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    1. Federal State Budgetary Educational Institution of Higher Education "National Research Ogarev Mordovia State University" (430005, Saransk, Republic of Mordovia, Russia)

    Keywords: gastroesophageal reflux disease, cardiac arrhythmias, heart rate variability, autonomic nervous system

    Abstract:The study involved 57 patients with GERD, of whom 26 (45.6%) men and 31 (54.4%) women. The average age of patients is 51.4 ± 8.6 years. Among patients with GERD, the typical course of the disease was observed in 49 people (84.7%), atypical — in 8 people (15.3%). Among atypical manifestations of GERD, cardiac prevailed: 5 people (8.8%) noted the appearance of postprandial chest pain, 2 (3.5%) had complaints of palpitations and interruptions in heart function. In one patient, the clinical manifestation of GERD had a "coma in the throat." According to the endoscopic examination, esophagitis was detected in 9 patients (15.3%). Catarrhal esophagitis was diagnosed in 7 (11.9%) patients, erosive — in 2 (3.4%). The article presents an assessment of the nature of changes in vegetative and temporal parameters of heart rate variability (HRV) over a long period of time in patients with gastroesophageal reflux disease (GERD), describes their dependence on the nature of the predominant reflux, the average daily value of intraesophageal pH, exposure time of acid gastroesophageal reflux, reflux index. Women suffering from GERD are 5.4% higher (p=0.01) than men in the arithmetic mean of the RR intervals, which may indicate a relatively higher risk of various kinds of arrhythmias. Also significantly higher in women were the average values of such indicators as the adequacy of the processes of regulation and the voltage index of regulatory systems by 15.2% (p=0.04) and 24.0% (p=0.04), respectively, indicating a greater impact on the sinus node of the sympathetic division of the vegetative nervous system.

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      4. Boraeva T. T., Matveeva U.V. Sostoyanie serdechnososudistoy sistemy pri GERB u detey v Severnoy Osetii (Alanii) [The state of the cardiovascular system in children with GERD in North Ossetia (Alania)]. Materialy nauch.-prakt. konf. pediatrov i neonatologov [Materials of the scientific-practical conference of pediatricians and neonatologists]. Stavropol', 2011, pp.35–41.
      5. Kozlova I.V., Loginov S.V., Shvarts Yu. G. Gastroesophageal reflux and the degree of esopha-gitis in patients with coronary heart disease: impact on myocardial repolarization parameters and cardiac rhythm variability. Clinical medicine. 2004, no. 9, pp. 33–35.
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      17. Velagapudi P., Turagam M. K., Leal M. A., Kocheril A. G. Atrial fibrillation and acid reflux disease/ Clin Cardiol. — 2012. — V.35(3). — P.180–186.

    Full text is published :
    Eremina E. Yu., Zvereva S. I., Kozlova L. S. Parameters of heart rate variability in patients with gastroesophageal reflux disease. Experimental and Clinical Gastroenterology. 2018;157(9): 10–17. DOI: 10.31146/1682-8658-ecg-157-9-10-17.
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    1. Volgograd State Medical University, the Ministre of the Russian Federation (400131, Volgograd, Russia)
    2. Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenovskiy University) (119991, Moscow, Russia)

    Keywords: irritable bowel syndrome, euthyroid sick syndrome, thyroid hormones, low grade systemic inflammation, cytokines

    Abstract:The article presents the results of the study assessing the role of thyroid dysfunction and cytokine imbalance in the pathogenesis and manifestations of irritable bowel syndrome (IBS). We have found low serum triiodothyronine (T3) levels as well as normal or mildly reduced serum TSH levels in 44.78% IBS pts, thus confirming the presence of euthyroid sick syndrome. These changes in thyroid hormone levels were more frequent in IBS with constipation. Moreover, the IBS group was found to have elevated mean anti-TPO levels as compared with the controls. Thyroid imbalances were associated with moderately elevated pro-inflammatory (TNF-α, IL-1ß, IL-6, IL-8) cytokine levels and low levels of serum anti-inflammatory IL-10 cytokine as compared with the healthy subjects. Along with this, hypercytokinemia was less pronounced in IBS than in ulcerative colitis (UC). We have revealed relationship between clinical manifestations of IBS and the severity of thyroid dysfunction. Positive correlation was found between T3, free T4 and IL-8, while anti-inflammatory IL-10 cytokine was negatively correlated with free T3 levels. Our findings suggest that thyroid dysfunction and regulatory cytokines play a significant role in the pathogenesis and manifestations IBS and can be considered as an objective markers of disease severity.

