Aims: 1. To evaluate the applicability of The Expert Assessment (EA) based on the algorithm developed by the authors in performance assessment of transient elastography by M-probe (TE-M) and XL-probe (TE-XL), Fibrotest® (FT), shear wave elastography (SWE) and liver biopsy (LB) in fibrosis staging in chronic hepatitis C (CHC) patients in an approach without a «gold» standard; 2. To evaluate the quality of the proposed model (EA efficacy) in comparison with the results of the Rasch Model (MR) being an extension of the Latent Variable Analysis.

Material and methods. Using the five studied diagnostic methods liver fibrosis staging was performed in chronic hepatitis C patients. Based on the algorithm developed EA was applied to each patient of the cohort and as a result fibrosis stage was established. That fibrosis stage considered a virtual reference. Sensitivity and specificity estimation as well as AUC calculation for studied methods was performed against the reference standard. The quality of the model (EA efficacy) estimated in the Rasch Model (MR) being an extension of the Latent Variable Analysis.

Results. 99 patients with reliable results of each of the five diagnostic methods were included into the study. The main characteristics of the cohort were: 59.6% individuals of male gender, average age of 37 years (21–63), median BMI of 25.8 kg / m2. As per the results of the EA in detecting of mild fibrosis (F1), the values of AUC, sensitivity and specificity were, respectively: 0,972; 94,3; 91,3 for TE-M; 0,964; 90,6; 91,3 for TE-XL; 0,806; 81,1; 73,9 for FT; 0,907; 88,7; 71,7 for SWE; 0,832; 92,5; 37,0 for LB. In detecting of moderate fibrosis (F2), the appropriate values were: 0,981; 93,8; 94,0 for TE-M; 0,967; 90,6; 97,0 for TE-XL; 0,873; 75,0; 80,6 for FT; 0,957; 84,4; 91,0 for SWE; 0,937; 90,6; 94,0 for LB. In detecting of significant fibrosis (F3), the corresponding values were: 0,994; 95,5; 96,1 for TE-M; 0,987; 90,9; 97,4 for TE-XL; 0,870; 63,6; 84,4 for FT; 0,961; 86,4; 97,4 for SWE; 0,990; 90,9; 98,7 for LB. In detecting cirrhosis (F4), the appropriate values were: 0,995; 92,3; 97,7 for TE-M; 0,994; 100,0; 98,8 for TE-XL; 0,874; 38,5; 93,0 for FT; 0,996; 92,3; 100,0 for SWE; 0,964; 69,2; 100,0 for LB. The EA was shown to have high degree of consistency (correlation coefficient = 0,923; p <0,05) when compared to the MR.

Conclusion. The EA was shown as a highly informative approach, applicable for performance assessment of the diagnostic methods for liver fibrosis staging without using LB as the “gold” standard. Non-invasive methods have demonstrated higher diagnostic characteristics with changing the standard from the traditional (LB) to virtual (EA). The high degree of consistency of the results of EA and MR confirm the high quality of the algorithm developed by the authors.

The aim to study the prevalence of abdominal pain syndrome in association with the nature of eating behavior and optimize health-saving technologies in young people.

Materials and methods: 3634 students of the Omsk State Medical University were surveyed for higher and secondary vocational education programs. We used the Russian-language version of the GSRS questionnaire and the questionnaire for assessing eating habits and preferences through online forms.

Results: abdominal pain is widespread among young people, has gender characteristics, is more common among students enrolled in higher education programs and is closely interconnected with the nature of nutrition and eating habits.

Non-alcoholic fatty liver disease (NAFLD) is the most common diseases all over the world, but there is no so much approved medicines treating liver fibrosis, which is a predictor of total and hepatic mortality in this group of patients. Innovation methods of treating the NAFLD/NASH include several ways: decrease fat accumulation in the liver; influence on oxidative stress; inflammation and apoptosis; impact on the intestinal microbiome and metabolic endotoxemia; antifibrotic drugs. A few drugs which have recommended to use in treating other diseases (for example GLP-1RA for diabetes), demonstrated the good effect of treating NAFLD in clinical trials. There is a big number of drugs from different pharmacological groups, which are on the second and third stage of international multicenter randomized clinical trials, reviewed in this article. Probably, versions of treating NAFLD, which will reduce the growth trend of NAFLD-associated diseases, will be proposed in the near future.

