[All-Russian Consensus on Diagnosis and Treatment of Celiac Disease in Children and Adults]. / Vserossiiskii konsensus po diagnostike i lecheniyu tseliakii u detei i vzroslykh.

The paper presents the All-Russian consensus on the diagnosis and treatment of celiac disease in children and adults, which has been elaborated by leading experts, such as gastroenterologists and pediatricians of Russia on the basis of the existing Russian and international guidelines. The consensus approved at the 42nd Annual Scientific Session of the Central Research Institute of Gastroenterology on Principles of Evidence-Based Medicine into Clinical Practice (March 2-3, 2016). The consensus is intended for practitioners engaged in the management and treatment of patients with celiac disease. Evidence for the main provisions of the consensus was sought in electronic databases. In making recommendations, the main source was the publications included in the Cochrane Library, EMBASE, MEDLINE, and PubMed. The search depth was 10 years. Recommendations in the preliminary version were reviewed by independent experts. Voting was done by the Delphic polling system.

[Pathogenetic bases and efficacy of slow calcium channel blockers in the therapy of recurrent peptic ulcer disease associated with hypertension]. / Patogeneticheskie osnovy i effektivnost' primeneniya blokatorov medlennykh kal'tsievykh kanalov v terapii retsidiva yazvennoi bolezni, assotsiirovannoi s arterial'noi gipertoniei.

AIM: To clarify blood calcium concentrations (BCCs) as an indicator of the functional state of the calcium-regulating system in the concomitant course of recurrent peptic ulcer disease (PUD) and hypertension, by comparing with the severity of a ulcerous process, with changes in regional microcirculation, and with the functions of the stomach. To elucidate the pathogenetic justification for and clinical efficacy of slow calcium channel blockers (SCCBs) in the treatment of this comorbidity. SUBJECTS AND METHODS: In the case-control study, each patient with recurrent PUD and grade 1, Stage I hypertension (Group 1; n=23) corresponded to a recurrent PUD patient matched for sex, age, and ulcer site (Group 2, n=23). The complex of treatment for these patients included the SCCB nifedipine. A control group consisted of 56 recurrent PUD patients who received combination therapy without nifedipine. All the patients over time underwent clinical and endoscopic examinations and determinations of BCCs, indicators of gastric secretory and motor functions, and regional microcirculation in the gastroduodenal mucosal biopsy specimens. RESULTS: Recurrent PUD was present with a reliable BCC increase that was more substantial when it was associated with hypertension. Calcium imbalance was accompanied by changes in regional microcirculation and gastric secretory and motor functional indicators forming an acid peptic factor, as well as by hypermotor dyskinesia, which were more pronounced in patients with comorbidity. Incorporation of a SCCB into a complex of therapy for recurrent PUD to eliminate the pathogenic effect of blood calcium contributed to more rapid arrest of the clinical symptoms of a recurrence, to elimination of acute-phase microcirculatory disorders in the gastroduodenal zone, and to the recovery of gastric functional indicators. Elevated blood pressure was ruled out during the therapy of concomitant diseases. CONCLUSION: Incorporation of a SCCB into the combination therapy of recurrent PUD associated with hypertension is pathogenetically sound and clinically effective.

[THE ROLE OF HELICOBACTER PYLORI IN NORMOMICROBIOCENOSIS AND DYSBACTERIOSIS OF MUCOSAL MICROFLORA OF OESOPHAGOGASTRODUODENAL ZONE IN THE CASES OF PEPTIC ULCER, CHRONIC GASTRITIS AND OESOPHAGITIS].

