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Results of surgical treatment for an acute ulcer gastroduodenal bleeding in 120 patients, ageing 16-75 yrs old, were analyzed. In 20 of them a gastric ulcer was a cause of bleeding, while in 84--a duodenal ulcer, and in 16--a coexistent gastroduodenal ulcer. The bleeding activity was estimated in accordance to J. Forrest classification. In 57 patients (a comparison group) preoperatively and postoperatively a complex of a standard basal conservative therapy without immunocorrection was conducted, and in 63 (the main group)--a systemic cytokinotherapy (SCKTH), using betaleukin, was applied postoperatively additionally in a complex of therapy. A content of CD3+, CD4+, CD8+, CD19+, IgA, IgM, IgG was estimated in dynamics, as well as circulating immune complexes, phagocytic index, phagocytic number. There was established, that a dysbalance depth in the immune status have had depended upon the blood loss severity. The SCKTH application is pathogenetically substantiated, it promotes the immune status normalization, as well as a more favorable course of postoperative period and the results of treatment improvement.

The Purpose of the Study: To determine the prognostic significance of the expression of molecules of PCNA, Bcl-2, NF-Kb and tachykinins (substance P, neurokinin A) in patients with gastric ulcer (CU) receiving cytotoxic therapy., Materials and Methods: Total surveyed 90 patients divided into 3. equal groups. The first comparison group consisted of patients with chronic atrophic H. pylori-associated gastritis (CAG) (30 pers.). A second control group consisted of patients with gastric ulcer (30 pers.). Third, the study group consisted of 30 people. with CU suffering from hematological malignancies, in a period of complete clinical remission of the disease and receiving supportive polychemotherapy (PCT). Patients underwent endoscopy, morphological and immunohistochemical study of the mucous membrane of the antrum and body of the stomach to detect the expression of molecules of PCNA, Bcl-2, neurokinin A, substance P and factor Nf-Kb., Results: The total level of dyspeptic syndrome on visual scale analogue in patients receiving chemotherapy and GU (GUpct) was significantly higher (p < 0.05) compared with patients with GU. It should be noted that patients with GUpct reducing clinical symptoms is much slower (p < 0.05). At the same time in 13 (43.3%) patients with GUpct determines the duration of ulcer healing, whereas in patients with GU in only 4 (13.3%) patients. Patients with GUpct more frequently (p < 0.05) were verified II and stage Ill chronic gastritis (CG), while Stage I--less (p < 0.05). Patients with GUpct significantly more often (p<0.05) was determined by the II degree of CG and significantly less (p < 0.05)--IV degree. Patients with GUpct determined significantly lower (p < 0.05), the expression performance PCNA, substance P and neurokinin A and higher (p < 0.05)--Bcl-2 and factor Nf-kB., Conclusion: GU in patients receiving chemotherapy, dyspeptic syndrome is characterized by severe, advanced stage of CG on the background of relatively low severity of CG in accordance with the classification of OLGA (2008). Patients with GUpht have a significant level of violation of regeneration changes how is this atrophy, intestinal metaplasia, dysplasia of gastric mucosa association with gross violations of the processes of epithelial cell homeostasis of epithelial cells regulation after molecules PCNA, Bcl-2, NF-kB and tachykinins (substation P, neurokinin A).

The results of surgical treatment of 39 patients, suffering an acute gastroduodenal ulcer hemorrhage, were analyzed. Gastric ulcer disease was diagnosed in 9 patients, duodenal ulcer disease--in 29, combined ulcer--in 1. A light degree blood loss was noted in 13 patients, while a middle degree--in 12, and severe--in 14. In accordance to J. Forrest classification in 6 patients an active bleeding was revealed (FIa, FIb), in 11--nonstable hemostasis (FIIa, FIIb, FIIc), and in 22--FIII. Preoperatively in patients on the third, seventh and fourteenth day the contents of CD3+, CD4+, CD8+, CD19, calculation of a CD4+/CD8+ ratio, the level of immunoglobulins (IgA, IgM, IgG) and circulating immune complexes were determined in peripheral blood. Phagocytic activity of neutrophils was estimated, using determination of phagocytic index and phagocytic number. In an acute gastroduodenal ulcer hemorrhage immunosuppression was noted, and severity of disorders in T- and B-chains of immunity have depended upon a blood loss severity. Conduction of a routine basic conservative therapy in postoperative period did not guarantee elimination of immunosuppression.

