The aim of review. To present modern data on epidemiology, etiology, pathogenesis, clinical presentation, diagnostics, differential diagnostics and treatment of H. pylori-negative peptic ulcer.

Key points. Increase in number of cases of such disorders detection is demonstrated. Basic concept on etiology and pathogenesis of H. pylori-negative peptic ulcer is presented. Its association with more severe course of disease, higher morbidity and mortality rates is emphasized. Approaches to diagnostics, differential diagnostics and treatment are revealed.

Conclusion. The review presents epidemiology, etiology, pathogenesis, clinical features of H. pylorinegative peptic ulcer. Existing problems in this area and possible ways out are described in detail.

Aim of investigation. To estimate presence of classical morphological signs of autoimmune gastritis (AIH) in patients with high titer of antiparietal cells antibodies.

Material and methods. Overall 15 patients (3 men and 12 women, 28 to 72 years old) have been included in original study. Clinical symptoms in the study group varied and included both severe В12-deficient anemia and normal levels of pepsinogen I, gastrin-17 and cyanocobalamine. In 4 patients Helicobacter pylori infection has been detected. According to guidelines of the Russian Society of Pathologists in all cases multiple biopsies have been taken at esophagogastroduodenoscopy. Biopsy specimens were processed by the standard technique, sections were stained by hematoxyline and eosine.

Results. Classical signs of AIH i.e. atrophy of mucosa of body of the stomach and intestinal metaplasia were not revealed. The signs of feeble inflammation in body of the stomach were found in 6 patients. In 4 cases biopsy specimens had no inflammatory or atrophic changes. Pseudo-hypertrophy of parietal cells was the unique morphological feature found out in these cases. At all patients involvement of antral region of the stomach was marked. Atrophic gastritis with intestinal metaplasia was diagnosed in 4 patients. In 3 cases non-metaplastic variant of patchy atrophic gastritis was present, the rest revealed superficial gastritis with signs of activity in 4 cases. No Н. рylori was found out morphologically.

Conclusion. In our investigation in patients with AIG no metaplastic atrophic lesions was found in body of the stomach, while metaplastic atrophy had patchy pattern. The pseudo-hypertrophy of parietal cells as well as dilation of main glands lumen can be the earliest and unique sign found in biopsy specimens. Involvement of antral region was revealed in all patients, in 4 cases it has been related to presence of H. pylori infection at the moment of investigation. Thus, the diagnosis of AIG was based mainly on elevated level antiparietal cells antibodies at blood serum test.

Aim of investigation. To estimate effect of biofeedback-therapy (BFT) on clinical symptoms, quality of life, sensorimotor function of anorectal area at irritable bowel syndrome (IBS) with refractory constipation (IBS-C).

Material and methods. Overall 38 patients with IBS-C (according to Rome III criteria) were investigated. All patient underwent BFT (mean No of sessions 6,1±0,9) with rating of IBS symptoms, quality of life (by SF-36 questionnaire), parameters of anorectal manometry before the termination of BFT course.

Results. According to anorectal manometry data 1-st type defecation dyssynergy (DD) was diagnosed in 28,9% of patients, dysfunction of an external anal sphincter – in 71,1%. BFT was effective in 24 (63%) patients: in 17 (62,9%) with IBS-C and in 7 (63,6%) with IBS-C and 1-st type DD. Frequency of defecations has increased from 1,1±0,1 to 4,9±0,3 per week (p<0,001), other IBS symptoms (p<0,01) have decreased. Defecation index (OR 6,5; 95% – CI 1,09–39,3) was significant prognostic factor for BFT efficacy.

Conclusions. In 63% of patients with IBS-C BFT was effective. The high defecation index (> 1,2) is significant prognostic factor for BFT efficacy.

The aim of review. To demonstrate modern concept on management and prevention in patients with drug-induced liver injury (DILI).

Key points. DILI have a wide spectrum of clinical symptoms, from asymptomatic elevation of serum transaminase activity to fulminant liver failure. The task of clinician – to withdraw a «causative» drug and under indications to prescribe specific and/or symptomatic treatment in due time. Preventive measures include global control of clinical and postmarketing investigations. Observation of mode of intake of the drug, analysis of risk factors, polypragmasy, drug interactions, carrying out of appropriate investigation at prescription of potentially hepatotoxic drugs lays at the basis of prevention concerning the specific patient.

