The article presents a block of clinical recommendations for the management of patients with non-alcoholic fatty liver disease and normal body weight. This problem is very relevant, since in real clinical practice this condition often remains unrecognized. At the same time, a sufficiently large number of studies have demonstrated that the risks of developing both unfavorable hepatic prognoses and extrahepatic ones, including the development of cardiovascular pathology and cancer, in patients with normal body weight are comparable to patients with overweight and/or obesity. The article proposes an algorithm for the diagnosis and management of patients with NAFLD and normal body weight, including those that are easily feasible in real clinical practice.

This article presents a block of clinical recommendations for the management of patients with non-alcoholic fatty liver disease (NAFLD), a section on the features of management of patients with NAFLD and concomitant chronic kidney disease (CKD). The article presents the pathogenetic connections of the formation of CKD in patients with NAFLD. There is no doubt about the close relationship between NAFLD, CKD and the development of cardiovascular diseases (CVD) within the hepato-cardio-renal continuum. The results of a large number of multicenter studies and meta-analyses demonstrating the relationship between these diseases are presented. The main directions of diagnosis and treatment of these conditions are considered.

This article presents a set of clinical guidelines for the management of patients with non-alcoholic fatty liver disease (NAFLD), a section on the specifics of managing patients with NAFLD and concomitant arterial hypertension (AH). The review examines the pathogenetic relationships of hypertension development in patients with NAFLD. The results of multicenter studies and meta-analyses demonstrating the relationship between these diseases are presented. The main directions of diagnostics and features of antihypertensive therapy in this category of patients are considered.

The purpose is to review the current scientific literature on the problem of non-alcoholic fatty liver disease and pregnancy Materials and methods: a literary review of domestic and foreign scientific publications has been carried out. The research was searched using the PubMed database using queries on the topics of Non-alcoholic fatty liver disease and pregnancy; pathology of the liver during pregnancy, using data from the scientific electronic library elibrary.ru Results: the data on the role of the liver in the metabolism of estrogens in the body of a woman in normal and pathological conditions, on exogenous and endogenous effects on the metabolism of estrogens outside pregnancy and during pregnancy were systematized. The information presented in the article will help the practitioner to identify risk factors for liver damage in a timely manner, identify signs of liver damage and management tactics of a woman in preparation for pregnancy and during pregnancy, correctly build a diagnostic algorithm and make a differential diagnosis.

The aim. to study the diagnostic characteristics of liver steatosis assessment indices in patients with non-alcoholic fatty liver disease (NAFLD) and postmenopausal obesity. Materials and methods. 88 postmenopausal women were examined, of whom 70 with an average age of 51.0 (49.0-52.0) years had NAFLD and pre-obesity/obesity and 18 with an average age of 50.5 (48.0-51.0) years without obesity and liver pathology. Waist size was measured in all women, body mass index was calculated, the level of transaminases, gamma-glutamyltranspeptidase and triglycerides were determined, and the steatosis indices HSI (Hepatic steatosis index) and FLI (Fatty liver index) were calculated. Verification of liver steatosis was performed by ultrasound examination. The ROC curve method was used to determine the threshold values and calculate the diagnostic characteristics of the models. Results. During the ROC analysis, the threshold value of the HSI index in patients with NAFLD was 30.5 with sensitivity and specificity of 98.5% and 97.3%, respectively. The predictor value of the FLI index for determining the risk of steatosis in this risk group was 35 (sensitivity 72.2%, specificity 100%). Conclusion. The calculated HSI and FLI indices are quite informative methods for diagnosing a high risk of steatosis in women with pre-obesity and postmenopausal obesity.

