Aim of review. To present data on the role of mitochondrial and lysosomal dysfunction in pathogenesis of acute pancreatitis (AP). Summary. Hyperamilasemia, premature intralobular activation of digestive enzymes, accumulation of large vacuoles in acinar cells, activation of proinflammatory mediators, apoptosis and necrosis of acinar cells are the basic pathomorphological signs of AP. The mitochondrial dysfunction that develops at acute pancreatitis is followed by disorders of ATP synthesis and initiation of processes of apoptosis and necrosis. The lysosomal dysfunction at AP is manifested by autophagy disorders that leads to vacuolation of acinar cells and intralobular trypsin accumulation. Conclusion. At the recent time there is noticeable growth in frequency of acute pancreatitis cases and increase of mortality in patients with pancreatic necrosis. Mitochondrial and lysosomal dysfunction acts as pathogenic basis for AP, leading to energy deprivation of pancreatic cells. Mitochondrial and lysosomal dysfunction initiates processes of apoptosis, necrosis, activation of trypsinogen and vacuolation of acinar cells that this disease. Therefore new studies aimed for therapeutic impact on mitochondrions and lysosomes are required. Key words: acute pancreatitis, dysfunction of organellas, mitochondrion, lysosome, apoptosis, necrosis, autophagy.

Aim of investigation. To estimate efficacy of the modified sequential therapy regimen of Helicobacter pylori (H. pylori) eradication (with addition of bismuth tripotassium dicitrate) at treatment of peptic ulcer of the stomach (PUS) and duodenum (PUD) of severe and complicated course in the Russian population. Material and methods. Original study included overall 105 patients with PUS and PUD with severe and complicated course of disease. The main group received modified sequential therapy regimen, the comparison group - standard triple mode. All patients underwent quantitative serological test for H. pylori-specific IgG antibodies, stool test for H. pylori antigen, fibrogastroscopy with stomach mucosa (SM) biopsy and rapid urease test, microscopic examination of SM biopsy specimens, polymerase chain reaction for H. pylori DNA in SM biopsy specimens. Results. Efficacy of H. pylori eradication at modified sequential therapy was 95,8%, at standard, also combined with bismuthate tripotassium dicitrate, - 86,4%. After successful H. pylori eradication decrease of inflammatory activity of the stomach mucosa at less prominent decrease of mononuclear infiltration was noted, however the tendency for reduction of these features was more significant in patients at modified sequential regimen. Conclusions. Growth of H. pylori antibiotic resistance requires accumulation of the Russian data on efficacy of sequential therapy to increase eradication rate and prevent growth of macrolide resistance. Sequential therapy was proposed as a way to overcome resistance to clarithromycin. Sequential eradication therapy with inclusion of bismuth tripotassium dicitrate has shown advantage over standard triple therapy at severe and complicated forms of gastroduodenal peptic ulcers. Results of original study allow to recommend sequential eradication therapy in Russia. Key words: peptic ulcer, Helicobacter pylori, eradication, modified sequential therapy, bismuth tripotassium dicitrate.

Aim of review. To compare the American, German, French and Russian guidelines on irritable bowel syndrome (IBS) management. Summary. According to the American and French guidelines, the diagnosis of IBS should be made mainly according to compliance of clinical symptoms to Rome criteria of IBS, whereas German and Russian guidelines determine these symptoms as nonspecific and consider the diagnosis of IBS as the diagnosis of exclusion which can be made only after careful investigation of patients. At definition of treatment approaches the American guidelines do not include general actions, consider dietic modifications as insufficiently effective as well as with such drugs as antispasmodics, polyethyleneglycol and probiotics. On the contrary, the German, French and Russian guidelines pay special attention to general recommendations and dietary modification and consider above-mentioned pharmaceuticals as quite effective. Conclusion. Presented guidelines are similar to each other in respect of their plot; however significantly differ in diagnostic approach to IBS and assessment of efficacy of series of drugs. Key words: irritable bowel syndrome, diagnosis, treatment.

