The aim of review. To give pathogenic substantiation to application of proton pump inhibitors in chronic pancreatitis (CP).

Recent literature data. At the last years CP is referred to acid-related diseases because low efficacy of treatment without additional stomach secretion inhibition. Prescription of gastric secretion inhibitors interrupts one of the mechanisms of pancreatic stimulation mediated by acidification of duodenum. Decrease of pancreatic secretory output with decrease of volume of pancreatic juice and concentration of enzymes results in reduction of ductal and tissue pressure and thus decrease edema and/or painful sensations. At patients with exocrine pancreatic insufficiency on a background of lower bicarbonate secretion acidification of duodenum increases risk of pancreatitis attack, caused by hyperexpression of secretin by S-cells. This can also aggravate exocrine pancreatic failure due to inactivation of both endogenous and exogenous pancreatic enzymes. Therefore application of antisecretory drugs reduces endogenous enzymes deficiency and increases efficacy of enzyme supplementation therapy.

Conclusion. Proton pump inhibitors concern are drugs of choice for treatment of chronic pancreatitis due to their good safety profile and long-lasting suppression of gastric acid production, potential of their long-term and safe application. The most efficient agent used in complex therapy of CP, is rabeprazole.

Aim of investigation. To study clinical and morphological pattern of Barret’s esophagus to improve its diagnostics and prognosis of neoplastic transformation.

Stuff and methods. 120 patients with gastroesophageal reflux disease (GERD) have been enrolled to the study. Investigation included polypositional X-ray of esophagus and stomach, esophagogastroduodenoscopy, 24-hour рН monitoring in esophagus and the stomach, morphological and immunohistochemical investigation of esophageal mucosa biopsies. Immunohistochemical investigation consisted of assessment of grade of apoptosis, proliferation, differentiation of epithelial cells of esophagus and expression of tumor marker р53 on a background of proton pump inhibitors (PPI) therapy. Statistical analysis was carried out by software pack «SPSS 13 for Windows».

Results. Frequent (in 64% of cases) development of cylindrical metaplasia of esophageal epithelium at erosive GERD (in 46% – gastric, in 18% – intestinal) was revealed. As a rule, the intestinal metaplasia of epithelium was incomplete with development of dysplasia, mainly of low grade on its background (75%). In one case on a background of high grade dysplasia adenocarcinoma has been diagnosed. Intestinal metaplasia and dysplasia were diagnosed more often in males and males/females ratio has made 5,5:1 (at dysplasia and neoplastic transformation — 9:1). Comparative analysis of clinical pattern of Barret’s esophagus and erosive esophagitis has not revealed significant differences of basic symptoms (intensity and frequency of heartburn, odynophagia, regurgitation). For Barret’s esophagus long (mean 5–14,5 years; р=0,008) and frequently relapsing course of GERD (r=0,4; р=0,01) was typical. Prevalence of smoking was higher (р=0,05) at intestinal metaplasia of epithelium (67%), than at gastric metaplasia (38 %) and uncomplicated reflux disease (35 %). Development of intestinal metaplasia and dysplasia in esophagus was accompanied by rise of apoptotic index and proliferation (р<0,05). At dysplasia of high degree and in adenocarcinoma specimens apoptotic index decreased, and proliferation continued to grow. р53 protein was not detected in multilayer squamous epithelium and at gastric metaplasia, it was found at some cells at intestinal metaplasia. Its expression was essentially increased at dysplasia and was maximal in adenocarcinoma (р><0,05). On background of PPI treatment decrease of proliferation in all types of epithelium of esophagus and suppression of apoptosis in multilayer squamous and gastric epithelium was observed. At intestinal epithelium apoptotic index grew, that correlated to esophageal mucosa inflammation degree. Conclusions. According to our data, prognosis of Barret’s esophagus development at the background of GERD is based on the set of factors: male gender, age over 50 years, relapses of erosive esophagitis several times per year, past history of GERD for more than 5 years, smoking. Increase of proliferative activity, р53 expression and decrease of apoptotic index can serve as markers of high risk of neoplastic transformation on a background of dysplasia of Barret’s esophagus epithelium.><0,05). At dysplasia of high degree and in adenocarcinoma specimens apoptotic index decreased, and proliferation continued to grow. р53 protein was not detected in multilayer squamous epithelium and at gastric metaplasia, it was found at some cells at intestinal metaplasia. Its expression was essentially increased at dysplasia and was maximal in adenocarcinoma (р<0,05). On background of PPI treatment decrease of proliferation in all types of epithelium of esophagus and suppression of apoptosis in multilayer squamous and gastric epithelium was observed. At intestinal epithelium apoptotic index grew, that correlated to esophageal mucosa inflammation degree.

