Chronic atrophic gastritis (CAG) is one of the most common gastrointestinal diseases characterized by decreased thickness of the gastric mucosa, reduced number of gastric glands and moderate inflammation. The etiology of CAG is related to the adverse effects of two major factors, Helicobacter infection and autoimmune aggression. The leading initial role in the damage to the gastric mucosa, leading to long-term consequences in the form of atrophy, belongs to H. pylori. As atrophic gastritis progresses, other bacterial species (Fusobacterium nucleatum, Streptococcus anginosus) appear in the gastric lumen and may cause additional damage and/or provoke carcinogenesis. Damage to the gastric epithelium is accompanied by two response patterns, superficial and glandular. In the context of CAG pathogenesis, the glandular response is of great importance, characterized by slow development and changes in the structure of the fundal glands. The most sensitive to damage are the lining cells, the death of which can be carried out by apoptosis, autophagy, pyroptosis and ferroptosis. The death of cladding cells triggers paligenosis - the process of stepwise transformation of the main cells into metaplastic SPEM-cells, which at the final stage due to the activation of mTOR pathway acquire the ability to divide, and repeated cycles of their de/redifferentiation contribute to the accumulation of oncogenic mutations. With continued exposure to unfavorable factors, gastric mucosal atrophy progresses to the next stage of the Correa cascade - pyloric metaplasia, then to intestinal metaplasia and dysplasia. Modern research methods, including sequencing of individual cells, molecular imaging, and the use of organoids allow us to identify the main molecular targets responsible for regenerative processes in the gastric mucosa. Stimulation of these mechanisms in the nearest future may become the basis for pathogenetic treatment of CAG, aimed not only at elimination of the main etiologic factors and cessation of inflammation, but also at regeneration of gastric glands and restoration of secretory function.

Introduction. Inflammatory bowel diseases (IBD), which include ulcerative colitis and Crohn’s disease, are an urgent problem of modern gastroenterology, as they have a chronic progressive course, affect people of working age and require long-term and expensive therapy. The aim of the study: to conduct a population-based assessment of epidemiologic and demographic indicators of IBD in the region as a whole, as well as to estimate the burden on the regional health care system due to this pathology. Study results. The average annual incidence of ulcerative colitis calculated from the data of the IBD registry was 37 cases per 100,000 population, the average annual incidence of Crohn’s disease was 29 cases per 100,000 population. The calculated prevalence of ulcerative colitis was 157 per 100,000 population, and the prevalence of Crohn’s disease was 140 per 100,000 population. The average annual mortality rate due to IBD was 0.4 cases per 100,000 population and 1.7 cases per 1,000 patients with IBD, with fatal complications occurring on average 2.4 times more frequently in the debut of IBD compared to the period after the diagnosis. 65.7% of patients with ulcerative colitis and 70.7% of patients with Crohn’s disease were between 18 and 59 years of age. Women (55.7%) prevailed among patients with IBD, which corresponded to the gender demographic features of the region as a whole. Between 2019 and 2024, there was a year-on-year increase in both the number of patients with IBD presenting to healthcare facilities in the region and the number of referrals. In 2024, nearly half of the region’s adult patients with IBD were observed at the region’s two specialized IBD state medical centers, with annual increases in caseloads at the specialized IBD state medical centers between 2021 and 2024. Conclusion. The first population-based regional registry of IBD of St. Petersburg made it possible for the first time to conduct a long-term population-based assessment of all key epidemiological and demographic indicators of IBD on the country region as a whole, as well as to evaluate the burden on the regional health care system and the actual routing of patients with this pathology. Calculation of average annual indicators allowed to ensure the validity of the calculated values. The obtained data will be used for planning the provision of specialized medical care to patients with IBD.

The aim: of this study was to evaluate the efficacy and safety of upadacitinib (UPA) in real clinical practice in patients with ulcerative colitis (UC) and Crohn’s disease (CD) in a specialized regional Center for the Diagnosis and Treatment of Inflammatory Bowel Diseases. Material and methods. A retrospective study of patients with IBD who received upadacitinib until December 31, 2024. To assess the efficacy and safety, the study included 91 patients who received treatment at the IBD Center for at least 12 weeks or until the drug was discontinued. Data were collected from October 2022 to December 31, 2024 (from 116 to 12 weeks of therapy). The following patient characteristics were analyzed: demographic parameters, number of lines of biological therapy before initiation of UPA, severity of the disease, previous treatment, presence of extraintestinal manifestations, extent of UC lesions, localization of gastrointestinal lesions and form of CD, presence of perianal CD lesions. Results. In patients with severe and moderate ulcerative colitis and Crohn’s disease resistant to standard therapy, upadacitinib demonstrated high efficacy and safety of induction and maintenance therapy in achieving clinical and endoscopic remission. Conclusion: Our clinical observation demonstrated high efficacy and safety of induction and maintenance therapy in patients with severe and moderate ulcerative colitis and Crohn’s disease resistant to standard therapy. Upadacitinib can be considered as a drug of choice in bionaive patients with moderate to severe IBD who have unfavorable prognosis factors. Our data on the high efficacy of upadacitinib in patients with failed biological therapy indicate the need to consider it as one of the preferred options in the 2nd and subsequent lines of therapy equally in patients with ulcerative colitis and Crohn’s disease.

