The authors present materials on existing and promising methods for diagnosing disorders of the motor-evacuation function of the stomach and duodenum aimed at identifying morphofucntional diseases in the upper GI tract and predicting their progression. In Russia, non-communicable diseases of the GI tract remain an acute health issue, stomach and duodenum pathology holding the first rank place among them. Their prevalence reaches 70-80% in adult population. Development of innovative diagnostic methods seems an effective way to reduce prevalence of such diseases since such methods allow not only identifying already existing pathology but also predicting its likelihood in future. Conventional methods for functional diagnostics of diseases of the stomach and duodenum provide only limited insight into the actual condition of the motor-evacuation function and we should point out that its impairment is usually a precursor of morphological changes in future. Clinical practice largely relies on using invasive or complex instrumental methods aimed at detecting late signs of disease, which do not involve any assessment of motor-evacuation impairments. A promising trend in early diagnostics of diseases in the upper GI tract is implementing analysis of results obtained by highly informative and safe functional examinations (US) in clinical practice. These examinations are based on mathematical models that describe properties, relations, structural and functional parameters of a modeled object. The review presents a multi-level mathematical model that describes digestion considering dysfunctions of the upper GI tract. In the ‘meso-level’ of the model, chyme is considered a multi-phase liquid with variable viscosity and density of its phases and its movement and mixing are described with the balance mass and impulse conservation equations. Use of results obtained with the multi-level mathematical model in evolution modeling makes it possible to predict the development of inflammatory-dystrophic diseases of the upper GI tract with high reliability. Literature sources were sought in several relevant databases including Scopus, Web of Science, CyberLeninka, Russian Science Citation Index, and statistical data collections issued in 2016-2024.

Goal. To study the role of hormonal factors in impaired motor evacuation function of the duodenum (duodenum) in chronic duodenal insufficiency (CDN). Methods. CDN verification was carried out by clinical, endoscopic, manometric and electrophysiological research methods. The study of the motor function of the DPC was carried out using the gastroenteromonitor “Gastroscan-GEM”. To determine motilin in the blood, Cloud-Clone Corp., USA) was used, gastrin was a set of Biohit reagents (Finland), and somatostatin -17 was used by Penis Laboratories, LLCA Memberof the Bachem Group (USA). Results. In patients with CDN, an inadequate response of the DPC to food stimulation is observed, expressed in a decrease in the electrical activity of the DPC (1.7± 0.07). A decrease in the coefficient of rhythmicity in the stomach is combined with a decrease in this indicator in the DPC (0.72 ± 0.12, p = 0.013 on an empty stomach, 0.3 ± 0.01, p= 0.000 postprandially). The blood levels of motilin and somatostatin are reduced, and gastrin are increased compared to those of healthy individuals. Against the background of a decrease in motilin content in patients with CDN, there was a decrease in the myoelectric activity of the DPC (-0.7, p=0.03), an increase in its K ritm (0.83, p=0.002) on an empty stomach and an increase in the K ritm of the stomach (0.5, p=0.04) and DPC (0.7, p=0.03) postprandially. There was a strong inverse relationship between gastrin and RyDPC, and a direct average relationship between somatostatin and RyDPC. Conclusion. The results of the conducted studies expand the understanding of the participation of gastrointestinal hormones (motilin, gastrin, somatostatin) in the violation of the motor evacuation function of the DPC in CDN.

The aim. To investigate the condition of the mucous membrane of the stomach and duodenum in users of electronic nicotine delivery systems Materials and methods. The study involved 34 people. Conducted: testing using questionnaires (a specially designed questionnaire to identify the fact of smoking, GSRS to identify dyspeptic symptoms), esophagogastroduodenoscopy to determine the condition of the gastric mucosa, histological examination of the materials obtained, determination of the Helicobacter pylori antigen using an immunochromatographic test system. According to the results of the survey, the participants were divided into 2 groups: people who use electronic cigarettes and non-smokers. Results. The intensity of gastroenterological symptoms measured using the GSRS questionnaire was significantly higher in vapers. The conducted studies have shown the presence of pathological changes in the mucous membrane of the stomach and duodenum in all users of electronic cigarettes. During the endoscopic examination, cardiac sphincter insufficiency was most often recorded, which is associated with the effect of cigarette components on the tone of the lower esophageal sphincter. According to the results of histological examination, 90% of e-cigarette users showed signs of chronic inflammation of the gastric mucosa. Half of these users also had atrophy of the gastric mucosa. The data of the immunochromatographic test for the Helicobacter pylori antigen in stool samples from e-cigarette users confirm the functional nature of the detected disorders. Conclusion. The study allowed us to collect objective information about the condition of the gastric mucosa and duodenum in active users of electronic cigarettes. The negative effects of e-cigarette components on the mucous membrane of the stomach and duodenum have been established.