AIM: Determine the qualitative and quantitative composition of the mucosal microflora of oesophagogastroduodenal zone to determine the location of Helicobocter pylori and its place in normomicrobiocenosis and dysbacteriosis in cases of peptic ulcer, chronic gastritis and oesophagitis. MATERIALS AND METHODS: Clinical and microbiological studies were conducted in 30 healthy individuals-volunteers, 130 patients with peptic ulcer, 36--chronic gastritis and 24--chronic esophagitis. RESULTS OF THE STUDY: Helicobacter pylori in 33% of cases included in normomicrobiocenosis of mucosal microflora oesophagogastroduodenal zone, which consists of 12 genera of microorganisms and carries out all protection functions. The recurrence of peptic ulcer disease, exacerbation of chronic active gastritis and oesophagitis are accompanied by a dysbacteriosis of mucosal microflora with overgrowth of typical and atypical microorganisms for normal biotope with reduced occurrenceof Helicobocter pylori. CONCLUSION: Helicobacter pylori in the biocenosis of mucosal microflora of oesophagogastroduodenal zone is not an infection, has no independent significance in the development of peptic ulcer, chronic gastritis and esophagitis, does not require eradication.

[NEW ASPECTS OF TRANSENDOSCOPIC TREATMENT OF PEPTIC ULCER ASSOCIATED WITH DYSBACTERIOSIS OF GASTRODUODENAL ZONE].

AIM: Find out the condition of mucosal microflora in gastroduodenal ulcer patients in different phases of its recurrence, to determine changes in the value of dysbiotic changes in ulcerogenesis, develop and confirm new transendoscopic treatment of gastroduodenal ulcers. MATERIALS AND METHODS: The study included 134 patients and 10 healthy volunteers RESULTS: At relapse of peptic ulcer and distant from the ulcer areas of the mucosa were allocated to 28 genera and species of microorganisms with a wide range of enzymatic activity and cytotoxicity, that corresponds to the 2-3 degree dysbacteriosis and shows microbiological parameters infected wound which required sanation. CONCLUSION: Application for transendoscopic sanation of gastroduodenal ulcers of new compounds iodine-lysozyme, dimexide-iodine-lysozyme and chitosan with bactericidal and sorption effects, can significantly reduce the time of ulcer healing and restore normobiocenosis of mucosal microflora of the gastroduodenal zone.

[The calcium-regulating system and recurrent peptic ulcer].

AIM: To elucidate the functional state and value of the calcium-regulating system, calcium and phosphorus metabolism in the pathogenesis and sanogenesis of peptic ulcer (PU); to define the possible ways to correct shifts found in the treatment of disease relapse, by affecting the different levels of their disorders. SUBJECTS AND METHODS: A total of 220 patients with recurrent PU were examined by determining the blood levels of parathyrin, calcitonin, calcium and phosphorus, as well as gastric secretory and motor functions. RESULTS: Recurrent PU was accompanied by a considerable increase in the blood concentration of parathyroid hormone and calcium, a slight rise in that of calcitonin, and a significant reduction in that of phosphorus. These changes were attended by a substantial increase in gastric acid- and pepsinogen-forming functions, a decrease in the production of gastric mucoproteins, and hypermotor dyskinesia. The use of calcitrin, nifedipine, and etidronic acid, which eliminate dysfunction of the calcium-regulating system at different levels of its impairments, leads to a significant reduction in the time of alleviation of the clinical and endoscopic manifestations of a recurrence. CONCLUSION: Recurrent PU runs in the presence of calcium-regulating system dysfunction. Incorporation of the thyroid C-cell hormone preparation calcitrin, the slow calcium-channel blocker nifedipine, and etidronic acid bisphosphonate into a complex of treatment for a disease recurrence is pathogenetically sound and clinically effective.

PHYSIOLOGY OF SYMBIOTIC AND OWN MAN DIGESTION.

Aimlo observe the qualitative and quantitative composition of the luminal and mucosal microflora in the functional departments of digestive tract, determine its participation in the fermentation of food ingredients and place of symbiotic digestion in the digestive conveyor. MATERIALS AND METHODS: The study involved 107 healthy volunteers aged 18-36 years. The qualitative and quantitative composition, enzymatic activity of the oral fluid on the surface of the cheeks and tongue, and the contents of the biopsies of the esophagus, stomach, duodenum,jejunum, ileum and colon have been studied. RESULTS: Symbiotic digestion is carried out by luminal and mucosal microflora provided cavitary and parietal bacterial dilestion in all parts of the digestive tract. Symbiotic digestion included in the own digestion takes place in the fermentation of food ingredients, complementing and extending the assimilation processes. gondusion. The obtained data allowed to expand understanding of the digestive, process in humans, the first describe four phases of enteric digestion, propose a scheme of digestive convey or that includes mechanisms of the own and symbiotic digestion in all its departments.

