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№ 10 (146) 2017

  • В течение уже более 25 лет наш журнал является важным источником научной информации в области гастроэнтерологии, гепатологии и смежных специальностей, оказывает ощутимую помощь в самообразовании врачам, избравшим гастроэнтерологию своей клинической профессией на всю жизнь, служит неоценимым помощником педагогам медицинских университетов при их подготовке к занятиям со студентами и врачами, наш журнал, наконец, – трибуна для научных и клинических дискуссий, публичных апробаций и коллегиальных экспертиз материалов диссертационных и иных исследований, и многие, многие другие замечательные по своей пользе функции и задачи выполняет наш журнал. Вот и теперь настоящий выпуск журнала посвящен широкому спектру важнейших вопросов о кишечнике, встречаться с которыми клиницистам-гастроэнтерологам приходится, пожалуй, ежедневно.
    Действительно, заболевания кишечника можно отнести к категории наиболее часто встречающейся патологии системы пищеварения, диагностика и лечение которой далеко не всегда оказывается легким для врача разделом его деятельности. Много усилий наш журнал, Научное общество гастроэнтерологов России, Российская гастроэнтерологическая ассоциация, Общество по изучению воспалительных заболеваний кишечника прилагают для усовершенствования врачей в области энтерологии. Так, последние годы в России авторскими коллективами выпущены «Клинические рекомендации по диагностике и лечению больных синдромом раздраженного кишечника» (2013), «Рекомендации по диагностике и лечению взрослых пациентов с болезнью Крона» (2013), «Рекомендации по диагностике и лечению взрослых больных язвенным колитом» (2013). Начинается работа, инициированная НОГР, по подготовке «Клинических рекомендаций по диагностике, лечению и профилактике НПВП-ассоциированных заболеваний ЖКТ», в которых будет представлены разделы «НПВП-энтеропатии» и «НПВП-колонопатии». Наш журнал, имеющий наивысший (0,602) среди других российских периодических изданий по гастроэнтерологии «импакт-фактор» (формальный численный показатель важности научного журнала, ежегодно рассчитываемый Web of Science) ежегодно публикует статьи, рассматривающие проблемы этиологии, патогенеза, клиники, диагностики, профилактики и лечения заболеваний кишечника, однако, настоящей выпуск журнала полностью посвящен энтерологии. В передовой статье рассматриваются вопросы диагностики, профилактики и лечения НПВП-индуцированной колонопатии.
    Взыскательная конкурсная работа редакции журнала допустила к опубликованию лучшие научные работы, поступившие в адрес журнала из разных городов нашей страны: Москвы, Санкт-Петербурга, Казани, Иркутска, Нижнего Новгорода, Ростов-на-Дону. На страницах журнала читатель найдет статьи клиницистов-ученых разных профилей – гастроэнтерологов, в том числе детских, абдоминальных хирургов, колопроктологов, микологов, морфологов, эндоскопистов, патофизиологов и др. Несомненно, это очень важное свидетельство притягательной силы нашего журнала для всех тех, кто в той или иной научной сфере изучает проблемы патологии кишечника, доверия журналу и его авторитету со стороны маститых и начинающих ученых, готовых представить на суд гастроэнтерологической общественности страны свои научные работы, поделиться сокровенными мыслями врачей-исследователей и перспективами профессиональной деятельности.
    На страницах настоящего выпуска журнала представлены работы, рассматривающие актуальные вопросы воспалительных заболеваний кишечника (ВЗК), в том числе опыт творческих групп ученых и клиницистов различных специальностей по системной организации лечебно-диагностической помощи больным язвенным колитом и болезнью Крона в крупном мегаполисе. Особенности течения первичного склерозирующего холангита, сочетающегося с ВЗК, генетические предпосылки стоматологической патологии (афтозный стоматит) и особенности изменения гемостаза при болезни Крона рассматриваются в данном блоке работ о ВЗК. Педиатры-гастроэнтерологи из Нижнего Новгорода приводят результаты серии своих исследований, выполненных с целью оптимизировать диагностику и лечение болезни Крона у детей на основе использования выявленных прогностических критериев различных форм заболевания. В аспекте прогноза осложненных форм болезни Крона у детей авторы приводят ранние морфологические критерии.
    Представлено превосходно подготовленное и иллюстрированное описание клинического случая аспергиллеза толстой кишки и результаты проспективного исследования в работе авторов из Санкт-Петербурга.
    Представлен фрагмент нескончаемой дискуссии в современной гастроэнтерологии: СРК – только ли функциональная патология? Насколько убедительны суждения авторов из Ростова-­на-Дону по этому вопросу оценят читатели.
    Серия публикаций в данном выпуске журнала обсуждает проблемы хирургической гастроэнтерологии: «Способ профилактики спаечной болезни брюшной полости (экспериментальное исследование)», «Эндоскопическая диагностика и лечение неуточненных желудочно-кишечных кровотечений», «Морфофункциональное состояние проксимального отдела тонкой кишки при формировании белково-энергетической недостаточности у пожилых людей после операций на желудке». Нет сомнений, что настоящий выпуск журнала «Экспериментальная и клиническая гастроэнтерология», посвященный болезням кишечника, найдет положительный отклик у клиницистов, представленные материалы окажутся интересными и полезными читательской аудитории, будут способствовать реализации генеральной направленности нашего журнала – повышению профессионализма гастроэнтерологов России.
    С уважением

      Главный гастроэнтеролог Северо-Западного Федерального округа России,
    руководитель центра гастроэнтерологии и гепатологии
    Санкт-Петербургского государственного университета
    д. м. н., профессор,
      Андрей Юрьевич Барановский
       

