Clostridium difficile (Clostridioides difficile) infection is an important public health issue due to its high incidence, high risks of recurrences, attendant severe complications and death, as well as long length of hospital stay. In 2017, the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) updated 2010 clinical practice guidelines for C. difficile infection. The article provides a brief overview of the updated IDSA/SHEA guidelines (2017). A critical look at these updated guidelines, considering some Russian and international recommendations, provides insights into effective strategies for treatment and prevention of C. difficile infection. Some promising strategies for primary prevention, treatment and prevention of C. difficile-associated disease recurrence with probiotics, human monoclonal antibodies against C. difficile toxin B (bezlotoxumab), intravenous immunoglobulin (IVIG) and vaccines, based on detoxified or recombinant forms of toxins, are highlighted in the article.

The aim of the study was to evaluate the gastroprotective effect of Alflutop solution for injection (K. O. Biotechnos S. A., Romania) on gastropathy induced by diclofenac in rats. Materials and methods: rats were treated with Alflutop (intramuscularly) and diclofenac (intragastrically) for 20 consecutive days. The levels of prostaglandins (PG) were estimated in stomach tissue homogenate supernatant using 4 groups, for the pathological study - 2 groups. Results: diclofenac administration resulted in development of lesions of the gastric mucosa. The 30% of animals treated with diclofenac and Alflutop did not demonstrate any pathological abnormalities, whereas pathological changes were observed in 100% of animals treated with diclofenac only. The decrease in the frequency and severity of desquamation of the epithelium was detected in the animals treated with Alflutop and diclofenac compared with the diclofenac group. Measurement of PG in stomach tissue homogenates showed that diclofenac induced decrease of the PGE₂, PGF_2α and PGI metabolite - 6-keto-PGF_1α. After discontinuation of diclofenac, PG levels continued to decline. The decrease of PGF_2α and 6-keto-PGF_1α was most pronounced (up to 16 and 20 times). Alflutop treatment was found to normalize the gastric levels of PGE₂ and 6-keto-PGF_1α by the 41^th day of the experiment. Reduced by diclofenac PGF_2α level was reinstated in the Alflutop group on the 21^th day, on the 41^th day PGF_2α concentration exceeded the levels of the control group. Conclusion: thus, Alflutop therapy resulted in rapid recovery of PG synthesis which had been suppressed by diclofenac. The potential mechanisms of Alflutop gastroprotective effects are discussed.

A comparative study of differentiation of CD3+CD4+ peripheral blood lymphocytes of healthy volunteers (n=30) and patients with irritable bowel syndrome (IBS, n=22) was conducted using multicolored flow cytometry. In patients with IBS, The level of T-helpers of Central memory (CM), CD45RA-CD62L+ in patients with IBS significantly exceeded the values of the control group. Among the General population of CCR6+ CM Th17 there were significant increases in the percentage of DN Th17 (from 2.58% (1.55; 3.15) to 3.14% (2.53; 4.09) at p=0.011) and Th17.1 (from 9.42% (7,594 10.52) to 10.08% (10.33; 14,48) at p=0,002) when compared with the control. Moreover, IBS showed a change in the subpopulation composition of follicular T-helper cells (Tfh). Thus, in patients with IBS the relative content of Tfh2 cells and not yet described in detail Tfh with phenotype CXCR3+CCR6-CCR4+ decreased, while the level of two populations of Tfh with properties of Th17 (DN Tfh17 and Tfh17.1) significantly increased. The detected changes in the composition of Tfh suggest the presence of changes in the functioning of a specific humoral immune response in this disease. Consideration of the participation of these cells in the pathogenesis of IBS stimulation and differentiation in lymphocytes - the subject of further research. The revealed features of the subpopulation composition of T - lymphocytes complement the existing understanding of the mechanisms of occurrence of this disease and should be taken into account in the diagnosis, therapy and prevention of complications of this disease.

