The authors consider the symbiotic microbiota of the human body as a leading factor in the health of the entire body, which should be managed in order to prevent and treat various diseases and possibilities of metabiotics and targeted metabiotics used for this purpose as the most promising direction for the treatment and prevention of diseases of various organs. It was noted that Russia is one of the first countries to assess biotechnological prospects and the importance of creating metabiotics for various purposes, capable of preventing, restoring and regulating physiological functions, biochemical and behavioral responses, signaling intra and intercellular communications, epigenetic regulation of gene expression and post-translational modification of their final products.

The prevalence of obesity and associated conditions has reached global epidemic proportions. Although nutritional correction and elimination of hypodynamia are considered the leading therapeutic approaches for these pathologies, there are many other factors that may play an important role in their correction. In view of this fact, the search for new safe molecules associated with the restoration of intestinal microbiota, improving metabolic parameters, is an actual problem today. Purpose: to evaluate the effect of enzymbiotic “Biokomplit Enzymbiotic” on lipid metabolism, quantitative and qualitative composition of microbiota and severity of dyspeptic symptoms in patients with obesity of 1-2 degree and dyslipidemia. Materials and methods. The study included 103 patients with obesity of 1-2 degree and dyslipidemia. All patients were divided into 2 groups: the main group - patients with obesity of 1-2 degree and dyslipidemia, receiving “Biocoplit Enzymbiotic” (n=68) and the comparison group - patients with obesity of 1-2 degree and dyslipidemia without treatment (n=35). In addition to general clinical examination and calculation of body mass index, all patients were examined: blood biochemical analysis, examination of intestinal microbiota by polymerase chain reaction (PCR) using a test system “Colonoflor 16”, dyspeptic symptoms were evaluated according to a standardized questionnaire. Results. In the patients of the main group, triglyceride (TG) level was significantly lower, and the concentration of Bacteroides spp. and Akkermansia muciniphila were higher in comparison with the group of patients without treatment: 1.53±0.11 (0.8-2.41) nmol/L vs 2.25±0.25 (0.67-6.2) nmol/L, p<0.05; 2.8*10¹¹ vs 1.1*10¹¹, p=0.02; 7.6*10⁸ vs 1.7*10⁸, p=0.05, respectively. Negative correlations were found between low density lipoproteins (LDL) levels and Bacteroides thetaiotaomicron concentration (rs= -0.342, p=0.023), between body weight and Akkermansia muciniphila concentration (rs= -0.268, p=0.044) and a positive correlation between Akkermansia muciniphila concentration and hight density lipoproteins (HDL) (rs= 0.2, p=0.044). 91% of patients with obesity of 1-2 degree and dyslipidemia experienced dyspeptic symptoms in the form of flatulence and/or fecal shape disturbance. In the main group of patients in 1 month after taking “Biocomplit Enzymbiotic” 65% of patients noted improvement of well-being: 18% of patients had normalized fecal form according to Bristol scale, 31% - decreased severity of flatulence, 16% - decreased appetite. Conclusion. Treatment with enzymbiotic «Biocomplit Enzymbiotic» is associated with an increase in the concentration of Akkermansia muciniphila and Bacteroides spp. in the intestinal microbiota, improvement of the lipid profile and a decrease in the severity of dyspeptic symptoms, decreased appetite in patients with obesity of 1-2 degree and dyslipidemia. Enzymbiotic administration can be considered as a potential therapy element in patients with MS components.

The article provides a review of the literature data on the study of diagnostics and the choice of a conservative or surgical method for the treatment of chronic colonic stasis (CCS). The literature data on the information content of various methods for diagnosing malformations and fixation of the colon, studying the rate of movement of intestinal contents along the colonic part of the gastrointestinal tract are presented. It has been established that in the diagnosis of chronic colonic stasis there are a number of difficulties, for the solution of which it is necessary to use a complex of various methods of instrumental diagnostics. The views on conservative treatment and approaches to the choice of surgical treatment option for CCS are highlighted. Literature data indicate that the most accurate indications for the use of conservative or surgical methods of treatment have not yet been established, and criteria for selecting patients have not been established.