    1. Scientific and clinical center of gastroenterology and Hepatology, Saint Petersburg state University (St. Petersburg, Russian Federation)

    Keywords:NSAIDs colonopathy,NSAIDs colonopathy risk factors,NSAIDs colonopathy early diagnosis,prevention and treatment

    Abstract:Purpose: to study the incidence of NSAIDs-induced colonopathy in inpatient and outpatient medical institutions in Saint-Petersburg, to analyze their clinical manifestations, special features of their prevention and treatment. Materials and methods. In 112 patients within the age limit of 44-83 years characteristics of occurrence and symptoms of NSAIDs-induced colonopathy were studied in 12 Saint-Petersburg inpatient and outpatient medical institutions. Most of the patients were observed by rheumatologists, orthopedists, neurologists and cardiologists. 77.6 % were given non-selective NSAIDs, the rest - selective. Besides standardized blood analysis the patients underwent fibrogastroduodenoscopy, fibrocolonoscopy, jejunoscopy, in 3 cases - total capsule endoscopy, in 67 cases mucosa biopsy followed by its histologic analysis Results and Discussion. NSAID colonopathy occurred in 12 % of 933 patients. Their gastrointestinal lesions were associated with NSAIDs. 51.7 % patients with NSAIDs colonopathy had different gastrointestinal disorders - nausea, vomiting, heartburn, constipation, pains in the epigastrium or mesogastrium, acute and chronic diarrhea. Intestinal bleeding was in 7.2 % of patients, in 4 of them there were no prodromal subjective manifestations and bleeding occurred spontaneously. Intestinal perforation was in 2.7 % of patients with NSAIDs colonopathy. Basing on literary data and own experience 7 risk factors of NSAIDs colonopathy were formed. The most important were advanced age, organic intestinal pathology in the anamnesis and simultaneous intake of NSAIDs and glucocorticoids. Data showing inadequate consideration of risk factors by clinicians and algorithms of prevention and early diagnosis of NSAIDs colonopathy are presented, which significantly influence the incidence of this pathology. Data concerning modern ideas of dietary and pharmacological approaches to NSAIDs colonopathy prevention and treatment are described.

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    Full text is published :
    Baranovsky A.Yu. DIAGNOSTICS, PREVENTION AND TREATMENT OF NSAIDS-INDUCED COLONOPATHY. Experimental and Clinical Gastroenterology Journal. 2017;146(10):04-14
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    1. The Federal State Budgetary Institution “Privolzhsky Federal Medical Research Center” of the Ministry of Health of the Russian Federation (PFMTS “PFMTS” of the Ministry of Health of Russia) (Nizhny Novgorod, Russian Federation)

    Keywords:Crohn’s disease,children,fistula prognosis,stenoses,morphological signs,complications of the disease

    Abstract:The aim of the study was to identify early morphological changes in the IA of the ileum and large intestine, which are of prognostic significance in stenosing and fistulous forms of Crohn’s disease (BC) in children. Materials and methods: A retrospective analysis of the case histories in 59 children with BC on the age of 3 to 17 years with their primary hospitalization to the formation of phenotypic forms of the disease for at least 8 years of follow-up. Three groups of patients were compared: group A (infiltrative form) - 39 people, group B (stenosing form) - 12 people, group C (fistula form) - 8 people. Results: early morphological signs of variants of the development of the disease were revealed. Prognostic morphological criteria of complicated forms of BC were revealed, the detection of which will allow changing the tactics of treatment to a more aggressive variant, which will allow avoiding complications and thereby surgical intervention. Conclusion: Based on the identified criteria, it is possible to predict complicated forms of BC in children during the initial treatment of the patient, along with the diagnosis of BC, it is possible to predict the course of the disease and determine the tactics of managing the patient with a view to preventing the development of complications.

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    Fedulova E.N., Shumilova O.V., Shirokova N.Ya. EARLY MORPHOLOGICAL CRITERIA FOR COMPLICATED CROHN FORMS IN CHILDREN. Experimental and Clinical Gastroenterology Journal. 2017;146(10):15-19
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    1. The Federal State Budgetary Institution “Privolzhsky Federal Medical Research Center” of the Ministry of Health of the Russian Federation (PFMTS “PFMTS” of the Ministry of Health of Russia) (Nizhny Novgorod, Russian Federation)

    Keywords:Crohn’s disease,children,prognosis of the disease course,diagnostic algorithm

    Abstract:The aim of the study was to optimize the diagnosis and treatment of Crohn’s disease in children on the basis of the use of the revealed prognostic criteria for various forms of the disease. Materials and methods: A retrospective analysis of the case histories in 59 children with Crohn’s disease aged 3 to 17 years with their primary hospitalization to the formation of phenotypic forms of the disease for at least 8 years of follow-up. Three groups of patients were compared: group A (infiltrative form) - 39 people, group B (stenosing form) - 12 people, group C (fistula form) - 8 people. Clinico-anamnestic, laboratory-instrumental and morphological signs of variants of the development of the disease have been revealed. Results: An algorithm for predicting various forms of Crohn’s disease based on the identified criteria was developed. Conclusion: at the primary treatment of the patient, along with the diagnosis of BC, it is possible to predict the course of the disease and determine the tactics of managing the patient with a view to preventing the development of complications.