Conclusions. According to our data, prognosis of Barret’s esophagus development at the background of GERD is based on the set of factors: male gender, age over 50 years, relapses of erosive esophagitis several times per year, past history of GERD for more than 5 years, smoking. Increase of proliferative activity, р53 expression and decrease of apoptotic index can serve as markers of high risk of neoplastic transformation on a background of dysplasia of Barret’s esophagus epithelium.

Aim of investigation. To specify concept of Barrett’s esophagus (BE) from oncology viewpoint and to estimate its relation to some complications of gastroesophageal reflux disease (GERD)

Stuff and methods. Article presents comparative data of endoscopic and morphological investigations for 168 patients with suspicion for BE. The protocol of endoscopy included application on mucosa of esophagus of 1,5% acetic acid solution, chromoesophagoscopy with Lugol’s iodine solution and methylene dark blue, inspection in NBI regimen with magnification, and combined procedures.

Results. Of 168 patients incomplete intestinal metaplasia (IM) of squamous epithelium proximal from cardioesophageal transition was revealed only in 21,4%. Other types of epithelium were found at esophagus in rest: complete IM of squamous epithelium, IM of cardial or fundal epithelium, gastric types of epithelium without IM. The majority (36,8%) of so-called «ultrashort BE» cases were presented by IM of cardia epithelium. Various stages of BE neoplastic transformation (mild, moderate and severe dysplasia, adenocarcinoma) were most frequently revealed on the background of IM of squamous epithelium. Cumulative frequency of GERD complications, such as ulcers, erosions and scars of esophagus at IM of squamous epithelium, was 42,1% that does not allow to assume clear association of BE and these forms of reflux disorders of esophagus.

Conclusions. BE as a facultative premalignant state should include only the cases of incomplete IM of squamous epithelium of esophagus. No direct link of BE and of its stages of neoplastic transformation with other complications of GERD was revealed in the study.

Aim of investigation. To study interrelation of a gastroesophageal and laryngopharyngeal reflux (LPR) with chronic larynx diseases.

Stuff and methods. 47 children in the age of 6 to 16 years with acquired scar stenosis of larynx (11), vocal folds nodules (17) and relapsing respiratory papillomatosis (19) were investigated. The reflux disease was diagnosed by original procedure of рН-monitoring at which electrodes were positioned in a laryngopharynx, middle and lower thirds of esophagus. Results. At typical low frequency of clinical symptoms various variants of reflux disease were determined at 42 (89,3%) children: gastroesophageal reflux disease (GERD) in combination to laryngopharyngeal reflux (LPR) – at 26 (55,3%), isolated LPR – at 15 (31,9%), isolated GERD – at 1 (2,1%). In patients with isolated LPR pH-metry data in laryngopharynx proved lower severity of acidic refluxes in comparison to combined GERD and LPR. At scar stenosis of larynx and vocal folds nodules refluxes episodes with рН <4,0, including ones longer then 5 min in esophagus, occurred more frequently in comparison to relapsing respiratory papillomatosis (р><0,05 – р><0,05). The similar trend of pH-metry figures was in laryngopharynx, but with absence of significant differences (р>0,05 – р>0,05).

Conclusion. Various variants of reflux disease are characteristic attributes of chronic larynx diseases. In the case of isolated LPR protective alkalizing mechanism of the esophagus often succeeds. For chronic larynx diseases it is reasonable to include 24-hour рН-monitoring to investigation plan of children with esophagus and laryngopharynx electrodes placement. Potential involvement of LPR in pathogenesis of chronic diseases of larynx requires further studies.

Aim of investigation. To increase efficacy of antihelicobacter therapy and improve cellular homeostasis of epithelial cells of stomach mucosa (SM) in patients with peptic ulcer of duodenum (PUD).

