The aim of review. To characterize possible relation between microbiome and cardio-vascular system structural and functional state. Key points. Along with traditional concepts on the risk factors of atherosclerosis and cardio-vascular diseases development one should take into account data on the new pathogenic mechanisms for these diseases. According to recent studies human gastrointestinal microbiome may increase cardiovascular risk due to bacterial production of proinflammatory proteins that both promote development of atherosclerosis and directly affect the heart and vessels. Probiotics, that are mainly prescribed at gastroenterological diseases, may be applied for correction of cardiovascular risk factors as well. Obtained data demonstrate that intake of certain probiotic strains may be applied as a successful treatment of atherosclerosis, systemic hypertension, metabolic syndrome and heart failure. Conclusion. Microbiome may be involved in development of cardio-vascular diseases and atherosclerosis due to metabolic symbiosis with the host. Probiotics may be applied as preventive medication for correction of metabolic disorders that result in development of cardio-vascular diseases and atherosclerosis.

The aim of review. To analyze reports and publications devoted to radiological methods in gastroenterology and to present options of these methods to doctors: gastroenterologists, experts in radiology and doctors of other specialties. Key points. Results of scientific development and applications of radiological methods in diagnostics of gastrointestinal diseases in clinical practice are presented. The further improvement of diagnostic techniques is required. High correlation rate of radiological to clinical and morphological data is demonstrated. Radiological methods are highly effective in different fields of clinical practice, including gastroenterology, pediatrics, oncology, surgery, transplantology etc. Conclusion. The range of issues that can be solved by modern radiological methods of diagnostics became broader.

Aim of investigation. To study the effect of some social and psychological factors, disease-related factors, patient-related factors, and also to estimate the effect of psychopathological disorders on treatment compliance in patients with gastrointestinal diseases. Material and methods. Overall 151 patients (57 - with irritable bowel syndrome, 57 - with gastroesophageal reflux disease and 37 - with peptic ulcer of the stomach and duodenum) were investigated by structured interview method applying «the basic questionnaire for clinical and epidemiologic ethnocultural studies». Compliance was estimated by the universal validated Morisky medication adherence scale; the degree of treatment compliance was specified with the help of specially designed questionnaire. Results. At investigation of social and psychological factors it was revealed that most of noncompliant patients were employed (85,9%; p<0,05), of 40 to 49 years of age (25,6%; p<0,05), having secondary education (56,4%; p<0,05), possessing nonconstructive model of parent-child relationship (85,9%; p<0,05), as well as the patients from risk groups and those with interfamily conflicts (18,2% and 15,4%; 0% p<0,05). Analysis of disease-related and patient-related factors of compliance has revealed, that patients from risk groups and noncompliant patients had more frequent complaints (75% and 78,2%; 34,5%; p<0,001). They less commonly choose official healthcare as a preferred treatment method (63,6%, 75,6% less often; 100% p<0,01), they had lower degree of awareness of their disease and provided treatment (82,1%; p<0,05). Most of the risk group patients had chronic diseases that lasted for more than 2 years (95,5%; p<0,05 and p<0,01), these patients were hospitalized in different hospitals more commonly (77,3%; p<0,001). Risk group patients were much more frequently dissatisfied by amount of time spent to them by their doctor at admission than compliant patients (40,9%; p<0,05). Studied patients revealed quite frequent psychopathological disorders. Risk group patients and noncompliant patients had significantly higher rate of paranoid disorders (15,9%, 16,7%; 0% p<0,05), in the risk group patients anancastic disorder prevailed along with paranoid (45,5%). Conclusions. Family conflicts, nonconstructive model of parent-child relationship, employment, absence of higher education and age of 40 to 49 years were noncompliance predictors among social and psychological factors. Personality disorders, in particular paranoid and anancastic are accompanied by low treatment compliance. Patients with low compliance had high number of complaints, multiple admissions to different hospitals, changing of the attending physician because of diagnosis and treatment disagreements, disease duration of more than 2 years, insufficient knowledge of the disease and prescribed medications.