MICROBIOCENOSIS OF THE ORAL CAVITY AS A REFLECTION OF INTESTINAL MICROBIOTA.

AIM: Determine qualitative and quantitative parameters of mouth and intestines microbiocenosis of healthy people in the age aspect to assess the status of the digestive tract microbiota, as an indicator of human health. MATERIALS AND METHODS: We examined 74 healthy subjects aged 12-18 years who have a comparative aspect investigated qualitative and quantitative composition of the oral fluid and feces microflora. RESULTS: The mouth and intestines microbiota of healthy people has a number of interrelated characteristics defined microbiota of the entire digestive tract The first time were described three variants of the mouth and intestines microbiota, characterized by a certain combination of obligate and facultasive microflora, depending on the age and livelihoods. CONCLUSION: Definition ofmouth and intestines microbiocenosis can be used to assess the status of the digestive tract microbiora as an indicator of health and correction of outlined features through a rational manner of life, balanced diet, pre-and probiorics administration.

[Calcium and phosphorus balance and its significance for the course of recurrent peptic ulcer disease].

AIM: To evaluate calcium and phosphorus balances during recurrent peptic ulcer disease (PUD) and to estimate the impact of found changes on the course of an ulcerative process, secretory and motor functions in the stomach. SUBJECTS AND METHODS: Sixty patients with recurrent PUD were examined. They underwent determinations of blood and urinary calcium and phosphorus levels and gastric secretory and motor functions in addition to clinical and endoscopic examinations. RESULTS: Recurrent PUD was shown to be accompanied by significantly elevated blood calcium and substantially decreased blood phosphorus, insignificant hypercalciuria and hyperphosphaturia. These changes were attended by considerably increased acid- and pepsinogen-forming functions of the stomach, lower gastromucoprotein production, and gastric hypermotor dyskinesis. More pronounced shifts in calcium and phosphorus balance were revealed in the acute phase of a disease recurrence in young men with duodenal ulcers. CONCLUSION: A clear relationship between calcium and phosphorus metabolic disturbances, ulcerative process activity, and gastric functional changes may point to the significance of found shifts in ulcerogenesis and to the pathogenetic substantiation of correction of these disorders in the treatment of a disease recurrence.

[Treatment of disbacteriosis of gastroduodenal mucous microflora in mucosa inflammation, ulcer and erosion].

AIM: To propose pharmacotherapy of disbacteriosis of gastroduodenal mucous microflora in gastroduodenal inflammation, erosion and ulcer. MATERIAL AND METHODS: The study enrolled 30 healthy volunteers, 130 ulcer patients and 36 patients with chronic gastritis (27% of the latter had chronic duodenitis). In addition to general clinical examination, fibrogastroduodenoscopy, we made histological and microbiological examinations of biopsy specimens of the mucosa from different parts of the stomach and duodenum, determined sensitivity of the microflora to antibacterial drugs. RESULTS: We found that recurrent ulcer, chronic gastritis and duodenitis are accompanied with overgrowth of pathogenic microflora in gastric and duodenal mucosa. CONCLUSION: We developed an effective method of the treatment of gastroduodenal mucosa microflora disbacteriosis in gastroduodenal inflammation, erosion and ulcer including antibacterial, antifungal drugs and probiotics.

[Helicobacter pylori as a part of microbiocenosis of mucosal microflora esophago-gastroduodenal zone in the norm and pathology].

