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Aim. To determine the frequency of celiac disease (CD) among gastroenterological patients and criteria for its active detection. Materials and methods. 1.358 patients referred for gastroenterologist consultation from 2016 to 2019 was conducted, of which 140 had CD (339 males 24.9%; 1019 females 75.1%). The average age was 40.415.4 (1886 years). All patients were determined anti-TTG IgA, IgG, and analyzed the clinical symptoms and analysis. The results were subjected to statistical processing Statistica 13.3 (StatSoft Inc., USA). Results. In patients without CD (1218 people), high level of anti-TTG IgA and IgG was observed in 59 (4.8%), an increase in anti-TTG IgA in 54 (4.4%), and anti-TTG IgG in 38 patients (3.1%). The CD diagnosis confirmed in 51 patients (4.2%). The main symptoms were diarrhea (88%), abdominal pain (60.7%), bloating (73.8%), nausea (40.3%), weight loss (44.3%). Anemia was determined in 31.6%, serum iron 33%, hypoproteinemia 12.6%, hypoalbuminemia 12%, hypokalemia 5.48%, hypocalcemia 21.9%. An increase in the level of AST 14.5%, ALT 14.6%. Comparative analysis showed that in the group with newly detected CD, anemia, malabsorption syndrome, increase AST, ALT were significantly more frequent than in patients with normal antibodies, which confirms the need to detect CD among patients with these laboratory abnormalities. Conclusion. The incidence of CD among patients with a gastroenterological symptoms was 4.2%. Analysis of clinical and laboratory data has shown that a comprehensive analysis of clinical symptoms and laboratory indicators at the stage of primary treatment will allow timely identification of CD patients and prescribe GFD.

The article provides clinical observation of a patient who was diagnosed with celiac disease when he was 52 years (Marsh stage IIIB). Following gluten-free diet (GFD) clinical remission and restoration of small intestinal mucosa (SIM) structure occurred, however in 6 years ulcerative colitis developed and an impairment of SIM morphological structure was identified (Marsh stage IIIA). Ulcerative colitis and celiac disease remission is supported by GFD, anti-cytokine therapy (adalimumab) in combination with mesalazine.

Bile acids were first considered carcinogenic in 1939. Since then, accumulated data have associated colon cell changes with high levels of bile acids as an important risk factor for developing colorectal cancer, which is more common among people who consume large amounts of dietary fat. Secondary bile acids formed under the influence of the intestinal microbiota can cause the formation of reactive forms of oxygen and nitrogen, disruption of the cell membrane, mitochondria, DNA damage, reduction of apoptosis, increased cell mutation, turning them into cancer cells. High-fat diet, intestinal microflora, bile acids are a risk factors for colorectal cancer.Желчные кислоты (ЖК) впервые рассмотрены в качестве канцерогенов в 1939 г. С тех пор накопленные данные подтверждают, что высокие уровни ЖК в толстой кишке являются важным фактором риска развития колоректального рака (КРР) у людей, регулярно употребляющих жирную пищу. Вторичные ЖК, образующиеся в кишечнике под влиянием кишечной микрофлоры, вызывают образование реактивных форм кислорода и азота, повреждают клеточные мембраны, митохондрии и ДНК, нарушают апоптоз, вызывают мутации клеток и их озлокачествление. Таким образом, ЖК, диета с высоким содержанием жира и кишечная микрофлора относятся к факторам риска развития КРР.

Hypogammaglobulinemic sprue (HGGS) belongs to orphan (rare) diseases. Its basis is a concurrence of primary immunodeficiency and celiac disease. The clinical picture of HGGS is characterized by recurrent bacterial infection foci, chronic diarrhea, and severe malabsorption syndrome (MAS). Immunological changes are exhibited by a decrease in the serum levels of γ-globulins (GG), immunoglobulins (Ig) A and G, and, to a lesser extent, IgM and B lymphocytes. The peculiarity of the morphological pattern of HGGS is the atrophy of the gastric mucosa and small bowel mucosal villi, which is accompanied by lymphocytic infiltration, formation of lymphoid follicles in the proper mucosal plate, and a drastic drop in plasma cells. It is precisely these signs that serve as a basis for identifying HGGS as an independent nosological entity. Its management is to be on a life-long gluten-free diet (GFD), to administer GG or Ig monthly, to correct metabolic disturbances, and to treat focal infections. The paper describes a case history of a female patient with HGGS. The disease was characterized by recurrent lung and kidney inflammatory foci concurrent with chronic diarrhea and grade 3 MAS. There was a dramatic reduction in GG, IgG, and IgA levels. Clinical remission and small intestinal mucosal structural recovery occurred due to GFD.Аннотация. Гипогаммаглобулинемическая спру (ГГГС) относится к орфанным (редким) заболеваниям. В ее основе лежит сочетание врожденного иммунодефицита с целиакией. Клиническая картина ГГГС характеризуется рецидивирующими очагами бактериальной инфекции, хронической диареей, тяжелым синдромом нарушенного всасывания (СНВ). Изменения иммунологического статуса проявляются снижением в сыворотке крови уровня γ-глобулинов (ГГ), иммуноглобулинов (ИГ) А и G , в меньшей степени - ИГ М и В-лимфоцитов. Особенностью морфологической картины ГГГС является атрофия слизистой оболочки (СО) желудка и ворсинок СО тонкой кишки, сочетающаяся с лимфоцитарной инфильтрацией и образованием лимфоидных фолликулов в собственной пластинке, резким уменьшением плазматических клеток. Именно эти признаки служат основанием для выделения ГГГС в самостоятельную нозологическую форму. Лечение ГГГС заключается в пожизненном соблюдении аглютеновой диеты (АГД), ежемесячном введении препаратов ГГ или ИГ, коррекции метаболических нарушений и лечении очаговых инфекций. Приведена история болезни больной ГГГС. Течение заболевания характеризовалось рецидивирующими воспалительными очагами в легких, почках, сочетавшихся с хронической диареей и СНВ III степени тяжести. Отмечалось резкое снижение ГГ и ИГ G и А. Под влиянием АГД наступила клиническая ремиссия и частичное восстановление структуры слизистой оболочки тонкой кишки.

