Epidemiological data suggests that approximately 10-65% of patients with mild to moderate COVID-19 have persistent symptoms already after an acute infection, which may last for six months or more. Previous clinical studies have shown that similar symptoms may also occur in the liver. Russian scientists have studied the phenomenon of hyperammonemia in the acute phase of COVID-19, but the problem of elevated blood ammonia levels in post - COVID syndrome has not been studied before. One possible option for the correction of hyperammonemia is the L-ornithine - L-aspartate (LOLA) preparation. The aim of the study was to investigate the manifestation of hyperammonemia in post - COVID syndrome and the possibility of its correction by using LOLA. Eighty-three patients (mean age 51.71 ± 12.82) with post-COVID syndrome, attention and memory impairment, chronic fatigue, hyperammonemia, 2-fold increase of alanine transaminase (ALT) and aspartate transaminase (AST) levels were included into multicenter, prospective observational study. L-ornithine-L-aspartate (LOLA) was given (3 g 3 times per day orally) for 4 weeks to correct hyperammonemia. Patients were accessed by the number connection test (NCT), fatigue evaluation test, measurement of ammonia and ALT, AST levels at baseline, and after 4 weeks. At week 4 the ammonia level was significantly decreased in 81 patients (97.6%). Time (sec) to complete the NCT was 49,43 ± 15,85 vs 64.67 ± 24.95 at baseline (p<0.001). Before treatment, the majority of patients had stage 1 hepatic encephalopathy (HE) - 50.6% and stage 1-2 (intermediate) HE - 30.1%, stage 2 HE - 10.9%, stage 3 HE - 2.4%. After LOLA treatment, the distribution changed: 41% of patients had no HE, 36.1% had stage 1 of HE, 22.9% had stage 1-2 (intermediate) of HE, and stage 2 and 3 of HE was no longer defined. The mean score in fatigue evaluation test was 46,27 ± 10.0 vs 64,71 ± 19,18 at baseline (p<0.001). ALT and AST levels were 47,83 ± 38,21 units/l vs 95,75 ± 68.99 units/l at baseline and 40,10 ± 35,97 units/l vs 78,51 ± 90,90 units/l at baseline respectively (p<0.001). This study showed that the inclusion of LOLA in a dose of 3 g 3 times a day for 4 weeks was associated with significant improvement in the objective and subjective outcomes in patients with post-COVID syndrome.

The authors consider diseases of internal organs as a reflection of the influence of various factors on the human exposome (as a complex symbiotic system) in the process of formation of the noosphere from the biosphere. At the same time, various exposome factors caused deep violations of the evolutionarily developed symbiotic relationships of a person with the environment and the internal environment with a violation of the basic systems of regulation and adaptation with the development of metabolic imbalance and the subsequent formation of various diseases. The important role of connective tissue in these processes, its various elements in the regulation of the structure of organs and cells, the near-cellular space, metabolism, immunity, ways of interaction with the microbiota and its network structures, decentralized forms of homeostasis regulation are considered.

The review presents up-to-date information on the pathogenesis of disorders of the intestinal microbiotope and the relationship of these disorders with the use of medications traditionally prescribed in treatment regimens for various diseases, presents the main aspects of drug-microbial interactions, highlights the issues of correction of iatrogenic intestinal dysbiosis. One of the main exogenous factors in the development of intestinal dysbiosis at the present time, of course, can be considered drug therapy. The extremely widespread and often uncontrolled use of antibacterial drugs, nonsteroidal anti-inflammatory drugs, laxatives, drugs for the correction of carbohydrate metabolism, proton pump inhibitors, glucocorticosteroids, antidepressants, cytostatic drugs to a greater or lesser extent has a negative effect on the human microbiotope. On the one hand, the microbiota is a drug target, on the other hand, the gut microbiota itself can have both direct and indirect effects on the metabolism of drugs. The potential of the influence of microorganisms on the absorption, distribution, and metabolism of drugs deserves increased attention and detailed study. At the same time, the issues of prevention and correction of intestinal microbiota disorders against the background of taking various medications deserve even more attention from doctors of various profiles with the mandatory inclusion of drugs that harmonize the intestinal microbiotope in the treatment regimens of the underlying disease.

Inflammatory bowel diseases (IBD) are one of the most complex and significant problems of modern gastroenterology. The steady increase in morbidity, complex pathogenetic mechanisms of development, the presence of severe extra-intestinal manifestations and complications make this problem socially significant. The article presents modern views on some aspects of the pathogenesis of IBD. Currently, the key links in the development and progression of IBD, as well as the development of associated cardiovascular diseases are the state of the intestinal microbiota and the level of endotoxemia. The role of trimethylamine N-oxide as a factor in the early development of atherosclerosis in patients with IBD was determined.

