The aim of the publication was to present the results of the Expert workshop on the high resolution esophageal manometry in Russia. It represents the agreement on the use of the language-specific terminology of the method, terms of the current classification of esophageal motility disorders, and uniformed protocol of the conclusion reached with the use of the Delphi process.

Aim. To make a review of the usefulness of the high resolution esophageal manometry (HRM) in the diagnosis of gastroesophageal reflux disease in accordance with the international consensus. Key points. Gastroesophageal reflux disease (GERD) is a multifactorial disease that may be caused by anatomical defects (hiatal hernia), impaired esophageal motility (ineffective esophageal motility, fragmented peristalsis, lack of contractility), and abnormal function of the lower esophageal sphincter (LES) (decrease of the LES basal and increase in the number of transient LES relaxation), and stomach (delayed gastric emptying). The role of HRM in the diagnosis of GERD had widely been studied and the data were summarized in several consensus documents. They cover wide spectrum of the matters including indications for the methods in functional esophageal disorders (pH-impedance and esophageal manometry), the algorithm of patients’ examination, data interpretation and their implication to clinical practice. Conclusion. High-resolution esophageal manometry plays crucial role in the evaluation of esophageal motility. In GERD, this method allows to reveal predisposing factors and choose optimal treatment.

The aim. To investigate esophageal motility in patients with GERD. Materials and methods. One hundred twenty-five GERD patients were examined. Esophageal motility was studied with the use of high resolution water-perfused catheter (MMS; Solar GI, Netherlands). Results. Normal esophageal motility was found in 70 patients, in 47 patients ineffective esophageal motility (IEM) was found. In 4 cases was revealed absent contractility, in 3 cases distal esophageal spasm (DES), and 1 patient suffered from achalasia type III. Among total group 13 patients had histologically confirmed Barrett esophagus, in 5 of them normal esophageal motility was found and 8 had signs of ineffective motility. Mean EGJ-CI in patients with GERD was 7.17 mmHg x cm (n=125). Conclusion. Patients with GERD have different patterns of esophageal motility. We should consider these differences to better understand the treatment options and prognosis of the disease.

Aim: To investigate the prevalence of gastrointestinal manifestations at the early stages of Parkinson’s disease (PD), and to evaluate the effect of their dietary correction. Materials and methods: One hundred forty three patients with initial manifestations of PD stages 1-2 (according to the Hoehn and Yahr scale) were examined. The group of patients with initial manifestations of the disease received the dietary correction along with the dopaminergic therapy (dopaminergic agonists) for the identification of the possibility of the dietary correction Results: Gastrointestinal symptoms in patients with initial manifestations of PD occurred were identified in 85,1% cases of PD stage I and in 82,5% cases of PD stage II (according to the Hoehn and Yahr scale). The most frequent of them were constipation and feeling of incomplete emptying, which were present 16.4±3.9 years before the onset of motor symptoms of PD. Unlike the control group, the group of patients that received dopaminergic therapy (dopaminergic agonists) and dietary correction revealed the decrease of severity of gastrointestinal dysfunction, such as constipation and anorectal dysfunction. The effect remained during the observation period (24 months). Conclusions: administration of the pharmacotherapy (ropinirole) combined with dietary correction decreased the severity of gastrointestinal dysfunction in patients with initial manifestations of PD

The aim was to assess notable diet features of patients with different types of SIBO in order to develop prevention of SIBO relapse. Materials and methods: There are analysis of three-day food diary, collected from 889 patients, undergoing CH4/H2 lactulose breath test. Results: It was found that patients with hyperproduction of CH4 demonstrated highest consumption of fruit (0,63 ± 0,7 compared with the normal levels of a healthy diet pyramid vs 0,37 ± 0,41 in H2 group, 0,39 ± 0,45, in H₂+CH₄ group) and protein dishes (1,61 ± 0,88 vs 1,25 ± 0,91 in H₂+CH₄ group, 1,37±0,84 in H2 group). Patients with isolated H2-hyperproduction consume more fat than other groups (1,20 ± 0,35 vs 1,14 ± 0,28 in group without gas overproduction, 1,15 ± 0,31 in H₂+CH₄ group). SIBO patients differ from group without gas overproduction lower red meat consumption (0,53 ± 0,66 in group without gas overproduction vs 0,31 ± 0,53 in H2 group; vs 0,37 ± 0,50 in CH4 group) and patients with hyperproduction of CH4 demonstrated highest consumption of fish (0,49 ± 0,73 vs 0,21 ± 0,41 in H2 group; vs 0,24 ± 0,77 in H₂+CH₄ group), patients with isolated H2-hyperproduction to consume more poultry (0,57 ± 0,64 vs 0,37 ± 0,50 in CH4 group; vs 0,45±0,52 in H₂+CH₄ group; vs 0,37±0,45 in group without gas overproduction). SIBO patients consumed less fiber than patients with no signs of SIBO (21,4 g/d ± 10,0 vs 19,0±9,5 in H2 SIBO group and 19,1±8,9 in H₂+CH₄ group). Conclusion: there are specific consumption patterns related to the type of the SIBO, which can be used for the planning of dietetic interventions in patients for prevention of SIBO recurrence.