Introduction. Upadacitinib is a selective Janus Kinase Inhibitor that has proven to be an effective drug in recent years for the induction and maintenance of remission in inflammatory bowel disease (IBD). The aim of the study was to assess the indications for upadacitinib, the efficacy, tolerability and “survival” of this therapy in real-world practice. Materials and methods. A retrospective cohort study was conducted, which included 17 patients with Crohn’s disease and 7 patients with ulcerative colitis who received upadacitinib therapy at the specialized city IBD clinic in St. Petersburg, Russia in 2023-2024. Study results. The main indications for upadacitinib in IBD were the ineffectiveness of immunosuppressants and the ineffectiveness of biologics. The median duration of upadacitinib therapy was about six months, as a result of treatment, 64.7% of patients with Crohn’s disease and 71.4% of patients with ulcerative colitis achieved endoscopic remission or histological healing, while a time-dependent effect of therapy was noted - the longer the therapy, the more often endoscopic remission or histological healing was achieved. Against the background of therapy, none of the patients had any adverse events that would require the withdrawal of upadacitinib. Upadacitinib therapy was discontinued in only 4 patients with Crohn’s disease and only due to lack of effect, while in all patients with ulcerative colitis, treatment was continued until the end of follow-up. Conclusion. Upadacitinib can be considered as an effective and safe drug for the induction and maintenance of remission in ulcerative colitis and Crohn’s disease, which can be used both as part of any line of therapy and as a “rescue therapy” in case of steroid resistance against the background of a moderate to severe IBD attack.

The aim of our study was to evaluate the efficacy and safety of taking a universal hepatoprotector based on ursodeoxycholic acid in patients with cholelithiasis who underwent cholecystectomy. Materials and methods. The study involved 52 patients with cholelithiasis and changes in the lipid spectrum who underwent elective laparoscopic cholecystectomy. The patients were divided into 2 groups of 26 people, the first group received treatment with ursodeoxycholic acid after surgical treatment, the second group received only non-drug recommendations. All patients before the operation and 3 months after it underwent a biochemical blood test, lipidogram, ultrasound of the abdominal cavity, magnetic resonance cholangiopancreatography, gastroenterological complaints, quality of life were evaluated. Results. In patients taking ursodeoxycholic acid, the severity of gastroenterological complaints after cholecystectomy was less pronounced, blood lipid profile indicators improved. Conclusion. The appointment of a hepatoprotector based on ursodeoxycholic acid makes it possible to eliminate the phenomena of biliary dyspepsia, improves the blood lipid spectrum. The drug demonstrates high efficacy and safety, it can be recommended for the curation of patients with cholelithiasis who have undergone cholecystectomy.

The COVID-19 pandemic has been a serious challenge for many comorbid patients, including those with pathology of the hepatobiliary tract. Risk factors for severe COVID-19 infection were older age, male gender, and the presence of concomitant diseases. Purpose of the study: To identify risk factors for severe COVID-19 in hospitalized patients with NAFLD. Materials and methods: A retrospective and prospective analysis of 185 medical records of patients hospitalized with COVID-19 in infectious diseases hospitals in Moscow from June to August 2021 was carried out. Study results: Patients with NAFLD hospitalized with COVID-19 compared to the comparison group were older, had a higher comorbidity index, a high body mass index (BMI) and longer hospitalization. Analysis of laboratory parameters of ALT, AST, CRP, GGTP over time revealed a statistically significant connection between the parameters of cytolysis and inflammation and the need for emergency respiratory support (ventilation). Conclusion: Risk factors for severe COVID-19 in hospitalized patients with NAFLD are older age, male gender, increased weight, high rates of cytolysis and inflammation upon admission and exceeding them on the 7th day of hospitalization, which requires additional measures of emergency therapy, respiratory support and, consequently, longer hospitalization.