Numerous studies have shown that changes in the intestinal microbial-tissue complex are a risk factor for the progression of chronic kidney disease (CKD) to end-stage renal disease and, therefore, a potential target for new therapeutic interventions. Thus, reliable and sensitive diagnostic tools for measuring intestinal permeability in the clinical setting are necessary. Modern genome sequencing and multi-omics technologies have established that patients with CKD are characterized by a specific imbalance between the saccharolytic and proteolytic microbiota, contributing to the accumulation of numerous toxic microbial products, such as indoxyl sulphate, p-cresyl sulphate, trimethylamine-N-oxide. Progressive kidney function decline leads to compensatory urea accumulation in the gastrointestinal tract. In the intestinal lumen, urea is hydrolyzed by microbial urease, forming a large amount of ammonium hydroxide, which may be accompanied by disruption of the epithelial barrier integrity with an increase in intestinal permeability for microbial molecules that initiate systemic inflammation. Experimental approaches to studying the intestinal barrier in CKD include the assessment of electrophysiological parameters of the intestinal epithelium and the transport of fluorescently labelled tracers in the Ussing chamber. Actively improving various cell-based in vitro methods, which may be useful for studying the effect of microbiota on the barrier functions of the intestinal epithelium. Gene expression and protein content of tight junctions are estimated using polymerase chain reaction, immunohistochemical methods and Western blotting. Using various biomolecular methods, it was found that renal failure is characterized by the presence of inflammatory and atrophic changes throughout the gastrointestinal tract, destruction of the mucin layer, damage to tight junctions with a decrease in the amount of claudine-1, occludin and ZO-1 as well as a decrease in transepithelial electrical resistance. Clinical examination of intestinal permeability by methods based on the urine excretion of orally administered sugars, polyethylene glycol polymers and labelled tracers indicate a distortion of the results in patients with CKD due to altered renal clearance. Alternatively, quantitative determination of bacterial DNA and D-lactate levels in the blood is considered. Identification of serum non-coding microRNAs, confocal laser endomicroscopy and impedance spectroscopy have the potential to be used as methods for assessing intestinal barrier function.

The luminal intestinal microflora affects the state of the muscular system of experimental animals and humans. The role of nutrition in the development of skeletal muscles is considered. The role of metabolically active substances secreted by the microbiota in the development of cachexia, sarcopenia, and kwashiorkor is considered. The effect of exercise on the gut microbiome was assessed. Possible variants of the influence of probiotics on the state of skeletal muscles and its functional activity in the experiment in animals and humans are presented.

Introduction. Systemic retinoids with a hepatotoxic effect and antibiotics affecting intestinal microflora are the first-line drugs in the treatment of moderate and severe acne. To prevent complications, it is necessary to search, develop and introduce into practice safe drug combinations, including drugs with a protective effect on intestinal microflora and liver. Objective. To study the effect of psyllium on tolerance and efficacy of systemic therapy with isotretinoin and doxycycline in patients with moderate acne having celiac disease. Material and methods. We examined 83 patients with celiac disease having moderate acne. They were randomized into two groups: group 1, receiving antibiotics (doxycycline), and group 2, receiving retinoid system (isotretinoin). Each group was divided into two subgroups A and B, depending on the reception of psyllium. Patients were followed up for 4 and 24 weeks, respectively. All patients received adjuvant topical therapy. Medical check-ups, biochemical blood and bacteriological stool analysis were done in each group before treatment and after the treatment. Results. In subgroup 1B (received psyllium) significant changes of intestinal microbiota were not observed during antibiotic treatment, in contrast to subgroup 1А, where severe intestinal dysbiosis was found. In subgroup 2A (without psyllium) carbohydrate metabolism disorder and lipid storage disease were noted on isotretinoin treatment, not being observed in subgroup 2B. Conclusion. Patients in both subgroups, who in addition to antibiotic and systemic retinoid treatment, received psyllium, showed better results of skin health, intestinal microbiome, general well-being, and quality of life.

To date, the study of the relationship between the intestinal microbiome and COVID-19 infection remains a topical issue. As is known, the gastrointestinal tract is the entrance gate for SARS-CoV2 infection, and the prevalence of gastrointestinal manifestations reaches 17,6%. The conducted studies testify in favor of changes in the composition of the intestinal microflora in patients with COVID-19 compared with patients without a respiratory infection, their influence on the course and prognosis of the disease is being studied.

Despite the mass population immunization, the total spread of the COVID-19 pandemic once again made scientists around the world doubt the effectiveness of currently existing methods of prevention and treatment of a novel coronavirus infection. The rationale for a potentially new approach to the preventive therapy of COVID-19 using probiotic bacterial strains was the presence of a bidirectional “gut-lung” axis, which interacts between these organs through transported soluble microbial metabolites in blood. The study aimed to determine the relationship between the correction of the gut microbiota with the polycomponent synbiotic Maxilac® and clinical and laboratory markers of the severity of the new coronavirus infection. During the open-label, prospective, observational study 60 patients with a confirmed diagnosis of COVID-19, a moderate severity and the presence of gastrointestinal symptoms were divided into 2 groups: the 1st performed the outpatient complex standard treatment with the addition of synbiotic, the 2nd - without addition. All patients of group 1 showed positive dynamics of clinical and laboratory indicators of COVID-19 severity, compared with group 2, where 2 patients needed hospitalization due to the aggravation of the course of novel coronavirus infection. A reduction in the duration of clinical symptoms and the duration of outpatient treatment was revealed in a group of patients taking Maxilac®. The dynamics of clinical and laboratory indicators reflecting the course of COVID-19 indicate the effectiveness of symbiotic’s usage as adjuvant therapy and the possibility of recommending its use in the complex treatment of patients with a novel coronavirus infection.

