In 129 patients with DGER-associated GERD, aged 18-76 years, the presence and severity of phenotypic and visceral signs СTD were recorded using the original screening kit, which detects them in adult patients. Dysplastic-dependent phenotype was diagnosed in 59 people (15 men and 44 women), absence of signs of CTD - in 70 (27 men and 43 women). Among the phenotypic signs of CTD in patients with GERD predominate musculocutaneous (47,9%), osteoarticular (27,5%) and cranial (18,5%). Among visceral symptoms dominated cardia insufficiency (57,6%), hiatal hernia (HH) (54,2%), the structure anomalies of gallbladder (39,0%). Regardless of the sex of patients, the severity of CTD was moderate. Chance of developing DGER-associated GERD, in patients with dysplastic-dependent phenotype was 3,7 times higher compared with individuals with no evidence of CTD in the presence of HH; 1,4-1,6 times - with cardia insufficiency, abnormal forms of gallbladder and their combination; 4,3 times - with combination of HH and an abnormal forms of gallbladder. In the adult population of patients with DGER-associated GERD in 45,7% of cases it occurs on the background of the high frequency of phenotypic and visceral manifestations of CTD. Visceral manifestations (HH, cardia insufficiency, abnormal forms of the gallbladder, and others) at high frequency of phenotypic signs appear predictors of GERD associated with DGER.

Протокол № 2, Приложение 2 УТВЕРЖДЕНЫ XVI Съездом НОГР Москва, 24-25 ноября 2016 г. Президент НОГР д.м.н., проф. Л. Б. Лазебник

Aim. The study of the qualitative and quantitative characteristics of microbiocenosis of the oral cavity and esophagogastroduodenal zone in patients with gastroesophageal reflux disease (GERD), associated with duodenogastroesophageal reflux (DGER) as a manifestation of biliary pathology. Materials and methods. In 83 GERD patients with symptoms of reflux esophagitis and DGER we studied the microbial landscape of the oral fluid and biopsy samples from visually unaltered sections of the mucosa of the lower third of the esophagus, antrum and duodenum by the classical bacteriological methods. Results. Biopsy specimens from the esophagogastroduodenal zone mucosa in patients with GERD indicated high content of staphylococci (92 %) and streptococci (85 %) in amount of from 4,8 to 6,1 lg CFU/g. Bacteria of the Enterobacteriaceae family were defined in 61 % of cases in an amount of 3,1-5,4 lg CFU/g. Fungi of the genus Candida were detected in 59 % of the samples in the amount of 10 4 -10 7 CFU. Bacteria characterized by cytotoxic, hemolytic and lecithinase activity were often detected in comparison with healthy people. Conclusion. The study revealed pathological microbiocenosis of upper gastrointestinal tract with opportunistic pathogens presence with factors of pathogen and cytotoxicity in patients with GERD associated with DGER, that define chronic inflammatory changes in the mucous membranes.

