Aim of review. To analyse existing molecular genetic methods for investigation of specific variety and the quantitative analysis of intestinal microbiome. Summary. Intestinal microbiome disorders play the leading role in development of many diseases of infectious and noninfectious origin. Monitoring of specific type, quantitative ratio of different types and strains of microorganisms in healthy people and at various diseases is essential for to develop strategy for microbiome restitution by microbial therapy. Modern molecular genetic methods of microbial investigation combined to the established methods of classical microbiology give the chance not only to identify microorganism species and even a strain, but also to decipher their genomes, to estimate antibiotic resistance and to establish its mechanism at genetic level, to estimate specific properties of specific microbial strain that will allow to define potential and efficacy of their clinical application etc. Meanwhile, today, to distinguish species and strains of microorganisms at DNAs or RNA level, standard culture and visual method are combined to molecular biology and genetics methods even more frequently. Conclusion. In molecular biology there is a stash of methods for intestinal microbial studying that can be implied in clinical practice. However there are also promising scientific methods, yet not applicable for disease diagnostics. Results of scientific activity is gradually translated into clinical practice and become the standard for diagnosis and a basis for development of new treatment methods.

Aim of investigation. To estimate the frequency of prescription of motility regulators and probiotics in the functional gastrointestinal diseases. To define efficacy of these agents according to results of «7×7» questionnaire (7 symptoms per 7 days) at treatment of functional dyspepsia (FD), irritable bowel syndrome (IBS) and combination of these diseases. Material and methods. Overall 502 patients aged 18 to 65 with symptoms complying to the «Rome-III» criteria and absence of «alarm symptoms» with the preliminary diagnosis of the functional gastrointestinal disorder: IBS, FD or combination of these diseases were started. During the first visit to the doctor patient was proposed to complete «7×7» questionnaire for baseline assessment of presence and severity of symptoms typical for FD and IBS. Later all patients underwent a set of laboratory and instrumental tests required according to «Guidelines on diagnostics and treatment of the irritable bowel syndrome in adults» of the Russian gastroenterological association and Russian Association of coloproctology and to «Clinical guidelines on diagnostics and treatment of the functional dyspepsia» of the Russian gastroenterological association. After primary investigation 108 patients were excluded from the study due to diagnosis change. Primary documentation data of 11 patients were unsuitable for statistical processing. The analysis of primary documentation and results symptom assessment of 383 patients with verified diagnosis of functional gastrointestinal disease by «7×7» questionnaire was carried out. Treatment algorithms, their conformity to establish diagnosis and efficacy were analyzed as well. Results. Motility regulator trimebutine was prescribed to 258 (67,4%) patients with various diseases: 30 (60%) IBS patients, 67 (73,6%) FD patients, and 157 (64,8%) patients with combination of both disorders. Modes of treatment which included trimebutine demonstrated higher efficacy in comparison to treatment algorithms, which included antispasmodic medications with respect to relief of all symptoms (according to the «7×7» questionnaire data), except for constipation and in disorders of stool consistency (firm stool): efficacy of trimebutinecontaining moods for those symptoms was comparable to those with application of spasmolytic drugs. Probiotic agents with various content in combination to other group drugs were prescribed to 127 patients: 29 FD patients (22,3%); 20 IBS patients (14,5%), and 78 FD to IBS combination (60%). It is established that presence of probiotic in the treatment mode leads to significant reduction in main symptoms severity typical both for FD and IBS according to the «7×7» questionnaire.

Aim of investigation. To estimate the role of alcohol abuse in gastroenterological patients. Material and methods. Overall 345 patients with various gastrointestinal diseases were enrolled in the study. Of all patients 162 (46,9%) were males, 183 (53,1%) were females, mean age was 43,18±13,04 years. Patients underwent inquiry by two questionnaires independently: AUDIT-C and CAGE. Gender, age, diagnosis and preferences in the choice of medical specialist were analyzed. Inquiry of doctors was carried out to assess personal experience of interaction with patients. Respondents were proposed to answer a set of questions, concerning frequency of routine application of AUDIT and CAGE questionnaires, carrying out of psychological support of the patient, experience of specific antialcoholic agent prescription in daily practice and interaction with narcologist doctors, satisfaction by obtained knowledge and craving for additional skills of diagnosis and treatment of alcoholism. Results. Of all 345 interrogated patients 49,8% were positive according to AUDIT-C and 45,3% - CAGE questionnaire. Thirty-two percent of patients had liver cirrhosis of toxic and viral etiology, 18% had chronic toxic and viral hepatitis, 11% - non-alcoholic fatty liver disease and various biliary diseases respectively, chronic pancreatitis and chronic gastritis subgroups represented 6% of all patients each, irritable bowel syndrome and gastroesophageal reflux disease - 4% each, primary biliary cirrhosis, hepatocellular carcinoma, stomach and duodenal peptic ulcer disease - 2%. According to doctors opinion strong correlation between between alcohol consumption and disease development was present in 22,2% of men and 8,7% of women. Sensitivity and specificity of questionnaires of AUDIT-C and CAGE was 66 and 91,4%, respectively, diagnostic accuracy - 86,2%, coherence coefficient (Kappa) - 0,567 (medium correlation). Of all patients with alcohol abuse, only 16,5% would refer to attending physician and 10,4% - to narcologist, 8,5% did not consider alcohol consumption as a problem, and 64,4% of them believe that they can cope with the problem on their own. Questioning of doctors indicated that only 35% of them constantly or frequently utilize AUDIT-C and CAGE questionnaires, 25% prescribed specific anti-alcoholic agents and 15% independently initiate anti-alcoholic therapy. However, 65% of physicians actively inquire patients for consumption, and 80% - constantly provide psychological support to patients. Despite that, only 10% of the interrogated doctors were completely satisfied by communication to the patient, and every fourth recognized lack of knowledge and skills in diagnosis and treatment of alcohol abuse. Over a half (60%) of doctors would like to gain additional knowledge in this field. About 50% of doctors recommended patients to address narcologist and only 25% have established contact to them. Conclusion. Development of the follow-up program is required for patients with alcohol consumption issues assisted by professional communities of internist and narcologist doctors. Physicians need to apply screening questionnaires of AUDIT-C and CAGE in their activity, encourage patients to decrease or completely stop alcohol intake, monitor and provide support to patients with alcohol abuse, initiate anti-alcoholic therapy in the cooperation with narcologists that will improve prognosis and decrease mortality from alcohol-related diseases.

