Objective — to determine changes of motor-evacuative and ultrasonic characteristics of the gall bladder (GB) in patients with chronic acalculous cholecystitis (CAH) against the background of metabolic syndrome (MS).
Materials and methods. The investigation involved 67 patients with CAH, 29 men and 38 women at age 30 to 59 years. Patients were divided into two groups: group I consisted of 37 patients with CAH against MS background, group II included 30 patients with CAH without MS. The CAH diagnosis was based on the results of clinical, laboratory and instrumental inspections. The state of the GB was determined on the basis of results of ultrasonic research (USR), duodenal biliary drainage (DBD), microscopic bile examination. The MS diagnosis was made in accordance with the criteria of the International Diabetes Federation (2005). The blood leptin levels were measured with immune-enzymatic method with the help of the commercial sets of «Leptin ELISA» (DRG International, Inc., USA).
Results. The analysis of DBD results allowed revealing of the changes in both duration of all phases and in the volume of the secreted bile in CAH patients compared to the healthy persons. Malfunctions of GB motility, mainly according to hypotonic-hypokinetic type, were found in patients with CAH and MS (88.06 %). The time for secretion of the cystic bile for the patients with CAH and MS was in 1.16 times longer, than in the patients with CAH without MS (р < 0.05). The blood leptin levels in all patients of group I exceeded the index of the healthy patients in 2.63 times (р < 0.001); for the patients of group II the level of leptin did not differ significantly from the healthy patients (p > 0.05). The direct correlation was established between the blood levels
of low-density lipoproteins and leptin (r = + 0.61; р < 0.05), the blood leptin levels and the GB wall thickness (r = + 0.49; p < 0.05), and the quantity of cholesterol crystals in bile (r = + 0.58; p < 0.05). The inverse correlation was found between the leptin levels and the speed of cystic bile secretion (r = –0.55; р < 0.05).
Conclusions. In patients with CAH against the MS background, the malfunctions of the gall bladder motility according to hypotonic-hypokinetic type prevailed. The dyslipidemia and the increase of blood leptin levels in patients with CAH and MS had a negative impact on the motor-evacuative indexes of the gall bladder.

Keywords: chronic acalculous cholecystitis, metabolic syndrome, leptin, duodenal biliary drainage

The aim — to develop a lifestyle modification program in patients with NAFLD and to determine its effect on weight loss, noninvasive biomarker of inflammation and apoptosis of liver CK 18 and body fat percentage using by bioelectrical impedancemetry.
Materials and methods. In this study included 42 patients. All patients were divided into 2 groups. Patients from the first group of participants were a part of motivational-controlled program of modification eating behavior during the 12-week observation. All patients have been performed anthropometric measurements, laboratory and instrumental examination at baseline. The first group have been given recommendations of low-calorie and high fiber diet, with menu selection of products for every day and proposed writing the weekly food diaries. Next there was a visit to the doctor after 7 days, estimate food diary, in whole there have been five visits to the doctor during 12 weeks.
Results. The level of CK 18 has a direct correlation of medium strength with BMI (r = 0,385), triglycerides (r = 0,319) and a strong direct correlation with waist circumference (r = 0,734) and visceral adiposity index (r = 0,766), the relative fat content using bioelektric impedancemetry has a direct correlation of medium strength with BMI (r = 0,575) and waist circumference (r = 0,548). The study of the effectiveness of a motivational-controlled program of modification eating behavior shows reduction of BMI (27,9/24,15; p < 0,01).and noninvasive biomarker of inflammation and degree of liver apoptosis CK18 12 after 12 weeks of observation.
Conclusions. To achieve compliance of lifestyle modifications and positive results in decreasing of BMI and CK18 levels in patients with NAFLD possible with an integrated motivational-controlled program of changing eating behavior during 12 weeks.

Keywords: nonalcoholic fatty liver disease, lifestyle modification, noninvasive biomarker cytokeratin-18, correction of eating behavior.

