The aim of review. To generalize cumulative data on the role of stem cells (SC) in treatment of gastroenterological diseases.

Original positions. Cell-based treatment is rather new and, probably, promising trend in treatment of many severe diseases in which traditional methods fail to achieve due results. In therapeutic aspect of gastrointestinal and liver diseases inflammatory bowel diseases, colorectal cancer and decompensated liver cirrhosis seem to be most perspective at the present stage. At the same time clinical application of SC is associated to array of serious problems: immune rejection and «graft-versus-host» response, neoplastic transformation as well as ethical and religious restrictions.

Conclusion. Application SC in clinical gastroenterology is premature today. Their efficacy and safety requires confirmation in multicenter randomized trials.

Aim of investigation. To estimate necessity and potentials of dynamic esophagogastroduodenoscopies (EGDS) at successful primary hemostasis in patients with high risk of relapse of bleeding.

Material and methods. Retrospective analysis of case records of 332 patients hospitalized for bleeding from chronic stomach and duodenum ulcers was carried out. Evaluation of results in 122 patients after repeated EGDSs was carried out with account to causes of inefficiency of previous investigations.

Results. Repeated gastroscopies were caused by: relapse of bleeding – in 21 (17,2%) patient, of them in 81% of cases it developed within first 3 days after primary examination, non-informative initial EGDS – in 12 (9,8%), control gastroscopy in dynamics – in 89 (73%). Frequently the bleeding relapses in early terms educed due to ineffective endoscopic hemostasis at active bleedings or absence of prophylaxis at high risk of relapse (Forrest IIA-IIB) at previous gastroscopy. Control gastroscopies in 55 (62%) patients were performed in 1 day after primary investigation that allowed in 6 patients with high risk of bleeding relapse to reveal active recurrent bleeding before its clinical manifestation. In 39 (32 %) patients further required repeated gastroscopies, 17 (14%) patients were urgently operated in relation to ineffective endoscopic hemostasis or high risk of bleeding relapse at repeated EGDSs. Of all patients 19 died (15,6%), of them 5 – in postoperative period.

Conclusions. Principal causes of repeated gastroscopies were relapses of bleeding in early period after primary hemostasis and ineffective investigations. Relapses of ulcerative bleeding develop mostly in the first 3 days after primary hemostasis. At clinically significant relapses repeated gastroscopy with preventive actions is proven in patients with high operational risk on concomitant diseases (4–5 points by ASA scale). Repeated endoscopic investigations have no significant effect on clinical results of treatment of ulcerative bleedings, frequency of relapses, operative activity, mortality.

Aim of investigation. To reveal features of nervous system in children with various variants of irritable bowel syndrome (IBS).

Material and methods. Overall 125 patients with IBS in the age of 3 to 17 years were included in original study. Features of pre- and postnatal past history were investigated, trigger factors promoting onset or relapse of this disease were analyzed. Assessment of initial state of autonomous nervous system by electroencephalography and heart rate variability measurement (HRV) was carried out.

Results. Investigation of the state of autonomous nervous system in children with IBS, was carried out by HRV, objectively demonstrated disorder of autonomous body supply in motor and evacuatory dysfunction of gastro-intestinal tract (constipation, diarrhea).

Conclusions. Disorder of autonomous function of the body is objectively detected at various clinical variants of IBS at children.

Aim of investigation. To evaluate the dynamics of clinical symptoms of constipation at children and parameters of peripheral electrogastroenterography (PEGEG) on treatment with osmotic laxative polyethylene glycol 4000 (PEGs).

Material and methods. For treatment of constipation in 15 children aged 5 to 17 years (average – 9,9±3,9 year) 14-day's course of intake of osmotic laxative PEG (Forlax®, «Beaufour Ipsen Pharma», France) was prescribed. The drug was prescribed under following mode: to children under 8 years of age - 1 sachet (4 g) bid (8 g/day), over 8 years – 1 sachet (10 g) 2 times day (20 g/day) for 14 days. With the help of specifically designed original questionnaire dynamics of clinical symptoms of constipation, and changes of scores of electrical activity of various regions of gastro-intestinal tract (GIT) by PEGEG was estimated. Results were processed by computer programs Microsoft Excel and Statistika 7.0 software.

