Key points. Article is devoted to one of the major syndromes of chronic pancreatitis — exocrine pancreatic insufficiency. Clinical symptoms of exocrine insufficiency: diarrhea with steatorrhea and flatulence are nonspecific and inconsistent. Laboratory diagnostics nowadays in our country is based on a single method — pancreatic elastase stool test which has low sensitivity and specificity, moreover it is characterized by low reproducibility. Thus, in practical situation it is reasonable to control both severity of disorders of pancreatic secretion, and efficacy of enzyme replacement therapy according to scores of trophological status of the patient both clinical (BMI), and laboratory (serum levels of prealbumin, retinol-binding protein, cholesterol, magnesium). Treatment should include high dose microgranulated enzymes in the form of capsules (the starting dose should be no less than 40 U of lipolytic activity per meal) as well as proton pump inhibitors. Replacement treatment should be life-long.

The aim of review. To present modern data on the pathophysiological mechanisms causing functional dyspepsia (FD) syndrome.

Key points. Nowadays FD is considered to be a complex multifactor process which cause and effect relationships are under continuous active study. Disorders of stomach motility (delay of evacuation, disorders of relaxation accommodation) and sensitivity (visceral hypersensitivity to distention) are considered to be the basic pathophysiological mechanisms of FD. These changes develop approximately in 40% of FD patients. Besides that, alteration of duodenal sensitivity to hydrochloric acid and lipids can play significant role in genesis of FD.

Conclusion. Mechanisms of FD are based on multiple heterogenous disorders of motor and sensitive functions of the stomach and duodenum. Due to major role of stomach motility disorders prokinetics are the priority drugs for treatment of FD.

Aim of investigation. To study polymorphism of СYP2E1-1293 G/C (c1/c2), CYP 3А4 1А/1В, NAT2 Leu161Leu (481 c/t), GSTP1 Ile105Val, IL4 C-589T, TNF-α G-308A genes at syndrome of obstructive jaundice and uncomplicated gallstone disease.

Material and methods. Overall 54 patients were divided into three comparison groups: those with obstructive jaundice of benign etiology, with cholestasis due to malignancy and uncomplicated gallstone disease. Genomic DNA of patients obtained from blood leukocytes analysed with application of «DNK-ekspresskrov» reagent utilizing «SNP-ekspress-RV» device of LLC Research and production company «Litekh» (Moscow).

Results. Carriage of C allele of СYP2E1 gene is a risk factor of development of biliary diseases. The interrelation of A allele of TNF-α gene G-308A (OR=2,68, 95% CI 1,23-5,84) with high risk of obstructive jaundice due to choledocholithiasis was revealed. At the same time carriage of Т-allele of NAT2 Leu161Leu and IL4 C-589T genes reduces risk of obstructive jaundice of benign etiology.

Conclusion. The high risk of biliary diseases is associated to allele C of СYP2E1-1293 G/C gene. Carriers of A allele of TNF-α gene G-308A have higher risk of obstructive jaundice on a background of gallstone disease, while Т alleles of NAT2 Leu161Leu and IL4 C-589T genes have protective action for posthepatic cholestasis.

Aim of investigation. Improvement of presacral tumors treatment results.

Material and methods. Data of surgical treatment 21 patients with true presacral tumors, operated in Federal government-financed institution «Ryzhikh State Scientific Center of Coloproctology», Ministry of healthcare of the Russian Federation with 2004 on 2013 was analyzed. Study group included 16 women (76%) and 5 men (24%) with mean age of 46,3±15,1 years.

Results. Tumor relapse was revealed in 4 (5,6%) of operated patients, tumors in these cases had various histological structure.

Conclusion. Experience of surgical interventions at benign retrorectal presacral tumors allows to consider surgical method as adequate treatment approach. The highest relapse rate was observed at malignant tumors; such patients require the combined treatment at specialized oncologic clinic. The choice of surgical access is determined, first of all, by neoplasm localization.

The aim of review. To analyze modern data on pathogenesis and principles of treatment of non-alcoholic fatty liver disease (NAFLD).

