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Aim: to assess effects of esophageal protector Alfasoxx on extraesophageal symptoms in patients with GERD.Materials and methods. A prospective open multicenter post-registration observational study was conducted. The study included 546 patients aged 6 to 85 years (the average age of patients is 42.4 ± 16.9 years) with a verified diagnosis of GERD (endoscopically and/or pH-metrically), the presence of extraesophageal symptoms of the disease (according to the results of an objective examination and consultations of specialists), to whom the attending physician prescribed a course of treatment with a medical device Alfasoxx in accordance with the instructions for medical use. The patients were recruited by 51 researchers in 26 cities of Russia. The study in chronological order consisted of a screening visit and two recorded visits (the observation period within the framework of the use of the Alfasoxx esophagoprotector). The screening visit was conducted on the day of the patient's admission. Visit 1 could be conducted on the same day as the screening visit, whereas visit 2 was conducted 4–5 weeks after visit 1 at the end of the course of treatment.Results. According to the results obtained, at the end of the study, 42.7 % (95 % CI: 38.5–46.9) had complete disappearance of extraesophageal GERD symptoms (questionnaire RSI = 0 points). When comparing the average values of the total RSI score before and after treatment, there was also a statistically significant regression from 13.8 points (95 % CI: 13.2–14.4) at visit 1 to 2.0 points (95 % CI: 1.8–2.2) at visit 2. Thus, the decrease in the total score was significant and exceeded 80 % of the initial value. When analyzing the dynamics of individual indicators of the RSI scale before and after treatment, a significant regression in the severity of all symptoms of the disease was noted. In addition, the results showed that the proportion of patients taking antacid-containing drugs at visit 1 significantly decreased from 58.2 % (95 % CI: 54.0–62.4) to 15.2 % (95 % CI: 12.1–18.3) by visit 2. The average score on the Likert scale of satisfaction with treatment was 4.8 (95 % CI: 4.8–4.9), whereas the convenience of using Alfasoxx is 4.7.Conclusion. This prospective observational multicenter study demonstrated that the addition of Alfasoxx to standard GERD therapy contributes to a significant regression of both esophageal and extraesophageal symptoms, as well as a decrease in the need for antacid medications.

Aim: to present modern methods of diagnosis and treatment of chronic pancreatitis for gastroenterologists, general practitioners and physicians.Chronic pancreatitis (CP) is a long-term inflammatory disease of the pancreas, manifested by irreversible morphological changes in the parenchyma and pancreatic ducts, which cause pain and/or persistent impairment of function. Current concept on the etiology of CP is reflected by the TIGAR-O classification. The criteria for establishing the diagnosis of CP include typical attacks of abdominal pain and/or clinical and laboratory signs of exocrine, endocrine insufficiency with the mandatory detection of characteristic morphological changes (calcifications in the parenchyma and pancreatic ductal stones, dilatation of the main pancreatic duct and its branches). CT, MRCP, and pancreatobiliary endosonography are recommended as the methods of choice to verify the diagnosis of CP. Conservative treatment of patients with CP is provided for symptom relief and prevention of complications. Individual cases with severe non-interactable abdominal pain, as well as a complicated course of the disease (development of ductal hypertension due to main pancreatic duct stones or strictures, obstructive jaundice caused by compression of the common bile duct, symptomatic postnecrotic cysts, portal hypertension due to compression of the portal vein or thrombosis of the splenic vein, persistent duodenal obstruction, pseudoaneurysm of the celiac trunk basin and the superior mesenteric artery) serve as an indication for endoscopic or surgical treatment. The Guidelines set out modern approaches to the diagnosis, conservative, endoscopic and surgical treatment of CP, and the prevention of its complications.Conclusion. The implementation of clinical guidelines can contribute to the timely diagnosis and improve the quality of medical care for patients with chronic pancreatitis.

Aim. A practical review of functional gastrointestinal disorder diagnosis in constipation patients and the rationale for opting treatment.Key points. Functional constipation commonly afflicts different ages and negatively impacts the quality of life. The current diagnostic algorithm in chronic constipation includes the disease identification according to Rome Criteria IV, red-flag symptom detection and instrumental laboratory examination. Functional constipation is notably often associated with anorectal abnormalities that bear a diagnostic value to elaborate an apt treatment strategy. Anorectal manometry, rectal sensation and balloon expulsion tests are the well-studied and significant probing techniques for objective anorectal zone sensorimotor function assessment in patients with functional constipation. The article reviews modern diagnostic methods in functional defecation disorders.Conclusion. The examination and treatment algorithms presented will help improve diagnosis and apply the most suitable management in a constipation-associated functional digestive pathology.

