The conference organized by the Russian Scientific Society of Therapists, Russian Scientific Society of Gastroenterologists and Russian Society for Endoscopy was held on March 31, 2015.

Proton pump inhibitors are the most effective treatment for all types of acid-base disorders. Despite differences between them, the available evidence demonstrated nearly the same clinical efficacy of various representatives of this group of drugs. Own experience with 115 patients with GERD 0-4 undergoing a treatment course with omeprazole, esomeprazole and rabeprazole at standard doses for 4 weeks showed high efficacy of all investigation drugs both in relation to symptom relief and healing erosions in the esophagus. The article demonstrates high efficacy of omeprazole (Omez) in the treatment of various acid-base disorders allowing to use it as the first-line therapy in most cases. Introduction of such forms as Omez Insta and Omez D allows to optimize treatment of GERD, DGER, FD and posteradication dyspepsia.

The article describes the experience of treatment of erosive reflux esophagitis in 30 patients after gastric resection, having mixed reflux determined by 24-hour esophageal pH-impedancemetry. Pharmacotherapy for background and maintenance treatment included a combination of PPI (Omez) with UDCA (Livodexa). The efficacy of different dosages of the drugs was evaluated in 2 groups of patients during background treatment: group 1 received Livodexa 10 mg/kg in combination with Omez 20 mg per day, group 2 received Livodexa 15 mg/kg in combination with Omez 40 mg/day. During maintenance treatment, subgroup 1 received Livodexa 2.5 mg/kg and Omez 20 mg, subgroup 2 - 5.0 mg/kg Livodxa and Omez 20 mg per day for 2 months. Changes in the clinical and endoscopic patterns were evaluated. The study showed that, according to the clinical and endoscopic data, Livodexa 15 mg/kg and Omez 40 mg/day for 112 days for erosive RE was effective in 76.6% (23) of cases. In the remaining 7 (23.4%) patients erosions healed by the 140th day of treatment. With regard to maintenance treatment, the combination of Livodexa 5.0 mg/kg with Omez 20 mg/day was effective.

The article tells about combined functional disorders of the gastrointestinal tract; their common properties are demonstrated, with a focus on functional dyspepsia combined with irritable bowel syndrome as the most prevalent coincidence of motility disorders involving stomach, duodenum, intestines. The author's findings on the treatment of combined functional disorders of the digestive tract and clinical efficacy of Trimedat are presented. Conclusion: Trimedat is effective in the treatment of patients with a combination of functional dyspepsia and irritable bowel syndrome. Trimedat's effect is in the restoration of various forms of motility disorders of the gastrointestinal tract (both the upper - stomach, duodenum, and the colon).

General idea. The article is a review of data on Helicobacter pylori resistance to antibiotics, the impact of CYP2C19 polymorphism on the metabolism of proton pump inhibitors, and recent findings on the effectiveness of eradication. The authors conclude that triple therapy (proton pump inhibitor + clarithromycin + amoxicillin) is still the best option for first-line therapy in the eradication of Helicobacter pylori. For the purpose of eradication, rabeprazole could be a proton pump inhibitor of choice due to the fact that its metabolism is not dependent on the polymorphism of cytochrome. The optimal second-line therapy schemes are quadruple therapy and 10-day levofloxacin-based scheme. Additional therapy with probiotics containing lactobacilli could improve the effectiveness of eradication and reduce the incidence of side effects.

Summary. Modern antacids are characterized not only by the capacity to bind hydrochloric acid: they also exert a strong cytoprotective effect which obviously distinguishes them from gastric secretion inhibitors. This is the reason to consider the group of drugs as having combined effect on the pathogenetic mechanisms of erosive and ulcerative lesions of the mucous membranes of the upper gastrointestinal tract. The modern classification of antacids and their role in the treatment of acid-base disorders are demonstrated.

