[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.

[CLINICAL AND MORPHOLOGICAL CHARACTERISTICS OF INTESTINAL LESIONS IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS].

Objective: To compare the clinical, endoscopic picture and morphological changes of the intestinal mucosa in patients with primary sclerosing cholangitis (PSC). Materials and methods: 31 patients with PSC (women - 15 men - 16) were included in study group. The diagnosis of ulcerative colitis (UC) was established in 8 patients, Crohn's disease (CD) - in 5, unclassified colitis (UCC) - in 7, and 11 patients had no clinical and endoscopic signs of IBD. The control group consisted of 30 patients with IBD: UC - 20 patients, CD - 10 persons. All the patients performed ileocolonoscopy (ICS) with multiple biopsy and histological examination of material. Results: The prevalence of IBD in patients with PSC was 64.5%. IBD with PSC was characterized by extensive colitis with mild clinical activity. Morphological activity of IBD associated with PSC was usually moderate and severe. Morphological activity of disease in IBD/PSC group was lower than in UC alone (p < 0.05). IBD onset came before PSC symptoms (p < 0.05). Distal gradient of inflammation in colon predominated in IBD/PSC group when disease starts with IBD symptoms, in case of PSC symptoms - proximal gradient was more frequent. In IBD/PSC group affected ileum were detected in a third of cases, including CD ileitis - 60%, backwash ileitis in UC (NCC) in 26.7%, that was significantly frequently than in UC alone (p = 0.02). Within the IBD/PSC group 30% of patients with colitis were without damaging of rectum. In all the patients with PSC without clinical, endoscopic signs of colitis polymorphocellular infiltration of mucosa were founded. Eosinophilic infiltration of mucosa in group of PSC met significantly more frequently than in other study groups. Fibrosis of intestinal mucosa was founded significantly more frequently in group of PSC without IBD compared with UC/PSC and UC patients, but not with CD group. Conclusions: For IBD in PSC extensive colitis without lesions of the rectum, backwash ileitis are common. There are some morphological differences in the intestinal lesions within the IBD/PSC patients depending on the type of disease onset. There is a dissociation between low clinical activity and intensive morphological inflammation. When PSC had no clinical features of IBD, a microscopic ileocolitis (characterized by eosinophilic infiltration and fibrosis of the intestinal mucosa) without nosological classification was founded in all patients.

[The clinical immunologic characteristics of different variants of course of ulcer colitis].

The study was carried out to determine clinical and immunologic predictors of unfavorable variant of course of ulcer colitis. The sample included 89 patients (48 females--53.9% and 41 males--46.1%) with ulcer colitis established on the basis of clinical, endoscopic and morphologic data. The age of patients was 18-79 years and mean age--42.49 +/- 1.61 years. The patients were divided on two groups depending on clinical course of disease: group 1 with favorable course and group 2 with unfavorable course. The group 2 included patients with frequently relapsing form of disease, patients with hormone-depended/hormone-resistant form of disease and patients with severe exacerbation ua ulcer colitis at the moment of examination. The groups were compared by gender and age. All patients underwent medical history and complaints acquisition and total clinical examination. The clinical and biochemical analysis of blood was made too. The severity of disease was established using the calculation of Trulove- Witts indicator The anti-neutrophil cytoplasmic antibodies of classes IgG and IgA were analyzed using indirect immunofluorescence (Euroimmun AG, Germany). The diagnostic anti-neutrophil cytoplasmic antibodies titer was established in 58 out of 87 of examined patients (66.6%). The antineutrophil cytoplasmic antibodies of class IgG was revealed in 42 patients and anti-neutrophil cytoplasmic antibodies of class IgA in 27 patients. The combination of both classes of anti-neutrophil cytoplasmic antibodies was established in 11 examined patients. In the group of favorable course of disease the diagnostic titer of anti-neutrophil cytoplasmic antibodies was revealed in 20 patients (51%). At the same time, in the subgroups with frequently relapsing, hormone-depended/hormone-resistant and severe forms of disease these antibodies were revealed with rate of 76, 77 and 86.3% correspondingly. Hence, the anti-neutrophil cytoplasmic antibodies can be used both in diagnostic of ulcer colitis and in prognosis of course of disease.