Objective — to evaluate CK-18 level in the blood plasma in patients with non-alcoholic fatty liver disease (NAFLD), and its dynamics by combined treatment of UDCA and ademetionine.
Materials and methods. The study involved 30 patients with NAFLD in NASH stage. The mean age of the patients was 47.6 ± 3.7 years, from them 16 (53 %) men and 14 (47 %) women. All patients were diagnosed with NAFLD in NASH stage, The investigations included routine clinical and laboratory methods, assessments of tophological status and lipid metabolism. Ther determination of CK-18 monoclonal antibody in blood plasma was performed. Analysis of the dynamics of biochemical parameters and the level of CK-18 was evaluated before and 30 days after the treatment. All patients received a combined therapy of ursodeoxycholic acid and ademetionine during one month.
Results. Evaluation of CK-18 level in the blood plasma of NAFLD patients in NASH stage before and after a month of treatment showed a significant decrease in the levels of CK-18 by 8.6 % (p < 0.05), cytolysis syndrome indicators: AST and ALT levels decreased in 2 and 2.4 times, respectively (p < 0.04). The lipid profile were normalized with total cholesterol, LDL and atherogenic ratio (p ≤ 0.05), TG, HDL and VLDL tended to decrease (p > 0.05).
Conclusions. The combined therapy of UDCA and ademetionine resulted in the decrease of CK-18 levels in blood plasma of NASH patients, reduction of cytolysis rates and normalization of the lipid profile, indicating the slowdown of disease progression.

Keywords: non-alcoholic fatty liver disease, cytokeratin-18, ursodeoxycholic acid, ademetionine.

Objective — to investigate the basic level and dynamics of lipid, carbohydrate metabolism, adiponectin and pro-inflammatory cytokines (TNF-α and IL-6) in patients with NAFLD and hypertension using combined therapy.
Materials and methods. The study involved 88 patients with NAFLD with hypertension stage II, 2 degree, treated in L. T. Mala National Therapy Institute of NAMS of Ukraine, form them 49 (55.68 %) men and 39 (44.32 %) females; the mean age was 51.3 ± 6.2 years. The control group consisted of 30 age and gender matched healthy volunteers. The examinations included indices of lipid and carbohydrate metabolism, blood pressure, adiponectin and pro-inflammatory cytokines (TNF-α and IL-6) by conventional methods. Ultrasound examinations of liver and other gastrointestinal organs were performed. Patients with NAFLD and hypertension (n = 88) were divided into two groups. Patients of group I (n = 44) received lisinopril 10 mg/day, atorvastatin 10 — 20 mg/day. Group II patients (n = 44) received lisinopril 10 mg/day atorvastatin and 10 — 20 mg/day in combination with omega-3 fatty acids 2 g/d and UDCA 10 mg/kg/day. Duration of treatment was 12 months. All were given recommendations for a balanced diet and exercises.
Results. The patients with NAFLD and hypertension demonstrated abnormalitis of lipid and carbohydrate metabolism, increase of pro-inflammatory cytokines (TNF-α and IL-6) and decrease of adiponectin levels. The metabolic profile was worse in patients with NAFLD and hypertension, combined with obesity. As a result of the study, the significantly better improvements were achieved in group 2, in the case of administration of the complex therapy using UDCA and omega-3 fatty acids. In these group of patients, adiponectin levels increased by 47.57 % vs. 20.67 % in group 1 (p < 0.001).
Conclusions. The combined therapy, including atorvastatin, lisinopril, UDCA and omega-3 fatty acids in combination with non-drug therapy, proved to be more effective for patients with NAFLD and hypertension in comparison with the treatment scheme, which included lisinopril and atorvastatin combination with non-drug therapy, in terms of correction of the metabolic disorders, associated with NAFLD. It resulted in the reduction the overall cardiometabolic risk and improvement of life prognosis in patients with NAFLD and hypertension.

Keywords: non-alcoholic fatty liver disease, hypertension, adiponectin, proinflammatory factors.

