The multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group (EHMSG) is conducted in 27 countries in Europe. The data from the Russian part of the European registry for the management of Helicobacter pylori infection (European Registry on the management of Helicobacter pylori infection, protocol: “Hp-EuReg”) allows us to analyze the real clinical practice of diagnosis and treatment of H. pylori and compare it with international recommendations. Materials and methods. A comparative analysis of the data entered in the register by the Russian research centers “Hp-EuReg”, in the period from 2013 to 2018, was conducted. Results and discussion. Invasive diagnostic methods prevail for the primary diagnosis of H. pylori [histology - 20.3% (in 2013 year) - 43.9% (in 2018 year), rapid urease test - 31.7% and 47.8% respectively]. The most popular mode of eradication therapy is a 10-day triple therapy (62.8-76.2%), the effectiveness of which does not exceed 79% (per protocol). Invasive tests (histology) are the leading method for control the effectiveness of therapy, however, there is a tendency towards a wider use of non-invasive methods (H. pylori stool antigen - from 17% in 2013 to 29.3% in 2018 and urea breath test from 6.9 to 18.3%, respectively). Serological test to control the effectiveness of eradication is still used from 8.2% (2013) to 6.1% (2018). Eradication therapy was not performed in 28% of patients throughout the entire observation period. Conclusion. In Russia, despite approved domestic and international recommendations, deviations in clinical practice persist, both during eradication therapy and in monitoring the effectiveness of eradication therapy.

On behalf of the scientific Committee and researchers Hp-EuReg European Registry on the management of Helicobacter pylori infection («Hp-EuReg») - a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group, conducted in 27 European countries in order to evaluate the real clinical practice of diagnosis and treatment of H. pylori and its comparison with international recommendations. Materials and methods. The analysis of 2360 patients entered in the register by the Russian centres of «Hp-EuReg» in 2013-2017, who were underwent 1st line eradication therapy. Results. The most common methods of primary diagnosis of H. pylori are histological (37.7%), rapid urease test (29.2%) and serology (29.7%). The duration of eradication therapy in 9.4% of cases was 7 days, in 65.3% - 10 days, and in 25.3% - 14 days. To control the effectiveness of treatment, H. pylori antigen in feces (31.3%), urea breath test (23.4%) and histological method (23.3%) were used. In 3.6% cases was used serology by mistake. In 17.3% of patients control was not carried out. The effectiveness of triple therapy with a PPI, amoxicillin, clarithromycin (per protocol) was 67.6%, with 7-day course, 81.1% at 10-day and 86.7% at 14-day course. Еradication rate of triple therapy with addition of bismuth (per protocol) reached 90,6% in the group receiving 10-day scheme and 93.6% in the group receiving the 14-day treatment. Conclusion. Significant deviations of clinical practice from expert recommendations, most pronounced at the stage of monitoring the effectiveness of therapy, were noted. The suboptimal efficacy of triple therapy is shown.

The aim is to evaluate the effectiveness of complex therapy with the inclusion of the drug Saccharomyces boulardii in patients with non-alcoholic steatohepatitis (NASH) and intestinal dysfunction. Material and methods. An open prospective comparative study of the effectiveness of complex therapy of intestinal dysfunction in patients with non-alcoholic steatohepatitis was carried out. The study included two groups of 36 patients with NASH with symptoms of intestinal dysfunction, established intestinal dysbiosis, structural changes in the mucous membrane of the colon. Results and discussion. It was found that the complex therapy of intestinal dysfunction with the inclusion of the drug Saccharomyces boulardii against the background of NASH reduces the frequency of abdominal pain associated with the intestines, normalizes stool, reduces the degree of dysbiosis, promotes epithelialization of microerosions, and reduces the frequency of neutrophilic infiltration of the colon mucosa. Conclusion. The results of the study indicate the effectiveness of complex therapy with the addition of Saccharomyces boulardii in patients with NASH and intestinal dysfunction

