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Today, nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) account for more than 50% of chronic liver diseases and cirrhosis in developed countries. The clinical significance of these pathologies lies in the formation of liver fibrosis and, therefore, in the increased risk of liver cirrhosis and hepatocellular carcinoma, which are life-threatening conditions. NAFLD is based on obesity and insulin resistance, whereas alcohol consumption is central to the etiopathogenesis of ALD. Recently, the role of the gut-liver microbiota axis in the genesis of NAFLD and ALD has also received increasing attention. Changes in qualitative and quantitative composition of intestinal microbiota and alterations of barrier function of intestinal mucosa can lead to entry of intraluminal antigens through portal vein system into the liver, inducing damage to hepatocytes and activation of proinflammatory processes. It is shown that in patients with CLD (NAFLD and ALD) there is an increase in the permeability of the intestinal mucosa and dysbiotic changes of the intestinal microbiome. The role of the gut-liver microbiota axis is well described in the genesis of NAFLD and ALD. Chronic alcohol consumption leads to increased colonies of Gram-negative bacteria in the intestinal mucosa and, therefore, to the accumulation of endotoxins (lipopolysaccharide components of bacterial cell membranes). Acetaldehyde produced by ADH of the intestinal epithelium stimulates tyrosine phosphorylation of tight cell contacts, increasing intestinal mucosal permeability, which leads to translocation of endotoxins into the portal bloodstream. Obesity is a major risk factor for NAFLD, which is also associated with dysbiotic changes in the intestinal microbiome. Obese individuals have increased Firmicutes, decreased Bacteroidetes, mediated reduction of short-chain fatty acid synthesis and increased intestinal wall permeability due to disruption of intercellular dense contacts, which leads to increased translocation of bacteria and endotoxins into the systemic bloodstream.

Steatohepatitises is an etiologically heterogeneous group of pathological changes in the liver, which are characterized by the inflammatory infiltration of the hepatic parenchyma with underlying fatty degeneration of hepatocytes. Whatever is the etiological cause, the clinical significance of steatohepatitis involves the formation of liver fibrosis and, as a result, an increased risk of developing liver cirrhosis and hepatocellular carcinoma, which are life-threatening conditions. It is common practice to identify the following etiological variants of steatohepatitis: metabolic (55–65% of cases), alcoholic (45–55% of cases) and drug-induced (approximately 5% of cases). The pathogenetic basis of metabolic steatohepatitis lies in the mechanisms of increased lipolysis, excess free fatty acid pool and reduced β-oxidation stemming from obesity and insulin resistance. Pathogenetic factors mediating the development of alcoholic steatohepatitis are the toxic activity of acetaldehyde and increased CYP2E1 activity. Intake of some hepatotoxic drugs increases lipogenesis in hepatocytes and disrupts the electron transport chain, which leads to the formation of liver steatosis followed by transformation into steatohepatitis. Whatever is the etiological varient, steatohepatitis is asymptomatic in the prevailing majority of cases. However, some patients may present complaints of weakness, discomfort, or indolent pain in the right hypochondrium. A detailed history taking is essential for the establishment of the etiological cause of liver damage. Laboratory tests allow to diagnose steatohepatitis in increased levels of hepatic transaminases, usually not exceeding 2–3 times the normal values. In addition to liver enzymes, increased levels of alkaline phosphatase and GGTP can also be observed in steatohepatitis. Ultrasound imaging is the most accessible instrumental tool in clinical practice to establish the primary diagnosis of hepatic steatosis. Indirect elastometry is an equally informative non-invasive method for diagnosing steatohepatitis, which allows to measure both the degree of steatosis (the function of determining the ultrasonic controlled attenuation parameter (CAP) and liver fibrosis.

Introduction. Functional dyspepsia (FD) and irritable bowel syndrome (IBS) overlap is an adverse clinical situation, as patients with this syndrome have more severe clinical manifestations resulting in significant reductions in quality of life. For now, there are no meta-analytical papers that would summarize the frequency of FD – IBS overlap using the revised Rome IV criteria. Objective. To organize data on the prevalence of FD – IBS overlap using the revised Rome IV criteria.Materials and methods. A search for studies was conducted in MEDLINE / PubMed, EMBASE, Cochrane electronic databases. The search depth was 6 years (from January 2016 to February 2021). The final analysis included original publications from peerreviewed periodicals that used the revised Rome IV criteria as a method for diagnosing FD and IBS in the adult population with detailed descriptive statistics allowing to include resulting data in the meta-analysis.Results and discussion. The final analysis included 6 studies involving 1,180 patients with PD and 600 patients with IBS. The generalized prevalence of IBS in patients with PD was 41.511% (95% CI: 22.203–62.288). The analysis was undertaken by using a random-effects model, as there was significant heterogeneity among results (p < 0.0001; I2 = 94.28%). The generalized prevalence of PD in patients with IBS was 38.791% (95% CI: 9.438–73.710). The analysis was undertaken by using a random-effects model, as there was significant heterogeneity among results (p < 0.0001; I2 = 99.25%).Сonclusion. The complete meta-analysis showed that the frequency of FD - IBS overlap using the revised Rome IV criteria is quite high and accounts for about 40%. At the same time, further large studies of more homogeneous structure are needed to verify these results and study the potential pathogenetic relationship between PD and IBS.

