Aim of investigation. To analyze initial stages of coupling between membrane hydrolysis of nutrients (sugar dimers) and membrane transport of formed monomers in rats and humans.

Material and methods. Electrophysiological experiments carried out on resected segments of small intestine of rats weighted 160 to 550 g (85 animals). The group of patients included 19 person in the age of 17–80 years with abdominal ischemia syndrome, chronic gastritis, gastric ulcer, irritable bowel syndrome. Method of gastric of short circuit current (SCC) in original modification was used. Values of responses of current to addition of nutrients (monomers and sugar dimers) in the mucosa-washing solution, used accepted, as it is consented up to now, as a measure of Na+-dependent nutrient absorbtion rate.

Results. SCC responses to glucose and maltose taken in 2:1concentration, under all tested conditions (85 pairs) appeared almost equal. The correlation coefficient was 0,992, linear regression equation was Аgl = 0,1 + 1,05 × Аml. Along with approach of maltose molecules to surface of enterocytes they without any delay, that could be necessary to fill certain hypothetical nearmembrane layer by molecules of released glucose, participate in development of the response of short circuit current. Hence, in rats Na+-dependent transport (absorbtion) of maltose and glucose is carried out by the same enzymatic-transport ensamble. For humans statement of the question on existence of enzymatic-transport ensemble due to initial disparity of serial responses to maltose (5 mM) and glucose (10 mM) makes no sense.

Conclusions. In rats Na+-dependent transport of maltose and glucose is carried out by the same mechanism. In enterocyte brush border of animals there is enzymatic-transport ensemble splitting molecules of maltose in two molecules of glucose which are immediately transferred to transport system entrance (A.M. Ugolev). In humans such enzymatic-transport ensemble is absent. Free and maltose glucose, apparently, are transported through brush border of enterocytes by two various mechanisms.

The aim of review. To present literature data on iron-regulatory hormone of the liver hepcidin and mechanisms of its involvement in reactions of congenital immunity.

Original positions. Hepcidin is coded by HAMP gene (Hepcidin Antimicrobial Peptide) in chromosome 19. Expression peptide mRNA in hepatocytes is induced by proinflammatory cytokines (IL-1α, IL-6 and TNF-α) similar to acute phase proteins of inflammation, and also by liver iron overload. Hepcidin promotes elevation of natural resistance of the body to infection, first of all due to direct bactericidal effect. Moreover, as key iron-regulatory hormone at conditions of infectious process it initiates systemic rearrangement of iron metabolism, reducing its availability to microorganisms. So-called inflammation anemia (anemia of chronic diseases) serves as clinical and morphological manifestation of this rearrangement, which severity correlates to unfavorable course of chronic hepatitis B and C, as well as neoplastic, renal and cardiac diseases. There are data on involvement of hepcidin in suppression of р53- controlled tumors.

Conclusion. Unique properties of hepcidin allow to consider this peptide as a part, linking two major systems of homeostasis maintenance – nonspecific protection of the body and iron metabolism.

Aim of investigation. To study prevalence and clinical aspects of Barrett’s esophagus at native and extraterrestrial inhabitants of Khakasia republic.

Material and methods. Clinical investigation and esophagogastroduodenoscopy were carried out at 12975 Caucasians and 1489 Khakases in the age of 18 to 65 years. Diagnosis of Barrett’s esophagus was verified by vital staining. Results. In the studied population prevalence of heartburn was 44,3% for Khakases and 48,6% for Caucasians (OR 0,84; CI 0,75–0,94; р=0,002). Prevalence of Barrett’s esophagus at Khakases was 2,9% (5,4% – at males, 1,3% – at females; OR 4,20; CI 2,15– 8,23; р<0,001), at Caucasians – 1,5% (2,3% – at males, 0,7% – at females; OR 3,25; CI 2,35–4,48; р><0,001). In both populations Barrett’s esophagus has been associated to complaints of cough, ENT-diseases and cardialgia frequency. Conclusion. Ethnic differences in prevalence of Barrett’s esophagus in the investigated groups were found.><0,001), at Caucasians – 1,5% (2,3% – at males, 0,7% – at females; OR 3,25; CI 2,35–4,48; р<0,001). In both populations Barrett’s esophagus has been associated to complaints of cough, ENT-diseases and cardialgia frequency.

