The aim of review. To analyze modern aspects of management of patients with premalignant changes in the stomach.

Key points. According to requirements of system OLGA or OLGIM application of modern endoscopic methods and morphological investigation is necessary for expert diagnostics of atrophy, metaplasia and dysplasia in the stomach. Detection of Helicobacter pylori infection and its eradication are important principles of management of patients with stomach premalignant lesions.

Conclusion. Monitoring methods of patients with stomach mucosa dysplasia are specified. Modes of H. pylori eradication are presented.

The aim of review. To present features of clinical presentation, diagnostics and treatment of special form of chronic pancreatitis – autoimmune pancreatitis (AIP).

Key points. The etiology of AIP is investigated insufficiently, the role of infection (in particular, viral), antigenic damage of pancreatic ducts and acinar cells is considered. AIP is frequently combined to other autoimmune diseases. The most typical serological marker of AIP is elevation of serum IgG4 level. Now 2 types of AIP are defined. AIP of the second type requires mandatory morphological confirmation. AIP is characterized by good treatment response by corticosteroids.

Conclusion. The issue of AIP remains actual and requires further studies.

The aim of review. To discuss basic methods of nutritional support in early phases of acute pancreatitis (AP). To show inconsistency of opinions on application of enteric feeding in early phases of AP.

Key points. It was demonstrated, that from the pathogenic point of view total parenteral nutrition is most justified in the phase of enzyme toxemia and intermediate phase of AP for 7 to 14 days and more in relation to the initial prognosis of disease severity. To establish a true role of early enteric feeding in AP treatment, it is necessary to continue monitoring of primary attacks, preventing its relapses, and to study effect of different types of enteric feeds on the level of APUD system hormones, that regulate pancreatic secretion.

Conclusion. High efficacy of early enteric feeding at various surgical diseases has turned it into fashionable trend with doubtful and unproved efficacy at AP, at absence of the clear pathogenic arguments. Total parenteral nutrition after obligatory intestinal lavage of chyme by cooled saline solution to decrease enteric stimulation of pancreatic secretion in postprandial phase is justified today.

Aim of investigation. To study efficacy of parenteral proton pump inhibitors in patients with ulcerative gastroduodenal bleeding.

Material and methods. Overall 71 patients were included in original study. Patients of the first group (n=30) received antisecretory treatment by parenteral omeprazole, the second group (n=41) — tablet form of the same preparation.

Results. In the first group no relapses of bleeding or mortality was detected, in the second group in 4 (10%) patients there was relapse of bleeding, that allows to assume higher efficacy of therapeutic hemostasis by the parenteral form of proton pump inhibitors within complex therapy.

Conclusions. Application of Omez, lyophilizate for infusions, allows to improve treatment results in patients of the main group, reduces risk of hemorrhage relapse and, therefore mortality and urgent surgery rates.

Aim of investigation. Efficacy of the modern methods of treatment of liver metastases of colorectal cancer was estimated.

Material and methods. Overall 117 patients have been included in the study with isolated metastatic liver involvement. Efficacy of liver resection, radio-frequency ablation (RFA), systemic and intra-arterial hepatic chemotherapy (IAHC) was studied.

Results. The five-years general survival rate at liver resection was 33,3%, relapse-free – 22,2%, at RFA – 16,2 and 13,5% respectively. HACE allows to achieve higher rate of positive response, not increasing risk of generalization of process, but does not improve scores of remote survival rate in comparison to systemic chemotherapy.

Conclusions. The most effective treatment method, allowing to achieve 33% of 5-year survival, is liver resection.

The aim of review. Article reviews of cumulated literature data on the rare form of cholangiocarcinoma in bifurcation of hepatic ducts and named after Gerald Klatskin.

Key points. Obstructive jaundice at the absence of abdominal pain is leading clinical symptom of this disease. The histological pattern is represented by adenocarcinoma of acinar, tubular, trabecular, alveolar or papillary types. Bismuth-Corlette classification, that allows more precise differentiation of hepatic ducts lesion localization, is presented; diagnostic methods are discussed in details.

