The aim of review. To discuss the factors, promoting development of resistance at treatment of gastroesophageal reflux disease (GERD), and possible means to overcome it.

Original positions. Pharmacological therapy of GERD is focused on change of refluxate properties besides decreasing of its volume and aggressive properties by such classes of drugs, as antacids, alginates and hydrochloric acid secretion inhibitors. However for today frequency of clinical resistance in GERD patients reaches 10–40%. The causes of resistance to antisecretory therapy are inadequate acid suppression, weakly acidic refluxes, duodenogastroesophageal reflux, psychological features of patients, etc. Potentials of treatment of the patients with sustained symptoms of GERD on a background of standard dose of proton pump inhibitors (PPI), include correction drug intake, doubling of PPI dose, application of intravenous forms, combination of antisecretory agents of different groups, addition to therapy of drugs, capable to adsorb bile components and modulation of psychoemotional status of patients.

Conclusion. Despite of significant progress in treatment of acid-related diseases the problem of resistance of significant part of GERD patients to antisecretory therapy is still actual.

The aim of review. To present literature data and to generalize accumulated by the author and his employees experimental and clinical material on the mechanisms of enzyme transport to systemic blood flow, process of recretion of enzymes by digestive glands in the lumen of gut and the functional role of circulating hydrolases.

Original positions. Digestive glands exosecrete two pools of hydrolases: postprandially de novo synthesized and recreted from blood circulation, to which they are transported by three mechanisms – endosecretion of glandular cells, resorption of hydrolases from ductal system of the glands and the small bowel. Enzymes, being switched off from circulation by recretion, are involved in gastro-intestinal digestion and carry out a signal role in modulation of secretory, motor and absorptive functions of the gut. Circulation and recretion of enzymes, their reutilization in alimentary process fit into principle of energetic and plastic economization in alimentary functions.

Conclusion. The principle of enterohepatic circulation of bile acids in general view is repeated at interorgan recirculation of hydrolases of the digestive glands providing process of digestion, and by enzyme signaling – integration and adaptation of functions of the gut organs by modulating effects.

Aim of investigation. To reveal a role of a psychological distress, in particular depressive disorders, in development of symptoms of functional dyspepsia.

Material and methods. Overall 53 patients with complaints of pain, burning, nausea, eructation, flatulence, early satiety, heaviness and distension in epigastrium were investigated. For verification of the «functional dyspepsia» diagnosis all patients were divided into two groups according to results of esophagogastroduodenoscopy. The first group included 18 patients at whom presence of dyspeptic complaints conformed the endoscopic pattern (erosive esophagitis, erosive gastroduodenitis). This group has been excluded from the further study. The second group (35 patients) has been represented by patients with functional dyspepsia at whom clinical symptoms could not be completely explained by the revealed organic changes of gastro-intestinal tract (GIT) – lower esophageal sphincter incompetence, atrophic and superficial gastritis.

Results. Psychopathologic and psycho-diagnostic investigations have shown, that at all patients with functional dyspepsia symptoms of anxiety and depressive disorder have been revealed. Thus moderate depression was detected in 20 (57,1%) patients, severe depression – in 15 patients (42,9%). The level of anxiety by Spielberger scale in 11 patients was in the range of 31–45 points that indicates moderate degree of anxiety, while in 9 patients the anxiety reached severe degree (>46 points).

Conclusions. Obtained data allow to judge quite convincingly that at patients with functional dyspepsia the symptom-complex of disorders related to GIT develops due to clinical manifestations of depression and anxiety.

Aim of investigation. The aim of investigation was improve sensitivity and specificity of endoscopic method of investigation in diagnostics of neuroendocrine tumors (NET) of the stomach.

Material and methods. The complex endoscopic approach in diagnostics NET of the stomach was developed, that included standard examination, narrow-band imaging (NBI) both as independent study and in combination to optical magnification of the image (x115) and subsequent endoscopic ultrasound investigation (EUS) of the pathological focus. This method had been applied in 53 cases with NET of the stomach in N.N.Blokhin Russian Scientific oncological center of the Russian Academy of Medical Science in a period from 2001 to 2010. Results. Analysis of obtained data has allowed to determine three macroscopic forms of NET – sessile, pedunculated and infiltrative and to reveal characteristic endoscopic and endosonographic criteria at various optional diagnostic approaches.