UNLABELLED: AIM; Revealing the level and significance of Helicobacter pylori (H. pylori) in the normobiocenosis and disbacteriosis of mucosal microflora in the osophagogastroduodenal zone. MATERIAL AND METHODS: Qualitative and quantitative composition of the mucosal microflora was defined in biopsy specimens from different parts of oesophagus, stomach and duodenum in addition to clinical and histological examination in 50 healthy volunteers, 106 ulcer duodenum patients, 24 patients with gastric ulcer, 36 with chronic gastritis and 24 with chronic oesophagitis. RESULTS: H. pyloril is involved into normomicrobiocenosis of the mocosal microbiota and take part of main defensive function of gastroduodenal tract. Excerbation of peptic ulcer, chronic gastritis and oesophagitis is accompanied with the reduction H. pylori in most cases, though the scar formation occurs both with and without presence of H. pylori. CONCLUSION: The colonization of the oesophagogastroduodenal zone by H. pylori has no infection process and play the independent role in the development of the ulcer disease, gastritis and oesophagitis and does not require the eradication.

[Meaning of the calcium regulating system in the pathogenesis of experimental gastric ulcers in rabbits].

UNLABELLED: The arm of the study was to examine the influence parathyrin and calcitonin on the development experimental gastric ulcers of rabbits. MATERIAL AND METHODS: The study involved 87 rabbits. All animals were divided on six groups in dependence on experimental influence (control, trauma celiac plexus, application parathyrin, trauma celiac plexus and introduction parathyrin, application calcitonin, trauma celiac plexus and introduction calcitonin). CONCLUSION: Experimental gastric ulcers reproducing of trauma celiac plexus are formed on the background of dysfunction parathyroid glands and C-cell thyroid gland and hypercalcemia. Parathyrin intensifies mechanisms of ulcer's formation, calcitonin prevents from it.

[Dysbacteriosis of mucosal microflora of the gastroduodenal zone in inflammatory and ulcer lesions: diagnosis and classification].

AIM: To study mucous (parietal) gastroduodenal microflora in healthy persons, patients with ulcer and chronic gastritis, to develop diagnostic criteria and classification of gastroduodenal dysbacteriosis. MATERIAL AND METHODS: Biopsy specimens were obtained from gastroduodenal mucosa of 134 patients with ulcer, 36--with chronic gastritis and 28 healthy subjects. The mucous microflora agents were isolated microbiologically from biopsy specimens obtained from different compartments of the stomach and duodenum. The spectrum of their enzymatic activity and cytotoxic properties were determined. RESULTS: Gastroduodenal mucous microflora of healthy subjects was represented with 1-2, less often with 3-4 cultures of 12 species, enzymatic activity spectrum of microorganisms was small, cytotoxicity was absent. In ulcer recurrence and exacerbation of chronic gastritis gastroduodenal zone showed dysbacteriosis characterized by overgrowth of mucous microflora (up to 22 species of microorganisms) with a wide spectrum of enzymatic activity and cytotoxic properties. The criteria of dysbacteriosis diagnosis and classification are proposed. CONCLUSION: The role of gastroduodenal mucous microflora in ulcer and gastritis course is specified. New approaches to effective treatment of gastroduodenal diseases may be developed with consideration of dysbacteriosis.

[Choline- and histaminergic shifts as a trigger of gastroduodenal erosive-ulcer lesions in myocardial infarction].

AIM: To clarify the role of cholin- and histaminergic shifts in the onset of circulatory and functional gastric disturbances associated with erosive-ulcer gastroduodenal lesions in myocardial infarction (MI). MATERIAL AND METHODS: Cholin- and histamine-reactive systems, end gastroduodenal mucosal circulation were studied in 80 Ml patients with gastroduodenal erosions and ulcers divided into three groups by the disease severity. RESULTS: MI features influence characteristics and severity of gastroduodenal erosions and ulcers. The latter develop due to focal microcirculatory disorders in gastric and duodenal mucosa by thrombohemorrhagic or thromboischemic type. Moderate and severe coronary pathology is associated with higher production of hydrochloric acid and pepsinogen, with depressed production of gastromucoproteins, hypo- or hypermotor dyskinesia, extremely severe coronary pathology--with decline of all gastric functions except normal acid production. Erosive-ulcer lesions may be triggered by alterations in cholin-histamine systems the activity of which in moderately severe and severe MI rises but in extremely severe--lowers. CONCLUSION: Pathogenesis of erosive-ulcer lesions of the gastroduodenal zone in MI has some specific features dependent on severity of MI. This should be taken in consideration in choice of drug therapy.

