Colorectal cancer (CRC) is an actual problem today. And it occurs 6 times more frequently in patients with inflammatory bowel diseases (IBD) than in healthy population. CRC in IBD patients is more aggressive and needs total colectomy, which leads to permanent disability. That is why canceroprevention is one of the key goals of IBD treatment. The aim of this review is to overview actual pathogenesis pathways of CRC in IBD and methods of chemoprevention. In this review we describe risk factors of CRC, which can be summarized as aggressive disease and chronic inflammation and are based on pathogenesis of CRC. That is the reason why methods of chemoprevention needs to influence on inflammation and other pathogenesis pathways. The role of such classes of medication as non-steroidal anti-inflammatory drugs, 5-aminosalicylic acid, immunomodulators, ursodeoxycholic acid in canceroprevention in IBD patients are described in this review.

Objective: To study the characteristics of gene polymorphism HLA II class, depending on the phenotype of celiac disease. Methods: genetic, clinical, morphological, mathematical. Results: in patients with celiac disease, the Uzbek population is positively established association of celiac disease with genes HLA DQA1 * 0501, HLA DQV1 * 0201, HLA-DRV1 * 07 and * 13. For children with allele DRB1 * 16 and DQA1 * 0501 is set at high risk for the disease refractory to carriers of alleles DRB1 * 12 - high risk of atypical forms of the disease. The presence of HLA DRB1 * 12, we regarded as an ethnic feature of the Uzbek population and the evidence of its participation in the pathogenesis of atypical forms of the disease.

Objective: To identify clinical, laboratory and morphological prognostic criteria at different during Crohn's disease in children. Materials and Methods: in 48 patients with primary BC in age from 1 year to 18 years retrospectively evaluated the clinical and medical history, laboratory parameters, used complex morphological study of the intestinal mucosa. Results: prediction of complicated Crohn's disease is important to the high humoral activity, small bowel localization process with the identification of ulcers, fractures, the presence of such cell populations in the mucosa of the colon as inactive macrophages and young fibroblasts, muscle infiltration of neutrophilic granulocytes plate. Conclusion: in the primary treatment of the patient along with the production of BC diagnosis can predict the course of the disease and determine the tactics of the patient.

The study aim was to assess the relationship between nutritional markers decrease and hemoglobin level in ulcerative colitis (UC) patients. Methods. The cross-sectional retrospective analysis was performed. Data from medical records of 103 ulcerative colitis patients was included to analysis. Demographic characteristics, disease behavior, gut involvement extension, hemoglobin and total serum protein levels were collected. Body mass index (BMI) and fat-free mass index mass were collected retrospectively from bioimpedance analysis data. A multiple linear regression analysis was performed to study the relationship between nutrition status parameters and hemoglobin level adjusted for demographic and disease-associated characteristics. Results. Prevalence of anemia in the sample was 37.9%. In adjusted multiple linear regression model total serum protein level and fat-free mass index were directly associated with the hemoglobin level: standardized β = 0.369 (p = 0.010) and standardized β = 0.509 (p < 0.001) respectively. Conclusions. We assume undernutrition is one of causative agents of anemia in UC patients. It is likely the anemia treatment in UC patient with undernutrition must be performed with nutritional support.

Purpose of the study - to study the clinical and epidemiological features of IBD according to the register in the Perm region. Materials and methods. It analyzed 411 case histories of patients with IBD. In each patient it was wound profile, details of which laid the foundation for a regional register. Results. Created register of patients with IBD. The data we have created registers allow clinically characterized patients with Crohn's disease and ulcerative colitis in the Perm Krai.

The genetic component of multifactorial diseases which include irritable bowel syndrome (IBS) is provided by single nucleotide polymorphisms (SNP) as usual. It is essential to detect the associations of polymorphisms with various pathologies, even if they are not causative factors. It can be used for diagnostic purposes and the development of drug therapies. Analyses of individual polymorphisms have not found their unique relationship with susceptibility to IBS. Possibly, several genetic risk factors, together with the influence of the environment cause a synergistic effect leading to the appearance of IBS certain phenotype. This paper presents a research panel of five SNP, which are hereditary factors for violations processes of innate immunity: CD14-159 C> T (rs2569190); TNF-α -308 G> A (rs1800629); IL17A -197 G> A (rs2275913); TLR2 Arg753Gln G> A (rs5743708); TLR4 Asp299Gly A> G (rs4986790). Results indicate genetically determined predisposition to IBS as the number of "rare" alleles in the test regions of genes CD14, TNF-α and TLR4. Carriage heterozygous genotype GA polymorphism IL17A -197 G>A is also a risk factor for IBS in the population studied. On the contrary, carriage of "rare" allele polymorphism Arg753Gln G>A TLR2 gene has to be protective, but normal - predictive properties in the context of the development of IBS.

