The aim of review. To present update on the causes of insufficient treatment response to proton pump inhibitors (PPI) at gastroesophageal reflux disease (GERD) and to inform on the options of increasing patients’ compliance.

Summary. Decline of treatment compliance remains to be one of the principal causes of refractory course of gastroesophageal reflux disease. Existing PPIs have some limitations — necessity of intake strictly before meal and short action period. Dexlansoprazole in double delayed release form allows intake without relation to food intake that allows to increase compliance to treatment.

Conclusion. The wide prevalence of GERD dictates necessity of search of new effective agents. Thus one of the principal causes of refractory course of disease is decreased adherence to treatment. Application of new PPI i.e. dexlansoprazole with once per day intake will allow to increase compliance to treatment and to reduce frequency and intensity of symptoms both at erosive esophagitis and non-erosive reflux disease.

Aim of investigation. To estimate effect of probiotics on severity of clinical symptoms, presence of bacterial overgrowth syndrome (BOS) and quality of life at diarrheal variant of irritable bowel syndrome (IBS-D).

Material and methods. In 47 patients with diagnosis of IBS-D, confirmed by conformity of symptoms to Rome-III criteria and absence of organic diseases according to carried out investigation comparative analysis of effect of probiotics and placebo on development of main clinical symptoms, state of intestinal microflora and quality of life was applied. Efficacy of probiotics containing microorganisms Bifidobacterium bifidum, Bifidobacterium longum, Bifidobacterium infantis, Lactobacillus rhamnosus (Florasan-D); yeast Saccharomyces boulardii (Enterol) was studied. Overall 25 men (53,2 %) and 22 women (46,8 %) with mean age 33 year (31,5; 37,8) were investigated. Probiotics Florasan-D, Enterol and placebo were prescribed in a doze of 250 mg bid. Intensity of abdominal pain and meteorism was estimated by visual analog scale (VAS), consistency of stool – by Bristol stool form scale, defecation rate — by calculation of number of bowel movements during every week of treatment. Besides that presence of BOS was investigated by hydrogen breath test with lactulose, quality of a life was determined using The Short Form-36 (SF-36) questionnaire prior to treatment onset and its termination. Treatment lasted for 28 days.

Results. In group of the patients who received Florasan-D and Enterol, in contrast to as placebo group improvement in relation to severity of main clinical symptoms was marked, quality of a life score increased. Besides that, according to hydrogen breath test with lactulose results on a background of Florasan-D it was possible to eliminate BOS in all patients.

Aim of investigation. To estimate the effect of combined treatment by pinaverium bromide and itopride hydrochloride on clinical semiology and quality of life of patients with combination of constipation-predominant variant of irritable bowel syndrome (IBS-C) with postprandial distress syndrome (PDS).

Material and methods. Overall 49 patients with IBS-C (Rome criteria III) were investigated, 31 of them also had accompanying PDS (Rome criteria III). Fourteen patients with combination of IBS-C and PDS (group I) for 4 wks received combined treatment by pinaverium bromide and itopride hydrochloride. Monotherapy by pinaverium bromide for 4 wks was carried out in 17 patients with combination of IBS-C and PDS (group II) and 18 patients with IBS-C (group III). Both symptoms and parameters of quality of life (SF-36) were estimated prior to onset of treatment and in 4 wks after its termination.

Results. Combined therapy by pinaverium bromide and itopride hydrochloride for 4 wks in comparison to monotherapy by pinaverium bromide promoted more prominent reduction of abdominal pain intensity (p<0,001), meteorism (p<0,001), epigastric heaviness (p<0,001), complete disappearance of nausea and belching in many patients with combination of IBS-C and PDS. Treatment by pinaverium bromide in combination with itopride hydrochloride was characterized by absence of serious side effects and resulted in significant improvement of quality of life (p<0,001).

Conclusions. Application of the combined therapy including spasmolytic drug pinaverium bromide and prokinetic agent itopride hydrochloride for patients combination of IBS-C and PDS significantly increased efficacy of relief of clinical symptoms of combined disease and improved quality of life of patients.

Aim of review. The prognosis and management approach for chronic liver diseases of any etiology in many respects are determined by stage and extent of fibrosis which reflects activity, spread and duration of liver disease. Aim of current publication was to highlight these issues.