Aim of investigation. To study pathogenic and clinical role of Helicobacter pylori infection at irondeficiency anemia (IDA). To present the diagnostic and treatment guidelines for these patients taking into account their specific requirements. Material and methods. Overall 120 H. pylori-positive patients of different age (from 18 to 70 years), which were subdivided into two groups were studied. The main group included 70 H. pylori-positive patients with chronic iron-deficiency anemia of unknown etiology. Patients of this group have been randomized in two homogeneous subgroups (according to severity of anemia). Patients of the subgroup 1a underwent eradication therapy for 10 days (amoxicillin 1000 mg b.i.d., clarithromycin 500 mg b.i.d.; esomeprazole 20 mg b.i.d.) followed by the course of treatment by ferrous iron combined to ascorbic acid. Subgroup 1b patients received only iron supplementation therapy. The group of comparison included 50 H. pylori-positive patients without coexistent iron deficiency who received the first line eradication therapy for 10 days as well. Presence of H. pylori infection and eradication control were carried out by urea breath test (Helic-test system). Efficacy of IDA treatment was evaluated by hemoglobin level, RBC color index, total iron-binding capacity (TIBC), serum ferritin and iron levels. Results. Patients were monitored with examination on the 14th, 28th and 56th days of treatment. Mean laboratory scores prior to onset of treatment in the subgroup 1a were: Нb 88,5 g/l, RBC 3,0×1012, RBC color index 0,74, serum iron 6,7 µmol/l, TIBC 89,4 µmol/l, transferrin saturation rate 9,3 %, ferritin 10,1 µg/l; in the subgroup 1B: 89,6 g/l, 3,1×1012, 0,75; 7,3 µmol/l, 88,6 µmol/l, 9,8%, 10,8 µg/l. At control examination in 28 days after iron supplementation onset positive changes were observed, that were more prominent in the subgroup 1a: Hb 117,8 g/l, RBC 3,9×1012, RBC color index 0,83, serum iron 17,7 µmol/l, TIBC 74,4 µmol/l, transferrin saturation percent 20,8 %, ferritin of 20,7 µg/l; in the subgroup 1B: 104,2 g/l, 3,6×1012, 0,81, 12,6 µmol/l, 79,2 µmol/l, 16,6 %, 17,9 µg/l respectively. Is also noticed that regression of anemia symptoms was more rapid than improvement of the laboratory scores especially in subgroup 1A patients. To 56th day of treatment all patients have reached target hemoglobin levels, that corresponded to a normal range. Conclusions. Eradication therapy in patients with iron deficiency anemia, allows to achieve improvement of both physical signs and the laboratory scores in shorter terms, as well as more rapid symptom relief. According to Maastricht IV consensus statements, all H. pylori-positive patients with idiopathic iron deficiency anemia require eradication therapy before onset of iron supplementation.

Aim of investigation. To estimate hematological disorders in patients with high titer of anti-parietal cell antibodies (APCA). Material and methods. Overall 71 patient with high serum APCA titer were included in original study. At all patients scores of clinical and biochemical blood tests were investigated. The special attention was given to RBC color index (CI), mean corpuscular volume (MCV), mean hemoglobin content per cell and serum iron and vitamin В12 concentration. Results. The mean indices of clinical and biochemical blood tests in APCA-positive patients were within normal range. Hematological changes were revealed in 25,4% of patients. In 11,3% of the cases either macrocytic or microcytic anemia was diagnosed. Increase in mean corpuscular volume and serum cobalamin level were found out in 16,9% of the cases, while low hemoglobin level - only at 25% of them. No Helicobacter pylori infection has been revealed in the patients with macrocytic anemia, however no significant difference on its prevalence in patients with different serum cobalamin level was found out. Conclusion. The majority of cases with high APCA titer has no hematological signs of autoimmune gastritis. In 25,4% of patients with APCA changes in common blood count were revealed, most often - of MCV and the CI. Anemia was diagnosed in 11,3% of patients. In investigated group cobalamin deficiency was found in 16,9% of patients, iron deficiency - in 9,9% of the cases. In 75% of patients increase in MCV was the only sign of cobalamin deficiency. Iron deficiency was more common in women.

