A number of objective and subjective reasons, such as aging of the population, environmental, economic and other factors, determine the trend of increasing incidence of malignant neoplasms worldwide. According to GLOBOCAN 2020 forecasts, in the coming years, prostate, lung and bronchial cancer, colorectal cancer will account for almost half (48%) of all cases of the disease in men, of which 27% are prostate cancer. In women, breast cancer, lung cancer and colorectal cancer will account for about 51% of all new diagnoses, while breast cancer alone will account for about 30%. In 2021, the Ministry of Health of the Russian Federation approved the Procedure for preventive examinations and medical examinations, within the framework of which screening measures for early detection of oncological diseases are carried out, the procedure for dispensary observation of certain groups of the adult population by specialist doctors is approved, the duration, frequency of dispensary observation, the scope of preventive, diagnostic, therapeutic and rehabilitation measures are determined. The aim of the review: to present epidemiological data on the most common forms of cancer in Russia and the world; current recommendations on the organization of screening and its informative value; primary prevention measures.

At present, pancreatic cancer morbidity continues to grow at an accelerated rate worldwide. At the same time the five-year survival rate of patients with pancreatic cancer remains low, occupying a significant position in the mortality structure. This is mainly due to late diagnosis, as well as to the increasing proportion of the elderly population. Factors influencing the prognosis include age, sex, blood group, family history and genetic predisposition, diabetes, smoking, alcohol, chronic pancreatitis, and obesity. Objective: to present up-to-date data on pancreatic cancer epidemiology in the world, Russian Federation and Omsk region. Materials and methods: the article analyzes the data of morbidity, mortality and five-year survival rate of patients with pancreatic cancer for the years 2020-2021. Results: the growth of morbidity and persistent low survival rates emphasize the necessity of determining methods of screening patients with high risk of pancreatic cancer, developing methods of early detection and improving both surgical and drug treatment of these patients, as well as prophylaxis.

This article presents a clinical case of a patient with colorectal cancer (CRC), who was diagnosed at the stage of a metastatic generalized process, due to a long asymptomatic course, non-specific symptoms and the difficulty of primary diagnosis. The features of management, as well as the possibilities of treating a patient with metastatic colorectal cancer (mCRC) at the present stage, are considered. This clinical observation demonstrates the relevance of the search for new diagnostic methods, treatment regimens and principles for the prevention of CRC.

