 times (p = 0.09), combined pathology 3 times (p = 0.24) and prolonged history of IBD 5 times (p <0.05). In men with colorectal cancer, hypodynamia (5 times, p = 0.003) and smoking (2 times, p = 0.23) occurred more often than in women. Conclusion. Risk factors for colorectal cancer were, 55 years of age, overweight or obesity, type 2 diabetes.

In the literature there is little information about the occurrence of dielectrolytes with inadequately selected parenteral-enteral correction. This fully applies to the correction of iron deficiency in colorectal cancer (CRC). Material and methods. On examination were 51 patients with CRC (T3N1M0 and T4N0M1) and iron deficiency of various severity. Nutritional status was assessed by the parameters of a known alimentary-volemic diagnosis (AED). Iron deficiencies resulting from chronic blood loss were assessed by the content of serum iron, ferritin, transferrin, the level of Hb and Ht, the number and average volume of red blood cells, and the average content of Hb in the red blood cell. The control group consisted of 10 patients with iron-deficient anemia. Results. One of the components of the AVD is the determination of electrolyte deficiencies, including gland. With a deficit of free iron in plasma up to 11%, a decrease in hemoglobin level and Ht, a slight decrease in the number of erythrocytes and normal parameters of ferritin, the average volume of erythrocyte and the content of Hb in it were sufficient nutritive correction mixtures containing 3.0-3.5 mg of iron in 100 g dry product. With a higher iron deficiency, additional parenteral administration of its drugs was required: as part of the nutritional correction, as a pharmacological supplement, supplements were injected with non-sorbed or sorbed iron on a special matrix (ironMatrix), which guaranteed the stability of the iron complex and its controlled release in the body. At the same time, sorbed iron provided a higher safety (no complications were observed in any of the studies. with the administration of non-sorbed iron in 2 cases, there were unpleasant sensations in the heart area, in the right hypochondrium, resembling signs of iron overload (ferritin could increase to 1340 mg), stopped, however, only by the administration of a hepatoprotector and 0.9% of the sodium chloride solution without the additional use of an antidote. Conclusion. For the sake of safety of iron deficiency correction (prevention of toxic-metabolic complications) when conducting a comprehensive nutritional correction in patients with CRC complicated by mild chronic anemia with iron deficiency not more than 11%, it is advisable to use drugs containing iron (3-3.5 mg per 100 g of dry product), and in case of a pronounced shortage of it, supplement the nutritional support with parenteral preparations of sorbed iron under the control of the parameters of iron metabolism.

Purpose of the study. Тo determine predictors of refractory course of irritable bowel syndrome with consideration for genetic markers and psychological peculiarities of patients. Materials and methods. 101 patients with irritable bowel syndrome (73 with refractory form of irritable bowel syndrome, 28 with non-refractory form of the same) have been examined. We analyzed the triggers of the disease, assessed the levels of distress, depression, anxiety, somatization, and aggression, and we have determined polymorphic variants of genes COMT Val158Met, TLR9 G2848A, TLR9 T-1237C. Results. Refractory variant of irritable bowel syndrome is associated with the onset at an earlier age, social and psychological triggers, extraintestinal manifestations and non-gastroenterological symptoms, high levels of distress, depression, anxiety, somatization, and aggression. We have revealed that refractoriness and some clinical forms of irritable bowel syndrome are associated with polymorphic variants of certain genes. Conclusion. Refractory variant of irritable bowel syndrome is associated with certain genetic and psychological factors.

Irritable Bowel Syndrome (IBS) is a functional bowel disease in which relapsing abdominal pain is associated with bowel movements or bowel movements. Despite the numerous works devoted to the investigation of the mechanisms of IBS development, the intestinal motility in this disease has not been studied enough. The aim is to reveal the features of the motor function of the large and small intestine in irritable bowel syndrome with constipation (IBS-C) and in the case of dolichosigma. Material and methods. 84 patients with IBS-C by electromyography in comparison with a group of 25 patients with dolichosigma and a group of 35 patients with functional constipation were examined. The frequency of slow waves of the small and large intestine (patients with functional constipation) and the left parts of the colon (patients with IBS-3 and dolichosigma) by the Conan-M hardware and software complex were measured Results and discussion. IBS-C is characterized by hypomotor dyskinesia of the left divisions with pronounced spastic contractions of the smooth muscles of the circulatory layer of the gut, possibly due to the activity of stimulating serotonergic effects on the spastic activity of the circular muscle layer or inhibitory adrenergic neurons of the intermuscular (Auerbach) nerve plexus. With dolichosigma, hypomotor dyskinesia of the left parts of the colon was revealed due to stretching of the mechanoreceptors of the afferent neurons of the intramural reflex arcs.

