The aim of review. To carry out analysis of the publications devoted to application of prokinetic drug domperidone (D) at various gastroenterological diseases.

Key points. Literature data demonstrate, that dopamine receptor antagonist D is effective drug for treatment of such diseases, as functional dyspepsia, diabetic and idiopathic gastroparesis, gastroesophageal reflux disease (within combined treatment modes), and for relief of nausea and vomiting, caused by cytotoxic agents as well. Side effects at application of D are determined by risk of hyperprolactinemia, which rarely clinically relevant.

Conclusion. Domperidone can be successfully applied for treatment of gastroenterological diseases accompanying primary or secondary disorders of stomach and duodenum motility.

Aim of investigation. To determine prognostic value of diagnostics of gastric metaplasia of esophageal mucosa in development of erosions in patients with gastroesophageal reflux disease (GERD).

Material and methods. Overall 100 patients with GERD have been enrolled in prospective comparative study: men – 57 (57%), women – 43 (43%), mean age was 50,2±18,1 years. Duration of follow-up was 3 to 10 years. Patients underwent esophagogastroduodenoscopy with guided biopsy of mucosa of the lower third of esophagus. Analysis of erosions frequency was carried out by 2 by 2 table (for χ2 criterion analysis).

Results. The high diagnostic value of presence of gastric metaplasia of esophageal mucosa for prognosis of erosions in patients with GERD was revealed: sensitivity – was 80,7% (95% CI: 69,8–91,6%); specificity – 83,3% (95% CI: 72,6–94,0%); rate of correct prognoses – 82% (95% CI: 74,4–89,6%); relative risk of prognosticated outcome – 4,2; relative risk of different outcome – 0,2 (95% CI: 0,1–0,39%); odds ratio – 4,5 (95% CI: 1,6–12,7%).

Conclusions. For the first time significant value of gastric metaplasia diagnostics in patients with GERD (p<0,001) for the prognosis of erosions of mucosa of the esophagus within 3–10 years it was found.

The aim of review. To demonstrate different points of view on hemorrhagic complications in patients with liver cirrhosis (LC), relation of these complications to disorders of hemostatic system.

Key points. Physiology of hemostatic system is intimately related to liver function because parenchymatous cells produce the majority of coagulating and fibrinolytic systems factors. Hence, chronic or acute diseases of this organ frequently have profound effect the system of hemostasis. Bleeding developing at invasive procedures in LC patients, bleeding from varicose esophageal veins, hematomas, hemorrhagic purpura, nasal bleeding, odontorrhagia, menorrhagias are actual clinical problems. Laboratory diagnostics of disorders in «hemostasisfibrinolysis» system in patients with the LC underwent essential changes at the last decade. Standard complex tests for hemostasis lose their diagnostic value in this group of patients. Active search of the laboratory methods is conducted, allowing to estimate the risk of bleeding in liver cirrhosis patients. Strategy in treatment of hemorrhagic complications in LC is directed on prevention of pending bleedings and well-timed onset of medical actions in the case of its development. Basic principles of therapy are: application of erythrocytes, plasma, platelets concentrate, recombinant factor VIIa, concentrates of prothrombin complex, desmopressin, antifibrinolytic drugs, thrombo-and erythropoietin, antibiotics. The relation to prescription of components of blood is cautious now, there are no definite indications to their application and criteria of efficacy.

Conclusion. The problem of prediction of hemorrhagic complications in patients with LC by modern laboratory tests remains open. There is no conventional strategy of treatment and prophylaxis of bleedings for these patients. Carrying out of randomized controlled studies for evaluation of laboratory tests in prediction of bleedings or thromboses at patients with cirrhoses, for studying efficacy of modern concentrates of factors of coagulation, for assessment of restrictive policy of decantation of blood components is necessary.

The aim of review. To analyze data of the clinical studies on chronic hepatitis C (CHC) treatment with application of new modes of combined therapy, including selective inhibitor of viral protease.

