Cardiomyotomy (in particular, oral endoscopic cardiomyotomy) is the most effective method of treating achalasia of the esophagus cardiac part, however, in some cases patient complaints persist or symptoms relapsed. This conditioned the need to perform the complex examination of a patient for the correct diagnostics of this disease, prognose assessment and treatment tactics determination as well as the identification of the causes of the persistence or resumption of clinical manifestations after surgical treatment.

Bronchial asthma, chronic cough, laryngitis, erosion of tooth enamel are attributed to extra esophageal manifestations of gastroesophageal reflux disease (GERD). This form of GERD is characterized by the difficulty of establishing the diagnosis and high frequency of ineffective therapy. The article describes the main endoscopic signs of damage to the esophagus and larynx, presents normal pH-impedance reflux monitoring and criteria for pathological reflux into the esophagus and the lower third of the pharynx, as well as the possibilities of additional diagnostic methods – esophageal manometry and pepsin test. Treatment of patients with extra esophageal manifestations of GERD is a difficult task; the results of randomized placebo-controlled studies are contradictory. At the same time, empirical therapy is most effective in patients whose extra esophageal symptoms are combined with typical ones

The literature review summarizes modern ideas about the pathogenesis of dumping syndrome, a pathological condition that occurs after gastric resection. Presented the principles of detecting and correcting of the manifestations of dumping syndrome, which allow improving postoperative rehabilitation and ensuring the acceptable quality of life for patients.

Achalasia is a chronic neuromuscular disorder of esophagus with supposed autoimmunity, genetic disturbancies and viral infection. The disease is characterized by poor relaxation of lower esophageal sphincter and absent of body peristalsis. The inflammation, eosinophilic and lymphocytic infiltration may play role in loss of inhibitory ganglion in the myenteric plexus. High resolution manometry is a gold standard for diagnosis of achalasia, because it distinguish three types of disorder. The aim of treatment of achalasia is to reduce symptoms, such as dysphagia. The most effective modality of surgical treatment are Heller myotomy and peroral endoscopy myotomy. The pneumodilation is less preferable because of short-term effect and high rate of relapse. The relapse after surgical treatment can be present and correlates increase with the time after intervention

Objective: to evaluate the benefits of co-administration of the esophagoprotector Alfazox and the proton pump inhibitor (PPI) for the relief of symptoms and epithelialization of esophageal mucosal erosions in patients with gastroesophageal reflux disease (GERD). Material and methods. 40 patients with GERD with reflux esophagitis were examined. Patients were randomized into two groups: 19 patients of the first group (8 men and 11 women, age 48,0 [39,0;60,5] years) received combination therapy: pantoprazole 40 mg per day and Alfazox 10 ml four times a day; 21 patients from the second group (13 men and 8 women, age 47,0 [33,0; 64,0] years) received pantoprazole 40 mg per day. The duration of therapy was 28 days. The dynamics of the frequency and severity of symptoms of the disease were evaluated on the Likert scale. According to the EGDS data, the effectiveness of the treatment of erosive esophagitis was evaluated. Results. The advantages in reducing the severity of symptoms in the first group were noted. On the first day of combined treatment, heartburn was stopped in 64% of patients (χ2 p < 0.05). By the fourth day of treatment in this group, heartburn persisted in 11% of patients and in 42% of patients receiving pantoprazole monotherapy (χ2 p < 0.05). Combination therapy was more effective in reducing the severity and frequency of belching and dysphagia (Wilcoxon p < 0.01, χ2 p < 0.05). Against the background of combined therapy, endoscopic remission of reflux esophagitis was achieved in all patients, and erosion of the esophageal mucosa persisted in 25% of patients in the control group (χ2 p = 0.033). Conclusions. The study showed the advantages of combination therapy (PPI + Alfazox) both in achieving the symptomatic response and in improving the endoscopic picture in patients with erosive reflux esophagitis.