Target. Evaluation of the role of chronic duodenal insufficiency (CDN) in the development of gastroesophageal reflux disease (GERD). Materials and methods. The study included 42 patients with GERD. In 23 patients, GERD was combined with CRF (observation group) and 19 patients had GERD without CRF (comparison group). The control group consisted of 30 healthy individuals. In the examination of patients, in addition to the study of anamnestic and physical data, the results of the study of hormones (gastrin, insulin, cortisol, somatostatin) and power acids of the parietal mucus of the esophagus were used. Instrumental research methods are represented by intragastric pH-metry with the help of “Gastroscan-5M”, gastroenteromonitoring “Gastroscan-GEM”, cavity manometry using the Waldman apparatus. The results obtained were analyzed on a personal computer using the Excel®2016 spreadsheet analysis package, IBM SPSS v. Results. The study found that the majority of patients with chronic duodenal insufficiency and gastroesophageal reflux disease noted pain in the epigastric region (16 (69.6%)) and behind the sternum (19 (82.6%)) and bitter belching 14 (60.8%). In patients in the comparison group, heartburn prevailed (15 (78.9%)) against the background of mild pain syndrome 8 (42.1%) (p=0.021). The coefficient of duodenal contraction rhythm in patients of the observation group (2.4±0.37) was significantly higher than in the comparison group (0.7±0.18, p=0.021). The acidification of the intraduodenal environment is indicated by the pH of the duodenal bulb (5.5±0.74). The content of hormones in the peripheral blood in GERD with chronic renal failure is represented by a reduced content of insulin and somatostatin and an increase in cortisol and gastrin in comparison with indicators in GERD and healthy individuals. Conclusion. The results of the research allowed to expand the understanding of the mechanisms of development of GERD in chronic renal failure and demonstrate that they include not only “aggressive” refluxants, but are also associated with changes in neurohormonal control systems.

Introduction: Peptic ulcer disease occurs in 5-10% of the adult population, and is characterized by a high percentage of complications, which is a serious medical and social problem. The contribution of hereditary factors to the etiopathogenesis of the disease leaves 5.5-50%. The aim of the study was to study the contribution of intergenic interactions of polymorphic variants of candidate genes (rs2294008, rs505922, rs6136, rs8176720, rs2519093, rs507666, rs651007, rs579459, rs649129) to the development of gastric ulcer (GU). Materials and methods: The sample consisted of 217 patients with GU and 347 individuals from the control group, the regulatory potential of polymorphic loci were evaluated using the online databases, and genotyping was performed by PCR. The study of SNP×SNP interactions of polymorphic variants of candidate genes associated with the development of GU was carried out using a modification of the MDR (Multifactor Dimensionality Reduction) - Model-Based-MDR (MB-MDR) method, data visualization was carried out in the form of a dendrogram and graph using MDR software (v. 3.0.2). Results: All 9 studied SNPs as part of 10 significant models of interlocus interactions are involved in the formation of GU. The largest number of models includes rs8176720 of the ABO gene and rs2294008 of the PSCA gene. These polymorphic variants have a pronounced regulatory potential in many organs (tissues), incl. in the target organ of GU (stomach).

Aim: to study opportunity of research the evacuation function of the stomach in young people by magnetic resonance imaging with a stress drinking test. Materials and methods: the study group included 20 young people (10 men and 10 women aged 23 ± 1,12 years). At the time of the study, each test person excluded organic and functional pathologies of the gastroduodenal zone. A method of magnetic resonance imaging of the stomach with a stress drinking test (still drinking water at room temperature with a volume of 1000.0 ml) was used. The examination lasted 30 minutes, scanning was carried out every 5 minutes, a total of 7 scans. Based on the obtained three-dimensional images of the DICOM format using the HorosMobile™ application (DICOM medical image viewer), the volumes of fluid in the stomach in dynamics were calculated for each test person in the study group according to the time intervals of the scans performed by the magnetic resonance imaging machine. Systematization and data processing were carried out a Microsoft Excel. A single graph was built for the study group in the Pages graphical editor (iWork productivity suite) based on the obtained data, reflecting the reference volumes of gastric contents relative to the time scale with possible deviations from the average. Results: regardless of the type of physique and shape of the stomach in the studied subjects, the evacuation of a larger volume of fluid (81,53-82,54%) occurred by the 15th minute of the study. Complete evacuation of gastric contents occurs between 25 and 30 minutes of the study. Conclusions: the results obtained by MRI studies of the stomach with a stress drinking test give an idea of the options for normal physiological evacuation of gastric contents in young people, in the absence of organic and functional pathology of the gastroduodenal zone.

In this data, we analyzed patients’ histories of 6466 outpatients with gastrointestinal (GI) diseases who visited gastroenterologist in Minsk Clinical Consulting Diagnostic Centre. 1698 patients with irritable bowel syndrome (IBS) were selected. It was revealed that IBS is a wide spread functional bowel disorder and its proportion among GI diseases was 26,3%. IBS in females is 2.5 times more common than in males. IBS occurred in all age groups with a small difference in the frequency of subtypes by age, mainly at the overage age.

