Patients with diseases of the cardiovascular system, in some cases require long-term or permanent therapy with antiplatelet and / or anticoagulant drugs, which increase the survival rate and are an integral component of a comprehensive treatment and prevention of a variety of these diseases. The diseases of the cardiovascular system such as coronary heart disease, atrial fibrillation, heart disease, hypertension, atherosclerosis vessels are accompanied by a high risk of intravascular thrombus and are common in elderly. The antithrombotic therapy is required in such cases. However the purpose of such therapy in patients of the older age group raises a number of issues. The Age (especially over 75 years) is a risk factor for both the development of thromboembolic complications, and gastrointestinal bleeding. The gastric secretion inhibitors can be used to protect the gastric mucosa in the case of the mucosal erosions in the antiplatelet and / or anticoagulant treatment.

The paper presents the results of a study of 83 patients with gastroesophageal reflux disease, hypertension and in their comorbidial course. The purpose of the study is to examine the characteristics of heart rate variability (HRV) in the given cohort of patients. Materials and Methods: The main group consisted of 68 patients with a mean age of 35,37 ± 10,34 years. Patients with isolated pathologies: 20 - with gastroesophageal reflux disease (GERD), 25 - with arterial disease (hypertension) without concomitant diseases. 23 patients had a combination of hypertension and GERD. The comparison group consisted of 15 healthy men. All the subjects were comparable in terms of age, sex, duration of Arterial hypertension and GERD. Results: Patients with associated course of arterial hypertension and GERD were found to have distinctions in HRV parameters, which indicate an increase in sympathetic nervous system activation and a decrease in parasympathetic influence. HRV was non-uniform in patients with different clinical and endoscopic GERD variants. In patients with endoscopically positive GERD (EPRD), there was a significant increase in both time (SDNN, SDANN, SDNN-index), and spectral parameters of HRV (VLF, HF). Conclusion: In associated course of acid dependent diseases (GERD) and hypertension, time and spectral parameters of heart rate variability significantly reduce, reaching the lowest values in patients with signs of reflux esophagitis. Comorbidity of GERD and hypertension exacerbates originally existing excessive influence of the sympathetic nervous system in patients with hypertension, leading to parasympathetic failure, and, ultimately, significantly weakening adaptive capabilities. Revealed changes in HRV parameters among patients with the given sintropy defines such a combination of diseases as undesirable, both for cardiovascular and autonomic nervous systems.

The aim was to explore the features of epithelial morphogenesis and reparation of gastric mucosa in chronic gastritis in patients with Marfan syndrome and Marfan -like states. Materials and methods. A histological evaluation and immunohistochemical analysis of the expression of antibodies against α-actin smooth muscle (α-SMA), collagen type III and transforming growth factor β (TGFβ) in the gastric mucosa in 50 patients with hereditary disorders of connective tissue between the ages of 17 to 41 years were performed. Results. In patients with Marfan syndrome and marfan-like states chronic gastritis was an unfavorable factor for the progression of the background atrophic and fibrotic processes in the gastric mucosa. It proved a key role disinhibited to TGFβ activity-dependent activation of fibrogenesis of subepithelial myofibroblasts (α-SMA +) with the development of a special morphogenetic variants of early chronic atrophic multifocal gastritis at a young age.

Objective of the investigation was to examine clinical characteristics of peptic duodenal ulcer (DU) associated with arterial hypertension (АH) after acute gastrointestinal bleeding (AGB). The study included 25 patients with AH associated with DU, 45 patients with AH in AGB, 63 patients with AGB without AH, 48 patients with AH without AGB and 69 patients with DU without AH. If AH joins the existing DU, it increases the intensity of pain and dyspeptic syndromes. If DU joins AH, on the other hand, the clinical picture of ulcer disease was unclear. The largest concentration of Helicobacter pylori antibodies was found in patients with AH in AGB. Hypertensive crises were detected more often in combination of AH and DU.

Purpose of the study: The investigation of clinical and laboratory parameters that characterize the pathogenetic connections of association of ulcerative lesions of the gastrointestinal tract and hypertension as work-related diseases among workers of locomotive brigades. Materials and methods: 192 railway workers were examined. The level of general clinical and biochemical parameters in the blood serum were investigated. Results: Due to the syntopy of duodenal ulcers and (or) the stomach and hypertension on the background of the negative impact of harmful factors of production the abnormalities in the vascular endothelium with signs of systemic inflammation are revealed. Conclusion: The identified parameters can be considered as an early predictor of formation of hypertension as well as a comorbid flow of duodenal ulcers and (or) of the stomach and hypertension, assessing it as work-related diseases.