Aim of publication. To present the modern concept on the causes and pathogenesis of pancreatic exocrine insufficiency (PEI) as well as the new diagnostic and therapeutic approaches at this syndrome to general practitioners. Summary. PEI in the state it which secretion of pancreatic enzymes into duodenum is insufficient for normal digestion of nutrients. This syndrome may develop primarily, due to various pancreatic diseases (chronic pancreatitis, pancreatic cancer, cystic fibrosis etc.), and secondarily, at impaired stimulation of pancreatic secretion or impairment of conditions, necessary for the normal action of pancreatic enzymes. Basic clinical manifestations of PEI include maldigestion and malabsorption that lead to development of nutritional failure. No standardized methods of pancreatic exocrine function assessment are developed at the present time, therefore standard diagnostic criteria of PEI are lacking. In routine clinical practice PEI is diagnosed mainly on the basis of decreased pancreatic enzymes activity in stool in patients with verified pancreatic disease but can result in decreased exocrine function. Basic method of PEI treatment is pancreatic enzyme replacement therapy (PERT). Within 50 years which passed after initial implementation of PERT in clinical practice it was significantly modified, numerous pharmaceutical forms of pancreatin were developed. Anyhow for the purpose of replacement therapy capsules with enteric-coated pancreatin microparticles should be applied. Initial recommended dose of PERT for adult patient is 25’000 lipolytical units per meal that should be subsequently increased up to normalization of patients nutritional status according to both clinical and laboratory scores. Digestive enzymes should be taken at the beginning of the meal, in the case of incomplete response it can be recommended to use antisecretory agents. Patient should be consulted by nutritionist, no significant limitation of fat intake is recommended. Daily ration should be divided into six or more meals. Patients should be motivated to stop both alcohol intake and smoking as they can cause progression of PEI alone and/or persistence of symptoms, like pancreatic pain.

The aim of publication. To present the modern concept of etiology and pathogenesis of exocrine pancreatic insufficiency to general practitioners as well as with the established approach to diagnostics and treatment of this syndrome. Summary. Exocrine pancreatic insufficiency (EPI) develops if activity of the enzymes in duodenal lumen in response to meal stimulation is insufficient to maintain normal nutrient digestion. This state can develop primarily, due to various pancreatic diseases (chronic pancreatitis, pancreatic cancer, cystic fibrosis), and secondarily, due to impaired stimulation of pancreatic secretion or non-physiological conditions for activity of digestive enzymes. Basic manifestations of EPN the syndromes of maldigestion and malabsorption leading to development of nutritional failure. At the present time there is no standardized diagnostic method for estimation of pancreatic exocrine function, therefore there are no standard diagnostic criteria for EPN. In clinical practice EPN is diagnosed according to decreased fecal elastase activity in patients with verified pancreatic disease, which can cause decrease of pancreatic exocrine function. The basic EPN treatment method is pancreatic enzyme replacement therapy (PERT). For last 50 years there was an significant progress in development of PERT, numerous pancreatin-containing preparations were developed. Treatment of PERT require prescription of capsules, containing pancreatin microparticles protected by enteric coating. The highest evidential base at EPN is accumulated for pancreatin mini-microspheres. The starting dose of pancreatic enzymes for adults is 25 000 units of lipase per meal, which should be subsequently increased up to achievement of complete response confirmed by both clinical and laboratory scores. Digestive enzymes should be taken at the beginning of food intake, to increase treatment efficacy PERT should be accompanied by prescription of proton pump inhibitors. Patient’s diet quantity and content should be adjusted with participation of nutritionist. Patient should intake at least normal daily amount of fat and divide daily ration to at least six meals. Patients should be motivated to restrain from alcohol consumption and smoking as they can lead to further progression of pancreatic exocrine insufficiency and symptoms of pancreatitis.

Aim of review. To present the modern concepts on epidemiological pattern and risk factors of esophageal adenocarcinoma (EAC) and analyze the modern screening approach. Summary. In developed countries EAC is characterized by rapid increase of mobidity, as well as by high mortality level. As a rule, EAC is diagnosed at the late stage: diagnosis is often made at the 3rd or 4th stage of the tumor that is a major contributing factor for high mortality as treatment options at these stages are significantly limited. The basic established risk factor for EAC is the gastroesophageal reflux disease (GERD). EAC develops usually as a complication of the Barret's esophagus (BE) being a consequence of the long-standing GERD. Male gender, Caucasian race, obesity and metabolic syndrome, tobacco smoking, and series of genetic markers are considered to be significant EAC risk factors. A main goal of EAC screening programs is the early diagnosis that allows to improve patient survival. Conclusion. Only GERD patients develop EAC, with the highest risk in males, Caucasians, smokers, overweight patients and those with uncontrolled symptoms. Timely diagnosis of GERD, its effective treatment and follow-up of BE cases can prevent EAC development.