The aim of the study was to determine the diagnostic value of various calculated non-insulin indices of insulin resistance (IR) as surrogate markers of inflammation in metabolically associated steatotic liver disease (MASLD) in patients without type 2 diabetes mellitus. Materials and methods. Fifty-one patients with MASLD were examined: 29 (56.9%) men and 22 (43.1%) women and 40 healthy donors. The IR indices were estimated: triglyceride-glucose index (TGI) = ln[(triglycerides mg/dl x fasting glucose mg/dl)/2]; TGI x body mass index (TGI х BMI); lipid accumulation product (LAP) for men = [(waist circumference (WC) cm - 65) x TG (mmol/L)] and LAP for women = [(WC - 58) x TG (mmol/L)]; visceral adiposity index (VAI) for men = [WC (cm)/39.68 + (1.88 × BMI)] × (TG (mmol/l)/1.03) × (1.31/HDL (mmol/l) and VAI for women = [WC (cm)/36.58 + 1.89 × (BMI)] × (TG (mmol/l)/0.81) × (1.52/HDL (mmol/l) and the ratio of triglycerides to high-density lipoproteins (TG/HDL). The ELISA method was used to determine the proinflammatory cytokines TNF-α (“Cloud-clone corp”, USA), IL-1β, IL-6 (“Vector-Best”, Russia) and IL-8 (“Cloud-clone corp”, USA). Results. All IR indices in patients with MASLD significantly exceeded those in healthy donors: LAP increased to the maximum - 4.5 times (p = 0.003), VAI - 2.6 times (p = 0.04), TGI x BMI - 2.3 times (p = 0.03), TG/HDL - 2.1 times (p < 0.001) and TGI - 1.1 times (p < 0.001). When analyzing the correlation links of IR with inflammation indicators, a direct correlation was found between TG/HDL and the levels of IL-8 - r = 0.63 (p = 0.02), IL-6 - r = 0.52 (p = 0.04) and AST - r = 0.56 (p = 0.001). TGI correlated with the level of IL-8 - r = 0.65 (p = 0.02). Conclusion. TG/HDL, an easily accessible and inexpensive index of insulin resistance, has demonstrated diagnostic value as a surrogate marker of inflammation in MASLD.

The article presents a brief review of current data on the etiology, pathogenesis, diagnosis and treatment of Wilson disease. Wilson-Konovalov disease (Wilson’s disease, hepatolenticular degeneration, hepatocerebral dystrophy) is a rare severe hereditary autosomal recessive disease caused by homozygous or compound heterozygous mutations (the presence of two different mutant alleles) in the ATP7B gene encoding transmembrane copper-transporting ATPase that mediates the excretion of copper into bile and delivers copper for the synthesis of ceruloplasmin. The article also presents a clinical observation of a young patient with an unrecognized onset of the disease in the form of psychiatric disorders. Subsequently, due to the increase in hepatocellular insufficiency in the form of persistent icteric syndrome, hepatic encephalopathy, decreased protein-synthetic function and coagulation factors, the patient was hospitalized in a multidisciplinary hospital, where a diagnosis of Wilson-Konovalov disease was established.

To assess the effect of gastrostomy feeding on the intestinal microbiome, a non-randomized retrospective study of 21 children aged 0 to 17 years was conducted. 3 groups were formed: the first group included children with a duration of gastrostomy feeding for less than a year, the second group - more than a year, and the third control group, which included children receiving oral feeding in accordance with age norms. 16S sequencing of the material (feces) was performed with subsequent determination of the taxonomic units of the intestinal microbiome and statistical processing of the results. Patients in groups 1 and 2 were found to have a decrease in microbial diversity compared to patients in group 3. Representatives of the phyla Euryarchaeota and Synergistota were significantly more common in intestinal microbiome of patients receiving gastrostomy feeding. Bacteria of the phylum Cyanobacteria, on the contrary, are more common in colon of children fed orally. The prevalence of representatives of the Methanobacteria class in the fecal microbiota was significantly higher in the group of children who received gastrostomy. The abundance of bacteria belonging to the Campylobacteria, Fusobacteriia and Synergistia classes was significantly higher in patients who received nutrition through a gastrostomy. The clinical significance of the identified changes requires further research. On the one hand, Campylobacteria and Fusobacteriia are opportunistic microorganisms and can participate in the development of infectious and inflammatory processes. On the other hand, representatives of the Euryarchaeota and Synergistota types are important participants in protein degradation and have an indirect anti-inflammatory effect.