Objective — to investigate the effects of the treatment with the preparation of ursodeoxycholic acid Choludexan on the blood lipid levels in patients with the postcholecystectomy syndrome (PCES).
Materials and methods. The investigation involved 46 patients with PCES and 21 healthy volunteers. The age of patients was 38 to 65 years; women prevailed among these patients: 35 (76.1 %). The examinations included general clinical investigations, body mass index, waist circumflex, esophagogastroduodenoscopy, abdomen ultrasonic examinations, multiphase duodenal intubation with the definition of the time of Oddi sphincter of opening, volume and rate of the choledochic bile portion excretion, bacteriologic investigation of the choledochic and hepatic bile portions. The blood lipid and glucose levels were measured, as well as the biochemical parameters of hepatic function. The patients were divided into two groups depending on the treatments: the main group (n = 23) and comparison group (n = 23). Patients of both groups were administered the individual diet with restriction of simple carbohydrates, fats and high protein proportion. The patients of main group were additionally administered Choludexan in a dose of 900 mg/day.
Results. At baseline, the dyslipidemia was revealed in patients with PCES. After the treatment, attenuation of the signs of sonographic liver steatosis was observed. The positive dynamics was more expressed in patients of the main group. In this group, the portion of patients with the dilatated bile duct decreased. Thus, the size of the bile duct of 8 — 10 mm was revealed only in 8.7 % of patients. After the treatment, the positive dynamics of blood lipid levels was observed in patients of the main group. In particular, the blood levels of the high density lipoprotein cholesterol significantly increased in patients of the main group (in 1.2 times, р < 0.01), whereas in patients of the comparison group, the trend toward the increase of this parameter was observed (the difference between these parameters before and after treatment wasn’t statistically significant).
Conclusions. The administration of the individual dietary treatment and ursodeoxycholic acid Choludexan preparation promoted the decrease of the sonographic signs of the liver steatosis, bile duct diameter, reduction of the blood levels of atherogenic lipids, and increase of the high density lipoprotein cholesterol levels.

Keywords: postcholecystectomy syndrome, lipids, bile duct, Choludexan.

The results of treatment of patients with a combination of drug-induced hepatitis and chronic pancreatitis are revealed in this article. Benefits of treatment including pantoprazole (Nolpaza) are demonstrated both in the positive dynamics of clinical manifestations, and regarding the influence on the functional state and sonographic changes of the pancreas and liver, metabolic indices, blood lipid profile, quality of life of patients.

Keywords: chronic pancreatitis, drug-induced hepatitis, treatment, dynamics of the functional state and sonographic changes of the pancreas and liver, influence of treatment on metabolic indices, blood lipid profile, quality of life of patients.

Objective — to evaluate the clinical efficiency of the Progepar preventing the progression of non-alcoholic fatty liver disease (NAFLD) in patients with elevated liver enzymes.
Materials and methods. The investigation involved 68 patients with NAFLD, 32 patients (12 men, 20 women) received the Progepar and the basic therapy (study group), and 36 patients (11 men, 25 women) received only the basic therapy (control group). The dynamics of clinical syndromes, liver enzymes (alanineaminotransferase, aspartateaminotransferase), sonographic parameters (size of the liver, the degree of steatosis) and the degree of fibrosis according to RTE-elastography of the liver were investigated.
Results. After 12 weeks from the treatment start, observations showed practically complete removal of clinical symptoms in the study group and trend the reduction of symptoms’ frequency in the comparison group. Positive dynamics of clinical symptoms was accompanied by a decrease in the activity of the inflammatory process in the liver tissue. This was followed by a decrease to normal alanineaminotransferase to 76.4 ± 14.6 to 28.8 ± 16.6 IU/L (p < 0.05) and aspartateaminotransferase to 51.5 ± 9.3 to 24.1 ± 7.7 IU/L (p < 0.05), the reduction of the livers’ size prior to treatment averaged 210.7 ± 25.4 mm, after treatment — 154.8 ± 11.1 mm (p < 0.05). Progepar marked positive impact on the regression degree of livers’ fibrosis and the degree of fatty livers’ infiltration. So, at the start 1 degree of hepatic steatosis was found in 13 patients (40.6 %), 2 degree — in 19 patients (59.4 %); Liver fibrosis: F0 — 4 patients (12.5 %), F1 — 15 (46.9 %), F2 — 9 patients (28.1 %), F3 — 4 (12.5 %). After 12 weeks therapy distribution degree of hepatic steatosis was as follows — 1 degree in 21 patients (65.6 %) and grade 2 in 11 patients (34.4 %); on the degree of livers’ fibrosis: F0 — 11 patients (34.4 %), F1 — 9 patients (28.1 %), F2 — 8 patients (25 %), F3 — 4 (12.5 %). In the comparison group, changes were observed in the downside performance of the morphological state of the liver.
Conclusions. Progepar contributes to improvement in both subjective clinical symptoms of NAFLD and objective indicators — reduces the activity of the cytolytic process in the liver, has a positive effect on the sonographic parameters reflecting the severity of steatosis and fibrosis of the liver, has a good tolerability profile and security. Such changes make a significant contribution to the prevention of disease progression. It lets us recommend Progepar for the treatment of NAFLD.

