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Background. The study of the cytokine balance is important due to searching the general links of the pathogenesis of comorbidity in precancerous gastric lesions and thyroid diseases. The purpose was to determine the peculiarities of the cytokine balance in terms of the level of vascular endothelial growth factor (VEGF), tumor necrotizing factor (TNF) α, interleukins (IL) 8 and IL-18 in patients with precancerous gastric lesions depending on the changes in the structure of the thyroid gland. Materials and methods. Forty-five patients with precancerous gastric lesions were examined. Inclusion criteria were as follows: intestinal metaplasia in the body and/or antrum, atrophy in the body of the stomach. According to the results of an ultrasound examination of the thyroid gland, patients are divided into the groups: group I — 19 patients with nodular changes, group II — 18 patients with diffuse changes, and group III — 8 patients without changes. The control group included 10 healthy individuals. The level of IL-8, IL-18, TNF-α, VEGF was determined in the blood serum by the enzyme immunoassay using reagent kits of the Vector-BEST company, Novosibirsk, Russia. Results. 82.2 % patients with precancerous gastric lesions developed the changes in the structure of the thyroid gland (n = 37), 42.2 % (n = 19) had nodular changes in. The concentration of IL-8 in patients of group I was higher compared with group II, III and control group by 2.0 (p

Background. Chronic gastritis is largely associated with clinical manifestations such as dyspepsia, but often, even in a severe form, it is asymptomatic, which causes difficulties in its timely diagnosis. The relationship of the clinical manifestations of functional dyspepsia and chronic gastritis still causes a number of contradictions due to the uncertainty of the form of comorbidity. Objective: to study the clinical manifestations in patients with precancerous lesions of the stomach, taking into account the symptoms of gastroesophageal reflux (GER) and functional dyspepsia — epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS). Materials and methods. Seventy-nine patients were examined. According to the results of a morphological study, they were divided into groups: group 1 (n = 13) — atrophic changes in the gastric mucosa; group 2 (n = 20) — intestinal metaplasia only in the antrum; group 3 (n = 33) — diffuse intestinal metaplasia; group 4 (n = 13) — patients with dysplasia. We analyzed the basic characteristics of the presence, frequency and severity of the main complaints of patients. The severity was determined on a 5-point Likert scale. All symptoms were grouped into the sets of symptoms characteristic of GER and functional dyspepsia with the definition of PDS and EPS according to the Rome criteria. Results. Manifestations of functional dyspepsia in all cases were combined with the clinical symptoms of GER. Symptoms of functional dyspepsia with a predominance of PDS were most intensive in all examined people. For patients with multifocal intestinal metaplasia, the maximum symptomatology of GER is characteristic, which is three times more intensive than in patients with atrophy (p

Background. According to the literature, there are a number of factors causing the development of candidiasis of the upper digestive tract; however, their significance in the formation of the disease has not been fully determined. Controversial data exist regarding antibiotic therapy as a risk factor in patients who are not treated in the intensive care unit. There are no recommendations on the management of patients after the use of antibiotics. The purpose was to determine the risk factors for oropharyngeal candidiasis according to their contribution in the risk of developing the disease, as well as to study the problem of antibiotic therapy and to develop guidelines for the management of these patients. Materials and methods. Six hundred and thirty-eight patients were examined and surveyed, they were divided into groups according to the results of microbiological study of the tongue scraping: group 1 — 151 patients with oropharyngeal candidiasis, that is, ІV degree of colonization, group 2 — 327 persons with mild and moderate fungal growth (I, II and III degree of colonization), group 3 — 160 people with a negative result of seeding (degree 0). Results. Significant differences were found between groups 1 and 3 for such risk factors for oropharyngeal candidiasis as antibiotic therapy over a year, smoking, wearing dentures, the presence of vulvovaginal candidiasis in women, as well as concomitant thyroid disease and anemia. When comparing groups 1 and 2, taking antibiotics over a year and thyroid pathology are significant. The diagnostic sensitivity of the questionnaire formed on the basis of the obtained data is 83.3 %, confidence interval (CI) 75.9–88.8 %, specificity 75.1 %, CI 70.7–79.0 %, efficiency 77.0 %, CI 73.3–80.4 %. Of the 291 patients who were taking antibiotics, antifungal therapy was administered to 199 individuals (68.4 %), but the distribution of the degrees of fungal contamination did not differ between them. The analysis showed that the doses, the timing and the choice of the antifungal drug did not meet current international guidelines. Conclusions. The use of a diagnostic questionnaire developed with consideration of the risk factors for oropharyngeal candidiasis can increase the efficiency of diagnosis. Administration of antibiotic therapy requires observation of the patient and after microbiological verification of the diagnosis of candidiasis — treatment. The optimal therapeutic approach is the use of systemic antifungal drugs in accordance with international recommendations, with simultaneous correction of risk factors that can be modified.

