Objective — to study the relationship between the plasma concentrations of apelin, tumour necrosis factor-α (TNF-α) and levels of fecal pancreatic elastase-1 in patients with chronic pancreatitis (CP), type 2 diabetes mellitus (DM 2) and their combination.
Materials and methods. The investigation involved 49 patients (22 men and 27 women, mean age 56.77 ± 1.79 years) with CP, type 2 DM and their combination. The control group included of 20 healthy individuals.
Results. The significant correlation was established between apelin and TNF-α levels, and reverse correlation between apelin and fecal pancreatic elastase-1 levels. The increased levels of these adipocytokines, along with the deterioration of the exocrine function of the pancreas were founded.
Conclusions.Hyperadipocytokinemia and itsrelationship with the indicators of the pancreas functional state may affect progression of the pathological process in the pancreas, that gives the opportunity to regard these indicators as markers of remodelling of the pancreas at CP against the background of type 2 DM.

Keywords: chronic pancreatitis, type 2 diabetes mellitus, apelin, TNF-α, elastase-1.

Objective — to investigate in the dynamics the L-carnitine levels and indices of oxidative stress in patients with non-alcoholic fatty liver disease (NAFLD) under the influence of Hepadif preparation.
Materials and methods. Observations involved 40 patients aged 23 to 67 years (the mean age — (47.88 ± 11.48) years), with NAFLD diagnosis. Form them, 22 (55 %) women and 18 (45 %) women. The patients were administered complex therapy with the use of Hepadif in a dose of 2capsules three times a day(457.2 mg of carnitine). The treatment duration was 1 month. The therapy efficacy was assessed based on the dynamics of clinical symptoms and biochemical indices of liver tests in blood serum (alaninaminotransferase, aspartataminotransferase, lipid profile), and blood levels of L-carnitine and lipid peroxidation parameters.
Results. At admission, the prevalence of dyspeptic complaints was reveled in 38 (95 %) patients. Based on the data of ultrasonic examinations,liver steatosis of 3rddegree was defined in 19 (47.5 %) patients, of the 2nd degree in 16 (40 %) subjects, and of the 1st degree in 5 (12.5 %) patients. The hepatomegaly was revealed almost in all patients: 39 (97.5 %). The cytolysis syndrome, dyslipidemia, carnitine insufficiency was observed in all patients. The normalization of indices of the cytolysis syndrome and lipid profile, as well as positive dynamics of biochemical indices were defined after the treatment; L-carnitine deficit was removed in all patients.
Conclusions. Therapy with the use of Hepadif had the positive effects on the disease clinical course, promoted removal of L-carnitine insufficiency and normalization of the lipid peroxide system, render the immune corrective and antioxidative effects.

Keywords: carnitine insufficiency, non-alcoholic fatty liver disease, Hepadif.

Objective — to evaluate the effects of H. pylori infection on the course of ischemic heart disease (IHD) combined with type 2 diabetes mellitus (DM2) based on the investigation of the clinical and laboratory parameters and Helicobacter pylori seropositivity.
Materials and methods. The study included 82 patients with verified ischemic heart disease (IHD) combined with type DM2, with/without evidence of H. pylori infection (HP). The mean patients’ age was 53.3 ± 9.2 years. Patients were divided into 2 groups: the I group consisted of 42 HP-seropositive patients with IHD and DM2, and the II group included HP-seronegative patients (n = 40). In all patients with clinically established diagnosis, the clinical and anamnesis data were studied, levels of blood glucose, glycosylated hemoglobin (HbA1c), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and triglycerides (TG) in serum were measured with colorimetric enzymatic method on biochemical analyzer. The concentration of C-reactive protein, insulin, and the titre of IgG antibodies to H. pylori were studied by enzyme immunoassay (EIA).
Results. Stable angina of I — III functional classes was established in the majority of patients, and 45.1 % of patients have had the evidence of myocardial infarction. Patients from the II group less frequently suffered from hypertension, obesity, type 2 diabetes and chronic pancreatitis. There was a different incidence of gastroduodenal pathology in the two groups with a predominance of higher frequency in patients with the history of myocardial infarction. Chronic gastritis with duration of 24.7 ± 3.2 years, was revealed in 76.2 % of HP- seropositive patients vs. 17.5 % of HP-seronegative subjects; the incidence of duodenal ulcer was 23.8 % vs. 20 %, respectively. The duration of the latter was 28.2 ± 1.8 years. The analysis of serum lipid spectrum of the patients showed the significant differences in triglyceride levels (3.1 ± 0.1 mmol/l vs. 2.0 ± 0.2 mmol/l; p < 0.05) and HDL (0.8 ± 0.03 mmol/l versus 0.9 ± 0.02 mmol/l; p < 0.05) in the group on HP-seropositive patients compared with seronegative. In HP-seropositive patients with combination IHD and DM2, unlike HP-seronegative patient, levels of C-reactive protein and insulin were significantly higher p = 0.001 and p = 0.0001, respectively, against the backdrop of significantly higher titers of antibodies to H. pylori (p = 0.001).
Conclusions. It has been established, that HP-seropositive patients with ischemic heart disease combined with type 2 diabetes mellitus, more frequently suffered from metabolic-related conditions such as obesity, hypertension, chronic pancreatitis and cholecystitis, and they had significantly higher levels of triglycerides, insulin, C-reactive protein and low levels of HDL cholesterol. All these findings can be considered as the manifestations of cardio-metabolic changes, resulting in the unstable course of the combined pathology. The presence of H. pylori-associated gastroduodenal pathology in the history of patients with IHD and DM2, gives the ground to suspend the probability of the development of adverse cardiometabolic consequences.