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    Fedulova E.N., Shumilova O.V., Tutyna O.A. THE ALGORITHM OF PREDICTING THE COURSE OF CROHN’S DISEASE IN CHILDREN. Experimental and Clinical Gastroenterology Journal. 2017;146(10):20-25
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    1. Saint-Petersburg state pediatric medical University of Ministry of healthcare of the Russian Federation (St. Petersburg, Russian Federation)

    Keywords:inflammatory bowel disease (IBD),bone mineral density (BMD),Crohn’s disease,ulcerative colitis,risk factors of low BMD

    Abstract:Aim of this study was to evaluate clinical and laboratory criteria which can help to identify patients with inflammatory bowel disease (IBD) with high risk of low bone mineral density (BMD). 91 patients (2-17 years old) were included in the study. Bone mineral density (BMD) of lumbar spine (DEXA) was assessed, level of serum osteocalcin (OC), C-terminal telopeptides (CTT), parathyroid hormone (PTH), serum calcium, alkaline phosphatase and 25 (OH) vitamin D was measured to evaluate bone metabolism. All patients have been divided in two groups: with normal and low BMD. Comparison of different clinical and laboratory factors have been made between those two groups. Statistics have been performed using Statistica 6.0 и MicrosoftExcel. According to our data high laboratory activity (clinical indices of activity, high CRP, low albumin and haemoglobin), extraintestinal manifestation and complicated form of disease, long course of steroids, low height and weight and also low level of calcium and 25(OH) vitamin D can be considered as risk factors of low BMD. Differences in bone metabolism markers between patients with low and normal BMD were no observed. Presence of risk factors of low BMD in patients with IBD leads to necessity of further radiological evaluation in order to identify low-energy fractures of vertebrae in this group of patients.

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    Gabrusskaya T.V., Revnova M.O., Kostyk M.M. PREDICTORS OF LOW BONE MINERAL DENSITY IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE. Experimental and Clinical Gastroenterology Journal. 2017;146(10):26-32
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    1. Scientific and Educational Center of Gastroenterology and Hepatology, Saint-Petersburg University (St. Petersburg, Russian Federation)
    2. Saint-Petersburg State Pediatric Medical University, Department of Gastroenterology (St. Petersburg, Russian Federation)
    3. Russian Scientific Center of Radiology and Surgical Technologies (St. Petersburg, Russian Federation)

    Keywords:primary sclerosing cholangitis,inflammatory bowel disease,ulcerative colitis,Crohn’s disease,cholangiocarcinoma

    Abstract:Characteristics of primary sclerosing cholangitis in combination with inflammatory bowel diseases were studied. Materials and methods. We have performed comprehensive laboratory and instrumental examination, and retrospective analysis of outpatient charts of 62 patients with confirmed diagnosis of primary sclerosing cholangitis (PSC), including 47 cases of PSC combined with inflammatory bowel diseases (IBD). We carried out morphological study of liver biopsy specimens in 26 (55.3 %) patients with PSC/IBD and 13 (81,3 %) with PSC only. Biopsy specimens of the colon of 26 patients with PSC/IBD were analyzed as well. Results. Combination of PSC with IBD has been detected in 47 (75.8 %) patients. At the time of the PSC onset, patients with PSC/IBD were significantly younger than those in the control group (patients with PSC only). They were characterized with asymptomatic onset of the disease with higher activity of laboratory markers of cholestasis. Pronounced leukocytosis, thrombocytosis, activity of cytolysis markers were significantly higher in PSC/IBD comparatively to PSC-only patients. Morphological examination in patients with isolated PSC revealed initial stages of the disease more often: J. Ludwig portal (I) stage in 8 (61.5 %) patients, F0 by METAVIR in 3 (23,1 %) patients, (p<0,05). Correlations were not detected between the morphological activity of IBD and the activity and stage of fibrosis of PSC. Strictures of ducts were diagnosed mainly in patients with combined pathology (p = 0,04). Malignancy was revealed only in PSC/IBD group (11 (23.4 %) people, p<0,02). The most common tumor was cholangiocarcinoma [5 (45 %) patients, p<0,05]. Conclusions. Patients with PSC in combination with IBD mostly had early onset and asymptomatic course of the disease with higher markers of cholestasis, due to the frequent development of strictures of the ducts and malignancy.

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    Pazenko E.V., Raikhelson K.L., Gabrusskaya T.V., Kondrashina E.A., Gerasimova O.A. CHARACTERISTICS OF PRIMARY SCLEROSING CHOLANGITIS CONCOMITANT WITH INFLAMMATORY BOWEL DISEASE. Experimental and Clinical Gastroenterology Journal. 2017;146(10):33-39
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    1. Republican Clinical Hospital of the Ministry of Healthcare of the Republic of Tatarstan (Kazan, Russian Federation)
    2. Kazan State Medical University (Kazan, Russian Federation)

    Keywords:Inflammatory bowel disease,thromboembolic complications,hemostasis,Crohn’s disease,ulcerative colitis,Thrombodynamics test

    Abstract:Aim. To study changes in hemostasis system in patients with inflammatory bowel diseases (IBD). Materials and methods. 127 patients with IBD (80 patients with ulcerative colitis, 47 Crohn’s disease) and 20 healthy volunteers were included into the study. The hemostatic system was studied using standard coagulation tests and the global method of thrombodynamics. Results. Shifting of the hemostasis system into the hypercoagulation was observed in IBD patients according to the parameters of the Thrombodynamics test, due to the increased procoagulant plasma features of these patients. This contributes to the formation of a denser clot, in comparison with the control group, and promotes the formation of spontaneous thrombus. Conclusion. The Thrombodynamic test reveals the hypercoagulable potential of plasma in patients with IBD, which not diagnosed by routine methods of hemostasis study. More pronounced changes in the blood coagulation system were observed in Crohn’s disease patients.

