Objective — to define the effects of the standard nonmedical treatment (NT) in combination of the cognitive therapy on the anthropometric indices of patients with nonalcoholic fatty liver disease (NAFLD) and obesity.
Materials and methods. The study involved 105 patients diagnosed with NAFLD with normal body mass and concomitant obesity; randomized in groups of NT, that included nutrition correction increase of physical activity and cognitive therapy, and the comparison groups. The control group consisted of 23 people with no signs of NAFLD and normal weight; control group was reciprocal by gender and age composition.
Results. The body mass decrease was registered in 24 weeks (in average by 10.21 % from the baseline), and reached the maximum values in overweight and obesity patients (14.32 %). Besides, the improvement of the anthropometric indices was observed, in particular the waist circumference and in the ratio waist circumference/hips circumference.
Conclusions. The administration of the nonmedical treatment to the patients with NAFLD is one of the most effective and safe methods of therapy.

Keywords: non-alcoholic fatty liver disease, obesity, nonmedical treatment.

Objective — to analyze the relationship between H.pylori and the severity of morphological changes in the gastric mucosa and gastrin levels in patients with chronic reflux gastritis.
Materials and methods. Study has been conducted with the participation of 140 patients, from whom 120 subjects suffered from chronic reflux gastritis. The comparative analysis was performed vs the control, consisted of 20 relatively healthy people. The material for the study of structural changes was presented as biopsies obtained during fibrogastroscopy, which was characterized by the morphological study. H. pylori infection was identified morphologically using cytology slides stained by Romanovsky-Giemsa method. All patients performed rapid urease test to determine the presence of H. pylori and H. pylori respiratory urease test (IRIS) to estimate the total urease activity; gastrin levels were determined in blood serum.
Results. Atrophy of the gastric glands was observed in 73.3 % of patients with chronic reflux gastritis; in 46.7 % atrophy was accompanied with more profound changes: intestinal metaplasia and hyperplasia of the glands. In patients with non-atrophic gastritis prevailed H. pylori-negative (43.75 %) form while H. pylori-positive with a strong colonization was observed only in 12.5 %. Whereas in patients with atrophic gastritis H. pylori-negative forms took 27.3 %, and H. pylori-positive with a strong colonization — 22.7 %.
Conclusions. It has been shown that the overall incidence of H. pylori for non-atrophic forms of chronic reflux gastritis was lower than for atrophic (56.25 % compared to 72.7 %), the detection rate of H. pylori in patients with intestinal metaplasia type I — II and dysplasia was significantly higher than that in the group of patients with atrophic gastritis without rebuilding of the native glands (p < 0.05). As resulted by the rapid urease test, infection of H. pylori was found in 56.7 % of all cases. According to the results of the morphological test the detection rate of H. pylori was 68.3 %, the results of 13C-respiratory urease test showed rate of 73.3 %. The difference in the detection rate of H. pylori-positive and H. pylori-negative between the different methods was within the statistical error (p > 0.05), but the individual data showed that the respiratory urease test proved to be the most sensitive one.

Keywords: chronic reflux gastritis, H. pylori, atrophy of the gastric glands.