      1. Abramova N.O., Pashkovskaya N.V. Current views on nonthyroidal illness syndrome in clinical practice . Vrachebnoe Delo. 2017; (1–2): 31–38. (In Russian)
      2. Babaeva A.P., Osadchuk M.A., Vidiker R.V., Kalinina E.V. et. al. Markers of systemic inflammation in pathogenesis and optimization of pharmacotherapy of irritable bowel syndrome. Experimental and Clinical Gastroenterology Journal. 2017;139(03):48–55 (In Russian)
      3. Babaeva A.R., Rodionova O.N., Vidiker R.V., Reutova E.Yu. Osobennosti narushenii neirogumoral’noy regulyatsii, tsytokinovogo i tireoidnogo statusa u bol’nykh s funktsional’nymi rasstroystvami zheludochnokishechnogo trakta. Vestnik Sankt-Peterburgskogo universiteta. 2009; 11(1): 51–57. (In Russian)
      4. Minushkin O.N. Sochetannye funktsional’nye rasstroistva zheludochno-kishechnogo trakta, ikh diagnostika i lechebnye podkhody. Meditsinsky sovet. 2015; 13: 21–26. (In Russian)
      5. Osadchuk M.A., Osadchuk M.M. Sindrom perekresta funktsional’noy dispepsii, gastroezofageal’noy refluksnoy bolezni i sindroma razdrazhennogo kishechnika: optimizatsiya terapii. RMZ “Meditsinskoe obozrenie”. 2015;28:1690–1692. (In Russian)
      6. Bashashati M, Moradi M, Sarosiek I. Interleukin-6 in irritable bowel syndrome: A systematic review and meta-analysis of IL-6 (-G174C) and circulating IL-6 levels.// Cytokine. 2017 Nov;99:132-138. doi: 10.1016/j. cyto.2017.08.017. Epub 2017 Sep 5.
      7. Bennet SMP, Palsson O, Whitehead WE, Barrow DA, Törnblom H, Öhman L, Simrén M, van Tilburg MAL. Systemic cytokines are elevated in a subset of patients with irritable bowel syndrome but largely unrelated to symptom characteristics//. Neurogastroenterol Motil. 2018 Oct;30(10):e13378. doi: 10.1111/nmo.13378. Epub 2018 May 24.
      8. De Vries E. M., Fliers E., Boelen A. The molecular basis of the non-thyroidal illness syndrome // J. Endocrinol. — 2015. — Vol. 225, N 3. — Р. 67–81.
      9. Drossman D.A., Hasler W.L. Rome IV — Functional GI disorders: disorders of gut-brain interaction. Gastroenterology 2016; 150(6): 1257–61.
      10. Farwell A. P. Nonthyroidal illness syndrome // Curr Opin Endocrinol Diabetes Obes. — 2013. — Vol. 20, № 5. — P. 478–484.
      11. Kindt S, Van Oudenhove L, Broekaert D, Kasran A, Ceuppens JL, Bossuyt X, Fischler B, Tack J. Immune dysfunction in patients with functional gastrointestinal disorders. Neurogastroenterol Motil. 2015 Apr;21(4):38998. doi:10.1111/j.1365-2982.2008.01220.x.
      12. Krysiak R, Kędzia A, Kowalcze K, Okopień B. Euthyroid sick syndrome: an important clinical problem, Рolish, 2017;70(2 pt 2):376-385.
      13. Kwakkel J., Fliers E., Boelen A. Illness-induced changes in thyroid hormone metabolism: focus on the tissue level (review article) // Neth. J. Med. — 2011. — Vol. 69, N 5. — Р. 224–228.20.
      14. Laterza L., Piscaglia A.C., Lecce S., Gasbarrini A., Stefanelli M.L. Onset of ulcerative colitis after thyrotoxicosis: a case report and review of the literature.// Eur Rev Med Pharmacol Sci. 2016;20(4):685-8.
      15. Ng Q.X., Soh A.Y.S., Loke W., Lim D.Y., Yeo W.S. The role of inflammation in irritable bowel syndrome (IBS).// J Inflamm Res. 2018 Sep 21;11:345-349. doi: 10.2147/JIR. S174982. eCollection 2018.
      16. Patel S.R., Singh A., Misra V., Misra S.P., Dwivedi M., Trivedi P. Levels of interleukins 2, 6, 8, and 10 in patients with irritable bowel syndrome. Indian J Pathol Microbiol. 2017 Jul-Sep;60(3):385-389. doi: 10.4103/IJPM. IJPM_544_16.
      17. Vara E.J., Brokstad K.A., Hausken T., Lied G.A. Altered levels of cytokines in patients with irritable bowel syndrome are not correlated with fatigue.// Int J Gen Med. 2018 Jul 6;11:285-291. doi: 10.2147/IJGM.S166600. eCollection 2018.

