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.

Purpose: To study the micro-topography of the abdominal wall of the esophagus and give it a quantitative characterization of tumor pathology of the esophagus. Methods: The study was performed using morphological methods: 1 anatomical dissection; 2 gistotopographical method with coloring of gistotopogramms with hematoxylin-eosin and Van Gieson; 3 Morphometry of macro and microstructures of the esophagus. Operating studied material from 15 patients who over the tumor lesion was performed resection of the lower third of the esophagus and the upper part of the stomach. Operations were carried out on the basis of the thoracic department of the Orenburg Regional Clinical Oncology Center (ORCOC). Results: This article describes the features of the morphological changes in the abdominal wall of the esophagus at its two forms of tumor lesions: in squamous cell carcinoma and in adenocarcinoma. For adenocarcinoma and squamous cell carcinoma is characterized by a different type of growth, a different degree of sprouting layers of the esophageal wall, different propensity to metastasize within the wall of the esophagus. Submucosa of the esophagus is the main layer in which there are significant changes in neoplastic lesions of the esophagus, both within tumor and in adjacent areas of the esophageal wall. Conclusion: The common involvement of submucosa of the abdominal esophagus in the pathological process in its malignant lesions (up to 5 cm in our study) should be considered when determining the upper limit of esophageal resection.

PURPOSE To study the micro-topography of the abdominal wall of the esophagus and give it a quantitative characterization of tumor pathology of the esophagus. METHODS The study was performed using morphological methods: 1 anatomical dissection; 2 gistotopographical method with coloring of gistotopogramms with hematoxylin-eosin and Van Gieson; 3 Morphometry of macro and microstructures of the esophagus. Operating studied material from 15 patients who over the tumor lesion was performed resection of the lower third of the esophagus and the upper part of the stomach. Operations were carried out on the basis of the thoracic department of the Orenburg Regional Clinical Oncology Center (ORCOC). RESULTS This article describes the features of the morphological changes in the abdominal wall of the esophagus at its two forms of tumor lesions: in squamous cell carcinoma and in adenocarcinoma. For adenocarcinoma and squamous cell carcinoma is characterized by a different type of growth, a different degree of sprouting layers of the esophageal wall, different propensity to metastasize within the wall of the esophagus. Submucosa of the esophagus is the main layer in which there are significant changes in neoplastic lesions of the esophagus, both within tumor and in adjacent areas of the esophageal wall. CONCLUSION The common involvement of submucosa of the abdominal esophagus in the pathological process in its malignant lesions (up to 5 cm in our study) should be considered when determining the upper limit of esophageal resection.