The article discusses esophageal and extraesophageal manifestations of gastroesophageal reflux disease in the abstract form. Particular attention is paid to broncho-pulmonary syndrome and its causes of development in gastroesophageal reflux disease. The possibility of timely clinical diagnosis of gastroesophageal reflux disease in persons with multimorbidity is discussed.

Aim. To estimate a clinical endoscopic picture in patients with the stable stenocardia associated with a gastroesophageal reflux disease (GERD). Material and methods of research. In the course of the research two groups of patients with stable stenocardia have been consistently created. The I group included the patients with a concomitant GERD (n=28), the II group - with a concomitant chronic gastritis (n=35). Infection H. pylori was confirmed for all patients. Patients of both groups received eradication therapy together with the basic therapy. The duration of the observation was 24 weeks. The dynamics of a clinical endoscopic picture has been estimated. Results. At patients of the I group the clinical status in addition to anginous pains was characterized by the expressed dyspeptic symptoms having negative impact on the quality of life of patients. Monitoring of an endoscopic picture of a gastroduodenal zone after eradikation of H. pylori showed improvement at sick patients of both groups. However more significant improvement of clinical parameters and indicators of quality of life is noted at patients with the stable stenocardia associated with GERD (the I group). Conclusion. Inclusion in an algorithm of treatment of patients with stable stenocardia with a combination of GERD of eradication therapy of H. pylori promotes stabilization of a clinical endoscopic picture, provides a reduction of dyspeptic symptoms, improves the quality of life, raises a self-assessment of state by the patients.

Purpose of the study. Development of diagnostic methods and detection of pathophysiological interrelations as targets of pathogenetic therapy of patients with gastroesophageal reflux disease (GERD) with comorbid gastrointestinal pathology. Material and methods. 433 patients were examined by esophagogastroduodenoscopy (EGD) in combination with acid-perfusion test (APT) with irrigation of the esophageal mucosa 0,1N HCL, congo red chromoscopy stomach, the identifying Helicobacter pylori (HP) in gastroduodenal mucosa. Results. The severity of reflux esophagitis (RE) in GERD found a direct correlation with subcompensated pyloric stenosis associated with duodenal ulcer, axial hernia and asthma. The age of patients with GERD was accompanied by a direct correlation with the degree of RE (χ², p=0,002), which directly correlated with the volume of the hungry stomach, exceeding 90 ml (ANOVA, p=0,015). APT reflected a statistically significant category correlation with severity of RE (χ², p=0,006). The degree of HP-infection of antral mucosa was accompanied by hypersecretion of HCL according to congo red chromoscopy and directly correlated with the severity of RE (Kruskal-Wallis, p<0,001). Conversely, the degree of HP-infection of the body of the stomach was inversely correlated with peak acid production, which suggests the HP-induced hypochlorhydria. The conclusion. Congo red chromoscopy and APT during endoscopy allows simultaneously detect acid production of the stomach and the early signs of non-erosive GERD in patients with unchanged and slightly altered esophageal mucosa for developing of managing patients with comorbid gastrointestinal pathology.

The paper presents the analysis of effectiveness of different modifications of the triple and combinatorial anti-Helicobacter pylori (H. pylori) therapy and their in-fluence on the small intestinal overgrowth syndrome (SIBOS) in type 2 diabetic patients with chronic gastroduodenal disorders (CGDD). The open comparative randomized study included 138 diabetic patients with CGDD. Methods: Gastro-duodenal - longpathology was confirmed by gastroduodenos-copy with biopsy, H. pylori contamination - by use of the urease and citological method or finding bacterial antigen in excrements. The SIBOS was recognized by a respiratory hydrogen method with lactulose. Results: Depending on the type of anti-H. pylori regimen all patients were divid-ed into 4 groups. The less effective were found to be the 10-days-long triple ther-apy with Omeprazol (eradication in 68,7%) and the 14-days-long optimized reg-imen with Rabeprazol (80,6%of eradication). Addition of both vismuth and pro-biotic resulted in increased eradication up to 94,1% (triple intensified optimized therapy), while the optimized triple regimen with metronidazol and probiotic (in-tensified concomitant therapy) proved to be the most effective (97,2%) in H. pylori eradication. The all 4 regimens of anti- H. pylori therapy resulted in de-creased number of SIBOS cases, but the best results were obtained in patients who were on the triple intensified optimized and intensified concomitant therapy - up to 60 and 78,3% correspondingly. The positive influence of an anti-H. pylori therapy on SIBOS seen in the study allows the authors to consider SIBOS as an additional indication for an anti-H. pylori therapy.

