Aim. The aim of this literature review is to generalize existing approaches to the pathogenetic treatment of gastritis as a basis for the prevention of gastric cancer, as well as to submit a resolution of a scientific symposium that brought together gastroenterologists from a number of CIS countries.

Background.  H. pylori infection is widespread in CIS countries. The proportion of infected adults in the population ranges from 60 % to over 90 %. This causes a high incidence of chronic gastritis and other diseases associated with H. pylori. In 2012, gastric cancer was recognized as the 3rd leading malignant disease in the Kyrgyz Republic and the Republic of Uzbekistan, 5th — in Belarus and Kazakhstan, 6th — in Armenia and the Russian Federation. According to the standardized cancer mortality rate, gastric cancer takes the 1st place in Kyrgyzstan and Uzbekistan, 2nd — in Belarus, 3rd — in Kazakhstan, and 4th — in Armenia and Russia. In every case of H. pylori detection, it is important to make a decision about the expediency of eradication therapy. This is particularly significant, since H. pylori eradication has been recognized as an effective method of gastric cancer prevention. In addition, H. pylori eradication therapy in patients suffering from chronic gastritis with dyspepsia symptoms serves as the firstchoice therapy that allows patients with dyspepsia resulting from H. pylori infection to be excluded. The choice of the H. pylori eradication therapy scheme is determined by the protocols (standards) of patient management accepted in the respective CIS country. A high efficacy of H. pylori infection eradication is shown to be provided by bismuthcontaining schemes.

Conclusion.  Opportunistic screening of H. pylori is carried out by general practitioners, district physicians, gastroenterologists and other specialists. The most effective method of gastric cancer prevention is the eradication therapy of H. pylori infection in chronic gastritis. The maximal positive potential of such a therapy is realized when it is performed before the atrophic changes of the gastric mucosa have appeared. 

Aim.  The aim of this review is to analyze and systematize data on the effect of Helicobacter pylori infection on hepatobiliary diseases.

Background.  Over the past two decades, a growing number of studies have been devoted to the possible involvement of H. pylori infection in the extragastric pathology. The presence of the bacterium was detected in many organs and tissues. Its relationship with the development of idiopathic iron-deficiency anemia, B12 deficiency anemia, idiopathic thrombocytopenic purpura is proved. The possible role of the bacterium in the development of hepatobiliary pathology is also discussed. The presence of the bacterium has been revealed in samples taken from the liver tissue, biliary tract, bile and gallstones of patients suffering from hepatobiliary diseases. The involvement of H. pylori in the formation of gallstones is considered possible. Non-alcoholic fatty liver disease (NAFLD) is more often diagnosed in H. pylori infected individuals compared to those not infected. The progression of inflammation in the liver of any nature is noted in the presence of H. pylori infection. Different species of the Helicobacter genus, including H. pylori, are shown to contribute to the development of liver cancer. However, some researchers report data against the involvement of H. pylori in the pathogenesis of various hepatobiliary diseases.

Conclusion.  The results obtained by the authors cannot be considered unambiguous, thus requiring further research. Given the high prevalence of H. pylori infection and the significant incidence of hepatobiliary pathology, the confirmation of their relationship can be of great epidemiological, preventive and clinical importance. 

Aim.  The aim of the study is to analyze the regularities of changes in the basic indicators of esophageal pH-impedance monitoring and high-resolution manometry in patients with non-erosive reflux disease (NERD), erosive reflux disease (ERD) and Barrett’s esophagus (BE) in comparison with healthy individuals.

Materials and methods.  69 patients were examined, including 19 patients with NERD, 16 patients with ERD, 14 patients with BE and 20 individuals comprising the control group (CG). The gender structure was as follows: 44 male and 25 female patients. The average age of the examined patients was 46 years. All patients underwent 24-hour esophageal pH-impedance monitoring and high resolution manometry.