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease, leading to deterioration in the quality of life, invalidism and mortality, due to the high risk of progression with the development of nonalcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma. In the development of NAFLD, an important place is given to systemic inflammation, which determines the development of metabolic and clinical manifestations against the background of genetic predisposition initiating the development of NAFLD, and its progression to NASH, fibrosis, cirrhosis and hepatocarcinoma. Laennec is a multicomponent drug based on the hydrolyzed of human placenta, which has a proliferative effect on the hepatocytes, connective tissue cells, other structures of the liver. This paper presents the results of the analysis of molecular mechanisms of action of peptide components of Laennec on pathophysiological mechanisms of development and progression of NAFLD. The efficacy of the drug in patients with NASH in the form of monotherapy for 4 months was shown. Conclusion: it was found that one of the drugs that contribute to the reduction of systemic inflammation in NAFLD is Laennec.

Influence of glucocorticosteroid (GCS) therapy on mineralization and bone metabolism in children with inflammatory bowel disease (IBD) was studied. 113 children (64 males and 49 females) with IBD were included in the study. Bone mineral density (BMD) of lumbar spine (DEXA) was assessed. Level of serum osteocalcin (OC), C-terminal telopeptides (CTT), parathyroid hormone (PTH), serum calcium, alkaline phosphatase and 25 (OH) vitamin D was measured to evaluate bone metabolism. Therapy in all patients was studied: type of the therapy, duration, dosage. In all patient who received GCS cumulative dose was calculated. 74,3% patients received GCS. Median cumulative dose of GCS was 48,8 mg/kg, majority of patients received just one course of GCS. We found negative correlation of BMD with cumulative dose of GCS (r= -0,24, p<0,05). It was shown in the study that main parameters in patients who received GCS in cumulative dose less than 100 mg/kg were no difference than parameters in patients who didn’t receive any steroids. Thus we suppose that this dose of GCS is relatively safe for bone metabolism and mineralization.

The article presents data on the etiology, classification and pathogenesis of constipation, discusses modern approaches to the diagnosis and treatment of patient data according to the latest recommendations. Constipation is extremely common in medical practice. Manifestations of constipation adversely affect the quality of life of patients, their daily activity and exacerbate the course of somatic pathology. Depending on the cause, primary, secondary and idiopathic constipation are distinguished. In the pathogenesis of constipation, an important role belongs to impaired motility of the colon, the functioning of the rectum, anal sphincter, muscles of the pelvic floor and the abdominal wall. When examining a patient, possible causes of constipation should be identified, and anorectal pathology should be excluded. In the treatment it is necessary to use a comprehensive and a stepwise approach. As a first-line therapy, osmotic (polyethylene glycol) and stimulant laxatives are recommended. Conclusion. Knowledge of the causes, pathophysiology and diagnostic criteria will allow clinicians to differentiate between subtypes of constipation followed by the appointment of effective treatments.