Objective: To identify chronic obstructive pulmonary disease (COPD) features of the clinical manifestations in patients with chronic pancreatitis (CP). Materials and methods. 67 patients with comorbidity of CP and COPD (main group), 54 - with isolated COPD (compared group) have been examined. Assessment of clinical symptoms severity was perfomed by Modified Medical Research Council (mMRC) Dyspnea Scale and a 4-point scale of COPD patients symptoms (P. L. Paggiaro). Integral assessment of the impact of COPD on patient was conducted in accordance with the GOLD guidelines (2015). Results. It has been found out that patients with comorbid pathology are characterized by the significant increase rate of infectious exacerbation of COPD than in the compared group: 67.2% vs. 48.1% (p = 0.03). The seasonal nature of COPD exacerbation was observed in isolated COPD in 88.9% of cases, in comorbid pathology - 73.1% (p = 0.03). In compared group 1,4 ± 0,2 exacerbations per year were recorded, in patients of the main group - 2,3 ± 0,4 (p = 0.03). Severity of dyspnea in patients of the main group was 2,4 ± 0,5 points, in compared group - 2,1 ± 0,6 points (p = 0.03). The expressiveness of cough in isolated COPD made up to 2,3 ± 0,4 points, while comorbid disease - 2,6 ± 0,5 points (p = 0.03). Intensity of sputum in patients of the main group reached 1,7 ± 0,6 points, in compared group 1,6 ± 0,7 points (p = 0.66). Integral assessment of the COPD impact on patient (GOLD, 2015) showed that the distribution of patients with comorbid pathology by groups of risk had a significant difference from the one in the compared group (df = 2, χ2 = 14,201, p < 0.001). Conclusions. The presence of concomitant chronic pancreatitis in patients with COPD brings in a certain deviation in the clinical characteristics of the disease: significantly more often as a trigger were acute respiratory viral infections, less pronounced seasonal nature of exacerbations, significantly increasing the number of exacerbations per year, a significant increase of dyspnea, cough and changes of sputum. Carrying out the integrated assessment of the impact of COPD on patient it has been observed that redistribution of main group patients into risk groups in the side of its aggravation.

The purpose - to determine the content of markers of inflammation, namely C-reactive protein and tumor necrosis factor-α in patients with combined course of chronic pancreatitis and type 2 diabetes mellitus. Materials and methods. The investigation involved of 20 patients with isolated chronic pancreatitis and 20 patients with combined course of chronic pancreatitis and type 2 diabetes mellitus. The control group consisted of 20 healthy individuals. Results. It was found that patients with combined course of chronic pancreatitis and type 2 diabetes had significantly higher levels of C-reactive protein and hyper-TNF-α-emia (p < 0.05). Patients of all study groups revealed a close correlation between C-reactive protein and tumor necrosis factor-α (p < 0.05)/ Conclusions. The results of the study suggest that the levels of C-reactive protein and tumor necrosis factor-α are important diagnostic markers of inflammation in patients with chronic pancreatitis and type 2 diabetes mellitus.

Currently, the non-alcoholic fatty liver disease (NAFLD) is recognized as the most common chronic liver disease. 27.8% of patients with NAFLD have diseases of the cardiovascular system (cardiovascular), which are the leading cause of death in patients with NAFLD. Objective: To study the probability of liver fibrosis in patients with metabolic syndrome and chronic heart failure (CHF). Materials and Methods: The study included 77 patients with CHF. The diagnosis of CHF was confirmed by the qualitative measurement of NT-proBNP. The severity of the clinical manifestations of heart failure, functional status of the patient was assessed. All patients underwent clinical and biochemical blood tests, ECG, ultrasound examination of the liver. The size of the heart chambers, wall thickness of the myocardium and epicardial fat were evaluated by echocardiography. The NAFLD Fibrosis Score (NFS) was calculated in all patients enrolled in the study. Results: In the study group patients The direct correlations between the value of NFS: weight (r = 0,38; p = 0,001), glucose levels (r = 0,54; p = 0,001), the level of glycosylated hemoglobin (r = 0,51; p = 0,002), LV myocardium mass (r = 0, 51; p = 0,005), the sizes of the right atrium (RA) (r = 0,45; p = 0,013), sizes of the left atrium (LA) (r = 0,41; p = 0,023) were found in the study group patients. Inverse correlation between the value of NFS: total cholesterol (r = -0,43; p = 0,008), epicardial fat thickness (EFT) (r = 0,29; p = 0,014), end-diastolic (CD) left ventricular size (r = 0,27; p = 0,02), end-systolic (CS), left ventricular size (r = 0,27; p = 0,02), CD ventricular volume (r = 0,25; p = 0,02), CS LV volume (r = 0,28; p = 0,02). NFS is correlated with the six-minute walk test (6MWT) (p = 0,023; U-Mann-Whitney). Using the NAFLD fibrosis score in internist routine practice help to identify patients with NAFLD and cardiovascular diseases by non-invasive way in the early stages of the disease and to adjust the current treatment, if necessary.