Results.  According to the data of 24-hour pH-impedance monitoring, the total time in the esophagus with pH < 4 was 2.4 % in the control group, 9 % in the NERD group, 20.25 % in the ERD group and 23.5 % in the patients with BE (p < 0.05). The average number of acid refluxes was 22.5 in CG, 61 in the NERD group, 77 in the ERD group and 86 in patients with BE (p < 0.05). The time of chemical clearance was 1.7 minutes in CG, 2.2 minutes in the group of patients with NERD, 2.9 minutes in the ERD group and 3 minutes in the BE group (p < 0.05). The mean nocturnal baseline impedance was 2483.5 Ohm in CG, 1775.0 Ohm in the NERD group, 771.0 Ohm in the ERD group and 911.0 Ohm in the BE group (p < 0.05). The normal parameters of the esophagogastric junction (EGJ) structure and function according to the data of highresolution manometry were observed among 85 % of the control group, 63 % of patients with NERD, 25 % of patients with ERD and 36 % of BE group. The presence of hiatal hernia (HH) and/or hypotension of lower esophageal sphincter (LES) was observed in 15 % of patients from the CG, in 37 % of patients with NERD, in 75 % of patients with ERD and in 64 % of patients with BE. The normal parameters of the motor function of the esophagus were observed in CG (85 %), as well as in patients with NERD (79 %). In patients with ERB and BE, normal motor activity was noted in 25 % and 29 % of the cases, respectively. Disturbances of the motor function of the thoracic esophagus in CG were represented in 10 % of the cases by ineffective peristalsis and hypercontractility in the form of distal esophagospasm in 5 % of the cases. In the NERD group, 16 % of patients had ineffective peristalsis and 5 % of patients had hypercontractility in the form of a hypercontractile esophagus. In patients of ERD and BE groups, the disorders of the motor function of the thoracic esophagus were predominantly represented by ineffective peristalsis, in 75 % and 50 % of the patients, respectively. In addition, in the group of patients with BE, in 21 % of the cases, motor function disorders were observed in the form of absence of thoracic esophagus contractions.

Conclusion.  It is shown that such indicators as increased level of acid exposure, increased amount of acid reflux, slowed chemical clearance, lowered mean nocturnal baseline impedance, as well as disorders in the structure and function of the esophageal-gastric junction and motility of the thoracic esophagus are associated with the severity of GERD. 

This paper is aimed at investigating the microbiota of the esophagus and stomach in patients with gastroesophageal reflux disease (GERD) and healthy volunteers.

Materials and methods.  The study included 15 patients suffering from GERD and 6 healthy volunteers. All subjects underwent sampling of esophageal and gastric contents. The study of the microbiota in the obtained samples was performed by sequencing the 16S gene of ribosomal RNA (rRNA).

Results.  The most common types of bacteria in the esophagus and stomach in patients with GERD and healthy volunteers are found to be Bacteroidetes, Firmicutes, Actinobacteria, Proteobacteria, Fusobacterium. By comparing the relative contents of the main types of bacteria in the esophageal mucus and gastric contents, a significant decrease in the proportion of Proteobacteria was observed in patients with GERD as compared to healthy volunteers. The decrease in the relative number of bacteria belonging to the Acetobacteraceae, Bacillaceae, Bdellovibrionaceae, Clostridiales Insertae Sedis XI, Fusobacteriaceae, Moraxellaceae, Pasteurellaceae and Rhodocyclaceae families was observed in the esophagus in patients with GERD as compared to healthy volunteers. A higher bacterial content of the Leptotrichiaceae and Veillonellaceae families was detected in the stomach of patients with GERD.

Conclusions.  The obtained results indicate differences in the intraluminal microbiota of the esophagus and stomach in patients with GERD and healthy volunteers. Further study should be carried out to study the effect of changes in bacterial composition on those in the esophagus and stomach. 

Aim.  This work is aimed at studying the role of the small bowel bacterial overgrowth syndrome (SBBOS) in the pathogenesis of bronchial asthma (BA).