The prevalence of polycystic ovary syndrome (PCOS) and non-alcoholic fatty liver disease (NAFLD) has a clear association with each other, and the presence of one disease increases the risks of developing the other, which must be taken into account when comprehensively assessing the patient’s condition. Both diseases increase the risk of developing socially significant diseases associated with decreased life expectancy, such as type 2 diabetes mellitus and cardiovascular diseases. The purpose of this review was to summarize current data on the prevalence and pathophysiology of NAFLD in PCOS. Publications on PCOS and NAFLD were analyzed using a search of the Russian Science Citation Index, MEDLINE and Pub Med over the past 10 years, using the keywords: “PCOS”, “NAFLD”, “insulin resistance”, “hyperandrogenemia”. The author of the review included the most interesting works, covering the problem broadly and comprehensively. The analysis of the literature showed that the pathogenesis of both PCOS and NAFLD involves factors such as hyperandrogenemia, insulin resistance with compensatory hyperinsulinemia (involving in the process of metabolic dysregulation of all “classical” insulin target organs, including skeletal muscles), mitochondrial dysfunction and intestinal dysbiosis. The pathophysiological process of the formation of PCOS and NAFLD is characterized by the formation of “vicious” circles, when a violation of one link in the pathogenesis activates other links, aggravating and maintaining primary deviations. This indicates that it is necessary to search for complex, non-trivial approaches to the diagnosis and treatment of these diseases, using drugs from various groups, including insulin sensors, metabiotics, antioxidants and hepatoprotectors. The role of each drug have to be assessed in clinical trials.

NAFLD is a spectrum of progressive phenotypes of liver disease from liver steatosis to non-alcoholic steatohepatitis (NASH), fibrosis and cirrhosis of the liver. Currently, NAFLD is one of the most common liver diseases both in the world and in the Russian Federation, affecting 20-40% of the population. In the coming years, a steady increase in advanced stages of the disease is expected, which is associated with an increase in the number of people with obesity and type 2 diabetes mellitus. Drug-based methods of NAFLD correction based on increasing tissue sensitivity to insulin and reducing the degree of liver damage prove their effectiveness only in combination with lifestyle modification measures. Changes in the qualitative and quantitative composition of the diet, weight loss and increased physical activity are the basis of non-drug correction methods for NAFLD. The choice of diet is carried out according to the nutrition standards available in Russia, and depends on the stage of the disease.

The proposed publication "Metabolic-associated fatty liver disease. Practical recommendations of the Scientific Society of Gastroenterologists of Russia" represents many years of work by a community of professionals aimed at improving the quality of treatment and diagnostic care for comorbid pathology, which is based on the concept of enterohepatocentrism developed by us. The material presented has already been largely presented in the form of separate articles in various issues of our journal, and the systematized materials will be published in a formalized form in subsequent issues of the journal. Part 1 is, in a certain sense, a report, presenting the names of oral reports that took place at the meetings of the Round Tables held over these two years. We draw the attention of colleagues to the lead article of this section "Targeted use of hepatoprotectors for the treatment of various stages of non-alcoholic fatty liver disease (fatty degeneration of the liver according to ICD 10) and associated comorbid conditions; tables for medical use”, which systematizes the latest data from national and international experience and is a logical continuation of the algorithm “Differentiated drug care for NAFLD-associated comorbidity”

The high prevalence of NAFLD, which correlates with metabolic syndrome, necessitates a rational choice of drugs to correct not only the stages of steatosis, steatohepatitis and fibrosis of the liver, but also its metabolic phenotypes. The original tables clearly present the possibilities of combined use of statins, fenofibrates, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, sodium-dependent glucose transporter type 2 inhibitors, glucagon-like peptide-1 receptor agonists, resmedirom, ursodesoxycholic and glycerhisinic acids and their combinations, essential phospholipids, ademetionine, ornithine aspartate, taurine, human placental hydrolysate, morpholine, silymarin, artichoke leaf extract, metformin, pioglitazone and a combined solution of succinic acid depending on the clinical situation. The confirming references are based on the “Scales for assessing the levels of reliability of evidence” approved by the Order of the Ministry of Health of the Russian Federation dated February 28, 2019 No. 103n “On Approval of the Procedure and Terms for the Development of Clinical Guidelines, Their Revision, the Standard Form of Clinical Guidelines and the Requirements for Their Structure, Composition and Scientific Validity of the Information Included in the Clinical Guidelines” (with amendments and additions).