Objective — to study the efficacy of boric carbonic hydrocarbonate-sodium mineral water of medium mineralization on the course treatment of patients with nonalcoholic fatty liver disease.
Materials and methods. Observations involved 60 patients with NAFLD with concomitant diseases of the digestive system, from them 45 % of patients had nonalcoholic steatohepatitis of minimum degree of activity, and the rest of patients suffered from nonalcoholic hepatic steatosis. The females prevailed among the patinets, the mean age was 54.56 ± 3.04 years. All patients underwent conventional clinical, laboratory and instrumental investigations. The study included patients with viral and alcoholic hepatitis, autoimmune and hereditary liver disease. The patients were divided into two groups: the main group consisted of 30 subjects, who received investigated mineral water for 1 month in the complex spa treatment (diet therapy, balneotherapy); the control group included 30 persons, who received normal drinking water in the same dosage regimen (1 month) in the complex treatment. The study used medical history, clinical and paraclinical methods (study of clinic, biochemical, immunoassay blood parameters, ultrasonographic examination of the digestive system), statistical methods.
Results. The improvement of the clinical course of NAFLD, NASH and comorbid digestive diseases under the influence of mineral water was established. The significant positive effects on lipid metabolism (p < 0.05), reduction of insulin resistance (p < 0.05), improvement in tolerance to carbohydrates (p < 0.05) have been proved.
Conclusions. The drinking course of the boric carbonic hydrocarbonate-sodium mineral water of medium mineralization, can be used for correction of such carbohydrate metabolism in patients with NAFLD as insulin resistance and impaired carbohydrate tolerance.

Keywords: nonalcoholic fatty liver disease, non-alcoholic steatohepatitis, alkaline mineral water, insulin resistance, carbohydrate metabolism.

Objective — to identify the risk factors for the development of hepatic encephalopathy (HE) in patients with hepatobiliary pathology (HBP).
Materials and methods. The study involved 71 patients with HBP (among them 32 patients with HE), for whom the following parameters have been investigated: indicators of cytolysis markers (alanine aminotransferase (ALT), aspartate aminotransferase (AST), cholestasismarkers (γ-GTP, alkaline phosphatase (ALP), total bilirubin), and markers of synthetic activity of the liver (albumin, prothrombin index).
Results. It has been shown that total bilirubinwas the most significant among the studied biochemical HBPmarkersfrom the point of view of the risk of HEdevelopment. Theviolations of liversyntheticfunction, apparent in the albuminlevelsand prothrombin index, can also contribute to the development ofHE, because the reduction ofalbuminlevels result in the increased free bilirubin in the blood, which is dangerous due to its high toxicity.
Conclusions. The relationship of the HBPtype and severity with the risk of HEdevelopmentis stipulated by the typical for them levels oftotal bilirubin, reflecting the severity of cholestasis, and albumin, which reflects the degree of the violations of liversyntheticfunction. Levels of total bilirubin and albumin in blood are closely associated with HE (p < 0.001): the total bilirubin levels more than 68 mmol/L increases the relative HE risk in 2.5 folds (95 % CI 1.86 — 3.37), and the albumin concentration is less than 35 g/l — 2.37 times (95 % CI 1.46 — 3.84).

Keywords: hepatobiliary pathology, hepatic encephalopathy, risk factors,total bilirubin, albumin