Materials and methods.  The study included 80 BA patients (45 and 35 patients allergic and non-allergic BA forms, respectively). Conventional laboratory and instrumental studies were conducted. SBBOS was confirmed by a hydrogen breath test with lactulose. Patients received conventional basal therapy with combined drugs (long-acting β2-adrenomimetics, and inhaled glucocorticoids). For SBBOS treatment, rifaximin (23 patients) or rifaximin followed by probiotic (B. bifidum, B. longum, B. infantis, L. rhamnosus) for 1 month (22 patients) was administered. Control studies were conducted on the 14th day and following 1 month of treatment.

Results. A frequent combination of the small bowel bacterial overgrowth syndrome and bronchial asthma was revealed. 67 % and 43 % of the patients with the allergic form and non-allergic asthma form, respectively, are shown to suffer from SBBOS, p = 0.028. High levels of IgE (p < 0.01) and eosinophils in sputum (p < 0.001), combined with severe impairment of the function of external respiration (p < 0.01) in the case of SBBOS with allergic asthma reflect a more pronounced degree of sensitization of these patients. The correction of composition disorders of the intestinal microflora is accompanied by a statistically significant decrease in the immune response (p < 0.01) and improvement in the function of external respiration (p < 0.001).

Conclusion.  SBBOS is a significant factor, aggravating the course of bronchial asthma and playing an important role in the development and maintenance of sensitization of patients. 

Sex hormone preparations are widely used in obstetrics for the treatment of infertility and miscarriage. Possible adverse effect of sex hormone preparations during pregnancy is their potential adverse impact on the hepatobiliary system. The most common pathology of the liver and gallbladder associated with pregnancy are intrahepatic cholestasis of pregnancy (ICP) and biliary sludge (BS).

Aim.  The aim of the study is to evaluate the effect of female sex hormones on the course and effectiveness of treatment of ICP and BS during pregnancy. Materials and methods.  The study included 158 pregnant women (97 patients with ICP and 61 patients with BS). Exogenous hormonal effects were the use of assisted reproductive technologies (ARTs) and in vitro fertilization (IVF) for the onset of conception and/or the use of estrogen and progesterone preparations during pregnancy. ICP was diagnosed on the basis of detection of an elevated level of bile acids (above 8 μmol/L) in the blood serum. Patients underwent clinical, laboratory and instrumental studies (abdominal ultrasound, including the assessment of gallbladder motor-evacuator function initially and after 2 months of treatment, and pelvic ultrasound). Pruritus intensity associated with ICP was assessed using a 0–3 score scale. Patients with BS received treatment with ursodeoxycholic acid (UDCA) in a dose of 250–750 mg and choleretic herbal preparation (artichoke extract) for 2 months. Patients with ICP were treated with UDCA in a dose of 500–2000 mg until delivery. Biochemical laboratory parameters in the ICP group were evaluated after 1 and 2 weeks of treatment.

Results.  More than half of patients with BS and ICP were taking sex hormone preparations or had a pregnancy that occurred after the application of ART programs. In patients who became pregnant after ART, the ICP developed at a significantly earlier time than in patients with a naturally occurring pregnancy (p < 0.001). The use of sex hormones proved to be interrelated with a high frequency of cholestasis recurrence after its regression in the course of the treatment (p < 0.001). Patients with pregnancy after ART programs, as well as taking sex hormones, had an increased risk of BS developement. The intake of sex hormones (p = 0.005) in patients with ICP was associated with a more frequent development of preeclampsia and the need for caesarean section (p = 0.003). The use of ART programs and hormonal therapy, as well as the presence of BS in patients with ICP, were interrelated with oxidative stress. BS on the ICP background was associated with the development of intrauterine fetal hypoxia. In pregnant women with BS, the reception of progestins was significantly (p = 0.004) correlated with functional impairment of the motor function of the biliary tract (BT). In the presence of BS, ICP occurs with more severe liver damage, and the patients are inferior to respond to UDCA treatment. Prognostic factors in the insufficient effectiveness of BS treatment: the use of sex hormone preparations during pregnancy, the presence of the polycystic ovary syndrome (PCOS) in the anamnesis, an older age at the time of pregnancy and conception after ART.

