Allergic reactions to foods can occur in any one of four major types of reactions [P. Gell, R. Coombs].The most typical combination of several types of reactions, one patient. Food antigens can modify cellular and humoral immune response by influencing the emergence of new and for chronic diseases. Objective: to study the spectrum of food sensitization in patients with diseases of the digestive system (DDS) to adjust their dietary therapy. The laboratory examination and treatment of 210 patient: 185 patients with DDS (gastroesophageal reflux disease, chronic gastroduodenitis, biliary dyskinesia, irritable bowel syndrome, IBD (ulcerative colitis(UC) and Crohn’s disease) and 25 healthy adults. To identify the reactions I, III and IY-type food allergens used a range of methods - ELISA (IgE-specific) and the reaction of inhibition of migration of leukocytes (RIML), modification NN Matyshevoy and LS Kositsky. Products that implement positive reactions, patients were excluded from the diet. 100% of patients identified specific reactions I, III and IY-type food allergy, the number of responses increased in proportion to the severity of the disease, most patients with IBD, the smallest - in healthy individuals. Exclusion from the diet of the identified potential allergens contributed to a significant clinical improvement, and in patients with UC onset of persistent clinical and endoscopic remission. Conclusion: to determine the most complete range of food sensitization in patients with DDS is necessary to use methods for assessing cellular and humoral sensitization types together. Diet exclusion of food allergens from the diet of patients with DDS leads to persistent clinical improvement and long-term maintenance of remission, especially in patients with UC.

Currently an increasing attention in rheumatology is paid to the identification of diseases at the earliest possible time, the so-called preclinical stages, which may contribute to a more favorable response to therapy and improved prognosis. The etiology of rheumatoid arthritis (RA) is still unknown. One of the possible factors of its development can be periodontal disease (PD) associated with oral dysbiosis. This review examines the relationship between the development of periodontitis and RA, discusses the involvement of the oral microbiome in the common mechanisms of the pathogenesis of PD and RA. Identified cell-mediated mechanisms that cause chronic inflammation and lead to bone resorption and destruction of the joints. The role of PD and P.gingivalis in the process of disruption of autoantigens citrullination is described.

Over the years, Barrett’s esophagus doesn`t lose its relevance to clinicians and researchers. The problem is acute as the disease is considered as a precancerous condition associated with the risk of adenocarcinoma in the lower third of the esophagus. Knowledge of non-esophageal clinical “masks” of gastroesophageal reflux disease (GERD) and timely diagnosis is extremely relevant for Barrett’s esophagus patients with a high risk of its development as well as complex treatment and dynamic observation of these patients. The article describes a clinical case of a 10-year unsuccessful case of a 36-years old man with GERD complicated by Barrett’s esophagus. Different specialists who observed the patient didn`t evaluate patient’s cardiac and otorhinolaryngological complaints as extra-esophageal “masks” of GERD, although there was a bright clinical picture of the disease, repeated instrumental examination, including esophagogastroduodenoscopy. courses of antioxidants, metabolic drugs, vegetocorrectors, local treatment of laryngitis, intraperitoneal instillations were unjustifiably prescribed. This practice underlines the timeless relevance of assessing anamnestic data, clarifying the presence of comorbid conditions to ensure an adequate personalized drug approach.

