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Aim: to evaluate the possibility of the MMR-system status, microsatellite instability (MSI) usage in the differential diagnosis of gastric mucosa dysplasia, determination of the gastric adenocarcinoma development risk. Material and methods. The study included gastric mucosa specimens of 75 patients: 25 with high-grade dysplasia, 25 with low-grade dysplasia, 25 were indefinite for dysplasia. Gastrobiopsy specimens were examined histologically, immunohistochemically using mouse monoclonal antibodies (Diagnostic BioSystems, USA) to the MMR system proteins: MLH-1 (clone G168-15, dilution 1:50), MSH2 (clone DBM15.82, dilution 1:100), MSH6 (clone 44, dilution 1:50), PMS2 (clone A16-4, ready to use). MSI was studied with multiplex PCR evaluation of DNA microsatellites (NR-21, NR-24, NR-27, BAT-25, BAT-26) from paraffin sections, their analysis with capillary electrophoresis. The obtained data were processed with the Statistica 10.0 (StatSoft, USA), presented using descriptive, analytical statistics. VOSviewer (1.6.20) was used to visualize the bibliometric analysis. Results. MMR-deficient cases were found in low (2.8 %) and high-grade (2.8 %) dysplasia with the immunohistochemical evaluation of MMR-system proteins in gastric mucosa specimens. In all indefinite for dysplasia cases MMR-system proteins remained unaffected. Three MSI-positive cases (6.5 %) were detected by PCR with two low-grade dysplasia, one high-grade dysplasia cases. All identified cases were also immunohistochemically MSI-positive. Conclusion. Determination of MSI can be used as an auxiliary study within a panel of biomarkers aimed to support the decision-making of a pathologist in the alternative of “indefinite for dysplasia” or “definite dysplasia — obligate precancer”.

An inflammatory process accompanied by the changes in mucosal microbiota is underlying the gastroduodenal diseases. Chronic inflammation of gastric mucosa is developed and supported by secretion of pro-inflammatory and anti-inflammatory cytokines by epithelial cells and immune cells induced by Helicobacter pylori and other microorganisms. Under the conditions of dysbiosis and immune dysregulation, gastric epithelial layer becomes like intestinal or colonic epithelium. The aim of this work was to determine diagnostic and prognostic value of cytokines in intestinal metaplasia of gastric epithelium. 204 patients with exacerbation of chronic gastritis, gastric ulcer, gastric polyposis and 40 healthy volunteers were included into the study, under their informed consent. The gastric biopsies were sampled by means of esophagogastroduodenoscopy (for histological and microbiological examination), along with drawing 5 ml of venous blood with serum separation (for enzyme immunoassay). Serum cytokine levels were studied by solidphase enzyme immunoassay. In statistical evaluation of the results, we have calculated sensitivity, specificity of indexes, logistic regression equations, characteristic curves were built with the definition of the index of consistency of the model by the area under the curves (AUC).Histological examination of gastric biopsies showed features of intestinal metaplasia in 61 patients (29.90%), colonic metaplasia was found in 40 cases (19.61%), being absent in healthy volunteers. The greatest sensitivity of intestinal metaplasia was observed for plasma levels of interleukin (IL)-6, IL-4, erythropoietin (EPO), tumor necrosis factor (TNF)α, IL-18, vascular endothelial growth factor (VEGF), interferon (IFN)α levels; in colonic metaplasia, for receptor antagonist IL-1β (IL-1ra), IL-8, EPO, IL-18, monocyte chemoattractant protein (MCP)-1, VEGF, IFNα, IL-1β, IL-6, IL-17. An increase in IL-6, EPO, IL-18, VEGF, IFNα were also common, thus indicative for changed functional activity of cytokines due to microbial contamination of gastric mucosa, tissue hypoxia with activation of angiogenesis, confirming a transition of intestinal metaplasia to gastric carcinogenesis. The greatest specificity in intestinal metaplasia was observed for IL-1β, IL-1ra, IL-8, IL-17, IL-2, IL-10; in colonic metaplasia, for IL-18, IFNα, IL-4, МСР-1, VEGF. In the intestinal metaplasia, the AUC interval was higher than 0.7 for IL-2, higher than 0.65, in VEG; in colonic metaplasia > 0.91, for IL- 18, VEGF, МСР-1, IFNα, having a significance level of < 0.001. The obtained prognostic models of intestinal metaplasia of gastric epithelium, according to the AUC index, had very good (Table 2, formula 1) and excellent quality (Table 2, 3, formula 2-11), confirmed by a high percent of cases which were correctly classified of metaplasia. Determination of serum cytokines in intestinal metaplasia of gastric epithelium is of diagnostic and prognostic value, and should be used for early diagnosis of precancerous conditions of the gastric mucosa, both as single indexes (IL-2, VEGF), and combined indicators, according to the calculated logistic regression equations.