Key points. Now concepts on genetic determinants of NAFLD and diagnostics methods develop rapidly. Treatment of NAFLD consists in application of graduated physical activity, diet modification, weight loss, application of insulin sensitizers, cytoprotective agents and antioxidants.

Conclusion. Prompt development of approaches to NAFLD requires enhanced attention of medical experts to this issue.

The aim of review. To generalize literature data on ways of non-alcoholic fatty liver disease (NAFLD) modelling in experimental animals, to reveal advantages of various techniques, to present results of original studies on diet-induced NAFLD at rats.
Key points. Data of the literature and author’s original data on experimental NAFLD modelling are presented. Today‘s methods of NAFLD modelling can be divided into two extensive groups: induction of liver disease by genetic mutation, and phenotypic development of NAFLD due to alimentary factor. Genetic models are subdivided into two categories. In the first the liver of laboratory animals is the main pathogenic target, metabolic disorders develop insignificantly (lines of animals with of Acetyl-CoA oxidase gene deletion, knockoutmice for methionine-adenosyl transferases-1А gene and animals with deleted specific hepatic phosphatase and tensin homologue gene). Genetic models of NAFLD developing on background of obesity and metabolic
syndrome represent the second category (animals, with leptin gene deletion – ob/ob, mice resistant to leptin action, – db/db and transgenic mice with excessive expression of styrene-regulating element of protein-1 isoform. Diet-induced models of NAFLD are engendered by modulation of various alimentary factors. They include methionine choline-deficient diet, fructoseenriched diet and various variations of high-fat diet. At diet-induced NAFLD the liver undergoes a complex of histological and metabolic disorders to the high extent close to clinical symptoms of this disease in humans.
Conclusion. There is a set of various ways of NAFLD modelling in animals. Numerous methods can be used for confirmation or refutation of NAFLD pathogenesis hypotheses. It is necessary to choose the optimal way of NAFLD modelling, allowing to reveal certain part of pathologic mechanisms of disease and to determine strategy of hepatotropic treatment according to determined task.

Aim of investigation. To study activity of the liver enzymes in monitoring patients exposed to vinylchloride (VC) at their professional activity.
Material and methods. Prospective cohort investigation of 120 workers exposed to VC was carried out. Activity of liver enzymes was determined by kinetic methods using «Human» test-systems at «Cormay multi» biochemical analyzer.
Results. It was found, that chronic VC exposition in group of service technicians and technical officers (engineering staff) at over 5 years of work experience results in decrease of alkaline phosphatases (AP) concentration, increase of contents cholinesterase (CE) and gamma-glutamyltranspeptidase (GGT) in blood serum along follow-up period. The highest count of interrelations between determinants of studied biochemical scores, work experience and-or exposition load was revealed at patients under 30 years of age.
Conclusions. Chronic VC exposition results in change of AP, CE and GGT concentration in blood serum during follow-up investigation. Thus the greatest number of determining relations was revealed at patients less than 30 years. Exposition and experience played predictor role only for engineering staff, exposed to the least toxin influence.

Aim of investigation. To estimate epidemiologic state on viral hepatitis B in Sakha republic (Yakutia).

Material and methods. Data of the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor) for Sakha republic (report form #1) and results of enzyme-linked immunoassay (EIA) for viral hepatitis markers (HBsAg, a-HBcor IgG, a-HDV, a-HCV) in population of 17 areas of republic were utilized.

Results. In investigated region morbidity due to both acute and chronic forms of hepatitis B has a tendency to decrease. According to EIA results the prevalence of hepatitis B virus infection markers in population corresponds to criteria of intermediate intensity and for hepatitis D virus — to high intensity.

Conclusions. Morbidity due to hepatitis is significantly higher: i.e. 5 times over that for the Russian Federation in general.

The aim of the publication. The «Clinical discussion» section will present clinical cases of the Vasilenko Clinic of internal diseases propedeutics, gastroenterology and hepatology, Sechenov First Moscow state medical university. Each clinical case is accompanied by the comments reflecting stepwise differential diagnostic approach. The section is opened by clinical case of the patient with systemic disease and multiply organ involvement.