Purpose of the study. Show the effectiveness of training for young people with chronic non-calculous cholecystitis on the example of a personality oriented educational program. Materials and methods. A total of 64 patients with chronic non-calculous cholecystitis in the remission phase were examined. They determined the levels of anxiety, indicators of quality of life, types of attitudes towards the disease. The obtained data were compared before and after training in a person-centered program. Results. In the course of dynamic management of patients with biliary pathology, a decrease in high anxiety levels, an increase in persons with a low level of anxiety, an increase in ergopathic, mixed types of attitudes towards the disease, a decrease in anxiety and hypochondriacal types was noted. In terms of quality of life, an increase in self-satisfaction along with a scale of health status was reliably detected. Positive changes in the behavior of patients in terms of adherence to the implementation of the recommendations of the doctor according to the person-oriented program are identified. Individual approach, familiarity of patients with the basics of the disease, risk factors, self-help, mutual aid, non-drug, urgent measures contribute to the primary and secondary prevention of the disease. Conclusion. In the course of this study, positive results were obtained in the psychosomatic status of patients. Due to the development of this trend now, increasing the level of education of certain groups of the population, individual approach to each patient, resolving issues together with the doctor in class, discussing emerging issues, getting advice - all this allows you to increase the patient’s participation in resolving issues of self-, mutual assistance, control the state of the main indicators of the level of health, monitor the levels of anxiety, depression and promptly contact specialists; therefore, this technique is relevant to and Use at the outpatient stage for people of all ages.

The aim of investigation: determination of the effectiveness of endoscopic methods in treatment of patients with low scarring strictures of bowel in settings of SBIHC “Region Clinic Hospital Nr 2” Materials and methods: we analyzed the treatment of 32 patients with low scarring strictures of bowel. The reasons of development of scarring narrowings and options of endoscopic treatment of this group of patients were studied. The causes of formation of scarring strictures in 29 patients (91,0%) were operarions performed. In 3 patients (9,0%) of this group low scarring strictures developed on the background of inflammatory bowel disease performed. Results: in SBIHC “Region Clinic Hospital Nr 2” the following methods of endoscopic recanalization of scarring strictures were used: hardware bougienage were performed in 12 patients (37,5%), mechanical bougienage (using silicone bougies) in 6 patients (18,8%), combination of methods of hardware and mechanical bougienage was used in 4 patients (12,5%), balloon dilatation as the method of the extension of the lumen was used in 4 patients (12,5%), combination of methods of mechanical bougienage and balloon dilatation was used in 4 (12,5%) patients, stenting with nitinole self-expanding stents was used in 2 patients (6,2%). The efficiency of used methods was 72%. In the majority of cases (65,6%) multi-stage treatment was required. In patients with whom we failed to achieve adequate expansion of the lumen the reconstructive surgery was performed. Conclusion: endoscopic methods of recanalization of the lumen in scarring narrowings are sufficiently effective with compliance of conditions of dynamic observation.

Rectal cancer is one of the leaders in the structure of mortality in both sexes, with the only radical method of treatment is surgery. For the planning of surgical treatment, it is important to assess the metastatic lesion of the locoregional lymph nodes, which is an important predictor of the recurrence of the disease. The efficiency and accuracy of the preoperative determination of metastatic regional lymph nodes in low-ampullar rectal cancer increased significantly after the introduction into clinical practice of magnetic resonance imaging with the use of diffusion-weighted image and a non-ionic paramagnetic. The article is devoted to the problems of preoperative staging and determination of metastases in regional pararectal lymph nodes by comparing the results of MRI studies with contrast enhancement and MRI with diffusion-weighted images (DWI) in the diagnosis of metastases -positive locoregional lymph nodes, comparison with the data of histological studies of intraoperative material.