Aim. To assess significance of serum fibronectin and new approaches of computed tomography for pancreatic cancer and chronic pancreatitis differential diagnosis. Material and methods. Data of 49 patients with pancreatic lesions who underwent multislice computed tomography (MSCT) with intravenous contrast enhancement and serum fibronectin (FN) evaluation in 2018 were analyzed. There were 29 (59.2%) males and 20 (40.8%) female patients, mean age 51.9+13.9 (30-82). All patients divided in 3 groups: 1 - with pancreatic ductal adenocarcinoma (PDAC) - 17 p., 34.6%, 2 - chronic pancreatitis with previous pancreonecrosis (CPPN) - 16 p., 32.7%, 3 - chronic calcifying pancreatitis (CCP) - 16 p., 32.7%. All cases of PDAC were pathologically proved. We calculated median of enhancement gradient between region of interest and intact parenchyma (М_grad) based on MSCT results. Pearson’s correlation coefficient (r_p) was calculated for correlation assessment. Results. We assessed mean М_grad and mean serum FN rate in all three groups: PDAC - 28.1+2.6, р=0.0001, CPPN - 14.9+2.4, р=0.07, CCP - 13.3+0.7, р = 0.08 for М_grad, and 239.8+30.1, p=0.8, 243.5+33.8, p=0.7, 227.2+34.3, p=0.8 for serum FN rate, respectively. There was statistically significant strong correlation of М_grad in patients with PDAC (r_p=0.63, p=0.0001). We revealed cut-off point of М_grad value for PDAC that was 20 (p=0.001). There were no statistically significant correlations of serum FN rate in all groups (PDAC r_p=0.04, p=0.8; CPPN r_p=0.06, p=0.7; CCP r_p= -0.03, p=0.8). Conclusion. Mgrad evaluation based on MSCT is an informative marker for differential diagnosis between PDAC and chronic pancreatitis, high rates of М_grad positively correlate with PDAC existence. There was no correlation between serum FN rate and existence of PDAC, CPPN or CCP revealed.

Purpose of the study. To assess the state of the acid-producing function of the stomach in patients with varying degrees of functional insufficiency of the pancreas in the presence of Helicobacter pylori-associated gastritis. Materials and methods: 77 patients with chronic pancreatitis and concomitant Helicobacter pylori-associated gastritis were examined. The control group consisted of 56 patients with chronic pancreatitis without Helicobacter pylori-associated gastritis. Diagnosis of chronic pancreatitis was based on anamnestic, clinical data, instrumental studies (MSCT). The exocrine function of the pancreas was assessed by the content of pancreatic elastase in the feces. Diagnosis of H. pylori infection was carried out by the morphological method, urease respiratory test 13C, by immunoblotting. All patients underwent endoscopic examination of the stomach. In some patients, the level of gastrin 17 in the blood was determined. Statistical processing was carried out using SPSS Statistic 17.0 application software packages. Results. Pain syndrome was significantly more frequently observed in H.pylori- positive patients with chronic pancreatitis (93.2%, p = 0.045), while more often epigastric pain was observed (30.7% versus 12.5% of the control group, p = 0.48). In patients with chronic pancreatitis with an intense pain syndrome, in 66.7% of cases, the combination of proteins p26, p19 and p17 with CagA H.pylori was detected. In patients with chronic pancreatitis with concomitant Helicobacter pylori-associated gastritis, the level of gastrin was outside the normal range in 57.1% of cases (control group - 18.2%, p = 0.048) and was below normal in 42.9% of patients. The average value of gastrin in patients of the studied group was lower (3.140 ± 0.802 pmol / l) than in the control group (4.833 ± 1.594 pmol / l, p = 0.045). In patients with exocrine pancreatic insufficiency, the level of gastrin was reduced / increased in 75% of cases (p = 0.014). In patients with severe chronic pancreatitis, gastrin levels were significantly more often not normal (p = 0.041). CagA VacA - positive strains were statistically significantly more frequently detected in patients with chronic alcoholic pancreatitis and correlated with the severity of the disease. Conclusion. Helicobacter pylori infection contributes to a variety of clinical manifestations in patients with chronic pancreatitis. Helicobacter pylori - a positive status in patients with chronic pancreatitis is associated with more intense gastric acid-induced acid production in the stomach. The severity of morphological changes in chronic pancreatitis, as well as exocrine pancreatic insufficiency correlates with CagA- positive strains of Helicobacter pylori and fluctuations in gastrin levels in the digestive period.

Aim - to study the morphological features of the pancreas in clinical and morphological forms of chronic pancreatitis. Materials and methods. Histological preparations of the pancreas were studied in 60 patients with various forms of chronic pancreatitis. Results. Scant inflammatory infiltration of the pancreatic parenchyma (represented by lymphocytes, plasma cells), atrophic and fibrotic changes, which were characterized by unidirection, were detected. The fibrosis was of two kinds - friable and dense fibrosis, that qualitative state of the connecting tissue at the different forms of chronic pancreatitis. Friable fibrosis has been revealed at patients for mild and moderate chronic pancreatitis and dense - for severe and complete fibrosis. Conclusion The morphological picture of fibrous changes of the pancreas does not depend on the form of the disease and is characterized by a mild degree of fibrosis in 6.6% of patients, moderate - in 20.0%, severe - 16.7%, full fibrosis - 56.7%.