1Moscow Clinical Research-and-Practical Center, Moscow Healthcare Department, Moscow; 2A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 3Children’s Health Research Center, Ministry of Health of Russia, Moscow; 4I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg; 5M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow; 6Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 7Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk; 8Russian Children’s Clinical Hospital, Moscow; 9Department of Pediatrics, Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 10I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint Petersburg; 11Acad. Yu.E. Veltishchev Research Clinical Institute of Pediatrics, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow; 12Clinic Four, Department of Pediatrics, I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint Petersburg; 13Childhood Diseases Department Two, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow; 14Research Laboratory of Surgical Gastroenterology and Endoscopy, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow; 15Department of Endoscopic Surgery, City Clinical Hospital Thirty-One, Moscow Healthcare Department, Moscow; 16A.N. Ryzhikh State Research Center of Coloproctology, Ministry of Health of Russia, Moscow; 17Department of Intermediate-Level Therapy, Tver State Medical University, Ministry of Health of Russia, Tver; 18Laboratory of Medical Genetics, Diagnostic Center of Medical Genetics, Saint Petersburg; 19HLA Typing Laboratory, Blood Transfusion Station, Moscow Healthcare Department, Moscow; 20S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow; 21Department of Nervous System Diseases, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow; 22Department of Endocrinology and Diabetology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 23Acad. V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow; 24Department of Therapy, Kazan State Medical Academy, Ministry of Health of Russia, Kazan; 25Department of Intermediate-Level Therapy with Course of Occupational Diseases, Faculty of General Medicine, Omsk State Medical University, Ministry of Health of Russia, Omsk; 26Dmitry Rogachev Federal Research Clinical Center of Pediatric Hematology, Oncology, and Immunology, Ministry of Health of Russia, Moscow The paper presents the All-Russian consensus on the diagnosis and treatment of celiac disease in children and adults, which has been elaborated by leading experts, such as gastroenterologists and pediatricians of Russia on the basis of the existing Russian and international guidelines. The consensus approved at the 42nd Annual Scientific Session of the Central Research Institute of Gastroenterology on Principles of Evidence-Based Medicine into Clinical Practice (March 2—3, 2016). The consensus is intended for practitioners engaged in the management and treatment of patients with celiac disease. Evidence for the main provisions of the consensus was sought in electronic databases. In making recommendations, the main source was the publications included in the Cochrane Library, EMBASE, MEDLINE, and PubMed. The search depth was 10 years. Recommendations in the preliminary version were reviewed by independent experts. Voting was done by the Delphic polling system.

Аннотация В статье изложен Всероссийский консенсус по диагностике и лечению целиакии у детей и взрослых, разработанный ведущими экспертами — гастроэнтерологами и педиатрами России на основе существующих отечественных и зарубежных рекомендаций. Консенсус утвержден на 42-й ежегодной Научной сессии ЦНИИГ «Принципы доказательной медицины в клиническую практику» (2—3 марта 2016 г.). Консенсус предназначен для практикующих врачей, осуществляющих ведение и лечение больных целиакией. Поиск доказательств основных положений консенсуса проводился в электронных базах данных. При составлении рекомендаций основным источником являлись публикации, вошедшие в Кохрейновскую библиотеку, базы данных EMBASE, MEDLINE и PubMed. Глубина поиска — 10 лет. Рекомендации в предварительной версии рецензированы независимыми экспертами. Голосование проводилось по Дельфийской системе.

AIM:To study the specific features of the clinical course of gastroesophageal reflux disease (GERD) associated with duodenogastroesophageal reflux (DGER) in patients with chronic acalculous cholecystitis (CAC) and cholelithiasis (CL), as well as qualitative and quantitative characteristics.SUBJECTS AND METHODS:The clinical, morphological, motor tonic characteristics of the esophagogastroduodenal area, mucosal microbial biocenosis in the esophagus, stomach, and duodenum were studied in detail in 83 patients with GERD that was associated with DGER and ran concurrently with CAC or CL.RESULTS:Impaired duodenal propulsive activity as a concomitance of the signs of gastrostasis and duodenal dyskinesia with dyscoordination of both anthroduodenal and duodenojejunal propulsion and with the development of duodenogastric reflux and DGER, which in turn determine esophageal and gastric pH values is shown to be of importance in CAC and CL, which match GERD. Abnormal microbiocenosis in the upper digestive tract is characterized by the higher quantitative and qualitative content of the mucous microflora. Opportunistic microorganisms exhibit cytotoxic, hemolytic, lecithinase, caseinolytic, urease, and RNAase activities.CONCLUSION:The found specific features of the course of GERD associated with DGER in patients with biliary tract abnormalities lead us to search for novel therapeutic approaches based on the correction of digestive motor tonic disorders and abnormal microbiocenoses of the mucous flora in the esophagus, stomach, and duodenum.

