The aim of review. To discuss the issues of etiology, pathogenesis, clinical presentation and differential diagnostics of irritable bowel syndrome (IBS).

Summary. At irritable bowel syndrome there are series of structural changes interconnected with each other, built into logic chain, that ends by development of symptoms. However it remains not quite clear, whether they determine severity and origin of clinical symptoms, as well as the degree of involvement of each of the basic known pathogenic mechanisms in development of symptoms in given patient is insufficiently clear. The long-term analysis of IBS symptoms has not led to development of clear diagnostic criteria due to both objective causes (frequent, up to 87% combination of various functional disorders) and due to possible identity of complaints in patients to IBS, clostridial infection, microscopic colitis, celiac sprue. Lack of scrutiny of etiology, pathogenesis, clinical presentation determines low treatment efficacy of such patients.

Conclusion. Treatment of patients will allow to optimize further investigations of certain etiological, pathogenic factors, to carry out differential diagnostics of IBS more clearly.

The aim of review. To present data on foreign and Russian clinical studies devoted to improvement of irritable bowel syndrome (IBS) treatment according to the new data on disease pathogenesis.

Summary. Spasmolytics, laxatives or antidiarrheal agents are traditionally applied for treatment of IBS patients according to leading symptom. Considering new data on IBS pathogenesis (disorder of intestinal microbiome, functional and structural remodeling of proteins of cell membrane at the level of synapses of spinal cord posterior horns), prescription of probiotics and peripheral opioid receptors agonists is proven as well. Number of studies, devoted to probiotics efficacy evaluation, is constantly increasing. As a whole, the majority of systematic reviews and metaanalyses draw a conclusion of high efficacy and safety of specified group of drugs at IBS. Agonists of peripheral opioid receptors normalize motility of gastro-intestinal tract and increase a threshold of pain sensitivity mediated by glutamate synaptic receptors of spinal cord posterior horns that prevents development of central and peripheral sensitization. Efficacy of this drug group in IBS patients, also is considered to be proven.

Conclusion. Prescription of probiotics, peripheral opioid receptor agonists at IBS is pathogenicly proven and allows to increase treatment efficacy significantly.

Aim of investigation. Clinical and endoscopical investigation of the large intestine in patients of senile age with chronic constipation and estimation of rational treatment.

Material and methods. Overall 287 senile patients with chronic constipation were included in original study (mean age 79±2,7). Complex investigation included videocolonoscopy and choosing of drug for rational therapy.

Results. It was revealed, that digestive and endocrine diseases are most common in this group of patients. At endoscopic investigation diverticulosis and polyposis coli were the most frequent findings. All patients have tolerated investigation well, no complications have developed. Restoration of regular defecations on a background of lactulose (Duphalac) intake was accompanied by disappearance of feeling of incomplete defecation and necessity of intensive straining effort at defecation.

Conclusions. In senile patients chronic constipation is widespread functional disorder, which does not exclude, however, endoscopic control. The age of the patient is not a limiting factor for colonoscopy. Lactulose (Duphalac) is an optimal pharmaceutical with high efficacy.

The aim of review. To present up-to-date data on etiology, pathogenesis and treatment of constipation in women of various age groups and at combined gynecologic diseases.

Summary. Prevalence of functional constipation in women is almost twice higher, than in men. Predisposition of women to constipation is predetermined by anatomic, physiological and hormonal factors. In obstetrical practice constipation is associated with pregnancy and postnatal period, inflammatory and noninflammatory gynecologic diseases. This review presents modern management approaches at this pathology from gynecological point of view.

Conclusion. Disorders of intestinal function in women are interdisciplinary issue. At constipated female patients detection of intestinal dysfunction etiology and improvement of management, it is necessary to pay attention not only to gastroenterological symptoms, but also to possible relation of symptoms to menstrual cycle, reproductive status and gynecologic pathology. Constipation at gynecologic diseases require treatment because disorders of bowel function in the most cases complicate course of gynecologic disorder and reduces treatment response rate.

