The aim of review. To present methods of studying of portal hypertension and means of its pharmacological treatment in experiment settings.

Original positions. To study complex pathophysiological disorders, innate to portal hypertension, various pilot models providing complex evaluation and development of adequate treatment methods are used. Nowadays mechanisms of hyperdynamic circulatory status development are detailed on laboratory animals. Ex vivo studies gave physiological characteristic to the mediators causing splanchnic vasodilation and increasing of vascular tension in cirrhotic liver, and methods of molecular biology identified defects in signalling routes responsible for disorders of metabolism of these substances.

Conclusion. In the last years application of various pilot models of portal hypertension promoted progress not only in understanding of pathophysiological mechanisms laying in its basis, but also development of new perspective methods of treatment. The further randomized controlled clinical studies will help to determine their safety and efficacy comparing to traditional treatment methods.

The aim of publication. To present up-to-date data on the role of disorders of motor function of the esophagus in development of gastroesophageal reflux disease and mechanisms of transient lower esophageal sphincter relaxations (TLESR) on functional activity of antireflux barrier.

Original positions. There are several components of TLESR mechanism: decrease of the lower esophageal sphincter pressure, modulated by inhibiting impulses; decrease of compression by crures of diaphragm; intensive contraction of longitudinal muscles of the esophagus; relaxation of circular musculature layer at its distal part. There are differences in TLESR mechanism between healthy persons and patients with gastroesophageal reflux disease (GERD) i.e.: at healthy subjects only gas enters the esophagus from the stomach during TLESR in contrast to patients with reflux disease. Obesity increases potential of TLESR appearance, associated with reflux of liquid contents from the stomach.

Conclusion. Taking into account comprehension of available regulatory parts, reality of influence on esophageal motility and especially LES is tempting. Studying of this function opens encouraging prospects of improvement of treatment of GERD.

Aim of investigation. To estimate the efficacy of vaccination against hepatitis B in patients in the Waiting list for liver transplantation, in prophylaxis of de novo infection of a graft.

Material and methods. Results of vaccination against hepatitis B in 41 patients with liver cirrhosis included into the Waiting list for orthotopic liver transplantation (OLT), and dynamics of HBV seromarkers in 72 patients before and after liver transplantation were analyzed.

Results. Only in 9 (22%) of the patients vaccinated against hepatitis B, the level of anti-HBs to the moment of OLT was over 100 mMU/ml. At one third of patients who had no signs of HBV-infection in past history before operation, anti-HBc have been revealed after OLT. In half of them de novo graft HBV-infection developed. Presence of anti-HBs in blood serum of recipients prevented infection even if anti-HBc appeared after OLT.

Conclusion. Vaccination against hepatitis B of patients with liver cirrhosis, etiologically not related to HBV-infection, standard doses of vaccine under the accelerated mode in most of the cases does not provide effective and sustained immunodefence and does not prevent development of graft HBV-infection de novo.

Aim of investigation. To study the prevalence of H. pylori infection among able-bodied population of Moscow.

Material and methods. Diagnostics of Н. pylori infection was implemented at 863 working inhabitants of megacity. Antihelicobacter IgG antibodies were determined in blood serum by immunoenzyme method. In 264 persons with diagnosed Н. pylori infection antiCagA-antibodies were studied. Interview of 634 persons have been taken using original questionnaire by random sample.

Results. Extremely high prevalence of infection – 88% was found. Risk factors of infection among population of the town were revealed: age, poor education, bad living conditions (residing at hostel or in shared apartment), absence of the water drain and contact with sewage. No relation of infection prevalence to gender, drinking of non-boiled Moscow tap water and contact with domestic animals was marked.

Conclusion. Moscow falls into group of cities with extremely high Н.pylori-infection prevalence, with predominance of virulent bacteria strains. Risk factors of Н. pylori infection in megacity were revealed.

