Objective — to evaluate histological lesions of the esophageal mucosa in patients with gastroesophageal reflux disease in combination with arterial hypertension.
Materials and methods. The study included 89 patients with gastroesophageal reflux disease and 126 patients with GERD in combination with arterial hypertension, mean age was (41.99 ± 1.57) and (55.92 ± 0.91) years, respectively. The histological investigations were performed on the biopsies, obtained at the video-endoscopy of the distal esophageal mucosa. The specimens were stained with hematoxylin and eosin. The investigations were performed on the mucosa specimens from the esophagus with esophagitis signs and compared them with the intact esophageal mucosa. The normal esophageal epithelium (control group) was defined as the absence of visible erosions at endoscopy and no basal cell hyperplasia, elongated papillae or cellular infiltrates on histological examination.
Results. The frequency of erosive reflux esophagitis in patients with comorbidity is higher than in patients with isolated gastroesophageal reflux disease (p < 0.05). Both groups were characterized by basal cell hyperplasia, elongation of the lamina propria papillae with vascular congestion, dilated intercellular spaces, focal or diffuse infiltration of the epithelium by polymorphonuclear leucocytes, and manifested hyperkeratosis, proliferation of basal cells and acanthosis. This change could represent a mucosal reaction towards recovery of the epithelial barrier. Morphometric study revealed a significant increase in the thickness of the basal layer of the epithelium and the papillae height both at isolated GERD, and at comorbidity compared to control (p < 0.05). Increasing in the basal layer of the esophageal mucosa epithelium thickness is less pronounced in comorbid patients compared with isolated pathology. Hyperplasia of the basal layer of the epithelium, the elongation of papillae, parakeratosis, acanthosis and neutrophilic infiltration found in both groups, with almost the same frequency. Vascular lesions (irregular hypertrophy of the muscular layer, focal sclerosis, hyalinosis and narrowing of the arteries), ectasia of venules, formation of perivascular hemorrhage; swelling and degeneration of the epithelium are more prevalent in the mucosa of comorbid patients compared to isolated gastroesophageal reflux disease (p < 0.05).
Conclusions. Combination of GERD and arterial hypertension resulted in the morphological and histological disorders in the esophageal mucosa, that may be associated with the pathogenetical causes of arterial hypertension, hypoxia and endothelial dysfunction.

Keywords: gastroesophageal reflux disease, arterial hypertension, esophageal mucosa, histological and morphometric analysis.

Objective — to study some indexes of the lipid metabolism in patients with acute edematous pancreatitis depending on the genes IL-4 (C-590T), TNF-α (G-308A), PRSS1 (R122H), SPINK1 (N34S) and CFTR (delF508C) polymorphisms.
Materials and methods. Genetic studies have been performed for 123 patients with edematous pancreatitis, among whom were 23 (18.7 %) women and 100 (81.3 %) men. The control group consisted of 40 healthy age- and gender-matched subjects. Gene PRSS1 (R122H) was investigated in 123 patients, CFTR (delF508) and IL-4 (C-590T) — in 101, SPINK1 (N34S) — in 63, TNF-α (G-308A) — in 11. Genes polymorphism was studied with the method of PCR using oligonucleotide primers company Metabion (Germany). The research of the lipids included the determination of the levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) and Apolipoprotein (Apo) B using the reagents of the firm «Thermo Fisher Scientific» (Finland), and calculation atherogenic index (AI).
Results. А pronounced dyslipidemia was revealed in the most part of patients. In NN genotype carriers of the gene CFTR (delF508) higher levels of TC, HDL-C and LDL-C were determined, while NM genotype carriers had the highest levels of TG, Apo B and AI. In the GG genotype carriers of the gene PRSS1 (R122H) significantly increased indexes of the TC, HDL-C, LDL-C and uncertain — TG, Apo B and AI. In the TT-genotype carriers of the gene IL-4 (C-590T) were observed higher levels of TC, HDL-C and LDL-C, while in the owners of the C-allele — higher content of TG, Apo B and AI. By GG genotype of the gene TNF-α (G-308A) were higher levels of TC, HDL-C and LDL-C compared with GA-genotype carriers in which have been higher TG, Apo B and AI.
Conclusions. The course of edematous pancreatitis was accompanied by significant dyslipidemic changes that had no clear correlation with the polymorphic variants of the gene CFTR (delF508) (hypercholesterolemia in the NN-genotype owners, hypertriglyceridemia — in NM carriers) gene PRSS1 (R122H) (more significant hypercholesterolemia in patients with GG-genotype, p < 0.01), IL-4 gene (C-590T) (increase of the TC by LDL-C in the TT-genotype owners) and TNF-α (G-308A) (hypercholesterolemia in GG- carriers hypertriglyceridemia — in persons with GA-variant).

