[Biliary sludge: pathogenesis, etiology and drug therapy].

AIM: To evaluate the effectiveness of the use of ursodeoxycholic acid (UDCA) for the treatment of biliary sludge (BS) and to compare the therapeutic effectiveness of the German substance UDCA and generic drugs from other manufacturers. MATERIALS AND METHODS: The study involved 65 patients diagnosed with BS (K80.8). To assess the severity of BS, ultrasound of the gallbladder was performed before treatment, after 1, 3, 6 months during therapy, as well as an assessment of its contractility. All patients were randomized into 2 groups. Patients of the main group received UDCA Ursofalk (Germany) at a dose of 10 mg/kg for at least 6 months. Patients in the comparison group received UDCA (another manufacturer) at a dose of 10 mg/kg for at least 6 months. RESULTS: After 3 months of follow-up, the number of patients with dissolved sludge in the main group was 87.1%, while in the comparison group 50%. In 71% of patients, the normalization of the lean volume of the gallbladder was noted, and in the comparison group only in 47.1%. After 6 months of follow-up, complete resolution of BS in the main group was observed in 93.5% of cases, and in the comparison group in 73.6% of cases. CONCLUSION: As a result of the study, the high effectiveness of Ursofalk during oral litolysis in patients with stage I GI (BS) in the first 3 months of therapy, as well as the normalization of the contractile function of the gallbladder, were noted.

[Nonalcoholic steatohepatitis and biliary sludge in people with metabolic syndrome]. / Nealkogol'nyi steatogepatit i biliarnyi sladzh u lits s metabolicheskim sindromom.

AIM: To determine the incidence of biliary sludge (BS) and to evaluate the clinical efficacy of Chophytol in patients with nonalcoholic steatohepatitis (NASH) and BS in the presence of metabolic syndrome (MS). SUBJECTS AND METHODS: Clinical laboratory examination was made in 72 patients with NASH in the presence of MS. BS was identified in 52 (72.2%) examinees who were divided in two (study and control) groups. The efficacy of Chophytol of plant origin, prepared from the purified extract of fresh artichoke (Cynara scolymus) leaf juice, which was used at a dose of 3 tablets thrice daily for a month, was evaluated. RESULTS: The use of Chophytol was established to promote BS elimination in 87% of the patients. This ceased pain syndrome in 87% and dyspeptic manifestations in 65.2% and normalized the levels of lipids and the biochemical indicators of liver process activity. No adverse drug reactions were seen. CONCLUSION: Chophytol used in patients with HASH and BS may soon be possible to make general condition better, to alleviate the symptoms of diseases of the liver and biliary system, and to appreciably improve the biochemical indicators of blood and bile.

[COURSE OF BILIARY SLUDGE ON THE BACKGROUND NON-ALCOHOLIC FATTY LIVER DISEASE].

To date, the factors significantly reduces the tolerance of the liver against the development of NAFLD and GSD. At the stage of biliary sludge cholelithiasis is found in more than half of the patients suffering from NAFLD. BS violates jelchnokamennouu and releaxation activity of hepatocytes, thereby slowing the passage of bile through the intrahepatic and extrahepatic bile ducts that aggravate the course of NAFLD. The reasons for the formation of sludge is not completely understood. To date there are no accepted tactics of conducting and treatment of patients with HB in the background of NAFLD. In our work we demonstrate one possible way to tackle this important problem.

[CHANGES IN MICROBIOCENOSIS OF THE COLON IN PATIENTS WITH CHRONIC LIVER DISEASE AND LATENT HEPATIC ENCEPHALOPATHY].

Interest in the study of complications of liver disease, in particular latent hepatic encephalopathy, due to its wide distribution, difficulty in diagnosis, the lack of differentiated treatment approaches. The correlation dependence of the influence degree of dysbiosis in the development of latent hepatic encephalopathy contributes to the formation of multiple organ pathology, including associated with the violation of the intestinal microbiota in chronic liver disease, is a separate link in the pathogenesis of hepatic encephalopathy. Dysbiosis of the colon in patients with chronic dislivoniami the liver is the triggering factor in the development of latent hepatic encephalopathy, and its level directly correlated with the execution time of the tests of numbers and lines, the manifestation of asthenovegetative syndrome, intestinal dyspepsia, cytolysis, cholestasis, hepatocellular nedostatusnosti.

[FEATURES OF FUNCTIONAL DISORDERS GASTRODUODENOBILIARY SYSTEM IN PATIENTS WITH CELIAC DISEASE].

The disturbances in synchronous functioning of gastroduodenal and biliary system and in their consequent interaction underlies functional disorders of the digestive tract. Motor and evacuation functioning of the gastrointestinal tract depends on the bile flow to the duodenum, which influences on digestive processes. Functional disorders of the biliary tract, contributing disturbances of the gastrointestinal motor activity, cause gastrointestinal symptoms. The cause of biliary dysfunctions often are gallbladder anomalies, which are accompanied by disturbances in drainage system of bile flow, development of the pathological refluxes, inflammation and formation of the biliary sludge. The progression of the biliary system deflux dysfunction leads to motor and evacuation dysfunction of the gut. According to the numerous data, gall bladder anomalies, which underlies functional disorders in bile deflux, are common in patients with coeliac disease. The results, obtained in the conducted research, revealed hypertonic hyperkinetic motor disorders of the upper part of the gastrointestinal tract and inflammation changes of the gastroduodenal zone in patients with coeliac disease with fixed bend in the gallbladder neck, necking and different deformation of the gallbladder, which are the visceral signs of undifferentiated connective tissue dysplasia. Disorders in every component of the digestive tract upper part motor activity lead to the corresponding clinical manifestations.