Aim of investigation. To determine activity of trypsin-, collagenase- and elastase-like proteinases, a1- proteinase inhibitor, a2-macroglobulin and contents of hydroxyproline in intestinal mucosa and blood plasma of patients with bowel diseases.

Material and methods. Sixty patients with ulcerative colitis, 42 – with Crohn’s disease, 18 - with irritable bowel syndrome and 30 practically healthy persons were investigated. A supernatant, obtained from biopsy specimens of intestinal mucosa, was used for assessment of biochemical parameters. Activity of trypsin-like proteinases was estimated by hydrolysis of synthetic substrate N-benzoyl-L-arginine ethyl ester (BAEE). Activity of a1-proteinase inhibitor (a1-PI) and a2-macroglobulin (a2-MG) was determined by unified method on of BAEE hydrolysis inhibition. A degradation of fibrous proteins of connective tissue was estimated by activity of elastase- and collagenase-like proteinases and by the contents of hydroxyproline fractions. Activity of elastase- and collagenase-like proteinases was determined, using N-butoxycarbonyl-L-alanine p-nitrophenyl ester (BANE) as substrate.

Results. Activation of proteolysis in mucosa of intestine and blood plasma of patients on a background of decrease of activity of proteinase inhibitors and elevation of hydroxyproline contents was revealed. Changes were most severe at Crohn’s disease in comparison to ulcerative colitis and irritable bowel syndrome. At ulcerative colitis along with increase of severity grade activity of trypsin-, elastase-like proteinases and level of free hydroxyproline of intestinal mucosa increased. By logistical regression method it was calculated, that deficiency of a2-MG increases the risk of Crohn’s disease development 3,85 times.

Conclusion. At ulcerative colitis and Crohn’s disease in mucosa of intestine activation of trypsin-, elastase- and collagenase-like proteinases on a background of decrease of activity of a1-PI and a2-MG that results in degradation of connective tissue proteins is observed. The most severe disorder of collagen and elastin metabolism, i.e. substantial increase of collagen decomposition products, proteinases activity on the background of deficiency of inhibitors in mucosa of intestine and blood plasma occurs in Crohn’s disease.

Aim of investigation. To analyze prevalence and risk factors of heartburn in organized population of administrative centre of Khakasia republic.

Material and methods. The epidemiologic screening diagnostics of gastroesophageal reflux disease was carried out by simultaneous (transverse) method at «Abakanvagonmash» enterprise in the city of Abakan at 1411 persons (506 native, 905 extraterrestrial) – the total scope was 93%. Results of clinical survey and interviewing were recorded in standard questionnaire of Mayo clinic for studying of heartburn.

Results. Prevalence of common heartburn was 31,4% in Caucasians and 25,5% — in Khakases, р=0,02, weekly heartburn – 14,7 and 10,3% respectively, р=0,02. In both ethnic groups studied scores were in direct relation to increase of age, excessive body weight and obesity. At Caucasians tobacco smoking abuse was a risk factor both in men (OR 3,25), and in women (OR 1,71). At Khakases only men (OR 2,79) showed this pattern, but not women (OR 1,31).

Conclusion. Ethnic features of clinical and epidemiologic characteristic of GERD were registered in studied populations.

The aim of publication. Main questions which arise both at the attending physician, who prescribes investigation of the small intestine, and at endoscopist doctor who plans to perform this invasive intervention are discussed. History of the issue, indications, contraindications and restrictions of this method, technical aspects of investigation, diagnostic and medical options of deep enteroscopy are briefly covered.

Original positions. Being based on literature data and personal experience authors show, that balloon enteroscopy provide stable access to deep regions of the small intestine and helps to carry out high performance diagnostics of its diseases. The option of biopsy of mucosa and medical interventions is one of the most attractive features of this method.

Conclusion. Authors believe, that wide application of deep enteroscopy in clinical practice will change existing concept on frequency, origin and nature of various pathological changes of small intestine.

Aim of investigation. To study potential of application of up-to-date laser technique and new technologies at multistage method of surgical treatment of patients with high posttraumatic fistulas of rectum.