Aim: The aim of this work is to assess the organizational risks of H. pylori eradication therapy and the control methods of antibiotic resistance by a clinico-pharmacological analysis of the purchases structure in Russian state-funded medical facilities. Materials and methods: A legal framework in the fields of purchases of products, works, services for state and municipal needs, open contract bids, schedule and annual procurement plans for 2017, the Ministry of Health of Russian Federation statistical materials were explored. Results: According to Russian and international guidelines, current purchases of products, works, services are mainly related to a primary H. pylori identification not its eradication control. “Quasi-reference” H. pylori diagnostic methods with lower sensitivity in comparison to reference ones and extremely low specificity are relatively popular. Conclusion: Information related to the structure of products, works and services purchases for H. pylori diagnostics on the Federal Acts No. 44 and 223 united information web-system (http://zakupki.gov.ru) shows no rational assessment of effective eradication therapy while H. pylori is recognized as a microorganism with a high potential for adverse drug reactions and drug-to-drug adverse interactions development. WHO made H. pylori a priority pathogen for antibiotics research and development.

Aim. To study the factors associated with an increase in surrogate serum markers of liver fibrosis in patients with chronic heart failure (CHF). Materials and methods. The study included 100 patients with CHF. All patients underwent echocardiography on a Samsung Medison EKO7 ultrasound scanner. The following liver fibrosis indices were determined: Forns index, FIB-4, Lok index, BARD, NAFLD Fibrosis Score (NFS). Results. According to the results of the correlation analysis, positive correlations were found between the NFS values and the thickness of the anterior wall of the right ventricle (RV) (r=0.218; p=0.036) and the inverse between the NFS values and the TAPSE value (r= -0.214; p=0.045). Lok index values directly correlated with the volume of the left atrium (r=0.220; p=0.035) and systolic pressure in the pulmonary artery (SPAP) (r=0.251; p=0.026). In addition, an increase in SPAP was also associated with an increase in the Forns index (r=0.395; p=0.0001) and FIB-4 (r=0.223; p=0.047). According to the results of a polynomial logistic regression analysis, the Forns index increase predictors of more than 75 percentile were an increase in the SPAP ≥50 mm Hg and hydrothorax; NFS - increase in SPAP ≥50 mmHg and the end-diastolic size of the RV> 4.2 cm; Lok index - an increase in SPAP ≥50 mm Hg, end-diastolic size of the RV > 4.2 cm and a decrease in TAPSE <17 mm. Conclusion. In patients with CHF, the presence of dilatation of the right ventricle, pulmonary hypertension, and reduction in contractility of the right ventricle are the main determinants of the increase in non-invasive serum indices of liver fibrosis.

Diagnosis of chronic liver diseases in elderly patients has features due to polymorbidity, multiple organ failure, erased the course of the disease. Aim - to identify correlations of biochemical parameters of inflammation and hepatocellular failure with histology in chronic hepatitis (CH) and liver cirrhosis (LC) in elderly patients. Materials and methods. 99 studied the medical records of patients with CKD who have died in the Clinical Hospital for War Veterans of St. Petersburg between 2009 and 2015 (an average age of 81 year). The diagnosis of chronic hepatitis (45 cases) and the CPU (54 cases) was confirmed by postmortem examination. Morphological changes in the liver were described by Knodell. The degree of inflammatory activity in the liver was evaluated in points (0.1 to 3.0) depending on the level of AST, ALT, γ-globulin, alkaline phosphatase, γ-GTP, bilirubin. For similar scoring severity hepatocellular insufficiency (0.1-3.0) considered total protein, albumin, prothrombin index, fibrinogen. For cirrhotic patients also used the criteria Child-Pugh. Results. Chronic liver disease (CKD) - hepatitis and cirrhosis of the elderly is detected at a frequency of 1.5%. In most cases, CKD develop against diseases of the cardiovascular system, are accompanied by clinical symptoms not evident, which limits their in vivo diagnosis. The integral evaluation of the degree of activity of the process according to biochemical indices significantly higher in the group of chronic hepatitis than in the group of liver cirrhosis. Correlations complex biochemical parameters of inflammation (AST and / or ALT, γ-globulin, alkaline phosphatase, γ-GTP) having a degree of Knodell Histological Activity Group chronic hepatitis and cirrhosis have not been established. Established correlation of histological activity with total bilirubin levels in both groups of CKD. Integral assessment of hepatocellular deficiency by biochemical indicators of liver cirrhosis group was higher than in the group of chronic hepatitis. Conclusion. Results of the study revealed a direct correlation of serum bilirubin with the degree of histological activity Knodell.