In the article we analysed the difficulties of differential diagnosis of portal hypertension, considers a clinical case that illustrates the presented theoretical material. In the presented clinical observation, the patient’s disease was manifested by bleeding from the varicose veins of the esophagus. In most cases, portal hypertension syndrome in practicing clinicians is associated with liver cirrhosis, however, it is necessary to remember about the possibility of developing subhepatic portal hypertension, in particular as a result of the formation of portal vein thrombosis. If there are signs of portal hypertension, it is necessary to specify the level of obstruction to blood flow, that is, the form of portal hypertension (subhepatic, hepatic, suprahepatic). Often, portal vein thrombosis can be formed due to undiagnosed blood diseases that occur without any clinical symptoms. The provided clinical example demonstrates a case of portal hypertension in the outcome of a chronic form of myeloproliferative syndrome. Portal cavernoma is quite rare and it is formed due to multiple small-diameter venous structures that gradually replace the occluded vessel with a system of collaterals proximal and distal to the portal vein thrombosis site. In the formation of the diagnosis the main are radiation research methods, but the conclusions should be considered only in conjunction with the clinical evidence. The clinical case is interesting because a large cavernoma of the portal vein in a patient with subhepatic portal hypertension was regarded as a «solid formation» according to magnetic resonance tomography. According to the literature data, cavernous transformation has an external similarity to the tumor process, which expands the range of differential diagnosis and requires the exclusion of oncological formations.

Purpose – the systematization of data on the resistance of Helicobacter pylori to clarithromycin in the Russian Federation. Material and methods. Necessary investigations were searched in the electronic databases MEDLINE/PubMed, EMBASE, Cochrane, and the Russian Science Citation Index (RSCI), published between January and September, 2020. The final analysis included original publications from periodically reviewed foreign and Russian publications, as well as dissertations that used validated H. pylori resistance assessment tests with detailed descriptive statistics that allow the resulting data to be included in the meta-analysis. Results. The final analysis included 16 studies (1227 isolates). The generalized indicator of H. pylori resistance to clarithromycin in the Russian Federation was 11.85% (95% confidence interval (CI) 7.315–17.302; I2 = 86.19%). When analyzing papers published over the past ten years, H. pylori resistance to clarithromycin was 10.39% (95% CI 7.103–14.219; I2 = 61.29%). In Moscow and the Moscow Region, the generalized indicator of H. pylori resistance to clarithromycin was 10.87% (95% CI 7,280–15,439; I2 = 50.57%), in St. Petersburg – 22.26% (95% CI 9,525–38,470; I2 = 84.75%), Smolensk – 5.74% (95% CI 3,511–8,789; I2 = 0.00%), Kazan – 10.0% (95% CI 5,023–17,355; I2 = 45.22%). Conclusion. The results show that the resistance of H. pylori to clarithromycin in Russia does not exceed the 15% threshold regulated by the Maastricht-V Consensus, which allows us to consider a triple regimen of anti-Helicobacter therapy with clarithromycin as a first-line therapy. At the same time, to achieve the maximum effect when using classical triple therapy and to level the risk of further progression of clarithromycin resistance of H. pylori in Russia, it is advisable to use methods of its optimization.

The review article presents current data on functional disorders of the biliary system, taking into account the latest recommendations of experts of the Rome Foundation (Rome Criteria IV, 2016) and the Russian Gastroenterological Association (specialized clinical recommendations, 2018). According to modern concepts, biliary dysfunction is a group of functional disorders of the biliary system caused by motor disorders and increased visceral sensitivity. According to the literature data, the prevalence of functional disorders of GB and OS is 10-15%, and violation of OS function is revealed in 30-40% of patients who underwent cholecystectomy (CE). The presence of biliary pain is an obligatory condition in the diagnosis of functional disorders of GB and OS. Bilirubin and serum transaminases (AST, ALT) levels may increase in biochemical blood analysis in patients with functional OS disorder of biliary type, and pancreatic amylase and lipase in case of functional OS disorder of pancreatic type. Ultrasound examination of abdominal organs is considered to be the priority among instrumental methods. This technique allows to exclude organic lesions of both the GB and visualized ducts, and adjacent organs (GSD, biliary tract, liver and pancreas neoplasms). Magnetic resonance cholangiopancreatography (MRCP) is used as a clarifying method, which allows to visualize the state of biliary ducts throughout. Ultrasonic cholecystography is used to assess the contractile activity of the GB. When duct dilation is detected and/or when liver/pancreatic enzyme levels are elevated in the absence of changes according to MRCP data, it is reasonable to perform an endoscopic ultrasound examination. According to the latest recommendations of the Russian Gastroenterological Association (2018), the foundation of pharmacotherapy for this group of diseases are antispasmodics and ursodeoxycholic acid (UDCA).