The aim of review. To demonstrate possible pathways of development of stomach malignant neoplasias at autoimmune gastritis.

Key points. Stomach cancer traditionally occupies one of the first places within oncologic diseases in the world. Nowadays some factors, increasing its risk are revealed. They include mucosal atrophy and presence of foci of metaplasia. Thus, it is possible to consider autoimmune gastritis as disease which natural course can lead to premalignant lesions of the stomach mucosa. Development of carcinoid tumor deriving from enterochromaffin-like cells (ECL-cells) is typical for type A gastritis. Gradual development of stomach corpus atrophy and respective reduction
of parietal cells number causes final development of hypergastrinemia. Excessive amount of gastrin, in turn, stimulates ECL-cells and can result in their hyperplasia and dysplasia. Development of adenocarcinoma is preceded by structural mucosal changes: atrophy and metaplasia that result from inflammatory changes at autoimmune gastritis. At the presence of accompanying H. pylori
infection eradication therapy is strongly recommended today for reduction of neoplasia risk.

Conclusion. One of the primary goals within framework of cancer-prevention and early diagnostics of neoplastic diseases is duly diagnostics of autoimmune gastritis and selection of groups of patients with high risk of stomach cancer for constant out-patient monitoring.

The aim of review. To estimate results of transanal endoscopic resection of rectal tumors and to analyze literature data devoted to this method.

Key points. Experience of Rostov Scientific Research Institute of Oncology has allowed to confirm literature data and to turn out perspective approaches to application of transanal endoscopic resection of tumors. It was found, that transanal endoscopic resection of benign tumors and early stages of malignant tumors of rectum is a modern, highly effective method of treatment that provides radical tumor removal within any layer of rectal wall and adjacent mesorectal soft tissue due to application of exact tools and precision technic of the intervention, it preserves intestinal function as well.

Conclusion. Described options allow recommending this method to broad application in surgical practice. According to received results it is possible to conclude, that transanal endoscopic tumor resection can become a method of choice at initial stages of rectal cancer.

The aim of review. To present literature data on surgical treatment of extrasphincteric and transsphincteric fistulas of rectum.

Key points. Treatment of fistulas of rectum remains a challenge because of risk of frequent relapses varying from 4,7 to 60%. Radical treatment methods are overly traumatic and result in severe fibrotic changes in the anal canal structures that are accompanied by high risk of anal sphincter incompetence - up to 83%. Now highly effective methods with application of various implants to eliminate tissue defect and improve regeneration are presented in the literature more and more commonly. Application of collagenic implants allows to decrease traumatization of sphincter fibres and thus to reduce to minimum risk of anal sphincter incompetence.

Conclusion. Elimination of postoperative anal incontinence is a priority task in treatment of extrasphincter fistulas of rectum.

The aim of publication. To analyze approach for long-term management of patients with chronic gastritis after H. pylori eradication for stomach cancer prevention by the example of clinical cases.

Key points. The management approach of patients with chronic gastritis after eradication of H. pylori is presented by the example of patients with various risk of development of stomach cancer. In one and half year after successful eradication therapy in 57 year-old female patient mild atrophy and intestinal metaplasia of antrum without atrophy and intestinal metaplasia of corpus of the stomach was confirmed. At absence of other risk factors for cancer development further endoscopic follow-up is not required. Monitoring of 62 year-old male patient after successful eradication for 5 years has shown stable morphological pattern without progression of premalignant lesions. Taking into account both severe atrophy and intestinal metaplasia of antral region and mild atrophy of body of the stomach, as well as positive family history, esophagogastroscopy with biopsy is recommended once per year to this patient.

Conclusion. Prognosis and management approach of patients after eradication of H. pylori infection are determined by chronic gastritis in relation to severity of atrophy and intestinal metaplasia of antral region and corpus of the stomach, along with other risk factors for cancer development e.g. positive family history.