    Full text is published :
    Babaeva A. R., Osadchuk M. A., Vidiker R. V., Solodenkova K. S., Reutova E. Yu. Euthyroid sick syndrome and cytokine imbalance in pathogenesis and clinical manifestation of irritable bowel syndrome. Experimental and Clinical Gastroenterology. 2018;157(9): 18–25. DOI: 10.31146/1682-8658-ecg-157-9-18-25.
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    1. Regional clinical hospital Saratov (410053, Saratov, Russia)
    2. Saratov State Medical University named after V. I. Razumovsky (410012, Saratov, Russia)

    Keywords: obesity, chronic cholecystitis, eating behavior

    Abstract:The aim. To assess the significance of somatotype and eating behaviour for evaluation of obesity risk resulting in the development of chronic cholecystitis in men and women. Materials and methods used: The 301 patients (97 men and 204 women) suffering from chronic cholecystitis were under medical observation. The impact of somatotype and eating behaviour on obesity risk and its further development into chronic cholecystitis in men and women was analyzed. Results. 62.8% of men and 79.9% of women suffering from obesity were reported to also suffer from chronic cholecystitis, while calculous cholecystitis burdened with obesity was registered more frequently in women rather than men — 88.5% and 59.1% respectively. The increased risk of chronic cholecystitis as a result of obesity in women was proved to be associated with significant frequency of metabolic syndrome with carbohydrate metabolism disorder prevailing. Conclusion. Results of survey have proven that frequency of obesity occurrence in men of abdominal, abdominal-muscular and abnormal constitutional types doesn’t almost depend on their eating behaviour while emotional eating behaviour in men of muscular-abdominal and muscular-thoracic constitutional types is an adverse prognostic factor for obesity progression and its further development into cholecystitis. The risk of obesity and resulting chronic cholecystitis in women is mostly associated with megalosomal constitution regardless of their eating behaviour type while external and emotional eating behaviours in women of other constitutional types are considered significant risk factors.

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      5. Vahmistrov A.B., Voznesenskaya T.G., Posohov S.I. Klinikopsihologicheskij analiz narushenij pishchevogo povedeniya pri ozhirenii [Clinical and psychological analysis of eating disorders in obesity]. S.S. Korsakov Journal of Neurology and Psychiatry. 2001; (12):19-24. [In Russian]
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    Full text is published :
    Zhukova E.V., Semikina T.M., Kashkina E.I., Kunitsyna M.A. Obesity and chronic cholecystitis risk in men and women with regard to their somatotype and eating behaviour. Experimental and Clinical Gastroenterology. 2018;157(9): 26–31. DOI: 10.31146/1682-8658-ecg-157-9-26-31.
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    1. Astrakhan State Medical University” of the Ministry of Health of the Russian Federation (414000, Astrakhan, Russia)

    Keywords: chronic hepatitis, liver cirrhosis, lipopolysaccharide-binding protein, soluble differentiation cluster 14, endotoxemia, portal blood flow

    Abstract:The aim of the study was to investigate the pathogenetic and diagnostic significance of changes in the concentrations of lipopolysaccharide-binding protein (LBP) and the Soluble Cluster of Differentiation 14 (sCD14) in plasma of the blood in  chronic hepatitis (CH) and liver cirrhosis (LC). Materials and methods: 54 patients with CH and 120 with LC was included in the study. Control group (CG) — 30 practically healthy donors. The concentration of LBP and sCD14 was studied in EDTA plasma by enzyme immunoassay using a commercial test — HyCult biotechnology systems (Netherlands). The study of the organs of the abdominal cavity and pulse dopplerography with color flow Doppler mapping of vessels were performed on an Ultrasound Monitor "Logic-500" (USA) with a 3.5-MHz convection sensor. Results: The mean values of LBP and sCD14 in CH and LC were significantly higher than in CG and did not differ significantly depending on the etiology of the disease. The concentration in the blood of LBP and sCD14 was influenced by the activity of CH and LC, the severity of portal hypertension and associated clinical manifestations, hepatic encephalopathy, the Child's Pugh class of severity. Reliable relationships between the studied parameters and a number of diagnostically significant ultrasound parameters of the portal blood flow (PBF) have been established. Conclusion: The study of the blood levels of LBP and sCD14 in CH and LC can be used to diagnose endotoxemia syndrome, the degree of activation of the anti-endotoxin immune response. Determination of the concentration of LBP in combination with the leading ultrasound parameters of the PBF contributes to the clarification of the degree of severity of the pathological process in the liver, allows predicting the transformation of CH to LC.

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      5. Szabo G., Mandrekar P., Dolganiuc A. Innate immune response and hepatic inflammation// Semin. Liver Dis. — 2007. — Vol. 27. — P. 339–350.
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      7. Levitan B., Levitan G., Kasyanova T. Condition of immune response to lipopolysaccharides of gut microbiota in chronic viral hepatitis and liver cirrhosis. Abstracts of Falk Symposium 205: New Treatment Targets in Gut and Liver Diseases. Lucerne (Switzerland), 2016. — P. 55.
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      25. Levitan B.N., Grinberg B.A., Astahin A.V., Kolchina O.S. Issledovanie parametrov portalnogo krovotoka v norme i pri hronicheskih diffuznyh zabolevaniyah pecheni: Metodicheskie rekomendacii [Investigation of parameters of portal blood flow in normal and chronic diffuse liver diseases: Guidelines.]. Astrakhan, 2000, 25 p. (in Russian).