Results. Complaints prior to the treatment onset included constipation (93%), difficulty of defecation (93%) and straining at defecation (87%). All children complained of hard stool. Complaints of long time spent in lavatory (67%) and «scybalous stool» (60%) had about half of all patients in the study. The symptoms testifying complication of disease, such as spastic abdominal pain (80%), flatulence (87%) and anal painfulness (73%) were revealed as well. As a result of treatment in all patients normalization of defecation act frequency, and resolution or significant decrease of other clinical symptoms of constipation are marked. Dynamics of PEGEG parameters, namely electrical activity (Pi/Рs) of every region of GIT before treatment, quotient of various gut regions interrelation, and rhythmicity quotient (Kritm) in general, proved presence of concomitant pathology of the upper parts of GIT, severe dysfunctional disorders. At the same time scores representing electrical activity of the large intestine, remained subnormal both prior and after course of treatment. In no patients drug side effects were not observed.

Conclusions. The osmotic laxative polyethylene glycol 4000 has high clinical effect at treatment of constipation in children.

The aim of review. To analyze main epidemiologic tendencies of development of alcoholic liver disease, mechanisms of its development, mortality in this population of patients. To discuss an option of new targets for treatment of this disease.

Original positions. Alcohol abuse is the third leading cause of morbidity and mortality in the young age. In the studies it was demonstrated, that there is significant difference in death rate of liver cirrhosis between European countries. Disease risk factors include: amount of taken alcohol, its type, frequency of use, female gender, excessive body weight. Besides damaging effect, in response to admission of alcohol processes of protection and neogenesis of the liver through activation of IL-6, IL-22 receptors, STAT-proteins system are initiated. Mechanism of TNFα action, resulting in apoptosis of hepatocytes through activation of acidic sphingomyelinase is investigated.

Conclusion. Application of acidic sphingomyelinase, influence on Kupffer's cells phenotype, cannabinoids receptors as new targets for treatment of alcoholic liver disease is possible. At treatment of patients with severe alcohol-induced hepatitis corticosteroids considerably increasing 28-day's survival rate are actively applied. To increase efficacy of treatment of acute alcoholic hepatitis the issue of addition to standard treatment by glucocorticosteroids IL-22 is taken into account.

Aim of investigation. To study damage of liver tissue, its infiltration by cells of innate and adaptive immunity and cell deathin the development of concanavalin (ConA)-induced hepatitis in mice.

Material and methods. Histological, cytologic and biochemical methods were applied. Activity of alanine transaminase in blood serum, activity of myeloperoxidase in liver tissue, cell deathby double vital staining, damage rate of microcirculation channel and parenchyma of the liver, diffuse and focal infiltration and cellular composition of infiltrates were investigated.

Results. Primary reaction of the liver at injection ConA consist in inflammatory changes in vascular bed followed by parenchymal disorders. Infiltration by leukocytes in the liver was increased, initially essentially grew neutrophilic, and then - lymphocytic. In the early terms after ConA injection destruction of thymic cells was amplified mainly by apoptotic pathway, and spleen cells – by necrotic pathway.

Conclusions. Obtained data assume, that infiltration of the liver by leukocytes, in particular neutrophiles, in combination to ascending necrotic destruction of peripheral cells of innate and adaptive immunity can be the essential pathogenic mechanism at inflammatory liver diseases of T-cell origin.

Aim. To estimate the impact of recipient IL28B genotypes on rapid (RVR) and early virologic responses (EVR) pattern in liver transplant recipients undergoing antiviral treatment (AVT).

Material and methods. Blood samples were screened for single nucleotide polymorphisms (SNP) near the IL28B genes (rs8099917 T ≥G and rs12979860 C>T) by kit «AmpliSens® Genoscreen-IL28B-FL» (CRIE) in 24 HCV-infected recipients. All the patients underwent pegylated interferon-alfa with (n=21) or without (n=3) ribavirin at least for 12 weeks.