 Conclusion. Ethnic differences in prevalence of Barrett’s esophagus in the investigated groups were found.

Aim of investigation. Assessment of prevalence of markers of the on-going, transferred or «concealed» CHB-infection at patients with HIV-infection in Moscow and in several regions of the Russian Federation.

Material and methods. In Moscow and in several regions of the Russian Federations analysis of questionnaires of 340 228 patients with HIV-infection staying at dispensary observation at 80 territorial centers of AIDS and infectious diseases prophylaxis has been carried out. The blood samples obtained from 2 754 HIV-infected patients from 8 regions of the Russian Federations and from 240 patients with HIV-infection, observed in Moskovsk city AIDS center were studied. Analysis of the out-patient records of 16 813 patients, observed at this center was carried out. All blood samples were investigated for the presence of НBV, HDV, HCV, HAV-virus markers in serum by enzyme-linked immunoassay and for the presence of RNA HIV, RNA HCV and DNA HBV by polymerase chain reaction.

Results. It was revealed, that CHB markers are detected approximately at 5,5–6,8% of patients with HIV-infection, in most of the cases in combination to CHC or CHD markers. Significant part (25%) of HBsAgpositive HIV-infected inhabitants of Krasnoyarsk region have hepatitis D markers. Frequency of «hidden» CHBinfection at HIV-infected patients was 8,8% in Moscow and 44,4 % – in Krasnoyarsk region.

 Conclusion. It is recommended to determine markers of transferred CHB-infection at HIV-infected patients and their presence to test blood for HBV DNA. Observation of patients with combined CHB/HIV infection, not requiring in antiretroviral treatment and CHBs receiving telbivudine treatment, revealed effective suppression of HBV replication and did not influence HIV viral load.

Aim of investigation. Studying of liver cirrhosis (LC) prevalence in Tajikistan, survival rates, lifetimes and principal causes of death of patients, and evaluation of prognostic value of manifestations and complications of LC.

Material and methods. 1374 patients of the LC were investigated. Main etiological factors of development of disease were: hepatitis virus B, hepatitis virus C, alcohol.

 Results. The incidence of viral LC in Tajikistan does not differ from that in Russia and some western countries and makes 2,32 per 10 000 of adult populations. Alcohol-induced LC and primary biliary cirrhosis are over 10 and 5 times less frequent respectively. Lifetime and 3-year survival rate of patients depend on a phase of cirrhotic process compensation. The highest 3-years survival rate of patients from the moment of establishment of the diagnosis was 79% at class A LC vs 28% at class C LC. At 89% of patients the cause of death has been directly related to complications of cirrhosis. Hepatic encephalopathy and bleeding serve as certain criteria of survival rate prognosis of LC patients. Hepatorenal syndrome, bacterial peritonitis and portal vein thrombosis are independent risk factors of lethal outcomes.

Conclusions. Prognosis of survival is most unfavorable at hepatic encephalopathy in comparison to other complications of the LC. Presence more than one complication increases probability of death of patients more than 2,5 times. The relative risk of death is higher at patients with class B and C in comparison to class A.

Aim of investigation. To determine clinical and morphological features and mechanisms of development of gastroduodenal lesions at alcohol-induced disease of liver.

Material and methods. Overall 137 patients with alcoholic disease of the liver were investigated. Clinical, endoscopic, morphological, immunehistochemical diagnostic methods were applied.

Results. Clinical, endoscopic and morphological features of gastroduodenal mucosa lesions in patients with alcohol-induced disease of the liver were revealed. Increase of morphometrical parameters of epithelial cells of stomach mucosa, immunepositive to nitric oxide synthase, endothelin-1, melatonin and glucagon, decrease of proliferative activity and increase of apoptosis of epithelial cells of stomach mucosa was found.