Aim: The aim of the paper is to study the clinical efficacy of carvedilol and ornithine-aspartate in the complex therapy (ACE inhibitors, diuretics, cardiac glycosides, nitrates indication), to assess their impact on quality of life, intracardiac hemodynamics, remodeling of the left (LV) and right ventricular (RV), indicators of the inflammatory enzyme activity in blood serum of patients with coronary heart disease with CHF II-III FC and alcoholic liver disease (ALD). Materials and Methods: 95 patients were studied 45-75 years (mean age - 58,2 ± 1,2) with CHF II-III FC and postinfarction cardiosclerosis, LVEF less than 45%. ALD was diagnosed in 58 patients. In 23 (39%) patients among them had steatosis, 18 (30.5%) - chronic hepatitis (CH), 17 (30.5%) - liver cirrhosis (LC). Patients were divided into 3 groups. Patients in the first group (37 people) with coronary artery disease and heart failure without a UPS received an average dose of carvedilol in - 32,8 ± 4,7 mg / day. Patients in the 2nd group (32 persons) suffering from coronary artery disease, heart failure, and UPS received carvedilol in an average dose of 25,4 ± 1,6- mg / day and L-ornithine-L-aspartate in a dose of 10 g granulate per day for 2 weeks, and then by 5g a day for 4 months. Patients in the third control group (26 people) with CHD and CHF and CHF ABP received basic therapy (without β-blocker) and ademetionine at a dose of 800 mg / day for 2 weeks, followed by 400 mg / day for 4 months. Results: After 4 months of observation, it was noted that CHF patients with IHD in combination with BPO flows less favorably. In all groups, the clinical status of patients was improved on the background of the therapy, however, the clinical status was more pronounced while using carvedilol and ornithine-aspartate (Group 2): summary measure of quality of life has improved by 38 points, the speed of the test increased with a digital sequence up to 54.4, decreased shortness of breath, edema, ascites, portal hypertension effects, hepatocellular insufficiency and hepatic encephalopathy. In general, was shown the normalization of sleep rhythm, reducing sleepiness, improved memory, attention, reduced asterixis and sweeping hand tremor, asthenia. Conclusions: The use of carvedilol and ornithine-aspartate in the treatment of patients with CHF FC II-III with CHD and BPO improves the clinical condition of patients, quality of life, hemodynamics, reduces the severity of pulmonary hypertension and normalizes serum biochemical parameters.

Objectives. The aim of our study was to investigate associations between the lipid profile, liver condition and the level of BMI. Methods. Our sample consisted of 58 patients: 30 - with morbid obesity and BMI - 40-49 (1 group), 28 - with superobesity, BMI - 50-69 (2 group). Lipids and hepatic functional tests were measured just prior to surgery. Ultrasound examination was used to estimate liver condition. Liver biopsy specimens were obtained at the time of surgery, classified according to the nonalcoholic fatty liver disease and steatohepatitis activity score. Results. Lower level of cholesterol has been found in the first group with morbid obesity. Higher level of triglycerides and very low-density lipoprotein has been found in the second group with superobesity (р=0,000 ANOVA). High-density lipoprotein was normal but significantly associated with BMI. The level of low-density lipoprotein was higher in the second group, but the difference between ptoups was not significant. BMI was associated with higher scores of ultrasonographic parameters and severity of steatosis, the increased prevalence of steatohepatitis and it activity. We also realized the positive correlation between ultrasonographic parameters and histological features. Conclusion. BMI has significantly positive correlations with the level of triglycerides and very low-density lipoprotein, ultrasonographic parameters, histological features of steatosis and steatohepatitis. The level of total cholesterol did not reflect all changes of lipid profile.

The article discusses the development of occupational pathologies of the digestive system and it is associated with dyslipidemia. Selected the most informative indicators for timely identification of metabolic «targets» of damage in workers in chemical production of methanol.