Introduction. Ulcerative colitis and Crohn’s disease belong to the inflammatory bowel diseases (IBD) and are one of the most urgent problems of gastroenterology worldwide, including due to frequent recurrence and development of specific complications. The aim of the study was to identify predictors of the development of life-threatening complications of IBD. Materials and Methods. A retrospective cohort study was conducted, 250 patients with ulcerative colitis and 266 patients with Crohn’s disease were included, they were observed in the specialized IBD city clinic in St. Petersburg, Russia. Demographic features of the patient’s cohort, clinical characteristics of the disease and the therapy used were assessed. The studied outcome was the development of the chronologically first life-threatening complication in the history of the disease. Data analysis included basic statistical methods, Kaplan-Meier survival analysis and Cox regression. Results. The median duration of patient follow-up from the moment of diagnosis was 2.5 years for ulcerative colitis and 2 years for Crohn’s disease. The incidence of life-threatening complications in ulcerative colitis was 8.0%, in Crohn’s disease - 28.2%. In ulcerative colitis, the predominant life-threatening complication was severe anemia requiring hemotransfusion, whereas in Crohn’s disease, complete intestinal stricture and intestinal perforation were the most common complications as a severe anemia. Only 59% of cases of life-threatening complications of IBD occurred after this diagnosis was established, while in 29% of cases they developed at the disease onset and became the reason for the IBD diagnosis, and in 12% of patients even the development of a life-threatening complication did not become the reason for the IBD diagnosis. As a result of multivariate Cox regression analysis, independent factors (predictors) of the development of life-threatening complications of IBD were identified: in Crohn’s disease, therapy with 5-aminosalicylic acid (5-ASA) and/or corticoids alone (RR 9.4; 95% CI 2.9-30.5) and a continuously recurrent or acute course of the disease (RR 3.0; 95% CI 1.1-8.3), and for ulcerative colitis, 5-ASA monotherapy (RR 28.0; 95% CI 2.0-401.0), a continuously recurrent or acute course of disease (OR 26.2; 95% CI 3.2-215.4), and a history of non-life-threatening complications (RR 7.7; 95% CI 1.5-39.8). Conclusion. To prevent the life-threatening complications development, both timely diagnosis of IBD and active specific therapy aimed at achieving and maintaining long-term remission of the disease are necessary. The presence of the above-mentioned predictors of life-threatening complications of ulcerative colitis and Crohn’s disease can be considered as a basis for intensification of IBD therapy using immunosuppressors, targeted immunosuppressors and biologics, taking into account a personalized approach to therapy of IBD patients.

Objective: to study the clinical, endoscopic and pathomorphological signs of erosive lesions of the gastric mucosa in patients with CHF II-III functional class. Materials and Methods: 185 patients of the main group (MG) with complete erosions (CE) were examined, the control group (KG) consisted of 183 patients with acute erosions (AE) of the stomach. Patients of both groups suffered from CHF II-III functional class according to NYHA. All patients were examined according to a single plan: EGDS in WLY, NBI and ZOOM, biopsy with pathomorphological research. The diagnosis of CHF was established on the basis of anamnestic data and the results of instrumental and functional methods, including electrocardiography (ECG), Holter monitoring of ECG, stress echocardiography, and coronary angiography. Results: The main clinical manifestation of erosive lesions in patients of both groups is gastric dyspepsia. According to the K. Toljamo classification, mature CE (subtype Ia) were detected in 83,8% of cases in the MG, and immature CE (subtype Ib) in 16,2%. In combination with hemorrhagic erosions (type III), CE were found in 12,6%, with incomplete erosions (type II) - in 11,4%. The combination of CE with erosive changes in the prepiloric part of the stomach (type IV) was detected in 8,7%. In KG, erosive gastric lesions were mainly represented by types III (41%) and IV (38,8%). Based on the analysis of the pathomorphological pattern and endoscopic changes in the gastric mucosa during examination in WLI, NBI and ZOOM, the most characteristic macro- and microscopic changes for each type and subtypes of erosive changes in gastric mucosa were identified. Morphological verification revealed that chronic atrophic gastritis (CAG) in patients with CHF II-III FC is most common: in MG - in 75,1%, in KG - in 58,5%. Among the focal changes in patients of the MG, intestinal metaplasia was diagnosed in most cases, which was 21,7%. Conclusion: The clinical picture of erosive lesions of the stomach and duodenum is nonspecific. As a result of comparing the macroscopic and microscopic features of complete gastric erosions, the most characteristic features for each type and subtypes are identified. A high prevalence of CAG has been established among patients with CHF II-III functional class.