Aim: we aimed to study the effect of the mixture of three broad-spectrum antimicrobials (amoxicillin, metronidazole, clarithromycin, AMC) on monosaccharide absorption in the isolated intestinal loop and on myocardial tolerance to ischemia-reperfusion injury (IRI). Materials and Methods: experiments were performed on adult male Wistar rats housed in conventional area. Glucose and fructose absorption was studied in the model of in situ isolated intestinal loop according to Thiry-Vella after administration of AMC into the intestinal lumen. Isolated heart studies were done using modified Landendorff setup after oral treatment of the animals with AMC. Results: AMC significantly inhibited glucose absorption in the isolated intestinal loop, mainly due to pronounced reduction of active, sodium-dependent glucose cotransporter 1-mediated transport. AMC also caused inhibition of fructose absorption. The animals treated with AMC showed decreased systolic pressure in the left ventricle up to 20% upon reperfusion, decreased pressure in the left ventricle during global ischemia (by 33-500%), increased coronary flow by 28-82%, and also insignificant trend to greater infarct size. Conclusion: AMC-induced inhibition of glucose and fructose absorption provides evidence for the existence of rapid changes in nutrient absorption, mainly due to inhibition of active transport. AMC treatment also resulted in deterioration of morphological and functional parameters of the isolated heart. The data obtained warrant further studies on the antibiotic-induced associated changes in enterocytes and cardiomyocytes.

The purpose of this work was to evaluate the bactericidal effect of helium plasma on Helicobacter pylori in vitro. Helium plasma was generated using a high-voltage generator with a gas flow rate of 2.5 l/min; the distance to the sample surface was 10 mm. A spectral assessment of the plasma torch was carried out, and the rate of accumulation of nitric oxide in the irradiated medium was also determined. To study the bactericidal effect of NTP, H. pylori was seeded onto Petri dishes and plasma treated for 15, 30, 60, 120, 300 s. After incubation, the diameter of the growth inhibition zones was measured. It was established that cold plasma had a bactericidal effect on H. pylori in vitro, this effect was dose-dependent and could be due to the complex effect of ultraviolet radiation, the formation of active nitrogen and oxygen particles and charged particles. Thus, cold plasma can be used for decontamination of biomedical equipment (gastroscopes) and, when modifying a source, can be a promising method for the eradication of H. pylori in vivo, including antibiotic-resistant strains.

Antiplatelet drugs are widely used for the prevention and treatment of vascular diseases of the heart and brain. The most popular drugs are non-steroidal anti-inflammatory drugs, the first place among which still belongs to acetylsalicylic acid (aspirin) and its derivatives. However, along with high clinical efficacy according to target parameters, these drugs have side effects that lead to damage to the mucous membrane of the gastrointestinal tract (GI). In order to eliminate the effects of damage to the gastrointestinal tract with the use of antiplatelet drugs, based on salicylic acid, using a natural dipeptide carnosine, a new compound was synthesized - salicyl-carnosine, which has an antiplatelet effect. A comparative study on carnosine, acetylsalicylic acid and salicyl-carnosine for the healing of ulcerative defect was carried out on the model of acetate gastric ulcer by Okabe. It was shown that salicyl-carnosine was more effective than carnosine both at the stage of ulcer formation (1-5 s) and at the stage of healing (5-10 s). Acetylsalicylic acid in the used model of gastric ulcer not only did not prevent the development of gastric ulcer, but also complicated the healing processes. The results indicate the possible prospects for the use of salicyl-carnosine as an antiplatelet drug in vascular pathologies (cardiac, Central nervous system, etc.), to avoid side effects associated with damage to the gastrointestinal tract, inherent in aspirin and other NSAIDs. Non-steroidal anti-inflammatory drugs