Results. Five recipients achieved RVR (one has HCV genotype 1 and 4 patients – HCV genotype 2 or 3) and other 10 – complete EVR. In 6 cases slow virologic response (aviremia between 12 and 24 weeks of treatment, SlVR) occurred. Three patients remained non-responders. G-allele (rs80999917) was present in 3 (20%) out of 15 pts. with complete EVR and in 5 out of 6patients with SlVR (p=0.014). Genotype C/C (rs12979860) was present in 6 (40%) patients with complete EVR and in none of slow-responders (one-sided p=0.041).The groups of recipients with and without complete EVR were comparable with sex, age, pre-treatment viral load, immunosuppression (cyclosporine vs. tacrolimus), weight and body mass index, and mean ribavirin dose. The only pre-treatment factors which have impact on complete EVR were genotype (1 vs. non-1) and IL28B polymorphisms.

Conclusion. The SNP in IL28B region may predict slow response to AT in post-LTx setting and should be considered when AT duration is planning.

The aim of publication. To show diagnostic and treatment algorithm for patients with cholestatic syndrome by the example of clinical case.

Features of clinical case. The patient self treated for a long time by various infusions and medicinal herbs (including the Chinese tea; celandine) with no medical control. On a background of such treatment within several weeks symptoms of severe general weakness, jaundice of skin and scleras, pruritus, disorders (inversion) of sleep have appeared. Multiple elevation of serum transaminase level and markers of cholestasis was revealed. The acute cholestatic hepatitis was diagnosed, that developed on a background of herbal infusions and celandine intake. As a result of the carried out therapy (desintoxication preparations, ursodeoxycholic acid) and cancellation of all possible hepatotoxic agents symptoms of disease gradually regressed and improvement of laboratory parameters was marked.

Conclusion. In the submitted case a main role in recognition of an etiology of liver disease have played by careful taking of past history and analysis of all possible causes of disease, that can be the key point in diagnostic search and choice of patient management tactics.

Aim of investigation. To estimate efficacy of ileostomy in patients with Crohn's disease of the large intestine with perianal involvement.

Material and methods. Overall 43 patients with Crohn's disease of the large intestine with perianal involvement who underwent ileostomy in January, 1998 to July, 2009 in The State scientific center of coloproctology were included in original study. According to the spread of inflammatory process patients were distributed as follows: in 4 patients (9,3%) – proctosigmoiditis, in 15 (34,8%) – left-side lesion and in 24 (55,9%) – total involvement of the large intestine. Perianal lesions were presented by following types: ulcers-anal fissures – in 6 (14%) patients, rectal fistulas – in 12 (27,9%), strictures of anal canal – in 3 (6,9%), combinations of two and three types of perianal lesions were present in 22 (51,2%) patients. Results. Thirty five of 43 patients (81,3%) were monitored in terms from 1 to 12 months (М=5,5±2,6). Twenty four of 35 (68,5%) patients underwent local conservative treatment in period from 1 to 6 months (М=4,1±1,1), that provided healing in 11 cases to 2,8±1,4 month. Surgical treatment of perianal lesions was performed in 11 (31,5%) patients in terms from 2 to 12 months (М=5,9±3,6), healing was obtained in 9 patients on average up to 4,5±2,2 month in terms from 2 to 9 months.

Conclusion. At total involvement of the large intestine in combination to two and more types of the perianal lesions along with severe metabolic disorders, ileostomy should be applied as the first-line surgical treatment.

Aim of investigation. Radical surgery at complicated forms of colorectal cancer frequently results in colostoma formation. In due course in diverted regions colitis of non-infectious character educes. The study is devoted to revealing of degree of morphological changes of defunctioning loop wall in relation to terms of colostoma formation.

Material and methods. Tissues received at resection of nonfunctioning regions of intestinal stump in 255 patients were subject of the study. Morphological investigation was carried out under the practical standard with staining of samples by hematoxylin and eosine. Stereometric analysis principles were used. Reconstructive and restitutional operations with formation of transverse-rectal or sigmoido-rectal anastomoses «end-to-end» with liquidation of colostoma in various terms, but mostly in 2–2,5 months (early surgical rehabilitation).

