[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.

[Diffuse esophageal spasm: difficulties of diagnosis and treatment].

The article describes the diffuse esophageal spasm which is not amenable to conservative treatment.

[Clinical immunological diagnostics of overlap syndrome during autoimmune hepatic disorders].

The complex determination of serum autoantibodies to hepatic antigens using enzyme immunoassay and immunoblot allows to increase the frequency of overlap syndrome identification during autoimmune hepatic disorders and its early diagnostics, that has a big clinical, diagnostic and prognostic importance. The levels of overlap autoantibodies combine with biochemical index and with disease activity and intensity of autoimmune processes during overlap syndrome of primary biliary cirrhosis/autoimmune hepatitis (PBC/AIH).

[Calprotectin concentration in stool samples as a determinant of the activity degree of inflammatory process in inflammatory bowel diseases].

At IBD in the exacerbation phase was detected the increase of fecal calprotectin (FC) level in 98% of patients. With increasing of clinical disease activity in patients with UC as well as CD was marked a significantly increased content of calprotectin in stool samples, which was accompanied by increase of indicators of inflammation acute phase: rising RRF, leukocytosis, an increase of frequency of stool with blood and mucus, fever and abdominal pain. In the phase of exacerbation the increase in concentration of CRP depends on the degree of inflammatory activity, rather than on lesion localization. The highest concentration of CRP was revealed at a high degree of IBD activity with stool frequency up to 8-10 times/day with impurity of blood and abdominal pain. At moderate activity of IBD, it is less expressed diarrhea (stool frequency 2-3 times a day), without blood, detected lower lever of PCF concentration--from 250 to 380 ug/g. A study of calprotectin concentrations in stool samples is considered to be reliable and sensitive method for evaluation of inflammatory activity in patients with inflammatory bowel disease.

[Gluttony, obesity and the metabolic syndrome in the context of the "seven deadly sins". Historical-theological, literary and art, mass media, political, philosophical, medical-psychological and geriatric aspects of the problem].

In this pape different aspects of problem of obesity are analysed.

[Fecal calprotectin as a biomarker effectiveness of various interventions in patients with inflammatory bowel disease].

Among the chronic diseases of the gastrointestinal tract of the special place occupied by inflammatory bowel disease (IBD), in which the lining of the intestine produces a significant number of neutrophils, which has prompted researchers and clinicians use a protein derived from neutrophils as a biomarker for the assessment of the intestinal wall and the effectiveness of treatment in patients IBD. One of these proteins is calprotectin (CP), which can be considered as a biomarker of activation, destruction and loss of neutrophil cells, to a lesser extent-- the activated monocytes and macrophages. Various studies have shown that the concentration of fecal calprotectin (FCP) correlates well with endoscopic and histological parameters of intestinal inflammation. Test the FCP can be used in healthy first-degree relatives of patients with IBD to assess the possible presence of subclinical variant of intestinal inflammation in this population. Thus, a simple test of the FCP can reduce the needs of various expensive and invasive method, including costs associated with them, especially in younger patients, where in terms of differential diagnosis of IBD is often not included neoplasia of the intestine. FCP is a non-invasive, inexpensive and at the same time, highly sensitive and specific biomarker that can be used successfully in the diagnosis, evaluation of the efficacy of treatment and predicting recurrence.

[Diagnostic value of autoantibodies to asialoglycoprotein receptor in autoimmune hepatitis].

Among 106 patients with autoimmune liver disease in 12 (11.3%) were found autoantibodies to asialoglycoprotein receptor (anti-ASGPR): in 5 (9.1%) of 55 with PBC, and 4 (17.4%) of 23 with AIH and 3 (10.7%) of 28 patients with syndrome chiasm (PBC + AIH). Detection of antibodies against the ASGPR is an effective method for diagnosis of autoimmune hepatitis. Further improvement of this method allows for monitoring and disease. Anti-ASGPR levels correlate with biochemical parameters and with the severity and manifestation autoimmune processes in patients with autoimmune hepatitis.

[Nutricional support in the complex treatment of a patient with esophageal spasm].

In the presented clinical case the theme of the need for an integrated therapeutic intervention has been disclosed, including nutritional support on the various links of the pathogenesis of esophagospasm to the effectiveness of the patient's treatment.