Aim.To study the state of oxidative phosphorylation in a model of chronic enteral insufficiency in the growing rats and to assess the effectiveness of ecdystene in their correction. Materials and methods. Laboratory white mongrel rats were used in the experiments. The animals were divided into 3 groups. 1 group - healthy animals (control). Group 2 - animals on a diet poor in protein (chronic malnutrition), group 3 - animals that received as a corrective drug ecdysthene. Mitochondria were isolated from the liver of 40-day-old rats by differential centrifugation. The parameters of oxidative phosphorylation, respiration rate of isolated mitochondria in the metabolic state V4 and V3, as well as the values of respiratory control and ADP / O were determined. Results. Treatment of rats with protein deficiency for 10 days with the drug ecdystene resulted in a significant increase in the body weight of the rats - an average of 45.5% - and by the 10th day of treatment this value was 71% of the values in the control group (P <0.01). In the group of animals that were on a diet poor in proteins, the oxidative phosphorylation parameters were significantly reduced. The rate of oxygen consumption by the mitochondrial suspension in the functional state of V3 and V4 in sick animals was almost half that in control animals. Respiratory control, in the group of sick animals was reduced by 20%. The ratio of ADP / O was also reduced and was 2.5 vs 2.8 in the control group. When using a corrective ecdystene preparation as a quality, the V3 state was 93.72, V4 was 15.62, and Vdnf was 109.34 ng at O / min / mg protein (P <0.001). The value of the respiratory control was also close to the control and was 6, and the ratio of ADP / O even slightly exceeded the control value and was 3.03 (P <0.05). Сonclusion. We detected a pronounced disconnection of the respiratory chain in the mitochondrial suspension when the animals were kept on a diet poor in proteins and also had a bright corrective effect in the ecdystene. The therapeutic effect of ecdysten revealed its pronounced ability to correct manifestations of chronic enteric insufficiency in growing rats.

Radiofrequency ablation can achieve a significant reduction of simple liver cysts. The aim of the study was to investigate the effects of RFA in various regimes on the wall of the liver cyst and adjacent tissue, and to define optimal exposure parameters. Materials and methods. An experimental study was performed by constructing of imitational models of a simple liver cyst (group № 1), a biliary cyst (group № 2), and a cyst with high electrical conductivity content (10% NaCl solution) -group № 3. The models were exposed to RFA in the range of temperatures from 50 to 92 °C with duration from 1 to 5 minutes. Then, the postablation changes of the preparations were assessed using histological examination. Results. In all groups, when heated, there was a lag of the temperature of the cystic medium compared with the temperature of the electrode. For models of group № 1, № 2, and № 3, the difference was 19.6 °C, 8.75 °C, and 3.8 °C, respectively. Coagulation necrosis was found in all preparations and was most pronounced in the surface layers of the tissue contacted with the heated medium. The absence of destruction of the adjacent liver tissue in group № 1 was found for RFA in regimes using 61-63 °C for 2 minutes; in group 2 - using 65-75 °C for 3 minutes; in group 3 - using 85 °C (for 2 minutes) or 53-55 °C (for 5 minutes). Conclusion. The destruction of all epithelial cells is achievable with RFA; however, the thermal range between total ablation and the thermal injury of adjacent healthy tissue is narrow. The introduction of 10% NaCl solution can increase the area of necrosis and makes possibility to control the temperature of the cyst. Achieving mild ablation with shallow penetration of necrosis is influenced by the volume and electrical conductivity of the cystic content, adequate control of the temperature in the cystic cavity, and dosed use of RFA power and exposure time.

Non-alcoholic fatty liver disease (NAFLD), according to forecasts of the World Health Organization, by 2020 it will take the 1st place among all liver diseases., Liver transplantation in patients with cirrhosis in the outcome of NAFLD already takes 2nd place after liver cirrhosis of viral etiology. In patients with NAFLD, mortality in the 1st month after surgery significantly exceeds this indicator in case of liver cirrhosis of a different etiology, and there is an increased risk of other complications of liver transplantation, such as sepsis, transplant rejection and cardiovascular pathology. Specific diagnostic criteria and standard therapy of 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.

