The aim of review. To demonstrate potentials and advantage of new method of gastroesophageal reflux disease (GERD) diagnostics – esophageal рН-impedance measurement.

Key points. рН-impedance measurement of the esophagus allows to identify reflux episodes in the esophagus irrespective of refluxate рН. In contrast to traditional pH-metry the new method represents physical state of refluxate (gas, fluid, mixed contents), time of volume clearance to determine relation of observed symptoms to non-acidic refluxes. This promotes improvement of diagnostics and treatment of GERD.

Conclusion. Application of esophageal рН-impedance measurement allows to consider this method as the most exact and modern in diagnostics of GERD.

Aim of investigation. To study features of pancreatic involvement in patients with metabolic syndrome

Material and methods. Overall 720 patients were investigated who have admitted to the clinic with referral diagnosis «chronic pancreatitis» (CP). Of them steatosis of pancreas (SP) was diagnosed in 49 and in 290 – chronic pancreatitis. Original investigation algorithm was based on tasks of the study and included careful inquiry and physical investigation of patients. Laboratory and instrumental studies included: total and biochemical blood tests, lipid profile, coprological test, transabdominal and (under specific indications) endoscopic abdominal US, esophagogastroduodenoscopy (EGDS), computer tomography (CT) of abdominal organs, magnetic-resonance investigation (MRI).

Results. According to diagnostic criteria of metabolic syndrome, the latter was detected in 48 patients. Abdominal CT was considered as non-invasive method of investigation allowing to reliably diagnose SP. At CT in 

49 cases SP was revealed. Direct CT signs of SP include decrease in pancreatic density score (<30 HU), lobulated pattern of the gland with pronounced fatty layers. Diagnosis of chronic pancreatitis was made according to conventional clinical, laboratory and radiological criteria. The metabolic syndrome was significantly more frequent (р<0,05) in patients with SP, than at chronic inflammatory pancreatitis: in 29 of 49 cases (59,2%) and in 29 of 147 cases (19,7%) respectively. The issue of application of new phospholipid drug Resalut in patients with SP, associated to hepatic steatosis and lipidemia is discussed. Conclusion. Steatosis of the pancreas can be considered as diffuse development of fatty tissue in all parts of the organ, developing mainly on the background of metabolic syndrome and combined to smoldering pancreatic inflammation under influence of pancreatoxic factors – alcohol, gallstone disease. Efficacy of new phospholipid drug Resalut in patients with steatosis of the pancreas associated to hepatic steatosis and lipidemia is demonstrated.

The aim of review. To present data on causes, pathogenesis, clinical manifestations and prognosis of renal disease at chronic hepatitis B (CHB).

Key points. Renal disease at chronic hepatitis B can be assessed from several points of view. First of all, it is HBV-associated glomerulonephritis developed as systemic manifestation of infection and presented, as a rule, by membranous nephropathy in children and mesangiocapillary glomerulonephritis in adults, resulting in chronic renal failure (CRF) in 30% of cases, while program hemodialysis is required in 10% of patients. Moreover, renal disease may be caused by medications used for CHB treatment, e.g. direct nephrotoxicity of adefovir or tenofovir, alpha interferon-induced glomerulonephritis, etc. Relation of HBV-infection to periarteritis nodosa - necrotizing vasculitis, ischemic nephropathy is known. Issue of CHB is important in patients who are undergoing substitution treatment: hemodialysis or post kidney transplantation. Antiviral therapy is indicated to the most of these patients which potential, at the same time, is limited by initially decreased renal function, nephrotoxicity of some drugs or simultaneous prescription of immunosuppressants after organ transplantation. At development of liver cirrhosis (LC) and its decompensation one more aspect of renal disease at CHB arises i.e. risk of hepatorenal syndrome (HRS) of the 1st or 2nd type that is a poor prognostic marker and requires individual therapeutic approach.

Conclusion. HBV-associated renal disease can develop as glomerulonephritis within systemic CHB manifestation or as complication of interferon-therapy due to nephrotoxicity of some antiviral agents, or as infection during replacement renal therapy (hemodialysis, transplantation of kidneys, etc.), as well as acute damage of kidneys or CRF (HRS of the 1st or 2nd type) in patients with decompensated LC at CHB outcome. Telbivudine is a drug of choice among new anti-HBV agents for treatment of patients, having high risk of renal disease, which demonstrates not only absence of nephrotoxicity, but also the proved predictable improvement of renal function.