Аtrial fibrillation (AF) still occupies a special place in the structure of cardiovascular diseases, both due to its high prevalence, close association with socially significant diseases, and due to the high risks of death, stroke, and other thromboembolic complications. In turn, a patient with AF is always a comorbid patient, and among extracardiac pathology, the prevalence of diseases of the upper gastrointestinal tract, especially gastroesophageal reflux disease (GERD), pay attention. Recently more and more data have appeared that indicate the non-randomness of this combination. Many authors consider GERD as another independent risk factor for AF, while others propose to consider AF as an extra-esophageal manifestation of GERD, of course, in the absence of other cardiac risk factors. This review discusses the main pathophysiological mechanisms that determine the pathogenetic relationship of AF and GERD, known to date.

Аim. To study the clinical course of chronic gastritis with erosions in the elderly, depending on the presence of Helicobacter pylori in the gastric mucosa.

Materials and methods. 75 patients (50 women and 25 men) aged 60 to 82 years with chronic erosive gastritis were examined. Тhey complained of pain in the epigastric region, pain of other localization, heaviness in the epigastric region, nausea, heartburn, constipation, having comorbidities. Patients were divided into 4 groups depending on the degree of contamination of the gastric mucosa with Helicobacter pylori: 1 group consisted of 20 people, which on the background of erosive lesions of the coolant, HP was not detected; in group 2 (25 man), it was observed a light contamination with coolant; in group 3 (20 patients) and in group 4 (10 patients) — high — were detected in more than 50 microbial cells in field of view.

Result. The clinical picture of chronic erosive gastritis varies depending on the degree of contamination of the gastric mucosa Helicobacter pylori.

Conclusion. This microorganism aggravates the course of the disease. The course of chronic erosive gastritis is influenced by concomitant pathology.

The purpose of the study is to research the morbidity, mortality and case fatality rate y of chronic viral hepatitis B without and with a delta agent from 2010–2017. in Kyrgyzstan.

Materials and methods: analyzed state reporting forms No. 12 “Report on morbidity and preventive work (family medicine center, dispensary)” and “C51 — Distribution of deaths by sex, age groups and causes of death” from 2010–2017. Data processed by Microsoft Office Excel.

Results: In the country from 2010–2017 3292 cases of chronic viral hepatitis B were detected, 1738 patients of them verified an independent course (СhHBV), and 1,554 patients combined with a delta agent (СhHDV), while the incidence did not have a statistically significant difference (3.80/0000, 95% CI 2.4–4.0 and 3.40/0000, 95% CI 2.2–3.4, СhHBV and СhHDV, respectively) were 20 times lower compared to the HBV Carrier (60 40/0000). There was no statistically significant difference between the cumulative morbidity, mortality, case fatality rate and the proportion of deaths in СhHBV and СhHDV. The death rate СhHBV increased by 4.7 times (0.090/0000 and 0.410/0000), case fatality rate — by 11.8 times (1355.00/0000 and 16025.60/0000) amid a decrease the incidence is 2.5 times (6.40/0000 and 2.50/0000) from 2014 to 2017, respectively. At СhHDV, the mortality rate was also increased by 4.7 times (0.030/0000 and 0.160/0000), case fatality rate — by 32.3 times (793.70/0000 and 25641.80/0000) against the background of a decrease in incidence by 6.9 times (4.40/0000 and 0.60/0000) from 2014 to 2017, respectively.

Conclusion: In Kyrgyzstan from 2010–2017, relatively low detectability of chronic forms of HBV infection with and without delta agent was found, compared with the “HBV carrier”. There has been an increase in mortality and case fatality rate over the past 4 years, with a sharp rise in 2017 against the background of a downward trend in the incidence of СhHBV and СhHDV.

Aim. To study the influence of clinical and pathogenetic factors in patients with pancreatic cancer on the efficacy and safety of analgesic therapy of chronic pain syndrome.

Materials and methods. Clinical features of formation of chronic pain syndrome predetermining the efficacy and safety of analgesic therapy were studied in 82 patients with pancreatic cancer.

