Prevalence of gastroesophageal reflux disease in Moscow.

Limited data exist to determine the prevalence and clinical spectrum of gastroesophageal reflux disease (GERD) in the Russian population, which might be different from those in Western countries. This study was performed in Moscow on randomized 1065 adults aged ≥ 15 years. A validated reflux questionnaire comprising 72 questions and an additional 29 sub-questions were used. The questions assessed (heartburn and regurgitation) and related (dyspepsia, dysphagia, odynophagia and chest pain) symptoms, the triggering factors of these symptoms, family history and data on demographic and socioeconomic features. GERD was defined as heartburn and/or regurgitation once a week or common. Of the 1065 participants, 42.1% were male and 57.9% were female. The prevalences of frequent and occasional symptoms were 17.6 and 22.1% for heartburn and 17.5 and 21.8% for regurgitation, respectively, over the last 12 months. The prevalence of GERD was found to be 23.6%. The rate of GERD was significantly higher in females than in males (15.4 vs. 29.5%, P < 0.001) and significantly increased as the age of the participants increased (P = 0.011). GERD was present in 20.4% of smokers, 24.2% of coffee drinkers, 21.5% of alcohol consumers and 45.9% of stressed participants. Although the rate of alcohol consumers was lower in those with GERD compared with those without GERD, the rate of coffee drinkers and stressed participants was higher among those with GERD. The rate of additional symptoms was higher even in participants complaining of regurgitation/heartburn rarely, compared with those without complaints. Using the same questionnaire, which makes it possible to compare the present results with those from different countries, we found the prevalence of GERD in Moscow to be 23.6%, one of highest in the Western populations. The rates of heartburn and regurgitation were found to be similar, which constitutes a different result than has been found in similar studies. Additional symptoms should be assessed, in all GERD patients even in the presence of rare complaints of regurgitation/heartburn.

[Prevention of complications of colonic diverticular disease in outpatient practice].

The literature review gives an update on the frequency and risk factors of complications of colonic diverticular disease, the results of recent investigations, which suggest the success and safety of outpatient treatment for uncomplicated acute diverticulitis. It evaluates the efficacy of pharmacological agents from different groups in preventing complications of colonic diverticular disease.

THE INCIDENCE OF PRIMARY AND SECONDARY RESISTANCE TO THE ANTI-CYTOKINE THERAPY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE.

Long-term experience of using irifliximab in patients with inflammatory bowel disease (IBD) have shown that 20-30% of patients couldn't achieve clinical improvement (primary failure) or have developed acquired drug resistance (secondary failure). The frequency of antibody formation to infliximab is to 28-61%, for adalimumab 4-12%, to certolizumab the guests to 12.3%, for etanercept to 2.5%. The ways to overcome the primary and secondary inefficiency of anti-cytokine the(apy (loss of response to therapy) at the present time are: increasing the dose, shortening the interval between infusions of genetically engineered biological drugs, additional immunosuppressive agents, as well as switching to another biologic drug. Search of primary and secondary inefficiency of anti-cytokine therapy in patients with IBD currently remains topical and requires new approaches to the solution of this problem.

A REVIEW OF INTERNATIONAL AND NATIONAL CLINICAL GUIDELINES FOR THE DIAGNOSIS AND TREATMENT-OF NONALCOHOLIC FATTY LIVER DISEASE.

The review presents comparative characteristics of domestic and foreign clinical guidelines for the diagnosis and treatment of nonalcoholic fatty liver disease.

[HEREDITARY HEMOCHROMATOSIS (clinical observations)].

The article presents two clinical observations of patients with different course genetically verified primary hemochromatosis.

CLINICAL STUDY OF THE EFFICACY OF NATURAL MINERAL WATER "BORJOMI" IN PATIENTS WITH FUNCTIONAL DYSPEPSIA.

The article presents the results of original research of the effectiveness and safety of natural mineral water "Borjomi" in patients with functional dyspepsia. Daily pH-metric study in dynamics showed that the positive effect of mineral water "Borjomi" depends on the leading symptom in patients with functional dyspepsia and may be connected with antacid and prokinetic effects.

[Central female hypogonadism as a model of premature aging].

Central (hypogonadotropic) hypogonadism in women could also be a cause of persistent amenorrhea and hypoestrogenemia. The aim of this study was to evaluate symptoms of premature aging in women of young age with central hypogonadism. 88 young women (25 [21; 30] y.o.) with central hypogonadism (with isolated hypogonadotropic hypogonadism n=42, and associated with the other types of pituitary insufficiencies n=46), 53 healthy young women (24 [23; 28] y.o.) and 50 healthy postmenopausal women (56 [53; 58] y.o.) were examined. In young women with central hypogonadism frequency of psychoemotional, neurovegetative and urogenital disorders, peripheral sex steroid concentrations, lipid and mineral homeostasis parameters differed significantly from the healthy young women of similar age and were comparable with postmenopausal women of middle/older age. Thus, according to clinical, hormonal and biochemical abnormalities biological age of female patients with central hypogonadism advanced significantly chronological young age and corresponded to middle/older age. The central female hypogonadism is a model of premature aging.

