The aim of review. To present literature data, to generalize cumulative experimental and clinical data of the author and his co-workers on effect of hydrolases of gastro-intestinal contents and circulating blood on digestive organs functions.

Original positions. The role of enzymes of digestive glands is not limited to depolymerisation of nutrients, inactivation of antigens and bacteriostatic action. They carry out also signaling role in modulation of exo- and endocrine secretions of digestive glands and motor activity of gastro-intestinal tract. Proteinases realize effects through protease-activated receptors of four types which are localized on membranes of glandular cells, leiomyocytes, sensory terminals of afferent neurons and neuroendocrine producers of regulatory peptides, yielding direct and mediated morphofunctional effects.

Conclusion. Enzymergic regulation of visceral functions, including sensory, alimentiry, protective, acts as new section of up-to-date science and, according to accumulated facts, is promising in gastroenterology, pancreatology, oncology, immunology and other segments of clinical medicine.

Aim of investigation. To study the role of serological markers of hepatitis B virus infection: antibodies to hepatitis B virus cor-antigen (anti-HВcor IgG) in progressing liver damage at patients with persistent hepatitis C virus infection.

Material and methods. For the first time in the large group of patients (2934) significant prevalence of serological markers of hepatitis B and C viruses among patients of versatile clinic was demonstrated.

Results. According to actual data it was proved, that antibodies to cor-antigen of hepatitis B virus at patients with persistent hepatitis С virus infection do not alter biochemical activity and severity of liver disease. With application of prognostic models tendency to higher risk of end-stages of liver disease development at patients with persistent hepatitis B virus infection and anti-HBcor IgG in blood serum was revealed. The potential of application of liver graft from the donor with serological profile anti-HCV/anti-HBcor IgG (at absence of other contraindications) is proved for certain groups of recipients. Arguments for revision of criteria for selection of donor of organs were presented for prophylaxis of de novo hepatitis B at the recipient (so-called de novo graft infection – HBsAg appearance at the recipient at absence of viral infection markers before operation).

The aim of review. To discuss issues of diagnostics of choledocholithiasis at the present time.

Original positions. The relevance of early recognition of choledocholithiasis is determined by high frequency at patients with cholelithiasis and risk of development of life-threatening complications. Diagnostics of choledocholithiasis is based on clinical data, laboratory and instrumental tests. Instrumental methods of investigation differ by their information value and invasiveness. So, it is important to define prognostic criteria (clinical, biochemical and ultrasound), determining necessity of additional more invasive and expensive investigation of bile ducts. However estimation of diagnostic criteria suggested by different authors and their threshold values is ambiguous. Discordant opinions frequently lead both to underestimation of the role of clinical and laboratory data, and to unjustified application of invasive diagnostic methods.

Conclusion. Further studies are necessary to develop more rational and objective systems of diagnostics of choledocholithiasis.

Aim of investigation. To estimate activity of cells of diffuse endocrine system of the esophagus at patients with refractory form of gastroesophageal reflux disease (GERD).

Material and methods. Twenty three patients with the refractory form of gastroesophageal reflux disease (RFGERD), 100 patients of GERD who responded to treatment, including 60 of those with non-erosive form of endoscopically positive GERD (NFGERD), 40 — with erosive form of GERD (EFGERD) and 14 patients with Barret’s esophagus (BE) were investigated. Groups of comparison included 30 patients with chronic H. pyloriassociated gastritis and 20 generally healthy patients. Contents of nephro-endocrine cells in mucosa of the esophagus, producing nitric oxide synthase, endothelin-1, melatonin, neurotensin and р53 was determined by immunehistochemical method.

Results. In contrast to NFGERD and EFGERD, at RFGERD higher grade of hyperplasia of esophageal neuroendocrine cells secreting neurotensin, and esophageal epithelial cells expressing р53 was observed.

Conclusions. Disorders of functional activity of neuroendocrinal cells of esophageal mucosa, producing neurotensin, and epithelial cells of the esophagus expressing р53, can act as a factor promoting development of refractory forms of GERD.

Aim of investigation. Development of guidelines on empirical treatment of H.pylori-associated diseases on the basis of local pattern of antibiotic-resistance.

Material and methods. Overall 210 adult patients have been included in original study of H. pylori-associated diseases with positive rapid urease test (Smolensk, 2009–2010). Sensitivity of H. pylori to amoxicillin, erythromycin, levofloxacin, ciprofloxacin, tetracycline and metronidazole was determined by dilution method in agar.

Results. Н.pylori has been detected in 64% (n=135) patients. Previous intake of antibacterial pharmaceuticals reduced frequency of Н. pylori detection. Of 133 H. pylori strains 24 isolates (18%) were resistant to one antimicrobial agent, 4 strains (3%) were refractory to two agents and more. Frequency of resistance to macrolides was 7.6% (n=10), to metronidazole – 3.8% (n=5). No strains resistant to amoxicillin and tetracycline were revealed. Ciprofloxacin resistance level was 12.8% (n=17), that of levofloxacin – 8.3% (n=11).

Conclusion. In Smolensk application of standard eradication modes of the first and second line for the treatment of Н. pylori-associated diseases is proven. The expediency of application of quinolones as back-up treatment of Н. pylori-associated diseases is doubtful in connection to rather high level of antimicrobial resistance.

The aim of review. To present possible management approach for patients with early stomach cancer.

