The aim of review. To analyze cumulative data of the global literature on skeletal musculature depletion or sarcopenia, in development of malignant cachexia syndrome, as well as diagnostics and clinical value of this state.

Original points. Cachexia syndrome is one of the most frequent consequences of malignant disease. In the last years it was demonstrated, that sarcopenia plays the leading role in pathogenesis and progression of this state. Various procedures, including anthropometry, bioimpedance analysis, dual photon X-ray absorptiometry can be applied in diagnostics of sarcopenia. However, computer and magnetic-resonance tomography have the highest value for this goal. The article presents in detail data on clinical value of sarcopenia along with academical aspects of body composition analysis by radiological methods. Perspective trends of scientific studies in this area are proposed.

Conclusion. Sarcopenia is the important component of malignant cachexia syndrome. Its investigation is perspective trend in clinical studies in oncology.

The aim of review. To carry out analysis of literature devoted to efficacy assessment of new prokinetic drug – 5-НТ4-receptor agonist prucalopride in treatment of patients with chronic functional constipation.

Original points. Being an agonist of 5-НТ4- receptors, prucalopride stimulates motility of the large intestine and promotes more frequent bowel movements. Numerous studies confirmed that on a background of prucalopride intake in a dose of 2 or 4 mg for 4-12 wks in patients with chronic constipation defecation frequency increases and quality of life improves. It is important, that the agent has no cardiotoxic effect and does not increase the length of Q–T interval.

Conclusion. Prucalopride can be recommended for treatment of functional chronic constipation, first of all – in women, resistant to laxatives.

Aim of investigation. Assessment of frequency of night eating syndrome (NES) at presence of depression (D) in men with obesity and diagnostics of initial cause of eating disorders (ED).

Material and methods. Overall 38 ьфдуы aged 47±4 years, BMI 38±3 kg /m2 were investigated. CES-D scale was used for D diagnostics. NES was registered according to A. Stunkard criteria. Statistical analysis was carried out by Statistica 8.0 software.

Results. NES with D was diagnosed in 64% of cases, without D – in 25% of cases. In the main group the risk of its development was significantly higher, than in control group – OR=1,75 (95% CI=1,2–3,7).

Conclusions. In patients with D and obesity NES was significantly more frequent, than in patients without affective disorders. The risk of ED development in patients with D is significantly higher, than in patients without D.

Aim of investigation. To estimate potentials of 24-hour esophageal рН monitoring for antisecretory treatment adjustment in patients with gastroesophageal reflux disease (GERD).

Material and methods. Overall 58 patients with GERD were included in original study (main group) and 18 healthy volunteers formed a control group.

Results. At evaluation of all pH-metry parameters, it has been noticed, that mostly two parameters – the fourth (total time of esophageal рН is under 4) and the seventh (cumulative, or DeMeester score) – show stable steady stage-wise increase of scores related to increase in severity of esophageal mucosa damage. At analysis of the first рН-gramm parameter (total reflux number) it was found, that average number of episodes was highest at erosive esophagitis of I stage. At the II stage this number decreases, but remains higher, than at non-erosive esophagitis, and at III and IV stages drops to the level of the latter. Statistically significant differences between main and control groups were revealed for all scores. Differences between pH-metry parameters of control group and normal scores were not statistically significant.

Conclusions. Introduction of 24-hour pH-metry of the esophagus in clinical practice enables monitoring of gastroesophageal refluxes, detection of their type (acidic, alkalinic), number (less or higher than 49 episodes per day), estimation of treatment efficacy. When necessary it helps to carry out treatment adjustment and to choose the most acceptable mode of treatment.

Aim of investigation. To determine the role of endoscopy in expertise and rehabilitational diagnostics of patients and disabled persons after stomach surgery.

