[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.

COELIAC DISEASE AND PSORIASIS COMBINATION IN 5-YEAR-OLD CHILD.

The article demonstrates a clinical case of a child observed over 3 years, whose parents initially complained of non-healing crack between the toes, the navel, the vulva and behind the ears in the appointment of traditionaitherapy. The child in the community conducted a full survey of allergy, the results of which were normative, Ineffective treatment of skin diseases, as well as the presence of family history for autoimmune diseases served as the need for hospitalization of the patient survey. The examination at the clinic revealed higher values of antibodies to tissue transglutaminase and gliadin in the blood, duodenojejunal according to the results of endoscopy and active manifestations of chronic enteritis expressed with total villous atrophy on the long section on the results of morphological study of biopsies of the small intestine mucosa. Based on the results diagnosis of coeliac disease. On the background of a gluten-free diet showed normalization of laboratory and morphological parameters, weight and growth rates, the results of densitometry. However, it was only a slight improvement from the skin lesions. When re-examination of the child set accompanying diagnosis of psoriasis.

[MALABSORPTION FAT-SOLUBLE VITAMINS AND PROSPECTS OF THEIR USE IN LIVER DISEASES].

In a review article considers issues of efficiency and tactics of the purpose of fat-soluble vitamins, as in cholestatic and noncholestatic liver disease, as well as water-soluble vitamins, particularly vitamin C cholelithiasis. Oxidative stress due to chronic inflammation is one of the major conversion mechanisms of liver fibrosis in cirrhosis. The imbalance between production of reactive oxygen species and antioxidant defense causes a number of pathophysiological changes in the liver, including activation of hepatic stellate cells. The carriers of the I148M PNPLA3 mutation was not observed concentration reduction in liver vitamin A with increasing severity of the disease, but the observed decrease in the level of circulating retinyl palmitate and retinol-binding protein. To the appointment of vitamin A in liver disease should be approached with caution. Hypervitaminosis A leads to accelerated liver fibrosis and stimulates carcinogenesis. Currently actively studied the possibility of using vitamin E as an antioxidant, in patients with non-alcoholic fatty liver disease. His presence in the membranes phospholipid bilayer allows cells to prevent non-enzymatic oxidation of cell components by free radicals. Vitamin E can suppress the profibrotic processes. In patients with chronic cholestatic liver disease is common, vitamin K deficiency, even when administered, and is associated with the degree of cholestasis and severity of disease. The vitamin D deficiency, liver disease is also associated with the severity of disease correlated with the severity of liver failure and infectious complications. Vitamin D is an independent prognostic parameter for mortality risk in patients with liver cirrhosis.

[MICROFLORA AND ORAL DISEASE].

Acid-producing microorganisms are base etiological agents of lesions of tooth enamel and destruction of dentin. The process start by specific microflora of tooth deposit--Streptococcus mutans, Lactobacteria and Actinomycetis viscosus which ferment food carbogydrate to form acids. High titre of them in oral cavity may be considered like a marker of carbohydrate food. But the pathogenic bacteria don't have aggression to host organism until they will have virulent factors which help to get over protection of host organism. At the same time, microflora of oral cavity is involved to form pellicula. Pellicula is a biofilm which to protect tooth enamel and dentin. Understanding relationships between safety factors of host and pathogenic microflora of oral cavity will give to create effective methods of prevention and treatment.

[DETERMINING THE DEGREE OF LIVER DYSFUNCTION IN CHILDREN WITH POSITIONS OF THE INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH (ICF)].

METHODS: Based on a retrospective analysis of biochemical blood parameters which characterize the role of liver function in the metabolism of proteins, fats and carbohydrates (considered indicators of ALT, AST, De Ritis coefficient, bilirubin, albumin, fibrinogen, prothrombin, transferrin, ceruloplasmin, cholesterol, urea, ammonia, glucose, lactate) in 95 children without liver pathology, 15 children who died of liver failure, 295 patients with various liver diseases who were treated in the SCCH, a scale system was developed as a support tool to assess liver dysfunction. RESULTS: Each biochemical indicator was assessed on a five-point scale. The level of a biochemical indicator, which corresponded to the absence of disorders, was estimated as 4 points, corresponding to "insignificant disorders"--as 3 points, "moderate disorders"--as 2 points, "severe disorders"--as 1 point, "absolute disorders"--as 0 points. The total score is the estimate of the degree of liver dysfunction. According to the recommendations of the International Classification of Functioning, Limitations of vital activities and Health, the decrease of the number of points on 0-4% (54-56 points) corresponds to the absence of the liver dysfunction, on 5-24% (43-53 points)--insignificant disorders of liver function, on 25-49% (29-42 points)--moderate hepatic impairment, on 50-95% (3-28 points)--severe disturbances of liver function, on 96-100% (0-2 points)--absolute dysfunction of the liver. CONCLUSIONS: A scoring system of assessing liver dysfunction can be applied at any stage of the examination and treatment of children of any age, as used in biochemical parameters do not depend on the age of the patient. It is an objective criterion for assessing the degree of liver dysfunction and can be used to assess the severity of the pathological process in the dynamics determining the prognosis of the disease and can be the criterion of the indications for liver transplantation, and also used during the of medico-social expert examination.

[OPTICAL BIOPSY FOR DIAGNOSIS OF ESOPHAGEAL MUCOSAL CHANGES IN CHILDREN].