Aim of publication. To present the latest data on adequate diagnostic methods, treatment approaches and features of rational pharmacotherapy of gastroesophageal reflux disease (GERD) based on the principles of evidence­based medicine to general practitioners. Summary. The prevalence of GERD occupies the first place of other gastroenterological diseases. The heartburn that is a leading GERD symptom is present at 20-40% of the population of developed countries. The prevalence of GERD in Russia ranges 18­46%. Diagnosis of GERD early stages is based on the primary appealability and clinical presentation evaluation. Esophagogastroduodenoscopy (EGDS) gives the chance to define the presence of reflux esophagitis, to estimate severity grade, to reveal development of esophageal epithelium columnar metaplasia. At the refractory course (lack of conclusive clinical and endoscopic remission within 4-8 wks of treatment by standard dose of proton pump inhibitor - PPI), and development of complications (strictures, Barret's esophagus) examination within specialized hospital or gastroenterological clinic is required, including their out­patient departments. Under certain indications the patient should undergo EGDS with esophageal biopsy and histological examination of biopsy specimens to rule out the Barret's esophagus, esophageal adenocarcinoma and/or eosinophilic esophagitis; intraesophageal 24­hour pH­metry or pH­impedance measurement; high resolution esophageal manometry; X­ray study of the esophagus and stomach. The treatment of GERD has to be individualized according to the pattern and severity of clinical symptoms. The goal of treatment is symptom relief, at erosive esophagitis - healing of erosions and complication prevention, at Barret's esophagus - prophylaxis of disease progression and dysplasia and adenocarcinoma development. Nowadays PPIs are considered as the most effective and safe agents for GERD treatment. PPIs are applied for the long­term baseline treatment (no less than 4-8 wks) and maintenance therapy (6-12 months). Intake of alginates is pathogenically reasonable therapeutic approach for reduction of «acid pocket» and acid neutralization in the area of gastro­esophageal junction in GERD patients by formation of mechanical barrier raft which prevents reflux of the stomach content into the esophagus. Antacid monotherapy is recommended for the cases of rare heartburn which is not accompanied by esophagitis and in complex modes of GERD treatment for achievement of rapid symptom relief. Adsorbents are applied as monotherapy at non­ erosive reflux disease, and as a component of comprehensive GERD treatment, especially of the cases of mixed (acid + biliary) refluxes. Prokinetic drugs promote recovery of a normal physiological state of the esophagus, controlling the pathogenic mechanisms of GERD, reducing the number of transient lower esophageal sphincter relaxations and improving esophageal clearance due to stimulation of the lower gastrointestinal motor function. Prokinetics can be applied as a component of comprehensive treatment of GERD along with PPI. Anti­reflux surgery is indicated in complicated cases (recurrent bleeding, peptic esophageal strictures, development of Barret's esophagus with high­grade epithelial dysplasia, frequent aspiration pneumonias). Surgical treatment of GERD is more effective in patients was typical manifestations and positive treatment response to PPIs. Conclusion. Implementation of clinical guidelines can promote improvement of healthcare quality for GERD patients and prevent complications, in particular if terms of treatment will be observed, at active outpatient follow­up for certain groups of patients.

Aim of review. To present management approach for acid-related diseases in patients with Helicobacter pylori (H. pylori) infection, under long-term proton pump inhibitor therapy. Summary. There is no relation of gastroesophageal reflux disease (GERD) symptom severity, the pattern of relapses and treatment efficacy to the presence or absence of H. pylori infection; successful H. pylori eradication does not cause relapse of pre-existing GERD and does not induce its development. At the same time it is impossible to neglect the data on potential induction or aggravation of GERD after H. pylori eradication in separate population groups, including those in Asia. The presence of GERD could not prevent infection eradication in the presence of other indications (e.g., peptic ulcer, chronic gastritis). Monotherapy by proton pump inhibitors (PPI) in H. pylori-positive patients with GERD may lead to progression of gastric corpus atrophy that can be regarded as risk factor for stomach cancer development. H. pylori infection eradication promotes reduction of gastritis-like changes severity irrespective of maintaining of acid-suppressive treatment. The choice of specific PPI for treatment of patients with GERD and other acid-related diseases, carrying out H. pylori eradication therapy or substitution of one PPI agent to another are individualized and depend on the indications registered in the drugs administration instructions, features of its pharmacokinetics and pharmacodynamics, possible drug-to-drug interactions. Conclusion. Testing for H. pylori infection and carrying out the subsequent eradication therapy could allow to prevent progression of corpus mucosa atrophy in patients with acid-related disorders, first of all those with GERD, who received long-term PPI treatment. Estimation of duration of PPI treatment at acid-related disorders, and terms of H. pylori eradication therapy should be evaluated according to clinical guidelines and treatment protocols of these diseases taking into account age of the patient, clinical features, course of disease, presence of complications.

Aim of the case presentation. To demonstrate the rare case of extranodal lymphoma with primary extensive liver involvement which caused difficulties at diagnosis verification. Despite of rapid disease progression with development of severe liver failure, that resulted in poor prognosis, patient demonstrated significant response to high-dose chemotherapy and achieved long-term remission. Summary. Male 38-year-old patient developed acute symptoms: sweating, general weakness, febrile fever, weight loss (50 kg for 4 months), abdominal pain combined to hepatomegaly and multiple focal lesions in the liver according to abdominal US, with 5 unsuccessful attempts for 6 months to receive informative tissue sample. Laboratory tests revealed progressive signs of liver failure at normal level of alpha-fetoprotein and carcino-embryonic antigen; clinical signs included progressive manifestations of liver encephalopathy, skin hemorrhages, severe edema, ascites, pruritis and excoriations. Empirical therapy by prednisolon resulted in no responce and was complicated by development of steroid diabetes. The diagnosis of diffuse B-macrocellular lymphoma was established only via open liver biopsy. Four sessions of high-dose polychemotherapy according to mNHL-BFM-90 program resulted in rapid reduction of liver size, recovery of consciousness, resolution of encephalopathy signs, however the liver and the spleen remained enlarged with focal parenchimatous lesions that required laparoscopy with biopsy of the pathological foci, the latter revealed no remaining neoplastic cells. During 10 years of patient follow-up liver function remains compensated, focal lesions in the liver and the spleen are undetectable, that indicates achievement of 113-months complete tumor remission. Conclusion. Presence of multiple focal lesions in the liver and signs of progressive liver failure at normal level of tumor markers requires taking into account primary liver lymphoma in the spectrum of possible etiologies. Potentially poor life prognosis in similar clinical situations at detection of primary liver lymphoma can flip to favorable due to high efficacy of modern chemotherapeutic agents.