Material and methods. At 46 patients with posttraumatic fistulas of rectum the multistage method of surgical treatment with application of modern laser technique, specific instruments and new technologies was utilized. During operation (at resection of intestine, resection of necrotic tissues and stumps of fistulous tract, management of purulent sinus) carbon dioxide laser device «Lancete-2» (wave length – 10,6 microns) and contact laser device «Atkus-15» (wave length – 0,81 microns) were used. The surgical intervention in 2 stages has been executed at 11 (23,9%), in 3 stages – at 31 (67,4%) and in 4 stages – at 4 (8,7%) patients.

Results. The multistage method of surgical treatment with application of modern laser technique and new technologies allows to stop inflammatory process in pararectal fat, provides an option of combined surgical interventions, improves functional results, decreases of frequency of relapses, shortens terms of wound repair and decreases the risk of development of incompetence of anal sphincter.

Conclusions. At localization of internal fistulous orifice in lower-, middle- and highampullary parts of rectum with severe inflammatory complications and purulent sinuses on within fistula tract, concomitant anal incontinence multistage surgical treatment is required. Application of original procedure allows to achieve high-grade medical and social rehabilitation of patients.

Aim of investigation. To estimate results of subtotal colectomy with antiperistaltic cecorectoanastomosis without dislocation of ascending colon and caecum.

Material and methods. Operation is executed at 25 patients. From them 20 patients are operated for chronic constipation with delayed passage through the large intestine (1-st group) and 5 patients with colostomas underwent simultaneous resection of affected regions of the large intestine, liquidation of stoma and restitution of continuity of intestinal tract (2-nd group).

Results. No postoperative complications were found. In 1 month at 11 patients periodically had frequent defecations requiring medicamental treatment. In 6 months after surgery average frequency of defecations in the 1-st group was 1,7 per day, in the 2-nd – 2,2 per day.

Conclusion. A subtotal colectomy with antiperistaltic cecorectoanastomosis is a simple and effective method of operative treatment of both severe cologenic constipation, and other diseases demanding resection of the most part of the colon.

The aim of the publication. To describe various methods of pH-metry and investigation of motor function of the esophagus, to expose a role of these methods for diagnosis statement and choice of treatment.

Original positions. Studying of motor function of the esophagus allows to obtain data on intraluminal pressure, coordination and motility of muscles of the esophagus, to carry out differential diagnostics of primary and secondary disorders of this function, differential diagnostics at chest pain of non-cardiac origin, to reveal and estimate defects of peristalsis before antireflux surgery and after surgical intervention, to estimate efficacy of carried out treatment. Manometry is an auxiliary method at carrying out of 24-hour pHmetry of the esophagus as well. 24-hour (or 48-hour) pH-metry is «the gold standard» diagnostics of GERD. Impedance measurement method allows to observe bolus passage in the esophagus without application of X-ray investigation and irradiating of patients, to establish physical properties of refluxate (gas, fluid, mixed), that is important at a choice of treatment.

Conclusion. Disorders of esophageal motility can be revealed by various systems of monitoring. Nowadays manometry is informative and available diagnostic method for a doctor. Assessment of physical and chemical properties of refluxate and parameters of peristalsis of the esophagus is necessary for establishment of etiology and pathogenesis of diseases that allows to prescribe specific treatment to the patient.

The aim of publication. To demonstrate contradictory issues of interrelation of «chronic gastritis» (CG) and «functional dyspepsia» (FD) concepts.

Original positions. Notwithstanding what at the majority of FD patients have the signs of concomitant CG, foreign doctors do not use this diagnosis in clinical practice. On the contrary, in such cases the Russian doctors prefer to diagnose CG. Combination of specified diagnoses is most justified, which allows to estimate severity of morphological changes of mucosa of the stomach, to establish basic pathophysiological mechanisms of development of dyspeptic complaints, to determine optimal management approach.

Conclusion. The problem of mutual relations between FD and CG has debatable character and deserves wide discussion.