Objective: to assess the quality of life of patients and the state of the hepatopancreatobiliary system before and after cholecystectomy in the long-term period. Materials and methods: at the first stage, 107 people were examined after emergency, planned cholecystectomy (with symptomatic and asymptomatic course of GI). At the second stage, 90 people at different times after cholecystectomy for a more detailed examination of the external secretory function of the pancreas was performed. Results: the majority of patients, regardless of the type of surgery, had symptoms of dyspepsia associated with the development of functional disorders of the gastrointestinal tract (gastroesophageal reflux, duodenogastric reflux, sphincter Oddi dysfunction). A decrease in the external secretory function of the pancreas was shown regardless of the period after cholecystectomy. Conclusion: after cholecystectomy, functional disorders of the digestive system predominate in the long-term period due to loss of the physiological function of the gallbladder.

The article presents a rare clinical case of Gaucher's disease, a hereditary disease that belongs to lysosomal accumulation diseases. A 36-year-old patient was admitted to the clinic with complaints of pain in the left half of the abdomen, pain in the chest, cough with yellow sputum, difficulty breathing due to pain, general weakness. The mental underdevelopment, hepatosplenomegaly, anemia, thrombocytopenia, and the threat of rupture of the spleen were revealed in the process of collecting anamnesis and examination. The patient was transferred to the surgical department, and a splenectomy was performed. Histological examination of the spleen and genetic examination confirmed the diagnosis of Gaucher's disease.

Gallstones with a zonal morphological structure have been studied using X-ray microtomography, X-ray diffraction analysis, Raman spectroscopy, and elemental analysis. Concrements have been investigated in vitro in the dried state; phases of cholesterol, bilirubin, calcium carbonate, and sodium and potassium chlorides are found in their composition. The analysis is performed within the development of tomographic methods, which can be used in future for intravital diagnostics of cholesterol cholelithiasis. The possibility of determining the phase composition of heterogeneous gallstones, based on the analysis of linear-absorption-coefficient distributions derived from X-ray monochromatic microtomography data, is demonstrated. The results of the tomographic analysis are in agreement with the data obtained using conventional direct methods for determining the phase and elemental composition of the objects under study.

Results are presented from in vitro investigations of gallbladder stones using X-ray microtomography with radiation energy of 17.5 keV. Linear absorption coefficients of gallstones that were obtained in the experiment are compared to corresponding coefficients calculated using reference data for pure cholesterol. The possibility of using X-ray microtomography to investigate the morphological structure of concrements is demonstrated. The stones are found to have cavities and layered formations. The phase composition of the stones is determined via powder diffraction.

The aim. The study of morphology and composition of gallbladder stones in the search for the possibility of differentiation of cholesterol type stones by X-ray tomography technique. Materials and methods. In-vitro investigation of gallstones were performed by the X-ray microtomography, X-ray phase analysis and electron microscopy methods. Results. The phase and element composition of gallstones were determined in our experiments. Cholesterol monohydrate, cholesterol anhydrous and calcium carbonate were discovered in the gallstones composition. 3D-distributions of linear attenuation coefficients of gallstones were obtained from X-ray microtomography measurements. The agreement of experimentally measured linear attenuation coefficients with the calculation based on tabular data for pure cholesterol is demonstrated. The cavities of different morphological structure formed in the process of growth were found in the gallstones. On the basis of X-ray, electron microscopic and optical measurements the possibility of formation of thin layers of bilirubin on the surface of cholesterol stones is demonstrated.

Aim: To develop evidence-based recommendations for primary care physicians and general practitioners (GP) on choosing the proper management tactics and making valuable & quick diagnostic decisions at outpatient phase for patients with symptoms of dyspepsia, and also reveal possible oncology on time. Summary of recommendations: Approximately 40% of the patients in Russia presenting to primary care with symptoms of dyspepsia. A doctor has to focus on the warning signs, which may require an urgent additional examination & the consultation with a surgeon/onco-surgeon or other specialists if required. With regard to a risk of cancer, a doctor should be more cautious in patients over 45 years of age. Early diagnosis of oncology depends mainly on cautiousness of GP, primary care physicians and their knowledge, future tactics with regard to the patients. From the mandatory diagnostic tests during the first visit, esophagogastroduodenoscopy and H. pylori diagnostics helps to exclude any organic esophagus and stomach pathology, possible oncology. While waiting for endoscopy results, a physician should use the preliminary diagnoses “Uninvestigated Dyspepsia” (ICD-10 К 31.9) (disease of stomach and duodenum, unspecified). After exclusion of all warning signs, therapy of dyspepsia should be in accordance to the order of the Ministry of Health No 248 which gives an option to use proton pump inhibitors (omeprazole or rabeprazole 20 mg daily) in combination with prokinetic (domperidone 30 mg daily). Fixed drug combination of omeprazole 20 mg and modified-release domperidone 30 mg/daily (Omez® DSR) is medically reasonable. Conclusion: The introduction of this recommendation into clinical practice will help clinicians to prevent diagnostic mistakes, unreasonable use of expensive diagnostic examinations and inappropriate treatment leads to improvement in the overall prognosis and quality of life for the patients.

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

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.

The article presents the results of a survey of 72 patients who underwent cholecystectomy in 2008-2010. 5 years after cholecystectomy were revealed the changes in the organs of the gastrointestinal tract caused by loss of the physiological function of the gallbladder: half of patients--had increasing fasting blood sugar and duodenal reflux, in 46% of patients--were reduction of pancreatic elastase-1 in stools. According to the fractional duodenal intubation prevails hypersecretory type of bile, 35%--hypotonia, in 45%-- hypertonicity of the sphincter of Oddi. Definition "postcholecystectomical syndrome" should not be limited only to the sphincter of Oddi dysfunction.

Animal Helicobacter species other than Helicobacter pylori are also able to cause human gastritis, gastric ulcers, and MALT lymphomas. Animal Helicobacter species are presented with typical spiral fastidious microorganisms colonizing the gastric mucosa of different animals. Bacteria initially received their provisional name Helicobacter heilmannii, and out of them at least five species colonizing the gastric mucosa of pigs, cats, and dogs were isolated later on. A high proportion of these diseases are shown to be zoonotic. Transmission of pathogens occurs by contact. The factors of bacterial pathogenicity remain little studied.