[Syndrome of overlap of autoimmune hepatitis and primary biliary cirrhosis with the outcome in cirrhosis of the liver, complicated by fatal bleeding in the small intestine].

The authors presents the clinical case of autoimmune overlap syndrome: autoimmune hepatitis and primary biliary cirrhosis with outcomes in the hepatic cirrhosis complicated fatal intestinal bleeding.

[Isolation of antibodies to Chlamydia and Mycoplasma pneumoniae during the immunosuppressive therapy of patients with inflammatory bowel disease].

UNLABELLED: Detection of IgM and IgG Chlamydia and Mycoplasma pneumoniae indicates an aggravation of intracellular infections, including, possibly, due to immunosuppressive therapy. It is possible that the intracellular infection may mediate the occurrence of certain extraintestinal manifestations of inflammatory bowel disease (IBD), such as bronchitis, pneumonia, etc. Chronic persistent chlamydial and mycoplasmal infections lead to disruption of both cellular and humoral immunity, resulting in the formation of autoimmune processes in patients with IBD, and in the future--reduce the immune status against the immunosuppressive therapy. Detection of antibodies to Chlamydia and Mycoplasma pneumoniae accompanies with increased total immunoglobulin IgM, IgG in blood serum. Determining the level of proinflammatory and antiinflammatory cytokines in the acute stage of the disease allows to evaluate the activity of the inflammatory process and the nature of the immune response to intracellular infection. THE CONCLUSION: to prevent extraintestinal septic complications in patients with IgM antibodies to Chlamydia and Mycoplasma pneumoniae, is recommended to combine the long-term immunosuppressive therapy of IBD with antibiotic therapy, usually with macrolides.

[Dynamics of proinflammatory cytokines during biologic therapy of inflammatory bowel disease].

Chronic inflammation in IBD is accompanied by an imbalance in the production of Tx1 and Tx2 cytokines. Imbalance of cytokine profile is important pathogenetic importance in chronic inflammatory process, since the formation of defective immune response to pathogenic agent promotes recurrence of the disease. Analysis of the dynamics of proinflammatory cytokines allows both the activity of inflammatory process and effectiveness. Increased levels of proinflammatory cytokines: TNF-alpha, IFN-gamma, IL-2, IL-5, IL-8, IL-12, IL-15 in serum of patients with IBD, indicate their possible involvement in the mechanisms of development of CD and UC. Increasing content of these cytokines is accompanied by increased activity of disease, which can be used in diagnose IBD activity.

[Dynamics of proinflammatory cytokine in biological therapy of inflammatory bowel disease].

Chronic inflammation in IBD is accompanied by an imbalance in the production of TX1 and Th2 cytokines. Imbalance of cytokine profile is important pathogenetic value at chronic inflammatory process, since the formation of a defective immune response to pathogenic agent promotes recurrence of the disease. Analysis of the dynamics of proinflammatory cytokines allows to estimate the activity of the inflammatory process, and effectiveness of the therapy. Increased levels of proinflammatory cytokines: TNF-alpha, IFN-gamma, IL-2, IL-5, IL-8, IL-12, IL-15 in serum of patients with IBD, indicating their possible involvement in the mechanisms of development of CD and UC. The increase in the content of these cytokines was accompanied by increased activity of disease that can be used to diagnose IBD activity.

[Gastroenterologist diagnosting left atrial myxoma in patient with gastroesophageal reflux disease].

The authors presents the clinical case of the left atrial myxoma diagnosed by gastroenterologist in patient with gastroesophageal reflux disease.

[Primary non-Hodgkin lymphoma of the liver in patients with chronic virus].

The article provides a brief overview of recent data on non-Hodgkin's lymphoma. We describe a special case primary isolation non-Hodgkin's lymphoma of the liver in a patient with chronic hepatitis C. Were analyzed medical errors at all stages of inspection and treatment of the patient. This exceptional case supplements small number of publications on a problem of the isolated lymphoma of a liver. We also wanted to pay attention once again to need of lifetime morphological research of a liver.

[Selection of "surrogate" and "endpoints" evaluation of the efficacy of medical interventions].