1Moscow Clinical Research-and-Practical Center, Moscow Healthcare Department, Moscow; 2A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 3Children’s Health Research Center, Ministry of Health of Russia, Moscow; 4I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg; 5M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow; 6Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 7Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk; 8Russian Children’s Clinical Hospital, Moscow; 9Department of Pediatrics, Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 10I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint Petersburg; 11Acad. Yu.E. Veltishchev Research Clinical Institute of Pediatrics, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow; 12Clinic Four, Department of Pediatrics, I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint Petersburg; 13Childhood Diseases Department Two, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow; 14Research Laboratory of Surgical Gastroenterology and Endoscopy, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow; 15Department of Endoscopic Surgery, City Clinical Hospital Thirty-One, Moscow Healthcare Department, Moscow; 16A.N. Ryzhikh State Research Center of Coloproctology, Ministry of Health of Russia, Moscow; 17Department of Intermediate-Level Therapy, Tver State Medical University, Ministry of Health of Russia, Tver; 18Laboratory of Medical Genetics, Diagnostic Center of Medical Genetics, Saint Petersburg; 19HLA Typing Laboratory, Blood Transfusion Station, Moscow Healthcare Department, Moscow; 20S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow; 21Department of Nervous System Diseases, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow; 22Department of Endocrinology and Diabetology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 23Acad. V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow; 24Department of Therapy, Kazan State Medical Academy, Ministry of Health of Russia, Kazan; 25Department of Intermediate-Level Therapy with Course of Occupational Diseases, Faculty of General Medicine, Omsk State Medical University, Ministry of Health of Russia, Omsk; 26Dmitry Rogachev Federal Research Clinical Center of Pediatric Hematology, Oncology, and Immunology, Ministry of Health of Russia, Moscow The paper presents the All-Russian consensus on the diagnosis and treatment of celiac disease in children and adults, which has been elaborated by leading experts, such as gastroenterologists and pediatricians of Russia on the basis of the existing Russian and international guidelines. The consensus approved at the 42nd Annual Scientific Session of the Central Research Institute of Gastroenterology on Principles of Evidence-Based Medicine into Clinical Practice (March 2—3, 2016). The consensus is intended for practitioners engaged in the management and treatment of patients with celiac disease. Evidence for the main provisions of the consensus was sought in electronic databases. In making recommendations, the main source was the publications included in the Cochrane Library, EMBASE, MEDLINE, and PubMed. The search depth was 10 years. Recommendations in the preliminary version were reviewed by independent experts. Voting was done by the Delphic polling system.

Aim. To clarify the indications for capsular endoscopy (CE) in patients with celiac disease. Materials and methods. The study included 10 patients with celiac disease (6 women, 4 men) aged 22 to 69 years. The median age was 42.4±17.5 years. The diagnosis of celiac disease established on the basis of histological examination of the mucous membrane (MM) of the duodenum and detection of antibodies to diaminononane peptide gliadin and to tissue transglutaminase. In three patients celiac disease was diagnosed for the first time, in others – in terms of 3 months to 2 years. CE was performed using a Given Imaging systems (Yokneam, Israel), Olympus (Japan), the obtained data were analyzed using Rapidr® Reade (version 7.0). The results of the endoscopy were compared with the data of 78 patients examined by us, in which the indicators conformed to the normal CE criteria. Results. All patients with celiac disease showed characteristic endoscopic markers of atrophy from the small intestine: scallop, nodularity, decrease in height and number of folds. Paid attention to the mosaic of defeat in the form of "atrophy fields" against a background of slightly modified MM. Erosive-ulcerative lesions of the small intestine were found in 4 patients. Conclusion. Indications for the appointment of CE in patients with celiac disease is the lack of response to treatment, which is based on strict adherence to gluten-free diet, the assumption of erosive and ulcerative lesions MM of the small intestine and refractory form of the disease. CE makes it possible to establish the extent of atrophy from the small intestine, which allows you to use it to evaluate the effectiveness of treatment.