Keywords: pancreatitis, polymorphism, lipids, gene, CFTR (delF508), PRSS1 (R122H), IL-4 (C-590T), TNF-α (G-308A).

The article presents data on the intestinal microbiota in the norm and at the irritable bowel syndrome (IBS). Modern approaches have been considered to the investigation of the role of intestinal microbiota at IBS, and clinical recommendation given for the module correction of intestinal microbiota at IBS, in particular with the use of antibiotics, probiotics and prebiotics. The results of own investigation have been presented, that showed the high clinical and microbiological efficacy of the probiotic, containing Saccharomyces boulardii CNCM I-745, in the IBS treatment.

Keywords: irritable bowel syndrome, intestinal dysbiosis, bacterial overgrowth syndrome, probiotics, Saccharomyces boulardii CNCM I-745.

Acute gastrointestinal bleeding (АGIB) is a dangerous complication of the peptic ulcer disease and non steroidal anti-inflammatory drug-associated gastro pathology. The clinical picture depends on the intensity of bleeding and accompanying pathology. The main АGIB reasons are peptic ulcers, Mallory-Weiss lesions, erosive gastritis, reflux esophagitis. The diagnosis and optimal treatment requires the risk stratification. Endoscopy gives the possibility of not only reveal the localization of the bleeding site, but also to use a variety of therapeutic measures, such as injection therapy and thermoscoagulation. Therapy with proton pump inhibitors contributes to the acid suppression, being highly effective at АGIB. The patients with peptic ulcer and chronic gastritis should undergo H. pylori tests, and in case of the infection exposure, should be administered. Patients under АGIB risk have to discontinue NSAID therapy whenever possible. If not, then cyclooxygenase-2 inhibitors in combination of PPIs must be the therapy of choice. Such a technique is aasociated with the lowest bleeding risk, however the incidence of the cardiovascular events can be increased, this the choice of therapy must be performed on the individual basis.

Keywords: ulcers, gastrointestinal bleeding, Helicobacter pylori, NSAID-associated gastropathy, proton pump inhibitors, omeprazole, Оmez.

Proton pump inhibitors are the drugs of choice for the treatment of acid-related diseases. Rabeprazole is a drug with strong evidence-based effectiveness and safety, but its therapeutic potential is not adequately appreciated by the Ukrainian clinicians. The paper presents a review of the literature, including a detailed description of the peculiarities of rabeprazole pharmacological properties, its clinical efficacy and safety in comparison with other proton pump inhibitors. Special attention is paid to the differences of mainly non-enzymatic metabolism of rabeprazole, and hence it’s low potential for the inter-medication interactions. The information has been presented as regards its gastroprotective properties and other pleiotropic effects on the upper gastrointestinal motility, the direct anti-helicobacter effect. The detailed characteristics have been given for the rabeprazole preparation Rabimak (MacLeods Pharmaceuticals), which meets the modern requirements to the generic drugs.

Keywords: acid-dependent diseases, treatment, proton pump inhibitor, rabeprazole.

