The aim of review. To analyze organ-specific features of gastrointestinal myofibroblasts, functional properties, role in embryogenesis and healing of ulcers of gastro-intestinal tract (GIT).

Original positions. Morphology, markers, origin and stimulators of development of myofibroblasts, their involvement in formation of microniche for epithelial stem cells, kinetics of tegmental epithelium, angiogenesis, control of vascular permeability is discussed. These
functions are related to wide spectrum of myofibroblast secretory products, producing molecules of basal membrane, components of matrix and growth factors. Intestinal myofibroblasts are pacemakers for smooth myocytes of GIT, they modulate neurotransmission, participate in modulation of immune response, playing a critical role in reparation of erosions and ulcers of GIT.

The aim of review. To define cirrhotic cardiomyopathy (CCM), to reveal its pathogenic mechanisms, features of clinical manifestations, to reflect main therapeutic approaches, effect of orthotopic transplantation of liver (OTL) and transjugular portosystemic shunting (TIPS) on the course and prognosis of cardio-vascular disorders at liver cirrhosis (LC).

Original positions. Disorder of signal conduction from β-adrenoreceptors, calcium channels receptors, decrease of cardiomyocyte membrane fluidity, increase of nitric oxide and carbon monoxide synthesis, elevation of endocannabinoid system activity and many other changes observed at LC, cause development of complex of structural and functional disorders in myocardium, underlying development of CCM. Results of numerous studies showed suppression of contractile response to action of various physiological and pharmacological stimuli, and disorder of diastolic function of the heart, development of electrophysiological, structural and biochemical changes at LC irrespective of its origin. Experimental and clinical data demonstrated significant improvement of cardiac activity after OTL, while TIPS acts as a kind of stress for the body, that is capable to manifest concealed disorders of cardiac activity at CCM. Low heart output at CCM in spontaneous bacterial peritonitis also increases risk of hepatorenal syndrome (HRS). Development of heart failure (HF) decompensation due to provoking factors action requires application of the standard therapeutic approaches to treatment of such patients. However there is specificity of CCM management: limited application of peripheral vasodilators, careful use of diuretics, absence of substantial effect of b1-agonists and presumably positive effect of b2-adrenoblockers on QT-interval and application of aldosterone antagonists to decrease both pre- and postload on the heart.

Conclusion. In studies, that were carried out, main clinical manifestations of CCM, effect on its course and the prognosis of various pharmacological drugs, application of TIPS and OTL were demonstrated. However, further large randomized investigations devoted to diagnostics and treatment of CCM, receiving serious evidential base are necessary. Their aim should be the detailed studying of pathogenic mechanisms, development of clear standard diagnostic criteria and methods of treatment of this category of patients.

The aim of review. To cite the literature data, confirming efficacy of ursodeoxycholic acid (UDCA) at alcoholic and non-alcoholic steatohepatitis (NASH).

Original positions. Prevalence of liver steatosis as pathomorphologic substrate of various liver diseases is quite high, however the special attention is given to patients with signs of inflammation and fibrosis, i.e. with confirmed alcohol-induced and non-alcoholic steatohepatitis. Article presents pathogenic mechanisms of the most important lesions of the liver – alcoholic and non-alcoholic steatohepatitis in pathogenesis of which the leading part belongs to accumulation of fat in cells of the organ and enhancement of lipid peroxidation processes with development of necrosis of hepatic cells. At assessment of management approach of steatohepatitis patients main etiological factors and background diseases are taken into account. In the case of NASH itself, developed on a background of obesity, diabetes mellitus, keeping a diet in a combination with the adequate physical activity is effective, that results in gradual normalization of body weight. If these means will give no required results, prescription of intestinal triglyceride-lipase inhibitors or anorexigenic agents is rational. Disorders of carbohydrate metabolism (including insulin resistance) serve as the indication for prescription of drugs, that sensitize peripheral tissues to insulin. At alcohol-induced steatohepatitis abstinence is categorical. Corticosteroids are drugs of choice at treatment of severe decompensated forms of alcoholic liver disease, that reduce level of circulating proinflammatory cytokines and promote histological improvement with a short period. UDCA has antiapoptotic, cytoprotective, immunomodulating, anti-oxidative effect, so it can be used as pathogenic therapy at alcohol-induced and non-alcoholic steatohepatitis. Potential of combination of glucocorticoids with anti-oxidative agents, including UDCA, that is especially promising for clinical practice, continues to be studied as well. Prescription of UDCA is recommended at cholestatic variant of acute alcoholic hepatitis for essential decrease of pruritus and improvement of biochemical scores. Cytoprotective effect of UDCA allows to apply it at severe steatosis in absence of inflammation, especially if the patient continues to consume alcohol.