The article presents the results of examination of 32 patients with common variable immune deficiency (barn) with involvement in the pathological process of the digestive system. The features of the clinical picture, the content of immunoglobulins in the blood serum, morphological structure of the mucosa of small intestine as well as treatment. Special attention is paid to the small intestine in the pathogenesis of the barn.

The paper describes a rare case of celiac disease in the absence of serum anti-tissue transglutaminase (anti-tTG) antibodies. A 51-year-old patient has been suffering from diarrheas for 20 years. He has lost 15 kg gradually; weakness progressed; muscle cramps, leg edemas, and signs of dynamic pseudoobstruction appeared. Morphological examination revealed small intestinal mucosal (SIM) villous atrophy (Marsh IIIC stage). IgA anti-tTG and IgG anti-tTG antibodies were 0.086 and 0.178, respectively. The patient was prescribed a gluten-free diet, water electrolyte solutions to correct metabolic disturbances, and prednisolone. During a control examination after 6 months, the patient had no complaints and gained 22 kg, and the SIM villus height was increased. The specific feature of the case is specific negative serological tests for celiac disease.Представлен редкий случай целиакии в отсутствие антител к тканевой трансглутаминазе (АтТГ) в сыворотке крови. Больной 51 года в течение 20 лет страдал поносами. Постепенно масса тела снизилась на 15 кг, нарастала слабость, появились судороги мышц, отеки голеней и признаки динамической псевдообструкции. При морфологическом исследовании выявлена атрофия ворсинок слизистой оболочки тонкой кишки (СОТК), стадия Marsh IIIC. АтТГ IgA 0,086, АтТГ IgG 0,178. Больному назначены аглютеновая диета, водно-электролитные растворы для коррекции метаболических нарушений и преднизолон. При контрольном обследовании через 6 мес жалоб не предъявлял, масса тела увеличилась на 22 кг, увеличилась высота ворсинок СОТК. Особенностью случая является отрицательные серологические тесты, специфичные для целиакии.

Excessive poorly differentiated epitheliocytes were detected in the crypts and subepithelial regions of the colorectal mucosa during the regeneration process in the majority of patients with diverticular disease. The compensatory reaction of the sigmoid mucosa decreased, which was seen from rarely detected cryptic hyperplasia. Disorders in the epitheliocyte proliferation and differentiation were paralleled by changes in tissue levels of proinfl ammatory cytokines (elevation of TNF-α and IFN-γ and reduction of IL-1β and IL-8) and increase of IL-4, regulating lymphocyte activation.

The complex determination of serum autoantibodies to hepatic antigens using enzyme immunoassay and immunoblot allows to increase the frequency of overlap syndrome identification during autoimmune hepatic disorders and its early diagnostics, that has a big clinical, diagnostic and prognostic importance. The levels of overlap autoantibodies combine with biochemical index and with disease activity and intensity of autoimmune processes during overlap syndrome of primary biliary cirrhosis/autoimmune hepatitis (PBC/AIH).

Aim. To clinically evaluate the activity of glucoamylase, maltase, saccharase, and lactase in the small intestinal mucosa (SIM) of patients with celiac disease. Subjects and methods. Twenty-nine patents with celiac disease were examined. The disease was first detected in 8 patients; in the remaining patients, it had been diagnosed 6 months to 35 years before. The diagnosis was verified by histological examinations of duodenal biopsy specimens and by determination of immunoglobulin (Ig) A and G antibodies to tissue transglutaminase (atTG) and gliadin (AGA) by an enzyme-linked immunosorbent assay (ELISA). Carbohydrase activities were estimated in the duodenal biopsy specimens, by applying the method of A. Dahlquist. Results. In the control group, the activities of glucoamylase, maltase, saccharase, and lactase averaged 598.8+184.2, 825.3+239.3, 180.2-68.1, and 53.4+16.3 ng/glucose/mg tissue min, respectively. In the patients with celiac disease, the average activities of all the examined enteric enzymes were significantly below the normal value even they had been on a gluten-free diet (GFD) for 10 years or longer. Complete SIM structural recovery (Marsh stage 0) occurred in only 7 of 18 patients who had been on a strictly GFD. Serological (atTG and AGA) tests got also negative in all the 7 patients with completely recovered SIM. Six of the latter patients continued to have abdominal bloating and borborygmus, unstable stool with a propensity for diarrhea and weakness. Each was detected to have a lower activity of one or a few enzymes. The activity of all the carbohydrases reached its normal value in only 1 patient and she felt healthy, without perceiving any food intolerance. Conclusion. The activity of membrane enzymes may serve as a marker for the degree of SIM recovery in patients with celiac disease.Цель исследования. Клиническая оценка активности глюкоамилазы, мальтазы, сахаразы и лактазы в слизистой оболочке тонкой кишки (СОТК) у больных целиакией. Материалы и методы. Обследовали 29 больных целиакией. У 8 больных заболевание выявлено впервые, у остальных диагноз установлен от 6 мес до 35 лет назад. Диагноз подтверждали с помощью гистологического исследования дуоденальных биоптатов и определения антител иммуноглобулинов (ИГ) классов А и G к тканевой трансглутаминазе (АтТГ) и глиадину (AГ) иммуноферментным методом (ELISA). Активность карбогидраз определяли в дуоденальных биоптатах по методу А. Далквиста. Результаты. У лиц контрольной группы активность глюкоамилазы в среднем составляла 598,8±184,2, мальтазы - 825,3±239,3, сахаразы - 180,2±68,1, лактазы - 53,4±16,3 нг/глюкозы/мг ткани·мин. У больных целиакией средние значения активности всех исследуемых кишечных ферментов достоверно ниже нормы даже при соблюдении аглютеновой диеты (АГД) до 10 лет и более. Полное восстановление структуры СОТК (стадия 0 по Маршу) произошло только у 7 из 18 больных, строго соблюдавших АГД. У всех 7 больных с полностью восстановившейся СОТК серологические тесты (АтТГ и АГА) также стали отрицательными. У 6 из 7 больных с восстановленной до нормальной СОТК сохранялись вздутие и урчание в животе, неустойчивый стул со склонностью к диарее и слабость. У каждого из них оказалась сниженной активность одного или нескольких ферментов. Лишь у 1 больной активность всех карбогидраз достигала нормы и она чувствовала себя здоровой, не ощущая непереносимости каких-либо продуктов питания. Заключение. Активность мембранных ферментов может служить показателем степени восстановления СОТК у больных целиакией.

