Over the past decade, a large number of major studies have been published analysing the efficacy of including probiotics in the eradication therapy regimens of Helicobacter pylori (H. pylori) infection. One of the catalysts for scientific activity in this direction is undoubtedly the negative trend associated with the decrease in the effectiveness of classical eradication therapy regimens observed all over the world. To date, the results of several meta-analyses show that the addition of certain strains of probiotics to standard eradication therapy regimens increases the efficiency of eradication therapy as well as reduces the frequency of side effects of the gastrointestinal tract associated with the treatment. Mechanisms allowing to increase the efficacy of eradication therapy when using probiotics are still being actively studied. The antagonistic role of some strains of probiotics against H. pylori both in vitro and in vivo has been shown in some works. In particular, probiotics can secrete antibacterial substances including short-chain fatty acids, lactic acid, hydrogen peroxide and bacteriocin. Probiotics can prevent the colonization of H. pylori by competitively inhibiting the adhesion of the microorganism to the epithelial cells of the gastric mucosa. It should be separately noted that probiotics make an important contribution to strengthening the protective properties of the gastric mucosal barrier. Probiotics are able to increase the expression of MUC1, MUC2 and MUC3, as well as restore the compromised proteins of dense contacts of cells, thus stabilizing the structural and functional integrity of the mucous layer of the gastric barrier. Probiotics are able to modulate the immune response of the macroorganism, reducing the production of proinflammatory cytokines involved in the chemotaxis and activation of immunocompetent cells in the gastric mucosa.

Gastrointestinal motility disorders can be a leading pathogenetic factor contributing to the development of many common gastroenterological diseases. Motor disorders can be a pathogenetic mechanism of development of both organic pathology (developmental abnormalities, acquired diseases, etc.), and functional gastrointestinal diseases associated with impaired nervous, humoral, metabolic and local regulation. (the latter are quite common in clinical practice). Correction of digestive motility disorders is determined by an understanding of the mechanisms of its complex regulation, which allows you to find the necessary points of application of drugs and select the necessary therapy. The motility of the gastrointestinal tract is primarily affected by prokinetics. Opioids used for many years are considered to be one of the most promising groups of prokinetics with proven effectiveness, they can both enhance and weaken the motor. A mu-, kappa-, and beta-receptor agonist, trimebutin, which acts on all receptors at the same time, coordinates the work of the intestines, and normalizes motility by reducing visceral sensitivity. Trimebutin favorably affects both hyperkinetic and hypokinetic forms of disorders of the motor activity of the gastrointestinal tract. This mechanism of action of trimebutin allows its effective use in patients with functional diseases of the digestive system, including those with the syndrome of their intersection. Trimebutin may be the drug of choice for such a combined pathology as irritable bowel syndrome and functional dyspepsia, the use of which is presented in the article on a clinical example of these two diseases.

Introduction. Chronic diseases of the digestive system lead to impaired absorption, assimilation and metabolism of macro- and micronutrients, primarily vitamins, inhibition of microflora, producing a number of vitamins, which requires correction of nutritional status. Purpose of the study. To study the clinical efficacy of the “Gastrobin Forte” vitamin-mineral complex in patients with gastritis and gastroduodenitis.

Materials and methods. An open observational clinical study was conducted on patients with chronic gastritis and gastroduodenitis (the main group - 60 patients) and a comparison group (30 patients). An objective examination of patients were evaluated before the study, on the 14th, 30th, 60th and 120th days of observation.

The results of the study. The 120-day administration of the vitamin-mineral complex «Gastrobin Forte» was well tolerated by patients, did not cause unwanted adverse reactions, including allergic ones. Two weeks later, there was a tendency to a decrease in the frequency of pain, discomfort in the epigastrium, and after 4 months all patients of the main group achieved persistent remission and the disappearance of the pain syndrome. At the same time, in the comparison group, complaints of discomfort in the epigastrium and unstable stool persisted in 10% of patients, and expressed pain syndrome persisted in 5% of patients. Conclusions. Gastrobin Forte is recommended as an additional source of vitamins and minerals for aftercare from hospital, as well as for prolonging remissions and preventing exacerbations.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are currently actively used in real clinical practice and everyday life with a wide range of pathological conditions and diseases, and are part of the medicinal arsenal of doctors of various specialties. Along with high pharmacotherapeutic efficacy according to the main indications, a whole range of various complications is associated with the use of NSAIDs. Of particular relevance is the negative specific effect of NSAIDs on the mucous membrane of the gastrointestinal tract.

