The human body, like any other, is an intermediate component of the nitrogen cycle in nature. Consuming nitrogen from the external environment in the form of various compounds, the body processes it into ammonia - one of the final products of exchange of nitrogen-containing substances [1], which is removed from the body in the form of urea. The most active ammonia producers are organs with high exchange of amino acids and biogenic amines - nerve tissue, liver, intestine, and muscles. In a state of nitrogen equilibrium, the adult body consumes and releases about 15 g of nitrogen per day, temporary or permanent disruption of nitrogen balance results in a great number of physiological conditions and diseases, and the need to stabilize it is well known. However, despite a huge number of studies on the role of nitrogen metabolism and its compounds in the clinic, to date we have not been able to find any conciliation document in the world literature on the classification of ammonia-ammonium levels in human blood and approaches to the correction of hyperammonemia, which was the basis for the emergence of this consensus.

The 8-year observation data of patients with ulcerative colitis and Crohn’s disease in the North West region are presented in the article. The patients were observed in the scientific and clinical center of Military Medical academy named after S. M. Kirov, specialized in the inflammatory bowel diseases (IBD). The aim of study is to assess the gender, age and clinical characteristics of patients with inflammatory bowel diseases, epidemiological features: factors of employment and place of residence, to study the outcomes of ulcerative colitis (UC) and Crohn’s disease (CD). Materials and methods. Retrospective analysis of 485 patient’s medical charts (373 patients with ulcerative colitis and 112 patients with Crohn’s disease) in the period from 2010 to 2018 was performed. Results. The onset of inflammatory bowel diseases is most common in the age group up to 40 years. The duration of the period before the diagnosis of ulcerative colitis and Crohn’s disease averaged 2.3 years. In UC the most frequent localization of the pathological process was left-side colon (51%), in CD - terminal ileitis (29%) and ileocolitis (27%). The anemia was the most frequent complication in both form of IBD, but structuring and penetrating complications were characteristic of CD. The most of patients (80.6%) had recurrent or continuous course of IBD. Small proportion of patients (19.4%) had sustained remission throughout the follow-up period. The frequency of surgical interventions in CD (27.6%) was comparable with the registers of the European study groups of IBD. In contrast, the frequency of colectomy in UC was significantly lower (0.8%) than in the published data of European countries, due to the predominance of mild and moderate forms of UC in the observed cohort. Mortality of patients with IBD was higher than in the General population of St. Petersburg due to the contribution of mortality from complicated forms of IBD (15.7%), while the structure of other causes of death was comparable to the General population

The article presents the results of the authors’ own observations and an overview of the main directions in clinical and experimental psychological studies of patients with irritable bowel syndrome (IBS), which includes complementary data in the framework of the modern biopsychosocial paradigm and the concept of psychosomatic relationships. The analysis confirms the complex somatocentric basis of the idea of the disease in patients using cognitively determined separation of physiological (bodily) and psychosocial determinants, which can be considered as a vector for psychotherapeutic interventions and secondary psychoprophylaxis. It is emphasized that the attitude to the disease as a socially frustrating factor has a stronger effect on the quality of life of patients and adaptive potential than the actual symptoms of the disease.

Introduction. Somatoform disorder (vegetative dysfunction), which occurs against the background of endocrine changes in the body during adolescence, is clinically inadequate vegetative regulation. Up to 50 percent of patients with primary care have physical symptoms that can not be explained by the general health status. In recent years, much attention has been paid to the problem of somatoform disorders in hypertension, chronic heart failure (CHF). There is a high prevalence of anxiety-depressive disorders, especially in patients with CHF. Unexplained symptoms of somatoform disorders often lead to more frequent visits to doctors, unnecessary visits to the clinic and laboratory tests or costly and potentially dangerous invasive procedures. The aim is to study autonomic dysfunction in patients with chronic heart failure and anxiety-depressive disorders and electrophysiological aspects of somatization of pathology in irritable bowel syndrome (IBS). Material and methods. The study was conducted in 35 patients with somatoform disorders in irritable bowel syndrome accompanied by severe abdominal pain. The study involved 25 patients with a functional class of chronic heart failure (CHF) NYHA II-III against a background of arterial hypertension (AH) of ischemic origin and 30 patients with arterial hypertension of II degree and abdominal obesity (AO). Results. All patients showed signs of anxiety-depressive or somatoform disorders, asthenia. The presence of signs of anxiety and depressive disorders in patients with CHF and AH was accompanied by violations of autonomic regulation of blood pressure level, activity of the sympathetic nervous system, frequent occurrence of cardiac arrhythmias, decreased tolerance to physical activity and deterioration of the quality of life of this category of patients. The IBS was studied by electromyography. In the descending part of the colon, an increase in the frequency and amplitude of slow waves was observed, and the power of contraction was increased to 3 times. Conclusions. Imbalance of the sympathetic / parasympathetic systems in favor of the sympathetic part of the ANS contributes to worsening of the compromised function of the vascular endothelium. These changes significantly increase the risk of developing a lethal outcome of acute myocardial infarction. The high prevalence and the associated increase in morbidity and mortality make it necessary to continue research into the regulation of regulation of somatoform disorders in chronic heart failure.