[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.

[Tactics for the correction of intestinal microbiocenotic disorders in the combination therapy of patients with chronic liver diseases].

AIM: To evaluate the efficacy of the symbiotic Linex used in the combination therapy of liver cirrhosis (LC). SUBJECTS AND METHODS: Seventy-four patients with LC, including 44 who received additionally the symbiotic Linex and 30 who had conventional therapy, were examined. All the patients underwent clinical and biochemical blood tests, abdominal ultrasonography, fecal test for bacteria, gas chromatography-mass spectrometry of the blood composition of microbial markers, number connecting test, and quality-of-life assessment (SF-36). RESULTS: The symbiotic-treated patients showed a significant improvement in biochemical parameters (decreases in transaminase activities, bilirubin levels, hepatic protein-synthetic function--there were elevations in the concentrations of total protein from 74.0 +/- 0.50 to 78.1 +/- 0.80 g/l (p < 0.05) and albumin from 30.6 +/- 1.7 to 35.5 +/- 1.6 g/l (p < 0.05). There were also increases in the count of bifidobacteria from 8.7 +/- 0.1 to 9.1 +/- 0.1 Ig CFU/g (p < 0.05), lactobacilli from 5.0 +/- 0.2 to 5.2 +/- 0.2 Ig CFU/g (p < 0.05) and in the total count of Escherichia coli from 7.6 +/- 0.3 to 7.9 +/- 0.3 Ig CFU/g (p < 0.05); a tendency for normalization of microbial markers was revealed by mass spectrometry; the manifestations of hepatic encephalopathy were alleviated (the number connecting test showed a reduction from 51.0 +/- 3.58 to 29.7 +/- 4.10 sec (p < 0.05)), and the quality of life improved. CONCLUSION: By normalizing enteric microbiocenosis, the symbiotic Linex positively affects the course and prognosis of LC and it is both a symptomatic and pathogenetic agent for the treatment of patients.

[New aspects of pharmacological effects of ursodeoxycholic acid].

The paper reviews the use of hepatoprotective agents in chronic liver diseases (CLD) and biliary disorders. A variety of clinical studies have shown the beneficial effect of ursodeoxycholic acid (UDCA) in liver disease worldwide. Besides the well-known mechanisms of action of UDCA we could show its prebiotic effect. Several studies have demonstrated that UDCA serves as a potential therapeutic agent for a number non-hepatobiliary disorders including cardiovascular disease, immune disorders, organ transplantation and other.

[Approaches to the treatment of patients with climacteric disorders complicated with menopausal metabolic syndrome with cholestasis].

RESEARCH OBJECTIVE: Development of the individual comprehensive program of follow treatment of patients with climacteric disorders complicated MMS (menopausal metabolic syndrome) with cholestasis; on the basis of application of low-dose hormone replacement therapy in combination with ursodeoxycholic acid, to improve the quality of life. MATERIALS AND METHODS: We observed 101 woman with climacteric syndrome, obesity and cholestasis; conducted a comprehensive clinical and laboratory examination, ultrasound of the hepatobiliary system, measurement modified menopausal index (MMI), the measurement of the quality of life on questionnaire SF-36 before treatment and after 6 and 12 months. THE RESULTS: Positive and statistically significant changes in lipid spectrum, the activity of transaminases, bilirubin and its fractions, improvement of MMI and quality of life, the indices of coagulation remained virtually unchanged. CONCLUSION: Low-dose hormone replacement therapies in combination with ursodeoxycholic acid are highly effective drugs for the treatment of menopausal syndrome, which normalize lipid profile of patients and the performance of the hepatobiliary system.

[Shunting operations in the hypertensive hydrocephalic syndrome in children with developmental defects of the central nervous system]. / Shuntiruiushchie operatsii pri gipertenzionno-gidrotsefal'nom sindrome u detei s porokami razvitiia tsentral'noi nervnoi sistemy.

By analyzing the outcomes of surgical treatment of 105 children with hypertensive syndrome of various genesis, the authors present their data on the detection, diagnosis, and treatment of children with malformations of the central nervous system (CNS). The paper defines the present feasibilities of neurosonography, magnetic resonance imaging, neuroendoscopic verification of CNS malformations and their place in determining the policy and choice of a surgical treatment. The rationale for and the efficiency of cerebrospinal fluid corrective operations in children with these abnormalities are defined. Less good prognosis and a higher risk of surgery for hydrocephalic complications have been revealed and statistically evidenced.

[Neurosonography in the diagnosis of brain tumors in young children]. / Neirosonografiia v diagnostike opukholei golovnogo mozga u detei rannego vozrasta.

The possibilities of neurosonography (NSG) application in the diagnosis of tumors of the brain were studied in 16 children of the age from 1 month to 2 years. Standard NSG age indices for principal anatomic brain compartments as well as both direct and indirect diagnostic signs of tumors are presented. It is shown that NSG is a method of choice in screening of children of early age for brain tumor. This permits both to find it on an early stage, before the development of the pronounced cerebral and dislocation syndromes, and to make a grounded choice of surgical policy.