In patients presenting with autoimmune CG, immunohistochemical techniques were used to identify herpes viruses in the epithelial and stromal cells of gastric mucosa (cytomegalovirus infection in 100% of patients, herpes simplex virus type 1 and 2 in 50%, a combination of two and three viruses in 72% of patients). There is an inverse association between herpes viruses and HP: the higher is the HP concentration in the gastric mucosa, the less is the number of cells containing herpesviruses, and vice versa. A prospective five-year follow-up included 45 patients with autoimmune CG either associated or not associated with HP, of which 27 patients had ACG. Novobismol for the treatment of patients with autoimmune CG demonstrated positive clinical, endoscopic and morphological changes: the incidence and severity of dyspepsia symptoms as well as inflammation of the stomach was reduced.

Peptic ulcer (PU) remains the most common disease of the gastrointestinal tract. There is evidence of the pathogenic role of Helicobacter pylori (HP) in this process. PU associated with HP is an indication for eradication therapy.

Summary: The article presents the results of a study of bile formation and secretion in various diseases of the gastrointestinal tract. There is a definition of biliary insufficiency syndrome as a polyetiologic set of symptoms typical for a majority of diseases of the digestive system. The leading pathogenetic link in the development of the disease is the change in the amount of bile and reduced secretion of bile acids into the intestine within an hour after the introduction of the stimulant.

Aim: to study the association of the levels of leptin and its soluble receptor in blood serum with nonalcoholic fatty liver disease (NAFLD) in obese or overweight patients. Material and methods: the open study included 105 patients with obesity or excess body weight. Patients were examined for NAFLD and divided into two groups: the treatment group included patients with NAFLD (n = 77) and the control group included patients without NAFLD (n = 28). Results: complaints of pain in the right upper quadrant, hypertension and diabetes type 2, as well as waist circumference, body mass index, glucose and triglyceride levels were reported significantly more frequently in the group of patients with NAFLD. Leptin was positively and the level of its receptors was negatively correlated with the degree of weight gain. Between these parameters in the group of patients with obesity and excess body weight, an overall moderate negative correlation was reported (rs = (-0.370), p <0.004). There was a tendency towards higher levels of leptin and lower levels of leptin receptors in the group of patients with NAFLD. In the treatment group, these parameters also had a moderate negative correlation (rs = (-0.384), p <0.007). Conclusion: the phenomenon of leptin resistance which occurs in individuals with obesity and excess body weight is associated with the development of NAFLD in this category of patients.

Currently, there is no doubt that all components of the metabolic syndrome (MS) (abdominal obesity, impaired glucose tolerance, hypertension and dyslipidemia) are risk factors for cardiovascular disease. Liver is the key link in the impaiment of lipid and carbohydrate metabolism, and at the same time one of the main targets of MS. The variety of metabolic changes in the liver manifest themselves in nonalcoholic fatty liver disease (NAFLD), which is recognized as the sixth MS criterion and one of the major risk factors for cardiovascular diseases and their complications.

The article tells about the current concept of the postcholecystectomy syndrome according to the Rome Consensus II - III guidelines, and therapeutic approaches in the management of such patients.

Current approach to the problem of liver cirrhosis and management of patients is described. Basic pharmacological groups and drugs used in the treatment of patients with liver cirrhosis are characterized. The focus is on the relevance of competent selection of medicines for the treatment of comorbid diseases in patients with liver cirrhosis. Conclusion: at the stage of cirrhosis, symptomatic treatment approach - a timely and proper management of the symptoms and complications of liver cirrhosis - could extend patient's life and improve its quality.

Ammonia is the most studied and, apparently, the most critical pathogenetic factor for hepatic encephalopathy (HE). The pathogenesis of PE is varied depending on the type of liver damage. Apart from neurotoxic properties, ammonia has general cytotoxic as well as hepatotoxic effects. A recent study allowed to register presence of hyperammonemia in patients with initial liver changes leading to latent cognitive dysfunction, which manifests itself in impaired reaction in stressful situations. Drug therapy of PE is primarily aimed at prevention and acceleration of metabolism of ammonia. Administration of ornithine metabolites reduces hyperammonemia, improves cognitive function and reduces enzyme activity, including in patients at pre-cirrhotic stage.