Aim of investigation. To specify relation between trophological status, severity of relapse of ulcerative colitis (UC) and efficacy of 5-aminosalicylic acid (5-ASA) for achievement of clinical remission.

Summary. Nutritional status plays important role for body recovery at relapse of chronic diseases, including UC. At patients with nutritional failure remission achievement time becomes longer, bed-stay duration is increased. On the other hand, overweight patients often have more severe course of UC, as it affects important pathogenic processes. This article discusses possible links between trophological status and achievement of clinical remission, as well as between nutritional failure at UC and efficacy of mesalazine monotherapy.

Conclusion. More severe course of UC, long bedstay, lower mesalazine efficacy are marked at patients with nutritional failure in comparison with those scores at patients with normal trophological status. At over-weight patients in comparison with patients with normal nutritional status no significant differences in specified parameters is observed.

Aim of investigation. To analyze authors’ experience of rectosacropexy results at prolapse of the rectum. Material and methods. Original study included 137 patients who underwent surgery for prolapse of rectum in the State scientific center of coloproctology from January, 2007 to December, 2013. The main group have included 60 patients (43,8%) who had rectosacropexy, control group included 77 patients (56,2%) after back loop rectopexy.

Results. Control examination was carried out in 24 patients (40%) of the main and in 26 patients (33,8%) of the control group. Average time of follow-up was respectively 9,8±2,0 months and 34,2±17,8 months. Relapse was diagnosed in 2 patients (7,6%) after back loop rectopexy. After surgical treatment of rectal prolapse statistically significant improvement of anal sphincter pressure was diagnosed in both groups at I and II degree of sphincter insufficiency. Application of rectosacropexy corrects pelvic floor descent syndrome and evacuatory function of the rectum. No deterioration of large intestinal transit after rectosacropexy was revealed (р>0,05). After back loop rectopexy deterioration of large intestinal emptying (р<0,05) was significant.

Conclusions. Rectosacropexy is effective method of rectum prolapse treatment and improves function of anal sphincter in postoperative period, corrects pelvic floor descent syndrome and cause no constipation.

Aim of investigation. To study the effect of nonpharmaceutical correction of body weight on the level of
high cardio-vascular risk markers at non-alcoholic fatty liver disease (NAFLD).
Material and methods. Overall 117 patients with NAFLD at steatosis stage combined to obesity or metabolic syndrome (MS) — 59 and 58 patents respectively, mean age 43 years (38 to 46 years) and 45 years (39- 49) were investigated. Levels of lipid and carbohydrate metabolism markers, TNF-α, leptin, adiponectin and nitric oxide (NO) metabolites were evaluated.
Results. Weight loss for at least 5% was gained in 44,1% of patients with NAFLD in association to obesity
and in 56,6% of those with NAFLD in combination to MS, that was accompanied by significant reduction of lipid atherogenic fraction levels (cholesterol, low density lipoproteins), decrease of insulin resistance index, CRP and TNF-α inflammation markers, and decrease of leptin concentration in MS group. Comparative analysis of adiponectin and NO metabolites concentration has shown demonstrated, that in patients with NAFLD both in combination to obesity, and in combination to MS the target level of weight loss is accompanied by elevation of adiponectin level (р<0,05) and NO stable metabolites (р<0,05), whereas concentration of nitrites is increased significantly (р<0,05) only in obese patients.
Conclusions. Weight loss for 5% and over at steatosis stage of NAFLD is characterized by decrease of
biochemical cardio-vascular risk markers, in addition the group with 40 min/day physical exercises inefficacy had lower level of insulin resistance index and TNF-α along with higher levels of NO metabolites.

The aim of publication. To describe clinical case of development B-cell non-Hodgkin's lymphoma (В-NHL) in the patient with chronic hepatitis C, to demonstrate potential of concurrent treatment of В-NHL and viral infection, regression of lymphoma on a background of antiviral therapy.