Conclusion. The use of sex hormone preparations and ART programs are shown to be additional factors contributing to the emergence of ICP and BS during pregnancy. For the pregnant women taking sex hormone preparations and/or becoming pregnant after ART programs, it is important to conduct laboratory and ultrasound screening for early detection and timely treatment of ICP and BS. BC patients of older ages who have become pregnant after ART programs and take sex hormones preparations and/or have a PCOS in an anamnesis may need longer or repeated courses of BS treatment. 

Aim. This study is aimed at evaluating the efficacy and safety of Bicyclol administration in patients suffering from non-alcoholic fatty liver disease (NAFLD) («ZIGUN» research) by monitoring laboratory data and non-invasive methods of diagnosis of liver fibrosis and steatosis.

Materials and methods.  The study included 93 patients with NAFLD with the average age of 44 (38–49) years, having the stage of liver fibrosis and steatosis greater than the 1st according to FibroScan (FibroScan 502 TOUCH with CAP software). Patients were randomized into 2 groups: 1) the main group comprised 67 patients receiving 75 mg/day of Bicyclol for 24 weeks in combination with aerobic exercise and Mediterranean diet; 2) the comparison group (26 patients) prescribed of only aerobic exercise and Mediterranean diet for 24 weeks.

Results.  During Bicyclol treatment, a decrease in the following indicators was observed: ALT, AST, GGT, CRP by 30 % or more, glycated hemoglobin (–10 %) and HOMA-index (–24 %), cholesterol (–12 %), LDL (–19 %), triglycerides (–31 %), atherogenic coefficient (–22 %). A decrease to the1st stage of fibrosis was observed in 30 patients (44 %), steatosis regression to the 1st stage was noted in 57 patients (85 %). Liver steatosis of the 4th stage was not revealed after treatment with Bicyclol. The number of patients with indolent steatosis (less than 2nd stage) increased 2 times (p < 0.001). No significant changes were found in the group without drug therapy.

Conclusions.  Bicyclol therapy in NAFLD is accompanied by positive dynamics of inflammation activity markers, insulin resistance and lipid spectrum, which suggests a positive dynamics of the stages of liver fibrosis and steatosis. 

Aim.  The aim of the study is to determine the effectiveness of liver transplantation (LT) in the treatment of unresectable hepatocellular carcinoma (HCC) occurred in normal liver.

Material and methods.  6 patients with unresectable HCC underwent orthotopic liver transplantation (OLT). The long-term OLT results were compared with survival results of liver resection in patients with late stage HCC.

Results.  Hepatocellular carcinoma is one of the most common types of cancer, which occurs mainly in patients with liver cirrhosis and chronic viral hepatitis. Only about 10 % of HCC develops in non-cirrhotic liver among young and somatically healthy patients. 1-, 3-, 5-year recurrence-free and overall survival in LT group was significantly better than in the control group.

Conclusion.  LT is indicated for patients with unresectable HCC in non-cirrhotic liver and its extrahepatic localization. A large tumor size and macrovascular invasion should not be a contraindication for LT in such patients. 

Aim.  The aim of the review is to present current data on the relationship between non-alcoholic fatty liver disease (NAFLD) with the metabolic disorders of bile acids (BA) and changes in the composition of the intestinal microbiota.

Background.  NAFLD is accompanied by a change in the intestinal microbiotic composition: the proportion of taxa deconjugating BAs increases, while the proportion of taxa converting primary BAs to secondary ones decreases. The number of bacteria forming lipopolysaccharide (LPS) also increases. LPS, entering the liver with the portal vein blood, promotes the development of its inflammation and insulin resistance. The disturbance of bile acid metabolism through the effect on the FXR and TGR5 receptors also leads to insulin resistance and liver steatosis. FXR probiotics and agonists are promising drugs for the NAFLD treatment.