Background. Chronic atrophic gastritis (CAG) is the pre-cancer diseases of stomach. There are often intestinal metaplasia and dysplasia, which could lead to gastric cancer development. The purpose was to study the different risk factors in patients with CAG, and their possible correlations with morphological gastric mucosal changes. Materials and methods. One hundred twenty patients with CAG were included in this study. They underwent an examination with magnifying narrow-band imaging endoscopy. Images resolution was evaluated, as well stomach endoscopic biopsies were analyzed to confirm diagnosis. The questionnaire was worked out and used in patients with CAG to evaluate risk factors. Results. It was found that acute stress (r = 0.593) and chronic stress (r = 0.544), large amounts of fried (r = 0.636), smoked (r = 0.512) and pickled foods (r = 0.591), age (r = 0.639), the A blood type (ABO blood group system) (r = 0.651), heredity (r = 0.533), duodenogastric reflux (r = 0.524), and thyroid disease (r = 0.522) were possible risk factors for CAG. According to examination with magnifying narrow-band imaging endoscopy and morphological results, the Helicobacter pylori incidence became rarer with the increase in gastric morphological changes (atrophy-metaplasia-dysplasia). Conclusions. The results show possible influence of risk factors, such as stress, age, the A blood type (ABO blood group system), heredity, large amounts of fried, smoked and pickled foods, as well as duodenogastric reflux and thyroid disease, in patients with CAG.

The role of buccal epithelial cells in candidiasis development and the interrelation with peculiarities of cytokine balance in patients with candidiasis of the upper digestive tract continues to be studied today. The aim of the investigation. To study levels of cytokines interleukin‑1β (IL‑1β), IL‑4, IL‑6, IL‑8 and tumor necrosis factor α (TNF-α) in gastroenterological patients with candidiasis of the upper digestive tract and to compare obtained data with indices of buccal epithelial cells ability to the adhesion of reference strain of Candida albicans depending on the depth of the damage of the mucosa. Materials and methods. The study was done on buccal epithelial cells from 66 patients, who were divided into three groups according to the results of microbiological investigation of the scrape from the tongue and biopsy materials of the esophagus and the stomach. The first group (1) — 31 patients with oropharyngeal candidiasis and superficial growth of fungi in biopsy materials, of them 1А subgroup — 8 people with superficial growth, the second group (2) — 25 patients with fungi invasion in the mucos, the third group (3) — 10 individuals without oropharyngeal candidiasis and without the growth of fungi. Results. It was demonstrated that the average index of adhesion of buccal epithelial cells was 1.3 and 1.6 higher in group 2 compared with subgroup 1 and 1A (р

The problem of the treatment for candidiasis of mucosa of the upper digestive tract remains relevant because of the need of both a causal treatment, and taking into account the variability of the immune response in the interaction of the microorganism and Candida albicans. Reduced immunoreactivity in this case requires the corrective treatment. The objective — to study the effect of therapeutic complex with an inclusion of polypeptide immunomodulator imunofan on the performance of innate and adaptive immunity in patients of this group. According to the findings, patients with invasion of fungi in the mucosa are characterized by the presence of immune deficiency in terms of the ratio of white blood cells/CD3+, which is 1.3 times higher than in patients with oropharyngeal and superficial candidiasis (p

The article presents the results of studying the sixth scale of comorbidity The Cumulative Illness Rating Scale, which represents the upper digestive tract diseases in patients with oropharyngeal candidiasis compared with patients without fungi and individuals with mild/moderate growth of Candida fungi on the oral mucosa. It was determined that at the same incidence of chronic gastroduodenitis and chronic gastritis, patients with oropharyngeal candidiasis are characterized by the decrease in the incidence of both gastroesophageal reflux disease — by 1.6 and 1.5 times compared with those without fungi and those with mild/moderate growth (p

The article describes the main stages of the development of views on the diagnosis of chronic gastritis with highlighting the issue of diagnosis as an integral part of the set of measures concerning the timely detection of preneoplastic changes in the gastric mucosa. The main views on the development of carcinogenesis are presented based on current knowledge about the factors influencing the course of this process. Among known measures to prevent the development of precancerous changes, today the most important ones are the reliable stratification of risk groups in terms of their development and the strategy for identifying and eliminating Helicobacter pylori as a recognized factor of carcinogenesis. The development of bacterial resistance to basic medications recommended in the schemes of eradication therapy causes a further search of ways to enhance their effectiveness. As shown in a number of studies, the results of which are presented in the article, the most reliable is the inclusion of bismuth subcitrate (De-Nol) in the schemes of eradication.

This article is devoted to the results of the research of comorbid pathologies such as gastroesophageal reflux disease and Oddi’s sphincter dysfunction. It was shown that pH-monitoring indices in the distal esophagus correlated directly with clinical manifestation of gastroesophageal reflux disease. It was also proved that any changes of Oddi’s sphincter tonus regardless of their character influenced negatively gastroesophageal reflux disease worsening its course.

