Inflammatory bowel diseases, which include Crohn’s disease and ulcerative colitis, in terms of severity of course, frequency of complications and lethality are among the main positions in the structure of diseases of the digestive system. With a question about modern ways of solving this important problem we addressed to Academician of the Russian Academy of Sciences, Head of the Department of Propaedeutics of Internal Diseases and Gastroenterology of A.I. Evdokimov Moscow State Medical University, Doctor of Medical Sciences, Professor Igor Veniaminovich Maev.

Gastroesophageal reflux disease (GERD) is one of the most common pathologies in modern clinical practice. Laryngopharyngeal reflux (LPR) is considered to be an extraesophageal manifestation of GERD and is characterized by retrograde ingestion of gastric content into the larynx and pharynx, leading to recurrent otolaryngological symptoms. Classical manifestations of LPR are hoarseness, perspiration, dryness and feeling of lump in the throat, coughing. There is no «gold standard» for the diagnosis of LPR. At the same time, several instrumental methods are used in clinical practice to verify the diagnosis: laryngoscopy and EGDS are the most common, and in some cases - 24-hour pH-metry and impedancemetry. In the case of an established diagnosis of LPR, it is recommended to use a standard dosage of PPI twice a day for 3–6 months.

Functional dyspepsia (FD) is one of the most common gastroenterological diseases. The article presents modern views on the pathogenesis of the disease. It is shown that disorders of motor skills (retardation of voiding function, disturbance of relaxation accommodation) and stomach sensitivity (visceral hypersensitivity to stretching) are considered to be one of the main pathophysiological mechanisms of FD. The authors present a modern algorithm of treatment of patients with FD, based on the clinical recommendations of the Rome Consensus IV revision (2016) and the Russian Gastroenterological Association (2017). The strategy of differentiated use of pharmaceuticals for different variants of FD is considered.

The article presents the definition and prevalence of sphincter of Oddi dysfunction in patients with various disorders of the biliary system. It describes the characteristics of sphincter of Oddi dysfunction with due account of its anatomical structure. Based on Rome IV Criteria (2016), the authors provide modern approaches to the diagnosis and treatment of sphincter of Oddi dysfunction. Special attention is paid to the diagnostic criteria for sphincter of Oddi dysfunction depending on its type. There are two basic types of sphincter of Oddi dysfunction: biliary dysfunction and pancreatitis. The paper presents the algorithms for the examination and treatment of patients with sphincter of Oddi dysfunction depending on the severity level of the disease and objective findings of laboratory and instrumental tests. The article presents a clinical history of a patient with sphincter of Oddi dysfunction. Depending on the characteristics of a clinical course of dysfunction, it was proposed that the patient was treated with a selective antispasmodic drug and a choleretic drug.

Acid-related diseases occupy a leading place in the structure of the incidence of the gastrointestinal tract. One of the important aspects of studying them now is to consider them in combination with coronary heart disease, hypertension, diabetes, asthma and other common diseases and conditions. Proton pump inhibitors are currently the basis for the treatment of acid-related diseases. Although all PPIs are very effective, the antisecretory effects of various drugs of this class may differ in different patients, especially in the presence of comorbidities and comorbidities. The pharmacokinetics and metabolism of rabeprazole are significantly different from those of other IPPs. The clearance of rabeprazole is largely non-enzymatic and depends little on the functioning of the cytochrome P450 (CYP) 2C19 system, which determines the predictability of 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 in a wide pH range, the presence of a gastroprotective effect and anti-helicobacter activity.

Aim of the review: to analyze the current aspects of the management of patients with precancerous changes in the stomach, as outlined in the new MAPS II European recommendations.

Basic provisions. For qualified diagnosis of precancerous changes in the stomach it is necessary to use modern endoscopic and morphological methods. Timely detection of atrophy, metaplasia and dysplasia significantly increases the effectiveness of gastric cancer prevention. Eradication of Helicobacter pylori infection is an important principle in the management of patients with precancerous changes in the stomach.