Aim of the investigation. To study the significance of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) in combination with markers of liver pathology in predicting one-year mortality in patients with liver cirrhosis. Materials and methods. Over the course of one year of follow-up, 159 patients with liver cirrhosis aged 26 to 64 years were examined. The primary endpoint was assessed: death from any cause. The blood levels of MMP-1, MMP-9, and TIMP-1 were determined by enzyme-linked immunosorbent assay. Results. One-year mortality was 8.5% and it was associated with parameters of Child-Pugh score ≥8 points, C-reactive protein ≥15.5 mg/l, ESR ³12 mm/hour, gammaglutamyltranspeptidase ≥124 u/l, prothrombin index ≤77%, albumin ≤30 g/l, MMP-1 ≥24.2 ng/ml, MMP-9 ≥331 ng/ml, TIMP-1/MMP-1 ≤19.4, TIMP-1/MMP-9 ≤2.4, with the presence of alcoholic etiology, inflammatory syndrome, ascites 2-3rd degree. According to multivariate regression analysis, the independent factors of one-year mortality in liver cirrhosis were Child-Pugh score and TIMP-1/MMR-9 ratio. The combination of these signs in predicting a lethal outcome had a sensitivity of 92.3% and a specificity of 84.3% (AUC 0.890). Conclusion. Thus, Child-Pugh score and TIMP-1/MMP-9 ratio are predictors of one-year mortality in patients with liver cirrhosis, which reflects the severity of liver damage and the development of complications, as well as due to the participation of MMP-9 in inflammation and vascular remodeling.

Pancreaticoduodenal resection is the only radical surgical method for the treatment of patients with malignant periampullary tumors. Mechanical jaundice in most cases is the first manifestation of the disease. Patients in this category are often emaciated, have impaired liver function and are at high risk of perioperative complications. One of the ways to solve this issue is preoperative drainage of biliary tract. At the same time, there are contradictory views on the optimal timing of radial surgery after biliary drainage. In this article we present our experience of using additional methods to assess liver function in a patient with mechanical jaundice, which allow us to optimize the treatment strategy. A 71-year-old patient diagnosed with adenocarcinoma of the large duodenal papilla complicated by intestinal bleeding and mechanical jaundice. Selective embolization of a. gastroduodenalis branches and percutaneous transhepatic biliary drainage were performed at the first stage. In the postoperative period active infusion and detoxification therapy was continued. On the 10th day the functional state of the liver and hemostasis system was evaluated using low-frequency piezothromboelatostography and evaluation of indocyanine green elimination: structural and chronometric hypocoagulation were eliminated, plasma elimination rate increased 5 times. On the 11th day the patient underwent pancreaticoduodenal resection, the postoperative period proceeded against the background of biochemical fistula formation. Thus, evaluation of indocyanine green elimination and low-frequency piezothromboelastography can be used in complex assessment of the patient’s condition when choosing the tactics of surgical treatment of patients with pancreaticoduodenal tumors complicated by mechanical jaundice.

It is known that weight loss after bariatric surgery is accompanied by a decrease in the risk of developing a number of cancer pathologies. However, gastric cancer deserves special attention, which in most cases is associated with Helicobacter pylori (H. pylori) infection, atrophy and intestinal metaplasia. When a patient undergoes gastric bypass, it is necessary to understand that most of the stomach, in which oncological transformation can begin, is no longer subject to visual endoscopic assessment, and therefore, for such patients, identifying early gastric cancer becomes impossible. The article discusses the risks of developing malignant neoplasms in patients with H. pylori-associated gastritis, autoimmune gastritis, atrophy and intestinal metaplasia, and also proposes a differentiated approach to the choice of gastric bypass as a bariatric operation in such patients.

