This review provides a systematization of literature on the problem of chronic diarrhea in adults, issues of differential diagnosis and diagnosis at the stage of primary health care Chronic diarrhea is a persistent deviation from the norm with the consistency of stool between types 5 and 7 on the Bristol stool scale and an increase in frequency of more than 4 weeks. The classification of diarrhea in terms of frequency (the most common causes, infrequent and rare), a brief description of clinical and laboratory signs of the most common causes of diarrhea in the practice of a General practitioner and gastroenterologist, a review of the literature on the features of diarrhea in COVID-19, and the stages of diagnostic search.

Hyperferritinemia in patients with COVID-19 is associated with liver dysfunction and an increased risk of the “cytokine storm”. The polypeptide preparation Laennec (6 ml per 350 ml of 0.9% NaCl solution, iv, cap. The first 3 days, from 4 days — 6 ml per 250 ml of 0.9% NaCl solution) was used in 14 patients (age 39–86 years old, 6 men, 8 women) with a long, stagnant course of COVID-19 as a hepatoprotector and immunomodulator as part of complex therapy until a stable remission is achieved. Patients in the control group (n = 14) received only standard therapy. The use of Laennec led to positive clinical dynamics: a decrease in ferritin levels (in men by –282 mcg / l, in women by –80 mcg / l, P = 0.039), an increase in blood oxygenation to the normal range (P = 0.0029), and a decrease in the area of damage lung according to CT data (on average, —10%, P = 0.0027), an increase in the relative content of lymphocytes (+ 8%, P = 0.04), normalization of markers of liver dysfunction (AST, ALT), creatinine and systolic blood pressure (P <0.05). All patients treated with Laennec recovered within 3–15 days after the start of the drug and were discharged with a negative test for the SARS-CoV-2 virus.

Purpose of the study. Compare the effectiveness of different eradication therapy regimens in patients with chronic pancreatitis with concomitant gastritis associated with various genetic variants of H. pylori.

Materials and methods: 63 patients with chronic pancreatitis and concomitant Helicobacter pylori-associated gastritis were examined. The control group consisted of 45 patients with chronic gastritis. Diagnosis of chronic pancreatitis was based on anamnestic, clinical data, instrumental studies (MSCT). Diagnosis of H. pylori infection was carried out by the morphological method, 13C urease breath test, and immunoblotting. Statistical processing was carried out using application packages SPSS Statistic 17.0.

Results. In patients with chronic pancreatitis, CagA-positive H. pylori strains were found 19.3% less often compared with the control group (p <0.05), VacA-positive—21.9% less often (p <0.05). In the study group, H. pylori genes encoding urease A production and genes encoding the synthesis of H. pylori outer membrane proteins (p33, p30, p29, p26, p19, p17) were significantly more frequently met. In the group of patients with chronic pancreatitis, the standard triple therapy of the 1st line with the inclusion of bismuth tripotassium dicitrate was 86.8% more effective (p <0.01) compared to the standard triple therapy of the 1st line, and the maximum increase in efficiency was observed among owners of H. pylori strains, expressing urease A and with the representation on the outer membrane of the proteins p30, p33, p26, p19, p17 (p <0.01).

Conclusion. Eradication therapy in patients with chronic pancreatitis in the presence of pathogenicity complex p30, p33, urease A, p26, p19, p17 in H. pylori according to the standard line triple therapy protocol with the inclusion of bismuth tripotassium dicitrate has advantages compared to the standard triple therapy protocol 1 line (p <0.001). 

In Chelyabinsk from January 2020 the method of 24-hour pH-impedance-monitoring of the esophagus was introduced. The analysis of diagnostic possibilities of this research even on a small initial sample of patients confirms high informativeness of the method in the section of diseases of the upper parts of the gastrointestinal tract. The combination of parameters of daily recording of pH-impedanceograms allows reliable identification of gastroesophageal refl ux disease (GERD) and functional dyspepsia. The tasks of differentiating the nosological affiliation of symptoms (heartburn, burning, chest pain, lump in the throat, voice axis, cough) arise for doctors of different specialties: gastroenterologists, otolaryngologists, pulmonologists, cardiologists. Comparing the complaints noted by the patient with episodes of the bolus hitting the esophagus, we get the opportunity to calculate the probability of association of symptoms with refl uxes, and thus correctly route the “complex” patient.