Aim. To analyze safety and efficacy of achalasia treatment options from the viewpoint of high-resolution esophageal manometry data. Methods. Literature search was performed in the database of National Center for Biotechnology Information, USA (NCBI) with the use of Keywords “achalasia” in combination with “high resolution esophageal manometry”, “treatment”, “effectiveness”. Inclusion criteria for study results were: type of study -original study or systematic review/meta-analysis; use of high-resolution esophageal manometry (HREM) to confirm and/or evaluate the effectiveness of treatment of achalasia; verified diagnosis of achalasia; availability of data at least in the form of an abstract; age of participants 18 y. o. or older; English or Russian language of the publication; presence of quantitative characteristics supporting conclusions and sufficient to check accordance with the mentioned criteria. Duplicate publications were excluded. Treatment efficacy was assessed on the basis of resolution of symptoms and/or HREM studies. Assessment of safety was retrieved from the presented data when possible. Results. Literature search with the use of keywords gave 1256 of the publications. The final analysis included 65 works selected according to the inclusion criteria. In most of studies analysis of safety and efficacy was related to treatment of achalasia with the use of balloon pneumodilation (EBD), peroral endoscopic myotomy (POEM) and laparoscopic Heller’s myotomy (LMH). The overall effectiveness of these methods ranged from 70 to 100%. In general, higher overall treatment efficacy was observed in type 2 achalasia (about 90-96%). Lower rates of overall treatment efficacy were related to type 3 achalasia especially when EBD and LMH were used. Low rate of efficacy does not allow to recommend the use of EBD when type 3 achalasia is poresent. Minimally invasive endoscopic treatment methods (POEM), allows to regulate the length of myotomy, and reach higher rates of the treatment efficacy in cases of spastic achalasia. Relatively small number of studies assessed the efficacy of non-surgical options of treatment of achalasia (botox injections, L-type Calcium channels blockers, donators of nitrogen oxide, etc.). These methods demonstrated low efficacy and may be used in those cases when surgical treatment is not possible. Conclusions. The use of high-resolution esophageal manometry allows to differentiate when making a choice of the treatment strategy in patients with achalasia, as well as to monitor the effect of the treatment afterwards. It seems reasonable to make HREM a mandatory diagnostic procedure in patients with suspected achalasia, this may help to choose optimal treatment strategy and increase its efficacy.

The aim: to assess the influence of HP pathogenicity factors (Cag A, Vac A) on atrophy, intestinal metaplasia, dysplasia of the gastric mucosa in patients with chronic gastritis (CG) associated with HP. Materials and methods: 64 patients (46 men, 18 women) with signs of chronic gastritis aged 30 to 60 years (mean age 43,5±8,4 years) were examined (fibrogastroscopy and histological examination of biopsies). Results: a direct correlation between the presence of HP pathogenicity factors (Cag A, Vac A) and the development of atrophic changes in the gastric mucosa, as well as the degree of chronization of the process and the activity of inflammation of the gastric mucosa was revealed in the groups of patients.

Aim to study structural changes in the organs of the pancreatobiliary system and pancreatobiliary ducts in patients with chronic pancreatitis (CP) of biliary genesis complicated by obstructive jaundice. Material and methods. 42 patients with CP of biliary genesis complicated by obstructive jaundice, aged - (60.5 ± 1.7) years, were examined, among them women prevailed - 59.5%. Used instrumental methods of research: ultrasound (USG) and endoscopic retrograde cholangiopancreatography (ERCP). Results. According to the ultrasound data, patients had an increase in the size of the pancreas (57.1%), liver (73.8%) and changes in their echostructure. Dilation of the biliary tract was detected in 88.1% of cases, signs of cholangitis in a third of patients. When ERCP choledocholithiasis was detected in 59.5% of cases, narrowing of the terminal portion of the choledochus - in 20.0%, stenotic papillitis - in 22.9%. Changes in the virsungian duct were detected in 16.7% of the patients, and virsungolithiasis in 8.3%. Minimally invasive treatment methods (sphincterotomy and litoextraction) were performed in 81.5% of cases. Conclusion For patients with CP of biliary genesis, complicated by obstructive jaundice, the size and structure of the pancreas and the organs of the hepatobiliary system are characteristic; dilatation of the common bile duct, due to partial or complete obstruction of its calculus and accompanied by cholangitis.