The phenomenon of “leaky gut” or increased intestinal permeability has been actively studied over the past two decades. Its role has been proven in the development of irritable bowel syndrome and a number of other intestinal pathologies. At the same time, more and more information is accumulating on the effect of “leaky gut” on the occurrence and progression of liver diseases. This article presents a literature review of recent materials on the relationship between the intestine and the liver through the phenomenon of “leaky gut” and new potential points for therapeutic intervention.

Post-Covid syndrome (PCS) is considered as a consequence of a previous coronavirus infection. The liver in COVID-19 is one of the most frequently affected organs, with the development of asthenia, cognitive impairment, as well as increased activity of alanine and aspartic transaminases (ALT and AST), which persist in some patients up to 4-6 months after discharge from the hospital. The cause of asthenia may be hyperammonemia (HA), which in COVID-19 is a manifestation of liver dysfunction against the background of the direct cytotoxic effect of SARS-CoV-2 on hepatocytes, which was previously shown as part of the clinical observational program protocol “LIRA - COVID”. Due to the great relevance of the problem of the combination of PCS, non-alcoholic fatty liver disease (NAFLD) and HA a post-hoc analysis of the observational clinical program LIRA - COVID was carried out. It was shown that NAFLD has a significant effect on the level of AST before the start of treatment with L-ornithine - L-aspartate (LOLA). The presence of NAFLD has a significant effect on ammonia levels after 14 days of treatment, since in the group of patients with NAFLD the ammonia level was significantly higher than in the group without NAFLD. It was concluded that it is advisable to include in the examination scheme of patients with PCS and NAFLD, determination of the level of ammonia in the blood, when elevated, the administration of the drug to such patients is justified LOLA course for 4 weeks at a standard dose of 9 g per day.

Inflammatory bowel diseases (IBD) have become the subject of numerous scientific studies in clinical practice in recent years. The review is examines in detail key aspects of IBD pathogenesis, including the role of the immune system, stromal components and genetic factors. Particular attention have been paid to the interaction of these factors and influence on the development and course of the disease. The review’s aims to provide a comprehensive understanding of the mechanisms of IBD development and identify potential avenues for diagnosis, therapy and prevention. The main content of the article covers the latest scientific data and clinical observations in the field of gastroenterology, emphasizing the integration of various disciplines in the understanding and treatment of IBD.

This work reviews current data on the structure of the microbiota and its interaction with the host, and assesses the impact of the microbial community on the immune system and the development of chronic inflammation in the gastrointestinal tract. This review presents current evidence on the influence of diet on the course and therapy of GI tract inflammation. Studies on the role of microbiota and diet in the pathogenesis of ICD have shown that microbial dysbiosis and Epstein-Barr virus can exacerbate the course of ICD. Certain foods worsen symptoms, while a monosaccharide diet favours remission. The results emphasise the importance of an individualised nutritional approach to improve the treatment of IBS.

The article presents data on the origin of the Russian names of the structures bounding or located in the oral cavity: mouth, lip, cheek, palate, gum, tooth (incisor, canine, molar (premolar)), tongue, fauces, tonsil.

Infantile systemic hyalinosis (ISH) is a rare genetic disease, which is associated with ANTXR2 gene defect. The disease is characterized by progressive deposition of amorphous hyaline masses in various organs and tissues. The main distinguishing features of ISH include thickening of the skin, erythema or hyperpigmentation of bone prominences, damage to internal organs, persistent diarrhea, frequent severe infections and developmental delay. This article presents a case of ISH diagnosis in a patient aged 2 years, the key feature of which is the establishment of a diagnosis based on the evaluation of the results of endoscopic and morphological studies. The purpose of our work is to increase awareness and alertness of doctors of different specialties in such a rare disease.

The relevance of studying various aspects of Crohn’s disease is due to the high prevalence of the disease, insufficient understanding of etiopathogenesis, the frequent need for surgical interventions, severe course with the development of complications. The article presents a clinical case of late diagnosis of Crohn’s disease with the development of rare urological complications of the disease. The variety of complications of Crohn’s disease involving various organs and systems dictates the need for a multidisciplinary approach to such patients, involving specialists of various profiles in order to more quickly establish a diagnosis and prescribe effective treatment.