Purpose: To carry out histologic and IHC study of MCR vessels, glial and nerve cells in the intestinal wall, to compare the revealed changes with the character of clinical manifestations in Hirschsprung's disease Materials and Methods. The study included 10 cases with complaints of chronic constipation with various complications, depending on the duration of the disease. The cases were referred from the surgical department with a provisional diagnosis of Hirschprung's disease with a lifetime pathologoanatomical diagnosis using selective staining. Results. In spite of the generally accepted “gold standard” immunohistochemical diagnostics with antibodies with calretinin, in the practice of pathologists there are more and more frequent cases where the results of ganglion neurons examination are not enough to substantiate the diagnosis. Histologic and immunohistochemical study of microcirculatory vessels, glial and nerve cells in the intestinal wall, comparison of the revealed changes with the character of clinical manifestations on the example of 10 cases in patients of different age was carried out. Conclusion. Based on the data of morphological study, the lesion of microcirculatory vessels can cause the development of hypoxia, which should be considered as the main pathogenetic factor causing characteristic changes in the structures of the intestinal wall in Hirschsprung's disease.

Introduction. Permanent stoma (PS) is one of the most unfavorable outcomes of Hirschsprung's disease (HD) treatment, permanently depriving the patient of the opportunity to realize the physiological needs for defecation. The article analyzes own and literature data on the causes of PS. The purpose of the study. To analyze the results of treatment of patients with HD who underwent a treatment method in the form of a permanent intestinal stoma. Materials and methods. The study included 367 patients with HD who received treatment during the period from 2016 to 2024 was carried out. Most of the children underwent radical surgery in different clinics using the Soave-Georgeson method. Among them, PS occurred in 8 cases. The reason for the permanent stoma was long-term recurrent complications: abscesses (n=7), fistulas of the perineum (n=5), fecal incontinence (n=6) and rectal stenosis (n=2). 3 patients had syndromic forms of HD, total agangliosis (TA) was diagnosed in 5 cases. Results. The analysis confirmed that permanent stoma formation in Hirschsprung’s disease (HD) is a necessary measure driven by severe complications such as anastomotic failure, recurrent abscesses, fistulas, and fecal incontinence. Key risk factors for permanent stoma (PS) include total aganglionosis (TA) and delayed specialized surgical intervention. The statistically significant association between TA and PS (p=0.002) and between delayed treatment and stoma risk (p=0.023) underscores the importance of early diagnosis and timely radical surgery. Patients with syndromic forms of HD require particular attention due to their increased risk of adverse outcomes. Conclusion. The study highlights the need for individualized surgical approaches, improved anastomotic techniques, and dynamic postoperative monitoring to minimize PS risk. Reducing the frequency of stoma formation may be achievable through optimized timing of surgical interventions, especially in total forms of HD, and proactive prevention of postoperative complications.

Purpose of the study: to investigate the relationship of polymorphisms of the fatty weight associated (FTO) gene: p.23525T>A, p.A23525T (rs9939609), leptin receptor (LEPR) gene: p.233A>G, p. Arg223Gln (rs1137101) with the development of NAFLD on the background of obesity. Materials and Methods. A cross-sectional (one-stage) study was carried out in which 80 children aged 10-17 years were examined. Nucleic acids were isolated using a set of reagents “DNA-EXPRESS-blood” based on lysing solution. The study of polymorphic variants of the gene was carried out using “SNP-EXPRESS” kits by PCR method. Results. Children with obesity and NAFLD have statistically significant changes in the levels of AsAT, AlAT and other parameters characteristic of hepatobiliary system damage. The association of LEPR gene polymorphisms with NASH in obese children was revealed, as well as the protective effect of carrying the FTO gene genotype in relation to the development of NASH. Discussion. NAFLD is caused by multiple risk factors, including genetic aspects, which may contribute to the development of this pathology. Based on a number of domestic studies, an association between this disease in obese children and the presence of polymorphism of the LEPR gene, which is involved in the regulation of nutrition, encodes a protein that plays a key role in energy metabolism and metabolism, has been identified. This was confirmed by the results of our work. There is no information about the influence of the FTO gene and its polymorphisms on the development of NAFLD. Conclusion. Thus, the identification of genetic variants associated with the risk of developing NAFLD may be an important direction for early diagnosis and prevention of this disease in obese children.

Despite the end of the pandemic, today more than 1000 different genetic lines of the Sars-Cov-2 virus continue to play an epidemiological role in the circulation of the infection. The severity of the disease with the strains circulating today has significantly decreased, but the prevention of the so-called post-COVID syndrome, a symptom complex that includes a variety of symptoms that often persist for weeks, months and even years after the acute period of the disease, has become especially relevant. It is noted that in the post-COVID period, the frequency of gastrointestinal manifestations increases in adults and children. In adults, the presence of gastrointestinal manifestations of COVID-19 during and after the disease is associated with a malfunction of the intestinal microbiota-lung axis. The pathogenesis of gastrointestinal symptoms in the post-COVID period in children is poorly understood. Objective: Based on clinical, anamnestic, molecular biological and immunological methods, to identify the main pathogenetic mechanisms for the development of gastrointestinal symptoms in the post-COVID period in children. Materials and methods. Calculation of risk factors for the development of gastrointestinal symptoms after coronavirus infection in children and analysis of pathogenetic mechanisms for the development of these symptoms in the post-COVID period were carried out using a neural network. A combined method of global optimization, random search, inertial and genetic algorithms was used. The structure of the neural network included an input layer of 7 neurons, 2 hidden layers of 10 and 9 neurons, and an output layer of one neuron. Results. Using a neural network, 5 signs accompanying the presence of post-COVID gastrointestinal symptoms in children a month after recovery from a new coronavirus infection were identified.

