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Aim. The clinical guidelines are intended to supplement specialty decision-making for improved aid quality in patients with gastritis and duodenitis though acknowledging the latest clinical evidence and principles of evidencebased medicine.Key points. Gastritis is an inflammatory disease of stomach mucosa, with a separate definition of acute and chronic gastritis. Chronic gastritis is a cohort of chronic diseases uniting a typical morphology of persistent inflammatory infiltration, impaired cellular renewal with emergent intestinal metaplasia, atrophy and epithelial dysplasia of gastric mucosa. Oesophagogastroduodenoscopy (OGDS) or high-resolution OGDS with magnified or non-magnified virtual chromoendoscopy, including targeted biopsy for atrophy and intestinal metaplasia grading and neoplasia detection, are recommended to verify gastritis and duodenitis, precancer states and/or gastric mucosal changes. All chronic gastritis patients positive for H. рylori should undergo eradication therapy as aetiological and subsidiary for gastric cancer prevention. Chronic gastritis patients with symptoms of dyspepsia (epigastric pain, burning and congestion, early satiety), also combined with functional dyspepsia, are recommended proton pump inhibitors, prokinetics, rebamipide and bismuth tripotassium dicitrate in symptomatic treatment. With focal restricted intestinal metaplasia, follow-up is not required in most cases, mainly when advanced atrophic gastritis is ruled out in high-quality endoscopy with biopsy. However, a familial history of gastric cancer, incomplete intestinal metaplasia and persistent H. pylori infection render endoscopy monitoring with chromoendoscopy and targeted biopsy desirable once in three years. Patients with advanced atrophic gastritis should have high-quality endoscopy every 3 years, and once in 1–2 years if complicated with a familial history of gastric cancer.Conclusion. The recommendations condense current knowledge on the aetiology and pathogenesis of gastritis and duodenitis, as well as laboratory and instrumental diagnostic techniques, main approaches to aetiological H. pylori eradication and treatment of dyspeptic states.

The aim: to provide clinical and instrumental characteristics and to evaluate the morphological changes of the stomach and duodenum mucous membrane in children with comorbidity of chronic gastroduodenitis (HGD) and primary hypertension (PH). Materials and methods. 102 children aged 9–17 years with HGD and PH were examined. The first group consisted of 47 children with a combination of HGD and PН, the second group – 55 children with HGD and normal arterial pressure. Morphological study of biopsy specimens of the stomach and duodenum mucous membrane (MM) was performed in 33 children. Results. Gastroduodenoscopy showed an erythematous gastroduodenopathy in 57.4 % of children in group І and 60.0 % of children in group ІІ (P = 0.79), hypertrophic changes in the stomach and duodenal ММ – in 6.4 % of children in group І and 12.7 % of children in group II (P = 0.28), subatrophy – in 10.6 % of children in group І and 14.5 % of children in group II (P = 0.56), erosion – in 25.5 % of children in group І and 12.7 % of children in group ІІ (P = 0.1), motor-evacuation disorders – in 63.8 % of children in group І and 41.8 % of children in group ІІ (Р = 0.03). Unlike this data, the morphological study of the MM biopsy revealed a statistically significant difference in microcirculatory disturbances in the MM, namely plethora was detected in 81.3 % of children in group I and 52.9 % of children in group II (P = 0.02), severe edema was observed in 75.0 % of children in group I and 41.2 % of children in group II (P = 0.049), hemorrhages in the lamina propria – in 62.5 % of children in group I and 23.5 % of children in group II (P = 0.02), microtrombosis – in 37.5 % of children in group I and 5.9 % of children in group II (P = 0.03), as well as concerning destructive changes in the MM: micro-erosion were found in 56.3 % of children in group I and 17.6 % of children in group II (Р = 0.02), erosion – in 43.8 % of children in group І and 11.8 % of children in group II (P = 0.04). Conclusions. The combined course of HGD and PH in children is characterized by more frequent motor-evacuation and microcirculatory disorders (plethora, severe edema, hemorrhages in the lamina propria, microtrombosis), as well as more pronounced erosive changes in the MM as compared to an isolated course of HGD.