    Full text is published :
    Levitan B.N., Kasyanova T.R., Voloshina O.A.. Clinical and diagnostic significance of the lipopolysaccharide — binding protein and the soluble cluster of differentiation 14 in chronic hepatitis and liver cirrhosis. Experimental and Clinical Gastroenterology. 2018;157(9): 32–37. DOI: 10.31146/1682-8658ecg-157-9-32-37
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    1. State-funded Educational Establishment of Higher Professional Education «Volgograd State Medical University of the Ministry of Public Health of the Russian Federation» (400131, Volgograd, Russia)

    Keywords: non-alcoholic fatty liver disease, obesity, fat dysfunction, structural and functional state of the liver

    Abstract:The aim of this study was assessment of the structural and functional state of the liver in patients with non-alcoholic fatty liver disease (NAFLD) with excessive body weight and obesity of I — II degree. The study included 120 patients with NAFLD (45 to 65 years old) with diabetes mellitus type 2. Depending on the body mass index, patients were divided into four groups, comparable by sex, age, severity of chronic heart failure (myocardial infarction from 6 to 12 months earlier). Patients were examined by standard clinical and anthropometric methods, assessment of visceral obesity with bioimpedanceometry and a calculation method. Level of functional status and markers of hepatocyte damage were studied by the biochemical blood test according to standard laboratory methods. Structural state of the liver was evaluated according to ultrasound data and with calculated indices of steatosis and fibrosis of the liver. The results of the study showed that as the body mass index increases, a significantly higher incidence of hyperfermentemia transaminases and gamma glutamyltranspeptidase is determined. The level of visceral adiposity and fatty tissue dysfunction in patients with NAFLD significantly correlated with the severity of cytolysis and cholestasis, decline of bilirubinemia. Patients with heavier structural changes in the liver, both from ultrasound data and from computational methods, are prevailed among patients with obesity. In conclusion: an increase of the severity of obesity, including visceral obesity, the severity of visceral fat dysfunction in patients with NAFLD is accompanied by an increase in structural and functional disorders in the liver.

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    Full text is published :
    Statsenko M.E., Turkina S.V. Shilina N.N. Kosivtsova M.A., Bakumov P.A. Structural and functional features of the liver in patients with nonalcoholic fatty liver disease, depending on the severity of obesity. Experimental and Clinical Gastroenterology. 2018;157(9): 38–44. DOI: 10.31146/1682-8658ecg-157-9-38-44
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    1. Saratov State Medical University named after V. I. Razumovsky (410012, Saratov, Russia)
    2. ANO SRC "St. Petersburg Institute of Bioregulation and Gerontology" (197110, Saint Petersburg, Russia)
    3. FGBOU VO "Penza State University" (440026, Penza, Russia)

    Keywords: non-alcoholic fatty liver disease, colonocytes, morphometry, leptin, vascular endothelial growth factor, Ki-67, Bcl-2

    Abstract:Objective: To study the indicators of cellular renewal of the colon mucosa in non-alcoholic fatty liver disease (NAFLD). Materials and methods: 138 people with NAFLD and intestinal pathology were examined. The indices of proliferation (Ki-67) and apoptosis (Bcl-2) in comparison with clinical, endoscopic features of the colon and morphometric features of colonocytes expression immunopositive to leptin and the factor of vascular endothelial growth were studied. Results: It was found that changes in the intestinal mucosa and liver in NAFLD are associated with changes in the parameters of the cellular renewal of epithelial cells (the colon proliferation marker is Ki-67 and the marker of apoptosis colonocytes is Bcl-2) with changes in the production of leptin and the vascular endothelial growth factor.

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      14. EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. Journal of Hepatology. 2016; 64:1388-1402.
      15. EASL Clinical Practical Guidelines: Management of Alcoholic Liver Disease. J Hepatol 2012; 57:399-420.
      16. Lee JH. Nonalcoholic fatty liver disease — index. EASL. 2009. Poster 59:25.
      17. Angulo P, Hui JM, Marchesini G, Bugianesi E, George J et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology.2007; 45(4): 846-54.
      18. Kostyuchek I.N. Metodologicheskie podhody k kolichestvennoj immunogistohimicheskoj ocenke ehkspressii markerov apoptoza i proliferacii v molochnoj zheleze [Methodological approaches to quantitative immunohistochemical evaluation of the expression of markers of apoptosis and proliferation in the mammary gland] Arhiv patologii. 2006; 1:47-48. [In Russian].
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    Full text is published :
    Kozlova I.V.1, Lapteva E.A.1, 3, Kvetnoy I.M. Indicators of cellular renewal of the colon mucosa in non-alcoholic fatty liver disease. Experimental and Clinical Gastroenterology. 2018;157(9): 45–50. DOI: 10.31146/1682-8658-ecg-157-9-45-50.
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    1. Samara State Medical University (443099, Samara, Russia)

