The aim of review. To present up-to-date data on etiology, pathogenesis, clinical presentation and diagnostics of cardiac achalasia.

Key points. Cardiac achalasia represents primary esophageal motor disease with involvement of myenteric plexus. Basic symptoms of achalasia include dysphagia, regurgitation, chest pain and weight loss. Esophageal manometry which allows to evaluate resting pressure and relaxation phenomenon of the lower esophageal sphincter and peristaltic activity of distal part of the esophagus is the «gold standard» of diagnostics. Genetic, autoimmune and infectious theories are considered for disease etiology.

Conclusion. For the present moment pathogenesis, clinical presentation and diagnostics methods of cardiac achalasia are investigated in detail, however etiology of disease remains unknown, despite of centuries-old history. The major attention is drawn to autoimmune theory which requires further investigations.

The aim of review. To present modern approach to treatment of functional dyspepsia (FD).

Key points. Treatment of FD should be comprehensive and include general recommendations, application of drugs and psychotherapeutic methods. At a choice of specific drug clinical variant of disease should be taken into account. At pain-predominant (ulcer-like) variant antisecretory agents (first of all — proton pump inhibitors) are the drugs of choice, at postprandial distress syndrome (dysmotility-like variant) - prokinetics. In resistant cases psychotropic drugs and psychotherapeutic methods are indicated.

Conclusion. Investigation of FD pathogenesis should be continued that will provide more differentiated treatment approach and improve the results.

Aim of investigation. To identify cellular «target» of bismuth tripotassium dicitrate (De-nol) therapy – DNA protection of generative zone cells of stomach mucosa (SM) from damages by oxidative burst products in neutrophilic leukocytes at continued intake of the drug for 4 wks after the ending of eradication therapy.

Material and methods. Overall 53 patients after successful eradication therapy for chronic H. pyloriassociated gastritis were investigated: in 28 of them De-nol treatment was continued, 25 were included to the group of comparison. At control upper GI endoscopy biopsy samples were taken from 5 SM points according to OLGA-system protocol. In biopsy specimens presence of neutrophilic infiltration was estimated in mucosal generative zones exclusively. Borders of a generative zone were determined by the presence of myofibroblasts surrounding glandular epithelium which were identified immunohistochemically, using smooth-muscle actin as a marker. Cells with damaged DNA were revealed by immunehistochemical detection of Р53 protein.

Results. No correlation between neutrophilic infiltration of SM and р53-positive cells quantity in generative zone (–0,14≤r≤0,08) was revealed in both groups. Comparison of cumulative scores of P53 label in generative zones epithelium after treatment demonstrated no significant difference between groups. Only at comparison of P53 expression level in each sampling point statistically significant differences before and after treatment (Wilcoxon W-matched-pairs ranks criterion) have been found only in group of patients who continued treatment.

Conclusions. Detection of the damaged DNA in SM generative zone cells by immunehistochemical assay of P53-positive cells allows to establish significant decrease of their number in biopsies of the patients, who received the drug after cessation of eradication therapy that can be considered as a marker of protective effect for generative zone cells — cytoprotective «target» of bismuth drug.

Aim of investigation. To estimate course of biliary pancreatic necrosis (PN) on a background of an «impacted» stone of major duodenal papilla in comparison to pancreatic necrosis of alimentary origin.

Material and methods. Treatment results of 76 patients with PN (33 patients with a stone of major duodenal papilla — main group, 43 — alimentary PN — control group) were analyzed. Study inclusion criterion: availability of papilla to endoscopic inspection. In main group women prevailed, patients over 60 years of age. In patients with alimentary PN late hospital admission (after 72 h) was more frequent. Severity of patient state was estimated on SAPS and SOFA multifactorial scoring scales. Disease development was controlled by ultrasound scanning, multispiral computer tomography, X-ray fistulography. All patients underwent duodenoscopy, videolaparoscopy with drainage of abdominal cavity for subsequent peritoneal lavage. In the main group endoscopic papillosphincterotomy was used for decompression and lithoextraction.

Results. In the main group the direct correlation between disease duration and frequency of acute pancreatitis development was revealed. Course of pancreatic necrosis were determined by volume of pancreatic lesion. Thus correlation between extent of necrosis and increase of SAPS and SOFA scale scores is confirmed, that indicates level of intoxication and multiorgan failure. Subtotal and total PN in main group (63,6%) was more frequent, than in control (37,2%). Local complications, including infected PN, in both study groups developed with identical frequency. On a background of major duodenal papilla stone in a pattern of purulent complications lesser sac abscesses (р=0,010) and peripancreatic necrosis — 8 of 33 (24,2%) were more commonly registered in comparison to alimentary pancreatic necrosis — 1 of 43 (2,3%). The general mortality was 25% (19 of 76 patients), the number of lethal outcomes in the main group was 2 times higher (36,4%), than in control (16,3%).

