The aim of review. To give analysis to modern concepts of colorectal cancer (CRC).

Original positions. CRC is the 2nd most common cause of morbidity after the lung cancer. It includes hereditary non-polyposis CRC (Lynch syndrome), hereditary CRC at familial adenomatosis and sporadic (non-hereditary) CRC. For each of these categories screening diagnostics programs are developed. At patients with ulcerative colitis the risk of CRC development depends on duration of disease, extent of the large intestine involvement, combination to primary sclerosing cholangitis and presence of blood relatives, affected by CRC.

Conclusion. Further studies to reveal causes and mechanisms of premalignant states of the large intestine and CRC are required. Methods of surgical and chemotherapeutic treatment of patients of CRC and its prophylaxis require improvement.

The aim of review. To analyze and present in brief contents of original materials, The Seventeenth Russian Gastroenterological Week (October, 10–12, 2011, Moscow,) published in the section «Diseases of the stomach and duodenum» (Ros. zhurn..gastroenterol. gepatol. koloprotol. – 2011. – Vol. 21, N 5. – Suppl. 38).

Original positions. The further accumulation and analysis of data on etiology, pathogenesis and clinical features of diseases of the stomach and duodenum based on the advanced methods of investigation. Elements of diagnostic concepts and therapeutic approaches for this group of diseases of gastro-intestinal tract (GIT) are modified. The most actual issues are: Helicobacter-associated pathology of the stomach, NSAID-related gastropathy and their complications and issues of early diagnostics of premalignant changes and stomach cancer.

Conclusion. Diseases of the stomach and duodenum remain significant problem of gastroenterology, despite of significant advances in last decades in diagnostics and treatment of these diseases of GIT.

Aim of investigation. To determine prevalence of atrophic gastritis of body of the stomach at Krasnoyarsk population over 45 years old.

Material and methods. Level of pepsinogen-1, pepsinogen-2 and presence of anti-Helicobacter pylori antibodies in blood serum was determined by «Gastropanel» test-system («Biohit», Finland). Original study was carried out with involvement of 387 men and 414 women over 45 years of age (n=801), selected as a random sample, and 29 relatives of stomach cancer patients.

Results. The prevalence of severe atrophic gastritis of the body of stomach, revealed by contents of pepsinogen-1 and pepsinogen-2, as well as pepsinogen-1/ pepsinogen-2 ratio under 3,0, was 10,9% (in males — 11,9%, in females — 9,9%). H. pylori infection was revealed in 90,0% of patients. Age of 55 years and older was a risk factor for severe atrophic gastritis.

Conclusions. Serological assessment of pepsinogen-1, pepsinogen-2 and H. pylori infection is effictove method of atrophic gastritis diagnostics.

Aim of investigation. To determine clinical and morphological features and some mechanisms of diseases of the large intestine in liver cirrhoses (LC).

Material and methods. Overall 146 patients with LC of various classes were investigated. Clinical, endoscopic, morphological, immunehistochemical methods of study were applied.

Results. Symptoms of intestinal dysfunction were revealed at 49% of patients. Endoscopic signs of portal colonopathy were diagnosed in 63% of cases. Frequency of clinical and endoscopical symptomatology of large intestinal pathology increased along with increase in LC class and was associated with hyperproduction of serotonin and chromogranin-A.

Conclusions. Absence of clinical symptoms of intestinal dysfunction does not exclude endoscopic and morphological signs of lesion of the large intestine at LC. Higher frequency of inflammatory and atrophic changes of mucosa of the large intestine at progressive stages of disease is caused by disorder of production of investigated components of diffuse endocrine system.

Aim of investigation. To assess the effect of combined drug meteospasmyl on intensity of clinical symptoms of irritable bowel syndrome (IBS).

Material and methods. Retrospective analysis of efficacy and safety of meteospasmyl in 30 patients with IBS diagnosis, confirmed by conformity of complaints to Rome-III criteria and absence of pathological changes at laboratory and instrumental investigations was carried out. Thirteen patients had clinical pattern of diarrhea predominance (IBS-D), 17 – predominance of constipation (IBS-С). The group IBS-D included 7 men (53,8%) and 6 women (46,2) with mean age of 39,2±3,0 years. The group IBS-С included 9 men (52,9 %) and 8 women (47,1%), mean age was 39,7±3,0 years. Meteospasmyl was prescribed in a dose of 1 capsule tid before meal for 28 days. Intensity of IBS symptoms as well as presence of side effects was estimated on 7, 14, 21 and 28-th day of treatment by 4-mark scale of symptoms degree, visual analog scales (VAS), verbal and nonverbal pain rating scale (PRS).