Results. Investigations demonstrated development of processes of remodeling in mucosa of defunctioning loop of atrophic type with decrease of quantity of mucus-producing epithelial cells. Simultaneously on a background of developing immunodeficiency there was progression of inflammatory processes, up to microabscess development. The direct interrelation between degree of «diversive» colitis and terms of intestine diversion from intestinal passage was is found. At early surgical rehabilitation in 125 patients no incompetence of anastomosis was observed. The postoperative morbidity rate was 7,2 % (9 patients).

Conclusions. Moderate inflammatory changes in defunctioning loop do not influence processes of healing of interintestinal anastomosis at early surgical rehabilitation.

The aim of publication. To present clinical case of the patient with functional disorder of gastro-intestinal tract (GIT) at combined management by gastroenterologist and psychiatrist.

Original positions. Patient Ch was monitored in the V.Kh.Vasilenko Clinic of propedeutics of internal diseases, gastroenterology and hepatology since 2001. Taking into account patient’s complaints (bloating and abdominal pain relieved after defecation, frequent stool up to 3–5 times per day, incidental imperative urgency to defecation and feeling of incomplete defecation), and long-term benign course of disease, absence of organic changes, according to results of laboratory tests and instrumental investigations irritable bowel syndrome has been diagnosed. However with the account of indications for psychiatrist consultation of patients of the functional diseases of GIT patient was referred to psychiatrist, first, for disorder of social adaptation which could not be explained by presence of GIT-related complaints, and second, each dialogue with him invoked inexplicable negative reaction in nurses and doctors. Patient received course of symptomatic treatment on which background some improvement of intestinal complaints was achieved. At the end of treatment patient was consulted by psychiatrist according to which opinion the state of the patient conformed several ICD10 headings, first of all to the mixed anxiety-depressive disorder, as well as to somatoform disorder of autonomous dysfunction type. Antianxiety treatment has been prescribed at which anxiety improved slightly. From now on the patient was constantly monitored by gastroenterologist and psychiatrist that allowed to improve considerably his social adaptation and to reduce severity of somatic complaints.

Conclusion. This case reflects problem of major group of patients, whose somatic complaints cannot be more exhaustively explained at objective medical investigation. Till now still there is no established position on treatment of such patients, significant part of whom receives treatment recommended at clinically similar somatic disease. In some cases their treatment can be not only conservative, but also invasive: operations, repeated diagnostic manipulations, etc. In some cases, when the physician implicates mental parentage of somatic symptoms, certain patients are referred to psychiatrist. More and more doctors recognize pathogenic relation between psychological disorders and physical symptoms without obvious organic substrate and, therefore — necessity of creation of interdisciplinary alliances to provide qualified aid to considerable number of such patients.

The aim of the publication. The control of hemostasis is important investigation in clinical practice. The differential diagnosis between surgical and coagulopathic nature of bleeding after the invasive intervention helps to choose optimal algorithm of patient management. Presented clinical case illustrates approach to investigation and treatment of such patients.

Original positions. Patient K., male 54 years was hospitalized to the clinic for decompensated liver cirrhosis of toxic and viral etiology. Due to high severity of patient’s state he was directed to intensive care unit. Intravenous infusion therapy required installation of central venous catheter, that was complicated by catheter bleeding. Application of thromboelastography helped to differentiate disorder of systemic hemostasis from mechanical damage of blood vessels at catheterization. Coagulopathic nature of complication has been confirmed. Dynamic control of thromboelastography allowed to estimate efficacy of transfusion therapy and to plan ways of its correction.

Conclusion. Estimating the submitted clinical case, it is possible to conclude on necessity of thromboelastography in patients with bleeding, which can develop both due to disorder of hemostasis (at patients with failure of protein-synthetic liver function), and due to invasive intervention. Data of thromboelastography help to adjust hemostatic treatment adequately and to avoid additional tests, and, probably, surgical interventions.

Ch.S. Pavlov – Liver fibrosis at chronic viral hepatitis B and C.