Conclusion. Pattern of gastroduodenal lesions in many respects is determined by clinical and morphological variant of liver diseases, as well as by equivocal changes of diffuse endocrine system components and proliferative activity of stomach mucosa epithelial cells.

The aim of review. To estimate up-to-date options and prospects of application of prokinetics in treatment of gastroesophageal reflux disease (GERD).

Original positions. Nowadays proton pump inhibitors (PPI) are the basic drugs used in treatment of GERD. At the same time in last years cases of their inefficacy became frequent that can be caused by «night acid outbreak», and also non-acid refluxes. As GERD is diseases with primary disorders of motility of the esophagus and the stomach, in its treatment prokinetics (domperidone, itopride hydrochloride) can be applied.

Conclusion. In the case of resistance of GERD prokinetics can be added to PPI treatment (itopride hydrochloride, domperidone).

The aim of publication. To describe clinical case with a rare combination of two diseases which developed almost asymptomatically for a long time: autoimmune hepatitis (AIH) of the 1-st type and non-alcoholic steatohepatitis (NASH) on a background of morbid obesity, 2-nd type diabetes mellitus and dyslipidemia. To demonstrate efficacy of budesonide treatment in combination to the lifestyle modification directed to weight loss that resulted in normalization of biochemical scores and improvement of histological liver pattern.

The basic contents. Presented clinical case shows a rare combination of high-activity asymptomatic autoimmune hepatitis of 1-st type of long duration with non-alcoholic steatohepatitis in a patient with morbid obesity. Drug effect was a trigger factor for clinical manifestation of disease. Activity of serum transaminases acutely increased following metformin dose increase and onset of intravenous infusions of α-lipoic acid (thiogamma) in patient with 2-nd type diabetes mellitus. In physical status asthenia, body mass index of 49,8 kg/m2, subicteric sclerae drawn attention. Blood pressure was 130/90 mm Hg, patient had hepatomegaly (+5 cm). Abdominal ultrasonography revealed liver and pancreatic steatosis. Specific tests excluded presence of viral hepatitis, hemochromatosis, Wilson disease and α1-antitrypsin insufficiency. Antismooth muscles antibodies titer was 1:40. Liver biopsy was executed for suspicion of NASH: histological activity index (HAI) was 14 points (4+3+4+3) with severe fibrosis, no fatty infiltration was revealed. According to international classifications the 1-st type AIH of high activity (triggered by medicinal factor) in combination to NASH on a background of morbid obesity (dyslipidemia: cholesterol – 198 mg/dl, very low and high-density lipoproteins 38,2 and 31,3 mg/dl respectively) was diagnosed. Treatment included budenofalk 9 mg per day, that was followed by normalization of transaminases within 3 months. Self-directed cancellation of treatment resulted in relapse. Liver biopsy was repeated: HAI was 10 points (3+1+3+3), hydropic, small and large droplet fatty dystrophy, moderate fibrosis. Clinical diagnosis was following: AIH of 1-st type with high degree of activity, NASH with severe fibrosis, second type DM in compensated phase, morbid obesity, dyslipidemia, systemic hypertension («metabolic syndrome»). Repeated prescription of budenofalk in a dose of 9 mg in combination to diet and weight loss resulted in normalization of serum transaminases.

Conclusion. Both autoimmune hepatitis, and nonalcoholic steatohepatitis can develop asymptomatically for a long time and result in severe liver fibrosis that is illustrated by presented clinical case. Efficacy of budesonide allows to assume improvement of disease and life prognosis at the observed patient. Modification of lifestyle directed to weight loss, results in more favorable course of non-alcoholic steatohepatitis that can be presumed by liver histological data (decrease of inflammatory activity degree in comparison to initial biopsy specimen).

