The high prevalence of cardiovascular disease and its frequent pathogenetic relationship with various comorbid diseases and conditions lead to polypragmasia and the development of undesirable adverse reactions. Treatment premorbidly disorders requires high clinical expertise and breadth of knowledge in the field of related disciplines that allows you to efficiently prescribe the appropriate drug therapy. It is important to emphasize that a patient with cardiovascular disease often receives antiplatelet therapy, including double, which can lead to adverse reactions from the upper gastrointestinal tract (due to the peculiarities of the mechanism of action of antiplatelet drugs), including from the esophagus, provoking the development or deterioration of gastroesophageal reflux disease (GERD). Proton pump inhibitors (PPI) are used for the prevention and treatment of these adverse events on the part of the gastrointestinal tract. Effective drug therapy for GERD also includes the administration of these drugs. However. Given the polymorbidity of patients and polypragmasia, the practitioner should strive to prescribe drugs with the lowest risk of drug interactions. These requirements are met by PPI rabeprazole, the metabolism of which is predictable. The use of this drug is presented in a clinical case.

Gastroesophageal reflux disease (GERD) in terms of prevalence ranks first among gastroenterological diseases. A large number of works on the diagnosis and treatment of GERD, forms the point of view that about GERD «everything is long and well known.» However, in real clinical practice, for various reasons, possible «pitfalls, reefs and shallows» are not taken into account, the underestimation of which can introduce certain difficulties in the diagnosis and treatment. This review discusses the most significant aspects of the diagnosis and treatment of GERD in real clinical practice by a general practitioner and general practitioner. Currently, proton pump inhibitors are the main drugs for the treatment of GERD and other acid-dependent diseases. The results of numerous foreign and Russian studies indicate the effectiveness and safety of pantoprazole in the treatment of GERD, especially in multimorbid patients due to the lower potential of drug interactions. The presence on the Russian pharmaceutical market of two forms of release of the generic drug pantoprazole Panum® increases the availability of effective and safe therapy for GERD and other acid-dependent diseases.

Diabetes mellitus (DM) is a moderately common issue both in the world and in the Russian Federation. Consequently, an interdisciplinary approach to studying the characteristics of the course and therapeutic management of gastroenterological pathology in this group of patients, in particular, Helicobacter pylori infection, which is associated with a whole range of diseases of the upper gastrointestinal tract, is of special interest. The article provides a systematic review of foreign and domestic studies of the efficacy and safety of various eradication regimens for Helicobacter pylori infection in patients with diabetes. In general, it was shown that the weighted average efficiency of eradication in people with diabetes was 17.7–23.8% lower than in people, who did not suffered from that disease.

 Along with the great progress in the fight against malignant neoplasms through the improvement of surgical care and the development of chemotherapy, the search for strategies and opportunities to prevent cancer is becoming increasingly important and promising. Early detection and rational treatment of chronic precancerous diseases must be a priority. In this regard, the possible role of ursodeoxycholic acid (UDCA, ursosan, etc.) has been closely studied in recent years. An overview of the role of ursodeoxycholic acid (UDCA) in the prevention of cancer is presented. The pathogenetic basis of this action is the proven normalizing effect of UDCA on bile acid metabolism, microbiome condition and apoptosis. The paper summarizes the latest data on the ability of UDCA to withstand malignization in the liver, throughout the gastrointestinal tract and beyond. These numerous experimental and clinical studies allow us to assert that UDCA drugs, except for the well-known and versatile hepatoprotective effect, can be considered as effective and promising means of cancer prevention throughout the digestive tract and associated organs. Further research into the broad spectrum of UDCA’s ability to prevent gastrointestinal malignization and beyond is reasonable and promising.

According to the Recommendations of the Scientific society of gastroenterologists of Russia for the diagnosis and treatment of cholelithiasis (GI), GI is a multifactorial disease of the hepatobiliary system and one of the most common diseases of the digestive system. It is known that in the vast majority of cases, GI develops as a result of the complex influence of many risk factors. Thus, the change in the qualitative and quantitative composition of bile, as well as a history of gastrectomy, papillosphincterotomy, the right-hand hemicolectomy, cholesterosis gall bladder, chronic hepatitis, peptic ulcer of the duodenum, duodenostasis contributes to the reduction of the contractile function of the gallbladder and the development of hypertonicity of the sphincter of Oddi. Current understanding of mechanisms of formation of gallstones is based on many studies, which proved that the GSD is a result of destabilized bile-damaged hepatocytes, the subsequent nucleation of crystals of monohydrate of cholesterol crystallization in the mucin matrix on the background of hypomotor dysfunction of the gall bladder. After anamnesis and General clinical examination, the main diagnostic method for suspected gastrointestinal tract is ultrasound (ultrasound). However, differentiation of stone types by ultrasound is generally not possible. The most modern diagnostic method is CT with an assessment of the density of stones on the Hounsfield scale. Today, it is common to distinguish three main types of gallstones found in humans: cholesterol, black and brown pigment stones. Methods of treatment of gastrointestinal tract can be divided into invasive or surgical, minimally invasive and non-invasive. Recommending a patient with gastrointestinal surgery, you should always remember that surgical treatment is the elimination of the consequences of cholelithiasis, and not the treatment of its essence. So, after the successful application of udhc in the early 80-ies of the last century for the dissolution of gallstones, drug litholysis, opened a new era in the treatment of gastrointestinal tract and reduced the amount of indications for surgical treatment.