The problem of NSAID gastropathy is widely discussed in the literature, which is largely due to the possibilities of its prevention and treatment using proton pump inhibitors. For a long time, much less attention was paid to the issues of NSAID-dependent bowel damage, which may be associated with less instrumental diagnostic capabilities of these lesions and the lack of effective means for their prevention and treatment. The review presented addresses the pathogenesis, clinical features and diagnosis of NSAID enteropathy.

Proton pump inhibitors effectively prevent the development of dyspepsia, erosion and ulcers, as well as gastrointestinal bleeding when taking NSAIDs at the level of the upper gastrointestinal tract, but they are ineffective in preventing and treating NSAID enteropathy. A new approach is the use of rebamipide, which has proven its clinical effectiveness in the prevention of NSAID-mediated Lesions in the upper and Lower gastrointestinal tract. Currently, rebamipid is included in the recommendations of the leading specialized communities in Russia and is recommended not only for the prevention and treatment of NSAIDs induced gastrointestinal lesions, but also as part of the complex therapy of peptic ulcer and anti-heLicobacter therapy.

The review reviewed studies showing the efficacy and safety of rebamipide for the treatment and prevention of NSAID enteropathy.

Today, oncological diseases are an important social problem, as they occupy leading positions in the structure of mortality, lead to increased disability, reduced working capacity and quality of life of a significant part of the population worldwide. Among the methods used to treat malignant neoplasms, chemotherapy has been actively used in recent years. Its popularity is associated with the development and implementation of new chemotherapeutic drugs that can improve the prognosis, increase the duration and quality of life of patients. To date, more than 150 antitumor agents have been used in clinical practice, new therapeutic regimens have been tested, which allows expanding the possibilities and improving the results of treatment of cancer patients. However, the development of drug-induced liver damage in cancer patients on the background of chemotherapeutic treatment remains an extremely important problem of modern oncology. On the one hand, it is not always possible to cancel a chemotherapeutic drug because of the high risk of disease progression. On the other hand, continued therapy can lead to serious and irreversible damage to a number of body systems, including the liver. So, according to various authors, gastrointestinal toxicity is observed in more than 90% of cases against chemotherapy. A similar complication is associated with the ability of antitumor drugs to exert cytotoxic and cytostatic effects, but not only on malignant cells. It is known that antitumor drugs are active both in relation to malignant cells and in healthy cells, which is manifested by clinically significant side effects. In this connection, it is necessary to actively introduce methods of primary and secondary prevention of toxic liver damage in the practice of chemotherapeutic treatment in cancer patients.

Alcoholic liver disease (ALD) is one of the major liver diseases associated with high mortality rates. There are about 3 million alcohol-related deaths worldwide every year. ALD covers the spectrum of liver damage ranging from asymptomatic steatosis, alcoholic steatohepatitis and fibrosis to cirrhosis. In addition, patients may suffer from acute and chronic liver failure, alcoholic hepatitis (AH), bleeding from esophageal or gastric varices, ascites, coagulopathy, hepatic encephalopathy and liver cancer. In most patients, AH is diagnosed at advanced stages of the disease with higher complication and mortality rates. Patients abusing alcohol may simultaneously have viral hepatitis B or C, genetic diseases such as alpha-1 antitrypsin deficiency or hemochromatosis. The clinical manifestations of the disease are very diverse. There is no special laboratory test to detect the alcoholic cause of liver damage. A liver biopsy in the context of alcohol abuse in the history is a diagnostic test, but is not indicated for all patients. The main focus of therapy for ALD patients regardless of the stage of the disease is prolonged alcoholic abstinence. Abstinence is also the main key to preventing alcoholic liver diseases. Corticosteroids provide short-term survival improvement in about half of the patients with severe AH, and long-term survival is related to the severity of the underlying liver disease and depends on alcohol abstinence. General therapeutic measures in patients hospitalized with ALD include inpatient treatment of complications, treatment of alcohol withdrawal syndrome, monitoring of concomitant infectious diseases and their early effective antibiotic therapy, addition of hepatoprotectors to therapy regimens, and treatment of the underlying alcohol-related disorder. Liver transplantation (LT) is the final treatment option in patients with decompensated alcoholic liver cirrhosis. LT may also be considered in individual patients with AH who do not respond to drug therapy. Existing AH treatment regimens have insufficient efficacy, therefore, development of new methods and regimens of ALD targeted therapy is required. In this article we will consider the pathogenesis and treatment of ALD, paying more attention to AH, its topical and promising methods of treatment.