The aim of review. To present modern concept on pathogenesis, clinical presentation, diagnostics and treatment of hepatic encephalopathy (HE). Summary. HE is a complex of neurological and psychiatric disorders that develop on a background of severe liver diseases due to portal blood shunting and impaired liver detoxication function. Expert opinions on the leading mechanism of HE pathogenesis are contradictory. Some believe, that the leading part is played by the effect of hyperammoniemia on neuronal functions; the others give major importance to the change in aminoacid spectrum and neurotransmitter disorders; the third give the most attention to elevation of mercaptan concentration and level of shortchain fatty acids, change of GABA-benzodiazepine complex function. HE is characterized by heterogeneity of manifestations. Cognitive (varying from the minimal changes to coma) and motor (muscles stiffness, baryphonia, tremor, etc.) disorders prevail in the clinical presentation. The basic approaches in treatment of HE include: detection and elimination liver damaging factors that provoke onset or stimulate progression of HE; reduction of production and absorption of ammonia or increase of its elimination. At frequently relapsing and progressing liver failure liver transplantation is performed. Conclusion. Involvement of the central nervous system at liver failure is the major problem from the point of view of duly and correct diagnostics, treatment, and social adaptation of patients. Many aspects of HE in particular its pathogenesis are insufficiently investigated.

Aim of investigation. To estimate frequency of hepatomegaly and splenomegaly in pediatric patients, to determine their causes and nosological pattern of hepatolienal syndrome (HLS) in relation to age. Material and methods. Overall 5178 children aged 1 month to 17 years were examined to detect hepatosplenomegaly. Frequency of hepatomegaly and/or splenomegaly of unspecified etiology was analyzed with correlation to outpatient clinic admission rate and results of routine inspections. Results. The spectrum of age and main causes of hepatosplenomegaly was studied according to physical examination of 241 children. The most common causes of HLS include infectious diseases - 56 cases (23,2%) and neoplasms - 55 cases (22,8%; p<0,05). Diseases of blood, represented mostly by hemolytic anemias, were revealed in 28 (11,6%) children, metabolic diseases - in 17 cases (7,1%). In 25 (10,4%) patients somatic HLS-associated diseases, and 24 (10,0%) - other rare liver diseases were diagnosed. Extrahepatic portal hypertension syndrome was revealed in 8 (3,3%) patients. Conclusion. Nosological attribution of hepatomegaly and splenomegaly is determined by the age of child, there degree of organ enlargement, clinical and laboratory features of the main disease.

The aim of review. To present basic issues of Helicobacter pylori gastritis that were covered during Kyoto consensus meeting. Key points. The panel of experts had discussed 22 questions, the answers to which resulted in formulation of 24 statements that were voted with estimation of degree of evidence, recommendation grade and consensus strength. Thus the consent rate has exceeded 80% for all statements. New classification of gastritis and duodenitis, based on the etiological approach has been proposed. It is recommended to qualify dyspepsia cases with sustained symptomatic improvement after successful eradication therapy as H. pylori-associated dyspepsia, and to distinguish them from functional dyspepsia. Broader application of magnification endoscopy methods is recommended for diagnostics of chronic gastritis. It is stressed, that the duly eradication therapy which is carried out before development of severe atrophy is capable to decrease the risk of stomach cancer. Conclusion. Proceedings and conclusions of consensus can become a cornerstone for development of new international gastritis classification.