Tufting enteropathy (Intestinal Epithelial Dysplasia, IED) is a rare genetic disease that manifests from the first days of life with severe intractable diarrhea, leading to profound protein-energy malnutrition, acidosis, and dehydration. In most cases, it results in partial or complete dependence on parenteral nutrition. The disease is caused by mutations in the EpCAM and SPINT2 genes and presents in two main forms: the typical form, characterized by refractory diarrhea, and the syndromic form, which includes congenital malformations such as anal and choanal atresias, as well as ophthalmological abnormalities. Diagnosis is based on a combination of clinical presentation and histological findings, including villous atrophy and disorganization of enterocytes with focal tufting. Genetic testing to detect mutations in the EpCAM and SPINT2 genes plays a crucial role in confirming the diagnosis. The primary treatment option remains small bowel transplantation. However, the high mortality rate, diagnostic challenges, and the absence of pathogenetic therapy underscore the unfavorable prognosis of the disease. The relevance of this topic is determined by the complexity of diagnosis, the rarity of the disease, limited awareness among healthcare professionals, high mortality, and the lack of pathogenetic treatment. These factors contribute to poor prognosis and reduced quality of life for patients, emphasizing the need for a deeper understanding of the disease’s pathogenesis and the development of new therapeutic approaches. This article reviews current knowledge on the pathogenesis, clinical manifestations, diagnostic methods, histological and genetic aspects, as well as treatment prospects and disease outcomes. The discussion of key issues related to tufting enteropathy aims to improve diagnostic accuracy and therapeutic outcomes, highlighting the need for further research to develop innovative treatments.

Background: Acute mesenteric ischemia is a surgical problem characterized by extremely high mortality and doesn`t decrease. Description of a clinical case: Two cases of successful treatment of patients with the background of a severe comorbid diseases in acute thrombosis of the superior mesenteric artery using transcatheter thromboaspiration are presented. Results: In the presented clinical cases, minimally invasive treatment was possible. The decision was based on the clinical picture and multispiral computed tomography results, in the absence of clinical and instrumental signs of peritonitis or intestinal wall destruction in MSCT. Despite the successful results, questions for further discussion and study were formulated. Conclusion: Transcatheter thromboaspiration is an effective and safe alternative to open thrombectomy. Postoperative diagnostic laparoscopy is necessary for intraoperative diagnostics of intestinal viability. The timing of diagnostic laparoscopy requires discussion. Today, in patients with suspected acute mesenteric ischemia, with a high level of clinical alertness, the chance for a successful prognosis is based on spiral computed tomography, angiography, endovascular interventions for intestinal revascularization. This treatment should be performed in a multidisciplinary hospital with appropriate technical capabilities, as well as a multidisciplinary team.

Introduction: Treatment methods for hemorrhoidal nodes (hemorrhoids) are still controversial. Despite many advances in surgery, postoperative pain and discomfort remain major treatment problems. Laser haemorrhoidoplasty (LHP) is a minimally invasive procedure that uses a diode laser to reduce hemorrhoidal nodes. This study aims to evaluate the efficacy of LHP in patients with grade II-III hemorrhoids. Material and Methods: The study included patients with grade II-III hemorrhoids who underwent LHP using a 1470/1064 nm diode laser. It studied the operation time, postoperative pain and complication rates, and how quickly patients returned to normal life. It also assessed the incidence of recurrence of hemorrhoidal nodes or symptoms during a minimum follow-up period of 6 months. Fifty patients (28 men and 22 women) were included in the study. Results: There were no complications during the procedures. The level of postoperative pain (12, 18, and 24 hours after the operation), determined by visual analog score, was very low (mean 2). No spontaneous postoperative bleeding was observed, and all patients returned to their daily life 2 days after surgery. With a mean follow-up of 8.6 months, the recurrence rate was 0%. LHP showed high efficacy in selected patients. Conclusion: The key advantages of this technique were low postoperative pain, only small perianal wounds, no need for special anal hygiene measures, and short operative time. Thus, LHP, which provides minimal postoperative discomfort, can be considered a painless and minimally invasive procedure for the treatment of hemorrhoids.

