The work objective is the analysis of approval documents concerning therapy of Helicobacter pylori (H. pylori) infection to formulate the most significant provisions for the practicing physician. The choice of the eradication therapy option must take into account the population antibiotic resistance and individual anamnesis of the antibiotics application. If resistance of H. pylori to clarithromycin in the population is lower than 15% or there are data of effectiveness of the standard triple therapy in the region, the optimized triple therapy must be used as first line therapy. If the resistance of H. pylori to clarithromycin in the population is higher than 15% or the anamnesis shows previous use by the patient of macrolides and if the situation by the antibiotic resistance in the region is unknown, bismuth quadrotherapy must be used as the first line eradication therapy. If triple therapy with clarithromycin was used the best second line treatment protocol is quadrotherapy with bismuth preparations. The optimum option of the third line therapy after the triple clarithromycin containing therapy and subsequent bismuth-containing therapy is the scheme with levofloxacin. The last line of therapy used after unsuccessfulness of 3-4 eradication schemes is protocol with rifabutin.

The article provides Maastricht V recommendations on management of ulcer disease patients. Possibilities of use of bismuth preparations in new recommendations in therapy of pathologies of upper departments of the gastrointestinal tract are considered. Materials of Russian studies on Novobismol drug in therapy of chronic gastritis, ulcer disease are provided by results of which the drug is characterized as effective.

The article presents the result of study of the effectiveness of a new drug dexlansoprazole in combination with the drug ursodeoxycholic acid in the group of patients with erosive esophagitis, with mixed reflux, as defined by results of 24-hour pHimpedance metering. Dynamics of clinical symptoms and endoscopic pattern when taking different doses of UDCA of primary and supportive therapy is monitored.

In recent years, GERD has attracted increased attention, which is associated with a clear tendency to increase the incidence of the disease. Adequate treatment of GERD is necessary, as this disease worsens the quality of life of patients, and prolonged existence and progression of esophagitis can lead to the development of strictures, Barrett’s esophagus and esophageal cancer. The main, basic link in the treatment of GERD is effective antisecretory therapy. Inhibitors of proton pump are currently the basis for the treatment of acid-dependent diseases. Although all PPIs are very effective, the antisecretory effect of various drugs of this class may differ in different patients. Pharmacokinetics and metabolism of rabeprazole significantly differ from those of other PPIs. The clearance of rabeprazole is largely non-enzymatic and depends little on the functioning of the cytochrome P450 (CYP) 2C19 system, which makes predictable the effect of rabeprazole and its safety for patients taking several drugs at the same time. A distinctive effect of rabeprazole is the activation of rabeprazole over a wide pH range.

Non-alcoholic fatty liver disease (NAFLD) is a multifactorial disease.Therefore,the treatment of NAFLD involves the use of drugs from different groups: omega-3 polyunsaturated fatty acids, statins, S-adenosylmethionine, ursodeoxycholic acid, essential phospholipids, metadoxine, glycyrrhizic acid, herbal products, vitamin E and some others. In particular, the use of Hepaguard Active®, which has a high safety profile and good tolerability for use, is justified.

Preparations of 5-ASA are the first line treatment of ulcerative colitis (UC). Today, in the market of drugs 5-ASA available for the treatment of UC, there are many dosage forms, varying in the coating, method of delivery of active substance and dosing regimens of the drug. The aim of this review is to compare these dosage forms by the main parameters: efficiency, safety and adherence to treatment.

The article provides factors that are involved in development of constipation. The main concern is the impairment of the motor function of the intestine, which is characterized by the ineffective movement of the contents of the colon. The pharmacological effect on 5NT₄ -serotonin receptors of patients is the most physiological way to restore the motor functions of the intestine, which preserves the daily rhythms of the defecation, initiate its high-amplitude propulsion reductions without significant side effects characteristic of some enterokinetic agents and laxatives. The use of prukalopride is a method of such action. It is effective in the case of chronic constipation and provides new therapeutic alternatives to patients whose symptoms have not been completely eliminated by laxatives. A new Russian prukalopride Vegaprat was launched.

The paper discusses the main aspects of the pathogenesis and incidence of SBBOS in the small intestine in patients with peptic ulcer of the duodenum associated with persistence of H. pylori; the effect of SBBOS on clinical manifestations. Diagnosis was made using the hydrogen breathing test with lactulose. The study found that SBBOS in patients with peptic ulcer associated with H. pylor is found in 62% and modifies the clinical pattern, prolonging the symptoms of gastric dyspepsia, provokes development of symptoms of intestinal dyspepsia, requires longer duration of treatment to achieve remission (clinical and endoscopic). This is the basis for its treatment.

The concept of pro- and prebiotic therapy finds both its followers and opponents. However, there is no doubt that there is a close connection between the microbiota of the various epitopes of our organism and the functioning of its individual organs and systems, as well as of the body as a whole. The accumulated amount of reliable data on the functioning of the microbiocenosis of the human organism makes it possible to see them as key points of influence on human health, not only in the treatment of existing diseases, but also in terms of primary and secondary prevention of a wide range of infectious, metabolic, immune-mediated and other diseases. In the near future, scientists would need to identify the indications, find effective probiotic strains, determine optimal one-time and daily doses, duration of the therapy, and criteria for effectiveness of the therapeutic and/or preventative measures.