Conclusion. According to European recommendations, timely diagnosis, adequate treatment and follow-up of patients with precancerous gastric changes play an important role in the prevention of stomach cancer. The application of such principles in daily clinical practice will allow standardization of the approach to the management of patients with pre-tumor pathology. 

Over the past decades, there have been significant changes in the structure of adult morbidity. Clinicians are increasingly faced with the problems of combined pathology and development of comorbidity, as well as to solve the issues of rational tactics of management of such patients. Polypragmasia due to comorbidity leads to a sharp increase in the probability of developing systemic and undesirable effects of drugs, while prolonged use of several drugs can lead to the development of complications that develop into independent nosological forms, which is especially important in older age groups. The most common forms of comorbidity in the elderly are in one or another combination of the following diseases: hypertension, coronary heart disease, diabetes, diseases of the musculoskeletal system. It is known that the leading place in the relief of pain in the latter is occupied by non-steroidal antiinflammatory drugs (NSAIDs), the use of which can be prolonged and induce the development of serious gastrotoxic reactions. Well studied and described NSAIDs-induced gastropathy, which, in most cases, is asymptomatic even in the presence of erosive and ulcerative changes. However, NSAIDs may be associated with the emergence of various dyspeptic complaints and lesions of the esophagus, which can be viewed in the framework of NSAID-associated esophageal, especially relevant in older patients. The article deals with the problem of comorbidity, polypragmasia, therapeutic tactics in the management of comorbid patients with NSAIDsesophagogastropathy and the possibility of prescribing for the prevention and treatment of not only effective, but also safe means of correction of these clinical and endoscopic manifestations.

The demand of work is connected with prevalence a gastroesophageal reflux disease (GERB) against the background of insufficient study of age features of a course of this disease in the senior age groups. The research cohort made 96 patients with GERB. All patients were divided by method of randomization into two equal groups by quantity: the first – the persons receiving пантопразол 40 mg/days, the second – омепразол in a dose of 20 mg/days. Comparative study of efficiency of reception of an omeprazol and pantoprazol in age aspect at patients with GERB from positions of assessment of indicators of the quality of life (QL) was carried out. Indicators of KZh estimated on a visual and analog scale and the questionnaire of SF-36. Direct correlation connection between the level of health of patients and the following factors is established: existence of heartburn, the general time рН <4.0, number of refluxes in a minute, duration of the most long reflux in minutes. It was reasoned it is shown that at persons of the senior age groups in treatment of GERB пантопразол is more effective medicine, than омепразол. Patients of young and average age of the convincing proof have advantages of a pantoprazol before omeprazoly is not found. The result of the carried-out therapy in many respects is defined by degree of commitment of the patient. Therefore the choice of optimum approach to purpose of concrete medicine has to be carried out taking into account assessment of its safety, availability and the acceptability from the point of view of the patient.

The management of patients in remission, rehabilitation after treatment of inflammatory and erosive-ulcerative lesions of gastroduodenal zone in spite of actively used schemes antihelikobakterna therapy require additional discussions regarding the issue of cytoprotective. The article substantiates the importance of the inclusion in the complex therapy of these diseases S-methylmethanesulfonamide ( vitamin U). The data of experimental and clinical studies, indicating the protective properties and clinical efficacy of this drug. The possibility of drug astrorex containing the active substance S-methylmethane to improve the course of disease, faster relief of symptoms, long disease-free. Pharmacological preparations containing vitamin U in their composition can be used in a complex of medical, preventive and rehabilitation programs with active participation and sufficient compliance in the implementation of these programs by the patient.