Objective of the study. To evaluate the effect of a high-fat diet in female rats on body weight, visceral fat deposits, biochemical and hematologic parameters in first generation offspring in an experiment. Materials and Methods. A control group of females receiving a normal fat diet (NFD) and a group receiving a high-fat diet (HFD) participated in the experiment. The diet was implemented before pregnancy, during pregnancy and during lactation. Male offspring within the group were divided into subgroups receiving the NFD and HFD. Feeding of males was continued for 2 months. Results. Mean weight (g) of HFD females 280.3±14.9, NFD 302±16.7; (p<0.05). Mean weight (g) of offspring of male offspring of NFD/HFD 201,9±28,7; NFD/NFD 198,2±28; HFD/HFD 207,8±29,1; HFD/NFD 185,9±27,3; (p>0,05). No relationship was found between male body weight dynamics and maternal diet [F (1, 79) = 0.002554, P=0.9598]. The increase in body weight of males was due to their diet [F (39, 79) = 2.282, P=0.0010]. The visceral adipose tissue mass ratio was predominantly HFD/HFD (p<0.05). The hemoglobin level of HFD/NFD was 6% higher than that of HFD/HFD (p<0.05). Statistically significant differences in cholesterol levels were determined between NFD/HFD and HFD/NFD (p<0.05). LDH levels were 47% lower in NFD/NFD than HFD/HFD (p<0.05). TNF-α level in NFD/HFD was 6 times higher than HFD/NFD (p<0.05). Statistically significant differences in glycemia levels at 120 min were determined between HFD/NFD and NFD/HFD (p<0.05). The glycemia level at 120 min averaged 5.9±0.6 mmol/L in the HFD/NFD group and 7.1±1.24 mmol/L in the NFD/HFD group. Conclusion. No changes in body weight, dynamics of feed and water consumption, and intergroup differences in glycemia levels were observed in females and offspring of first-generation males derived from females on HFD. No inflammatory or metabolic changes were detected. It is reasonable to consider a number of other alternative models of obesity

Ulcerative colitis (UC) and Crohn’s disease (CD) belong to the group of inflammatory bowel diseases (IBD), being chronic relapsing inflammatory conditions of the gastrointestinal tract. There is a continuous increase in morbidity and disability among the working-age young population aged 20-40 years. The most effective method for studying the pathogenesis of the disease and developing new lines of therapy remains experimental modelling of IBD in vivo. There are more than sixty different experimental models of UC and BC in animals, which include chemically induced colitis (oxazolone, TNBS, sodium dextran sulfate, acetic acid), models with adaptive T-cell transfer, genetic models, models with spontaneous mutations, and models induced by changes in the composition of the intestinal microbiota. Despite the results obtained in animal studies and which have made a huge contribution to the study of the mechanisms of IBD, today there is no ideal model that would ensure full compliance with the clinical situation. When choosing an experimental model, a number of factors should be taken into account, namely, the localization of inflammation, the nature of the inflammatory stimulus, the dynamics of the course of inflammation, the features of the immune response and the composition of the cellular infiltrate, as well as the presence of chronic complications specific to the two most important forms of IBD.

Intraoperative assessment of tissue viability of hollow organs of the gastrointestinal tract during surgical interventions for acute mesenteric ischemia and a number of other surgical operations remains an unsolved problem. Existing methods for determining tissue viability limits in conditions of acute circulatory failure are characterized by a low sensitivity, which determines the choice of surgical treatment tactics for the patient. The aim of the work was to assess the effectiveness of the intraoperative fluorescence visualization technique for ischemic changes in the intestinal wall using a new device “MMC Scope ICG”, which allows using the V / Q-ICG method of research for quantitative angiography with indocyanine green (ICG), performed in the near infrared range. Wistar rats were divided into four groups: 1) 15-minute, 2) 30-minute, 3) 45-minute and 4) 60-minute intestinal ischemia, which after 30 minutes of reperfusion underwent recordings of curves of changes in time of ICG fluorescence brightness in zones with ischemic and reperfusion damage of intestinal tissue in comparison with control areas of healthy intestine. The analysis of relationship between changes in the indicated dynamic curves of indocyanine green fluorescence intensity and typical morphological changes in rat intestinal samples shows direct (positive) relationship between the dynamics of the increase in indocyanine green fluorescence intensity and the degree of morphological changes in the damaged area of the intestine