Conclusion. Difficulties of diagnosis and verification of Klatskin tumor determine a broad field for differential diagnostics. By virtue of low frequency disease represents a serious problem in assessment of cholestatic syndrome origin.

The aim of review. Primary biliary cirrhosis (PBC) is related to the group of autoimmune cholestasisassociated liver diseases. In the last years prevalence of PBC increased considerably, especially – in Northern European countries. Despite of sufficient progress in studying of main pathophysiological mechanisms of PBC, etiology of disease remains obscure. There was a task to fill these gaps to some extent.

Key points. Etiological factors increasing risk of PBC development include genetic factors, immunologic disorders, and environmental features. Thus the contribution of each of the mentioned groups of factors, at least, partly is determined by demographic, ethnic and geographical features.

Conclusion. Detection of risk factors and the possible PBC causes allows to develop additional treatment approaches, and define new PBC markers, increase rate of early stage diagnostics.

Aim of investigation. To estimate risk of development of liver function decompensation, hepatocellular carcinoma (HCC) development and prognostic factors of liver-related mortality in patients with chronic viral mixed-hepatitis.

Material and methods. 82 patients with hepatitis D, 56 – with hepatitis B+C and 20 – with hepatitis B+C+D, followed-up from Jan 2002 to Dec 2011, were included in the study. Results. During follow-up, decompensation occurred in 45.1, 8.9 and 62.5% of patients with compensated liver cirrhosis in groups D, BC and BCD, respectively. The 5-year risk of decompensation was 62%, 27% and 60%. HCC developed in 5.7% of patients, high AFP being the only predictor of HCC. The 5-year risk of HCC was 3.8%, 3.5% and 0%, respectively. 17.1%, 1.8% and 20% of patients died in groups D, BC and BCD, respectively, 5-year survival rate was 90%, 97% and 82%.

Conclusions. In patients with chronic viral mixed hepatitis it is decompensation with liver failure development that determines prognosis and is principal cause of liver-related mortality in the most cases, not HCC development.

Aim of investigation. To study the effect of various factors on the blood ferritin level in patients with chronic hepatitis C (CHC) and baseline ferritin level on treatment response rate of pegilated interferon α-2a (PEG-IFN α-2a) combined to ribavirin (RBV). Material and methods. The level of ferritin was determined in 67 patients with CHC by two solid-phase sandwich immunoenzymatic assays. In 32 patients, who received PEG-IFN α-2a and RBV, it was determined on starting point, on the 12th week and after termination of therapy. Logistical regression has been applied to study effect of ferritin and other variables on frequency of sustained virologic response (SVR). Results. Elevated ferritin level was revealed in 34,3% of patients, and it was significantly higher in men, than in women (326,0±38,4 vs 108,2±44,7 ng/dl, p <0,05). The average level of ferritin in the patients included in PEGIFN α-2a and RBV group, prior to onset of treatment was normal (241,4±33,1), on the 12th week of treatment it turn to be elevated in 90% of patients with average level of 703,5±133,4 ng/dl (p=0,009 at comparison to initial level), and after the end of treatment course elevation was observed in 66,6% of patients at average value of 473,6±96,3 ng/dl (p=0,044 at to starting point, p=0,07 at comparison to the 12-th week data). By comparison of average levels of ferritin in patients with SVR at intake of PEG-IFN α-2a in combination to RBV and in patients without SVR the difference was also apparent, especially at the 12th week.Conclusions. Application of logistical regression analysis demonstrated, that the baseline ferritin level is independent predictor of sustained virologic response at treatment by pegilated interferon α-2a with ribavirin.

The aim of the publication. To present a clinical case of the chronic glomerulonephritis (CGN) associated with hepatitis B virus (НВV) infection. To demonstrate efficacy of nucleoside analogues with high antiviral activity in the treatment of such patients and importance of well-timed prescription of antiviral therapy.