Conclusions. Application of the complex endoscopic approach has allowed to develop endoscopic semeiology of gastric NET. It includes complex of endoscopic and endosonographic signs, characteristic only for this type of neoplasms and provides quite exact differential diagnostics with other forms of epithelial and non-epithelial tumors of the stomach. Besides that, selection of patients for organ-sparing noninvasive radical endoscopic interventions is considerably facilitated.

Aim of investigation. Quantitative analysis of HBsAg contents in the blood in relation to HBV viremia level in patients with various variants of natural course of chronic HBV-infection at dynamic evaluation within 1,5–2 years.

Material and methods. Overall 135 patients with chronic HBV-monoinfection were included in original study. Dynamic assessment of HBV viremia level by polymerase chain reaction and quantitative assessment of blood HBsAg by chemiluminescence was carried out.

Results. Blood HBsAg concentration significantly differed between НВе-positive and НВе-negative phases of chronic HBV-infection. At analysis of serum HBsAg fluctuations in НВе-negative chronic hepatitis B patients no correlation of HBsAg concentration with the level of HBV viremia was revealed at dynamic observation for 1,5 to 2 years. Received data on low HBsAg concentration in a part of inactive HBV carriers allow to consider, that quantitative assessment of HBsAg contents as a supplemental criterion for diagnosis of «hepatitis B virus inactive carriage».

Aim of investigation. To study efficacy and complications of antiviral therapy in patients with liver cirrhosis of HCV-etiology.

Material and methods. Original study included 57 patients with liver cirrhosis of HCV-etiology of A and B classes by Child-Pugh, treated in Sverdlovsk regional center of hepatology, based on «Sverdlovsk regional hospital №1» (Yekaterinburg) in 2008 to 2010. All patients were separated into two groups: the first (27 cases) received antiviral therapy (AVT), the second (30 cases) – received no AVT.

Results. The most significant factor of the positive response to AVT (even transient) was presence of non-1-st genotype of the virus C. Differences in average MELD indices in studied groups of patients at the moment of the investigation onset and after its termination show, that AVT allowed to maintain the degree of severity of cirrhosis at initial level without further progression, and in some cases at achievement of the positive response to antiviral treatment, to reach certain regression of disease.

Conclusions. Optimal candidates for antiviral therapy are patients of younger age with the HCV-associated liver cirrhosis of Child-Pugh A and B classes, with non 1-st genotype. At prescription of this treatment it is necessary to take into account high risk of infections development.

Aim of investigation. To estimate efficacy and safety of «Phosphogliv» in combined therapy of patients with chronic hepatitis C (CHC), that received no previous antiviral treatment.

Preliminary results. Four-week application of phosphogliv (glycirrhizinic acid) in a dose of 2,5 g iv 5 times per week, previous to onset of antiviral therapy (AVT) by standard interferon α-2b/ribavirin in the mode corresponding to revealed genotype, has resulted in statistically significant decrease of serum transaminases: alanineaminotransferase (ALT), asparaginaminotransferase (AST) and gamma-glutamyltranspeptidase (GGT) activity in comparison to the group of the patients, that received only standard interferon α-2b/ribavirin (р <002, Wilcoxon T) to the 4-th week of treatment. At this stage of AVT statistically significant decrease of viral load level in comparison to reference value was observed in both groups. Analysis of cases with rapid virologic response (absence of HCV RNA or its level less than 750 copies/ml) within 4 wks of treatment has shown, that only the group phosphogliv/standard interferon α-2b/ribavirin included 3 such cases and that was especially important – all had the 1-st virus genotype. This fact assumes, that phosphogliv can enhance efficacy of standard treatment as adjuvant to antiviral therapy. In both groups usual side effects of AVT developed, which did not require change of treatment mode.

Conclusion. Final results of the presented study help to estimate the role of rapid virologic response in the treatment of CHC by standard interferon/ribavirin, to define group of patients for which this mode of therapy is associated with favorable prognosis, and to determine the role of phosphogliv as adjuvant agent in antiviral treatment programs.

Aim of investigation. To estimate results of diagnostics and endoscopic treatment of patients with suspicion for early colorectal cancer (ECRC).

Material and methods. Overall 46 patients were included in original study with suspicion for ECRC in the period from 2006 to 2010.

Results. Lesions were localized in the left side of the large intestine (45,6%) more frequently, referred into to the type Is (52,2%). The average size was 17,1±6 mm. The «none-lifting sign» had the greater sensitivity and specificity (88 and 100%) for differentiation of penetrating and superficial/no invasion, than intestinal fossas pattern (68 and 92%). At following accepted criteria (high or moderate grade of tumor differentiation, absence of malignant cells at the crust line, absence of vessel invasion, absence of secondary foci, submucosal invasion of no more than 1000 µm or 2-nd Haggit level) no local relapses or metastatic lesions after endoscopic tumor removal were detected.