Purpose of the study. Examine the dynamics of the content of ferritin and other indicators of iron metabolism in the blood of patients with colorectal cancer before surgery and in the postoperative period to 7 days, and compare it with other known non-specific criteria of the acute phase of inflammation. Respond to the question whether changes in iron metabolism parameters in patients with colorectal cancer after surgery are specific. Materials and methods. The content of ferritin, transferrin, iron and unsaturated iron binding capacity (TIBC) in the blood serum of patients with colorectal cancer before surgery and in the postoperative period of 1, 3 and 7 days was determined at the biochemical analyzer Cobas Integra 400. The values of parameters in the group of individuals without cancer pathology (control group) were used for comparison. Results. Before surgery, patients studied parameters were within normal limits. In the postoperative period (7 days) ferritin level was significantly increased by 88%, and transferrin level was reduced by 73% in relation to that of the control group (p <0.05; U-Mann-Whitney). Total iron binding capacity was significantly reduced by 250%. Conclusions. Opposite changes of ferritin and transferrin, known as the acute-phase proteins, show predominance in the first week after surgery nonspecific reaction of patients to surgical stress. These metalloproteins are considered as one of the markers of the stress. We compared revealed changes in the studied parameters of iron system with the experimental data on the changes in the membrane potential of red blood cells and lymphocytes, and came to the conclusion that the identified synchronicity indicates their potential conditionality.

Aim: To assess normal measurements of pressure in anal canal during sphincterometry on S4402 МSМ and WPM Solar GI devices. Materials and methods: The study included 126 patients with colonic polyps. Inclusion criteria were absence of anal incontinence and defecation disorders. Seventy-three patients were assessed with S4402 МSМ device. Included were 28 males (mean age 56,2±10,2 years) and 45 females (mean age 54,9±13,7 years). Fifty-three subjects were assessed via WPM Solar GI device: 23 women (mean age 51,4±11,1 years) and 30 males (mean age 65,1±15,9 years). Results: Sphincterometry results using S4402 МSМ device in males were as follows: mean resting pressure - 52,1±19,8 mm Hg; maximal resting pressure - 60,3±21,9 mm Hg; mean pressure at voluntary contraction - 118,2±41,5 mm Hg and maximal pressure at voluntary contraction - 174,2±56,8 mm Hg. Corresponding values in females were 37,1±15,3 mm Hg, 43,8±15,5 mm Hg; 75,1±29,5 mm Hg and 99,1±39,7 mm Hg, respectively. Using WPM Solar GI sphincterometry the following figures were obtained in males: resting pressure - 43-61 mm Hg; maximal voluntary contraction pressure - 121-227 mm Hg; mean pressure - 106-190 mm Hg; maximal pressure with coughing test - 45-175 mm Hg; at straining minimal pressure decreased to 19-43 mm Hg (20-60%). In females the results were as follows: resting pressure - 41-63 mm Hg; maximal pressure at voluntary contraction 110-178 mm Hg; mean pressure - 88-146 mm Hg; maximal pressure at coughing test - 76-126 mm Hg, pressure decrease at straining to 28-52 mm Hg, relaxation up to 19-40%.