Conclusion. Ursodeoxycholic acid has antiapoptotic and anti-inflammatory effect and good safety profile. Application of UDCA can be recommended for patients with steatohepatitis of various etiology. At alcoholic lesion of the liver complete abstinence of alcohol intake is mandatory. Combination of corticosteroids with anti-oxidative drugs, including UDCA that look most perspective for clinical practice continues to be studied. In the case of NASH itself on a background of obesity UDCA can be prescribed as a drug with cytoprotective, antiapoptotic action, retarding fibrosis.

Aim of investigation. To reveal frequency of clinical and structural and functional features of esophagogastroduodenal diseases at patients with gallstone disease (GSD) in various terms after cholecystectomy.

Material and methods. Questioning of 625 person with cholecystectomy in past history was carried out, 94 patients with GSD, that underwent cholecystectomy, and 62 not operated patients with GSD were prospectively investigated. All patients were examined by endoscopic and histological studies, biochemical and immunoenzyme tests with assessment of the level of elastase, glycosaminoglycans, protein-bound hydroxy-proline, interleukins 1, 8, 10 in blood serum, in part of patients 24-hour pH-metry was done. Results. In operated patients, with increase of time, past after surgery, significantly more frequent atrophic and reflux-gastritis, duodenogastric reflux, duodenitis were found, atrophy, metaplasia and dysplasia of stomach epithelium grow. Inflammatory and erosive-ulcerative changes of esophagogastroduodenal mucosa in these patients develop and progress on a background of disbalance of cytokines and metabolites of connective tissue in blood serum, the most severe in terms over 3 years after cholecystectomy. After operation secretory and motor dysfunction of gastroduodenal zone aggravated: significantly more frequent decrease secretion of muriatic acid, duodenogastric and duodenogastroesophageal refluxes were found. Studying of the contents of interleukins, as well as parameters of reparation and destruction of connective tissue in blood serum have highly diagnostic value in evaluation of severity of changes of gastroduodenal zone. Patients with GSD after cholecystectomy, should be included to group of dispensary observation and the directional therapeutic management.

Conclusions. Parameters of concentration of interleukins 1, 8, 10, elastase, glycosaminoglycans, proteinbound hydroxy-proline in blood serum can be used as additional criteria of noninvasive diagnostics of gastroduodenal diseases in postcholecystectomy patients.

Aim of investigation. To present data on screening investigation of patients at suspicion for diffuse liver disease, including series of routine methods specified by medical standards.

Original positions. Article presents data on diagnostic accuracy, sensitivity, specificity of taken into account methods both separately and at integrated application in comparison to subsequent biopsy and liver elastometry.

The aim of review. To assess clinical efficacy of antisecretory drugs at gastroduodenal ulcer bleedings.

Original positions. Parenteral forms of Н2-blockers as conservative hemostasis components showed efficacy which statistically does not differ from that of placebo. Metaanalysis of 18 studies revealed, that continuous intravenous infusion of omeprazole significantly reduces frequency of recurrent hemorrhage. Parenteral injection of esomeprazole after endoscopic hemostasis provides highly effective decrease in frequency of recurrent ulcer bleeding in the first 72 hs of hospital stay, as well as for the next 7 and 30 days.

Conclusion. Prolonged intravenous injection of esomeprazole with subsequent intake of the drug per os is proved for application in clinical practice for patients with bleeding stomach and duodenum ulcers after endoscopical verification of hemostasis.

The aim of review. To generalize modern indications for bismuth drugs at treatment of gastroenterological diseases, and to estimate safety of their application basing on the literature data.

