The aim of review. To demonstrate modern methods of investigation of motor function of the esophagus, stomach, small and large intestine, anorectal area and their clinical value.

Key points. First attempts to study qualitative and quantitative indicators of gastro-intestinal motor function were undertaken by clinicians in 80ies years of XIX century. Nowadays investigation of motor function of the esophagus can by carries out both by open catheter method (water perfused manometry), and by the newest hi-tech method – high resolution manometry (HRM) and volume 3D manometry. Combined recording of HRM and impedance allows to carry out differential diagnostics at belching, to detect aerophagy that helps to individualize treatment of the patient. The «gold standard» diagnostics of stomach motor disorders is radioisotope imaging. High resolution manometry allows to assess contractile function of pyloric part of the stomach, to reveal disorders of antroduodenal coordination. С13-octanoic acid breath test, ultrasound investigation, single-photon emission computed tomography, magnetic-resonance tomography are widely applied as well. Myoelectric activity of the stomach and small intestine can be analyzed by electrogastroenterography method. To study motor function of the colon and anorectal area defecography, intestinal transit time investigation with application of radioactive labels, balloon expulsion test, sphincter profilometry, large intestine manometry by solid-state catheter and other studies are performed. High resolution anorectal manometry is an up-to-date method of anorectal motor activity rating, that is practiced in specialized research centers. This method allows to estimate obturative function of rectal sphincter, intestinal component of stool continence.

Conclusion. Clinical value of digestive system motor function investigation grows steadily and skill to diagnose disorders of peristaltic activity according to symptoms can and should be complemented by with modern methods of esophageal, gastric and intestinal motor activity registration.

Aim of investigation. Assessment of sensitivity and specificity of the questionnaire GerdQ for diagnostics of gastroesophageal reflux disease (GERD) in everyday practice of primary healthcare level physician in the Russian Federation.

Material and methods. Survey by GerdQ questionnaire included 145 patients with symptoms related to upper parts of the gut, who were recommended due to main disease to undergo esophagogastroduodenoscopy (EGDS) and 24-hour intraesophageal pHmetry prior to enrollment to this investigation. After filling the questionnaire all patients were examined by gastroenterologist to establish preliminary diagnosis (GERD or other disease). During the subsequent 2 wks patients underwent EGDS, 24-hour pH-metry and diagnosis was specified. Upon termination of the study the data received after filling of questionnaire and data of physical investigation by gastroenterologist have been compared to results of instrumental methods of GERD diagnostics. Statistical analysis was carried out by application software packs IBM® SPSS® Statistics.

 Results. Sensitivity of GerdQ questionnaire was 65,4% (87 of 133 patients), specificity – 91,7% (11 of 12 patients).

Conclusion. High sensitivity and specificity of GerdQ questionnaire will help physicians and other experts at primary healthcare level to establish diagnosis of GERD, to choose adequate approach at investigation and treatment of patients with symptoms related to upper parts of the gut.

Aim of investigation. Improvement of management approach of patients with acute smallintestinal adhesive obstruction (ASIAO) based on choice of method and duration of conservative obstruction treatment.

Material and methods. The study group included 516 patients with obturation form of ASIAO without indications for emergency surgery, who underwent conservative treatment. In 188 patients endoscopic nasointestinal decompression of gastro-intestinal tract was carried out. Due to inefficiency of therapy 269 patients were operated urgently. Original method of treatment efficacy prediction was developed in the clinic. Groups with low, medium and high probability of obstruction resolution were defined.

Results. The group with resolved obturation ASIAO (n=247) average duration of conservative treatment was 11,4±4,8 h. In 92 patients results of conservative treatment prediction were determined at ASIAO (forecast effectiveness was 98,9%).

Conclusions. The differentiated approach to choice of conservative actions and improvement of its terms have allowed to increase treatment response rate of obturation ASIAO to 66,3% and to decrease mortality to 2,2%.

The aim of review. Nuclear receptors are ligandactivated transcription factors, involved in regulation of metabolism and transport of bile acids (BA) both under physiological, and cholestatic conditions. Accumulation of BA and other bile components in hepatocytes during cholestatic liver diseases is accompanied by liver cells damage and ready to fibrosis and cirrhosis. This article is devoted to the above-mentioned issues.