The objective is to study the morphometric signs of small bowel ischemic damage basing on intravital optical coherence tomography data and further histological analysis Materials and methods. The study was carried out on male Wistar rats with the use of two models of acute intestinal ischemia: acute occlusive mesenteric ischemia by а. jejunales ligation (group “I”) and acute arteriovenous ischemia by a small bowel loop and frill strangulation together with а. et v. jejunales (group “II”). The state of intramural vessels in vivo was evaluated with the use of optical coherence angiography (OCA). After the macroscopic signs of non-viability appeared the bowel was resected and its stepwise histological analysis was carried out. Results. Ischemic damage development in group “I” was accompanied by decrease of bowel wall thickness by 34,8-42,4% (p=0,032) due to submucous layer destruction - based on histological analysis data and also by decrease of total length of functioning intramural vessels by 4,6% (p=0,004) - based on OCA data. According to the OCA data in group “II” the length of functioning vessels decreased by 89,6%in the strangulated bowel loop and by 6,1% in adducent and abducent sections (p=0,001). In the strangulated loop histological specimens sharply dilated thrombosed veins were seen in all layers of bowel wall, seromuscular layer oedema and diapedesis hemorrhages of mucous coat also took place as well as bowel wall thickening by 25,2% in comparison with the intact one. Conclusions. Сomplex analysis of in vivo optical coherence tomography results and further histological analysis of ischemic small bowel wall made it possible to determine the morphological manifestations which are specific for arterial and arteriovenous mesenteric blood flow disorder. In cases of mesenteric artery occlusion hypoperfusion and mucous coat ischemia are predominant among pathogenetic mechanisms of bowel wall alteration. In the strangulated bowel the main factor of destruction and necrosis is acute insufficiency of venous outflow.

The aim was to characterize the structural and functional features of the nervous and endocrine systems and the microbiota composition of the colon in newborns and prepubescent Wistar rats. Materials and methods: The study was performed on 12 newborns and 13 prepubescent male Wistar rats. We used immunohistochemical methods to investigate the structure of the intermuscular nerve plexus and to detect endocrine cells in the colon. The concentration of serotonin in the colon wall and peripheral blood plasma was evaluated with high-performance liquid chromatography. The ratio of the main taxa of bacteria of the luminal microbiota was determined by real-time PCR. Results: We identified that in the neonatal period the intermuscular nerve plexus was not completely formed, there were few glial cells in the ganglia. The relative number of enteroendocrine cells and the serotonin content in the intestinal wall and in blood at this age period was minimal. The composition of the luminal microbiota in newborn rats was characterized by the predominance of taxons Firmicutes, Enterobacteria. In comparison with the newborns the intermuscular nerve plexus in the prepubescent rats was mature: the neural network formed large mesh, while the number of glial cells in the ganglia increased 3-4 times. The number of enteroendocrine cells increased 2.5 times, the content of serotonin in the colon wall and peripheral blood increased almost 80 and 6000 times, respectively. Firmicutes predominated in the luminal microflora, the number of Bifidobacteria, Enterobacteria decreased.

Thickening of the wall of the colon (TC) is one of the easily detectable and common symptoms of TC diseases detected by computed tomography (CT). The aim of the study was to reveal the possibilities of standard abdominal CT in the diagnosis of TC disease. To achieve this goal, 359 CT of the abdominal cavity performed according to the standard Protocol were analyzed. The average age of patients was 64.1+15.8 years. Gender ratio: prevalence of male patients 1,3:1,0. The normal thickness of the wall of the colon depends on the degree of expansion of the lumen or stretching and in most cases is changeable. The thickening of the TC wall was considered to be a persistent mismatch of its thickness to the inner lumen or outer diameter, taking into account the extreme values of the norms according to the literature data from 2 to 10 mm. The Analyzed cases of thickening of the TC wall were divided into 3 groups: focal (53%), segmental (30%) or diffuse thickening (17%). Wall thickening defined in nonspecific inflammatory diseases (Crohn’s disease, ulcerative colitis, undifferentiated, pseudomebranous and ischemic colitis) often had segmental (12%) or diffuse (16%) length, with a minimum in the group of focal thickening - 1% in Crohn’s disease. The authors determined a significant difference in the length of TC wall thickening in benign and malignant processes (p<0.05). The probability of diagnosis of TC cancer significantly increases with a decrease in the length of the determined thickening of the TC wall to the focal, with an inverse relationship with an increase and a high probability of inflammatory disease (p<0.01). Thus, the symptom of thickening of the wall of the TC is a marker symptom of diseases of the TC. In our study, the thickening of the TC wall was found in both malignant and benign diseases, with the prevalence of the latter, and a large proportion of inflammatory diseases in them (p<0.05). In the group of focal thickenings, the leader, not taking into account diverticulitis due to easily recognizable signs of this disease, was TC cancer, which indicates in favor of the high specificity of the sign (p<0.01). However, the analysis of additional features was crucial in the differential diagnosis of TC pathology: the type and nature of contrast enhancement, changes in mesentery, fiber and adjacent vessels.

