Aim. To present practical guidelines on management of patients with chronic hepatitis B (CHB).

Original positions. Guidelines on support of patients ХГВ have been developed by the American association for the study of liver with involvement of general practitioners and other experts in public health services related to this problem. Presented guidelines base on the recent advances of the global science and practice in diagnostics, treatment and prevention of hepatitis B virus infection (HBV). They include the following sections: investigation of patients with chronic HBV-infection; prevention of HBVinfection; patient management with chronic HBV-infection and treatment of patients with chronic hepatitis B.

Conclusion. Presented recommendations allow internists to use optimally achievements in the treatment of chronic HBV-infection.

Aim of the review. To emphasize problem of digestive organs lesion at metabolic syndrome from clinical, laboratory, instrumental and morphological points of view.

The recent literature data. Data on presented problem published in the last years in scientific literature testify interlinking of metabolic syndrome to typical gastroenterological manifestations – steatosis of the liver and pancreas, chronic pancreatites, cholelithiasis, cholesterosis of the gallbladder. The basic role in development of metabolic disorders with insulin resistance syndrome is supposed, on one hand, to steatosis of the liver and pancreas and, on the other hand, to hyperinsulinemia, hyperglycemia, dyslipidemia and microcirculation disorders, that aggravate gastroenterological problems. In the author’s opinion, inflammation, intimately conjugated to development of steatohepatitis, steatopancreatitis, choledocholithiasis, intestinal endotoxemia, concomitant diseases and their complications (mainly obesity, that is obligatory for metabolic syndrome) is the trigger of comorbid digestive pathology progression at metabolic syndrome.

Conclusion. Changes of digestive organs, characteristic for metabolic syndrome, are not only secondary by their origin, but also promote further progression of this syndrome and development of complications, closing vicious pathogenic circle.

Aim of investigation. To study pathogenic aspects of irritable bowel syndrome clinical types.

Methods. Sixty patients with irritable bowel syndrome (IBS), divided in two peer groups, were investigated. Patients of the first group had irritable bowel syndrome with predominance of constipation (IBSc), patients of the second group - with predominance of diarrhea (IBSd). The control group included virtually healthy 12 persons. Patients were inspected dynamically, in relapse period and in the phase of remission according to standardized program that included clinical, endoscopic, morphological and immunohistochemical tests.

Results. It was found, that IBSc development is related to hyperplasia and hyperfunction of serotoninproducing cells on a background of decreased amount and functional activity of vasoactive intestinal peptide (VIP) synthesizing cells and decreased number of mast cells. Thus there is a statistically significant increase of proliferative activity of colonocytes, revealed by the number of epithelial cells, immune positive to cyclin D1, and compensatory increase of apoptotic activity. For patients with IBSd increase of number and function activity of total population of APUD-cells, serotonin, melatonin, VIP-producing and mast cells, decrease of amount of cyclin D1-positive colonocytes, proliferating cell nuclear antigen, and increase of apoptotic activity of epithelial cells of large intestinal mucosa (LIM) were noted. More considerable changes of diffuse endocrine system in IBSd patients cause progression of colonocyte regeneration changes with rapid development of LIM atrophy, serving as a background for carcinogenesis.

Aim of investigation. Improvement of medical tactics at irritable bowel syndrome (IBS) on the basis of comparative evaluation of clinical efficacy and effect of various pharmacological groups of spasmolytics on visceral sensitivity.

Methods. Overall 180 patients were separated into 3 groups, 60 persons in each, in relation to applied antispasmodic drug (hyoscine butylbromide 60 mg per day, or mebeverine 400 mg per day, or pinaverium 300 mg per day). Each group included 3 subgroups of 20 persons: IBS with predominance of constipations; IBS with predominance of diarrhea; IBS with predominance of pain and meteorism. Before 2-week course of treatment intensity of pain was estimated by visual-analogue scale for abdominal pain. For objectification of data on pain syndrome balloon-dilatation test was used.

Results. At IBS with predominance of a diarrhea cholineblocker has completely removed pain in 70% of patients, at IBS with predominance of constipations the sodium channels blocker has stopped pain in 65% of cases, at IBS with predominance pains and meteorism calcium channels blocker has removed pain in 40% of patients. Used drugs had no statistically significant effect on frequency of bowel movements and meteorism. At IBS with predominance of diarrhea cholineblocker has resulted in normalization of pain threshold in 65% of patients. In predominance of constipation sodium channels blockers appeared to be more effective (the normalization was achieved in 50% of patients), and at IBS with predominance pains and meteorism – calcium channels blockers (normalization in 55% of patients).

Conclusions. Cholineblockers, sodium and calcium channels blockers eliminate pain and reduce visceral sensitivity for the majority of patients with various clinical variants of IBS.

Aim of investigation: to study features of blood circulation in mucosa of the anal channel in patients with hemorrhoids complicated by bleeding and anemia, to estimate changes of blood flow at correction of anemia in pre- and postoperative periods for defining optimal conditions and terms for radical surgery.