Conclusion. Pancreatic necrosis on background of major duodenal papilla stone is characterized by severe course with development of multiorgan failure and high mortality. Form of PN does not affect infection rate. In treatment of biliary pancreatic necrosis duly decompression of major duodenal papilla is required.

The aim of review. To present modern data on hypercoagulation syndrome at liver cirrhosis.

Key points. Changes in hemostasis system at liver cirrhosis have complex and ambiguous character. The total effect of all changes is frequently balanced, and the hemostatic system remains functional. However hemostasis equilibrium at liver cirrhosis is unstable. There is always potential risk of both hemorrhage and thromboses. As the possible reasons causing clotting, decrease of plasma anticoagulants level, elevation of von Willebrand factor level, decrease of ADAMTS13 protease level, changes of vascular wall and decrease of profibrinolytic factors level are taken into account. Application of anticoagulants for liver cirrhosis patients becomes an actual issue nowadays.

Conclusion. Patients with liver cirrhosis are distinguished by high risk of both hemorrhagic, and thrombotic complications, that requires profound investigation of hemostasis system. Prescription of anticoagulant therapy to such patients should be based on verified thrombosis, absence of direct contra-indications, considering risk of anticoagulant therapy complications.

Aim of investigation. Complex estimation of endothelial function at non-alcoholic fatty liver disease (NAFLD) in association with early disorders of carbohydrate metabolism, in relation to liver fibrosis severity.

Material and methods. Overall 67 patients with metabolic syndrome (MS) in combination to early carbohydrate metabolism disorders (71,6% women), mean age was 47,5 (42–49 years), body mass index — 34,6 kg/m2 (32,4–38,4 kg/m2) were investigated. In 72% of patients presence of NAFLD at steatosis stage and in 18% —at non-alcoholic steatohepatitis stage was found.

Results. In patients with MS in association to early disorders of carbohydrate metabolism liver fibrosis at F1 METAVIR stage was revealed in 25%, at F2 — in 16%, at F3 — in 13% and at F4 — in 1,5% of all cases. Along with increase of fibrosis stage progressive elevation of TNF-α (p=0,0265), IL-6 (p=0,0012) and endothelin-1 (p=0,0137) contents on background of decrease of adiponectin concentration (p=0,0026) and gain of humeral artery diameter after compression (p=0,005) was marked.

Conclusions. Presence and severity of liver fibrosis at MS in combination to early disorders of carbohydrate metabolism are related to increase of proinflammatory cytokines, endothelin-1 concentration on a background of reduction of adiponectin contents and decrease of endothelium vasodilation capacity.

Aim of investigation. Development of adequate screening and diagnostic algorithms on colorectal cancer detection.

Material and methods. The main group included 204 patients with colorectal cancer (CRC),that has been revealed at screening of 1669 patients by immunochemical fecal occult blood test (FOBT). Control group included 213 CRC patients who have addressed oncologic institutions for intestinal or general complaints independently. Screening program included: immunochromatographic FOBT, blood test for tumor markers — carcinoembryonic antigen (CEA), oncoantigens СА 19-9, СА 242), methylated DNA of septin 9 gene.

Results. Diagnostic efficacy of CRC screening diagnostics by testing of blood levels of CEA, СА 242 and СА 19-9 was 40,4, 50,8 and 51,7% respectively. Epigenetic tests for DNA methylate of SEPT9 gene in blood as screening procedure was characterized by high diagnostic efficacy — 86,5%. At the initial stage of screening diagnostics optimum combination of methods is immunochemical FOBT at 100 ng/ml threshold and assessment of DNA methylate of gene SEPT9 in blood. Diagnostic efficacy of the 1-st stage of screening diagnostics was 90%.

Conclusions. The initial stage of screening diagnostics CRC including immunochemical FOBT tests at threshold of 100 ng/ml, assessment of DNA methylate of SEPT9 gene in blood, provide optimum ratio of sensitivity and specificity and cost efficacy.

Aim of investigation. To estimate level of oncologic aid to patient with colorectal cancer in Tomsk area according to survival parameters.

Material and methods. Depersonalized data of the Tomsk area population cancer register on 3173 patients with colorectal cancer diagnosed in 2004–2012 were used. Observed, corrected and relative survival rate were designed by actuarial method.

Results. Observed survival rate at colorectal cancer was:1-year — 57,8 and 56,4%, 5-year — 38,1 and 38,2%, 9-year — 36,8 and 37,3% in men and women respectively. Comparison of relative survival rate in Tomsk area and in the USA has demonstrated, that the highest difference in scores was marked for 1-, 2- and 3-years survival rate — by 23,7, 24,4 and 22,3% is higher than in the USA. This difference decease along with time interval increase, making 5,9% at 9-years survival rate.

