The aim of review. To analyze the information published in scientific literature on a role of serotonin in regulation of structural homeostasis of gastro-intestinal tract (GIT) organs, realizations of compensatory-adaptive and pathological processes at ulcerogenesis in gastroduodenal zone.

Original positions. Enterochromaffin cells and intramural neurons of GIT are main source of serotonin in the body. At analysis of pathogenesis of atopic/allergic diseases it is important to take into account mast cells releasing serotonin as well. The secreted serotonin is accumulated in platelets and released at aggregation. It determines its involvement in pathogenesis of the diseases related to disorders of motility, microcirculation, inflammation and disregeneration. Authors discuss receptor-specific effects of serotonin on blood-tissue barriers of GIT, synaptic transmission, regulation of local and systemic afferentation, motility of the stomach and intestine, and mechanisms of defense. Immunomodulating role of serotonin realized by modulation of cytokine secretion of dendritic cells and lymphocytes is demonstrated.

Aim of investigation. To estimate esophageal clearance in patients with reflux-esophagitis (RE) and its changes at intake of «Smecta®» in standard dose. Material and methods. Overall 30 patients whose symptoms included heartburn (100%), burning chest pain (70%), belching (30%) were enrolled in original study. Of them 16 were women and 14 – men, mean age – 46,02 years (22 to 74 years). The body mass index in group was elevated (mean —25,0 [24,2; 28,6] kg/m2). Patients underwent esophagogastroduodenoscopy (EGDS), 24-hour pH-metry, X-ray investigation with barium meal, investigation of esophageal motor function. Results. According to the data of EGDS, pH-metry, non-erosive reflux disease (NERD) was found in 21 patients (70%), erosive GERD — in 9 (30%). At investigation of motor function decrease of amplitude and nonperistaltic waves are registered in 33,3 and 13,3% of patients respectively, esophageal spasm – in 20%, and tertiary contractions – in 36,7% of cases. In 46,7% of patients delay in clearance of the esophagus up to 9 min on average was registered [3,5; 15], all patients with erosive RE had increased clearance time (р<0,05). At catarrhal RE delayed clearance was observed in patients with hypermotor disorders (р<0,05), normal scores of clearance – in patients without severe disorders of motor activity of the esophagus, 2,5 min mean [1; 3]. On a background of intake of smecta in patients with prolonged clearance its time decreased to 3 min [1; 4]. Rate of refluxate elimination from the esophagus at delayed natural clearance was 0,9•10–2 U/s, on background of smecta intake - 13•10–2 U/s, i.e. 14 times faster. Conclusions. Disorders of motor activity of the esophagus and salivation impact to decrease in esophageal clearance. Intake of smecta accelerates process of refluxate elimination from the esophagus for one order more and restores normal scores of рН, reducing duration of reflux and exposure to aggressive contents of the stomach to the esophagus in patients with NERD and GERD equally. Decrease of intensity of heartburn and the arrest of retrosternal pain is found in 80 and 72% of patients respectively. Thus of patients with catarrhal RE improvement was achieved in 93% of cases. Thus, smecta can be recommended as monotherapy at catarrhal RE and in composition of complex treatment at erosive GERD.

Aim of investigation. To determine efficacy of complex treatment of patients with acute ulcerative gastroduodenal bleeding (AUGDB) with high risk of relapse including endoscopic hemostasis, basic intensive antisecretory treatment by «Sunpraz» (pantoprazole) in combination to antihelicobacter agents.

Material and methods. Overall 30 patients with AUGDB, including 17 cases of stomach ulcer, 13 cases of duodenal ulcer were investigated. Acute symptomatic ulcers were diagnosed in 14 patients, peptic ulcer – at the other 16. In 17 cases ulcerative bleeding developed on a background of severe concomitant cardio-vascular disease. Of them 19 were men, 11 – women, mean age 53 and 73 years respectively, 81,8 % of patients over 65 years old. Esophagogastroduodenoscopy data (EGDS) indicating the source of bleeding, its intensity (according to Forrest classification), risk of relapse were analyzed. Injection method, argon plasma laser coagulation, clipping of the vessel were applied for endoscopic hemostasis. Bolus intravenous injection of 40 mg of sunpraz, followed by infusion of 160 mg of sunpraz by infusion for 3 days at intensive care unit was carried out. EGDS was repeated on the 2, 4, 7 and 14th day for evaluation of treatment efficacy.

Results. At admission ongoing AUGDB (Forrest Iа) was revealed at 6 patients, bleeding from under a clot (Forrest Iв) – in 2 patients, bleeding stopped at the time of examination (Forrest IIа) – in 14, with fixed thrombus (Forrest IIв) – in 8. Endoscopic hemostasis in combination to intravenous sunpraz injection in the majority of patients resulted in arrest of bleeding. Relapse developed only in 2 person. Five patients died of concomitant diseases.