Key points. New algorithms of antiviral therapy for patients infected by the 1-st virus genotype not treated earlier, and after treatment failure, implicate presence or absence of so-called «induction phase», the kernel of which is application of pegilated interferon-α and ribavirin combination at the beginning of treatment with subsequent addition of the third agent (the direct action antiviral agent). Triple therapy with induction phase strategy is recommended at application of boceprevir as the third agent. Another antiviral drug with direct action – telaprevir is recommended for prescription from first day of treatment.

Conclusion. Taking into account an apparent positive effect of induction phase for boceprevir modes of treatment and absence of that evidence for telaprevir application, both new antiviral strategies are justified for clinical application in CHC patients.

Aim of investigation. To estimate efficacy and safety of application of «Phosphogliv»® (glycyrrhizinic acid) within combined therapy of patients with chronic hepatitis C (CHC) who received no previous antiviral therapy (AVT).

Material and methods. Overall 80 out-patients over 18 years of age with the diagnosis of CHC confirmed by laboratory and instrumental methods have been included in original study. Patients in group A (n=40) prior to onset of AVT received phosphogliv intravenously (iv) 2,5 g 5 infusions per week for 4 wks, in the subsequent 4 wks it was applied iv on a background of AVT by Altevir® and ribavirin. Altevir was injected subcutaneously in a dose of 3 million IU 3 times per week in combination to ribavirin dosed according to body weight. After the termination of phosphogliv infusions oral intake of phosphogliv forte of 1 capsule tid along with ongoing AVT was prescribed to patients. Total duration of treatment by studied drug for the 1-st HCV genotype patients was 52 wks, with 2nd and 3rd genotypes – 28 wks. The patient of the group B received no phosphogliv treatment, they received only standard AVT according to revealed virus genotype.

Results. Intravenous injection of phosphogliv, prior to beginning of standard AVT, resulted in essential decrease of serum transaminase activity in group A, that was statistically significantly different from initial level. In group B patients with same HCV genotype no dynamics of serum transaminases level prior to AVT was found. Significant decrease of histological activity index in patients with 2/3 genotype of CHC in both groups and change of this score in the group, that received standard AVT in combination to phosphogliv was revealed as well, was much more significant in comparison to the group receiving standard treatment alone. Statistically significant differences in dynamics of viral load and frequency of achievement of sustained virologic response in patients with identical HCV genotype between groups A and B was revealed. No difference in adverse events rate of between groups was observed.

Conclusions. Efficacy of domestic standard IFN-α altevir in combination to ribavirin in CHC treatment at 2nd and 3rd HCV genotypes, and at 1-st genotype HCV in patients with low viral load as well can be considered as high. Addition of phosphogliv to treatment leads to more rapid improvement of biochemical and histological scores.

Aim of investigation. To study the functional changes of cardio-vascular system in patients with viral liver diseases.

Material and methods. Overall 150 patients with hepatitis virus C-associated liver diseases, including 80 patients with chronic hepatitis and 70 – with liver cirrhosis (LC) have been included in original study. All patient underwent electro- and echocardiography, and Reberg test with calculation of sodium filtration fraction. At ECG analysis corrected Q-T (Q-Tс) interval was calculated by Bazett's formula.

Results. In LC patients elongation of Q–Tc interval (432±21 ms) was revealed in comparison to patients with hepatitis (412±20 ms, р<0,001). Direct correlation of Q–T interval elongation and cirrhosis severity was marked. At echocardiography in LC patients the impairment of diastolic function and thickening of left ventricular walls was observed in comparison to hepatitis patients. Hypertrophy of myocardium was detected in 5,0% of patients with hepatitis and 17,1% of cirrhotic patients (р<0,05), diastolic dysfunction of left ventricle – in 20,0 and 50,0% respectively. The sodium filtration fraction in patients with decompensated LC was significantly lower, than in patients with compensated cirrhosis and hepatitis.

Conclusions. In patients at liver cirrhosis stage elongation of Q-Tc interval was significantly more frequent (40% of cases) in comparison to patients at hepatitis stage (6,25%). Mean duration of Q-Tc interval was 432±21 ms and 412±20 ms respectively (р<0,001). Diastolic function of myocardium considerably worsens at patients with cirrhosis in comparison to patients at hepatitis stage (Е/А ratio was 1,01±0,29 and 1,29±0,39 respectively, р<0,001). In patients with LC, especially at decompensation stage, significant decrease of sodium filtration fraction (0,52±0,21%) was marked in comparison to patients with hepatitis (0,80±0,29%, p=0,01) and compensated cirrhosis (0,75±0,22, p=0,021).