Key points. Some adaptive processes including change of hepatocyte transport systems expression reduction of BA synthesis, activation of BA detoxication and elimination are upredgulated during cholestasis. All listed mechanisms are directed to minimize damage hepatocytes and nuclear receptors play the main role in their regulation. Nevertheless, realization of these adaptive processes, apparently, is insufficient to prevent cholestatic liver diseases.

Conclusion. Accumulation of data on metabolism and transport of BA under physiological and cholestatic conditions allows not only to explain the mechanism of action of the drugs empericaly utilized for treatment of cholestasis for many years, but also to develop new, probably, more effective pharmaceuticals. So, it is supposed, that application of nuclear receptor ligands will help to boost hepatocyte protection mechanisms, and, hence, to slow down or arrest progression of disease.

The aim of review. To discuss potential of telaprevir application in patients with the 1-st genotype of chronic hepatitis C (CHC) representing certain difficulties in treatment, in patients having antiviral therapy experience, patients with liver cirrhosis, including, those, enrolled to liver transplantation waiting list, and after liver transplantation, in patients with human immunodeficiency virus coinfection, as well as nephrologic patients receiving renal substitution therapy.

Key points. Adding of NS3/4A protease inhibitor telaprevir to treatment mode for patients infected with 1-st genotype of hepatitis C virus for 12 wks allowed to increase treatment response rate considerably. The potential of decreasing of antiviral therapy (AVT) duration to 24 wks is proved, based on dynamics of viral load at AVT, at week 4 and 12 of treatment in patients who receiving no AVTs earlier, and in groups, representing as a rule, difficulty for treatment (patients with CHC relapse or absence the response/incomplete response to previous AVT). Patients with liver cirrhosis who represent quite heterogenic group require special approach. AVT in patients with compensated cirrhosis, those, enrolled to liver transplantation waiting list (if MELD index ≤18 and Child-Pugh score ≤8 points), with good efficacy and adequate treatment safety profile is now available. Known risk factors of death or severe adverse events are level of platelets under 100 Gi/L, serum albumin level less than 3,5 g/dl, and HVPG ≥10 mm Hg. Studying of telaprevir application options for treatment of patients with CHC relapse in post-transplantation period, patients with chronic renal disease, including those, receiving renal substitution therapy is still in progress. The primary data received in studies, devoted to these issues, enable to expect expansion of indications and options of three-componential AVT application.

Conclusion. According to data of original studies, inclusion of telaprevir in treatment mode of patients with 1-st genotype of chronic hepatitis C increases treatment response rate in group of patients with unsuccessful AVT experience, severe fibrosis or liver cirrhosis, and unseals new options of treatment of patients from the liver transplantation waiting list, after transplantation and in group of chronic renal disease.

Aim of investigation. To compare efficacy of vasoactive therapy by terlipressin and octreotide at bleeding from varicose veins of the esophagus in patients with liver cirrhosis.

Material and methods. Investigation was based on the retrospective analysis of results of treatment of 72 patients with liver cirrhosis and portal hypertension syndrome. According to Child-Pugh criteria patients were distributed as follows: class A – 12 (16,7%), class B – 41 (56,9%), class C – 19 (26,4%). Terlipressin (main group, n=32) and octreotide (control group, n=40) were used as vasoactive drugs. Both groups have been comparable by age, gender, etiology of cirrhosis, degree of varicose dilation of esophageal veins and severity of liver dysfunction.

Results. Terlipressin prescription reduced rate of bleeding and promoted achievement of temporary hemostasis in 71,9% of patients, while application of octreotide – only in 55% of cases. Early relapse of esophageal bleeding has developed in the main group in 6,3% of cases, in control – in 12,5% (р<0,05). Terlipressin injection was accompanied by significant decrease both linear, and volume velocity of portal blood flow on average by 41,6±9,7% (р=0,038) and 33,9±5,8% (р=0,024), respectively. This effect was observed for over 60 mines from the moment of injection. After injection of octreotide decrease of main velocity features of portal blood flow was marked as well: linear speed has decreased by 34,1±10,3% (р=0,030), and volume – by 28,6±9,8% (р=0,041). However in 60 min after injection of octreotide both parameters returned almost to baseline level (р>0,05). In both groups injection of studied agents was accompanied by change of parameters of central hemodynamics. Though the level of mean blood pressure and heart rate decreased, only reduction of cardiac output in the main group significantly differed from reference values.

