Currently, biliary sludge (BS) is considered as a pathological process associated with an increase in the lithogenicity of bile and according to the modern classification of gallstone disease referred to the prestone stage of the disease. In the mechanism of BS formation, the main role belongs to four factors: glut of bile with cholesterol, formation of crystallization nucleus, dysfunction of the gallbladder (contraction, absorption, secretion), violation of the enterohepatic circulation of bile acids. Clinical manifestations in BS are most often associated with concomitant functional disorders of the biliary tract and chronic bacterial duodenitis with duodenal hypertension. The main directions in the treatment of BS are reduced to the restoration of the normal rheological properties of bile, the normalization of the motor function of the biliary system and the duodenum, the correction of the intestinal microbiome. The article discusses effective treatment regimens for BS depending on its morphological features and clinical course with the use of ursodeoxycholic acid or hofitol. The mechanism of Chophytol action (Mayoly Spindler, France) at BS is presented. The additional use of Meteospasmyl in the presence of intestinal antiseptic indications contributes to the rapid resolution of clinical manifestations in this pathology.

Inflammatory bowel diseases (IBD) are chronic autoimmune inflammatory diseases with intestinal damage and extraintestinal manifestations. The concept of permanent life-long medication is the cornerstone in the treatment of IBD. Adherence to drugs is defined as the degree to which the patient observes the dose and the interval between them in accordance with the prescribed dosage regimen. Unfortunately, in general, in chronic diseases, adherence decreases over time, reaching 50 % in developed countries and even more in developing ones. Objective. To assess adherence to therapy in patients with Crohn's disease (CD) and ulcerative colitis (UC), observed in the department for the treatment of inflammatory bowel diseases at the Moscow Clinical Scientific and Practical Centre n.a. A.S. Loginov. Materials and methods. The study included 55 (45.8 %) men and 65 (54.2 %) women older than 18 years, 70 (58.3 %) patients with UC, 50 (41.7 %) with CD, who were treated and examined in the department of treatment of inflammatory bowel disease of the centre. Patient adherence to therapy was evaluated using the Moriska-Green test, the results of which were used to divide all patients into two groups: first, patients with low treatment adherence (LTA); the second is with high commitment (HTA). Results. It was found that patients with low adherence to therapy turned out to be significantly more than patients with high: 78 (65.0 %) vs. 42 (35.0 %), respectively (p < 0.001). In the group of patients with HTAs, women prevailed: 26 (61.9 %) versus 16 (30.1 %) (p < 0.001). In the group of HTAs, patients with BC also prevailed: 30 (71.4 %) versus 12 (28.6 %) patients with UC (p < 0.001). It was established that in the group of HTAs, patients receiving 5-aminosalicylic acid preparations (5-ASA) prevailed 23 (54.8 %) and genetically engineered biological preparations (GIBP): 15 (35.7 %). In the LTA group, patients receiving systemic immunosuppressants and glucocorticosteroids prevailed at 54 (69.3 %) versus patients receiving 5-ASA and GIBP at 24 (30.7%) (p < 0.001). The frequency of exacerbations of diseases more than once a year was significantly higher in the LTA group at 52 (66.6 %) versus 13 (30.9 %) in the HTA group (p < 0.001). The incidence of surgical interventions in patients with CD was significantly higher in the LTA group - 15 (75.0 %) versus 5 (16.6 %) in the HTA group (p < 0.001). A significant difference between the groups was noted, if possible, to receive drugs in the SDS list (supplementary drug supply) - 38 (90.5 %) in the HTA group versus 40 (51.3 %) in the LTA group (p < 0.001). It is established that the form of mesalazine also affects the adherence to therapy. It has also been shown that adherence is not affected by the patient s age and socioeconomic status. Conclusion. Among patients with IBD, examined in the department of treatment of inflammatory bowel disease of Moscow Clinical Scientific and Practical Centre n.a. A. S. Loginov, 65 % have a low commitment to taking prescribed medications. Such factors as the use of systemic immunosuppressors and glucocorticosteroids in therapy, the complicated course of CD, an increase in the frequency of exacerbations of IBD are associated with a low adherence to treatment. The female sex, the presence of drugs in the SDS list, and the convenience of therapy are reliably associated with high treatment adherence.