Summary. Investigations in the field of fibrogenesis processes made possible quantitative estimation of liver fibrosis by non-invasive tests based both on assessment of peripheral blood levels of substances, directly involved in various stages of extracellular matrix synthesis and disintegration, and on the routine laboratory tests reflecting activity of inflammation, degree of disorder of synthetic liver function and fibrosis progression.

Conclusion. Study of diagnostic accuracy of serum markers for assessment of fibrosis stage in liver disea ses of various etiology will provide development of comprehensive non-invasive test for estimation of treatment response rate, course and progression rate of disease

The aim of review. To prove competency of application of probiotics and to analyze data of the original studies of efficacy of various probiotic agents in treatment of inflammatory bowel diseases (IBD).

Summary. The role of microflora in pathogenesis of this group of diseases becomes more and more obvious. At patients with IBD the intestinal microbiome have quantitative and qualitative differences from microbiome of healthy patients aside of increase in contents of opportunistic and pathogenic microorganisms. Microbiome changes result in initiation of cascade of pathological immune reactions of the host in related to presence of genetical defects, that, in turn, promotes development of clinical symptoms and morphological changes in intestinal wall. Potential of probiotic agents effect on microflora is actively studied in the last years, including patients with IBD.

Conclusion. The highest efficacy the Bifidum and Lactobacilli-containing probiotics, possess at advance and maintenance of remission of reservoir ileitis (pouchitis). Addition of probiotics in mode of treatment significantly increases probability of clinical improvement and, at level of the statistical trend, achievement of clinical remission at ulcerative colitis. In remission maintenance efficacy of the studied probiotic drugs is comparable to efficacy of maintenance dozes of mesalazine. Efficacy of probiotics is not proved at their addition in the mode of standard therapy used for achievement and maintenance of remission of a Crohn's disease.

The aim of review. To present modern approaches to surgical management of chronic inflammation of epithelial pilonidal sinus (EPS), efficacy of treatment methods, rates of complications and relapses.

Summary. Up to now there is no common judgement on etiology and pathogenesis of epithelial pilonidal sinus. All theories may be divided to two basic classes: congenital and acquired EPS. In the Russia opinions on development of this disease cardinally differ from that of foreign scientists. Traditionally in Russian domestic literature EPS is considered as congenital anomaly, while foreign researchers decline acquired etiology of this disease. Furthermore issues of optimal surgical treatment choice are solved. The long period of wound healing, postoperative pain and quite frequent disease relapses remain common in such patients. According to various authors, EPS relapse rate makes 20 to 40% irrespective of treatment method. Attempts to find the radical EPS treatment method providing the lowest pain level, small wound surface and allowing the lowest possible disability period and motor activity limitation, stimulate development of new surgical treatment methods and improvement of already established operations.

Conclusion. Now methods of EPS surgical treatment should meet following requirements: be simple in performance, provide low pain, rapid restoration of work capacity and social activity. Application of modern surgical approaches strictly following indications and individual approach to choice of surgery provides maximal conformity to the specified requirements.

Aim of investigation. Improvement of diagnostics and efficacy of radiological methods of investigation by technique computer-tomography (CT) enterography at inflammatory bowel diseases.

Material and methods. Original investigation was based on the data of comprehensive clinical and instrumental investigation of 111 patients with suspected Crohn's disease (CD). The set of tests included colonoscopy, abdominal US, CT-enterography, X-ray investigation of small intestine. Signs of CD were obtained by CT-enterography in 62 patients (55,9%), in all of these cases it was possible to establish localization of process, to estimate its spread and reveal complications.

Results. Data of roentgenological and CT investigation comparative analysis were similar. Thus, CT-enterography technique of can be regarded either as alternative to X-ray investigation of the small intestine at CD diagnostics or important addition to diagnostic algorithm for this group of patients.

The aim of review. To analyze reports and publications devoted to radiological methods at investigation and treatment of gastroenterological patients and to acquaint gastroenterologists, radiologists, doctors of other specialties with potential of these methods.

Summary. Modern concepts of radiological methods of investigation and their application at detection and differential diagnostics of gastroenterological diseases are presented. Significant input of radiological methods to assessment of treatment approach at therapeutic and surgical pathology of digestive system, necessity of utilization of radiological methods at noninvasive medical manipulations, classical surgical interventions, long-term monitoring by patients is shown.

Conclusion. Expansion of range of issues solved by radiological methods at investigation of patients with digestive diseases is marked. Priority of noninvasive ways of diagnostics is indicated.