The range of causal combinations of various types of intestinal lesions and spondyloarthritis (SpA) is extremely wide: from subclinical pathology to manifest manifestations of Crohn’s disease and ulcerative colitis. In studies of the last decade it is assumed that not only inflammatory bowel diseases (IBD), psoriasis, but also SpA are diseases with activated innate immunity, which provides an early non-specific response mediated by the barrier function of the epithelium. Modern data on the cellular and molecular mechanisms of SpA pathogenesis allow rheumatologists to hypothesize the concept of a “barrier organ disease” as the preclinical stage of development of diseases belonging to the SpA group, which is based on impaired immune tolerance to autologous synanthropic microflora in genetically predisposed individuals.Key words: microbiome; spondyloarthritis; inflammatory bowel disease, pathogenesis

The problems of ulcerative colitis (UC) in pediatric practice are the difficulties of primary diagnosis, the severity of the course due to the greater extent of the colon lesion and the difficulty in choosing a drug effect. The age of the patients determines the extent of colon lesions in UC in children. Thus, in the older age group, especially older than 15 years, characterized by a high frequency of left-sided ulcerative colitis forms in contrast to adults. The choice of therapy in children with UC depends on the severity of the condition, localization and extent of the lesion, the severity of humoral activity and the age of the child, as well as adherence (compliance) therapy. This example demonstrates that in a teenage boy ulcerative colitis had a rare localization for children, there was a violation of the recommended therapy at the beginning and dynamics of observation, which led to a relapse and progression of the disease. Low adherence to therapy significantly worsened the course and prognosis of the pathological process, and therefore the quality of life of the patient.

Lactitol is a prebiotic disaccharide that supports the functioning of lacto- and bifidobacteria, also inhibits the growth of pathogenic flora. The results of transcriptome and proteomic studies have shown that lactitol is characterized by unique absorption and processing mechanisms in lactobacteriathat distinguish it from other prebiotics. In high doses (5 … 50 g/day) lactiol is used as an osmotic laxative. Lactictol enhances the detoxification of the body (in particular, the excretion of ammonia and toxic amines). The detoxification effect of lactitol, lack of lactitol’seffect on blood lipid and glycemic profiles, lack of food intolerance and rare occurrenceof side effects (flatulence, transient diarrhea when the dose is exceeded) make lactitol an important tool in the treatment of dysbiosis, liver disease and hepatic encephalopathy.

The article describes the most common iron deficiency syndromes (IDS) in inflammatory bowel disease (IBD) and presents the modern principles of differential diagnosis of gastrointestinal disease, the advantages and disadvantages of standard methods for the correction of Iron-Deficiency (ID) and anemia in this group of patients. The authors give a circumstantial outline of their own data of examination and treatment of 77 patients with IBD and anemia, and prove the necessity of compulsory ferritin serum (FS) testing as the most important differential marker of the IDs., Inadequate production of erythropoietin as the main cause of anemia has been proven in 15% of patients with high FS values. On the contrary, the necessity of mandatory use of iron preparations in management of anemia was determined in 85% of patients. The high efficiency and safety of sucrosomial iron are proven in patients with IBD and anemia. The effectiveness of this method shows the normalization of hemoglobin in 68% of patients within 3 months. In contrast, intravenous iron administered during the inpatient treatment period is not sufficiently effective in this category of patients, which requires the continuation of outpatient therapy with preparations of sucrosomial iron. Conclusions: Based on the obtained data and international experience, there was formulated and substantiated the algorithm of differentiated therapy of IDS in patients with a mild form of IBD.

The effectiveness of probiotics is strain-specific. This paper presents the results of a systematic analysis of the promising lactobacterial strain Lactobacillus paracasei CNCM I-1572 (L. casei DG; L. paracasei DG). L. casei DG well survives in the conditions of the stomach and intestines, supports the beneficial microbiota and inhibits the growth of pathogenic bacteria, exhibits a therapeutic effect in ulcerative colitis, eradication of H. pylori, diverticular bowel disease, and irritable bowel syndrome.