Aim of investigation. To study the features of gastroesophageal reflux disease (GERD) in patients with irritable bowel syndrome (IBS) in the light of the Rome IV criteria. Materials and methods. 102 IBS patients (55 females, mean age 40,8, diagnosis of IBS was established according to Rome III criteria) with esophageal symptoms were examined in gastroenterology department. Esophageal symptoms were presented with heartburn, belching, globus sensation and noncardiac chest pain. All patients underwent endoscopy, with biopsies if required, X-ray examination of upper gastrointestinal tract; 24-hour multichannel pH-impedance monitoring;¹³C-urea breath test. Evaluation of esophageal symptoms was carried out on the basis of Rome IV criteria. Results. 21 (20,6%) individuals had esophagitis (ERD). According to 24-hour pH-monitoring data, 7 of them had normal acid exposure time (AET) off proton pump inhibitors (PPIs) therapy. Using symptom association probability (SAP) for heartburn, overlap between GERD and reflux hypersensitivity (RH) was revealed in 3 patients with SAP+, and overlap between GERD and functional heartburn (FH) was revealed in 4 patients with SAP-. 27 (26,5%) individuals had nonerosive reflux disease (NERD) (19 with abnormal AET and 8 with normal AET, but SAP+ for globus and chest pain). Esophageal symptoms such as globus sensation and chest pain were only manifestation of NERD in 33,3% IBS patients. Conclusion. The course of GERD in IBS patients differs in a number of features. According to 24-h pH-impedance measurement data, some patients have the overlap between erosive reflux disease and functional esophageal disorders such as functional heartburn and reflux hypersensitivity. Esophageal symptoms such as globus sensation and chest pain can be only manifestation of NERD in IBS patients.

A study of the state of the mucosa of the upper gastrointestinal tract (GIT) in patient with portal hypertension (PH) is necessary to stratify the risk of bleeding and correct of treatment. The purpose of the study was to study the state and dynamics of changes in mucosa of upper gastrointestinal tract in patient with PH. Materials and methods: Esophagogastroduodenoscopy (EGD) and sessions of endoscopic ligation (EL) were performed in 190 patients with PG. The cause of PG was liver cirrhosis (LC) in 170 cases and portal vein thrombosis (PVT) in 20 cases. Results: Becides varices, portal hypertensive gastropathy and GAVE -syndrome, chronic gastritis, ulcerous lesions, polyps, erosive esophagitis, tumors were found in 48%, 34,7%, 10,5%, 13,4%, 2,1% accordingly. 130 patients bled previously, and 8.6% of them had not variceal cause of bleeding. Conclusions: Pathological changes of mucosa of upper gastrointestinal tract in patients with PG are different and can lead to a bleeding. There are not significant difference in pathology between different types of portal block. Eradication of varices leads to an increase in pathology of the mucosa and PHG. The level of blood pressure in varices correlates with the severity of PHG.

Aim. To evaluate the number and structure of complications associated with peroral endoscopic myotomy procedure. Materials and methods. Retrospective analysis of 3-year experience of peroral endoscopic myotomy (POEM) for achalasia in one center was performed. The analysis included data of 120 cases. Diagnosis of achalasia was established with the use of water-perfused high-resolution manometer (MMS; Solar GI, Netherlands). Descriptive statistics was used to perform the analysis. Results. Treatment was successful in all 120 cases, mean Eckardt score before and after POEM was 6.2±1.4 and 1.4±0.9, accordingly. The following complications occurred: perforation of mucosa (n=6), suture failure after endoscopic clips application (n=4), submucosal hematoma (n=1). In one case of suture failure it caused mediastinitis, that was managed by toracotomy and drainage of the mediastinum. Other complications were managed by endoscopic methods. Conclusion. POEM is an effective method for achalasia treatment. However, during the operation and in early postoperative period may occur complications that can be treated conservatively or by using minimally invasive procedures.