The aim of the study was to compare the diagnostic efficacy and safety of emergency colonoscopy without colon preparation at patients with intestinal bleeding. Material and methods. In a comparative cohort study included 252 patients admitted due to intestinal bleeding in 2006-2015. 118 men, women 134. The average age was 60,15 ± 15,7 years. Patients with explicit anal / hemorrhoidal bleeding at admission or manifestations of gastroesophageal bleeding were excluded. Randomization was performed by alternating days of hospitalization. In Hospital № 29 colonoscopy was performed at admission without prior colon preparation, patients of Hospital № 1 performed lavage or enema preparation prior to colonoscopy within 24-48 hours of hospitalization. Results. Significant differences in the structure of intestinal bleeding source were identified. In patients without bowel preparation most frequently detected bleeding diverticula and cancer - 17%, ulcerative colitis - 10%, intestinal bleeding - 16%, upper bleeding - 16%. At preliminary colon preparation most often as likely causes bleeding source detected cancers - 22%, ulcerative colitis - 15%, angiodysplasia - 13%. Analysis of the dependence of bleeding sources structure from bowel preparation revealed differences only in women. The number of endoscopic findings at colon preparation was 1.5 times higher versus emergency colonoscopy without colon preparation. The number and structure of the observed changes were significantly different between groups, and depending on the sex of patients. There were no complications. Conclusion. Colonoscopy at intestinal bleeding without colon preparation is safe and highly informative in identifying of the true bleeding source.

Based on the literature overview and summarizing of practical experience we provides a current review of data regarding the epidemiology, etiology and pathogenesis of IBD. In this review authors focuse their attention on different links of the immune system, including the components of the innate immune system (macrophages, monocytes, neutrophils, dendritic cells), adaptive or acquired immunity (T and B cells), secreted mediators (cytokines and chemokines), as well as the cells of the intestinal epithelium and congenital limphoid cells, because according to modern concepts, elements of this system are the key factors of understanding the pathogenesis of IBD.

Inflammatory bowel disease (IBD) are systemic diseases with different intestinal and extra-intestinal manifestations (EIM). This fact can determin an examination plan and the disease course and prognosis. Up to 8.4% of children with IBD have EIM like the first symptom of the disease. The range of EIM of IBD in children is differ from that one of adult patients: rarer arthropathy and arthritis, skin and liver diseases, an extremely rare eye disease. The physical development disorder is a typical children's manifestation of the IBD, the “failure of the weight curve” is an early symptom of the IBD debut (82% of examined children), especially ulcerative colitis. The article discusses the clinical features and therapy of the most frequent extraintestinal manifestations of IBD in children: skin, mucous, eye diseases, axial and peripheral arthropathies, primary sclerosing cholangitis, physical, sexual development disorders, decreased bone mineral density. Most often, we observed patients with arthritis and primary sclerosing cholangitis - up to 12.5% of patients with active disease. A growth failure was observed in 20% of children with IBD debut, and remained in 9.7% children despite adequate anti-inflammatory therapy. Decreased bone mineral density in children with IBD observed in 30% cases (ISCD-recommendations). Extraintestinal manifestations are very important to make the early diagnosis of IBD without any intestinal symptoms. The pediatrician can suspect a systemic diseases course. EIMs adversely impact upon patients, quality of life and some can be life-threatening.

Based on the analysis of literature and our own studies we propose hypothesis of the pathogenesis of acute appendicitis (AA), which differs from the following generally accepted provisions. Acute appendicitis develops as a result of immunological reaction and hyperplasia of the mucous membrane of the appendix. Frequency peaks related to age, sex, and seasonal changes of AA are due to increased excretion of sex hormones. Only a small percentage of cases of primary hyperplasia causes a complete occlusion of the lumen and destructive AA. Usually it is exposed to regression without causing the typical symptoms, but leaving the damaged nervous system and / or sclerotic changes that violate the peristalsis of the appendix. Faeces, lingering in appendix eventually harden, increasing in size and often get saturated with salts. In the next fit of hyperplasia, the walls are stretched over fecolithe, causing obstruction of the lumen, the formation of a closed cavity and the known mechanisms of inflammation. Inflammation leads to increased tone of the stomach and colon, but strong in the segments of intestine lay next to the A. This is accompanied by increased of the anal canal pressure. Increased tone of the digestive tract is a nonspecific response to acute inflammation. We can assume that the same reaction is observed at any localization of acute and chronic inflammation.

Biochemical process that lay in the core of non-invasive detection of Helicobacter pylori with the help of HELIC Ammonia breath test, manufactured by AMA Co Ltd., St.Petersburg, is shown. Patents from various countries, describing ammonia as H.pylori diagnostic marker, are reviewed. Approaches for evaluation of efficacy of the test-system are analyzed, validation and verification data is provided. High diagnostic characteristics are confirmed by the results of comparative studies on patients of different age groups, reaching 97% sensitivity and 96% specificity.