Aim of investigation. To carry out comparative analysis of diagnostic sensitivity of three immunochemical stool tests as a first step of laboratory algorithm to define high risk groups for colorectal cancer (CRC) and other clinically severe diseases of gastrointestinal tract (GIT). Material and methods. Content of hHb, hHb/ Hp and fTu M2-PK was investigated by solid-phase immunoenzyme tests in stool samples of 447 patients: 157 primary CRC cases, 121 stomach cancer (SC) patients, 64 ulcerative colitis (UC), 20 colonic polyps (CP) patients and 85 healthy donors. Following cut off levels were used: hHb - 2,0 µg/mL, hHb/Hp - 0,5 µg/ mL and fTu M2-PK - 4,0 U/mL. Results. The test systems for hHb and hHb/Hp in stool had high sensitivity, that was similar for CRC (89.5% of and of 87.9%, respectively) and UC (79.0% of and of 71.9%). The rate of exceeding upper thresholds for hHb and hHb/Hp in SC patients was 51.2 and 43.8%, respectively, and only 20% for CP patients. hHb and hHb/Hp markers had high specificity for healthy donors (95.3% of and of 97.6%, respectively). Close correlation between hHb and hHb/Hp indicates that these tests are interchangeable for CRC diagnostics. fTu M2-PK sensitivity was 79.2% for CRC, 68.3% - for UC, 51.2% - for SC and fTu M2-PK-specificity was 94.7% as compared to donors. If elevation of at least one marker in a pair (hHb and fTu M2-PK) will be considered as positivity of the test overall, the sensitivity of laboratory testing rises for CRC to 95.0%, for UC - to 83.6% and for SC - to 69.0% at specificity of 91.3%. Conclusions. Comparative analysis of three stool tests (hHb, hHb/Hp and fTu M2-PK) has shown that the optimal combination for detection of CRC risk groups includes detection of fecal hHb and fTu M2-PK. Increase of at least one marker in this pair may be due to the presence of severe gastrointestinal disease, including CRC, that allows to select patient for subsequent investigation of the digestive system. Key words: colorectal cancer, stomach cancer, ulcerative colitis, colonic polyps, fecal immunochemical test (FIT), hHb, hHb/Hp, fTu M2-PK.

Aim of investigation. To estimate efficacy of Doppler-controlled dearterialization of internal hemorrhoids with mucopexy by instrumental diagnostic tests. Material and methods. Randomized, prospective trial included 240 patients with hemorrhoids of the 3-4th stage. Patients of the first group (n=120) underwent Doppler-controlled hemorrhoid artery ligation with mucopexy, the second group patients (n=120) - hemorrhoidectomy by harmonic scalpel. All patients underwent instrumental tests (colonoscopy, ultrasonography by transrectal ultrasound probe, anorectal manometry) in pre- and postoperative period. Results. In both groups control instrumental assessment was carried out in 45 days after surgery. At anorectal manometry decrease of mean resting anal canal pressure after dearterialization with mucopexy was detected, and became comparative to post-hemorrhoidectomy level. Control colonoscopy at first group patients revealed preserved integrity of anoderma and mucosa of low ampullary region of the rectum with complete elimination of hemorrhoid tissue. At control ultra sonography by transrectal ultrasound probe after dearterialization with mucopexy neither cavernous tissue nor blood vessels feeding hemorrhoids were visualized, that was comparable to post-hemorrhoidectomy data. Conclusion. The Doppler-controlled hemorrhoid artery ligation with mucopexy is pathogenically justified surgical procedure with comparable efficacy to hemorrhoidectomy, that is confirmed by instrumental diagnostic tests. Keywords: hemorrhoids, Doppler-controlled dearterialization with mucopexy, hemorrhoidectomy, ultrasonography by transrectal ultrasound probe, anorectal manometry.