Keywords: coronary heart disease, type 2 diabetes, inflammation, antibodies, Helicobacter pylori.

Objective — to study the structure and gender peculiarities of the clinical and endoscopic manifestation of the gastroduodenal pathology inadolescence.
Materials and methods. Observations involved 937 adolescents (504 boys and 433 girls), aged 10 to 18 years, with upper digestive tract diseases who were supervised in the period of years 2011 to 2014. The clinical and laboratory-instrumental investigation were performed on the basis of the «Institute of Public Health of Children and Adolescents AMS of Ukraine».
Results. It has been established that the nature of pain and dyspeptic syndromes, and results of physical examination did not allow the objective assessment of the natureof pathological changes in the digestive organs of adolescents. The mostly informative proved to be the endoscopic and laboratory methods.
Conclusions. The non-destructive inflammatory lesions of the upper digestive tract are predominant in patients of adolescence age.The frequency of destructive lesions at the age of 10 — 14 years was 8 — 10 %, and it doubled at the age of 15 — 18 years. In girls, thestructure of the upper digestive tract lesions formed at the age of 10 — 14 years did not change with ageing. In the boys, the frequency of destructive lesions of the upper digestive tract increased, including esophagus, which appeared to be associated with the higher levels of testosterone at this age. The Helicobacterpylori infection was revealed in 2/3 of patients with digestive pathology. The analysis of clinical and endoscopic peculiarities of the formation of upper digestive tract pathology makes the ground to suppose that for boys hyperacidity is the leading reason in the disease progression, and for girls this reason lays in the disorders of the upper digestive tract motility. This can serve as the ground for the choice of priority directions in the pathogenetic therapy of these disorders.

Keywords: inflammatory diseases of the upper gastrointestinal tract, duodenal ulcer, adolescents, esophagogastroduodenoscopy.

Objective — to investigate the age-related aspects of formation of the cluster of gastrointestinal comorbid diseases in patients with osteoarthritis (OA), their effects on the OA manifestations and peculiarities of pharmacological correction.
Materials and methods. The three-year prospective studies with participation of 312 patients with OA have been performed with the use of the modern clinical and instrumental and biochemical methods of diagnosis of OA and comorbid processes.
Results. It has been established that in the group with the age of less than 50 years, the comorbid cluster of gastrointestinal disease was moderate (hastroduodeno- and choletsystopathy) and allowed the proper gastroprotection with the effective implementation of modern technologies on antirheumatic therapy. In the patients with OA of the age group of 51 — 60 years, this cluster was significant, was aggravated with liver damage (steatohepatosis, hepatitis, cholekalkulosis), pancreatitis, enterocolopathy, dyslipidemia, requiring an appropriate medical response, that complicated the implementation of anti-rheumatic therapy, reduced its efficacy, and its implementation is impossible in 20 % of cases. Arthritic process in the age group over 60 years becomes more systemic, accompanied by more pronounced clinically cluster of the same illnesses, more profound biochemical disturbances in blood, requires the use of more drugs, increases the frequency of side effects from anti-rheumatic drugs including chondroprotectors, and low performance is the argument otherwise of their use in such displays cluster of gastroenterological diseases.
Conclusions. In OA patients, with increasing of age and OA duration, the number and clinical manifestations of the cluster of gastrointestinal diseases progressively increase. In case of moderate manifestations of the cluster, the implementation of modern tactics of antirheumatic therapy seems to be possible, but at the expressed forms the use of chondroprotective drugs is not advisable.