AIM: To analyze the value of confocal laser endomicroscopy in diagnostics of upper gastrointestinal tract mucosa changes in children. PATIENTS AND METHODS: In the current study a total of 116 children aged from 3 to 18 years old undergo conventional endoscopy with confocal laser endomicroscopy supplemented with mucosal biopsy followed by traditional histology in the period from 2011 until 2014. To determine the prognostic value of the of probe based CLE in the evaluation of normal and pathological changes of the esophageal mucosa a comparison of results of optical biopsy with the data obtained during the standard histological examination were performed. RESULTS: After results of probe-based CLE and traditional histology were comprised optical biopsy showed 88.8% sensitivity and 88.3% specificity to esophagitis with Spearmen correlation 0.79 (p = 0.001); 92.3% sensitivity and 95.3% specificity to metaplastic changes of esophageal mucosa with Spearmen correlation 0.85 (p = 0.001); 92.4% sensitivity and 95.2% specificity in differential diagnosis of esophageal polyps with Spearmen correlation 0.95 (p = 0.001). CONCLUSION: Confocal endomicroscopy may become one of the leading methods in pediatric gastroenterology since it allows the endoscopists to inspect the mucosa at the cellular level during the endoscopic procedure and can help in establishing the diagnosis.

[The clinical significance of evaluation of the inflammatory infiltrate in chronic gastroduodenitis in children].

OBJECTIVE: To establish the diagnostic value of the determination of leukocyte composition of inflammatory infiltrate in chronic gastroduodenite in childhood. PATIENTS AND METHODS: We examined 103 patients aged 8-17 with chronic gastroduodenitis associated with Helicobacter pylori. To detect Hp and Epstein-Barr viral infections we used esophagogastroduodenoscopy, quick urease test, bacterioscopy of gastrobiopsies. We performed the analysis of the cellular composition of the inflammatory infiltrate. RESULTS: It was found that the number of lymphocytes and neutrophils located in the lamina and intraepithelial increases, which is associated with the degree of inflammation. Increased to the maximum was the number of intraepithelial lymphocytes, both in the body, and in the antrum. Intensity of leukocyte infiltration is directly correlated with the increased prevalence of inflammation. Persistence of Epstein-Barr virus (35.9% of patients) is followed by more severe intraepithelial lymphocytic infiltration in the stomach. In 4-6 months after treatment 18 patients with severe gastritis were repeatedly studied for the inflammatory infiltrate. A significant decrease in the number of intraepithelial neutrophils was found. CONCLUSION: Cellular composition of the infiltrate is an objective characteristic of chronic inflammation in the gastric mucosa. Persistence of Epstein-Barr virus is accompanied by an increase in the amount of intraepithelial lymphocytes and neutrophils.

[Functional digestive disorders in infants. Working protocol of diagnostic and treatment].

Functional digestive disorders in infants comprise a group of disorders characterized by several specific features. They are related to structural and physiological peculiarities of the gastrointestinal tract in children during lactotrophic period of nutrition, limited pharmacotherapeutic options and supremacy of dietary correction in this age group, and psychological discomfort that has a negative impact on the quality of life of the whole family. The working protocol "Functional gastrointestinal disorders in infants' was prepared by the Russian Society for Pediatric Gastroenterology, Hepatology, and Nutrition (RusPGHAN) based on the previously proposed European (ESPGHAN) and American (NASPGHAN) guidelines. The protocol includes detailed description of the current approaches to diagnosis and management of the functional digestive disorders in young children, as well as algorithm tables that can be used by pediatricians and familial physicians in routine clinical practice.

[Age aspects of diagnosing and treating gastroesophageal reflux in children]. / Vozrastnye aspekty diagnostiki i lecheniia gastro-ézofageal'noi refliuksnoi bolezni u detei.

Regurgitation is one of the most frequent symptoms in newborn infants and children during the first months of their life. Regurgitation is defined as a passive reflux of a small amount of stomach contents into the gullet and oral cavity. Regurgitations can be found both as independent manifestations in practically healthy infants and as a concurrent pathology in a number of diseases.

[Evaluation of the state of systemic and local cellular immunity using loading tests]. / Otsenka sostoianiia sistemnogo i mestnogo kletochnogo immuniteta pri ispol'zovanii nagruzochnykh testov.

Local and systemic cellular immunity parameters of the blood and gastrointestinal mucosa were studied in 165 children suffering from chronic gastritis, duodenitis, celiac, secondary malabsorption syndrome, and phosphate diabetes by spontaneous E-RFC method with a number of loading tests in vitro. Thymalin, theophylline, cold incubation were used. Three types of T lymphocyte response were distinguished: the hypoergic, resistant, and hyperergic. To make the interpretation of the findings easier, coefficients were calculated for each type of response of the blood and gastrointestinal mucosa immunocompetent cells.

[X-ray diagnosis of chronic gastritis in children]. / Rentgenologicheskaia diagnostika khronicheskogo gastrita u detei.

A comparative roentgeno-endoscopic examination made in 80 children with gastritis has demonstrated the high information content of the x-ray method of one-stage double opacification of the stomach with barium. The method is based on an analysis of the thin relief of the mucous membrane. Coincidence with the morphological diagnosis has been recorded in 85% of the cases.