To date the mechanisms of etiopathogenesis of functional gastrointestinal diseases continue to be actively studied. By now, alteration of the components of the intestinal epithelial tight junctions supporting the intestinal barrier integrity has been identified in several studies in patients with irritable bowel syndrome and functional dyspepsia (FD). Characteristic changes in patients with IBS compared with healthy controls include decreased expression of ZO-1 protein and occludin in mucosal biopsy specimens from various parts of the colon. On the other hand, the analysis of duodenal biopsy specimens shows similar changes in patients with FD. The causative factor of these changes continues to be studied. In fact, experimental and clinical studies conducted to date have demonstrated that there are factors that affect adversely the structural and functional stability of intestinal tight junctions. Regardless of the initiating factor, the compromise of tight junctions results in the breach of permeability of the intestinal mucosa and the entry of various intraluminal factors into the proper mucous plate, contributing to the activation of resident immunocompetent cells. Due to the production of cytokines and other biologically active substances, the latter lead to sensitization of nerve endings, thereby inducing the development of visceral hypersensitivity phenomenon and alteration of the motor behaviours of the gastrointestinal tract. The literature describes the phenomenon of activation of a local inflammatory response in patients with functional gastrointestinal diseases as “low-grade inflammation”. These data update the need to consider restoration of the intestinal mucosal barrier in patients with diseases in question as a therapeutic target. This review article systematizes data on this problem.

Введение. В ряде исследований была выявлена достоверная ассоциация между низкой эффективностью эрадикационной терапии инфекции Helicobacter pylori (H. pylori) и избыточной массой тела или ожирением у пациентов без сахарного диабета. Данный тренд может объясняться различиями в профиле фармакокинетики ингибиторов протонной помпы, входящих в состав схем эрадикации.Цель исследования: оценить эффективность эрадикационной терапии инфекции (H. pylori) при использовании препаратов омепразола и рабепразола у пациентов с избыточной массой тела и ожирением.Материалы и методы: в проспективное рандомизированное сравнительное исследование было включено 34 пациента (21 мужчина и 13 женщин) с H. pylori -ассоциированной патологией и избыточной массой тела или ожирением (согласно классификации ВОЗ). В процессе рандомизации пациентов было сформировано 2 равные группы в зависимости от назначаемой схемы ЭТ. Первая группа (n = 17) получала классическую тройную схему ЭТ с омепразолом (омепразол 20 мг х 2 раза в стуки, амоксициллин 1000 мг х 2 раза в стуки, кларитромицин 500 мг х 2 раза в сутки) в течение 10 дней. Второй группе (n = 17) назначалась классическая тройная схема ЭТ с рабепразолом (рабепразол 20 мг х 2 раза в стуки, амоксициллин 1000 мг х 2 раза в сутки, кларитромицин 500 мг х 2 раза в сутки) в течение 10 дней. Скрининг и контроль эрадикации инфекции H. pylori производились при помощи быстрого уреазного теста биоптата или С13-уреазного дыхательного теста. Оценка эффективности ЭТ осуществлялась не ранее чем через 6 недель после окончания курса лечения.Результаты: Средний возраст пациентов составил 41,9 лет (95% ДИ: 36,5-47,2), а медиана ИМТ - 28,1 кг/м2 (95% ДИ: 26,9-32,0). Эффективность ЭТ в первой группе составила 64,7% (ITT), 73,33% (PP), а во второй группе - 82,35% (ITT), 87,5% (PP). Использование рабепразола в схеме классической тройной ЭТ потенцирует эффективность лечения у пациентов с избыточной массой тела и ожирением в выборке ITT (ОШ 2,54; 95% ДИ: 0,51-12,54) и PP (ОШ 2,54; 95% ДИ: 0,39-16,55) в сравнении с применением омепразола. При отборе для анализа исключительно пациентов с ожирением (ИМТ ≥ 30 кг/м2) в выборке PP эффективность ЭТ в первой группе составила 50,0%, а во второй - 83,33%.Заключение: проведенное исследование и данные литературного анализа позволяют сделать вывод, что тактика оптимизации ЭТ инфекции H. pylori с использованием рабепразола в качестве ИПП является наиболее многообещающей стратегией повышения эффективности лечения, особенно в группах риска неэффективного лечения, к которым относятся пациенты, страдающие избыточной массой тела и ожирением.