Objective — to improve the efficiency of non-drug treatment of patients with non-alcoholic fatty liver disease (NAFLD) with visceral obesity against the background of hypertension (H) of I — II stage by means of correction of the eating disorders (ED) and administration of the optimal schemes of nutrition, individually designed based on the nutrigenetic investigation of the sensible nutrition with account of the peculiarities of eating behavior (EB), basic metabolism and physical activity (РhA).
Materials and methods. The study involved 84 patients (mean age 53.0 ± 0.8 years) with NAFLD with visceral obesity against the background of H I - II stage, admitted in the SI «National Institute of Therapy named by L. T. Malaya of the NAMS of Ukraine». The hypertension in all patients was medically controlled. The control group consisted of gender and age marched 30 practically healthy subjects. The EB types were investigated with the use of questionnaire DEBQ, the actual nutrition was defined based on the specially designed for this study questionnaire, and analysis of weekly food diary. The nutrigenetic investigation was performed. All patients underwent standard anthropometric measurements and monitoring of body composition, ultrasound examination (sonography) of the abdominal cavity (AC) and heart computed tomography (CT) AC and daily blood pressure monitoring (DBPM), the index of visceral obesity (IVO), the calculation of the index against the plane of the visceral adipose tissue (VAT) in subcutaneous abdominal adipose tissue (SAT) (VAT/SAT). All patients (n = 84) were with drug controlled H. The patients were divided into 2 groups: group I (n = 42) received standard non-drug treatment NAFLD with the additional purpose of optimal schemes individually designed nutrition with the features of EB basic exchange and PhA based nutregena of the study; group II received standard drug-free treatment pursuant. Duration of observation was 12 months.
Results. After 6 months, patients of group I demonstrated the significant changes in the main anthropometric indicators: body mass decreased by 10.8 % (10.1; 11.2) , IMT by10.2 % (10.0; 10.6) , waist circumference by 8.9 % (8.6; 9.1) , % VAT by 8.0 % (6.0; 9.0), VAT/SAT up to 0.46 (0.40; 0.52), IVO to 1.7 (1.3; 2.4) (p < 0.05). After 12 months all patients of the I group reached the target levels of the gradual weight loss and stabilization. During the final check with DEBQ questionnaire, no violations of the EB were found. The achieved 100 % complacent as to the recommendations on modification of lifestyle and treatment in general, whereas indicators of patients of group II had no significant changes in the relevant indicators.
Conclusions. The increase the effectiveness of non-pharmacological treatment of patients NAFLD with visceral obesity against the background of H I — II stage can be achieved by the correction of EB violations and administration of the optimal schemes of nutrition, individually designed based on the nutrigenetic investigation of the sensible nutrition with account of the peculiarities of eating behavior, basic metabolism and physical activity.

Keywords: eating behavior, nutritional status, nonalcoholic fatty liver disease, hypertension, visceral adipose tissue, visceral adiposity index.

Objective — to investigate the functional liver state in pediatric patients with ulcerative colitis, depending on the localization, activity and disease duration.
Materials and methods. The study involved 110 children (64 (58 %) boys and 46 (42 %) girls) with ulcerative colitis (UC), aged 3 to 18 years. The complex investigations were performed in compliance with the Orders of the Ministry of Health of Ukraine dated 29.01.2013 and № 59 of Second European evidence-based Consensus on the diagnosis and management of ulcerative colitis Definitions and diagnosis (2012). The disease activity was determined with the help of pediatric ulcerative colitis activity index (Pediatric Ulcerative Colitis Activity Index, PUCAI). The study of the functional state of the liver was carried out with the help of analysis, biochemical blood and ultrasound examination of the abdominal cavity. To assess the immune inflammatory syndrome, the levels of γ-globulins, total protein, IgG were defined, and thymol test was performed.
Results. The liver dysfunction was established in 50 % of children with ulcerative colitis, from them which 10 % had established diagnosis (primary sclerosing cholangitis in 4.5 %; autoimmune hepatitis in 1.8 %, granulomatous hepatitis in 0.9 %, steatohepatitis in 1.8 % ; and cholelithiasis in 0.9 %); in other cases the etiology of elevated liver function tests couldn’t be established. The most (43.7 %) children with impaired liver state had mixed version of pathological changes in liver tests (cytolysis and cholestasis). It was established that in severe UC, the increase of the levels of ALT ≥ 40 units/l, ALT ≥ 30 units /l, AST ≥ 40 units /l, AST ≥ 30 units /l, GGT, thymol and γ -globulin was significantly higher than in mild to moderate colitis (p < 0.05). It was found that in total colitis, the ALT elevations ≥ 40 units/l, AST ≥ 40 units /l, GGT, thymol diagnosed significantly more often than the left-handed form of the disease (p < 0.05). It is found that during the first 36 months from the cytolytic syndrome establishing (p < 0.05), the UC was diagnosed more often. The direct correlation was established between the cytolysis indices and immuno-inflammatory syndrome of UC activity (for PUCAI index) and fecal calprotectin levels (p < 0.05).
Conclusions. It has been established that functional liver state depends on the ulcerative colitis activity, extension and duration. The highest risk of the development of liver dysfunction was defined for the pediatric patients with severe UC, total intestinal lesions and with disease duration of ≤ 36 months.

