The incidence and prevalence of inflammatory bowel diseases (IBD) is growing in parallel with the obesity pandemic. The geography of the distribution of obesity and IBD on the planet have common features. In recent years, there has been information about the epidemiological interaction of predisposing factors to obesity and ulcerative colitis (UC). The aim of the study was to assess the prevalence of overweight and obesity in patients with UC in the Western Siberia region. Materials and methods: a case-control study of 165 ulcerative colitis was conducted in 56 healthy volunteers of comparable gender and age. Body mass index (BMI) was calculated using the formula: weight (kg)/weight (m2). Results: only in 7.9% of patients with UC BMI corresponded to a lack of body weight, in 48% BMI within normal parameters, in 43% of cases BMI corresponded to overweight and obesity. At the same time, the average values and median BMI in UC patients with acute and chronic course of the disease are close to the upper values of normal values. There are no gender differences in BMI compared to the control group. The BMI of patients with severe attack is significantly less than the BMI of patients with moderate attack. Hormonal dependence and resistance, the use of GIBP did not have a significant effect on the BMI of UC patients. In patients with UC, when compared with the control group, there are significantly more patients with type 2 diabetes mellitus. However, there was no significant relationship between the severity of the current attack among UC patients and the presence of type 2 diabetes mellitus in them. When comparing the group of patients with UC with the control group, there were no significant differences in the frequency of occurrence of NAFLD, cholelithiasis, coronary heart disease, arterial hypertension, while in patients with continuously recurrent UC, liver damage characteristic of NAFLD is significantly more common.

Early diagnosis of autoimmune gastritis (AIG) is quite difficult in a physician’s daily practice. Since the disease is asymptomatic for a long time, it is often diagnosed already with severe atrophy with the loss of a large number of gastric glands and potentially significant pernicious anemia, and sometimes with the onset of cancer. Morphological and endoscopic changes do not occur immediately and are not specific in patients with AIG. In this case, non-invasive diagnostics play a key role. The diagnostics of AIG are often done in patients with vitamin B12 and iron deficiency. However, the development of these deficiencies can take a long time. The non-invasive technique with the determination of such biomarkers as pepsinogen I, II (PGI, PG II), their ratio, gastrin-17, as well as Helicobacter pylori (H. pylori) infection, including a cytotoxic (CagA +) strain, is used to exclude preclinical stages of AIG. The titer determination of anti-parietal cell antibodies and the anti-intrinsic factor antibodies allows identifying the immune nature of gastritis. But recent studies show that these markers can be negative in some patients. This article actualizes the problem of early diagnosis of AIG and demonstrates the importance of practical application of currently existing non-invasive methods for the diagnosis of stomach diseases.

The purpose of the work: to investigate the possibilities of combined models including electrical, viscoelastic parameters of erythrocytes, fatty acid levels of erythrocyte membranes, blood serum to improve the accuracy of early colorectal cancer (CRC) diagnosis. Materials and methods. 65 patients with stages 1-2 of CRC (mean age 63.3±9.6 years), 25 people with adenomatous polyps (AP) and 35 people of the comparison group were examined. The electrical and viscoelastic parameters of erythrocytes were studied by dielectrophoresis in the frequency range 5x10⁴-10⁶Hz; the levels of fatty acids (FA) in erythrocyte membranes, blood serum - using gas chromatography/mass spectrometry (Agilent 7000B (USA). When creating combined models, machine learning methods were used, for their interpretation and assessment of the degree of contribution of parameters to their composition, the method of constructing SHAP diagrams was used. Results. The use of combined models made it possible to achieve high diagnostic accuracy of distinction: for the pair “healthy versus patients with AP” during ROC analysis, the AUC was 1,0 (sensitivity 1,0, specificity 1,0). This model included parameters: diameter of erythrocytes at a frequency of 10⁶Hz, proportion of deformed cells, summerized rigidity, amplitude of cell deformation at a frequency of 10⁶Hz, speed of movement of erythrocytes to electrodes, electrical conductivity of cells, level of arachidonic acid, aggregation index at a frequency of 5x10⁴Hz, polarizability at a frequency of 10⁶Hz, total content of eicosapentaenoic and docosahexaenoic (n3), level of docosatetraenoic FA (n6). For the pair “healthy vs patients with 1-2 stages of CRC”, the AUC also reached 1,0 (an increase in AUC from 0.916 when using only FA to 1.0 in combined models) (sensitivity 1,0, specificity 1,0); the most significant for the distinction were: electrical conductivity, cell capacity, erythrocyte level of palmitooleiс C16:1;9 FA, the position of the crossover frequency, summerized rigidity, the amplitude of cell deformation at a frequency of 10⁶ Hz, the degree of cell deformation at a frequency of 5x10⁵ Hz, the level of the dipole moment, the total content of serum saturated FA, the proportion of deformed cells, serum levels myristic, palmitic FA, the rate of movement of erythrocytes to the electrodes, the level of docozapentaenoic C22:5n-3 in the blood serum. For the pair “patients with 1-2 stages of CRC versus patients with AP”, the AUC was 0,98 (sensitivity 0,92, specificity 1,0). This model consisted of indicators: the diameter of erythrocytes at different frequencies of the electric field, the level of decadienic FA (n6) in erythrocyte membranes, the proportion of discocytic forms, the content of stearic FA in erythrocytes, the serum level of palmitoleic C16:1;9 FA, the total content of saturated FA, aggregation indices at low frequencies of NUAEF, the level of pentadecanoic FA in erythrocyte membranes, serum stearic acid content and cell polarizability at a frequency of 10⁶ Hz. Conclusion. The creation of combined models consisting of electrical, viscoelastic parameters of erythrocytes, fatty acid levels of erythrocyte membranes, blood serum using machine learning methods and the construction of SHAP diagrams ensures high accuracy in the diagnosis of precancerous and early colorectal cancer.

