[Clinical cases of microscopic colitis: Diagnosis and treatment issues. Case report].

Currently, there is an increase in the incidence of microscopic colitis. There are difficulties in diagnosing this disease due to the variability of histological signs, variability of morphological changes in the mucous membrane of the colon in different parts of the colon, and the combination in one patient of not only various forms of microscopic colitis, but also other intestinal diseases. The article describes the differential diagnosis, an example of its staging and successful treatment of various forms of microscopic colitis with budesonide (two clinical cases presented).

[Erosive and ulcerative lesions of the digestive tract: optimization of diagnosis and management tactics].

Erosive and ulcerative lesions of the digestive tract are one of the most pressing problems in the clinic of internal diseases due to the extremely widespread prevalence, the presence of severe complications, often fatal, diagnostic difficulties due to the presence of a large number of asymptomatic pathologies and difficulties in the rational choice of therapy. Particularly noteworthy is the data that during the global pandemic of Covid-19 infection, it is capable, quite often, of causing the development of erosive and ulcerative lesions of the gastrointestinal tract. In this regard, it seems important to use drugs that can not only prevent the occurrence of erosive and ulcerative lesions and strictures throughout the gastrointestinal tract, but also effectively achieve epithelialization of injuries to the mucous membrane of the oral cavity, esophagus, stomach, small and large intestine. One of them is Rebamipid-CZ, which has a fairly high safety and efficacy profile. It seems important to consider the issues of optimizing the prevention and treatment of erosive and ulcerative lesions of various parts of the gastrointestinal tract of various etiologies, taking into account the possibility of using rebamipide both as part of complex therapy and in isolation.

[Pages from the history of therapeutic schools of the Central Institute for Improvement of Doctors - Russian Medical Academy of Continuous Professional Education].

In the 1930s, therapeutic scientific and pedagogical schools were formed at the Central Institute for Advanced Training of Physicians: Cardiology School of prof. Dmitry D. Pletnev, School of Clinical Hematology and Emergency Care of prof. Alexander N. Kryukov, School of Dietetics and Gastroenterology of prof. Manuel I. Pevzner and School of Hematology of prof. Joseph A. Kassirsky. 2022 marks the 125th anniversary of the birth of an outstanding therapist, academician of the USSR Academy of Medical Sciences, Major General of the Medical Service, prof. Miron S. Vovsi. Along with the fact that M.S. Vovsi belongs to the scientific and pedagogical school of cardiology of prof. D.D. Pletnev, he managed to create his own. M.S. Vovsi is one of the creators of modern military field therapy, expanded the understanding of the pathogenesis of nephritis, pneumonia, coronary heart disease, hypertension, heart failure, he introduced new methods for diagnosing and treating these therapeutic pathologies that have not lost their relevance today.

[Significance of platelets in inflammatory and thrombotic reactions in the elderly.]

The development of thrombotic reactions that lead to undesirable clinical consequences in the elderly is known in many diseases, including pathology of the cardiovascular system. Today, data on the severity of changes in the hemostatic system in patients with a new coronavirus infection (COVID-19) and the study of platelet and plasma levels are being accumulated. In order to understand some of the mechanisms associated with platelet pathology, we present a review that summarizes information about the pathophysiological reactions of platelets in the conditions of their aging and possible mechanisms of their pathological aggregation. Perhaps the presented fundamental and clinical data will be of interest to a wide audience of specialists to discuss early antiplatelet therapy and its justification not only in patients with cardiovascular diseases, but also with COVID-19.

[General and particular issues of etiopathogenesis of peptic ulcer and gastric cancer: current status of the problem].