This article is devoted to the study of clinical manifestations in patients with the comorbid diseases, such as gastroesophageal reflux disease and Oddi’s sphincter dysfunction. There were 78 patients included into the study. All patients were divided into 3 groups depending on the type of Oddi’s sphincter dysfunction. This approach allowed make some important conclusions about negative worsening influence of biliary tract dysfunction on as gastroesophageal reflux disease course without regard for the type of dysfunction that was confirmed by more frequent and intense dyspeptic symptoms and pain syndrome in those patients.

he article presents up-to-date data concerning psychosomatic problem in medicine, in particular world experience of studying disorders of psychological of adaptation in patients with gastroesophageal reflux disease (GERD), as well as own researches data. When using psychological tests, detection rate of anxiety and depression in patients with GERD was 100 and 91.2 %, respectively. Follow-up research studies revealed that presence of psychological dysadaptation in patients with GERD makes it impossible to achieve a stable remission of the underlying disease and necessitates appropriate correction.

Article deals with a review of contemporary methods that provide the ability to determine the functional state of the stomach, esophagus. Due to the improvement of modern research methods, methods that are capable of graphic registration of physiological processes are particularly important. Progression of technical capabilities contributed to the development of techniques, the essence of which lies in the long-term recording of sensors located on the intracavitary catheters. Thus, the method of endocavitary pH-measurement facilitates the diagnosis of intragastric pH and, very importantly, intraesophageal. Until now, the method of intraesophageal pH-monitoring was considered the «gold standard» for the diagnosis of gastroesophageal reflux disease (GERD). The results of own researches of intraesophageal pH-monitoring in patients with GERD are provided. But many hours of pH monitoring of the esophagus showed only acid reflux, but alkaline and slightly alkaline refluxes remain outside of this method of investigation, so for the final identification of the causes of GERD symptoms the technique of impedance-pH-monitoring is being proposed. Impedance-pH-monitoring was proposed in 1991 by J. Silny as a method based on the evaluation of the motion of fluid, gas in the esophageal lumen by multiple impedance measurement with simultaneous registration of the pH. Technical capabilities of the impedance-pH-monitoring enabled to broaden our understanding of the physiological processes in the esophageal lumen and to determine the role of mixed, alkaline reflux in the development of GERD symptoms. This article presents the results of several studies conducted in different groups of patients with pathology of the upper digestive tract, which showed the superiority of impedance pH-monitoring and its high level of sensitivity and specificity in terms of reflux detection. The widespread introduction of new techniques and technologies into clinical practice will improve the efficiency and timeliness of medical care, avoiding time consuming for the selection of therapy, evaluation of its effectiveness.

The article resolves of actual problem of interrelation of clinical and endoscopic aspects of mucosal candidosis in upper part of digestive tract. The results of investigation performed in 122 patients led to reveal the prevalence of dyspeptic syndrome in patients with this pathology, in patients with esophageal disorder the intensity of abdominal pain syndrome was 1.5 times higher than in group with only oropharyngeal candidosis (p < 0.001). The deeper mucosal disorder by Candida was associated with increase of frequency of revealing macroscopic signs of esophageal inflammation (р < 0.05), fur (r = 0.220; р = 0.02), difficulty of food pass through the esophagus (r = 0.235; р = 0.02), retrosternal pain (r = 0.249; р = 0.01) with absence of influence of such inflammatory factors as gastroesophageal and duodenogastral refluxes. There was revealed the direct relation of macroscopic signs of inflammation and postulcerative deformation in duodenal bulb with mucosal candidosis degree (r = 0.250; р = 0.01). On the whole the analysis of received data showed the necessity of further study of the role of opportunistic infection in formation pathological process and development of diseases.

The study involved 84 patients with inflammatory and erosive and ulcerative diseases of esophagogastricarea, 72 of them — with Candida infection. It is found that typical histological features are dyskeratosis of esophageal mucosa and more severe inflammation as compared with patients without candidiasis, furthermore, all cases of esophagitis grade II were detected in patients with deep esophageal candidiasis. The spread of infection into the esophagus and/or stomach accompanied by decreasing the thickness of the basal epithelial in significant increase in the average ratio of its height to the total height of the epithelium, and is accompanied by inflammatory and atrophic changes in the mucosa of the gastric fundus, the predominant characteristic of the majority of patients.

The article deals with the problem of gastrointestinal complications during administration of nonsteroidal anti-inflammatory drugs, commonly used to treat a range of conditions, particularly rheumatic diseases. The results of own researches, which served to define the characteristics of changes in the state of gastric secretory function in patients receiving non-selective and selective anti-inflammatory agent and their comparative analysis, are provided. The data obtained demonstrated a certain contribution to the understanding of the mechanism of development of complications from the gastrointestinal tract when taken drugs of above group.