Aim of review. The review is devoted to the effects of probiotics and prebiotics on emotional, cognitive, systemic and central spheres of psychophysiological activity in animals and humans. Microbiome is a basis of the gut-brain axis. The bacterial colonization of the gut is initiated at the moment of delivery and represents incomplete copy of maternal microbiota. Intestinal microbiome is a factor of hypothalamic-pituitary-adrenal axis formation that is involved in regulation of immunomodulation, lipid metabolism, energy balance and electrophysiologic activity of enteric nervous system. Summary. Comparison of probiotic affects in animal and human experimental studies demonstrates their equivalence. Many experimental data indicative of relation of probiotic intake and patients’ mood are accumulated. The effect of probiotics on cortisol level was demonstrated. The proof of possible immunologic effects of probiotics at irritable bowel syndrome that is associated with gut-brain signal axis disorders and microbiome changes was received. Attempts to reveal intrinsic mechanisms of positive emotional shifts in humans are of a great interest. Ability of psychobiotics to influence the depth of emotions is confirmed. Conclusion. Psychobiotics are capable to provide positive impact on patients’ mood. Addition of behavioral criteria of concern, cognitive control and suppressed mood to the studies will broaden spectrum and palette of a self-assessment of study participants. At a systemic level suppression of cortisol and proinflammatory cytokines production by psychobiotics maintain the positive effect on the mood due to reduction of systemic inflammation severity.

Aim of review. To review the recent publications and reports devoted to application of radiological methods in gastroenterology and to acquaint gastroenterologists, radiological experts and doctors of other specialties with modern potential of these methods. Summary. Results of radiological methods efficacy estimation analysis for digestive diseases and potential of clinical application is presented. Ongoing improvement of investigation technique is noted. Agreement of radiological investigation results to clinical and morphological data is emphasized. Efficacy of radiological methods application in practical activities of doctors of various specialties, including gastroenterologists, pediatricians, oncologists, surgeons, transplantologists etc. is demonstrated. Conclusion. Improvement of diagnostic radiology methods and expansion of the range of issues that can be resolved by the means of modern radiology is noted.

Aim of investigation. To estimate the role of genetic polymorphism (rs1800566) of NAD(F)H quinone oxidoreductase-1 in development of acute pancreatitis in the Russian population. Material and methods. Whole blood samples were received from 349 unrelated AP patients and 329 unrelated individuals of Russian nationality having no gastrointestinal diseases. Mean age of patients was 48.9±13.1 years, mean age of healthy controls - 47.8±12.1 years. Genotyping of NQO1 gene polymorphism (rs1800566) was carried out by real-time polymerase chain reaction. Results. The association of polymorphism (rs1800566) of NQO1 gene T/T genotype with high risk of AP development, mostly - acute and non-biliary pancreatitis, in males. The risk of disease was elevated in patients with TT genotype irrespective of intensity and duration of alcohol intake, as well as in smoking patients with ST genotype at alcohol consumption exceeding 10 years, even in those receiving less than 199 g of ethanol per week.