Pathology of the liver and gallbladder is one of the extra-intestinal manifestations of inflammatory bowel diseases (IBD). Targeted examination indicates clinical, laboratory, and structural changes in the liver and gallbladder in 30% of patients with IBD. However, information about the state of the hepatobiliary zone in comparison with the IBD phenotype, the features of the course, and the nature of therapy are few, and their results are contradictory. The aim − to study the frequency of occurrence, to analyze the structural and functional features of the liver and gallbladder in relation to the phenotype, clinical and endoscopic activity of the process, the nature of the course, and the effectiveness of IBD therapy. Material and methods. A simple, open, single-stage, non-randomized study involved 157 patients with ulcerative colitis (UC) and 37 patients with Crohn's disease (CD) who were treated in the Gastroenterology Department of the City Clinical Hospital No. 5 in Saratov in the period of 2016−2019. Complex clinical, biochemical, and instrumental studies were performed (ultrasound examination of the abdominal organs, fibrogastroduodenoscopy and colonoscopy, general morphological examination of colonobioptates). Results. Non-alcoholic fatty liver disease (NAFLD) was verified in 10.8% of patients with UC (3.8% had non-alcoholic steаthohepatitis (NASH), 7% − liver steatosis) and in 27% of patients with CD (NASH – 5.4% of cases, liver steatosis – 21.6%). Dysfunctional disorders and structural changes of the gallbladder were detected in 14.3% of patients with UC and 20.8% with CD. Of these, cholelithiasis was found in 9.5% of patients with UC and 10.8% with CD. When analyzing the association of risk factors for hepatobiliary pathology with a variant of IBD, NAFLD was associated with the type of IBD course (recurrent course for CD), localization of the process (in UC – with left-sided colitis, in CD – with terminal ileitis), an operational history on the intestine in CD, the duration of CD for more than five years, overweight in UC, and the effects of basic therapy (steroid resistance). The pathology of the gallbladder is associated with the duration of IBD for more than three years, the continuous course of UC, and surgical interventions on the intestine in CD. When analyzing laboratory and structural markers of steatosis, it was noted that high values of the steatosis index prevailed in UC (according to J.H. Lee). Abdominal ultrasound revealed mild (41% in UC, 40% in CD) and moderate (47.1% in UC, 50% in CD) liver steatosis more often. When analyzing the clinical features of the hepatobiliary system, it was found that liver pathology was detected by instrumental and laboratory criteria, and gallbladder pathology was characterized clinically by symptoms of biliary dyspepsia in the absence of biliary colic attacks. Conclusion. The features of liver and gallbladder pathology identified during the study can be used to optimize the management of patients with IBD

Контактная информация: Стройко Милла Сергеевна s-milla@mail.ru Коррекция роговичного астигматизма у пациентов с тонкой роговицей с помощью усовершенствованной... 2018;15(2S):166-173 166 ISSN 1816-5095 (print); ISSN 2500-0845 (online) https://doi. РЕЗЮМЕЦель исследования -проведение усовершенствованной сочетанной технологии (фемтосекундная астигматическая кератотомия и топографически-ориентированная фоторефрактивная кератэктомия), для коррекции роговичного астигматизма при тонкой роговице. Пациенты и методы. В статье приведен анализ данных 19 пациентов (30 глаз) c диагнозом сложный миопический астигматизм в сочетании с тонкой роговицей, которым была выполнена операция фемтосекундной астигматической кератотомии (первый этап усовершенствованной сочетанной технологии). Средние значения показателей до операции: сферический компонент рефракции -4,1 ± 2,1 дптр, цилиндрический компонент рефракции -4,9 ± 1,4 дптр, НКОЗ 0,1 ± 0,05, КОЗ 0,6 ± 0,1, K max 46,70 ± 1,1, K min 42,8 ± 1,3, толщина роговицы 470,0 ± 12,7 мкм. Вторым этапом тем же пациентам была проведена топографически-ориентированная фоторефрактивная кератэктомия с целью коррекции остаточной аметропии. Средние значения показателей до операции: сферический компонент рефракции -5,3 ± 2,0 дптр, цилиндрический компонент рефракции -1,6 ± 0,8 дптр, НКОЗ 0,3 ± 0,1, КОЗ 0,7 ± 0,1, K max 44,00 ± 0,9, K min 44,3 ± 0,8, толщина роговицы 464,3 ± 8,3 мкм. Всем пациентам, вошедшим в клиническое исследование, проведено офтальмологическое диагностическое обследование стандартными и специальными методами, скрининг кератоконуса. При проведении первого этапа усовершенствованной сочетанной технологии была использована фемтосекундная лазерная установка LenSx Laser (Alcon, США), при проведении второго этапа -эксимерлазерная установка WaveLight EX-500 (Alcon, США). Результаты. После завершения двух этапов усовершенствованной сочетанной технологии были получены следующие результаты: снижение сферического компонента рефракции с -4,1 ± 2,1 до -0,4 ± 0,3, цилиндрического компонента рефракции с -4,9 ± 1,4 до -0,1 ± 0,1, K max с 44,70 ± 1,1 до 37,8 ± 1,6, K min с 42,80 ± 1,3 до 37,00 ± 1,3, увеличение КОЗ с 0,6 ± 0,1 до 0,8 ± 0,1, НКОЗ с 0,1 ± 0,05 до 0,7 ± 0,1. Выводы. Усовершенствованная сочетанная технология (фемтосекундная астигматическая кератотомия и топографически-ориентированная фоторефрактивная кератэктомия) является эффективной, безопасной, позволяет выполнять коррекцию астигматизма у пациентов с тонкой роговицей, которым ранее было отказано в рефракционной операции.Ключевые слова: астигматизм, тонкая роговица, усовершенствованная сочетанная технология, фемто-АК, фемтосекундный лазер Для цитирования: Стройко М.С., Костенев С.В., Пахомова А.Л. Коррекция роговичного астигматизма у пациентов с тонкой роговицей с помощью усовершенствованной сочетанной технологии. Офтальмология. 2018;15(2S):166-173. https://