Aim of investigation. Clinical and endoscopical investigation of the large intestine in patients of senile age with chronic constipation and estimation of rational treatment.Material and methods. Overall 287 senile patients with chronic constipation were included in original study (mean age 79±2,7). Complex investigation included videocolonoscopy and choosing of drug for rational therapy.Results. It was revealed, that digestive and endocrine diseases are most common in this group of patients. At endoscopic investigation diverticulosis and polyposis coli were the most frequent findings. All patients have tolerated investigation well, no complications have developed. Restoration of regular defecations on a background of lactulose (Duphalac) intake was accompanied by disappearance of feeling of incomplete defecation and necessity of intensive straining effort at defecation.Conclusions. In senile patients chronic constipation is widespread functional disorder, which does not exclude, however, endoscopic control. The age of the patient is not a limiting factor for colonoscopy. Lactulose (Duphalac) is an optimal pharmaceutical with high efficacy.

Aim. The guidelines set out the modern methods of diagnostics and treatment of peptic ulcer and are created for gastroenterologists, primary care physicians, general practitioners, surgeons, endoscopists.Key points. The clinical guidelines contain modern views on the etiology and pathogenesis of peptic ulcer, its clinical features, methods of laboratory and instrumental diagnostics, the main approaches to conservative and surgical treatment. They include the criteria for assessment of the quality of medical care, the algorithm of the doctor's actions, as well as information for the patient.Conclusion. Knowledge of modern methods of diagnostics and therapy of peptic ulcers will contribute to improving the results of its treatment.

Aim. These clinical recommendations present up-to-date methods for the diagnosis and treatment of peptic ulcer. The recommendations are intended for gastroenterologists and general practitioners.General provisions. Peptic ulcer (PU) represents a chronic relapsing disease occurring with alternating periods of exacerbation and remission. The main manifestation of the disease is the formation of a defect (ulcer) in the wall of the stomach and duodenum. Most cases of peptic ulcer are pathogenetically associated with the infection of H. pylori. PU can be an independent disease or represent symptomatic ulcers of the stomach and duodenum (medicinal, as a result of stress or endocrine pathologies, associated with chronic diseases of internal organs). In the absence of contraindications, esophagogastroduodenoscopy is recommended for all patients with suspected ulcer with the purpose of confirming the diagnosis. In order to determine indications for eradication therapy, all ulcer patients should be tested for the presence of H. pylori using a 13C-breath test or a stool antigen test. In the case of simultaneous endoscopy, rapid urease test can be used. For the prevention of subsequent relapses of ulcer, all PU patients with confirmed H. pylori should undergo eradication therapy. In addition, in order to achieve ulcer healing, 4–6 week antisecretory therapy with proton pump inhibitors is recommended. Clinical recommendations contain criteria for assessing the quality of medical care, an algorithm of the doctor’s actions, as well as information for patients.Conclusions. These clinical recommendations present modern ideas about the etiology and pathogenesis of peptic ulcer disease, its clinical manifestations, methods of laboratory and instrumental diagnostics and basic approaches to conservative and surgical treatment.

The multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group (EHMSG) is conducted in 27 countries in Europe. The data from the Russian part of the European registry for the management of Helicobacter pylori infection (European Registry on the management of Helicobacter pylori infection, protocol: “Hp-EuReg”) allows us to analyze the real clinical practice of diagnosis and treatment of H. pylori and compare it with international recommendations. Materials and methods. A comparative analysis of the data entered in the register by the Russian research centers “Hp-EuReg”, in the period from 2013 to 2018, was conducted. Results and discussion. Invasive diagnostic methods prevail for the primary diagnosis of H. pylori [histology - 20.3% (in 2013 year) - 43.9% (in 2018 year), rapid urease test - 31.7% and 47.8% respectively]. The most popular mode of eradication therapy is a 10-day triple therapy (62.8-76.2%), the effectiveness of which does not exceed 79% (per protocol). Invasive tests (histology) are the leading method for control the effectiveness of therapy, however, there is a tendency towards a wider use of non-invasive methods (H. pylori stool antigen - from 17% in 2013 to 29.3% in 2018 and urea breath test from 6.9 to 18.3%, respectively). Serological test to control the effectiveness of eradication is still used from 8.2% (2013) to 6.1% (2018). Eradication therapy was not performed in 28% of patients throughout the entire observation period. Conclusion. In Russia, despite approved domestic and international recommendations, deviations in clinical practice persist, both during eradication therapy and in monitoring the effectiveness of eradication therapy.