Results. The efficacy and safety of opioids in the comparison groups of morphine sulfate, fentanyl TTC and oxycodone / naloxone in patients with pancreatic cancer was shown.

Purpose of the study — study of the role of adrenoreceptors in the development of the stimulatory action of serotonin on the gastric motor activity.

Materials and methods. The experiments were performed on rats (27) of the Wistar line in the surgical stage of anesthesia. Electromyogram and hydrostatic pressure in the stomach cavity were recorded using a BioAmp ML132 amplifier (Adinstruments, Australia), an Maclab 8e analog-to-digital converter (Adinstruments, Australia), a Macintosh Performa 6400/180 computer, and Chart 4.2.3. program. Serotonin injected into the body to intact animals and against the background of separate and joint blockade of α- and β-adrenoreceptors.

The results of the study. In experiments on rats established that the preliminary simultaneous blockade of α- and β- adrenoreceptors leads to an increase in the stimulatory effect of the stomach with the introduction of serotonin by 58%, blockade of α-adrenoreceptors only — by 62%, β-adrenoreceptor blockade — by 89%. In intact animals, the stimulatory eff ect of serotonin is only + 26%. Simultaneous blockade of α- and β-adrenoreceptors and blockade of α-adrenoreceptors only (without serotonin administration) did not aff ect the gastric motor activity of intact animals. Blockade only β-adrenoreceptors will lead to an increase in gastric contractions by 34%.

Conclusion. Intact α- and β-adrenoreceptors inhibit the stimulatory eff ect of serotonin on gastric motor activity.

Non-alcoholic fatty liver disease (NAFLD) went beyond the competence of a gastroenterologist and acquired the character of a multidisciplinary problem. NAFLD requires the attention of many professionals. A characteristic feature of NAFLD is the variety of concomitant diseases and pathological conditions with common pathophysiological mechanisms. This review summarizes and presents the data available in the modern literature on the association of NAFLD with cardiovascular diseases, type 2 diabetes mellitus, hypothyroidism, polycystic ovary syndrome, chronic kidney disease, colorectal cancer, obstructive sleep apnea, osteoporosis, psoriasis.

Various lifestyle facts influence on microbial landscape of gut and change variety of microbiota with ulcerative colitis. New technologies of nucleotide sequencing, innovating statistics and bioinformatics grade into presentation about etiology and pathogenesis of some illness, for example ulcerative colitis. Current studies demonstrate that microbiome of gut acquaint with eukaryotic and prokaryotic viruses, which make virome of gut and be much part of microbial eco-system of intestinal tract. Number of bacteriophages and viruses escalete in the context of environmental stress so microbiome of the digestive tract disturbed. When we open specific microbiota, which associated with etiology of ulcerative colitis, we will create new treatment modality. Drive of this review is generalization of information about involvement with virome in ulcerative colitis becoming. For searching the literature were use systems PubMed and GoogleScholar with keywords: ulcerative colitis, gut virome, gut microbiome. Nowadays in the literature have limited but necessary information about this question. It requires accumulation scientifi c facts for integrated data.

Functional diseases of the digestive tract are frequent enough pathology, there is often a combination of different variants of functional disorders. Having common pathogenetic mechanisms of development, they require the search for complex therapeutic approaches that allow increasing the effectiveness of treatment and avoiding polypharmacy. The appointment of a combined herbal preparation Iberogast®, which has a scientifically proven multipurpose action, can simultaneously treat multiple disorders in patients with this pathology. Acting on different targets simultaneously, the components of the medicine have a synergistic effect, potentiating the actions of each other. The eff ectiveness and safety of Iberogast® in the treatment of functional diseases of the digestive tract is based on a large number of clinical studies and corresponds to the level of evidence 1A.

Here we present the results of a systematic analysis of publications on the clinical and the experimental pharmacology of human placental hydrolyzates (HPH). Searches were performed in the PUBMED, ELIBRARY and RSL databases. The results of the analyses of the peptide composition of HPH allowed us to formulate a number of previously unknown molecular mechanisms of their action. In the article we examine the effects of HPH in the therapy of liver diseases, atopic dermatitis, herpetic infection, viral hepatitis, joint diseases, iron overload, chronic fatigue syndrome and consider the general regenerative abilities of the HPH.