Material and methods. Overall 156 patients after stomach and duodenum surgery were investigated (99 had «peptic ulcer» diagnosis and 57 – diagnosis of «stomach cancer»). In resected stomach diseases physical disability was mainly caused by dumping syndrome. Of all 52 patients (33,3%) had physical disability: II degree – 28,9%, III degree – 71,1%. Evaluation of anastomosis functional activity was carried out according to N.S.Rudoy classification (1996, 1997).

Results. At endoscopic investigation the combined lesions of gastro-intestinal tract were frequently observed: gastroesophageal reflux disease (GERD) – in 30 (19,2%) patients, acute erosions of the stomach stump – in 45 (37,5%), inflammatory changes in anastomosis region (anastomositis) – in 87 (72,5%). At morphological study pyloric and intestinal metaplasia was revealed in 108 (69,2%) patients, various degrees of glandular atrophy – in 82 (52,5%), polyps in anastomosis area – in 8 (5,1%), in 2 (1,2%) early relapse of stomach cancer anastomosis zone, in 3 (1,9%) – cancer of the stomach stump was diagnosed. In patients with operated stomach high degree (56,7%) of stomach stump mucosa contamination by Helicobacter pylori was preserved. According to chronometry data, functionally passive anastomosis was found in 47,3% of patients, functionally active anastomosis of the 1 degree – in 25,4%, of II degree – at 22,7%, of the III degree – at 4,6%. Authors give a new definition to the term «expertise and rehabilitational endoscopy» and the new diagnostic procedure is introduced into practice of medical and social examination for the first time.

Conclusions. Endoscopic investigations have the important value in expertise and rehabilitational diagnostics at examination of patients for establishment of physical disability degree on the basis of analysis of biological disorders transformation and assessment of type, degree and causes of social disability of the patient.

The aim of review. To highlight up-to-date modes of chronic hepatitis C treatment.

Original positions. Nowadays conventional «gold standard» treatment of chronic HCV-infection is antiviral therapy by pegilated interferon and ribavirin combination. Recently principles of antiviral treatment were seriously reconsidered, that inevitably leads to sophistication of therapeutic algorithms. So, modification of treatment mode according to virologic response is rational today. In near-term prospect addition of the third agent — protease inhibitor to the standard combination treatment mode will become possible soon. Published results of large investigations prove significantly higher efficacy of triple therapeutic mode in patients with the 1-st hepatitis C virus genotype, that opens new wide perspectives in treatment of these patients.

Conclusion. Recently individual approach to treatment of patients with chronic HCV-infection becomes more actual. In particular, the algorithm of therapeutic mode modification according to virologic response to treatment at the specific patient is developed. In some cases it enables reduction of treatment terms, decrease of cost and increase of patient’s compliance. Moreover, in the close perspective new antiviral agents - protease inhibitors will appear at the market, that allows to increase antiviral treatment efficacy in patients with the 1-st hepatitis C virus genotype.

The aim of review. To discuss main concepts on the damaging role of lipids in non-alcoholic fatty liver diseases (NAFLD) pathogenesis.

Original points. According to modern concepts, at NAFLD stress of endoplasmic reticulum plays the central role in damage of liver cells which is accompanied by dysfunction of chaperone proteins. The subsequent biochemical changes cause disorders of cellular respiration, disorder of mitochondrial integrity, increase probability of hepatocyte death. Excessive accumulation of free fatty acids acts as direct impulse for development of endoplasmic reticulum stress, and resulting events inside a cell are named «lipotoxic stress» or «lipoapoptosis». Saturated fatty acids – palmitic and stearinic have maximal damaging potential, that, probably, is related to slower incorporation of esters. In NAFLD pathogenesis other damaging factors, e.g. oxidative stress play important role, therefore the theory of «multiple collateral impulses» is justified today. Unsaturated fatty acids, essential phospholipids, antioxidants, silymarinum, hypolipidemic agents, glitazones can have protective action. Potential of medical application of caspase inhibitors, cathepsine B, JNKkinase and «chemical chaperones» is under investigation.