This article analyzes the pathogenetic mechanisms of thrombus formation in inflammatory bowel diseases (IBD). The main processes leading to the activation of the coagulation cascade are discussed, including chronic inflammation, endothelial dysfunction, and immunomodulatory reactions that contribute to the development of thrombosis. The study pays special attention to risk factors such as genetic predisposition, comorbidities, and features of the pathogenesis of IBD. It also considers the effect of drugs used to treat IBD, including glucocorticosteroids, immunosuppressants, and biological drugs. It evaluates how drug therapy can change thrombus risk profiles and worsen the patient’s prognosis. In addition, the article analyzes modern diagnostic markers, including not only D-dimer, but also microvesicles, microRNA, and many other coagulation indicators. Existing risk assessment scales are presented that facilitate diagnosis and timely adoption of preventive measures. Attention is also drawn to anticoagulant therapy in patients with IBD as an important area for the prevention and treatment of thromboembolic complications. In conclusion, a number of possible directions for future research are proposed aimed at identifying new biomarkers, creating more accurate risk scales, and optimizing treatment strategies for IBD in order to reduce the likelihood of thrombotic complications and improve the quality of life of patients.

The review article discusses age-related obesity, sarcopenia with obesity, sarcopenia without obesity in the elderly and old people. According to the results of large epidemiological studies, it is known that sarcopenia is more often observed in the elderly and old people, but can develop in young people and even in children with severe diseases, which is due to the development of chronic inflammatory, autoimmune, endocrine and oncological diseases, impaired motor activity, lack of balanced nutrition, i. e. the resulting sarcopenia can be both a consequence and a cause of various diseases. The main indicator of probable sarcopenia is reduced muscle strength measured by a dynamometer. Currently, a distinction is made between primary sarcopenia, which developed as a result of age-related changes, without other causes, and secondary sarcopenia, which occurs against the background of chronic diseases, pathological conditions. A distinction is made between acute and chronic sarcopenia, where acute sarcopenia lasts less than 6 months and is usually associated with an acute illness or injury; chronic sarcopenia lasts 6 months or more and is caused by chronic progressive diseases. It is well known that as a person ages, the amount of adipose tissue in the body increases with a gradual loss of muscle mass. Age-related accumulation of adipose tissue in the elderly and old people can be combined with sarcopenia, and then sarcopenic obesity develops, that is, a combination of age-related decrease in muscle mass with an increase in the amount of adipose tissue. Sarcopenic obesity is associated with inflammation, an increased risk of fractures and is observed in patients with visceral obesity, but older people with excess accumulation of subcutaneous fat have a lower mortality rate, which corresponds to the modern concept of the “obesity paradox”. Currently, there are more than 500 articles in the literature with conflicting results on the effect of obesity on sarcopenia.

The article explores modern methods for diagnosing gut microbiota disorders, including cultural, molecular-genetic, and chromatographic approaches. Their advantages, disadvantages, and clinical significance are highlighted. A significant milestone was the adoption of the international consensus standardizing microbiome diagnostic practices. The article emphasizes the need to select diagnostic methods based on research goals and clinical conditions, considering accuracy, availability, and cost.

Currently, the treatment of patients with perianal manifestations of Crohn's disease is a complex task that requires an integrated approach. Existing methods of surgical correction are often only temporary, the rate of relapse of the disease remains high. Unsatisfactory treatment results, especially in the late postoperative period, a small number of clinical observations in published scientific papers devoted to the treatment of perianal fistulas against the background of Crohn's disease, the lack of a unified treatment strategy for these patients, as well as the low reliability of the results, determine the need for further research.

Crohn’s disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract (from the mouth to the anus).Malnutrition affects 65-75% of patients with Crohn’s disease, and it is now generally accepted that diet is of primary importance in the treatment of the disease.In this review, we would like to highlight the most recent discoveries in the field of nutrition for the treatment of Crohn’s disease.Our analysis will cover a wide range of topics, from established diets to new nutritional theories, as well as recent progress in new research areas such as nutrigenomics.

Cardiovascular diseases (CVD) remain one of the leading causes of mortality worldwide, especially in developed countries. In recent years, researchers have focused on the role of gut microbiota and its metabolites in the development and progression of CVD. The gut microbiota produces various metabolites, such as short-chain fatty acids (SCFAs), trimethylamine-N-oxide (TMAO), secondary bile acids, and tryptophan derivatives, which can influence the cardiovascular system. TMAO, derived from dietary components (choline, carnitine), is associated with an increased risk of atherosclerosis, inflammation, and thrombosis. High levels of TMAO correlate with an increased incidence of cardiovascular events, such as myocardial infarction and stroke. In contrast, SCFAs have anti-inflammatory properties, improve endothelial function, and reduce the risk of CVD. Secondary bile acids and tryptophan derivatives also play an important role in regulating inflammation and vascular function. Research suggests that modulating the microbiota through diet, probiotics, and prebiotics could be a promising approach for the prevention and treatment of cardiovascular diseases. Thus, the study of the intestinal metabolome opens new opportunities for identifying biomarkers and developing personalized strategies for the treatment of cardiometabolic diseases.

