65 patients with nonalcoholic fatty liver disease (NAFLD) were included in open-label observative prospective cohort study. Mean age was 54.8 ± 10.5 y. o. All patients were treated with metformin before and during the study. All patients were treated by GLP-1 receptor agonist dulaglutide subcutaneously weekly 26 weeks. Patients of group with type 2 diabetes were treated with dulaglutide 0.75 mg weekly 2 weeks, than 1.5 weekly 24 weeks. Patients of group without diabetes were treated by dulaglutide 0.75 mg weekly 4 weeks, than 1.5 weekly 22 weeks. Both groups of patients were demonstrated significant reduce of body weight, BMI, waist circumference, glucose, HbA1c, insulin resistance indexes, transaminases and gamma-glutamyltranspeptidase activity. Fatty liver index and liver stiff ness also decreased after treatment. We can conclude that dulaglutide treatment in NAFLD patients decreases body wieight, improves glucose and lipid metabolism and decreases inflammatory activity of steatohepatitis.

Introduction. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in curing rheumatologic diseases. To minimize the negative impact of NSAIDs on the gastrointestinal tract (GIT), it is essential to consider the patient’s risk factors and to conduct adequate gastroprotection. The main objective of the study was to assess the knowledge of primary care physicians about NSAIDs — associated gastrointestinal lesions, and to analyze the validity of choosing NSAIDs for patients with rheumatic diseases at the outpatient stage.

Materials and methods. 100 of outpatient physicians were surveyed. 100 patients with rheumatic diseases referred by general practitioners/physicians for a consultation with a rheumatologist were surveyed and their medical records were analyzed.

Results: 28% of rheumatological patients had a low level of risk of complications from the gastrointestinal tract, 53% — moderate level of risk, 19% — high level, but it is not reflected in the medical records. Physicians are not aware enough about the risk factors for NSAID-associated lesions of the gastrointestinal tract. Doctors find it difficult to identify groups of moderate and low risk. In 95% of cases gastroprotective proton pump inhibitorswas conducted regardless of current indications. Rebamipidewas not assigned in any case, although it was mentioned in the survey by 4% of the respondents. Most often, patients with rheumatological pathology are prescribednimesulide (37%), Ketorolac (26%). Coxibe, amtolmetinguacylwere not prescribed by general physicians to a single patient.

Conclusion: Physicians are not aware enough about the risk factors for NSAID-associated lesions of the gastrointestinal tract. NSAIDs are chosen without taking into account modern clinical recommendations.

In article the reasons of erosive and ulcer injuries of a stomach, a small intestine are described. Special attention is paid to intake of nonsteroid anti-inflammatory medicines, microcirculation violation. Side effects of nonsteroid anti-inflammatory medicines and inhibitors of a proton pomp are in detail considered. Groups of patients with erosive and ulcer injuries of a stomach, small intestine with dyspepsia to which purpose of inhibitors of a proton pomp is not shown are allocated. Rebamipide can be appointed for prevention and treatment of erosive and ulcer injuries of a stomach, a small intestine with dyspepsia, both with inhibitors of a proton pomp, and in the form of monotherapy for the purpose of a gastroprotection to patients when use of inhibitors of a proton pomp is inexpedient. The gastroprotection algorithm depending on a condition of a gastric acid secretion of patients is offered.

Purpose of the study. To evaluate the effectiveness of interactive teaching technologies and rebamipids in the complex therapy of erosive lesions of the gastroduodenal zone in young men.

Material and research methods. Two groups of patients were examined. The observation group included 36 recruits with HP-associated gastritis with erosion (HSE) and duodenitis with erosion (DSE). Comprehensive treatment was used as a treatment: standard first-line triple therapy with the inclusion of rebamipide 100 mg 3 times a day for 14 days and interactive therapeutic training. The comparison group consisted of 18 patients with HP-associated GSE and DsE who received standard triple eradication therapy also for 14 days. The average age of the examined patients in the observation group was 21.0 ± 0.7 years, the comparison group was 20.1 ± 0.7 years.