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    Full text is published :
    Ramazanova A.Kh., Mustafin I.G., Odintsova A.Kh., Nabiullina R.M. et al. HEMOSTASIS CHANGES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE. Experimental and Clinical Gastroenterology Journal. 2017;146(10):40-45
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    1. Northwestern State Medical University (St. Petersburg, Russian Federation)
    2. Institute of Obstetrics, gynecology and reproductology (St. Petersburg, Russian Federation)

    Keywords:Crohn’s disease,recurrent aphthous stomatitis,genetic research

    Abstract:The aim of the study. The aim was to reveal the relationship between gene polymorphism and phenotypic features of Crohn’s disease (CD) in the form of recurrent aphthous stomatitis and extraintestinal manifestations. Materials and methods. 210 patients with CD had clinical, instrumental and genetic studies with the determination of polymorphisms of the genes NOD 2 / CARD 15 (Gly908Arg, Arg702Trp, Leu3020finsC), TNF-α (-308G / A), ATG16L1 (841 * A/G), JAK2 (1358 * C / A). Results. Aphthous stomatitis occurs more often in the lesions of the proximal parts of the gastrointestinal tract. The polymorphism of the NOD 2 / CARD 15 gene (Gly908Arg) was found to correlate with the frequency of aphthous stomatitis and the development of perianal lesions. Conclusion. The frequency of occurrence of aphthous stomatitis depends on the localization of the CD. The association of the Gly908Arg polymorphism of the NOD 2 / CARD 15 gene with recurrent aphthous stomatitis makes it possible to consider aphthae in the oral cavity as a phenotypic manifestation of Crohn’s disease.

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    Shchukina O.B., Robakidze N.S., Nasykhova J.A. ASSOCIATION OF POLYMORPHISM OF THE NOD 2/ CARD 15 GENE WITH APHTHOUS STOMATITIS IN CROHN’S DISEASE. Experimental and Clinical Gastroenterology Journal. 2017;146(10):46-49
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    1. The Rostov State Medical University (Rostov-on-don, Russian Federation)

    Keywords:irritable bowel syndrome,ulcerative colitis,proteolysis,matrix metalloproteinase-9,tissue inhibitor of matrix metalloproteinase

    Abstract:The objective of the our study - to investigate the components of proteolysis in patients with irritable bowel syndrome (diarrheal variant) (IBS-D), and in patients with ulcerative colitis (UC) in the different stages of the disease. Materials and methods. The study included 17 patients with IBS-D, as the comparison groups were 7 patients with mild UC and 16 - remission of UC. Proteolysis system evaluated by production of matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of metalloproteinase 1 (TIMP-1) in the mucosa of the sigmoid and rectum with the use of immunohistochemical analysis (rabbit polyclonal antibodies to MMP-9 and mouse monoclonal antibodies to TIMP-1). The results of morphological investigation of colon mucosa in patients with IBS-D showed cellular infiltration, which gives opportunity to doubt the functional nature of the disease. Furthermore production of MMP-9 and TIMP-1 in patients with IBS-D and UC in remission had similar values. Conclusion: The results of our study indicate on presence of the morphological substrate of functional diseases, as evidenced by studies of the ultrastructure of mucosa in patients with IBS-D. We can suggest that one of the mechanisms influencing on the development of mild inflammation in the colon mucosa is the increasing of the production of MMP-9 and decreasing of the production of TIMP-1 in IBS-D, which probably explain the development of a surface inflammation of the colon mucosa.

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    Tkachev A.V., Mazovka K.E., Mkrtchyan L.S. IBS: FUNCTIONAL OR ORGANIC PATHOLOGY?. Experimental and Clinical Gastroenterology Journal. 2017;146(10):50-53
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    1. North-West State Medical University named after I. I. Mechnikov (St. Petersburg, Russian Federation)

    Keywords:postoperative protein-energy insufficiency,enteral insufficiency,elderly and old patients

    Abstract:The study performed showed that elderly and old patient surviving ulcer disease surgical treatment suffer one of the most common complications (31 % of cases) in the remote postoperative period, i. e. protein-energy insufficiency, occurring on the background of the enteral insufficiency development and progress. Hypertrophy and hyperplasia of the superficial-foveolar epithelium of the small intestine (in 62.15 % and 71.8 % respectively) arising probably as a result of inadequate adaptive-compensatory reaction to the disorder of neurohumoral regulation of the alimentary tract activity is rather often precedes the development of protein-energy insufficiency in postoperative period in elderly patients. Formation of enteral insufficiency and protein-energy insufficiency on its background is connected with the depression of functional competence of the atrophically changed small intestinal mucosa, manifested in secretory disorders and disturbances of its absorptive function.

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    Baranovsky A.Yu., Khmelnitskaya N.M., Protopopova O.V. MORPHOFUNCTIONAL STATE OF SMALL INTESTINE PROXIMAL PART AT THE FORMATION OF PROTEIN-ENERGY INSUFFICIENCY IN ELDERLY AND OLD PATIENTS AFTER STOMACH SURGICAL TREATMENT. Experimental and Clinical Gastroenterology Journal. 2017;146(10):54-60
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    1. Federal State Budgetary Institution «V. A. Almazov Federal North-West Medical Research Centre» of the Ministry of Health of the Russian Federation (St. Petersburg, Russian Federation)
    2. Pavlov First Saint Petersburg State Medical University of the Russian Federation (St. Petersburg, Russian Federation)

    Keywords:Non-alcoholic fatty liver disease,non-alcoholic steatosis of the liver,liver cirrhosis,type 2 diabetes mellitus,insulin resistance,hyperinsulinemia,obesity,bariatric surgery,glucagon-like peptide-1,ghrelin

    Abstract:Patients with a metabolic syndrome in combination with non-alcoholic fatty liver disease (NAFLD) have an increased risk of cardiovascular complications and mortality. The review presents epidemiology, the pathogenesis of non-alcoholic fatty liver disease, the possibilities of bariatric surgery in treatment of this disease, and current understanding of the hepatotropic effects of the most studied gastrointestinal hormones: glucagon-like peptide-1 and ghrelin, which profile changes under the influence of bariatric operations.