With the advent of new medical technologies and medicines, as well as due to changes in disease patterns and demographic problems rises the need for continued increases in health spending. Increased costs can be totally inadequate, if it has been done without studying the effectiveness of medical interventions, based on the results of evidence-based medicine and economic of their feasibility. To evaluate the clinical effectiveness of medical interventions have been recently used specific criteria, so called points of clinical efficacy (surrogate and endpoints), that allow to conclude feasibility or harmfulness of the introduction or application of the intervention in clinical practice. The endpoint is reliable indicator the effectiveness of medical intervention. Surrogate point--is a biomarker that is intended to replace the endpoint and is a predictor of the effectiveness of medical intervention. The use of surrogate points has several advantages such as simple in identification and measurement, as well as more higher in compare with endpoints the vents frequency, that can significantly reduce the size of the selection and duration and cost of clinical trials, respectively. Finally, the surrogate points allow to evaluate treatment effect in situations where the use of endpoints is difficult or is unethical.

[Painless course of chronic calcificated pancreatitis manifesting as hyperglycemia].

The clinical case of chronic calcifying pancreas (CCP) was described. It was reveal that obligate sign CCP as a painful syndrome can disappeared in some circumstances, in particular when the patient refused of smoking and alcohol intake.

[Esophagus defeat in patients with scleroderma].

This article presents clinical case of scleroderma with affection of esophagus.

[Analysis of total cost of treatment of patients with inflammatory bowel diseases].

The article stresses that among the chronic diseases of the digestive tract occupy a special place inflammatory bowel disease (IBD)--UC and BC with multiple complications and the onset of early disability of patients. IBD is a serious issue of gastroenterology, since their etiology remains unknown, and specific treatment hasn't yet been developed. Finally, the prevalence and social significance of IBD also occupy a leading place among the diseases of the digestive organs, since they are characterized by recurrent course and have adverse medical and social prognosis. According to sources in various countries annually spend huge money for treatment of IBD. The costs of IBD depends on the severity and nature of complications, duration of illness, the choice of treatment, frequency of hospitalization and the patient's country of residence. Various studies demonstrate the feasibility of using more modern efficient methods of treatment (MSSC + therapy) to reduce the incidence of complications associated with IBD, resulting in huge costs.

[Antibodies to infliximab and antigens HLA I-II class as the witnesses of immune response to the biological treatment of inflammatory bowel disease].

Despite combination therapy with immunosuppressive agents, 32.5% of patients with IBD showed the formation of antibodies to infliximab. Simultaneous study of the concentration of the drug (infliximab), TNF-alpha and antibodies to it in the blood serum allows to judge not only on the effectiveness of anticytokine therapy, but also on the advisability of further conducting therapy. Elevated levels of AINF may lead to infusion reactions, reducing the effectiveness and duration of response to this therapy. Transplantation of MSCs reduces the level of antibodies to infliximab, but in 2 (5%) patients noticed a gradual increase of these antibodies. After infliximab infusion from 4 to 8 weeks the level in serum increased up to 45 mg/ml and higher, further serological concentration of infliximab is gradually reduced and then falls below the-horn. High concentrations of infliximab (> 45 mkg/ml) in blood samples at combined immunosuppressive therapy (infliximab + glucocorticoids + cytotoxic agents) should be considered as a sign of potential complications. The absence of antibodies to antigens of HLA I and class II after systemic transplantation of allogeneic mesenchymal stromal cells (MSCs) of bone marrow demonstrates not only the effectiveness but also the safety of transplantation of allogeneic MSCs, in relation with that the special selection of donors for transplantation of allogeneic MSCs is not required.

[Dynamics of serum IL-17A, IL-17F and IL-23 in patients with inflammatory bowel disease].

The analysis of the levels of proinflammatory cytokines IL-17A, IL-17F and IL-23 allow to evaluate the effectiveness of the therapy:, so MSCs systemic immunosuppressive therapy and corticosteroids increasingly reduces the level of all studied proinflammatory cytokines, while in therapy with infliximab, a selective immunosuppressive agent, significantly less effect on the level of proinflammatory cytokines IL-17A, IL-17F and IL-23.