Aim of review. To present the modern data on interrelation of bile acid (BA) metabolism, microbiome and liver diseases. Summary. Bile acids are important signaling molecules that regulate lipid and glucose metabolism. Enterohepatic circulation of BA plays the central role in nutrient absorption and metabolic regulation. Data of investigations demonstrate interrelation of BA, intestinal microbiome and liver diseases. In particular, the role of BA metabolism disorders in development of non-alcoholic fatty liver disease is extensively studied. Sequestrants of BA are under study as putative BA and glucose metabolism regulators then draws interest from practical point of view. Conclusion. Bile acids carry out multiple physiological functions. The link between BA metabolism, liver disease and intestinal microbiome is demonstrated by numerous investigations.

Aim of review. To analyze the basic esophageal pressure metrics according to Chicago classification v3.0, received at high-resolution manometry and to present the results of clinical application. Summary. Nowadays high-resolution manometry is the most exact hi-tech diagnostic method for esophageal motor function disorders. The changes identified during the investigation are systematized in the Chicago classification v3.0. This relatively new diagnostic method was introduced to clinical application in Russian Federation for the first time in 2011. Vasilenko clinic of internal diseases propedeutics, gastroenterology and hepatology (Sechenov University) accumulated significant experience of high-resolution esophageal manometry of overall 1150 studies. Uniqueness of the method consists in capacity to define integrated quantitative and qualitative metrics of esophageal contractile function and to establish their specific disorders e.g.: change of intrabolus pressure at disorders of esophagogastric junction (EGj) outflow, hypercontractile esophagus, fragmented contractions and weak or failed peristalsis, distal esophageal spasm. Assessment of the type of achalasia subtypes has significant impact on the patients’ treatment choice. Differential diagnosis of belching type, rumination, aerophagy became possible at combined application of high-resolution manometry and impedance measurement. According to anatomical location of the lower esophageal sphincter and crural diaphragm several morphological types of gastro-esophageal junction are defined that determine severity of gastroesophageal reflux disease. Additional provocative tests can be recommended prior to considering anti-reflux surgical treatment that will help to forecast the risk of complications. High-resolution manometry is indicated for patients presenting with dysphagia symptoms, noncoronary chest pain, gastroesophageal reflux disease and other disorders. Conclusion. High-resolution manometry is a fundamental diagnostic test of esophageal motor function disorders. Clinical application of this method significantly expands diagnostic potential and allows to carry out personalized treatment that increases treatment quality.

Background. Atrophic gastritis (AG), being the basic premalignant condition for the stomach cancer (SC), is commonly diagnosed and screened for by noninvasive biomarkers (pepsinogens, gastrin-17), however the data on those biomarkers at SC is inconsistent. Aim of investigation. To evaluate the markers of stomach atrophy along with risk factors of SC of different localization, histological type and stage in the «case series» study. Material and methods. Original investigation was designed as «case series», that included 85 patients with SC (48 m and 37 f, mean age 61.2±13,6 years) who were consistently referred to two medical institutions. All patients underwent interviewing the questionnaire concerning smoking and alcohol consumption, presence of gastroenterological symptoms and family history. Blood serum samples were analyzed using ELISA test kits «GastroPanel» («Biohit Plc», Finland). Manufacturer recommended threshold levels were used at diagnostics of AG. Results. The diagnosis of SC of the III to IV stage was established in 67.9% of patients. The most common location of the neoplasm was the stomach body (63,5%). Helicobacter pylori (H. pylori) infection was revealed by serological method in 74.1% of cases, of which in 15.1% the attempt of eradication treatment was carried out. In 90.6% of patients the adenocarcinoma of different differentiation grade was diagnosed, low degree of differentiation was the most common (57.6%). Signet-ring cell carcinoma was diagnosed in 7.1% of patients, undifferentiated tumor - in 2.4%. Pepsinogen-I (PGI) level under 50 mcg/l was found in 43.2% of patients, indicating different degrees of fundic atrophy. Significantly lower PGI scores were detected in SC patients with histologically verified atrophy. No significant differences in biomarker levels according to tumor location, histological type of SC and tumor stage were found. Conclusions. The «case series» study demonstrated high rate of late SC diagnostics with predominance of corpus location and the most malignant types. H. pylori infection was diagnosed in serologically in the most of patients, however attempts for eradication therapy was carried out only in 15% of patients. Fundic atrophy was diagnosed by serological tests in over 40% of patients, however no association with location, stage and morphological type of the tumor was established. Blood serum samples were analyzed using ELISA test kits «GastroPanel» («Biohit Plc», Finland). Manufacturer recommended threshold levels were used at diagnostics of AG.