Assessment of the diagnostic accuracy of predictive indexes of liver fibrosis for the identification of severe fibrosis and cirrhosis (F3F4) in patients with chronic hepatitis C (CHC).The retrospective design study included 127 patients with chronic hepatitis C (mean age 44.511.1 years). To assess the degree of liver fibrosis, all patients underwent transient elastography using a Fibroscan (EchoSens, France) and predictive indexes of liver fibrosis were calculated (APRI, FIB-4, discriminant Bonacini score). Transient elastography was considered as a reference method for assessing the degree of liver fibrosis for subsequent comparison of results with predictive fibrosis indixes.The sensitivity of the APRI index for the identification of severe fibrosis and cirrhosis of the liver (F3F4) was 79%, and specificity was 69%. The FIB-4 index showed greater specificity (86%), but less sensitivity (68%). The sensitivity of the discriminant Bonacini scale was 81%, and the specificity was 77%. The positive predictive value of the APRI index, FIB-4 and the Bonacini scale for the identification of severe fibrosis and cirrhosis of the liver (F3F4) in patients with chronic hepatitis C was 66; 78 and 72% respectively, and negative predictive value 82; 78 and 84% respectively.The results of this study indicate the relatively high diagnostic accuracy of a number of predictive indexes for evaluating liver fibrosis (APRI, FIB-4, discriminant Bonachini scale) in identifying severe fibrosis and cirrhosis of the liver (F3F4) in patients with chronic hepatitis C.Цель исследования.Оценка диагностической точности предиктивных индексов оценки фиброза печени при идентификации выраженного фиброза и цирроза печени (F3F4) у пациентов с хроническим гепатитом С (ХГС). Материалы и методы.В исследование ретроспективного дизайна включено 127 пациентов с ХГС (средний возраст 44,511,1 года). Всем пациентам для оценки степени фиброза печени выполнялась транзиентная эластография на аппарате Fibroscan (EchoSens, Франция) и рассчитывались предиктивные индексы оценки фиброза печени (APRI, FIB-4, дискриминантная шкала Боначини). Транзиентная эластография рассматривалась как референтный метод оценки степени фиброза печени для последующего сопоставления результатов с предиктивными индексами фиброза. Результаты.Показатели предиктивных индексов фиброза печени, свидетельствующие в пользу наличия у пациента выраженного фиброза и цирроза печени (F3F4), выявлены у 64 пациентов при расчете индекса APRI (1,5), у 47 пациентов при расчете индекса FIB-4 (3,25) и у 41 больного при оценке по дискриминантной шкале Боначини (6). Чувствительность индекса APRI при идентификации выраженного фиброза и цирроза печени (F3F4) составила 79%, а специфичность 69%. Индекс FIB-4 продемонстрировал большую специфичность (86%), однако меньшую чувствительность (68%). Чувствительность дискриминантной шкалы Боначини составила 81%, а специфичность 77%. Положительная предсказательная ценность индекса APRI, FIB-4 и шкалы Боначини при идентификации выраженного фиброза и цирроза печени (F3F4) у пациентов с ХГС составила 66; 78 и 72% соответственно, а негативная предсказательная ценность 82; 78 и 84% соответственно. Заключение.Результаты настоящего исследования свидетельствуют об относительно высокой диагностической точности ряда предиктивных индексов оценки фиброза печени (APRI, FIB-4, дискриминантная шкала Боначини) при идентификации выраженного фиброза и цирроза печени (F3F4) у пациентов с ХГС.

Diabetes mellitus (DM) is a moderately common issue both in the world and in the Russian Federation. Consequently, an interdisciplinary approach to studying the characteristics of the course and therapeutic management of gastroenterological pathology in this group of patients, in particular,Helicobacter pyloriinfection, which is associated with a whole range of diseases of the upper gastrointestinal tract, is of special interest. The article provides a systematic review of foreign and domestic studies of the efficacy and safety of various eradication regimens for Helicobacter pylori infection in patients with diabetes. In general, it was shown that the weighted average efficiency of eradication in people with diabetes was 17.7–23.8% lower than in people, who did not suffered from that disease.

In the present article, the authors provide detailed material on the 13-year observation of a patient with such a rare disease as Whipple’s disease. Pathophysiological aspects, in particular changes in immunity within the framework of this nosology, clinical picture are also described in detail, and the emphasis is placed on the interrelation of certain symptoms, their intensification and regression. Taking into account the absence of clear recommendations for the management of such patients, the article considers various options of therapeutic schemes, and also reflects the own results of treatment.