Original positions. Nowadays morbidity and mortality due to stomach cancer still occupies the leading positions all over the world. The main way to decrease its prevalence is diagnostics and well-timed treatment of preneoplastic states, first of all – chronic atrophic gastritis associated to Helicobacter pylori infection. Revealing of stomach cancer at early stages and adequate treatment of patients improve the prognosis. Screening diagnostics of the asymptomatic population and investigation of risk groups are efficient approaches in detection of early stomach cancer. Of all diagnostic methods high quality endoscopic investigation is considered to be the most effective. The important stage of management of patients with early stomach cancer is endoscopic resection of tumor. In the last years in practice of clinics in many countries of the world new procedure – endoscopic submucosal resection began to be introduced widely.

The aim of review. To discuss the factors promoting development of refractory and relapsing forms of colitis, associated to Clostridium difficile infection, to present the state-of-the-art in management of patients with these variants of the course of disease.

Original positions. Relapsing forms of the Clostridium difficile-associated colitis, are seen in 15– 30% of patients. Their development is promoted by elderly age of patients, significant duration of diarrhea at the first relapse, intake of proton pump inhibitors. In treatment of such patients courses of vancomycine and metronidazole, supplemented by probiotics (Sacharomyces boulardi), adsorbents (Colestyraminum, smecta) and rifaximin are applied.

Conclusion. The problem of refractory and relapsing forms of Clostridium difficile-associated colitis, requires the further studying to increase treatment efficacy.

The aim of publication. To show complexities of diagnostics and treatment at hereditary multiple gastrointestinal polyposis by the example of clinical case.

Features of clinical case. At the patient with PeutzJeghers syndrome, despite of well-timed diagnosis, annual screening and treatment, it was not possible to avoid development of serious complications. Recurrent bleedings from polyps and intestinal obstruction became the cause of four extensive resections of the small and large intestine that resulted in development of short bowel syndrome and disability of the patient.

Conclusion. Now there is no pathogenically proved treatment of Peutz-Jeghers syndrome. The main management approach consists in dynamic observation and the prevention of fatal complications.

The aim of publication. To show a rare case of pulmonary and hepatic vascular malformations development, to discuss pathophysiological mechanisms of revealed changes and clinical symptoms of disease.

Features of clinical case. At the young patient disease manifested by nasal bleedings, that was subsequently accompanied by severe respiratory failure and portal hypertension. Clinical signs were related to skin and mucosae teleangiectasias, diffuse small vascular malformations of the liver and lungs with left-toright shunting of the blood. Difficulty of medical tactics choice was determined by impossibility of conservative treatment, vascular embolization or organ-preserving resection of lobe of the organ. Patient has been referred to inclusion to the Waiting list for the lungs and liver transplantation.

Conclusion. Hereditary hemorrhagic teleangiectasia is infrequent genetic disease described by anomaly of vascular development and diversity of clinical symptoms. Despite of the better comprehension of mechanisms of disease and introduction of new methods of its diagnostics, hereditary hemorrhagic teleangiectasia is not completely estimated by clinicians, frequently remaining unrecognised, up to development of severe, sometimes — life-threatening states.

The aim of review. To illuminate principal causes and features of manifestations of constipation at elderly patients, to present a general investigation and treat- ment plan.

Original positions. In economically developed countries about one third of population over 65 years of age has constipation. One of the vital issues related to it, is decrease of quality of life and social activity of patients. The basic role in intestinal function disorders is played not so much by age-related changes of gastro-intestinal tract, but rather by systemic back- ground disease, characteristic for persons of the senior age. In some cases functional constipation is present. At investigation of the patient it is especially important to estimate history of drug intake, to pay the special attention to signs of obscure depression and anxiety, systemic and neurologic diseases and so- called «red flags». Constipation with delayed transit and megarectum are associated to the risk of fecal impaction, compression of urinary tract and stercoral colitis development, with intestinal perforation, blee- ding and suppuration.

At treatment prescription it is necessary to take into account nature of constipation, features of clini- cal pattern, intestinal transit, incidental or persistent course. Adequate nutrition, physical motions, treat- ment of cognitive disorders and care for the patient have major value. Algorithms of stage-by-stage treat- ment of constipation with normal and delayed transit are presented.

Conclusion. Disorder of emptying of intestine in elderly age is a common problem which can significantly aggravate general state of the patient and sometimes result in lethal complications. Medical staff should pay special attention to evaluation of intestinal functions and comprehend stage-by-stage constipation treatment.

The aim of review. To demonstrate modern approach to preparation of patients for endoscopy and colon and rectal surgery.

Original positions. Due to application of polyethylene glycol (PEG) obligatory cleaning of the large intestine became possible without application of flush enemas. PEG is high molecular weight linear polymer retaining water that increases fluid volume in the bowel and stimulates mechanoreceptors. Application of sodium phosphates is an alternative preparation method. Risk of hyperphosphatemia that develops in some groups of patients limits their application. Preparation with excellent cleaning of large intestinal lumen is necessary for conclusive endoscopic investigation. Preparation is required as well before elective laparoscopic and rectal surgery. Authors’ experience of preoperative management of colorectal patients is presented.

Conclusion. Application of PEG agents allows to obtain safely high-quality preparation for surgical and endoscopic colorectal interventions with the least number of relative and absolute contraindications.

I.V. Aleksandrova – Extracorporeal hemocorrection in the complex treatment of liver failure.

O.V.Dobrovolsky – Pharmakokinetics and potentials of endoscopic evaluation of esomeprazole pharmacodynamics.

O.V. Paklina – Morphogenesis of chronic pancreatitis and pancreatic ductal adenocarcinoma.