Aim of investigation. To estimate duration of remission of irritable bowel syndrome after treatment by multistrain probiotic drug, motility regulator or antispasmodic medication. Material and methods. Original study included overall 87 patients with irritable bowel syndrome (IBS) or IBS in combination with functional dyspepsia (FD) in whom the diagnosis was confirmed according to compliance of symptoms to the Rome-III criteria and absence of organic diseases according to laboratory and instrumental investigation. In 42 patients diarrheapredominant variant of IBS was diagnosed (IBS-D), in 45 patients - constipation-predominant (IBS-C). All patients enrolled in original study underwent monotherapy by probiotic agent, motility regulator trimebutine or spasmolytic drug. The probiotic agent (Bifidobacterium bifidum, B. longum, B. infantis, Lactobacillus rhamnosus) was prescribed to 15 patients with IBS-D and 15 patients with IBS-C, motility regulator (trimebutine) - respectively to 12 and 15 patients, antispasmodic was used in 15 patients with IBS-D and 15 - with IBS-C. All patients at the end of 28thday of treatment achieved clinical remission of the disease (decrease of the total score of «7×7» Questionnaire for 50% and more). At the 30, 45 and 60 days after treatment secession in patients had telephone interview with health-related questions. Patients’ responses of those who received no maintenance therapy were statistically analyzed. Results. In 30 days secession of pharmaceutical therapy 73.3% of patients with IBS-D who received probiotic therapy during relapse maintained clinical remission, 75% of patients often motility regulator treatment and 60% of those who received antispasmodic medications. Of patients with IBS-C in 30 days after treatment termination remission was maintained in 60% of those after probiotic treatment, in 80% of the motility regulator treatment and in 60% antispasmodic therapy. In 45 days 47% of IBS-D patients treated by probiotics had sense of well-being, 58% of those who received motility regulators and 47% of patients who received antispasmodics previously. Of IBS-C patients in 1.5 months 33.3% of those, who received probiotic were symptomless, 46,3% of patients after trimebutine therapy and 33,3% of patients who achieved remission after antispasmodic therapy. In 60 days of IBS-D 20% in the group of patients remained in remission after probiotic treatment, 20% after trimebutine therapy and 33% after antispasmodic. Of IBS-C patients 20, 33 and 20% of patients respectively maintained clinical remission. No statistically significant differences between groups of patients with IBS-D and IBS-C were revealed (р>0.05). Conclusion. According to the obtained data, pharmacologically induced remission in the most of IBS cases is short-term. Remission duration depend neither on clinical variant of disease, nor on the group of drugs applied for remission induction.

Aim of investigation. To estimate the effect of carriage of endothelial dysfunction and hemostasis gene allelic variants on development of cryoglobulinemic vasculitis (CryoVas) and its clinical symptoms in patients with chronic hepatitis C (CHC). Material and methods. Original study included overall 72 patients with CHC and cryoglobulinemia: 21 patients had CryoVas, 51 - CHC without vasculitis. Results. The T allele of NOS3 894 G/T gene was more frequent, T allele of ITGA2 807 C/T gene (OR =0.419) was less common and C allele of ITGB3 1565 T/C gene was more frequent (OR=2.33) in CryoVas patients. Multivariate assay revealed the number of mutant alleles («total score») of NOS3 894 G/T, ITGA2 807 C/T and ITGB3 1565 T/C genes as independent risk factor. The T allele of NOS3 894 G/T gene was found in patients with renal disease significantly less frequently (15% vs 45.5%; р=0.035) as well as in patients with systemic hypertension (30% and 72.7%; р=0.086). Conclusions. Carriage of GT genotype of NOS3 894 G/T gene and CC genotype of ITGB3 1565 T/C gene is associated with high risk of CryoVas development. The TT genotype of ITGA2 807 C/T gene possess «protective» properties. The «total score» is independent predictor of CryoVas development.

Aim of the study. To estimate efficacy and safety of cepeginterferon-alpha 2b (cPEG-IFNα2b) and ribavirin combination for the treatment of chronic hepatitis C (CHC), to define necessity of IL-28V genetic polymorphism diagnostics, to estimate liver elastometry scores at the background of antiviral therapy. Material and methods. Overall 164 patients with hepatitis C viruses (HCV) genotypes 1, 2 and 3 in 4 medical centers received antiviral therapy. All patients received cPEG-IFNα2band ribavirin. The treatment mode and dose of drugs conformed to the existing standards. Treatment response was defined by the frequency of sustained virologic response (SVR) achievement. All patients were included in the treatment safety analysis. Besides that, in 104 patients liver tissue elasticity scores dynamics was estimated according to elastometry data. Results. Results of double mode antiviral therapy (cPEG-IFNα2band ribavirin) at treatment of 164 CHC patients were analyzed: 58.5% (n=96) - patients had HCV genotypes 2-3, 41.5% (n=68) of patients - HCV genotype 1. The majority of the patients had mild fibrosis and low viral load. Overall SVR was achieved in 86.5% of patients (n=142). Of patients with HCV genotype 1 the rate of SVR was 79.4% (n=54), in patients with genotypes 2 and 3 - 91.7% (n=88). In patients with the IL-28V genotype variant C/C the SVR rate was 93.7% (n=45): in 100% of patients with HCV genotypes 2 and 3 and in 85.7% of patients with HCV genotype 1. In 83,7% of the patients included in the analysis no statistically significant dynamics of liver tissue density was noted. Conclusion. As administration of interferon-free treatment modes for most of patients is limited due to financial considerations, application of IFN-based modes of treatment in clinical practice is still actual. Results of the present study demonstrate that screening for treatment candidates allows to achieve high efficacy and favorable safety profile of double treatment mode (cPEG-IFNα2b and ribavirin).