Summary. Presented case shows development of B-cell non-Hodgkin's lymphoma in the patient with long-term infection of hepatitis C virus and autoimmune disorders, i.e. mixed cryoglobulinemia. Laboratory tests revealed moderate cytolytical activity: alanine transaminase (ALT) was 135 U/ml, aspartate aminotransferase (AST) —140 U/ml. Immunologic tests have confirmed the presence of HCV (RNA HCV — 15374 IU, genotype 1b). Abdominal US demonstrated signs of severe diffuse changes of the liver, pancreas, splenomegaly, signs of lymphadenopathy. Presence of mixed cryoglobulinemia within symptomatics of chronic HCV-infection, long history of infection were indicative of HCV-associated lymphoma development. Treatment: interferon-æ2b 3 million IU per day, ribavirin 1000 mg per day. On the 4-th week of treatment rapid virologic response (RNA HCV <16 U/ml), accompanied by biochemical remission (ALT 17 U/ml, AST 19 U/ml) was achieved. At US of the chest soft tissues and anterior abdominal wall no pathological mass lesions were revealed, at investigation of abdominal organs and retroperitoneum no lymph nodes were visualized.

Conclusions. Rapid regression of foci lymphatic proliferation on a background of antiviral treatment (interferon-α2b combined to ribavirin) can serve as confirmation of HCV-infection role in lymphoma development and correlates to HCV suppression. Simultaneous antiviral treatment and polychemotherapy can be recommended at HCV-associated lymphomas.

The aim of review. To discuss modern aspects of diagnostics and treatment of H. pylori infection in relation of stomach cancer prophylaxis according to data of oral and poster presentations, delivered at XXVII International workshop of the European Helicobacter Study Group.

Summary. The main attention has been given to relation of H. pylori infection to stomach cancer and eradications of infection as a mean of malignancy prevention. Data on relation of H. pylori to other diseases, including non-gastroenterological disorders are presented. Comparative estimation of efficacy of different modes of eradication therapy is given. According to conclusion of the majority of publications and data of meta-analyses, nowadays both bismuth-based and bismuth-free quadrotherapy are considered as the most effective treatment algorithms.

Conclusion. For estimation of role of H. pylori infection in development of various diseases, and to improve management of patients further studies are required.

The aim of review. To present data on pathogenic significance of bile acids for upper regions of gastrointestinal tract (GIT) and to describe medical properties ursodeoxycholic acid (UDCA) at reflux-gastritis.

Summary. Reflux-gastritis is chemical type gastritis, morphologically manifested by foveolar hyperplasia, edema, proliferation of smooth-muscle fibres of lamina propria, insignificant chronic inflammation. There is evidences of relation of intestinal metaplasia to duodenogastric reflux (DGR). Bile acids at certain conditions possess damage effect on mucosa of the stomach and all GIT. They can increase endocellular concentration of calcium which is responsible for toxic effects of bile acids as a secondary messenger. Increase of endocellular calcium stimulates secretion of pepsinogen and acid production in the stomach,  that in the case of decreased cytoprotective factors by DGR can cause changes mucosal injury. According to the modern point of view bile acids are associated with a lot of neoplasms of digestive organs, including esophageal, stomach, small intestine, liver, pancreas and colorectal cancer. Exposition of bile acids results in formation of active forms of oxygen and nitrogen, damage of DNA, mutagenicity, induction of apoptosis in short-term prospect and resistance to apoptosis in long-term prospect. Gastric remnant gastritis is consideres to be a premalignant disease, thus bile acids play essential role in carcinogenesis. UDCA possesses choleretic effect and ability to displace toxic hydrophobic bile acids. It protects from oxydative stress, stabilizes cell membranes and inhibits apoptosis. At reflux-gastritis UDCA relieves clinical symptoms, improves of state of mucosa of the stomach and esophagus, and possess series of cytoprotective properties.

Conclusion. Prescription of UDCA is pathogenicly proved in patients with reflux-gastritis and gastroesopha geal reflux disease (GERD) with non-acidic refluxes. Cytoprotective and antiapoptotic effects of UDCA at reflux-gastritis are especially significant from the point of view of smoothing cancerogenic potential of bile acids.