Aim. To demonstrate the role of concentrated human albumin in cirrhotic patient management.

The main content. Albumin has a clear place in the clinical practice of cirrhotic patients managing. The structure and functions of albumin can be impaired in patients with acute and chronic liver failure, which correlates with the severity of the disease course and can affect its outcome. Intravenous transfusions of highly concentrated (20%) human albumin are necessary to achieve a response to diuretic therapy. Plasma volume expansion should be performed by albumin transfusing after removal of ascitic fluid during a large volume paracentesis in patients with tense ascites.

The administration of albumin is recommended in patients with spontaneous bacterial peritonitis; the aim: to potentiate the action of antibiotics and prevents the development of other complications, such as encephalopathy, progressive liver failure, impaired renal function. The combination of terlipressin with albumin is a first-line therapy in patients with hepatorenal syndrome-acute kidney injury (hepatorenal syndrome of type I according to the old terminology). The same combination is effective in treating another form of renal dysfunction - type II hepatorenal syndrome according to the old classification, i.e. a patient with hepatorenal syndrome does not meet the criteria for acute kidney injury. Recently, the results of a multicenter randomized parallel-group study, Answer (human Albumin for the treatmeNt of aScites in patients With hEpatic cirrhosis) were published, which showed that prolonged weekly use of human albumin contributes to control of ascites, reduces the incidence of infectious complications, episodes of encephalopathy in patients with decompensated cirrhosis. This leads to a decrease in the frequency of repeated hospitalizations, a decrease in mortality, an improvement in the quality of life, and an increase in the overall survival.

Introduction. Diseases of the liver and biliary tract are a significant problem in the clinic of internal diseases. Opistorchiasis is one of the most frequent causes of this pathology and is one of the most widespread parasitoses in the Russian Federation.

Clinical course of this pathology is characterized by high frequency of allergic and skin symptoms. Treatment of such patients is a big problem.

Aim. To determine the effectiveness of the use of complex therapy with the inclusion of enterosorbent in patients with opisthorchiasis with skin syndrome.

Materials and methods. The study involved 92 patients with chronic opisthorchiasis, of which 38 patients were with skin syndrome and 54 individuals without skin manifestations. Diagnosis of opisthorchiasis was carried out by two methods: microscopic examination of duodenal bile and coprooscopy. All patients underwent clinical examination, a clinical and biochemical blood analysis, esophagogastroduodenoscopy, ultrasound of the abdominal organs and liver elastometry with fibrosis assessment using the METAVIR system. Skin syndrome was diagnosed by dermatologist. After etiological treatment, 38 patients with opisthorchiasis with skin syndrome underwent reconstructive pathogenetic therapy for 6 weeks, which included an antispasmodic, ursodeoxycholic acid, desensitizing drug, and enterosorbent.

Results. In patients with opisthorchiasis with a skin syndrome, the severity of clinical and laboratory manifestations was significantly higher than in individuals with parasitosis without skin syndrome. Reconstructive pathogenetic therapy of patients with opisthorchiasis with the inclusion of enterosorbent Polysorb has allowed to achieve a significant improvement in the condition of patients. Conclusion. From our point of view, the results obtained make it possible to raise the question of changing the treatment standards for patients with opisthorchiasis with skin syndrome.

Introduction. Ursodeoxycholic acid (UDCA) came into modern medicine in the 1970s as a potential solvent for small gallstones. But as early as the 1980s, there were clinical studies to improve biochemical indices when using UDCA in other liver diseases. These studies initiated a worldwide active study of the clinical possibilities and various therapeutic effects of UDCA in various diseases, including those beyond the liver. Today, worldwide, UDCA drugs are the lifelong basis for the treatment of primary sclerosing cholangitis (PSC). It is indicated for all types of hepatitis: infectious, toxic, drug-induced, autoimmune and others. It can be stated that the history of study and introduction of UDCA drugs in medicine is the history of the expansion of its application areas, which continues to this day. The purpose of the review is to present the results of the use of UDCA drugs outside the traditional circle of cholestatic liver diseases, the causes and possibilities of their use in other areas of medicine.

