The aim of review. To present main pathogenic aspects of development of alcohol-induced liver disease (ALD), principles of diagnostics and treatment of this disease.

Original positions. The alcohol-induced liver disease includes some variants of parenchymal damage caused by regular alcohol intake: steatosis, alcoholic hepatitis and liver cirrhosis (LC). There are series of factors contributing to ALD development. The main of them include amount of taken alcohol, gender, genetic polymorphism of enzymes involved in alcohol metabolism (метаболизме алкоголя?), nutritional status. At application of alcohol within several days there is a probability of liver steatosis development – the state at which in hepatocytes gather macrovesicular triglyceride inclusions. As a rule, disease has no clinical symptoms, frequently it is a casual diagnostic finding and does not require specific treatment besides abstinence of alcoholic beverages. Alcoholic hepatitis is significantly more severe form of ALD. Manifestation of disease usually appear after another episode of alcohol intake. Severe alcoholic hepatitis, especially if develops on a background of pre-existing LC, in high number of cases is associated to unfavorable life prognosis. Cirrhosis is the end-stage of ALD. Diagnostics of severe ALD forms is based on finding-out past history data indicating alcohol abuse, revealing clinical and laboratory signs of liver failure, ruling out other liver diseases. Therapeutic approach includes complete abstinence from alcohol, wholesome nutrition, application of glucocorticosteroids, anticytokine agents and drugs, containing S-adenosylmethionine. Article presents the clinical case of successful treatment of severe alcohol-induced hepatitis.

Conclusion. Pathogenesis of ALD is based on direct toxic operation action of ethanol on one hand and on endotoxemia and increased production of proinflammatory cytokines, on another hand. Based on knowledge of liver damage mechanisms, prognosis of disease and its proper treatment are possible.

The aim of review. To discuss features of course of chronic hepatitis C virus infection at elderly, efficacy and safety of antiviral treatment of patients of this age group.

Original positions. In every day clinical practice elderly patients with chronic hepatitis C are extremely rarely considered as candidates for antiviral treatment. Such therapeutic tacticsis is not always justified. At patients in the age of 65 and over chronic hepatitis C has more severe course, than at young patients, with more rapid progression of fibrosis and low level of alanine transaminase. Due to this liver cirrhosis (LC) at elderly patients is more frequent, than at younger subjects. In series of studies it was demonstrated, that elderly age is independent risk factor of development of both LC, and hepatocellular carcinoma. Expediency of prescription of antiviral therapy to elderly patients should be solved individually, taking into account patient’s activity and quality of life. To assess the stage of disease and degree of fibrosis methods, alternative to liver biopsy, are preferable. Before onset of treatment, additional investigation to establish severity of concomitant diseases and risk of their complications should be carried out. One of the basic problems during antiviral therapy is development of ribavirin-induced anemia that is especially dangerous at patients with cardio-vascular diseases. This complication requires careful monitoring of hemoglobin and hematocrit level during the whole period of treatment and, if necessary, decline of drug doses according to established algorithms.

Conclusion. Elderly age is not an absolute contraindication for antiviral treatment. At solving a question of prescription of antiviral therapy for chronic hepatitis C to elderly patients it is necessary to represent clearly the balance of the possible harm and benefits as well as the probable consequences of treatment cancellation.

The aim of review. To present information on the drugs nowadays used in gastroenterology, that interact with opiate receptors. Original positions. Opiate receptors in the body have been discovered about 35 years ago. For this time their various types have been found, many peptides are discovered, their classes are characterized. Methods of peptide chemistry provide synthesizing hundreds of endogenous peptide compound analogues. On their basis new medicamental agents were developed. The first-ever synthetic drug manufactured on the basis of leucine-enkephaline, was the Russian drug dalargin. Article presents features of its synthesis, pharmacological effects, main directions of application: peptic ulcer of the stomach and duodenum, pancreatitis. Compounds of non-peptide nature, capable to interreact with opiate receptors are used now as well. There is information on loperamide, diphenoxylate, trimebutine and fedotozine – all these drugs find their application in treatment of intestinal diseases. Conclusion. The drugs interacting with opiate receptors, are widely used in gastroenterological practice and there are preconditions to broaden spectrum of these agents.

The aim of review. To demonstrate value of disorders of cholinergic innervation in pathogenesis of irritable bowel syndrome (IBS).

Original positions. The important place in regulation of gastro-intestinal tract functions belongs not only to M-, but also to N-receptors localized in enteral plexus ganglions and on presynaptic endings of cholinergic motor neurones. Acetylcholine is the universal mediator which is intimately interacts with other mediators regulating intestinal functions. The role of disorders of cholinergic innervation in pathogenesis of IBS is actively investigated by now. Experimental data allow to assume, that «subclinical inflammation» within intestinal wall at IBS, disturbances of peristaltic activity and hyperalgesia, are related to altered response of immune and smooth-muscle cells to acetylcholine stimulation.

Conclusion. Acetylcholine represents the major mediator regulating motor and secretory function of intestine. Change of acetylcholine metabolism of has immediate value in pathogenesis of IBS. The agents, influencing cholinergic receptors, are one of basic resources of modern pharmaceutical therapy of irritable bowel syndrome.