The article evaluates the role of the cardio-ankle vascular index CAVI in determining the vascular wall stiffness in patients with ulcerative colitis. The pathogenesis of vascular changes in inflammatory bowel diseases is considered, the influence of the patient’s age, duration of the disease, number of hospitalizations, ulcerative colitis attacks and endoscopic activity of ulcerative colitis according to Schroeder on the state of the vascular wall of patients with ulcerative colitis is determined.

Purpose of the study: Adipokines, myokines, neurotrophins, hormones and growth factors have a pivotal role on the control of inflammatory processes in the body. However, the relationship between them in development of ulcerative colitis (UC) still remains unclear. Taking this into account, the purpose of this study was to determine the level and relationships between the blood concentrations of adipokines, myokines, neurotrophins and growth factors in patients with ulcerative colitis. Materials and methods: The studies included 19 healthy men and 18 men with UC, as well as 91 healthy women and 29 women with UC. In the blood samples of the subjects was determined the level of leptin, adiponectin, resistin, apelin, irisin, adipsin, myostatin, FGF21, osteocrin, oncostatin, insulin, VEGF, FABP3, BDNF, NGF and fractalkine using a multiplex analysis, and the correlation relationships between them were studied too. Results: Studies have shown that in patients with UC, regardless of gender, there was a decrease in the levels of leptin, insulin and NGF in the blood. In addition, in men with UC, the level of osteocrine decreased, and in women, the concentration of apelin and VEGF decreased, and the level of BDNF in the blood increased. Conclusions: The emerging changes make significant adjustments during the inflammatory process in the intestine in UC and form the prerequisites for the emergence of gender characteristics in the formation of extraintestinal complications of this disease.

Background: Inflammatory bowel diseases (IBD) include ulcerative colitis (UC) and Crohn’s disease (CD) are chronic, progressive, immunomodulated inflammatory diseases of the gastrointestinal tract. Treatment goals in IBD have evolved greatly. Aim of the study: to assess clinical and endoscopic remission rates in IBD patients treated with infliximab, infliximab biosimilar for more than 1year and assessing the correlation of scoring systems used to assess clinical remission in association with endoscopic disease activity. Patients and methods: Observational cross-sectional study involved 50 patients diagnosed with IBD (27 CD,23 UC) who responded to infliximab/ infliximab biosimilar induction therapy and subsequently received scheduled maintenance therapy and adherent to therapy for more than 1year. Ileo-colonoscopy done, endoscopic healing assessed and clinical scoring systems were used to assess correlation to endoscopic activity. Demographic, clinical and treatment variables that may affect the proportion of mucosal healing were selected and assessed if they have significant associations. Results: The clinical remission rate was 65.2% in UC, 74.1% in CD, endoscopic remission rate was 60.9% in UC, 48.1% in CD. Endoscopic healing with infliximab biosimilar was higher in CD, than those treated with infliximab (85.5% vs. 25%) with statistical significance. Endoscopic remission rates were higher in old, male, shorter treatment durations and concomitant use of azathioprine. Conclusions: Long-term remission can be achieved by treatment with infliximab and its biosimilar, especially UC. Clinical scoring systems in UC are well correlated with endoscopic activity, while clinical indices in CD are poorly correlated. Loss of response to infliximab was higher in young, female and longer duration of treatment.

The aim of the study was to evaluate the content of T-cells expressing ectonucleotidases CD39 and CD73, as well as their association with the mRNA level of ADORA2A gene encoding adenosine A2A receptor in the peripheral blood of ulcerative colitis (UC) patients in comparison with healthy donors. Material and Methods. The group of UC patients (n=18) and healthy donors (n=22) was examined. The content of lymphocytes carrying ectonucleotidases on their surface in peripheral blood was estimated by flow cytometry. The mRNA level of ADORA2A gene was analyzed by real-time PCR. Results. A higher content of activated CD8⁺CD25⁺ T-cells was registered in UC patients than in healthy subjects (5.85% (3.02-27.17) vs. 2.36% (1.35-3.12) at p=0.0008). Expression of ectonucleotidases on the surface of T-cells depended on their belonging to a certain subpopulation. It was noted that in UC patients the content of CD8⁺CD73⁺ T-cells was higher than in healthy individuals (29.29% (19.73-49.70) vs. 20.00% (8.01-27.41) at p=0.031). The increase in CD8⁺CD73⁺ T-cells in UC was accompanied by an increase in the number of activated CD8⁺CD25⁺ T-cells (r_s=0.66, p=0.031). The level of ADORA2A mRNA was higher in UC patients than in healthy donors (0.415×10³ (0.006×10³-1.540×10³) vs. 0.014×10³ (0.005×10³-0.046×10³) at p=0.000025). ADORA2A mRNA levels did not correlate with the number of CD39⁺ and CD73⁺ T cells, nor did they correlate with the content of CD8⁺, CD4⁺ and Treg cells themselves. Conclusion. In UC patients, activated cytotoxic CD8⁺CD73⁺ T cells may play a significant role in the adenosineergic pathway.