Objective: to study the frequency and clinical manifestations of cryoglobulinemia in a population of patients with chronic hepatitis C at different stages of fibrosis. Materials and methods: The source population is 23492 patients with HCV who are registered at the dispensary according to the Register of the Chelyabinsk region. The studied population was randomly formed - 100 patients with verified HCV. As part of the ongoing single-stage clinical study, standard general clinical and biochemical studies (bilirubin, ALT, AST, GGT), HCV RNA in blood with subsequent genotyping of the virus, qualitative and quantitative analysis for serum cryoglobulins (cryocrite level), instrumental methods of research (ultrasound, transient liver elastometry with determination of the degree of fibrosis on the METAVIR scale) were performed for each patient. Results: Cryoglobulins were found in the blood of 63 patients (63%). At the same time, with stage 4 fibrosis in 14 (22%), with stage 3 in 8 (13%), with stage 2 in 1 (1.5%), with grade 1-17 (27%), with stage 0-23 patients (36.5%). Of the total number of patients, only 22 (35%) had complaints and clinical manifestations of cryoglobulinemia. In the vast majority of cases, hemorrhagic purpura was recorded - 18 (28.5%), volatile arthralgia - 4 (6.5%). Clinical manifestations of mixed cryoglobulinemia were observed in 35% of patients with HCV (hemorrhagic purpura, arthralgia). A reliable correlation was obtained between the level of cryocrit and the female sex with a pair correlation coefficient of 0.237 (p<0.05). Conclusion: The data obtained indicate the need for constant monitoring of the frequency of mixed cryoglobulinemia in patients with HCV, early etiotropic therapy with direct antiviral drugs

The aim of the study was to determine the clinical and diagnostic significance of collagens of the third type (Col3) and the fourth type (Col4) in various forms of alcoholic liver disease (ALD). Materials and methods. 98 patients with ALD were examined: 13 (13.3%) with liver steatosis (LS), 15 (15.3%) with steatohepatitis (SH), 56 (57.1%) with liver cirrhosis (LC), 14 (14.3%) with severe alcoholic hepatitis against the background of liver cirrhosis (SAH-LC). Among the examined there were 59 (60.2%) men and 39 (39.80%) women, the average age was 53.48±11.45 years. The content of fibrogenesis proteins in the blood serum - type III collagen (Col3) and type IV collagen (Col4) was determined by enzyme immunoassay (test systems “Kit For Collagen Type III (Col3)” and “Kit For Collagen Type IV (Col4)”, “Cloud-Clone Corp”, USA), a marker of hepatocyte apoptosis - fragments of cytokeratin-18 (FCK-18) (“Biotech” test system, Sweden), cytokines - IL-1β, IL-4, IL-6, IL- 8, TNF-α (“Vector-Best”, Russia). Results. The level of Col3 in healthy individuals was 6.12±0.73 ng/ml and Col4-9.45±0.32 ng/ml. In all forms of ALD, the content of both types of collagen exceeded that in healthy individuals: Col3 in LS was 6.52±0.94 ng/ml (p<0.05), in SH it was 12.50±3.18 ng/ml (p<0.05), in LC - 20.96±4.93 ng/ml (p<0.05), in SAH-LC - 26.90±3.87 ng/ml (p<0.05); Col4-10.14±0.66 ng/ml, 13.87±1.15 ng/ml, 79.56±33.10 ng/ml and 107.12±39.09 ng/ml, respectively. Col3 positively correlated with ALT (r=0.27, p=0.02) and alkaline phosphatase (r=0.28, p=0.04). Col4 correlated with bilirubin (r=0.74), AST (r=0.65), glutamyl transpeptidase (r=0.58), cytokeratin-18 (r=0.56), sedimentation rate of erythrocytes (r=0.61), C-reactive protein (r=0.59), IL -6 (r= 0.51) and leukocytes (r=0.45) (all p<0.001). Conclusion. Col4 demonstrated greater diagnostic and clinical significance in alcoholic liver disease compared to Col3. The level of Col4 increased by an average of 8 times with the progression of the disease from liver steatosis to cirrhosis, and Col3 - only by 3 times. There were more diverse and stronger associations between Col4 and markers of hepatocellular damage and inflammation than between Col3 and these indicators. The maximum rise in the levels of both types of collagen found in SAH-LC confirmed the important role of this form of liver disease in the development of fibrosis, and hence in the further decompensation of liver cirrhosis.

Purpose of the study. To study the distribution and role of polymorphic loci of the cytokine gene IL6 (C174G) in inflammatory and ulcerative lesions of the stomach. Material and research methods. In this study, the detection of the polymorphic IL6 gene (C174G) was carried out in patients with inflammatory and ulcerative lesions of the stomach (n=96) and healthy individuals (n=88). Results. Analysis of the features of the distribution of IL6 (C174G) gene polymorphism among the studied groups of patients with inflammatory and ulcerative diseases compared with healthy ones, its contribution to the pathogenetic mechanisms of their formation was found, which is confirmed by the presence of a pronounced tendency to increase the frequencies of the major C allele by 3.3 times (χ² = 3.3; P=0.1) and C/C genotype by 2.9 times (χ²=2.9; P=0.1) in chronic non-atrophic gastritis (CNG), as well as the minor allele G by 2.5 times (χ²=2.5; P=0.2) in ulcerative diseases of the stomach (GU). In addition, the contribution of the studied genetic marker is also confirmed by the presence of a tendency to increase the major allele C by 3.1 times (χ²=1.9; P=0.2) and the C/C genotype by 2.8 times (χ²=1.4; P=0.3; OR=2.8; 95%CI: 0.52-15.37) among patients with CNG compared with those in the group with chronic erosive gastritis (CEG), as well as a statistically significant increase in these indicators by 5.8 times (χ²=6.6; P=0.025) and 6.2 times (χ²= 6.3; P=0.025), respectively, in comparison with the group of patients with GU. No significant association between the likelihood of erosive chronic gastritis and C174G polymorphic loci of the IL6 gene was found compared to healthy individuals. However, compared with GU, the contribution of the major C allele and the major C/C genotype is confirmed by the presence of a trend towards their increase among patients with CEG by 1.9 (χ²=2.0; P=0.2) and 2.2 times (χ²=2.1; P=0.2). Conclusions: based on the results of the study, it can be argued that the C174G polymorphic loci of the IL6 gene play a significant role in the mechanisms of formation of inflammatory and ulcerative diseases of the stomach in Uzbekistan.

