Aim of review. To present the modern concept of functional gastrointestinal diseases (FGID) and to analyze the basic clinically relevant changes made in Rome IV criteria (2016) in comparison to the previous edition. Summary. According to the due definition that was proposed by the Rome IV advisory council, FGID are the brain-gut axis interaction disorders. It was proposed to exclude the term «functional» from the definition. The new nosological entities with known causative factor (opioid-induced gastrointestinal hyperalgesia, opioidinduced constipation, cannabinoid induced hyperemesis syndrome), hypersensitive reflux syndrome, nausea and vomiting syndrome (that encompasses previously separate nosological forms: chronic idiopathic nausea and functional vomiting) were added to the new version of the classification. In the new edition of Rome criteria the management approach to patients with sphincter of Oddi dysfunction is specified, along with diagnostic criteria of functional dyspepsia and irritable bowel syndrome. Conclusion. The classification of FGID is revised in updated Rome criteria, diagnostic features of several nosological entities were specified.

Aim of review. The role of emotional disorders of dysphoric range (irritability, strain, hostility etc.) in clinical presentation of the irritable bowel syndrome (IBS). Summary. Systematic literature search on severity of dysphoric disorders and their relation to somatic symptoms at IBS was carried out in the PubMed scientific database and Russian Science Citation Index (RSCI). Overall 42 articles were selected. The results of analysis has demonstrated that dysphoric emotional disorders are typical for IBS patients. These disorders are manifested as tendency to react by discontent and irritation in stressful situations. Somatic manifestations of IBS are associated to dysphoric experience indicating their potential pathogenic value. Imbalance between the scope of data on emotional disorders at IBS and the number of studies devoted to psychopharmacotherapy efficacy assessment at emotional disorders was revealed. Dysphoric disorders are not regarded as independent target for therapeutic actions. Conclusion. The chronic discontent and trend to react by anger to stressful situations are traits of IBS patients, and is the basis of the development and persistance of the somatic symtpoms. They have to be considered as an independent targets for medical care.

Aim of review. To analyze the proceedings of the 22ndUnited Russian gastroenterological week devoted to radiological diagnostic methods in gastroenterology. Key points. Potential of radiological methods in diagnostics of the diseases of a gastrointestinal tract, hepatobiliary system, pancreas etc. are demonstrated. Radiological signs at chronic diffuse liver diseases, disorders of portal blood flow and associated extrahepatic hemodynamic disorders are present. Modern advances of elastometry at diseases of the liver, spleen and pancreas are reflected. Radiological features at medical emergencies with involvement of digestive organs (thrombosis, ileus, circulatory intestinal disorders, closed diaphragmatic trauma) are demonstrated. Conclusion. Presented data will provide general practitioners with expanded concept on diagnostic radiology potential in digestive diseases and indications for ultrasound procedures at primary diagnosis and in dynamic assessment - broad application of radiological tests in scientific research.

Aim of investigation. To analyze treatment compliance at initial course and maintenance treatment by proton pump inhibitors at gastroesophageal reflux disease (GERD). Material and methods. Overall 84 GERD patients with took part in prospective study: 50 (59.5%) men and 34 (40.5%) women aged from 18 to 74 years. By results of esophagogastroduodenoscopy and morphological investigation of mucosal biopsies non-erosive reflux disease (NERD) was diagnosed in 32 (38.1%) patients, reflux esophagitis was found in 52 cases (61.9%). Total period of patients monitoring was 12 months at which patients made five visits to the research center: initial, through 1.5, 3, 6 and 12 months with filling in of questionnaires of Spielberger-Khanin, Beck, SF-36 and abridged multifactorial questionnaire of the personality (AMQP). Treatment compliance was established according to duration of study participation, along with that patients self-estimated it on 2, 3, 4 and 5 visits by Morisky-Green test and 5-score analog scales of pharmaceutical treatment compliance and lifestyle verification. The first visit patients underwent 1:1 randomization to the educational program devoted to reflux disease. Results. Of all patients 17.9% missed the second visit, the logistic regression analysis revealed no factors associated to the early low compliance; 38% of patients made all five visits for 12 months. The latter differed significantly from those who dropped out of the study at different stages: they had high number of chronic diseases (р<0.01), received higher quantity of drugs on the constant basis (р<0.01), got lower scores by the paranoid trait scale of AMQP (р<0.05). Logistic regression is revealed factors associated to the low level of treatment compliance: number of chronic concomitant diseases (OR=1.64; р=0.0033), quantity of the received drugs (OR=1.63; р=0.0158), scores by paranoid trait AMQP scale (OR=0.95; р=0.042). Conclusion. Single course educational program in GERD patients increases treatment compliance for initial course while does not affect maintenance therapy compliance. Following predictors of high treatment motivation were found: existence of chronic diseases and intake of medications on the regular basis for concomitant diseases, minimal intensity of rigidity of affect personality trait. Constant maintenance therapy is optimal for GERD patients in the Russian population, at the same time in NERD patients without low compliance markers the course maintenance therapy can be applied.