In the article are collected “gastronomic” Russian- and the English-speaking medical metaphors connected with digestive system. Terms are grouped on nozologic and organic sign. The diseases having “gastronomic” symptoms are shortly outlined.

Chronic constipation remains a current issue in clinical medicine. The publication presents the results of an open non-comparative observational study of the efficacy and safety of the Zajecicka horka' mineral water on functional constipation. The study included 31 patients with functional constipation. All patients were treated with sulfate-magnesium mineral water in a dose of 100 ml for 15 days. After the end of treatment, a statistically significant decrease in the main symptoms of functional constipation was recorded: rare bowel movement, form of stool, straining during bowel movement, a feeling of incomplete defecation. 74.2% of patients rated the effectiveness of mineral water as good. Thus, magnesium-sulfate mineral water can be prescribed as a first-line therapy in the treatment of functional constipation.

On behalf of the scientific Committee and researchers Hp-EuReg European Registry on the management of Helicobacter pylori infection («Hp-EuReg») - a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group, conducted in 27 European countries in order to evaluate the real clinical practice of diagnosis and treatment of H. pylori and its comparison with international recommendations. Materials and methods. The analysis of 2360 patients entered in the register by the Russian centres of «Hp-EuReg» in 2013-2017, who were underwent 1st line eradication therapy. Results. The most common methods of primary diagnosis of H. pylori are histological (37.7%), rapid urease test (29.2%) and serology (29.7%). The duration of eradication therapy in 9.4% of cases was 7 days, in 65.3% - 10 days, and in 25.3% - 14 days. To control the effectiveness of treatment, H. pylori antigen in feces (31.3%), urea breath test (23.4%) and histological method (23.3%) were used. In 3.6% cases was used serology by mistake. In 17.3% of patients control was not carried out. The effectiveness of triple therapy with a PPI, amoxicillin, clarithromycin (per protocol) was 67.6%, with 7-day course, 81.1% at 10-day and 86.7% at 14-day course. Еradication rate of triple therapy with addition of bismuth (per protocol) reached 90,6% in the group receiving 10-day scheme and 93.6% in the group receiving the 14-day treatment. Conclusion. Significant deviations of clinical practice from expert recommendations, most pronounced at the stage of monitoring the effectiveness of therapy, were noted. The suboptimal efficacy of triple therapy is shown.

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

Aim of the study. To investigate the effect of Helicobacter pylori infection on pregnancy and its outcome. Material and methods. An observational study involving 200 pregnant women divided into 3 groups. The first group included 100 women suffering from diseases associated with H. pylori, in the second - 50 pregnant women with digestive diseases, but H. pylori negative, a third - 50 healthy women. Results. It has been shown that women infected with H. pylori, significantly more likely to have the non-developing pregnancy in history, higher duration and severity of early toxicity, the frequency and severity of anemia in pregnant women, as well as the incidence of vaginal candidiasis. However, the presence of H. pylori had no effect on outcome of pregnancy, fetal development and weight and neonatal growth indicators.

The study included 31 patients aged 18 to 50 years (mean age 35.8 years) with functional constipation. Of these, 25.8 % of males and 74.2 % of women. The diagnosis was established according to the clinical picture of the Rome IV criteria. All patients there was no “alarm symptoms”. When performing a colonoscopy or barium enema revealed no important pathology of the colon. All patients for 15 days was prescribed mineral water “Zayechickaya Gorkaya” in a dose of 100 ml for the night. Overall, 74.2 % of patients evaluated the effectiveness of mineral water “Zayechickaya Gorkaya“ as “well”, 16,1 % - “satisfactory” and 9.7 % was not fully achieved effect. On a background of reception of mineral water “Zayechickaya Gorkaya“ there were no significant adverse reactions. 29 % of patients reported periodic appearance of mild diarrhea, but only two of them described it as a negative phenomenon. Course reception natural high mineral sulphate-magnesium water “Zayechickaya Gorkaya“ leads to statistically significant decrease of the main symptoms of functional constipation. Most patients appreciate the laxative effect of mineral water as “good”. While no significant adverse reactions. The use of mineral water “Zayechickaya Gorkaya“ can be the first-line treatment therapy for functional constipation prior to use of laxatives, and if necessary, perhaps in combination with them.