Aim of publication. To present proceedings of Advisory council on postcholecystectomy syndrome (August 25, 2017; Prague, Czech Republic) with support of the Adamed Group company. Summary. The Advisory council proposed algorithm for investigation and management of patients with postcholecystectomy syndrome (PCS). Gallstone disease (GSD) is diagnosed in 10-25% of the population of various age, with obvious trend to involvement of the younger patient categories in the last decades. The total number of GSD patients increases every decade no less than twice. Cholecystectomy remains the basic method of surgical treatment of symptomatic GSD. Nowadays laparoscopic cholecystectomy became universally popular and earned the status of the «gold standard» of surgical treatment. At the same time at asymptomatic GSD the watchful waiting approach avoiding active treatment is considered to be the most expedient. Biliary sludge and microlithiasis including cases undiagnosed at routine investigation can be one of important factors for development of the PCS. Pharmacological treatment of sphincter of Oddi dysfunction that develop at GSD/PCS include following of dietary recommendations, intake of selective spasmolytics, digestive enzymes and ursodeoxycholic acid. Conclusions. Follow-up program for the patient of the cholecystectomy should include regular assessment of clinical symptoms for duly diagnostics of acute and/or severe complications and associated diseases, that may require surgical treatment. Treatment has to include regular courses of selective antispasmodics, the presence of indications - prescription of bile acid supplements, when required - methods of endoscopic surgery.

The aim of review. To present the diagnostic and treatment algorithm for abdominal pain at out-patient/ polyclinic healthcare institutions and to demonstrate potential of hyoscine butylbromide application during diagnostic process and for relief of abdominal pain at irritable bowel syndrome.Summary. From 20% to 50% of all admissions to medical institutions are related to abdominal spasms and pain caused by irritable bowel syndrome (IBS). According to the Clinical guidelines of the Russian gastroenterological association and abdominal pain management algorithm at outpatient reception, the doctor on the basis of interviewing, inspection and physical data first of all should exclude acute abdominal diseases (acute pain, parietal pain) requiring urgent examination by the surgeon or gynecologist and subsequent hospitalization. In the case of visceral pain the minimal range of laboratory and instrumental tests is indicated. If the history of visceral pain is more than 6 months and there are no alarm symptoms, doctor should define specific features of clinical presentation already during outpatient visit, taking into account pain location, that provides formulation of preliminary diagnosis. Epigastric pain (dyspepsia), biliary pain, abdominal pain which can be accompanied by impaired frequency and consistency of stool determine the further investigation plan. Implementation of diagnostic algorithm allows to distinguish the organic disease or to establishthe diagnosis of functional disease. Hyoscine butylbromide at short-term treatment will relieve abdominal spasm as a symptomatic agent. Course treatment effectively reduces intensity and frequency of abdominal pain at IBS. The rate of adverse events and tolerability of hyoscine butylbromide are comparable to that of placebo.Conclusion. Symptomatic treatment by antispasmodic drugs is justified from the moment of referral for medical aid to outpatient department. Hyoscine butylbromide can be prescribed for relief of acute and chronic pain at any stage of diagnostic process. Course intake of antispasmodics has proved its efficacy for pain relief at IBS.

The aim of review. To highlight modern aspects of clinical presentation, diagnostics and treatment of gastroduodenal variant of Crohn's disease (GDCD).Key points. Gastroduodenal involvement at CD is a rare clinical variant of disease and develops in less than 5,5% of cases. By the present time association of GDCD with L1007P mutation of NOD2/CARD15 gene is detected. Epigastric pain, loss of body weight, nausea and — in some cases — vomiting are the most frequent symptoms of this pathology. Endoscopy of the stomach and duodenum with histological examination are the «gold» standard of GDCD diagnostics and quite often have crucial importance in the proof of diagnosis. In difficult cases test for antiSaccharomyces cerevisiae antibodies (ASCA) can be used as additional tool of differential diagnostics. Prescription of proton pump inhibitors in combination to system corticosteroids and azathioprine/6-mercaptopurine if required can be considered as the most successful therapy. Infliximab should be considered as alternati ve drug to other forms of treatment at nonresponding cases.Conclusion. No matter that GDCD is not the common form of disease, knowledge of the clinical variant is important for its duly recognition.

The aim of review. To present modern data on the pathophysiological mechanisms causing functional dyspepsia (FD) syndrome.Key points. Nowadays FD is considered to be a complex multifactor process which cause and effect relationships are under continuous active study. Disorders of stomach motility (delay of evacuation, disorders of relaxation accommodation) and sensitivity (visceral hypersensitivity to distention) are considered to be the basic pathophysiological mechanisms of FD. These changes develop approximately in 40% of FD patients. Besides that, alteration of duodenal sensitivity to hydrochloric acid and lipids can play significant role in genesis of FD.Conclusion. Mechanisms of FD are based on multiple heterogenous disorders of motor and sensitive functions of the stomach and duodenum. Due to major role of stomach motility disorders prokinetics are the priority drugs for treatment of FD.