Objective. To study the frequency of the presence of Helicobacter pylori (HP), the effectiveness of eradication treatment, the factors that determine the failure of treatment among doctors in Chita. Material and methods. The study involved 164 people aged 19 to 73 years (average age 45.34 ± 13.15 years), including 93 doctors and 71 patients not related to medical activities. The presence of HP infection in 112 people was investigated by determining the antigen (AH) in the feces. 98 people were examined for the presence of HP DNA in gastric biopsies and A2142G, A2143G, and T2717C mutations in the bacterial genome, providing its resistance to clarithromycin by PCR. 59 doctors performed eradication treatment for HP with different schemes. Control of eradication was carried out 6-8 weeks after the end of therapy by determining AH HP in feces. Genetic testing was carried out in 30 doctors for the carriage of polymorphic genes CYP2C19 * 2: G681A (P227P), CYP2C19 * 3: G636A (W212X), CYP2C19 * 17: C-806T, MDR1 (ABCB1: C3435T) by PCR and the effect of the revealed genetic characteristics on the results of treatment. Statistical processing was carried out using descriptive statistics, x2 test and Fisher’s test for small samples (Biostatistics software). Results. A positive AH of HP in feces was registered in 62.5% of the examined: 66.3% of doctors and 50% in the compared population (p = 0.187). HP DNA in the gastric mucosa was detected in 49 people, which was 50% of the examined people. HP DNA was detected in 73.8% of doctors and in 32.1% of non-medical workers (p < 0.001). Subject to the treatment regimen, the effectiveness of all eradication regimens was 72.5% (regimens with clarithromycin - 72.7%, with josamycin - 100%, with tetracycline and metronidazole - 43%, with levofloxacin - 85.7%). Non-compliance with the therapy regimen was noted in 8 people. The effectiveness in this group was 12.5% (p≤0.01). Mutations in the HP genome, providing resistance to clarithromycin, were found in 38.8%: in the group of doctors - 45.2%, in non-medical workers - 27.8% (p = 0.368). In the absence of genotypic resistance, effective eradication took place in 42.1%, in the presence of resistant strains - in 16.7% (p = 0.364). When genotyping CYP2C19, ultrarapid (UM) and rapid metabolizer (RM) accounted for 30%, normal - 46.7%, intermediate - 20% and poor metabolizers (PM) - 3.3%. The effectiveness of all eradication regimens among UM and RM was 55.5%, the clarithromycin regimen - 16.7% (p > 0.05). In the CT and TT MDR1 mutant alleles, the effectiveness of all eradication schemes was 69.2% - 70%, of the clarithromycin scheme - 37.5% (p> 0.05). Conclusion. Doctors are at risk for Helicobacter pylori infection. In doctors, the infection is determined 1.3-2.3 times more often (when examined by different methods) than in patients not associated with medical activities. The effectiveness of all eradication schemes was 72.5%. The worst results were demonstrated by the scheme with tetracycline and metronidazole (43%). In case of non-adherence to the therapy regimen, the probability of successful treatment was reduced by 5.8 times. There is a tendency to a decrease in the level of eradication with genotypic resistance to clarithromycin in the genome of Helicobacter pylori, in carriers of mutant alleles with UM and RM of CYP2C19 and in the TT MDR1 genotype. The revealed reasons for the ineffectiveness of HP eradication in the doctors of Chita did not differ from the general population. The exception was the genotypic resistance of Helicobacter pylori to clarithromycin, which tended to develop more frequently in doctors.

It has been shown that in patients with GERD and functional dyspepsia, the use of proton pump inhibitors leads to a decrease in heartburn and pain behind the sternum. However, symptoms such as regurgitation, belching, feeling of early satiety and heaviness after eating were stopped ineffectively. The inclusion in the treatment complex of the prokinetic domperidone at a dose of 10 mg 3 times a day contributed to a more effective regression of symptoms of impaired motility of the esophagus and stomach.

Introduction: Gastric ulcer is a chronic disease with a recurrent course. The morphological substrate during periods of exacerbation are ulcers of the gastric mucosa. Peptic ulcer disease has a high prevalence among the adult population and is often characterized by a complicated course. Hereditary predisposition, along with other external and internal risk factors, plays a role in the etiopathogenesis of the disease. The aim of the study: To evaluate the effect of polymorphic variants of cell adhesion molecule genes on the development of Helicobacter pylori-negative gastric ulcer (GU). Materials and methods: 119 patients with Helicobacter pylori-negative GU and 347 individuals of the control group were examined. The regulatory potential of 7 polymorphic loci of genes of cell adhesion molecules pathogenetically significant for the development of gastric ulcer (rs6136 of the SELP gene, rs8176720, rs2519093, rs507666 of the ABO gene, rs651007, rs579459, rs649129 of the ABO/RF00019 gene) was evaluated using the HaploReg v4.1, PolyPhen-2, GTEx Portal Internet resources. DNA samples isolated from peripheral blood were genotyped by PCR. The analysis of associations was carried out by the method of logistic regression in the framework of allelic, additive, dominant and recessive genetic models. Results: The T allele of the RF00019/ABO gene (rs651007) is a protective factor in the development of H. pylori-negative GU (OR=0.14). This polymorphism is located in the region of histones marking promoters, regions of hypersensitivity to DNAse and the HNF4 regulatory motif, is associated with the expression of the ABO and SURF1 genes and alternative splicing of the ABO and LCN1P1 genes in various organs (tissues), including in the organs of the digestive and nervous systems.