The development of peptic ulcer (PU) and gastric cancer (GC) is the result of the interaction of various internal and external factors. Moreover, if the role ofHelicobacter pylori(H. pylori) in the development of diseases of the stomach is fully established, the significance of many other factors continues to be discussed. Serious controversy is caused by the participation of various strains ofH. pyloriin the development of PU and GC. First of all, these are Vac- and Cag-positive strains ofH. pylori. The role of genetic human polymorphism in the development of this pathology is debatable. Especially the interleukin genes and necrotizing tumor factor alpha. The role of environmental factors in the formation of PU and GC is not fully understood. So, the role of alcohol, occupational hazards and drugs in the development of these diseases continues to be discussed. Further study of risk factors for various diseases of the stomach will optimize their prevention and treatment. The review presents a modern view of individual issues in the pathogenesis of PU and GC.

[Gastroesophageal reflux disease and esophagitis associated with the use of drugs: the modern state of the problem].

From the standpoint of evidence - based medicine, the ability of various drugs to induce the development of gastroesophageal reflux disease and esophagitis is considered. Thus, all known drugs can be divided into 3 groups: drugs that have the ability to reduce pressure in the lower esophageal sphincter, for example, ß-adrenoreceptor agonists, α-adrenoreceptor antagonists, anticholinergics, calcium channel blockers, nitrates, benzodiazepines (diazepam), estrogen, progesterone, aminophylline (theophylline), tricyclic antidepressants, selective serotonin reuptake inhibitors, glucocorticosteroids; means providing a direct damaging effect on the esophageal mucosa, as well as lowering its resistance reflyuktatu, e.g., bisphosphonates, acetylsalicylic acid / non - steroidal anti - inflammatory agents, anticoagulants, antiplatelet drugs, iron preparations, ascorbic acid, potassium chloride, quinidine, phenytoin, calcium dobesilate, 131I sodium iodide, antibiotics (tetracycline, doxycycline, clindamycin, ciprofloxacin, ornidazole, clindamycin, rifampicin), antitumor agents; drugs that impede gastric emptying: calcium channel blockers, anticholinergics. These data can be used in practice in the choice of treatment tactics, especially in individuals with a diagnosis of gastroesophageal reflux disease or heartburn.

[CLINICAL AND ENDOSCOPIC, MORPHOLOGIC AND IMMUNOHISTOCHEMICAL FEATURES OF GASTRIC ULCER IN H. PYLORI-INFECTED INDIVIDUALS RECEIVING CYTOTOXIC THERAPY].

THE PURPOSE OF THE STUDY: To determine the prognostic significance of the expression of molecules of PCNA, Bcl-2, NF-Kb and tachykinins (substance P, neurokinin A) in patients with gastric ulcer (CU) receiving cytotoxic therapy. MATERIALS AND METHODS: Total surveyed 90 patients divided into 3. equal groups. The first comparison group consisted of patients with chronic atrophic H. pylori-associated gastritis (CAG) (30 pers.). A second control group consisted of patients with gastric ulcer (30 pers.). Third, the study group consisted of 30 people. with CU suffering from hematological malignancies, in a period of complete clinical remission of the disease and receiving supportive polychemotherapy (PCT). Patients underwent endoscopy, morphological and immunohistochemical study of the mucous membrane of the antrum and body of the stomach to detect the expression of molecules of PCNA, Bcl-2, neurokinin A, substance P and factor Nf-Kb. RESULTS: The total level of dyspeptic syndrome on visual scale analogue in patients receiving chemotherapy and GU (GUpct) was significantly higher (p < 0.05) compared with patients with GU. It should be noted that patients with GUpct reducing clinical symptoms is much slower (p < 0.05). At the same time in 13 (43.3%) patients with GUpct determines the duration of ulcer healing, whereas in patients with GU in only 4 (13.3%) patients. Patients with GUpct more frequently (p < 0.05) were verified II and stage Ill chronic gastritis (CG), while Stage I--less (p < 0.05). Patients with GUpct significantly more often (p<0.05) was determined by the II degree of CG and significantly less (p < 0.05)--IV degree. Patients with GUpct determined significantly lower (p < 0.05), the expression performance PCNA, substance P and neurokinin A and higher (p < 0.05)--Bcl-2 and factor Nf-kB. CONCLUSION: GU in patients receiving chemotherapy, dyspeptic syndrome is characterized by severe, advanced stage of CG on the background of relatively low severity of CG in accordance with the classification of OLGA (2008). Patients with GUpht have a significant level of violation of regeneration changes how is this atrophy, intestinal metaplasia, dysplasia of gastric mucosa association with gross violations of the processes of epithelial cell homeostasis of epithelial cells regulation after molecules PCNA, Bcl-2, NF-kB and tachykinins (substation P, neurokinin A).