Chronic pancreatitis is a polyetiological disease characterized by progressive structural changes of the pancreas with the development of its exo- and endocrine insufficiency. In childhood, possible causes of chronic pancreatitis may be obstruction of the ducts of pancreas due to gallstone disease, chronic cholecystitis with biliary sludge, anomalies of the excretory ducts; obesity and hyperlipidemia; injuries of the abdomen and infectious lesions of the gland. In recent years, due to better diagnostics, new probable variants of chronic pancreatitis have been found: autoimmune and hereditary. According to reviewing data, more than 70% of children with idiopathic chronic pancreatitis have genetic mutations of SFTR, PRSS1 and SPINK1 genes, both single and combined. This leads to disturbance of the balance of activation and inactivation of trypsinogen in the pancreatic tissue. Severe mutations can be an independent cause of chronic pancreatitis, mild mutations manifest after environmental impact. The study included: a) family cases of pancreatitis (16 families, 37 patients); b) patients with idiopathic pancreatitis, i. e., with the presence of acute recurrent or chronic pancreatitis of unknown etiology and the absence of similar diseases among relatives (n = 21). An analysis of 19 frequent mutations in 5 known genes (PRSS1, SPINK1, CTRC, CFTR, CPA1) associated with the development of NP was carried out. Results: mutations were detected in 11 of 58 patients (19%), and in two of 190 healthy donors (2%); p <0.0001. The cause of the development of pancreatitis was identified in members of 5 of 16 (31%) families, and only in 1 of 27 (4%) patients with an idiopathic form of the disease.

Purpose: research objective was to establish interrelation between the nature of damage of a pancreas and retroperitoneal space and number of the microparticles which are formed as a result of activation and a blebbing of lymphocytes. Materials and methods. Results of the prospective cohort research which was taking place on clinical bases of department of the general surgery of the prof. M. I. Gulmana KRASGMU in 2013-2017 are presented. Group of clinical observation - 248 patients with the severe acute pancreatitis. For comparison two more groups - group of patients with not severe acute pancreatitis where 35 patients with acute pancreatitis easy and moderate severity and control group of almost healthy faces - 35 people entered were created. For visualization of necrotizing process in a pancreas and retroperitoneal space carried out on the third week of a disease (14-21 days). Blood sampling for assessment of number of lymphocytes and quantity of the circulating microparticles was performed at receipt prior to therapy. Results. The obtained data demonstrate that the microparticles of lymphocytic origin which are formed as a result of activation and a blebbing of lymphocytes can act as an early pathogenetic marker of necrotizing pancreatitis, due to high and very high correlations with a volume (rS=0,84, p <0,001) and depth (rS=0,98 p=0,007) defeats of a parenchyma of a pancreas, and prevalence of pathological process in retroperitoneal space (rS=0,82 p <0,001). Conclusion. The obtained data demonstrate that the microparticles of lymphocytic origin which are formed as a result of activation and a blebbing of lymphocytes can act as an early pathogenetic marker of necrotizing pancreatitis, due to high and very high correlations with a volume and depth of defeat of a parenchyma of a pancreas, and abundance of pathological process in retroperitoneal space.

The aim is to identify the characteristics of nutrition and their relationship with gastrointestinal symptoms in women with Gallstone Disease (GSD) with metabolic syndrome (MS). The open clinical study “series of cases” included 97 patients with GSD: group 1 - GSD with MS (n=67), group 2 - with GSD without MS (n=30), comparable in age and BMI. Criteria for MS - NCEP ATP-III, 2001. A nutritional frequency questionnaire validated at the Institute of Nutrition RAS was used. Results. In group 1, significantly less vegetable proteins (22.6 ± 1.2) and fats (29.7 ± 2.0), total carbohydrates (161.6 ± 8.5), and sugar (74.1 ± 4,5) and fibers (27.9 ± 1.7 g/day) than in group 2 (26.2 ± 1.7, 38.8 ± 3.7, 194.7 ± 15.6, 107.3 ± 12.2, 43.1 ± 6.4 g/day, respectively). In group 1, significantly more animal proteins (56.8 ± 2.4 g/day) and cholesterol (223.6 ± 12.0 mg/day) were consumed than in group 2 (45.5 ± 3.2 g/day and 188.8 ± 21.6 mg/day, p<0.05). Association between the animal fats and proteins consumption with pain and dyspeptic symptoms was stronger in group 1 than in group 2. Conclusion. Women with GSD and MS consumed less vegetable foods and more animal food, which were accompanied by an increase in gastrointestinal symptoms of gallstones.