The aim of the study was to conduct a comparative analysis of the features of anemia in patients with Crohn’s disease and with spondyloarthritis. Materials and methods. The study included 48 patients with Crohn’s disease, which was verified in accordance with the clinical recommendations of the Russian Gastroenterological Association (2018) and 62 patients with spondyloarthritis meeting the criteria of axial spondyloarthritis Assessment of Spondyloarthritis International Society (2009). Results. In patients with Crohn’s disease, anemia was detected in 25 (52.1%) patients, of whom 80% had mild anemia, and 20% had moderate anemia. Anemia was found in 22 (35.5%) patients with spondyloarthritis. Mild anemia was detected in all patients with spondyloarthritis. The level of CRP in patients with Crohn’s disease in the presence of anemia was 17.8 [5.8; 35.8] mg/l, in patients without anemia - 6.4 [3.3; 12.8] mg/l (p=0.0006); the average value of ESR in patients with anemia - 20.8 [12; 32] mm/h, in patients without anemia - 8 [5;13] mm/h (p=0.0000). The serum concentration of CRP in patients with spondyloarthritis with anemia was 16.4 [6.8; 34.2] mg/l, in patients without anemia - 8.2 [3.8; 15.2] mg/l (p=0.0007); the average value of ESR in patients with anemia - 19.2 [11; 29] mm/h, in patients without anemia - 9 [6;14] mm/h (p=0.0000). Thus, in patients with Crohn’s disease and with spondyloarthritis with anemia, the activity of systemic inflammation was significantly higher. Taking into account the indicators of ferrokinetics, 4 (16%) patients with Crohn’s disease and 6 (27.3%) patients with spondyloarthritis had anemia of chronic disease, 17 (68%) patients with Crohn’s disease and 14 (63.6%) patients with spondyloarthritis showed signs of a combination of anemia of chronic disease and iron deficiency anemia. Isolated iron deficiency anemia was detected in 4 (16%) patients with Crohn’s disease and in 2 (9.1%) patients with spondyloarthritis. Conclusion. Anemia was detected in half of patients with Crohn’s disease and one third of patients with spondyloarthritis. Anemia of mixed genesis (anemia of chronic disease and iron deficiency anemia) turned out to be the most characteristic for both Crohn’s disease and spondyloarthritis.

Purpose - optimize the treatment of patients with ulcerative colitis (UC) and Crohn’s disease (CD), taking into account the bacterial diversity of the intestinal microbial flora in inflammatory bowel diseases. Materials and methods: The study analyzed the results of colonoflora of 243 patients hospitalized in 2021-2023 in the 1st pediatric department of the University Clinic of the Federal State Budgetary Educational Institution “PIMU” of the Ministry of Health of the Russian Federation with confirmed UC (61.7%, n=150/243) and CD (38.3%, n=93/243). The diagnosis was established on the basis of generally accepted criteria in accordance with ECCO recommendations. Of these, 134 are boys (55.1%) and 109 are girls (44.9%). All children were divided into the following age groups, according to the WHO classification: 1-3 years old, 6 patients (2.5%), 3-7 years old - 25 patients (10.3%), boys 7-12 years old - 44 patients (18.1%), girls 7-11 years old - 25 patients (10.3%), boys 12-16 years old - 53 patients (21.8%), girls 11-15 years old - 40 (16.5%), boys 16-21 years old - 20 (8.2%), girls 15-20 years old - 30 (12.3%). The PCR method was used in the work, which allows using the Colonoflor-16 test system (manufacturer Alfalab company (St. Petersburg)) to quantify the state of the microbiocenosis of the large intestine in children and adults in real time. Results: In the course of the work, it was proved that inflammatory bowel diseases are directly related to changes in the composition of the microbiota, since in UC and CD, changes other than the normoflora of the colon were observed in 99% of cases. There were significant differences in the microbial landscape with different flow variants. In addition, Crohn’s disease and ulcerative colitis have a number of differences between representatives of the microbiota of the colon. In ulcerative colitis, a decrease in lactobacilli is more often observed, p= 0.033. In Crohn’s disease, an increase in Staphylococcus aureus bacteria (p=0.001) and an increase in Clostridium perfringens (p=0.026) were more often detected. Conclusion: Thus, when diagnosing ulcerative colitis and Crohn’s disease, it is necessary to examine the microbiota and subsidize differentiated probiotic groups of bacteria during the follow-up period, since in 58%-70% of cases there was a decrease in lactobacilli. p=0.033.