Objective — to study the prevalence of gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS), as well as the frequency of their combination in patients of the gastroenterological department.
Materials and methods. The examinations involved 92 patients, aged 18 to 64 years. The control group consisted of 30 practically healthy age- and sex-matched subjects. The patients were divided into three groups: 31 patients with GERD (the 1st group), 32 persons with IBS (2nd group), and 3rd group included 29 patients with GERD and IBS combination. For the preliminary confirmation of this diagnosis, esophagogastroscopy (EGD) was performed with the obligatory express pH of the esophagus. The basis criterion for the presence of reflux was reduction of pH < 4 in the lower third of the esophagus.
Results. In the first group, GERD more frequently was diagnosed in middle-aged men (43.5 ± 4.9 years).
The maximal GERD incidence was at the age of over 46 years. The main symptom of gastro-esophageal reflux was heartburn, which appeared daily or more often 4 times a week in 2/3 of patients. In 68 % of patients in the first group there was endoscopically positive reflux disease, and in the rest of patients it was endoscopically negative. More than half of the patients had the first degree of esophagitis (mucosal hyperemia or single erosion) and significantly more pronounced changes in the mucosa of the 2nd degree (16 %). There were no patients with a 3 — 5 degree of esophagitis (there were no erosion, ulcers, strictures or Barrett’s esophagus). In two patients, indirect signs of bile reflux (bitterness in the mouth, endoscopic in the stomach of bile impurities) were revealed, as well as a periodic increase in intra-esophageal pH > 7.2. In the second group, the IBS patients with constipation prevailed (40.5 %), the number of patients with diarrhea was less (31.3 %). Among the possible IBS causes, stress was on the first place (46.9 % of vases). In the majority of patients, (90.6 %) the abdominal pain was registered (mean VAS score (6.1 ± 1.3) cm). The EGD showed no visual signs of esophagitis or cardial sphincter insufficiency, and reduction of рН < 4 was not revealed. In the third group, patients the IBS patients with constipation prevailed (34.5 %), the number of patients with diarrhea was less (27.6 %). The frequency of complaints, specific gastroesophageal reflux, did not significantly differ from that of in the 1st group. The endoscopically positive form was revealed in less than 42 % of patients (р < 0.05). The degree of esophageal рН reduction was less intensive than in patients of the 1st group. In 5 patients the signs of bile reflux were revealed.
Conclusions. The middle-aged men prevailed among the patients with isolated GERD. The heartburn was defined as the main GERD symptom. The endoscopically positive reflux form was in the majority of patients. The IBS with constipating was the most frequent form of isolated IBS. In the majority of patients, abdominal pain and absence of the EGD signs of esophagitis and cardial sphincter insufficiency were observed. Among the patients with the combined GERD and IBS pathology, the IBS with constipation was most frequent, and endoscopically positive GERD form was in the minor quantity of patients in comparison with the group of patients with isolated GERD.

Keywords: irritable bowel syndrome, gastroesophageal reflux disease, pH-metry, Rome III criteria.

Objective — to assess the autonomic balance in patients with rheumatoid arthritis (RA) with concomitant irritable bowel syndrome (IBS) and IBS peculiarities of these patients according to the type of autonomic dysfunction.
Materials and methods. The study involved 52 patients with RA, including 27 patients with RA complicated by IBS. 25 patients presented isolated RA (control group). The vegetative status was assessed on the basis of «Standardized questionnaire for signs of autonomic disorders», «Inspection schemes for signs of autonomic disorders» by A. M. Wayne, and the Kerdo index.
Results. It was found that in patients with RA in combination with IBS, the autonomic disorders encountered more frequently (in 21 patients out of 27) than in the control group (12 patients out of 25). Sympathicotonia was predominant in both groups of the examined patients. The higher expressiveness of this type of autonomic dysfunction was observed in the main group. Constipation prevailed in the clinical IBS symptoms in RA patients. The direct correlation (Q = 0.591) of average power between the presence of constipation and sympathicotonia was discovered. The differences in the characteristics of pain depending on the type of autonomic dysfunction were not observed. The reduction of expressiveness of clinical IBS manifestations was observed during RA exacerbation in 18 (69 %) patients.
Conclusions. The comorbid pathological condition of RA and IBS exists mainly against the background of autonomic sympathicotonic imbalance, which acquires a generalized character in these patients. The IBS formation in RA patients can be considered as visceral autonomic dysfunction, occurring as the result of violations of the regulatory action of the autonomic nervous system. При обострении РА клинические проявления СРК нивелируются симптоматикой суставного синдрома. During RA exacerbation, the IBS clinical manifestations are leveled by the symptoms of articular syndrome.

Keywords: rheumatoid arthritis, irritable bowel syndrome, autonomic dysfunction, clinical features, ­pathogenesis.