Conclusion.  In the course of NAFLD, a change in the composition of the intestinal microbiota is observed, which contributes to the development of inflammation in the liver and disrupts the metabolism of bile acids, leading to insulin resistance. 

Aim. The aim of the review is to systematize the principles of interpretation of morphological and molecular-cellular signs underlying the biopsy diagnosis of chronic gastritis from the standpoint of personified prevention of gastric cancer.

Background.  The chronicle of cancer prevention is presented as an evolution of views on the possibility of clinical interpretation of structural changes in the gastric mucosa such as early (inflammation, metaplasia, atrophy) and pronounced (intraepithelial neoplasia/dysplasia) precancerous changes. The protocols of taking gastric bioptates and their violations, the principles of formulating the pathoanatomical conclusion (Updated Sydney system, OLGA system) and a personalized forecast of the risk of gastric cancer are discussed. Molecular classification of gastric cancer is considered from the standpoint of carcinogenesis cascade and WHO 2010 histological classification. New molecular and cellular targets for the preparation of bismuth tripotassium dicitrate and practical steps of its use in the prevention of gastric cancer in chronic inflammation of the mucosa of various etiologies are conceptually described.

Conclusion.  Biopsy diagnosis of chronic gastritis combined with the evaluation of gene structure (genetic polymorphism) and epigenomic mechanisms (microRNA) allows the risk of gastric cancer to be ranked in a particular patient even with early precancerous changes in the gastric mucosa. The activity of gastritis (infiltration of the mucosa with neutrophilic leukocytes) of any etiology is the theoretical justification for the use of bismuth tripotassium dicitrate pharmacological preparation to protect the genome of stem cells of the gastric epithelium as a secondary prevention of gastric cancer. 

Aim.  This paper is aimed at presenting the materials of clinical observations associated with diagnosing rare-occurring ruptures of the right dome of the diaphragm that have been overlooked for a long period.

Results.  A 61-year-old man was admitted to hospital with a diagnosis of chronic heart failure. Chest radiograph revealed a high position of the right dome of the diaphragm. Computed tomography revealed a defect in the central parts of the diaphragm on the right, the liver was rotated outward with its visceral surface deployed anteriorly and upward. In the right thoracic cavity, anterior to the liver, were the loops of the intestine and the outlet of the stomach.

More than 30 years before, the patient had experienced an explosive trauma, which might have caused a rupture in the right dome of the diaphragm. A 70-year-old man, a smoker with a ten-year history of hypertension, was hospitalized with an increase in dyspnea, a cough with the discharge of purulent sputum, the feeling of heaviness behind the sternum. Chest radiograph revealed a high standing of the right dome of the diaphragm at the level of 3rd rib with a decrease in the volume of the right lung, and an increase in cardiac silhouette (cardiothoracic index 0.64). Computed tomography revealed a high standing of the right dome of the diaphragm as well as the compression of the middle and lower lobe of the right lung with the presence of compression atelectasis. The liver was rotated, displaced into the right thoracic cavity, the deformation of the inferior vena cava to the right was visualized due to the displacement and rotation of the liver. The consolidated fractures of 10th–12th ribs on the right were visualized. The patient had had a chest injury resulting from a traffic accident about 15 years before, with no X-ray examination having been conducted at that time.

Conclusion.  In the case of left-sided diaphragm ruptures, which are much more frequent than the right-sided ones, the stomach, large and small intestines as well as spleen are displaced into the thoracic cavity. In the case of rightsided diaphragm ruptures, the liver and gallbladder are displaced into the thoracic cavity. Right-sided posttraumatic diaphragmatic hernias that are not diagnosed at the time of injury or trauma and continue to be asymptomatic for a number of years are very rare. The sensitivity and specificity of computed tomography for the diagnosis of diaphragm ruptures is 61–87 % and 72–100 %, respectively. In an acute period, the treatment of diaphragm ruptures is surgical. However, in long-term asymptomatic ruptures, expectant management is possible, particularly if the risk of surgical treatment is high.