The problem of endoscopic diagnosis of early esophago-gastric junction cancer is one of the most important in modern endoscopy and oncology, since most malignant tumors of the esophagogastric junction are detected at late stage. The 5-year survival rate of such patients remains low. Definition of early esophagogastric junction cancer, resectability criteria, features of the course of the disease at early stage will be considered in this article. It has been proven that NBI-ME and NBI Dual Focus in combination with endosonography are the most accurate in the diagnosis of early esophagogastric junction cancer. The most typical endoscopic features of early esophagogastric junction cancer are discussed in this review. All these methods are applied to the patient in Herzen Moscow Cancer Research Institute, branch of National Medical Research Radiology Center.

Aim. To compare the long-term outcomes and qualitive of life (QOL) of robot-assisted fundoplication (RAF) and laparoscopic fundoplication (LF) in patients with cardiofundal and subtotal hiatal hernias (HH). Materials and methods. The study included 62 patients with HH, who underwent antireflux surgery in the clinic of Faculty Surgery No. 1 of Sechenov University in the period from January 2015 to February 2021. The main group included 32 patients who underwent robot-assisted fundoplication (RAF) according to A. F. Chernousov, the comparison group included 30 patients who underwent laparoscopic fundoplication (LF). Complaints of the patient, X-ray, endoscopic studies, PH-impedance-metry in the long-term period were evaluated. To assess the quality of life, the questionnaires SF 36 (The Short Form-36) and GERD-HRQL (Health-Related Quality of Life in Patients with Gastroesophageal Reflex Disease) were used. Results. Periodic heartburn in the long-term period was noted by 2 (6%) patients of the RAF group and 4 (13%) in the LF group. Endoscopic signs of mild esophagitis were detected in 1 (3%) patient from each group. X-ray in 9 (28%) patients of the RAF group and 11 (37%) patients of the LF group showed migration of the esophageal-gastric junction above the diaphragm level with complete preservation of the antireflux function of the fundoplication cuff. The QOL indicators of the SF 36 questionnaire did not differ in both groups and were comparable to the population of “conditionally healthy” people. The indicators of the GERD-HRQL questionnaire were better in the RAF group, but the differences had no statistical significance (RAF - 2.53 ± 5.1 points versus LF - 5.23 ± 9.4 points, p-value = 0.321). Conclusion. RAF and LF in the modification of A. F. Chernousov are equally effective in the treatment of RE and GPOD in the long-term period and provide good indicators of quality of life that do not differ statistically from each other.

Aim. To study the incidence of hemorrhoidal disease in the Udmurt Republic on the basis of statistical data of the coloproctology department at the Budgetary Healthcare Institution “The First Republican Clinical Hospital of the Ministry of Health of the Udmurt Republic”, Izhevsk, for 2018-2020 and a clinical case of a patient with acute hemorrhoids. Materials and methods. The data of 6506 medical records of outpatients and inpatients with diagnoses K64.0-K64.5 were analyzed. The evaluation of the results was carried out according to the following criteria: gender, age composition, region, diagnosis of patients, progression of the disease, type of surgery. A clinical case of a patient with acute hemorrhoids is presented. Results. Among the hospitalized patients, the male population prevailed (57.1%); among the outpatient patients, the female population prevailed (57.5%). Most of the patients were young and middle-aged patients (77% of hospitalized patients, 70.6% of outpatient patients). The urban population comprised 65.1% of hospitalized patients and 59.1% of outpatient patients. A chronic form of the disease was registered in 94.6% of the hospitalized patients and in 92.3% of the outpatient patients. Among all surgical interventions hemorrhoidectomy was conducted in 73.0% of cases. The analysis of the diagnosis and treatment of hemorrhoidal disease on the basis of a clinical case with positive results was carried out. Conclusions. According to the data obtained by the department, it can be said that among all patients diagnosed with hemorrhoids, the able-bodied and young, mainly urban population prevails, which indicates the influence of urabanization on the development of hemorrhoidal disease. The disease is equally prevalent in men and women. The chronic form prevails in the structure of the incidence of hemorrhoidal disease. The most commonly used surgical treatment of hemorrhoidal disease is hemorrhoidectomy.