The purpose of the study is to improve the quality of diagnosis and treatment in patients with cholecystocholedocholithiasis and MJ aggravated by concomitant diseases. To achieve it, clinical, laboratory and morphologic studies were performed in 537 patients admitted to the emergency surgical department of the Republican Clinical Hospital of Nalchik. The stages of jaundice development were revealed in these patients: cholestasis, cytolysis and cholangitis. The majority of concomitant diseases was generalized atherosclerosis - 372 (69,3%) cases. CHD was diagnosed in 284 (52.9%) patients, hypertension in 99 (18.4%), obesity in 85 (15.8%), and diabetes mellitus in 39 (7.3%). Other comorbidities were less common. The conducted study allowed us to come to the definition of the syndrome of mutual aggravation in patients with LCDD and MJ as a pathologic influence of comorbidities on the main, surgical disease. CIRS, Kaplan-Feinstein and Charlson comorbidity scales were used to characterize the severity of mutual aggravation at different stages of mechanical jaundice. In cholestasis no increase in the index of these scales was noted. At stages of cytolysis and cholangitis comorbidity indices increased significantly. That is, the determination of the severity of mutual aggravation was directly related to the stages of the main pathologic process. At cholestasis in MF patients due to insignificant changes in comorbidity indices the prognosis of mutual aggravation increase is minimal, at hepatocytolysis - the severity of the influence of comorbidities on the main disease increases. In cholangitis - mutual aggravation becomes maximum.

The aim of the study was to estimate the influence of the extract from flowers of Calendula officinalis on the course of experimental cholecystitis in hamsters. Materials and methods. In the first series of experiments, the acute hepatitis was simulated by subcutaneous injection of 50% oily solution of carbon tetrachloride to hamsters at the dose of 0.4 ml/100 g once a day for 4 days. The acute cholecystitis was simulated by a single introduction of 3% hydrogen peroxide into the gall bladder at the dose of 0.1 ml. The C. officinalis extract was orally introduced to the animals of the experimental group at the dose of 100 mg/kg since the second day of the experiment once a day for 14 days. On the 14th and 28 th days the functional state of the liver was estimated and the pathomorphological study of the gall bladder was carried out. Results. It has been established that the C. officinalis dry extract at the dose of 100 mg/kg has high efficacy: it significantly decreases manifestations of cytolysis and cholestasis in the liver and normalizes the structures of the gall bladder decreasing dystrophic and necrotic changes and limiting inflammatory reactions thus promoting reparative processes in the organs of the hepatobiliary system. Conclusion. The C. officinalis dry extract has the marked phramacotherapeutical effect in experimental hepatitis and cholecystitis diminishing functional disturbances and mobilizing reparative processes in the liver and gall bladder of hamsters.

The purpose of the study was to assess the level of transcriptional activity of the Gstt1 and Gstm1 genes in the liver of rats under long-term exposure to acrylamide against the background of preventive correction with hydroxymethyluracil complex compounds. Materials and methods. The experiment was carried out on outbred male rats with oral administration of acrylamide at a dose of 5 mg/kg and complex compounds of hydroxymethyluracil with ascorbic acid, sodium succinate and acetylcysteine in a prophylactic regimen for three months. The study of gene transcription in liver tissue samples was carried out using real-time polymerase chain reaction using oligonucleotide specific primers and the intercalating dye SYBR Green. The Gapdh gene was used as a reference gene. For statistical analysis of the results, the IBM SPSS Statistics 21 application package was used. Results. In our study, the expression of the Gstm1 and Gstt1 genes decreased after 1.5 months of exposure to acrylamide in animal liver tissue samples. The introduction of prophylactic drugs contributed to an increase in its level: to a greater extent, a complex compound of WMU with sodium succinate, which was statistically significant, and to a lesser extent, complex compounds of WMU with ascorbic acid and acetylcysteine. After 3 months, differences between groups were less noticeable for these genes. Conclusion. With long-term exposure to acrylamide, the most significant changes in gene expression in rat liver tissue were observed at 1.5 months, compared with data at the end of the experiment. At the same period of the study, complex compounds of oxymethyluracil have a certain corrective effect on the transcriptional activity of both the Gstt1 gene and the Gstm1 gene. To make a final judgment about the protective properties of the complex compounds being studied, further research is needed to analyze changes in other indicators of the health status of laboratory animals.