Studied indicators microflora and immune parameters in 75 patients with chronic obstructive pulmonary disease (COPD). Of these, 54 - COPD with arterial hypertension, at 21-isolated leaking COPD. The degree of dysbiosis evaluated on caseinolitic activity feces, immune status - by performance of leukogram and immunograms at determining the levels of CD3+-, CD4+-, CD8+-, CD19+-cells, Ig A, Ig M, Ig G, NST-test. For most COPD patients with hypertension compared with patients with COPD characterized by more pronounced dysbiosis, inflammatory syndrome, the weakening of the functioning of cellular immunity, increased tension of humoral immunity and changed reactions in phagocytic immunity. Disbiotic and immune changes increase with increasing the degree of hypertension from I to III.

One of the most popular abdominal diseases is an acute cholecystitis. that’s why is very actual in acute cholecystitis the study of clinical features in the older age group of patients in improving of preoperative diagnosis and adequate option of treatment. In the research were involved 1273 patients, wiich were the patients during 2007-2014 years in Medical center of Yerevan, department of Laporacopic surgery, who suffered from acute cholecystitis. Research findings from the data analysis allows us to assume that the characteristics of the older age group of patients during the acute cholecystitis are difficult to do some surgical intervention and it needs very clever prediction for treatment.

Objective: to improve the diagnosis of the diseases of the pylorus and prepyloric region in patients with duodenal peptic ulcer based on the study of the mucous membrane folds Materials and methods: endoscopic examination of 208 patients without diseases of the gastroduodenal transition (healthy) and 112 patients with duodenal peptic ulcer of three age groups from 35 to 90 years. Men were 72 and 61, women - 136 and 51 respectively groups. Endoscopic examinations were performed by endoscopes EVIS GIF-130, XP-150 N, GIF H-180 and instruments of the company «Olympus» (Japan). Results: Individual differences were revealed in the formation of mucous membrane folds of the pylorus and prepyloric region, in the frequency of participation of the walls in healthy people and patients with duodenal peptic ulcer. Age differences were revealed. Gender differences were not revealed. The clinical case of the patient with duodenal peptic ulcer and maltoma in prepyloric region was presented. Conclusion: The features of the formation of mucous membrane folds, the relief of the mucous membrane of the pylorus and prepyloric region in healthy people and patients with peptic ulcer of the duodenum are necessary to consider. It is important to perform a biopsy, histological, c

The aim of the present study was to show different aspects of the interrelation between pathology of the gastrointestinal tract and rheumatic diseases based on literature rewiev, single-centers data and case reports. Materials and methods. First literature review was performed (databases PubMed, Medline). Then was analyzed information according presence of gastrointestinal disease in 126 patients with axial spondyloarthritis (SpA) and collected case reports as illustration the problem. Results. Involvement of the gastrointestinal tract in rheumatic diseases in general is characterized by clinical, etiologycal and pathogenetic heterogeneity. It was found a few typical combinations: the defeat of the digestive tract as one of the clinical manifestations of rheumatic disease (hemorrhagic vasculitis, etc.); the defeat of the digestive tract and rheumatic disease as equal related conditions (Crohn’s disease and ankylosing spondylitis); the defeat of the digestive tract as a consequence of long-existing inflammation (amyloidosis, esophagus Barrett); gastrointestinal tract involvement as complication of treatment of the rheumatic disease (bleeding when using nonsteroidal anti-inflammatory drugs); rheumatic disease as a manifestation of paraneoplastic syndrome of the digestive tract. The presence of diseases of the gastrointestinal tract is established in more than half (58%) patients with axial SpA. In the group of patients considered the most frequently met gastritis (15%), chronic pancreatitis (15.9%) and chronic cholecystitis (19%). Conclusions. Gastrointestinal tract occurs no less than half of the patients with rheumatic diseases and may be either primary or secondary to systemic disease. The possibility of coexistence of diseases of the gastrointestinal tract and rheumatic disease must be taken into account in the course of patient care. In some cases, treatment should be carried out together - a gastroenterologist and a rheumatologist.

In a review article analyzes and summarizes information on the current pathogenesis of bile peritonitis. The role of endothelial dysfunction markers, as a factor in the development of ischemic disorders interstitial circulation contributes to the elucidation of the molecular mechanisms of the pathogenesis of peritonitis, including bile peritonitis. This review is an attempt to synthesize and analyze accumulated information on the pathogenetic aspects of the development of peritonitis, which will optimize the diagnosis, the development of methods of prevention and treatment. This study dysfunction of vascular endothelium, will provide additional information relevant to the prediction of the adaptation of the organism in the syndrome of endogenous intoxication.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most demanded drugs. Paper presents the data review on the drug activity mechanisms, effectiveness, safety, and major drug interactions of NSAIDs at co-morbid conditions in different age groups, as well as measures of prevention of NSAID-gastropathy, which can occur even against the use of small doses of NSAIDs. The existing recommendations on the selection of NSAIDs and the complex therapy with drugs of this pharmacological group are shown in considering the individual characteristics of the patient, the pharmacological properties of drugs, the clinical picture of the disease, the presence of risk factors for adverse reactions and drug interactions.

