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Aim: to optimize outcomes of the treatment and prevention of gastrointestinal diseases in adults and children. Key points. The Methodological Guidelines contain sections on the terminology, classification, mechanisms of action, requirements for sale in the Russian Federation, requirements for proving the efficacy and safety of probiotics, prebiotics, synbiotics and metabiotics, as well as functional foods enriched with them. An overview of relevant data allowing to include these drugs and products in the treatment an d prevention of gastrointestinal diseases in adults and children is presented. Conclusion. The clinical efficacy of probiotics, prebiotics, synbiotics and metabiotics depends on the specificity and quantity of their components, the dosage form, the regimen and duration of treatment. Products and functional foods with proven efficacy and safety are recommended for the treatment and prevention of gastrointestinal diseases in adults and children.

Aim. The practical guidelines are intended for primary care physicians, general practitioners, paediatricians, gastroenterologists and general internists to advance the treatment and prevention of gastroenterological diseases in adults and children in therapies with probiotics, prebiotics, synbiotics and their enriched functional foods.Key points. Probiotics are live microorganisms that sustain health of the host when supplied in adequate amounts. Prebiotics include human-indigestible but accessible to gut microbiota substances expediting specific changes in the composition and/or activity of gastrointestinal microbiota that favour the host health. The mechanism of probiotic action comprises the quorum resistance maintenance, nutrient substrate metabolism and end metabolite recycling, macroorganism-sustaining substrate production, as well as the mediation of local and adaptive immune responses.The Russian Federation regulates market differently for biologically active food additives (BAFA), medicinal products (drugs) and functional food products (FFP). We overview the probiotic strains regulated in Russia as BAFAs, drugs and FFPs and provide recommendations on the use of these strains in treatment and prevention of gastroenterological diseases in children and adults.Conclusion. The clinical efficacy of probiotics, prebiotics, synbiotics and fortified functional foods depends on the prebiotic and strain properties and is verified in appropriate comparative clinical trials. Not all probiotics registered in Russia as BAFAs, drugs and FFPs have a strain identity, which provides no warranty of the clinical effect expected. The FFP legislation demands improved regulation mechanisms and control for therapeutic efficacy.

Among the many causes of the inflammatory process in the esophagus, infectious diseases are becoming increasingly important due to their steady growth. Previously esophageal infections have traditionally been associated with immunodeficiency syndromes, but now in clinical practice, these disorders are becoming increasingly recognized in immunocompetent individuals. Early diagnosis of infectious esophagitis is necessary to develop effective treatment tactics, and, as a result, reduce the risk of complications and adverse outcomes of the disease. This study reviewed the most clinical relevant pathogens of infectious esophagitis, both among patients with immunodeficiency and among healthy individuals. Specific diagnostic, risk factors, clinical presentation and therapeutic features were considered depending on the immune status of patients.

Aim. To provide practical recommendations on the use of probiotics for the treatment and prevention of gastroenterological diseases in adults.General provisions. Probiotics are living microorganisms that benefit the health of the host when administered in adequate amounts. The main functions of probiotics include the support for colonisation resistance, the metabolism of food substrates and utilisation of end metabolites, the production of substrates necessary for the macro-organism, as well as the regulation of local and adaptive immune responses. Probiotics can be registered in the Russian Federation as biologically active food additives (BAFA) or as pharmaceutical products (drugs) in accordance with the microbiological standards and legislative requirements of the Russian Federation. The probiotics registered in the Russian Federation as BAFA for adults include bacteria of the Lactobacillus, Bifidobacterium, Enterococcus, Pediococcus, Lactococcus, Streptococcus, Bacillus, and Escherichia genera, and fungi of the Saccharomyces genus; probiotics registered as drugs — bacteria of Lactobid, Lactobacid, Escherichia and Enterococcus genera and fungi of the Saccharomyces genus. Some probiotics registered in the Russian Federation include probiotic strains that have proved to be effective for the prevention and treatment of antibiotic-associated diarrhea, the prevention of C. difficile-associated disease, the eradication of H. pylori infection, as well as for the treatment of irritable bowel syndrome and functional constipation.Conclusions. The clinical efficacy of probiotics depends on the probiotic strains included in their composition and is confirmed by a comparative analysis of the results of appropriate clinical studies. Not all probiotics registered in the Russian Federation as BAFA or drugs contain bacterial or fungal strains; as a result, the expected clinical effect may not be achieved.

Aim. This paper presents guidelines on the diagnostics and treatment of eosinophilic esophagitis, which can be used by practitioners in their everyday practice.Summary. Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized by the symptoms of esophageal dysfunction and a pronounced eosinophilic infiltration of the esophageal mucosa. The EoE diagnostics is based on the clinical manifestations of the disease (dysphagia, food impaction, chest pain regardless of swallowing), as well as on the combination of endoscopic and histological signs. The diagnostic criterion is the eosinophilic infiltration of the esophageal mucosa with an eosinophil density of ≥ 15 per high power field (×400) in at least one of the biopsy specimens (about 60 eosinophils in 1 mm2). Total IgE levels, peripheral blood eosinophilia and skin allergy tests are considered to be additional diagnostic means. Several approaches are used for the treatment of EoE, including proton pump inhibitors (PPIs) and topical glucocorticosteroids (GCS), as well as elimination diets. The choice of therapy should be individualized, with the mandatory assessment of the treatment efficacy after 6–12 weeks using esophagogastroduodenoscopy with biopsy sampling. Endoscopic dilatation should be considered in patients suffering from severe dysphagia due to esophagus stricture.Conclusion. Increased incidence of EoE predominantly among children and young people, as well as its chronic character requiring long-term maintenance therapy, make EoE a significant issue to the practice of gastroenterology.