The aim of review. To estimate possible interrelation between bacterial overgrowth syndromes in the small intestine (BOS) and irritable bowel syndrome (IBS).Key points. BOS and IBS are extremely common syndromes, that contributes to their casual coexistence within same patient from epidemiological point of view. Clinical symptoms of BOS and IBS include meteorism, abdominal pain and disorders of defecation, that are difficult, at first sight, for differential diagnostics. From positions of pathophysiology it is possible to believe, that the IBS causes background for development of BOS, on the contrary, BOS increases risk of IBS development. Unfortunately, despite of huge quantity of studies, there is lack of convincing evidence to this for the present time. The evidential base is generated according to the studies showing high frequency of pathological breath tests in patients with IBS in comparison to healthy patients, however at IBS the rapid intestinal transit can promote false-positive results of breath tests. Other portion of evidential data is based on empirical application of nonabsorbable antibiotics that results in reduc tion of IBS symptoms. Failure to cure IBS by enteroantiseptic drugs requires necessity of search for new ways of treatment, including agents with enterosorptive action, capable to reduce BOS, velocity of intestinal transit and manifestations of IBS.

The aim of review. To analyze proceedings of the Seventeenth Russian Gastroenterological Week (October, 10–12, 2011, Moscow), published in «The biliary tract» section (Ros. zhurn. gastroenterol. gepatol. koloproktol. – 2011. – Vol. 21, N 5. – Suppl. 38).Original positions. Analysis of 29 abstracts, accepted for publication as proceedings of the Seventeenth Russian Gastroenterological Week, was carried out. Of them 14 publications (48,3%) were devoted to issues of conservative and surgical treatment of biliary diseases, rehabilitation after surgical operation, achievement of patients treatment compliance. Overall 44,8% of abstracts accepted to publication contained results of statistical analysis. Other publications, though of major interest, unfortunately, were bare descriptive works or specialists’ opinions.Conclusion. It is necessary to improve quality of the theses presented by authors, first of all by compliance with requirements for publication and presentation of statistical analysis results

The aim of review. To analyze proceedings of the Seventeenth Russian Gastroenterological Week (October, 10–12, 2011, Moscow), published in the «Liver» partition (Ros. zhurn. gastroenterol. gepatol. koloproktol. – 2011. – Vol. 21, N 5. – Suppl. 38).Original positions. Analysis of 149 abstracts accepted for publication as proceedings of the Seventeenth Russian Gastroenterological Week was carried out. The most of publications (70,5%) has been devoted to etiopathogenesis, features of clinical pattern, diagnostics and treatment of acute and chronic viral hepatitis (2542 patients), liver cirrhoses (1338 patients), non-alcoholic fatty liver disease (1145 patients), toxic liver diseases (834 patients) that indicates medical and social impact of these diseases. Statistical analysis, allowing to make any conclusions on studies represented by the abstract, was contained in 44 abstracts of 149, submitted in the «Liver» section (29,5%). Other publications, some from which are invoked major interest, unfortunately, still remain to be only descriptive researches and experts opinions, that requires improvement quality of the theses presented by authors, first of all by compliance with requirements for publication and presentation of statistical analysis results.

Aim: to provide the basic points of the Expert Panel of the Russian Gastroenterological Association with discussion of measures to improve diagnostics, treatment and management of chronic gastritis patients.Key points. In the Russian Federation in 2021 more than 30 million patients diagnosed with “Gastritis and duodenitis” were recorded (K29 in accordance with International Classification of Diseases-10). H. pylori incidence rate in the Russian population has reduced and presently is about 40 %. In chronic gastritis pattern H. pylori-associated gastritis has still dominated though gastritis percent after successful H. pylori eradication, reactive gastropathy (including reflux gastritis) and autoimmune gastritis, has increased. Endoscopic and histologic examinations serve as key diagnostic techniques that provide a means for assessing the ethiology of gastritis, topography and degree of atrophic changes, gastritis staging as per OLGA/OLGIM system that properly correlates with the risk of stomach cancer and determines endoscopic examination strategy. H. pylori eradication therapy of gastritis serves as an etiotropic treatment and makes it possible to prevent progression of atrophy and stomach cancer. Conventional triple therapy combined with bismuth tripotassium dicitrate allows for achieving optimal cure rates of H. pylori eradication. Addition of rebamipide to regimens of H. pylori eradication improves their efficiency. Rebamipide arrests symptoms of dyspepsia in the case of chronic gastritis and functional dyspepsia. The administration of rebamipide for chronic gastritis makes it possible to influence the syndrome of increased epithelial permeability and inflammation, which makes it advisable to study it as a means of preventing stomach cancer and the progression of atrophy in various types of chronic gastritis.Conclusion. Members of the Expert Panel has approved the algorithm of diagnosis and treatment of H. pylori-associated gastritis, gastritis after H. pylori eradication and H. pylori-negative gastritis at the diagnostic stage in the case of initial presentation and long-term follow-up when needed.