The aim of the study was to compare endosonographic signs of pancreatic lesion in patients with inflammatory bowel diseases (IBD) and in patients with diagnosed chronic pancreatitis (CP). Materials and methods. 62 patients with IBD (39 with ulcerative colitis (UC), 23 with Crohn’s disease (CD)), 33 patients with previously established CP without IBD and 42 patients without CP and IBD were examined. All patients underwent endosonographic examination of the pancreas with an assessment of parenchymal and ductal criteria according to the Rosemont classification. Results. There was no statistically significant difference when comparing changes in the pancreas in UC and BC. Ductal disorders in patients with UC and CD were more common than in the control group. Parenchymal changes of the pancreas were statistically significantly more common in patients with IBD than in CP, and ductal, on the contrary, less common. At the same time, a significant difference was determined between the frequency of ductal changes in IBD and CP when compared with the control group. According to the Rosemont classification, certain CP was more common in patients with previously verified gland damage, probable - in patients with IBD. Conclusion. Based on the results of our study, with different etiologies of CP, endosonographic changes in the pancreas will manifest in different ways. A detailed approach to the etiology of CP will optimize the diagnosis and treatment of pancreatic insufficiency, and as a consequence of the underlying pathology of the intestine. Timely administration of therapy for changes in the pancreas can help to avoid progressive changes in the pancreas and improve the prognosis of the disease.

The increase in the frequency of the use of video capsule endoscopy (VCE) in the study of the gastrointestinal tract, the improvement of this technology over the past decade determine the relevance of describing the advantages of this method over traditional endoscopic methods, as well as the disadvantages of the method and directions of development. VCE is a method in which diseases that were previously detected only posthumously are detected. VCE is more informative than X-ray contrast examination methods or magnetic resonance imaging of the gastrointestinal tract. VCE better detects small neoplasms, which improves the quality of diagnosis and allows you to start timely treatment. VCE is rarely the first choice of imaging method. It is most useful for detecting superficial or hidden lesions and is best used in combination with other endoscopic methods. The cost-effectiveness of this study has yet to be determined. The use of video capsule endoscopy is limited by the high cost of research, but in the coming years, thanks to the development of technologies, the cheaper production process, it will become available to many clinics and patients as a research method.

High mortality and disability from cancer remains one of the important and unresolved issues of modern medicine. Experts of WHO consider, that cancer is the second leading cause of death worldwide. Approximately 9 million people die of cancer each year, and more than 14 million are diagnosed with cancer. At the same time, according to Russian epidemiology, there is a trend to increase of cases of cancer, including people of young working age, and there is no reliable, verified information about the causes and mechanisms of development of tumor cells. The patient may begin to complain too late, so it is not always possible to suspect this and prevent the diseases. Many research centers and clinics are concerned about this problem and are deeply involved in solving it. To date, a promising direction in the diagnosis of oncological diseases are omics technologies, which are being studied, tested and gradually introduced into modern medicine. According to scientists, the future of healthcare lies with omics technologies, since they allow studying the whole patient’s genotype, which will allow to suggest a person’s predisposition to a particular disease very early, develop methods of correction and prevention, and select the most effective methods of treatment. The purpose of this review is to systematize domestic and foreign data on the current results of the use of omics technologies in the early diagnosis of oncological diseases.

To date, the problem of pancreatic cancer is the high mortality rate. The IARC predicts that pancreatic cancer will become the second leading cause of cancer deaths by 2030. Because patients usually present with advanced disease and respond poorly to broad-spectrum chemotherapy, overall survival is only 10%. This highlights the urgent clinical need to identify new therapeutic approaches for patients with pancreatic adeno-carcinoma. Objective: To identify patterns of genetic changes in the development of pancreatic carcinoma and to consider pathogenesis of this process. Materials and methods: data from multi-genetic panels of Memorial Sloan Kettering Cancer Center, articles of the journal Cancers, and PubMed re-source articles. Results: the work has uncovered major and alternative pathways in the pathogenesis of pancreatic cancer, established hypotheses of similar pathways in tumors of other localizations and the presence of fundamental pathogenetic links in pathogenesis, indicating the universality of certain genetic changes in tumor growth.