A study of 35 patients, whom operated by obstructive jaundice of neoplastic origin was done. They were divided into 2 groups: І (comparison groups, n = 15) - in the early postoperative period patients were given standard therapy and II (studied groups, n = 20) - Remaxol was included in the scheme of traditional treatment. In the study dynamics were carried out laboratory and biochemical tests: malonic dialdehyde (MDA) and diene conjugates (DC); phosphalipase A2 (PL A2); hypoxia ratio (HR); middleweight molecules (MWM), total (TAC) and effective albumin concentration (EAC), toxicity index (TI), total bilirubin (TB), alanine aminotransferase (ALT), activated partial thromboplastin time (APTT) and fibrinogen. Thromboelastography (USA) was used to assess the state of the hemostasis system. It was established that postoperative patients in the early time had oxidative stress, increased phospholipase activity, endotoxicosis syndrome, hemostatic disorders (hypercoagulation and hypofibrinolysis), which persisted throughout the observation period. The inclusion Remaxol in traditional therapy led to suppression of the intensity of lipid peroxidation (LP), reduction of phospholipase activity, relief of endogenous intoxication and hypoxia, restoration of blood coagulation-lytic status. The most significant effect of the drug was determined in the first 3 days after surgery.

The aim. On clinical examples to demonstrate to the Therapist and General practitioner the possibility of using the road-map of management of primary patients with symptoms of dyspepsia at the stage of outpatient care. Fundamentals. Clinical cases of patients with established diagnoses of Functional dyspepsia; Dyspepsia associated with Helicobacter pylori infection; Nonerosive reflux disease; Gastroesophageal reflux disease of I degree with nocturnal acid breakthroughs in combination with functional dyspepsia are presented. The questions of substantiation of preliminary and final diagnoses, approaches of differential diagnosis of diseases using the road-map are considered in the comments. The main methods of diagnosis of diseases and disorders with symptoms of dyspepsia are presented and justified. It is shown that prior to obtaining the results of esophagogastroduodenoscopy, a preliminary diagnosis Uninvestigated Dyspepsia “K 31.9 Disease of stomach and duodenum, unspecified” should be made. After elimination of the organic cause of dyspepsia, treatment is carried out using proton pump inhibitors (omeprazole or rabeprazole 20 mg/day) in combination with a prokinetic (domperidone 30 mg/day). Rational use of a fixed combination of omeprazole 20 mg with modified release domperidone 30 mg / day (Omez®DSR). Conclusion. Compliance with the algorithm of management of primary patients with symptoms of dyspepsia in a wide clinical practice will avoid errors in the diagnosis, the appointment of unreasonable research, irrational treatment, which will improve the quality of life and prognosis of patients with dyspeptic disorders.

Introduction. Intestinal intussusception is the most common type of non-congenital intestinal obstruction and one of the most common nosologies in emergency pediatric surgery. This disease occurs mainly in children of the first year of life and is extremely rare in older age. In children over 3 years of age, intussusception usually has leading points in the form of organic causes: diverticulum, doubling of the intestinal tube, polyps, tumors and others. Material and methods. A child of 7 years old, entered the department of pediatric surgery with acute abdominal pain syndrome, repeated vomiting, the duration of the disease is about 20 hours. The child was operated on urgently basis with a preliminary diagnosis of acute appendicitis. Results. Intraoperative ileocecal invagination with necrosis of the ileum was detected, about which a resection with an anastomosis of the intestine was performed. Histological examination of a remote small intestine revealed the presence of Peutz-Jeghers polyps. After discharge from the surgical department, the child was sent under the supervision of an oncologist and a gastroenterologist. Conclusion This clinical case demonstrates one of the possible causes of intestinal invagination in children older than 1 year. Peutze - Jeghers syndrome is an autosomal dominant condition defined by the development of characteristic polyps throughout the gastrointestinal tract and mucocutaneous pigmentation. Invagination of the intestine is one of the frequent complications of this disease and occurs, as a rule, in older children.

The article presents a clinical case of combined liver damage in an elderly patient. On the one hand, monochemotherapy with cytostatics for true polycythemia (erythremia) became a probable cause of liver damage by the type of destructive cholangitis, and possibly provoked the development of AMAM2-positive primary biliary cirrhosis. On the other hand, on the background of subcompensation of the underlying disease, difficulties arose with verification of the Genesis of rapidly developed portal hypertension.