UNLABELLED:PURPOSE OF A STUDY: To estimate the possibility of applying the complex of the noninvasive methods of investigating the state of the liver for finalizing of the ways of the differentiated pathogenetic therapy.MATERIALS AND METHOD:Over the 2008 to 2013 period was carried out the open comparative study, in which were included 75 patients with non alcoholic steatohepatitis (NASH) and type 2 diabetes mellitus (SD). The Menghini Method of Liver biopsy was carried out for histological study. The FibroMaksTest was used for the to diagnose of inflammatory and necrotic changes, steatosis and fibrosis of the liver. The determination of the stage of the fibrosis of the liver was conducted with the aid of transient elastography. Was performed the calculation of sensitivity (SE), of specificity (Sp) the results of noninvasive methods with respect to the results of the histological examination of the liver.RESULTS:According to the data of FibroMaksTest, for steatosis 1 of degree the sensitivity composed 81,0%, specificity--100%; for steatosis 2 and 3 degrees--100 and 100%. For determining the inflammatory--necrotic changes 1 of degree the sensitivity composed 100%, specificity--96.9%; 2 degrees-- 95.2 and 93.3%, correspondingly, of 3 degrees--81.8 and 100%, respectively. During the estimation of the stage of fibrosis 1 sensitivity was 85.4%, specificity--94.4%, respectively; 2 stages--94.1 and 97.1%, respectively; 3 stages--90 and 100%, respectively. During the estimation of the stage of fibrosis by the method of transient elastography of the liver for the degree of fibrosis F1 the sensitivity composed 83.8%, specificity 93.8%; for F it is 2nd 87.5 and 98.6%, respectively; F3-87.5 and 100%, respectively.CONCLUSION:The results of the noninvasive methods of diagnostics of the state of parenchyma of the liver in patient with NASG (transient elastography and the FibroMaksTest) are compared with the data of histological studies, that they make it possible to enlarge the possibilities of the morphological interpretation of the defeat of the liver in patients with SD of 2 types.

Results of multicenter study "Efficacy of Lansoptol (lansoprazole, KRKA) and its influence on the Dynamics of GERD symptoms" (LIEDER) are presented. The impact of 56-days treatment with lansoprazole 30 mg once daily on symptoms relief, a quality of life of 121 patients with gastroesophageal reflux disease (GERD) and healing of esophageal lesions of 30 patients with reflux esophagitis were investigated. Rapid acid inhibition effect of first dose of lansoptol was shown by 48-hr pH-monitoring. At the first day of the treatment 43.1% of patients reported decreasing of intensity of heartburn and 36.5%--of regurgitation. It were shown that the treatment with lansoptol provided symptoms relief in 25% patients at day 3, in 50% of patients at day 5 and in 75% at day 8 for heartburn, and at days 2, 6 and 9--for regurgitation. It was conducted improvement of quality of life. Healing rate of esophagitis at 28 day was 83.3%.

Retrospective analysis of 3D-reconstruction of ultrasound images is discussed with reference to the diagnosis of pancreatic disorders, such as pseudotumorous pancreatitis and pancreatic head neoplasm, based on the data extracted from case records collected in the Central Clinical Hospital No 1, OJSC RZhD, for the period of 2004-2008. In addition, comparative analysis is presented of different beam diagnostics methods for the examination of hepatobiliary system (classical ultrasound, 3D-reconstruction of ultrasound images, CT, endoscopic techniques, e.g. retrograde cholangiopancreatography). Control group comprised 20 patients without signs of gastrointestinal pathology, group 2 included 24 patients with pseudotumorous pancreatitis, group 3 54 patients with pancreatic head neoplasm (up to 3 cm). It was shown that 3D-images facilitate detection of pathologic processes in the pancreas. Minimal slice thickness permits to visualize small objects, segmentation of irregularly shaped tumorous foci and their volume. This method gives better idea of the relationship between the tumour and other tissues and vessels than other diagnostic tools and thereby makes easier the choice of treatment strategy and prognosis of its outcome. Also, it improves the quality of information about arterial and venous circulation and permits to differentiate between benign and malignant tumours.

Four hundred and twenty-three patients with chronic diffuse hepatic diseases (hepatitis and viral hepatic cirrhosis) underwent complex clinico-instrumental examination; the control group consisted of 30 healthy individuals. Hepatic encephalopathy syndrome was a much more frequent finding in patients with hepatic cirrhosis. Association of chronic viral hepatic lesion with alcohol abuse increased the frequency of latent central nervous system lesions.