CHRONIC GASTRITIS AND FUNCTIONAL DYSPEPSIA: CURRENT ISSUES IN CLASSIFICATION, DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS IN THE CONTEXT OF THE KYOTO GLOBAL CONSENSUS.

Set out the basic problems of classification, diagnostics and differential diagnostics of chronic gastritis and functional dyspepsia in the context of the Kyoto global consensus.

[[Overview Basic Provisions Consensus of the III Working Italian Group for Diagnosis and Treatment of H.Pylory-Infection].]

The purpose of the review. Outline the main points of consensus III Working Group Italian for the diagnosis and treatment of H.pylori-infection. The work of the Working Group III was the clarification of certain provisions of the Maastricht IV consensus, and, namely, the nature of H.pylori relationship with gastroesophageal reflux disease, functional dyspepsia, NSAID / aspirin gastropathy, extra-gastric diseases, detailed scope of the invasive and non-invasive methods of investigation, treatment algorithms updated H.pylori-infection antibiotic growth conditions. Indented understanding of the role of H.pylori eradication in the prevention of gastric cancer.

[Gastroesophageal reflux disease in patients receiving chemotherapy: clinical, endoscopic, morphological and immunohistochemical features].

THE PURPOSE OF THE STUDY: Determine the pathogenetic significance of express molecules PCNA, Bcl-2, NF-Kb and tachykinins (substance P, neurokinin A) in patients with gastroesophageal reflux disease (GERD), receiving polychemotherapy (PCT). MATERIALS AND METHODS: In total 60 patients were examined with GERD time-divided into 2 equal groups on the receiving PCT Leukemia over standard dose for at least one year. The first group consisted of 30 subjects with non-erosive GERD (NEGERD) endoscopically positive form receiving PCT. The second group consisted of 30 subjects with erosive form of GERD (EFGERD) receiving PCT. Patients underwent endoscopy, morphological and immunohistochemical examination of the esophageal mucosa to the definition expression of molecules PCNA, Bcl-2, neurokinin A, substance P and factor Nf-Kb. In patients with refractory form of GERD to proton pump inhibitors therapy (PPIs), additionally imposed ursodeoxycholic acid. THE RESULTS: Patients with NEGERD receiving PCT in 33.3% of cases formed refractory to PPIs form of the disease, when EFGERD refractoriness occurs in 46.7% of patients, which is associated with slowing the proliferation of epithelial cells of the esophagus due to decreased expression of PCNA. Reduced expression of neurokinin A in patients receiving PCT is associated with less activity and intensity of inflammation of esophageal mucosa. Against the background of a high degree of PCT expression of Bcl-2 and factor Nf-Kb, which may explain the frequent detection of atrophic and meta- plastic changes in the esophageal mucosa. Appointment of ursodeoxycholic acid in the complex therapy of GERD can overcome resistance to PPIs and improve the performance of cell renewal. CONCLUSION: Due to the frequent development of GERD refractory to PPIs in patients suffering from diseases requiring the appointment of long-term courses of PCT requires the appointment of cytoprotective therapy, as that can be used ursodeoxycholic acid.

[Functional disorders of the gastrointestinal tract in the context of morphofunctional unity].

The aim of this work was systematization of the currently available data on pathological physiology and morphology of functional disorders of the gastrointestinal tract (GIT) underlain by combined changes of neuroendocrine and neural regulation related to genetic polymorphism and external provoking factors (in the first place, stress). Altered function and morphology of diffuse neuroendocrine system and expression of certain regulatory molecules (nitric oxide, interleukin-1) in the patients with functional GIT disorders induce inflammation and changes in epitheliocyte regeneration, i.e. morphological substrate of the disease. Verification of various morphofunctional and structural changes accompanying functional pathology of GIT necessitates further improvement of classification criteria for functional diseases as reflected in the forthcoming Rome criteria IV.