The aim of the study was to assess the effectiveness of the inclusion in the scheme remaxol treatment of metabolic syndrome in patients with nonalcoholic steatohepatitis and diabetes mellitus 2 type. Materials and methods: Data of 76 patients with metabolic syndrome in a non-alcoholic steatohepatitis and type 2 diabetes were analyzed. Patients were randomized by gender and age, and are divided into 2 groups according to the scheme of therapy: patients in group I (major - 38) conducted a basic therapy in combination with remaxol: intravenous infusion of 400 ml of 1 times a day for 10 days, group II patients (comparison - 38) combined basic therapy with intravenous ademetionine: 400 mg, in a solution diluted NaCL 0,9% 400 ml 1 time per day for 10 days. In addition to standard clinical and laboratory tests were studied biochemical parameters of liver activity, lipid and carbohydrate metabolism in the dynamics: before therapy and after its completion. Results: it was found that the inclusion in the scheme of drugs from the group of succinates (remaxol) reduces the severity of metabolic syndrome by reducing the manifestations of cholestasis and cytolysis, and improving lipid and glucose metabolism. As a result, significantly reduced the severity of the main clinical syndromes: asthenovegetative 46% and dyspeptic syndromes - 46% and 15%, respectively.

Widespread in clinical practice, comorbid conditions and diseases, among which is the high prevalence of metabolic syndrome (MS), determine the need for selection of the optimal pharmacotherapy. The presence of certain liver diseases, including nonalcoholic fatty liver disease (NAFLD), may interfere with the processes of transformation of drugs, the metabolism of which occurs in the liver, which has been proved by experimental investigations. The article deals with the rational choice of antihypertensive drugs as a whole, and angiotensin-converting enzyme (ACE) in particular in patients with metabolic syndrome and NAFLD. Particular attention is paid to the possibilities of certain ACE inhibitors and their pharmacological properties.

Conducting daily pH monitoring in patients with asthma has a number of features. Due to the fact that the introduction of the pH probe in such patients may provoke an asthma attack, necessary pre-treatment of the patients to the study. It is necessary to perform the procedure for achieving remission of asthma medication. Utility of the modified pH measuring techniques (prolonged, 48-hour) is the need to identify pathological gastroesophageal reflux in patients with asthma and evaluate the effectiveness of antisecretory drugs, allowing for improved asthma, increasing the period of remission, and to improve the quality of life of patients.

Objectives of the investigation was to examine the dynamics of emotional and autonomic disorders in patients with peptic duodenal ulcer (DU) associated with arterial hypertension after acute gastrointestinal bleeding during training at School of Combined Pathology (SCP). Main group included 25 patients. The comparison group consisted of 26 patients with the matched pathology, sex and age, but not trained at SCP. Results. Both groups of patients demonstrated improvement in emotional sphere and autonomic regulation. However, in patients who had training at the SCP the indicators of emotional status improved earlier and got a greater extent. Optimization of autonomic regulation was identified in 3 months, not six months, like in untrained patients. Conclusion. Training hypertensive patients with peptic DU at the SCP improves the efficiency of emotional state and autonomic regulation.

The aim of research - a comparative study of the microflora of the vagina and bowel in women with secondary infertility and gastrointestinal distress. Materials and methods. We examined gut and vaginal microbiota in 17 infertile women according to the presence or absence of gastrointestinal diseases. We used a standard procedure for microbiological examination. Results. Certain changes of bacterial load and composition in both reservoirs were established. They allowed us to conclude the same trends in characterizing of the developing dysbiosis. Conclusion. Thus, the simultaneous studying of vaginal and gut microflora seems to be rational during the examination of women with childbearing disorders. It could possibly increase the treatment efficacy and/or prevent the development of some pathology.

The article presents variants of the course of cardiovascular disease under a clinical mask of gastroenterological diseases. The author analyzes the clinical examples of atypical symptoms, discusses the diagnostic errors and shows ways to prevent them

This paper present an overview of the life and work of the outstanding Russian physician and gastroenterologist professor A. M. Nogaller