Objective — to examine non-specific resistance of the oral cavity in patients with gastrointestinal disorders and identify its diagnostic and practical value.
Materials and methods. The study included 34 inpatients aged 42 to 50 years with acute GIT disorders. All patients underwent upper endoscopy and abdominal ultrasound. The following diagnoses have been established in the patients: 4 gastroduodenitis, 3 gastric ulcer, 4 chronic cholecystitis, 3 with chronic pancreatitis and 20 combined pathology. All the patients underwent dental examination to detect pathological conditions of hard dental tissues, periodontal tissues or oral mucosa. The comparison group involved 15 people aged 23- 25 years without GIT complaints, with oral cavity sanitation. Oral mucosa samples were obtained after an overnight fast with a sterile spatula after applying a mouth wash and then placed on a slide. Samples were dried at room temperature and fixed in Nikiforov’s mixture for 4 minutes, and further exposed to Romanowsky-Giemsa staining. The reaction of adsorption of microorganisms (RAM) was studied with a Primo Star Zeissplan-Achromat microscope. The number of bacteria was counted on the surface of 100 epithelial cells. Depending on the number of adherent microorganisms epithelial cells were divided into 4 groups: first — epithelial cells with no or up to 5 microorganisms on the surface; second — epithelial cells which adsorbed no more than 25 microorganisms; third — epithelial cells with 26 to 49 microorganisms, fourth- epithelial cells with 50 or more microorganisms which resemble an anthill. The cells in the first and second groups were classified RAM-negative; third and fourth groups as RAM-positive. With 30 % of RAM-positive cells in a sample, non-specific resistance (NSR) of the oral cavity was estimated as low; the index of 31 — 69 % corresponded to satisfactory NSR; 70 % or more of RAM-positive cells indicated good NSR.
Results. The examined patients had catarrhal inflammation of periodontal tissues, erosive lesions of the mucous membrane, etc. The study proved the correlation between the average value of the adsorption reaction of microorganisms and satisfactory non-specific resistance in the examined groups. Low resistance was found in patients with peptic ulcer disease (19.9 % of RAM-positive cells). Non-specific resistance of the oral cavity was close to good in healthy individuals (63.2 % of RAM-positive cells), good resistance was characteristic of patients with gastroduodenitis (74 % of RAM-positive cells).
Conclusions. The study of adsorption properties of epithelial cells makes it possible to evaluate the functionality of the mucosa in patients and healthy individuals. Non-specific resistance of the oral cavity in the examined groups did not differ significantly. They tended to satisfactory non-specific resistance. Thus, the loss of local protection mechanisms of the oral cavity mucosa (OCM) can aggravate the medical condition and must be taken into account when examining and treating GIT patients. Virtually healthy individuals with reduced OCM resistance may constitute a GIT pathology risk group.

Keywords: oral cavity, non-specific resistance, GIT pathology, epithelial cells, microorganisms.

Objective — to investigate the dynamic changes of metabolic parameters in patients with nonalcoholic fatty liver disease (NAFLD), hypertension and visceral obesity within 8 weeks of the appointment of policosanol (FitoStatin) 10 mg/day in addition to the statin therapy.
Materials and methods. The studies involved 32 patients with NAFLD in combination with hypertension stage I — II and visceral obesity and with dyslipidemia. All patients (n = 32) were divided into two groups: the first group consisted of 16 patients (males — 9 (56.3 %) women — 7 (43.7 %), who received 10 mg policosanol for 8 weeks, administered as one dose of 10 mg every evening during dinner in addition to atorvastatin treatment. The second group consisted of 16 patients (males — 8 (50.0 %) women — 8 (50.0 %)), who were administered atorvastatin 10 mg per day as lipid-lowering monotherapy. The mean age of patients was 53.0 ± 0.8 years. The control group consisted of 14 age- and gender-matched healthy subjects (men — 7 (50 %), women — 7 (50 %).
Results. It has been established that in 1st group patients, the triglycerides levels considerably decreased, and HDL levels significantly increased (p < 0.05), testifying the adequate hypolipidemic efficiency of the drug. This effect enables preventing the development of NAFLD (with triglycerides etiology), atherosclerosis and hypertension progression. The positive policosanol effects on the dynamics of indices of the dysfunction of visceral fatty tissue (p < 0.05).
Conclusions. To achieve prognostically significant changes in lipid spectrum in patients with comorbid disorders, the long-term (6 — 12 months) therapy is preferable, which includes the low initial doses of lipid-lowering drugs (10, 20 mg) daily in combination with policosanol 10 mg/day. It promotes the positive dynamics of the lipid spectrum indices without side effects that can occur at the high doses statin therapy.