Conclusions. Low rate of colorectal cancer early detection, 1-years survival rate and high scores of disease neglecting testify inefficiency of oncologic aid in Tomsk area at primary diagnostic stage. Actions for its improvement are proposed.

Aim of investigation. To improve results of treatment of extrasphincter and transsphincteric fistulas of rectum.

Material and methods. Treatment experience of 70 patients aged 22 to 61 years with extrasphincteric and transsphincteric rectal fistulas using new surgical technique: resection of fistulous tract, internal ostium plastic by allocollagen membrane and sealing of excised fistulous tract by bioplastic material is presented.

Results. In remote postoperative period, in 5 months to 3 years, 45 (64,3 %) patients were followed-up. In 4 (5,7%) patients relapse of disease was detected: in 3 (4,3%) cases fistula relapse in its initial location, these patients underwent segmentary proctoplasty, the fistula was closed, in one case (1,4%) after 2 months postsurgery intrasphincteric fistula was found that required resection into intestinal lumen. Good functional results were confirmed by sphincterometry and profilometry both in preoperative period, and in 3 months after surgery in 15 (21,4%) patients. No decrease of obturative rectum device scores was revealed.

Conclusion. Application of bioplastic material can be technique of choice at treatment of extrasphincter and transsphincteric fistulas with involevement of deep portion of sphincter.

Aim of investigation. Improvement of results of surgical treatment and quality of life of patients with severe forms of ulcerative colitis.

Material and methods. Investigation is based on analysis of results of surgery of 123 ulcerative colitis patients operated in coloproctology center of Ministry of Health of Russia in 2007 to 2013, that was completed by reconstructive — plastic stage. Formation of smallintestinal reservoir in one stage with total resection of large intestine was carried out in 46 (37,4%) patients (the first group) and secondary, remote — in 77 (62,6%, the second group).

Results. At analysis of complication types it was revealed, that complications related to stapling device prevailed in groups. At the present moment of 123 patients who have underwent surgical treatment with formation of smallintestinal reservoir, in 101 (82,1%) ileostoma was liquidated. Of them in the first group it has been closed in 31 (67,4%) patient, in the second — in 70 (90,1%). Thus only in 2 (4,3%) patients of the first and in 1 (1,2%) patient of the second group with developed postoperative complications closure of imposed ileostoma was not performed.

Conclusions. Today formation of smallintestinal reservoirs is unique way of rehabilitation of patients with ulcerative colitis after total colectomy. Comparable results of treatment in analyzed groups have been received due to refusal of primary reservoir formation in patients with more severe course of disease and more intensive and long-term steroid therapy.

Aim of investigation. To study efficacy of biological feedback treatment (BFT) at proctogenic constipation in adult patients.

Material and methods. Overall 30 patients with proctogenic constipation and dyssynergia of pelvic floor muscles i.e. spasm of puborectalis muscle were included in original study and treated by BFT method. Mean age of patients was 31,2±9,8 year, men to women ratio was 1:5.

Results. During treatment decrease in difficulty to defecate according to Rome-III criteria was observed in 22 (73,3%) patients. The other 8 (26,7%) patients demonstrated no improvement. According to subjective assessment of rectal evacuatory function by questioning before and after BFT statistically significant reduction of proctogenic constipation symptoms was revealed. By the data of objective investigation (profilometry and electromyography) signs of dyssynergia of pelvic floor muscles were revealed in no patient.

Conclusions. The biological feedback is effective treatment method for proctogenic constipation, allowing to reduce symptoms in 73,3% of patients and to correct dyssynergia of pelvic floor muscles in all cases.

The aim of review. To discuss functions of intestinal bacteria as a part of the «host» body basing on the present-time publications, to consider interaction of bacteria with macroorganism, which reminds intercellular cooperation by its nature.

Key points. Intestinal microbiome encompasses about 1014 microorganisms, over 99% of microbiome genetic material belong to bacteria. In healthy people three basic enterotypes (according to the type of dominating species) are defined. The pattern of small intestine microflora is studied much poorly, than that of the large intestine. Due to difference in sampling methods it is difficult to draw clear-cut conclusions on microflora role in pathogenesis for scientific investigations. Analysis of sequential cloning of 16S ribosomal RNA possesses the highest information value of all up-to-date methods. Interaction of bacteria with the «host» reminds cooperation of usual cells and can be carried out due to receptor binding, paracrine and humoral pathways, as well as due to phagocytosis and endocytosis. Microbes produce hormone-like substances, analogues of growth factors and neurotransmitters that determine two-way interaction of microflora with the central nervous system and its active metabolic role. The microbiome dynamically reacts to environmental changes, including stress. Studing of intestinal microbiome impact in development of visceral hypersensitivity, regulation of intestinal motility and sensitivity is quite promising trend.

M.D. Mikhailova — Gastroesophageal reflux disease: comparative efficacy of non-pharmacological and pharmacological treatments.