Objectives. To determine the features of the practical use of minimally invasive transpapillary interventions in urgent abdominal surgery. Materials and methods. The results of endoscopic treatment of patients with choledocholithiasis and icteric tumors of the periampullary zone were studied of 2305 patients with stones in the common bile ducts and periampullary tumors over a 6-year period were studied. 1690 transpapillary interventions were performed in patients with choledocholithiasis and 615 endoscopic operations in patients with periampullary malignant neoplasms. Results. Complications of endoscopic operations in patients with choledocholithiasis occurred in 7.5% of patients, in patients with periampullary malignant neoplasms - in 11.7% of cases. Endoscopic transpapillary interventions were urgently performed to treat purulent cholangitis and obstructive jaundice. Conclusion. Endoscopic transpapillary interventions for benign and malignant obstruction of the biliary tract should be performed in clinics equipped with modern X-ray endoscopic equipment and qualified specialists.

The article presents clinical cases of the use of virtual chromoscopy in the endoscopic diagnosis of colon neoplasms. The effectiveness of these methods and the specifics of their application in clinical practice have been evaluated.

The aim of the study was to evaluate the pathomorphological picture of experimental models of gastric ulcer obtained by intragastric administration of ethanol of various concentrations, wormwood bitter herb tincture, as well as prednisone. Materials and methods. The experiment was conducted on 5 experimental groups of 5 stock Wistar rats. Gastric ulcer was modeled by a single injection of 96% and 70% ethanol, wormwood bitter herb tincture made with 70% ethanol, as well as 4- and 7-day administration of prednisone. Ulcerogenic agents were administered intragastrically, ethanol and wormwood bitter herb tincture at a dose of 5 ml / kg, prednisolone at a dose of 20 mg / kg. A pathomorphological study of the stomachs of experimental rats was performed at the macro- and microscopic level. Results. With intragastric administration of 96% and 70% ethanol, as well as wormwood bitter herb tincture, there is a pronounced formation of erosions with an average depth of 358.5 ± 29.7, 199.9 ±22.0 and 307.8 ± 7.5 microns, respectively, the development of foci of thrombosis and diapedetic hemorrhages, as well as necrotic-dystrophic lesions, most pronounced with the introduction of 96% ethanol. Against the background of 7-day intragastric administration of prednisolone, a significant ulcer with an average erosion depth of 164.8 ± 10.8 microns is formed in the absence of pathological changes with 4-day administration. Conclusion. The pathomorphological picture of gastric ulcer with the introduction of 70% ethanol is characterized by significant erosion with less pronounced tissue necrosis compared with 96% ethanol. The introduction of wormwood bitter herb tincture is characterized by a tendency to form erosion of coolant of greater depth than against the background of the introduction of 70% ethanol. Intragastric administration of prednisone for 7 days makes it possible to reliably obtain erosive damage to the stomach.

Research Objective: To study the histological features of the reaction of liver tissue in an in vivo experiment when modeling various types of liver damage and using new samples of local hemostatic agents Materials and methods. The research materials used were samples of new spongy polymer hemostatic agents (based on marine collagen, in different weight ratios with sodium salt of carboxymethylcellulose (three types of samples containing 15%, 25%, 50% collagen), as well as products used in clinical practice - hemostatic collagen sponge, Tachocomb collagen plate. The reaction of liver tissues to the use of these products in a chronic in vivo experiment was evaluated: rabbits underwent laparoscopic modeling of three variants of liver injury (tangential marginal resection of the right lobe, laceration of the middle lobe with a depth of 1.5 cm, superficial wound of the left lobe 1×1 cm), while hemostasis was performed by application or injection. In this case, hemostasis was performed by applying or injecting the tested products into the wound. The animals were taken out on the 28th day. Micro-preparations were manufactured, which were stained with hematoxylin and eosin, according to the Van Gieson method. Results. A comparison of the histological picture of connective tissue in the area of experimental liver damage under conditions of use for hemostasis of different materials: hemostatic collagen sponge, Tachocomb hemostatic plate, as well as new samples shows that, regardless of the type of liver damage (wound in the thickness of the organ, marginal injury or superficial injury), a less pronounced tissue reaction and rapid Biodegradation shows the hemostatic collagen sponge material. Conclusion. In comparison with a hemostatic collagen sponge, the use of a sample based on the sodium salt of carboxymethylcellulose with the addition of 15% collagen as a local remedy for stopping bleeding leads to a slowdown in the formation of connective tissue due to the “distraction” of macrophages to resorption of the remnants of the sodium salt of carboxymethylcellulose.