Identification of changes in biochemical parameters of liver functional activity during screening studies requires additional examination of the patient in order to determine the genesis of the disease. In recent years, in routine practice, the most frequently used is an isolated definition of the level of transaminases (ALT, AST), which does not allow timely detection of latent cholestasis syndrome. Primary biliary cholangitis (PBC), previously referred to as primary biliary cirrhosis, is a relatively rare chronic autoimmune cholesthetic liver disease, predominantly affecting middle-aged women and prone to progressing liver cirrhosis. The recommendations of AASLD and EASL note the need for long-term monitoring of patients with ongoing UDCA therapy and regular diagnostic studies to identify signs of disease progression. A clinical example of successful treatment of a patient with PBC with the Russian drug Exhol® is described.

Gastroesophageal reflux disease (GERD) is one of the most common pathologies in modern clinical practice. Laryngopharyngeal reflux (LPR) is considered to be an extraesophageal manifestation of GERD and is characterized by retrograde ingestion of gastric content into the larynx and pharynx, leading to recurrent otolaryngological symptoms. Classical manifestations of LPR are hoarseness, perspiration, dryness and feeling of lump in the throat, coughing. There is no «gold standard» for the diagnosis of LPR. At the same time, several instrumental methods are used in clinical practice to verify the diagnosis: laryngoscopy and EGDS are the most common, and in some cases - 24-hour pH-metry and impedancemetry. In the case of an established diagnosis of LPR, it is recommended to use a standard dosage of PPI twice a day for 3–6 months.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that is characterized by periodic abdominal pain associated with altered bowel habits and/or changes in stool consistency. The chronic course of the disease marked by alternating periods of exacerbation and remission necessitates the long-term use of non-drug and pharmacological methods for the treatment of IBS, which is extremely negative for the patient’s compliance. A strategy for improving compliance of a patient with IBS is the cornerstone that allows a physician to ensure the optimal level of effectiveness of the prescribed therapy and minimize the risk of disease recurrence.

Functional dyspepsia (FD) is one of the most common gastroenterological diseases. The article presents modern views on the pathogenesis of the disease. It is shown that disorders of motor skills (retardation of voiding function, disturbance of relaxation accommodation) and stomach sensitivity (visceral hypersensitivity to stretching) are considered to be one of the main pathophysiological mechanisms of FD. The authors present a modern algorithm of treatment of patients with FD, based on the clinical recommendations of the Rome Consensus IV revision (2016) and the Russian Gastroenterological Association (2017). The strategy of differentiated use of pharmaceuticals for different variants of FD is considered.

Aim.This paper presents guidelines on the diagnostics and treatment of eosinophilic esophagitis, which can be used by practitioners in their everyday practice.Summary.Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized by the symptoms of esophageal dysfunction and a pronounced eosinophilic infiltration of the esophageal mucosa. The EoE diagnostics is based on the clinical manifestations of the disease (dysphagia, food impaction, chest pain regardless of swallowing), as well as on the combination of endoscopic and histological signs. The diagnostic criterion is the eosinophilic infiltration of the esophageal mucosa with an eosinophil density of ≥ 15 per high power field (×400) in at least one of the biopsy specimens (about 60 eosinophils in 1 mm2). Total IgE levels, peripheral blood eosinophilia and skin allergy tests are considered to be additional diagnostic means. Several approaches are used for the treatment of EoE, including proton pump inhibitors (PPIs) and topical glucocorticosteroids (GCS), as well as elimination diets. The choice of therapy should be individualized, with the mandatory assessment of the treatment efficacy after 6–12 weeks using esophagogastroduodenoscopy with biopsy sampling. Endoscopic dilatation should be considered in patients suffering from severe dysphagia due to esophagus stricture.Conclusion.Increased incidence of EoE predominantly among children and young people, as well as its chronic character requiring long-term maintenance therapy, make EoE a significant issue to the practice of gastroenterology.

The article presents the results of a pilot prospective randomized study aimed at evaluating the efficacy and safety of rebamipide (Rebagit, PRO.MED.CS Praha a.s., Czech Republic) as part of the triple therapy for helicobacter pylori (H. Pylori) eradication. 54 patients with H. pylori-associated gastric ulcer/duodenal ulcer were enrolled to the study. All patients were randomized to two therapeutic groups depending on the eradication therapy to be received. Group 1 received the standard triple therapy, Group 2 received the standard triple therapy plus rebamipide. The efficacy of H. pylori eradication in Group 1 amounted to 78,2% (ITT), 81,8% (PP), and in Group 2 to 83,8% (ITT), 86,6% (PP). Odd ratio of efficient eradication with the use of rebamipide as part of standard triple therapy for helicobacter pylori eradication was 1,44 (95 CI: 0,36–5,72). The side effect rates between the groups were comparable

The review article reflects a contemporary view of irritable bowel syndrome (IBS) based on the Rome IV Criteria (2016). The paper studies the matters of definition, classification, features of the clinical picture and diagnostic criteria for IBS. It outlines the real-time findings of the pharmacotherapy of IBS from the perspective of evidence-based medicine.

