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Multimodality and differentiated treatment of small-intestinal diseases is to combine methods of etiological action with pathogenetic treatment of the main clinical syndromes: chronic diarrhea, malabsorption syndrome, hypercatabolic exudative enteropathy. Each nosological form should be treated specifically. Pathogenetic treatment involves diet therapy, chemotherapeutic correction of metabolic processes (vitamin administration, recovery of normal protein and lipid metabolism, water and electrolyte balance, anemia), management of chronic diarrhea. Treatment regimens are specified for gluten enteropathies, total variable immunodeficiency, Whipple disease, small-intestinal diverticulosis, Crohn's disease, amyloidoses, intestinal lymphoma and retroperitoneal lymph nodes. Clinical experience justifies the above methods as highly effective.

The results of studying mechanisms underlying chronicity of functional (chronic enteritis ) and severe organic (celiac disease) lesions of the small intestine have been analyzed. Mechanisms causing the diseases take a chronic course appeared very similar. They involve bacterial proliferation in the intestine with consequent impairment of the digestion, absorption and motility resultant in derangement of metabolism. Defects in protein and lipid metabolism proved most essential. Chronic enteritis is associated with a favorable outcome provided there are no grave malabsorption symptoms. Combined treatment as a rule produces good therapeutic response in chronic enteritis and celiac disease. Relevant schemes are presented.

Lipid metabolism was evaluated in patients with chronic enteritis, celiac disease, general variable immunodeficiency (GVI), short-bowel syndrome. In chronic enteritis with malabsorption syndrome degree I and II changes in metabolism were characterized by hyperlipidemia due to high lipid fractions, mainly triglycerides; in malabsorption syndrome degree III (celiac disease, general variable immunodeficiency, short-bowel syndrome) by a drop of serum total lipids, phospholipids, cholesterol, beta-lipoproteins, free fatty acids, elevated concentrations of triglycerides. Changes in fatty acid composition of blood serum in patients with malabsorption syndrome degree III manifested by derangement of polyunsaturated fatty acids ratio. Arachidonic acid concentration was reduced in 100% of cases, linolenic acid in 45%. In all the patients with celiac disease and malabsorption syndrome degree III there was hypoactivity of lipolytic blood enzymes lipase and tributyrinase.

The study of 53 patients with celiac disease provided evidence for the impotent role of the inhibited hyposecretion of pancreatic enzymes, atony of the gallbladder responsible for abnormal bile acids introduction into the intestinal lumen in digestion, elevated concentrations of free bile acids at the expense of lowjugated ones in duodenal and jejunal contents as well as bacterial dissemination of the proximal portion of the small intestine in pathogenesis of diarrhea observed in celiac disease. It is concluded that inclusion of continuous courses of enzyme preparations and light cholagogues in the treatment schemes of celiac disease and administration in its exacerbation of adsorbents, astringents, antibacterial preparations should be necessary therapeutic measures.