Aim of investigation. To estimate results of three- stage treatment approach in severe ulcerative colitis aimed for resection of affected colon and restoration of intestinal continuity. Material and methods. Overall 22 patients were treated according to the three-stage mode, of them 20 were operated urgently due to development of acute complications. The average duration of conservative treatment was 32,8±42,5 months. All patients at the first stage underwent operations related to the emergency state, at the second stage - reconstructive surgery with formation of the ileal J-pouch followed by closure of ileostoma. Results. Patients, who underwent the first stage of treatment on the basis of our institution, had shorter time of surgical treatment, as compared to the cases when colectomy was performed in the other clinics: 4,7±1,6 and 46,1±39,8 months respectively (p=0,02). The average work capacity recovery after surgical treatment was 4±2 months. Stool frequency was 6,1±2,45 times per day, every fifth patient had nighttime defecation; 19 of 21 patients could distinguish type of their reservoir contents and were able to provide its retention. Pouchitis was observed in 21% of cases. The pouch malfunction requiring its resection occurred in 4%. Conclusions. The three-stage surgery for ulcerative colitis is an optimum management approach in the presence of complicated ulcerative colitis. It allows to carry out colonic resection with the lowest risk of morbidity, to create the intestinal reservoir , to provide social professional rehabilitation of patients and to reduce postoperative complications rate significantly. Key words: ulcerative colitis, ileal pouch, colectomy, proctectomy, laparoscopy

Aim of review. To present basic information on the short bowel syndrome (SBS) Summary. Patients with the SBS are quite rare in practice of a clinician and, as a rule, require multidisciplinary approach. Most frequently disease manifests by malabsorption signs: diarrhea, weight loss, macro - and micronutrients deficiency, meteorism and abdominal pain. Nevertheless the spectrum and severity of signs considerably vary among patients. The aim of review was to highlight features of pathogenesis, clinical manifestations and treatment of SBS after small intestinal resection for various reasons. Localization and volume of resection, presence of the background affection of the small intestine and other abdominal organs involved in digestion process and also adaptation capacity of the remaining part of the gut fragment are the basic factors that determine severity of SBS and prognosis of patients. Conclusion. SBS prophylaxis is feasible and, taking into account of high disability and mortality rates of such patients, is essential both at preoperative stage, and during surgical intervention. Even at following of all modern guidelines only stabilization of the state is available in part of the SBS patients, while improvement of remaining small intestinal segment function will be impossible. Small intestinal transplantation may be considered as alternative treatment approach in these patients. Key words: short bowel syndrome, malabsorbtion syndrome, diarrhea, rehabilitation, parenteral nutrition.

Aim of the case report presentation. To draw attention of general practitioners to the rare case of intestinal obstruction - intussusception of Meckel's diverticulum in small intestinal lumen. Key points. The present case is characterized by development of chronic small-intestinal obstruction due to repeating intussusception of Meckel's diverticulum in the small intestinal lumen. Episodes of intussusception manifested clinically by attacks of severe right iliac pain that made patient to take «embryonic posture». Deep palpation revealed «spastic bowel» sign in the area of intussusception. A specific type of intussusception was detected by transabdominal ultrasound: thickening and «lamination of intestinal wall» due to «diverticulum interposition» into the lumen of ileum and «overlaying» of wall layers. The evacuation delay at the small intestine was followed by dilation of overlying loops of the small intestine containing bulky liquid content; pendular movement of liquid observed at ultrasonography with visible «air-fluid levels» at plain radiograph. The patient at the same time had frequent liquid stool that indicated presence of incomplete obstruction. Surgical intervention for intussusception and resection of diverticulum-containing portion of the small intestine resulted in improvement of the patient state, relief of pain attacks and signs of intestinal obstruction. Histological examination of resected specimen revealed the presence of ectopic pancreatic tissue in the Meckel's diverticulum wall. Conclusion. Carrying out differential diagnosis in colicky abdominal pain should encompass existence of Meckel's diverticulum with recurrent small intestinal intussusception that can result in chronic intestinal obstruction. In diverticulum wall ectopic pancreas can be detected. Key words: ileus, Meckel's diverticulum, ectopic pancreas.