The aim of review. To present algorithm of stepwise clinical and laboratoric testing of patients with long-term asymptomatic elevation of serum aminotransferase activity.

Key points. According to epidemiologic data, 10–20% of adult population of the developed countries has increased activity of aminotransferases. The majority of such patients present either no health-related complaints at all, or nonspecific symptoms. Data of common clinical examination and routine laboratory and instrumental tests frequently do not allow to determine satisfactory diagnostic hypothesis. The situation is even more complicated by the absence of domestic practical guidelines on management of these patients. Article presents the algorithm of clinical, laboratory and instrumental testing in described clinical situation. The algorithm is based on the analysis of consensus documents, original studies, experts opinions and authors’ experience.

Conclusion. Differential diagnostics at long-term asymptomatic elevation of serum aminotransferase activity should be carried out by step-wise algorithm at which diagnostic search is directed from the most common to more rare possible nosological units.

Aim of investigation. HEP3002 is the international early access program of efficacy and safety estimation of telaprevir in combination to peginterferon alpha and ribavirin for patients with severe fibrosis or liver cirrhosis caused by hepatitis C virus (HCV) genotype 1. Efficacy and safety of this therapeutic mode were evaluated in intermediate analysis on 16-th week of treatment in 153 patients from Russia who have already reached the 16-th week of treatment or potentially can do so.

Material and methods. The study has prospectively included 153 HCV infected patients (genotype 1), with bridging fibrosis or compensated liver cirrhosis who received treatment by telaprevir in combination to peginterferon-alpha and ribavirin for 12 wks with subsequent 12-or 36-week rate of antiviral therapy (AVT) by peginterferon alpha and ribavirin in relation to virologic response and fibrosis severity. Analysis has been carried out for intention to treat (ITT) populations with application of 16-th week AVT data.

Results. Total of 153 patients have completed 12-week course of triple therapy and 4-week course of peginterferon-alpha and ribavirin treatment (48% cirrhotic patients, 97% – HCV-1b). The level of HCV RNA was undetectable both at the 4-th week, and at the 12-th week (extended rapid virologic response) in 42 (75%) of 56 previously untreated patients, in 34 (89%) of 38 with relapses after previous treatment, in 4 (57%) of 7 with previous incomplete response, in 22 (52%) of 42 with the previous zero response and in 7 (70%) of 10 with previous virologic breakthrough. Sustained virologic response was achieved in 73 (80%) of patients available for analysis (n=91). Most frequent adverse events of the 2-4 degrees, related to telaprevir, were anemia (63 patients, 41%), thrombocytopenia (15 patients, 10%) and skin rash (7 patients, 5%). For anemia treatment in 50 (33%) patients the doze of ribavirin has been reduced, erythropoietin was prescribed to 12 (8%) to patients and no blood transfusion was required; 10 (7%) patients have ahead of schedule stopped course of treatment by telaprevir in connection with development of anemia (6), thrombocytopenia (2) and occurrence of skin rash (2).

Conclusion. In 153 patients with severe liver fibrosis caused by hepatitis C virus (genotype 1), on background of triple AVT with telaprevir high level of immediate virologic response and low level of the preterm treatment discontinuation was marked.

Aim of investigation. Comparative assessment of efficacy and safety of Pegaltevir and PegIntron in within pattern of combined antiviral therapy in previously untreated patients with chronic hepatitis C.

Material and methods. Overall 140 patients with chronic hepatitis C, who received no antiviral therapy previously were included in original study. Patients were randomized in 4 groups. Groups differed in relation to received drug and hepatitis C virus genotype. All patients received 1,5 mkg per 1 kg body weight per week of Pegaltevir or PegIntron and 800–1400 mg of ribavirin per day. Preliminary estimation of drug efficacy was based on rates of rapid and early virologic response (RVR and EVR) achievement, dynamics of biochemical tests, dynamics of blood level of peginterferon alpha and neopterin. Safety features were estimated as well.

Results. Comparative analysis has demonstrated absence of statistically significant distinctions of RVR and РВО rates at application of two peginterferon alpha-2b drugs. There were no differences in frequency of achievement of serologic response, as well as safety in Pegaltevir and PegIntron groups. Dynamics of blood concentration of peginterferon alpha correlated to neopterin concentration both in Pegaltevir group and in PegIntron group.

Conclusions. Study results have shown high rates of RVR and РВО achievement, and acceptable safety profile of Pegaltevir, comparable with that of PegIntron at chronic hepatitis C in previously untreated patients.