Helicobacter pylori represents a pathogen causing chronic infection in around a half of the global human population, which manifestations vary from asymptomatic infection to developing gastritis and peptic ulcer. The data accumulated suggest that overt clinical types of this infection are associated with lost immunoregulation and increased pro-inflammatory cell-mediated immune response triggered by H. pylori-specific T helper cells. Here, we examined the degree of peripheral blood CD4+ T cell maturity and related expression of chemokine receptors involved in migration to gastrointestinal tract (CCR9 and CCR6), as well as Тand B-cell zones of lymphoid organs (CCR7 and CXCR5). It was shown that overt H. pylori-infection was coupled to changes in expression pattern of chemokine receptors on T helper cells. In particular, percentage of mature CD4+CD45RO+ T cells bearing CCR9 and immature CD4+CD45RO– Т cells expressing CXCR5 was increased in peripheral blood of patients with chronic gastroduodenitis. However, increased amount of activated mature CD4+CD45RO+ICOS+ T cells was observed in patients with chronic gastroduodenitis comorbid with peptic ulcer that was also associated with elevated amount of mature CCR6+ T helpers (mainly CD4+CD45RO+CCR7– CCR6+ cells) and follicular T helper cells as well as emerging minor CD4+CD45RO+CXCR5+CCR6+.T cell subset, not affecting CD4+CCR9+ Т cells. Thus, the data obtained evidence that tissue-specific T-helper cell migration is controlled separately in of H. pylori-associated diseases.

Aim. To develop new criteria of gastric and duodenal mucosa image assessment using endoscopic system for narrow band imaging (NBI). Material and methods. Endoscopic and morphological findings were compared in 460 patients with different chronic diseases of the stomach and duodenum. Esophagogastroduodenoscopy was made according to the standard technique by the gastroduodenoscope EVIS EXERA-II GIF H180 (Olympus, Japan) with NBI-system. Biopsy material was studied by standard pathomorphological techniques. Results. The novel system of the visual picture evaluation during conduction of endoscopic investigations in monochromatic light provides higher significance of identification of inflammatory and destructive processes in mucosa including foci of structural alterations, their location and extent. Conclusion. We propose a protocol for description of the endoscopic picture in conduction of examinations with application of the NBI-system of visualization in monochromatic light. It can help physicians to correctly estimate the image and interpret the detected changes.

Vitamin D and calcium play a key role not only in maintaining skeletal integrity, but are also important in the functioning of other systems of the human body. The aim of the study is to evaluate the dietary intake of calcium and vitamin D in the children with different somatic pathologies (gastroenterological and endocrine) and its impact on somatic health indicators. Material and methods . 114 children, aged 4-17 years old, were involved in the study. They underwent inpatient treatment for somatic pathology. The patients were divided into 4 groups: 36 children with chronic gastroduodenitis (the 1st group); 25 children with functional disorders of biliary tract (the 2nd group); 30 children with hypothalamic pubertal syndrome (the 3rd group); 23 patients with type 1 diabetes mellitus (the 4th group). Dietary intake of calcium and vitamin D was evaluated using a questionnaire. The sources of vitamin D and calcium intake were determined and the amount of these sources in the weekly diet of a child was evaluated. Then the total of vitamin D and calcium in the diet of each child and the average daily consumption of these nutrients with each food source were evaluated as well. All children underwent physical examination; a special attention was paid to the health of their teeth, nails, hair, skeletal system, as well as the presence of allergic reactions. Serum calcium concentration was determined by the colorimetric method with o-cresolphthalein in an alkaline medium and inorganic phosphorus by the phosphomolybdate method with aluminum molybdate in an acidic medium. Results and discussion . It was established that the diet of the most children comprised baked goods (94.7%), meat (92.9%), dairy products (up to 90.4%), and eggs (90.4%). The children received most of their dietary vitamin D with fish (335.63±472.82 IU), butter (124.64±114.31 IU) and eggs (101.15±96.77 IU) per week. The dairy products, i.e. milk, yogurt, cheese, and cottage cheese, were the largest source of calcium. Calcium intake varied in different patient groups due to their food preferences and dietary recommendations related to their health. It was also proved that the average daily diet vitamin D intake at 123.98±53.52 IU was insufficient. The average daily intake of calcium with food was 524.53±248.38 mg. The insufficient intake of vitamin D and calcium with food correlated with clinical manifestations. Posture disorders were evidenced in 48.2% of children, tooth decay - in 40.4%, and hair illnesses - in 32.4%. These disorders were more significant in the children of the 1st group, who were proved to have the lowest vitamin D intake. The serum calcium level was lower than the reference values in 79.8% of children, the phosphorus level was lower than the reference values in 41.2% children. Conclusion . The dietary intake of calcium and vitamin D in the children with different somatic pathologies (gastroenterological and endocrine) was insufficient, despite differences in children's diets under various pathologies, which led to the appearance of clinical signs of mineral metabolism disorders, among which posture disorders and tooth decay were most often observed., Competing Interests: The authors declare no overt and potential conflict of interest related to the publication of this article., (Copyright© GEOTAR-Media Publishing Group.)