Aim: assessment of morphological and functional parameters of the isolated heart subjected to global ischemia-reperfusion in conventional and SPF rats with antibiotic-induced intestinal dysbiosis (AID). Materials and methods: experiments were performed on male Wistar rats belonging to conventional and SPF colonies. AID was induced by intragastric administration of clarithromycin and metronidazole during 3 days. Results: SPF animals demonstrated more severe disorders in the evacuatory function of the gastrointestinal tract. In addition, important differences in baseline myocardial function and myocardial tolerance to ischemia-reperfusion were noted between SPF and conventional rats. Conclusion: conventional animals are characterized by increased myocardial tolerance to ischemia-reperfusion injury versus SPF animals, which might be attributed to the presence of chronic low-grade systemic inflammatory response causing activation of cardioprotective signaling in conventional rodents.

The irritable bowel syndrome (IBS) is the most common functional disorder of gastrointestinal tract which can lead to reduced quality of life in a considerable proportion of young working-age population. Global prevalence of IBS is 10-20%, and clinical particulars of the disease depend on the region of habitation and race. Currently, the IBS is considered as a polyetiologic condition with underlying complex multicomponent pathophysiological mechanisms. Despite there are international standards of IBS diagnosis and treatment, this disorder remains one of the most complex gastroenterology diagnoses which imperfection is evidenced by the fact that diagnostic criteria for IBS have been revised three times. Besides, the similarity of IBS clinical symptoms with those of other gastroenterology diseases does not always enable to avoid the diagnostic errors. Medication treatment of IBS includes the use of drugs relieving pain syndrome and normalizing intestinal motor function and frequency of bowel movements. However, as a rule symptomatic therapy is not sufficiently effective and seldom results in prolonged remission leaving both doctor and patient dissatisfied with treatment. In Russia no epidemiologic data on the IBS are available. Also, there are diagnostic and therapeutic difficulties with the IBS partly associated with limited access to IBS medicinal products not authorized in the Russian Federation. Therefore, currently in Russia we have the prerequisites for conducting a multicenter study to build the IBS patient registry (ROMERUS) which would allow us to collect the up-to-date information on the particulars of the IBS clinical picture and to evaluate current therapy and the possibility of applying modern Rome criteria for IBS to the population of Russian patients.

The literature review represents current understanding of the spectrum of disorders, such as non-erosive reflux disease, hypersensitive esophagus and functional heartburn, occurring in the absence of endoscopic data for damage to the mucous membrane of the esophagus and the main symptom of which is heartburn. Particular attention is paid to the importance of differential diagnosis of these disorders, which is carried out using various diagnostic methods and is necessary to choose proper treatment. 24-hour esophageal pH-impedance is the “gold standard” for the diagnosis of patients with heartburn and normal endoscopic picture. The article presents data on the main parameters of daily monitoring, diagnostic criteria that allow to establish the correct diagnosis with high accuracy. The diagnostic capabilities of high-resolution esophageal manometry and therapeutic approaches used in patients with non-erosive reflux disease, hypersensitive esophagus and functional heartburn are also highlighted.

Aim. Study of the gastric acid features and acidity variants formation in patients with connective tissue dysplasia. Materials and methods: Gastric acidity variants had selected by Kohonen Self-Organizing Feature Maps. The 24-pH-metry was performed in patients with acid-dependent diseases and connective tissue dysplasia (n=42), patients acid-dependent diseases without connective tissue dysplasia (n=37), patients with connective tissue dysplasia without acid-dependent diseases (n=39), control group (n=36). Results. 1. The 5 gastric acidity variants had selected: hypoacidity, normally, hyperacidity, biliary and reflux. 2. It was detected that biliary and reflux variants diagnosed in patients with acid-dependent diseases and connective tissue dysplasia, hyperacidity variant diagnosed in patients with acid-dependent diseases without connective tissue dysplasia, hypoacidity variant diagnosed in patients with connective tissue dysplasia without acid-dependent diseases (n=39), normally variant diagnosed in control group patients (n=36). Conclusion. The acidity variants described in this study can be used in the work of general practitioner, therapist, gastroenterologist. The symptoms of the connective tissue dysplasia suggests a violation of the acidity so that can improve diagnostic of acid-related diseases in patients with connective tissue dysplasia.