The purpose of the study is the effect of mildronate on the proliferation of hepatocytes and on the activity of liver enzymes in rats during physical activity of varying intensity. Material and methods. 84 white male rats weighing 240 grams were used as experimental animals. The animals were divided into three groups. The experiment was carried out in two stages. In the first stage, the rats were given loads of varying intensity: the first group of rats was given a light physical load, for which they were placed in a bath with a water temperature of 29-32˚C in which the animals swam for 15 minutes. The rats of the second group spent 30 minutes in the bath; this load was considered to be of moderate severity. To simulate heavy physical activity (third group), the animals swam in the bath until they began to lose strength and drown. This usually occurred 55-59 minutes after the animals were in the water. After being removed from the bath, the animals of this group, unlike the animals of the first two groups, were lethargic, lay down for some time, and did not eat. Animals of all groups underwent 10 sessions of water loading, after which they were taken out of the experiment immediately after the last session (7 animals per group) and 30 days after the end of the experiment (7 animals per group) using zoletil anesthesia at the rate of 5 mg per 100 g in accordance with the International Rules for Work with Experimental Animals. At the second stage, another group of rats, also divided into three groups, received a similar load of varying intensity, however, throughout the entire experiment (10 days), oral administration of mildronate, 3-(2,2,2-trimethylhydrazine) propionate at a dose of 100 mg was observed daily. / kg. Control animals (n=7) were white rats weighing 240 grams. After removing the liver, pieces measuring 1x1 cm were cut out from it, which were fixed in 10% neutral formaldehyde and embedded in paraffin; The resulting serial sections were stained with hematoxylin and eosin and van Gieson. Binucleate hepatocytes were counted per 7000 cells. SDH, NADH, NADFH, acid and alkaline phosphatases were determined histochemically in hepatocytes. Statistical analysis was carried out using the Statistica-6 program. Student’s t-test was used to analyze differences between samples. Research results. The study found that the use of mildronate when rats performed physical activity significantly changes the situation: the proliferative activity of hepatocytes increases when rats perform light and moderate exercise, occurring against the background of increased activity of redox enzymes. When rats perform heavy workloads, the use of mildronate supports the reproductive potency of hepatocytes and the normal enzymatic characteristics of the liver. Conclusion. The study shows that the use of mildronate is not only desirable when animals perform heavy physical activity, but also, apparently, is necessary for health reasons.

The aim of the investigation is the study of the serum leptin content and polymorphism of the leptin receptor gene glutamine 223 arginine (LEPR^Gln223Arg) as additional criteria for the differential diagnosis of metabolic and alcoholic liver diseases. The subject of the study: serum leptin content and polymorphism of the leptin receptor gene LEPR^Gln223Arg in patients with metabolic fatty liver disease and alcoholic liver disease. The investigation methods. A comparative analysis of the serum leptin level and polymorphism of the leptin receptor gene LEPR^Gln223Arg was carried out in 108 patients with metabolic fatty liver disease and in 80 patients with alcoholic liver disease with an assessment of body mass index, lipid metabolism, and gender differences. Results. Reliable differences in serum leptin content and the frequency of genotypes of the leptin receptor gene LEPR^Gln223Arg were revealed in patients with metabolic fatty liver disease and alcoholic liver disease. The results obtained can serve as additional differential diagnostic criteria between metabolic fatty liver disease and alcoholic liver disease in the early stages. Conclusion. The results obtained confirm hyperleptinemia in patients with metabolic fatty liver disease exceeding that in patients with alcoholic liver disease. Leptin resistance in men and women with metabolic fatty liver disease is associated with different genotypes of the leptin receptor gene LEPR^Gln223Arg. No similar association of the genotypes of the leptin receptor gene LEPR^Gln223Arg was found in patients with alcoholic liver disease.