The article present literature review and results of own investigations (50 patients with acid-related peptic esophago-gastroduodenal diseases) with the use of gastric рН-monitoring to assess acid-inhibiting actions of pantoprazole (Zolopent), pharmacokinetics, clinical efficacy and safety of its use in comparison with omeprazole, lansoprazole and omeprazole. Based on own data, the acid-inhibiting pantoprazole action exceeds that of omeprazole, lansoprazole and esomeprazole. acid-inhibiting рantoprazole action depends not only on the peculiarities of its acting substance, but from other factors (bio availability, clinical group of the investigated subjects: healthy volunteers, patients with gastroesophageal disease, H. pylori infection, pharmacokinetics of the enzymes of cytochrome Р450 system with presence of the ethnic-dependent metabolism type from rapid to slow etc.). The clinical efficacy and safety profile of pantoprazole meets the modern standards of treatment of acid-related peptic esophago-gastroduodenal diseases, including disorders associated with H. pylori eradication. The considerable рantoprazole advantage over other PPIs lays in the possibility of its use in the complex therapy, for example in geriatric cardiology. Pantoprazole in combination with clopidogrel, in contrast to оmeprazole, doesn’t threaten drugs interactions with slowdown of anti-aggregate action of clopidogrel resulting from the low Pantoprazole affinity to the enzymes of cytochrome Р450 system.

Keywords: pantoprazole, pharmacokinetics, acid-inhibiting action, клиническая clinical efficacy, safety profile.

Objective — to study Betargin effects on the structural and functional state of erythrocytes, lipids and homocysteine  blood levels in patients with nonalcoholic steatohepatitis (NASH).
Materials and methods. Investigation involved 50 patients with NASH against the background of abdominal syndrome, from them 29 (58 %) women, and 21 (42 %) men with the mean age 38 to 60 years. Anthropometric, clinical laboratory, biochemical studies, ultrasound of the abdominal cavity have been conducted.
Results. The following changes of structural and functional state of erythrocytes were revealed before the treatment in patients with NASH: reduction of the deformation index, aggregation index, relative contact hemolysis, intensity of red blood cells and glucose utilization, the decrease of the in erythrocyte ATP levels and erythrocytes resistance to the peroxidation, and increase of the relative viscosity of erythrocyte suspension (p < 0.001), indicating the microcirculatory disorders. After the treatment, patients of the main group demonstrated considerable improvement of the structural and functional erythrocytes’ status. Thus, one of the most important indicators deformation index, characterizing the ability of erythrocytes to change their form with the purpose of oxygen transport to the terminal parts of the microvasculature, increased in 1.7 times in patients of the main group after 4 months of treatment (p < 0.001). Treatment with the Betargin contributed to the improvement of structural and functional indicators of erythrocytes. The relative viscosity of erythrocyte suspension reduced in 2.1 times, aggregation index increased in 1.9 times, the relative contact hemolysis increased in 1.6 times, ATP in 1.9 times. Moreover, the intensity of glucose metabolism in erythrocytes and resistance to the peroxidation increased (р < 0.001), and positive dynamics of the blood lipid spectrum enhanced (р < 0.001).
Conclusions. The study revealed positive effects of Betargin on the lipid metabolism, homocysteine  blood levels, as well as on the structural-functional state of erythrocytes.

Keywords: Betargin, L-arginine, betaine, nonalcoholic steatohepatitis, erythrocyte, lipids, homocysteine.