Aim of investigation. To estimate efficacy and tolerability of Forlax® in non-interventional observation study as laxative agent at short-term constipation for achievement of one-time laxative effect and at long course treatment of functional chronic constipation at adults in out-patients and hospitalized patients.

Material and methods. A short-term constipation, i.e. state functional constipation was diagnosed in 9 patients (constipation caused by compelled bed rest, – in 4 patients, in the first days after admission to hospital – in 5). Duration did not exceed 3–5 days in this subgroup. Chronic functional constipation was diagnosed at 31 patients. The number of defecations per day did not exceed of 2–3 times per week at all patients. Patients received 20 g of macrogoal per day. Time span in hours from the moment of the first dose of forlax intake to the first defecation time was determined individually for each patient (Δt), on the average for the whole group, the optimal dose of drug necessary for the first purging effect was calculated. Duration of the subsequent treatment in the group of constipated patients did not exceed 5–10 days. Patients with chronic constipation received forlax for a month more (30±9 days) on average.

Results. The first laxative effect at the majority of patients developed on the second day of treatment. Weighted mean time of purging effect onset was 26 h 40 min (total of Δt for each patient by the moment of first defecation, divided by 40). The average weighted dose of forlax necessary for of the first bowel movement – 30 g of macrogoal. The average frequency of stool on a background of long treatment at patients was 4–6 times per week.

Conclusions. Observation demonstrated high clinical efficacy of laxative effect of macrogoal: 38 patents rates the drug as «perfect» and «good» vs 2 as «satisfactory».

The aim of review. To present the up-to-date information on pathogenesis, diagnostics and treatment of bacterial overgrowth syndrome (BOS).

Original positions. Now there are no general guidelines on diagnostics of bacterial overgrowth syndrome in small intestine besides there is no common opinion which diagnostic test is preferable. Intestinoscopy with aspiration of small intestinal contents and culture of aspirate should be used in the special cases. Breath tests with carbohydrate-containing substrates (lactulose, glucose, xylose), with glycocholate, hydrogen breath test have various sensitivity and specificity. Treatment of the basic disease, that provoked development of BOS, is the most important approach. Broad-spectrum antibiotics are prescribed. Application of modern enterosorbents having cytoprotective properties is proved.

The aim of review. To draw attention to problems of the style of clinical diagnosis and its encoding at gastroduodenal ulcers and NSAIDs-related gastropathies according to ICD-10.

Original positions. Multiplicity of causes of stomach and duodenum ulcers requires assessment of nosological belonging of gastroduodenal ulcers and changes of system of their registration in medical statistics. ICD-10 does not meet modern demands of differentiation of erosive and ulcerative lesions of the stomach and duodenum, combining them in a joint heading of «ulcer» equating thereby to peptic ulcer. Variants of improvement of their encryption in frameworks of ICD are presented.

Conclusion. Change of erosive and ulcerative lesions encoding within ICD system results in specification of diagnosis at symptomatic gastroduodenal ulcers and NSAIDs-related gastropathies, development of differentiated approaches to their treatment and prophylaxis, improvement of statistical reporting.

Aim of investigation. Assessment of М2-pyruvate kinase level (M2-РК) at patients with ulcerative colitis (UC) and Crohn’s disease (CD) and its relation to course, clinical and endoscopical activity of disease.

Material and methods. Overall 70 patients were investigated: 42 – with UC, 15 – with CD, 13 – with irritable bowel syndrome (IBS) and 10 healthy patients. Blood plasma concentration of M2-РК was determined by solid-phase sandwich method of enzyme-linked immunoassay with application of «ScheBo» (Germany) test-systems.