Results. The inclusion of Helicobacter pylori-associated gastritis and duodenitis with erosion of rebamipide and interactive learning technologies into the treatment regimen resulted in more effective relief of pain syndrome and dyspeptic manifestations in conscripts, restoration of mucus-forming and acid-producing functions of the stomach; to lower blood cortisol levels; reduce the degree of morphological activity of inflammation. There is a more effective eradication of Helicobacter pylori (91.7%) and epithelization of erosion (97.2%) in comparison with the standard scheme (88.9% and 94.4%, respectively). The use of interactive teaching technologies allowed to increase the level of medical activity and hygienic literacy (96.0% of recruits changed their diet, the nature of nutrition — 88.0%). The level of psycho-emotional status significantly improved after the treatment.

Conclusion Combined therapy using rebamipide and interactive therapeutic training is effective in erosive lesions of the gastroduodenal zone in young men and increases patient adherence to treatment and leads to stabilization of psycho- emotional status.

Objective. To prove that increased acid production in patients with gastric ulcer and duodenal ulcer is associated with the impact of the virulent strains of Helicobacter pylori but due not to the persistence of non-virulent strains.

Materials and methods. Patients with active gastroduodenal ulcer and patients with active chronic pancreatitis accompanied by the gastritis were compared in the respect of the level of pH in the antrum and corpus gastricum, as well as Helicobacter pylori virulence according to the presence cagA gene, especially in combination with vacA allele s1 / m1 (if any of the strains were found in gastric biopsy specimen).

Results. In patients with gastric ulcer the average values of pH were significantly lower, both in the antrum and corpus gastricum, than in patients with chronic pancreatitis accompanied by gastritis. Helicobacter pylori strains were found only in half of the patients, either in the gastric ulcer group or in the group of chronic pancreatitis accompanied by the gastritis. Significant difference was revealed after virulent genes identification: virulent strains prevailed in patients with gastric ulcer and in contrast to the prevalence of non-virulent strains in patients with chronic pancreatitis accompanied by the gastritis (Mann-Whitney test, p = 0.001). Since there is no available data that Helicobacter has an affinity for a highly acidic medium in comparison with moderately acidic medium, it is concluded that just primary colonization of the stomach with virulent strains results in hyperacidity (as the consequence of cytotoxicity) and that persistence of non-virulent strains hardly effects hyperacidity.

The aim of the study was to assess the influence of the types of attitudes to disease and depression on adherence to treatment of patients with duodenal ulcer.

Material and methods: Adherence to treatment was evaluated in 43 patients with sub- and decompensated scar-ulcerative stenosis aged from 21 to 74 years old (the average age being 47,5±26,5 years old), who underwent surgical removal of stenosis in the amount of duodenoplasty. The compliance of duodenal ulcer patients was assessed on the basis of the questionnaire developed by us. Assessment of the level of depression in patients was carried out using the Russian version of the Beck questionnaire (BDI). The method “type of attitude to disease” was used for psychological diagnosis of the types of attitude to the disease, the method being developed in the laboratory of clinical psychology of the Institute named after V. M. Bekhterev.

Results: all 43 patients according to the degree of adherence to treatment were divided into 2 groups: compliant (20 patients) and non-compliant (23 people); also the types of attitudes to the disease and the level of depression were assessed. It was found that adaptive types of attitude to the disease were found in 51.2% of patients. Adaptive responses to illness provide overall adaptive behavior due to the adequate assessment of patients’ condition, or due to the obsessive desire for active employment, which is typical for ergopathic type of attitude to the disease, or due to the negation of everything associated with the disease with anosognosic type of the relation to disease. In «non-compliant» patients, in comparison with “compliant” ones, both before and after the surgery, statistically significant differences in the severity of the diagnosed depressive disorder were revealed. For «non-compliant” patients significantly more often mild depression and moderate depression were revealed, requiring the reception of psychopharmacological drugs.

Purpose of the study. To evaluate the clinical and genetic picture of patients with duodenal ulcer.

