The aim of review. To analyze literature data on the role of genetic polymorphism of interleukin-1b in development and course of H. pylori infection.

Recent literature data. Now a key question of H. pylori infection is the potential of the microorganism to induce such diverse diseases, as duodenal peptic ulcer and stomach cancer. A basis of H. pylori infection pathogenesis is inflammation of the stomach mucosa. In development of any inflammatory process, and also in its outcome the balance of production, expression and inhibition of synthesis of interleukin-1 protein family plays important (if not the main) role. Today it is proved, that the various levels of interleukin-1 production are related to the presence of certain alleles.

Conclusion. Genetic polymorphism of interleukin-1 family has essential effect on course, outcomes and finally on the treatment of Helicobacter pylori infection.

The aim of review. To describe basic mechanisms of development of abdominal pain and methods of its relief.

Recent literature data. Chronic abdominal pain (CAP) is one of the most frequent causes of visits to general practitioner. Within the most frequent causes, irritable bowel syndrome (IBS), which is related to functional disorders (FD) of gastro-intestinal tract (GIT), occupies the third place. Stress, chronic psychological overload promoting misbalance of neurotransmitters (enkephalines, serotonin, cholecystokinin, etc.) are defined as pathogenic mechanisms of FD, including IBS. Intestinal wall receptors sensivity threshold determines perception of pain and motor function of intestine. Trimebutine interreacts with m-, d - and k-enkephaline receptors, promotes normalization of intestinal motility, relief of flatulence and stomach distention, increases pain threshold in large intestine. It also has beneficial effect both at hypokinetic, and at hyperkinetic forms of motor disorders.

Conclusion. Treatment of the patient with abdominal pain should be complex and strictly individual. Trimebutine is a promising agent of pathogenic therapy of IBS and other functional GIT disorders related to hyperalgesia.

The aim of review. To demonstrate features of pharmakokinetics and pharmacodynamics, as well as options of clinical application of nonabsorbable antibiotic rifaximin.

Recent literature data. Nonabsorbable antibiotic rifaximin has a lot of advantages from the point of view of pharmakokinetics and pharmacodynamics in comparison to systemically acting drugs. Now the range of gastroenterological diseases with proven efficacy of rifaximin can be outlined. They include: contagious diarrhea (including travelers’ diarrhea), bacterial overgrowth syndrome, diverticular disease of intestine, chronic inflammatory bowel diseases, hepatic encephalopathy. This range can grow wider after additional studies of potential of rifaximin application at other diseases (for example, Cl. difficile–related diarrhea, functional disorders of intestine, eradication of H.pylori infection, etc.).

Conclusion. Alpha-normix (rifaximin) is highly effective and safe nonabsorbable antibiotic which broad spectrum of application, that can be applied for treatment of various gastroenterological diseases.

Aim of investigation. To estimate morphofunctional state of duodenum in patients with different variants of functional dyspepsia.

Stuff and methods. Fifty patients with diagnosis of functional dyspepsia syndrome (FD), established according to the Rome-II criteria, 15 patients with peptic ulcer of duodenum (PUD) and 15 persons without gastroenterological complaints (control group) were investigated. Esophagogastroduodenoscopy with biopsy of mucosa (body and antral region of the stomach, duodenal bulb and postbulbar region) and morphological study has been carried out for all patients. Diagnostics of H. pylori infection was done by rapid urease test and histological method. 3-hour pH-metry with positioning of potential electrodes in duodenum, antral region and body of the stomach was performed.

Results. At ulcer-like FD variant рН scores appeared to be significantly lower and were similar to those at PUD patients: mean рН in the body of stomach was 1,448±0,237, subcompensation of alkalization was revealed in 60% of patients, decrease of neutralizing function of antral region at stimulation of secretion – in 40%, mean рН in the duodenum was 6,2±0,5, peaks of acidification of duodenum (рН <3,0) were revealed at 40% of patients. On the contrary, at dysmotility-like variant рН values (mean рН in the body of stomach 4,504±1,872, maximal – 6,0±1,756, increase of time with рН>4 to 53%, peaks of duodenum acidification were revealed in 20 %) appeared to be significantly higher at comparison to PUD, ulcer-like variant of FD and even to the control group. Duodenitis was diagnosed in the majority of FD patients. H. pylori was found significantly more frequently in patients with ulcerlike variant of FD (in the bulb of duodenum – in 48% of cases, in postbulbar region – 24 %), a quarter of them had gastric metaplasia. Intestinal metaplasia was revealed only in patients with dysmotility-like variant of FD (20 % of cases – statistically significant difference with ulcer-like type) and PUD (20 %).