Irritable bowel syndrome is a chronic, relapsing gastrointestinal disorder characterized by abdominal pain, bloating, and changes in bowel habits. Although the exact prevalence and incidence depend on the criteria used, all studies agree that it is a common disease, affecting a large proportion of the general population and frequently presenting to general practitioners and specialists. Irritable bowel syndrome is a concern, having a significant negative impact on the quality of life and social functioning of many patients. Irritable bowel syndrome is one of the most commonly diagnosed gastrointestinal diseases. This represents a significant healthcare burden and remains a clinical problem. Irritable bowel syndrome has been described from different perspectives over the years; from strict gastrointestinal disease (medical model) to more complex polysyndromic disorders of the brain-gut axis (biopsychosocial/psychosomatic model). The purpose of our review is to present modern aspects of the pathophysiology and treatment of irritable bowel syndrome.

The purpose of the study: The purpose of the study: to evaluate possibility of screening programs of colorectal cancer by analyzing modern literature, as well as to analyze the place of capsule endoscopy in these programs. Conclusion: Capsule endoscopy is perceived as an alternative screening method for colorectal cancer, along with standard colonoscopy.

In recent decades, there has been a significant increase in oncological diseases, including colorectal cancer. Moreover, cancer is significantly younger; various scientists, including different schools, indicate that oncological diseases are associated with poor nutrition. The risk of CRC increases in obese patients, people who lead a sedentary lifestyle, smoke and abuse alcohol. CRC is fraught with complications that require emergency care. The role of diet therapy and rational nutrition is noted.

Periodontal tissue diseases are among the most common diseases of the oral cavity and, along with dental caries, constitute the main cause of tooth loss. Cardiovascular and metabolic diseases, as the most common causes of mortality throughout the world, are, in turn, considered one of the most socially significant diseases. Common factors that contribute to the development of periodontal disease and cardiovascular and metabolic disease include aging, smoking, alcohol abuse, race/ethnicity, educational level and socioeconomic status, male gender, diabetes mellitus and overweight or obesity, and inflammation. Inflammation is a well-organized protective response to pathogens and involves the recruitment of recruited immune cells to sites of infection. Either the inflammatory process eliminates pathogens and resolves, leading to tissue healing, or remains predominantly unresolved, causing pathological processes in organs. However, failure to shut down the inflammatory cascade after removal of the pathogenic stimulus results in chronic inflammation (i. e., an uncontrolled inflammatory response that can lead to host tissue damage) and is a hallmark of several pathologies associated with inflammatory disorders. Particularly in periodontal disease, the inflammatory response becomes chronic when pathogenic bacteria continue to multiply and cannot be controlled by the acute immune response, resulting in unresolved inflammation, destruction of the periodontium or the supporting tissues of the teeth (gingival tissue, periodontal ligament and alveolar bone). The review article presents data from scientific studies devoted to the study of the systemic inflammatory component in the mutually directed development of diseases of periodontal tissue, the cardiovascular system, and metabolic pathology.

The prevalence of allergic diseases is increasing every year. The development of allergic diseases is based on the interaction of a genetic predisposition to the Th2 immune response and various epigenetic factors. A popular explanation for the increase in allergy prevalence is the hygiene hypothesis, which explains the allergy epidemic by the inability to develop appropriate immune regulation due to a decrease in microbial diversity. The observation that some helminth infections negatively correlate with allergic and inflammatory diseases has led to an expansion of the field of research on parasite immunomodulation. However, the relationship between allergic diseases and helminthic infections is contradictory. Helminthiasis can have both stimulating and suppressive effects on allergic reactions. Intestinal helminths are capable of altering the host’s response to other infectious agents. In particular, they enhance the antiviral immune response, affect the balance of commensal organisms, changing the size of the microbiome and its qualitative composition. Helminths suppress inflammatory reactions. Thanks to this knowledge, it has become possible to use helminths as therapeutic agents for various diseases, such as inflammatory bowel diseases, multiple sclerosis, celiac disease. However, the results of these studies are ambiguous, and further observations are needed. Increasing scientific knowledge about the mechanism of immunological modification as a result of helminth infection and understanding the interaction between helminth infections and allergic diseases is useful for the development of potentially new treatments using helminths. Thanks to which it will be possible to reproduce and adapt the beneficial effects mediated by helminths, in the absence of harmful effects arising from a parasitic infection.