Results of pharmacokinetic study of a new dipeptide anxiolytic GB-115 in rats, rabbits and volunteers were presented. After oral drug administration significant differences were found. For example, a dose-independent parameter - the elimination rate constant was decreased: rat < human < rabbit. By contrast the half-life of GB-115 was increased: rat

Pharmacokinetic study of а new original anxiolytic drug GB-115, developed on the basis of endogenous tetrapeptide cholecystokinin, in healthy volunteers was performed. Volunteers were received drug as single 1, 3, 7, 11 or 15 mg tablets. The parent drug in the human blood plasma was detected within 2-6 hours after ingestion. Cmax/AUC0-T for doses 3-15 mg were averaged 0,482-0,552 h-1. Cmax were averaged from 7,29±2,83 ng/ml (for dose 1 mg) to 44,02±13,23 ng/ml (for dose 15 mg). Half-life of the drug is changed in the range of 0,6-1,0 h. Vd/F amounted to an average of 2,47 l/kg. Summarizing the obtained results it can be concluded that consistent, linear increase in the dose of GB-115 from 1 to 15 mg there is an increase in dose-dependent pharmacokinetic parameters. In the studied range of doses pharmacokinetics of GB-115 was linear.

Aim of investigation. To analyze efficacy of heartburn relief and pathological gastroesophageal reflux (GER) elimination as well as dynamics of endoscopic changes at gastroesophageal reflux disease (GERD) under dioctaedric smectite (Smecta) treatment in standard doze as monotherapy and within complex mode of treatment.Material and methods. Overall 45 case records of GERD patients (25 women and 20 men, mean age 43,06 years) were analyzed. All patients underwent esophagogastroduodenoscopy (EGDS) and 24-hour рН-impedance recording prior to the treatment onset and at the 14-th day of therapy. The first group included patients with erosive esophagitis (EE) of the I–II degree receiving combination of proton pump inhibitors (PPI) and Smecta, the second group included patients with EE, receiving PPI monotherapy, the third group — patients with non-erosive reflux disease (NERD) at Smecta monotherapy.Results. On a background of treatment by PPI + Smecta relief of heartburn was achieved at the 3rd day in 10 (66,7%) patients, at PPI monotherapy — in 4 (26,7%) patients with EE, at monotherapy by Smecta — in 6 (40%) patients. At the 5th day heartburn has been completely relieved in 11 (73,3%), 9 (60%) and 8 (53,3%), and at the 14-th day — in 13 (86,7%), 11 (73,3%) and 12 (80%) patients respectively. In the first group according to upper endoscopy data healing of erosions was confirmed in 13 (86,7%) patients, in the second — in 10 (66,7%). In the third group cessation of catarrhal signs was revealed in 13 (86,7%) patients. According to 24-hour рН-impedance esophageal recording prior at the beginning of therapy pathological acidic, weakly acidic and weakly alkalinic GERs were diagnosed in 34 (75,5%), 18 (40%) and 12 (26,7%) patients in group as a whole respectively. On a background of therapy by PPI + Smecta acidic refluxes have been eliminated in 14 (93%), at PPI monotherapy — in 11 (73%), at Smecta monotherapy — in 100% of patients. In the first group weakly acidic refluxes disappeared in 2 (67%), in the second — in 1 (50%), in the third – in 9 (69%) cases, weakly alkaline refluxes: in 4 (80%), in 2 (40%) and in 100% of cases respectively.Conclusions. Addition of Smecta in treatment mode at erosive form of GERD essentially increases treatment response rate, significantly reducing terms of clinical improvement onset. Dioctaedric smectite appears an effective drug as monotherapy of NERD. The chief advantage in treatment of GERD is ability of the drug to stop all reflux types: acidic, weakly acidic, and weakly alkalinic.

The purpose of the review is to determine the relationship between the clinical symptoms of diseases and disorders of the motor function of the esophagus, stomach and duodenal bulb, to present modern methods of their diagnosis and pathogenetic principles of treatment of diseases. Depending on the pathogenesis, it is possible to distinguish secondary motility disorders resulting from organic lesions, and primary (functional) changes. The emergence of clinical symptoms is associated with impaired motor - evacuation function of the digestive tract, which can be divided into two large groups: changes in the peristaltic activity of the organ wall and the work of the sphincter apparatus. The basis of the regulation of motility of the esophagus, stomach and duodenum is the interaction of nervous and humoral factors, the central processing of impulses is carried out in the cerebral cortex. In case of violation of the coordinated action of inhibitory and excitatory regulation systems, pathological contractile activity occurs, which manifests itself as hypo - or hyper - motor dyskinesia. X-ray, ultrasound, high resolution manometry of the esophagus, pH-meter, scintigraphy, computed tomography, antroduodenal manometry and a number of others are used to diagnose disorders of the motor function of the digestive tract, which can determine the mechanism of the development of symptoms and prescribe pathogenetic treatment to the patient. Thus, the occurrence of clinical symptoms is associated with changes in the motor - evacuation function of the digestive tract due to a violation of the coordinating action of inhibitory and excitatory factors. The use of modern diagnostic methods for the study of motor function makes it possible to determine the mechanism for the development of clinical symptoms, which allows the patient to prescribe an effective pathogenetic treatment.