Methods. Overall 26 patients – 12 men and 14 women, aged 27 to 86 years were investigated by laser Doppler flowmetry (LDF) with application of LAKK01- analyzer. The level of hemoglobin was 38–101 g/l, severe anemia (Нb under 70 g/l) was detected in 10 patients. Number of recordings: 67 points of record in projections of internal hemorrhoids at 3, 7 and 11 hours. LDF was carried out in various terms before hemorrhoidectomy and in the postsurgical period. Results. The severity of anemia determines type and severity of microcirculation disorders and trophicity of tissues. Improvement of blood flow scores on a background of successful anemia correction and local treatment in pre-and postoperative periods in patients with Нb level over 90 g/l was detected.

Conclusions. Initial severe disorders of anal mucosa trophicity should be taken into account at treatment tactics choice for patients with hemorrhoids complicated by bleeding and anemia, and at decision on terms of surgery.

Aim of investigation. Improvement of functional, long-term results of treatment and quality of life of patients with mid-ampullar rectal cancer by substantiation and development of method of low anterior resection (LAR) of rectum with total mesorectumectomy (TME).

Methods. The experimental investigation stage included series conducted on non-purebred dogs. In clinic 33 patients underwent surgery according to original method. Results. Adequacy of blood supply to rectum stump by aa. rectales caudales after simultaneous switching off a. rectalis cranialis and aa. rectales mediales at TME was detected. In clinical practice it was possible to decrease frequency of locoregional relapses of cancer from 30,8±9,2% in control group to 9,4±5,2% – in the main group (р<0,05) and to increase number of patients with 5-year relapse-free survival rate from 42,3±9,9 to 71,9±8,0% respectively (р><0,05). Conclusions. Developed LAR method with TME has allowed to improve function and long-term results of treatment, as well as the quality of life of patients with cancer of mid-ampullar region of the rectum>< 0,05) and to increase number of patients with 5-year relapse-free survival rate from 42,3±9,9 to 71,9±8,0% respectively (р<0,05).

Conclusions. Developed LAR method with TME has allowed to improve function and long-term results of treatment, as well as the quality of life of patients with cancer of mid-ampullar region of the rectum.

Aim of the review. To define symptomatic gastroduodenal ulcers (SGDU), to demonstrate necessity of their timely diagnostics, treatment and prophylaxis according to presented data.

The recent literature data. Gastroduodenal ulcers can be a manifestation not only of peptic ulcer disease with its complex polyetiologic nature. In contrast to the latter, SGDU are secondary lesions intimately related in pathogenesis to other background diseases or extreme effects. For such ulcers it is typical that one factor or group of pathogenic factors break the balance between aggressive and protective mucosal factors, becoming leading in ulcerogenesis. Differential diagnostics with peptic ulcer disease is a difficult challenge. For symptomatic ulcers the cause should be revealed. For SGDU multiplicity of ulceration, localization at the stomach outlet, frequency of asymptomatic course and tendency to bleedings are typical. Surviving of patients after extensive surgeries and traumas, acute disorders of vital body functions, maintaining of life of patients with severe somatic diseases can result in development of gastroduodenal ulcers and death of massive erosive-ulcerative gastroduodenal bleeding even at successful treatment of the basic disease. Treatment and prophylaxis of SGDU in many respects depend on their type and presence of complications. For patients with uncomplicated ulcers, first of all, it is necessary to treat actively the primary disease and its complications, and to eliminate the causes of ulceration as well. Antiulcerative treatment taking into account specificity of ulcerogenesis should be carried out simultaneously. Medical algorithm at bleeding SGDU differs slightly from that at bleeding ulcers in patients with peptic ulcer disease.

Conclusion. Symptomatic ulcers are the secondary ulcers pathogeneticly linked to other diseases of internal organs. They should be differentiated from peptic ulcer, it is necessary to define the basic ethipathogenic factor and develop management algorythm on this basis.

The program and up-to-date indications to ultrasound investigation (US) of abdominal cavity are developed on the basis of literature data and original investigation of about 20 000 patients. Indications to investigation include typical complaints of patient, data of past history, results of physical investigation (inspection, percussion, palpation and auscultation), changes of laboratory parameters, clinical assumptions, general problems of diagnostics, verification of other methods data. Article presents additional prospects of US and perspectives to broaden indications to this abdominal US.

Aim of the review. Discussion of reports of 15-th United European Gastroenterological Week, devoted to irritable bowel syndrome (IBS).

Obtained data. In reports devoted to the problem of IBS, main attention was paid to the possible pathogenetic components of the disease (first of all, to intestinal gas transport disorder, intestinal microflora state, inflammatory changes of large intestinal mucosa), to combination of IBS to other diseases of gastro-intestinal tract, optimization of treatment methods.

Conclusion. High number of the reports devoted to inflammatory changes of large intestinal mucosa, proves gradual gliding away from assessment of IBS as purely function disease