Aim of investigation. To study the dynamics of viral hepatitis detection rate after implementation of donors preliminary testing for alanine aminotransferase (ALT) activity. Material and methods. Viral hepatitis markers detection rate by immuno-chemiluminescence assay at testing for ALT activity in venous (n=47080) and capillary (n=22530) blood of donors was studied. Results. Males had higher ALT activity in comparison to that in females, both in venous (for 54.1%), and in capillary (for 27.2%) blood. ALT capillary blood activity was higher on the average, than in venous, for 10.1% in men and 33.3% in women. Conclusions. ALT activity elevation is associated by twofold increase in the rate of lacteous serum and more frequent detection of hepatitis serological markers. In the samples received after capillary blood culling the anti-hepatitis C virus antibodies positivity rate was decreased. No relation of ALT activity to results of parenteral virus genomes screen was revealed.

Aim of publication. To present indications for antihelicobacter therapy, methods and sequence of diagnostics and eradication treatment of Helicobacter pylori (H. pylori) infection to general practitioners. Key points. Chronic gastritis caused by H. pylori infection, including that in «asymptomatic» patients can be considered to be an indication for H. pylori eradication therapy both as etiological treatment and opportunistic screening diagnostics for gastric cancer prevention. Indications for obligatory antihelicobacter therapy include stomach and a duodenum peptic ulcer (PU), stomach MALT-lymphoma, early gastric cancer with endoscopic resection. Breath test with 13С-labeled urea, laboratory test for assessment of anti-H. pylori antibodies in feces, rapid urease test and serological method can be recommended for primary diagnostics of infection. Serological test is not applicable after antihelicobacter therapy. According to the bulk of regional studies clarithromycin resistance level of H. pylori strains in Russia does not exceed 15%. Obtained data indicate the absence of high metronidazole-resistance of H. pylori as well as double resistance to clarithromycin and metronidazole. Standard triple therapy including proton pump inhibitor (PPI), clarithromycin and amoxicillin is recommended as first-line treatment for H. pylori eradication. Standard triple therapy should be carried out, applying various means that increase its efficacy. Alternatively to standard triple therapy, first-line eradication treatment may include four-component bismuth tripotassium dicitratebased therapy or non-bismuth quadrotherapy which includes PPI, amoxicillin, clarithromycin and metronidazole. Quadrotherapy with bismuth tripotassium dicitrate can also be applied as a basic mode of the second line treatment at inefficiency of standard triple therapy. Alternative mode of second line eradication treatment includes PPI, levofloxacin and amoxicillin. Levofloxacinbased triple therapy prescription in the presence of strict indications should be limited to gastroenterologists. The third-line eradication treatment is adjusted individually according to the history of previous treatment modes. Eradication efficacy may be increased by prolongation of treatment up to 14 days, applicaiton of modern PPIs or increase of PPI doze, addition of bismuth tripotassium dicitrate or probiotic. Conclusion. In each case of H. pylori detection it is reasonable to consider eradication therapy that is especially actual as H. pylori infection eradication is recognized as effective method of stomach cancer prevention. H. pylori eradication optimization methods can be applied both to standard and alternative modes while combination of these approaches allows to achieve the best result in a given patient.

