The aim of review. To present data of the foreign clinical studies devoted to optimization of diagnostics of gastroesophageal reflux disease (GERD) in children.

Key points. GERD is a frequent issue in pediatrics, its manifestations are difficult to reveal sometimes. In most of the cases gastroesophageal reflux (GER) is physiological, especially postprandially and can be detected in every child. Many episodes of refluxes proceed asymptomatically, however in some children GER is related to various serious symptoms and damage of esophageal mucosa because protective mechanisms are insufficiently developed in the young age. Therefore additional investigations are required to differentiate esophageal and extraesophageal manifestations of GERD. Multichannel intraluminal impedance — pH-metry is one of the modern diagnostic methods. It is very sensitive, allowing to reveal non-acidic, weakly acidic refluxes, as well as the height of refluxate spread.

Conclusion. Multichannel intraluminal impedance measurement in comparison with intraesophageal pH-metry has wider diagnostic potentials as allows to determine episodes of acidic, non-acidic and alkaline refluxes.

The aim of review. To present features of hepatocellular carcinoma (HCC) diagnostics.

Key points. Factors of HCC development, principles of screening diagnostics in risk group are discussed. The role of ultrasound investigation, X-ray, computer and magnetic-resonance tomography in HCC diagnostics is described, and also additional data which can be received with by radiological diagnostic methods that has high value in assessment resectability and preoperative surgical planning are reflected. The radiology is described at accompanying cirrhosis, difficulty of small HCC detection. Radiological differential diagnostics of HCC should be carried out with dysplastic nodules. Advantages and restrictions of each of method of visualization are presented.

Conclusion. The issue of hepatocellular cancer diagnostics remains actual and requires further studies.

The aim of review. A critical estimation of interferon-free modes of antiviral therapy (AVT) of chronic hepatitis C (CHC) according to the analysis of clinical studies.

Key points. Interferon-free variants of CHC treatment have certain advantages over modes of interferon-α based treatment. Monotherapy by drugs with direct action on virus is less effective in comparison to combined application. Combination of agents with direct antiviral effect considerably reduces risk of resistance, increasing probability of virus eradication. The role of ribavirin at various interferon-free modes of treatment requires specification.

Conclusion. New variants of the AVT providing combined application of agents with direct antiviral action (without interferon and ribavirin), will allow to simplify algorithms principally, decrease terms and improve efficacy of treatment in all categories of patients. Such variants of therapy can be considered as a new paradigm of CHC treatment.

Aim of investigation. To estimate prevalence nonalcoholic fatty liver disease (NAFLD) with assessment of age dynamics of distribution, interrelation of stages and value of clinical cardio-vascular markers in patients addressing for medical aid to physicians of polyclinics of Russia.

Material and methods. First Russian epidemiologic observational study DIREG L 01903 on prevalence of non-alcoholic fatty liver disease was carried out in the Russian Federation in 2007. Overall 30 754 patients (56% of women, 44% of men) in the age of 18 to 80 years who sought medical attention of municipal polyclinics irrespective of the reference reason (either with subjective symptoms of liver disease or in the absence of those) have been investigated in 208 large medical centers for 8 months. Investigation included general (anthopometrical), laboratory and instrumental investigations, such as assessment of hepatites B and C markers, liver transaminases, gamma-glutamyltranspeptidase, blood lipid spectrum, glucose level, and abdominal ultrasound investigation, if required — esophagogastroduodenoscopy. In 4–6 wks at the second visit of the patient biochemical tests were repeated or supplemented with tests for alkaline phosphatase, bilirubin, albumin, gammaglobulin, serum iron.

Results. The prevalence of NAFLD among adult population of the Russian Federation was 27%, including 80,3% of hepatic steatosis cases, 16,8% — nonalcoholic steatohepatitis and 2,9% — liver cirrhosis. Frequency of NAFLD detection increase by the age of 50. In the age group of 50–59 years the prevalence of disease reached the highest values, making 31,1% among the whole screened population. The impact of all studied risk factors of cardio-vascular diseases (р<0,001) has been found. The major risk factors revealed in NAFLD patients population, were systemic hypertension (69,9%), abdominal obesity (56,2%), hypercholesterolemia (68,8%).

Conclusions. Prevalence of NAFLD among adult population of Russia is very high: almost every third patient who was looking for medical attention in polyclinic, has one of NAFLD-related disease entities. Metabolic syndrome and its components have been determined as leading risk factors of this disease, that once again emphasizes significance of interrelation of cardio-vascular diseases and NAFLD. Therefore, development of management approach and search of effective treatment should be carried out in two directions — for liver and cardiac diseases.

Aim of investigation. To estimate efficacy of combined hepatotropic drug «Hepaguard Active» for prevention of progression of non-alcoholic fatty liver disease (NAFLD) at steatosis stage.

Material and methods. Overall 25 patients with verified NAFLD at steatosis stage were studied. All patients received Hepaguard Active 1 capsule tid at meal time for 3 months. Before and after treatment course general examination was performed, including: inquiry and physical examination, clinical and biochemical blood tests, FibroMax tests, large intestine contents culture, bioimpedance analysis of componental body composition, ultrasound investigation of abdominal organs.

Results. On a background of «Hepaguard Active» therapy improvement of symptoms was marked, condition of hepatobiliary tract has improved, lipid spectrum was normalized, excessive body weight decreased, quality of life improved.

Conclusions. Hepaguard Active can be recommended to patients with NAFLD at steatosis stage for correction of revealed disorders and prevention of disease progression.

Aim of investigation. Improvement of results of organ-preserving treatment of early rectal cancer, and assessment of sensitivity and specificity of transrectal ultrasound investigation (TRUS) at these patients.