A study of the clinical efficacy and safety of the drug Samelix (ademetionine, manufacturer – JSC «Canonfarma production», Russia) in 30 patients with chronic alcoholic liver disease (steatohepatitis mild to moderate currents, cirrhosis of the liver grade a ChildPugh) with the syndrome of cholestasis. Purpose of the study: evaluate the clinical efficacy and safety of Samelix (ademetionine) in 30 patients with chronic alcoholic liver disease. Objectives of the study: evaluate the effect of the drug on biochemical parameters, evaluate the effect of the drug on the clinical manifestation of the disease based on the individual diary data during the course therapy, assess the quality of life through the SF-36 questionnaire before and after treatment; report adverse events. The results of the study showed that therapy with this drug leads to a significant positive dynamics of biochemical parameters, regression of clinical manifestations of the disease, a significant increase in the quality of life. Good and excellent results of therapy were observed in 76.7% of cases. The drug is safe and well tolerated.

Introduction. The urgency of the problem of opistorchiasis is dictated by the long clinical course of the disease with the possibility of formation of hepatobiliary pathology, including cancer. Aim. To study the peculiarities of the production of active oxygen forms of blood phagocytes in patients with opistorchiasis. Material and methods. A total of 42 patients with chronic opisthorchiasis (22 men and 20 women) and 35 apparently healthy patients (18 men and 17 women) between the ages of 24 and 45 were examined. Opistorchiasis was diagnosed by three methods: microscopic examination of duodenal bile, coproovoscopy and serological method. The control group was composed of healthy individuals who underwent routine medical examinations, which included biochemical blood tests, identification of markers for viral hepatitis and antibodies to opistorchs. The culture of neutrophils and blood monocytes was isolated by fractionation of cells on the ficoll with subsequent cleaning from adhering cells. Functional activity of neutrophils and blood monocytes was estimated by chemiluminescence method on production of active oxygen species: basic and after induction with zymosan. Results. In patients with opistorchiasis in comparison with healthy people, in neutrophil granulocytes, the maximum intensity of active oxygen species production decreased and the time to reach the maximum of active oxygen species production was increased both in spontaneous and zymosan-induced reactions in luminoland lucigenin-dependent processes. In monocytes during spontaneous reaction study it was discovered that the maximum intensity of oxygen production in luminoland lucigenindependent processes decreased and the time of reaching the maximum of oxygen production in luminol-dependent process increased in opistorchiasis patients in comparison with healthy people. When studying the zymosan-induced reaction in monocytes, a decrease in the maximum intensity of active oxygen species production in both reactions and an increase in the time to reach the maximum output of active oxygen species in the luminol-dependent process was registered in patients with opistorchiasis in comparison with healthy people. Conclusion. The data obtained indicate low functional activity of blood phagocytes in patients with chronic opistorchiasis in comparison with healthy people.