Aim: to present the morphological characteristics of changes in the gastric mucosa in patients with dyspepsia syndrome. Materials and methods: The study included 262 patients (men - 25.6%, n=67; women - 74.4%, n=195), the median age was 57 (45;64) years. The results of laboratory and instrumental studies, clinical and anamnestic data were studied. In all cases, a biopsy was taken according to the standard of five points (two biopsies from the antrum of the stomach, two biopsies from the stomach body, one from the corner of the stomach) to verify the grade of inflammation, stage of gastritis and diagnosis of H. pylori status. Results: The study showed that in patients aged 57 (45;64) years with dyspeptic complaints at the stage of primary health care, the predominant variant of dyspepsia was epigastric pain syndrome. All patients with dyspepsia syndrome had signs of chronic gastritis. According to histobacterioscopy, grade III or IV inflammation was more often registered in patients with H. pylori-positive gastritis (78.6% vs. 30.8% in patients with H. pylori - negative gastritis, p<0.001). In patients with H. pylori - negative gastritis the stage of atrophy was higher (stage III or IV was registered in 18.5% of patients vs. 7.1% in patients with H. pylori negative gastritis, p<0.001). To clarify the etiology of gastritis, in case of a negative result of histobacterioscopy for H. pylori, it is advisable to confirm the absence of H. pylori by the second method using a respiratory urease test C13 or detection of H.pylori antigen in feces or a test for antibodies in the blood to H. pylori; exclude the persistence of immune inflammation due to genetic predisposition in previously infected persons; exclude other, rarer etiological forms of gastritis.

Stomach cancer (GC) ranks fifth in the structure of cancer incidence and remains the third leading cause of cancer mortality worldwide. The formation of gastric cancer occurs under the influence of genetic and epigenetic factors. Among the latter, eating habits play a significant role. Primary prevention of cancer through lifestyle and dietary changes is an important and high priority strategy in modern health care. This article presents an overview and systematization of the available data on the influence of nutritional factors on the risk of gastric cancer formation.

Numerous epidemiological studies demonstrate that cystic fibrosis, the most common orphan disease in the world, can not occur in isolation, but can be combined with other serious diseases. The most common such combination in all populations is traditionally cystic fibrosis and celiac disease, which, on the one hand, differ in the leading mechanism of inflammation, in cystic fibrosis - chronic microbial inflammation, in celiac disease - autoimmune, on the other hand, these two diseases have a number of common pathogenesis links, in particular, realizing the syndrome of malabsorption, which only complicates the timely diagnosis of these combined pathological conditions. In addition, the authors of the literature review focus on clinical examples of late detection of autoimmune gluten intolerance against the background of cystic fibrosis. They also consider the combination of cystic fibrosis with other severe, disabling diseases (rheumatoid arthritis, phenylketonuria, oncological diseases), which sometimes require a serious change in therapeutic tactics.

The purpose of this publication is to systematize available data on the risks of developing stomach cancer in patients with a chronic autoimmune gastritis with a demonstration of the clinical case of a patient with a chronic autoimmune gastritis and a neuroendocrine gastric tumor of the type 1. Discussion: the article discusses the risks of stomach cancer in patients with chronic autoimmune gastritis. A mechanism for the formation of a neuroendocrine gastric tumor of the type 1, associated with autoimmune gastritis, is given. A clinical example of a patient with a long history of dyspepsia, the presence of concomitant changes in the results of laboratory tests, describes an algorithm for diagnosis of autoimmune gastritis and associated neuroendocrine tumors. The risks of the development in patients with autoimmune gastritis of formidable complications as an adenocarcinoma of the stomach are considered. Conclusion: Chronic autoimmune gastritis is a precancerous diseases of the stomach, with the progressive atrophy of the gastric body mucosa, and associated with an increased risk of developing neuroendocrine gastric tumor of the type 1 and adenocarcinoma of the stomach. Patients with autoimmune gastritis need dynamic outpatient observation, with endoscopic control and assessment of the degree and stage of gastritis in OLGA system, with immunogistochemistry to evaluate the risks of stomach cancer and timely implementation of the necessary measures of carcinoprection.