Ileocecal region can be affected by many pathological conditions, such as benign and malignant tumors, inflammatory processes (appendicitis, diverticulitis, Crohn’s disease) and infectious diseases, which determines the importance of knowledge of differential diagnosis. Lipomatous lesions in intestine may be single or multiple, encapsulated lipomas or diffuse, discrete, uncapsulated areas of adipose tissue called lipomatosis, occurring in 0.04 to 4.5% of cases according to autopsies and more often affecting the cecum. A case of lipomatosis of the ileocecal valve in a patient with aplastic anemia, manifested by symptoms of an acute abdomen due to massive hemorrhage into it due to severe thrombocytopenia, regarded intraoperatively as a malignant tumor that was not removed due to the high risk of bleeding on the background of severe thrombocytopenia, is presented. Preoperatively, CT scans of the abdominal cavity, retroperitoneal space, and pelvis revealed thickening of the colon walls throughout up to 14 mm with smoothness, straightening of contours, and moderate infiltration of surrounding fiber. In the area of the dome of the cecum, an infiltrate with dimensions of 10,0×6,0 cm, with areas of liquid density, is determined. The diameter of the cecum is 6,0 cm, its walls are sharply thickened to 2.5 cm, the lumen is deformed, narrowed. Retroperitoneal lymph nodes are not enlarged. Finally, the nature of the process was established by histological examination of autopsy material. Intestinal lipomatosis is a rare pathology with nonspecific manifestations from the gastrointestinal tract and certain diagnostic difficulties. It is necessary to remember about its possible presence for inclusion in the differential diagnosis.

Superior mesenteric artery syndrome (SMAS) in children is a rare cause of chronic duodenal obstruction (CDO), in which the inferior horizontal branch of the duodenum is compressed between the aorta and the acutely angled superior mesenteric artery. There are not many publications of clinical cases of SVBA in the literature, especially in the pediatric population. The main cause of the disease is weight loss due to various reasons, including anorexia nervosa, trauma, burns and other conditions. Currently, there is a frequent association of the syndrome with mental disorders. Literature data on the treatment of SVBA associated with various psychosomatic conditions vary; both conservative and surgical treatment methods are used. We present two clinical cases of SVBA in adolescent children, in which the cause of patient weight loss was concomitant mental disorders and previous surgical interventions. Both patients underwent laparoscopic side-to-side duodenojejunostomy with good long-term treatment results, confirmed during follow-up examination.

Helicobacter pylori (H. pylori) is one of the most common infections worldwide. According to modern ideas, it is the main cause of a number of diseases of the stomach and duodenum (peptic ulcer, chronic gastritis, MALT lymphoma) and the leading risk factor for stomach cancer. In the hospital therapy clinic of the Kirov Military Medical Academy, we observed 118 patients. The study groups included patients with various types of chronic gastritis (atrophic and non-atrophic). The patients were comparable in gender and age. Infection H. pylori was verified in 22 patients (68.8%) suffering from chronic non-atrophic gastritis and in 34 patients (37.2%) suffering from chronic atrophic gastritis. In the course of the study, the relationship between the contamination of H. pylori and the presence of dysregenerative changes in the gastric mucosa was evaluated. It was found that H. pylori infection does not significantly affect the development and progression of atrophy in the mucous membrane of the antrum of the stomach. Also, no convincing data on the effect of H. pylori on dysregenerative processes (intestinal metaplasia and dysplasia) in the gastric mucosa. At the same time, the presence of pathogenicity factors H. pylori Vac A and Cag A significantly affects the progression of atrophic changes in the gastric mucosa. At the stage of formed atrophy, the intensity of H. pylori invasion is significantly reduced.

