This article describes a problem of sleep disorders, nighttime heartburn, the peculiarities of etiopathogenesis of night gastroesophageal reflux, the possibility of diagnosis and rational therapy of nighttime heartburn.

The article analyzes the prevalence and principles in treatment of Barrett’s esophagus. The prevalence of Barrett’s esophagus varies widely from region to region of the world and has ethnic differences. The use of endoscopic methods and the histological examination of the biopsies of esophageal mucosa are of utmost importance in the diagnosis of this pathology. The prevention of esophageal cancer is the main task in managing patients with Barrett’s esophagus. The length of the Barrett’s esophagus segment, the presence and extent of dysplasia is of the greatest importance to select tactics for managing patients. Endoscopic methods are widely used for the eradication of metaplasia sites, among which the radiofrequency ablation is the most effective one. Prolonged treatment with proton pump inhibitors is safe and reduces the risk of transformation of Barrett’s esophagus into adenocarcinoma of the esophagus. There is evidence that small doses of aspirin, nonsteroidal anti-inflammatory drugs, statins and ursodeoxycholic acid have the preventive effect on the development of esophageal cancer. However, the possibilities of using these drugs for this purpose are still limited. Anti-reflux surgery still holds relevance, but at the same time, it has no advantages over the drug therapy for the prevention of esophageal cancer.

It is known that gastritis, gastroduodenitis and peptic ulcer belong to the group of acid-dependent diseases, which occupy a significant proportion among the digestive system diseases. Despite the use of proton pump inhibitors in therapy, the discovery of an important role of H. pylori infection in the genesis of these diseases and the development of eradication schemes, the urgency of the problem persists due to the development of formidable complications (bleeding, perforation). The modern therapeutic concept of treatment of peptic ulcer (including gastroduodenitis) provides active therapeutic tactics and includes multicomponent drug regimens. Along with proton pump inhibitors, the dietary recommendations, appointment of gastro-cytoprotectors, including ones of natural origin, and the individual approach to the patient in each specific case have not outlived their usefulness. Methylmethionine sulfonium chloride (vitamin U) Gastrarex, which improves the secretory and reparative function of the stomach, may be administered as one of the components of the complex therapy of peptic ulcer and gastroduodenitis.

Hyperammonemia is a metabolic disorder, which is caused as a result of high levels of ammonia present in the blood. Hyperammonemia is related to severe liver diseases, primarily to cirrhosis in 90% of cases. Non-cirrhotic causes should be considered in the remaining 10%. The article describes various causes and clinical features of hyperammonemia related to the pre-cirrhotic stages of liver disease, especially to non-alcoholic fatty dystrophy. The authors also provide other etiologies that cause hyperammonemia of varying severity, from minimal to very severe, leading to fatal outcome. The paper provides an analysis of the efficacy of L-ornithine-L-aspartate in hyperammonemia, and the results of own original author’s pharmaceutical equivalence study of the original and generic drug L-ornithine-L-aspartate.

The article is devoted to the use of vedolizumab, an α4β7 integrin antagonist, in the treatment of inflammatory bowel diseases (ulcerative colitis and Crohn’s disease). It presents the results of clinical trials of the drug and the experience of using vedolizumab in actual clinical practice. The latest available information about the drug’s safety profile is provided. The authors considered the practical aspects of therapy, such as determining the indications for treatment, tactics in loss of response, the need for a combination of vedolizumab with immunosuppressors, and the use of the drug in specific categories of patients.

Enterosorption, as one of the methods of detoxification therapy, has become widespread in clinical practice and is successfully used in the treatment of various diseases of the gastrointestinal tract (GI tract). Safety and ease of use, absence of contraindications and the possibility of combination with other medicines allow individualizing therapeutic tactics, avoiding the side effects of therapy and achieving high treatment effectiveness while reducing its duration.

Probiotics are an agent renewable from the outside that is capable of delivering active factors (metabolites, regulatory molecules, etc.) to target points of the gastrointestinal tract, and ensure the formation of a regulatory impact source for extraintestinal effects (target points). The uniqueness of probiotics lies in the fact that the microbial cell is simultaneously a proper transport container, a delivery system with a specific distribution in the gastrointestinal tract and a factory for reproduction of effector molecules.

The modern Probiotics 2.0 concept implies not only the development of bioengineering strains, but the use of probiotics for the maximally proven indications. Conducting research in the most promising areas of probiotics usage, on the one hand, and the development of evidence base for a particular strain in a relatively narrow spectrum of clinically significant effects, on the other hand, significantly reduces the financial and time costs to bring new products to market. An example is a strain of Bifidobacterium longum longum 35624® that was authorized for the treatment of patients with irritable bowel syndrome. However, the “old” probiotics are no less important, especially if the original strain compliance with the “10 golden rules for probiotic therapy” is high.