Conclusion. Lipoapoptosis is considered as cardinal marker of NAFLD, and free fatty acids – as activators of the programmed death of hepatocytes. The further studying molecular events at lipotoxic stress will, probably, open new era in the treatment of fatty liver disease.

Aim of investigation. To study features of development and course of colorectal cancer (CRC) in patients with ulcerative colitis (UC), and to determine risk groups for CRC on a background of UC.

Material and methods. Retrospective analysis of 65 cases with diagnosed CRC (2,1%) of 3154 patients with UC (treated in The State Scientific Centre of Coloproctology, Moscow, Russia from 1981 to 2010).

Results. UC was diagnosed at the age of under 10 years in 5 patients (7,7%), from 10 to 19 years – in 16 (24,6%), 20–29 years – in 27 (41,5%), 30–39 years – in 4 (6,2%), 40–49 years – in 6 (9,2%), from 50 years and over – in 7 (10,8%). The left-side lesion was revealed in 8 patients (12,3%), proctitis – in 8 (12,3%), total involvement of the large intestine – in 49 (75,4%). Chronic relapsing course was observed in 49 cases (75,4%). Duration of UC past history at the moment of CRC diagnosis was: less then 5 years – in 6 patients (9,2%), 6–10 years – in 10 (15,4%), 11–15 years – in 18 (27,7%), 16–20 years – in 9 (13,8%), 21–25 years – in 6 (9,2%), 26–30 years – in 14 (21,5%), 31–35 years – in 2 (5,1%). The tumor was localized in rectum in 30 cases (46,2%), in the caecum in 8 cases (12,3%), in sigmoid colon – in 13 (20,0%), in ascending colon, left flexure and descending colon respectively in 4 (6,2%). In 1 patient (1,5%) tumor was localized in the right flexure and in 1 (1,5%) – in transverse colon. In 12 patients (18,5%) CRC was characterized by primary multifocal with up to 5 tumors in different regions of the large intestine in T4N0M0stage. In 7 (10,8%) cases of 65 the signs of dysplasia of intestinal epithelium were not revealed, in 24 (36,9%) dysplasia of moderate degree and in 34 (52,3%) – high degree was observed. In 32 patients (49,0%) the type of tumor was moderately-differentiated adenocarcinoma, 7 patients (10,8%) had mucous and poorly differentiated adenocarcinoma, 6 (9,2%) – tubular-villous adenoma, 9 (13,8%) – welldifferentiated adenocarcinoma and 4 (6,2%) – gobletcell cancer. According to ТNM classification tumor at Т4 stage was revealed in 48 (73,8%) patients, Т3 – in 15 (23,1%), Т2 – in 2 (3,1%); N0 – in 56 (86,2%), N + in 9 (13,8%). In 6 (6,2%) patients distant metastases were found. All patients survived for 1 year after operation (100%), 5-years survival rate was 76,9%.

Conclusions. The risk of CRC development, apparently, directly depends on duration of intestinal inflammatory process, growing exponentially after 10 years of disease history. Combined effect of disease duration and UC intestinal extent increases probability of CRC development several times. Presence of two peaks of CRC development – at patients with 11 to 15 years of UC past history and from 26 to 30 years has been revealed.

The aim of the publication. To present the modern data on pain sensitivity at pancreatic lesion, interrelation of mechanisms of inflammation and nociception, to determine main directions in pain relief at chronic pancreatitis (CP), to demonstrate potentials of modern enzyme preparations for this purpose.