The purpose of the study. To determine the frequency of occurrence and prevention measures of erosive and ulcerative lesions of the proximal gastrointestinal tract in patients operated for critical ischemia with a diagnosis of obliterating atherosclerosis of the arteries of the lower extremities. Materials and methods. The examination included patients with lower limb ischemia - III-IV stage of ischemia according to the Fontaine-Pokrovsky classification. The patients were divided into 2 groups: the control group, where treatment was carried out according to the recommendations: HP diagnosis (express test) was carried out only with an endoscopic picture of gastric ulcer and duodenal ulcer, as well as the main group, in which HP diagnosis was carried out totally with fibrogastroduodenoscopy and a standard three-component eradication scheme was prescribed for at least 14 days when bacterial contamination of the gastric mucosa was detected. Results. In all cases, endoscopic changes characteristic of gastritis were registered in patients of the first group. Of the eight patients (100%), two (25%) were diagnosed with single erosions in the distal parts of the stomach, one patient (12.5%) had atrophic gastritis, and the remaining 5 (62.5%) patients had hyperemia of the antral and prepiloric mucosa. In patients of the second group, there were no changes in FGDS in one patient (25%), foci of mucosal atrophy were diagnosed in two patients (50%), and single erosions in one (25%). Conclusion. Among patients with peripheral artery diseases accompanied by critical ischemia, by the time they seek specialized medical care, there are no healthy or close to such persons with unchanged mucous membrane of the proximal parts. In the high-risk groups for the occurrence of gastrointestinal bleeding, a complex effect on aggression factors is necessary

The effect of salivary amylase on changes in gastric protein hydrolysis was studied. The study was carried out in vitro, saliva, gastric juice, solutions of starch, casein, albumin and hemoglobin were used in the work. It was concluded that the use of starch-protein mixtures helps to reduce protein hydrolysis by gastric juice, due to the formation of starch-protein complexes that prevent protein hydrolysis, and reduce the access of gastric proteases to proteins in the starch-protein complex. An increase in the ratio of starch and protein in the direction of increasing starch contributes to an additional decrease in protein hydrolysis, which may be an additional decrease in the access of gastric proteases to proteins, in addition to an obstacle to proteins in the starch-protein complex. In addition, salivary amylase helps to improve the digestibility of proteins by gastric juice, both due to a decrease in starch-protein complexes, and to increase the access of proteases to proteins by reducing the concentration of starch as a result of its digestion by salivary amylase.

When studying the effect of feeding, emulsions of gelatin subjected to incubation with gastric juice and sunflower oil on triglycerides and blood cholesterol were higher compared to the average values before feeding, and after feeding were slightly higher compared to the emulsion of gelatin and sunflower oil. At the same time, triglyceride and cholesterol values were not significantly higher throughout the entire 6-hour observation period compared to pre-feeding values. It was also found that the average increase in triglycerides and cholesterol under the influence of feeding with an emulsion of gelatin and sunflower oil incubated with gastric juice is not significantly higher, and with pancreatic juice is not significantly lower than those after feeding with an emulsion of gelatin and sunflower oil. This indicates that gelatin hydrolysates obtained under the influence of both gastric and pancreatic juice do not significantly affect the digestion and absorption of fats in the small intestine.

Helicobacter pylori (HP) bacteria have a wide range of pathogenicity factors. The HP genome contains genes of the CagA group (cytotoxin-associated genes). Infection with CagA-positive HP strains is associated with the production of pro-inflammatory cytokines, which are involved in the maintenance and development of destructive and inflammatory changes in the organism. Here we studied the role of CagA proteins in the regulation of the immune response in DBA mice and evaluated the corrective effect of polyprenyl phosphate (PP) on this process. Genetically modified strains of E. coli were used, differing by the presence of an island of genes encoding the synthesis of HP CagA proteins. The drug Phosprenyl was used as a source of PP. The subpopulation composition of spleen cells was evaluated by flow cytofluorimetry using monoclonal antibodies. The level of IL 10, TGF-β in blood serum was determined by the enzyme immunoassay. The proliferative activity of splenocytes was measured by the standard procedure based on the inclusion of³H-thymidine in the DNA. CagA HP proteins caused the polarization of the immune response by the Th1-dominant type, which was expressed by an increase in the population of CD4⁺cells, CD25⁺ and CD25⁺ Foxp3⁺ T cells and increase proliferation T- limphocytes. Inoculation of CagA + bacteria was accompanied by a quantitative increase in TGF-β produced by activated Treg cells. PP inoculation led to the normalization of the CD4 and CD8 T cells, a decrease in the populations of CD25⁺, Foxp3⁺, CD25⁺ Foxp3⁺ cells, and further increase in the IL-10 levels. Thus, PP corrected cellular immune response, prevented the pronounced polarization of the Th1 immune response, and reduced the activation of Treg population. The results obtained indicate a possible decrease in the pro-inflammatory immune response under the influence of PP.

The purpose of this study is to determine the distribution and features of sympathetic innervation of the tissues of the human colon wall in chronic slow-transit constipation using immunohistochemical methods. Materials and methods. Immunohistochemical study of large intestine segments (colon and sigmoid colon) obtained as a result of surgical treatment of patients with chronic slow-transit constipation was carried out using neural markers (PGP 9.5 protein, tyrosine hydroxylase, synaptophysin). Results. It has been shown that the majority of postganglionic sympathetic nerve fibers are localized in the Auerbach and Meissner plexuses. Their terminal axons form pericellular synaptic apparatuses around cholinergic neurons. Another part of the sympathetic fibers is involved in the innervation of the muscular plate of the mucous membrane and the walls of the venous vessels of the submucosa; their terminal varicose axons can be seen on smooth muscle cells as distant synapses en passant. Significant features of sympathetic innervation disorders of the large intestine of the studied patients were established; morphological evidence for the reactive, dystrophic and degenerative changes in the sympathetic apparatuses in the ganglionic plexuses were found. The regularities of the absence of sympathetic innervation in two muscle layers (longitudinal and circular), as well as in the mucous membrane, were revealed. Sympathetic neurons were not found in the studied sections of the large intestine. Conclusion. It is assumed that the identified pathological changes in sympathetic innervation in chronic slow-transit constipation can serve as one of the main causes of disruption of normal bowel functions.