The article presents etiology, pathophysiology and epidemiology of constipation. The main groups of drugs that are used for this pathology are described in the section Treatment of Constipation. Stimulant laxatives are the most commonly demanded by the patients. The article provides the analysis of the use of sodium picosulfate in various clinical studies. Sodium picosulfate is one of the main drugs from the stimulant laxative group.

The article shows the dynamics of evaluation of prognostic factors of irritable bowel syndrome. Evolution of the views indicates an increasing evaluation of inflammation and the role of markers of inflammation of cytokines, especially alpha-TNF in clinical manifestations. The rationale for using a complex drug based on affinity purified release-active antibodies to alpha-TNF, to the brain-specific protein S-100 and histamine-colourant is presented.

The article presents the results of using a combination of PPI (pantoprazole) and UDCA for the treatment of erosive esophagitis induced by mixed reflux in patients with coronary artery disease.

A total of 62 patients with EGDS-proven erosive esophagitis were enrolled in the study. The patients were divided into two groups: the active treatment group (ATG) which included 34 patients with erosive reflux esophagitis and control group (CG), which included 28 patients with erosive reflux esophagitis without CAD. The patients of both groups received IPP (pantoprazole) 80 mg/day and UDCA at a dosage of 15 mg/kg/day for 12 weeks. (84 days).

The study showed that complete epithelialization of esophageal mucosa defects was detected in 100% of ATG patients by Day 84 of therapy, the same was achieved in CG patients by Day 56 of the basic course of therapy.

The treatment of EE induced by mixed reflux with a combination of PPI (pantoprazole) at a dose of 80 mg/day and UDCA at a dosage of 15 mg/kg/day was efficient in patients with GERD and CAD as a basic course of therapy for not less than 84 days. An effective dose of UDCA for maintenance therapy is 5 mg/kg/day in combination with PPI at a daily dose of 40 mg for not less than 2 months. 

The article presents data on a new classification of functional disorders according to Rome IV criteria. Particular attention is given to the combined functional pathology - the overlap syndrome. The combination of functional biliary disorders (PBD) and irritable bowel syndrome (IBS) is the most common functional disorder. The tactic of conservative treatment - the choice of myotropic antispasmodic is considered. The analysis of the results of our own study of the efficacy of Niaspam in the treatment of abdominal pain, flatulence and stool disorders in patients with PBD and IBS are presented.

At present, much attention is paid to the study of the influence of gut microbiota on the development of many diseases of internal organs, including chronic kidney disease. Thus, changes of gut microbiota in the qualitative and quantitative composition toward increasing the proteolytic flora, which is the source of the formation of uremic toxins, endotoxinemia, systemic inflammation, secondary immunodeficiency and cardiovascular complications, contribute to the worsening of the course and the progression of chronic kidney disease. That why the use of medicines which normalize gut microbiota, is the significant aspect of preventing the progression of chronic kidney disease.

The article presents international materials on studying the issue of biliary sludge (BS). The authors also share their own data resulting from conducted studies, where the first group included 1107 patients with BS; the second – 208 patients with different forms of BS; the third group – 40 patients with regular course of BS, in the absence of pharmacological influence; the fourth group – 60 patients (20 patients for each type of BS) with UDCA Exhol 500 mg No. 50 and antispasmodic agent Sparex 200 mg No 30. Intake of Exhol at an initial dose of 15 mg/kg/day was effective in 97% of cases and BS elimination was achieved in 12 weeks. The BS elimination rate depended on its type (1st – 4 weeks, 2–3rd types – 8–12 weeks).

Background: Accumulating evidence supports the view that an imbalance of gut bacteria contributes to IBS, and that increasing the mass of beneficial species may reduce the numbers of pathogenic bacteria and help alleviate symptoms.

Methods: In this double-blind trial 400 adult patients with moderate-to-severe symptomatic diarrhea-predominant IBS (IBS-D) were randomized to treatment with the multi-strain probiotic Bio-Kult® (14 different bacterial strains) or placebo for 16 weeks. The change in severity and frequency of abdominal pain was the primary outcome measure.