Non-alcoholic fatty liver disease (NAFLD) becomes gradually the most frequent liver disease in the world. Expert teams in the USA, Western Europe, and Russia give pride of place within the NAFLD treatment regime to lifestyle modification including the optimization of physical activity, diet and, as a consequence, the BMI reduction. However, it is often difficult for the practitioner to motivate the patients to change their lifestyle and eating habits. Due to this, it is extremely important to use a pharmacologic therapy aimed at weight loss, reducing insulin resistance and repopulating the severely damaged liver parenchyma. By now ursodeoxycholic acid drugs (Ursosan) have been proved to be highly effective in treating NAFLD in clinical practice, having a significant impact on several pathogenetic mechanisms of this disease.

This paper deals with the second phase of the prospective, randomized comparative study of the efficacy and safety of the hybrid eradication therapy (ET) regimen in patients with H. pylori-associated gastroduodenal ulcer. Objective: Evaluation of the acid-forming function of the stomach with a pharmacological proton pump inhibitor (PPI) test in patients with H. pylori-associated gastroduodenal ulcer disease and no response to eradication therapy. Materials and methods. 19 patients were enrolled in this study after the failed ET using any of the following three regimens: standard triple regimen, four-component therapy with bismuth agents, hybrid regimen; in all regimens, omeprazole (20 mg b.i.d.) was used as an IPP. All patients underwent a 48-hour intragastric pH-meter (Gastroscan-GEM device, Istok-System, Russia) to assess the initial state of the acid-forming function of the stomach during the first day and the subsequent pharmacological PPI test (omeprazole 20 mg b.i.d.) on the second day. The minimum, maximum and average pH values in the cardia and body of the stomach, as well as the time with pH> 4 in the body of the stomach during the entire study period (48 hours) were analysed. Results. Median time average with pH> 4 in the body of the stomach for the first day of the study (before PPI administration) was 1.0 hour (IQR from 0.0 to 1.5), and against a pharmacological test – 15.5 hours (IQR from 11.1 to 16.5). At the same time, an adequate alkalization of the gastric environment under pressure of IPP therapy was identified in 12 patients, when the pH level> 4 in the body of the stomach was maintained for 16–17 hours. In 7 patients, pH> 4 was maintained for less than 16 hours, which is a symptom of insufficient antisecretory effect. During this study, no PPI resistance was revealed. The conclusion. Evaluation of the state of the acid-forming function of the stomach with pharmacological tests upon conduct of the 48-hour pH-metry makes it possible to evaluate the antisecretory effect of the used PPI and, thus, to predict the probability of effective eradication.

The article reflects the main statements of the Maastricht V/Florence Consensus Report (2015), dedicated to the diagnosis and treatment of Helicobacter pylori infection and associated with this pathogen gastroduodenal diseases. The above statements of the Consensus Report are illustrated as the original, and their own comments.

The article presents the results of a prospective clinical study in which 100 patients with H. pylori -associated peptic ulcer disease of stomach/duodenum were examined. The aim of the study was to assess the effect of concomitant anamnestic and clinical factors on the efficacy and safety of eradication therapy (ET). Type 2 diabetes mellitus is a factor that significantly reduces the efficiency of ET with OR 0.21 (95% CI 0,06-0,69, p = 0,0102). Using a macrolide antibiotics prior to ET during the previous 12 months is associated with a reduction in the effectiveness of H. pylori eradication with OR 0.27 (95% CI 0,08-0,90, p = 0,0342). Despite the lack of statistical significance observed negative effect on the efficiency of ET factors such as smoking and increased BMI. Smoking, female gender, age over 50 years and the presence of type 2 diabetes mellitus had no significant impact on the safety profile of ET.

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.

It is not for nothing that gastroesophageal reflux disease (GERD) is called the "disease of the XXI century": it is characterized by very high incidence and affects people of different age groups. Increased incidence of adenocarcinoma of the esophagus has led researchers to identify the chain of pathological changes: GERD - Barrett's esophagus - esophageal cancer. The diagnosis of the disease is complicated by atypical extraesophageal manifestations which are often associated with diagnostic errors and inadequate therapeutic measures. This in turn increases the percentage of GERD complications, especially in socially active young patients who usually do not comply with doctor's recommendations concerning lifestyle changes, having as a result a further complication of the disease.