The results of numerous studies indicate an increase in the incidence and prevalence of obesity and diabetes in various age groups. To create a system of effective prevention of complications of these diseases, it is necessary to use an interdisciplinary approach. In order to comprehensively apply preventive measures, the epidemiological features of obesity and diabetes are studied. In the study, groups with high morbidity, frequency of complications and the main causes of death were identified. In St. Petersburg, the highest incidence of obesity is observed among adolescentso - 13.3 per 1000 surveyed. Diabetes mellitus is most common among the working population - 5.0 per 1000 patients. Deach rate due to diabetes complications was 20.5 per 100,000 population.

Today there are many proofs that the microbiota can have an impact on organism owner body weight, increasing efficiency of extraction of energy from the absorbed food, first of all - from polysaccharides. During too time and a dietotherapy considerably affects structure of a microbiota, for example, the diet with the high content of fats can change structure of bacteria in intestines. It is known that at identical consumption of food and the mode of exercise stresses the different susceptibility to increase or decrease in body weight is noted. As the reason serves various metabolic activity of a microbiome of the person, including various composition of intestinal microflora. Influence of intestinal microflora on development of atherosclerosis, obesity, the metabolic syndrome (MS) is proved, diabetes mellitus (DM), non-alcoholic fatty liver disease (NAFLD), irritable bowel syndrome (IBS). The research objective consisted in normalization of intestinal microflora of patients with obesity for optimization of process of a dietotherapy and rehabilitation in general. The research was conducted in two large networks fitness of downtowns of St. Petersburg and in the center of recovery medicine and correction of weight of medical holding of “Physician” (base of department of physiotherapy exercises and sports medicine of SEI VPO to SZGM by it I. I. Mechnikov) with the 2016-2018th. Three hundred patients 180 (60%) women and 120 (40%) men with the diagnosis the excess body weight (preobesity) (BMI> 24.99) and obesity (BMI> 29.99) (the recommendations of WHO of 1997) were divided into two groups - the main and control. To each of the examined patients the analysis a calla on an intestinal dysbiosis with sensitivity to bacteriophages was made. As a result of a research significant decrease in own microflora (86.45%) of intestines of patients of the significant bacteria (32.56%) having obesity and also growth existence etiologically was revealed. For normalization of intestinal microflora drugs of the following groups were used: adsorbents; means the normalizing microflora, in combinations; antidiarrheal means; bakteritofag. After the carried-out therapy on normalization of intestinal microflora on the scheme offered by us in combination with rehabilitation actions decrease in symptoms of a metabolic syndrome, diabetes mellitus, NAFLD, IBS and also reduction of terms of rehabilitation in the main group (28.56%) was noted. In this regard as the perspective direction of prevention of metabolic disturbances at patients with obesity use of the scheme of normalization of intestinal microflora offered by us can be considered.