Aim of investigation. To assess colonic cytokines profile at severe ulcerative colitis (UC). Material and methods. Overall 48 biopsy specimens of colonic mucosa obtained at resection operations in 7 patients with total form of UC were investigated. All patients underwent total colectomy for severe treatment-resistant UC. Activity of inflammatory process was determined by severity of erosive and ulcerative lesions of the colon. Cytokine concentration was evaluated in supernatant fluid after centrifugal separation of 10 mg biopsy specimen homogenate by the protein analyzer «Bio-Plex» («Bio-Rad», USA). Colonic mucosa biopsy specimens of unaffected parts of the large intestine resected in 10 patients with colorectal cancer were used as controls. Results. Tissue levels of IL-1β, IL-8, IL-6, TNF-α (tumor necrosis factor-α), IFN-γ (interferon-γ), IL-17 and IL-12 in biopsy specimens the large intestine of UC patients were significantly elevated. The most significant elevation was found for IL-8 and IL-1β, with the ratio of 3:1 (in the control group 0,35:1). The cytokine content in biopsy specimens of the large intestine has been increased in comparison to terminal portion of the small intestine, and the cytokine level in the left and transverse part of the colon was higher, than in cecum and ascending colon. At severe inflammation as compared to moderate inflammation the most significant increase was found for IL-8, IL-6 and TNF-α. Cytokine profile with the prevalence of IL-1β (IL-1β>IL-8>IL-6 (IFN-γ)>TNF-α) was observed in 14 (77,7%) of 18 biopsy specimens with moderate inflammation while similar cytokine pattern was observed in 9 (47,3%) of 19 biopsy specimens with severe inflammation (p=0,05). Domination of IL-8 (IL-8> IL-1β> IL-6 (TNF-α)> TNF-α (IL-6)) in cytokine profile was found in 3 of 18 (16,6%) biopsy specimens with moderate and in 9 of 19 (47,3%) biopsy specimens with a severe inflammation (p<0,05). Cytokines IL-2, IL-4, IL-5, IL-7, IL-10 and IL-13 when undetected neither in UC patients, nor in control group. Conclusions. Significant increase in proinflammatory cytokine level with prevalence of IL-1β and IL-8 at moderate and severe erosive - ulcerative involvement respectively was observed in colonic mucosa biopsies in comparison to terminal ileum of UC patients and control group; in the left part and transverse colon versus ascending colon and caecum of UC patients. Elevation of IFN-γ and IL-17 content at severe inflammation indicates presence of common mechanisms in ulcerative colitis disease and Crohn's disease pathogenesis.

Aim of investigation. To estimate possible advantages and shortcomings of laparoscopic complete mesocolic excision with D3 lymph node dissection in the treatment of left-sided colon cancer in comparison to open approach according to analysis of short-term outcomes. Material and methods. Investigation was designed as retrospective-prospective case-control study (with analog group comparison). Patients with left-sided colon cancer of stages II-III were selected from prospectively collected database. Groups have been generated according to case-control principle: the I group included patients who underwent open complete mesocolic excision with D3 lymph node dissection, the II group comprised patients who underwent laparoscopic intervention in the same volume. Results. Each group included 54 patients. Duration of operation and volume of intraoperative blood loss in the II group patients was less, than in the I group. Postoperative morbidity rate had no statistically significant differences in both groups. Rehabilitation in early postoperative period was faster in the II group vs I group. Conclusion. Laparoscopic complete mesocolic excision with D3 lymph node dissection is safe type of surgery, which allows to improve short-term results of surgical treatment of patients with stage II-III left-sided colon cancer. Morphological scores indicate identical efficacy in achievement of radical treatment for laparoscopic and open techniques from the standpoint of modern oncology principles. However, correct estimation of long-term outcomes require further studies.

The aim of review. To generalize literature data on endoscopic and morphological diagnostics of serrated adenomas of the colon. Key points. In 2010 a new variant of histological classification of colonic tumors have been accepted by WHO, according to which serrated neoplasms were defined as separate group of preneoplastic changes, along with colonic adenomas. At the present time hyperplastic polyps and other serrated neoplasms are considered to be precursor lesions for 15 to 20% of sporadic or asymptomatic colorectal cancers located mainly in proximal colon, that progress by specific serrated adenoma-related pathway. Diagnostics of such lesions both on microscopic and macroscopical levels is associated with significant difficulties due to absence of the uniform nomenclature, definite morphological features and endoscopic semiotics. Conclusion. Definition of main morphological and endoscopic diagnostic criteria of all types of serrated adenomas will provide successful diagnostics along with differentiation with other epithelial colonic lesions that is required for proper choice of management approach.