AIM:To investigate the phenotypic and visceral signs of connective tissue dysplasia (CTD) and comorbid diseases of the digestive system in gastroesophageal reflux disease (GERD) patients with different types of esophageal reflux as the predictors of its variants.MATERIAL AND METHODS:In 124 patients with GERD the clinical features, phenotypic and visceral signs of undifferentiated CTD were studied in details.RESULTS:In 82.0% of patients with GERD associated with gastroesophageal type of reflux (GER) phenotypic and especially visceral signs of STD were detected, mainly in the form of cardiochalasia and hiatal hernia. In patients with duodenogastroesophageal reflux symptoms (DGER) the signs of STD were marked in 42.0% of cases, mostly in the form of biliary tract structure abnormalities. The risk of GERD associated with prevalence of GER, was 11.9 times higher in the presence of diagnostically meaningful combination of 6 or more signs of STD than in patients with DGER. Realization of predictor options in GER occurs in the preference of sharp, acidic foods, spices, taking medications that reduce lower esophageal sphincter tone. GERD, associated with DGER, is formed in patients with family history of diseases of the biliary tract and in the preference of food rich of calories.CONCLUSION:Study of STD symptoms as predictors of structural development of GERD and its variants is prospective to predict disease, choice of profession and eating behavior, primarily in young adults.

Aim. To study the clinical and pathogenetic types of gastroesophageal reflux disease (GERD) in terms of different types of reflux into the esophagus, their risk factors and predictors.Materials and methods. The clinical, morphological, motor tonic characteristics of the esophagogastroduodenal area, the phenotypic and visceral signs of existing undifferentiated connective tissue dysplasias (UDCTD), and the suprasegmental and segmental autonomic apparatus were studied in detail in 124 patients with GERD.Results. Two clinical and pathogenetic types of GERD associated with the predominance of gastroesophageal or duodenogastroesophageal refluxes (GER and DGER) are identified. The type of the disease running in the predominance of GER develops in subjects with the high rate of visceral stigmas of UDCTD - cardiac failure and hiatal hernias, sympathetic autonomic tone in the digestive system. The feeding preference of piquant and spicy dishes and spices serves to realize the predictors of this type. The DGER-associated type develops in subjects with a concurrence of sympathetic and parasympathetic total autonomic tones in the digestive system in the presence of preexisting biliary tract diseases, including abnormalities in the structure of the gallbladder as visceral signs of UDCTD and it is realized in the feeding preference of high-calorie dishes.Conclusion. It is promising to study the autonomic status and the signs of UDCTD as structural and functional predictors of GERD and its types for the prediction of the disease, professional orientation, and the acquisition of eating behavior primarily in young people.

Endoscopical and histological features of oesophagogastroduodenal zone, parameters of pH-metry and electrogastroenterography, qualitative and quantitative characteristics of microbiocenosis were studied in 80 female persons with postcholecystectomy syndrome more then a year after cholecystectomy. In the presence of duodenogastral reflux the most natural is the combination of distal oesophagitis, antral atrophic gastritis and duodenitis, accompanied with low level of gastric acidity, gastric hypokinesis and duodenal dyskinesis, dysbacteriosis of mucosal microflora with its quantitative increase and appearance of bacteria with expressed pathogenicity non-typical for this biotope. These data should be taken into consideration for determination of pre- and postoperative treatment tactics for patients with gallstones.

Was conducted a muIticenter study VIA APIA, in which the impact of gaviscon forte (suspension) on symptoms, general state and quality of life of 148 patients (male 53, female 95, age 42.9 +/- 15.6) with gastroesophageal reflux disease (GERD) were investigated. The patients had undergone clinical evaluation of dynamics of GERD symptoms (Likert scale), general state (Visual Analogue Scale, questionnaire SAN) and quality of life (SF-36). It was shown that 14-days treatment with gaviscon forte provided symptoms relief in 84.5% patients and conducted improvement of general state and quality of life. Gaviscon forte recommended as drug of choice in initial treatment for the first time visited patient with heartburn before endoscopy and for pathogenetic treatment of typical reflux syndrome.

Examination of morphological features, clinical symptoms and psychological status in 114 patients with endoscopically positive type of gastro-oesophageal reflux disease (GERD) revealed that intensity of heartburn depends on the extent of inflammatory and erosive changes in the oesophageal mucous membrane. It has an effect on the emotional sphere of patients and contributes the development of depression, anxiety and phobia tendencies with psychical disadaptation, somnolent disorders and the decrease of the quality of life. These data must be interpreted within the conception of pathogenesis of GERD and the individual methods of its prevention, treatment and reablement.