Aim of review. To review in brief the reports of the XXIX international working meeting of the European Helicobacter pylori (H. pylori) and Microbiota Study Group (Magdeburg, 2016) and to discuss the key points of «Maastricht V» consensus meeting, devoted to diagnosis and treatment of infection. Key points. Association of H. pylori to both gastroenterological and non-gastrointestinal diseases and optimization of eradication therapy modes were discussed at the consensus conference. The special attention was paid for decreasing of infection burden and the stomach cancer prevention. New eradication therapy modes were presented for the regions with high and low H. pylori resistance to clarithromycin and metronidazole. It was demonstrated that clarithromycin resistance in Russia significantly varies in different regions and highest efficacy was observed for bismuth-based (in particular - bismuth tripotassium dicitrate) eradication modes. Conclusion. The guidelines of «Maastricht V» consensus meeting provide significant improvement of treatment results in H.pylori-infected patients as well as decrease of the risk of associated diseases (first of all - the stomach cancer).

Aim of review. To present literature data on efficacy and safety of esomeprazole for the treatment of gastroesophageal reflux disease (GERD). Summary. GERD is one of the most widespread chronic diseases. Proton pump inhibitors (PPI) are the basic treatment of GERD that promote symptom relief (both esophageal, and extraesophageal) as well as the healing of esophageal mucosa lesions, prevent development of relapses and complications of reflux esophagitis. Results of multiple studies prove that esomeprazole is a highly effective antisecretory drug which can be used as for treatment of patients with erosive esophagitis and non-erosive reflux disease and as a maintenance therapy. Conclusion. Esomeprazole, in particular generic drug Emanera, is one of the most effective and safe antisecretory drugs. Pharmacokinetic and pharmacodynamic properties of the drug determined its ability to relief heartburn faster than other PPIs, to provide higher rate of erosion healing than omeprazole. In addition, esomeprazole (Emanera®) possess more pronounced antisecretory effect, than omeprazole that results in higher treatment compliance of the patients.

The aim of publication. To present the modern concept on etiology and pathogenesis of functional dyspepsia (FD) to general practitioners, as well as with the accepted approach to diagnostics and treatment of this disease. Summary. FD is the most common digestive disease. It’s etiology includes genetic predisposition, bad habits, previous intestinal infections, psychosocial factors. The basic pathogenic factors may include HCl hypersecretion, stomach and duodenal dysmotility and visceral hypersensitivity. FD diagnosis should be established after ruling out of the organic diseases that may manifest by dyspepsia. Treatment is based on the stepwise approach, that includes general procedures, application of the drugs reducing hydrochloric acid secretion and normalizing motility and visceral sensitivity of the stomach and duodenum, in difficult to treat cases - psychopharmacological drugs and psychotherapeutic methods. Conclusion. Following of the functional dyspepsia management algorithm allows to increase the accuracy of FD diagnosis and improve treatment results.