 Alcohol is one of the leading etiological factors in liver damage. In alcoholic liver disease (ALD), hypoxia occurs due to an imbalance between the energy requirement of hepatocytes and energy production in the mitochondrial oxidative phosphorylation system. Diagnosis of ALD includes the taking of an anamnesis, questioning of patients, clinical examination data, laboratory and instrumental study. For the treatment of ALD, agents are used that protect cell membranes from oxidative stress factors and restore the energy potential of cells under conditions of tissue hypoxia. One such hepatotropic infusion is Remaxol®, the original polyionic succinatemethionine complex based on succinic acid. Aim of the study: to consider the effects of using Remaxol® infusion drug in the group of ALD patients. Materials and methods: treatment of 40 patients (male) with ALD was carried out, all of whom had a distinct history of the disease with regular and prolonged alcohol abuse. The duration of the disease in the group was 4.8 ± 0.7 years. Initially, all of them showed increased lipid peroxidation, depression of antioxidant protection, as well as pronounced sings of cytolysis, cholestasis and lipid metabolism. Then, all patients in the group were treated with Remaxol®. The course of treatment ranged from 5 to 10 daily intravenous drip infusions. After treatment, the parameters of lipid peroxidation malondialdehyde (MDA), diene conjugates (DC), enzymes of antioxidant system catalase (Cat), superoxide dismutase (SOD), glutathione peroxidase (GP), markers of cytolysis, cholestasis and lipid metabolism were again investigated in the serum of patients. Results of the study: a positive effect after monotherapy with Remaxol® was observed in 34 patients, which amounted to 85% of the group. They recorded a significant decrease in lipid peroxidation and a compensatory increase in antioxidant system enzymes. The indicators of cytolysis and cholestasis syndromes significantly decreased, lipid metabolism was restored, and the subjective status of patients improved. There were no side effects during the treatment with Remaxol® in the group of patients with ALD. Conclusions: It was noted that therapy with Remaxol® caused positive laboratory dynamics in 34 patients, which amounted to 85% of all treated patients with ALD. Thus, it has been shown that therapy with Remaxol® is an effective method of treating alcoholic liver disease.

The purpose of the review article is to demonstrate generalized ideas on the classification and diagnosis of cholestasis syndrome of various etiologies, to consider the possibility of using laboratory and instrumental research methods in real clinical practice in a comorbid patient. The main provisions. According to the mechanism of development, cholestasis is conditionally divided into intrahepatic and extrahepatic, as well as a mixed type. Extrahepatic cholestasis develops with mechanical obstruction of the main extrahepatic or main intrahepatic ducts. Intrahepatic cholestasis as a result of a number of diseases, such as acute viral hepatitis, primary biliary cholangitis, drug damage to the liver, amyloidosis of the liver. In real clinical practice, a combination of several etiological factors leading to the development of cholestasis is possible in a comorbid patient. A clinical observation is given when, in a patient with gallstone disease, melanoma and ulcerative colitis, after excluding a number of possible causes of cholestasis, autoimmune cross syndrome, autoimmune hepatitis and primary sclerosing cholangitis (PSC), was diagnosed, which allowed the initiation of immunosuppressive therapy with 48 mg corticosteroid (per day) and the preparation of ursodeoxycholic acid (UDCA) exhol at a dose of 1500 mg per day. Regardless of the cause of intrahepatic cholestasis, UDCA remains the drug for the treatment of first-line cholestatic lesions. Conclusion. Only a consistent methodological approach, taking into account all the possible causes of cholestasis, can lead to a correct diagnosis and timely adequate treatment in each case.

Aim of the study. To compare the efficacy of treatment of patients with moderate left-sided and overall affection ulcerative colitis (UC) receiving equivalent doses of mesalazines – Mesacol and Salofalk.

Materials and methods. 90 UC patients of medium severity who received mesalazine Salofalk (group 1) were included, of which 41 (45.5%) were males and 49 (54.5%) females, mean age 35.8 ± 2.5 years, and 96 UC patients of medium severity who received mesalazine Mesacol (group 2), of whom 42 (43.75%) were males and 54 (56.25%) females, mean age 37.1 ± 3.1 years. Patient follow-up time was 12 weeks. The efficacy of the therapy was assessed taking into account 1) response to therapy in 2 weeks from the beginning of therapy; 2) achievement and maintenance of clinical remission (persistent remission) within 12 weeks after the beginning of therapy.

Results and discussions. After 2 weeks 78 (86,7%) patients of the 1st group responded to the therapy with mesalazine Salofalc (stool frequency decreased to 4–6 t/day, presence of pathological impurities in the stool decreased, according to laboratory indices anemia and leukocytosis decreased, and the level of CRP and ESR decreased). Twelve patients (13.3%) did not have a proper response to therapy. In the 2nd group of patients receiving Mesacol mesalazine, 80 (83,4%) out of 96 patients responded to the therapy, and 16 patients (16,6%) did not respond. After 12 weeks, 78 (86.7%) of the 90 UC Group 1 patients who responded to mesalazine Salofalk treatment still had clinical remission. The Mayo index in the group decreased from an average of 7.98 ±0.11 to 2.9 ±0.24 points. After 12 weeks, in group 2 UC patients (n = 96), 80 patients (83.4%) who responded to Mesalazine Mesacol therapy also had clinical remission. The Mayo Index in Group 2 decreased on average from 7.8 ± 0.1 to 2.8 ± 0.25 points. One year after the start of Salofalk mesalazine therapy, clinical remission remained in 76 (84.4%) of the 90 UC patients who responded to therapy, of whom 32 (35.5%) had clinical endoscopic remission. In the second group of UC patients receiving Mesacol, clinical remission remained in 78 (82.0%) out of 96 patients who responded to therapy, clinical endoscopic remission in 32 (35.5%) patients with UC. When comparing the duration of remission among UC patients receiving mesalazine Salofalk and patients receiving mesalazine Mesacol, there was no statistically significant difference (p = 0.45).