Aim. To evaluate specific features of the course of chronic gastritis (CG), morphofunctional condition of gastric mucosa, vegetative regulation, adrenergic and cholinergic shifts, histamine metabolism and effects of exogenic and endogenic risk factors in CG patients; to study clinicopathogenetic variants of CG. Material and methods. A total of 311 CG patients aged from 16 to 72 years were studied. They were divided into three groups by their gastric mucosa condition. The control group consisted of 30 healthy donors. The following parameters were studied: visual and histological condition of gastric mucosa, total acidity, the levels of free hydrochloric acid, pepsin, bioelectric gastric activity, general autonomic tonicity, cholinesterase activity. Results. Three clinicopathogenetic variants of the disease have been identified. Variant 1 was characterized by a recurrent course, subjective manifestation of the disease only in exacerbation, surface (primarily antral) mucosal affection, normal or enhanced secretory and motor functions of the stomach, adequate reaction of acid production to caffeine and histamine stimulation, parasympathicotonia, absolute hyperhistaminemia, relative hypoacetylcholinemia, subnormal urinary excretion of adrenalin. Variant 2 manifested with rare recurrences, longer and more severe exacerbations, frequent spontaneous and provoked aggravations, moderate focal atrophy of the mucosa, secretory insufficiency with adequate reaction to histamine and minor to caffeine stimuli, hypomotor gastric dyskinesia, vegetative eutonia, normohistaminemia, absolute hypoacetylcholinemia, subnormal urinary excretion of noradrenaline. Variant 3 runs without definite remissions and exacerbations, with continuous abdominal pain and dyspepsia, frequent spontaneous aggravations, marked extended mucosal atrophy with secretory insufficiency up to achlorhydria, no stimulation of acid production in response to caffeine and histamine, gastric hypomotility, sympathicotonia, absolute hypohistaminemia, hypoacetylcholinemia, normal urinary excretion of catecholamines. Conclusion. The findings expand our knowledge about clinicopathogenetic variants of CG and necessitate new approaches to development of effective methods of CG prevention and treatment.

Complex examination of 311 patients with chronic gastritis allows to differentiate three clinical types of this disease. The first type is characterized by superficial mucous disorders with constant or increased secretory function and motility of the stomach. It has relapsing course with moderate decrease of patient's life quality. The abdominal pains and dyspepsia are observed only at periods of exacerbation. Anxiety-phobic and anxiety-depressive tendencies prevail in the mental status. The attitude to illness differs mainly by emotional-willed disorders. Insomnia is manifested by a slight delay in awakening. Focal atrophic gastritis with moderate decrease in secretory and motor functions of the stomach is typical for the second type. It develops as relapsing or monotonous suffering with insignificant decrease in patient's life quality. The pains and dyspepsia in residual state persist after exacerbation reduction. The changes in the mental status are rare. The patient's attitude to the illness is basically adequate. Slight disturbances of falling asleep prevail among sleep disorders. Diffuse atrophic gastritis with secretory failure reaching the degree of an achlorhydria and hypokinesis of stomach are observed in the third type. The course of the disease is basically monotonous with pronounced decrease in patient's life quality, with the obstinate abdominal pains and dyspepsia irrespective of the exacerbation phases of chronic gastritis. A combination of asthenic and neurotic complaints and combined sleep disorders are typical. Emotional disorders with disharmonization of personality accompanied by signs of their social and mental disadaptation are observed in the patient's mental status.

Examination of 118 patients with various morphofunctional types of chronic gastritis for quality of life (QL) and personal attitude (PA) to the disease has revealed that in non-atrophic gastritis QL deteriorates moderately because of the diet, diagnostic procedures and treatment. PA is anxious, neurastenic, sensitive and hypochondriac; in focal atrophic gastritis QL is the same but PA is less negative, primarily adequate; in diffuse atrophic gastritis there are the worst trends in QL because of the disease, abnormal physical activity and routine life, PA is hypochondric, melancholic, neurastenic and egocentric. Thus, therapeutic policy in various morphofunctional types of chronic gastritis should account for personality reactions of the patients and deterioration of life quality. This allows maintenance of social and medical adaptation of the patients, development of adequate mechanisms of psychological defence, adequate treatment compliance.