Stuff and methods. 172 patients were investigated: 100 of them had PUD, 30 – chronic non-atrophic gastritis (CNG), 30 – chronic atrophic gastritis (CAG) and 12 generally healthy persons. Only patients with Н. pylori infection proved by morphological investigation of the stomach mucosa were included in PUD, CNG, CAG groups. PUD patients were separated into 2 equal groups: in the first group eradication H. pylori was carried out according to established 7-day’s mode with application of omeprazole on 20 mg bid, clarithromycin 500 mg bid and amoxicillin 1000 mg bid, in the second group taurine 500 mg bid was added to conventional algorithm of eradication. Then the first group continued to receive omeprazole for 6 wks followed by maintenance therapy. The second group has continued treatment by omeprazole in combination to taurine for 6 wks, and then – maintenance therapy. Comparison groups have been presented by patients with CNG, CAG and practically healthy persons. Along with endoscopy control in 2 and 4 wks for all patients with CNG and PUD regulatory molecules (Ki67, Bcl2) and apoptotic activity of antral epithelial cells prior to treatment and in 6 wks after Н. pylori eradication was studied.

Results. At patients with CNG slight increase of apoptotic activity of stomach epithelial cells was determined and proportionally – expression Ki67 and Bcl2. CAG development is pathogenically related to high proliferative and antiapoptotic activity of epithelial cells of the stomach mucosa at moderate increase of their apoptotic potential. CAG and CNG are complicated by PUD at significant increase of apoptotic potential of epitheliocytes. Н. pylori eradication in patients with PUD reduces proliferation of SM epithelial cells and – in higher degree – their apoptotic activity. It is known, that addition of taurine to eradication therapy algorithm significantly increases elimination rate, reduces terms of healing of duodenal ulcers. At taurine application for 6 wks expression of Ki67, Bcl2 and apoptotic activity of epithelial cells are restored in the much greater degree, than at isolated application of omeprazole.

Conclusions. Addition of taurine to eradication therapy H. pylori increases its efficacy and improves parameters of epithelial cell regeneration of SM at patients with PUD.

Aim of the review. To present data on epidemiology, etiology and pathogenesis, diagnostics and treatment of rare type of lymphoma: primary lymphoma of the pancreas.

The recent literature data. Lymphocytic lymphomas (non-Hodgkin's lymphomas) have lymphoreticular origin and include plenty of types distinguished by cellular origin, clinical presentation, localization and prevalence, response to treatment. Extranodular nonHodgkin's lymphomas have frequency of 30 to 40% of all lymphocytic lymphomas cases, gastro-intestinal neoplasms are diagnosed approximately in half of these cases. The stomach and small intestine are the most frequently affected of digestive organs. Lesion of the pancreas can be both solitary (primary), and due to neoplastic infiltration from adjacent organs involved in neoplastic process, as well as from the lymph nodes. Clinical signs, data of laboratory and instrumental investigation at primary pancreatic lymphoma (PPL) are nonspecific. Diagnostics is based on morphological study of bone marrow and neoplastic tissue. The special difficulties occur at differentiation with pancreatic cancer. Well-timed detection of PPL helps to avoid extremely invasive surgery as the tumor is highly sensitive to chemotherapy.

Conclusion. Primary pancreatic lymphomas are responsible for only 0,5–0,9% of all pancreatic tumors and, as a rule, present themselves as a focal lesion which should be differentiated with pancreatic cancer. Their early diagnostics allows to resort to chemotherapy with favorable prognosis.

The aim of review. To analyze basic groups of drugs used for symptomatic treatment of chronic diarrhea.

Recent data of the literature. At the moment both well-known groups of antidiarrheal drugs (obducting agents, m-), and relatively new antidiarrheal agents (5-НТ3-receptor antagonists, d-opioid receptors agonists) are applied for symptomatic treatment of chronic diarrhea.

Conclusion. Despite of high number of proposed antidiarrheal preparations, range of drugs substantially used for symptomatic treatment of chronic diarrhea remains narrow enough. New drug groups having potential antidiarrheal effect, require further studying.

Aim of investigation. Studying of the morphological changes in hemorrhoids after sclerosing treatment, and evaluation of injected agent diffusion in the area of injections.

Stuff and methods. From December 2006 to October 2007 93 patients with chronic hemorrhoids of 1 to 4 stages after sclerosing treatment by 3% etoxysclerol solution were included in prospective comparative study. Of them sclerotherapy in combination to ultrasonic cavitation was carried out to 33 patients, with application of foam agent – to 31 patient and by traditional method – 29 patients. Ultrasound investigation by the rectal probe was implemented for evaluation of sclerosing agent diffusion. Patients with 3–4 stages of hemorrhoids complicated by moderate anemia (hemoglobin under 90 g/l), sclerotherapy was carried out in preoperative period to stop the bleeding. Hemorrhoidectomy was carried out after increase of hemoglobin over 100–110 g/l.