Aim. Current recommendations of the Russian Gastroenterological Association are developed to acquaint medical practitioners with modern diagnostics, treatment and trends in rational drug therapy for gastroesophageal reflux disease (GERD).General provisions. Incidence rate of GERD in the Russian Federation varies from 11.3 to 23.6%. GERD is diagnosed with medical history and laboratory examination evidence. Esophagogastroduodenoscopy (EGDS) allows detection of reflux esophagitis of various severity and cylindrical epithelial metaplasia of esophagus. The refractory form of disease (lack of conclusive clinical and endoscopic remission during 4-8 weeks of standard-dose PPI therapy), presence of strictures and Barrett's esophagus require EGDS with esophageal biopsy and bioptic histological examination. Patients should be conclusively performed esophageal 24-hour pH-metry or pH-impedance monitoring, high-resolution manometry to thoroughly examine functionality of esophagus, esophagogastric junction and assess disease prognosis and therapy outcomes.Treatment of GERD should be personalised accounting for clinical manifestations and severity, as well as aimed at symptom improvement, lesion healing in erosive esophagitis, averting complications, Barrett's esophagus progression, dysplasia and esophageal adenocarcinoma.Proton pump inhibitors (PPIs) are most effective agents in primary (4-8 weeks) and maintenance anti-GERD therapy. Antacids are recommended in monotherapy for occasional nonerosive heartburn and complex anti-GERD settings for fast symptom improvement. Prokinetics can be used in combination with PPIs for their properties to recover normal functionality of esophagus through affecting pathogenetic mechanisms of GERD.Complicated patients (repeated bleedings, peptic esophageal strictures) are recommended anti-reflux surgery with prior examination of esophageal functionality using pH-impedance and high-resolution manometry.Conclusion. Current recommendations provide an up-to-date evidential medicial review of GERD and guidelines to advance special medical care and timely preventive measures.

Aim. Current recommendations of the Russian Gastroenterological Association on clinical use of high-resolution manometry in diagnosis of esophageal disorders are intended to assist in clinical decision making, terminology standardisation and interpretation of clinical data.Key points. In 2018, a joint meeting of the Russian Gastroenterological Association and Russian Neurogastroenterology and Motility Group approved unified terminology and classification of esophageal motor function disorders for high-resolution manometry diagnosis.Gastrointestinal patient complaints typically concern esophageal disorders such as dysphagia, regurgitation, heart-burn, chest pain or belching. To exclude erosive and ulcerative lesions, eosinophilic esophagitis and organic changes, esophagogastroduodenoscopy and biopsy are recommended in pre-treatment. Upon excluding mucosal lesions and esophageal lumen obstruction as causal for symptoms, use of high-resolution manometry is recommended. This method of esophageal examination has become the “gold standard” in diagnosis of motor disorders.High-resolution manometry enables detailed investigation of integral quantitative and qualitative characteristics of esophagus motor function and specific related disorders, analysis of esophageal contractile propagation and strictly coordinated synchronous peristalsis of upper esophageal sphincter, esophagus and lower esophageal sphincter, which malfunction may provoke development of achalasia, esophagospasm, hiatal hernia, ineffective eso pha geal motility and other motor disorders.Conclusion. High-resolution manometry is a relatively new method for study of esophagus motor function gaining increasingly wide application in clinical practice. It enables a medical professional to obtain evidence that may critically affect the choice of optimal patient care strategy and effective treatment. Current recommendations are based on an extensive review of up-to-date information and will be updated with new corpus of clinical data and assessment emerging in evidential medicine to provide gastroenterologists country-wide with latest scientific and practical guidelines.

Aim. To present the materials of an Expert Council, which was held on September 23, 2019 in Istanbul (Turkey) under the auspices of a World Gastroenterology Organisation congress and the support of the Abbott company.General provisions. During the work of the Expert Council, the role of motility disorders of the stomach and duodenum, intestines, gall bladder and the sphincter of Oddi in the development of functional diseases of the digestive system, such as functional dyspepsia (FD), irritable bowel syndrome (IBS), biliary dyskinesia (BD) was discussed, and the effectiveness of antispasmodics and prokinetics in their treatment was shown. At the same time, the advantages of the mebeverin antispasmodic drug, as well as the high efficiency and safety of the itopride hydrochloride prokinetic drug were noted. It is emphasized that, at the stage of a diagnostic search in the absence of “alarm symptoms” in patients with suspected FD, IBS, and BD, these drugs can be prescribed empirically.Conclusions. When selecting pharmacotherapy for patients with motor impairment, it is extremely important to consider the nature of these disorders. The use of modern medical preparations, which are characterized by a high level of safety and the targeted action towards a specific motility disorder, allows optimal therapy results to be achieved with minimal risks for the patient.

