The approvals and provisions of the Management of Helicobacter pylori infection-the Maastricht V/ Florence Consensus Report and those of the Kyoto Global Consensus Conference on H. pylori-associated gastritis, concerning with the primary and secondary prevention of gastric cancer (GC), unambiguously suggest that H. pylori infection is the most important risk factor of GC. Accordingly, the basis for the primary and secondary prevention of GC is the optimization of H. pylori eradication therapy. The clear direct relationship of the risk of GC to the severity and extent of atrophic gastritis, intestinal metaplasia and dysplasia and no reversal of intestinal metaplasia and dysplasia in the presence of H. pylori eradication presume that gastroprotective agents should be used for primary and secondary prevention. Experimental and clinical findings can lead to the conclusion that rebamipide is a highly effective and safe agent for the primary and secondary prevention of GC in patients with and without H. pylori infection, by optimizing anti-Helicobacter therapy, its anti-inflammatory effect and ability to restore the cellular structure of the gastric epithelium.

The purpose of the review is to acquaint general practitioners, therapists, gastroenterologists with the possibilities of diagnosing functional disorders of the gastrointestinal tract associated with constipation, as well as to draw attention to the need for additional examination methods for a comprehensive assessment of functional disorders of the gastrointestinal tract in patients with constipation on pathogenesis.Functional constipation is an urgent problem today due to its prevalence among different age groups, a negative impact on the quality of life, as well as the variability of the clinical forms of diseases associated with this symptom. The modern diagnostic algorithm for chronic constipation consists of several stages, including the identification of signs of the disease, according to the Rome criteria of the IV revision (2016), the identification of symptoms of “red flags” and laboratory and instrumental research. It should be borne in mind that functional constipation is often based on the pathology of the anorectal zone, which is an important factor in the diagnosis and development of further therapeutic strategies. The article provides an overview of modern and promising methods for diagnosing functional disorders of defecation, taking into account functional disorders of the anorectal zone associated with constipation.Functional methods such as anorectal manometry, rectal sensory test and balloon expulsion test are the  most studied and obligatory tests for an objective assessment of the sensorimotor function of the anorectal zone. In Russia, these methods are used very little, which requires extensive familiarization of practitioners with the advantages of these techniques. Knowledge and application of the presented examination algorithms will help the clinician to increase the overall diagnostic efficiency and apply the most justified tactics of managing patients with functional pathology of the digestive system associated with constipation.

The problem of comorbidity with a high risk of polypragmasia is relevant in a large group of patients with diseases in the digestive system. Currently, the problem of comorbidity in patients with gastroesophageal reflux disease (GERD) attracts the attention of specialists due to the high disease prevalence and data indicating its association with other digestive system diseases, primarily of the hepatobiliary system. The article presents the results of clinical and experimental studies revealing the pathogenetic connections of GERD and hepatobiliary pathology accompanied by biliary dyskinesia, factors leading to an impairment of the duodenal propulsive activity. It is noted that the most important components of the esophageal mucosa lesion in duodenogastroesophageal reflux are bile acids, lysolecithin and pancreatic enzymes. The relevance of prescribing drugs that can affect the course of pathogenetically related diseases, which can significantly reduce the risk of polypragmasia, is justified. Such drugs include ursodeoxycholic acid, which, in the conditions of the GERD and hepatobiliary pathology association, contributes to the functional state normalization of the liver and biliary tract, reduces biliary dyskinesia, the severity of duodenal hypertension and duodenogastroesophageal reflux. The next example is the rebamipide cytoprotector, which has a multilateral protective effect against the mucous membrane of the GIT, including the esophagus, gastroduodenal zone, small intestine, as well as liver. The expediency of prescribing rebamipide to patients who are refractory to therapy with proton pump inhibitors is justified. KEYWORDS: comorbidity, hepatobiliary pathology, gastroesophageal reflux disease, ursodeoxycholic acid, rebamipid, proton pump inhibitors. FOR CITATION: Kazyulin A.N., Goncharenko A.Yu., Kalyagin I.E. Association of hepatobiliary pathology and gastroesophageal reflux disease. Russian Medical Inquiry. 2021;5(6):404–412 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-404-412.

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