Aim of the lecture. To present modern approaches to prokinetic treatment at gastroesophageal reflux disease (GERD) to gastroenterologists. Summary. GERD belongs to acid-related diseases, because detrimental action of hydrochloric acid on esophageal mucosa plays major role in its pathogenesis. However esophageal and stomach motility disorders, e.g.: increase in frequency of transient lower esophageal sphincter relaxations, decrease of esophageal clearance and increase of intragastric pressure play important role in GERD development as well. These factors along with the not uncommon resistance of GERD patients to the proton pump inhibitors (PPI) caused by nonacidic refluxes require prokinetic administration. Most commonly prokinetics are prescribed as supplemental to PPI treatment. At the present time the optimal prokinetic drug, with proved efficacy at GERD and other diseases associated to gastrointestinal dysmotility is itopride hydrochloride (Ganaton®). Conclusion. Taken into account important role of esophageal and stomach dysmotility in GERD pathogenesis, prokinetics can be recommended for comprehensive disease treatment, especially at PPI inefficacy.

Aim of review. To present the data on the effect of proton pump inhibitors to gastrointestinal microbiota. Summary. Proton pump inhibitors (PPI) - is a basic class of drugs for acid-related diseases treatment. The data proving gastrointestinal microbiota alteration at PPI administration were obtained. Possible mechanism may include the direct action on bacterial H+/ K+-ATPase, as well as indirect action on the environment pH. Increase of Lachnospiraceae family bacteria quantity in esophagus after PPI treatment and unclassified Clostridial families alone with reduction of Methylobacteriaceae family were observed. Decrease of Moraxellaceae, Flavobacteriaceae, Comamonadaceae, Methylobacteriaceae family bacteria and increase of Erysipelotrichaceae family and unclassified Clostridiales order families was noted in the stomach. Long-term PPI intake can result in development of small-intestinal bacterial overgrowth syndrome, and also can be associated to development of Clostridium difficile-associated disease. Conclusion. The data of few available studies demonstrate microbiota changes throughout gastrointestinal tract at PPI intake. However these results are inconsistent and provide no definite answer whether this changes are beneficial or harmful that requires further studies.

Aim of review. To demonstrate modern potential of bismuth agents administration for increasing of Helicobacter pylori (H. pylori) eradication efficacy. Summary. Prevention of peptic ulcer and stomach cancer makes eradication of H. pylori infection more and more important. At the same time efficacy of some eradication modes, first of all - that of standard triple therapy, steadily decreases because of growing antibiotic resistance of H. pylori strains, first of all - clarithromycin resistance. The concept that empirical prescription of standard triple therapy should be abandoned in favor of initial H. pylori clarithromycin-resistance testing by culture or real-time polymerase chain reaction became widely accepted. Bismuth-based quadrotherapy mainly - with bismuth tripotassium dicitrate (BTD) is alternative to standard triple mode therapy nowadays. Potential of BTD combination not only to tetracycline but to other antibiotics as well was demonstrated. Addition of BTD to triple therapy containing clarithromycin, levofloxacin, metronidazole allows to increase eradication efficacy for 30-40% at H. pylori-resistant strains. Absence of H. pylori resistance development to BTD, combined antibacterial and cytoprotective effects as well as good tolerance are important advantages of the drug. Conclusion. Addition of BTD to triple H. pylori eradication modes, that include different antibiotics (clarithromycin, levofloxacin and metronidazole) provide significant increase in efficacy of eradication at antibioticresistant Helicobacter pylori strains.

Aim of investigation. To study early outcomes of surgical treatment of intestinal obstruction of neoplastic origin. Material and methods. Overall 730 patients operated for acute bowel obstruction of neoplastic origin for the interims of 1993-2005 and 2010-2016 were studied. All operations were carried out urgently for decompensated intestinal obstruction within 1 day after admission to medical institution. Urgent operations were performed according to oncologic treatment principles in the same way as elective surgery. Results. In 603 of 730 patients (82.6%) the tumor was localized distally to the transverse colon. Early postoperative motility for the period of 1993-2002 was 22.8%, for the period of 2011-2016 - 10.2%. The rate of primary radical interventions in the general framework of operations was 88.3%. Conclusions. Original approach to colorectal cancer surgical treatment complicated by acute large-intestinal obstruction resulted in significant decrease in early post-operative motility. Successful performance of radical operations at the first treatment stage considerably facilitates further treatment, social and medical rehabilitation.