Aim of investigation. To estimate doctors’ awareness on diagnostic methods and eradication treatment modes of Helicobacter pylori (H. pylori) infection in routine clinical practice. Material and methods. Overall 261 doctors of healthcare institutions in 15 cities of Russia (Orel, St. Petersburg, Veliky Novgorod, Smolensk, Krasnoyarsk, Ulyanovsk, Krasnodar, Arkhangelsk, Yaroslavl, Ufa, Bryansk, Kaliningrad, Nizhny Novgorod, Moscow and Tyumen) were surveyed in 2016-2017. Data acquisition provided voluntary anonymous application of questionnaire consisting of 12 questions that will allow estimating knowledge of indications to H. pylori testing, diagnostic methods for this infection and utilized antihelicobacter treatment modes. Results. Primary diagnostics of H. pylori infection is carried out at peptic ulcer and chronic gastritis by 85 and 84% of surveyed doctors, at GERD - by 59.4%, at NSAID -related gastropathy - by 32%, at MALT lymphoma by 32%, at stomach cancer - by 30.7% and at autoimmune thrombocytopenia - by 16.8% respectively. Primary diagnostics of infection is based mainly on invasive methods: histological method (41.8% of respondents) and rapid urease test (38%). Noninvasive diagnostic methods for H. pylori infection: 13C urea breath test, stool test for H. pylori antigens and serological method were applied by 29.5%; 32.2% and 34.4% of respondents respectively. Of 241 described antihelicobacter first-line treatment modes 49.8% of respondents checked completely adequate treatment in accordance to the Russian Gastroenterological Association (RGA) guidelines. Of specified modes mainly clarithromycinbased standard triple therapy, including combination to the bismuth agent was mentioned. H. pylori eradication efficacy control is carried out by adequate invasive tests, such as urea breath test and fecal antigen test being utilized by 17.4 and 16.2% of respondents respectively. The inadequate control using serological method and rapid urease test was recommended by 10.7 and 6.6% of surveyed doctors respectively. At the choice of second line antihelicobacter therapy mode components 34.8% of doctors complied to RGA guidelines. Quadrotherapy with bismuth agent was advocated by 28% of doctors, levofloxacin-based triple therapy by 6.8%. Conclusions. Overall, doctors from different regions of the Russian Federation are well aware of the primary diagnostic methods of H. pylori infection, indications for eradication therapy and first-line treatment mode. However, additional education is required to inform doctors on necessity for H. pylori eradication, efficacy control methods, mode of second line treatment and drug dosages.

Aim of investigation. To investigate treatment compliance of patients with the liver cirrhosis (LC). Material and methods. Overall 43 patients (17 men, 26 women) were enrolled to original study. Mean age of the patients was 47.1±11.9 years. Development of LC was the outcome of viral hepatitis, alcoholic liver disease and other diseases in 13, 14 and 16 patients respectively. Demographic features, disease duration, etiology, severity according to Child-Pugh score and «compliance level» questionnaire score were analyzed [Kadyrov R.V. et al., 2014]. Results. High level of dental compliance in LC patients was revealed (91.97±11.3), including emotional (32.52±4.4) and behavioral components (31.45±5.0). Social compliance level was estimated as average (28.00±3.6). No relation of treatment compliance to demographic features as well as to disease duration was found. The etiology of LC had no statistically significant impact on treatment compliance degree. Patients with LC of the Child-Pugh class B had highest compliance level (97.00±7.31), while those with Child-Pugh Class C - the lowest (80.89±11.73). Progression of encephalopathy exerts negative impact on treatment compliance. Emotional compliance of patients with the history of bleeding is significantly higher. Conclusions. Identification of factors that determine treatment compliance of LC patients is required for effective choice of treatment method and complication prophylaxis.

