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Aim: To study the specific features of the clinical course of gastroesophageal reflux disease (GERD) associated with duodenogastroesophageal reflux (DGER) in patients with chronic acalculous cholecystitis (CAC) and cholelithiasis (CL), as well as qualitative and quantitative characteristics., Subjects and Methods: The clinical, morphological, motor tonic characteristics of the esophagogastroduodenal area, mucosal microbial biocenosis in the esophagus, stomach, and duodenum were studied in detail in 83 patients with GERD that was associated with DGER and ran concurrently with CAC or CL., Results: Impaired duodenal propulsive activity as a concomitance of the signs of gastrostasis and duodenal dyskinesia with dyscoordination of both anthroduodenal and duodenojejunal propulsion and with the development of duodenogastric reflux and DGER, which in turn determine esophageal and gastric pH values is shown to be of importance in CAC and CL, which match GERD. Abnormal microbiocenosis in the upper digestive tract is characterized by the higher quantitative and qualitative content of the mucous microflora. Opportunistic microorganisms exhibit cytotoxic, hemolytic, lecithinase, caseinolytic, urease, and RNAase activities., Conclusion: The found specific features of the course of GERD associated with DGER in patients with biliary tract abnormalities lead us to search for novel therapeutic approaches based on the correction of digestive motor tonic disorders and abnormal microbiocenoses of the mucous flora in the esophagus, stomach, and duodenum.

The key task of the district physician is staged diagnostic search and clinical detection of functional disorders--conduction of laboratory tests and device investigations (in cholelithiasis patients--ultramicroscopic investigation of bile, x-ray methods, ultrasonography) to initiate prophylactic-therapeutic measures (medico-social, pharmacological and therapeutic-dietary).

Aim: To study heterogenic forms of LDLP and LP(a) in blood serum of patients with cholelithiasis (CL) and gallbladder cholesterosis (GBC)., Material and Methods: Native gradient (3-12%) electrophoresis in polyacrylamide gel, rocket immunoelectrophoresis with antibodies to apo(a) were made in 20 patients with CL and 20 with GBC, 13 controls without gastrointestinal disease. Correlation of retardation factor (Rf) of LDLP and LP(a) with blood lipids, cholesterol (C) and triglycerides (TG) levels, body mass index (BMI) and age was studied. CL and GBC risk factors were analysed basing on a retrospective assessment in random representative samples of patients (100 CL and 100 GBC patients)., Results: There was a shift of the main peak in LDLP spectrum in the direction of smaller particles in GBC (Rf = 0.171 +/- 0.003) which was significant in comparison with CL group (Rf = 0.146 +/- 0.004, p < 0.001) and control (Rf = 0.114 +/- 0.013, p < 0.05). The analysis of LDLP Rf distribution in patients with different C levels has shown that LDLP small particles can occur in a normal C level: 75% in GBC and 50% in CL groups. Prevalence of small dense LDLP was recorded in both groups (87.5% cases) in hypercholesterolemia. Compared to control, LP(a) concentration was significantly elevated both in GBC (23.7 +/- 4.9 mg/dl) and CL (15.7 +/- 4.4 mg/dl) patients (control--7.5 +/- 1.4 mg/dl, p < 0.01), p > 0.5 in comparison between the groups. The correlation analysis found no correlations between LP9(a), other lipids, BMI and age in both study groups while Rf of LDLP correlated with C and TG levels (r = 0.596 and r = 0.226, respectively, p < 0.05), age and BMI (r = 0. 533 and r = 0.363, respectively, p < 0.05) in CL and did not correlate in GBC., Conclusion: A C level in CL changes with age and BMI while in GBC high LDLP C level was caused by other factors. No correlation of LP(a), LDLP Rf with age, body mass and blood lipids indicates that the above factors are independent in development of GBC.

Aim: To study hepatic function after cholecystectomy and the role of absorptive-excretory function of the liver and hormonal factors in development of postcholecystectomy syndrome., Materials and Methods: 106 patients long after cholecystectomy for cholelithiasis were examined for absorptive-excretory function of the liver and blood hormones (hydrocortisone, insulin, gastrin, thyroxine, triiodothyronine, thyrotropine). I-131-bengal-rose hepatography, dynamic hepatobiliscintigraphy with brommeside-Tc-99m, radioimmunoassay were employed., Results: Impairment, often subclinical, of hepatic absorption and excretion after cholecystectomy was found in 94% of the patients. External function of the liver after cholecystectomy was disturbed depending on the condition of its absorptive-excretory function. Hepatic dysfunctions and changes in blood hormones correlated., Conclusion: Absorptive-excretory function and hormonal factors are essential in pathogenesis of postcholecystectomy syndrome.

Aim: Elucidation of some pathogenetic mechanisms of cholelithiasis in biliary diseases., Materials and Methods: The examination of 45 patients suffering from gall bladder and biliary tracts lesions complicated with cholelithiasis included: measurements of bilirubin, bile acids and cholesterol in bile portions B and C; estimation of the cholatocholesterol coefficient; duodenomanometry; radioimmunoassay of thyroxine, thyrotropine, insulin, hydrocortisone and gastrin in peripheral blood., Results: A correlation was found between cholelithiasis and changes in intraduodenal pressure as well as secretion of hormones (gastrin, insulin, hydrocortisone, thyroxine, thyrotropine). Combined therapy including xenofalk and polyphepan in biliary diseases produced a good therapeutic response. Besides relief of clinical symptoms and improvement of intraduodenal pressure, positive changes were seen in bile lithogenicity., Conclusion: The data obtained contribute to better understanding of cholelithiasis and planning of relevant preventive measures.