The paper presents evidence on the important contribution of the peripheral serotonin system in the process of immunomodulation. The main components of the system - serotonin, receptors and serotonin transporter - are described. Possible mechanisms of serotonin regulation of activity of immune cells - lymphocytes, macrophages and dendritic cells - are reviewed.

The influence of regulatory peptide type of AFP on the course of experimental ulcers was investigated. It has been shown that activation of apoptosis by AFP enhance local necrotic inflammatory reaction, on the one hand, and enables the development of adhesions with the other.

The study included 120 patients with pre-cancer conditions of the stomach and 30 patients with gastric cancer stage II-IV. The ELISA method in the blood serum was used to determine the markers of the infection caused by Herpes simplex virus (HSV) types 1 and 2, Cytomegalovirus (CMV), and Epstein-Barr virus (EBV). The majority of the patients exhibited high titers of markers of Herpesvirus mixed infection. These data allow recommending the determination of IgG antibodies to antigens of herpesviruses in patients with the diseases of the stomach and assigning the appropriate antiviral drugs.

Aim: Study H. pylori strains circulating in St. Petersburg among patients with various gastrointestinal tract pathology as well as study of frequency of infection by H. pylori based on serological markers data among this group of patients., Materials and Methods: By using serological method 162 individuals with various chronic diseases of stomach and duodenum were examined. The presence in blood serum of IgG against H. pylori bacterial antigen and IgG against its toxin--CagA was studied. 129 patients were examined bacteriologically, biopsy samples of stomach mucous membrane were studied. PCR in real time format was used for study of H. pylori strains (49) and biopsy samples (36) of stomach mucous membrane., Results: The analysis performed showed that on the territory of St. Petersburg H. pylori strains containing cagA gene predominate (81.63% of the isolated strains). Genotyping of strains by vacA showed that s1m1 genotype was more frequent (in 57.14% of cases). The fraction of CagA positive strains in patients in St. Petersburg is maximum for stomach cancer (90.8%), whereas for peptic ulcer disease and gastritis it is 64.7% and 72.2%, respectively. In patients with stomach and duodenum pathology the parameters of seropositivity for H. pylori were significantly higher than in individuals without clinical manifestations of H. pylori infection (86.72% against 65.09%; p < 0.05)., Conclusion: The data obtained on increase of fraction of CagA positive strains among H. pylori circulating in St. Petersburg determine the importance of conducting eradication H. pylori.

Unlabelled: The purpose of the study--to determine the serum concentration and the pathogenetic significance of changes of interleukin-18 in patients with chronic atrophic gastritis, peptic ulcer disease and gastric cancer. MATERIAL AND METHODS.:A comprehensive survey of 192 patients with diseases gastroduodenal zone. Diagnostic emphasis was placed on ELISA method as defined in the serum of IL-18, --1beta, interferon-gamma, kantsernogo antigen 19-9, vascular endothelial growth factor, total antibodies to CagA Helicobacter pylori., Results: We examined patients revealed an increase in the concentration of interleukin-18, which correlated with tumor stage, the level of vascular endothelial growth factor, total antibodies to CagA Helicobacter pylori., Conclusion: The data obtained allow to recommend the use of interleukin-18 in serum for diagnostic of atrophic gastritis, peptic ulcer diseases and gastric cancer.

Treatment results of 986 patients with perforative gastroduodenal ulcers were analyzed. The sequence of surgeon's acts was diagnostically effective in 99.5%. 776 (78.7%) of patients presented with duodenal ulcer; 210 (21.3%) had gastric ulcer. Ulcer closure was performed in 934 (94.7%) cases; gastric resection was made in 52 (5.3%) cases. Postoperative lethality rate was 4.3%. Tissue destruction proved to be partly connected with the level of the connective tissue metabolites in blood. The balance of factors of aggression and defense (Helicobacter invasion, level of mucus formation, mucosal leucocytal infiltration, acid level in stomach and level of necrosis factor in blood) was registered in long-term follow-up in dependence of the operation performed. Ulcer perforation recurrence was registered in 18.8% of simple closure cases and in 3.8% of patients after gastric resection.