Aim - to evaluate the effect of exogenous serotonin on the motility of the bauhinian valve and to identify the mechanism of this effect. Materials and methods. The experiments were performed on 36 Wistar rats weighing 250-270 g. The motor function of the ileum, ileocecal region, and caecum was recorded in the animals of two experimental groups (n=30). tonic contractions and propulsive activity. As a result of the study, it was shown that serotonin has a prokinetic effect on the ileum, the ileocecal junction with the Bauhinian valve and the caecum. 5HT3,4 receptors are located on the cytolemma of intramural serotonergic neurons and EC cells, and 5HT1,2 receptors are located on the cytolemma of effector smooth muscle cells. The Bauhinian valve contains the largest number of 5HT3,4 serotonin receptors, which is due to the complex function of this formation in the regulation of propulsive activity at the border of the small and large intestine.

Despite significant advances in the diagnosis of tuberculosis, the issues of the mechanism of development and treatment of fibrotic manifestations are relevant and take place in the treatment. The aim of the study was to study the content of perlecane and to find out its participation in the remodeling of the extracellular matrix of the organs of mice with tuberculous inflammation and when they were injected with an antitubercular composition. Materials and methods. The experiment was carried out on male mice of the BALB/c line, which were divided into 4 groups of 5 individuals each. All animals, with the exception of intact mice (group 1), were retroorbitally injected with BCG vaccine once (0.5 mg of microbial bodies in 0.2 ml of 0.9% NaCl solution) to simulate a generalized tuberculosis process. After infection 6 mo for 3 mo, group 2 mice were intraperitoneally injected with 50 µl of 0.9% NaCl solution, group 3 - intraperitoneally with 50 µl of liposome-encapsulated dextrazide solution (LEDZ, isoniazid conjugate and oxidized dextran enclosed in liposomes), group 4 - LEDZ solution was inhaled by spraying in the chamber through a nebulizer for 5 min at the rate of 50 µl of solution per animal. After the last administration of the NaCl and LEDZ solution, mice were removed from the experiment, organs were taken, and tissue homogenates were prepared. The content of perlecane, hyaluronan, protein-bound hydroxyproline, tissue metalloproteinase inhibitors (TIMP-1, TIMP-2) and the activity of matrix metalloproteinases (MMP), hyaluronidases, α2-macroglobulin were measured. Results. In all organs of infected mice, the content of perlecan, hyaluronan, protein-bound hydroxyproline, TIMP-1, TIMP-2 was increased, MMP, hyaluronidase, α2-macroglobulin were activated. Regardless of the method of administration of LEDZ, the severity of fibrosis decreased due to a decrease in the content of hyaluronan in all organs and protein-bound hydroxyproline in the lungs. Perlecan with intraperitoneal administration is involved in fibrosis of the spleen, inhalation - reflects the severity of liver fibrosis. Conclusion. Correlations of perlecan with extracellular matrix components reflect participation in the regulation of fibrosis of organs in BCG-induced inflammation.

The study aimed to investigate the protective mechanisms of substance Darmonal and phytin compounds in the experimental model of acute toxic drug-induced hepatitis caused by paracetamol in rats. The material and methods The research was carried out on white outbred rats of both sexes weighing 140-200 g. Drug-induced liver damage was reproduced by introduction of paracetamol into the stomach in dose 500 mg/kg for 2 days. The test compounds Darmonal, Fitin-C and reference drug Liv.52 were administered for 7 days after hepatitis reproduction in doses 100 mg/kg. The effectiveness and mechanism of action for selected supramolecular complexes in the model of toxic drug-induced hepatitis was made by paracetamol. It was researched that liver protein-synthesizing function was due to the content of total protein and albumin in the blood serum, the excretory and toxic function of the liver by the content of total and direct bilirubin as well as the endogenous intoxication were according to the content of urea in the blood serum, but cytolytic syndrome occurred because of the activity of indicator enzymes (alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in blood serum). Research results. The study of specific activity of Darmonal in combination with Fitin-C and the reference drug Liv.52 on the model of paracetamol and carbon tetrachloride hepatitis showed that the drugs, being administered in dose 100 mg/kg, had a pronounced hepatoprotective effect.

Lesions of the digestive system in diabetes mellitus (DM) are of secondary nature and arise due to autonomic neuropathy. As a result of hyperglycemia, lesions of the esophagus, stomach, small and large intestine develop. The most common disorder of the digestive system in diabetes is gastroparesis. The diagnosis of gastroparesis is currently insufficient. It is connected with low awareness and, as a consequence, rare visit of patients to specialists, and also with similarity of clinical symptoms with other functional disorders of gastrointestinal tract (GIT). The main risk factors for gastroparesis are hyperglycemia, smoking, alcohol, and certain medications. Most patients with gastroparesis suffer from depression and increased anxiety. Taking medications to treat depression negatively affects the function of the digestive system. This problem interferes with patients’ quality of life. During the pandemic of coronavirus infection, the number of patients seeking medical care due to exacerbation of gastrointestinal disorders increased. The question of etiology is subject to further study. This review also considers the effect of cholecystectomy on the development of gastroparesis in these patients. These patients need special monitoring of glucose levels to prescribe timely antidiabetic therapy and prevent future gastroparesis. For the treatment of lesions of the digestive system in diabetes mellitus, a special diet, in particular the exclusion of hard-to-digest fiber, fatty foods, inclusion of vitamin complexes and normalization of the microbiota plays a paramount role. The main therapeutic value is the timely diagnosis and normalization of glucose levels.