Irritable bowel syndrome is one of the most common, and at the same time one of the most controversial pathologies of the gastrointestinal tract. Over the years, leading experts in the field of functional bowel disorders have been creating new criteria to facilitate the work of practitioners. This article is devoted to the literature review in connection with the release of the new Rome criteria IV revision. We attempted to analyze the new features of the pathophysiological basis of IBS, as well as to study the changes in the classification and diagnostic criteria of this pathology. As a result of the work of the new consensus, opioid-induced constipation was singled out as a separate category for the first time.

One of the diseases that occurs under the “mask” of irritable bowel syndrome (IBS) is disaccharidase deficiency, which develops due to the deficiency of disaccharide hydrolysis enzymes. The probability of disaccharidase deficiency in a patient with IBS-like symptoms is quite high and reaches 22-26%. Disaccharide intolerance develops against the background of congenital or acquired galactosidase deficiency. Beta-galactosidase is an enzyme, often called lactase, that catalyzes the reaction of hydrolytic cleavage of non-reducing residues of beta-D-galactose in milk sugar, the disaccharide lactose. Impaired or decreased synthesis of beta-galactosidase is the cause of intolerance to milk and dairy products. Lactose intolerance is diagnosed based on a thorough collection of complaints, anamnesis, physical examination and medical tests. A connection between symptoms and the intake of dairy products is traced. In this regard, a patient who has come to the doctor for the first time with IBS symptoms is recommended to keep a food diary. Poor milk tolerance appears within 1-1.5 hours after consuming dairy products. Rumbling, abdominal pain, loose stools and bloating appear. The severity of clinical manifestations of lactase deficiency often does not correlate with the degree of decrease in enzyme activity. Lactose intolerance is associated not only with the level and activity of the enzyme, but also with the number of lactose-fermenting bacteria. Lactase deficiency is combined with manifestations of excessive bacterial growth in the small intestine, which affects the clinical symptoms and their duration. Diagnosis is made by performing a hydrogen breath test to confirm excessive colonization of the small intestine. Treatment of lactose intolerance involves dietary changes, taking lactase-containing enzymes, and treating the underlying disease in patients with secondary lactase deficiency.

Cholecystectomy continues to be the main method of treating gallstone disease. This is one of the most frequent surgical procedures in the world. Despite the continuous improvement of techniques and good surgical results, the consequences of cholecystectomy for the physiology of the gastrointestinal tract and metabolism in general can be unfavorable. In the absence of a gallbladder, the mechanics of digestion change, which affects the condition of the digestive tube, hepatobiliary system, and pancreas. In addition, without a gallbladder, the body suffers from the modulation of the flow of bile acids, which normally should compensate for the metabolic stress caused by eating. The article highlights the most important aspects of the effect of cholecystectomy on the gastrointestinal tract, the mechanisms of these effects and the results of modern research on these issues.

Potassium-competitive acid blockers (P-CABs), such as tegoprazan, are a new class of drugs that can completely block the potassium-binding site of the gastric H+/K+ ATPase, potentially overcoming the limitations of proton pump inhibitors (PPIs). Tegoprazan was developed by CJ Healthcare (Republic of Korea) for the treatment of gastroesophageal reflux disease and Helicobacter pylori infection. Tegoprazan is independent of CYP2C19 metabolism, which emphasizes its importance in decision-making on difficult-to-treat conditions such as peptic ulcer, refractory gastroesophageal reflux, antibiotic-resistant H. Pylori, especially in some regions of the geographic regions. High efficiency of tegoprazan in the treatment of nocturnal acid breakthroughs, when used in 14-day eradication regimens together with bismuth, clarithromycin, recommended by international and national professional societies. When comparing the efficacy and safety with various PPIs and other P-CABs used to treat acid-related diseases, tegoprazan shows a small number of easily tolerated and eliminated undesirable side effects. Tegoprazan demonstrates a rapid onset of action, direct action on the proton pump (without turning into a prodrug), its complete inhibition starting from the starting dose, a high duration of the therapeutic effect, prevention of nocturnal acid breakthrough, can be taken regardless of meal time.

This article discusses the clinical case of a giant duodenal bulb ulcer with multiple concomitant complications in the form of ulcer penetration into the pancreas and hepatoduodenal ligament, ulcer bleeding, and ulcer perforation. Duodenal suture failure and iatrogenic damage to the choledochus contributed to the development of local biliary fibrinous peritonitis. The patient underwent surgery three times: gastric resection by Hand and two rehabilitation relaparotomies. Despite intensive therapy in the Department of anesthesiology and intensive care, the patient's condition progressively worsened, and the patient died.