Keywords: osteoarthritis, comorbidity, gastroenterology cluster, treatment.

Objective — to investigate the real nutrition of subjects of older age groups and develop the approached to its correction, aimed on the prevention and treatment of metabolic syndrome.
Materials and methods.  Investigations involved of 77 people of middle age (35 — 59 years) and 104 elderly subjects (60 — 74 years). The anthropometric indices, fasting glucose and lipid profile were determined. The food intake was evaluated by the method of the 24 hour food recall and the weighting methods.
Results. In the middle-aged men, the following positive correlations have been established: the cereals and legumes consumption with waist circumference (WC) (r = 0.51) and the level of fasting blood glucose (r = 0.59) (p < 0.05);the increased consumption of meat products with body mass index (BMI) (r = 0.40), body obesity index (BOI) (r = 0.52) and hip circumference (HC) (r = 0.57); the consumption of animal protein with WC (r = 0.46) and HC (r = 0.44; p < 0.05); diet cholesterol with total cholesterol blood level (r = 0.55) and blood low density lipoprotein cholesterol (LDLC) (r = 0.59; p < 0.05). In middle-aged women the positive correlations of cereals and legumes consumption with high density lipoprotein cholesterol levels (HDLC) (r = 0.33; p < 0.05), the daily amount of meat products with WC (r = 0.39; p < 0.05) have been revealed, as well as negative correlation of vegetables’ consumption with total cholesterol level (r = –0.33) and LDLC (r = –0.33) (p < 0.05). In the elderly men the correlations of cereals and legumes consumption with blood triglyceride levels (r = 0.36; p < 0.05), the consumption of meat products with BOI (r = 0.39) and HC (r = 0.38) (p < 0.05) were found; animal protein consumption correlated with HC (r = 0.41), BOI (r = 0.39) and fasting glucose level (r = 0.41) (p < 0.05). Less consumption of vegetables was accompanied by higher total cholesterol levels (r = –0.35) and LDLC (r = –0.39) (p < 0.05). In elderly women, only negative correlation of fruits consumption with BMI (r = –0.39), BOI (r = –0.42), WC (r = –0.37) and HC (r = –0.39) (p < 0.05) was established.
Conclusions. The age and sex-related differences between nutrition and metabolic risk factors have been revealed. In both groups of different age, the relationship between meat consumption and obesity was mostly evident, especially in men, that should be considered at elaboration of diet recommendations.

Keywords: nutrition, nutrients, middle age, elderly, metabolic risk factors.

Objective — to describe the ultrastructural, immunohistochemical and morphometric characteristics of proliferative processes in the esophageal mucosa against the background of gastroesophageal reflux disease (GERD) and their relationship with the bile acids’ level in gastric juice.
Materials and methods. The study involved 123 patients with clinically confirmed GERD prior the treatment start in the department of stomach and duodenum diseases of the SI «Institute of Gastroenterology of NAMS of Ukraine». A comparative analysis was conducted with a control group, which consisted of 20 almost healthy people. The material for the study of structural changes were biopsies obtained during fibrogastroscopy; morphometric and immunohistochemical methods, including high-resolution microscopy of half-thin slides were used during morphological analysis. The level of total bile acids was measured in the gastric juice by methods of Reinhold, Wilson.
Results. The considerable increase of bile acids (77.5-fold) was found in gastric juice in all patients with GERD vs. the control group. An increase of total bile acids in gastric contents contributes to the development of inflammatory processes in the mucosa, as evidenced by an increase in the thickness of the basal layer of the esophagus mucosa and the expansion of the epithelial intercellular spaces to (1.391 ± 0.041) µm.
Conclusions. It has been established that increase in the frequency and duration of contact of esophageal mucosa with the high bile acids’ level in patients with GERD contributed to the reflux esophagitis with high proliferative characteristics, which was confirmed by the direct correlation between the total level of bile acids and thickening of basal esophageal mucosa layer r = 0.355 (p < 0.05) and dilation of the intercellular spaces of esophageal epithelium r = 0.309 (p < 0.05).