Conclusions. Syndrome of functional dyspepsia is characterized by significant heterogeneity. It is possible to define subgroup of patients with functional dyspepsia having significantly low level of intragastric and intraduodenal рН, close to those in PUD patients, with epigastric pain as basic clinical sign. Morphology of duodenum in subgroup of patients with ulcer-like variant of FD is characterized by high frequency of gastric metaplasia due to excessive acidification of duodenum. Another differentiable subgroup differs significantly by high level of intragastric and intraduodenal рН related to duodenogastric reflux, clinically it is characterized by epigastric discomfort, and morphologically – by higher frequency of intestinal metaplasia.

Aim of investigation. Studying of results of laparoscopic closure (LC) of perforative duodenal ulcers at differentiated approach to choice of surgery method.

Stuff and methods. In original study results of LC for perforative ulcers of duodenum (172 patients), operated in Moscow city hospital #31 in 1996–2007 were analyzed.

Results. The early postoperative period was uncomplicated in 167 (97,0%) of 172 patients. Complications of various severity developed in 5 (2,9%) patients, including intraoperative in 1 case (0,6%) and postoperative in 4 cases (2,3%). No lethal outcomes occurred. In the short terms 22 (12,7%) and in remote terms 42 of 168 patients (25,0%) were investigated. According to Visick scale long-term results were assessed as excellent and good in 31 patients (73,8%), satisfactory (erosions) – in 8 (19,1%), bad (relapse of peptic ulcer) – in 3 patients (7,1%).

Conclusions. LC application at perforative duodenal ulcer followed by modern antiulcerative therapy is an efficient noninvasive intervention with low complication rate, good immediate and long-term results.

Aim of investigation. To study a structure of functionally active zones of lymph patches of small intestine, their cellular composition and cytoarchitectonics, contents of peripheral blood units in a state of emotional stress (ES), and also after preliminary injection of deltasleep inducing peptide (DSIP) and semax (ACTH 4–10 synthetic analogue).

Stuff and methods. The microtopography of lymph patches of small intestine and smears of peripheral blood of 104 Wistar rats (experimental and control groups) with various types of individual stress resistance were studied. The «open field» test was applied preliminarily, that allowed to divide animals according to resistance to stressful stimuli. Rats have been killed by decapitation method within 1 h after exposure to ES. Microscopical anatomy of functionally active zones of lymph patches of small intestine was studied by modern and immunohistochemical methods.

Results. It was revealed, that injections of DSIP and semax have a stress-limiting action on macrophageal, proliferative and destructive processes in functionally active zones of spleen and lymphoid patches of small intestine. Contents of small lymphocytes at germinal centers of lymphoid patches after 1-hour stress exposure in resistant and predisposed experimental rats dropped respectively 1,2 and 1,4 times in comparison to results in control groups. At stress-resistant rats in germinal centers of small intestine lymphoid patches at injection of semax after 1-hour stress exposure value of this parameter basically did not change and was 58% (57% – in the control group). At the predisposed rats, that experienced ES with preliminary semax injection, contents of small lymphocytes slightly increased in comparison to controls and was equal to 64,8% (60,0% – in the control group). Injection of stress-limiting oligopeptides (DSIP and semax) promoted decrease of stress-induced changes of lymphoid cells in peripheral blood, and also in lymphoid tissue of spleen and small intestine lymph patches.

Conclusions. Obtained data can be applied at treatment of diseases of gastro-intestinal tract, immune system, and also at treatment and prophylaxis of various stress-related states. Study results allow to estimate compensatory potentials of immune organs at exposure to ES (for example, at erosions and stressful ulcers of gastric and duodenal mucosa), and also can be helpful in clinical practice of gastroenterologist, allergist, immunologist. Basing on these results, it is possible to recommend application of DSIP and semax for treatment and prophylaxes of various stress-induced states.

Aim of investigation. To investigate permeability of the gut for obligate intestinal microflora at small bowel mucosa damage at mechanical obstruction of intestine in experimental setting.

Stuff and methods. Investigation was carried out on 60 Wistar rats with modelled strangulated and obturation small intestinal obstruction by dynamic and static scintigraphy with technetium-99m radiolabeled bacteria E. coli, and by light microscopy.

Results. Bacteria can not penetrate intestinal barrier at healthy animals. At a strangulated obstruction of a small bowel bacterial translocation educes from first minutes of disease. Thus bacteria move from lumen of strangulated region of intestine into abdominal cavity with subsequent resorption to systemic blood flow, and from adducting part – into portal system. At obturation obstruction bacterial translocation develops only on the late stage of disease and is limited to development of portal bacteriemia, and then – to systemic bacteriemia associated with incompetence of hepatic barrier.

Conclusion. One of the causes of bacterial translocation at mechanical obstruction of small bowel is structural damage of intestinal barrier.

Aim of investigation. To study morphological changes of liver biopsy specimen at extrahepatic biliary atresia (EHBA) in relations to age of patients and to reveal clinical and morphological interrelations.