Thus, the daily pH-impedanceometry demonstrates high diagnostic capabilities and allows us to reliably distinguish the pathological gastroesophageal refl ux from functional heartburn. Conducting research at the stage of diagnosis and during treatment makes the technique an effective tool for quality control of the therapeutic solution in each clinical situation. 

The cross—sectional study included 194 senior students of a medical university, of which 156 were women and 38 were men. To judge the frequency and severity of the course of PD and IBS, the 7x7 questionnaire was used. A set of psychodiagnostic questionnaires included: an integrative anxiety test; a scale for psychological express—diagnostics of the level of neurotization; the methodology of the Strategy of coping behavior.

The psychological characteristics of the examined men with PD and IBS were characterized by a predominance of subscales of personal anxiety (“emotional discomfort”, “asthenic component”, “phobic component”, “anxious assessment of perspective”). In the repertoire of strategies coping with stress, coping “acceptance of responsibility” and, on the contrary, less often “planning of solving a problem” was much more common.

The women with the presence of PD and IBS, along with exceeding the general level of personal anxiety often have subscales such as “emotional discomfort”, “phobic component”, “anxious assessment of perspective”. Among the prevailing coping strategies noted “distance”, “the search for social support”, “acceptance of responsibility”, “fl ight—avoidance”. In addition, the female “cohort” with PD and IBS, in contrast to the male, was characterized by a significantly high level of neuroticism. 

Aim: To study the compliance features of patients with coronary artery disease and erosive-ulcerative lesions of the gastroduodenal zone.

Methods: The study included 93 patients: 55 (59%) men and 38 (41%) women. Comorbidity indices Charlson, Kaplan-Feinstein and CIRS-G (Cumulative lllness Rating Scale for Geriatrics) system, anxiety and depression scores were calculated for all patients. The questionnaire Kadyrov R. V. et al. “The level of compliance was used to evaluate patient adherence. Statistical processing was performed using PAST (v. 3.21; Hammer et al., 2001) and MedCalc (v. 13.0; MedCalc®).

Results: All patients are divided into two groups: group I—30 (32%) patients with coronary artery disease with erosive and ulcerative lesions of the stomach and duodenum, group II—63 (68%) patients with coronary artery disease without erosive-ulcerative gastroduodenopathies. We found significant intergroup differences in patients according to the CIRS-G and KAPLAN-FEINSTEIN comorbidity indices.

In patients with coronary heart disease with erosive-ulcerative gastroduodenopathies the level of general compliance and its components was significantly higher than in patients without pathology of the gastroduodenal zone. It should be noted that high compliance according to the questionnaire was observed in 22 (73.3%) patients in group I and in 19 (30.2%) patients of group II (p <0.001), while with a low level of compliance—in 1 (3.3%) in group I and 17 (27.0%) in group II (p = 0.009). The level of compliance did not correlate with age, duration of disease, and comorbidity indices.

Conclusion: In the study group of patients the frequency of erosive and ulcerative gastroduodenopathies was 32%. Patients with ischemic heart disease and erosive-ulcerative gastroduodenopathies are characterized by higher levels of compliance and anxiety. 

Purpose of the study. To study the prevalence of digestive diseases in patients with acute coronary syndrome.

Materials and methods. A retrospective study included 1079 patients with acute coronary syndrome who were treated in the cardiology department No. 2 of the Chelyabinsk Regional Clinical Hospital in 2015. After further examination, the diagnosis of acute coronary syndrome was withdrawn in 40 patients (3.7%). In the future, this group was not studied due to the small number of patients. Of the group of patients with acute coronary syndrome (n = 1039 people), patients were distributed taking into account gender and age, of which 679 (65.4%) were men, 360 (34.6%) were women. The average age of all patients was (61.9 ± 11.9) years, men (58.9 ± 11.9) years, women (67.6 ± 12.0) years. Statistical analysis was performed using Microsoft Offi ce applications and SPSS Statistics programs (version 21.0).

Results. Among all concomitant diseases in patients with acute coronary syndrome, digestive diseases take the third place. Among the risk factors in patients with acute coronary syndrome and digestive diseases, hypertension and hypercholesterolemia were most often recorded. Multivascular damage to the coronary arteries was more often observed in patients with myocardial infarction in the presence of digestive diseases. At the time of discharge from the hospital in patients with acute coronary syndrome in the presence of diseases of the gastroduodenal zone, monotherapy (clopidogrel / ticagrelor) was recommended three times more often in comparison with the group without digestive diseases. Inhibitors of the proton pump (omeprazole) in the presence of pathology of the digestive system are recommended in almost 100% of cases, regardless of the clinical form of acute coronary syndrome. 