Original positions. Preparations of bismuth (first of all – bismuthate tripotassium dicitrate) can be applied as main component of helicobacter eradication modes of the second (and in some cases – the first) line, as a drug for monotherapy for acute infectious diarrhea (in particular – travellers diarrheas), and also several chronic bowel diseases (postinfectious IBS, lymphocytic and collagenous colitis). Short (4–8 wks) courses of bismuth treatment are well tolerated by patients, are safe and do not cause serious side effects.

Conclusion. Carried out analysis testifies that agents of bismuth still take the important place in the treatment of gastroenterological diseases.

The aim of review. To demonstrate a role of fermented-milk bacteria, first of all Lactobacillus and Bifidumbacterium geni, and their metabolic products – short-chain fatty acids in regulation of peristalsis of the bowel.

Original positions. In clinical studies the effect of probiotic strains on severity of symptoms of functional bowel disorders is investigated. The greatest attention is given to the effects of Bifidobacterium animalis DN-173 010 strain (commercial name — ActiRegularis). It was found out, that probiotics containing various strains of Lacto- and Bifidobacteria, have mild purging action without the essential undesirable effects and reduce abdominal dyscomfort.

Conclusion. The product containing Bifidobacterium animalis DN-173 010 strain (commercial name — ActiRegularis) is effective for medical and preventive purposes for correction of frequency and improvement of stool consistence, decrease of abdominal distention both at functional bowel disorders, and at practically healthy people.

The aim of publication. To present a case of sarcoid-like reaction development, induced by antiviral therapy, in patient with chronic hepatitis C, as well as the management approach for this patient.

Features of clinical case. At female 53 year-old patient with chronic hepatitis C (HCV RNA+, genotype 1b) of moderate activity (А2, F0 by METAVIR scale) development of granulomatous pulmonary lesion accompanied by fever, respiratory failure, asthenic syndrome had been observed on the 22-nd week of antiviral therapy by PEG-interferon and ribavirin. Sarcoid-like reaction has been diagnosed. At computer tomography of the chest organs bilateral miliary monomorphic dissimination on a background of interstitial changes was found, intrathoracic lymph nodes were increased in their number and size. Cessation of antiviral therapy did not result in improvement of patient’s state within 2 months. Immune-suppressive therapy by methylprednisolon and phosphogliv was prescribed, that resulted in complete regression of clinical symptoms and radiological changes in the lungs. Sustained virologic response was preserved in the patient.

Conclusion. Sarcoid-like reaction falls to rare unpredictable complications of antiviral therapy. Expected side effects of antiviral therapy can mask development of sarcoid-like reaction.

Aim of investigation. To study potentials of simultaneous radical operations at rectal cancer with lymph node dissection and application of low and ultralow colorectal anastomoses.

Material and methods. For 25 patients with cancer of the rectum radical surgery with lymph node dissection in D2 and D3 volume according to the level of tumor location was carried out. Reconstructive stage of operation was carried out with application of low and ultralow colorectal anastomoses by circular-stapler device of «Eticon» company. Results. No complications in postoperative period were marked. Term of observation was 1 year. No relapses and metastases were registered.

Conclusions. Preliminary data allow to make conclusion on expediency of these types of operations with application of circular-stapler device and lymph node dissection.

Aim of investigation. To highlight experience of treatment of patients after circular mucoso-submucosal resection of low-ampullary region of the rectum (stapled hemorrhoidopexy) with clinical and instrumental investigation of operated patients in early and remote postoperative periods.

Material and methods. Monitoring of 197 patients with hemorrhoids, operated by specified procedure was carried out. The age of patients varied from 27 years to 71 years (average – 43,5±10,6 year). Of them 118 (59,8%) were men and 79 – (40,2%) women.

Results. Considered method is an efficient treatment mode for hemorrhoids of II–IV stages. Operation is followed by long-lasting clinical effect, small number of postoperative complications and reduces terms of aftertreatment of operated patients.

Conclusion. Pathogenetic validity of this operation basing on mechanical and vascular theories of hemorrhoids development is proved.

A.M. Polenov – Diagnostics and treatment of sphincter of Oddi dysfunction after cholecystectomy.

S.A. Abdullayev – Clinical value of polymorphism of cytokine genes and hemochromatosis gene at chronic hepatitis C patients.

S.A. Abdullayev – Clinical value of polymorphism of cytokine genes and hemochromatosis gene at chronic hepatitis C patients.