NAFLD is a leader among chronic liver diseases worldwide. Polymorbidity of such patients requires the appointment of different groups of drugs. The quality of pharmacological correction, which is determined in achieving the desired therapeutic effect and the absence of adverse reactions of the therapy, depends on the functional state of the liver. In diseases of the liver clearance of drugs is reduced, and the period of their half-life increases. Thus, drugs with high hepatic extraction may increase the risk of overdose. In this connection, prior to therapy, laboratory and instrumental control of liver function is necessary to reduce the risk of its drug damage, side effects of pharmacotherapy and prevention of complications.

Identification of changes in biochemical parameters of liver functional activity during screening studies requires additional examination of the patient in order to determine the genesis of the disease. In recent years, in routine practice, the most frequently used is an isolated definition of the level of transaminases (ALT, AST), which does not allow timely detection of latent cholestasis syndrome. Primary biliary cholangitis (PBC), previously referred to as primary biliary cirrhosis, is a relatively rare chronic autoimmune cholesthetic liver disease, predominantly affecting middle-aged women and prone to progressing liver cirrhosis. The recommendations of AASLD and EASL note the need for long-term monitoring of patients with ongoing UDCA therapy and regular diagnostic studies to identify signs of disease progression. A clinical example of successful treatment of a patient with PBC with the Russian drug Exhol® is described.

Drug-induced liver injuries (DILI) remain today one of the most pressing problems not only in gastroenterology, but also in all therapy. Up to 10% of the changes in laboratory parameters can be attributed to the use of drugs. The importance of DILI has increased significantly in recent years, due to the increase in the number of over-the-counter medicines on the pharmaceutical market, as well as non-compliance with the methods and modes of administration. There are common links in the pathogenesis of DILI, including hypoxia, de-energization (deficit of ATP production), damage to hepatocyte membranes and suppression of antioxidant protection. Therefore, pathogenetic pharmacotherapy and prevention of liver damage are based on drugs with an action mechanism aimed at eliminating one or more links in the pathogenesis. One of these drugs is Remaxol, which includes antihypoxantantioxidants of metabolic type: natural metabolites, substrates and cofactors involved in energy metabolism. Remaxol was administered to 30 patients with duodenal ulcer (DU) in the acute phase in addition to the main eradication therapy in the case of cytolytic syndrome by the end of the first week of therapy intravenously dripping at a rate of 40-60 drops/min in a daily dose of 400 ml for 10 days a day. Against the background of Remaxol application, the patients with DILI had stabilization of the main biochemical parameters: the level of AST, ALT, direct bilirubin, GGT and alkaline phosphatase. These changes were accompanied by a positive dynamics of the general state of health. The use of Remaxol in patients with DILI will allow to achieve clinical and biochemical remission, preventing the development of severe liver damage, and contributes to the preservation of the recommended duration of treatment of the underlying disease.

The major concern for the practitioner is to determine the correct approach to the treatment. The personalized medicine allows the modern practitioner to leverage the individual patient characteristics, preventing the development of complications and disability. What therapeutic possibilities do modern gastroenterologists have for the treatment of ulcerative colitis? We asked this question to the Chairman of the Russian Society for the Study of Inflammatory Bowel Diseases, Head of the Department of Gastroenterology of Vladimirsky Moscow Regional Clinical Research Institute, Doctor of Medical Sciences, Professor Elena Alexandrovna Belousova.

Constipation, which is currently one of the global problems of mankind, requires modern approaches to its pharmacological correction. Constipation that occurs in the absence of organic digestive pathology is in most cases considered a symptom of functional constipation or irritable bowel syndrome, the diagnosis of which is based on the compliance of the patient’s complaints and anamnestic data with the Rome IV criteria for the diagnosis of these functional disorders. Regulax Picosulphate, an intravenous droplet, is a modern laxative drug with a possibility of precise and easy dosing that does not have a local irritant effect on the gastric and duodenal mucous membranes; the efficacy and safety of this drug has been proven in controlled clinical trials.

