Objective — to study changes of themotor and evacuation functions of stomachand indicators of the 24-hours pH monitoring in the esophageallower third, to establish the role of gastrin-17 (G-17), cholecystokinin-pancreozymin, changes in the level of pepsinogens I and II, and their correlation in the pathogenesis of gastroesophageal reflux disease (GERD).
Materials and methods. Examinations involved 80 patients with GERD. The GERD diagnosis was based on the diseaseanamnesis, patients’ complaints, results of 24-hours pH monitoring in the lower third of the esophagus, results of esophagogastroduodenoscopy, chromoendoscopy, 13C-octanoic breath test, serum levels of G-17, pepsinogens I and II (PI and II) and cholecystokinin-pancreozymin (C-P).
Results. The results of 24-hours pHmonitoring of the lower esophagusshowed the predominance of acid refluxes in 40 GERD patients and of the mixed refluxesin the rest of patients.In patients with predominance of acid refluxes, the mean values of the 13C-octanoic breath test (half-life excretion of solid food from the stomach) was (45.25 ± 1.34) min.In patients with the mixed refluxes, the hypergastrinemia was established, as well as the high C-P and PI II levels ((37.44 ± 3.41) μg/l; р < 0.05), as well as a trend towards the hypokinetic stomach motility, evident due to the decreasedhalf-life excretion of solid food from the stomach up to (139.24 ± 11.87) min. In case of the predominance of acid refluxes, the significance reduction of the G-17, C-P and PI II levels was reveled, and increased PI I levels.
Conclusions. The results of 24-hours pH monitoring of the lower esophagus showed virtually equal rate of the acid and mixed refluxes.In case of the predominant acid refluxes, the accelerated stomachmotilitywas established, and the delayed motility was reveled in the patients with mixed refluxes.The acid refluxes prevailed in GERD patients with the low serum G-17 level and mixed reflux was more frequent in subjects with the increased levels. With the predominance of acid refluxes, blood levels of pepsinogen I was 3.5 times higher than in healthy people, and in case of the mixed reflux,it was within normal ranges with the increased levels of pepsinogen II.

Keywords: gastroesophageal reflux disease, daily pH monitoring in the lower third of the esophagus, 13C-octanoic breath test, gastropanel, cholecystokinin- pancreozymin.

Objective — to investigate the topographic and functional peculiarities of the stomach and esophagus in patients with GERD with the use of esophageal and gastric 24-hours pH monitoring.
Materials and methods. The study involved 28 patients (11 men and 17 women, the mean age 47 ± 2.4 years), from them GERD was diagnosed in 15 subjects, and functional gastric dyspepsia without GERD in 13 patients. The data, obtained with 3-channel esophageal and gastric 24-hours pH monitoring, were analyzed separately in the groups with GERD and without GERD.
Results. Medium and minimum values of intragastric pH as in the cardia and the body were lower in patients with GERD (p < 0.05 for cardia). Undoubtedly, esophageal monitoring of the is decisive in the GERD diagnosing, however the presence of daily intragastric pH high potency was considered as a predictor of GERD development.
Conclusions. The presence of more acidic stomach contents in patients suffering from GERD not only confirmed the major role of hydrochloric acid in a damaging effect on the esophageal mucosa and occurrence of symptoms, and should also be considered as a possible predictor of GERD in patients without severe clinical symptoms during the examination.

Keywords: gastroesophageal reflux disease, 3-channel esophageal and gastric 24-hours pH monitoring, functional gastric dyspepsia, acid-dependent diseases of the stomach.

Objective — to evaluate the advisability of the use of CT scan as a routine diagnostic method for patients with suspected inflammatory bowel disease (IBD).
Materials and methods. A retrospective analysis was performed on 72 outpatient cardsof patients with suspected IBD or with established diagnosesof ulcerative colitis (UC) or Crohn’s disease (CD). All patientswere undergone a CT scan with the Aquilion-64 helix computer tomography scanner with 64-slices and with double-contrast method (oral and intravenous) for the primary diagnosis of IBD or to evaluate the effectiveness of the treatment. The patientswere divided into three groups: subjectswith suspected IBD, patients with established UC and CD diagnoses; and persons to be under regular medical check-up due to IBD, for whom CT was used to assess the efficacy of treatment.
Results. In patients of the 1st group, CT scan confirmed the UC and CD diagnosis (similar to the endoscopyresults) and allowed to reveal the terminal ileitis and the UCinitial stage of without visual changes in the mucosa during endoscopy but with signs of inflammation in the histology. Besides, it allowed disproving the IBD diagnosis and confirmingother diseases (diverticulitis, pseudomembranous colitis). In group 2 patients, CT scan gave the possibility to confirm or disprove the pre-exposed UC and CD diagnoses, and to detect concomitant pathology at an early stage (primary sclerosis cholangitis and hepatocellular carcinoma). For the subjects of group 3 CT scan enabled tracking of the treatment efficacyin patients with UC and CD, correct choice of the treatment tactics,and complications’ identifying.
Conclusions. The use of CT scan is advisable in the routine practice of diagnosis in patients with the suspected IBD, the established UC and CD diagnosis, as well as assessment of the treatmentefficacy.

Keywords: inflammatory bowel disease, ulcerative colitis, Crohn’s disease, CT scan.

Functional diarrhea is a type of functional bowel disorder presenting with loose or watery stool as consequence of intestinal transit dysregulation. The peculiarities of patients’ management dependon the presence of alarm symptoms. Clinical and instrumental measurements aim to rule out of diarrhea secondary to organic disease. The dietary interventions, loperamide, cholestyramine, probiotics and synbiotics may have good efficacy in the functional diarrhea management.