162 patients with a stomach ulcer were examined, 98 people were with torpid course of a stomach ulcer, and 64 sick people were usual periods of cicatrizing ulcers. 56 sick people (the first group) with torpid course of a stomach ulcer received immunal as a part of complex irradical therapy and comparising group 42 sick people (the second group) with torpid course used only irradical therapy. In estimation of efficiency of therapy, in addition to clinical and endoscopies data, indicators of genotypes Helicobacter pylori and immune system were used. The pathogenetic role of virulent genotypes Helicobacter pylori in the formation of the torpid course of a stomach disease is shown. The information about the dependence of the immune defense from cytotoxic characteristics Helicobacter pylori was received. Inclusion of immunal in complex therapy improves the elimination of Helicobacter pylori and has good clinical effect.

We investigated the levels of proinflammatory and antiinflammatory cytokines in experimental gastric and duodenal ulcers. Precedence shown an increase of pro-inflammatory cytokine TNF-a level in the isolated simulation of gastric ulcers and duodenal ulcers and preferential increase in cytokine IL-4 level in a prior administration of serotonin. The development of chronic diseases of the gastrointestinal tract is largely mediated by immunological reactions and the activation of the serotonergic system. Diversion of functional activity of the immune system plays a big role in the pathogenesis of ulcer disease, particularly T-helper lymphocytes and cytokines produced by them. The formation of the ulcer was accompanied by massive apoptosis of epithelial cells, development of vascular reactions--a plethora of vessels, edema and development of fibrinoid necrosis and infiltration of the mucosa by neutrophils, plasma cells and proliferation of fibroblasts. These processes significantly induced and regulated by cytokines, particularly interleukin IL-1beta, TNF-alpha, IL-4, -6, -8, -12 [4-7]. The purpose of the study was to identify the role of serotonin in the development of immunological reactions during experimental gastric and duodenal ulcers.

Aim: to provide a rationale for the use of immunal in intractable gastroduodenal peptic ulcers (PU), by studying Helicobacter pylori genotypes and immunological parameters., Subjects and Methods: Sixty-eight patients (37 men and 31 women) with torpid PU were examined. A study group comprised 35 patients who took immunal as a component of complex eradication therapy; a control group included 33 patients who received complex eradication therapy only. In addition to clinical and endoscopic data, the values of H. pylori genotypes were used to evaluate therapeutic efficiency., Results: The inclusion of immunal into the complex therapy in patients with torpid PU exerts a significant clinical effect in relieving the pain syndrome and dyspeptic symptoms and in accelerating ulcer cicatrization. The disappearance of virulent H. pylori strains was noted during treatment. Recovery of phagocytic, cellular, and humoral immunities is an important result of therapy., Conclusion: The use of immunal as a component of complex therapy for torpid PU is pathogenetically founded and clinically effective.

The indices of local and the system immunity were studied up in the patients, suffering gastroduodenal ulcer disease. The local immunity peculiarities were noted, characterizing the lowering of the reparative processes activity and gastric ulcers refractivity to conservative treatment, thus confirming the necessity of active surgical tactics application in such patients.

It is shown that multipotent mesenchymal stromal cells (MMSC) grafted to the zone of ulcer defect contribute to better wound repair in case of chronic non-healing gastric ulcers. It is noted that precultivative MMSC isolated from bone marrow achieve their bioregulatory activity in patient's organism not at once but due to prolonged functioning in the grafting zone (not less than 30 days).

The efficiency of correction of cytokine disbalance and peptic ulcer regeneration has been studied using the model of chronic peptic ulcer at use based on mononuclear fraction cells (MFC) of autologous bone marrow (BM). MFCs are shown to remove cytokine disbalance, reduce systemic inflammation reaction and accelerate peptic ulcer regeneration.