Conclusions. Injection of sunpraz with subsequent oral intake of the drug in combination to endoscopic hemostasis and antihelicobacter treatment is an effictive method of treatment of AUGDB at high risk of relapses.

Aim of investigation. Improvement of diagnostics of pseudomembranous colitis.

Material and methods. Ultrasound signs of pseudomembranous colitis (PMC) received by comparison of ultrasound, endoscopic, clinical and morphological data in 64 patients aged from 24 to 76 years were presented. Patients admitted with suspicion to acute abdominal surgical pathology. Abdominal ultrasound was carried out according to standard procedure with assessment of disintegration of peritoneal layers, state of all parts of the large intestine, loops of small intestine and its mesentery were examined.

Results. Set of ultrasound signs, according to which it is possible to suspect pseudomembranous colitis is determined: thickening and lamination of walls of the large intestine, paracolic edema, free fluid in abdominal cavity, depositions of fibrin on parietal and visceral peritoneum. Sensitivity of the test was 95%, specificity – 47%, accuracy – 84%.

Conclusions. The ultrasound method can be applied as one of the first and available methods of revealing of PMC signs at severe patients receiving massive antibacterial treatment. This method allows to carry out dynamic control of the course of disease, is well-timed to reveal its complications, to control efficacy of specific treatment.

 

The aim of review. To describe methods of bleeding from varicose esophageal veins (VEV) risk estimation in patients with liver cirrhosis and to demonstrate a role of some of them in monitoring of treatment response rate.

Original positions. Gastroduodenoscopy and hepatic venous pressure gradient measurement remain to be the standard methods of screening diagnostics of patients with liver cirrhosis for estimation of VEV bleeding risk nowadays. Their inherent disadvantages promoted studying of sensitivity and specificity of other predictors of this complication, as well as technologies estimating severity of portal hypertension, such as capsule endoscopy, Doppler ultrasound, multispiral computer tomography, non-invasive methods of liver fibrosis diagnostics and of some others.

Conclusion. Optimization of known methods of assessment of portal hypertension, and development of new, pathophysiologically based methods, allows to increase efficacy of VEV bleedings prophylaxis in patients with liver cirrhosis.

Aim of investigation. To estimate prevalence of non-alcoholic fatty liver disease (NAFLD) in patients with obesity and to determine its interrelation with cardiometabolic risk factors of cardio-vascular diseases (CVD) and diabetes mellitus of the 2nd type (type 2 DM).

Material and methods. Retrospective analysis of case records of 560 obese patients aged 18 to 55 years was carried out. At the investigation past history, anthropometric data, level of blood pressure were analyzed, blood lipid spectrum, activity of ALT, AST, markers of viral hepatites – HbsAg, HCV-at (to rule out viral etiology of liver disease), fasting and at 120-th minute of the standard glucose tolerance test blood glucose and immunoreactive insulin were determined. Insulin resistance was estimated by HOMA-IR score. Metabolic syndrome was verified by IDF (2005) criteria. Liver US was carried out to diagnose NAFLD.

Results. During investigation NAFLD was revealed in 77,7% of patients. At multi-factor analysis of variance interrelation of NAFLD with CVD and type 2 DM risk factors, such as systemic hypertension, dyslipidemia, disorders of carbohydrate metabolism and insulin resistance was confirmed.

Conclusions. Study results determine necessity of more careful investigation of patients with obesity and NAFLD for early diagnostics and treatment of cardiometabolic risk factors of cardio-vascular diseases and type 2 DM.

Aim of investigation. Assessment of HВcorAg expression features and interrelations of necrotic - inflammatory process with the level and distribution of HBcorAg in hepatocytes in patients with HBeAgnegative AbHBe-positive chronic hepatitis B (CHB) having different HBsAg-status.

Material and methods. Overall 32 patients HBeAg (–) AbHBe (+) CHB were studied: 13 – with HВsAg and 19 – without HВsAg. HBcorAg was estimated in liver tissue by immunehistochemical method («Novocastra» UK tests-systems). Routine laboratory tests, Knodell histological activity index and modified index, Metavir fibrosis score were assessed.

Results. In 25 patients (78,1%) cytoplasmic and nuclear HBcorAg expression and in 7 (21,9%) – only cytoplasmic HBcorAg expression was revealed. Cytoplasmic HВcorAg level was significantly (9-fold) higher, than that in nucleus. Cytoplasmic HBcorAg distribution was distinct: 20 patients (62,5%) had peripheral juxtamembrane and 12 (37,5%) – diffuse expression. The severity of necrotic and inflammatory syndrome according to laboratory and histological data was higher at cytoplasmatic expression of nuclear protein (NP), than at nucleocytoplasmic, and was also higher at peripheral juxtamembrane NP expression, than at diffuse.