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    Full text is published :
    Kornyushin O.V., Toropova Ya.G., Neimark A.E., Glistenkova D.D. et al. MECHANISMS OF INFLUENCE OF BARIATRIC OPERATIONS ON THE COURSE OF NON-ALCOHOLIC FATTY LIVER DISEASE. Experimental and Clinical Gastroenterology Journal. 2017;146(10):61-73
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    1. FGBUZ Clinical Hospital No. 122 named after LG Sokolov FMBA of Russia (St. Petersburg, Russian Federation)
    2. Saint-Petersburg state University (St. Petersburg, Russian Federation)
    3. MSH "Road Clinical Hospital of JSC "Russian Railways" (St. Petersburg, Russian Federation)

    Keywords:obscure gastrointestinal bleeding,capsule enteroscopy,ballon-assisted enteroscopy,endoscopic hemostasis

    Abstract:The purpose of this study was the improvement of management results of patients with obscure gastrointestinal bleeding through the development of a differential diagnostic algorithm with the integration of new endoscopic methods. We analyzed the results of diagnosis and treatment of 137 patients with unspecified gastrointestinal bleeding through 8 years. It is revealed, that the subsequent application of capsule and balloon-assisted enteroscopy allows to improve the diagnostic results of diseases caused bleeding, time to establish indications for surgical treatment, to perform the medical benefits of minimal invasive methods (including endoscopic), as well as to avoid “unnecessary” operations in unclear diagnostic situations. In 10 patients the source of bleeding was identified with “traditional” endoscopic technologies without the examination of the small intestine, this underlines the importance of esophagogastroduodenoscopy and colonoscopy of the expert level as a “first step” in diagnosis..

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    Full text is published :
    Nakatis Ya.A., Kashschenko V.A., Sishkova E.A., Vasyukova E.L. et al. ENDOSCOPIC DIAGNOSIS AND MANAGEMENT OF OBSCURE GASTROINTESTINAL BLEEDING. Experimental and Clinical Gastroenterology Journal. 2017;146(10):74-79
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    1. Orenburg State Medical University, Orenburg regional hospital (Orenburg, Russian Federation)

    Keywords:ileocecal transition,bauginia valve,ulcerative colitis,Crohn’s disease

    Abstract:Objective: to improve the diagnosis of diseases of ileocecal transition. Materials and methods. A survey of 191 patients of mature and elderly age, of them men - 63, women - 128. There are 2 groups: 1 - conditionally healthy (97 people) and 2 - patients with ulcerative colitis (76 people) and Crohn’s disease (18 people). Endoscopic studies (videocolonoleoscopy) were carried out with the EVIS EXERA II video system of the CV-180 series, “Olympus” (Japan). Results. It was found that patients with ulcerative colitis and Crohn’s disease significantly more frequently encountered patients with a change in the direction of the caudal flap toward the ascending colon and perpendicular to the cecal axis, a decrease in length and an increase in the thickness of the upper and lower lips of the caudal flap, large sizes of bridles, the formation of a cone-shaped cecum and inflammatory changes in the mucosa of the ileocecal transition. Conclusion. Inflammatory diseases of the ileocecal transition (ulcerative colitis, Crohn’s disease) are accompanied by changes in its elements compared with normal endoscopic anatomy. Knowledge of the norm and the definition of changes that make up the ileocecal transition contribute to the improvement of the diagnosis of inflammatory diseases.

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    Dronova O.B., Fateev I.N., Petrov S.V., Neverov A.N. COMPARATIVE ANALYSIS OF THE RESULTS OF THE STUDY OF ENDOSCOPIC ANATOMY OF THE ILEOCECAL TRANSITION IN HEALTHY AND DISEASED PATIENTS. Experimental and Clinical Gastroenterology Journal. 2017;146(10):80-82
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    1. Irkutsk Scientific Centre of Surgery and Traumatology (Irkutsk, Russian Federation)

    Keywords:peritoneal adhesions,abdominal cavity,MAP kinase,prevention,experimental studies

    Abstract:Objective: to study the efficacy of the new promising medication as a way of preventing peritoneal adhesions. Material and methods. Peritoneal adhesion process was simulated in 30 Wistar rats. Intraperitoneal injection of a sterile conjugate aqueous solution of 4- [4- (4-fluorophenyl) -2- (4-methylsulfylphenyl) -1H-imidazole-5-pyridine with polyvinylimidazole (main group) was chosen as prevention of adhesion formation. Saline solution was used for control group. The pronouncement of the adhesion process was determined by macroscopic rate scale and histologic examination on the day 7, 14, and 30. Results. Significant differences between comparing groups on the day 7, 14 and 30 were determined with the help of scoring system of the pronouncement of the adhesion process. The severity of the adhesion process in main group was lower than in the control group. Also, significant differences in the morphological structure of adhesions were noticed. Conclusion. We demonstrated the first experience in use of promising medication as a way to prevent adhesions. The conducted study showed that in main group adhesion formation was not progressing during 7 days while in control group active adhesion formation and vascularization were proceeding. Thus, the use of promising medication is an effective way to prevent peritoneal adhesions.