Main principles. It has been shown that UDCA, originally designed for the treatment of cholestatic liver diseases, along with the known antioxidant, antifibrotic and immunomodulatory effects has a proven fundamental apoptosis regulatory effect. This allows it to have as a possible therapeutic target a whole range of extrahepatic diseases, such as gastrointestinal lesions (IBD, clostridi-osis, radiation and medical intestinal lesions, etc.), diseases of the cardiovascular system, neurodegenerative diseases (Alzheimer’s disease, Parkinson’s disease, ALS), prion diseases (Kuru, Creutzfeldt-Jakob disease) and a number of others.

Conclusion. According to modern views, UDCA can be considered as a unique drug of universal cytoprotective action, the expansion of its therapeutic possibilities is promising and is subject to further multilateral study.

To date the mechanisms of etiopathogenesis of functional gastrointestinal diseases continue to be actively studied. By now, alteration of the components of the intestinal epithelial tight junctions supporting the intestinal barrier integrity has been identified in several studies in patients with irritable bowel syndrome and functional dyspepsia (FD). Characteristic changes in patients with IBS compared with healthy controls include decreased expression of ZO-1 protein and occludin in mucosal biopsy specimens from various parts of the colon. On the other hand, the analysis of duodenal biopsy specimens shows similar changes in patients with FD. The causative factor of these changes continues to be studied. In fact, experimental and clinical studies conducted to date have demonstrated that there are factors that affect adversely the structural and functional stability of intestinal tight junctions. Regardless of the initiating factor, the compromise of tight junctions results in the breach of permeability of the intestinal mucosa and the entry of various intraluminal factors into the proper mucous plate, contributing to the activation of resident immunocompetent cells. Due to the production of cytokines and other biologically active substances, the latter lead to sensitization of nerve endings, thereby inducing the development of visceral hypersensitivity phenomenon and alteration of the motor behaviours of the gastrointestinal tract. The literature describes the phenomenon of activation of a local inflammatory response in patients with functional gastrointestinal diseases as “low-grade inflammation”. These data update the need to consider restoration of the intestinal mucosal barrier in patients with diseases in question as a therapeutic target. This review article systematizes data on this problem.

Many publications and major population studies have been devoted to the problem of combination of two or more functional disorders (FD) of digestive organs. The Rome Consensus IV applies the term “overlapping of FD” to cases of combinations within a single organ and stresses that the irritable bowel syndrome in any form should rather be regarded as a “continuum of different clinical variants” according to modern ideas. As a possible explanation for the existence of the overlap of FD the increase of visceral hypersensitivity, the expansion of the hypersensitivity zone, the progression of motor disorders are considered. With a combination of FD the number and intensity of complaints increases, the quality of life indicators decrease, the average number of concomitant somatic symptoms and drugs taken increases. Functional dyspepsia is more common in combinations of FD. At the same time, postprandial distress syndrome is more often combined with irritable bowel syndrome with constipation, epigastric pain syndrome with irritable bowel syndrome with diarrhea, and endoscopic-negative gastro-esopha-geal reflux disease. In addition to food components, a special role in the development of visceral sensitization is given to the persistence of inflammation after infection, gluten exposure, disorders of the intestinal microbiome, conditions of depression and anxiety. When two or more digestive organ FDs combine, it is advisable to choose the methods of treatment aimed at eliminating the action of intraluminal stimuli and the formation of “pain memory”. Drugs that normalize intestinal peristalsis and secretion are used, the choice of which is determined by the clinical version of the course, probiotics, as well as the means that affect the state of the central nervous system. When two or more digestive organ FDs combine, it is advisable to choose medications that affect their general pathogenetic mechanisms.