Conclusions. НBcorAg expression did not depend on HВsAg-status, but in HВsAg-negative patients grade of parenchymatous damage, premalignant hepatocyte changes i.e. micro- and macrocellular dysplasia was higher, than in HВsAg-positive patients.

Aim of investigation. Development and efficacy evaluation of oncologically proved and safe surgical methods for various locations and stages of left-sided colon cancer.

Material and methods. Overall 59 patients with left-sided colon cancer were selected from February, 2008 to May, 2011. All patients underwent bowel resection in different volume with para-aortic lymph node dissection and skeletization of inferior mesenteric artery (detailed description of the procedure is presented): 11 left-side hemycolectomies, 14 partial resections of the left colon, 13 distal and 21 segmentary resection of sigmoid colon were executed.

Results. The highest duration of operation (250,9±71,5 min) and volume of intraoperative blood loss (745,4±737,0 ml) was observed at left-side hemicolectomy, duration of other interventions did not exceed 3 h, and the blood loss – was less than 250 ml. Postoperative complications developed in 9 patients. The mean number of investigated lymph nodes in resected speciemens was 26,4±18,2. Metastatic involvement was most frequent in paracolic lymph nodes, affected apical lymph nodes are revealed in 2 cases. Cumulative three-year survival rate was 93%.

Conclusion. Applied technique of inferior mesenteric artery skeletization allows to carry out extensive para-aortic lymph node dissection and to keep supplying vessels. This allows to decrease considerably the number of left-side hemicolectomies for segmentary resections. Presented interventions are safe from the point of postoperative morbidity and are characterized by good oncologic results.

Aim of investigation. To estimate efficacy of rifaximin in complex conservative treatment of chronic diverticulitis.

Material and methods. The main group included 43 patients that received 200 mg rifaximin every 8 h within conservative treatment mode for 14 days. Of all patients 34 were women (79,1%), 9 – men (20,9%), age of patients ranged 44 to 84 years. Severity of clinical symptoms at onset of treatment varied from 1 to 3 points, mean score was 2,11 points (М0=2 points). Extent of inflammatory changes (according to abdominal US or CT with estimation in relation to sigmoid colon axis) varied from 5 to 8 cm, mean – 6,2 cm (М0=6 cm), thickness of muscular layer – from 2 to 5 mm (mean – 2,7 mm, М0=2,5 mm). The control group included 40 patients, who received no rifaximin at conservative treatment. Of all patients 32 were women (80,0%), 8 – men (20,0%), age of patients ranged from 32 to 74 years (mean — 60,9 years, М0=60 years). Severity of clinical symptoms at beginning of treatment varied from 1 to 3 points, 2,18 points mean (М0=2 points). Extent of inflammatory changes varied from 5 to 8 cm, mean – 6,8 cm (М0=6 cm), thickness of muscular layer – from 2 to 5 mm (mean – 2,6 mm, М0=2,5 mm).

Results. At the end of 2nd day of treatment intensity of symptoms in main group was 1,55 points, in the control group – 1,69 points (р=0,12). According to US data, no changes in both groups were observed. At the 14th day intensity of clinical symptoms in the main group was 0,26 points (in the control group – 0,71 points; р=0,09). According to results of US in 31 patients of the main group (72,1%) and in 28 controls (70,0%) signs of active inflammation were absent.

Conclusions. Rifaximin – is an effective drug for complex conservative treatment of the chronic relapsing diverticulitis, that allows significantly to reduce terms for achievement of complete clinical response.

The aim of review. To carry out analysis of the publications devoted to Helicobacter pylori infection and stomach cancer (SC) interrelation.

Original positions. Available data convincingly confirm that Н. pylori infection increases risk of SC development, however in close interaction with host factors – genetic factors, dietary habits, etc. Eradication of Н. pylori results in decrease of atrophic gastritis severity, but does not affect intestinal metaplasia process. Nowadays it is indicated for patients with high risk of SC (having atrophic gastritis, postgastrectomy patients for early SC, first-degree relatives of patients with SC).

Conclusion. Pathophysiological and clinical aspects of interrelations between Н. pylori infection and SC require the further studies.

The aim of clinical case presentation. To draw attention of specialists to rare neoplastic bowel diseases.

Original points. Article presents the case of small intestinal neurilemoma in 69 years-old woman with incidental abdominal pain. Abdominal ultrasound investigation (US) was diagnostic (it demonstrated the volume lesion located at the loops of ileum with thickened vascularized walls) and helical computer tomography – CT (tumor with irregular outlines ileum, with the lobular heterogeneous structure was revealed, contrast agent accumulation was uneven). Ileectomy with formation of end-to-end anastomosis was carried out. The resected speciemen revealed signs of neurilemoma at histological study.

Conclusion. It was possible to detect ileal tumor at abdominal US and CT. The diagnosis was verified at histological investigation.