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    Shurygina I.A., Ajushinova N.I., Chepurnyh E.E., Shurygin M.G. METHOD OF PREVENTION OF ABDOMINAL CAVITY ADHESIVE DISEASE. Experimental and Clinical Gastroenterology Journal. 2017;146(10):83-87
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    1. The Chair of Military Therapy and the Chair of Military Toxicology and Medical Protection of Military Medical Academy of name S. М. Kirov (St. Petersburg, Russian Federation)

    Keywords:an experimental cirrhosis,dimethylnitrosamine,alcohol,treatment

    Abstract:Research objective: working out of model of a cirrhosis at animals, an estimation of its clinical-morphological features, studying of therapeutic efficiency of inosin glitsil-tsisteinil-glutamat dinatrium in comparison with ademetionin. Material and methods: Series of experiences (200 white rats), a chronic dimethylnitrosamine's intoxication (DMNA)) in different modes and alcohol within 3-4 weeks. Against a proceeding intoxication introduction of inosin glitsil-tsisteinil-glutamat dinatrium (10 or 30 mg/kg) or ademetionin (70 mg/kg) till 9 weeks. Through every week series from 7-8 animals weighed, estimated a condition of bodies of a belly cavity, visible vessels, presence of ascites. Samples of blood for the biochemical analysis and a liver for histological research took. Results: It is established that at introduction DMNA intraperitoneally in a dose of 10 mg/kg 3 times a week + ethanol in a dose of 3 g/kg (oral every other day) within 4 weeks naturally develop macroscopic (hepatomegaly, ascites, collaterals), biochemical and histological signs of a cirrhosis (a dystrophy of hepatocytes, endocellular cholestasis, the reaction of macrophages, expressed fibrosis, nodular reorganization, blood circulation infringements). Application with the medical purpose of ademetionin promoted regress of signs of a cirrhosis, but the fullest clinical-morphological answer has provided inosin glitsil-tsisteinil-glutamat dinatrium in a dose of 30 mg/kg. Conclusion: In the given research the adequate model of an experimental cirrhosis with a substantiation of conformity of the majority of criteria to a cirrhosis at the person is developed. The conclusion is drawn on high polyvalent therapeutic efficiency of inosin glitsil-tsisteinil-glutamat dinatrium and perspectivity of its application in clinical hepatology and toxicology.

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    Full text is published :
    Golofeevskiy V.Yu., Antushevich A.E., Antonov V.G., Grebeniuk A.N. NEW MODEL OF THE EXPERIMENTAL CIRRHOSIS FOR ESTIMATION HEPATOPROTECTIVE AND ANTIFIBROTIC EFFICIENCY OF DRUGS. Experimental and Clinical Gastroenterology Journal. 2017;146(10):88-93
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    1. Prenolica Limited, Biotechnology Company; Saint Petersburg State Forest Technical Academy (Moscow, Russian Federation)
    2. Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Science (Moscow, Russian Federation)
    3. State Forest Technical University (Moscow, Russian Federation)

    Keywords:long-chain isoprenoid alcohols,polyprenols,dolichol,Ropren,Essentiale Forte,carbon tetrachloride,hepatocytes,liver function

    Abstract:The mechanism for the ability of pharmaceutical-grade plant long-chain isoprenoid alcohols (polyprenols) to improve liver function was investigated in a carbon tetrachloride animal model of liver damage. The pharmaceutical-grade polyprenol substance, Ropren®, was compared with a commonly used phospholipid substance, Essentiale Forte, for 21 days of treatment. The condition of hepatic cells and cellular membranes was investigated using electron and light microscopy. The study showed Ropren® restored liver function and morphology as soon as day 7-14 of treatment, an effect that was faster than improvement after treatment with Essentiale Forte. Similarly, levels of glycogen in the liver were restored faster after treatment with Ropren® than Essential Forte. Measurement of the activity of the membrane-bound enzymes, monoamine oxidase (MAO) and butyrylcholinesterase (BuChE) also showed Ropren® improved liver function by improving cellular membrane and mitochondrial membrane function. To our knowledge, these results show for the first time a mechanism of the stabilisation of cellular membranes after treatment with Ropren® along with improvements in liver enzymes. These functional improvements occur faster than Essentiale Forte, a commonly used hepatoprotector.

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    Soultanov V.S., Sukhinin V.P., Roschin V.I., Rozengart E.V., Nikitina T.V. PLANT LONG-CHAIN ISOPRENOID ALCOHOLS (POLYPRENOLS) PROTECT LIVER VIA STABILISATION OF CELL MEMBRANES AND ORGANELLE STRUCTURE IN A CARBON TETRACHLORIDE ANIMAL MODEL OF TOXIC LIVER DAMAGE. Experimental and Clinical Gastroenterology Journal. 2017;146(10):94-101
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    1. Research Institute of Phthisiopulmonology at the Sechenov I. M. First Moscow State Medical University (Moscow, Russian Federation)
    2. Solagift Pty Ltd (St. Petersburg, Russian Federation)
    3. Saint Petersburg State Forest Technical University; Prenolica Limited, Biotechnology Company (Moscow, Russian Federation)

    Keywords:Ropren®,isoniazid,polyprenols,isoprenoid alcohols,tuberculosis,liver,hepatoprotector,neurotoxicity