Helicobacter pylori (HP) - the human infection that persists for a long time in the stomach and can cause chronic gastritis, gastric and duodenal ulcer, MALT-lymphoma, gastric adenocarcinoma. There is a well-adapted niche-specific microbial community in the stomach represented by Lactobacillus, Streptococcus and other bacteria. Use of probiotics is considered to be an alternative or supplement to eradication therapy. Among the Lactobacillus the most promising is Lactobacillus reuteri, who are able to have the anti-HP activity. L. reuteri produces powerful antimicrobial compounds such as reuterin, reuteritsin 6, reutetsiklin and metabolites that inhibit the growth of HP (volatile fatty acids, lactic acid, hydrogen peroxide, etc.). These compounds could reduce the adhesion of HP to gastric epithelial cells, inhibit growth HP, which leads to a significant reduction in the degree of contamination of HP and the severity of gastric mucosal inflammation. The data on the effectiveness of L. reuteri as monotherapy in patients with HP without absolute indications for eradication, and as an additional component, which increase the effectiveness of eradication are presented.

Constipation is a common symptom during pregnancy. The majority of cases are simple constipation that occurs due to a combination of hormonal and mechanical factors affecting normal GI function. However, a number of women suffer from constipation prior to conception and find their symptoms worsen during pregnancy. Patients with simple constipation can usually be treated by diet recomendation, physical activity. Medications are best avoided but if necessary should be taken under supervision using best available evidence. It is important that all patients be evaluated by detailed history, physical examination and basic investigations to outrule GI pathology that may be present in a small number of cases.

The article presents a clinical case of observation of the course of pregnancy and delivery in women with a rare manifestation of Crohn's disease with a primary lesion of the anal canal with extraintestinal manifestations (perianal region and external genitalia). Prospective clinical observation demonstrates the possibility of work with adequate outpatient and inpatient obstetric services in collaboration with relevant specialists, a favorable course and outcome of pregnancy in women with Crohn's disease of moderate severity with extraintestinal manifestations in the phase of incomplete remission and the birth of healthy full-term newborns. It should be noted that the use of drugs for the treatment of Crohn's disease and related complications (anemia) had no teratogenic effects on the growth and development of the fetus, and on and on the health of the newborn. Joint management of these patients by the obstetrician-gynecologist, gastro-enterology and a proctologist in the form of joint inspections and allows councils, in a timely manner to verify diagnosis of the disease and its complications, and provide adequate correction treatment patient to obtain a favorable pregnancy outcome, birth and the postnatal period.

The article demonstrates a clinical case of a child observed over 3 years, whose parents initially complained of non-healing crack between the toes, the navel, the vulva and behind the ears in the appointment of traditional therapy. The child in the community conducted a full survey of allergy, the results of which were normative. Ineffective treatment of skin diseases, as well as the presence of family history for autoimmune diseases served as the need for hospitalization of the patient survey. The examination at the clinic revealed higher values of antibodies to tissue transglutaminase and gliadin in the blood, duodenojejunal according to the results of endoscopy and active manifestations of chronic enteritis expressed with total villous atrophy on the long section on the results of morphological study of biopsies of the small intestine mucosa. Based on the results diagnosis of coeliac disease. On the background of a gluten-free diet showed normalization of laboratory and morphological parameters, weight and growth rates, the results of densitometry. However, it was only a slight improvement from the skin lesions. When re-examination of the child set accompanying diagnosis of psoriasis.

Aim. The purpose of the study. To determine methods of functional diagnostics of disorders of motor-evacuation properties of the colon, to study motor activity with involvement in the pathological process of certain segments. Materials and methods. The basis of our work comes from the experience of a survey of 389 patients with chronic constipation for congenital anomalies of the colon. On the basis of the results proposed to be chronic constipation. Cologny and laparoscopic. Application of the proposed methods allowed us to completely eliminate radiation load for the patient. Methods are simple, require no special costs are paid by the patient. Results. Presents functional methods of examination of the colon depending on the type constipation. To evaluate the functional state of the terminal segments of the colon can be based on the following parameters: and propulsive peristaltic activity, reservoir function of the rectum, the condition of the switching apparatus, the possibility of evacuation of feces. Conclusion. In each case needs to be clarified diagnostics of the functional condition of the colon when anomalies of its development. Our methods are allowed to individualize the approach to the choice of medical tactics depending on the type of chronic a constipation and convenient in the analysis of remote results of treatment.