The purpose of our study was to investigate whether polymorphisms -238G/A, -308G/A, and -863C/A within the promoter of the TNF-alpha gene are associated with clinical features of gastric and duodenal ulcer disease in a Russian population. DNA samples of 381 unrelated patients with gastric and duodenal ulcer disease and 216 sex- and age-matched healthy controls were used to determine the TNF-alpha gene polymorphisms by PCR-RFLP assay. Logistic regression analysis has revealed significant associations of polymorphism -308G/A with size of ulcerous defect (p=0.03) and intestinal dyspepsia (p=0.05), polymorphism -238G/A with gastric dyspepsia (p=0.04) and reflux-esophagitis (p=0.05), polymorphism -863C/A with perforation of ulcer (p=0.04). The study results highlight impact of the TNF-alpha gene polymorphisms on various clinical features in patients with peptic ulcer disease.

Aim: To determine clinicoimmunological and microbiological efficacy of ronkoleukine in the treatment of Helicobacter pylori-associated gastric ulcer (GU)., Material and Methods: A total of 108 H. pylori-associated GU were randomized into two groups. Patients of group 2 received standard 3 or 4 component therapy including proton pump inhibitor and two antibiotics (amoxicillin and clarithromycin). Patients of group 1 received the same treatment but antibiotics were replaced for recombinant interleukine-2 ronkoleukine (Biotech, Russia) which was delivered via gastroscope and injected submucously along the periphery of the ulcer defect in 4-6 points in a dose 0.1 mg; 0.4 mg of the drug was simultaneously injected intravenously. The procedure was made 3 times with a 72 hour interval., Results: One month after the treatment H. pylori eradication was 81.5 and 95.4% in groups 1 and 2, respectively. Mean duration of ulcer epithelization was 35.23 +/- 1.58 and 10.79 +/- 0.46 days, respectively., Conclusion: Clinically and pathogenetically sound method of H. pylori-associated GU with application of systemic and local (paraulcer) immunotropic ronkoleukine therapy is more cost and immunologically effective than standard treatment and can be used both in hospital and outpatient setting.

Clinical, immunological and DNA diagnostic examinations of 101 patients with chronic generalized parodontitis and peptic ulcer have revealed similar features of immunological disorders of gastric and oral mucosa and the role of Helicobacter pylori.

The effect of the immunity state on the clinical course of stomach ulcer was studied. The study involved 50 patients (38 men and 12 women being 17-67 years old) with stomach ulcer (n = 14) and duodenal ulcer (n = 36) in the acute condition and 25 healthy blood donors. Twenty-seven patients underwent an immunology study. It was revealed that the evident increase of circulatory lymphocyte apoptosis (> 10), which is associated with the depression of their proliferative activity in vitro culture, is recorded with 40.7% of patients (11/27). It was also revealed that a high level of circulatory lymphocyte apoptosis and apoptosis-associated dysfunctions are found more frequently in people with long-term and complicated clinical course.

Results of examination of systemic immunity state, microbiocenosis and immunohistological changes of tissues of the esophagus and stomach in 37 adult patients and 69 children with erosive-ulcerous diseases of the gastrointestinal tract were analyzed. Based on these examinations, up-to-date immunomodulator tamerit inhibiting pathologic activity of monocytes/macrophage system with simultaneous activation of neutrophil granulocytes was used in 154 adult patients and 69 children. Positive result was achieved in all the cases when tamerit was used.

There were followed up 62 patients with multiple gastroduodenal ulcers. Before the operation in them distinct changes of the cell chain of immunity were established: T-lymphopenia, the T-lymphocytes subpopulations dysbalance, predominantly with reduction of the circulating T-helpers/inductors (CD4+) quantity with preservation on nearly normal and moderately subnormal level of T-suppressors/killers (CD8+), the immunoregulatory index (CD4/CD8) lowering. The quantity of B-lymphocytes (CD22+) was in normal limits or moderately reduced. Essential lowering of index of the lymphocytes blasttransformation reaction was noted, witnessing inhibition of the T-lymphocytes functional activity occurrence. Overall the data obtained have had witnessed the secondary immunodeficiency state presence, which deepened after operative intervention performance and was not removed as a result of the conventional treatment conduction.

Ulcer disease is accompanied by all immune responses with the development of secondary immune deficiency. This makes it necessary to include immunomodulators into the complex antiulcer treatment. The application of a new drug Bestim in the combined antiulcer treatment affects the immune state of the patients favourably. It decreases the inflammatory effect in the stomach and duodenal mucosa, it precipitate regress of clinical symptoms and scarring of the ulcer.