    Abstract:Objectives. Treatment of tuberculosis (TB) with medications such as isoniazid may lead to antibacterial resistance, hepatotoxic and neurotoxic effects. The development of other methods of treatment for TB is needed. Ropren® is an established hepatoprotector and neuroprotector and was tested in isoniazid rat and mouse models. Methods. Analysis of liver function was performed in rats by measuring alanine aminotransferase (ALT), aspartate transaminase, (AST), total and direct bilirubin and alkaline phosphatase (AP). The condition of the liver (density, colour, elasticity and the condition of the front edge) was also recorded and hematoxylin and eosin stained sections were analysed. The distribution of dystrophic changes in hepatocytes was determined. Neurotoxicity was evaluated in mice by measuring the onset of seizures and the subsequent mortality rate of mice. Results. Ropren® (30 mg/kg, given concomitantly with isoniazid, total daily dose 75 mg/kg, over 14 days) protected the liver of rats from isoniazid toxicity. Loss of body weight in rats given 30 mg/kg doses of Ropren® was significantly less than in the control group and in the groups given 10 or 15 mg/kg doses of Ropren®. AST levels in rats given Ropren® (10, 15 and 30 mg/kg) were similar to levels in the control group. ALT levels decreased significantly in rats given 30 mg/kg of Ropren®. AP decreased significantly in rats given 10 and 15 mg/kg of Ropren®. The AP level in rats given 30 mg/kg Ropren® also decreased, but this was not statistically significant. Total and direct bilirubin levels were similar in treated and control rats. Rat livers from the control and experimental groups showed reduced elasticity and a colour change. Rats given 30 mg/kg Ropren® had a decrease in the weight index compared to the control group. There was a significant decrease in the degree of dystrophy in hepatocytes in rats given Ropren®. Hepatoprotective effects were more pronounced at 10 and 30 mg/kg Ropren®. Ropren® (20 and 100 mg/kg) given 40 minutes prior to isoniazid (200 mg/kg) delayed the onset of seizures in mice and improved survival rate. Conclusion. Ropren® reduced isoniazid toxicity and had a protective effect on the liver. Ropren (20 mg/kg) also had a neuroprotective effect. Ropren® should be considered as an adjuvant treatment for TB in humans, where it could be used concomitantly with current established therapies.

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    Mozhokina G.N., Elistratova N.A., Mikhailova L.P., Makarova O.V. PLANT LONG-CHAIN ISOPRENOID ALCOHOLS (POLYPRENOLS) DECREASE HEPATOTOXICITY AND NEUROTOXICITY CAUSED BY ISONIAZID, AN ANTI-TUBERCULOSIS DRUG. Experimental and Clinical Gastroenterology Journal. 2017;146(10):102-109
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    1. Omsk State Medical University (Omsk, Russian Federation)

    Keywords:ulcerative colitis,prevalence,risk factors

    Abstract:Ulcerative colitis (UC) is idiopathic chronic relapsing inflammational disorder of the colon. In recent years, there are new details appeared about the prevalence and development of UC. In the present review article sanctified influence of factors such as patient age, sex, influence of heredity, environmental factors, behavioral factors. Also considered a possible protective effect of the microorganism Helicobacter pylori against inflammatory bowel disease. The article also discussed the possible involvement of viruses, medications, nutritional factors, as well as psycho-emotional factors on the risk of formation of ulcerative colitis.

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    Akhmedov V.A., Bikbavova G.R., Emeliyanova U.A. MODERN VIEWS ON PREVALENCE, RISK FACTORS AND CAUSES OF ULCERATIVE COLITIS. Experimental and Clinical Gastroenterology Journal. 2017;146(10):110-115
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      1. The city center of diagnosis and treatment of inflammatory bowel diseases (St. Petersburg, Russian Federation)
      2. City clinical hospital № 31 (St. Petersburg, Russian Federation)

    Keywords:IBD,optimization of medical care,specialized centers,multidisciplinary collaboration

    Abstract:Optimal management (treatment and monitoring) of patients with Crohn’s disease may in the specialty unit where medical services will be provided by a multidisciplinary team, the process of functioning of which is based on modern recommendations. However, not all gastroenterology departments or offices have the possibility of forming such a unit. The article presents the results of a 2010 survey of experts of the Russian group for the study of IBD. Only in 6 cities (42.8 per cent) care to patients was conducted jointly by the gastroenterologists and Coloproctologists. The lack of specialized IBD endoscopists were noted in three cases (16.7 %), and the morphologist is 8 (44,4 %) institutions. Software specializing in IBD by radiologists occurred in 39 %, dieticians - 11,1 %, psychologists - 39 %. Mandatory participation of the legal entities included in the programme of work only 9 (56 %). Less than half (44 %) of the respondents indicated that they have a certain algorithm of interaction with specialized in issues of IBD paediatric gastroenterologists and the same number reported in the center of the patient support programs, including school patients. An algorithm for optimization of specialized care for patients with IBD is proposed, which is carried out by providing outpatient and inpatient care in the framework of multidisciplinary collaboration of specialized gastroenterologists and coloproctology specialists on IBD.

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    Shchukina O.B., Grigorian V.V. ORGANIZATION OF SPECIALIZED UNITS - CENTERS OF IBD AS A WAY OF OPTIMIZING MEDICAL CARE FOR PATIENTS WITH ULCERATIVE COLITIS AND CROHN’S DISEASE. Experimental and Clinical Gastroenterology Journal. 2017;146(10):116-123
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    1. North-Western State Medical University named after I. I. Mechnikov (St. Petersburg, Russian Federation)
    2. Scientific Research Institute named after N. N. Petrov (St. Petersburg, Russian Federation)
    3. Leningrad Regional Clinical Hospital (St. Petersburg, Russian Federation)
    4. I. P. Pavlov First Saint Petersburg State Medical University (St. Petersburg, Russian Federation)

    Keywords:Aspergillus,invasive aspergillosis,mycosis of the digestive tract,Aspergillus

    Abstract:Invasive aspergillosis is actual problem in patients with hematological malignancies. Lungs damage develops most often. Digestive tract involvement occurs in 1.3 % of patients with invasive aspergillosis, mainly as a result of hematogenous dissemination. Risk factors are lymphocytopenia, neutropenia, corticosteroid therapy, and staying in the ICU. The most frequently we identified liver involvement (63 %), rarely - intestines (25 %) and esophagus (12 %). Infection is characterized by a high 12-week mortality - 63 %. Early diagnosis, voriconazole therapy and surgical treatment are necessary.