Results. The level of M2-РК in patients with UC, CD, IBS and healthy persons was 29,1±3,0, 17,3±1,5, 7,9±1,6 and 7,0±1,5 U/ml respectively (р<0,05 – for UC and CD in comparison to IBS and control group and for UC in comparison to CD). The level of M2-РК considerably raised in patients with severe (45,9±6,4 U/ml) and moderate (20,9±3,2 U/ml) UC, including steroid-resistant patients (61,5±6,2 U/ml), in comparison to patients in remission (11,0±1,8 U/ml, р><0,05) and at patients with chronic continuous course in comparison to chronic relapsing course (40,3±5,0 and 22,7±3,8 U/ml, р><0,05). The level of M2-РК had the strong tendency to increase with progression of endoscopic activity of UC. Increase of M2-РК concentration (М±σ of the control group, р><0,05) was observed in 76,2% of UC patients, at 73,3% of patients with CD and in 15,4% of patients with IBS.>< 0,05 – for UC and CD in comparison to IBS and control group and for UC in comparison to CD). The level of M2-РК considerably raised in patients with severe (45,9±6,4 U/ml) and moderate (20,9±3,2 U/ml) UC, including steroid-resistant patients (61,5±6,2 U/ml), in comparison to patients in remission (11,0±1,8 U/ml, р<0,05) and at patients with chronic continuous course in comparison to chronic relapsing course (40,3±5,0 and 22,7±3,8 U/ml, р><0,05). The level of M2-РК had the strong tendency to increase with progression of endoscopic activity of UC. Increase of M2-РК concentration (М±σ of the control group, р><0,05) was observed in 76,2% of UC patients, at 73,3% of patients with CD and in 15,4% of patients with IBS.>< 0,05) and at patients with chronic continuous course in comparison to chronic relapsing course (40,3±5,0 and 22,7±3,8 U/ml, р< 0,05). The level of M2-РК had the strong tendency to increase with progression of endoscopic activity of UC. Increase of M2-РК concentration (М±σ of the control group, р<0,05) was observed in 76,2% of UC patients, at 73,3% of patients with CD and in 15,4% of patients with IBS.>< 0,05) was observed in 76,2% of UC patients, at 73,3% of patients with CD and in 15,4% of patients with IBS.

Conclusions. Blood level of M2-РК of patients with UC and CD increases considerably. Elevation of M2-РК level at patients with UC is associated to enhancement of clinical and endoscopical activity, chronic continuous course and steroid-resistance.

Aim of investigation. A comparative study of shortterm results of extra- and intraperitoneal plastic operations in 98 patients with formed fistulas of small and large intestine.

Material and methods. In the open prospective controlled study results of extraabdominal (37) and intraperitoneal (59) restorative operations at patients with formed external intestinal fistulas, operated in department of surgical infection #2 of the health department «Sverdlovsk regional hospital #1» from 01.01.2002 to 31.12.2009 were investigated.

Results and conclusions. Frequency of intestinal fistulas relapses, wound infection after restorative surgery by extraabdominal approach did not differ from morbidity of operations with laparotomy incisions. Lifethreatening complications were observed only after restorative operations with intraperitoneal operative approaches.

Aim of investigation. To evaluate psychometric properties of original «Quality of life after rectal surgery questionnaire».

Material and methods. Original study included results of 86 patients rectal cancer in whom the anterior rectectomy has been executed. Investigation was carried out in 3 months after intervention. At 46 patients the level of colorectal anastomosis was higher than 5 cm from anus, in 40 – lower, than 5 cm. An assessment carried out by proposed questionnaire including 34 items with defining of following scales: «General life satisfaction»; «Change of life mode»; «Social functioning»; «Change of psychoemotional status»; “Pain syndrome”; «Anal incontinence»; «Frequency of bowel movements» and «Disorders of evacuatory rectal function».

Results. Reliability of questionnaire was shown. Cronbach’s coefficient was higher than 0,7, and quotient of interclass correlation – over 0,8 for each scale. Reproducibility data by test-retest method demonstrated stability of obtained results. Evaluation of design validity proved sufficient sensitivity of the questionnaire. Criterial validity was confirmed by correlation with МOSSF 36 questionnaire scales.

Conclusion. Conclusion on eligibility of the proposed «Quality of life after rectal surgery questionnaire» for study of parameters of quality of life of patients after sphincter-preserving operations.