Purpose of the study. To study the relationship between the gut microbiota composition and the levels of the end glycation products precursors in individuals without clinical manifestations of chronic diseases. Materials and methods. The study included 92 participants aged 25 to 76 years without clinical manifestations of severe somatic pathologies not receiving any drug therapy but with the possible presence of risk factors including metabolic disorders. All participants underwent a thorough preliminary examination, which included physical examination, clinical and biochemical blood tests, electrocardiography and treadmill test, applanation tonometry, as well as V3-V4 sequencing of variable regions of the 16S rRNA gene of gut microbiota and analysis of glyoxal and methylglyoxal levels in the blood. Results. The levels of glyoxal and methylglyoxal correlated with each other (r = 0.238, p = 0.0016). Among the clinical parameters, a high level of glyoxal in the blood was associated with an increase of systolic blood pressure (r = 0.24, p <0.002). At the same time, the correlation did not reach the level of confidence in the relationship of glyoxal with the vascular wall rigidity. The result of the analysis of the microbial composition of the gut microbiota was the discovery of relationship between an increase in the level of glyoxal with a high representation of the poorly studied family of gram-positive bacteria Mogibacteriaceae. Without the use of filtration methods of underrepresented genera, the interrelation of Fusobacteria order with a high level of methylglyoxal was also discovered, which, nevertheless, requires further study on larger cohorts. Conclusion. High levels of circulating glycation end products precursors are associated with changes in the composition of the gut microbiota, including an increase in the number of Mogibacteriaceae family.

The article presents the patients with irritable bowel syndrome quality of life dynamics on the butyric acid (butyrate) treatment. The high efficiency of the complex therapy of IBS with the addition of butyrate is shown in relation to the effect on pain and the intensity of bloating. The addition of butyrate to the complex therapy of IBS had a positive impact on the patients’ quality of life: all indicators of the psychological component of health and most indicators of the physical component of health improved, with the exception of role-playing physical functioning.

The article provides a brief literature review on the role of intestinal microflora and the possibilities of its correction. As a result of using modern molecular genetic research methods, more than 50 genera and more than 500 species of differing types of bacteria populating the gastrointestinal tract have been identified. The composition of the intestinal microflora is individual, is formed from the moment of birth, depends on genetic factors and is determined by the conditions of existence. The intestinal microflora provides a protective function, antitoxic effect, maintains an optimal level of metabolic and enzymatic processes, participates in local and general immune reactions. Environmental degradation, stress, uncontrolled use of drugs, malnutrition leads to disruption of the qualitative and quantitative composition of the intestinal microflora - dysbiosis. Probiotics, prebiotics and synbiotic are used to treat intestinal dysbiosis. Probiotic strains most effectively act as part of synbiotic, representing a combination of probiotic with prebiotic. One of the long-used and well-proven synbiotic in clinical practice is Maxilac.

The article provides a brief literature review on the problem of comorbid pathology, namely, chronic heart failure (CHF) in patients with coronary heart disease (CHD) in combination with alcoholic liver disease (ABP). The issues of epidemiology, the relationship of pathogenetic mechanisms in the development and progression of CHF and ABP are considered. The issues of optimizing the treatment of CHF and ABP are discussed in the light of current recommendations and evidence base. Of particular interest is the diagnosis of such a complication as hepatic encephalopathy (PE), the possibility of its reversibility during therapy with the inclusion of L-ornithine-L-aspartate. A clinical case of a patient suffering from heart failure due to post-infarction cardiosclerosis in combination with toxic hepatitis is given.

According to the forecasts of the World Health Organization, by 2020, non-alcoholic fatty liver disease (NAFLD) will occupy the 1-st place among all liver diseases. The prevalence of type 2 diabetes is as rapid as that of NAFLD. The etiopathogenetic community of type 2 diabetes mellitus and NAFLD is a subject of debate. The binding pathogenetic link of one and the other disease is a violation of lipid metabolism, insulin resistance and chronic, subclinical inflammation. Realization of these pathogenetic mechanisms, unified for NAFLD and SD2 type, is carried out primarily at the level of hepatocyte. NAFLD is a predictor of severe cardiovascular complications, multiple polytopic drug resistance, creates difficulties in the effective therapy of not only type 2 diabetes, but also many other diseases. Liver transplantation in patients with cirrhosis in the outcome of NAFLD already occupies the 2 nd place after cirrhosis of the liver of the viral etiology. In patients with NAFLD, mortality in the 1st month after surgery is significantly higher than that for cirrhosis of another etiology, and there is an increased risk of other complications of liver transplantation, such as sepsis, graft rejection and cardiovascular pathology. According to modern views, NAFLD is a liver lesion, including fatty dystrophy, fatty dystrophy with inflammation and damage to hepatocytes (nonalcoholic / metabolic steatohepatitis) and fibrosis (with the possibility of cirrhosis). Specific diagnostic criteria and standard therapy NAFLD, in practice, does not exist, most likely the diagnosis of NAFLD - “diagnosis of exclusion”. Despite the high prevalence of NAFLD to date, the problem of its effective therapy has not been solved. None of the drugs used in the treatment of NAFLD has a high evidence base. Correction of body weight, changes in food addiction, physical activity are the most effective measures preventing the development of NAFLD and elimination of those negative metabolic processes that are predictors of development of severe forms of type 2 diabetes and high risks of cardiovascular diseases.