[Clinico-pathogenetic variants of chronic gastritis]. / Kliniko-patogeneticheskie varianty khronicheskogo gastrita.

AIM: To evaluate specific features of the course of chronic gastritis (CG), morphofunctional condition of gastric mucosa, vegetative regulation, adrenergic and cholinergic shifts, histamine metabolism and effects of exogenic and endogenic risk factors in CG patients; to study clinicopathogenetic variants of CG. MATERIAL AND METHODS: A total of 311 CG patients aged from 16 to 72 years were studied. They were divided into three groups by their gastric mucosa condition. The control group consisted of 30 healthy donors. The following parameters were studied: visual and histological condition of gastric mucosa, total acidity, the levels of free hydrochloric acid, pepsin, bioelectric gastric activity, general autonomic tonicity, cholinesterase activity. RESULTS: Three clinicopathogenetic variants of the disease have been identified. Variant 1 was characterized by a recurrent course, subjective manifestation of the disease only in exacerbation, surface (primarily antral) mucosal affection, normal or enhanced secretory and motor functions of the stomach, adequate reaction of acid production to caffeine and histamine stimulation, parasympathicotonia, absolute hyperhistaminemia, relative hypoacetylcholinemia, subnormal urinary excretion of adrenalin. Variant 2 manifested with rare recurrences, longer and more severe exacerbations, frequent spontaneous and provoked aggravations, moderate focal atrophy of the mucosa, secretory insufficiency with adequate reaction to histamine and minor to caffeine stimuli, hypomotor gastric dyskinesia, vegetative eutonia, normohistaminemia, absolute hypoacetylcholinemia, subnormal urinary excretion of noradrenaline. Variant 3 runs without definite remissions and exacerbations, with continuous abdominal pain and dyspepsia, frequent spontaneous aggravations, marked extended mucosal atrophy with secretory insufficiency up to achlorhydria, no stimulation of acid production in response to caffeine and histamine, gastric hypomotility, sympathicotonia, absolute hypohistaminemia, hypoacetylcholinemia, normal urinary excretion of catecholamines. CONCLUSION: The findings expand our knowledge about clinicopathogenetic variants of CG and necessitate new approaches to development of effective methods of CG prevention and treatment.

[Ulcer recurrence and gastroduodenal dysbacteriosis]. / Retsidiv iazvennoi bolezni i disbakterioz gastroduodenal'noi zony

The studies that were conducted for 82 patients with ulcer established that 22 genera of microorganisms including H. pylori in a combination from 2 up to 8 various microbial cultures can be secured from the biopsy of the mucous coat of the pre-ulcer zone at the acute phase of recurrence. They have high enzymatic and cytotoxic activity. This draws together microbiological characteristics of the ulcer defect with parameters of the infected wound and corresponds to dysbacteriosis of the third degree. The data obtained form the basis for considering that the exacerbation of ulcer is accompanied by expressed dysbiotic shifts depending on the recurrence phase. It is necessary for taking this into account in the development of methods of adequate therapy for the disease aimed at the suppression of the excess growth of mucous microflora and restoration of normal microbiocenosis in the gastroduodenal zone.

[Microflora of the gastroduodenal zone and morphological characteristics of phases of recurrent peptic ulcer]. / Mikroflora gastroduodenal'noi zony i morfologicheskaia kharakteristika faz retsidiva iazvennoi bolezni.

The studies conducted for 126 patients with stomach and duodenal ulcers revealed that at the acute state of recurrent ulcer activation of the microflora displaying pathogenetic signs and corresponding to the third or fourth degree of dysbacteriosis takes place in the ulcerous defect zone along with microcirculatory disorders, necrotic inflammatory processes and reduction of the lysozyme content in tissues. This allows comparing ulcers of the gastroduodenal zone to an infected wound. At the sub-acute phase of recurrent ulcer (next one or two weeks) microbiological changes in the per-ulcer zone reduce to dysbacteriosis of the second or third degree as inflammatory and necrotic processes cease, an at the phase of cicatrisation and epithelization they are similar to normal biocenosis.