Results: Probiotic treatment significantly improved the severity of abdominal pain in patients with IBS-D. A 69% reduction for probiotic versus 47% for placebo (p < 0,001) equates to a 145 point reduction on the IBS-severity scoring system (IBS-SSS). The proportion of patients who rated their symptoms as moderate-to-severe was reduced from 100% at baseline to 14% for the multi-strain probiotic at follow-up (month 5) versus 48% for placebo (p < 0,001). Also, the number of bowel motions per day from month 2 onwards was significantly reduced in the probiotic group compared with the placebo group (p < 0,05). In addition to relieving symptoms, the probiotic markedly improved all dimensions of quality of life in the 34-item IBS-Quality of Life (IBS-QoL) questionnaire. No serious adverse events were reported.

Conclusions: The multi-strain probiotic was associated with significant improvement in symptoms in patients with IBSD and was well-tolerated. These results suggest that probiotics confer a benefit in IBS-D patients which deserves further investigation. Trial registration: [Clinicaltrials.gov NCT03251625; retrospectively registered on August 9, 2017]. 

The article presents a review of current European and Russian guidelines on diagnostics and treatment of exocrine pancreatic insufficiency in patients with chronic pancreatitis. Results of our own comparative study on treatment of 55 chronic pancreatitis patients with low and adequate doses of pancreatic enzyme replacement therapy (PERT) confirm the need for usage of recommended doses of modern micronized polyenzyme drugs since it improves both clinical manifestation and nutritional status in such patients unlike the lower doses. Our research findings show that the optimal criterium for PERT efficacy assessment is the normalization of antropometric and biochemical nutritional markers.

Purpose of the study. Determine the gastric mucosa Structure in patients with different serum pepsinogen levels and ratios.

Material and methods. 801 people (387 men, 414 women) underwent clinical examination and determination of pepsinogen-1, pepsinogen-2 and serum anti-Helicobacter pylori antibodies using GastroPanel (Biokhit, Finland). 161 patients with different levels of atrophy determined by serological screening method underwent a fibroesophagogastroduodenoscopy (Olimpus-10) with biopsy and subsequent morphological examination of the gastric mucosa performed using a visual analogue scale according to the Sydney Staging System. 107 patients had morphometry of the gastric mucosa with the determination of the number of central, parietal and mucoid cells.

Results. The prevalence of severe atrophic gastritis in the stomach accounted for 10.9%. H. pylori was detected in 90.0% of the subjects. The morphological study showed atrophy in 94.4–95.8% of subjects with atrophic gastritis of the corpus mucosa of the stomach as defined by serological testing.

Conclusions. Atrophy of the stomach mucous membrane as determined by morphological examination was prevalent in patients with severe atrophic gastritis of the corpus mucosa of the stomach, diagnosed using the method for determining serum pepsinogen levels. 

In this article there are data of comparative analysis of the results of minimally invasive treatment of benign stenosis of the major duodenal papilla through the use of endoscopic retrograde papillosphincterotomy and antegrade laser papillotomy carried out by means of high-energy holmium (YAG:Ho) laser.

Resolution of stenosis of the major duodenal papilla was performed in the patients of the control group (n = 102) through the use of endoscopic papillosphincterotomy before and after laparoscopic cholecystectomy.

Antegrade laser papillotomy (invention patent №2449757 from 09.11.2010) and cholecystectomy were performed in the patients of core group (n = 35) in the presence of evidence.

Antegrade laser papillotomy was successfully performed in all cases. It allows to less traumatic resolve the stenosis of the major duodenal papilla, even in its intradiverticular location and with the combination of choledoholitiasis. It minimizes the possibility of complications such as bleeding, perforation, pancreatitis in comparison with retrograde techniques. 

Endoscopic screening is the main method of colon examination. An important factor for the accurate diagnosis of various pathological changes in the mucous membrane of the lower part of the digestive tract is the degree of its visualization, which directly depends on the quality of preparation for colonoscopy. There are many colon cleansers, but the peristaltic motion of the gut slows down in various diseases and syndromes, which results in the reduced accuracy of endoscopy.

The paper presents the analysis of colon preparation quality using Phospho-soda (Casen Recordati, S.L., Spain) for colonoscopy in 198 patients with pathological conditions that impedes passage of all bowel contents: inflammatory bowel disease, acromegaly, and hypotonia of the large intestine. The authors carried out a comparative analysis with a control group, which included 106 patients without factors that slowed down the peristaltic motion of the intestine, who were preparing for endoscopic examination according to a similar scheme.

The study showed that using Phospho-soda to prepare for endoscopic examination in patients with decreased colonic tone resulted in the efficacy of the drug comparable with its efficacy in a group of patients without dysmotility.