Keywords: dyslipidemia, visceral obesity, nonalcoholic fatty liver disease, hypertension, policosanol.

The study was performed to assess Trimebutine efficacy for correction of the symptoms of irritable vowel syndrome (IBS): constipation, diarrhea, pain, bloat. A group of patients (8 men, 24 women) was selected with different disease variants: IBS with constipations was diagnosed in 21 (65.6%) patients, IBS with diarrhea in 4 (12.5 %) subjects, and mixed disease variant was in 7 (21.9%) patients. Against the background of a diet therapy, all patients were administered Trimebutine (Trimspa 200) in a dose of 1 tablet 3 times a day during or after meals, for three weeks. In accordance with Rome Criteria IV, the main compulsory complaint in patients with IBS is pain. One week of treatment resulted in pain relief in 22 patients, and pain removal in 6 subjects. After three weeks of treatment, pain was eliminated in 15 patients, the additional pain attenuation was observed in 13 subjects. Defecation act was normalized in the majority of patients. «Trimspa» proved to be an effective medicinal product, which resulted in pain relief and promoted normalization of the disturbed motor function of intestine, attributable to the patients with IBS.

Keywords: irritable bowel syndrome, pain, defecation, treatment.

The modern concepts of epidemiology, approaches to the diagnosis and treatment’s tactics of patients with metabolic syndrome (MS) have been elucidated. The inclusion of ursodeoxycholic acid (Choludexan) in the complex therapy, targeted on all MS components, proved to be effective and advisable. The rational ursodeoxycholic acid use in the treatment of MS enables reducing the risk of atherosclerosis, cardiovascular events and type 2 diabetes mellitus, preventing side effects of statins, as well as the development and progression of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Moreover, it reduces the financial cost of the treatment of MS and its complications.

Keywords: metabolic syndrome, dyslipidemia, insulin resistance, ursodeoxycholic acid, Choludexan.

Objective — to assess the Doktovit effects on the disease clinical symptoms, frequency of epithelialization of ulcers and erosions, as well as the dynamics of morphological changes in the gastric mucosa in patients with NSAID-induced gastropathy.
Materials and methods. Examinations involved sixty patients (26 men and 34 women) with NSAID-induced gastropathy, not associated with Нelicobacter pylori, the mean age was 46.1 ± 3.2 years. Patients of the main group (n = 30) received a proton pump inhibitor (PPI) — pantoprazole 40 mg 2 times per day and the study drug Doktovit in a dose of 1 tablet 3 time per day. Subjects of comparison group (n = 30) received only PPI therapy in a standard daily dose for 30 days. All patients underwent clinical examinations, gastroduodenoscopy of esophagus, stomach and duodenum, with a histological examination of the gastric mucosa bioptates.
Results. The faster normalization of clinical symptoms has been established in the group of patients, administered Doktovit. By the end of the third week of treatment, fewer complaints were registered in patients from the main group. The treatment contributed to the subsidence of the inflammatory process in the mucous membrane of the stomach and duodenum, epithelization of erosion. In the main group, absence of erosive lesions was observed in 29 (96 %) patients, whereas in the comparison group only in 22 (73 %) subjects. According to the histological examinations, additional Doktovit administration also contributed to more pronounced decrease in the activity of the gastric mucosa inflammation. The drug was well tolerated, did not cause adverse reactions.
Conclusions. The proposed scheme for the treatment of NSAID-induced gastropathy with additional DoctoVit administration promotes the rapid relief of clinical symptoms, epithelization of erosions, improves the histological picture of the gastric mucosa. The high efficacy of the drug, its good safety profile provides a basis for its wide use in clinical practice.

Keywords: NSAIDs-gastropathy, gastric erosion, reparative agents, vitamin U, Doktovit.

The article presents data of evidence-based medicine that has acknowledged the efficacy of sodium alginate in the treatment of GERD. The authors summarized the results of randomized clinical trials and meta-analyses that provided evidence of sodium alginate’s mechanism of action, its clinical effectiveness and safety of use.

Keywords: sodium alginate, Gaviscon, GERD, heartburn, evidence-based medicine.