The article discusses the current issues of managing patients with colonic diverticular disease. The prevalence of pathology is steadily increasing, which is due to the more frequent diagnosis of the disease and the increase in life expectancy of the population. Meanwhile, the wrong approaches to the management of this category of patients can result in the development of serious complications that often result in fatal outcomes. The paper presents data on the efficacy of rifaximin therapy of colonic diverticular disease, including using cyclic courses that significantly reduce the risk of complications. Particular attention is paid to the role of dietary fiber in the prevention of the inflammation development in the diverticular disease, including dietary fiber combined with rifaximin.

In the present article, the authors provide detailed material on the 13-year observation of a patient with such a rare disease as Whipple’s disease. Pathophysiological aspects, in particular changes in immunity within the framework of this nosology, clinical picture are also described in detail, and the emphasis is placed on the interrelation of certain symptoms, their intensification and regression. Taking into account the absence of clear recommendations for the management of such patients, the article considers various options of therapeutic schemes, and also reflects the own results of treatment.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that is characterized by periodic abdominal pain associated with altered bowel habits and/or changes in stool consistency. The chronic course of the disease marked by alternating periods of exacerbation and remission necessitates the long-term use of non-drug and pharmacological methods for the treatment of IBS, which is extremely negative for the patient’s compliance. A strategy for improving compliance of a patient with IBS is the cornerstone that allows a physician to ensure the optimal level of effectiveness of the prescribed therapy and minimize the risk of disease recurrence.

The duodenum ulcer disease (DUD) has high specific weight among digestive tract pathologies, influencing working capacity and quality of life of patients. Now the tendency of increase in mortality and complications of DUD against the background of decrease in incidence is characteristic of Russia.

For the purpose of identification of the patients infected with H. pylori and also purposes of the most effective H. pylori therapy by him are accepted the recommendations developed by the V Maastricht consensus (Management of Helicobacter pylori infection – the Maastricht V/Florence Consensuns report).

Besides H. pylori therapy to patients the medicines promoting maintenance intragastric рН > 3 not less than 18–20 hours a day are also appointed. Such effect PPI, antacids and H2-receptor antagonists have. PPI are characterized by more expressed antisecretory action and do not cause a tachyphylaxis, than favourably differ from histamine H2-receptor antagonists.

Lancid (lansoprazole) – medicine from the PPI group. It is shown to application for treatment of DUD and for an eradication of H. pylori at the infected patients with erosive and ulcer damages of a stomach and duodenum (as a part of complex therapy). Lansoprazole as a part of Lancid promotes faster healing of ulcer defects and decrease in clinically expressed symptomatology in comparison with omeprazole and pantoprazole. 

The article is devoted to the diverticular colon disease, its uncomplicated form, the connection with age. Symptoms allowing to define presence at this form of disease of IBS-like symptoms – pains and infringements of the psycho-emotional status are highlighted. The results of psychometric research and psychiatrist’s consultation of 102 patients are presented. The role of obesity in the genesis of diverticular disease is highlighted. The significance of spasmolytic therapy, in particular mebeverine, is presented.

The article provides a brief description of the causes and mechanisms of intestinal intussusception and a description of two cases of invagination in children over 7 years. The occurrence of intestinal intussusception in children older than 1 year often has a pathological leading point – a disease or pathological condition, as a result, of the course or complication of which it is possible to introduce one section of the intestine into another. Two children, 8 and 7 years old, were hospitalized at our clinic with signs of acute surgical pathology in the abdominal cavity, were operated on in an emergency order. In both cases, necrosis of the intestinal area, as a result, of invagination was detected, resection and anastomosis were performed. The leading points in these cases were Schönlein-Genoch purpura and Peutz-Jeghers polyps. Invagination of the intestines in these diseases occurs with atypical clinical symptoms, making it difficult to diagnose in time and leads to more frequent development of ischemia and necrosis of the intestinal wall.

The aim of the study – to evaluate the quality of life of patients after liver transplantation.