Keywords: functional diarrhea, chronic diarrhea, stoolprevalence, diagnostic criteria, diet intervention, μ-opioid agonist, cholestyramine, probiotics, synbiotics.

It is known that about 15 — 25 % of the adult population in the developed countries have functional disorders of the gastrointestinal tract, regardless of age, race, religion or socio-economic status. Among the functional diseases of the gastrointestinal tract, patients with irritable bowel syndrome occupy a significant proportion at the reception of a general practitioner and a gastroenterologist (30 % to 50 %). The article deals with the main differences between the Rome IV Criteria for the diagnosis and treatment of irritable bowel syndrome. The necessity of the use of spasmolytic therapy, laxative and antidiarrheal drugs, depending on the clinical variants of the irritable bowel syndrome have been discussed.

Keywords: Rome consensus IV, functional disorders of the gastrointestinal tract, irritable bowel syndrome, diarrhea, constipation, laxatives, antidiarrheal drugs, Mikrolaks®, Imodium®.

This paperpresents modern approaches to the treatment of autoimmune hepatitis (AH) according to the latest international recommendations, their positive and negative aspects. Data on alternative therapies for AH, the prospects of introducing immunologically active and targeted drugs into the clinical practice for treatment and management of AHpatients have been elucidated. A clinical case of a patient with AH against the background of nonspecific ulcerative colitis has been presented.

Keywords: autoimmune hepatitis, prednisolone, azathioprine, budesonide, mycophenolatemofetil, tacrolimus.

Nonalcoholic fatty liver disease (NAFLD) combines a range of diseases, including simple steatosis, non-alcoholic steatohepatitis (NASH), liver cirrhosis and hepatocellular carcinoma. Recent studies have shown the high prevalence of NAFLD and its close pathogenetic relationship with the metabolic syndrome. The relationship between MS and NAFLD allow assuming that both conditions have pathogenetic interconnections and common pathways and mechanisms of the development. Insulin resistance and inflammation are involved in the process of both diseases. The insulin resistance promotes inflammation, which in turn increases lipolysis of adipocytes and aggravates lipotoxicity. Moreover, IR and inflammation form a vicious circle, with each condition contributing to another and accelerating the development of NAFL in the presence of lipotoxicity. Biologically active fat tissue regulates the expression of pro-inflammatory cytokines, such as tumor necrosis factor α, interleukin-6, and anti-inflammatory cytokines such as adiponectin in NAFLD.

Keywords: non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, metabolic syndrome, obesity, diabetes, tumor necrosis factor, interleukin.

The article presents a literature review on the main genetic mutations leading to the development of pancreatitis. The analysis has been performed for the pathogenesis of hereditary pancreatitis and the high risk of pancreatic cancer at this disease. The authors described their own clinical observation of calcificating pancreatitis that developed in a patient with a mutation of the cationic trypsinogen gene and presented discussion of the treatment and follow-up tactics.

Keywords: pancreas, hereditary pancreatitis, mutation of the cationic trypsinogen gene, risk of pancreatic cancer, clinical observation.

Viral infections is a key safety concern in the treatment of patients with chronic inflammatory bowel disease (IBD).Patients with chronic inflammatory bowel disease do not receive routine preventative care at the same rate as other patientsof general medical.The improvement of the tacticsof ІВD management involves control of the diseaseinflammatory activity with thecontroller medicationsand prevention of viral infections.The author highlights the recommendations for vaccination against influenza and herpetic infection in patients with IBD, especially those receiving treatment with immunosuppressive drugs.

Keywords: inflammatory bowel disease, ulcerative colitis, Crohns disease, viral infections, treatment, preventive care.

The article presents the main invasive and non-invasive methods for diagnosing nonalcoholic fatty liver disease (NAFLD). Although liver biopsy is the only accurate method for differentiating patients with nonalcoholic fatty steatohepatitis (NASH) and without it, as well as fibrosis, which is important for determining the tactics of patient management and monitoring, several existing scales and patented panels that also predict the severity of fibrosis. One of the main markers of hepatocyte apoptosis, the definition of which is included in many non-invasive panels for the diagnosis of NASH, is blood plasma cytokeratin -18. Non-invasive imaging techniques, such as ultrasound-based elastography (Fibroscan) and magnetic resonance imaging, are sufficiently accurate studies available to determine the severity of fibrosis in NAFLD, but none of them can replace liver biopsy. The search for the new non-invasive NAFLD markers is ongoing.

Keywords: diagnostics, NAFLD, NASH, fibrosis, fibrogenesis, non-invasive markers.

The pathogenic mechanisms of development of non-alcoholic fatty liver disease (NAFLD) have been elucidatedin the paper. The author outlined that insulin resistance, resulting in a hyperinsulinemia, plays the pivotal role in the steatosis development in liver tissue. Oxidation offree fat acids and export of triglycerides from the liver in a form of very low density lipoproteins are less important. Steatosis livers are played by the decline of oxidization of and. Syndrome of excessive bacterial proliferation in the intestine can also be referred to the pathogenetic mechanisms of NAFLD formation. The effects of lipid peroxidation are considered as most important universal mechanism of NAFLD development. An important place in the pathogenesis of liver steatosis is given to micro-RNA, regulatinglipids’accumulation in hepatocytes. The new data from the study ofthe NAFLD genetic mechanisms have been presented.

Keywords: non-alcoholic fatty liver disease, insulin resistance, metabolic syndrome, free fat acids, micro-RNA, endothelial dysfunction.

Consideration has been performed for the modern data on epidemiology, etiology, pathogenesis, features of clinical course and treatment of peptic ulcer of the stomach and duodenum, not associated with Helicobacter pylori infection.

Keywords: Helicobacter pylori-negative peptic ulcer of the stomach and duodenum, epidemiology, etiology, pathogenesis, clinic, treatment.