Stuff and methods. 30 children with EHBA aged 26 to 102 days were investigated. Severity of pathological processes in the liver was determined by Knodell histological activity index. Desmet score was used for evaluation of fibrosis stage.

Results. Various severity of cholestasis and proliferation of bile ducts, dependent on age of patient was determined. All children had low or minimum degree of histological activity of inflammation by Knodell index. Direct correlation of fibrosis severity to age of the patient (r=0,92, p<0,05) was revealed. The strong negative correlation between level of serum gamma-glutamyltranspeptidase (GGT) and severity of fibrosis according to Desmet score (r=0,93, p <0,05) was determined.

Conclusions. The degree of cholestasis, proliferation of bile ducts and prevalence of fibrosis at EHBA was proportional to age of a child. Intensity of inflammation does not depend on age. According to clinical and morphological interrelation analysis diagnostic value of GGT level was established. No other clinical or laboratory parameters significantly exhibiting degree of morphological changes at EHBA were revealed.

The aim of the review. To present characteristics of basic forms of alcohol-induced lesions of the stomach mucosa.

Recent literature data. Alcohol-induced lesions of the stomach mucosa most often manifest as alcoholic gastropathy (acute alcoholic erosive gastritis) or Mallory-Weiss syndrome. The most dangerous clinical sign of these lesions is gastro-intestinal bleeding. Its treatment requires application of conservative methods including intravenous injection of Н2-blockers or proton pump inhibitors and endoscopic methods of bleeding control (laser-therapy, electro- and thermocoagulation). Effect of alcohol on the course of chronic H. pyloriassociated gastritis is discordant, however there is more evidence of unfavorable influence.

Conclusion. Alcohol-induced stomach lesions more frequently result in alcoholic gastropathy or Mallory-Weiss syndrome, the most severe clinical sign of which is gastro-intestinal bleeding.

The aim of review. To study issues of diversion colitis and its effect on results of reconstructive interventions on the large intestine.

Recent literature data. The diversion colitis is the inflammatory disease, that develops in defunctioned colon and/or rectum with histological pattern of noncontagious colitis. Different authors claim, that elimination of short-chain fatty acids (SCFA) from intestinal lumen plays the leading role in pathogenesis of diversion colitis. Up to now, there are no convincing data on preference any of methods of conservative therapy for diversion colitis, that as well proves complexity of its pathogenesis and necessity of intensive studying of this problem by both coloproctologists and gastroenterologists. Definite positive effect of restoration of natural passage of intestinal contents through excluded region is an important factor in comprehension of this pathological process. Preoperative therapy decreasing degree of inflammation is necessary.

Conclusion. Further studies on application of SCFA preparations, anti-inflammatory drugs in preparation to reconstructive operations are necessary to improve efficacy of diversion colitis treatment.

Aim of investigation. To demonstrate complexity of differential diagnostics of granulomatous diseases clinical forms.

Stuff and methods. Article presents a case of disease with fatal course, which leading signs included longstanding intermittent fever, granulomatous pulmonary lesion, cholestatic granulomatous lesion of the liver, nephrotic syndrome, ischemic lesion of intestine. Differential diagnosis was carried out between ANCAassociated vasculitis, primary sclerosing cholangitis and lymphogranulomatosis.

Results. Morphological analysis of the autopsy samples give ground to conclude, that patient had combination of two diseases: lymphogranulomatosis and systemic vasculitis. However, the literature review devoted to ANCA-associated vasculites, and features of clinical course entitle doubts and reflections.

The aim of clinical case presentation. To show features of clinical manifestations of Whipple’s disease, its treatment; to compare to literature data to the authors’ two-years experience of patient observation.

Clinical case features. The Whipple’s disease of typical course is diagnosed for the 56 years-old patient with characteristic signs of diarrhea, loss of body weight, other malabsorption signs and joints involvement. Complexity of the Whipple’s disease diagnosis was related to the fact that extraintestinal signs developed long ahead to clinical signs which dominated in the developed stage of disease. Founding of macrophages with PAS-positive granules at histological study mucosa of the small intestine was decisive for diagnosis. Moderately severe persistent articular involvement after treatment by co-trimoxazole 960 mg/day for 4 months with the subsequent interchange of co-trimoxazole and erythromycin 1000 mg/day (for 2 weeks each agent) determined complexity of management in presented case that required prolongation of antibacterial therapy.

Conclusion. Whipple’s disease should be suspected at presence of malabsorption signs combined to lesions of joints, cardio-vascular, respiratory and nervous system. The diagnosis is verified by revealing of macrophages containing PAS-positive granules in lymph nodes and the intestine.

Article presents the clinical case of stomach lesion in
AIDS. Disease had pseudo-neoplastic pattern. Literature
data on stomach lesions in AIDS are submitted, lessons
of presented clinical case are formulated.

T.Yu.Tupitsyna – Improvement of diagnostics and choice of treatment method of patients with postcholecystectomy syndrome.