Aim of review. To present clinical guidelines of the Russian gastroenterological association on management of cardiac achalasia and cardiospasm to practical doctors. Summary. Cardiac achalasia is primary esophageal motor function disorder manifested by impaired lower esophageal sphincter relaxation and defects of thoracic esophagus peristalsis. Etiology of the disease remains unknown. Three main hypotheses of disease etiology are discussed: genetic, contagious and autoimmune. Clinical symptoms of disease: difficulty of passage of solid and liquid food through the esophagus, vomiting, in certain cases - chest pain; severe disease is accompanied by cough and weight loss. Differential diagnosis is carried out with cardioesophageal cancer, peptic stricture, esophageal webs and rings, neurogenic anorexia and coronary heart disease in the cases with chest pain. Barium meal study reveals dilation and deformity of the esophagus, coneshaped narrowing in the lower esophageal sphincter area, retention of barium contrast in the esophagus, absence of stomach gas bubble. Endoscopy discloses dilation and deviation of esophageal lumen, presence of food remnants, liquids and mucus, uniform opening of cardia at air insufflation and capability of passage of endoscope into the stomach. «The gold standard» of investigation of patients with suspected achalasia is manometry. Clinical guidelines for the first time in Russian literature presents the latest approaches to cardiac achalasia diagnosis by high resolution esophageal manometry with application of modern Chicago classification. This classification defines three types of cardiac achalasia, and its usage provides significant increase of treatment prognosis accuracy. Clinical guidelines contain the detailed description of all up-to-date treatment methods for cardiac achalasia and cardiospasm (conservative, endoscopic, surgical) aimed to dilation of cardia and decrease of its pressure to improve of passage of food through area of gastroesophageal junction. Disease prognosis at timely diagnosis and treatment is favorable; remission rate for 10 years post-pneumocardiodilation ranges 75 to 90%. However patients require constant outpatient monitoring due to esophageal cancer risk (3 to 8% of cases). Conclusion. Clinical guidelines contain complete modern information, essential for the practical doctor on diagnosis and treatment of cardiac achalasia and cardiospasm.

Aim of review. To consider different treatment options for dyslipidemia in non-alcoholic fatty liver disease (NAFLD). Summary. NAFLD occurs in 20-30% of adult population. In the Russian Federation its rate is estimated as high as 37,1%. In the most of NAFLD cases severe disorder of lipid metabolism takes place. In large clinical trials it was demonstrated that the dyslipidemia significantly increases cardiovascular risks and worsens life expectancy in these patients. In the present overview treatment options of several therapeutic agents for dyslipidemia treatment at NAFLD are discussed: phenofibrate, omega-3 polyunsaturated fatty acids (omega-3-PUFAs) and S-adenosylmethionine (SAM). Results of numerous experiments and several clinical trials form the basis for phenofibrate administration for NAFLD patients. In animal experiments the positive role of phenofibrate as PPARα agonist was demonstrated (Peroxisome proliferator activated receptor alpha) for NAFLD prevention and treatment. Results of several studies published at the moment demonstrate that at NAFLD lipid metabolism markers, and serum transaminase levels normalize, sensitivity to insulin increases, the liver histology pattern improves at phenofibrate treatment. Specification of efficacy and safety of application of the drug requires more large-scale clinical studies. Omega-3-PUFAs is one more option in the lipid metabolism disorders treatment in this group of patients. These substances play important role in lipid metabolism regulating expression of the genes (including PPARα) involved in lipid and glucose metabolism. Available clinical trials demonstrate high therapeutical effect of these agents at NAFLD. In the review results of the experimental studies investigating the role of SAM in NAFLD pathogenesis and disorders of lipid metabolism is presented. Conclusion. Now data on a pathogenesis of lipid metabolism disorders at NAFLD are accumulated. The bulk of experimental data and series of clinical trials allow to assume positive affect of such drugs as phenofibrate, omega-3-PUFA and SAMe for treatment of dyslipidemia. Further high-grade studies in this area is necessary.