Helicobacter pylori (HP) is a proven pathogen of the stomach. Along with HP, other infectious agents, in particular herpesviruses, can colonize the gastric mucosa (GM). The occurrence and association of HP and Epstein-Barr viruses (EBV), cytomegalovirus (CMV) and herpesvirus type 6 (HV6), the effect of these pathogens on inflammation, atrophy in the stomach, on the effectiveness of HP eradication were studied. Materials and methods. DNA of HP and viruses (EBV, CMV, HV6) was determined by polymerase chain reaction in biopsy samples of the antrum of the stomach of 99 people. Morphological study of GM according to the OLGA system was performed in 56 patients. HP eradication treatment was carried out in 29 people, in 9 of whom DNA of viruses was found. Descriptive statistics, Student’s t-test and x2-test were used (Biostatistics program). Results. HP DNA in GM was found in 44.4%, herpes virus DNA in 35.3% of cases. EBV was detected more often - in 21 patients, HV6 - in 11 people, both viruses (EBV + HV6) were found in 3 samples. CMV DNA was not found. HP co-infection with herpesviruses was determined 2 times more often than in the absence of bacteria (50% and 23.6%, respectively, p=0.007). A combination of HP and EBV was more often recorded (36.4%), EBV mono-infection occurred in 9.1% (p<0.001). HB6 in 14.5% was determined in the absence of HP, in combination with HP - in 6.8% of cases (p = 0.225). The morphology of gastric biopsies showed that III-IV degree of inflammation according to OLGA occurred in 74% of patients with HP and in 31% in the absence of bacteria (p=0.002). The average degree of inflammation was 2.14±0.20 points in patients intact for any infection, increased by 1 point with НР (p<0.01) and did not change with the persistence of viruses (p=0.235). There were no differences between atrophic changes when HP or viruses were detected (p>0.05). Successful HP eradication was registered in 75% of cases in the absence of a viral infection and in 11.1% of cases with co-infection with herpes viruses (p=0.002). Conclusion. Colonization of the GM is typical for HP, EBV and HV6. Combination of EBV and HP was the most common. A high degree of inflammation activity is characteristic of Helicobacter pylori infection. In case of non-effective eradication of HP, it is necessary to examine herpes viruses, which may interfere with the success of treatment.

Hepatobiliary cancer is one of the leading causes of cancer death and a major public health problem in both developed and developing countries. Chronic infections are common risk factors for cancer. Animal studies have shown that Helicobacter pylori (H. pylori) infection can cause hepatitis, colitis, and liver cancer in susceptible individuals. Data from clinical and experimental studies point to the involvement of the gastrointestinal microbiota in the pathogenesis of the non-alcoholic fatty liver disease, including H. pylori infection. The researchers included H. pylori infection in the list of etiopathogenetic factors of primary biliary cholangitis due to the detection of its DNA in the liver tissue and antibodies to H. pylori in the bile and serum of patients with primary biliary cholangitis. A growing body of evidence suggests that H. pylori may be a risk factor for the development of liver cirrhosis and hepatocellular carcinoma in patients with viral hepatitis B and C. The contribution of H. pylori infection to the development of hepatic encephalopathy and hyperammonemia has been identified. H. pylori infection is associated with liver inflammation, fibrosis, and necrosis by inducing the synthesis of systemic inflammatory mediators and increasing intestinal permeability. Along with these consequences, bacterial translocation through the biliary tract can also lead to direct liver damage, predisposing or even triggering the carcinogenic process. The study of subspecies of Helicobacter shows that they can lead to the development of not only hepatocellular carcinoma but also other malignant neoplasms of the hepatobiliary system. This review presents current data on the epidemiology and mechanisms of the influence of H. pylori infection on malignant neoplasms of the hepatobiliary tract, with an emphasis on possible prevention strategies.

Tropheryma whipplei and Helicobacter pylori share common transmission routes and epidemiological risk factors. A review of the current literature reflecting the relationship between Whipple’s Disease and Helicobacter pylori is presented.

The article presents data on the results of a comparative study of the clinical and antihelicobacteric efficacy of two schemes of eradication therapy in 60 patients with HP-associated chronic gastritis. The main group of patients received eradication therapy consisting of vonoprazane, amoxicillin, clarithromycin and bismuth tricalium decitrate for 10 days. In the second group of patients with chronic gastritis, esomeprazole was used as an antisecretory drug against the background of similar therapy. The results of the study showed that in the first group of patients, the dynamics of acid suppression under the influence of vonoprasane was significantly higher compared to esomeprazole. Also, in the main group of patients, the rate of eradication of HP infection was 93%, whereas in the group of patients taking esomeprazole, this indicator was 80%.