    Keywords: ulcerative colitis, microbial composition, antibacterial therapy

    Abstract:Objective: The purpose of the study: optimization of diagnosis and treatment of patients with ulcerative colitis by selecting rational antibacterial therapy based on the results of microbiological examination of the microflora of the wall of the colon. Materials and methods: 35 patients with ulcerative colitis aged from 28 to 61 years who were on outpatient and inpatient treatment at the departments of coloproctology and gastroenterology of the SamSMU Clinic were examined. Collection of biopsy material of ulcerative defects of the mucous membrane of the large intestine was performed during the fibrocolonoscopy, and a pure culture of microorganisms was isolated from biopsy material using classical methods. The isolated cultures were identified using MALDI-TOF mass spectrometry. All the isolated cultures were sensitive to antibiotics by a disco-diffusion method. Results: In assessing the quantitative composition of the isolated microflora in patients with mild disease, the microflora in the wall of the colon was absent, or low titers of the sown strains (10²–10³ CFU per biopsy) were determined. In patients with an average severity and severe course of the disease in 50.0% and 53.8% of cases, respectively, a pronounced microbial contamination of the submucosal layer (the number of microorganisms 105–106 CFU per biopsy), a wide variety of species. When analyzing sensitivity to antibiotics of isolated strains, it was found that 45% of them have resistance to 1–2 groups of drugs, 33% have resistance to 3 or more groups. Only 22% of the strains were sensitive to all tested drugs. Conclusion: The eradication of a resistant flora is complex and, from our point of view, pathogenetically substantiated and requires the appointment of a combination therapy after microbiological examination of the biopsy specimen.

      1. Davydova O.E., Andreev P.S., Katorkin S.E., Ljamin A.V. et al. Microbiological investigation of biopathes of the tolstous wall tile in patients with ulcerative colitis. Lechashchij vrach. 2017; (8): 18-21. [In Russian].
      2. Vorob'ev G.I., Halif I.L. Nespecificheskie vospalitel'nye zabolevanija kishechnika [Nonspecific inflammatory bowel disease], Moscow, Miklosh Publ., 2008, 400 p. [In Russian].
      3. Tkachev A.V., Mkrtchjan L.S., Nikitina K.E. Osobennosti jepidemiologii i patogeneza vospalitel'nyh zabolevanij kishechnika: sostojanie problem [Features of epidemiology and pathogenesis of inflammatory bowel diseases: state of the problem]. Teoreticheskie voprosy mediciny — Theoretical issues of medicine. 2011; (2): 175-180. [In Russian].
      4. Zhukov B.N., Isaev V.R., Andreev P.S., Katorkin S.E., Chernov A.A. Complex treatment of nonspecific ulcerous colitis with endolymphatic therapy application. Novosti hirurgii. 2012; (2): 49-54. [In Russian].
      5. Lyagina I.A., Korneva T.K., Golovenko O.V., Veselov A.V. The characteristic of intestinal microflora in patients with ulcerative colitis. RJGHC. 2008; (2): 48-54. [In Russian].
      6. Reid K.C., Cockerill III F.R., Patel R. Clinical and Epidemiological Features of Enterococcus casseliflavus/ flavescens and Enterococcus gallinarum Bacteremia:A Report of 20 Cases. Clin. Infect. Dis. 2001 Jun; 32 (11): 1540-6.
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      8. Lyamyn A.V., Andreev P.S., Zhestkov A.V., Zhukov B.N. Antimicrobial Resistance of Gram-negative Bacteria Isolated from Biopsy in Patients with Ulcerative Colitis. Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC) 2010; (4): 342346. [In Russian].
      9. Ivashkin V.T., Lapina T.L. Gastrojenterologija: nacional'noe rukovodstvo, Moscow, GJeOTAR-Media Publ, 2008, 700p. [In Russian].
      10. Ivashkin V.T., Shelygin Ju.A., Halif I.L., et al. Clinical guide of Russian Association Of Gastroenterology And Russian Association Of Coloproctology on dyagnostics and treatment of ulcerative colitis. Koloproktologija. 2017; (1): 6-31. [In Russian].
      11. Truelove S.С., Witts L.J. Cortisone in ulcerative colitis; final report on a therapeutic trial. BrMed. J; (2): 1041-8.
      12. Davydova O.E., Andreev P.S., Katorkin S.E. Jazvennyj kolit — osobennosti diagnostiki i lechenija [Ulcerative colitis — features of diagnosis and treatment]. Gastrojenterologija Sankt-Peterburga — Gastroenterology of St. Petersburg. 2017; (1): 76-77. [In Russian].
      13. Davydova O.E., Katorkin S.E., Lyamin A.V., Andreev P.S. Improvement of results of treatment of patients with ulcera-tive colitis using individual schemes of eradication therapy of conditionally pathogenic microflora, based on microbio-logical monitoring. Vrach-Aspirant. 2016; (4): 49 — 55. [In Russian].