Purpose. To study the frequency of genotypes and alleles of C282Y and H63D mutations in the HFE gene in patients with porphyria cutanea tarde of the West Siberian region and their influence on the clinical and biochemical characteristics of the disease. Materials and methods. We observed 14 patients with porphyria cutanea tarde (PCT), who underwent a comprehensive general clinical and instrumental examination. The indicators of the excretory profile of porphyrin metabolism indicators were purposefully determined, a molecular genetic examination was carried out to determine the genotypes and alleles of the C282Y and H63D mutations of the hemochromatosis gene HFE. Results and discussion. Molecular genetic research found that the HFE gene mutation was found in 7 patients (50.0%). Polymorphism for the C282Y allele was found in 2 (14.3%) patients, and for the H63D allele - in 5 patients (35.7%). Risk factors for the manifestation of PCT included frequent alcohol consumption and chronic HCV infection. Genotype 1b was recorded more often (9 people), less often - genotype 3a (4 people). The excretory profile of porphyrin metabolism indices in patients of both groups exceeded the control values. Porphyrin metabolism parameters in patients without HFE gene mutations were significantly higher than those in patients without HFE gene mutations. Conclusions. Polymorphism of the hemochromatosis gene HFE in PCT was detected in 50% of patients. The most common mutation was the H63D allele. The level of porphyrin metabolism disorders in patients with HFE hemochromatosis gene mutations is significantly lower. The clinical picture of PCT in all observed patients did not differ. Chronic viral hepatitis C is assessed as a risk factor for the manifestation of PCT.

Increase intestinal permeability is one of the main mechanisms for the development of irritable bowel syndrome (IBS). The role of stress and nutrition factors is considered as key modifiable factors contributing to the development of increase intestinal permeability. Purpose of the study: to evaluate the content of a marker of increased intestinal permeability (zonulin in feces) in relation to dietary habits, levels of anxiety and depression, levels of stress hormones (cortisol in saliva) and neurotransmitters (serotonin in blood serum, dopamine in blood plasma) in patients with IBS. Materials and methods: an open cohort prospective study was conducted with the inclusion of 263 patients with an established diagnosis of IBS. The control group consisted of 40 healthy volunteers. All individuals included in the study were assessed for diet and eating habits, the severity of anxiety and depression, including the level of specific anxiety in relation to gastrointestinal symptoms, and quality of life. In addition, the levels of cortisol in the morning and evening portions of saliva, serum serotonin, plasma dopamine and fecal zonulin were assessed. Results: in patients with IBS, the marker of increased intestinal permeability (zonulin in feces) is closely related to the nature of nutrition, anxiety levels, cortisol and serotonin secretion, and is also associated with the development of abdominal pain, diarrhea, and the severity of the disease.