To determine the influence of the gut microbiota to the severity and development of complications during COVID-19. Consider the importance of taking pro- pre- and metabiotics in increasing the body’s resistance to viral infections. Recently, much attention has been paid to the influence of the gutl microbiota on the course of many internal diseases of an infectious and non-infectious nature. The pathogenetic influence of changes in the gut microbita on the initiation and maintenance of the inflammatory response of the body, as well as the immune response, has been proven. A number of studies have noted a direct correlation between the increased susceptibility of the human gut microbiota to a new coronavirus infection and the occurrence of complications from the respiratory system. Microbiome’s changes lead to increase gut permeability, weak protective barrier and immune mechanisms of the gastrointestinal mucosa, lead to easier and faster penetration of the SARS-CoV-2 virus into the blood stream, followed by dissemination and damage to the lungs. In light of the available data, a close relationship between the severity of the novel coronavirus infection and the composition of the gut microbiota is highly likely. The article presents the results of some studies, on the basis of which it can be concluded about gut microbiota changes in COVID-19 patient and efficiency of pro-, pre- and metabiotics, including strains of Lactobacilli and antimicrobial peptides (AMP), in the treatment of patients with COVID-19 in order to improve prognosis and prevent complications. The information presented can be useful for those who are faced with the effect of the virus on the gastrointestinal tract and respiratory system and for those who, for preventive purposes, want to increase the resistance of their body.

When studying molecules of promising drugs for COVID-19 therapy, it is important to evaluate their prebiotic and antibiotic properties, i. e. impact on the growth of beneficial and pathogenic microbiota. In the present study, the results of chemomicrobiome analysis of 5 bioflavonoids (hesperidin, leukodelphinidin, rutin, quercetin, baicalin), 2 polyphenols (curcumin, epigallocatechin gallate) and their synergistic substances (glycyrrhizin saponin and piperine alkaloid) were obtained for 38 human commensal bacteria and 152 strains. pathogenic microorganisms. The studied molecules significantly supported the growth of beneficial microbiota: for each of the molecules, the AUC values were 0.67..0.79 c. u. (average for a sample of 38 commensals) and had good safety ratings. The greatest contribution to the support of beneficial microbiota was made by rutin and glycyrrhizin (AUC 0.78±0.14 a. u.), the smallest contribution was made by baicalin (AUC 0.66±0.24 a. u.). A synergistic interaction between the studied substances was established: with the combined use of 9 substances, the average AUC value can increase up to 0.84±0.06 c. u. Normobiota most actively processes glycyrrhizin (19.2±12.1%), the least actively - piperine (6.0±5.9%). The most active metabolizers of the studied substances were bacteria of the genus Bacteroides (more than 30%), the least active were bacteria of the genus Collinsella (<1%). The results of chemomicrobiome analysis of the studied molecules in volunteers with different microbiome profiles confirmed that the studied substances do not contribute to the growth of pathogenic flora. The studied substances can inhibit the growth of pathogenic Acinetobacter baumannii, Candida albicans, Candida glabrata, Cryptococcus neoformans, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphlococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus pyogenes (MIC values of about 10-25 µg/ml).

The aim of the study was to identify the pathogenetic role of intestinal microflora in the development of diabetes mellitus. The review presents data on the peculiarities of the development of the intestinal microflora (MC), factors that determine the occurrence of dysbiosis, as well as the effect of dysbiotic changes in MC on the pathogenesis of various types of diabetes mellitus. The role of MC in the occurrence of insulin resistance, as well as the metabolism of peptides that determine eating behavior, has been studied. The contribution of short-chain fatty acids produced by microorganisms to the regulation of metabolism in diabetes mellitus is considered, and the role of pathogenicity factors of MC representatives is studied. Conclusion. The gut microbiota makes a significant contribution to the regulation of metabolism through various mechanisms. The resulting dysbiotic changes can negatively affect metabolic processes and be a risk factor for the development of diabetes mellitus. The identification of new pathogenetic pathways can be useful in finding points of application of drug therapy, which will contribute to improving the results of DM treatment.