Materials and research methods. A total of 139 patients with duodenal ulcer were examined. Of these, hereditary predisposition groups (n = 102) and without it (n = 129) were selected, which were examined according to standards, including the analysis of polymorphic variants of IL8 genes (–251T>A; rs4073), IL10 (–627С> A; rs1800872), TNFA (–308G> A; rs1800629), the gene for antagonist to the IL1 receptor (IL1RN (VNTR); rs71941886)) by PCR, investigated the psychological status.

Results. Patients with a genetic predisposition were found to have the first blood group, non-compliance with the diet, threshold resistance to stress, lack of family life, the presence of duodeno-gastric reflux, gross deformity of the bulb, increased acidity, men had more frequent night work, smoking, alcohol intake, medium-specific education. In patients, the rs1800872 * AA genotype and the rs1800872 * A allele of the IL10 gene (–627С> A; rs1800872) are markers of the development of duodenal ulcer.

Conclusion. Conducting genetic studies of individuals along with clinical examinations contributes to an integrated approach in the management of individuals with duodenal ulcer.

Aim. Study of levels of CA-19.9, CA-125, CA-72.4 and He-4 in tissues of tumor, peritoneum and omentum in patients with gastric cancer T_3–4аN_0–3M₁ and T_3–4аN_0–3M₀.

Materials and methods. The study included 62 patients: 21 (10♂, 11♀) — gastric cancer T_3–4аN_0–3M₁ and peritoneal metastases; 24 (15♂, 9♀) — gastric cancer T_3–4аN_0–3M₀ without metastases; 17 (6♂, 11♀) — non-cancer patients (controls). Levels of oncofetal proteins were measured by ELISA in tissues of the peritoneum, greater omentum, and gastric tumors (GT).

Results. Levels of practically all studied factors were elevated in tissues of GT, omentum and peritoneum. Levels of He-4 and CA-19.9 in all tissues of patients with advanced cancer increased higher than in the majority of patients without metastases: in GT — respectively by 2.6 and 1.8 times (p<0.05), in the omentum — respectively by 24.4 and 4.8 times, in the peritoneum — respectively by 2.1 and 8.5 times. Omental tissues of patients with advanced cancer showed a higher increase in levels of CA-72.4 and CA-125 as well — by 6.1 and 2.1 times, respectively. A small number of patients with T_3–4аN_0–3M₀ gastric cancer, who had CA-19.9 in the omentum and peritoneum as high as in patients with T_3–4аN_0–3M₁, developed metastases in the corresponding tissues 4–6 months after the study.

Conclusion. The content of oncoprotein markers in tissues of the peritoneum and omentum is one of the factors associated with metastatic characteristics, and CA-19.9 level can serve as an informative laboratory test for the predictive assessment of the further disease development.

Aim of research: to study the comparative effectiveness of new polycompositive of hemostatic implant on in vivo model of liver parenchymal bleeding.

Material and methods. Experimental studies were performed using the developed polycompositive hemostatic implant (CPM) from cellulose derivatives. Main components of implant include: natrium carboxymethylcellulose, oxidized cellulose, nanocellulose and bonded calcium ions. In vivo experiments were conducted in both sexes white 24 utbred rats weighing 196.5 ± 2.8 grams. The animals were divided into two groups: the comparative group (n = 24) with an application of polycomposite hemostatic implant and main group (n = 24) with medical gauze. The hemostatic materials were used in equal weight 30 mg. All surgical procedures on animals were performed under general inhalation anesthesia in model of liver parenchymal bleeding.

Results. Thus, hemostasis was reached within 34.0 ± 2.5 seconds in the main group with CPM, in the comparative group with medical gauze — 142.2±7.7 seconds. Repeated bleeding was observed in 11 (45.8%) cases of the comparative group and in the main group — 2 (8.3%) cases. Biodegradation of the hemostatic implant and regenerative processes in the liver parenchyma were registered on the 14 day, especially in the injured area that indicates the restoration of liver tissue. In the comparative group on the 30th day, the preservation of medical gauze structure was revealed without degradation signs.