Results. In IBS-D group of the patients, after 4-week course of meteospasmyl treatment stool frequency significantly decreased, consistency of feces became less loose. Intensity of abdominal pain by VAS data significantly decreased at the end of 4-week treatment course. Besides that, the drug appeared more effective in relieving symptoms of functional dyspepsia, such as nausea, belching and early satiety. Similar data have been obtained in IBS-С group. To the end of 4-week meteospasmyl treatment course remission has been achieved in 10 of 17 patients in IBS-D group (58,8%) and in 8 of 13 in group IBS-С (61,5%). According to analysis of patients’ diaries, examinations at physician’s visits no adverse effects in the majority of investigated patients has been marked, that confirmed good tolerability of meteospasmyl in all patients.

Conclusions. The 4-week course of treatment by meteospasmyl significantly reduces severity of basic symptoms of IBS (abdominal pain, disorder of frequency and consistence of stool, meteorism). Moreover, the drug is effective for relief of symptoms of functional dyspepsia, concomitant to IBS, such as belching, nausea and early satiety. Its good tolerability in all investigated patients was revealed.

The aim of review. To analyze results of controlled clinical studies of efficacy and safety of telaprevir within triple antiviral therapy of chronic hepatitis C (CHC) with evaluation of frequency and spectrum of adverse effects (AE), and also approaches of their management.

Original positions. Investigations carried out to the present time demonstrated, that addition of telaprevir to standard therapy by pegilated interferon-alpha and ribavirin increases frequency of achievement sustained virologic response in CHC patients with the 1 genotype of virus almost 2-fold. Tolerability of treatment with addition of telaprevir was satisfactory as a whole; however frequency of skin rashes and pruritus (over 50%), anemia (about 40%) and anorectal symptoms (26%) was higher, than at standard double therapy (placebo group). A little higher frequency of serious AE (7%), cancellation of all drugs due to AE (8%) was observed. Increase of frequency and severity of skin reactions, that was a principal cause of treatment cancellation, is of special importance. AE spectrum at telaprevir application differs from AE spectrum at triple therapy with addition of another new protease inhibitor – boceprevir (predominance of anemia, dysgeusia). Original approach of monitoring and effective management of AE allowed to decrease frequency of cancellation of treatment due to dermal reactions in III phase investigations in comparison to results of II phase studies. Special attention is given to prophylaxis of interactions with other pharmaceuticals, as telaprevir is P450 (СYP) 3A4 substrate and inhibitor and P-glycoprotein transporter.

Conclusion. Application of telaprevir within triple therapy of CHC results in change of AE spectrum. The major importance has elevation of frequency and severity of skin reactions. Tactics of early diagnostics, monitoring and active treatment of AE, and drug interactions prophylaxes increase safety and efficacy of treatment.

Aim of investigation. With the help of up-to-date molecular-biological and morphological methods to determine frequency of the occult form of chronic hepatitis B (CHB) among HBsAg-negative patients with chronic liver diseases (CLD) of various etiology and to present clinical and morphological characteristic.

Material and methods. Overall 168 patients were investigated. Of 60 patients with anti-HBcAg antibodies 35 patients without HBsAg and DNA HBV in blood serum have been selected, who underwent fine-needle transcutaneous liver biopsy. Molecular biologic enzymelinked immunoassay (ELISA), polymerase chain reaction (PCR) and morphological (immunohistochemistry, electron microscopy) methods were utilized for diagnostics.

Results. Novel two-stage algorithm of diagnostics of CHB occult form was developed. Morphological criteria, typical for obscure HBV-monoinfections and HCV coinfection are described. With the help of immunohistochemistry and electron microscopy in all patients with anti-HBcAg antibodies in serum and absence of HBsAg and DNA HBV, presence of HBV virions in liver tissue was revealed. HBV and HCV coinfection was accompanied by more severe (in comparison to monoinfection) immune inflammatory response. In 80% of cases presence of TT-like mini virus (TTMV) in blood lymphoid elements was revealed, in two patients this virus was detected in hepatocyte nucleus that proves its hepatotropic properties.

Conclusions. Frequency of the occult form of hepatitis B among CLD patients is no less than 20%. It was found, that anti-НВсAg antibodies can be effective, though «surrogate» marker of HBV-infection.