The purpose of this review was to update information on the prevalence and relationship of cancer development of various localizations with non-alcoholic, metabolic-associated fatty liver disease (NAFLD/MAFLD). Discussion: The second most common cause of death among patients with NAFLD are malignant neoplasms both in the gastrointestinal tract (liver, colon, esophagus, stomach and pancreas) and in other organs (kidneys, prostate gland in men and mammary gland in women). Obesity and other metabolic disorders are associated with an increase in morbidity or mortality from various types of cancer. Due to the high prevalence of NAFLD among patients with metabolic syndrome, type 2 diabetes mellitus, an extrapolation of this development is assumed among patients with NAFLD. Metabolic disorders, imbalance of the intestinal microflora are considered as possible pathogenetic mechanisms for increasing the risk of cancer among patients suffering from NAFLD. Conclusion: in addition to the risk of developing hepatocellular carcinoma as a natural course of the disease, convincing evidence is accumulating for the role of NAFLD as an independent risk factor for the development and progression of cancer, especially in the gastrointestinal tract.

The aim of the study was to study the literature data on the effect of liposuction and abdominoplasty on metabolic parameters and the course of NAFLD. In recent years, technologies for the surgical treatment of obesity have been actively developed, the final stage of which is often liposuction and abdominoplasty. Surgical removal of excess fat mass leads to an improvement in the metabolic profile of patients. In patients with non-alcoholic fatty liver disease on the background of obesity after bariatric interventions, there is a regression of structural and functional changes in the liver. Modern literature convincingly shows the positive effect of bariatric surgery on the course of non-alcoholic fatty liver disease, however, there are no similar data on liposuction and abdominoplasty, which makes further research in this area relevant.

The gut microbiota is a unique structure that is normally in an equilibrium state and performs a huge number of diverse functions. Cigarette smoke modifies the intestinal microbiota through a variety of mechanisms and affects the work of enzymes associated with oxidative stress, the mucin layer and the expression of proteins of dense contacts of the intestinal mucosa, the balance of acids and bases in the colon. And this is in addition to the direct toxic effects of many components of tobacco smoke and the spread of bacteria directly from cigarettes. The article examines the data of modern literature on the complex and ambiguous mechanisms of the influence of tobacco smoke and its individual components on the gut microbiota.

Gout is one of the most common forms of inflammatory arthritis. It is known that gout occurs in connection with the deposition of mono-sodium urate crystals in the joints due to high levels of serum uric acid. One of the main risk factors for developing gout is dietary habits. Changes in dietary habits and recommendations for lifestyle modification in gout are the main principles of treatment and management of patients. The purpose of this study is to summarize the current knowledge on non-pharmacological treatment and management of patients with gout.

Patients with chronic gastritis (CG) with the development of atrophy of the gastric mucosa are at an increased risk of developing gastric cancer (GC). In the management of such patients, the development of high-grade dysplasia and invasive gastric cancer should be defined as adverse outcomes that must be prevented. To this end, patients with a diagnosis of «Chronic atrophic fundic/multifocal gastritis» are subject to dynamic dispensary observation to assess the achievement of target indicators, take into account information about changes in the diagnosis and concomitant diseases, emerging complications, as well as to enter data on ongoing therapeutic and preventive measures. This article presents the main aspects of prevention and dispensary monitoring of patients with an increased risk of gastric cancer.

The article describes a clinical case of Buschke - Levenstein condyloma. The development of the tumor is associated with a papillomavirus infection against the background of an immunodeficiency condition. The difficulties of identifying a causally significant factor, the complexity of patient management, the risk of an unfavorable outcome of the disease are considered. This clinical example demonstrates the need for a timely examination of men for papillomavirus infection and the search for new therapies against the background of topical and systemic immunostimulants.