Keywords: functional liver state, pediatric patients, ulcerative colitis, the course, the disease duration.

Objective — to evaluate the efficiency of complex treatment with the use of singlet-oxygen therapy with cholereticherbs and combined iron supplementation in children with dysfunction of gallbladder and Oddi’s sphincter (GSOD),combined with mild iron deficiency anemia (IDA I).
Materials and methods. A prospective study involved pediatric patients aged 9 to 17 years, who were treated in hospital for GSOD exacerbation. From them, 29 subjects with GSOD and IDA I received investigational treatment complex, and 40 patients with GSOD received standard treatment. All patients were undergone clinical examinations, ultrasonic cholecystography in dynamics, follow-up study for 12 months. Investigations included blood biochemistry, detection of serum iron levels, total iron-binding blood serum capacity and percent transferrin saturation.
Results. It has been established that the use of the investigational treatment complex for pediatric patients  with GSOD and IDA I, resulted in a rapid clinical symptoms’ regression, long-term clinical remission and decreasedGSOD exacerbations’ frequency.
Conclusions. Pediatric patients with dysfunction of gallbladder and Oddi’s sphincter and iron deficiency anemia demonstrate the burdened course of GSODdue to the increased frequency of exacerbations and severe dyspeptic and asthenic-vegetative symptoms in the exacerbation phase. The treatment with the use of singlet-oxygen therapy with choleretic herbs and combined iron supplementation resulted in the rapid regressionof exacerbation symptoms and reduction the frequency of GSODexacerbations for the next 12 months.

Keywords: pediatric patients, dysfunction of gallbladder and Oddi’ssphincter, iron deficiency anemia, singlet-oxygen therapy.

Objective — to evaluate the profile of outpatients, suffering from chronic liver diseases, who were administered essential phospholipids as an adjunctive therapy to the standard treatment in the conditional of actual clinical practice.
Materials and methods. The non-interventional descriptive epidemiological study consisted of two phases: a cross-sectional study to evaluate the profile of patients, administered «Essentiale forte N»; and retrospective observation of 20 % of subjects enrolled in the first phase, to assess the adherence to prescribed treatment. The study involved 20 general practitioners and gastroenterologists, in total 402 patients were enrolled in the study.
Results. The fatty liver disease and chronic viral hepatitis were the most common liver diseases in clinical practice. The hepatoprotectors were administered to almost all patients (97 %).
Conclusions. The widespread administration of hepatoprotectors to the patients with liver diseases indicates a high degree of confidence in this type of therapy in both practitioners and patients. The high satisfaction with clinical efficacy and high compliance to the treatment were demonstrated when using the essential phospholipids as hepatoprotective therapy in the conditionals of actual clinical practice.

Keywords: fatty liver disease, chronic viral hepatitis, essential phospholipids.

The recent data show that approximately 25 —40 % of the population suffer from dyspeptic symptoms. The dyspepsia causes include both functional and organic ones. The gastric motility disorders play an important role in the pathogenesis of functional dyspepsia, therefore the use of prokinetics proved to be advisable in the treatment of this group of patients. Domperidone is a highly selective blocker of peripheral dopamine receptors type 2. It has the ability to increase the spontaneous activity of the stomach, the lower esophageal sphincter (LES) pressure, and to activate peristalsis of the esophagus and antrum. This medicine increases the frequency, amplitude and duration of duodenal contractions and reduces the passage of food masses in the small intestine. Domperidone treatment demonstrated its efficacy in many patients with dyspepsia. The described earlier probability of adverse effects on the cardiovascular system in patients receiving domperidone was not confirmed in recent studies, even when using very high doses of the drug.

Keywords: digestive system, functional dyspepsia, prokinetics, domperidone (Motilium®).