Aim of investigation. To estimate the effect of carriage of various allelic variants of blood coagulation system and platelet receptors genes on Wilson’s disease (WD) clinical presentation features. Material and methods. Original study included 85 patients with a Wilson’s disease who were divided into two groups: without neurological symptoms (abdominal form; n=51) and with neurologic symptomatology (mixed form; n=34). Genetic polymorphism testing was carried out by real-time polymerase chain reaction with melting curve analysis. Results. Alleles A of hemostasis genes FII 20210 G/A, FV 1691G/A were more frequent in the group with neurologic symptomatology as compared to the group of patients with abdominal form of WD at the level of trend. Frequency of 5G allele of plasminogen activator inhibitor gene PAI-675 5G/4G in the group with neurologic symptoms was lower (41.17%), than in the group without symptoms of central nervous system (CNS) involvement (49.02%) (odds ratio - OR: 1.374; 95% confidence interval - CI: 0.739-2.553). In the group of patients with neurological symptoms 4G4G genotype of PAI-675 5G/4G gene was more common (47.06%), than in patients without those symptoms (23.53%) (OR: 2.889; 95%-CI: 1.135-7.350). The allele T of platelet receptor gene ITGA2 807 C/T was more common in patients with CNS involvement than in the group of patients without neurological symptoms (р =0.018; OR: 2.172. 95%-CI: 1.163-4.058). Integrated genotype CT+TT was significantly more common in patients with neurological symptoms (82.35%) as compared to patients without those (54.90%) (р =0.010; OR: 3,833; 95%-CI: 1.355-10.846). Conclusion. Carriage of mutant genotypes FII 20210 G/A, FV 1691G/A, PAI-675 5G/4G, ITGA2 807 C/T is the factor associated to the presence of neurological symptoms at Wilson's disease.

Цель исследования. Оценить особенности течения, диагностики и лечения бессимптомных форм внутрипеченочного холестаза беременных (ВХБ). Материал и методы. Лабораторным маркером ВХБ служило повышение уровня определявшихся суммарных сывороточных желчных кислот (ЖК). У пациенток оценивали клинико-анамнестические данные, исход беременности, лабораторные биохимические показатели до лечения, а также в динамике через 1 и 2 нед после начала терапии урсодезоксихолевой кислотой в дозе от 500 мг до 2 г в сутки. Результаты. Из 97 беременных с лабораторно подтвержденным ВХБ кожный зуд наблюдался у 70 (72,2%), отсутствовал в 27 (27,8%). Достоверных различий в клинико-анамнестических показателях, частоте неблагоприятных исходов для плода, биохимических показателях до начала лечения между пациентками с манифестным и бессимптомным течением ВХБ не отмечено. При ВХБ, сопровождавшемся кожным зудом, скорость и выраженность снижения активности печеночных трансаминаз были достоверно выше, чем при бессимптомных формах (p <0,001). Значимых различий в динамике уровня сывороточных ЖК на фоне лечения в изучаемых группах не выявлено. Заключение. Отсутствие достоверных различий в клиническом течении, частоте развития осложнений беременности и лабораторных признаках повреждения печени позволяет рассматривать ВХБ без кожного зуда как бессимптомную форму заболевания. При бессимптомных формах ВХБ существуют такие же риски для плода, как и при его классических формах. В связи с этим представляется целесообразным проводить лабораторный скрининг беременных на содержание сывороточных ЖК для выявления субклинически протекающего ВХБ.

Aim of investigation. To estimate short-term results of ileal pouch anastomosis after urgent colon surgery at complicated ulcerative colitis. Material and methods. Two peer groups including 26 patients each after multi-stage surgical treatment were analyzed. In the first group of patients ileal pouch was created in less than 12 month after primary resection operation, in the second - in more than 12 months. Results. No statistically significant differences between groups were found by any of short-term result scores (p>0.05), including operation time (p=0.48) and volume of blood loss (p=0.88). No significant differences in morbidity rate were found at any stage, including the rate of ileal pouch-anal anastomosis incompetence (p=1.0). Conclusions. Technically ileal pouch anastomosis can be created both several months or several years after colectomy. Time span from subtotal colectomy performance before ileal pouch does not influence short-term treatment results.