Research objective: to study the frequency of small intestinal bacterial overgrowth (SIBO) and factors associated with it in patients with inflammatory bowel diseases (IBD). Materials and methods of the study: 152 patients with IBD (Crohn’s disease and ulcerative colitis) a hydrogen breathing test (HBT) with lactulose, performed by the “Gastro+” monitor using lactulose. In all patients, the characteristics of the course of IBD were evaluated, including 60 parameters: the time of diagnosis of IBD, the existing symptoms assessed by a visually analog scale (VAS), extra-intestinal manifestations, current and previous treatment, severity of attack, extent of the lesion in UC, phenotypic variant in CD, the level of endoscopic activity, the presence or absence of surgical interventions, indicators of laboratory and instrumental methods of examination, etc. Results. The frequency of positive hydrogen breath test was 48%, in patients with CD - 50.7% (n=36), in patients with UC - 45.7% (n=37) (p= 0.626). The presence of SIBO in general in IBD patients was associated with the level of clinical and endoscopic activity and the form of the disease, the severity of the attack; as well as in UC patients - the extent of the colon lesion, in CD patients - the presence of penenting and stenosing phenotypes. Patients with IBD with the presence of SIBR complain of a greater number of defecations, a lower body mass index, the presence of a decrease in body weight within 1 month before the examination and more frequent complaints of bloating, flatulence, tearfulness and weakness. Thus, a hydrogen breath test can be used for differential diagnosis of exacerbation of IBD from clinical manifestations caused by SIBO.

The aim: To compare the adequacy of calculating the parameters of the fetal cardiointervalogram obtained by Doppler and phonography methods from the degree of obesity in a pregnant woman Materials and methods: The study involved 54 pregnant women aged 16 to 42 years, all women are classified as having a high degree of perinatal risk. The gestational age at the time of the study was 27-41 weeks. In 26 women, the course of pregnancy was complicated by gestational diabetes mellitus, in 28 women this diagnosis was absent. The BMI of the study participants ranged from 21 to 35 kg/m2. The cardiotocogram was recorded using Sonicaid Team (Sonicaid Ltd/ Huntleigh Healthcare, UK) and FC 1400 (Bionet, South Korea) devices. Recording of the phonocardiogram was carried out using the FetalCare software and hardware complex (Diagnostics+ LLC, Tomsk). For each study, the time when the simultaneous presence of a heart signal on CTG and FCG averaged 23.7 ± 8.8 minutes. Results: Based on the data obtained from CTG and FCG, the dependence of the percentage of the lost signal (%), the volume of intersections of the graphs (%), the correlation between the CTG and FCG graphs (r,%), the percentage of recording with a deviation of the CTG and FCG graph of less than 12.5 beats/min was calculated (1-RO,%), the absolute difference in the values of the average heart rate (bpm), basal rate (BR, bpm), STV and LTV (ms) from the patient’s body mass index. Conclusion: Phonocardiography is a promising method for long-term continuous monitoring of the fetal heart rate, given the low cost of equipment and absolute safety for mother and fetus. The conducted study proved the possibility of using the FCG method in obese women, a small dependence of the calculated parameters of the cardiointervalogram on the body mass index. It is necessary to continue developments on the creation of new modifications of fetal monitors based on various principles of heart rate recording.

Purpose of research. The study of the statistical and clinical features of liver cirrhosis (LC) against the background of a coronavirus infection caused by the SARS-CoV-2 virus. Materials and methods. 98 patients (51 men and 47 women) aged 23 to 69 years (mean age 53.8±1.9 years) with a verified diagnosis of cirrhosis were examined. The patients were divided into 2 groups. Group 1 consisted of 49 patients who underwent surgery in 2020-2021. coronavirus infection. The 2nd group also included 49 patients with cirrhosis who underwent treatment and examination in 2017-2018, which made it possible to exclude infection caused by the SARS-CoV-2 virus in them. Both groups were divided into 2 subgroups: recovered and deceased. A comprehensive statistical processing was carried out. Results. In the subgroups of recovered patients, the results in the dynamics of treatment were positive. The dynamics of liver function indicators in deceased patients of the 1st and 2nd groups also turned out to be similar, but negative. The analysis of cytolysis indicators established their significant progression and more significant in the 1st group. Alkaline phosphatase and gammaglutamyltransferase had the same dynamics, which indicated the progression of cholestasis syndrome. Violations of bilirubin metabolism worsened and also significantly significantly in the 1st group. Worsened protein metabolism. Hemostasis indicators worsened in patients of the 1st group. As expected, the level of C-reactive protein was higher in patients of the 1st group, which was due to a specific inflammatory process of the respiratory organs. Conclusion. Our observations allow us to state that patients with cirrhosis have certain features of the course of the disease against the background of COVID-19 infection, namely, higher rates of liver function decompensation and death when infected with the SORS-CoV-2 virus.

