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Extraesophageal manifestations of gastroesophageal reflux disease (GERD), despite the improvement of methods of diagnosis and treatment of patients with this pathology, still remain an urgent problem of medicine and cause increased attention of clinicians and researchers. In some cases, patients with GERD do not present typical complaints of heartburn, regurgitation; the disease may manifest extraesophageal manifestations, such as chronic cough, hoarseness, reflux laryngitis, and others caused by the presence of laryngopharyngeal reflux (LFR) – inflammation of the mucous membrane of the upper digestive and respiratory tracts with possible morphological changes associated with direct and indirect (reflex) exposure to gastroduodenal reflux. The occurrence of LFR is possible due to a violation of the motor function of the esophagus and insufficiency of the upper esophageal sphincter, as well as a decrease in the tone of the pharyngeal muscles. The most accessible methods of diagnosis of LFR are registration of complaints according to the questionnaire “index of reflux symptoms”, assessment of the clinical and functional state of the larynx using a visually analog “scale of reflux signs”. A positive response to the empirical use of proton pump inhibitors in combination with procinetics and determination of pepsin content in saliva can also be alternative diagnostic methods. To date, 24-hour pH-impedance monitoring is a method that allows the most accurate diagnosis of all types of reflux, regardless of the pH value, to verify high reflux in combination with its physical properties, as well as to estimate the time of chemical and volumetric esophageal clearance. In addition to performing esophagogastroduodenoscopy, the use of this method is indicated in patients with suspected extraesophageal manifestations of GERD. The article presents clinical examples of patients with extraesophageal manifestations of GERD, describes the possibilities of 24-hour pH-impedance monitoring of the esophagus in the diagnosis of LFR and reflux-associated diseases of the larynx.

Objective: to identify psychosomatic and somatopsychic ratios in the clinical picture of disorders detected by internists as functional disorders (FD) of unexplainable or insufficiently explainable origin.Patients and methods. In 2000 to 2017, an internist and a psychiatrist in the Internal Medicine Clinic made a joint examination of 640 patients (175 men and 465 women; the mean age of those in cardiology practice was 27.52±9.03 years; that of those in gastroenterology practice was 42.44±17.2 years, and that of those in pulmonology practice was 40.20±11.4 years) with various risk factors (RFs), who had for many years exhausted the clinical picture of diseases: neurocirculatory dystonia (NCD), irritable bowel syndrome (IBS), functional dyspepsia (FD), hyperventilation syndrome (HVS), and thermoneurosis (TN) (a study group). A comparison group included 245 patients (81 men and 164 women; their mean age was 38.78±8.07 and 48.12±10.92 years, respectively) with verified somatic diseases: hypertension, duodenal ulcer, asthma, and inflammatory bowel diseases. The patients were examined using both clinical and paraclinical studies in accordance with the standards for the above diseases and applying psychopathological and psychometric tests.Results and discussion. A comparative interdisciplinary study established that the general medical practice patients with NCD, IBS, FD, HVS, and TN had two etiopathogenetically different clinical RFs: a) RF as the clinical essence of the current somatic disease and b) RF comorbid in certain psychopathological disorders: affective (F30–F39) (57.9%), neurotic (F40–F48) (27.1%), and schizotypic (F21) (15.0%). In the structure of complex psychosomatic syndromes that are often encountered in therapeutic practice, they represent the pivotal manifestations of disease, the adequate diagnosis of which is supposed to require cooperative interdisciplinary work.Conclusion. Thus, our long-term study that is based on a single interdisciplinary approach has allowed us to formulate a modern concept of unity of the clinical stereotype of development of psychosomatic syndromes.

The article is devoted to the diverticular colon disease, its uncomplicated form, the connection with age. Symptoms allowing to define presence at this form of disease of IBS-like symptoms – pains and infringements of the psycho-emotional status are highlighted. The results of psychometric research and psychiatrist’s consultation of 102 patients are presented. The role of obesity in the genesis of diverticular disease is highlighted. The significance of spasmolytic therapy, in particular mebeverine, is presented.