The way to correct diagnosis in the Irritable bowel syndrome (IBS) in the most of cases is long and requires the number of laboratory and instrumental examinations. The diversity of the pathophysiology of IBS and heterogeneity within the syndrome nosology, including genetic predisposition, psychological aspects, visceral hypersensitivity, disorders of gastrointestinal motility, changes in the neuroendocrine system (brain-gut axis), low-grade inflammation, imbalance of microbiota, etc. dictate the necessity of developing a workable routine tests for rapid and efficient verification of IBS. Considering IBS as a diagnosis of exclusion, we are on a path that requires a clear pharmacological justification and, therefore, in most Western countries remains unacceptable. Therefore, the search for biomarkers of IBS is actual. Current publication describes current data available on this subject. Among them are the data of studies on the diagnostic value of markers of inflammation in patients with IBS, elevated levels of stress agents in biological environments, and the development of special diagnostic panels of biomarkers, allowing to exclude a wide range of the diseases that have similar presentations to IBS.

Aim. To present a literature review on pathogenesis, diagnosis and treatment of eosinophilic esophagitis (EE). Methods. Eosinophilic esophagitis is a chronic immune-mediated inflammatory disease of the esophagus. Diagnosis of EE is based on the characteristic clinical presentation of esophageal dysfunction (dysphagia) in combination with the detection of eosinophilic infiltration of the esophageal mucosa by histological examination. Basic therapy of eosinophilic esophagitis includes dietary restrictions, the use of proton pump inhibitors and topical corticosteroids.

The aim of the study was to evaluate the diagnostic value of the traditional indicators of acidity of daily pH - grams of the esophagus:% of the time from pH<4, the generalized DeMeester index and a new indicator of acidity of daily pH-grams of the esophagus (PCP). Material and methods. The results of the analysis of pH-grams of the stomach and esophagus of patients with pathological parameters of daily pH-metry (DeMeester index >14.72;% of time with pH<4 more than 4.5%) and with normal parameters of daily pH-metry (DeMeester index <14.72;% of time with pH<4 less than 4.5%). As PCU per diem rn-gram of the esophagus is proposed to use the sum of average daily concentrations of H+ ions (mmol/l) are abandoned in the esophagus of reflectata in the range of pH: 0,8-0,9; 1,0-1,9; 2,0-2,9 and 3.0 to 3.9 pH units and the time of exposure of reluctate on the mucosa of the esophagus within the specified ranges of pH of the esophagus. Results. The use of PEP (mmol/l x hour) can provide in the analysis of the per diem rn-grams a more accurate estimate of the influence of pathological and physiological GER in the esophagus due to the use in the calculation of the panel average of the concentrations of H+ ions in the range of pH: 0,8-0,9; 1,0-1,9; 2,0-2,9; 3,0-3,9 and the time of exposure of reluctate on the mucous membrane of the esophagus in each of the specified ranges of pH. Conclusion. The use of the generalized indicator DeMeester and% time with pH<4 may lead to erroneous assessment of the results of the analysis of diurnal pH-gram of the esophagus due to the fact that average daily concentration of H+ ions of reluctate and the exposure time of reluctate on the mucosa of the esophagus within the specified ranges of pH are not included in the definition of the generalized indicator DeMeester and% time with pH<4. It was found that the use of PCP in the analysis of daily pH-grams of the esophagus can provide a more accurate assessment of the impact of pathological and normal SER on the esophageal mucosa.

Recent years the number of eosinophilic esophagitis (EE) has increased. The disease is characterized by complex of clinical and histological features, the main of them are dysphagia and eosinophilic infiltration of esophageal mucosa. The etiology and pathogenesis of the disease are poorly studied. Allergy, nutritive factors and genetics are supposed to play leading role in the EE development. The incidence of EE varies worldwide. Only few cases of diagnosed EE were reported in Russia. Our experience includes five cases of EE within 3 years. The aim of the present article is to provide a literature review on the diagnosis and treatment of EE and to present a case of the diagnosed EE in a young man who complained on permanent dysphagia and who was previously treated for supposed gastroesophageal reflux disease and underwent fundoplication for this reason. We achieved complete resolution of the clinical manifestations of the disease.