The aim of review. To present state-of-the-art in active detection of risk group for colorectal cancer (CRC) by screening laboratory methods – biochemical and immunoenzyme.

Key points. The high morbidity and a mortality in the world from CRC makes active detection of this disease very important, thus the first stage of investigation supposes application of non-invasive laboratory methods. It was demonstrated, that biochemical methods for fecal occult blood testing (hemoccult tests) – guaiac Weber's test (gFOBT) and Gregersen test, at adherence to rules of procedure technique, are applicable for active detection of CRC and some other gastro-intestinal diseases. However, low specificity of biochemical tests and necessity of long preparation for analysis limit their clinical application. Searches of the laboratory methods, that allow to overcome this restriction, resulted in development several qualitative (rapid) and quantitative enzyme-linked immunoassays for detection of hemoglobin in feces (FIT). Essential difference of immunoenzyme tests from biochemical is application of antibodies, specific to human hemoglobin and complex of human hemoglobin with haptoglobin. These tests are deprived of some disadvantages of biochemical method. Besides that, detection of the tumor-specific pyruvate kinase type М2 in feces (fTu M2-PK) also can be used in the screening programs for active detection of CRC, as it was shown in series of studies.

Conclusion. Now series of copro-tests are available, that are promising for application as screening laboratory methods for active detection of high risk groups for CRC.

Aim of investigation. To develop reconstructed mucosa of the rectum for improvement results of surgical treatment of familial adenomatosis polyposis coli (FAP).

Material and methods. Overall 27 patients with FAP underwent surgical treatment including colectomy, demucosation of rectum and allogenic transplantation of fetal intestinal epithelium cells and mesenchyma of various origin to develop reconstructed mucosa. In 5 patients the ileorectal anastomosis, in 22 – small-intestinal reservoirs were created.

Results. During period from 4 to 12 wks development of rectal mucosa was observed in all patients. At follow-up from 1 year to 5 years no proliferation of polyps was revealed in 26 (96,3%) patients.

Conclusions. Cell transplantation can successfully be applied for development of reconstructed rectal mucosa. Keeping part of rectum after colectomy and formation of smallintestinal reservoir allows to keep natural intestinal passage with good functional results.

The aim of review. To demonstrate value of H. pylori eradication therapy in patients for prophylaxis and treatment of nonsteroid antiinflammatory drugs (NSAID)- induced gastropathies.

Key points. NSAID and H. pylori act as independent risk factors of ulcer development. Eradication therapy is the major way of prevention of gastroduodenal ulcer and its complications, especially if prophylaxis is carried out prior to onset of NSAID treatment. At long-term application of NSAID the preventive effect of H. pylori eradication is less pronounced. Low doses or special aspirin preparations can not only cause erosions and ulcers, but also result in development of gastro-intestinal bleedings. Well-timed eradication therapy in patients receiving aspirin can decrease risk of ulcer bleeding even without maintenance treatment by proton pump inhibitors (PPI). Diagnostics H. pylori with prescription of antihelicobacter therapy at positive result should be provided in all patients receiving aspirin, with peptic ulcer in past history. Pantoprazole should be preferred at complex treatment of these patients to decrease adverse effects due to drug interaction.

Conclusion. Successful and well-timed combination of eradication treatment and standalone PPI therapy is the important prerequisite in avoidance of dangerous gastro-intestinal complications at intake of NSAID and aspirin.

Т.G. Zaviktorina - Clinical value of gastroesophageal and pharyngolaryngeal refluxes at esophagus and larynx diseases in pediatrics.

Ye.B. Yaroshenko – Comparative clinical characteristic of liver cirrhosis of various etiology.

O.G. Stepanov – Regulatory disorders in pathogenesis of irritable bowel syndrome in children.