Aim of investigation. To study the vascular wall changes of common carotid artery and internal carotid arteries in patients with abdominal obesity (AO) and different forms of nonalcoholic fatty liver disease (NAFLD). Material and methods. The study involved 60 patients with AO (waist circumference ≥80 cm in women and ≥94 cm in men) and NAFLD who provided written informed consent to participate in the study. The age of the patient ranged from 18 to 59 years. Patients’ symptoms, past history, were evaluated to exclude alcoholic or drug-induced liver disease, anthropometric parameters were studied. All patients underwent a complex of laboratory and instrumental tests required by the Russian guidelines for diagnosis and treatment of NAFLD (2015). Severity of pathological changes in the liver tissue (fibrosis and steatosis) was assessed by noninvasive Steatoskrin diagnostic method (Biopredictive laboratory, France). Measurement of the intima-media complex thickness of the common carotid artery (IMT CCA) was performed by standard procedures at Voluson 730 Expert device, equipped with 7,5 MHz linear phased array transducer. The presence of early atherosclerotic markers was evaluated by local thickening of the IMT CCA over 0.86 mm in any point of the carotid artery (IMT CCA max). The data were processed by comparative and correlation analysis. Results. The relationship between the presence of NAFLD, initial manifestations of atherosclerosis and insulin resistance was established. This resulted in the rank of prognostic factors based on severity of carotid artery changes, making it possible to conclude individual atherosclerotic risk score for AD and different forms of NAFLD. Conclusion. The results of the study require more profound examination of patients with NAFLD to evaluate both liver and cardiovascular diseases risk.

Aim of investigation. To estimate epidemiology of the liver cirrhosis (LC) in Chelyabinsk region in 2006-2015. Results. Statistically significant increase of the both total (254.1-391.8 per 100,000 population) and primary (43.3-67.3 per 100,000 population) incidence of the liver diseases was detected. For the 10-year period of monitoring considerable sporadic fluctuations due to the liver diseases were noted. Since 2013 there was a gradual gain in mortality which in 2015 reached 38.35. By 2015 the decline in mortality due to alcohol-induced LC down to 12.6 cases per 100,000 population alone with increase of female proportion up to 42.5% was noted. No less than 50% of LC motility was due to the working-age patients. The basic direct cause of death in LC patients is hepatocellular failure, in 12.84±0.6% of the cases patients died of gastro-intestinal bleeding. Over the half of the cases of annual motility was due to out-hospital cases. By 2015 liver disease associated motility increased by 31.5% and reached 16.91. The number of hospital admissions of patients with liver diseases for the last 10 years decreased and made 95,8±5,5 cases per 100,000 population, the rate of decrease was 8.7%. Conclusions. The negative trends require further improvement of the healthcare management for LC patients. However objectively restrictions in utilization of the available range of treatment-and-prophylactic actions for treatment of LC in the outcome of viral hepatitis (in drug addicts, alcoholic or asocial patients) due to their low treatment compliance.

The aim of case presentation. To present a typical case of systemic autoimmune disease related to extremely aggressive medical alterations of the immune status which were carried out not only for life-saving indications, but for cosmetic reasons as well. Summary. The patient (32-year-old female) had a history of persistent irregular febrile fever for two years, renal disease (tubulointerstitial nephritis with papillary necrosis), hemorrhagic vasculitis-like skin involvement and mediastinal lymphadenopathy. Patient underwent multiple investigations aimed for ruling out infectious causes of the disease that yielded negative result, repetitive courses of antibiotics provided transient positive effect at onset of disease. Five years before the origin of symptoms patients underwent sleeve gastrectomy with biliopancreatic shunting for obesity (body weight - 130 kg, BMI - 43.4 kg/m2), cholecystectomy and appendectomy. After that within a year patient lost 55 kg of body weight and developed severe symptoms of malabsorption. In 1.5 years after the fever onset bilateral mammaplasty with silicone implants was carried following which the fever became constant. At transthoracic biopsy of mediastinal lymph nodes demonstrated the pattern of Wegener-type ANCA-negative necrotizing granulomatous vasculitis of small arteries (PCR for mycobacteria and acid fast stain were negative). Despite provided corticosteroid and cyclophosphan treatment, the disease progressed (focal affection of the lungs) and the patient died of brain stem hemorrhage. Autopsy revealed the signs of vasculitis with involvement of the brain, skin, mediastinal lymphnodes, lungs, as well as the signs of chronic inflammation, atrophy of breast gland lobules, embolization of the focal lymphatics by the implant substance, ulceronecrotic enteritis of defunctioning bowel, severe liver steatosis with the chronic vitamin deficiency. Conclusion. The relation of atypical necrotizing vasculitis with yet undescribed clinical presentation with previous bariatric surgery and long-standing malabsorption is highly probable; application of silicone implants with adjuvant-associated immune response were additional resolving factors. Incomplete effect of immunosuppressive therapy indicates the dominant role of autoinflammation in the course of disease. Selection of patients for bariatric and cosmetic surgery should be more careful and involve estimation of the general and immune status of the body.