The purpose of the study is to study the effectiveness of sanatorium-resort treatment of NAFLD with the use of balneo-drinking intake of MW and its combination with ultrasound therapy. Materials and methods: There have been observed 80 patients with a verified diagnosis of NAFLD, of both sexes, at the age of 52.8 (47, 3; 59, 6) years old. Two groups of 40 people were formed by simple randomization - a control group (CG), its patients were prescribed traditional balneo-drinking treatment by MW “Slavyanovskaya”, and a group of comparison (GC) who additionally had ultrasound therapy (UST) on the projection of the liver. The effectiveness of the treatment was assessed by the dynamics of clinical symptoms, indicators of the functional state of the liver (total bilirubin level, activity of cytolysis and cholestasis enzymes), as well as the parameters of the speed characteristics of portal blood flow. Results: comparative analysis showed that in the group of comparison, positive changes in clinical manifestations of the disease were 10% higher than in the control group (p < 0.05). Favorable shifts in liver function tests were observed in the CG in 67.5% by 15.6% - 27.2%, and in the GC - in 75% by 30.2% - 40.4% with significant differences (p < 0.01). Normalization of the velocity parameters of portal blood flow was observed in the CG - 67.5% by 6.3% - 8.5%, and in the GC - 77.5% by 7.6% - 12.1% (p < 0.05). Conclusion. The inclusion of UST in the traditional complex of spa treatment of patients with NAFLD contributes to a significant increase in the favorable effect of MW on the dynamics of clinical symptoms, liver function tests and portal blood flow with an increase in the overall effectiveness of the treatment by 10% due to the mutual and comparative effect of MW and ultrasound therapy.

Chronic hepatitis B virus (HBV) infection remains a global public health problem. Patients with chronic HBV infection are at increased risk of progression to cirrhosis and development of hepatocellular carcinoma (HCC). The primary goal of therapy is to improve quality of life and survival by preventing disease progression to cirrhosis, HCC, and death. Induction of long-term suppression of HBV replication represents the most important goal of current treatment strategies, and clearance of hepatitis B surface antigen (HBsAg) is its optimal endpoint. Long-term administration of potent nucleos(t)ides analogues (NA) with a high barrier to resistance (entecavir, tenofovir disoproxil fumarate, or tenofovir alafenamide) is the therapy of choice. However, factors associated with response to NA-based antiviral therapy (ART) are not clear and have not been included in treatment recommendations. The purpose of this review is to summarize the results of studies evaluating the influence of factors on the effectiveness of NA-based ART. The study examined the significance of baseline pre-treatment factors (demographic, histological, virological, biochemical) as well as dynamic changes in viral load and HBsAg levels during ART in predicting treatment efficacy.

Purpose. To summarize the estimates of the effect of the use of potassium-competitive proton pump inhibitors in pharmacotherapy algorithms for patients with peptic ulcer disease, GERD on treatment outcomes. Material and methods. The most large-scale (as a rule) publications of the last five years devoted to the problem under consideration are analyzed. The search was carried out by keywords in the Pubmed information database (ncbi.nlm.nih.gov). Findings. Potassium-competitive acid blockers (P-CABs), in comparison with «traditional» drugs of this class (proton pump inhibitors), have advantages from a clinical and pharmacoeconomic point of view both in peptic ulcer disease (in particular, as part of eradication therapy) and in gastro-esophageal reflux disease. Confirmation of these data in the conditions of use of K-CCB in patients of the Russian Federation seems appropriate.