The main link in the pathogenesis of functional constipation (FC) with slow intestinal transit is a decrease in the motor function of the colon. Data from experimental and clinical studies indicate that the gut microbiota is involved in the regulation of colonic motility through various mechanisms. At the same time, the study of the molecular processes underlying the influence of the intestinal microbiota and its metabolites on the motor function of the colon is at an early stage. The review analyzes the literature on the role of intestinal microbiota in the development of FD, presents data on the mechanisms of action of various microbial metabolites on the motor and secretory function of the colon, and briefly describes new approaches to the treatment of FD based on modulating the composition of the intestinal microflora. FZ is accompanied by specific changes in the composition of the intestinal microbiota, and in recent years, researchers have established cause-and-effect relationships between certain enterotypes and the development of FZ. To date, the main microbial metabolites have been identified that have a stimulating or inhibitory effect on propulsive peristalsis, as well as on the intensity of secretion of anions and water by colonocytes. Approaches to optimizing the composition of the microbiota in FZ are based on the use of pro- and prebiotics, antibiotics, as well as the use of intestinal microbiota transplantation. A deeper understanding of the molecular mechanisms mediating the influence of the microbiota and its metabolites on colonic motor function may serve as the basis for the development of new approaches to the treatment of FZ.

Objective: evaluation of the effectiveness of an autoprobiotic based on indigenous enterococci in the correction of lipid metabolism disorders. Materials and Methods: 17 patients with metabolic syndrome and dyslipidemia were under observation. All patients signed an informed consent prior to the start of the study procedures. An autoprobiotic (AP) based on indigenous enterococci was prescribed as a personalized functional food product (PFPP). AP was prescribed 50 ml 2 times a day for 20 days, 2 courses were used with an interval of 1 month. The effectiveness of AP was assessed by changes in lipid metabolism at two time points: V1 (before the start of treatment), V2 (2 weeks after the end of the second course of autoprobiotic therapy). Lipid profile indicators: total cholesterol (CL), low-density lipoproteins (LDL), high-density lipoproteins (HDL), triglycerides (TG) were evaluated in fasting blood serum in dynamics before treatment and two weeks after the end of the second course of autoprobiotics. At the same time points, the level of C-reactive protein (CRP) was additionally assessed as a marker of chronic low-level inflammation, which can aggravate lipid profile disorders in patients with metabolic syndrome. Statistical processing was carried out using the SPSS8.0 computer software package. Results: After taking the autoprobiotic, a statistically significant improvement was revealed in most of the analyzed parameters of lipid metabolism, as well as a decrease in the level of C-reactive protein. (p<0.05). Conclusions: autoprobiotics can be a promising method of correcting disorders not only of the intestinal microbiota, but also changes in lipid metabolism. It seems relevant to use a combination of autoprobiotics with statins, because this will provide an impact on different pathogenetic pathways of dyslipidemia. However, further research is needed to gain a deeper understanding of the underlying mechanisms of the identified effect.

The aim of the study: to evaluate the effect of the Maxiflor Maximum dietary supplement on the severity of dyspepsia and colon microbiota in patients who had a new coronavirus infection and were treated with antibacterial drugs. Materials and methods. The study included 60 patients with gastrointestinal symptoms who had a novel coronavirus infection and received antibacterial drugs for at least 7 days to treat complications of COVID-19. Of these, 30 people made up the “Treatment” group and received the biologically active supplement “Maxiflor Maximum” at a dose of 1 capsule per day for 4 weeks. 30 people were observed prospectively in the Control group. Analysis of subjective status was carried out using the Russified Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. All patients underwent fecal analysis for dysbacteriosis. The questionnaire and microbiological test were performed on the first day of the study, and again after 10 and 30 days. Discussion. The severity of gastroenterological symptoms after 4 weeks of “Maxiflor Maximum” therapy was statistically significantly lower than in the control group. There was a significant subjective improvement in well-being - a decrease in the frequency of abdominal pain, the intensity of dyspepsia, the frequency of stools normalized (p<0.05). A positive dynamics of intestinal microbiota indicators was registered in the “Treatment” group. The number of opportunistic representatives of the microflora decreased statistically and the pool of beneficial saprophytes increased (p<0.05). In the “Control” group, there was a lack of statistically significant changes in the state of the intestinal microbiota. Conclusion. The dynamics of clinical and laboratory parameters reflecting the course of COVID-19 indicates the effectiveness of using the Maxiflor Maximum synbiotic as an adjuvant therapy, and makes it possible to recommend it for use in the complex treatment of patients with a new coronavirus infection.