    Full text is published :
    Davydova O.E., Andreev P.S., Katorkin S.E., et al. The value of the wall of the microbiota of the colon in the selection of rational antibiotic therapy in patients with ulcerative colitis. Experimental and Clinical Gastroenterology. 2018;157(9): 51–56. DOI: 10.31146/1682-8658-ecg-157-9-51-56.
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    1. South Ural state medical University (454092, Chelyabinsk, Russia)

    Keywords:comorbidity; multymorbidity; liver cirrhosis

    Abstract:The role of comorbidity in the treatment of liver cirrhosis (LC) and its complications is unknown. Purpose: studying of comorbidity in patients with LC and its impact on outcome of the disease. Materials and methods. 155 patients (women — 49,4%, men — 50,6%, mean age 52,15±12,41) were follow up for 3 year. Viral LC was diagnosed in 33.8%, alcohol LC — 22,1%, autoimmune LC-15, 6%, other causes and cryptogenic causes noted in — 28,5%. More than half of the patients had a class В of Child-Pugh (51.9%). Comorbidity was determined by Charlson and CirCom (Jepsen, 2014) scales. Results: during 3 year of observation 44 people died (28,4%): 33 (75%) patients died from LC complications; 11 (25%) patients died from causes not directly related to LC (4-cancer, 2-diabetes mellitus (DM), 1-trauma, 1-atrial fibrillation, pulmonary embolism-1, stroke-1). 44 patients (28,4%) had no comorbidities. Hypertension was noted at 26.6%, cholelithiasis — 22.1% and DM-14.9%. 41.9% of patients had 1 concomitant disease, 18.7% — 2 diseases, 10.9% — more than three. The number of comorbidities significantly increased the risk of death from causes unrelated to LC (RR: 5,000; 95% CI: 1,426-17, 532). Bilateral positive correlation (rs=0,304, p=0,00012) between the age of patients and the number of comorbidities was revealed. The analysis of the relationship between Charlson and CirCom scales confirmed their correlation at rs=0,543, p=0,0000001. Statistically significant differences of Charlson and CirCom comorbidity were found in groups of patients who died from causes unrelated to LC and lived to the end of the follow-up period (p*=0.000048, p**=0.000243). Conclusion. In patients with LC, comorbidity significantly impacts on mortality from causes unrelated to LC.

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    Full text is published :
    Olevskaya E.R., Dolgushina A.I., Tarasov A.N., Khihkhlova A.O. Comorbidity patients with liver cirrhosis: effect on course and outcome. Experimental and Clinical Gastroenterology. 2018;157(9): 57–63. DOI: 10.31146/1682-8658-ecg-157-9-57-63.
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    1. Kharkiv National Medical University (61022, Kharkiv, Ukraine)

    Keywords: chronic pancreatitis, arterial hypertension, polymorphism of VDR gene, osteoporosis

    Abstract:The aim of the research: to establish diagnostic and prognostic values of chromosomal aberrations in the gene of vitamin D receptors in the combined course of chronic pancreatitis and arterial hypertension. Materials and methods: For this research, two groups of patients were created — the main one — 70 patients with chronic pancreatitis and arterial hypertension and a comparison group — 40 persons with isolated course of chronic pancreatitis. Results: The prevalence of B-allelic polymorphism of this gene was established. The comorbidity of chronic pancreatitis and arterial hypertension in 51.4% of cases occurs against the pathological (ВВ-genotype) polymorphism of the VDR gene, which means early development of complications. With В-allelic polymorphism of the VDR gene, favorable conditions for the development of osteopenic conditions (32.9%) are created, which causes their early diagnosis and treatment.

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    Pasieshvili L.M., Viun T.I. Сhromosome aberration as a possible mechanism of early complications in the combined course of chronic pancreatitis and hypertensive disease. Experimental and Clinical Gastroenterology. 2018;157(9): 64–68. DOI: 10.31146/1682-8658-ecg-157-9-64-68.
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    1. "Izhevsk State Medical Academy" (426034, Izhevsk, Russia)

    Keywords: ulcer disease, chronic duodenal insufficiency, duodenogastric reflux, motor-evacuation function of the stomach and duodenum