Aim of investigation. To estimate pathogenic and diagnostic value of detection of hepatotropic viruses components (DNA, RNA, antigens) and antiviral immune response at acute hepatitis of non-specified etiology by the methods of enzyme-linked immunoassay (EIA), polymerase chain reaction (PCR) and Т-cellular lymphocytes proliferation in response to HCV antigens stimulation.

Methods. Overall 42 patients with acute hepatitis of not specified etiology (AHNSE) were included in original study. Thirty three patients with acute hepatitis C and 36 patients with acute hepatitis B made groups of comparison, control group included 15 healthy persons. Investigation of patients with acute hepatitis of non-specified etiology included clinical, epidemiologic, routine laboratory, serological methods; molecular biological method (RNA of hepatitis A, C, Е, G viruses; DNA of hepatitis B virus, TTV, CMV, EBV, HHV of 1, 2, 6 and 8 types, PV B-19, NV-f – qualitative analysis); method of immunofluorescence (assessment of antimitochondrial and antinuclear antibodies); immunologic methods (laboratory diagnostic methods) – independent assessment of specific antibodies for individual HCV antigens spectrum, including structural and unstructural proteins and compound peptides, representing the whole HCV polyprotein (overall 38 antigens: 34 HCV antigens and 4 control antigens) in blood serum by EIA method; investigation of Т-cellular immune response to HCV antigens by blast-cell lymphocytes transformation method under stimulation by HCV antigens with quantitative evaluation of cytokine secretion; instrumental method – ultrasound investigation of abdominal organs.

Conclusions. As a result of the study within the group of patients with acute hepatitis, that never visited precinctive regions, viral hepatitis Е was revealed by EIA in 4,8% of cases, including 2,4% when it was detected both by EIA and PCR. It is possible to assume, that the portion of acute HCV-infection with atypical serological profile (according to commercial tests-systems data) reaches 17% of AHNSE patients, and at application of multiparametric diagnostic criterion, including 6 parameters, – 43,5%.

Aim of investigation. To study efficacy of phlebodia-600 (diosmin) in treatment of portal hypertension at patients with liver cirrhosis (LC).

Methods. Comparative investigation of efficacy of monotherapy by enalapril (10 mg/day) and phlebodia600 (1200 mg/day), and their combination at portal hypertension has been carried out at 35 patients with LC of Child-Pugh classes A and B.

Results. Phlebodia-600 more significantly, than enalapril, decreased diameter of portal and splenic veins, but had no essential effect on peripheral blood flow velocity. Combined treatment by these agents along with decrease of diameter of veins significantly increased average rate of blood flow in portal vein and decreased splenic venous blood flow. The average value of congestive index in portal vein at monotherapy by enalapril decreased by 30,5%, at application of phlebodia-600 – by 26,0%, at their combined application – by 51,4%. The combined treatment significantly decreased hepatic artery resistance index (by 25%) as well.

Conclusion. Combined application of enalapril and phlebodia-600 in the treatment of portal hypertension is more effective, than monotherapy.

Aim of investigation. The standard of diffuse liver disease (DLD) diagnostics, allowing to determine etiology, stage of liver fibrosis (LF), histological activity index (HAI) is the liver biopsy (LB). At inaccessibility of LB for diagnostics, LF stage can be assessed by noninvasive methods based on mathematical modelling with plotting of «images» of various etiological forms, LF stages and HAI of disease. An aim of investigation was stepwise application of mathematical analysis methods for improvement of diagnostics of DLD stage and its activity.

Methods. Overall 450 patients were investigated: 319 HCV RNA-positive patients and 131 HBV DNApositive patients. To construct the «images» of stages of chronic HCV-and HBV-infections discriminant analysis, neural networks, computer programming were applied. The result of non-invasive diagnostics of patients with HСV-infection in 71% of cases coincided with LB data by LF stage, in 62% – by HAI. At HВV-infection LF stage conformed LB data in 78%, HAI – in 71% of the cases.

Conclusions. Combined application of mathematical methods in DLD diagnostics with assessment of LF stages and HAI allows non-invasive estimation of these parameters with sufficient diagnostic accuracy. At revealing of severe liver disease (LF stage ≥2 by METAVIR, HAI by Knodell ≥4 points) LB is recommended.

The aim of review. To present data on surgical treatment of patients of senile age with colorectal cancer, to estimate principal causes of unsatisfactory results.

Original positions. According to literature data, the present level of medical care for geriatric patients with colorectal cancer is insufficient all over the world, including in Russia. In last decades scientific community was unanimous in opinion, that results of surgical treatment of cancer of the rectum and colon at careful perioperative evaluation and transdisciplinary preparation do not depend on patients’ age.

Conclusion. Multidisciplinary approach in preparation and perioperative management of senile patient with colorectal cancer, allows to carry out radical surgical treatment without increase of mortality that results in decrease of urgent surgery rate and therefore improves survival rate. If patient at multidisciplinary evaluation of perioperative risk is recognized as resectable, standard surgical approach based on oncologic principles can be carried out without substantial increase of risk of surgical complications.