Findings. According to our research data, a polycompositive hemostatic implant adheres tightly to the liver tissue, stops bleeding without its recurrence. In histological studies conducted in the dynamics of wound healing of the liver it was found that the implant does not cause a severe inflammatory reaction and biodegradation occurs after 14 days.

The aim of this work was to study the results of a new method of gastroplication in patients with overweight and obesity.

Materials and methods. Presented the results of applying the original laparoscopic gastroplication technique in 15 patients with morbid obesity at the BSMU Clinic.

Results. The observation time was from 4 months up to 18 months. A stable effect was achieved in 12 patients (80%), who decreased in overweight from 20 to 52% and a regression of comorbid pathology. Further studies will allow to detail the indications and selection of patients and determine the place of the proposed method among restrictive operations to reduce weight.

Aims: to draw attention to the lack of recommendations for the prevention and treatment of acute erosive-ulcerative gastroduodenal lesions and their complications associated with the severity of the patient’s condition, the massiveness of antiplatelet and anticoagulant therapy and the degree of risk of bleeding.

Materials and methods: a literature review was conducted of domestic and foreign authors on the problem of pathogenesis, clinical manifestations, diagnosis, treatment and prevention of lesions of the upper gastrointestinal tract in cardiovascular diseases.

Results: there are no standardized recommendations for the prevention and treatment of OEGP and their complications, taking into account the individual characteristics of the patient, based on evidence.

Conclusion: it is necessary to develop a scale that assesses the risk of OEGP and gastrointestinal bleeding in cardiovascular diseases, methods of treatment and prevention of these conditions, taking into account the specific parameters of the patient.

Hyperammonemia is considered as a significant trigger factor in the progression of liver diseases, starting from the stage of steatosis. There is also a link between high levels of ammonia and metabolic syndrome. The article discusses the relationship of hyperammonemia with a violation of carbohydrate metabolism. It is likely that an increase in ammonia is associated with an increase in visceral fat and may be a predictor of the development of insulin resistance as a key factor in carbohydrate metabolism disorders.

The aim was to study the hyperammonemia level and the duration of implementation of the number connection test (NCT) for patients with nonalcoholic fatty liver disease (NAFLD) in the pre-cirrhosis stage, including effect of the oral administration of L-ornithine-L-aspartate (LOLA) on these indices, and NCT correlation with body chemistry values. Material and methods: the research covered 103 patients with NAFLD to study the hyperammonemia level and other relevant blood chemistry values; we performed NCT before and after the LOLA treatment. The aim was to study the hyperammonemia level and the duration of implementation of the number connection test (NCT) for patients with nonalcoholic fatty liver disease (NAFLD) in the pre-cirrhosis stage, including effect of the oral administration of L-ornithine-L-aspartate (LOLA) on these indices, and NCT correlation with body chemistry values. Material and methods: the research covered 103 patients with NAFLD to study the hyperammonemia level and other relevant blood chemistry values; we performed NCT before and after the LOLA treatment.

In this article is discussed the historical facts of the study of peptic ulcer during 190 years after its self-selection in an independent nosological form. The scientific facts and arguments refuting the leading role of Helicobacter pylori infection in its etiology and pathogenesis are given; the conclusion of the authors of this article about the inevitability of a new paradigm of peptic ulcer in the near future is supported.

A 31-year-old man admitted to clinic with complains of occasional pains in the right upper quadrant unrelated to the food. Results of laboratory tests were in the normal range. There were wall thickening of the ascending colon with sites of calcification located intramural according to abdominal contrast-enhanced multislice computed tomography. The above-mentioned structures accumulated contrast during a venous phase of computed tomography. A barium X-ray was performed, filling defects in right colon were detected but barium follow throughs was normal. Multiple dilated vascular structures of variable sizes l affecting the bowel submucosa in ascending colon for more than 10 cm were detected during the colonoscopy. The patient was diagnosed with hemangiomatosis of colon. Because of the high risk of massive large-bowel hemorrhage and malignization the laparoscopic right hemicolectomy was performed. Morfologic findings were interpreted as vascular malformation of colon. The patient has been activated fully on 1-st day after surgery, discharged on 5-th day in hospital. Gastrointestinal (GI) vascular malformation is an infrequent disorder of blood vessel formation characterized by existence of tumor-like vascular structures through the entire GI tract. Nowadays there is no single approach to the management of this group of diseases. Surgery is the only radical metod of the treatment of vascular malformation. The laparoscopic approach has substantional advantages in treatment of this infrequent group of diseases.