Aim: to assess the effectiveness of conservative rehabilitation with the use of biofeedback therapy in elderly patients with functional anorectal disorders and prolapse of the pelvic organs. Materials and methods. The study represents the results of a single-center prospective trial on effectiveness of conservative treatment of elderly (≥60 y. o.) patients with functional disorders of defecation and prolapse of the pelvic organs. To diagnose the presence of functional anorectal disorders we used Russian version of the specialized questionnaire “Score-system for the assessment of disorders of the evacuatory function of the colon”; high-resolution anorectal manometry (HRAM) with the standard software (Solar Gastro, MMS, The Netherlands) with 8-channel water-perfusion catheter (UniTip, Unisensor AG, USA); evacuation test with balloon and defecography, carried out according to the standard procedure. Biofeedback therapy was performed with the use of specialized hardware complexes Urostim (Canada) and WPM Solar (The Netherlands) in accordance to the standard technique. The effectiveness of treatment was evaluated after a course of biofeedback therapy using the same methods. Statistical analysis was carried out using a set of standard applications (Statistica, StatSoft, USA, MS Excel). Results. The study included 82 (89.1% of the follow-up group) women (mean±SD mean age: 64.7±5.5 years [min-max: 60-89 years]) and 10 (10.9% of the study participants) men (mean age 67.4±4.8 years [61-74 years]). According to HRAM, spasm of puborectal loop (type I manometric pattern) was diagnosed in 48/92 (52.2%) patients; type II pattern with increased pressure in the anal canal when straining relative to the pressure at rest with inadequate propulsions in 12/92 (13.0%); Type III manometric pattern with signs of incomplete relaxation with adequate propulsion - in 27/92 (29.4%) and type IV manometric pattern with inadequate propulsion - in 5 of 92 (5.4%). Positive dynamics and normalization of the state after the course of treatment were achieved in 38 (79.1%) patients with type I manometric pattern, in patients with initial type II manometric pattern - in 12 of 12 (100%), in the initial type III manometric pattern - in 20 of 27 (74.1%), and in type IV - in 5 of 5 (100.0%) patients. No adverse events were recorded during the study. No deterioration was detected in any of the cases. Conclusion: Implementation of the conservative rehabilitation with the use biofeedback therapy for the elderly patients who have functional defecation disorders leads to improvement of evacuation in 81.5% cases. Normalization of straining was achieved in 34.8% of cases, respectively.

The aim of the research is to study the influence of concentration of the tumor necrosis factor alpha (TNF-α) in the blood serum and polymorphic genes variants TNF-α (G-308A) on the clinical course of Crohn’s disease and Ulcerative colitis. Materials and methods. We examined 123 patients with inflammatory bowel diseases, observational group consisted of 40 healthy volunteers. Results. Findings of a study have shown that serum TNF-alpha level is increased greatly among the inflammatory bowel disease patients in comparison with the value of the observational group and correlates with the disease activity. Crohn’s disease patients had TNF-α polymorphic G-308A variant 6 times oftener than ones in the observational group. Patients with TNF-α -308A allele had a more severe disease, however no veridical relations between TNF-α polymorphic G-308A variant and the course of the Crohn’s disease were discovered.

Purpose of the study. To study the functional state of the digestive system in children with atopic dermatitis. Materials and methods: 40 children with atopic dermatitis aged 6 months were examined. up to 3 years. The comparison group consisted of 20 children without hereditary burden of allergies. Clinical and anamnestic studies supplemented by studying the composition of the intestinal flora in children, the dynamics of the level of eosinophils, total Ig E. Results. The first complaints of mothers, along with a skin rash in a child, were intestinal dysfunction, manifested by intestinal colic, the presence of pathological impurities in the form of greenery, streaks of blood, foam, or delayed stools up to several days.

In assessing the dynamics of clinical symptoms, the following signs were selected as analyzed signs: general condition, fever, diarrhea, and vomiting, catarrhal phenomena. The inclusion of zinc in the treatment of acute diarrhea in children contributed to a more rapid improvement in the general condition of children. Thus, in more than 2/3 of the patients of the main group (75.4%), already on the 5th day of the disease, the general condition was assessed as satisfactory; whereas in the control group this indicator was almost 2 times lower (32.3%). On the 7th day of treatment, no child had an increase in temperature, whereas in the comparison group it was observed in 2% of patients on day 7 and in 1% of children on day 10 of treatment. The inclusion of zinc drugs also has a positive effect on the rate of elimination of the main clinical manifestations of acute intestinal infections of various etiologies (viral, bacterial and their associations), which, as a result, helps to reduce the length of hospital stay and has both a clinical and economic effect.