LOOKING INTO THE FUTURE OF DIGESTIVE HEALTH.

The article describes comments to the concepts of development of the European health until 2040 on the example of Gastroenterology. UEG's major project "Healthcare in Europe 2040: Scenarios and implications for digestive and liver diseases", was launched at UEG Week in Viena, in October, 2014.

[UNMODIFIED DIAMETER V. PORTA. IN 79-YEAR-OLD PATIENT WITH CONGESTIVE HEART FAILURE AND SEVERE PULMONARY HYPERTENSION IN THE SETTING OF COMPLEX CONGENITAL HEART DISEASE--PATENT FORAMEN OVALE AT THE CONFLUENCE OF THE LEFT PULMONARY VEINS INTO THE V. CAVA SUPERIOR AND MIXED (HCV) LIVER CIRRHOSIS].

The clinical observation and analysis of the reasons for late diagnosis of congenital heart disease is presented. A feature of this observation is diagnosed complex congenital heart defect with shunting of blood in elderly woman with the second disease--chronic viral hepatitis C and cirrhosis of the liver. Long-term compensation circulation and lack of pulmonary fibrosis in our patient with patent foramen ovale was due to the presence of a second malformation--confluence of the left pulmonary veins in vena cava superior that apparently contributed to the constant lung tissue haemooxygenation.

[WILSON'S DISEASE (HEPATOLENTICULAR DEGENERATION, DYSTROPHIA HEPATOCEREBRALIS) DIAGNOSIS, TREATMENT AND DISPENSARY OBSERVATION. GUIDELINES WERE APPROVED BY THE XV GASTROENTEROLOGICAL SCIENTIFIC SOCIETY OF RUSSIA IN 2015].

Wilson's disease (hepatolenticular degeneration, dystrophia hepatocerebralis)--a chronic, progressive disease with a genetically determined autosomal recessive mode of inheritance. The violence in metabolism of copper with its excessive accumulation in visceral organs and central nervous system is the basis of the disease. The guidelines on clinical diagnosis and management of patients based on a Review and analysis of recent publications on this topic in the global and Domestic literature and on the authors' experience in treating patients with Wilson's disease.

[AUTOIMMUNE LIVER DISEASES: CLINICAL FEATURES, DIAGNOSIS, TREATMENT. GUIDELINES WERE APPROVED BY THE XV GASTROENTEROLOGICAL SCIENTIFIC SOCIETY OF RUSSIA IN 2015].

The group of liver autoimmune diseases (LAD) includes autoimmune hepatitis (AIH), Primary biliary cirrhosis (PBC) and Primary sclerosing cholangitis (PSC) The guidelines on clinical diagnosis and management of patients based on a review and analysis of recent publications on this topic in the global and domestic literature and on the authors'experience in treating patients with autoimmune liver disease.

[NONALCOHOLIC FATTY LIVER DISEASE: DIAGNOSTIC, SYMPTOMS, TREATMENT. GUIDELINES WERE APPROVED BY THE XV GASTROENTEROLOGICAL SCIENTIFIC SOCIETY OF RUSSIA IN 2015].

According to the World Health Organization, it is recorded steady growth of the number of chronic liver diseases, including nonalcoholic fatty liver disease (NAFLD), in recent years. As an independent nosological entity, NAFLD is one of the risk factors for cardiovascular diseases, associated with abdominal-visceral obesity, peripheral insulin resistance (IR), and is regarded as the hepatic component of Metabolic syndrome (MS). Nowadays there are no generally accepted national standards for diagnosis and treatment of NAFLD for physicians, gen- eral practitioners, gastroenterologists in Russia. This was the essential reason in their development. The main reason of The guidelines development is the absence of generally accepted national standards for diagnosis and treatment of NAFLD for physicians, general practitioners, gastroenterologists in Russia. These guidelines are based on the global and local data of treatment experience of NAFLD, recently published in reviews, analytical studies in the literature. Guidelines are intended for physicians, general practitioners, gastroenterologists and contain the description of the preferred approaches to the provision of diagnostic, curative and preventive care of patients NAFLD. The quality of recommendations was grading according to the GRADE approach.

Pacemakers in extrahepatic biliary ducts.

Pacemaker cells in the biliary system were studied by using electromyographic and histological methods. The pacemaker cells of the duodenal-biliary complex are located in the bile duct (predominantly, in its proximal part). They are characterized with enhanced spontaneous spike and slow-wave electrical activity. The pacemaker cells organize the sequential motor activity of the proximal and distal portions of ductus choledochus, with subsequent involvement of the duodenum into this activity.