Aims: to identify the “marker” changes in the composition of intestinal microbiota in patients with disorders of carbohydrate metabolism. Materials and methods: to investigate the gut microbiota composition in association with the glucose tolerance analyzed 92 patients (Me 52,8 years): with normal glucose tolerance (n=48), prediabetes (n=24) and T2D (n=20). Metagenomic analysis was performed using 16SrRNA sequencing. Results: Firmicutes (68,2±11,9%) predominantly represented microbiota, in a less degree by Bacteroidetes (15,1±11,1%). Shannon diversity index was higher (3.71±0.56) regardless of the presence or absence of impaired carbohydrate metabolism. The representation of Firmicutes was higher (p=0,007), Bacteroidetes (p=0,01) was lower in T2D. Blautia was a dominant genus in all samples. The representation of Blautia, Serratia was lower in prediabetes than in T2D, and even lower in normal glucose tolerance. C-reactive protein and Interleukin-6 were associated with higher representation of Serratia and Paraprevotella (p<0,007). Taxonomic analysis of the faecal metagenomes revealed two fecotypes with an average silhouette value of 0.22. Subjects in each fecotype did’t differ according to sex distribution and age but differ according to high incidence of T2D (p=0.016) in fecotype where there was low index of alpha diversity (p=8.089e-05) and the representation of the enzymes that converts butyryl-CoA to butyrate. In clusters found differences according to the percentage of vitamin (B9, B2, B6, K, B12) synthesis pathway. Fecotype 1st is dominated Prevotella, Oscillospira, Flavobacterium, Sphingobacterium, Parabacteroides, while fecotype 2 by Ruminococcus, Peptoniphilus, Thiothrix, Legionella (p<0.004). Conclusions: study provides the further evidence concerning the structural modulation of the microbiota in the T2D pathogenesis.

Аim. To study the severity of chronic erosive gastritis associated with Helicobacter pylori and Epstein-Barr virus depending on the number of copies of Epstein-Barr virus in biopsies of gastric mucosa. Materials and methods. The severity of chronic erosive gastritis associated with Helicobacter pylori in the presence and absence of Epstein-Barr virus in the gastric mucosa was compared in 65 patients, divided into 4 groups depending on the detection of Epstein-Barr virus in the gastric mucosa. Result. the presence of Epstein-Barr virus in the gastric mucosa aggravates the course of chronic erosive gastritis associated with Helicobacter pylori.

Aimto study to compare the factors contributing to the development of gastric ulcer and gastric cancer in the population of the Republic of Khakassia. Materials and methods. Epidemiological screening of the ulcer was carried out by the simultaneous transverse method (n = 4217) using endoscopy, morphological, rapid urease, serological and PCR for biopsy testing of H. pylori. Patients were selected by 25% random sampling. Retrospectively investigated the epidemiological parameters of the GC (2295 patients) 2002-2017. Risk factors were studied by questioning patients with a newly established diagnosis (2018-2019). Results. The prevalence of ulcer was 8.9% in Caucasians and 4.5% in Khakasses, p <0.001. The incidence of pancreatic cancer in men is 2 and 1.28 times higher than in women, respectively. With age, the incidence of ulcer and cancer increased. The association of H. pylori with peptic ulcer is registered in both populations. Among patients with gastric cancer, 78% of respondents had H. pylori-positive status, 18% of patients had a combination with peptic ulcer. Tobacco smoking had a pronounced direct relationship with ulcerogenesis. The incidence of peptic ulcer in smokers of more than 10 packs/year of Caucasians was 17.0%, Khakasses - 17.2%, p <0.001. Among patients with gastric cancer, the fact of smoking was found in 45% of respondents; the proportion of men is 3 times more than women. Conclusion In the population of the Republic of Khakassia, conventional risk factors for peptic ulcers, such as male gender, increasing age, tobacco smoking, and H. pylori infection, are also predictors of the development of stomach cancer