The article tells about the evolution of approaches to assessing the etiological factors, pathogenesis, treatment and diagnostics of irritable bowel syndrome. Evolution of approaches demonstrates the relevance of the pathology in overall morbidity and for the specific practice.

The article tells about intermediate results of a comparative study of the efficacy and tolerability of Lavacol® in the treatment of chronic constipation. The treatment group consisted of patients receiving Lavacol®, and the control group included patients after treatment with Forlax. Comparison of findings obtained before treatment and within the same periods from the beginning of treatment, showed no significant difference between the groups. The results demonstrated high efficacy and safety of Lavacol® similar to that of Forlax for the symptomatic treatment of constipation in patients with functional constipation and constipation-predominant irritable bowel syndrome (in accordance with Rome III criteria).

Based on the evaluation of the composition and functions of the intestinal microflora and mechanism for the realization of "microflora - macroorganism" relationship, as well as causes of intestinal micro-ecological disorders, the need and options for their timely correction are demonstrated. The main principles of treatment and preventive actions are presented. Taking into account recent classifications and requirements for drugs, as well as evaluation of the mechanism of action and therapeutic options, the main groups of drugs (pro-, prebiotics and metabiotics) used in the management of gut microbiota in disease are described.

The most interest among laxatives used in the treatment of functional constipation is earned by Exportale (lactitol monohydrate) which belongs to osmotic laxatives. The osmotic effect is produced by its metabolites which are formed in the colon as a result of obligate enzymatic cleavage creating short-chain fatty acids, carbon dioxide and water which liquify and increase stool volume, as well as increase osmotic pressure. A study of the effectiveness of the drug was conducted in 90 patients with functional constipation aged from 60 to 84 years. The overall effectiveness of the drug for relief of constipation was 90%. The effect was accompanied by restoration of colonic motility, reduction or a tendency to restore the colonic microflora metabolites, and in patients with encephalopathy - a decrease in its severity.

Over the last decade, bacteriophages for the purpose of prevention and treatment have been enjoying ever growing global interest. This is caused by the steadily growing resistance of bacteria to antibiotics. In the conditions of global antibiotic resistance, bacteriophages could be effective in the treatment and prevention of many bacterial infections. The review tells about the key achievements of domestic science and healthcare in the use of bacteriophages to fight infectious diseases. High efficacy of phage therapy in the treatment of intestinal infections is demonstrated. Advancements in the use of bacteriophages to treat infections in other locations are described: urinary tract infections, healthcare-associated infections including surgical site infections. There are results of studies evaluating the efficacy of phage therapy conducted in other countries. The review tells about the relevant role of temperate phages in strengthening the pathogenic capacity of bacteria. With this in mind, it is imperative to follow a rational approach to phage therapy (mandatory assessment of sensitivity of pathogens to bacteriophages before administration, use of only highly virulent phages in phage therapy).

The article is devoted to the etiology, pathogenesis, clinical symptoms, approaches to diagnosis, therapy and prevention of functional dyspepsia.

Summary: in the present-day routine clinical practice, measurement of GFR in the absence of risk factors for the development of CKD is not common. However, recent research shows that evaluation of GFR in patients with NAFLD is imperative even in the absence of classical risk factors for CKD. Early detection of kidney damage in patients with CHF and NAFLD will enable to define the right dose of pharmacotherapy and avoid overdose.

Timely and accurate diagnosis of tumors of the small intestine remains a clinical challenge. The article presents own experience of the combined use of video capsule and balloon-assisted enteroscopy in the diagnosis and treatment of tumors of the small intestine complicated by hemorrhage.

The article tells the short history and describes current trends in the endoscopic treatment of patients with achalasia. The technique, specific equipment and first results of endoscopic operations conducted jointly with Prof. H. Inoue in Russia are demonstrated.