The aim of review. To present accumulation and development of modern knowledge of secretory activity of the pancreas with accent on regulation of enzyme production.

Key points. I. P. Pavlov in acute, followed by chronic experiences on fistulated dogs has proved phases and regulatory mechanisms of exocrine secretion of the pancreas, its adaptation to types of ingested food, accented in enzymatic secret pattern. In development of concepts basic reflex, paracrine and humoral mechanisms of stimulation, inhibition and modulation of exocrine and endocrine secretions of enzymes by the pancreas are revealed now. The original concept of the functional nonequipotentionality of the gland and modular principle of the organization of its exocrine secretion, acute adaptation of enzyme secretion to nutritional structure of duodenal chyme are described.

The aim of review. To detect relation between Gilbert's syndrome (GS) and other diseases of a gastrointestinal tract (GIT).

Key points. Gilbert's syndrome - hereditary, unconjugated jaundice related to decrease of activity of uridinediphosphate glucuronosyltransferase 1А1 (UGT 1А1) in the liver. The prevalence in European countries of reaches 9 %. Mutation of encoding gene — A (TA) 7TAA A is the principal cause of insufficiency of this enzyme, however development of clinical syndrome and severity of symptoms is related to other factors as well (male gender, additional genetic mutations, et al.). Provoking factors of jaundice attacks include fasting, infectious diseases, overstrain, effect of drugs and xenobiotics. Patients demonstrate various complaints related to disorders — nausea, decrease of appetite, heartburn, epigastric pain, defecation disorders. Gilbert's syndrome quite often is combined to of the upper gastro-intestinal diseases (gastroduodenitis, esophagitis, sphincter disorders). Recent studies have demonstrated, that this hereditary syndrome is a risk factor of gallbladder diseases, including biliary sludge, gallstone disease. Lower gastro-intestinal disorders often have functional origin. In the literature publications on rare frequency of colorectal cancer and Crohn's disease in patients with GS have appeared. The protective role of unconjugated bilirubin in relation to various diseases - cardio-vascular, autoimmune, oncologic is studied.

Conclusion. The reasons of development of symptoms related to gastro-intestinal organs in patients with Gilbert's syndrome are investigated insufficiently. It can be assumed, that there is combination to other gastro-intestinal diseases. Diseases of the esophagus, stomach, duodenum and biliary tracts decelop most frequently at GS. To author’s opinion and literature data, it is caused by embryogenetic affinity and functional relation between liver, biliary tract and upper gastro-intestinal tract, disorder of structure and rheologic properties of bile, characteristic for GS, and also decrease of detoxification liver function. Doctors should be concerned in relation of gastro-intestinal diseases GS.

The aim of review. To demonstrate most pressing issues of diagnostics and treatment of gastroesophageal reflux disease (GERD), presented in abstracts of the World gastroenterological congress (China, 2013).

Key points. Following tendencies and advances deserve the highest attention: wide introduction of new diagnostics methods of GERD in the last years, e.g.: рН-impedance measurement and high resolution manometry, development of new method of non-invasive GERD diagnostics at primary healthcare stage - GERD Q questionnaire, optimization of GERD treatment and its complications.

Aim of investigation. To determine efficacy of ulcer bleeding treatment at high risk of relapse after endoscopic hemostasis: the baseline intensive therapy including antisecretory treatment including parenteral form of rabeloc (rabeprazole) was applied.

Material and methods. Original study included overall 25 patients with acute ulcer gastroduodenal bleeding. Past history was complicated for peptic ulcer in 14 patients. Ongoing ulcer bleeding (Forrest Ia, b) was found in 5 patients. Hemostasis has been effectively carried out by combined approach (injection of epinephrine solution and argon plasma coagulation). In the other 20 patients with stopped bleeding by the time of examination preventive endoscopic hemostasis was implemented.

Results. Patients received rabeloc (rabeprazole 20 mg) bolus intravenous injections every 6 hs for 3 days until high risk of bleeding relapse disappeared, followed by single-dose 20 mg intravenously for 10 days. Dynamic endoscopy on the 2, 4, 7, 14 day have been carried out in 25 patients, of them 4 patients required additional endoscopic hemostasis and continued of parenteral injection of rabeloc 20 mg every 6 hs for three days more. In all studied patients it was possible to avoid bleeding relapse. By the 4-th day of treatment in 21 (84%) patient signs of high risk of a bleeding were absent. For relatively short 2-week treatment term stomach ulcer size reduced by 54%, duodenal ulcers — by 47%, and in 24% complete healing was achieved.

Conclusions. Parenteral form of second generation proton pump inhibitor rabeloc (rabeprazole) meets requirements for treatment active gastric or duodenal ulcers complicated by acute bleeding.

Aim of investigation. To analyze clinical, biochemical features of various forms of pathology of a gallbladder in view of features of food behavior and factors of its regulation at patients with the various trophological status.

Material and methods. Overall 167 patients with gallbladder diseases and various trophological status were included in original study. Food behavior analysis was carried out, clinical features, anthopometry were determined, bile lipid spectrum, serum content of leptin and insulin were studied by enzyme-linked immunoassay.

Results. Investigation of gallbladder diseases has objectively demonstrated, that trophological status affects development and course of chronic cholecystitis, but is not the only determining factor.

Conclusions. Development and course of gallbladder diseases are defined by trophological status based on disorders of food behavior, change of production of leptin, insulin.

