The aim. To present the review of literature data for state-of the art of occult (latent) hepatitis B virus (HBV) infection in the modern world.

Recent literature data. A phenomenon of latent infection HBV is related  mainly to intrahepatic persistence of viral cccDNA and severe suppression of viral replication and expression of viral antigens. Taking into account very low level of DNA HBV its detection requires very sensitive serological and specific molecular biology methods. Inhibition of HBV replication is reversible and latent infection can turn into acute which, as a rule, progress very severely. At infestation by hepatitis B virus from subjects with latent course of HBV-infection (at hemotransfusion or transplantation of organs and tissues) acute hepatitis can develop as well. Due to persistence of virus moderate progressing necroinflammatory reaction in liver tissue is observed, which for a long time can (even at the absence of other causes) result in liver cirrhosis. Besides this, the latent HBV-infection has oncogenic properties, that are characteristic for classical, «manifestative» infection, and thus it is an important risk factor for hepatocellular carcinoma development.

Conclusion. Studying of the issues related to latent course of hepatitis B virus infection, has the important value for definition of management of such patients. At the moment there are no clear references concerning terms of follow-up, and no fixed criteria for onset of antiviral therapy, its validity, duration and evaluation of results.

The aim of review. To analyze literature data on definition of hepatopulmonary syndrome (HPS), its diagnostics, pathogenesis, features of clinical presentation and treatment options.

Recent literature data. HPS is complication of liver diseases, leading to disorders of perfusion in lungs and decrease of blood oxygenation. Diagnostics of this syndrome requires triad of signs: chronic liver disease, dilation of intrapulmonic vessels, decrease of arterial blood oxygenation. For the present time the concepts of causes and pathogenesis of pulmonary vasodilatation and disorders of blood gases composition at HPS are still inconsistent.

Conclusion. Up to now the definite algorithm of diagnostics and management of patients with HPS is not developed.

The aim. To give the characteristic of liver failure in patients of multipurpose hospital according to the data of retrospective investigation.

Methods of investigation. 357 inpatients with major liver failure (MLF) were investigated.

Results. Most frequently MLF developed on background of liver cirrhoses (235 person, 65,8%) and acute hepatites (91 person, 25,5 %). By clinical and pathogenetic features four MLF types were defined: acute/ chronic it was recorded in 46,1 % of patients, mixed – at 20,2 %, including hepatorenal – in 12,0 %, fulminant – in 18,3 % and chronic – in 15,4 %, including portosystemic encephalopathy – in 8,1 %. Besides, probably previously unknown MLF variant was described – persistent relapsing hepatogenic hypnargy (5 patients) which was characterized by "quiet" relapsing coma of substantial duration. At 28 patients albumin dialysis on MARS device was applied. It appeared effective in 9 of 13 patients with fulminant MLF and less effective in 5 of 15 - with acute/ chronic MLF. At one patient chronic albumin dialysis was carried out for one year. Without liver transplantation mortality was at acute/chronic MLF 92,7 %, mixed – 81,9%, at fulminant –  69,9%, at chronic – 65,5%.

Conclusion. The major liver failure in general is a very severe complication of liver diseases with high mortality. The further studies devoted to increase of treatment efficacy of such patients are required.

Aim of investigation. To study markers of hepatitis B and C viruses at inpatients and blood donors.

Stuff and methods. At A.A.Vishnevsky Central Military Clinical Hospital 118299 patients admitted in 2001-2005 were investigated without any pre-selection. For all patients surface hepatitis B antigen – HBsAg («DS-IFA-HBsAg», Russia, Nizhny Novgorod; MONOLISA® HBsAg-ULTRA BIO-RAD, France) and antibodies to hepatitis C virus («IFA-ANTI-HCV», Russia, Nizhny Novgorod; MONOLISA® HCV Ag-Ab-ULTRA BIORAD, France) were assessed. Aminotransferases and bilirubin levels have been studied.

Results. Anti-HCV was found in 3,60%, HBsAg – at 1,94% of patients. Comparison to data of 1992–1994 give 2,7 fold decrease for anti-HCV at inpatients, and 6,4 fold – for HBsAg. For 2001–2005 decrease in antiHCV concentration is marked for both inpatients and donors, that for HBsAg – only for blood donors. Change in concentration of viral hepatitis markers at inpatients and donors correlates to number of investigated subjects and lethal outcomes of viral liver cirrhoses.