Intestinal microflora in terms of the integral body of knowledge about its importance for the human body is now considered as an additional “virtual” organ, producing many biologically active compounds that affect the various properties and functions of the macroorganism: fermentation of non-digestible food polysaccharides, maintenance of the optimal values of the intra-lumen pH and “intestinal barrier”, the activity of the immune system, vitamin status, energy homeostasis, angiogenesis. Saccharomyces boulardii is not a representative of the natural microflora of the human intestine, but, used as a probiotic, interacts with it, restoring the balance of short-chain fatty acids, reducing the levels of bacterial toxins, acting as a surrogate normal microflora until it is restored and replaced by natural representatives. S. boulardii has immunostimulating and anti-inflammatory activity. The results of clinical studies have demonstrated the effectiveness of S. boulardii in correcting pathological conditions associated with Helicobacter pylori, Clostridium difficile, Candida albicans, Salmonella typhimurum, Yersinia enterocolitium, protozoa Entamoeba and in treating irritable bowel syndrome and antibiotic-associated diarrhea. The efficacy of a drug containing S. boulardii has been demonstrated in the article by clinical studies and a clinical example. This drug has proven to be a highly effective and safe probiotic agent for the prevention and treatment of a number of diseases of the gastrointestinal tract with physiologically optimized pharmacodynamic effect that simulates the protective properties of normal human intestinal microflora. When using a drug containing S. boulardii, both adults and children do not have serious side effects, which increases the possibility of its safe use in clinical practice.

The article presents data of some skin diseases, that often appear in inflammatory bowel diseases (IBD).

Some of the skin diseases are directly connected with the activity of the main inflammatory process (erythema nodosum, Crohn’s disease of the skin and mucous, hidradenitis suppurativa) and the main method of the treatment is the decrease of main disease’s activity. Also the patient’s presence of skin lesions shows the presence of body’s system reaction and makes the main disease more difficult to cure. Medications for specific treatment of inflammatory process in the bowel (mesalasine, vedolizumab) for these patients are inefficient, as usual. Besides, patients with hidradenitis suppurativa and pyoderma gangrenous who have difficult cases of skin lesions will need the local therapy in addition to the main treatment. Generally, gastroenterologist needs dermatologist’s help in that case. Some of these diseases are not linked with the activity of inflammatory bowel diseases (“paradoxical” psoriasis, melanoma). The “paradoxical” psoriasis appears in inflammatory bowel diseases patients in the context of medication anti-TNF therapy and can be usually cured with local mecations. In case of inefficient local therapy we can appeal to change the supportive inflammatory bowel diseases therapy with anti-TNF medications to the medications belong to the group of antibodies to IL 12, 23 (ustekinumab). Also, the skin diseases, provoked by the therapy of these diseases (paradoxical psoriasis, melanoma, non-melanomic skin cancer) often appear at patients with inflammatory bowel diseases. The basic in treatment of skin diseases is reduction of activity. However, skin diseases, which are not connected with the inflammatory bowel diseases activity or are complications of therapy require to multidisciplinary approach with necessary participation of dermatologists.

Development of probiotic products containing several strains: Bifidumbacterium lactis BI-04, Lactobacillus acidophilus La-14 and Lactobacillus rhamnosus Lr-32, is an upcoming trend, as it builds capacity of preventive treatment. According to the results of in vitro experimental studies, the strains of Lactobacillus acidophilus La-14, L. rhamnosus Lr-32, Bifidumbacterium lactis BI-04 are resistant to low pH conditions and survive in the concentrations of bile salts in the small intestine. Demonstrate high adhesion to the human epithelial cell lines - Caco-2 and HT-29. In vitro experiments have shown the inhibitory effect of strains L. acidophilus La-14, L. rhamnosus Lr-32 on the following pathogens: Salmonella typhimurium, Staphylococcus aureus, Escherichia coli, Listeria monocytogenes. The probiotic strains with in vitro and in vivo confirmed effects combined a prebiotic and B vitamins is considered a rational combination. Additional favourable conditions in the form of nutrient medium (prebiotic), sufficient energy supply (coenzyme vitamins) contribute towards the increase of colonization potential. Inulin and B vitamins have their own activity, which is synergistic with the probiotic microorganism activity. Vitamin B12 has a porphyrin-like or corrine ring in its structure, which is linked to the cobalt atom by four coordination bonds and is representative of corrinoids group. Microorganisms inhabiting the GI tract use exogenously produced cobalamin corrinoids as cofactors. It is appropriate to add the use of probiotics with additional exogenous intake of vitamin B12, as microbial communities of the human gut are likely competitors in the consumption of cobalamin. The rational selection of components contributes to the maximum implementation of potential preventive effects of probiotic microorganisms.