Benign neoplasms of the colon, rectum, anus and anal canal are true neoplasia of the colon mucosa and are associated with a high risk of colorectal cancer (CC). The literature review analyzes epidemiology, risk factors, and modern methods of diagnosis and treatment, and describes priority minimally invasive interventions for benign colorectal tumors.

The article presents data on post-covid disorders of internal organs and systems with an emphasis on involvement in the pathological process of the gastrointestinal tract. The authors showed a high frequency of grastroenterological changes detected endoscopically: GERD of varying degrees of manifestation - 63%, inflammatory changes in the stomach (superficial, atrophic, hemorrhagic, erosive gastritis) - in 46%, damage to the duodenum and jejunum - in 12% and inflammatory changes in the ileum - 9% in the form of hemorrhages of varying degrees of prescription against the background of edematous pastous hyperemic folds, of which 4% had single or multiple erosions up to 3 mm, located in different parts of the small intestine, and 20% had lymphangiectasia of varying severity (in 4% of them in the form of “confluent fields” over several segments of the small intestine), epithelial formations of the upper gastrointestinal tract (hyperplasia, early cancer, GIST, neuroendocrine formations) - in 11%, inflammatory diseases of the colon (CD, UC) - in 4%, epithelial formations of the colon - 17%, diverticula of the colon - 8%. In 3 patients, solitary colon ulcers were found, located in the sigmoid and rectum. The effectiveness of the inclusion in the complex therapy of the recombinant interferon alfa 2-b in combination with vitamins E and C of post-covid changes in the gastrointestinal mucosa, especially solitary ulcers, has been shown

The presented clinical case demonstrates the appearance of vivid clinical manifestations of Crohn’s disease after a COVID-19 infection. It was not possible to diagnose the disease in the early stages due to the lack of typical symptoms and the necessary examination. A new coronavirus infection acted as a trigger factor for the progression of Crohn’s disease. The diagnosis was confirmed during instrumental and laboratory studies, adequate therapy was prescribed, which led to a rapid relief of the attack of the disease.

The article introduces two clinical cases of successful treatment of Crohn’s disease (CD) of the upper gastrointestinal tract (UGT) with TNF inhibitors. Besides that, the article presentes the review, devoted to diagnostics and treat the same injury of patients with CD. It should be mentioned, that number of publications in worldwide and national literature is quite insignificant. One fact that is more important is the unavailability of unificational approach to treatment of such group of patients. We suppose that epidemiological research is necessary to define the true prevalence of lesions of the upper gastrointestinal tract in CD, risk factors and prognosis for this patient group, and to output the diagnostic and therapeutic tactics.

Introduction. Clinical manifestations of inflammatory bowel diseases (IBD) are limited not only by the gastrointestinal tract syndromes, but also by a wide range of extra-intestinal manifestations, which include skin manifestations. Skin lesions in IBD occur in different forms. Some of them are associated with the activity of the main process, for example, gangrenous pyoderma. Others, such as psoriasis, are combined with pathogenetic factors common to IBD. Materials and methods. Three clinical observations of patients with IBD and extra-intestinal manifestations are presented: gangrenous pyoderma (case 1) and psoriasis (cases 2, 3). The stages of differential diagnostic search and treatment are described. The interleukin 12/23 inhibitor ustekinumab is prescribed to both bionaive patients (observations 1, 2), and to the patient who (observation 3) had high activity of the inflammatory process in the intestine and had received early treatment with GEBD. The extension of indications for use ustekinumab (ulcerative colitis, Crohn’s disease, psoriasis, psoriatic arthritis) of allows for its wider use in the treatment of patients. Conclusion. The interleukin 12/23 inhibitor ustekinumab has broad indications for use; its use allows to achieve a positive clinical, laboratory and endoscopic effect at the early stages of use. This effect has spread to skin manifestations, the reduction of which occurs in parallel with the healing of the intestinal mucosa.

Acute appendicitis is still the most common surgical disease in the experience of surgeon and it requires operative treatment in hospital. There are several suggestions on the causes of acute appendicitis: infectious or neurovascular conditions, obturation of the orifice of vermiform appendix with a fecal bolus, and other versions. One of the rare causes of acute appendicitis is ischemia of vermiform appendix, which results in the development of primary gangrenous appendicitis. The clinical manifestation of this pathology may be atypical. We present a case report of a 65-year-old patient with acute gangrenous appendicitis complicated by localized purulent peritonitis. When admitted to the hospital, the patient was suspected of mesenteric thrombosis. MSCT angiography was performed about that, which diagnosed thrombosis of a. appendicularis and acute appendicitis. Treatment included laparotomy, appendectomy, sanitation, and abdominal drainage. In the paper, we discuss the incidence and results of treatment of acute appendicitis.