The article is devoted to the description of a rare intestinal disease - eosinophilic colitis. Presented patient O., 27 years old, whose disease was diagnosed during histological examination after an emergency surgery for perforation of the sigmoid colon. The clinical data, results of laboratory, instrumental, morphological examinations are analyzed. A comparative analysis was carried out with Crohn's disease, collagen colitis.

There are pharmacodynamics, pharmacokinetics, clinical aspects of the use of bismuth tripotassium dicitrate and comparative analysis of the physicochemical and structural properties of tableted forms of preparations containing bismuth tripotassium dicitrate - the original drug De-Nol® (Astellas) and the generic drug Ulcavis® (KRKA) in the article. Demonstrated similar physical and chemical properties, the similarity of the disintegration rate of the two tablets of bismuth tripotassium dicitrate suggests a similar clinical effectiveness of the reproduced and reference drug.

An analysis of the diagnosis of extrahepatic bile duct diseases in 115 patients is presented. With the diagnostic purpose they performed ERCP, EPT, cholangioscopy. The method of direct visualization of the mucous membrane of the bile ducts allows you to identify endoscopic signs of strictures. Differential diagnosis of benign and malignant strictures of the bile ducts using cholangioscopy is difficult. Nevertheless, we were able to identify some typical signs for malignant strictures, including ulceration and mucosal infiltration, vascular pattern irregularity, stricture asymmetry.

The article provides information about the physiology and pathology of membrane digestion. Described etiology, pathogenesis, clinical picture and diagnosis of enteropathy with impaired membrane digestion are described in it. The treatment is based on cytoprotector-Rebamipide that increases the activity of membrane enzymes of duodenal mucosa.

The aim of the study was to determine for patients with non-alcoholic fatty liver disease (NAFLD) the possibilities and effectiveness of the course use of chloride-bicarbonate sodium mineral water (MW) (by the example of MW Karachinskaya). A total of 76 patients (20 women and 56 men) with NAFLD aged 42 to 72 years (mean age 59.4 ± 1.2 years) were examined. MV was taken in 200 ml in 8, 10, 12, 15 and 17 hours (5 times a day, in a volume of 1,000 ml), room temperature (18-20 °C). The course of treatment was 10 days. In the dynamics of treatment, lipid spectrum parameters were evaluated: total cholesterol, triglycerides, high, low and very low density lipoprotein cholesterol, atherogenic index. The results obtained allow us to draw the following conclusions. 1. In patients with NAFLD observed by us, comorbid pathology is observed at least 3-4 diseases of internal organs are registered at the same time. The most frequently detected pathology of the cardiovascular system and disorders of carbohydrate metabolism. 2. The vast majority of patients revealed lipid metabolism disorders. The most significant disorders were characterized by increased levels of total cholesterol. 3. The inclusion of the 10-day drinking course of the chloride-bicarbonate sodium MW Karachinskaya’ contributes to the correction of lipid metabolism. The identified cholesterol-lowering effect of MW Karachinskaya' with mild and moderate hypercholesterolemia allows recommending it for non-pharmacological correction of elevated total cholesterol, which is currently considered as an established risk factor for IHD and arterial hypertension.

Currently, the problem of early rehabilitation of stroke patients is important, since in terms of the prevalence of cerebrovascular diseases and disability after suffering a stroke, Russia is one of the first places in the world. The complex of medical rehabilitation of such patients should provide for the early and most complete restoration of all body functions, patient education for lost skills, re-socialization of the patient and improvement of the quality of life. One of the factors contributing to a significant reduction in the quality of life after a stroke is the development of chronic constipation. The article reflects the modern methods of correction of chronic constipation in patients with limited mobility.

In 72 patients with chronic pancreatitis were studied quality of life indicators using a common questionnaire the SF-36 (Short Form-36, Healt Status Survey) in the dynamics of treatment. It was established that the disease affects the quality of life of patients, affecting all levels of life:physical, emotional, role, psychological, social functioning. After treatment, the quality of life of patients significantly improved both indicators of physical and social health of patients increased the overall tone and physical activity during the day, improves sleep at night.