To define the value of a new enzyme immunoassay in determining the level of anti-deamidated gliadin peptide (DGP) antibodies (Abs) in the diagnosis of celiac disease.One hundred and twenty-four patients treated at the Department of Intestinal Pathology, Central Research Institute of Gastroenterology, were examined. Enzyme-linked immunosorbent assay (ELISA) was employed to determine Abs to tissue transglutaminase (tTG) and DGP of the IgA and IgG classes in the sera of all the patients. The diagnosis of celiac disease was verified by the histological examination of small bowel mucosa biopsy specimens.The examinees were divided into 3 groups: 1) 27 patients first diagnosed with celiac disease; 2) 40 patients keeping a gluten-free diet (GFD); 3) 57 patients with other gastrointestinal diseases (a comparison group). In the patients first diagnosed with celiac disease, the detection rate of elevated titers of anti-tTG and anti-DGP Abs in the IgA class was equal and constituted 92.5%; that in the IgG class was 96.2 and 55.5%, respectively. The comparison group showed an increase in the DGP levels in the IgA and IgG classes in 4 (7%) patients and a rise in tTG concentrations in the IgA and IgG classes was seen in only 2 (3.5%) patients.In the patents first diagnosed with celiac disease, the detection rate of elevated levels of anti-DGP Abs in the IgA and IgG classes is 92.5 and 96.2%, respectively, and significantly indifferent from that of IgA and IgG anti-tTG Abs. The patients keeping GFD displayed a reduction in anti-DGP Abs. The high detection rate of IgA anti-DGP Abs in the patients first diagnosed with celiac disease allows this method to be recommended for immunological diagnosis of this disease in adults.

On the basis of morphological and immunological study of biopsies of the colon in patients with diverticulosis was revealed that microscopic inflammation of the mouth of the diverticulum is characterized by several features that include excessive proliferation of the epithelium, the predominance of macrophage reaction in the development of the immune response, increased cell adhesion and unusual ratio between the expression of cytokines and other regulatory molecules. Changes in the structure of the formed diverticula tissue are associated with dysregulation of many processes of tissue metabolism and morphogenesis. These include the dysregulation of cell renewal of the epithelium (increased level of proliferation of epithelial cells and inhibition of apoptosis), degradation of extracellular matrix components, moderate vascular reaction. All these processes take place on the background a particular form of immune protection and adaptation mechanisms.

The paper describes a clinical case of celiac disease with grade 3 malabsorption, which is associated with recurrent aphthous stomatitis and schizophrenia. On readmission after 8 months of strict adherence to his gluten-free diet, the patient was observed to be in clinical remission and to have normalized laboratory indices and immunological tests. The signs of recurrent stomatitis disappeared. However, the symptoms of the mental disease remained.

To elaborate recommendations for rehabilitation of patients with gluten-sensitivity celiac disease (GCD) on the basis of a long-term follow-up.Eighty-seven patients with GCD were followed up for as long as 31 years. Of those, 72.4% of the patients kept strictly to their gluten-free diet (GFD) throughout the follow-up; 9.2% did not follow the diet periodically; and 18.4% did not at all. The sera from 71 patients were tested for IgA and IgG anti-gliadin antibodies (AGAb) and anti-tissue transglutaminase antibodies (ATTGAb) at as long as 19-year follow-up. AGAb and ATTGAb were estimated by enzyme immunoassay (IMMCO Diagnostics). All the patients underwent endoscopic and histological examinations of the small bowel mucosa (SBM).To support the validity of keeping to the GFD, the time course of clinical, laboratory, and morphological changes were analyzed in 63 and 24 GFD followers and non-followers, respectively. The GFD non-followers were more frequently found to have diarrheic syndrome, symptoms of malabsorption syndrome, lower serum concentrations of hemoglobin, total protein, iron, and calcium; no SBM structural recovery was seen in any patient. When the GFD was long adhered to, there was also a reduction in detection rates and AGAb and ATTGAb concentrations.The adherence to the GFD was ascertained to contribute to fuller rehabilitation in the patients. However, even the patients who had strictly kept to their GFD showed periods of an exacerbation and incomplete SBM structural recovery. Therefore, the rehabilitation system for patients with GCD must involve diagnostic, therapeutic, and organizational measures that promote not only rapid clinical recovery, but also better quality of life in these patients.