Surgical interventions for benign lesions of the extrahepatic bile ducts in 15-25% of cases end with the creation of bypass biliodigestive anastomoses. After pancreaticoduodenal resection, every 6 patients have failure of biliodigestive anastomoses and the formation of an external biliary fistula. During the same operation, failure of the pancreatodigestive anastomosis develops in about 15-40%, leading to high mortality. The use of traditional technologies in the surgical treatment of pancreatic pseudocysts is accompanied by the development of early complications and leads to relapses. In connection with this, interest arose in the use, for the treatment and prevention of these complications accompanying operations on the bile ducts and pancreas, of a new generation of implant materials with shape memory. From 1990 to 2021, we performed 183 stenting operations for pancreato- and biliodigestive anastomoses with titanium nickelide stents. In the comparison group of 56 patients with cicatricial lesions of the extrahepatic biliary tract, who used STPD and precision suture, good results were achieved in 58.5%, satisfactory in 22%, unsatisfactory in 19.5%. In the second comparison group of patients with this pathology, who underwent X-ray endobiliary stenitization with nitinol stents with a round thread section, good results were obtained in 41.8% of patients, satisfactory - in 58.2%. The average duration of stent functioning in this group of patients was 38.2±2.3 months. The results of treatment and prevention of the development of cicatricial lesions of the extrahepatic bile ducts of pancreato- and biliodigestive anastomoses using superelastic stents made of titanium nickelide with shape memory indicate the effectiveness and prospects of this direction both in open and laparoscopic operations.

Purpose An observational study was undertaken to identify differences in children^’s homeostasis in the early postoperative period after orthotopic liver transplantation (OLT) depending on the age. Materials and methods. We have compared the paraclinical parameters of children in the early postoperative period after OLT in the early postoperative period (up to 4 days). Selected groups: group 1-18 patients aged 2 to 11 months; group 2-13 patients older than 1 year. Observational study. Statistical processing by nonparametric criteria. Results. The identified intergroup differences in homeostasis in the immediate postoperative period after OLT were determined mainly by the usual nuances of age-related physiological differences. In the children of the first year of life, the functions of the donor liver made it possible to level the preoperative deficiency in the synthesis of antithrombin-III, but this group demonstrated manifestations of the refeeding syndrome and intestinal motor dysfunction, which led to a prolongation of observation in the intensive care unit. The results obtained are reproducible in the most surgical hospitals. Conclusion. In the children of the first year of life after orthotopic liver transplantation, the digestive and motor functions of the digestive tract are slowly restored, which necessitates prolonged epidural blockade, careful resumption of nutritional support, and prolonged observation in the intensive care unit. In the children older than 1 year, there was noticed a tendency to leukopenia, which increases the probability of infectious complications. No dangerous manifestations of acute renal injury were noted.

The aim of the study was to study the effect of oxymethyluracil complex compounds on the expression of glutathione-S-transferase genes in rat liver under conditions of its toxic damage by acrylamide. Materials and methods. The animals were divided into 5 groups of 6 animals each: control, acrylamide, acrylamide + complex compound of oxymethyluracil with ascorbic acid (MG-1), acrylamide + complex compound of oxymethyluracil with sodium succinate (MG-2), acrylamide + complex compound of oxymethyluracil with acetylcysteine (MG-10). The drugs were administered 1 hour before exposure to the toxicant for 28 days. After the end of the experiment, the animals were decapitated, the liver was removed, which was frozen in liquid nitrogen. Real-time reverse transcription polymerase chain reaction was used to analyze gene expression. Results. Exposure to acrylamide did not significantly affect the expression of the GSTP1, GSTT1, and GSTM1 genes in the liver of rats, however, for all the studied genes, there was a tendency to increase the value of the studied indicator. Prophylactic administration of a complex compound of oxymethyluracil with sodium succinate (MG-2) led to a statistically significant decrease in the transcriptional activity of the GSTM1 gene under conditions of toxic damage to the liver by acrylamide. Conclusion. The results of the study indicate the ability of the MG-2 drug to suppress the expression of the GSTM1 gene in the liver of rats when exposed to acrylamide. Further research is needed to better understand the molecular mechanisms of acrylamide-induced toxicity and to develop new therapeutic approaches to treat liver pathology.

This study aims to give an analytical assessment of transplantation of fecal material in Russia. There was conducted a systematic review of Fecal Microbiota Transportation (FMT) publications over the past 10 years, studied the FMT experience of Russian research centers, and made a legal assessment of the efficacy and safety of this method of treatment. A conclusion was made about favorable conditions for the development of unique methods for correcting the intestinal microbiota by transplanting fecal material in clinical medicine and creating banks of donor material.