The article presents the literature data on the pathogenetic relationship between chronic dermatoses and diseases of the gastrointestinal tract. The high frequency of their combination, the mechanisms of formation of skin lesions in gastroenterological pathology are shown.

This article reviews a large number of papers on the problem of esophageal cancer (EC) incidence and presents current data on the disease epidemiology, including its main morphological types such as esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EA); incidence rates have shown a tendency to increase. Epigenetic factors are an important mechanism of carcinogenesis in EC. They do not affect the primary DNA structure but change activity of certain genes; one of important characteristics of epigenetic modifications is their persistence throughout cell division. Methylation of DNA cytosine bases at smoking and alcohol consumption is a common epigenetic mechanism in EC. Simultaneous tobacco use and alcohol consumption is reported to have a synergetic effect on carcinogenesis. The article presents modern data on genes often subjected to methylation in EC, especially RASSF1A, as well as on cyclin-dependent kinase inhibitor proteins responsible for important stages of cell division. An association between epigenetic methylation processes and the depth of tumor invasion and a tendency to metastasis is shown; epigenetic effects, in particular methylation processes, can be a marker of advanced esophageal cancer.

Luminescent and immunohistochemical changes in various morpho-functional areas of appendix vermiformis after bone marrow allotransplantation in animals are described. The obtained data indicate an increase in mast and granular luminescent cells with an increased content of biogenic amines in them in 40 minutes after transplantation. In the germinal centre of lymphoid nodes in appendix vermiformis cellular programmed differentiations with a high content of catecholamines and serotonin were defined. An active proliferative cellular activity both in lamina propria in crypts’ t. mucosa and in lymphoid nodules of appendix vermiformis was identified. In 2 hours in experimental animals the number of MCs and GLCs decreased both in t. mucosa and in t. s/mucosa appendix vermiformis and the content of catecholamines and serotonin in them decreased, which resulted in a decrease in proliferative cellular activity.

Purpose of the study. The study of clinical and pathophysiological constellations in patients with non-alcoholic fatty liver disease (NAFLD), comorbid with gastroesophageal reflux disease (GERD) to determine the target of therapeutic effects, taking into account the level of ammonium. Material and methods. The study included 47 patients with comorbid NAFLD and GERD in age from 37 to 67 years who were surveyed, bioimpedansmetry, esophagogastroduodenoscopy, ultrasonic examination of the gastrointestinal tract, biochemical studies for noninvasive calculation steatogepatosis and liver fibrosis, determination of ammonia in the blood microdiffusion method on PocketChemTMBA analyzer. Results. Comorbidity of NAFLD and GERD is associated with obesity, high polymorbidity, severe heartburn, acid regurgitation and positive correlation with gallstone disease and type 2 diabetes. To the predictors of steatohepatosis and early liver fibrosis, in addition to the generally accepted, you can add increased levels of visceral fat, alkaline phosphatase and creatinine. Conclusion. In order to reduce the risk of steatohepatosis and fibrosis, patients with NAFLD must control the daily sufficient amount of fruits and vegetables and minimize the consumption of sausages. The determination of ammonia concentration is promising for the detection of minimal hepatic encephalopathy. The methodology requires regulation of standard values and indications for monitoring for such risk factors as tobacco smoking and non-systematic use of alcoholic beverages.

The article presents an analysis of a clinical case of unrecognized gallstone disease with perforation of the gallbladder complicated by peritonitis in a patient of the old age group. Difficulties in diagnosing the underlying disease that led to the death of the patient were associated with pathological syndromes and features of their course characteristic of the elderly age group, as well as with the use of multidrug therapy, which masked the clinical picture of the disease. However, the crucial role in the adverse outcome of the disease in this patient was played by the errors in the provision of medical care, due to the underestimation of the results of diagnostic clinical, laboratory and instrumental tests, as well as the formal maintenance of medical records.

A clinical observation of the patient is presented, where the verification of ulcerative colitis was difficult due to the fact that intestinal symptoms required a differential diagnosis. A definition of the etiological identity of the skin rash was also required. The diagnosis was promoted by identification of gangrenous pyoderma. During the treatment of ulcerative colitis, the patient developed a proximal myopathy of the lower limbs, which, after conducting a diagnostic search, was regarded as a side effect of sulfasalazine, and the abolition of the drug led to the complete elimination of muscle damage.