This article describes a case of diagnosis of generalized B-cell lymphoma of marginal zone cells, which debuted with hepatolienal syndrome. Presented the latest information on etiology, pathogenesis, clinical manifestations, diagnostic methods and treatment of non-Hodgkin's lymphoma.

Violation of reproductive function in patients with celiac disease can manifest as delayed puberty, infertility, amenorrhea, premature menopause, spontaneous abortion, low birth weight. The aim of the study was to establish the frequency and nature of reproductive function violation in patients with CD in the Russian Federation.The study included 132 women (average age 38,5 +/- 1,17 years) with CD observed in CSRIG in the period from 2000 to 2010. Comparison group consisted 105 women (average age 38,7 +/- 1,6 years) with predominantly functional bowel disorders (irritable bowel syndrome, functional constipation, functional bloating, inert colon). Were took into account information regarding obstetric history, physical and laboratory signs of malabsorption syndrome (MS) study of antibodies to alpha-gliadin immunoglobulin (IG) A class (AGA) and tissue transglutaminase (AtTG).The average age of onset of menses was 14,3 +/- 1,4 years, and in the control group - 13,0 +/- 1,3 years (p0.05), half of patients with C (43.9%) had menstruation begun at age 15 years and older, while 7.6% of the women--aged 17 and older. In the comparison group menses beginning after 15 years was only at 13.3% of women. In 61.3% of patients with CD was irregular menstrual cycle while in the comparison group such violations were noted in 13.3% (p0.001). Prolonged periods of amenorrhea we observed in women with newly diagnosed GC 3 times more likely than the comparison group: 43.9% and 11.4% respectively (p0.01). They also had nearly 3 times more likely to occur spontaneous miscarriage: at 46.9% and 14.3% respectively (p0.01). The frequency of dead children birth was about the same: 2.3% and 1.9% respectively (p0.05). The frequency of reproductive disorders increased with the growth of the severity of MS. In 43% of women after 6-8 months of strict adherence to a gluten-free diet (GFD) had disappeared amenorrhea and there were regular menses. Three women of childbearing age, strictly abided the GFD and had a history of repeated spontaneous abortion during the year managed to get pregnant and give birth to healthy full-term baby.Reproductive disorders in women with celiac disease are significantly more likely than at women with functional bowel disease. One of the reasons of reproductive disorders in patients with CD can be malabsorption of necessary nutrients in the small intestine. The presence of reproductive disorders should be considered as a risk factor for celiac disease, so these women should be screened for celiac disease.

We described a patient 40 years old, admitted to the clinic with periodic attacks of pain in the right upper quadrant. With ultrasound it was confirmed chronic acalculous cholecystitis, and at endoscopy and multiple biopsies revealed atrophy of the mucosa of the duodenum (DM), corresponding to celiac disease (stage III in the Marsh classification). Titer of antibodies to gliadin (AGA) and tissue transglutaminase (AtTG) were higher: 60 and 110 units/ml, respectively, at a rate of 10 units/ml. The patient was assigned a lifetime adherence to a gluten-free diet, serologic test and a control endoscopy with biopsy at 6 months. The important role of the doctor-endoscopist in the diagnosis of latent forms of celiac disease. The significance of DM atrophy in the pathogenesis of patients with chronic cholecystitis.

This article demonstrated changes in the level of pro-and anti-inflammatory cytokines in serum of patients of older age groups with small symptom diverticular disease of the colon. Was considered one of the links of the possible pathogenesis of this nosology, touched upon the contribution of involutive changes in the formation of the features of nonspecific immunity and the development of autoimmune reactions in elderly patients.

In this article presented results of examination and treatment of 207 patients with glutensensitive celiac disease. And also you can find comprehensive method for the treatment of patients with varying severity of disease. The fundamental method of therapy glutensensitive celiac disease is strict lifelong adherence to a gluten-free diet (GFD), which eliminated protein cereal--gluten contained in wheat, rye and barley. Recently, there is large number of products which include the "hidden gluten". Its elimination from the diet of GFD is mandatory for patients with celiac disease. In the presence of diarrhea and malabsorption syndrome are used adsorbents, astringents, enzymes, intestinal antiseptic, probiotics. With the purpose of correction of metabolic disorders intravenous electrolyte mixture containing potassium, calcium and magnesium. To eliminate protein deficiency drugs used solid protein mixture of pure amino acids, gluten-free mixes for enteral feeding. Clinical examination of patients with celiac disease is aimed at monitoring compliance with GFD, early detection of cancer, autoimmune and other related diseases.