This article examines the preconditions and origins of the competence approach and various approaches to apprehending the essence of competencies: personal, functional, and cognitive. The authors cover the major stages in the making of the competence approach at institutions of higher medical learning.

The article is concerned with the issues of gastroenterology training in terms of already employed or primary retraining gastroenterologists' skills improvement (certification cycles), discusses methodological issues of lecture course materials gathering, discussion sessions, considering age peculiarities, professional background, students' contingent.

Gastroduodenal bleeding may complicate a variety of diseases of the esophagus, stomach, duodenum and hepatopancreatobiliary system. Patient's life ultimatley depends on how well a clinician is informed in modern diagnosis methods and how capable he/she is of making an adequate treatment choice [1].

The clinical example demonstrates several stages of diagnostic search in patients admitted to hospital with severe manifestations of cholestatic syndrome. Due to the presence of alimentary liver cirrhosis and absence of cholelithiasis, cholestasis was evaluated with regard to the underlying disease. However, progressive jaundice against a background of adequate treatment and deterioration of the general condition of the patient forced the doctors to extend the range of diagnostic search. Heterogeneity of results of diagnostic imaging was the major obstacle to the detection of Klatskin tumor.

The paper provides a literature review of an update on the molecular genetic basis of inherited syndromes associated with the development of pancreatic neuroendocrine tumors, such as type 1 multiple neuroendocrine neoplasia, von Hippel–Lindau disease, type 1 neurofibromatosis, and tuberous sclerosis.

To evaluate the efficiency and safety of two eradication therapy (ET) regimens for Helicobacter pylori infection in patients with concomitant chronic hepatitis C (CHC) in relation to the stage of liver fibrosis (LF).A prospective clinical trial was conducted in parallel groups. Group 1 included 50 HCV-negative patients with H. pylori-associated peptic ulcer of the stomach or duodenum; Group 2 consisted of 50 HCV-positive patients with H. pylori-associated peptic ulcer of the stomach or duodenum concurrent with CHC. Each group was divided in 2 subgroups according to the used triple ET (a proton pump inhibitor (PPI) in a standard dose + amoxicillin 1000 mg twice daily + clarithromycin 500 mg twice daily for 10 days) or sequential therapy (PPI in a standard dose + amoxicillin 1000 mg twice daily within the first 5 days and then PPI in a standard dose + clarithromycin 500 mg twice daily + metronidazole 500 mg twice daily for the next 5 days). LF was assessed using indirect elastometry. The efficiency of ET was evaluated by a breath test (after 4 weeks) and an analysis depending on intention-to-treat (ITT) and per-protocol (PP) treatments. A patients recorded adverse events in specially developed diaries.The efficiency of ET was 74% (ITT) and 80.4% (PP) in Group 1 and 76 (ITT) and 79.1% (PP) in Group 2. Both groups displayed a tendency towards an 11.9-12.4% increase in the efficiency of the sequential therapy versus the classical triple (PP) one. The rate of totally found side effects was 20% in Group 1 and 28% in Group 2. During sequential therapy, the rate of side effects was lower than that during the classical one. The efficiency of ET did not significantly depend on the stage of LF. Only the presence of concomitant type 2 diabetes mellitus and the use of macrolides (12 months before treatment) significantly lowered the efficiency of ET (OR 0,21; 95% CI 0,06-0,69, p=0,0102 and OR 0,27 95% CI 0,08-0,9, p=0,0342). LF regardless of its magnitude significantly determined the risk of adverse events during ET (OR 3,33 95% CI 1,19-9,31, p=0,0217). A group at the highest risk of adverse events included patients with liver cirrhosis (OR 4,87; 95% CI 1,01-23,5, p=0,0492).It is appropriate to prescribe a sequential ET regimen as more effective and safe for patients with concomitant CHC during therapy for H. pylori infection-associated diseases. LF increases the risk of adverse events during ET.Цель исследования. Оценка эффективности и безопасности двух схем эрадикационной терапии (ЭТ) инфекции Helicobacter рylori у пациентов с сопутствующим хроническим гепатитом С (ХГС) в зависимости от стадии фиброза печени (ФП). Материалы и методы. Проведено проспективное клиническое исследование в параллельных группах. В 1-ю группу вошли (HCV–) 50 пациентов с ассоциированной с H. pylori язвенной болезнью (ЯБ) желудка/двенадцатиперстной кишки (ДПК), во 2-ю (HCV+) - 50 пациентов с сочетанием ассоциированной с H. pylori ЯБ желудка/ДПК и ХГС. Каждая группа разделена на 2 подгруппы в зависимости от назначаемой схемы ЭТ: трехкомпонентная (ингибитор протонного насоса - ИПН в стандартной дозе + амоксициллин 1000 мг 2 раза в день + кларитромицин 500 мг 2 раза в день 10 дней) или последовательная (первые 5 дней: ИПН в стандартной дозе + амоксициллин 1000 мг 2 раза в день, последующие 5 дней: ИПН в стандартной дозе + кларитромицин 500 мг 2 раза в день + метронидазол 500 мг 2 раза в день). Фиброз печени (ФП) оценивали методом непрямой эластометрии. Эффективность ЭТ определяли при дыхательным тесте (через 4 нед) с проведением анализа в зависимости от назначенного лечения (intention-to-treat - ITT) и от полученного лечения (per-protocol - PP). Побочные явления регистрировались пациентом в специально разработанных дневниках. Результаты. В 1-й группе эффективность ЭТ составила 74% (ITT) и 80,4% (PP), во 2-й группе - 76% (ITT) и 79,1% (PP). В обеих группах отмечалась тенденция к большей эффективности последовательной терапии по сравнению с классической трехкомпонентной на 11,9-12,4% (РР). Частота суммарно выявленных побочных эффектов составила 20% в 1-й группе и 28% во 2-й. При применении последовательной ЭТ частота побочных эффектов оказалась ниже, чем при классической. Эффективность ЭТ достоверно не зависела от стадии ФП. Только наличие сопутствующего сахарного диабета 2-го типа и использование макролидов (за 12 мес до лечения) достоверно снижали эффективность ЭТ. Наличие ФП независимо от выраженности достоверно определяло риск развития побочных явлений на фоне ЭТ. К группе с максимальным риском развития побочных явлений относились пациенты с циррозом печени. Заключение. Пациентам с сопутствующим ХГС в рамках терапии заболеваний, ассоциированных с инфекцией H. pylori, целесообразно назначать последовательную схему ЭТ как более эффективную и безопасную. ФП увеличивает риск развития побочных явлений на фоне ЭТ.