Objective — to evaluate effects of Hepaval (L-glutathione) on the state of gastric mucosa and course of non-alcoholic steatohepatitis (NASH) after Helicobacter pylori eradication in patients with type 2diabetes mellitus (DM 2).
Materials and methods. This open comparative study included 84 patients with DM 2 (39 men and 45 women) with a mean age of 53.8 ± 7.6 years. Rapid urease test and a stool antigen test were used to determine H. pylori infection in each patient. Quadruple therapy was administered for 14 days. After eradication therapy, patients were randomized into two groups, each of42 patients: subjects from the main group received Hepaval 2 caps. twice a day in addition to basic therapy (basic group 1) for six weeks, while 42 patients received only basic therapy (comparative group 2).
The upper endoscopy, morphological study of gastric biopsy specimens (semiquantitative evaluation of composition and degree of infiltration of gastric mucosa, the total volume density of the microvasculature); liver sonographic parameters (size, degree of steatosis) and the degree of liver fibrosis, according to RTE-elastography; liver enzymes were evaluated before and after the treatment period.
Results. In both groups, the successful eradication of H. pylori resulted in the reduction of inflammation endoscopic signs, the healing stomach and duodenal ulcers, the epithelialization of gastroduodenal erosions, accompanied with improved histology of gastric mucosa, reduction of gastritis activity degree. With this, patients of the maingroup 1, administered Hepaval, demonstratedmore significant improvement, while dysmotility of upper gastrointestinal tract and gastroduodenal mucosal defects were revealed in patients from comparison group. In both groups, significant (p < 0.001) reduction in inflammatory cell infiltration was found. However, these indices were significantly better (p < 0.05) in the main group, while in comparison group 2 more significant inflammatory infiltration of gastric mucosa, degenerative and necrotic changes in epithelial cells with the presence of multiple cases of gastroduodenal erosions were still present after the bacteria elimination. The manifestations of atrophic changes of the stomach mucosa, intestinal metaplasia, microvasculature condition, hepatomegaly, steatosis (1 — 2 degree), fibrosis (F0-F2) were not statistically different before and after treatment. At the same time, the normalization of transaminases was indicated in the main group 1 after 6 week treatment with Hepaval. In the comparison group 2, serum aminotransferase levels were not statistically different at the end of treatment period and significantly (p < 0.05) differed from group 1 patients.
Conclusions. Based on the data of endoscopy and morphological studies, Hepaval (L-glutathione) contributed to more rapid recovery of the natural state of gastroduodenal mucosa during regression of Helicobacter pylori-induced gastritis. The inclusion of Hepaval in the basic therapy resulted in the fast normalization of liver enzymes at NASH. Hepaval did not cause seriousside effects, requiring drug discontinuation, and was well tolerated. The additional Hepaval (L-glutathione) inclusionin the complex therapy of patients with type 2 DM is pathogeneticallyjustifiedby its effects in eliminating metabolic disorders in gastroduodenal mucosa and liver.

Keywords: diabetes mellitus type 2, non-alcoholic fatty liver disease, steatohepatitis, Hepaval, L-glutathione, gastroduodenal mucosa.

The modern schemes without oral interferon provide the achievement of sustained virological response (SVR) in 90 % of cases, and can reduce the duration of treatment to 12 weeks for the majority of patients with chronic hepatitis C, for both non-treated and treated patients. A plenty of combinations of antiviral drugs with the direct action exist, that can help achieving the optimal balance of the therapeutic efficacy and safety. Each of these schemes can be modified according to different parameters. The application of combinations based on sofosbuvir is advisable for patients, infected with hepatitis C virus (HCV) of 1 — 6 genotypes. Its efficacy, confirmed in the clinical trials, was combined with the high safety profile, it resulted in the shortening of treatment duration and achieving of patients’ recovery.

Keywords: chronic viral hepatitis C, sustained virological response, sofosbuvir, efficiency, safety.

Ulcerative colitis (UC) represents a widespread disease. The article deals with the modern methods of UC treatment with the use of aminosalicylates, corticosteroids, immunosuppressive drugs and biological therapy, but most of the standard therapeutic approaches to the treatment of patients with UC are ineffective. The author present data from controlled trials of safety and efficacy of new bioactive molecules (adhesion molecules inhibitors,anti-cytokines, immunosuppressive agents) in the treatment of refractory forms of disease.

Keywords: ulcerative colitis, treatment, aminosalicylates, corticosteroids, immunosuppressive, tumour necrosis factor alpha monoclonal antibody, adhesion molecules inhibitors.

The article presents consideration of the peculiarities of the atypical forms of GERD course. For the primary differential diagnosis patients with bronchopulmonary symptoms, the use of two-week test with proton pump inhibitors (nolpaza 40mg) is recommended. In the case of chest pain, further patient’s examination is advisable to exclude the coronary disease. For the patients with refractory GERD, triple the dose of PPIs is proposed together with replacement of the former drug by another one with a different type of metabolism. Theseclinical examples allow us to recommend an individualized approach to the treatment of the atypical and refractory forms of GERD.

Keywords: atypical and refractory forms of the gastroesophageal reflux disease, clinics, diagnosis, treatment, proton pump inhibitors.