Laser iridotherapy was carried out simultaneously with irradiation of immuno-competent zones on the integument of the human body in patients with stomach and duodenal ulcers. As a result of such treatment, it was discovered that laser therapy has immunomodulating action leading to the reduction of the ulcer cicatrisation period.

The work has shown that patients with ulcer disease of the stomach and duodenum have immunogenetic features. In particular, genetic markers were detected for ulcer disease of the stomach and duodenum whose presence allows to predict with certain probability the development of ulcer disease of the stomach and duodenum. The presence of antigen HA-At and haploids--AxB18 and HLA--A10B27 is prognostically unfavorable factors for the development of complications of this disease.

Some clinicomorphological correlations are made in Helicobacter pylori (H. pylori) associated diseases of the gastroduodenal zone. Genes vacA and cagA in the H. pylori genome were revealed by PCR in stomach biopsies of infected patients and the results were compared with histological changes in the patients' mucous membrane. Specific IgG antibodies to some H. pylori antigens were detected in the serum and a comparative analysis of serological and histological data was performed. The findings suggest that H. pylori associated gastroduodenal pathology is determined by interaction between macro- and microorganisms taking account of genetic characteristics of the infective microorganism, its phenotypic variations and properties of inflammatory and immune response of the host.

The increase of the contents of serum IgA, IgG, IgM on the edge of long non-cicatrizing gastric ulcer was determined. At the same time the level of SIgA decreased in comparison with unaltered gastric mucosa. It is shown that the immunoglobulin content in the healed ulcer cicatrice depended on treatment method. The medicamentous therapy was accompanied by lowering of the contents of IgG, IgA, SIgA and by some increase of IgM level. The laser therapy is characterized by lowering of IgA, IgG, IgM level on a background of significant increase of SIgA content. The local humoral immunity after laser therapy was the same as in persons with unaltered gastric mucosa.

Frequently recurrent stomach ulcers are ulcers that exacerbate 2-3 times per year. Indolent ulcers are ulcers for which there is no healing during three months of continuous treatment.

The analysis of Helicobacter pylori (HP) and secretory IgA (SIgA) effects on the course and recurrence of gastroduodenal ulcer provides grounds to suggest that a pathogenic role of HP in secretory hypofunction of the gastric stump, unchanged mucosa and normal SIgA production is not leading. Elimination of the pathological process may bring functional restoration of the stump mucosa which adapts to HP invasion. Therefore, expansion of indications to eradication therapy in late postoperative period needs further study.

In males with peptic ulcer of the stomach and the duodenum, associated with H. pylori, the population and subpopulation spectrum of peripheral blood lymphocytes was studied by the method of CD typing with the use of monoclonal antibodies manufactured by the Research Institute "Preparat" (Nizhny Novgorod, Russia). The study revealed the development of disturbances in the amount of populations and subpopulations of peripheral blood lymphocytes, accompanied by a decrease in the absolute number of T lymphocytes (CD3, CD7), T helpers (CD4), T cytotoxic lymphocytes (CD8), B lymphocytes (CD22) and the ratio of CD4/CD8 cells. A decrease in the amount of IgA, IgG, the key complement components C1, C3, C5 was established. In peptic ulcer the immunological characteristics of gastric juice were found to essentially differ from those of saliva by a lower content of mucin, IgA and a higher content of SIgA and IgM in gastric secretions, which may form prerequisites for the colonization of the gastric mucosa by H. pylori.

Microwave puncture (MP) effects were compared to effects of 4-component basic medication in 63 patients with gastric ulcer. The study was made of nonspecific defense factors, serum levels of IgA, IgM, IgG, gastric juice levels of IgA, pool structure of circulating lymphocytes (DR+, CD3+, CD22+, CD4+, CD8+), spontaneous and LPS-stimulated Ig-synthetic function of B-lymphocytes. Mean time of the ulcer healing in MP usage made up 14.6 +/- 1.6 days, in standard therapy--27.2 +/- 3.1 days (P < 0.001). Immunomodulating effect shown by MP consisted in activation of nonspecific defense factors and activation of immunoglobulin-synthetizing function of B-lymphocytes.