The article shows the dynamics of evaluation of prognostic factors of irritable bowel syndrome. Evolution of the views indicates an increasing evaluation of inflammation and the role of markers of inflammation of cytokines, especially alpha-TNF in clinical manifestations. The rationale for using a complex drug based on affinity purified release-active antibodies to alpha-TNF, to the brain-specific protein S-100 and histamine-colourant is presented.

The article gives information on the scope of ursodeoxycholic acid (UDCA). The most evident positive effects of therapy for cholelithiasis (SCI) and in primary biliary cirrhosis (PBC). The probability of using UDCA as a means of preventing CLS in cases of biliary sludge (SB) and in the risk group in elderly and elderly people is discussed. The data of our own study of the results of UDCA in 34 patients with non-alcoholic fatty liver disease, combined with the dyskinesia of the gallbladder (BL), BS and gastroesophageal reflux disease (GERD) are presented. Admission UDCA Grinterol demonstrated high clinical efficacy, safety and the absence of side effects.

To systemize anxiety-depressive disorders in patients with inflammatory bowel diseases (IBD) and to reveal clinically relevant psychosomatic correlations.Fifty inpatients with IBD, including 32 with ulcerative colitis and 19 with Crohn's disease, were examined using clinical and follow-up methods.Affective mental disorders (depressions of various structures of different genesis) were found in most (72%) of cases. Adaptation disorders in patients with personality pathology, depression in cyclothymia, bipolar disorder and schizophrenia were identified as well. Psychosomatic correlations depended on the stage of IBD and the genesis of affective disorders. Somatogenic asthenic disorders prevailed at the stage of IBD manifestation and depressions of different structure with different course (recurrent, bipolar, attack-like) at the further stages of IBD. The psychosomatic relations at the subsequent stages of IBD were characterized by psychosomatic balancing. There were tendencies of convergence and divergence of mental disorders with the current somatic disease. The most severe variants (chronic continuous course, resistance to therapy) were found in patients with comorbid endogenous mental disorders. This was primarily due to the lack of a rational attitude of patients to the somatic disease and, therefore, the low compliance that must be taken into account in the treatment.Цель исследования. Систематика тревожно-депрессивных расстройств при воспалительных заболеваниях кишечника (ВЗК) с выявлением клинически значимых психосоматических соотношений. Материал и методы. В гастроэнтерологическом стационаре клинико-катамнестическим методом были обследованы 50 пациентов с ВЗК (у 32 был диагностирован язвенный колит, у 19 - болезнь Крона). Результаты и заключение. Психические расстройств, преимущественно аффективные (депрессии различной структуры и различного генеза) выявлены в 72% случаев. Имели место расстройства адаптации при личностной патологии, депрессии при циклотимии, биполярном расстройстве и шизофрении. Психосоматические соотношения зависели от этапа ВЗК и генеза аффективных расстройств. На этапе манифеста ВЗК превалировали соматогенные астенические расстройства, на дальнейших этапах течения - депрессии различной структуры с разными вариантами течения (рекуррентное, биполярное, приступообразное); психосоматические соотношения на последующих этапах течения ВЗК имели характер психосоматического балансирования. Отмечены тенденции конвергенции и дивергенции психических расстройств с текущим соматическим заболеванием. Наиболее тяжелые варианты соматического заболевания (непрерывное безремиссионное течение, резистентность к терапии) выявлены при коморбидности с эндогенными психическими расстройствами, что обусловлено в первую очередь недостаточностью рационального отношения пациентов к имеющемуся соматическому заболеванию, соответственно - проблемами комплаентности; это обстоятельство должно учитываться в процессе терапии.