To determine the role of immune response with production of auto- and heterologous antibodies (Ab) in development of the pathological process and in structural changes in colon mucosa (CM) in diverticulosis (Dv).Of 219 Dv patients, 39 were newly diagnosed with x-ray-detected signs of previous inflammation (group 1), 180 had earlier detected Dv which was confirmed and endoscopic examination detected inflammation (group 2). The comparison group consisted of 25 patients with irritable colon syndrome. The immune status was assessed by concentration of immunoglobulins (Ig), auto- and heterologous Ab. Antibodies to catalytic cytoplasmic antigens to proteinase-3, myeloperoxidase, bactericide protein BPI, tissue transglutaminase (tTG) and antiglycanic Ab were detected with solid-phase enzyme immunoassay.IgA and IgG levels in group 2 were significantly higher than in group 1 and in the controls. Elevation of both IgA and IgG levels reflects activation of B-cell immunity. Group 2 patients had a higher level of Ab to endogenic peptides Saccharomyces cerevisiae (ASCA) of class IgG and IgA than group 1 and controls. The level of Ab to tissue molecules was elevated: antibodies to tTG IgG were detected in both groups--in group 2 twice more often than in group 1, while Ab to BPI--in 27% cases in group 1 and in 97%--in group 2. IgG Ab to antigens associated with phagocytic cells were detected in group 2, while Ab in group 1 were positive in single cases.Activation of immune response with a high concentration of IgA and IgG, Ab to tissue antigens (BPI, tTG) and IgGAb to catalytic antigens is characteristic of chronic course of Dv. Morphological changes in CM reflect different severity of inflammation-dystrophic process.

The aim of the study was to determine the efficacy and safety of mesenchymal stromal cells (MSCs) of bone marrow in the treatment of patients with ulcerative colitis (UC).The study included 44 patients with ulcerative colitis (UC), which was implemented MSC transplantation, 40 patients with UC who received standard therapy with mesalazane (salofalka) 4-6 g/day and corticosteroids (prednisone)--1-2 mg/kg, azathioprine--1.5 mg/kg methotrexate 20-50 mg/m2, and 12 patients who underwent induction and maintenance of infliximab therapy. 2-3 days prior to the induction of MSCs abolish immunosuppressive doses of corticosteroids reduced to 15-20 mg/day dose of aminosalicylates was left at 2.0 g/day. To quantify the results using the average values of indices of Rahmilevich clinical activity, indices of endoscopic and histological activity scales Mayo and Gebs. The patients were observed for 24 months after transplantation. Were studied parameters of the humoral immune status (immunoglobulin A, G, M, autologous antibody), cytokine profile. Bone marrow cells were obtained from the donor's sternum or the iliac crest. By culturing the end of 5 to 6 weeks received a population of allogeneic donor's MSCs in the amount of (1.5-2) x 10(8) cells needed for transplant patient. Culture of MSCs injected in the drip i/v, single dose.In 34 (72.7%) patients with UC after the induction of MSCs was statistically significant compared with the group of patients treated with drugs only 5-aminosalicylic acid and corticosteroids, reducing the clinical and morphological indices of inflammatory activity. In 12 patients with UC include MSCs in the treatment program did not have a therapeutic effect. Application of MSC allowed to cancel corticosteroids in most patients with hormone-dependent and steroid resistance forms of UC, and in 7 to reduce the dose of prednisolone to 5 mg/day, limiting the use of drugs 5-ASA. According to the anti-inflammatory effectiveness of combined therapy with MSCs comparable to infliximab therapy.The use of MSCs can be evaluated as a new strategic direction for therapy UC. MSC, introduced in I/O, have powerful immunomodulatory effects, reduce the activity of autoimmune inflammation and stimulate the reparative process in the intestinal mucosa, thereby increasing the duration of remission, reduces risk of recurrence of disease, reduces the frequency of hospitalizations.

It was established the activisation of macrophages and plasma cells with raise their adhesion in diverticular disease. The express of immune response depends on unit or plural diverticuls. Epithelial cells proliferation is on the increase in the cript and mouth region of diverticul. The small undifferential epithelial cells migrated from depth to top of cripts. These cells formed some fields of cells connected by means of branches. Therefore the chronic inflammation and local disturbance of epithelium regeneration were established in diverticular disease.

High concentration of Ab Gl, Ab tTG, Ab Em and Ab Rt and increased amount of immunocompetent cells in the SIM in coeliac disease is an index of the developing specific immune response to gliadin and tissue antigens. High specificity and sensitivity of Ab tTG and Ab Em were determined in celiac disease.