Aim of investigation. To estimate diagnostic value of liver and spleen elastography in patients with extrahepatic portal vein obstruction - non-cirrhotic portal vein thrombosis (PVT). Material and methods. The study group: 19 patients (Age 21-76 years) with PVT diagnosed by multispiral computed angiography without liver/pancreatobiliary tumors and/or liver cirrhosis (LC). The comparison group included 23 patients with LC Child-Pugh class A. Past history of portal hypertension, platelet count, serum albumin level, alanine and aspartate aminotransferase level; prothrombin according to international normalization ratio; grade of esophageal varices (EV); spleen longitudinal size according to abdominal ultrasound, liver and spleen stiffness were evaluated in both groups. Results. The group of patients with non-cirrhotic PVT was characterized by presence of clinically significant portal hypertension (EV, splenomegaly and hypersplenism). Following causes for PVT were established: systemic factors - myeloproliferative diseases, G20210A prothrombin gene mutation, and local factors: complications after pancreatobiliary surgery, omphalitis and neonatal umbilical sepsis. Nine patients, 1 to 2 years prior to hospitalization, were previously misclassified as «cryptogenic liver cirrhosis» in various medical institutions. Liver stiffness in PVT group was 2,8-11,5 kPa. The grade of EV tended to increase along with progression of the spleen stiffness. Statistically significant difference in serum aminotransferases levels in non-cirrhotic PVT vs Child-Pugh class A HCV-LC was observed: enzyme levels were 1,5-2 fold higher in LC (р<0,0001). No differences in the protein-synthetic liver function and severity of thrombocytopenia were found. Prevalence of EV was higher in non-cirrhotic group (р=0,028).) Statistically significant differences between groups in a liver stiffness were revealed: in non-cirrhotic PVT patients the median liver stiffness was 5,6 kPa, in LC patients it was 20,6 kPa, (p<0,0001). Conclusions. Liver elastography is rational in patients with primary diagnosed portal hypertension and PVT. For the differential diagnosis between LC-related PVT and the non-cirrhotic PVT the cut-off value of 11,5 kPa can be applied. Plotting of multifactorial model requires further studies with larger number of patients. Diagnostic value of spleen stiffness measurement as method for noninvasive diagnostic of degree of portal hypertension in non-cirrhotic PVT has been confirmed by the published data. Estimation of a cut-off value to predict EV development and EV bleeding in these patients requires larger number of patients and considering confounding factors.

Aim of review. To discuss features of prevalence and the clinicodiagnostic role of R702W, G908R and 3020insC NOD2 gene polymorphisms associated to Crohn's disease (CD) in various populations and regions of the world. Key points. It is established that there are significant differences in prevalence and clinical manifestations of R702W, G908R and 3020insC polymorphisms of NOD2 gene associated to CD in different countries, as well as in different regions of the same country and in representatives of different ethnic groups enhabiting different regions. Some populations are characterized by high prevalence of the above-mentioned polymorphisms in the absence of CD association, the others are characterized by low prevalence while the association to CD is present, in the third the absence of associations to the Crohn's disease risk is combined to integration of polymorphisms to specific features of the course of disease, treatment efficacy and surgery rate. Conclusion. According to literature data analysis it is possible to conclude that there are clear populationrelated features of the prevalence, clinical and diagnostic role of NOD2 genetic polymorphism associated to Crohn's disease that requires development of the international data bank of all genetic nucleotide polymorphisms associated to various stages of CD pathogenesis in different countries and populations. It will allow not only to increase efficacy of early diagnosis and the CD risk prognosis, but to define environmental factors affecting clinical utilization of genetic factors that is a premise for development of pathogenic justified management algorithm encompassing both populationbased and regional factors.

Aim of review. To analyze the changes in the IV revision of Rome criteria of the functional dyspepsia (FD) in comparison to existing criteria. Key points. The definition of FD and its main variants - postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) in new criteria did not undergo major changes in comparison to previous edition. Frequent combination of PDS and EPS both with each other, with such symptoms as nausea and belching and some other diseases as gastroesophageal reflux disease and irritable bowel syndrome was demonstrated. It is, still, recommended to make the diagnosis of FD, being guided both by compliance of patients symptoms to Rome criteria and the absence of alarm symptoms. The major place in the treatment of PDS is occupied by prokinetics, in EPS treatment - by antisecretory medications. Conclusion. The fourth revision of Rome criteria of FD have certain advantages in comparison to the previous criteria, but at the same time preserve essential shortcomings.