Aim of publication. To present the modern concept on the causes and pathogenesis of pancreatic exocrine insufficiency (PEI) as well as the new diagnostic and therapeutic approaches at this syndrome to general practitioners. Summary. PEI in the state it which secretion of pancreatic enzymes into duodenum is insufficient for normal digestion of nutrients. This syndrome may develop primarily, due to various pancreatic diseases (chronic pancreatitis, pancreatic cancer, cystic fibrosis etc.), and secondarily, at impaired stimulation of pancreatic secretion or impairment of conditions, necessary for the normal action of pancreatic enzymes. Basic clinical manifestations of PEI include maldigestion and malabsorption that lead to development of nutritional failure. No standardized methods of pancreatic exocrine function assessment are developed at the present time, therefore standard diagnostic criteria of PEI are lacking. In routine clinical practice PEI is diagnosed mainly on the basis of decreased pancreatic enzymes activity in stool in patients with verified pancreatic disease but can result in decreased exocrine function. Basic method of PEI treatment is pancreatic enzyme replacement therapy (PERT). Within 50 years which passed after initial implementation of PERT in clinical practice it was significantly modified, numerous pharmaceutical forms of pancreatin were developed. Anyhow for the purpose of replacement therapy capsules with enteric-coated pancreatin microparticles should be applied. Initial recommended dose of PERT for adult patient is 25’000 lipolytical units per meal that should be subsequently increased up to normalization of patients nutritional status according to both clinical and laboratory scores. Digestive enzymes should be taken at the beginning of the meal, in the case of incomplete response it can be recommended to use antisecretory agents. Patient should be consulted by nutritionist, no significant limitation of fat intake is recommended. Daily ration should be divided into six or more meals. Patients should be motivated to stop both alcohol intake and smoking as they can cause progression of PEI alone and/or persistence of symptoms, like pancreatic pain.

Aim of review. To summarize the modern data on pathogenesis of symptoms irritable bowel syndrome (IBS) symptoms, to present nutraceutical product «Standart zdorovya: GASTRO» as an agent for IBS remission maintenance. Summary. Recent data indicate essential changes of intestinal microbiota in IBS in comparison to healthy population. These changes may be associated to development of inflammatory processes of intestinal wall. Long-term inflammation may result in nociceptor hypersensitivity i.e. peripheral sensitization that in turn, lead to the central sensitization and indirectly - to gastrointestinal tract (GIT) motility disorders. Besides, change of intestinal microbiota may impact the development of emotional disorders (e.g.: impaired capacity of affected intestinal microbiota to produce neurotransmitters). Therefore, according to the results of available studies, intestinal microbiota changes in IBS is a key factor for the cascade of events including intestinal wall inflammation, changes of gastrointestinal motility, decreased threshold of gastrointestinal receptor sensitivity, as well as emotional disorders resulting in development of disease symptoms. Medical preparation for IBS remission induction and remission maintenance should possess probiotic/prebiotic and anti-inflammatory properties, reduce visceral sensitivity, normalize intestinal motility and modulate patients’ emotional sphere. Due to capacity of «Standart zdorovya: GASTRO» components to deliver above-listed effects it can be promising for administration in patients with IBS.

Aim of case presentation. To demonstrate the course of inflammatory and sclerosing variant of the Crohn’s disease, complicated by severe nutritional failure. Nonetheless good therapeutic response was achieved at combined anti-cytokine therapy with immunosuppressive drugs and adequate nutritional support. Summary. Disease manifested with diarrhea, general weakness, high fever, abdominal pain and significant weight loss. Laboratory tests demonstrated elevation of ESR and C-reactive protein and anemia. Patient was diagnosed as having irritable bowel syndrome in local hospital and received symptomatic treatment for one year. Later on patient underwent examination to exclude hematological disorder. In 1.5 years before admission to Vasilenko clinic of Sechenov University patient lost 30 kg of body weight. The diagnosis of Crohn’s disease in our clinic was established on the basis of careful study of clinical course of disease (late postprandial pain, diarrhea, fever and progressive weight loss). The diagnostic concept was confirmed by modern laboratory and instrumental methods of investigation (CT enterocolonography, endoscopic and histological study). Evaluation of nutritional status revealed the presence of protein-energy malnutrition of severe degree of alimentary marasmus type. Taking into account severe manifestations of a nutritional failure along with baseline therapy of autoimmune process at Crohn's disease (corticosteroids, immunosuppressors added by anticytokine therapy) patients received nutritional support that allowed to achieve clinical remission. Conclusion. Progression of Crohn’s disease with involvement of terminal ileum can result in proteinenergy malnutrition. Management of relapse of Crohn's disease and severe protein-energy malnutrition require nutritional support already at initial treatment stages