Intrahepatic cholestasis of pregnancy (ICP) is a relatively benign cholestatic pathology of the liver developing in II or III trimester of pregnancy and characterized by itchy skin and enhanced serum bile acid levels. The cause of ICP is unknown; it may have a multifactor nature involving genetic (ABCB4, EXR, ABCC2 genes), hormonal (estrogens, progesterone), and environmental factors. As a rule, ICP first manifests itself on weeks 28-30 of pregnancy in the form of pruritus especially pronounced at night time. Almost half of the patients develop jaundice, usually within 1-4 weeks after appearance of pruritus. The enhanced serum bile acid level is sometimes the first or the sole laboratory sign of the disease. Ursodeoxycholic acid is currently the drug of choice for the treatment of ICP due to its confirmed effectiveness and safety.

Current clinical practice lays special emphasis on drug interactions. High rates of cardiovascular morbidity and acid-dependent diseases dictates the necessity of antiaggregation and antisecretory therapy. The former uses a variety of medicines with acetylsalicylic acid (ASA) and clopidogrel being the most popular ones. Therapy using drugs with different mechanisms of action on the thrombocytic component of homeostasis appears to be especially promising as having synergic antiplatelet effect. The most common variant of antiplatelet therapy is a combination of ASA and clopidogrel usually referred to as double antiplatelet therapy (DAP). Current consensus recommends intake of proton pump inhibitors (PPI) during DAP to reduce the risk of gastrointestinal complications. However, recent studies showed that this approach is fraught with severe cardiovascular disorders, such as myocardial infarction, stroke, unstable angina, necessity of repeat coronary interventions, and coronary death. Hence, the importance of differential application of PPI in patients treated with ASA and clopidogrel. A comprehensive review of this problem is presented along with results of investigations of PPI action on clinical outcome of clopidrogel therapy.

This article presents main principles of chronic gastritis treatment. Therapeutic abilities and possible side-effects due to components of antacids are analyzed. Special attention is paid to antisecretory and cytoprotective activity of Pepsan-R, which contains haiasulen (the main active component of chamomilla) and dimeticon. The authors of the article emphasize opportunity of using Pepsan-R in case of heartburn, gastric pain, abdominal distention during pregnancy and lactation.

Patients with gastric and duodenal ulcer, in who never had the typical complaints, and anamnestic data about pathology of biliary system were examined. More than one third of the biliary sludge was found. Finding dates demonatrate an appearence of hypokinetic biliary dysfunction in patients with gastric and duodenal ulcer. The received results indicate the for necessity of obligatory ultrasonic research for the purpose of revealing biliary dysfunctions in patients with gastric ulcer; subsequent dynamic supervision and preservation of pathological changes to prevente cholelithiasis.

The article describes the clinical picture and particular features of the diagnostics of the neoplastic process with uncommon localization--intestinal adenocarcinoma. The authors present their own observations.