Aim. To assess the clinical practice of diagnosis and treatment in patients with Helicobacter pylori infection and to compare this practice with the international guidelines in the European Registry on the management of Helicobacter pylori infection, Hp-EuReg protocol), a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group.Materials and methods. The data of 813 patients infected with H. pylori and entered in the Hp-EuReg register by the Russian centers in 2013-2015 were analyzed.Results. The most common methods for the primary diagnosis of H. pylori infection are histology (40.3%), rapid urease test (35.7%), and serology (17.2%). The duration of H. pylori eradication therapy was 7, 10, and 14 days in 18.0, 49.3, and 25.1%, respectively. To monitor the effectiveness of treatment, the investigators used a histological examination (34%), a urea breath test (27.3%), H. pylori stool antigen (22.8%), and a rapid urease test (16.3%). A serological test was carried out in 2.5% of the cases. No monitoring was done in 13.5% of the patients. The average eradication efficiency was 82.6%. If the therapy was ineffective, 80% of physicians did not intend to prescribe a new cycle of treatment.Conclusion. Significant differences were found between clinical practice and the current guidelines.

Diverticulosis of distal parts of a small intestine is a rare and difficultly diagnosed disease. This pathology usually is asymptomatic, and the first clinical manifestations oftenly testify the development of complications. The leading seat in the diagnosis of diverticulosis is borrowed with beam investigative techniques: ultrasonography, barium enterography, CT or MRI.In this article a brief review of clinics and possibilities of instrumental diagnosis of diverticulosis of small intestine is presented and illustrated by clinical case of a patient with large jejunoileal diverticulosis.

Резюме Цель исследования. Оценка клинической практики диагностики и лечения больных с инфекцией Helicobacter pylori и сопоставление этой практики с международными рекомендациями в Европейском регистре (European Registry on the management of Helicobacter pylori infection, протокол: «Hp-EuReg») — наблюдательном многоцентровом проспективном исследовании, инициированном Европейской группой по изучению H. pylori и микробиоты (EHMSG). Материалы и методы. Проведен анализ данных 813 больных, инфицированных H. pylori и внесенных в регистр Российскими центрами исследования «Hp-EuReg» в 2013—2015 гг. Результаты. Наиболее распространенными методами первичной диагностики инфекции H. pylori являются гистологический (40,3%), быстрый уреазный тест (35,7%) и серологический (17,2%). Длительность антихеликобактерной терапии в 18% случаев составила 7 дней, в 49,3% — 10 дней, в 25,1% — 14 дней. Для контроля эффективности лечения используются гистологический метод (34%), уреазный дыхательный тест (27,3%), антиген H. pylori в кале (22,8%), быстрый уреазный тест (16,3%). В 2,5% случаев использовался серологический метод. У 13,5% больных контроль не проводился. Средняя эффективность эрадикации составила 82,6%; 80% врачей в случае неэффективности терапии не намерены назначать новый курс лечения. Заключение. Выявлены значительные отличия клинической практики от современных рекомендаций.

This work is based on the analysis of data doing 409 patients with polyps in the stomach. Among them 200 men (48.9%) and 209 women (51.1%) aged 18 to 91 years. The average age of men was 67.4 years, and women 66.8 years. All these patients were find 1034 neoplasms of various sizes. At all of this patients polyps were identified on a background of chronic gastritis, as a rule, has the character of atrophic process. Histological research was conducted 775 (74.6%) polyps, of which focal hyperplasia and hyperplastic polyps detected in 49% of cases, and adenomas in 51% (including adenomas with varying degrees of dyspiasia, and prostatic adenocarcinoma cells). Endoscopic polypectomy performed 367 patients, and the remaining 42 was merely the dynamic monitoring of the identified entities. In 79 (28.8%) patients after polypectomy noted relapse formations and in 10 cases (3.65%) diagnosed with cancer in the intervention area. 4 (0.98%) patients from 409 cancer in polyps detected during the initial survey and in 4 patients the cancer originated in the not associated with polyps of stomach. As a result of the research of the dependence of the size of neoplasms on the nature of destruction and histological structure. For most existing polyps characteristic of the stability of their morphological structure and the absence of its transformation.

This article discusses features of drug therapy of digestive diseases in women during pregnancy. A detailed analysis of the most frequently used groups of drugs with possible teratogenic or fetotoxic actions and the results of clinical trials are presented.