Vol 18, No 8 (2016)

The prevalence of non-alcoholic fatty liver disease (NAFLD) is 10-40% in developed countries. In various regional and international guidelines for drug treatment there is no consensus on the effectiveness and safety of the use of certain drugs in NAFLD. Perhaps this is due to regional characteristics with the prevalence of NAFLD in the pathogenesis of a variety of factors listed in the theory of «multiple parallel strokes», the differences in the design of randomized clinical trials, the analysis of which is the basis of these recommendations. The use of essential phospholipids (EPL) in diseases of the liver, and in particular NAFLD is pathogenetically substantiated. However EPL are unstable substance, as they may be involved in lipid peroxidation processes with increasing levels of lipid peroxides, oxidants are active, and hence, increased oxidative stress. Accordingly, the actual improvement was a given dosage form by offering innovative solutions. An effective solution to this problem was the creation of a domestic combined hepatoprotective BAA Hepaguard Active®, one capsule that contains 222 mg of EPL, 93 mg of L-carnitine and 1.25 mg of tocopherol acetate (vitamin E). All these three biologically active substances act synergistically, providing of membrane, lipotropic, lipid-lowering and cholesterol-lowering effect. According to laboratory and instrumental studies, its effect is to reduce the severity of steatosis and nonalcoholic steatohepatitis with - and in the reduction of necroinflammatory and fibrosis of the liver. The drug helps normalize body weight, lipid profile, has a prebiotic effect, reduces the insulin resistance that is mechanisms not only impact on the manifestation of NAFLD, but also other components of the metabolic syndrome, has good portability.

The incidence of gastroesophageal reflux disease (GERD), as well as the number of patients with complications of this disease (Barrett's esophagus, adenocarcinoma) has been steadily growing. Not only gastorenterologists but other medical specialists face the need of treating GERD patients. The article presents the modern methods of diagnosis and various therapeutic approaches in the management of patients with GERD. In many clinical situations, the drug of choice in the treatment of this disease is esomeprazole due to its high efficiency and safety.

Current knowledge about the human body and the nature of the proceeding in its disease provides a new approach to the physiology and pathophysiology of the processes taking place in order to ensure recovery of the underlying disease by systemic exposure to the entire affected network, not only due to the relief of the primary symptoms. Researching the dysregulation of affected systems and their mechanisms allows us to understand the complex nature of the diseases, their pathophysiology, and to assess autoregulatory capabilities of the organism and to maintain homeostasis in the face of changing conditions of external and internal environment. Established by H-H.Reckeweg, the theory of homotoxicology has much in common with modern advanced scientific and medical concepts of the medical system. Antihomotoxic drugs smoothly integrated into the system and bioregulatory medicine and can be used as ba-sic therapy or in combination with classical allopathic therapy.

Diabetes mellitus type 2 (DM 2) is often associated with non - alcoholic fatty liver disease (NAFLD). The combination of type 2 diabetes and NAFLD is associated with a high risk of developing liver cirrhosis and hepatocellular carcinoma in patients with data. All aspects of the pathogenesis of NAFLD is unknown until the end, but a key role for insulin resistance. A new class of oral antidiabetic drugs - inhibitors of sodium - glucose cotransporter type 2 (inhibitors of SGLT2) - reduce the level of blood glucose independent of insulin manner. SGLT2 inhibitors lead to a decrease in body weight, thereby reducing insulin resistance, hyperinsulinemia, and glucose normalization synthesis and its utilization in the liver. This class of antidiabetic drugs may have positive effects on NAFLD and be used to treat patients with a combination of type 2 diabetes and NAFLD.

Both Russian and international clinical guidelines on the treatment of non-alcoholic fatty liver disease (NAFLD) have important modifications to give the image of the patient's life, such as weight loss. That body mass correction in many ways is a basic method of treatment of NAFLD, which allows to slow down the progression of the pathological process and the complications of the disease prophylaxis. However, patients with NAFLD are extremely difficult in implementing this recommendations due to the formed dietary habits. With this in mind the practical skills of GPs and gastroenterologists in this area allow to identify and take the first steps for the correction of eating disorders in this group of patients.

Recent decades have seen a marked increase in the prevalence of diseases associated with a change in the nature of power and way of life. One of the most often associated with pathological conditions of obesity is a metabolic syndrome (MS). Almost all patients with MS there is fatty degeneration of hepatocytes, and nearly half found steatohepatitis, which can be considered non - alcoholic fatty liver disease (NAFLD) as the hepatic component of MS. A promising drug in NAFLD associated with obesity and impaired metabolic processes in the body, is taurine.

The following review of the literature is devoted to the publication of the next Rome criteria for the diagnosis and treatment of functional disorders of the digestive system. IV review focuses on the most frequently encountered and difficult curable pathology - Irritable bowel syndrome (IBS). We present the new diagnostic criteria, observed important differences from the previous version. The attention of readers to the peculiarities of the pathophysiology of IBS and related misunderstanding in this area frequent errors in the conduct of such patients. Submitted by the modern view of the IBS drug therapy based on evidence - based clinical trials, a brief critical analysis of the most common mistakes in choosing drugs and other agents in the treatment of this disease.

Objective. To study the effect of early enteral nutritional balanced mixtures containing glutamine in patients with ulcerative general fibrinous-purulent peritonitis in the docking compartment syndrome in the early postoperative period. Materials and methods. The study included 43 patients with perforated gastric ulcer, complicated by diffuse purulent peritonitis. All patients underwent an emergency surgical resection guide in the form of perforated ulcer. We used the technique of programmed (24-48 hours) rehabilitation of the abdominal cavity. In the main group, which includes 30 people, patients received in the structure of the above indicated basic treatment 500 ml of the product Intestamin. Results and its discussion. The use of a standard protocol of nutritional support, without a high content of glutamine resulted in the comparison group to almost two - fold increase in complications is an average of 38.5% and an increase in mortality in the group to 30.7%, while in the basic group the above figures were 20.0% and 16.6%, respectively. One of the significant reasons for the above difference was pronounced and the long - term cropped compartment syndrome in the control group, as well as the speed of its resolution on the background of Intestamin. Conclusions. Application Intestamin in the perioperative period in patients with peritonitis ulcerogenic justified by the possibility of full implementation of ERAS protocol, which in turn significantly affects the speed of the correction compartment syndrome and leads to a significant reduction in such important indicators as the number of complications, length of hospital stay, mortality.

The article presents a literature review on one of the actual problems of surgery concerning liver echinococcosis. Discusses some of the controversial and unresolved problems of surgical treatment of liver echinococcosis. Today, in addition to traditional operations, in cases of liver echinococcus widely used videoendosurgical and minimally invasive surgery, which cause a lot of mixed opinions. Despite the improvement of methods of surgical intervention with the use of modern technologies, the introduction of various chemical and physical methods of influence on the parasite, the recurrence rate of hydatid cyst of the liver remains high. Challenges the effective treatment of liver echinococcosis and a high likelihood of recurrence due to the lack of generally accepted optimal variant of surgical treatment depending on the size and localization of cyst, fibrous cap thickness, the qualitative characteristics of the parasite, the lack of unified methods of processing the bed of the cyst and a small selection of highly effective germicidal solutions. This shows the relevance of the problem and makes the search for new solutions to improve the efficiency of surgical treatment of liver echinococcosis.