[Pathogenetic basis of the application of calcium antagonists in the treatment of recurrent peptic ulcer]. / Patogeneticheskie osnovy primeneniia antagonistov kal'tsiia v lechenii retsidiva iazvennoi bolezni.

Examination of 150 ulcer patients determined that the exacerbation of the disease proceeds against the background of essential augmentation of calcium in the blood, which is most expressed at the acute phase of relapse, at the localization of ulcer in the duodenum, in men of young age. This is accompanied by the rising production of hydrochloric acid and pepsinogen, decrease of production of gastromucoproteins, hypermotor dyskinesia of stomach, hypocoagulation, infringement of microcirculation in the mucous coat of the gastroduodenal zone displayed as microthromboses, plasmorrhagias, hemorrhages. The inclusion of the calcium antagonist Corinfarum in the complex therapy reliably accelerates the liquidation of signs of relapse, reduces terms, increases the percentage of ulcer cicatrisation, and promotes normalization of stomach functions, calcium balance, hemostasis and microcirculation.

[Clinical symptoms of erosive and ulcerous lesions of gastroduodenal zone in patients with unstable ischemic heart disease and the significance of endoscopy in diagnosis]. / Klinicheskie proiavleniia érozivno-iazvennykh porazhenii gastroduodenal'noi zony pri nestabil'nom techenii ishemicheskoi bolezni serdtsa i znachenie éndoskopicheskogo issledovaniia v ikh diagnostike.

We studied 103 patients with unstable ischemic heart disease and clinical signs of gastroduodenal injury. Among them 62 (60.2%) patients had moderate gastric dyspepsia and abdominal pain during first 1-5 days of hospitalization. In 17 (16.5%) cases these clinical symptoms were accompanied with symptoms of gastroduodenal hemorrhage. Twenty four patients (23.3%) with history of ulcer disease or chronic gastritis, were asymptomatic. In 96 (93.2%) patients endoscopy performed mainly on days 20-24 of hospital stay detected gastroduodenal erosions and ulcers: acute ulcers were found in 19.4, acute erosions - in 40.8, exacerbations of peptic ulcer - in 33.0% of patients. Clinical symptoms of gastroduodenal ulcers and erosions often did not reflect character, severity and dynamics of pathological process. Therefore gastro- duodenoscopy had decisive importance for diagnosis and assessment of effect of treatment. Endoscopy should be carried out with due consideration of concomitant coronary pathology.

[Clinico-morphological features of acute gastroduodenal erosion and ulcers in an unstable course of myocardial ischemia and role in disturbances of microcirculation, stomach function and their development]. / Kliniko-morfologicheskie osobennosti ostrykh gastroduodenal'nykh érozii i iazv pri nestabil'nom techenii ishemicheskoi bolezni serdtsa i rol' narushenii mikrotsirkuliatsii, gemostaza, funktsii zheludka v ikh razvitii.

AIM: Determination of clinicomorphological characteristics of acute gastroduodenal erosions and ulcers in unstable course of IHD and the role of disorders in microcirculation, hemostasis, gastric function in development of these erosions. MATERIAL AND METHODS: Clinically and endoscopically were examined 124 patients with unstable IHD. By detected gastroduodenal changes the patients were divided into three groups. The study was also made of local and systemic microcirculation, hemostasis, gastric functions. RESULTS: Acute gastroduodenal erosions and ulcers in unstable course of ischemic heart disease manifest with mild abdominal pains and gastric dyspepsia for several days. Disorders in the gastroduodenal zone arise because of focal disturbances of terminal circulation in the mucose according to thromboischemic or thrombohemorrhagic types related to generalized changes of microcirculation and hematasis. High activity of acid-peptic factor, low production of gastromucoproteins and hypomotor dyskinesia of the stomach contribute to development of erosive-ulcerous lesions. CONCLUSION: The above information is useful for early diagnosis of acute gastroduodenal erosions and ulcers in unstable course of IHD and upgrading of therapeutic measures.