This article examines the current state of the problem of acute mesenteric ischemia. To date, this issue remains unresolved in urgent surgery. Despite the intensive development of diagnostic methods, mortality in this nosology remains extremely high. At the moment, there are no specific markers that would allow diagnosing AMI at early stages, and more modern and significant diagnostic methods are available in large medical institutions. The review analyzes a comprehensive approach to the diagnosis and treatment of this pathology.

The article presents data on the effectiveness of microbial therapy for colorectal cancer (CRC) and the need to use probiotics and autoprobiotics to correct disorders associated with the use of cytostatics that cause side effects and additional disorders of intestinal myrobiocenosis. The literature data indicating the specific effect of individual chemotherapy drugs and probiotics are analyzed. The clinical example demonstrates the effectiveness of the use of indigenous beneficial bacteria (autoprobiotic enterococci) isolated from the body of patients with CRC and introduced during the use of 5-fluorocytosine, cisplatin and leucovorin. The use of probiotics and autoprobiotics in the treatment of CRC is a promising area that requires additional clinical studies and monitoring of changes in intestinal microbiocenosis to reduce the risks of postoperative complications, increase the effectiveness and tolerability of the basic chemotherapeutic regimen, as well as improve the quality of life.

Atrial fibrillation (AF) is a pathology that leads to a significant increase in the risk of stroke and other thromboembolic complications (TEC), varying in frequency. This necessitates the appointment of anticoagulant therapy (ACT) for patients with this pathology. The specifics of the appointment of an ACT, taking into account the risks of hemorrhagic and thromboembolic complications, is currently still an urgent issue. Gastrointestinal bleeding is a significant problem for patients receiving oral anticoagulant therapy. In this article, we review current evidence on the association between hemorrhagic complications and oral anticoagulants, focusing on randomized controlled trials, meta-analyses, and postmarketing observational studies. We have presented a brief overview of current knowledge about the risk factors for hemorrhagic complications when taking certain anticoagulants, prevention strategies that reduce their risk.

Sclerosing cholangitis (SC) is a rare chronic disease characterized by inflammation and progressive obliterative fibrosis of the intrahepatic and/or extrahepatic bile ducts. Diagnosis is based on a cholangiogram showing dilatation of the bile ducts, narrowing and obliteration of the biliary tree, and histologically the presence of inflammatory lesions of the bile ducts leading to periductal fibrosis. In children, the most common SC is associated with prominent autoimmune manifestations, overlapping with those of autoimmune hepatitis (AIH); this form is known as autoimmune sclerosing cholangitis, ASC. Conversely, primary SC (PSC), a condition in which the term “primary” indicates that the etiology and pathogenesis are unknown, is rare in pediatrics. Secondary SC (SSC) defines cholangiopathy associated with an identifiable etiology, such as immunodeficiency, infection, or hematologic disorder. ASC and PSC are closely associated with inflammatory bowel diseases (IBD). ASC responds biochemically well to immunosuppressants and ursodeoxycholic acid (UDCA). Primary forms are treated exclusively with oral UDCA, whereas in secondary forms, drug treatment depends on the underlying etiology. Despite treatment, SC often progresses to biliary cirrhosis and end-stage liver disease requiring liver transplantation. The disease may recur after transplantation. To improve the prognosis of this disabling liver disease, a better understanding of the pathogenetic mechanisms and improved treatment methods are needed.

Aim. Our research aimed to describe a case of pseudomembranous colitis in a patient with secondary immunodeficiency. This case stresses the crucial importance of heightened awareness among physicians from diverse specialties when managing patients with diarrhea. Methods and material: We analyzed the clinical case of a 52-year-old woman, Ms. T, who had a history of systemic psoriasis and prolonged therapy with systemic steroids. She developed a diarrhea two weeks after receiving antibiotic treatment. Results: Patient T. was admitted to a local hospital with a diagnosis of gastrointestinal infection, but testing for Clostridioides difficile was not performed After receiving symptomatic therapy, the patient was discharged with some improvement in her condition. A day later, the diarrhea recurred. However, the patient refused to be hospitalized again. Within 30 days of staying at home and using only symptomatic therapy, the patient experienced increasing weakness and dyspepsic syndrome, diarrhea persisted up to 20 times a day, which prompted her emergency hospitalization in the gastroenterology department of the Central Clinical Hospital. On admission, her condition was considered as moderately to severe with pronounced protein-energy deficiency, electrolyte disturbances and moderate dehydration. Following a comprehensive differential diagnosis, the patient was diagnosed with severe pseudomembranous colitis. Treatment commenced with targeted antibacterial, symptomatic, and pathogenetic therapies, showing initial positive results. However, severe exhaustion and microbiota translocation resulted in sepsis, prolonging her hospital stay. After a series of therapeutic and rehabilitative interventions, the patient was discharged in a satisfactory condition. Conclusion: This clinical case highlights the importance of routine testing for clostridial infection in patients with diarrhea and risk factors. Such proactive measures could potentially prevent life-threatening complications and reduce hospitalization periods.