The aim was to develop a new diagnostic tool for reservoir and evacuatory rectal functions assessment without radiation exposure and to collect normative values. Materials and methods. Literature search was performed to collect data on the limitations of the existing methods of rectal function assessment. Based on the results, we identified requirements for a new diagnostic technique development to avoid limitations of the existing methods. We developed new optical weight sensor and modified defecoflowmetry technique to make possible simultaneous evaluation of rectal reservoir and evacuatory functions. Safety and efficacy of the method were assessed based on the examination of 19 healthy volunteers, who gave informed consent to participate in the study. Results: Optical weight sensor used with defecoflowmetry allows parallel assessment of evacuation and reservoir functions of the rectum in qualitative and quantitative measures without exposure to X-ray. Preliminary results obtained in 19 healthy volunteers shows that the method is safe, well-tolerated and objective. Conclusions: the developed modified DFM technique with the original optical weight sensor is a new way to assess the functional state of the anorectal zone. The technique effectively allows parallel assessment of the evacuation and reservoir functions of the rectum without radiation exposure.

The article analyzes the literature devoted to modern ideas about NAFLD, and provides data that allow us to consider it as a predictor of the occurrence of various extrahepatic diseases. In most cases, the presence of NAFLD of different stages, having common etiological factors and pathogenesis links, is associated with an increased risk of CVD and DM 2, which adversely affects the quality and life expectancy of patients. The study of these interrelations is of great practical importance, since it will allow timely application of preventive measures of development of concomitant pathologies, carry out routine screening of CVD and DM 2 in patients with NAFLD and modify risk factors.

We studied association of the regularity and acrophase of the intestine’s circadian rhythm in survey of 356 medical students. Subjects were divided to groups with regular stool rhythm (euenteria - 7 times per week) and irregular rhythm (bradienteria - 1-6 times per week). Four variants of the intestine acrophase (evacuation time) were determined for 4 periods of the day: morning, afternoon, evening, night. It was shown that subjects with euenteria had morning acrophase of intestine 2 times more frequent than its absence. The absence of morning acrophase occurred 3 times more often than its presence. The regularity of the defecation rhythm depends on presence of the morning acrophase of this rhythm, and irregular rhythm is associated with the absence of the morning acrophase of the bowel movement. The “exellent” level of wellbeing, activity and mood in students with euenteria was higher than in students with bradyenteria.

Chronic Helicobacter pylori (Hp) gastritis is recognized as an infectious disease requiring treatment. The effectiveness of the standard seven-day triple therapy (PPI + clarithromycin + amoxicillin) has now significantly decreased as a result of the development of Hp resistance to antibiotics. To increase the effectiveness of eradication therapy, it was proposed to increase the duration of treatment to 14 days, prescribe antibiotics to which resistance rarely develops, include bismuth, probiotics, rebamipid (rebagit) in the regimen, as well as increase patient compliance as a result of using ready-made sets of drugs for course eradication therapy in one package (gastrostat, pilobact AM, etc.) or a combination of drugs in one capsule (Pylera).

The study of interdisciplinary communication between gastropathology and the course of dental diseases is an urgent problem for both gastroenterology and dentistry, as it is aimed at finding ways to treat diseases and prevent patient disability. In the practice of the dentist, it is increasingly possible to encounter various diseases associated with inadequate reaction and the work of the immune system, which is manifested in various organs and systems. The manifestation of exacerbations of various diseases in one period of time confirms the lack of work of immunity. Primary immunodeficiencies (FIDs) are hereditary diseases caused by defects in the genes that control immune responses. The article presents a clinical case of a 12-year-old girl with a primary immunodeficiency, which proceeds with autoimmune polyendocrine and hemorrhagic syndromes, who appealed to a dental clinic with complaints about the failure of the tooth 15, a prolonged painful reaction to cold in the lower first molar on the left. A history of systematic appearance of ulcers on the oral mucosa, which are not amenable to traditional therapy. Ulcerative colitis was diagnosed by gastroenterologist, and an immunologist diagnosed autoimmune multiple organ failure. The article spelled out the features of the interaction of a gastroenterologist, an immunologist and a dentist in the care of the patient