Vol 17, No 8 (2015)

The article provides an overview of the literature on the problem of polymorbidity treatment of comorbidity: coronary heart disease and gastroesophageal reflux disease, the selection of the optimal therapy. Emphasis is placed on the use of proton pump inhibitors as the primary method of treatment of gastroesophageal reflux disease.

This paper describes the mechanisms of action of the two phyto-medications most commonly used in the treatment of diseases of the hepatobiliary system, standardized extract of flavonoids thistle and herbal extract (Fumitory based) medication. The data of studies of varying degrees of evidence demonstrating the efficacy and safety of these phyto-medications described insufficiently judging by the studied aspects of their application. Presents the possibility of using the combined phyto-preparation Gepabene for the treatment of diseases of the hepatobiliary system.

Objective: to investigate the functional state of the pancreas (P) in patients after resection of pancreas operations for complications of chronic pancreatitis calcification (CPC), and tumors of the pancreas.The study included 52 patients: 30 CPC patients, 16 of which were subjected to surgical treatment, and 22 patients after resection surgery for tumors of the pancreas. The control group consisted of 20 people, not suffering from diseases of the digestive system.The level of C-peptide in CPC patients in all studied groups was significantly reduced in comparison with the control value. No significant difference between the groups treated with conservative and surgical treatment (14 and 16 patients, respectively) was noted. And the difference was not as the whole group with surgery and between subgroups with different types of surgical treatment (draining, resection, resection-draining operation). Similar results were obtained in studies of exocrine pancreatic (fecal elastase 1).The level of C-peptide for surgery for pancreatic cancer was 0,9 ± 0,3 mg/g and 1,9±0,3 mg/g for the control group, that is, there was a significant decrease in C-peptide (p=0.0005). However, this study was limited and required further expansion.It is concluded that the CPC on the background of complicated surgeries and developing functional insufficiency of the pancreas (exocrine like and endocrine). This surgery does not affect the development of functional pancreatic insufficiency.

The aim of the study is to retrospectively evaluate the efficacy of long-term infliximab treatment for patients with refractory ulcerative colitis (UC). Materials and methods. The study included 48 patients with refractory UC who had been receivinginfliximab treatment from 2008 to 2014. Steroid-associated or steroid-refractory UC was diagnosed in 40 (83.3%) patients. Eight (16.7%) patients were resistant to azathioprineor 6-merkatopurinetherapy. We used induction therapy with infliximab in a regimen of 5 mg/kg at 0.2 and 6 weeks, and continued the supportive therapy every 8 weeks.Results. After induction courses, 3 (6.3%) patients did notdemonstrate the clinical response to infliximab induction therapy and were excluded from the study. 25 (55.5%) patients in state of clinical remission up to the present day continued to receive infliximab in a regimen of 5 mg/kg every 8 weeks among 45 patients responded to therapy. 4 (8.8%) patients after 18 months therapy became non-responder, and we had to use its intensification. We increased the dose of infliximab in 2 times (to 10 mg/kg of body weight) in 2 patients and we shortened the time between the regimens from 8 to 4 weeks in other 2 patients. The changing in the therapy was successful: all 4 patients had been staying in state of clinical remission up to the present day. Asa result the maintenance infliximab therapy was successful during 64 months in 29 (64.4%) patientsamong 45 providing to increase its intensity if necessary.Conclusion. The results of long-term usage of infliximab in patients with UC study confirmed the international data concerningthe high efficiency in terms of achieving clinical response, the induction of the clinical remission, the ability to heal the mucous membranes lining the colon and decrease the frequency of relapses.

The article discusses the surgical treatment of reflux esophagitis and hiatal hernia, complicated by Barrett's esophagus.