The aim of review. To carry out analysis of literature data on necessity of the uniform approach to diagnostics and treatment of patients with Fournier’s disease (FD) and anaerobic paraproctitis (AP).

Original positions. High mortality and morbidity at these diseases is caused by rapid generalization of process, development of septic states and multiorgan failure. A basis of treatment is the urgent surgical intervention in combination to application of antibacterial and detoxication agents. Modern principles of antibiotic selection and carryings out of surgical interventions, application of additional methods of treatment in postoperative period are analyzed. At FD and AP radical elimination of suppurative focus in optimal terms (3–6 days after disease onset), subsequent complex antibacterial and detoxication therapy result in regression of signs of inflammation and convalescence of the majority of patients.

Conclusion. It is proposed to apply the «Fournier’s disease» term only to infection originating from genitalia, differentiating that from anaerobic paraproctitis, because extensive use of this term complicates analysis of prevalence.

Aim of investigation. To analyze causes and frequency of non-closure of colonic stomas created for prophylactic or medical reasons after anterior resections with stapled colorectal anastomosis for cancer of the rectum.

Material and methods. Results of treatment of 215 patients after anterior rectal resection with formation of stapled colorectal anastomosis from June, 2006 to June, 2011 were analyzed.

Results. Creation of colorectal anastomoses after anterior and low anterior resections is quite often accompanied by formation of «temporary» protective stoma to reduce consequences of possible anastomotic leak (AL). Nevertheless, in some patients these «temporary» stomas are never reversed.. By the moment of discharge from hospital 111 (52%) patients had colostomies: in 103 of them were preventive double-barrelled transverse colostomies were created at primary surgical intervention, the remaining 8 patients underwent colostomy formation in postoperative period because of development of AL. Average follow-up was 32,3 months (12 to 70 months). Among 111 patients the restorative operations were done in 96 (86,5 %). At multivariant analysis the following factors were identified as predictors of non-closure of stoma after anterior resection: death due to disease progression (correlation coefficien = 0,24) and chemotherapy treatment (correlation coefficient = 0,22).

Conclusions. The risk of «temporary» stoma nonclosure even in specialized center is 13,5%. When sphincter-sparing operations are performed for all stages of rectal cancer the most essential risk factors of non-closure of stoma were progression of disease and chemotherapy treatment and patient death related to it, and patient’s death.

Aim of investigation. Ligation of fistulous tract in intersphincteric layer (Ligation of Intersphincteric Fistula Tract – LIFT) – is a new method of surgical treatment of trans- and extrasphincter fistulas. It is obviously important to estimate LIFT results according to original experience and literature data.

Material and methods. LIFT technique is described. Overall 19 patients were operated: men – 11, women – 8, mean age 48±13 years (26 to 74 years). Ten patients had anterior transsphincteric fistula, anterior extrasphincter — 4, posterior transsphincteric – 1, posterior extrasphincter – 4.

Results. The median of term of follow-up was 42 wks (3 to 105 wks). The relapse of fistula was is marked in 2 patients. No disorders of fecal continence were revealed. At the moment of article submission literature data on LIFT results in 353 patients were available. The relapse rate at follow-up for 20–30 wks was 26%.

Conclusion. LIFT – is the simple, safe and effective method of treatment trans- and extrasphincter fistulas of the rectum.

The aim of clinical case presentation. To show importance of interpreting of morphological data not only for statement of diagnosis and evaluation of activity of inflammatory process, but also for revealing morphological changes testifying aggressive course of disease, and to demonstrate efficacy of anticytokine therapy in achievement of histological remission.

Features of the case. Definition of indications for infliximab prescription, based on morphological data is submitted, as well as efficacy of this agent in achievement of histological remission in a child with hormonedependent ulcerative colitis. Morphological criteria of aggressive variant of pathomorphism of ulcerative colitis (ileal spread with development of the structural features typical for mucosa of the large intestine, and phenomenon of small-intestinal metaplasia in distal parts of the large intestine) can serve as one of indications to prescription of infliximab.

Conclusion. Morphological criteria of aggressive variant of pathomorphism of ulcerative colitis allowed well-timed prescribtion of anticytokine treatment for a girl with ulcerative colitis, and efficacy was confirmed by achievement of histological remission.

S.Yu. Serebrova – Comparative clinical pharmacology of modern proton pump inhibitors.

A.O. Bueverov – Apoptosis of hepatocytes and peripheral blood leukocytes at chronic hepatites B and C.