Key points. Presented case shows renal onset of chronic viral hepatitis B, that was previously asymptomatic for long time in patient, who was infected at early childhood. Clinical manifestation of disease was characterized by nephrotic syndrome, hematuria, systemic hypertension. Severe dependent edema, abdominal and pleural effusions, splenomegaly and hypertension up to 160/90 mm Hg drew attention. Laboratory tests revealed markers of НВе-negative НВV-infection, high serum level of НВV DNA replication, severe proteinuria at preserved renal function. At ultrasound liver elastometry showed severe fibrosis (METAVIR F3). On a background of glucocorticosteroid treatment elevation of cytolytic enzymes (alanine transaminase of 120 U/L, aspartate aminotransferase of 98 U/L) was registered for the first time. Treatment included entecavir 0,5 mg per day for 12 wks with normalization of transaminase levels, virologic response (DNA НВV under 50 МЕ/ML) at the 30th week, НВе seroconversion at the 42nd week of treatment.

Conclusions. Extrahepatic manifestations of viral hepatites frequently not only mask liver disease, but determine prognosis in many respects as well. Pathogenic treatment of НВV-infection associated CGN without antiviral treatment is accompanied by risk of liver disease activation. Patients with renal involvement within the framework of chronic НВV-infection require antiviral therapy by nucleoside analogues, their high antiviral activity is demonstrated by presented clinical case.

The aim of review. To analyze publications devoted to significant advances in treatment of colorectal cancer.

Key points. Essential successes in colorectal cancer treatment are determined: improvement of surgical technique, performance of total mesorectumectomy and expanded lymph node dissections, application of staplers at anterior rectectomy, laparoscopic surgery, improvement of radiation technique and its integration with chemotherapy, development and introduction of new chemotherapeutic agents, application of targeted therapy. Existing problems in treatment of colorectal cancer are determined: low rate of early stage detection, investigation and treatment of cancer patients by non-oncologist doctors, wide promotion of alternative medicine methods by mass media.

Conclusion. The further introduction of scientific advances in clinical practice, modernization of public health services will promote new achievements in treatment of colorectal cancer.

Aim of investigation. To present experience of monitoring of 17 patients with 3-rd degree rectocele by clinical and instrumental tests in the early and remote postoperative periods. Studied patients underwent transrectal circular proctoplasty with plasty of rectovaginal septum by allotransplant.

Key points. Operation was pathogenically proved, accompanied by long-lasting clinical effect, low rate of postoperative morbidity and reduces terms of rehabilitation of operated patients.

Conclusion. Surgical technique, discussed in the article is efficient method of treatment of rectocele of the 3-rd degree.

The aim of review. To analyse publications devoted to idiopathic gastroparesis (IG) issue and present original case of this disease.

Key points. IG is a common manifestation of impaired evacuatory function of the stomach. Psychoemotional factors represent one of its principal causes. Ultrasound and roentgenologic investigations, scintigraphy, 13С-octanoic acid breath test play important role in diagnostics of gastroparesis. Prokinetics (in particular, domperidone) occupy the main place in the treatment of IG.

Conclusion.  IG is quite common in the practice of gastroenterologist. Treatment of such patients in many cases should be carried out along with psychiatrist.

The aim of review. To discuss the reports delivered at the International Workshop of the European Helicobacter Study Group (Ljubljana, Slovenia, 13-15 September 2012).

Summary. Possible correlations of H. pylori infection with rate of various diseases development – both positive (colorectal cancer, liver diseases, Alzheimer's disease), and negative (gastroesophageal reflux disease, adenocarcinoma of the esophagus, chronic inflammatory bowel diseases, bronchial asthma) continue to be studied. Increasing resistance H. pylori to various antibiotics require the further improvement of modes of eradication therapy.

Conclusion. Pathogenic and clinical aspects of H. pylori infection issue require further investigation.

A.L. Korkin – General principles, features of development
and course of gallstone disease on a background of opisthorchiasis.

M.V. Bundina – Outcomes of liver cirrhoses of various etiology.