Aim. The present guidelines intended for primary care physicians are aimed at facilitating early diagnosis of malignant tumours of the digestive system, which can significantly improve the immediate and long-term results of their treatment.General provisions. The guidelines comprise sections devoted to esophageal adenocarcinoma, esophageal squamous cell carcinoma, gastric cancer, colorectal cancer, hepatocellular carcinoma and extrahepatic bile duct and gall bladder cancer, as well as pancreatic cancer. Each section contains information on risk factors and precancerous diseases, which allows a physician to identify whether a particular patient falls into the risk group of digestive system neoplasms. It is shown how digestive system cancers can be suspected on the basis of patients’ complaints and past medical history, as well as data obtained both from a direct examination and laboratory instrumental studies. Each section offers practical algorithms in cases of suspected esophageal adenocarcinoma, esophageal squamous cell carcinoma, gastric cancer, colorectal cancer, hepatocellular carcinoma and extrahepatic bile duct and gallbladder cancer, as well as pancreatic cancer.Conclusion. The knowledge of clinical manifestations and risk factors in the development of digestive system neoplasms allows a physician to suspect cancer and devise a timely and adequate diagnostic strategy, including laboratory and instrumental studies at specialised clinical centres.

Aim. The aim of the study is to analyze the regularities of changes in the basic indicators of esophageal pH-impedance monitoring and high-resolution manometry in patients with non-erosive reflux disease (NERD), erosive reflux disease (ERD) and Barrett’s esophagus (BE) in comparison with healthy individuals.Materials and methods. 69 patients were examined, including 19 patients with NERD, 16 patients with ERD, 14 patients with BE and 20 individuals comprising the control group (CG). The gender structure was as follows: 44 male and 25 female patients. The average age of the examined patients was 46 years. All patients underwent 24-hour esophageal pH-impedance monitoring and high resolution manometry.Results. According to the data of 24-hour pH-impedance monitoring, the total time in the esophagus with pH < 4 was 2.4 % in the control group, 9 % in the NERD group, 20.25 % in the ERD group and 23.5 % in the patients with BE (p < 0.05). The average number of acid refluxes was 22.5 in CG, 61 in the NERD group, 77 in the ERD group and 86 in patients with BE (p < 0.05). The time of chemical clearance was 1.7 minutes in CG, 2.2 minutes in the group of patients with NERD, 2.9 minutes in the ERD group and 3 minutes in the BE group (p < 0.05). The mean nocturnal baseline impedance was 2483.5 Ohm in CG, 1775.0 Ohm in the NERD group, 771.0 Ohm in the ERD group and 911.0 Ohm in the BE group (p < 0.05). The normal parameters of the esophagogastric junction (EGJ) structure and function according to the data of highresolution manometry were observed among 85 % of the control group, 63 % of patients with NERD, 25 % of patients with ERD and 36 % of BE group. The presence of hiatal hernia (HH) and/or hypotension of lower esophageal sphincter (LES) was observed in 15 % of patients from the CG, in 37 % of patients with NERD, in 75 % of patients with ERD and in 64 % of patients with BE. The normal parameters of the motor function of the esophagus were observed in CG (85 %), as well as in patients with NERD (79 %). In patients with ERB and BE, normal motor activity was noted in 25 % and 29 % of the cases, respectively. Disturbances of the motor function of the thoracic esophagus in CG were represented in 10 % of the cases by ineffective peristalsis and hypercontractility in the form of distal esophagospasm in 5 % of the cases. In the NERD group, 16 % of patients had ineffective peristalsis and 5 % of patients had hypercontractility in the form of a hypercontractile esophagus. In patients of ERD and BE groups, the disorders of the motor function of the thoracic esophagus were predominantly represented by ineffective peristalsis, in 75 % and 50 % of the patients, respectively. In addition, in the group of patients with BE, in 21 % of the cases, motor function disorders were observed in the form of absence of thoracic esophagus contractions.Conclusion. It is shown that such indicators as increased level of acid exposure, increased amount of acid reflux, slowed chemical clearance, lowered mean nocturnal baseline impedance, as well as disorders in the structure and function of the esophageal-gastric junction and motility of the thoracic esophagus are associated with the severity of GERD.

The aim of review. To reflect modern concepts on clinic, diagnostics and treatment of Zollinger–Ellison syndrome (ZES).Key points. ZES is rare disease related to intragastric hyperacidity. Phenomenon of hyperacidity in ZES patients is caused by hypergastrinemia associated with ectopic gastrin production. Disease frequently develops in patients with multiple endocrine neoplasia syndrome of the 1-st type. Clinical presentation of ZES directly reflects hypersecretion of hydrochloric acid with development of erosive — ulcerative lesions of esophagus, stomach and duodenum, resistant to standard dozes of proton pump inhibitors (PPI). One of basic methods of ZES diagnostics is assessment of serum gastrin level and intragastric acid production. Conservative treatment includes prescription of high PPI dozes, and octreotide analogues.Conclusion. ZES is not a common disease, anyhow knowledge of its clinical course is important for duly recognition. ZES should be considered at differential diagnostics in patients with frequently relapsing upper gastro-intestinal erosive-ulcerative lesions and in patients resistant to standard dozes of PPI.

The aim of review. To summarize and analyze main causative factors determining inefficacy of modern algorithms of antihelicobacter therapy.Key points. Efficacy of eradication therapy (ET) can depend on a lot of factors which generally can be divided in three main groups in relation to origin: factors determined by microorganism (bacteria); factors determined by macroorganism (patient); the factors determined by doctor. Hence, in clinical practice cases a single patient may have combination of several independent factors determining failure of provided treatment.Conclusion. Efficacy ET depends upon wide spectrum of heterogeneous mechanisms. For the present moment, the primary factor determining inefficacy of treatment, is increase of H. pylori antibiotic resistance to the basic drugs, applied in modes of the first line of ET.