Purpose of the work: to analyze the research performed in the last decade on the study of serum markers used to diagnose inflammatory bowel diseases (IBD), differential diagnosis of nosological forms of IBD, to predict the course of the disease, response to ongoing therapy, as well as to predict the recurrence of the disease. Materials and methods. A search was carried out in the text databases “Scopus”, “Web of Science”, “PubMed” using keywords from the literature sources of the last 10 years about blood serum biomarkers used for diagnosis, evaluation of therapeutic efficacy, monitoring of disease activity and evaluation of prognosis in patients with IBD. Results. Information on serological biomarkers of IBD, which are well known and widely used in clinical practice (C-reactive protein), recently discovered biomarkers (cytokines, antibodies and non-coding RNA), as well as recent advances in serological biomarkers (metabolomics, proteomics, oncostatin M, galectins), were analyzed, which are used in various aspects of the diagnosis of IBD. Since intestinal fibrosis significantly affects the prognosis in patients with IBD, data on serum markers of intestinal fibrosis are presented separately. Conclusion. Recently, serum biomarkers in patients with IBD have become the object of close attention, since they are minimally invasive, convenient, and relatively inexpensive than markers in biopsy specimens, other biological fluids, fecal, and respiratory tests. Despite an extensive list of studies conducted over the past 10 years, there are still no ideal serum biomarkers for the diagnosis of IBD. Serum and non-coding RNA profiling techniques are just beginning to develop, but offer great promise for clinical practice. A combination of different biomarkers may be useful to improve the efficiency of IBD diagnosis.

The aim of this review is to systematise the available evidence on the comorbid course of non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease, assessing the role of liver fibrosis in patient prognosis. Discussion: the criteria for the diagnosis of metabolic-associated liver disease (MAFLD) in comparison with non-alcoholic fatty liver disease (NAFLD) were presented. The results of studies demonstrating the close relationship of NAFLD and NAFLD with the development of cardiovascular diseases were occurred. The underlying factor tending the cardiovascular risk of patients with NAFLD and MAFLD is liver fibrosis. Invasive and non-invasive methods for the diagnosis of liver fibrosis in NAFLD were discussed. The evidence of the expediency and safety of the use of statins in this pathology was presented. Conclusion: according to the pandemic growth of NAFLD and its association with cardiovascular risk, the question of how to properly monitor patients with comorbid cardiovascular diseases and NAFLD in order to reduce the risks is timely and very relevant. One of the main prognostic risk factors for an unfavorable outcome in this category of patients is liver fibrosis. Lipid-lowering therapy seems to be the most optimal and safe treatment strategy for these patients.

This article discusses the association between non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD). There is ample evidence of an increased risk of CKD in patients with NAFLD. Most researchers attribute to the common risk factors for these two conditions. Currently, in addition to traditional factors associated with CKD and NAFLD, such as components of the metabolic syndrome, the influence of new pathogenetic factors, i. e. endothelial dysfunction, metabolic disorders of fibroblast growth factor-21, pathological activation of the renin-angiotensin system and influence of adiponectin level change are considered. Further examination of these mechanisms will open up new therapeutic options for the treatment of CKD and NAFLD.

Solitary rectal ulcer syndrome is a rare, polyethiological disorder that occurs mainly in young men and presents a complex of clinical, endoscopic and morphological manifestations. In addition, the widely accepted term ‘solitary ulcer’ itself is often misleading to gastroenterologists and endoscopists. This is because the macroscopic picture does not always correspond to this term and manifestations can vary from a focus of hyperemic mucosa to a giant ulcer, or several ulcers in different parts of the rectum and polypoid stem-like masses. This article summarises the literature on the manifestations of solitary rectal ulcer syndrome in children and presents our own experience in 5 patients. Besides, taking into account that all observed patients had phenotypic signs of connective tissue dysplasia, the assumption concerning the participation of this pathophysiological phenomenon in the pathogenesis of the solitary rectal ulcer syndrome in children was formulated.

A clinical case of a 62-year-old patient in whom recurrent esophageal candidiasis led to a complication - stricture of the cervical esophagus is presented. The immune dysfunction clarified with the help of an immunological study was characterized by a combined defect in the effectiveness of inflammation, phagocytosis and cytotoxicity, but its cause was not established. In this patient, previous repeated courses of treatment with fluconazole led to the selection of a strain of Candida albicans resistant to fluconazole, therefore, candidiasis was treated with an alternative drug - voriconazole.