The aim to study: To study the structure and clinical features of the course of joint damage as an extra-intestinal manifestation in patients with infl ammatory bowel diseases.

Materials and methods: 332 patients with infl ammatory bowel diseases were questioned and examined, who applied to the gastroenterological offi ce and were hospitalized at the Chelyabinsk Regional Clinical Hospital from October 2017 to November 2019.

Results: Joint syndrome was found in 94 (28.3%) patients with IBD, more often had an oligoarticular character (79 (84%) patients) with localization mainly in the joints of the lower extremities. When examining patients, peripheral arthritis was diagnosed in 41 (43.6%) patients, osteoarthrosis was detected in 38 (40.4%), 13 (13.8%) patients did not have objective signs of infl ammation. 

Background: Takayasu arteritis (TA) is a systemic vasculitis, affecting mainly large aortal branches. AT is considered to be a rare disease [1]. TA actual frequency in the general population is not estimated due to a number of objective and subjective factors [2]. Gastrointestinal (GI) diseases in TA patients are not sufficiently studied. GI involvement can be a consequence of the main pathological process as well as drug treatment complication. The need to analyze the frequency and structure associated with at lesions of the digestive system determines the relevance of this work.

Objective: in a retrospective cohort study to assess the frequency and structure of TA-associated GI pathology.

Materials and methods: a retrospective cohort study included 183 patients with verifi ed TA. All had been hospitalized and observed in the Sverdlovsk regional Clinical Hospital 1 from 1979 to 2018, and were examined according to the clinical guidelines valid by the period of hospitalization. The results of 22 fatal cases autopsies were also analyzed. The study was approved by the local Ethical Committee, the Sverdlovsk Regional Clinical Hospital 1.

Results: GI diseases were registered in 70 (38%) of the cohort 183 participants. The most frequently registered GI disease was chronic gastritis (28 cases; 40%), nonalcoholic fatty liver disease (22 cases; 31%), chronic pancreatitis (33 cases; 47%). Meanwhile, GI lesion was confi rmed in 20 cases of autopsy (87%). Moreover, 2 tumors of the stomach and hepar were revealed only postmortem.

Conclusion: the data obtained emphasize the importance of more thorough clinical and instrumental monitoring of the GI tract in TA patients. 

Objective: to identify among the allelic polymorphisms of the folate cycle genes: RFC-1 80G> A, MTHFR C677T and A1298C, TS2R/3R and 6bp del/ins, GGH-401C>T, MDR1 C3435T, hepatotoxicity predictors of methotrexate in patients with rheumatoid arthritis.

Materials and methods: the frequency of liver dysfunction in 85 patients with rheumatoid arthritis was analyzed retrospectively with methotrexate therapy, followed by an assessment of the correlation with allelic polymorphisms of the folate cycle genes that regulate the diff erent stages of drug biotransformation.

Results: an analysis of the distribution of alleles and genotypes of the folate cycle genes mentioned above allowed the identifi cation of protective genetic markers for methotrexate-induced hepatotoxicity in the form of allelic polymorphisms MTHFR1298AC and TS6bp del/ins, as well as suggesting the role of TS6bp ins/ins polymorphism in the development of hyperfermentemia.

Conclusion: the ambiguity of the literature data on the search for prognostic markers of hepatotoxicity of methotrexate, as well as our data, which do not have comparable results in both domestic and foreign publications, dictate the need to continue research on the safety of methotrexate in rheumatoid arthritis. 

Objective: to study the characteristics, frequency of occurrence, and clinical signifi cance of nausea, vomiting, abdominal pain associated with a migraine attack, in children and adolescents.

Materials and methods. Included 32 patients aged 7 years to 18 years with a diagnosis of episodic migraine. All patients were carefully analyzed for nausea, vomiting, and abdominal pain accompanying a migraine attack.

Results. Nausea bothered 78% of patients, the median of its intensity corresponded to pronounced. Vomiting accompanied attacks in 68%, the median of its quantity—3 per day. Attack pain in the abdomen developed in 6% of patients. Moreover, the early onset of migraine seizures is associated with severe nausea and vomiting (p = 0,015 and p = 0,043, respectively). Among male patients, direct correlations were obtained between headache intensity and nausea intensity (rS = 0,456, p = 0,029, n = 23) and the amount of vomiting (rS = 0,417, p = 0,048, n = 23).

Conclusion.