Metabolic-associated fatty liver disease is a widespread disease whose incidence is increasing worldwide and has become one of the leading causes of terminal stages of liver disease and hepatocellular carcinoma with increased liver-related morbidity and mortality and overall. The new term, fatty liver disease associated with metabolic dysfunction, has a set of positive diagnostic criteria and has been shown to have great clinical utility. Currently, there are no standardized universal screening methods for liver steatosis, despite the fact that this disease has a significant impact on health. Metabolic-associated fatty disease encompasses a wide range of conditions, from simple steatosis and steatohepatitis to fibrosis and hepatocellular carcinoma. It is also accompanied by numerous extrahepatic manifestations such as cardiovascular disease, malignancies outside the liver, and cognitive and respiratory changes. Given the extensive target organs affected and the high prevalence of the disease, it is critical to timely identify individuals at high risk of metabolic dysfunction. Liver biopsy has so far been considered the reference method for assessing the stage of hepatic steatosis and fibrosis. Given the limitations of biopsy for large-scale screening, non-invasive tests to assess the stage of steatosis and fibrosis, including serum-based algorithms and methods based on ultrasound and magnetic resonance imaging, will play an increasing role in the management of patients with MAFLD. This article presents a review of the scientific evidence on non-invasive diagnostic options used in clinical practice to detect hepatic steatosis.

Sarcopenia is considered primary when it is associated with age, and secondary when it is associated with diseases. The decrease in skeletal muscle mass during age-related sarcopenia occurs gradually and has gender differentiation: it is more pronounced in men than in women. Skeletal muscle mass loss has been found to be approximately 5% over 10 years in older adults. In disease-associated sarcopenia, the rate of skeletal muscle mass loss does not follow a linear trend: the percentage of muscle mass loss exceeds the level noted in age-related sarcopenia and increases exponentially in later stages of the disease. Sarcopenia resulting from liver disease is one example of the formation of secondary sarcopenia. The purpose of this review is to present current literature data on the relationship between sarcopenia and liver diseases, taking into account the characteristics of pathogenesis, clinical presentation and diagnostic methods. The purpose of this review is to present current literature data regarding the relationship between sarcopenia and liver diseases, taking into account the characteristics of pathogenesis, clinical picture and diagnostic methods.

Nonalcoholic fatty liver disease (NAFLD) is most commonly a component of the metabolic syndrome with a global prevalence of 25% and the number of patients continues to increase. According to current projections, in the near future, NAFLD will become the most common indication for liver transplantation. The search for new risk factors for the development and progression of this disease is actively underway. The article considers the role of intestinal microbiota in proinflammatory processes, bile acid metabolism and liver lipogenesis. Attention is paid to the qualitative composition of the microbiome depending on the stage of NAFLD. Conclusions are made about heterogeneity of the research results in case of NAFLD and relatively stable microbiota in liver cirrhosis. Faecalibacterium prausnitzii and its role in the progression of NAFLD are considered separately. Probable reasons for the disagreement of the results of the studies are presented. In the part devoted to the treatment of NAFLD, the focus is on the ways of correction of intestinal dysbiosis, the influence of various microbiological preparations on lipogenesis and the process of inflammation in the liver. The optimal composition of probiotic preparations is discussed in detail. Their combination with prebiotics and isolated administration of inulin, fructooligosaccharide. Conclusions are drawn that in the future the assessment of intestinal microbiome will help to improve therapeutic approaches in the treatment of NAFLD patients.

Introduction: Non-alcoholic fatty liver disease (NAFLD) is widespread and is considered a component of the metabolic syndrome. Excessive accumulation of free fatty acids (FFA), insulin resistance, are considered as the main mechanism of formation of liver steatosis. Endotoxemia associated with intestinal dysbiosis is of great importance, contributing to the development of the inflammatory process in NAFLD. The article presents data from clinical and experimental studies of the effectiveness of drinking mineral waters in NAFLD and its concomitant pathology of the gastrointestinal tract, GI, pancreatitis. Purpose of the study. To prepare a literature review using Russian and foreign sources and present the data of modern research on the mechanism of action of drinking MV in non-alcoholic fatty liver disease.