Keywords: gastroesophageal reflux disease, bile acids, gastric juice.

Objective — to determine the frequency and severity of obstructive sleep apnea/hypopnea (SOAGS) in patients with isolated gastroesophageal reflux disease (GERD) and GERD in conjunction with coronary heart disease (CHD) and to identify the main factors influencing the severity of the syndrome.
Materials and methods. The main parameters that reflect the OSA severity, including indices apnea/hypopnea (AHI), obstructive sleep apnea (OAHI), sleep fragmentation (the AAI) and cardiac risk (SRI), were compared in 65 patients with GERD and associated coronary artery disease (the main group 1) and in 29 patients with isolated GERD (the comparison group 2).
Results. It has been established that patients with GERD and CHD have had more severe OSA form in comparison with patients with isolated GERD, as evidenced by significant differences in the indexed marks: ANI (p < 0.001), OAHI (p < 0.001), AAI (p < 0.001), CRI (p = 0.003). In group 1, correlation was established between CRI and the age of a patient (p = 0.039), AHI and BMI (p = 0.0014), ANI and CHD duration (p = 0.015), the severity of GERD clinical symptoms by the results of the questionnaire and AHI (p = 0.018). Moreover, the relationship was revealed between erosive and non-erosive GERD and forms of AHI, (p = 0.0007). In group 2, ANI correlated with patient’s age (p = 0.040), BMI (p = 0.011), clinical symptoms of the disease on the survey results (p = 0.006). In both groups, the GERD severity correlated with the disease duration, and in the main group it correlated with the CHD duration.
Conclusions. The combination of GERD and coronary heart disease can be considered as the factor that considerably aggravates the symptoms of sleep apnea syndrome.

Keywords: gastroesophageal reflux disease, coronary heart disease, a syndrome of obstructive hypopneas/sleep apnea.

Objective — to investigate the impact of liver functional disorders on the development and course of ischemic heart disease (IHD), depending on the presence of concomitant nonalcoholic steatohepatitis (NASH) and justify the differentiated treatment approaches.
Materials and methods. The study involved 76 IHD patients, aged 40 to 69 years, from them 10 women (13.2 %) and 66 men (86.8 %). To study included patients with the established IHD diagnosis (of II, III functional class). The presence of atherogenic dyslipidemia (AD) type IIa and IIb by Fredrickson and related NASH were taken into account. In additional to basic IHD therapy, patients received ursodeoxycholic acid (UDCA), and in case of concomitant NASH, the UDCA combined with L-carnitine was administered.
Results. The concomitant NASH was revelled in 29 (38.2 %) patients with ischemic heart disease, among them 82.7 % were patients of young and middle age with the increased risk of myocardial infarction. In IHD patients with concomitant NASH, the obesity was defined in 15 (51.7 %) patients, which can be considered as a risk factor for early development of AD and IHD. The significant AD was defined in patients with NASH and IHD. The advisability has been proved obtained for inclusion of UDCA in the treatment schemes of patients with IHD, and combination of UDCA and L-carnitine in case of IHD and concomitant NASH.
Conclusions. The violations of the liver functional state in patients with ischemic heart disease with the concomitant NASH results in the formation of AD, aggressive course of IHD with early myocardial infarction in patients of young and middle age. The increased lipid-lowering effect of statins can be achieved by additional inclusion of UDCA in the treatment schemes of patients with IHD, and combination of UDCA and L-carnitine in case of IHD and concomitant NASH.

Keywords: ischemic heart disease, nonalcoholic steatohepatitis, lipid-lowering therapy, ursodeoxycholic acid, L-carnitine.