Conclusions. Endoscopic erasion of early neoplasms of the large intestine is an effictive method of treatment at strict following of radical surgery criteria.

The aim of review. To present state-of-the art on the role and value of videocapsular and balloon enteroscopy in diagnostics of small intestinal tumors.

Original positions. Tumors of the small intestine are quite rare, despite of major extent of the organ, that is due to the presence of antineoplastic media. Nevertheless, neoplasms in this area are represented by multiple types with various location and nonspecific clinical course, that complicates their diagnostics. The methods of videocapsular and balloon enteroscopy which have appeared in 2001 allow to estimate macroscopic appearance of tumor more clearly, to determine its character and location, to carry out biopsy, to obtain the proof for chemotherapy prescription, to remove tumor endoscopically or determine indications for elective surgery.

Conclusion. Introduction of modern videoendoscopic methods of the small bowel into clinical practice has got diagnostics of neoplasms of jejunum and ileum to new level. Tumors are more frequently diagnosed in time, electively, before development of complications and urgent surgical interventions.

The aim of publication. To demonstrate features of diagnostics and adjustment of treatment in the patient with combined functional disorder, by the example of clinical case.

Original positions. Patient М., 36 years old, female, has referred to the clinic with multiple complaints, such as postprandial feeling of heaviness and epigastric pain, bile vomiting, pain in the right hypochondrium, developing without any obvious cause, poorly localized aching abdominal pain in the afternoon, intensified at the evening time, meteorism, frequent bowel movements, up to 3 times per day (night-time diarrhea was absent), loose stool with admixture of mucus. Patient complained of weakness, drowsiness, dizziness, attacks of subfebrile fever, accompanied by bone aching, frequent painless micturition. Patient felt sick for the first at the age of 7, deteriorations in state of health were directly related to events (or risk of events), requiring mobilization of inner forces – study at school and institute, intrafamily conflicts, individual activity, etc. Patient was investigated repeatedly. Differential diagnostics was carried out between organic disease of gastro-intestinal tract, i.e. gastroduodenal erosions or ulcers, celiac disease, inflammatory bowel diseases, functional disorders. Treatment, that was carried out brought incomplete and inconsistent effect. At admission during physical examination no significant deviations from normal values were revealed except for increased skin sensitivity at palpation of all regions of abdomen. On the basis of complaints, data of past history and physical examination the diagnosis: functional dyspepsia syndrome and irritable bowel syndrome with diarrhea was established. Treatment by trimedat, that modifies nervous reactivity at the level of intestinal wall and spinal cord synapses, was prescribed. It was possible to achieve significant improvement in the state of health on the background of therapy. However, the overall prognosis for this patient is unfavorable. Prescription of pharmacological agents can hardly result in complete cure, as presence of almost constant complaints has «secondary psychologic benefit» for this patient.

Conclusion. The factor determining quite low efficacy of pharmacotherapy at combined functional disorders is the personality features of the patient, that determine relationship with society, and development of symptoms as the adaptive mechanism protecting from necessity to be socially active.

The aim of review. To present the basic concept of dietetic therapy at bowel diseases, as well as the prospects of its improvement by addition of the specific components decreasing intestinal permeability.

Original positions. In modern medicine dietetic therapy is still of value. In the last years essential progress was achieved for diet at diabetes mellitus, peptic ulcer and liver failure. Principles of dietetic therapy at bowel diseases as a whole remain unchanged and are based on the concept of mechanical and chemical sparing during relapse with gradual transition to general diet along with symptom regression. Issues on necessity of complete avoidance of lactose and gluten at «non-gluten» diseases of intestine are still disputable. It was demonstrated, that some components of food, in particular glutamine, omega-3-non-saturated fatty acids, zinc, selenium, curcumine, meletin, in an essential degree promote restoration of mucosal integrity and decrease intestinal permeability. Now these substances became obligatory components of enteric feeding mixtures. Development of alimentary additives and drugs on their basis is going on. Application of pre- and probiotics for stimulation of regeneration and development of functional nutrition products on their basis invokes major interest.

Conclusion. Investigations of methods to reveal those components of food which can have the concealed damaging effect or, on the contrary, to sustain integrity of a mucosa, is still in the progress as well as development of the drugs, food additives and functional nutrition components, which can be applied as addition to traditional diet and promote decrease of intestinal permeability.