To examine incidence of celiac disease in patients with iron deficiency anemia (IDA) of unclear origin.A total of 331 IDA patients were examined for celiac disease (CD). The diagnosis was made on the basis of histological findings upon examination of the biopsy of small intestinal mucosa, detection of antibodies to alpha-gliadine (AGA) and tissue transglutaminase (TTG).The cause of anemia was revealed in 270 (81.5%) of 331 patients. The rest 61 patients (18.4%) had anemia of unknown cause. A rise of AGA was detected in 33 (54.0%) of 61 patients, TTG--in 29 (47.5%) patients. CD was diagnosed in 29 (47.5%) patients. Four of 61 patients (6.5%) had no symptoms of malabsorption.All the patients with IDA of unclear genesis must undergo serological tests for CD. In high titers of antibodies to AGA and TTG, retrobulbar duodenal biopsy is indicated with histological study of small intestinal mucosa.

To examine characteristics of the course of primary biliary cirrhosis (PBC).The study of 150 PBC patients aged 26-82 years used clinical, biochemical, immunological and morphological methods.Antimitochondrial antibodies of type M2 (AMAM2) were detected in 85.4% patients with PBC. A positive correlation was found between clinicobiochemical activity of the disease and number of AMAM2. AMAM2-positive patients more frequently had extrahepatic manifestations, overlap syndrome, higher biochemical and immunological activity vs AMAM2-negative patients.The following variants of PBC course were identified: classic AMAM2-positive, AMAM2-negative, overlapping of PBC and autoimmune hepatitis. Concentration of AMAM2 has diagnostic and prognostic value in PBC.

The objective of this research was to study the frequency of celiac disease in patients with chronic diarrhea. The biopsy materials of the small intestine and levels of antibodies to alpha-gliadin of class A immunoglobulins (IgA) and tissue transglutaminase were studied in 206 patients with chronic diarrhea. Morphologic celiac-specific symptoms were discovered in 35 (16.9%) patients. Symptoms of the total atrophy were discovered in 28 patients (13.5%); those of subtotal one were found in 7 (3.4%) patients. The increase of antibody levels to IgA alpha-gliadin and tissue transglutaminase was discovered in all 35 patients. Their average level made up 123.7 21.2 units per milliliter and 48.7 11.3 units per milliliter, respectively. It was possible to observe the typical celiac form only in 4 (11.4%) patients; the latent form was found in 30 (85.7%) patients, and the torpid (refractory) form was discovered in 1 (2.8%) patient. The frequency of celiac disease in patients with chronic diarrhea is equal to 16.9%. Patients with the latent form of the disease prevail among patients with celiac disease. Immunological screenings with the subsequent morphologic study of the mucous coat of the small intestine should be prescribed to all patients with the chronic diarrhea syndrome to enable the early diagnostics of celiac disease.

To study concentrations of serum pro- and anti-inflammatory cytokines (CK), CK correlations with clinicobiochemical activity, diagnostic and prognostic implications in primary biliary cirrhosis (PBC).Enzyme immunoassay has been used to study content of IL-1 beta, IL-4, IL-6, IL-8, TNF-alpha, INF-gamma in peripheral blood of 96 women aged 26 to 82 years (mean age 56.2 +/- 12.6 years) with PBC (kits "Protein Contour", "Cytokine", St-Petersburg). The control group consisted of 20 healthy women matched by age.PBC is associated with changes in serum CK content correlating with the disease activity and stage. Elevated levels of proinflammatory IL-6, TNF-alpha, INF-gamma and anti-inflammatory IL-4.Definition of the cytokine spectrum in PBC has made a prognostic significance as it allows judging about the disease activity, stage and prognosis.

To study prevalence of celiac disease (CD) among patients with chronic diarrhea (ChD).Serum levels of IgA-antibodies to gliadin, endomysium, reticulin and tissue transglutaminase were examined in 206 patients with CD. Biopsies were obtained from a distal portion of the duodenum or a proximal portion of the jejunum.CD was diagnosed in 35 (16.9%) of 206 patients with ChD. The disease was typical in 5 (2.4%) patients and was latent in 30 (14.5%) patients. Antibodies to gliadin, endomysium, reticulin and tissues transglutaminase in diagnostically significant titers were detected in the serum of all the examinees with CD. Formation of the antitissue antibodies occurred because of destructive-dystrophic alterations of the connective tissue of the lamina propria mucosae pointing to the autoimmune nature of a pathological process in celiac disease.To diagnose CD in ChD patients, it is necessary to supplement standard examination with duodenobiopsy, tests for antibodies to gliadin, tissue transglutaminase and to tissue structures--endomysium and reticulin.

The purpose of the paper was studying the features of course and treatment of common variable hypogammaglobulinemia (CVHG), proceeding with intestinal function disorders functions.