The article presents the detailed analysis of literature concerning ademetionine physiological role in biochemical processes. There was conducted pathophysiological substantiation of ademetionine (Heptral) appropriateness in treatment of liver cholestatic diseases, alcoholic liver disease, nonalcoholic fatty liver disease, liver drug injuries, viral hepatitis. The antidepressant ademetionine properties and its effects at various mental disorders have been described. The pathophysiological and experimental data were confirmed by the results of clinical trials, that showed its efficacy in the treatment of lever diseases, depressions, alcohol abstinence etc. The results of the investigation of ademetionine safety, as well as perspectives of its use in the clinical practice, including pancreatology, have been presented.

Keywords: ademetionine, transmethylation, transsulfonation, anticholestatic effect, antidepressant properties, prospects of clinical application.

The article presents consideration of the problems associated with the efficacy of generic pantoprazole preparations. It has been established that Zovanta is therapeutically equivalent to the original pantoprazole due to the similar pharmacological profile, as well as in the compliance with the Orange Book and Rx-index (Approved Drug Products with Therapeutic Equivalence Evaluations).

Keywords: original drugs, generic drugs, proton pump inhibitors, pantoprazole, therapeutic equivalence, Zovanta.

Objective — to study the efficacy and safety of Zafakol in patients with irritable bowel syndrome and inflammatory bowel diseases (ulcerative colitis (UC) and Crohn’s disease (CD)).
Materials and methods. The study involved sixty patients aged 25 to 65 years (mean age 39 ± 17 years) with intestinal diseases (40 patients with IBS without constipation, 10 patients with UC and 10 patients with CD). In the control group, IBS patients (n = 20) received basic therapy, including the use of spasmolytics (mebeverin) and loperamide as needed for 1 month, and patients with IBD (5 patients with left-sided mild to moderate UC, and 5 patients with CD) were administered basic therapy with mesalazine (salofalk) in a dose of 2 —4 g/day (with mild course 2 g/day, with moderate course — 4 g/day). In the experimental group, patients with IBS (n = 20) and patients with IBD (5 patients with left-sided mild to moderate UC and 5 patients with CD) received additional Zafakol (1 tablet 2 times a day for 1 month).
Results. In patients with IBS, additional use of Zafakol was accompanied with the increased efficacy of treatment compared with baseline therapy: in the experimental group, the number of responders (13 of 20 patients, 65 %) was significantly higher than in the control group (9 of 20 patients, 45 %; р < 0.01). In addition, in the experimental group, an improvement in stool consistency was noted in 15 cases (75 %), decrease in bloating in 14 cases (70 %), decrease or normalization of imperative urges in 15 (75 %) patients, while in the control group similar rates were 50 %, 55 % and 55 %, respectively (р < 0.01). The Zafakol use for patients with UC, the mild to manifested improvement was registered in 4 patients (2 subjects with UC and 2 with CD) in each group. Therapy enhancement required for two patients with UC. The positive dynamics in the level of fecal calprotectin in the experimental group was more pronounced than in the controls, though this difference was not significant.
Conclusions. Zafakol is an effective multicomponent coloprotector with pleiotropic effects, which makes it possible to recommend its wide application at the functional and inflammatory intestinal pathology.

Keywords: irritable bowel syndrome, inflammatory bowel disease, treatment, probiotics, coloprotectors.

The article presents the arguments for the necessity of the use of «hepatoprotection support» strategy. The data presented about the new the pleiotropic effects of ursodeoxycholic acid, and capabilities of its application as an universal hepatoprotector have been elucidated.

Keywords: pleiotropic effect, ursodeoxycholic acid, hepatoprotector, treatment.

The article presents information on the physiological and pathophysiological mechanisms of insulin secretion, the role of adipose tissue and some adipokines in development of insulin resistance, glucotoxicity, lipotoxicity at the metabolic syndrome. The importance of chronic systemic inflammation of low intensity on the tissue, cellular and intracellular levels has been outlined for the obesity progression due to the violations of the endocrine function of adipose tissue. It plays the significant role in the formation and development of insulin resistance, as well as the development and persistence of violations of the endocrine function of the pancreas and metabolic syndrome.

Keywords: pancreas, metabolic syndrome, insulin resistance, hyperglycemia, adipose tissue, adipokines, chronic systemic inflammation of low intensity.

The article presents the achievements of twenty years of work of the scientists of the Lviv gastroenterological school, aimed on the diagnosis and treatment of peptic ulcer associated with Helicobacter pylori infection. It outline results of the researches that were not only in line of the provisions of the Maastricht consensus, but in some extent were ahead of them.

Keywords: Helicobacter pylori, diagnosis, treatment.