Vol 19, No 8 (2017)

Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases in the world. The review article deals with the approaches to diagnosis and treatment of patients with NAFLD from the perspective of evidence-based medicine and 2016 guidelines by the European Association for the Study of the Liver, the European Association for the Study of Diabetes and the European Association for the Study of Obesity.

Acid-related diseases (ARDs) are one of the most common disorders among of the digestive system diseases. Damaging action of hydrochloric acid is the main part of ARDs pathogenesis. The first pharmacological therapies that began to be used to treat ARDs several centuries ago were antacids. Antacids are included in all schemes and standards of ARDs treatment, nowadays. In the review we discuss the mechanisms of action and basic pharmacological characteristics of antacids, their classification and describe the characteristics of monocomponent drugs of this group. We show the facts about combined antacids and discuss the clinical pharmacology and the main indications for appointment of combined antacid - Antareit. The review stress that Antareit is an effective and safe antacid providing combined acid-neutralizing, cytoprotective, coating, adsorption, antifoaming capacity.

Helminthiases are widespread among all sections of the population. According to World Health Organization, more than half of the world's population is affected by helminths. On the territory of the Russian Federation, helminthiasis is monitored, however, the low alertness of medical personnel, the lack of diagnostic tools and drugs for the treatment of helminthiasis, the noncompliance with the rules for processing food products in industries and individuals, as well as the way of life of indigenous peoples and the low level of population education contribute to the retention of the morbidity level, and in some cases, its growth. The article contains information about the incidence of helminth invasions over the past few years and brief data on the features of parasite biology, the main points of pathogenesis, clinical manifestations of parasites, specific diagnostic methods and etiotropic treatments.

The history of the development of methods of radiologic imaging in gastroenterology decades and represents, basically, the evolutionary transformation of contrasting methods of study of the digestive tract. Classical research methods of the stomach, colon and small intestine with contrast still remain relevant to the present time, as represent the most simple and physiological way of obtaining information on the morphology and function of the digestive tract, both in normal and in pathological conditions, including postoperative changes. Fluoroscopy of the stomach and duodenum ulcer, barium enema was initially performed using only barium suspension. Then, techniques have improved through the use of double contrast techniques. To improve imaging of the digestive tract significantly contributed to the improvement of x-ray equipment, namely, the appearance of electron-optical image converters. Absolutely new stage in development of radiation technology in gastroenterology has become computerized tomography that provides a revolutionary leap forward not only in diagnostic systems, but also in all clinical disciplines that use the information to determine the optimal tactics of conservative treatment and selection of adequate operative approaches in various clinical situations.

Aim of review - to present our readers a clinical case of ulcerative colitis, in which the recurrence of the disease has developed on the background of biological therapy Summary. Inflammatory bowel disease, which includes ulcerative colitis and Crohn's disease, has been and remains one of the most serious problems in modern gastroenterology. According to severity, frequency of complications and mortality, inflammatory bowel diseases in the world occupy one of leading places in the structure of diseases of the gastrointestinal tract. The article presents a clinical case of ulcerative colitis, which has manifested in a patient aged 30 years with the development at first hormonal dependence, then - hormone resistance, and then - a relapse of disease on the background of biological therapy with adalimumab. In this connection it is planned to appoint the patient another biological agent - vedolizumab. The vedolizumab is anti-a4b7-integrinhumanized class IgG1 antibodies which suppresses migration of leukocytes in intestinal tissue, interfering thereby with development of pathologic inflammation.

The article highlights laboratory and clinical laboratory syndromes associated with the diffuse liver lesions, which are most commonly occur in everyday practice of primary care physician.

In the article the main ways of differential diagnosis of hepatic encephalopathy (HE) is one of the earliest clinical manifestations of hepatocellular failure in chronic liver diseases. Diagnostic search is considered in the framework not only of the etiological factors of brain damage, but also at all stages of development of the HE, given the difficulties in establishing minimal clinical manifestations of the latent HE, with the use of psychometric tests for the detection of hidden functional disorders of brain activity and instrumental methods of diagnostics, allowing to determine the structural changes of the brain. From the perspective of the pathogenesis of HE represented a leading direction in the choice of therapy and the role of medicines L-ornithine-L-aspartate, acting on ornithology cycle, representative of which is a new domestic drug Ornilatex having pronounced hypoazotemic action.

Objective: to provide data corroborating the relationship between non-alcoholic fatty liver disease - NAFLD (in particular, non-alcoholic steatohepatitis - NASH) and diseases of the cardiovascular system and to study the prevalence of NAFLD in patients with cardiovascular disease in Republic of Crimea and to compare the effectiveness of different strategies of treatment of NAFLD. Materials and methods. The study included 100 patients with essential hypertension stage II 2 degree, of which 65% patients had also hypercholesterolemia. All patients underwent ultrasound of the abdomen, biochemical blood analysis, blood tests for markers of viral hepatitis, 13C-metathetin breath test. Frequency of NAFLD in the studied population was 54%, in the group with hypercholesterolemia - 45 persons (69.2%). Among them, the patients were divided into 2 groups: 1 group (n=22) with NASH received atorvastatin 20 mg at bedtime, essential phospholipids 2 caps. × 3 t/d; 2 group (n=23) without NASH received only atorvastatin 20 mg at night, for 6 months. Results of the study. After 6 months of treatment comparable results were obtained in both groups: normal levels of transaminases and decreased total cholesterol and lipid profile parameters in 90.9% of patients 1 group vs. 91.3% of patients 2 group, as well as improvement in the 13C-metathetin breath test that indicates the increase in mass of functioning hepatocytes. Conclusions. Considering the high incidence of NAFLD in patients with cardiovascular disorders, especially in combination with hypercholesterolemia, it is useful in complex survey of patients include abdominal ultrasound, 13C-metathetin breath test, as well as determining of the level of transaminases, bilirubin, alkaline phosphatase and GGT. In the presence of NASH it is advisable to include essential phospholipids in therapy, which will reduce mortality.

The article discusses the diagnosis and treatment of chronic gastritis differential diagnosis. There are practical difficulties in the diagnosis of pathology of the stomach, limiting the granularity of the diagnosis. Required routine screening of atrophy and dysplasia in patients with pathology of the stomach. To identify inflammatory diseases of the stomach, it is advisable to use the gastropanel. To improve the effectiveness of relief of symptoms, it is possible to add prokinetic in the scheme of therapy, to reduce the frequency of relapses, the application of gastroprotectia of rebamipide.

Chronic constipation is the greatest global medical social health problem, and rational therapy of this disorder is one of the most topical themes in modern gastroenterology. Therapeutic approaches in the treatment of chronic constipation should be characterized by the stage of sequence. The treatment should started lifestyle changes of the patients, increase of water intake to over 1.5-2 liters per day, include a diet rich in dietary fiber, in particular wheat bran, or the use of psyllium. In case of inefficiency of these activities, it is important to use pharmacotherapy, and the priority should be given to the non-absorbable disaccharides, in particular the next generation drug - lactitol (Exportale®). This drug within the framework of the treatment of chronic constipation is characterized by an equivalent and in some cases more effective, in comparison with first generation non-absorbable disaccharides (lactulose) and has a better safety profile (decrease the frequency of side effects by 1.5-2 times), as well as that drug has the best taste, that allows to consider this drug as first-line therapy in the treatment of chronic constipation.