In order to establish the supposed role of the complement system in the regulation of homeostasis and defense reactions in the intestinal epithelium, an immunofluorescent analysis was conducted of localizing the C1q complement component in the inflamed mucosa of the human duodenum (DM) (duodenitis II-III degree) using C1q-specific antibodies. The findings suggest a pronounced presence of the C1q complement component in various DM areas during inflammation, both in the epithelial layer and in the lamina propria, where C1q is localized in the region of the basolateral membrane of enterocytes and some free cells, presumably neutrophils, macrophages and mast cells. A C1q-specific reaction in the epithelial cells and secretory ducts of the duodenal glands indicates a possible secretion of C1q. Co-localization of C1q, cathepsin G and cell adhesion proteins in the DM epithelium implies their interaction in the regulation of tissue metabolism, modification and maintenance of the barrier properties of the intestinal epithelium in normal and with inflammation.

Goal: To study the peculiarities of the course of acute glomerulonephritis in youngmen. Material and research methods: Current study presents the results of clinical examination of 150 youngmen, aged 18-22, who were hospitalized with acute glomerulonephritis. The control group consisted of 50 practically healthy youngmen. Results: The study results showed, that subclinical liver injury was observed in 66 out of 150 examined patients with acute glomerulonephritis, the cause of which can be hepatotoxic effects of antipyretic drugs, taken in the early stages of the disease. In general, liver injuries occurred in acute glomerulonephritis caused by streptococcal infection. Moreover, manifestation of liver injury did not depend on the dose of medicine. Due to toxic and immunological liver injury, levels of transaminases increase and albumin levels decrease.

The aim was to study levels of VEGFA, VEGFC, sVEGFR1, sVEGFR3 and TGFβ1 in malignant gastric, peritoneal and omental tissues. Materials and methods. 62 patients were enrolled in the study: 21 (10, 11) -stomach cancer T_3-4аN_0-3M₁ and metastases to the peritoneum; 24 (15, 9) - stomach cancer T_3-4аN_0-3M₀without metastasis; 17 (6, 11) - non-cancer patients (controls). Levels of growth factors and their receptors were measured by ELISA in tissues of the peritoneum, greater omentum, gastric tumors (GT) and their perifocal tissues (PT). Results. All patients had elevated GT and PT levels of VEGFА and VEGFR1, but not VEGFСand VEGFR3; GT tissues contained more VEGFR1, and PT - more VEGFА. Only metastatic peritoneum and omentum showed increased levels of VEGFs: in the omentum -VEGFА (by 2.8 times), VEGFС (by 2.7 times), VEGFR1 (by 2.3 times), VEGFR3 (by 1.6 times (p<0.05)); in the peritoneum - VEGFА (by 4.2 times0, VEGFС (by 3.5 times), VEGFR1 (by 2.5 times), VEGFR3 (by 2.3 times). The TGF-β1 level increased in GT, PT and omentum tissues in all patients despite metastases, while peritoneal TGF-β1 levels sharply increased - by 3.1 times with metastases and decreased - by 1.8 times (p<0.05) without ones. Conclusion. The role of VEGFА and TGFβ1 in omental and peritoneal metastasis from gastric cancer was confirmed.

Polyp’ is a descriptive term for abnormal projection above an epithelial surface and is not a histological diagnosis. Adenoma is a benign neoplasm of glandular origin and is significant because they are cancers in making. Once a polyp is found, it must be removed in total. Attempts at estimating the polyp histology by endoscopic appearance are often incorrect. With recent advances in endoscopic techniques, most of the polyps are removable through endoscopy. However, there remain a few situations depending on location, size of the lesion and endoscopic expertise available, where complete removal of the polyp requires surgical intervention especially so for large sessile adenomas. We are presenting here four cases of villous adenoma requiring surgical intervention each managed differently depending on presentation and overall clinical picture.