Conclusion. Terlipressin has more significant effect on portal hemodynamics and possesses the greater efficacy in comparison to octreotide at bleeding of portal origin.

Aim of investigation. Biological therapy by monoclonal antibodies against tumor necrosis factor (infliximab) allows to avoid colectomy at steroid-resistant severe attack of ulcerative colitis. High cost of such treatment and risk of adverse events related to it requires definition of strict indications for application of this drug. It was necessary to detect factors due to which at early stage of biological therapy it is possible to decide whether infliximab will allow to achieve long-term clinical remission, and also to avoid operative treatment.

Material and methods. The retrospective analysis of biological therapy results in 30 patients with severe steroid-resistant attack of ulcerative colitis, assessed by Truelove and Witts’ criteria was carried out.

Results. Colectomy due to inefficiency of infliximab was executed in 11 patients (36,7%). In groups of the patients, who undergone surgery and those, who avoided resection of the large intestine, various clinical, laboratory and endoscopic parameters were compared. By results of logistic regression predictors of infliximab inefficiency were determined: presence of extensive ulcerative mucosal defects of the colon prior to the beginning of biological therapy (accuracy of colectomy prognosis 78%) and absence of clinical remission at the third injection of the drug (accuracy of colectomy prognosis of 69%).

Conclusions. The investigated risk factors do not allow clear-cut prediction of relapse-free course of ulcerative colitis for one year of maintenance therapy by infliximab.

The aim of review. To present literature data on the most actual modes of Helicobacter pylori eradication therapy and tactics for their choice in various clinical situations.

Key points. Following modes of H. pylori eradication therapy have the greatest practical value: standard triple therapy with clarithromycin, including proton pump inhibitor (PPI) + clarithromycin + amoxicillin (or metronidazole); sequential two-stage mode; four constituent component mode without bismuth drug; four-component mode including bismuth agent; triple therapy with PPI and levofloxacin. According to the Russian data, clarithromycin resistance of H. pylori ranges from 5 to 11% that allows to consider standard triple therapy as first line treatment. Quadrotherapy can be utilized as serves as alternative mode of the first line and the most justified mode in case of failure of standard triple therapy. Efficacy of sequential therapy mode and non-bismuth quadruple therapy requires more detailed studying in Russian studies.

Conclusion. The rational choice and the justified sequence of modes of antihelicobacter therapy allow to achieve successful H. pylori eradication almost in all treated patients.

The aim of the publication. By the example of clinical case to show modern algorithm of diagnostics and choice of pathogenically proved treatment for patient with continuously relapsing course of irritable bowel syndrome (IBS).

Key points. Patient S., 20 years, has addressed in clinic with symptoms of boring pain in the lower regions of the abdomen, aggravating after meal and decreasing after defecation, increase of stool frequency up to 6 times day, mainly in the morning time, general weakness. Symptoms developed about two years ago after the intake of unsound food nausea, vomiting by taken food, abdominal pain, frequent stool with admixture of mucus appeared. Patient had no nausea and vomiting the next day, however the abdominal pain and unstable stool persisted for a long time. The patient was repeatedly examined, but according to carried out investigation no significant changes were revealed. Antispasmodics of various groups, enzyme and antisecretory agents in this relation were prescribed to him without any noteworthy effect for two years prior to admission to Vasilenko Clinic of internal diseases propedeutics, gastroenterology and hepatology. In the clinic differential diagnosis between organic diseases of gastro-intestinal tract was carried out (erosive-ulcerative lesion of the upper parts of GIT, celiac disease, inflammatory bowel diseases), functional gastro-intestinal disorder, thyroid gland hyperfunction). According to symptoms, data of past history and carried out investigation clinical diagnosis was made: postinfectious irritable bowel syndrome, diarrhea-prevalent variant. Prescribed treatment included dioctaedric smectite, probiotic and antipsychotic drug, which had led to complete relief of all symptoms.

Conclusion. Careful taking past history and carrying out detailed laboratory and instrumental tool investigation allowed to establish clinical diagnosis in the patient, and pathogenicly proven treatment promoted achievement of disease remission.

L.V. Tarasova – The role of nutritional deficiency of selenium, zinc and manganese in pathogenesis of chronic gastritis and duodenal peptic ulcer (evidence from Chuvash Republic).

M.A. Morozova – Differential diagnosis of fever in patients with diffuse liver diseases.