This article is about learning of the aggression factors and the gastric juice and oral liquid protection of the patients with precancerous changes in the mucous gastric membrane of stomach. 32 middle-aged people were researched, who were at the inpatient treatment at the SI “Institute of Gastroenterology of NAMS of Ukraine”: 6 of them were with the atrophic changes of mucous membrane of stomach with different rate of severity (the I group), 12 people were with the intestinal metaplasia in the antrum (the II group), 14 patients were with intestinal metaplasia in the body and in the antrum of mucous membrane of stomach (the III group). The diagnosis was established after meticulous endoscopic and histological researches of biopsy material of mucous membrane of stomach. During the esophagogastroscopic research the gastric juice was being collected. It was determined its pH, pepsin, glycoprotein, sialic acids, fucose and hexosamines concentration. Also there were conducted the investigations of oral liquid, where the content of glycoprotein, sialic acid, fucose and hexosamines was determined. In the gastric juice of patients of the II and III groups, the content of sialic acids was increased, in the III – the acid secretion increased the hexosamines, with anacid – of fucose and it was decreased the amount of pepsin. In the oral liquid, the content of sialic acids in all researching groups was increased, fucose - only in the I group, hexosamines and glycoproteins - only in the III group. The further complex study of functional-morphological changes of gastric secretion and salivary glands activity will allow to assess the condition of reserve capabilities of the protection factors of the mucous membrane of the stomach and to determine the risk groups of patients with the precancerous condition.

The aim of publication. To analyze approach for long-term management of patients with chronic gastritis after H. pylori eradication for stomach cancer prevention by the example of clinical cases.Key points. The management approach of patients with chronic gastritis after eradication of H. pylori is presented by the example of patients with various risk of development of stomach cancer. In one and half year after successful eradication therapy in 57 year-old female patient mild atrophy and intestinal metaplasia of antrum without atrophy and intestinal metaplasia of corpus of the stomach was confirmed. At absence of other risk factors for cancer development further endoscopic follow-up is not required. Monitoring of 62 year-old male patient after successful eradication for 5 years has shown stable morphological pattern without progression of premalignant lesions. Taking into account both severe atrophy and intestinal metaplasia of antral region and mild atrophy of body of the stomach, as well as positive family history, esophagogastroscopy with biopsy is recommended once per year to this patient.Conclusion. Prognosis and management approach of patients after eradication of H. pylori infection are determined by chronic gastritis in relation to severity of atrophy and intestinal metaplasia of antral region and corpus of the stomach, along with other risk factors for cancer development e.g. positive family history.

The role of intestinal differentiation transcription factor Cdx2 in the development of gastric intestinal metaplasia was established on the basis of its expression in material of gastric mucosa biopsies. Taking into account of CDX2 expression intensity the diagnostic algorithm of gastric intestinal metaplasia for further tactics of patients management was proposed.

Article presents the morphological peculiarates of gastritis in patients with erosions with biliary tract disease in comparison with patients with gastric erosions and duodenal ulcer disease and chronic gastritis. It is revealed, that patients with gastric erosions and biliary tract diseases are characterized by bigger spreading of gastritis: inflammation, activity, atro-phy, intestinal metaplasia with predominant small intestine in gastric body, intestine metaplasia in antral part of the stomach is revealed more frequently inthese category of patients.

The aim of review. To present possible management approach for patients with early stomach cancer.Original positions. Nowadays morbidity and mortality due to stomach cancer still occupies the leading positions all over the world. The main way to decrease its prevalence is diagnostics and well-timed treatment of preneoplastic states, first of all – chronic atrophic gastritis associated to Helicobacter pylori infection. Revealing of stomach cancer at early stages and adequate treatment of patients improve the prognosis. Screening diagnostics of the asymptomatic population and investigation of risk groups are efficient approaches in detection of early stomach cancer. Of all diagnostic methods high quality endoscopic investigation is considered to be the most effective. The important stage of management of patients with early stomach cancer is endoscopic resection of tumor. In the last years in practice of clinics in many countries of the world new procedure – endoscopic submucosal resection began to be introduced widely.

Aim. To study the role of Helicobacter pylori (HP) persistance in generation of gastric mucosa adenoma. Material and methods. Esophagogastroduodenoscopy with biopsy of the mucosa from the antral portion and body of the stomach was made for diagnosis of HP and morphological changes in 28 patients \ aged 47 to 86 years with gastric adenoma. Results. Chronic gastritis with HP was diagnosed in 57.1% patients. HP contamination was, as a rule, weak (32.1%) or moderate (53.5%). It correlated with activity of inflammatory and dystrophic changes (thefirst degree - 35.7%, the second one - 39.3%; atrophy - 99.6%, metaplasia - 92.8%, respectively). Conclusion. The morphological study revealed a strong correlation between gastric adenomas and HP persistance. As adenomas are characterized by a high risk of malignant transformation and must be removed, it is recommended to eradicate HB infection.