Conclusion. Mesalazines remain the first line of treatment for mild and moderate UC patients. Treatment of moderately active UC should start with oral mesalazine >2 g/day in combination with local mesalazine. Prolonged continuous use of Mesacol and Salofalk mesalazines for a year is comparable in efficacy.

Just like the vast majority of diseases, constipation is now associated with civilization and urbanization. According to epidemiological data, up to 30% of the adult population of economically developed countries suffer from this nosology, among which women predominate. It is known that only one of four patients suffering from stool retention visit a specialist. The rest confine themselves to the advice of friends, reading of popular medical literature or consulting a pharmacist at the pharmacy. Thus, only 25% of our patients receive medical care (we cannot talk about quality, nevertheless, the care is medical), and 75%, as a rule, only periodically try to set off this condition. Constipation is dangerous as it may cause the development of complications: secondary colitis, proctosigmoiditis, hemorrhoids, anal fissures, paraproctitis and the most threatening disease – colorectal cancer. Therapy for constipation should first begin with lifestyle changes. The irritating agents that enhance secretion are the drugs that are most frequently used, because they very quickly and reliably achieve the effect. Thus, among the most commonly used and effective ones are sodium picosulfate (Regulax®) preparations.

The article is devoted to new possibilities in the treatment of hereditary intestinal diseases, accompanied by a decrease in kinetic activity or the absence of enteric enzymes, including celiac disease. Despite strict adherence to the elimination diet, some patients develop IBS-like symptoms, which may be caused by a violation of the qualitative and quantitative composition of the intestinal microflora. Dysbiotic disorders play a role in the pathogenesis of the appearance of IBS-like symptoms and complicate the course of celiac disease, which requires the use of antibacterial drugs. The presence of side effects when using systemic antibacterial drugs limits their use. In this regard, the search for ways to correct the intestinal microflora, as well as the study of various approaches to maintaining the intestinal microecology in a state of physiological equilibrium in patients with celiac disease, are relevant for medical science. The article presents a clinical example of the successful and safe use of a drug with low absorption, high antibacterial activity – rifaximin in a patient with celiac disease to correct dysbiotic disorders.

Psyllium is a predominantly soluble fiber among other natural plant-based dietary fiber used in food and pharmaceuticals and is sold as a laxative fiber. Isphagula (lat. ispaghula)– international nonproprietary name of a medicine of «psyllium». Accordingly to ATX belongs to the group of «Laxatives», subgroup «A06AC «Laxatives increasing volume of intestinal contents» (Bulking laxatives) and has the following code and name: «A06AC01 «Ispaghula» (plantain oval seeds)». Isphagula is a medical dietary fiber; in the context of gastrointestinal problems in terms of «ispaghula» and «psyllium» are synonymous. Psyllium flour has virtually no digestible carbohydrates. This fact is a significant advantage of psyllium over oat bran, in which such carbohydrates are more than 60%. A distinctive feature of psyllium is that it is almost completely (80–85%) consists of fiber (about 70% of which is soluble), which in contact with water turns into a soft gel. Only 1 gram of fiber ground fiber flour is able to absorb up to 45 ml of water. In the colon, psyllium is resistant to fermentation, remains intact in the feces and significantly increases the water content in the feces, providing a laxative effect. Psyllium softens hard stools in constipation, normalizes loose stools in diarrhea, and normalizes stool shape in patients with IBS, relieving gastrointestinal symptoms. Dietary supplement «Fitomucil® Norm» contains 4.5 g of psyllium (Plantago psyllium), and dry pulp of prunes (Prunus domestica) – 0.5 g. This combination of psyllium and prunes can be widely used in patients with constipation and other functional digestive disorders in different age groups, including pregnant and lactating women, as a first-line remedy.

The role of duodenogastric reflux (DGR) in malignant degeneration of the gastric mucosa. It was demonstrated by immunohistochemistry using monoclonal antibodies to p53, PCNA, CD10, MUC2, MUC5AC, MUC6, CD31 and the polymerase chain reaction to detect CDX1, CDX2, FXR genes. The main carcinogenic components of bile are lysolecithin and conjugated bile acids. Biliary reflux increases the risk of malignant tumors in combination with Helicobacter pylori. DGR is one of the etiological factors for gastric cancer, so it determines the necessity for detailed diagnosis in clinical practice.