Results. At morphological study of internal hemorrhoids thrombosis of all or majority of cavernous veins and cushions, irrespective of procedure of injections, has been revealed in no speciemens. The most severe changes were found in connective tissue septa delimiting cavernous veins and around of veins. The degree of manifestation of morphological changes after various variants of sclerotherapy was not identical. At transrectal ultrasound investigation in all cases diffusion of sclerosing agent within submucosal layer for 15–25 mm proximally from injection site has been revealed. It was also found, that the solution injected into 2 hemorrhoids can spread for ¼ – ¾ of intestine circumference.

Conclusions. In no type of sclerosing treatment there was thrombosis of all cavernous veins and cavernous cushions of hemorrhoids in areas of injections. Only at sclerotherapy with ultrasonic cavitation in lumen of some cavernous veins new thrombi were revealed. Obtained data prove that the clinical effect of sclerosing treatment by 3% etoxysclerol solution is not due to thrombosis, but mainly as a result of compression of cavernous veins due to edema at initial stage, followed by sclerotic changes of the connective tissue, surrounding vein. Diffusion of sclerosing agent for 15–25 mm proximally form site of needle injection proves that there is no need to do injections precisely in submucosal layer over internal hemorrhoid as it was proposed earlier by many authors.

Aim of investigation. To improve results of treatment of patients with colorectal cancer complicated by obstruction, by application of preoperative endoscopic recanalization of constrictive tumor.

Stuff and methods. Original study was carried out on 22 patients with the left-sided colorectal cancer complicated by ileus. Mean age of patients – 65 years. Duration of disorder was on average 3 days. In the study original method of endoscopic recanalization of large intestine tumor complicated by obstruction was applied. Complete recanalization was considered to be achieved if it was possible to pass by endoscope above tumor narrowing and at complete emptying of large intestine. If emptying of large intestine was temporal and it was not possible to achieve complete passage of stool and gases through created canal in tumor, manipulation was assessed as incomplete recanalization of tumor. Duration of procedure was on the average 2,5 h.

Results. Complete recanalization of tumor has been achieved in 9 (41%) patients, incomplete – at 5 (23%) and in 8 cases (36%) procedure was ineffective. Complications developed in 2 patients (9%). After endoscopic tumor recanalization 21 patient (one patient has refused from operation) has been operated. The lateterm interventions were carried out in 2 hs (at ineffective recanalization) up to 6 days (at complete recanalization). Operative treatment is completed by primary colic anastomosis in 11 (52%) patients, colostoma – in 10 (48%) patients. Postoperative complications developed in 2 (10%) patients, one patient died (5%).

Conclusion. Endoscopic recanalization of large intestinal tumor complicated by acute ileus, allows to eliminate acute ileus in majority of cases (64%) and so to suspend immediate surgery that enables high-grade preoperative preparation of the patient. The deferred surgical intervention allows to impose a primary colic anastomosis in most of the cases (52%).

Aim of investigation. To develop new low cost non-invasive informative tests of Helicobacter pylori (H. pylori) diagnostics.

Stuff and methods. 52 patients with chronic inflammatory and erosive-ulcerative gastroduodenal diseases, and 30 healthy persons were investigated. Patients were separated in two groups: infected and non-infected by H. pylori (diagnostics of helicobacteriosis was carried out by urease test and histology). Physical and chemical properties of urine and condensate of expired air humor (EAH) were studied by dynamic interphase tensiometry and rheometry. Tensiograms analysis was done before and after urea intake. All patients underwent endoscopy, histological study of the stomach and duodenum.

Results. Significant differences of urine and EAH tensiograms integrated discrepancy were revealed at presence and absence of helicobacteriosis. Besides this integrated difference score essentially differed in patients with gastroduodenal erosions/ulcers and without them, in patients with gastric metaplasia of duodenal mucosa, intestinal metaplasia of gastric mucosa, and also in patients with atrophy of stomach mucosa.

Conclusions. The interphase tensiometry and rheometry of urine and EAH before and after urea load is informative non-invasive method of helicobacteriosis diagnostics, that allows to predict erosive-ulcerative changes, metaplasia and atrophy of gastroduodenal mucosa.