The aim of the article. Evaluation of the clinical effectiveness of the natural honey drug Metrop GP in patients with metabolically associated fatty liver disease (MAFLD). Materials and methods. A prospective randomized open multi-center study was conducted. 70 patients aged 39 to 55 years with an established diagnosis of MAFLD were included. The study group consisted of 40 patients, the control group - 30 patients. All patients received drug therapy with the hepatoprotective drug S-ademetionine. Patients in the study group were also prescribed a 10-day course of Metrop GP therapy. For a detailed assessment of the effect of the honey preparation, all subjects were divided into subgroups depending on the genesis of MAFLD: obesity/type 2 diabetes mellitus (DM2)/metabolic syndrome (MS). The dynamics of complaints was assessed. The effect of the Metrop GP on biochemical blood parameters (indicators of liver cytolysis and cholestasis, carbohydrate and lipid metabolism) and oxidative stress markers was studied. The dynamics of all indicators were assessed twice (before the study and 2 weeks after the 10-day course of treatment with Metrop GP). Non-invasive assessment of liver steatosis and fibrosis was performed using the FibroMax serological test once before the start of therapy. The study was approved by the ethics committee of Union Clinic LLC (St. Petersburg). Protocol No. 1-06/2023 dated June 6, 2023. All patients in the study group signed voluntary informed consent to conduct the study. Statistical processing of the results was carried out using SPSS 26 for Windows. Differences were considered significant at a significance level of p<0.05 (95%). Results. According to the results obtained at the end of the study, patients receiving additional Metrop GP as part of complex therapy showed a statistically significant improvement in laboratory parameters of the indices of liver cytolysis, lipid metabolism and antioxidant status, which was not achieved in the comparison subgroups. In patients with MAFLD and type 2 diabetes, a significant decrease in glucose levels was also noted during the study therapy, in contrast to the control subgroup. Patients from all study groups noted an improvement in general well-being and a decrease in dyspeptic symptoms, but without significant differences. The study drug was well tolerated. Conclusion. The addition of the hepatoprotector Metrop GP to the treatment of MAFLD leads to an improvement in lipid metabolism, normalization of the indices of liver cytolysis and the body’s antioxidant system.

Aim: to study the treatment results of the proposed surgical procedures in children with pilonidal diseases and determine the prospects for treatment based on a review of the literature from 1992 to 2023. Materials and methods. A review was conducted in domestic and foreign databases: eLIBRARY, PubMed, The Cochrane Library, CyberLeninka, Google Scholar for the period from 1992 to 2023. Key words used for the search: pilonidal cyst, pilonidal sinus, children. Results. Midline closure as a standard surgical approach has a recurrence rate reaching 45%, and after excision with open healing by secondary intention the recurrence rate was 23%. Procedures such as Karydakis, Bascom, “Cleft lift” and procedures with an advancement skin flap, recurrences occur in up to 10.2%. The use of minimally invasive procedures such as phenol, fibrin glue, pit-picking technique, Gips procedure, “sinusectomy” were accompanied by the occurrence of recurrences in 1% - 20% of cases. PEPSiT and laser probes proved promising, with recurrences occurring in 2.9%-4.8% of cases. Conclusion. The question of the ideal surgical procedure of pilonidal diseases in adult and children remains controversial. The procedures are always chosen individually, and depends on the severity and prevalence of the disease. Minimally invasive procedures are effectiveness with a low recurrence, however, to assess long-term results, it is necessary to accumulate material with subsequent analysis.