[Value of adhesion molecules for evaluating the efficiency of therapy for ulcerative colitis and Crohn's disease].

AIM: To define the value of adhesion molecules (sVCAM-1 integrin, P-selectin, E-selectin, and L-selectin) for the prediction and evaluation of the efficiency of treatment in patients with ulcerative colitis (UC) and Crohn's disease. SUBJECTS AND METHODS: Twenty-six patients with UC and 14 patients with CD were examined. Of them, 16 patients took infliximab (INF) in a dose of 5 mg/kg of body weight according to the standard scheme; 14 patients received cultured mesenchymal stem stromal cells (MSSCs) in a quantity of 150 x 10(8) cells, and 10 had azathioprine (AZA) 2 mg/kg and glucocorticosteroids (GCS) 1 mg/kg of body weight. Enzyme immunoassay was used to determine the serum concentration of the adhesion molecules (L-selectin, E-selectin, P-selectin, and sVCAM-1 integrin) before and 2 months after treatment. RESULTS: The signs of bowel inflammatory disease activity and the elevated levels of adhesion molecules whose synthesis did not occur under normal conditions remained in the patients receiving GCS and AZA. INF treatment caused a decrease in P-selectin, E-selectin, and sVCAM-1 levels to 8.9 +/- 1.0, 5.5 +/- 1.7, and 9.5 +/- 4.4 ng/ml, respectively (p < 0.001). Incorporation of MSSCs was followed by a reduction of the concentrations of P-selectin and E-selectin to 6.9 +/- 1.1 and 5.7 +/- 1.3 ng/ml, respectively (p < 0.001). The level of integrin (cVCAM-1) fell to 12.2 +/- 2.2 ng/ml (p > 0.1); that of L-selectin did not drop after MSSC administration and INF induction therapy. CONCLUSION: P-selectin, E-selectin, L-selectin, and sVCAM-1 integrin are current inflammatory markers and may be used to evaluate the efficiency of standard and biological therapies for inflammatory bowel diseases and to predict disease course.

[Elevated levels of circulating immune complexes -C3d and-C1q as a criterion for acute extraintestinal manifestations of ulcerative colitis].

During ulcerative colitis in the exacerbation phase the high level of circulating immune complexes -C1q and -C3d (CIC-C1q and -C3d) was detected in 35.4% and 28.9% of patients respectively. This raise of CIC-C1q and -C3d level was accompanied by increase of clinical and endoscopic activity of ulcerative colitis (AC). In 45.4% of AC patients with extraintestinal onsets CIC-C3d was detected and only in 11.7% of patients CIC-C1q was found. These data confirm that activation of the humoral immunity accompanied by increase in formation of immune complexes is characteristic for AC patients with extraintestinal onsets. CIC emergence in serum of AC patients is considered as a prognostically unfavorable sign indicating that the disease may be accompanied by extraintestinal onsets.

[Serum calprotectin as a marker for determining the activity of the inflammatory process and the effectiveness of therapy in inflammatory bowel disease].

The increase in the concentration level of calprotectin in serum (ICP) in patients with inflammatory bowel disease (IBD) is closely associated with increased rates of acute phase of inflammation and combined with worsening of clinical and endoscopic disease activity. In the acute stage IBD concentration UPC hung on the degree of inflammatory activity, not localization. Test with the act is a highly sensitive method for assessing the degree of inflammatory activity and the effectiveness of therapy in IBD. After transplantation of mesenchymal stromal cells from bone marrow and standard therapy largely reduced levels SKP than selective immunosuppressive therapy with infliximab (INFL) in patients with IBD.

[Immunologic and oncological safety of autologous and allogenic mesenchymal bone marrow stromal cells].

It is indubitable that autologous transplantation of mesenchymal stromal cells (MSCs) is the golden standard for cell therapy. But also it is still in interest to explore the possibilities of allogeneic MSCs transplantation, because of their special role in lymphopoiesis, particularly in the positive selection of T-lymphocytes.

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

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

[Diagnostic of oncology diseases by the flexible biomarker].

It is Known that the interest of express diagnostic oncology degasses is growing up every ear. Recently, researchers from different countries proved highly effective studies of exhaled air in the diagnosis of breast cancer, cancer of lung and gastrointestinal tract. The purpose of our study was to identify a biomarker in the air of patients using hrormato-mass-spectrometer. We examined 79 patients. 47 patients with clinically and histologically proven oncology proses (II-IV stage), and 32 patients as a control group--without cancer. Chromatograms were obtaining, which was defining from 50 to 70 individual compounds. The overwhelming majority of cancer patients present organic matter--a biomarker and absent in the healthy group. At this stage of the technical capabilities of the equipment made it possible to carry out only a qualitative determination of this biomarker.

[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).