Material and methods. Overall 14 patients with adenocarcinomas (uT1N0) of high or moderate degree of differentiation were selected for transanal endoscopic operation (TEO), as a basic treatment method of villous rectal tumors. Male to female ratio among investigated patients was equal (7/7). Mean tumor size was 2,6±0,8 cm (1,0–4,0 cm). The average distance from the lower pole of tumor to outer edge of anal canal and to dentate line was 7,1±1,7 cm (4,0–9,0 cm) and 4,8±1,9 cm (1,5–7,0 cm) respectively. Preoperative examination included: digital investigation of the rectum, rectoromanoscopy with biopsy, colonoscopy, TRUS, computer tomography and magnetic-resonance tomography of abdominal cavity and small pelvis.

Results. The median duration of operation was 39 (25–110) minutes. Tumor-free resection edges have been obtained in all operation specimens. All tumors were removed en bloc. No postoperative morbidity was marked. Preoperative and final diagnoses coincided in all cases. At pathomorphological study adenocarcinoma at Tis stage was revealed in 3 patients (21 %), Т1 — in 10 (71%) and Т2 — in one (8%). In female patient with Т2 adenocarcinoma radical operation was executed, in the removed specimen pararectal lymph node (N1) metastasis was found out. The mean follow-up of patients was 12 (2–20) months, no signs of local tumor relapse were found.

Conclusion. TEOs, having minimal morbidity level, are alternative to radical operations at early rectal cancer, however wide utilization of the method is limited by such factors, as depth of neoplasm invasion and involvement of pararectal lymph nodes. Application of TEO should be prudent. Preoperative tumor staging plays the key role.

Aim of investigation. To determine frequency of detection and level of circulating cytokines at ulcerative colitis (UC) and assess their interrelation with clinical activity and efficacy of conservative treatment. Material and methods. The serum level of IL-2, IL-4, IL-6, IL-8, IL-10, granulocyte-macrophage colonystimulating factor (GM-CSF), IFN-γ and TNF-α was studied in 37 ulcerative colitis patients. Investigation was carried out by «Bio-Plex» protein analyzer («Bio-Rad», USA). Moderately severe and severe forms of UC were diagnosed in 15 and 18 patients respectively, mild — in 4, resistance and sensitivity for conservative treatment were detected in 15 and 22 patients. Surgical treatment was carried out in 14 patients. The control group included 20 blood donors. Results. In patients with moderately severe, severe forms and in the control group IL-6 and IL-10 were revealed in 33,3, 61,1 (р<0,05), 5% of cases and 26,6, 50 (р<0,05), 10% of cases respectively. Substantial increase of IL-6 and IL-10 level was observed in severe form of UC (42,4±21,2 and 22,7±6,4 a pg/ml) as compared to the control group (1,5±1,8 and 5,2±4,1). In groups of patients, resistant and sensitive to conservative treatment, frequency of circulating IL-6 detection was 86,6 and 22,7% (р<0,05), level of IL-6 — 53,4±24,5 and 2,0±0,62 (р<0,05); detection rate of IL-10 — 66,6 and 9% (р<0,05), level of IL-10-31,6±7,4 and 7,1±6,9 (р<0,05) respectively. Three and more circulating cytokines were revealed in 80% of patients, resistant to conservative treatment and in 22,7% (р<0,05) of patients responded to treatment. The profile of IL-6, IL-8 and IL-10 was observed in 60 and 4,5% (р<0,05) patients of these groups respectively. Conclusions. Frequency of detection and level of circulating cytokines IL-6 and IL-10 is considerably higher at severe forms of UC and in patients, resistant to conservative treatment. Expansion of circulating cytokines spectrum, mainly IL-6, IL-8 and IL-10 profile in combination to 1–3 of the other studied cytokines (GM-CSF, IFN-γ, TNF-α) is typical for resistant form of disease.

The aim of review. To reflect modern concepts on clinic, diagnostics and treatment of Zollinger–Ellison syndrome (ZES).

Key points. ZES is rare disease related to intragastric hyperacidity. Phenomenon of hyperacidity in ZES patients is caused by hypergastrinemia associated with ectopic gastrin production. Disease frequently develops in patients with multiple endocrine neoplasia syndrome of the 1-st type. Clinical presentation of ZES directly reflects hypersecretion of hydrochloric acid with development of erosive — ulcerative lesions of esophagus, stomach and duodenum, resistant to standard dozes of proton pump inhibitors (PPI). One of basic methods of ZES diagnostics is assessment of serum gastrin level and intragastric acid production. Conservative treatment includes prescription of high PPI dozes, and octreotide analogues.

Conclusion. ZES is not a common disease, anyhow knowledge of its clinical course is important for duly recognition. ZES should be considered at differential diagnostics in patients with frequently relapsing upper gastro-intestinal erosive-ulcerative lesions and in patients resistant to standard dozes of PPI.

The aim of review. To present modern data on the genetic theory of development of cardiac achalasia and data of original clinical case of the patient with vertical type of achalasia inheritance.

Key points. Cardiac achalasia is idiopathic disease, caused by inflammation and degeneration of myenteric plexus resulting in loss of postganglionic inhibitory neurons, essential for relaxation of the lower esophageal sphincter and peristaltic contractions of the esophagus. Main symptoms of achalasia are: dysphagia, regurgitation, chest pain and weight loss. Nowadays there are three main etiological hypotheses in cardiac achalasia development — genetic, infectious and autoimmune. Genetic theory is one of most widely discussed concepts.

Conclusion. Presented clinical case illustrates genetic theory of cardiac achalasia development in 81 year-old mother and 58 year-old daughter. Genetic analysis which is broadly applied for patients with achalasia, has allowed to come around to disease etiology, anyhow additional investigations in this area are necessary.