Objective — to evaluate efficacy of infliximab for achieving clinical and endoscopic remission in patients with moderate to severe ulcerative colitis (UC) without previous treatment of conventional therapy.
Materials and methods. The observations involved 51 patients with moderate to severe UC from own database (30 men and 21 women with the mean age 39.4 ± 11.6). The patients were divided into two groups: group 1 consisted of 26 patients (51 %), who did not receive conventional UC therapy, and group 2 included 25 patients (49 %), previously treated with conventional UC therapy. All the patients were infliximab naїve. The laboratory and endoscopic investigations were performed to evaluate the baseline and after treatment patient’s condition, as well as international questionnaires, and detection of calprotectin levels. The infliximab efficacy of assessed on the week 8 of treatment.
Results. The clinical and endoscopic remission was achieved almost equally at both groups (about 80 %). Patients who did not achieved clinical and endoscopic remission the diseases activity reduced to the criteria of mild UC activity.
Conclusions. In patients with moderate to severe UC, it is advisable to prescribe the anti-tumor necrosis factor-alpha therapy without preliminary conventional therapy.

Keywords: ulcerative colitis, conventional therapy, infliximab, remission, anti-tumor necrosis factor-alpha therapy.

The authors presented the Rome criteria IV, presented at the Digestive Diseases Week in San Diego (USA) in May, 2016. The differences between the Rome criteria III and IV have been considered, as well as pathogenic mechanisms of irritable bowel syndrome, one of which is violation of visceral hypersensitivity, the basic cause of abdominal pain, resulting in the development of inflammation in the intestinal wall and changes in composition of the intestinal microflora. The basic principles of treatment of irritable bowel syndrome, according to current international recommendations have been outlined. The role of Spazmomen in eliminating abdominal pain in patients with irritable bowel syndrome was shown, and data of meta-analysis of Spazmomen effectiveness, in comparison to other antispasmodics in the treatment of functional bowel disease were presented.

Keywords: abdominal pain, visceral hypersensitivity, irritable bowel syndrome, antispasmodics, Spazmomen.

The article provides a review of literature on the «fatal chain» in pancreatology. This refers to the links starting from acute pancreatitis to its relapse, development of chronic pancreatitis, pancreatic fibrosis progression and increasing risk of pancreatic adenocarcinoma (similar to the «fatal chain» in hepatology: from acute to chronic hepatitis, cirrhosis and liver cancer). Logical links have been confirmed by the literature data and results of the evidence-based trials. The preventive and curative actions aimed to interrupt «fatal chain» have been discussed.

Keywords: pancreatic diseases, stages of progression, risk factors, pathogenesis, treatment.

This review presents the contemporary views on therapeutic and preventive nutrition of patients of the gastroenterological profile in combination with the most common «diseases of civilization». The considerations have been given for the peculiarities of nutrition at diseases of liver, gall bladder, intestine, at the gall-stone and gastroesophageal reflex disease, peptic ulcer diseases, as well as at their combination with hypertension, ischemic heart disease, abdominal obesity, type 2diabetes mellitus, metabolic syndrome.

Keywords: gastrointestinal pathology, diseases of «civilization», the connected course of treatment-and-prophylactic food.

The article presents the basic views on the melatonin effects, describes observations on the positive effects of this hormone on the neuroendocrine regulation, and the use of its various therapeutic doses. The extensive application of melatonin in clinical practice is determined with its low toxicity and lack of serious side effects and contraindications. Melatonin is being used as a universal preparation for the treatment of disorders with multifactorial pathogenesis and wide clinical polymorphism, accompanied with the desynchronosis phenomenon. The administration of melatonin therapy requires the consideration of the individual peculiarities of an organism, as well as strict compliance of the hours and administered doses. The significance of melatonin in the mechanisms the correction of disorders of different genesis has been established, as well as its effects on the functioning of the organs and tissues of a human body.

Keywords: pineal gland, melatonin, side effects.

The gallstone disease (GSD) is one of the most worldwide-spread diseases of the digestive system. Recent reports present the new aspects of the gallstones’ pathogenesis, which determine the complexity of GSD prevention. According to the literature data, each type of biliary calculus has its own pathogenesis. The mostly comprehensive understanding of cholelithogenesis in each individual case can contribute to the reduction of the risk of this disease. The clinical significance of the gastric acid production and gut microflora in the development of GSD requires further investigations.

Keywords: gallstone disease, cholelithiasis, pigment stones, cholesterol stones, acid producing function of the stomach, hypochlorhydria, achlorhydria, syndrome of intestinal bacterial overgrowth, Helicobacter pylori.