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    Shadrivova O.V., Shevyakov M.A., Desyatik E.A., Bogomolova T.S. INVASIVE ASPERGILLOSIS OF THE DIGESTIVE TRACT: PROSPECTIVE STUDY RESULTS AND CLINICAL CASE OF COLON ASPERGILLOSIS. Experimental and Clinical Gastroenterology Journal. 2017;146(10):124-127
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    1. FGBOU IN "Moscow State Medical and Dental University. AI Evdokimova »Ministry of Health of the Russian Federation (Moscow, Russian Federation)

    Abstract:The article deals with the wide review of activity of the outstanding scientist, the clinical physician, the philosopher, the firm person V. H. Vasilenko. The school which left the academician V. H. Vasilenko from S. P. Botkin-V.P.Obrazstov-F.G.Yanovsky-N.A.Strazhesko is given. His organizing abilities in the days of the Great Patriotic War, research activity in the field of cardiology, gastroenterology are reflected. High human, civil qualities, his role as Teachers from the capital letter, the talented diagnostician, philosopher are shown.

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    Paltsev A.I., Lazebnik L.B., Maksimov V.A. FROM THE FOURTH CONGRESS OF GATROENTEROLOGISTS OF THE SOVIET UNION PRIOR TO THE 120-YEAR ANNIVERSARY OF MEMORY OF THE OUTSTANDING SCIENTIST, THE CLINICAL PHYSICIAN, THE FIRM PERSON V.H. VASILENKO. Experimental and Clinical Gastroenterology Journal. 2017;146(10):128-134
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    1. Volgograd state medical University (Volgograd, Russian Federation)

    Abstract:The report about the Plenary Session of the Gastroenterological Scientific Society “CONSTIPATION AS A MANIFESTATION AND REASON OF SYSTEMIC DISEASES” held in Volgograd, 26-27 September 2017. The main objective of the meeting was to discuss a differentiated approach to the treatment of chronic constipation by understanding the pathogenetic features of its appearance, creating an algorithm of diagnosis and targeted, personalised treatment patients with polymorbidity. Decisions of the Plenary Session: To accept the proposed concept of the “Constipation” as a practical for doctors of any specialty and answering the patient’s question: ”Constipation is the absence of spontaneous defecation for 72 hours or more since its last act, with unwillingness or impossibility of its arbitrary execution". To organise working groups for writing clinical guidelines “Constipation as a manifestation and cause of systemic human diseases; diagnosis, treatment and prevention of constipation in polymorbidity " with the following sections: “Constipation in pregnant women”, “Constipation in young”, “Constipation in elderly”, “Habitual constipation”, “Lazy” intestine ”, “Medicinal ”constipation as undesirable effects of targeted therapy for somatic diseases”, “Constipation in congenital dysplastic diseases of the connective tissue (dolichogeneous, megacolon, etc.)”, “Constipations in water and electrolyte balance disorders”, “Constipations in inflammatory bowel diseases”, ”Constipations in cardiovascular diseases”, “Constipations in neurological diseases,” ”Constipation in non-traditional sexual orientation people”; development of a professional standard "Doctor-Gastroenterologist”

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    Turkina S.V. PLENARY SESSION OF THE GSSR “CONSTIPATION AS A MANIFESTATION AND REASON OF SYSTEMIC DISEASES” (Volgograd, 26-27 september, 2017). Experimental and Clinical Gastroenterology Journal. 2017;146(10):135-136
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    1. Perm State Medical University. Acad. E. A. Wagner (Perm, Russian Federation)

    Abstract:A report about scientific-practical conference dedicated to the 95th anniversary of Professor Ya. S. Zimmerman "Actual issues of gastroenterology." The conference was organized by the Therapeutic Doctors Association of the Perm Territory, the Perm Regional Branch of the RNMOT, the Perm State Medical University named after Academician E. A. Wagner and the Ministry of Health of the Perm Territory in Perm, September 30, 2017

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    Khlynova O.V. REPORT ON THE SCIENTIFIC-PRACTICAL CONFERENCE DEDICATED TO THE 95TH ANNIVERSARY OF PROFESSOR YA. S. ZIMMERMAN (Perm). Experimental and Clinical Gastroenterology Journal. 2017;146(10):137-137
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    1. Moscow Clinical Scientific Center (Moscow, Russian Federation)

    Abstract:The article is dedicated to the milestones of Professor Galina Aleksandrovna Drozdova is a prominent scientist - pathophysiologist in the field of cardiology and general pathology.

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    Trubitsyna I.E. TO THE JUBILEE OF GALINA ALEXANDROVNA DROZDOVA. Experimental and Clinical Gastroenterology Journal. 2017;146(10):138-139
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    1. FGBOU IN "Moscow State Medical and Dental University. AI Evdokimova »Ministry of Health of the Russian Federation (Moscow, Russian Federation)

    Abstract:The report about the XXX-TH INTERNATIONAL WORKSHOP ON HELICOBACTER & MICROBIOTA IN INFLAMMATION & CANCER Bordeaux (France) - September 6-9, 2017 with a course of postgraduate education "Antibiotic therapy and intestines - new ideas" (Antibiotherapy and the Gut - New Concepts) which took place in Bordo, France.

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    Levchenko S.V. XXX-TH INTERNATIONAL WORKSHOP ON HELICOBACTER & MICROBIOTA IN INFLAMMATION & CANCER Bordeaux (France) - September 6-9, 2017. Experimental and Clinical Gastroenterology Journal. 2017;146(10):140-140
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