The prevalence of nonalcoholic fatty liver disease (NAFLD) in the world steadily increasеs, turning it into a most prevalent liver disease in the last decade. NAFLD is a multidisciplinary problem, it attracts the attention of specialists of different specialities. Especially interesting is the clarification of the main links of the pathogenesis of nonalcoholic fatty liver disease, including the effect of endogenous microflora on the occurrence and course of disease. Modern information is represented in the review, it confirm the association between Helicobacter pylori infection (H. pylori) and NAFLD. It has been proven that successful eradication of H. pylori detaines the fibrosis in the liver, reduces the level of proinflammatory markers, and improves insulin resistance.

This review article presents the results of research in recent years on the evaluation of the motor-evacuation function of the stomach in patients with diabetes mellitus. The data on the pathogenesis, clinic, differential diagnosis and the principles and current trends in the treatment of diabetic gastroparesis. Diabetic gastroparesis is a component of autonomic neuropathy, resulting from prolonged, poorly controlled type 1 and type 2 diabetes. Gastroparesis manifested by a significant decrease in the quality of life of patients with diabetes mellitus. Diagnostic examination of DG first eliminates obstruction and other causes, including drugs that can mimic the delay / violation of gastric emptying. A balanced diet, a healthy lifestyle, symptomatic treatment and glycemic control are the main components of the treatment of DG.

The aim. To review the composition of gut microbiota in the presence of metabolic syndrome. Materials and methods. Authors analysed Russian and foreign research publications of the database PubMed and Electronic Research eLibrary over the last 20 years from the position of evidence-based medicine. An analytical method has been used. Results. A literature review showed the ambivalence of composition of gut microbiota phyla in the presence of metabolic syndrome, but indicated on specific species whose number correlates with the manifestations of metabolic syndrome. Among such bacteria can be highlighted Faecalibacterium prausnitzii, which can be the obesity risk indicator and also bacteria of genus Lactobacillus and the class Betaproteobacteria which have confirmed inverse and direct links with the blood glucose level in patients with type 2 diabetes. Special attention should be given to Proteobacteria species (Escherichia coli, Citrobacter, Shigella, Staphylococcus aureus, Enterobacter), which are found in larger quantities in patients with manifestations of metabolic syndrome. Conclusion. According to recent studies the role of gut microbiota in the development of metabolic syndrome is not in doubt. Specific bacteria species can be considered as predictors of the metabolic syndrome presence. The composition of gut microbiota phyla in the presence of metabolic syndrome requires further studies.

The presented 18-year follow-up of a 46-year-old patient E. with chronic hepatitis C genotype 1B with a pronounced autoimmune component demonstrates the difficulties of diagnosis and treatment of this form of the disease. By the beginning of observation (in April 2001) the disease was manifested by a slight increase in the liver and moderate splenomegaly with thrombocytopenia, pronounced cytolysis and cholestasis syndrome (Alat and ASAT Activity exceeded the norm by nine times; γ-GT activity was higher than the norm by five times). HCV RNA was detected at a concentration of 3,1 × 10 ⁵ IU/ml, genotype 1b, followed by an increase in the virus content to 8,8 × 10 ⁵ IU/ml. Autoimmune markers: ANF, anti-LKM-1, SMA, IgG were significantly increased. Given that interferon could lead to an exacerbation of the autoimmune component, immunosuppressive therapy carried out before interferon and ended with a slow normalization of autoimmunity markers. The course of treatment with realdiron after that was ineffective, but autoimmune markers increased. In subsequent years, the patient had an undoubted progression of liver cirrhosis, as evidenced by increased portal hypertension, increased degree of liver fibrosis. Approval of non-interferon schemes of antiviral therapy allowed without risks to carry out treatment with drugs with direct antiviral action. From 01.04 15.10.2016 the city conducted, a 24-week course of treatment with sofosbuvir at a dose of 400 mg concurrently with 90-mg. ladypassion in 2 weeks achieved sustained virologic response, and then normalized modified autoimmune markers. There is a tendency to reduce the severity of liver fibrosis. The positive effect preserved to the present time (about 3 years).