Introduction. Adenomas of the major duodenal papilla are benign neoplasms, but due to their high tendency to malignancy, they must be removed. At present, minimally invasive methods of operations are increasingly being considered as an alternative to surgical interventions, while cases of a combination of a neoplasm of the major duodenal papilla with choledocholithiasis and bile duct strictures are of particular difficulty in endoscopic treatment. Clinical case. A 62-year-old patient underwent complex endoscopic treatment at the Vishnevsky National Research Medical Center for Surgery about adenoma of the major duodenal papilla type IV, extending to the walls of the duodenum and the terminal section of the common bile duct, in combination with choledocholithiasis and cicatricial stricture of the common bile duct. Results. The patient successfully applied a complex approach of minimally invasive treatment in the amount of endoscopic lithoextraction, fragmentary removal of adenoma of the major duodenal papilla with intraductal high-frequency electrosurgical ablation of residual adenomatous tissue and subsequent staged biliary stenting for cicatricial stricture of the common bile duct, as well as stenting of the main pancreatic duct to prevent post-manipulation pancreatitis. Discussion. An integrated approach in the treatment of a patient with adenoma of the major duodenal papilla IV, choledocholithiasis and stricture of the common bile duct, made it possible to achieve clinical success in the absence of complications and the need for long-term rehabilitation.

Heterotopic pancreas (HPG) is an aberrant anatomical malformation that is most commonly located in the upper gastrointestinal tract. The presence of an aberrant pancreas in most cases is asymptomatic, but in a number of clinical situations it is accompanied by symptoms that require drug therapy, sometimes surgical or endoscopic intervention. Analysis of the clinical manifestations and symptoms of BPH is important in choosing the tactics of treating patients. The difficulty lies in the fact that there is not enough information on BPH in the literature, there are no data from a study in a large cohort of patients with BPH. The purpose of the publication is to review clinical cases, including our own observation, and compare them with a systematic review of the literature in order to draw conclusions about the features of clinical manifestations, pathomorphosis and modern principles of treatment of the disease.

Purpose. To present a clinical case of bezoar in a girl of 13 years old, with differential diagnosis of infectious, surgical and gynecological pathology.

Materials and methods. The mother of a 13-year-old girl turned 26. On 10.2022, for consultation with complaints of abdominal pain, nausea, vomiting, loose stools. According to the mother, despite repeated visits to doctors, the child could not be diagnosed. Because of this, initially there was hospitalization in the infectious diseases department, re-hospitalization in the surgical department and then in the gynecological department. On 29.10.2022, the girl was operated on in a gynecological hospital, together with a pediatric surgeon.

Results. During the surgical intervention, about 400.0 serous effusion was found in the abdominal cavity. During the revision of the organs of the female reproductive system, two paraovaril cysts up to 1 cm were found on both sides, removed. When revising the appendicular process, no pathology was revealed. When revising the intestine, a dense consistency of bezoar was found measuring 8 × 6 cm. The wall of the small intestine was opened over the bezoar, evacuation of a foreign body, layer-by-layer suturing. In the postoperative period, the patient received antibacterial, infusion and symptomatic therapy. The postoperative wound healed initially, without signs of inflammation. After discharge, a psychologist’s consultation is recommended.

Conclusion. Bezoars are a rare type of pathology. Their diagnosis is difficult due to the absence of early specific clinical symptoms. This case from practice indicates that bezoar can simulate various pathologies of the abdominal cavity. Particular attention should be paid to pathological behavioral reactions, to consult children and adolescents with a psychologist and a neurologist. Unfortunately, the diagnosis is made when patients are admitted to the hospital with the phenomena of an “acute” abdomen, for surgical intervention.

The annular pancreas (CPJ) is mainly considered in pediatric surgical practice as a pathology of the newborn period, manifested by a picture of duodenal obstruction and having the potential for complete cure. Nevertheless, during the course of life, patients with this defect may develop complications such as chronic pancreatitis, peptic ulcer, pancreatic tumors, changes in the biliary tract, etc., which develop in adulthood and often cause complications and deaths. There are very few descriptions of such complications in children in the available literature, and therefore, we want to provide a clinical case of an 8-year-old boy with a complicated course of CPJ.