1. With migraine in children and adolescents, nausea and vomiting are often seen as symptoms associated with an attack, while abdominal pain is a rare manifestation of a migraine attack.

2. There is a negative relationship between the age of the patient and the intensity of vomiting, the early onset of migraine attacks is often associated with severe nausea and vomiting, and in male patients, the intensity of the headache directly correlates with the intensity of nausea and the amount of vomiting.

3. There was no dependence of gastrointestinal manifestations on the patient’s gender, the presence of an aura during an attack, the frequency of attacks and the number of pain days. 

The aim of the study was to clarify the causes that reduce the effectiveness of surgical treatment of focal liver diseases of various origins. The presented review of the literature data showed an urgent need tothe need to remove large volumes of liver parenchyma. To reduce the number of complications (liver failure, bleeding), a combination of approaches is proposed. Use of chemotherapy andembolization of the arteries of the resection area reduces the size of the formation. Obstruction of portal vein branches by embolization or ligation increases the amount of repair and prevents the development of hepaticfailures. The rate of remnant hypertrophy increases the separation of the liver parenchyma along the resection border. Combined use of tactical approaches, modern equipment and surgical techniquesincreases the effectiveness of treatment of focal liver formations.

The new coronavirus infection COVID-19 that appeared at the end of 2019 is signifi cantly different from the viral infections that existed previously. The new SARS-CoV-2 coronavirus combines two transmission routes—aerosol and oral-intestinal. The targets for this virus are both cells of the respiratory system and the human gastrointestinal tract. Along with the classical form of this disease, the so-called “gastrointestinal” form is described, in which the clinical picture is dominated by signs of damage to the gastrointestinal tract (diarrhea, vomiting, anorexia). These symptoms are detected, in general, in 20% of patients with COVID-19. More than 80% of patients have mild forms, a third of these individuals had diarrhea. Although SARSCoV-2 viral RNA is detected in faeces samples of patients with COVID-19, it does not carry an infectious onset, and not a single case of fecal-oral transmission has been confi rmed. Since the intestines are the most powerful organ of our immune system, we can introduce SARS-CoV-2 viral RNA into the gastrointestinal tract to ensure the formation of immunity to this infection.

The aim was to study the effectiveness of the use of turmeric extract in the composition of the original rectal suppositories in experimental Crohn’s disease (CD) based on the assessment of the clinical picture and indicators of the immune status.

Materials and methods. The work was performed on 70 rats of the Wistar line. CD was unduced by the rectal administration of a trinitrobenzenesulfonic acid solution, rectal suppositories with 0.000075 mg of curcumin based on an alcohol solution of rhizome extract with turmeric roots were used after 12 hours for 7 days, in the comparison group rectal suppositories with 50 mg of 5-aminosalicylic acid were used (5-ASA). To assess the clinical status, the Disease activity index scale was used, the population spectrum of leukocytes, CD3 + and CD45RA + lymphocytes, the concentration of IgG, IgM, IL-23 on the 3, 5 and 7 days of the experiment were determined.

Results: In CD, the clinical signs of the disease progress from 3 to 7 days, the total number of leukocytes in the blood increases due to monocytes, lymphocytes, including CD3 +, CD45RA +, the concentration of IL-23, IgM, Ig G. Local use of turmeric extract in CD reduces the severity of clinical symptoms on days 5 and 7, restores the total number of leukocytes, lymphocytes, including CD3 +, the concentration of IgM on days 3, 5, 7, and IL-23 on days 5 and 7, partially restores serum concentration of IgG on the 3-rd, 5th, 7th day, IL-23—on the 3-rd day of observation. The eff ect of CD in the composition of rectal suppositories of turmeric extract is comparable to the eff ect of 5-ASA on the 3-rd, 5th, 7th day of observation in relation to the severity of clinical symptoms, the number of leukocytes, lymphocytes, CD3 + in the blood, the concentration of IgM and IgG; less pronounced in relation to the concentration of IL-23 on day 3.

Conclusion. The clinical and immunological efficacy of local application of turmeric extract every 12 hours as part of the original rectal suppositories in experimental CD has been demonstrated, comparable with the use of rectal suppositories with 5-ASA. 

Purpose of the study—to develop a new dosage form—rectal suppositories with vitamin D3 and at the preclinical stage to analyze its clinical and immunological efficacy compared to 5-aminosalicylic acid (5-ASA) in the dynamics of experimental ulcerative colitis (UC) in rats.