A description of the clinical case of a rare complication of combination therapy of chronic hepatitis C - lung sarcoid syndrome, the formation of noncaseating granulomas, and the involvement of several intrathoracic lymph nodes in the process of using Russian interferon alpha 2b.

Introduction. Meckel diverticulum-is a residue of not completely reduced yolk duct. Among the occurring complications of Meckel’s cuticle in the adult population, acute intestinal obstruction prevails. In this case, the most common intussusception and inversion of the intestines. The occurrence of small bowel obstruction due to phytobesoar in the Meckel diverticulum is a rare condition and has been described in the literature in isolated cases. Materials and methods. The patient of 29 years entered the surgical Department with complaints of abdominal pain of a permanent nature, violation of the discharge of stool and gases, vomiting up to 4 times. Sick for about 2 days. Fluoroscopy of the abdomen showed multiple arches with small bowel fluid levels, single bowl kloybera. The man was operated on urgently with a diagnosis of acute mechanical small bowel obstruction. Results. During the operation, Meckel’s phytobezoar diverticula was detected, which caused acute small bowel obstruction, for which the fragmentation of the bezoar was performed with its relegation to the cecum. The postoperative period proceeded without complications, the patient was discharged on the 10th day after surgery. After 6 weeks, the patient underwent laparoscopic diverticulectomy as planned. Discharged for 5 days. Conclusion. A clinical case of treatment of a patient with phytobezoar Meckel diverticulum complicated by acute mechanical small bowel obstruction is presented. The use of delayed diverticulectomy can reduce the risk of anastomosis failure in acute intestinal obstruction, and if proper diet is observed, it reduces the risk of recurrent intestinal obstruction before re-planned hospitalization.

The aim of the work is to study the differences in changes in the viscoelastic parameters of erythrocytes (amplitude of deformation, summarized viscosity and summarized rigidity) in the dynamics of interaction with ethanol in vitro in patients with non-alcoholic (NAFLD) and alcoholic (AFLD) fatty liver disease for use in differential diagnostics. Materials and methods. 50 men were examined, 24 - with NAFLD (46.5±1.5 years), 26 - with AFLD (48.6±1.2 years). The study of viscoelastic parameters of erythrocytes was carried out by dielectrophoresis with an electro-optical cell detection system. The levels of erythrocytes were evaluated before and after in vitro exposure for 300 s with 10 μl of a 0.02% ethanol solution in the dynamics of the experiment. Results. In erythrocytes of patients with NAFLD after exposure with ethanol, a decrease in strain amplitude was revealed against the background of an increase in summarized viscosity and summarized rigidity, on the contrary, in erythrocytes in patients with AFLD, an increase in the ability to deform was observed with a decrease in generalized viscosity and rigidity (p <0.01-0.05). Inverse reaction of cells to ethanol exposure allowed to distinguish patients with fatty liver disease of various origins with sensitivity of 87.5%, specificity of 96.2%, predictive value of positive - 95.4% and negative - 89.3%, as well as an accuracy of 92%. The proposed method for distinguishing fatty liver disease of various origins is promising due to its simplicity, high throughput and low cost.

The low-protein diet including new bakery products with enrichment of soy flour, mountain spring water “Beshbulok” and local national dishes has been developed for diet therapy in chronic kidney disease. Long-term use (within six months) of low-protein diet with the inclusion of new bread “Boyitilgan”, water “Beshbulok” and national dishes for patients suffering from chronic kidney disease allow us to recommend use of the diet in outpatient and inpatient settings in treatment and prevention of renal failure.

This narrative review summarizes a selection of recent, clinically-important novel gastrointestinal developments, presented and discussed at the European Gastro Update In Budapest. The selected topics reflect what the distinguished faculty considered of vital importance to be communicated to the astute busy gastro-hep clinician, who is eager to stay well informed of important novel developments in his discipline. Whenever appropriate a personal comment or addition was added to further raise the educational value of this review. Given its narrative character, statements and conclusions are largely expert opinion-based and referencing is limited to the selected images.