Aim. Assessment of diagnostic significance of informativeness and security of ultrasonography with contrast enhancement drug SonoVue in the diagnosis of Crohn's disease (CD) and ulcerative colitis (UC). Materials and methods. The pilot conducted a prospective study which involved 15 patients with inflammatory bowel disease (IBD). All patients gave written consent to participate in the study and processing of personal data. The study included adult patients with an established diagnosis of UC and CD, with proven clinical activity of the disease. Activity was evaluated based on clinical and laboratory data on the scale of best (CDAI >150) for patients with CD and on a scale of Trulove-Witts (2-3 stage) and the Mayo index (DAI) for patients with UC. All the patients underwent colonoscopy with biopsy, ultrasound examination of abdominal cavity organs with the study of the vascularization of the intestinal wall (color Doppler, power Doppler, contrast study). Results. The use of contrast showed additional features in the instrumental evaluation of activity of inflammatory process, identification of complications and assessment of prognosis. Conclusion. The results of ultrasound of the bowel with contrast can be used to assess the activity and stage of disease in patients with UC or CD.

Since 1980 when L. Ludwig et al. [1] identified changes in the liver characteristic of alcohol-induced hepatitis in persons who didn’t misuse alcohol, intense study of non-alcoholic fatty liver disease (NAFLD) started. The definition of NAFLD has two major principles: a morphological pattern in biopsy ma terial microscopy completely corresponds to changes induced by alcoholic pathology and the major etiologic factors is lacking – alcoholic at hepatotoxic dosages. Obligatory condition is to rule out viral, drug, metabolic and other reasons [2].

The article tells about the indications for use of ursodeoxycholic acid (UDCA). The most significant positive effects were demonstrated in primary biliary cirrhosis (PBC) and cholelithiasis (CL). The possibility of using UDCA for CL prophylaxis during biliary sludge (BS) and in risk groups -people of elderly and senile age - is discussed. The article presents the results of the authors’ study of UDCA administration in 32 patients with gallbladder deformity (GD) and BS. Grinterol (UDCA) demonstrated high clinical efficacy, safety and no side effects.

The authors relate the results of examining 120 patients with functional disorders of the colon. The majority of the patients manifested diverse mental abnormalities of the neurotic origin, represented by different patterns of mental pathology, somatized disturbances, neuroses and psychopathies. The conditions favouring the origin of neurotic and functional disorders have been elucidated. It is concluded from the comparison of different treatment modalities that psychotherapy may be preferred.

Basing on comprehensive clinical investigations of 50 patients with colon dysfunction, relevant somatic and psychological aspects have been analysed. Colon dysfunction in shown to attend neurotic and personality disorders, to be in some cases a somatoform manifestation of endogenic depression. The majority of the patients had psychogenic neurotic affections closely related to colon dysfunction which is considered a psychosomatic pathology.

Basal and maximum gastrin levels were measured in 81 patients with various stages of chronic alcoholism and different periods of alcohol intake, in 23 patients with chronic gastritis of nonalcohol etiology, and in 12 normal subjects. The findings permit a conclusion on the depressive effect of alcohol on the function of gastrin-producing G-cells, this resulting in lowered levels of both basal and maximal gastrin. A direct correlation between the degree of alcohol depression of gastric gastrin production and the length of alcohol consumption was revealed.

The characteristics of all types of chronic gastritis in patients with chronic alcoholism is given. Alterations of the stomach mucous membrane in alcoholism of different duration are described in detail. The intermediate type filaments in the surface epithelium, cells of glands and macrophages are found which is reported to be a morphological manifestation of alcoholism.

The results of puncture biopsy of the liver, ultrasonic and angiographic investigation of the liver and pancreas in 114 patients with chronic alcoholism revealed an increment of changes in these organs in parallel with an increase in the duration of chronic alcoholic intoxication. A simultaneous study of immunoreactive insulin (IRI) and C-peptide showed that an increase in the IRI basal level in the patients suffering from alcoholism up to 10 yrs was determined mainly by an increase in the activity of beta-cells. In a long period of alcoholism an increase in the IRI basal level resulted from a decrease in the rate of insulin degradation in the liver as assessed by a lower level of C-peptide. In liver cirrhosis a noticeable decrease in pancreatic incretory function was combined with noticeable disturbance of insulin degradation in the liver. The above investigations showed that there were morphological, functional and clinical signs of the "hepatopancreatic syndrome" in chronic alcoholism.