Conclusion. 1225 inpatients (2005) – all «owners» anti-HCV or HBsAg were divided into three groups. The first – 272 persons (22,2%) included patients with proved liver diseases, the second – 363 persons (29,6%) included patients with probable diseases (elevation of ALT and/or AST activity, bilirubin contents) and the third – 590 person (48,2%) – with presumed absence of diseases (normal blood enzymes activity). The second group is 1,33 times larger than the first and deserve special attention as comprising probable candidates for antiviral treatment. All patients with the revealed markers of hepatitis viruses were divided to «owners» and «carriers».

Aim of investigation. Effect of moderate doses of alcohol (21–39 g of ethanol/day) on the course of chronic hepatitis C (CH C) and results of antiviral therapy by pegilated interferon-alpha-2а (PEG-IFN-α-2а) in combination to ribavirin were estimated.

Stuff and methods. Forty seven patients with chronic hepatitis C that have been distributed in 2 groups were included to original study. The group 1 has consisted of 21 patients, suffering of CH C with the alcohol burden in past history. This group included 15 men and 6 women in the age from 19 to 52 years (average 33,3±10,8), of them 12 had genotype 1 HCV, 9 – genotype 3. Group 2 included 26 patients who did not take alcohol or did it incidentally in small doses. Of them 18 were men and 8 — women in the age of 19 to 58 years (average 36,5±11,04), of them 17 had genotype 1 HCV and 9 – genotype 3. The dose of alcohol in milliliters per day was recalculated to grams by Widmark formula. All patients underwent needle liver biopsy with evaluation of histological activity index (HAI) and index of fibrosis (IF).

Results. In CH C patients, taking medium doses of alcohol (21–39 g of ethanol/day), activity of serum transaminases and g-glutamyltransferase (GGT) was significantly higher, than in patients that either did not take alcohol, or drink incidentally in small doses. However, there were no statistically significant differences between groups by HAI and IF. No significant difference was revealed on efficiency and tolerability of therapy as well. Frequency of late relapses after combined antiviral treatment PEG-IFN-α-2а/ribavirin was 5% and it does not depend on alcoholic abuse in past history of patient. Only two factors had effect on the rate of sustained virologic response (SVR) – virus genotype and presence of early virologic response (EVR).

Conclusion. Results of the original investigation give no testimony for complete abandoning of alcohol use by patients with chronic hepatitis C and not having alcohol or narcotic addiction.

Aim of investigation. To estimate relation of interleukin-6 (IL-6) level in blood serum of patients with chronic hepatitis C (CHC) with features of clinical course, degree of fibrosis and level of cytochrome Р450 expression in liver for prognosis assessment.

Stuff and methods. Overall 124 patients at different stages of CHC were investigated with assessment of IL-6 level in blood serum. In 36 patients cytochrome Р450 of isoform CYP2E1 gene expression was studied in liver tissue at biopsy samples.

Results. Patients with progression of liver fibrosis had high levels of IL-6 in blood serum and decrease of cytochrome Р450 gene expression in hepatocytes, that positively correlated to degree of liver fibrosis and rate of its progression.

Conclusion. According to multifactor discriminant analysis elevation of IL-6 in blood serum of CHC patients is independent factor of liver fibrosis progression as well as the age and renal disease.

Aim of investigation. To analyze the state of intestinal microflora in patients with ulcerative colitis (UC) and healthy persons with the help of two methods - bacteriological investigation and application of fixed stained preparation developed on special technology for direct microscopy.

Stuff and methods. Using two above-mentioned methods 200 persons were investigated, of them 150 patients with UC and control group - 50 healthy persons. 400 specimens were studied.

Results. In patients with UC in comparison to healthy people changes in concentration and frequency of occurrence of basic and facultative flora were detected by bacteriological method. In microbial landscape it was not possible to define leading species of microorganisms in quantitative aspect that indicates instability of microbial assembly. Comparative analysis of obtained data has allowed to determine basic morphotypes of microbes of intestinal microflora, their quantity, interrelation of grampositive and gram-negative microflora, as well as sizes of microbial cells, diversification and predominance of fixed morphotypes in UC patients.

Conclusion. Method of direct microscopy of native biosubstrate has revealed new criteria for evaluation of disorders of intestinal microflora at patients with UC. Direct visualization of microflora of large intestinal lumen can provide information on relation of microbial coenosis with state of large intestine. The direct bacterioscopy allows better standartization and reproduction, than routine culture.

The aim. To show the role of hydrochloric acid in development of esophageal mucosa changes in patients with gastroesophageal reflux disease (GERD).