Patients and methods. The quality of life of patients after liver transplantation was studied with the help of «SF-36 Health Status Survey» questionnaire and correlation analysis of all scales of the questionnaire with the MELD indices, Child-Pugh before transplantation, SCORE before and after transplantation, body mass index, immunosuppressants, presence of tumor, encephalopathy, hepatitis transplant was performed.

The results. In the surveyed group, the average indicators on the scales «physical functioning» were reduced by 31.3%, «role functioning due to physical condition» - by 60.8%, «pain intensity» - by 13.2%, «general health condition» - by 33.4%, «Life activity» by 19.9%, «social functioning» by 19.8%, «emotional role functioning» by 52.9%, «mental health» by 11.7%, «physical component of health» by 24.5% and «psychological component of health» by 15.6%. Between hepatitis grafts and psychological health, as well as between the presence of tumors and pain intensity, the correlation coefficient is greater than 0.25, and the significance levels of both chi-square criteria are less than 0.05.

Conclusions. Liver recipients have the lowest quality of life on the role-playing scale due to their physical condition compared to healthy liver recipients. A moderate statistically significant relationship between hepatitis grafts and psychological health, as well as the presence of tumors and pain intensity, has been revealed. There are no gender differences in all components of QL in the group of liver recipients. 

The article presents the results of pharmacoeconomic analysis of classical and alternative schemes of the first line of Helicobacter pylori eradication therapy used in Russian practice. The most profitable from the economic point of view were sequential therapy, quadrotherapy with bismuth drug and hybrid therapy. In turn, from the point of view of clinical and economic balance, such schemes as triple therapy with addition of bismuth drug, as well as quadrotherapy without bismuth drug were the most optimal.

This article is devoted to the theme of the etiology of irritable bowel syndrome. This topic is highlighted in comparison with the Roman diagnostic criteria of III and IV revision. The following is considered: the theory of disturbed interaction within the «brain-gut» axis and visceral hypersensitivity induced in this way, as well as a possible mechanism for its implementation; also, the relationship of symptoms of IBS with patients’ mental state: anxiety, depression, sleep disorders. The relationship of IBS with microbiota of the intestine, the genetic mediation of IBS, the examples of candidate genes in biomarkers; the mechanisms of work of these genes are also described; the issue of intolerance to certain foods (FODMAPs, IgE-mediated hypersensitivity) in patients with IBS is highlighted as well; immunological aspects, including the theory of subclinical inflammation (low-grade inflammation) or post-infection IBS.

According to the latest data, the risk of vitamin D deficiency in patients with chronic pancreatitis (CP) and associated exocrine pancreatic insufficiency (EPI) is higher than in the general population. The aim of the present study was to evaluate the dynamics of vitamin D level in patients with CP with EPI against the background of long-term enzyme replacement therapy (ERT) with the use of microencapsulated pancreatin preparations. The study included 58 CP patients, who were divided into two groups depending on the results of laboratory assessment of nutrient status parameters. The 1st group consisted of the patients with the signs of EPI (according to the data of low values of the elastase test) without deviations in the nutritive status. The 2nd group consisted of CP patients with EPI and low values of stool elastase-1 and abnormal nutrient status. According to the results of the study, the serum level of vitamin D in the 1st group was 36.05 (95% CI 32.8397–38.9603) ng/ml, and in the 2nd group - 10.6 (95% CI 32.8397– 38.9603) ng/ml. A reliable inverse correlation between the past history duration and vitamin D level (r = -0.5644; 95% CI -0.8162 – -0.1324, p = 0.0147) was revealed, as well as a reliable direct correlation between elastase and vitamin D levels in the 2nd group (r = 0.8296; 95% CI 0.592–0.9345, p < 0.0001). Long-term ERT (8-12 months) resulted in a significant increase of vitamin D level in the 2nd group of patients from 10.6 (95% CI 32.8397–38.9603) ng/ml to 17.1 (95% CI 12.0166-23.6232) ng/ml (p < 0.0003).