Noonan-like syndrome with anagen hair loss is a RAS pathology and is characterized by craniofacial features resembling Noonan syndrome, a spectrum of cardiovascular abnormalities, cognitive deficits and behavioral distorders, short stature usually associated with growth hormone deficiency, a unique combination ectodermal disorders. It results from a missense variant (c.4A>G, c.Ser2Gly) in the SHOC2 gene, located on chromosome 10q25, which encodes a protein that facilitates signaling through the RAS mitogen-associated protein kinase pathway, triggering a number of cellular processes. The prevalence of the syndrome is less than 1 in 1,000,000 (worldwide). Evidence has been obtained that disturbances in the level of expression and activation of the Ras family signaling pathway and its downstream kinases, such as Raf/MEK/ERK1-2, contribute to the pathogenetic mechanisms of the development of autoimmune diseases. Description of a clinical case. We present a previously undescribed clinical case of the development of juvenile arthritis associated with Crohn’s disease in a 13-year-old girl with Noonan-like syndrome with hair loss in the anagen phase. At birth, the patient was diagnosed with a congenital heart defect (multiple atrial septal defect), corrected at 4 years, articular syndrome debuted at 8 years 4 months, intestinal syndrome at 10 years 4 months. Genetic analysis was carried out only at 10 years 7 months, DNA sequencing results were obtained and a pathogenic variant of the nucleotide sequence of the SHOC2 gene was identified in a heterozygous state (c.4A>G, p.Ser2Gly). As a result of the analysis of clinical data, laboratory and instrumental studies, a diagnosis was made: “Juvenile arthritis (pauciarticular variant) associated with Crohn’s disease (ulcerative bauginitis, ulcerative ileitis, catarrhal jeunitis, aphthous left-sided colitis, erosive gastritis). Noonan-like syndrome with hair loss in the anagen stage 1. Hypopituitarism. Partial growth hormone deficiency. Condition after ASD repair.” The girl received treatment: a course of glucocorticosteroids (methylprednisolone) with gradual withdrawal, methotrexate, adalimumab and mesalazine with positive dynamics. Conclusion. Pediatricians need to remember the possibility of developing autoimmune diseases in children with NPS, the need for their early diagnosis, timely referral to specialists and adequate therapy.

Aim: The purpose of the study: to present a clinical observation of a patient with a foreign body (gallstone) of the rectum. To suggest the migration path of the gallstone into the rectum. Materials and methods: The research work was based on the data of the medical history taken from the archive of the coloproctology department of the BUZ UR “1RKB” of the Ministry of Health of UR. An X-ray phase analysis of a foreign body found in the patient’s rectum was performed. The molecular composition of the foreign body sample has been studied. Results: Patient S., 80 years old, came to the reception department of the coloproctology department complaining of a difficult act of defecation during the week and a feeling of a “foreign body” in the rectum. She did not make any other complaints. During finger examination, a rocky density formation up to 4 cm in size was found in the rectum, which was extracted from the rectum transanally with a manual aid. X-ray phase analysis of the foreign body showed a predominant content of cholesterol compounds in the composition of the stone (75%), which made it possible to establish a final diagnosis: A foreign body of the rectum. A large gallstone. Conclusion: A rare complication of gallstone disease is described - the migration of a gallstone through a formed biliodigestive fistula (cholecysto-colonic) into the rectum. Due to the large size, the gallstone could not pass through the anal canal on its own during defecation, which caused the clinic to have difficulty defecating and a feeling of a “foreign body” in the rectum.

Hirschsprung’s disease is a congenital malformation of the colon, which occurs in 95% of cases in children under 1 year of age.Diagnosis and surgical treatment at this age are not difficult. However, Hirschsprung’s disease can be detected in older children and adult patients, in the absence of proper alertness and diagnosis at an early age, as well as a mild clinical course. At older ages, the clinical picture and diagnostic and treatment tactics differ significantly from those in younger children. The article presents the experience of treating a child with Hirschsprung’s disease in adolescence. Management tactics in the pre- and postoperative period, surgical treatment, as well as postoperative complications and methods for their resolution