AIM To comparatively analyze clinical manifestations in patients with primary esophageal spasm (ES) and its concurrence with gastroesophageal reflux disease (GERD) and the results of their instrumental examinations and psychodiagnostic tests. SUBJECTS AND METHODS A total of 104 patients with the clinical and manometric signs of ES were examined and divided into two groups: 1) 42 patients with primary ES; 2) 62 patients with ES concurrent with GERD. The examination encompassed esophageal manometry, esophagogastroduodenoscopy, 24-hour pH metry, and an interview using a questionnaire to identify autonomic disorders, and the Mini-Mult test. RESULTS The patients with primary ES compared to those with ES concurrent with GERD significantly more frequently showed severe pain syndrome (p = 0.009) and a paradoxical dysphagia pattern (p = 0.03); manometry revealed an incoordination in the motility of the entire esophagus (p = 0.001). Comparison of the statistical series of values for contraction amplitude and duration in the distal esophagus found no significant difference in the patients of both groups. Autonomic disturbances were detected in 76.0% of the patients with ES; but the intergroup differences were insignificant. Mental maladaptation was observed in 81.7% of the patients in the absence of intergroup differences. CONCLUSION The etiopathogenetic factor of ES is a psychoautonomic response to chronic stress in both primary ES and its concurrence with GERD. The reflux of gastric contents into the esophagus does not appear to be one of the leading causes of ES. In primary ES, esophageal motor function is generally impaired to a much greater extent than that in ES concurrent with GERD. The degree of motor disorders is embodied in the specific clinical features of the disease.

Aim of investigation. To estimate advantages of combined intake of proton pump inhibitor (PPI) and alginate in comparison to monotherapy by PPI in terms of symptom relief in the first days of gastroesophageal reflux disease (GERD) treatment.Material and methods. Overall 96 patients with GERD were investigated. All patients complained of heartburn, 41 patients had regurgitation. Symptoms were estimated by Likert scale prior to onset of therapy and daily during treatment course. General well-being was evaluated by visual-analog scale (VAS) prior to therapy, at the 7th and 14th days of treatment. The first group (46 patients, 19 males, mean age — 50,2±12,7 years) received combined therapy by pantoprazole 40 mg/day and alginate (Gaviscon DD) 20 ml qid at the 1st and 2nd days of treatment followed by «on demand» mode. The second group (50 patients, 22 males, mean age 51,3±14,4 year) received pantoprazole 40 mg per day. All patients underwent esophagogastroduodenoscopy.Results. At the 1st day of treatment heartburn has been completely relived in 61% of patients of the first group and in 14% — of the second (р<0,001), at the 2nd day — in 63% and 20% (р<0,001). At the 3rd day (alginate in «on demand» mode) the heartburn was absent in 48% of patients of the first group and in 44% — of the second (р=0,8). Regurgitation at the 1st day of treatment was relieved in 78% of patients of the first group and remained in all patients of the second group, who initially complained of it (р<0,001), at the 2nd day it stopped in 83% and 22% of patients respectively (р<0,001), at the 3rd day — in 67% and 22% (р=0,01). After the 4th day there were no intergroup differences. At the 7th day of treatment according to VAS wellbeing score in the first group increased from 57,3±9,7 to 78,1±11,2 mm (р <0,001), in the second — from 54,9±14,9 to 67,0±15,2 mm (р<0,001). The intergroup differences of the score at the 7th day was statistically significant (р<0,001). By the 14th day difference disappeared (78,8±9,7 mm vs 75,6±12,5 mm, р=0,1).Conclusions. This study has demonstrated advantages of the combined therapy in the first days of GERD treatment in decreased terms relief of symptoms and improvement of state of health.

The paper presents a clinical case of complicated gastroesophageal reflux disease (GERD) and describes problems in the differential diagnosis of malignant esophageal lesion in patients with GERD and a treatment modality used in this clinical case.

Aim. To reveal the specific features of pancreatogenic diabetes mellitus (DM) and to discuss the principles of its medical therapy.Subjects and methods. Sixty-six patients (55 men and 11 women) aged 30 to 65 years with chronic pancreatitis (CP) were examined. The disease was accompanied with pancreatic calcification and cyst formation in 22 and 13 patients, respectively; 5 patients were found to have a pseudotumorous form of CP and 10 had clinically and laboratorily verified DM. 14 resections and 11 drainages for complicated CP were performed. Its diagnosis was established on the basis of clinical, instrumental, and laboratory findings. Pancreatic exocrine function was evaluated from the results of the C-13-trioctanain breath test (BT) that is designed for its in vivo diagnosis. The level of C-peptide was studied by an enzyme immunoassay.Results. The findings suggest that pancreatic exocrine function is diminished in CP patients both with and without complications as compared with the normal value in 44% (24.3 +/- 1.7 and 26.6 +/- 1.3%, respectively), as shown by BT. According to the results of BT, a substantial decrease in the total proportion of a released label was noted in patients with CP and pancreatic calcification, diabetes mellitus, after resection operations for complications of CP and there were also significant differences, as compared to a group of CP patients without complications. In these patient groups, the level of C-peptide fell to a larger extent than that in CP patients without complications and in patients with CP and DM it was decreased to 0.11 +/- 0.02 ng/ml, the normal level being 0.7-1.9 ng/ml. There was a direct correlation between C-peptide levels and BT results in the patients with CP after resection operations. Insulin antibodies were absent in all the examined patients with CP, which proves the specific type of DM in CP. These are detectable only in type 1 DM. Seven patients with CP and DM were found to have calcification, 5 underwent resection operations, 3 had calcification and underwent pancreatic resection operations.Conclusion. The development of DM may be predicted in CP patients with formation of pancreatic calcification and resections. In these patients, pancreatic exocrine dysfunction achieves a severe degree.