The article is devoted to the classification and treatment of diverticular disease of the colon, which is by its prevalence, nature, clinical manifestations, complications is not only a medical but also a huge socio-economic problem. The article elaborates various domestic and foreign classification approaches with the reflection of the merits and costs requiring appropriate changes in the modern Russian guidelines for the diagnosis and treatment of adult patients with diverticular disease of the colon for the development of treatment and preventive measures in different forms of the disease. The place and the analysis of the effectiveness of different therapy regimens with the use of the effect of rifaximin-α (Alfa Normix), mesalazine, dietary fiber, particularly psyllium in the treatment of diverticular disease without clinical manifestations (asymptomatic diverticulosis); DB with clinical manifestations, including recurrent form (symptomatic uncomplicated diverticulosis); in the treatment of acute uncomplicated diverticulitis and for prevention of recurrence of acute diverticulitis (term and permanent treatment) are established.

Preparations of 5-aminosalycil acid (Mesalazine) are used as the first-line therapy to induce remission if the UC activity is minimal and as the priority drugs for anti-recurrence therapy of patients with UC and are included in the Russian recommendations on the therapy of the colitis of the slight and moderate activity. The choice of the drug and its form requires individual approach, it must be based on the UC duration, activity of the inflammatory process as of the moment of the treatment decision taking, the drug safety profile, its effectiveness and tolerability.

Colonoscopy is the golden standard for the colon visualization. The precancerous changes in the large intestine include adenomatous polyps, serrated lesions and changes in the mucosa associated with dysplasia (in patients with inflammatory bowel disease). Because of the flattened nature of the identification of serratic entities is complocated, and the localization in the right departments requires a thorough bowel preparation. Apparently, unrecognized serratic flat adenomas serve as a primary source for the development of «interval cancer». One of the most important indicators of quality of colonoscopy are good and excellent quality of bowel preparation, completeness of the examination, time of extraction of the endoscope is not less than 6–10 min, the detection rate of adenomas, which is about 15–30%. Insufficient quality of preparation for colonoscopy is directly connected with a high frequency of missed adenomas and the likelihood of «interval cancer.» Among the predictors of lack of preparation the use of narcotic drugs and tricyclic antidepressants, the presence of diabetes, obesity, arterial hypertension, liver cirrhosis, constipation, incomplete adherence to the patient instructions are noted. The degree of purification of various segments of the colon is often assessed using the 9-point Boston Bowel Preparation Scale, BBPS. The standard of preparation today is the use of a solution of polyethylene glycol (PEG). But currently Russian and international experts recommend using a two-stage (split) regime of PEG solution 2l + 2l. PEG doesn’t interfere with ingestion processes and is not absorbed in the intestine. A split-regime of PEG 2l + 2l demonstrates a high effectiveness and significantly better tolerance by patients due to which it’s a standard of preparation to colonoscopy recommended by professional unions.

The aim of this work was to assess the frequency and severity of major interferon-induced side effects depending on the applied interferon drug. The study included 29 patients with chronic hepatitis C with genotype 1b, 2, 3a/b. Patients received one of three drugs: interferon-alfa-2b, peginterferon-alfa-2b or repagination-alfa-2b in combination with ribavirin. The most commonly registered side effects induced by the interferon: flu-like syndrome, leukopenia, weight loss, thrombocytopenia and depression. Flu-like symptoms and depression were more often recorded when using peginterferon-alfa-2b. The weight loss and leukopenia were often associated with the use of repagination-alpha-2b. Thrombocytopenia with approximately the same frequency was recorded when using repagination-alfa-2b and peginterferon-alfa-2b; interferon alfa-2b caused thrombocytopenia less frequently. All these side effects in one way or another were subjected to correction (recommendations for lifestyle to reduce the doses of interferons, indication of additional drugs). Thus, the applied drugs have a similar safety profile slightly differing frequency and severity of most common side effects.

The article shows the basic properties of mineral water that can be used in gastrointestinal practices. The basic indications for the Donat Mg therapeutic mineral water have been identified based on practical use examples. A range of indications for the use of Donat Mg mineral water in patients with diseases of the upper and lower divisions of GT as well as of the hepatobiliary system is provided.

Today, NAFLD is one of the most common pathologies in the structure of liver diseases. Because the liver itself is involved in many pathological processes, its dysfunction contributes to the development of serious metabolic disorders, detoxification and antimicrobial defense of the body. One of the most frequent complications of liver disease is hepatic encephalopathy, which in most cases is latent.

The article describes the current views on the pathogenesis of nonalcoholic fatty liver disease and a short overview of possible methods of therapy. The main mechanisms of antioxidant action of ademetionine in the treatment of NAFLD and the analysis of the evidence base of its effectiveness are discussed. We present clinical cases of a positive impact of ademetionine in NAFLD patients.