The aim of review. To discuss value of medical genetic consultation at diseases of gastro-intestinal tract (GIT).

Key points. The analysis of frequent hereditary gastroenterological diseases diagnosed with participation of doctor - geneticist. The role of hereditary factors in manifestation of monogenic and multifactorial diseases of a GIT is demonstrated. Value of modern molecular genetic technologies for detection of early stages of gastroenterological diseases is proved. General indications for medical genetic consultation for all gastrointestinal diseases are determined.

Conclusion. Detection of disorders of functioning of various genes and duly medical genetic consultation allow to carry out early diagnostics, choose optimum mode of treatment and prevent diseases of GIT.

Aim of investigation. To estimate efficacy of D3-lymph node dissection with mesocolic excision in comparison to standard surgical technique of right hemicolectomy for right colon cancer in long-term terms.

Methods. Comparative analysis of the long-term results of treatment of right colon cancer at I–III stages with D2- and D3-lymph node dissections was carried out. Traditional right hemicolectomy with D2-lymph node dissection was applied in 132 patients (control group). Patients after right hemicolectomy with D3-lymph node dissection, mesocolic excision with «notouch» principles have been included to the main group (n=64). Groups were comparable by demographic and clinical features, and also by stage of local neoplastic spread.

Results. Significant differences in general cumulative 5-years survival rate (69 and 86% respectively, р=0,043) and 5-years cancer-specific survival rate (91 and 71% respectively, р=0,014) have been revealed between control and main groups. Among patients with involved lymph nodes (III stage) overall 5-years survival rate after standard surgery (58%) was worse, than after right hemicolectomy with D3-lymph node dissection (83%, p=0,042). In patients with D2-lymph node dissection the involvement of regional lymph nodes was significant prognostic factor deteriorating overall 5-years survival rate (p=0,039) while at D3-lymph node dissection this factor had no effect on the prognosis (p=0,535).

Conclusion. At right colon cancer of I–III stages D3-lymph node dissection is the major factor significantly improving overall 5-years survival rate. Extended lymph node dissection is the factor levelling negative prognostic effect of metastatic lymph node involvement which can be accomplished by prevention of local lymphogenic relapse of tumor.

Aim of investigation. To determine morphological rating of connective tissue structures of perineum and detect neurophysiologic disorders of pelvic floor in patients with the descending perineum syndrome (DPS).

Material and methods. Original study included 39 women with DPS in the age of 21 to 68 years, with clinical and instrumental signs of descending perineum syndrome. Comparative study of pattern of connective tissue structures in 14 DPS patients that constituted main group and in 10 women without clinical and instrumental DPS signs (control group) was carried out. In 27 DPS patients conductivity of genitofemoral nerve, F-wave latency and anal sphincter motor activity potential were investigated.

Results. In main group changes of collagen skeleton of perineal skin, pelvic ligaments, vaginal walls with significant dissociation, disorganization and breakdown of collagen was revealed that was associated by severe hyperelastosis and lymphostasis in connective tissue structures of perineum. In 88,8% of patients with DPS statistically significant disorder of electric conductivity by genitofemoral nerves, and in 70,4% - severe denervation of reflex arch from sacral region of vertebral column to anal sphincter was revealed.

Conclusions. Along with distinct changes of connective tissue structures of perineum, DPS it is characterized by neurophysiologic disorders of pelvic floor registered not only in peripheral innervation zone, but also along the whole reflex arch.

The aim of review. To discuss the reports on functional dyspepsia (FD), presented at the American gastroenterological week (Orlando, May 18-20, 2013).

Key points. Of all etiological factors of FD the major attention is paid to hereditary predisposition, pattern of nutrition, bad habits (smoking), past food toxicoinfection, psychological and social factors. Frequent combination of FD to other gastro-intestinal functional diseases (most notably — irritable bowel syndrome), as well as to gastroesophageal reflux disease is marked. Treatment of FD includes application first of all of proton pump inhibitors, prokinetics, antidepressants and selective serotonin reuptake inhibitors.

Conclusion. Pathophysiological and clinical aspects of FD require further studying.

Z.V. Gesheva — NSAID-gastropathies at juvenile arthrites (risk factors, prevention, treatment) 

D.A. Kakhramanova — Combination of gastroesophageal reflux disease to 2nd type diabetes mellitus: features of course and potential of early diagnostics of complications