Keywords: Progepar, gidralizat calves liver, non-alcoholic fatty liver disease, liver steatosis, liver fibrosis.

The metabolic syndrome (MS) is one of the most worldwide spread pathological states. It is an important factor, stipulating cardiovascular and metabolic risks of mortality. The persistency of the chronic inflammation at MS is the basis for the development of pathological processes, combined by the MS concept, which is both the reason and consequence of the development of a great number of its clinical manifestations. The article presented considerations for the basis mechanisms, connecting intestinal microbiota and MS. The effects have been shown of various polymorphisms of the Toll-like receptors on the risks of MS development due to the changes of changes in the intestinal microbiota composition. The intestinal dysbiosis with reduction of the Bacteroidetes proportion to Firmicutes is specific for both MS and its composing nosologies. It is believed that prebiotics and probiotics can regulate metabolism at MS, as well at MS-associated conditions. Probably, in the nearest future it will play a crucial role in the development of preventive and therapeutic strategies for curation of patients with MS.

Keywords: metabolic syndrome, intestinal microbiota, Toll-like receptors, intestinal dysbiosis, metabolism, insulin resistance, dyslipidemia.

Objective — to compare efficacy of different formulations of enzyme preparations for pancreatic enzyme replacement therapy (PERT) based on the results of 13С-Mixed Triglycerides Breath Test (13MTBT).
Materials and methods. The open-labelled comparative study involved five patients with moderate pancreatic exocrine insufficiency (PEI) with average concentration of fecal pancreatic elastase 1 (FPE1) of 81.0 mcg/g and five patients with severe pancreatic exocrine insufficiency with average concentration of FPE1 of 37.4 mcg/g. All patients underwent 13MTBT twice: the first test was performed after intake of test meal with a tablet of Mezim forte 20 000 and the second one — after intake of one capsule of Pangrol 25 000 with a test meal.
Results. The cumulative concentration 13СО2 after 360 minutes of 13MTBT, which reflects the activity of pancreatic enzymes in the duodenal lumen, was used as parameter of estimation for PEI compensation by means of PERT (the norms is > 26.8 %). The intake of one tablet of Mezim forte 20 000 resulted in PEI compensation in all patients with moderate PEI, but only in 40 % of patients with severe PEI. The usage of one capsule of ­Pangrol 25 000 resulted in the normalization of the cumulative concentration 13СО2 after 360 minutes of 13MTBT in all patients with moderate and severe PEI.
Conclusions. The consecutive detection of FPE1 and conducting of 13MTBT is a rational approach to diagnosis of PEI and personalization of the PERT. Gastroresistant tablets Mezim forte 20 000 is economically acceptable and fairly affective PERT method for compensation of mild to moderate PEI. The administration of capsules with minitablets Pangrol 25 000 can be recommended for the patients with severe PEI. Depends on the residual excretory pancreas capacity and volume of meals ingested by a patient (the average dose is 25 000 — 50 000 IU per meal and 10 000 — 20 000 IU with snacks).