The article presents a clinical case of late diagnosis of Wilson-Conovalov disease at the stage of liver cirrhosis. The presented observation demonstrates the manifestation of clinical symptoms in a young patient after a coronavirus infection, decompensation of the existing liver cirrhosis with rapid progression of liver failure after re-infection with SARS-CoV-2 virus and administration of nonsteroidal anti-inflammatory drugs, and postmortem confirmation of the disease.

The article presents a unique clinical case of heterotopy of liver tissues in the lower third of the esophagus. A 35-year-old patient was admitted to the surgical department of the GKB with a picture of gastrointestinal bleeding, which was regarded as bleeding from varicose veins of the lower third of the esophagus. To stop the bleeding, a Blackmore probe was installed in the patient, which led to a decrease in blood loss. However, the development of posthemorrhagic anemia was not stopped (a drop in hemoglobin levels from 104 g/l to 70 g/ l), the patient’s condition continued to deteriorate and biological death was pronounced the next day. The autopsy revealed a bulky formation in the lower third of the esophagus, which, after histological examination, was regarded as a heterotopy of liver tissue into the lower third of the esophagus with necrosis. This was the source of bleeding with the development of posthemorrhagic anemia, and subsequently the cause of death.

The article presents a clinical case of late diagnosis of systemic AL amyloidosis. Severe hepatomegaly, cholestasis syndrome combined with progressive heart failure and nephrotic syndrome prompted the patient to be examined for systemic amyloidosis. This observation demonstrates the need for knowledge of gastroenterologic and systemic manifestations of amyloidosis, algorithms for diagnosing the disease in order to timely identify such patients, prescribe effective chemotherapy to increase the life expectancy of patients.

The problem of echinococcosis incidence among the population of different countries still remains a pressing issue and is the subject of consideration at international congresses and conferences. The article presents a unique clinical case of multiple localization of giant echinococcal cysts. Two multi-chamber cysts were located in the liver, a giant cyst measuring 15*18*18 cm filled the entire left lobe of the liver, the second cyst measuring 10 cm in diameter was located in the projection of segments 6-7 of the right lobe of the liver, and the patient also had a cyst in the lower segments of the left lung. Of additional interest is the fact that the first clinical signs of echinococcosis appeared in the patient after a coronavirus infection. In this regard, the article considered the pathogenetic features of coronavirus infection and echinococcosis, as well as the course of the disease when they are combined. Based on the results of a comprehensive examination, it was decided to carry out a 2-stage treatment for the patient. First of all, due to the presence of clinical indications from the digestive system, to excise the liver cysts. Then, after the patient’s rehabilitation, proceed to the second stage of treatment: excision of the lung cyst in the thoracic surgery department. The patient underwent left-sided hemihepatectomy, resection of liver segments with a reconstructive-plastic component, cholecystectomy, external drainage of the bile ducts according to Kehr. The postoperative period was uneventful. The patient was discharged from the surgical department with an appointment for planned hospitalization in the thoracic surgery department for the 2nd stage of treatment.

Sump-syndrome is a rare pathology that arises as a consequence of surgical interventions on the biliary tract. Previously, the widely used technique of side-to-side anastomosis between the common bile duct and the duodenum contributed to the formation of a poorly drained reservoir in the distal bile duct, leading to recurrent infections and pancreatic complications. Modern endoscopic methods, such as sphincterotomy and biliary drainage, have virtually eliminated this syndrome. However, the recent development of endoscopic choledochoduodenostomy may bring it back into clinical relevance. This article presents a clinical case of a 52-year-old patient with sump-syndrome following endoscopic choledochoduodenostomy performed for unresectable pancreatic head cancer. The patient was admitted with symptoms of cholangitis and elevated inflammatory markers. Diagnosis and treatment included antibiotic therapy and supportive care. This case highlights the importance of considering sump syndrome in the differential diagnosis of abdominal pain in patients with prior biliary interventions and emphasizes the need to assess the risks associated with different biliary drainage techniques.

The article presents data on the origin of the Russian names of the structures of digestive system: liver, gallbladder and bile ducts, pancreas, peritoneum, omentum.