Aim of investigation. Assessment of sensitivity and specificity of the questionnaire GerdQ for diagnostics of gastroesophageal reflux disease (GERD) in everyday practice of primary healthcare level physician in the Russian Federation.Material and methods. Survey by GerdQ questionnaire included 145 patients with symptoms related to upper parts of the gut, who were recommended due to main disease to undergo esophagogastroduodenoscopy (EGDS) and 24-hour intraesophageal pHmetry prior to enrollment to this investigation. After filling the questionnaire all patients were examined by gastroenterologist to establish preliminary diagnosis (GERD or other disease). During the subsequent 2 wks patients underwent EGDS, 24-hour pH-metry and diagnosis was specified. Upon termination of the study the data received after filling of questionnaire and data of physical investigation by gastroenterologist have been compared to results of instrumental methods of GERD diagnostics. Statistical analysis was carried out by application software packs IBM® SPSS® Statistics. Results. Sensitivity of GerdQ questionnaire was 65,4% (87 of 133 patients), specificity – 91,7% (11 of 12 patients).Conclusion. High sensitivity and specificity of GerdQ questionnaire will help physicians and other experts at primary healthcare level to establish diagnosis of GERD, to choose adequate approach at investigation and treatment of patients with symptoms related to upper parts of the gut.

Aim of the Review. To analyze current data about possible influence of nutritional fiber on the course of GERD.Key points. Systematic review in PubMed/Medline databases was performed with keywords food, dietary fiber in combination with gastroesophageal reflux, GERD. The review contains data concerning influence of nutritional fiber on the pathogenetic mechanisms of GERD and illuminates results of epidemiological studies suggesting positive correlation between quantities of nutritional fiber in the patient’s diet and manifestations of the disease. The main features of pathogenesis caused by the lack of nutritional fiber include slow gastric emptying, increased gastric volume, increased risk of obesity and hiatal hernia, reduced lower esophageal sphincter pressure. The epidemiological studies suggest the higher incidence of GERD symptoms, higher prevalence of Barrett’s esophagus and esophageal adenocarcinoma in patients who consume low quantity of nutritional fiber.Conclusion. Despite the lack of interventional studies the literature data about impact of nutritional fiber on the manifestations of GERD show probable approach for the correction of diet in GERD patients. There is a need for prospective studies evaluating correction of diet on the course of the disease.

Aim of the Study. The administration of ursodeoxycholic acid (UDCA) as monotherapy or in combination with lactulose for the treatment of the patients with nonalcoholic steatohepatitis (NASH) has been studied insufficiently. The aim was to assess the impact of the 90-day therapy with Ursoliv® drug (20 mg/kg per day of the UDCA and 25 mg/kg per day of the lactulose) on the biochemical blood tests values of the NASH patients in comparison with the Ursosan® drug (20 mg/kg per day of UDCA).Мaterials and methods. 60 patients with the NASH were included into the open randomized prospective comparative study without applying control. The patients were separated into 2 equal groups. The 1st group was administered Ursoliv®, and the 2nd group – Ursosan®. The baseline laboratory tests – markers of cytolysis and cholestasis, lipid profiles – and after 45 and 90 days of the treatment were assessed.Results. The credible dynamic of the biochemical tests values of the cytolysis as compared with the baseline (the reducing of the activity of the alanine transaminase and the aspartate transaminase) and of the cholestasis (gamma-glutamyl transpeptidase) was observed; the positive changes in the lipid profile (the increase in the concentration of the high density lipoproteins and the reduction in the total cholesterol, the low density lipoproteins, the very low density lipoproteins and triglycerides ) were seen during the treatmet in both groups. The tendency towards the more expressed impact of the combination of UDCA and lactulose (Ursoliv®) in comparison to the monotherapy by UDCA (Ursosan®) on the biochemical parameters were discovered. However, the statistical credibility was not reached, which, probably, can be explained by the peculiarities of the sampling.Conclusions. The administration of the UDCA in the dosage of 20 mg/kg per day as monotherapy as well as in the combination with the lactulose (25 mg/kg per day) in the patients with NASH is characterized by the expressed positive impact on the laboratory markers of cytolysis, cholestasis and the lipid profile. The higher dosages of the UDCA and of the UDCA in combination with the lactulose can be recommended for the treatment of the NASH patients.

The aim of review. To analyze proceedings of the Seventeenth Russian Gastroenterological Week (October, 10–12, 2011, Moscow), published in the section «Pancreas» (Ros. zhurn. gastroenterol. gepatol. koloproktol. – 2011. – Vol. 21, N 5. – Suppl. 38).Original positions. Analysis of 53 abstracts, accepted for publication as proceedings of the Seventeenth Russian Gastroenterological Week was carried out. The most of publications (64,2%) was devoted to issues of management of patients with acute and chronic pancreatitis (case presentation, surgical, endoscopic and conservative treatment). Overall in 37,7% of abstracts accepted for publication results of statistical analysis were presented. Other publications, some of which invoked major interest, unfortunately, still remain to be only descriptive works and experts opinions.Conclusion. It is necessary to improve quality of the theses presented by authors, first of all by compliance with requirements for publication and presentation of statistical analysis results.