    Abstract:The purpose: to study the peculiarities of motor and evacuation functions of the stomach and duodenum in patients with peptic ulcer with associated chronic duodenal insufficiency (СDI). Materials and methods. The complex examination was carried out by 160 patients with ulcer disease (UD) with concomitant CDI (group 1) and 104 patients with no concomitant CDI (2nd group). The verification of UD was carried out by clinical and fibrogastroduodenoscopy studies. In the definition of CDI contrast duodenography and fibrogastroduodenoscopy were used. The evaluation of the motor-evacuation function (MEF) of the stomach and duodenum was carried out with the help of the peripheral electrogastroenterograph. Results of the study. In patients with UD with associated HDI before meals were identified bradygastria (75%) and hypertension (67%) of the stomach, and after eating the parameters of the electrical activity of the stomach in frequency and amplitude were decreased. We revealed hypokinesia (74%) and hypertension (52%) of duodenum on an empty stomach, postprandial frequency of it decreases compared with a thorough examination. The duodenogastric reflux is revealed in the fasting phase of the study. A segmenting and peristaltic contractions of the duodenum are slowed down, which is manifested in a decrease in the evacuation function of stomach and duodenum. Before meals in patients with UD without accompanying HDI were identified hypertension of the stomach (15%) and duodenum (68,95%), after a meal the indices of electrical activity of the stomach and duodenum were increased. In patients with duodenum ulcer of 1 group the electrical activity of duodenum before meals was corresponded to hyperkinetic (98.2%) and hypertensive (62.3%) type of the curve. The eating in patients of this group increases the peristaltic contractions of the longitudinal muscle layer of the duodenum, thereby accelerating the evacuation of the chyme without mixing it and disrupting the digestion process. In patients with duodenal ulcer without accompanying HDI before meals were identified the hypertension of the stomach (15%) and duodenum (68.95%), coordinated work of stomach and duodenum, as well as evacuation of food chyme were preserved. The conclusion. In patients with ulcer disease of stomach and duodenum with accompanying duodenal insufficiency, there was a violation of motor and evacuation activity of the stomach and duodenum both on an empty stomach and after eating, which adversely affects the course of ulcer disease.

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    Full text is published :
    Vahrushev Ya.M., Busygina M.S., Zelenin V.A. The motor and evacuation function of the stomach and duodenum in patients with ulcer deseas with associated chronic duodenal incufficiensy. Experimental and Clinical Gastroenterology. 2018;157(9): 69–75. DOI: 10.31146/1682-8658-ecg-157-9-69-75.
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    1. Saratov State Medical University named after V. I. Razumovsky (410012, Saratov, Russia)

    Keywords: Rheumatoid arthritis, pharmacoepidemiology, adverse events, disease-modifying antirheumatic drugs; glucocorticosteroids, nonsteroidal anti-inflammatory drugs

    Abstract:Aim. Analysis of gastroenterological adverse events of rheumatoid arthritis (RA) pharmacotherapy and measures for their prevention and correction. Materials and methods. An open pharmacoepidemiological prospective study was conducted based on the analysis of 230 medical records of patients with diagnosis of RA in the specialized department. Results of the study. Adverse events from the digestive system were developed in 52,2% patients taking diseasemodifying antirheumatic drugs (DMARDs). The largest number of adverse events were registered for the methotrexate use. The average dose of methotrexate that led to adverse events was 15±7,1 mg per week. Correction of folate deficiency with the use of methotrexate was performed only in 84,4% of patients. NSAIDs-gastropathy was developed in 25,5% cases using of nonsteroidal anti-inflammatory drugs (NSAIDs)/ All patients taking NSAIDs and/or glucocorticosteroids received proton pump inhibitors. Conclusion. For the treatment of RA used DMARDs, NSAIDs, glucocorticosteroids. Adverse events are developing in most patients. Most often adverse events occured from the digestive system.

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    Full text is published :
    Reshetko O.V., Levitan A.I., Suleymanova R.R. Gastrosafety of rheumatoid arthritis pharmacotherapy. Experimental and Clinical Gastroenterology. 2018;157(9): 76–80. DOI: 10.31146/1682-8658-ecg-157-9-76-80.
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    1. Federal State Budgetary Educational Institution of Higher Education “Petrozavodsk State University” (PetrSU) (185910, the Republic of Karelia, Petrozavodsk, Russia)
    2. Institute of Biology of Karelian Research Centre Russian Academy of Sciences (IB KarRC RAS) (185910, the Republic of Karelia, Petrozavodsk, Russia)

    Keywords: non-alcoholic fatty liver disease, hepatic steatosis, apoptosis, cytokeratin-18, tumor necrotic factor-alpha