The aim of publication. To present the case of severe acute drug-induced hepatitis after halothane anesthesia in relation to significance of allergies history preoperative inquiry and assessment of medical management of patients, using modern prognostic scales.

Key points. Biotransformation of volatile anesthetics can result in production of toxic metabolites and metabolic by-products, resulting in damage of the liver and kidneys. Disorders of liver function can be of two types: early – transient elevation of transaminase activity and late – liver necrosis. Mortality rate at the latter reaches 50–80%. In presented clinical case both variants developed in the same patient in different terms are described. Despite of acute drug-induced hepatitis with severe liver failure, complex treatment resulted in favorable outcome, including the remote-terms result.

Conclusion. The most important factors determining favorable prognosis at drug-induced liver disease, include adequate doses of glucocorticosteroids, application of MARS-therapy and absence of background liver disease. Application of differential diagnostics algorithms and prognostic scales at drug-induced liver disease helps clinician to choose proper treatment approach at specific stage.

Aim of investigation. To characterize frequency of TPMT gene mutations in patients with inflammatory bowel diseases (IBD) with myelosuppression and to estimate value of these mutations in prognosis of myelosuppression development in patients receiving thiopurine treatment.

Material and methods. From general register of IBD patients, those with bone marrow toxicity on a background of immunosuppressants in past history (n=21) were selected for assessment of TPMT gene allelic variants by polymerase chain reaction.

Results. Only in one patient (4,7%) with Crohn's disease and leukopenia (3,85·109/l) and thrombocytopenia (80·109/l), developed in the remote terms (61 wks) after onset of azathioprin intake, TPMT*3A polymorphism has been revealed, as point mutations 460 G> A and 719A>G. In all other cases (20 patients) allelic variant TPMT*1 with normal enzyme production have been found.

Conclusions. There is no need of study for genetic mutations before prescription of thiopurines, however application of effective methods of evaluation of prognosis of bone marrow toxicity development remains an actual issue. Careful control of laboratory parameters of myelosuppression during treatment by thiopurines is required. In case of intolerance or bone marrow toxicity at intake of thiopurines methotrexate should be prescribed.

The aim of review. To demonstrate main causes of constipation at various endocrine diseases, to present general approach to constipation treatment at endocrine diseases.

Key points. Defecation disorders on a background of endocrine diseases are regarded as secondary, symptomatic disorders. Constipation is a characteristic component of such endocrine syndromes, as diabetes mellitus (DM), hypothyroidism, hyperparathyroidism, hypopituitarism, pheochromocytoma, hyperaldosteronism, Addison's disease. DM occupies a leading place among them. Gastro-intestinal motility disorder at this syndrome is related to development of diabetic autonomous neuropathy, asynchrony of peristalsis and pressure of sphincters, acute decrease of cells of Cajal density, change of gastrointestinal hormones secretion. Constipation is typical symptom of hypothyroidism. Severe hypothyroidism can result in dynamic ileus and megacolon. Constipation is one of broad spectrum of gastro-intestinal hyperthyroidism manifestations, probably, related to change in expression of the genes regulating motility, decrease of autonomous nervous system excitability and dehydration. Decrease of enterochromaffin cells number and change of intestinal nervous ganglia structure is typical for hereditary endocrine syndromes (APECED, MEN-2). Disorders of defecation are observed at adrenal insufficiency (alternates with diarrhea), hyperaldosteronism, hypopituitarism, changes of sexual hormones secretion, hyperinsulinemia. Laxatives, including volume and osmotic laxatives, stimulating drugs, are prescribed in absence of response to nonpharmaceutical procedures.

Conclusion. Disorders of defecation is a characteristic symptom of the most common endocrine diseases; at some from them constipation alternates with diarrhea. Many endocrine diseases are oligosymptomatic for a long time. Doctor should pay special attention to constipation development and try to find other concomitant signs indicating systemic nature of disease. stepwise treatment of constipation is necessary.

Ye.V. Bystrovskaya – Postcholecystectomy syndrome: clinical variants, prediction and prophylaxis.

N.I. Zhernakova – Clinical neuroimmunoendocrinology of peptic ulcer in elderly patients. 

K.T. Umbetova – Autoimmune signs in patients with viral hepatites.

A.A. Nizhevich – Clinical and morphological characteristic, genetic markers, diagnostics and treatment Helicobacter pylori-associated gastroduodenal diseases in children.