The problem of osteopenia and early osteoporosis in celiac disease has a great socio-economic importance and is an important area of medicine, primarily from the point of view of a diagnostic search and treatment. This article presents a clinical case of the atypical form of celiac disease with a lesion of skeletal system, osteopenia and secondary osteoporosis without symptoms of intestinal dyspepsia and obvious signs of malabsorption. The basic mechanisms for the development of osteopenic complications in celiac disease are described, and recommendations for follow-up and treatment of such patients are presented.

Objective of the Paper. To update the problems of eating disorders and psychosocial characteristics of patients with morbid obesity and associated gastrointestinal complications after bariatric intervention in the late postoperative period.

Key Points. Obesity is an urgent medical and social problem that increases the cost of medical care and worsens the quality of life of patients and requires lifelong treatment. In severe forms of obesity, surgical methods of treatment remain uncontested. The paper presents the literature data on the epidemiology of obesity, methods of treatment of morbid obesity, the risk of complications associated with bariatric surgery. We present our own observation of the clinical case, demonstrating the development of gastrointestinal complications that occurred in the patient in the late postoperative period, the main component of the development of which were non-compliance with the diet and diet after bariatric intervention and especially the psycho-social characteristics of the patient.

Conclusion. In the treatment of gastrointestinal complications of surgical treatment of morbid obesity, it is necessary to take into account the peculiarities of eating behavior, violation of dietary recommendations, diet, personal characteristics of patients. Patients who have undergone bariatric surgery are recommended to be under the supervision of a multidisciplinary team of specialists with experience in the treatment of medical, psychological and gastroenterological side eff ects of bariatric surgery for life.

In the clinic of various diseases (especially hematological) Budd-Chiari syndrome occupies a signifi cant place. The occurrence of blood fl ow disorders in the portal vein system can be a manifestation and the only symptom that manifests itself in a number of diseases. Given the rapid development of portal hypertension, this syndrome requires rapid diagnosis and timely initiated therapeutic measures, as well as comprehensive research to identify the etiological cause of Budd-Chiari syndrome.

Objectives: In this paper we demonstrated a clinical case of a young patient with Budd-Chiari syndrome, an unusual course and a combination of etiological factors.

Materials and methods. Data from the medical history of the patient who was on treatment at the surgical department of the City Multi-profile Hospital № 2, Military-medical Academy St. Petersburg were used as materials.

Result. The patient developed severe ascites 3 months after delivery, for which she was unsuccessfully examined by gynecologists to exclude ovarian tumors. Then, in the course of laboratory and instrumental studies, a final diagnosis was made of Budd-Chiari syndrom (thrombosis of the intrahepatic part of the inferior vena cava in the phase of partial recanalization against the background of chronic myeloproliferative disease and genetically determined thrombophilia.

Conclusion: As this case shows, in the development of non-cirrhotic portal hypertension, it is necessary to exclude hepatic thrombosis, in the detection of which it is recommended to conduct a comprehensive examination to exclude all causes of this thrombosis (genetic analysis for thrombophylia, antiphospholipid syndrome, Jak-2 v617f for exclude polycythemia and myelofi brosis, examination for cancer pathology). Manifestation and the only symptom of thrombophilia and idiopathic myelofi brosis may be acute Budd-Chiari syndrome, which requires complex medical and surgical treatment, further observation and especially treatment of causal diseases.

The article contains a literature review of clinical cases describing sessile serrated adenomas in the appendix from 1998 to 2018. Currently, it is still diffi cult to assess the true incidence of this pathology due to the fact that in most cases serrated adenomas are accidental fi ndings diagnosed after removing an inflamed appendix, since often, at small sizes, they do not cause clinical symptoms, do not bother patients and are inaccessible for endoscopic examination (if located behind its orifi ce). In addition, we present 2 clinical cases of sessile serrated adenoma of the appendix in patients who were admitted to the City Clinical Hospital No. 31 of the Moscow City Health Department in 2018 due to acute appendicitis, with a clinical and morphological characteristic, including a molecular genetics study.