The article gives information on the scope of ursodeoxycholic acid (UDCA). The most evident positive effects of therapy for cholelithiasis (SCI) and in primary biliary cirrhosis (PBC). The probability of using UDCA as a means of preventing CLS in cases of biliary sludge (SB) and in the risk group in elderly and elderly people is discussed. The data of our own study of the results of UDCA in 34 patients with non-alcoholic fatty liver disease, combined with the dyskinesia of the gallbladder (BL), BS and gastroesophageal reflux disease (GERD) are presented. Admission UDCA Grinterol demonstrated high clinical efficacy, safety and the absence of side effects.

The aim of the study. To evaluate the contribution of eradication therapy of Helicobacter pylori to the correction of protein-energy wasting (PEW) in patients on hemodialysis. Patients and methods. 102 patients with end-stage renal disease receiving chronic hemodialysis, among which 52 men and 50 women aged 49 ± 7.7 years. All patients was performed endoscopy with biopsy of antrum and body of the stomach and the determination of infection of Helicobacter pylori. The nutritional status and composition of the patient’s body was estimated using the method of a comprehensive nutritional evaluation, caliperometry, bioimpedance analysis body composition. Determining the level of acyl-ghrelin serum was performed using enzyme-linked immunosorbent assay (ELISA) using commercial kits (Spi-bio, Montignyle Bretonneux, France). All patients with a positive Hp result received 14-day three-component eradication therapy: amoxicillin 1000 mg/day, clarithromycin 500 mg/day, pantoprazole 80 mg/day. Results. In the course of the study demonstrated the deterioration of some key indicators of nutritional status based on the presence of Helicobacter pylori (HP). The level of acyl-ghrelin serum in patients with HP colonization was reduced. After the 14 days of eradication therapy of HP we saw improvements in key nutrition indicators and increase the concentration of acyl-ghrelin. Conclusion. Eradication therapy Helicobacter pylori can be considered as an additional method of PEW correction in Hp-positive hemodialysis patients.

Inflammatory bowel diseases are chronic relapsing immune-mediated diseases affecting the gastrointestinal tract. The goal of therapy of ulcerative colitis (one of the IBD variants) is the achievement and maintenance of steroid-free remission, prevention of UC complications, prevention of surgeries and the timely use of surgical treatment when the process progresses and lifethreatening complications develop. It Is predominantly diagnosed in young people and leads to a significant reduction of quality of life. The peculiarity of the UC is its chronic recurrent course. Work on the choice of the most rational schemes of therapy continues goes on. New data from clinical studies on the efficacy and safety of modern methods of pharmacotherapy in addition to data on pharmacoepidemiology and pharmacoeconomics should help the medical community to develop the most optimal treatment strategies based on clinical and socio-economic factors. The standard therapy in the first phase is 5-ASA preparations, such as sulfasalazine and mesalazine. Given the efficacy and safety of each of these preparations it is possible to predict the frequency of transition of patients to more difficult treatment options systemic corticosteroids and biological agents arising in connection with this the possible side effects and additional economic load on the healing process. The article presents economic assessment of the use of two alternative first-line drugs for therapy - mesalazine and sulfasalazine; it shows a possible burden on the budget and subsequent benefit when switching to the most optimal treatment option.

The article provides major reasons of diarrheal syndrome development, major approaches to mechanisms of diarrhea development are formulated as well as algorithm of actions for successful treatment of the patient.

The article provides analysis of the study of diagnostic value of the epithelial lesions of the column – a combination of newest visualization methods as NBI and ZOOM with confocal laser endomicroscopy. The study was conducted in 202 patients aged 40–84, 47 lesions were identified. Results of preparation of the colon to the study by drugs Phospho-Soda and Macrogol were evaluated. The obtained results allow making a conclusion that use of CLEM allows determining the structure of the polyp in the real time regime (in vivo) and increases the diagnostic accuracy of the study up to 96.5%, and quality of preparation of the colon has the decisive meaning.

Aim of the study. Assessment of the capacity of multiparametric elastography (MPE) in the individual selection in diffuse liver diseases. Material and methods. A survey of 235 patients with diffuse liver diseases: 128 (54,5%) men and 107 (45,5%) women. The first group included 64 (27,2%) the patient with steatogepatitis, second – 97 (41,3%) with hepatitis, third – 74 (31,5%) with cirrhosis of the liver. Obligatory examination: transient elastography, compression elastography, elastography with endosonography, shear way elastography. Results. The initial examination of patients the results of the diagnostic accuracy sensitivity and specificity of all types of elastography: AUROC 0,461 to 0,987. Dynamic monitoring of patients to comply with medical advice: AUROC from 0,829 to is 0,997, who did not follow recommendations – 0,775 to 0,840. It helped to introduce the concept of multiparametric elastography (MPE). Conclusions. MPE can be considered as a universal tool for screening liver fibrosis both at the initial stage and in the process of dynamic observation.