Medicinal liver damage (LPP) is one of the main undesirable effects of pharmacotherapy. The emergence of new drugs on the pharmaceutical market, an increase in the number of LPP caused by herbal preparations and biologically active additives, as well as the expansion of the market for immunobiological drugs, make drugs the most important etiological factors for liver damage. For timely diagnosis of LPP, it is necessary to take into account the totality of risk factors, among which, in recent years, significant attention has been paid to biomarkers. The choice of tactics for the management of a patient with LPP is determined by the nature and severity of the disease, the characteristics of the use of a potentially hepatotoxic drug and the individual characteristics of the patient. The appointment of drugs with high hepatotoxic potential sometimes requires a preventive prescription of pathogenetic agents. When using drugs with low hepatotoxic potential, individual monitoring of biochemical parameters is recommended.

The modern literary review the devoted question of sharp cholecystitis and mechanical jaundice is presented in article, it is established that now weight of a condition of the patient with sharp cholecystitis and mechanical jaundice is still estimated on kliniko-biochemical weight of an ikterus and the progressing liver failure. Other syndromes are considered insufficiently. It is especially important to reflect a syndrome of the system inflammatory answer (SIRS) which reflects weight of the developing inflammatory process in a biliarny system.

Purpose. To analysis of Russian and foreign literature about epidemiology, etiology and pathogenesis of chronic viral hepatitis B and C, including the factors that are likely to have effect on the progression of liver fibrosis, such as, condition of protein metabolism. Materials and methods. The literature data about this subject in the volume 58 sources of literature, 22 - Russian works and foreign - 36 was studied. Results and discussion. The most frequent factors that are likely to have effect on the progression of liver fibrosis, such as, etiology of chronic viral hepatitis B and C, combined viral pathology, features of the macrooganism, duration of infection, effect of alcohol and smoking were detected. The questions of the condition protein metabolism of chronic viral hepatitis B and C has been considered. Conclusion. The obtained data is different, because impact of the condition protein metabolism and other factors are important for learning and use in clinical practice with this pathology.

Stomach metastases from different types of malignant tumors are extremely rare. Common sources of secondary gastric involvement are breast and lung cancer, neoplasms of unknown primary site, malignant melanoma (2). Ovarian carcinomas average 0,013-1,6% of all gastric metastases (1). Ulceration is one of the important features of metastatic stomach lesions (3). We herein present the case of ovarian carcinoma metastasis to the stomach 13 years after panhysterectomy. Secondary gastric involvement was diagnosed during esophagogastroduodenoscopy and biopsy of posterior gastric wall infiltrated mucosa. The result was additionally confirmed immunohistochemically while analyzing biopsy specimens of visceral peritoneum. In conclusion, although gastric metastases from ovarian carcinoma is exceptionally rare, clinicians should nevertheless be aware that in patient with gastric tumor and a history of ovarian cancer, gastric lesions may be metastases from the ovarian cancer.

Wilson-Konovalov disease (WKD) is one of the most difficult to diagnose liver disease due to the long latent course in the early stages and the large polymorphism of symptoms in the advanced stage of the disease. The main signs of WKD are liver diseases, neuropsychiatric disorders, Kayser-Fleischer ring, acute episodes of hemolysis, often in combination with acute liver failure. The diagnosis is especially difficult in children and adults with active forms of liver disease. Timely diagnosis is an important medical and social problem, since early pathogenetic therapy improves the quality of life and social adaptation of patients. The article deals with the pathogenesis of BVK, the clinical and morphological features of the variants of the course of the disease: fulminant hepatic failure, chronic hepatitis and latent variant with the development of liver cirrhosis. An abdominal form with early development of edema and ascitic syndrome on the background of a violation of the synthetic function of the liver was identified. A detailed description of the role of a violation of copper metabolism To overcome the diagnostic problem, several clinical and laboratory signs are evaluated, as well as genetic testing in a point system; this assessment allows you to calculate the likely and very likely diagnosis. The tactics of drug therapy and the possibility of optimizing it are considered, the advantage of liver transplantation is evaluated. Two clinical observations of Wilson-Konovalov’s disease are presented, demonstrating the capabilities of various diagnostic methods (1st observation) and features of the course of the hepatic form of the disease (2nd observation).