The aim of the study was to compare the level of nitric oxide to clinical and laboratory criteria for acute CP, and indicators of oxidative stress in CP. A total of 129 patients with CP (96 males and 33 females), mean age 46,9 +/- 9,2 years, were distributed to the groups with uncomplicated and complicated course. A study of nitric oxide in the blood as an additional criterion for acute CP. Found it significantly increased in patients with CP compared with control values. The content of nitric oxide in the blood during uncomplicated CP was 149,07 +/- 15,4 umol/l, with complicated course increased to 211,5 +/- 17,7 umol/l, which is significantly higher than that in uncomplicated CP (p = 0,042). A significant increase of NO level in the amplification of pain intensity (10-point analogue scale), and also obtained a direct correlation between these criteria (r = 0,69, p = 0,01). Received a significant increase in levels of nitric oxide with an increase in pancreas head size, revealed a direct correlation between these parameters (r = 0,59, p = 0,04). The obtained results allowed using nitric oxide as a criterion of acute HP. For diagnostic levels of nitric oxide made its rise above 120 mmol/liter. Sensitivity and specificity improvement of nitric oxide above 120 umol/L were 97% and 57% respectively when compared with the pain syndrome and 42% and 62% respectively when compared to pancreas head size. Were studied AAO and MDA indices. A significant increase in MDA (t = 2,58, p = 0,012), indicating that activation of LPO. There was a significant increase of MDA in the amplification of the intensity of pain, and also obtained a direct correlation between these criteria (r = 0,30, p = 0,03). Identified a direct correlation between levels of MDA and nitric oxide (r = 0,63, p = 0,01). Study of the level of nitric oxide can be used as an additional criterion of exacerbation of CP. In patients with CP enhanced LPO processes, as evidenced by the increase of MDA in patients with high levels of nitric oxide in the blood. Growth of LP may be an additional pathophysiological factor amplifying damaged pancreas.

In order to identify features of the course pancreatic diabetes and discussion of the principles of conservative therapy were examined 66 patients with CP in age of 30 to 65 years (55 men, 11 women). Among them in 22 cases disease was followed with formation of calcification of pancreas, 13 - pancreatic cysts, and 5 revealed pseudo tumor form of CP, 10 patients had clinical and laboratory evidence of diabetes. Concerning CP complicated course were performed 14 resection and 11 draining operations on the pancreas. Based on clinical, instrumental and laboratory data was made the diagnosis of CP. Exocrine pancreatic function was assessed on the results of the breath test, using 13C-trioktanaine, which is applied for exocrine pancreatic function in vivo test. The content of C-peptide was investigated by enzyme-linked immunosorbent assay (ELISA). The data indicate pancreatic exocrine function decrease in patients with CP with complications and without complications in compare with the norm of 44% (24,3 +/- 1,7, 26,6 +/- 1,3%, respectively) according to the breath test. Significant decrease of the cumulative output tags based on the test data of patients with CP and pancreatic calcification, diabetes mellitus, after resection surgery with CP complications, and there were significant differences in compare with a group of patients with CP without complications (p = 0.5). The level of C-peptide in these groups of patients decreased significantly in compare with a group of patients with CP without complications, and patients with CP and Diabetes was reduced to 0,11 +/- 0,02 ng/ml, at a rate range of 0.7-1.9 ng/ml, ie below the minimum values of norm. Obtained a direct correlation between the level of C-peptide and indicators breath test in patients after resection HP (r = 0,84, p = 0,03). Antibodies to insulin in the whole group of studied patients CPs were negative, which proves the specific type of Diabetes at HP. Antibodies to insulin can be detected only at diabetes type 1. In 7 patients with CP and CD detected calcification, 5 patients performed resection surgery, 3 patients had calcification and conducted the pancreas resection. Thus, we can conclude that in patients with CP and formation of pancreas calcification, pancreas resections may predict the development of diabetes.