Aim of investigation. To determine diagnostic value of procalcitonin (PCT) and C-reactive protein (CRP) at anastomotic leakage (AL) following lower anterior resection (LAR) of the rectum. Material and methods. Overall 100 patients underwent surgery for epithelial tumors of rectum in the period 2013-2016 yy in the volume of LAR with the formation of anastomosis and preventive stoma. In patients without clinical symptoms radiopaque study was performed in order to identify asymptomatic AL on day 7 after the surgery. AL rate, difference in PCT and CRP levels in patients with AL and consistent anastomosis were assessed along with sensitivity, specificity, positive and negative predictive value of these markers. Results. AL was diagnosed in 20% (20 of 100) of patients: in 11% (11 of 100) - with clinical manifestations, in 9% (9 of 100) - without clinical symptoms (contrast leakage according to X-ray study). In the group of patients with anastomotic leak, the median of C-reactive protein level differed from that in patients with uncompromised integrity of anastomosis at 3rd day after surgery (156 mg/L vs 81 mg/L, respectively - t-test, p=0.0004) and postoperative day 6 (136 mg/L vs. 52 mg/L, respectively - t-test, p <0.0001). In patients with AL the median procalcitonin level was significantly higher compared to the group of uncomplicated course: at the day 3 it was 0.50 ng/mL versus 0.10 ng/mL, respectively - Mann-Whitney test, p<0.0001, at the day 6:1.16 vs. 0.10 ng/mL, respectively - Mann-Whitney test, p<0.0001. Conclusion. Anastomotic leakage rate was 20%, but only 11% of the patients had AL-related clinical manifestations. Changes in PCT and CRP levels in postoperative period correlated to the presence of AL.

Aim of investigation.To estimate efficacy of combined treatment of colorectal cancer (CRC) in senile patients, to determine risk factors for postsurgical complications and evaluate postoperative mortality. Material and methods. The retrospective and prospective analysis of primary CRC patients, who were operated in The First Sechenov Moscow State Medical University and Petrovsky National Research Center of Surgery in April, 2006 to May, 2014 was carried out. Overall 122 patients with CRC of the II-IV stage of senile age were selected, whose mean age was 79 (75-95) years. Preoperative comorbidity assessment and perioperative complications risk were assessed by Charlson comorbidity index and ASA physical status classification system. Cr-POSSUM scoring system was applied to predict postoperative (30-day) mortality. Overall and cancer-specific survival rate were assessed taking into account comorbidity of patients and prescribed adjuvant therapy. Results. The average Charlson score taking into account age of the patient was 7.6±2.4. Forty seven patients (39%) were classified as ASA≥3. The predicted postoperative motility (Cr-POSSUM) was 13.2%. In 106 (87%) patients colon or rectum resection with formation of primary interintestinal anastomosis and D3 lymph node dissection, at 11 (9%) - abdominal and perineal rectum extirpation is executed, 5 patients had obstructive Hartmann operation. Patients with the IV stage of CRC underwent standard volume surgery with high-grade lymph node dissection due to the high risk of obstruction or tumor bleeding. Achieved 30-day postoperative mortality was 4.9%, overall 5-year survival rate - 67.3±5.6%, cancer-specific survival - 70.1±4.4%. In group of patients with III and IV stages of CRC who received postoperative adjuvant therapy, the tendency to higher total survival was noted, however only cancer-specific survival scores had statistically significant differences in this subgroup. Conclusions. Multidisciplinary approach to CRC treatment provides achievement of satisfactory postoperative mortality in senile patients (4.9% versus predicted 13.2%) along with satisfactory total and cancer-specific 5-year survival rate. Postoperative adjuvant therapy significantly improves treatment results for third stage CRC, however the objective indications for adjuvant therapy are yet to be established. Due to complex drugto-drug interactions specificity of metabolism and biological tumor properties, cross-reactions of concomitant diseases in senile patients each step of combined treatment should be discussed at multidisciplinary consultation.