Recent literature data. Data of various studies testify the damaging effect of hydrochloric acid, pepsin, bile acids, oxidative stress on mucosa of esophagus that results in development of GERD.

Conclusion. Development of painful sensations in patients with GERD can be related to direct action of hydrochloric acid on damaged mucosa (at erosive form), and hypersensitivity of mucosa to hydrochloric acid (at non-erosive form). 

The aim of review. To describe basic mechanisms of abdominal pain pathogenesis and approaches to its treatment.

Recent literature data. Abdominal pain is the most frequent symptom of gastroenterological diseases having characteristic clinical manifestations, the specific causes and mechanisms of development. Article discusses mechanisms abdominal pain, its classification and differential diagnostics. Spasm of smooth muscles of gastro-intestinal wall, esophagus, biliary and pancreatic ducts serves as a general pathophysiological equivalent of chronic abdominal pain. It explains a choice of spasmolytics as effective drugs for pain relief.

Conclusion. Abdominal pain should not remain outside therapeutic and diagnostic process of doctors of any specialities. The correct comprehension of its mechanisms, careful propedeutic approach to finding basic characteristics of pain will allow to direct differential search to the necessary route and to assist patient in time.

The aim of review. To present proceedings about the causes and features of treatment of a pain syndrome at chronic pancreatitis.

Recent literature data. Despite of significant successes achieved in diagnostics and pharmacotherapy, the problem of chronic pancreatitis falls into to number of the most complex sections of clinical gastroenterology. In pancreatitis patients abdominal pain syndrome is almost obligatory component of disease and is present in 85–95 % of the cases. Therapy of abdominal pain as one of most difficultly relieved syndromes of chronic pancreatitis is an uneasy problem due to virtue of objective complexities related to its multifactorial pathogenesis, and due to a wide range of therapeutic options. Now for patients with chronic pancreatitis comprehensive approach for relief of abdominal pain syndrome is applied. From the viewpoint of pathogenic mechanisms the special attention is given not only to spasmolytic, but also to enzyme therapy.

Conclusion. Enzyme therapy at chronic pancreatitis is applied not only as supplementation treatment, but also to relief abdominal pain syndrome by inhibition of pancreatic secretion and to promote  physiological rest for pancreas.

The aim. To share experience of patient management with persistent hepatitis C virus infection at different stages of liver damage.

Clinical cases data. 3 clinical cases of antiviral therapy at «difficult-to-treat» patients with various forms of HCV-infection are presented. Presented cases include: 1-st genotype HCV, two previous ineffective attempts of antiviral therapy and successful prolonged course; with decompensated liver cirrhosis; 1-st virus genotype and metabolic syndrome. Features of such patient management are demonstrated.

Conclusion. The choice of optimal medical tactics should base on virologic characteristic, stage of hepatitis, presence of concomitant diseases, efficacy of previous courses of antiviral therapy and on specific personal features of patient and his/her tuning on coping with disease. There is no doubt, that individual approach will allow to improve essentially treatment results in many cases.

The aim. To demonstrate successful treatment of severe form of acute alcohol-induced hepatitis on background of complete abstinence.

Clinical case features. Female patient with alcohol-induced liver cirrhosis after drinking-bout developed acute alcohol-induced hepatitis (AAH), spontaneous bacterial peritonitis (SBP) with intense ascites, severe depression of liver function (prothrombin ratio of 25%), encephalopathy (coma I), acute adrenal failure, hypothyroidism. As a result of treatment: abstinence, injections of albumin, ofloxacin, intake of neomycin, spironolactone and therapy by cortisone and cortineff – it was possible to restore function of the liver, to reduce essentially manifestations of AAH and SBP, acute adrenal failure, hypothyroidism. After discharge, at continuing abstinence, the state went on to improve. In 10 months mild ascites and elements of adrenal insufficiency have disappeared, spironolactone and cortineff were cancelled. Patient has started to work. The subsequent follow-up for 7 years.

The aim of review. Discussion of the 15-th United European Gastroenterology Week reports (15-UEGW), devoted to chronic hepatitis C.

Recent literature data. In the reports submitted to 15-th UEGW, the basic attention was given to study of factors affecting efficacy of antiviral therapy, to development of methods, predicting treatment response in early terms, to search of the routes of improvement of its results.

Conclusion. According to the majority of reports, up-to-date modes of antiviral therapy are quite effective, and available methods allow to predict the virologic response to treatment.