[The role of epitheliocytes secreting vascular endothelial growth factor, pancreatic polypeptide and glucagon in the development of oncological diseases of the stomach].

The present study included 104 patients with gastric disorders associated with Helicobacter pylori infection. Thirty of them presented with chronic atrophic gastritis (CAG), 30 with gastric ulcer (GU), 20 with adenomatous gastric polyps (AGP), and 24 with gastric cancer (GC). The control group was comprised of 12 practically healthy subjects. We elucidated the role of vascular endothelial growth factor (VEGF) and endocrine cells of gastric mucosa producing glucagon (GC) and pancreatic polypeptide (PPP) in the patients with GAG, GU, AGP and GC prior to and after the surgical intervention and following eradication therapy. It was shown that GAG, AGP, and GC were associated with the persistence of Helicobacter pylori infection and accompanied by hyperplasia of GC and PPP-secreting endocrine cells of gastric mucosa. GU was characterized by hypolasia of VEGF-secreting epithelial cells of the stomach and GC and PPP-secreting endocrine cells of gastric mucosa. The levels of VEGF, GC and PPP that directly or indirectly realize their pathological properties through H. pylori, Bcl-2, and proapoptotic protein BAX proved to be of high prognostic value as regards the evolvement and clinical course of gastric disorders associated with Helicobacter pylori infection. The study demonstrated that adequate eradication therapy in patients with H. pylori-associated diseases of the stomach significantly reduces the number of gastric cells secreting VEGF and has practically no effect on the amount of GC and PPP-producing endocrine cells of gastric mucosa.

[Dynamics of regeneration of epitheliocytes from gastric mucosa at different modes of antirelapse treatment of ulcer disease].

Exacerbation of duodenal ulcer disease (DUD) is associated with elevated number of Ki-67 and Bcl-2 positive endtotheliocytes and apoptotic activity. Inhibition of endotheliocyte proliferation and apoptotic activity in gastric mucosa (GM) upon eradication of Hp in DUD patients promotes ulcer healing. Combination of eradication with melaxen therapy substantially enhances efficiency of Hp elimination and reduces cicatrization time. Antirelapse treatment with melaxene and omeprazole normalizes endotheliocyte homeostasis on GM to a greater degree than omeprazole monotherapy.

[Eradication therapy and processes of proliferation and apoptosis in the stomach of patients with duodenal ulcer].

A total of 172 subjects were enrolled in the study including 100 with duodenal ulcer (DU), 30 with chronic non-atrophic gastritis (CNG), 30 with chronic atrophic gastritis (CAG), and 12 practically healthy controls. All DU, CNG, and CAG patients had Helicobacter pylori (Hp) infection confirmed by morphological study of gastric mucosa. Patients with DU were divided into 2 groups matched for age, endoscopic, morphological, and immunohistochemical characteristics. In group 1, Hp was eradicated by traditional therapy with omeprazole (20 mg), clarithromycin (500 mg), and amoxicillin (1000 mg) twice daily for 7days. This treatment in group 2 was supplemented by dibicor (500 mg twice daily). Thereafter, patients of group 1 continued to receive omeprazole for 6 weeks followed by maintenance therapy; those of group 2 received omeprazole plus dibicor for 6 weeks and maintenance therapy. CNG and CAG patients and healthy subjects served as controls. Fibrogastroduodenoscopy was performed after 2 and 4 weeks. CNG and CAG patients were examined for the presence of KI-67, BCL-2 regulators and apoptotic activity of epitheliocytes from antral mucosa before and 6 weeks after eradication therapy. It is concluded that its combination with dibicor significantly contributes to Hp elimination, shortens duodenal scarring time, improves KI-67, BCL-2 expression, and stimulates apoptotic activity of epitheliocytes compared with traditional omeprazole treatment.