Aim of investigation. Objective is to optimize treatment strategy for patients presenting with acute small bowell obstruction (SBO) due to adhesions. We developed a prognostic scale for conservative treatment outcome utilizing multiple prognostic factors.

Methods. In retrospective study case records of 385 patients for 2003–2008 have been analyzed. Patients with suspicion to strangulation were not included in investigation. According to the designed integrated prognostic system with application of Bayesian statistical methods patients have been distributed into three prognostic groups. Patients with low chances for conservative resolution of obstruction underwent surgery, i.e. adhesiolysis. Standard conservative therapy was carried out to patients with high chances. Conservative treatment that included endoscopic nasointestinal decompression (ENID) was prescribed to patients from the group of peer probability of obstruction resolution. Results. Prognostic system has been tested in 2009. During observation time 56 patients with SBO were admitted to the clinic, of them 13 were operated urgently and 43 were included into prospective study. Favourable results of standard conservative treatment were received in 68,7% of the cases (11 of 16 patients), ENID was effective in all 15 patients of this group and 22 patients with low likelihood of conservative resolution have been operated. The over-all mortality was 2,2% (1 patient of 43).

Conclusion. The designed prognostic scale allows to prove with high accuracy the choice of SBO treatment method and to predict treatment outcome at this disease with high performance.

The aim of publication. Absence of clear practical guidelines on management of patients with asymptomatic elevation of serum aminotransferases can cause difficulties for general practitioners. Presented clinical case illustrates management approach in such cases.

The basic contents. Patient D. has admitted to the clinic in July, 2010 for changes blood biochemistry at absence of any symptoms or clinical signs. According to past history it was known: the patient is non-smoker, absolutely denies use of pharmaceuticals and alcohol abuse. At physical examination excessive body weight (BMI of 31 kg/m2) drew attention. The aim of investigation was definition of the cause of elevation of serum aminotransferases activity, and assessment of approach to further management. According to the data of carried out investigation the non-alcoholic steatohepatitis has been diagnosed, that was successfully treated by combination of metformin and ursodeoxycholic acid.

Conclusion. Estimating the submitted clinical case it is possible to conclude, that there is no strict association between accumulation of subcutaneous fat and severity of liver steatosis. Hence, non-alcoholic steatohepatitis always should be included in differential diagnostic range of search in patients with asymptomatic elevation of serum aminotransferases. For treatment of nonalcoholic steatohepatitis it is rational to use as drugs of choice metformin (treatment of insulin resistance) and ursodeoxycholic acid (anti-oxidative properties).

The aim of review. To present up-to-date data on diagnostics and treatment of MALT-lymphoma of the stomach and experience of N.N.Burdenko Chief military clinical hospital in treatment of patients with this disease.

Original positions. Not so long ago mucosa-associated lymphoid tumor was included in WHO classification of hemopoietic and lymphoid tissues tumors, which is terminologically determined as extranodal marginal zone В-cellular lymphoma of the MALT-type. It is proved, that approximately 90% of cases of stomach МАLT-lymphomas are related to H. pylori infection. Despite the extensive data obtained for the last two decades on clinical and pathomorphologic properties of this disease, its molecular genetic features, optimal medical approach for this nosological entity it is not developed yet. It is especially actual for regional stages of disease. The article stresses therapeutic aspects: correspondence of treatment approach to disease stage, presence of Н. pylori infection, role of eradication and radiation therapy, surgery and chemotherapy. Basing on obtained data, original treatment algorithm was developed, which is proposed to application in clinical practice to provide optimal amount of medical care to the patient.

Conclusion. Findings in MALT-lymphoma biology allowed to introduce new scientific and practical treatment projects in practice.

The aim of publication. To reflect state-of-the-art of radiology in gastroenterology.

Original positions. Potentials of modern radiology at diseases of biliary tracts, liver, pancreas, gastrointestinal tract, front abdominal wall, etc. are analyzed according to the data of The 16-th Russian gastroenterological week which was held in Moscow October, 11–13, 2010. Features of application of ultrasound investigation, roentgenologic procedures, magnetic-resonance tomography as stand alone methods and at complex investigation are underlined. Algorithms of diagnostics of various diseases, noninvasive medical procedures are proposed. Attention is drawn to necessity of contrast agents application, software improvements and conservation of obtained information is inverted.

Conclusion. The further improvement and application of modern radiological methods of investigation will promote improvement of diagnostics of diseases of digestive organs that allows to prescribe adequate treatment and to provide correct patient management approach.

Yu.V. Korotchayeva – Clinical value of IL-6 assessment in blood serum and urine and cytochrome Р450 in liver tissue at chronic hepatitis C patients.

L.R. Idrisova – Value of a latent HBV-infection in progression of chronic liver diseases.

T.A. Batyukhno - Chronic pancreatitis: disorders of protective immune mechanisms and their pharmacological treatment.

S.P. Fedorov – Pharmakokinetics and pharmacodynamics of rabeprazole.