Original points. Chronic pancreatitis is characterized by resistant pain in comparison to other gastroenterological diseases. Abdominal pain determines quality of life of CP patient to the highest degree of all other symptoms. It can be related to intraductal hypertension caused both by pancreatic juice outflow obstruction, and by increased volume as a result of activated stimulation. Intrapancreatic parenchymal pressure is increased exceeding perfusion pressure of pancreatic capillaries that causes ischemia. At CP there is sensitization to pain. Histological study frequently reveals signs of neural damage, inflammatory mediators often can act as pain mediators. Sensitization affect not only nerve terminals, but neurones of spinal cord and brain as well. Patients develop plastic changes in central nervous system as well, i.e. «remodeling», enhancing pain perception. This may cause pain persistance after block of peripheral nociceptive pathways or after total pancreatectomy («pancreatic pain in the without the pancreas»). The CP diagnosis should be based on revealing of irreversible changes of the pancreas by modern radiological diagnostic methods: pancreatic enlargement 1,5 times and more, dilation, presence of strictures or severe irregularity of main pancreatic duct, calcification or parenchymal atrophy. It is also important to detect prominent ductal changes (strictures, stones), requiring endoscopic or surgical treatment as promptly as possible. Medical treatment of pain includes, first of all, elimination of toxic factors and stimulations of pancreatic secretion. Smoking cessation is important no less. Pancreatic enzymes represents the basis of pharmaceutical treatment nowadays. Their application is based on multiple negative feedback mechanisms involved in pancreatic secretion regulation. The high contents of proteases in the drug «Ermital» allows to relieve pain effectively, reduce number of taken capsules per day. Absence of phthalates, which can be dangerous at pregnancy, in microtablets coating is major advantage. Besides enzymes, antisecretory drugs represent another integral component of CP patients treatment. Many patients require prescription of analgetics. Tramadol and propoxyphene to acetaminophen combination are used most often. Development of TRPV4 and TRPA1A ionic channels blockers is perspective direction in pancreatic pain relief.

Conclusion. Drug therapy of pancreatic pain is based on digestive enzymes, antisecretory and analgetic agents.

The aim of publication. To show features of clinical pattern, difficulties of diagnostics and treatment of eosinophilic esophagitis at the example of clinical case.

Features of clinical case. In young patient the diagnosis of eosinophilic esophagitis at stage of complications (esophageal stricture) has been made 20 years after manifestation of disease. Conservative treatment by topical corticosteroids did not result in resolution of dysphagia and morphological changes of esophageal wall that required a course of systemic corticosteroids with further dilatation of the esophagus recommended to the patient. Poor knowledge of this disease by internists and endoscopists often results in establishment of incorrect diagnoses, late diagnostics, development of complications requiring surgical interventions, decrease of quality of life of patients.

Conclusion. Eosinophilic esophagitis is chronic immune antigen-mediated inflammatory disease of the esophagus with still obscure etiopathogenesis. Diagnostics is based on characteristic clinical pattern of dysphagia that is always combined to eosinophilic infiltration of esophageal mucosa at histological study. Treatment options of eosinophilic esophagitis are limited now and include strict eliminative diet and application of steroid hormones.

Aim of investigation. Evaluation of effect of ursodeoxycholic acid (Ursosan) on levels of immunoreactive insulin, leptin, clinical and biochemical tests in metabolic syndrome.

Material and methods. The group of patients with metabolic syndrome (66 patients, aged 38 to 67 years) received Ursosan within complex treatment. Control group included 21 patients. Dynamics of immunoreactive insulin, leptin, lipid spectrum was determined by immunoenzyme test.

Results. Significant decrease of transaminase, gamma-glutamyltranspeptidase, alkaline phosphatase activity, total cholesterol, triglyceride level, atherogenicity index was found in patients receiving Ursosan 15 mg/kg of body weight for 8 wks within complex treatment with trend for decrease of leptin and hyperinsulinemia level.

Conclusions. Addition of Ursosan to complex treatment of patients with metabolic syndrome results in significant decrease of immunoreactive insulin, atherogenous fractions of lipids parameters with the tendency for decrease of leptin that playing the leading role in development and progression of metabolic syndrome.

Ye.V. Vinnitskaya – Spontaneous bacterial peritonitis at patients with liver cirrhosis