Aim. An illustration of a case of diminutive sessile serrated adenoma (SSA) as a variant of the development of the normal colon mucosa.

Materials and methods. In 2017 a diminutive SSA was identified in the case of a 77 year-old patient. During endoscopic examination, which included white light endoscopy examination, narrow band imaging (NBI) and near focus, the main endoscopic signs of SSA were determined. Endoscopic removal of the lesion with subsequent confirmation of its histological structure was performed.

Results. The colonoscopy revealed a diminutive SSA of up to 3mm in size with typical endoscopic signs: a flat-elevated type 0-IIA, a “mucinous cap”, the same color to the surrounding mucosa, pit pattern type II-О, absence of meshed capillary vessels, but with isolated dilated capillaries. Histological examination revealed the crypts to have a cytoplasmic-type serration, drop-like expansion and horizontal growth of the basal parts, without epithelial dysplasia.

Conclusion. The presented clinical case shows a rare observation of a diminutive SSA, and the complexity of endoscopic diagnosis due to its small size. The above observation demonstrates one of the pathways — developing directly from the normal mucosa, bypassing the stage of hyperplastic polyp. Thus indicating the need for further study of serrated polyps, morphogenesis mechanisms and precancerous potential.

Crohn’s disease is an immune-mediated disease characterized by non-specific granulomatous transmural inflammation with segmental damage to any part of the gastrointestinal tract with the formation of extraintestinal and systemic complications. Clinical observation of patient I., 23 years old, a student who was sent for consultation to a gastroenterologist in the direction of a dentist, is presented. Active examination of the gastrointestinal tract during the inspection did not show any complaints. He considers himself ill for 6 months, when he first complained of pain in the neck, sore throat, and body temperature rise to 37.4–37.5 °C, mostly in the evening. Were treated by an otolaryngologist and a dentist without significant effect. In this connection, a biopsy of the ulcerative defect of the left retromolar region was performed, revealing noncaseating granulomatous inflammation. A follow-up examination by a gastroenterologist with colonoscopy and biopsy made it possible to establish Crohn’s disease as the true cause of aphthous stomatitis.

The article presents a clinical case of a combination of ulcerative colitis and infectious endocarditis of the bicuspid aortic valve. The presence of such a combination is very difficult for the curation, primarily due to the high risk of complications associated with the peculiarities of specific therapy of these diseases and significantly affect the quality of life and prognosis. It is obvious that there is a need to accumulate knowledge about the development and course of cardiovascular diseases in patients with ulcerative colitis and to clarify the pathophysiological mechanisms of such conditions.

The interaction of genetic and environmental factors leads to development of autoimmune diseases. Autoimmune diseases have common pathogenetic mechanisms and are combined often. in recent years Epidemiological studies have shown a significant increase in the prevalence of celiac disease in patients with type 1 diabetes mellitus (T1DM) in recent years. Comorbid pathology is a heavy clinical case to determine the treatment of patients. The association of celiac disease and T1DM leads to enhanced immune response and rapid development and progression of complications. A gluten-free diet is only treatment for celiac disease. Gluten-free diet complicates glycemic control. This article presents our clinical case of a patient with combination of celiac disease and T1DM.

The article provides the clinical observation of an unusual case of Crohn’s disease in combination with perforation of the ileocecal angle by a chicken bone complicated by a formation of infiltrate and abscess of the abdominal cavity in a 23-yearold patient. A brief overview of literature is present in the paper.