Materials and methods. UC was simulated by cutaneous and then rectal application of a 3% solution of oxazolone. Original rectal suppositories with 1500ME of vitamin D3 were administered per rectum every 12 hours, in the comparison group with the same interval, rectal suppositories with 50 mg of 5-ASA. To assess the clinical status, the Disease activity index (DAI) scale was used, the serum concentration of IgG, IgM, IL-6, IL-8 was determined by the enzyme immunoassay using rat-specific test systems on days 2 and 6 of the experiment.

The results of the study. In experimental UC, DAI rises, and the concentration of IgG, IgM, IL-8 and IL-6 in serum increases on the 2nd and 6th day of the experiment. DAI increases as serum concentrations of IgG, IgM, IL-8 and IL-6 increase. The use of vitamin D3 in UC leads to a decrease in DAI and serum concentrations of IgG, IgM, IL-8, IL-6 mainly on the 6th day of observation. The use of rectal suppositories with 5-ASA in UC leads to a decrease in DAI and the concentration of IgM, IgG, IL-6, IL-8 on the 2nd and 6th day of observation.

Conclusion. The efficacy of rectal suppositories containing 1500 IU of vitamin D3 in experimental UC was found to be comparable with the use of rectal suppositories with 5-ASA based on the assessment of the clinical status and serum concentration of IgM, IgG, IL-6, IL-8.

Helicobacter pylori infection is widespread worldwide. It plays a signifi cant role in the pathogenesis of many diseases of the gastrointestinal tract, such as peptic ulcer, atrophic gastritis, and cancer of the stomach. Recently, a large number of works have appeared that indicate the association of Helicobacter pylori infection with extragastric diseases. Liver diseases, and especially fatty liver disease, are also widespread and actively studied. The association between Helicobacter pylori infection and non-alcoholic fatty liver disease has been the subject of many studies, but there is still insufficient evidence to make it clear.

There are the high incidences of gallbladder cancer in endemic countries for S. Typhi infection. In this regions, the majority of chronic carriers suffer from calculous cholecystitis, that in turn have been indicated as predisposing factor for the development of gallbladder cancer. Stones in a gallbladder represent a sort of platform for the formation of bacterial biofilm. It was shown that human bile activates the synthesis of the third type secretory system (T3SS) responsible for the invasion of S. Typhi into the gallbladder cells that may result in intracellular synthesis of typhoid genotoxin with possible carcinogenic effect. The knowing of the pathogenesis of the development of gallbladder cancer makes target therapy of the disease possible.

Colorectal cancer is a disease that is far from the last place in the morbidity statistics in the Russian Federation and in the world. Along with well-known risk factors for the development of this pathology, some representatives of the intestinal microbiota are possible to participate in this process. Some studies suggest that Akkermansia muciniphila, a mucin-degrading bacterium, is associated with colorectal cancer development, but other studies cast doubt on this statement. In this review, we describe a series of studies devoted to determining the dependence of colorectal cancer on the amount of A. muciniphila, the relationship of this bacterium with inflammation development as a predictor of oncogenesis, the influence of other representatives of the intestinal microbiota on its function, and also describe one of the possible mechanisms linking the mucin-degraging ability of this bacterium with the development of oncogenesis.

Chronic mesenteric ischemia until now represent the difficult tasks of primary diagnosis and ambiguous approaches to therapy. This review analyzes domestic and foreign research articles from the PubMed database, the eLibrary scientifi c digital library over the past decades. A review of literary sources allowed to provide modern data on the epidemiology, diagnosis and treatment of chronic mesenteric ischemia from the standpoint of evidence-based medicine.

The human gastrointestinal tract is more complex in its structure and volume of its functions, an organ, or rather, a system of organs. In addition, the intestinal microbiota, which, in turn, is part of the brain-intestine-microbiota axis, is also included in the process of implementing the tasks of the gastrointestinal tract. In this regard, not only instrumental, such as radio-radiological, ultrasound, endoscopic (with subsequent study of biopsy material) and other research methods are relevant, but also laboratory ones aimed at obtaining information about the microbiome and signal molecules involved in regulatory processes gastrointestinal tract. This literature review is devoted to the analysis of modern research methods for neurotransmitters synthesized by the digestive tract and of diagnostic value.

A case of acute opisthorchiasis that characterised by clinic of hepatobiliary system, upper section of gastrointestinal tract damage and toxic thrombocytopenia, is presented in this article. The complex of diagnostic methods is evaluated. Symptoms that determine differential search in conditions of specific diagnostic methods' vulnerability are selected.