Artrofoon as alternative preparation in the treatment of uncomplicated forms of nonspecific ulcerative colitis.

Therapy of uncomplicated nonspecific ulcerative colitis with artrofoon effectively reduces the duration and number of relapses. During remissions, the count of apudocytes, serotonin-, melatonin-, vasointestinal peptide-producing, and mast cells and the parameters of cell homeostasis against the background of artrofoon therapy were much closer to the normal than during treatment with salofalk.

[The state of cell regeneration (proliferation and apoptosis) of gastric mucosa in rheumatological patients].

The results of comparative analysis of apoptotic and mitotic indices in groups of patients (20 persons in each group) with rheumatologic diseases and ulcerative disease of duodenum (UDD) are shown in the article. It was established, that both apoptotic and mitotic indices in UDD patients were significantly higher than in rheumatologic patients. Indices of necrosis of gastric mucous membrane epithelial cells in UDD patients were also higher than in rheumatologic patients.

[The role of some cell regeneration markers of epithelial cells in genesis of gastric tumors associated with H. pylori].

It is established, that chronic atrophic gastritis adenomatous polyps and gastric cancer are consecutive stages of gastric mucous tunic cell renovation disturbance, manifests itself in progressive delay its apoptosis activity from proliferation, which reflects increase in expression Ki-67 and Bcl-2. Eradication of Helicobacter pylori shorts activity and reduces intensity of inflammatory process in gastric mucous tunic and improves indices of cell renovation.

[The role of diffuse endocrine system and colonocytes cellular renovation in formation of clinical variants of irritable colon syndrome in young persons].

60 patients with irritable colon syndrome (ICS) were examined. They were divided into 2 groups. Group 1 included 30 patients who had ICS with dominating constipation (ICSc). Group 2 consisted of 30 patients with ICS and dominating diarrhea (ICSd). 12 practically healthy persons composed control group. The patients were being observed in dynamics (in periods of aggravation and remission), under uniform program including clinical, endoscopic, morphologic and immunohistochemical methods. It was established that ICSc development related to hyperplasia and hyperfunction serotonin producing cells together with decrease of number and functional activity of VIP-producing cells and mast cells. It was detected significant increase of colonocytes proliferative activity, shown throw number of immunopositive to cycline Dl epithelial cells, and compensatory increase of apoptosis activity. In patients with ICSd it was registered increase of number and functional activity of general population of apudocytes, serotonin-, melatonin- and VIP-produsing cells and mast cells. It was detected decrease of number of colonocytes immunopositive to cycline D1 and proliferating cell nuclear antigen, and growth of colon epithelial cells apoptosis activity. More significant changes of diffuse endocrine system in patients with ICSd set conditions for progress of changes of cell renovation with frequent colon mucous tunic atrophy, acting as a background for carcinogenesis.

[Specifics of apoptotic activity and expression of regulatory molecules (Ki-67, Bcl-2) of gastric mucosal epitheliocytes, in the process of Correa's cascade].

The subjects of the study were 104 patients with Helicobacter pylori (HP)-associated gastric pathology, including 30 patients with gastric ulcer (GU), 30 patients with chronic atrophic gastritis (CAG), 20 patients with CAG plus adenomatous polyps (AP), and 24 patients with gastric cancer (GC). All the subjects were examined dynamically; the comparison group consisted of 12 practically healthy people. The study revealed that GU, CAG, AP, and GC were consequent stages of gastric mucosal epithelial cell regeneration disorder which manifested by the fact that the apoptotic activity of these cells was lower than their proliferation rate, and this difference grew with time; the reflection of this was the growth of Ki-67 and Bcl-2 expression. HP eradication improved the process of cell regeneration. Epithelial cell apoptosis/proliferation ratio tended to normalize, which suggests that the processes of mucosal atrophy and metaplasia, and initial signs of gastric mucosal dysplasia in patients with HP-associated pathology may be reversible.