As many as 82 patients were studied for effects of electrophoresis of the drug Béres Drops Plus against the background of basic therapy with a blocker of the histamine H2-receptors ranitidin in the treatment of gastric and duodenal ulcer. Adoption of the above therapeutic complex appeared to be associated with great therapeutic benefit evidenced by earlier clinical and endoscopic remission, with the impaired bodily immunologic reactivity returning to normal, antioxidant properties of blood being improved.

475 patients with stomach ulcer (1984-1993) were studied using various methods: endoscopical, immunological, biochemical, bacteriological and morphological. Morphology of exacerbation and type of reparative processes in normal scarring and torpid course of disease are presented. Under adequate regeneration there is an activation of immune system, first that of T-cell compartment. Torpid course is characterized by a grave regeneration disturbance and depression of the immune system. The interpretation of the so-called "red scar" is given: it reflects different stages of the epithelial regeneration, however in 4.8% of duodenal ulcers and in 11.2% of stomach ulcers it masks a torpid course. Helicobacter pylori has no influence on the reparative processes. Adequately chosen therapy improves and accelerates ulcer scarring.

The association of duodenal ulcers with antigens AIO and combinations of antigens B18B40, B35B40, A10B5, A10B40 and others and the association of gastric ulcer with antigens A3B7, A3B40, B14B15 were revealed by an investigation of HLA antigens in 46 patients with ulcer disease of the duodenum and 25 patients with ulcer disease of the stomach. It was concluded that the ulcer disease had a hereditary predisposition characterized by genetic heterogeneity with different etiopathogenetic mechanisms of the development of ulcers of different localizations. The HLA antigens may be used as immunogenic markers of ulcer disease if observing the population method in the investigations.

Of 182 examined patients with the stomach and duodenum ulcer disease (UD) 104 (57.14%) of whom with complications. Antiulcerous antibodies were determined in patients according to results obtained in passive hemagglutination reaction (PHAR) using erythrocytic diagnosticums. In patients with gastric and duodenal UD the antitissue antibodies to corresponding antigens from gastric and duodenal ulcers were determined before the operation. The incidence of antibodies discovery depends on the patients condition. In 18 months after the operation the percentage of PHAR positive results have reduced down to 72.5% on average.

The state of cellular and humoral immunity in patients with gastric and duodenal ulcer disease residing at the territory contaminated with radionuclides (35 patients) and at relatively clean (42) territory, as well as in 47 virtually healthy subjects was studied. It was established that in patients residing at contaminated territory, the ulcer diseases aggravated rapidly, the complications often occurred, and the immunologic indices didn't differ from those in patients residing at relatively clean territory.

A total of 55 gastric ulcer patients and 1045 healthy persons were investigated for 36 HLA antigens (A, B, C loci). The study revealed that HLA B12, B15, B35, Cw4 were more common in the patients (34.55, 18.18, 27.27 and 25.45%, respectively). HLA A3 (10.9% in the patients and 25.74% in those healthy) is found to be protective against gastric ulcer. The data obtained are considered with regard to heterogeneity of the disease.

In examination of 42 patients with gastric and duodenal ulcer disease, the disorders in cellular and humoral immunity were revealed. The immunologic indices didn't normalize under the influence of the operative treatment. This is indicative of the necessity to perform the immunocorrigative therapy before the operation.

Results are presented of treatment of 109 patients with prolonged nonhealing gastric ulcers using a new method of highly intensive impulse laser radiation. A scarring effect was achieved in 87% of cases. Correction of immunological indices and sanation of pathological flora, apparently, contributes to the favourable effect.

Studies into the content of nonspecific defense factors, secretory and serum immunoglobulins in blood and biological fluids (saliva, gastric juice, duodenal contents) in patients suffering from peptic ulcer have demonstrated significant changes in local and general immunity. Exacerbation of the disease was marked by a decrease of the titer of complement, C3-component of complement, and lysozyme level. At the same time there was an increase of the concentration of secretory immunoglobulins and immunoglobulins in blood serum and external secretions. The data obtained attest to the tension of humoral immunity and nonspecific defense in peptic ulcer patients, giving rise to the consideration of the changes in the humoral component as one of potential mechanisms by which ulcer is formed.