Proton pump inhibitors (PPI) are efficient for ex juvantibus diagnostics of non-coronary chest pain (NCCP) of gastroesophageal reflux origin as well as for its course treatment. The aim of this randomized cross-over study was to compare the efficiency of rabeprasol and omeprasol as means of both diagnostics and long-term treatment. In rabeprasol group the symptoms disappeared more quickly, and the maximum effect was achieved by day three, while in omeprasol group the best results were achieved only by day six (p < or = 0.05). The sensitivity and specificity of rabeprasol test was 81.6% and 80.6%, respectively, while those of omeprasol test were 73.5% and 77.4%, respectively. By the end of the 12th week of treatment pain syndrome had been completely or partly coped with in 92% of rabeprasol patients, and 76% of omeprazol patients (p < 0.05). Thus, response to rabeprasol takes place twice as quick as response to omeprasol, which makes it possible to shorten the time of NCCP diagnostics. Furthermore, rabeprasol test is more sensitive and specific. Course treatment with high doses of PPI increase the number of patients with eliminated pain syndrome, and rabeprasol here is more efficient than omeprasol.

The paper reviews current treatments of acid-dependent diseases. The role of hydrochloric acid hypersecretion in pathogenesis of some gastroduodenal diseases is shown. Efficacy of antisecretory drugs from different groups is compared.

AIM:To assess efficiency of esomeprazole in the treatment of duodenal ulcer (DU) associated with H. pylori in various eradication regimens.MATERIAL AND METHODS:80 patients with duodenal ulcer at least 0.5 cm in diameter were randomized into three groups. 23 patients of group 1, 28 patients of group 2 received esomeprazole for 7 days in a dose 20 mg twice a day, in a single morning dose 40 mg, respectively. 29 patients of group 3 received omeprazole 20 mg twice a day for 7 days and further 3 weeks 20 mg twice a day. All the patients were also given amoxicillin 1000 mg twice a day and clarithromycin 500 mg twice a day for a week.RESULTS:An antisecretory effect of esomeprazole as shown by 24-h monitoring of gastric secretion was longer and more stable than that of omeprazole: a latent period averaged 1.5 +/- 0.6 h in a pharmacological test with 20 mg esomeprazole, 1.2 +/- 0.4 h in intake of 40 mg esomeprazole and 2.1 +/- 0.3 h in intake of 20 mg omeprazole. Overall duration of the antisecretory effect averaged 16.8 +/- 1.9, 20.3 +/- 1.7 and 12.5 +/- 1.9 h, respectively. The time of intragastric pH > 4 was 13.1 +/- 1.6, 17.2 +/- 1.6 and 9.8 +/- 1.5 hours, respectively. Eradication of H. pylori in group 1, 2 and 3 was 91.3, 89.3 and 89.6%, respectively. Complete epithelization of ulcer occurred in 95.6, 92.8 and 93.1% cases, respectively. In 77 patients who finished the treatment according to the protocol the treatment resulted in eradication in 95.6, 92.5 and 92.8%, respectively; in epithelization--in 100, 96.3 and 96.4% patients of groups 1, 2 and 3, respectively. Side effects were mild or moderate but not causing changes of the regimen or treatment discontinuation.CONCLUSION:Esomeprazole in three-component treatment was highly effective in eradication of H. pylori and epithelisation of duodenal ulcer defects in various regimens of administration. Esomeprazole in combination with amoxicillin and clarithromycin reduces the time of treatment of DU associated with H. pylori to 1 week without further monotherapy with antisecretory drugs.

The article deals with side effects of present-day antihelicobacter therapy including side effects of some drugs with antisecretory and antibacterial action and complications observed in using combined treatment of helicobacteriosis (triple and quadrotherapy).

Combined therapy with gepa-merz (L-ornitine-L-aspartate) and lactulose (a synthetic disaccharide) was given to 40 patients with hepatic encephalopathy and toxic hepatic cirrhosis in decompensation. Combination of gepa-merz with lactulose was effective in the above patients. Moreover, it is an optimal one as it has a double impact on ammonia toxicity which is a basic neurotoxin in pathogenesis of hepatic encephalopathy.

Each patient with ulcer has his/her own 24-h biorhythm of acid production, features of food alkalization, duration of duodenogastric and gastroesophageal reflux. Pharmacological test conducted in prolonged 24-h pH-metry helps to select the most effective antisecretory drug, while analysis of 24-h biorhythm of acid production--optimal time for drug intake and number of its daily doses.

Data are submitted on the condition of haemodynamics of greater and lesser circulation in patients with ischemic heart disease (IHD) presenting with the bundle-branch block. On the basis of the results from a combined clinical-instrumental investigation involving electro- and echocardiography the authors present the early objective quantitative criteria for the diagnosis of those haemodynamic shifts occurring in formation of the bundle-branch block. The blockade of the left bundle of His has a more pronounced effect on the greater circulation haemodynamics while that of the right one--on the lesser circulation. The authors give a comparative assessment of haemodynamic effects of a single dose of isosorbide dindtrate and nifedinin in the patients. Nitrosorbide and corinfar improve contractility of the left ventricle, decrease pulmonary hypertension and overloading of the right side of the heart.

Values for the function of external respiration are submitted as are hemodynamic indices in patients with chronic obstructive bronchitis concurrent with arterial hypertension, who had not only been administered antimicrobial, anti-inflammatory and bronchoispasmolytic therapies but also received hypotensive agents in different doses. Effects of the latter on results of a multimodality treatment were studied.