The aim of review. To estimate effect of genetic polymorphism of hepatitis C virus on risk of hepatocellular carcinomas (HCC).

Key points. Hepatocellular carcinoma is one of the most dreadful outcomes of chronic liver diseases, in particular — chronic hepatitis C (CHC). Now it is revealed, that frequency of HCC in patients with 1b genotype of hepatitis C virus (HCV) was significantly above, than other genotypes. In aminoacidic sequences analysis in patients with 1b genotype of HCV mutations with substitution of arginine to glycine in codon 70 (Glu 70) and leucine to methionine in codon 91 (Met 91) were revealed. Thus it is revealed, that mutant type Glu 70 is significantly more frequent in patients with HCC in comparison to CHC and liver cirrhosis, in older age groups, at elevation of serum level of gamma-glutamyltranspeptidase and aspartate aminotransferase. Frequency of mutant forms of 1b genotype is related to discovery of previously unknown protein of HCV — minicor-protein with absence of N-terminal of classical Cor-protein p21.

Conclusion. Early detection mutant Glu 70, Met 91 forms of HCV genotype 1b will provide prediction of HCC risk in CHC patients and to begin adequate etiological treatment for preventive maintenance of this dangerous complication intime.

Aim of investigation. Investigation of association of leptin receptor (LEPR) gene Gln223Arg polymorphism with obesity and non-alcoholic fatty liver disease (NAFLD).

Material and methods. Overall 107 patients with NAFLD, 81 patient with alcoholic liver disease (ALD) and 117 patients without liver diseases (control group) were investigated. Obesity criterion was body the body mass index (BMI) ≥30,0. Cholesterol and triglycerides serum levels were estimated by enzyme colorimetric method, leptin concentration — by immunoenzyme method. Genotyping for LEPR Gln223Arg gene polymorphism was carried out by allele — specific polymerase chain reaction.

Results. In control group and ALD patients no correlation of obesity with LEPR Gln223Arg gene polymorphism was revealed. In NAFLD patients without obesity Arg223Arg genotype, as well as 223Arg allele, was less frequent, than in control group — 3 times (P<0,05) and 1,5 times (P<0,05) respectively. Frequency of this genotype / allele was also significantly less in NAFLD group without obesity, than in those with obesity. Mean serum cholesterol level at NAFLD was higher, than at ALD (Р <0,05), and in Gln223Gln genotype carriers this parameter was highest in comparison to that parameter in other groups. At NAFLD patients 223Arg variant was less frequent (49,5%), than 223Gln variant, in contrast to other groups. Allelic frequency of 223Gln in women with NAFLD was 1,5 times higher (P<0,05) , than in women with ALD, and 1,3 times higher (P<0,05), than in women of control group. Frequency of Gln223Gln genotype in women with NAFLD was higher than that in women with ALD 1,5 times (Р<0,01), in women of control group — 1,3 times (Р<0,05) and in men with NAFLD — 3 times (Р=0,05) respectively.

Conclusions. Carriage of 223Gln variant of LEPR Gln223Arg gene polymorphism can promote increase of cholesterol level and development of non-alcoholic fatty liver disease in absence of obesity as well, is especial in women.

The aim of review. To analyse of publications on qualitative and quantitative changes in pattern of intestinal microflora in patients with irritable bowel syndrome (IBS) and options of its treatment by pre-, pro-, and symbiotic drugs.

Key points. In the last years more and more data appear on changes in qualitative and quantitative spectrum of intestinal microflora in combination to low degree inflammation of colonic mucosa at IBS that allowed to reconsider standard concepts on pathogenesis of this functional disorder. Agents restoring intestinal microflora balance are effective for symptom relief of this disease.

Conclusion. The analysis of the information concerning disorder of qualitative and quantitative structure of intestinal microflora at IBS, mechanisms of action of pre-, pro- and synbiotics, allows to expand essentially treatment options of this disease.

The aim of clinical case presentation. To illustrate difficulties of detection of sources of gastro-intestinal bleeding (GIB) at investigation of patient with severe chronic iron-deficiency anemia.

Key points. At the moment of hospital admission in obvious cause of GIB has not been revealed. At complex investigation potential sources of blood loss were found out: hiatal hernia (HH) and diverticula of the large intestine. Pathology data in some cases are complicated both by overt clinical GIB, and microlosses. Presented case illustrates extremely high adaptive potential of female body to chronic blood loss - patient continued to work down to the moment of hospital admission. Definite feature of presented case is the dissociation between severity of anemia and absence of clinical symptoms of HH and diverticular disease.

Conclusion. Presented case emphasizes exclusive importance of control of total blood count in women in postmenopausal period and necessity in prophylactic medical examination of patients.

The aim of review. To discuss the reports devoted to the issue of irritable bowel syndrome (IBS) and chronic functional constipation (CFC), that were presented at the 21st United European Gastroenterological Week (Berlin, October, 14–16, 2013).

Key points. Of etiological and pathogenic factors of IBS the major attention is given now to hereditary factors, past intestinal infections, bile acids absorbtion disorders, changes of innate immune system. Differential diagnostics of IBS with other diseases (celiac sprue, chronic inflammatory bowel diseases, et al.), that may progress under a mask of the functional intestinal disorders is required. The range of pharmaceuticals has been replenished by new agents (linaclotide, prucalopride), increasing efficacy of IBS and CFC treatment.

Conclusion. Pathophysiological and clinical aspects of IBS and CFC require further investigation.