AIM. To assess the frequency and clinical presentation of celiac disease (CD) among women with reproductive disorders (RD) and to estimate the efficiency of influence of GFD in CD women with RD. MATERIALS AND METHODS: At the period from 2002 to 2011 we examined 217 women from gynecological-obstetrics departments. Age ranged from 16 to 72 years, the average age was 30,5± 5,8 years. The first stage of examination determined anti-TTG and main classes of immunoglobulin. The second stage women with high level of anti-TTG were undergone endoscopy examination with biopsy. The great attention was paid to careful data collection of gastroenterological symptoms in women with RD. CD diagnosis was based on duodenal biopsy. Results of intestinal biopsy were classified according to revised Marsh criteria 1999. The control group consisted of 15 healthy women. RESULTS: The majority of the patients (87,3%) had spontaneous abortions in anamnesis, infertility in 12.7% cases. The great attention was paid to careful data collection of gastrointestinal symptoms in women with RD. Established that the majority of patients had normal stool once or twice a day (89,8%), however, 18,5 % of the patients had diarrhea, 29,7%-constipation, 40,5% had bloating, 40%-weakness. The anti-tTG level ranged from 1 to 280 while 16 of them exceeded upper limit of normal level and averaged 50,2± 19.4. The anti-tTG level in patients of control group ranged from 0 to 10 and the average level 4,4 ±1,5. We compared gastroenterological symptoms in women with high level of anti-tTG and women with normal level of anti-tTG.Women with increased level of anti-tTG suffered from bloating75%(p

The authors relate the results of 10 years of observations of 113 patients suffering from gluten enteropathy (GE) of the adults. In all the patients, the diagnosis was supported by the presence of hyper-regenerative atrophy of the small intestinal mucosa (total in 70% and subtotal in 30%). Metabolic disorders and cellular immunity were investigated. At the onset of the observations 70.7% of the patients demonstrated malabsorption, stage III gravity, and 29.3% stage II. It has been proved that permanent and strict adherence to the agluten diet and administration of corticosteroids in the most severe cases in combination with pathogenetic therapy of diarrhea and metabolic disorders permit attaining a steady clinical remission, improvement of normalization of the biochemical and immunological characteristics, a tendency toward normalization of the small intestinal mucosa, and even the recovery of its normal structure in part of the cases.

Twenty-two patients with general variable immunodeficiency (GVI) and malabsorption syndrome (MS) were followed up for 2-12 years. III degree MS was found in 17 cases. Serum immunoglobulins concentration and T-lymphocyte count were reduced, the latter at the expense of theophylline-resistant and active E-RFC. With casein and milk albumin as the antigens, lymphokine-producing capacity of the mononuclear cells appeared elevated. MS treatment with adjuvant gamma-globulin produced a positive trend in clinical manifestations of the disease, content of T lymphocytes and relevant subpopulations. Long-term results were less favourable: partial compensation with recurrences persisted in 15 patients only. Seven patients died: two of pneumonia, five of cardiac failure and visceral dystrophy. All MS patients are recommended to undergo serum immunoglobulins diagnosis of GVI and in case of its verification to receive life-time gamma-globulin replacement therapy.

The interaction of extravascular erythrocytes with lymphocytes, macrophages, polymorphonuclear leucocytes and fibroblast like cells in human gastric ulcer and in post-ulcer scar was studied by means of electron microscopy and cytochemical methods. It was shown that such interaction results in autologous rosette formation. There were also autorosette in the capillaries where autorosette forming cells were endothelial cells and lymphocytes. Many kinds of autorosette forming cells were connected with some peculiarities of ulcer process in the stomach.

During chemical carcinogenesis in Wistar rats the activity of acid phosphatase and certain dehydrogenases in the blood lymphocytes was compared with the development of cellular immunity revealed by the macrophage migration inhibition test. In the early periods of carcinogenesis the changes in succinate dehydrogenase and acid phosphatase activity were shown to correspond to a high level of immunological reactivity of cellular type in 66% of the animals. During progressive growth of the tumors in the rats the enzyme balance in the lymphocytes was disturbed and, at the same time, the immunological response was depressed.

The course of embryogenesis is disturbed in CBA mice during prolonged administration of morphine. There is a parallel decrease in the level of antibody-synthesizing cells and a significant fall in cooperative interaction between T-and B-lymphocytes in response to injection of sheep's red blood cells. Meanwhile stimulation of bone marrow cells and specific sensitization of producers of migration inhibition factor to antigen from the brain of mice treated with morphine are observed.

The effect of serum components on manifestation of the cellular reactions of immunity during chemical carcinogenesis was investigated by studying inhibition of migration of peritoneal macrophages from the capillaries. The level of inhibition of migration of the macrophages was higher and inhibition was observed in a larger percentage of cases when macrophages were cultured on autologous serum of animals with induced tumors than when normal sera were added to this test system. In cases in which the ability of the macrophages to migrate was increased, the serum of normal animals facilitated this phenomenon more than the serum of rats with induced carcinogenesis. The cellular reactions of immunity were sharply reduced at the 6th month of carcinogenesis regardless of the action of serum factors.

The activity of acid phosphatase and some dehydrogenases in the peripheral blood lymphocytes was compared with the development of cell immunity, assessed by the macrophage migration inhibition test, during chemical carcinogenesis in Wistar rats. At the early stages of the carcinogenesis the changes of the enzymatic activities of succinic dehydrogenase and acid phosphatase proved to coordinate with a sufficiently high level of the immunological reactivity of the cell type in 66% of the animals. With the progressive growth of the tumours there occurred a disturbance of the enzymatic balance in the lymphoid cells and a simultaneous decrease in the immunological response.