    Abstract:The aim of the research was to assess the severity of hepatocyte apoptosis in early form of non-alcoholic fatty liver disease (NAFLD) — liver steatosis (LS). Materials and methods. Total of 83 patients of LS were examined: men 42 (50.6%), women — 41 (49.4%) at the age of 52.4 ± 12.3 years. The diagnosis of the LS was established on the basis of clinical, laboratory data, the results of ultrasound liver examination and histological examination of liver biopsy specimens. Blood plasma levels of cytokeratin-18 (CK-18) (apoptosis marker) («TPS ELISA test system», Biotech, Sweden), tumor necrotic factor alpha (TNF-α) («Human TNFα Platinum ELISA test system», "EBioscience", Austria), insulin («Insulin TEST system», USA) were examined by ELISA. The HOMA index, the NAFLD fibrosis score (NAFLD FS) were calculated. The histological activity and fibrosis were evaluated using the Brunt method. Statistics were analyzed using the "StatGraphics 2.1" , using the Mann-Whitney U test, Spearman's rank correlation analysis. Results. High content of CK-18 was found in patients with hepatic steatosis compared with that in healthy individuals — 184.4±64.6 U/l versus 90.1±37.2 U/l (p=0.030). A significant increase of laboratory markers of intrahepatic cholestasis, HOMA-IR, TNF-α, cholesterol, low-density lipoproteins, triglycerides, glucose and NAFLD FS were revealed in patients with liver steatosis relative to the control. The level of CK-18 correlated only with cholesterol in LS — r=+0,70 (p=0,004). Conclusion. An increased CK-18 level of hepatocyte apoptosis marker was detected in an early form of NAFLD — liver steatosis, indicating the risk of progression of this disease. The close relationship between the content of CK-18 and the level of cholesterol in the blood confirmed the role of the latter in the development of hepatocyte apoptosis. Therapy is aimed at arresting hepatocyte apoptosis and normalization of cholesterol levels, appropriate for the earliest form of NAFLD — liver steatosis.

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    Full text is published :
    Dudanova O. P., Shipovskaya A. A., Kurbatova I. V. Apoptosis of hepatocytes in the early form of non-alcoholic fatty liver disease. Experimental and Clinical Gastroenterology. 2018;157(9): 81–85. DOI: 10.31146/1682-8658-ecg-157-9-81-85.
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    1. Federal State Budgetary Institution “Almazov National Medical Research Centre” of the Ministry of Health of the Russian Federation (197341, Saint-Petersburg, Russia)
    2. Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation (197022, Saint-Petersburg, Russia)

    Keywords: Non-alcoholic fatty liver disease, type 2 diabetes mellitus; obesity; adipocytokines; leptin; adiponectin; glucagon-like peptide-1; ghrelin; incretinomimetics; galectin-3, markers of fibrosis: glucagon-like peptide-1 receptors agonists

    Abstract:Therapy of glucagon-like peptide 1 receptors agonists (aGLP1) liraglutide within 24 weeks led to considerable weight reduction, a circle of a waist, HbA1c, TG, AST and increase in HDLP at patients with type 2 diabetes mellitus (2TDM) and multiple manifestations of metabolic syndrome (obesity, dyslipidemia, hypertension) in real clinical practice. Effects of therapy liraglutide on the markers of fibrosis and a scale estimating risk of its progression were ambiguous and depended on various predictors. Decrease in the index of fibrosis on therapy aGLP1 depended on a floor and extent of increase in HDLP. Dynamics galectin-3 depended on weight reduction and its significant decrease is noted only at patients with loss weight ≥ 5%. Initial levels of incretin (GIP and GLP1) acted as predictors of decrease in PIIINP. Further researches on big cohorts of patients with obesity, a metabolic syndrome and 2TDM are necessary for definition of groups of the patients capable it is essential to reduce risk of a progression of fibrosis on therapy aGLP1

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    Babenko A.Yu., Laevskaya M.Yu., Trofimova A.Yu., Simanenkova A.V. et al. Dynamics of markers of hepatic fibrosis on therapy liraglutide at patients with type 2 diabetes mellitus in combination with a metabolic syndrome. Experimental and Clinical Gastroenterology. 2018;157(9): 86–94. DOI: 10.31146/1682-8658-ecg-157-9-86-94.
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    1. Saratov State Medical University named after V. I. Razumovsky (410012, Saratov, Russia)

    Keywords:sarcoidosis, pathology of digestive organs

    Abstract:Methods of retrospective analysis analyzed the case histories of 85 patients that hospitalized in the pulmonology department of the Saratov City Clinical Hospital No.8 in 2015-2017 with sarcoidosis of the intrathoracic lymph nodes and lungs. Pathology of the gastrointestinal tract was detected in 28% of cases. The most frequent disease was chronic gastroduodenitis, in the most cases it was asymptomatic. The revealed pathology of the gastrointestinal tract was not associated with drug therapy of sarcoidosis of the intrathoracic lymph nodes and lungs. Perhaps the described combinations can be considered as a manifestation of the comorbidity of diseases of the gastrointestinal tract and bronchopulmonary system.

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    Full text is published :
    Shapovalova T.G., Shashina M.M., Ryabova A.Yu., Arhangelskaya al. Pathology of digestive organs in group of patients with sarcoidosis: a vision of the pulmonary physician. Experimental and Clinical Gastroenterology. 2018;157(9): 95–100. DOI: 10.31146/1682-8658ecg-157-9-95-100.
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