The high frequency of the use of various antibiotics, the irrational and sometimes unjustified appointment of these drugs result in the development of adverse events, the most frequent include dyspeptic, allergic, toxic and allergic reactions. Moreover, the probability exists of the development of antibiotic-associated diarrhea. The risk of these conditions significantly increases with the prolongation of antibiotic therapy, its repeated courses, as well in case of combination of several anti-inflammatory drugs. Criteria of the evidence based medicine provided the conformation if the probiotics’ efficacy as agents for the prevention and treatment of antibiotic-associated diarrhea. Laktimak Forte is one of such probiotics, that recently appeared on the pharmaceutical market in Ukraine.

Keywords: antibiotic-diarrhea medication Laktimak Forte.

The literature review is devoted to the problem of the loperamide (Imodium®) use of in the practice of an infectious disease physician. The mechanism of action and peculiarities of the drug, making its use advisable in the treatment of various diarrhea types, caused by infectious agents, have been described. The article presents recent data on the classification of infectious diarrhea and empirical treatment of traveler’s diarrhea, as well as the results of randomized clinical trials for evaluation of loperamide efficacy and safety at infectious diarrhea. The emphasis is made on the use of the drug for diarrhea monotherapy, as well as its use in conjunction with antibiotics. Considerable attention is paid to the safety of the drug, side effects and ways to overcome them. The issue of Imodium® use in children and pregnant women with travelers’ diarrhea has been elucidated.

Keywords: acute infectious diarrhea, traveler’s diarrhea, loperamide.

Objective — to compare frequency of the development of gastroduodenal erosive and ulcerative changes due to the diclofenac intake against the background of prophylactic administration the proton pump inhibitor or rebamipid.
Materials and methods. The randomized comparative trial involved 118 patients aged 25 to 65 years (the mean age 45 ± 18 years), from them 94 patients were diagnosed osteoarthrosis and 24 patients had rheumatoid arthrosis diagmosis. All patients were administered diclofenac during 1 month in a dose of 100 mg once a day. Depending on the additional treatment, all patients were randomized into 3 groups. During 1 month, patients of the 1st group (42 subjects) were administered omeprazole in a dose of 20 mg/day, and patients of the second group (46 subjects) received rebamipid in a dose of 100 mg 3 times/day. Patients of the control group (30 person) received diclofenac only. The main efficacy criterion was the cumulative frequency of development of gastroduodenal erosive and ulcerative changes, that were detected endoscopically after the end of treatment. Secondary criteria were frequency of the development of dyspeptic symptoms and adverse events.
Results. After one month of the continuous diclofenac intake, peptic gastric and duodenal ulcers were found in 4 of 42 (4.8 %) and 4 of 42 (4.8 %) patients of the 1st group and in 3 of 46 (6.5 %) and 2 of 46 (4.3 %) patients of the 2nd group accordingly. In the control group there were peptic gastric and duodenal ulcers in 5 of 30 (16.6 %) and 3 of 30 (10 %) patients; in addition, two cases of the ulcers (1 gastric and one duodenal) had clinical manifestation with gastrointestinal bleeding. The frequency of NSAIDs-induced dyspeptic symptoms and complications, except for the diarrhea syndrome, did not significantly differ in the 1st and 2nd groups, and was significantly lower than in the controls. In two patients of the control group, the gastrointestinal bleeding developed, cured with conservative methods, which were not observed in patients of the 2 main groups.
Conclusions. The rebamipid administration to patients. requiring long-term treatments with NSAIDs. is the safe method of prevention of the NSAID-induced gastropathies and their complications. Its efficacy was not lower than that of the prophylactic proton pump inhibitor administration.

Keywords: rebamipid, proton pump inhibitors, NSAID-gastropathy.

The analysis has been performed for the literature data, and the main methods of diagnosis of gastroesophageal reflux disease have been presented. The possibilities of modern endoscopic technologies have been demonstrated in detecting the minimal changes in the esophageal mucosa

Keywords: gastroesophageal reflux disease, diagnosis, esophagogastroduodenoscopy, reflux esophagitis.