Keywords: pancreatic exocrine insufficiency, fecal pancreatic elastase 1, 13С-mixed triglycerides breath test, pancreatic enzyme replacement therapy.

The article presents recent data on cholestatic liver disease and gall bladder. The opportunities to improve the therapy efficiency with ursodeoxycholic acid (UDCA) have been outlined. The problems of changes in the diseases’ nomenclature and their definitions have been considered, in particular, primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). Steps of diagnostic search at cholestatic syndrome on the basis of recommendations of the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases were specified. The substantiation was given for the principled approach and PBC treatment schemes using UDCA with account of patient’s clinical phenotypes, presence of PBC, biliary sludge, Gilbert syndrome. The bicarbonate «umbrella» theory was presented. Until the year 2004, only foreign drugs UDCA preparations were used in Ukraine, and their high cost greatly limited application by a significant number of patients with need of treatment. The implementation UDCA domestic product Ursohol (CJSC «Pharmaceutical company Darnitsa») into clinical practice allowed to increase the number of patients, receiving modern therapy, to improve the quality of life and to increase their life expectancy.

Keywords: cholestasis, primary biliary cirrhosis, primary sclerosing cholangitis, biliary sludge, Gilbert syndrome, ursodeoxycholic acid, ursotherapy.

Pancreatic cancer is the fourth leading cause of cancer-associated death in men and women. Prevention of pancreatic cancer is one of the most pressing problems of modern medicine and should be aimed at correction of the risk factors, promoting carcinogenesis and the development of pathological changes. Unhealthy lifestyle, pathological habits and food, not corresponding to the principles of rational nutrition, are the major risk factors. Moreover, along with the adequate ratio of macronutrients, dietary must contain an adequate amounts of micronutrients, including selenium.

Keywords: pancreatic cancer, risk factors, nutrition, microelements, selenium.

Irritable bowel syndrome (IBS) is a heterogeneous functional disorder with a multifactorial etiology that involves the interplay of both host and environmental factors. Among environmental factors relevant for IBS etiology, the diet stands out given that the majority of IBS patients report their symptoms to be triggered by meals or specific foods. The diet provides substrates for microbial fermentation, and, as the composition of the intestinal microbiota is disturbed in IBS patients, the link between diet, microbiota composition, and microbial fermentation products might have an essential role in IBS etiology. In this review, the authors summarized current evidence regarding the impact of diet and the intestinal microbiota on IBS symptoms, as well as the reported interactions between the diet and the microbiota composition. Based on existing data, the mechanisms have been summarized, by which diet components, via the microbial fermentation, could trigger IBS symptoms.

Keywords: irritable bowel syndrome, intestinal microbiota, diet.

The paper summarizes data about the features of diagnosis of non-alcoholic fatty liver disease. The diagnosis of non-alcoholic fatty liver disease can be made through imaging studies or liver biopsy with histologic confirmation. The results of study of sensitivity and specificity of different non-invasive methods of diagnosis hepatic steatosis and fibrosis in different cohorts of patients have been presented.

Keywords: non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, non-invasive biomarkers of liver steatosis and fibrosis.

Irritable Bowel Syndrome (IBS) is a common disorder of the gastrointestinal tract. In recent years, the new data on the intestinal microflora, genetic polymorphisms, inflammation associated with the occurrence of IBS symptoms, gave an impetus to the disease investigation. Criteria for the IBS diagnosis seems to be outdated and require revision. The new recommendations for the IBS diagnosis are currently under discussion and are planned to be adopted in 2016 as the Rome criteria IV. This review highlights problems of diagnosis and treatment of this disease. The analysis of the various groups of drugs to treat the disease has been performed. It has been proved that IBS is a serious illness, which requires an individual approach to the patients’ treatment.

Keywords: Irritable bowel syndrome, visceral sensitivity, microbiota, probiotics, antispasmodics, rifaximin.