The aim of this review is to summarize the world data about cardiovascular and digestive systems damage, caused by COVID-19 infection, known by June 2020. An attempt was made to suggest a pathophysiological explanation of structural and functional changes in internal organs. The main focus of the article is on the damage of the cardiovascular system, liver and small intestine, as well as on the diagnosing and optimizing the basic therapy for inflammatory bowel diseases, arterial hypertension and coronary heart disease.

The article presents the results of the section of the multicenter Observation program TRIGON initiated by the Gastroenterology Scientifi c Society of Russia (GSSR). The aim of the TRIGON-1 study was to study the mechanisms of comorbidity formation in patients with non-alcoholic steatohepatosis and predictors of cardiovascular diseases (CVD) and the effect of multi-organ therapy on this. Over the course of two months, 30 patients with non-alcoholic steatohepatosis and predictors of CVD development who received thiotriazoline monotherapy were observed. It is shown that the formation of mechanisms of comorbidity of NAFLD and cardiovascular diseases occurs at the early stages of the development of these sufferings. Course monotherapy with drug multiple organ action - thiotriazoline in patients with NAFLD improves liver health and reduces the risk of CVD.

Background. The primary diagnosis of functional and organic disorders in the gastrointestinal system is always a big problem, especially in patients with systemic diseases caused by disorders of carbohydrate metabolism, which can manifest themselves as directly the development of somatic pathology, as well as dysfunction of the Autonomous nervous system

The purpose is to study the structure of gastrointestinal diseases in patients with dysmetabolic disorders, in particular, with type 2 diabetes mellitus, the relationship of these disorders with indicators of autonomous regulation, and to evaluate the informativeness of some diagnostic methods in assessing the function of the stomach in these patients.

Material and methods. The study involved two stages. On the ground were examined 312 patients with impaired carbohydrate metabolism, with emphasis on the structure of comorbid pathology. The second phase was conducted in-depth survey of 49 patients to assess the state of processes of autonomic regulation and the functional state of the stomach. During the examination, special methods were used, such as intragastric pH-metry, gastroscintigraphy, and assessment of heart rate variability.

Results. The prevalence of diseases of the gastrointestinal tract in patients with impaired carbohydrate metabolism was very high and depended on the duration of the disease (more than 10 years in 100% of patients) and the severity of dysmetabolic disorders — in 91.5% of patients with unsatisfactory control of metabolic processes and in 25.3% of cases, if the disorders of carbohydrate metabolism were well controlled. The risk of developing concomitant pathology of digestive organs was higher in patients with multiple complications (RR=1,214, p<0.01, overweight (OR=5.37; p<0.001). Patients with disturbance of the autonomous regulation were more frequent hypersympathictonу that pursued disturbances of the acid-forming and motor-evacuation function.

Conclusion. In the pathogenesis of comorbid diseases that combine vomiting of the gastrointestinal tract and dysmetabolic disorders (disturbance of carbohydrate metabolism), the development of Autonomous neuropathy is important, which is simultaneously the cause of the progression of comorbid pathology and its consequence. The presence of Autonomous neuropathy makes it difficult to diagnose the disease and should be taken into account in the complex therapy of comorbid diseases.

Background. Diseases of the gastrointestinal tract and arterial hypertension (AH) are among the diseases with a high frequency of spread. Their combination is often considered as a comorbid pathology, especially in a population that has an increased risk of their development.

Aims: to study the clinical and laboratory features of the formation of a combination of erosive-ulcerative lesions of the gastroduodenal zone in patients with arterial hypertension and to develop a method for predicting the likelihood of this comorbidity.

Methods: employees were Examined (n=127, male 100%). locomotive crews art. Perm-II of the Sverdlovsk branch of Russian Railways with more than 10 years of experience. Methods of examination included analysis of anamnesis data, physical, laboratory and instrumental examinations of patients. Laboratory tests of General blood analysis were performed on a 3-diffhematological analyzer V–Counter (“West-Medica”, Austria). Traditional biochemical parameters were determined in the blood serum, as well as the concentration of individual proteins: endlotelin-1 (ET-1), monocyte chemotactic protein-1 (MCP-1) and C-reactive protein (hs-CRP).

Statistical processing of the obtained data was performed on a PC using the built-in analysis package of the Excel® 2016 MSO table processor (© Microsoft, 2016), the author’s (©V. S. Sheludko, 2001–2016) package of applied spreadsheets (ppet) “Stat2015”

Results: the diagnostic value of a number of studied indicators was Established: the concentration of plasma proteins ET-1 and MSR-1; the level of glucose and cholesterol, as well as the content of white blood cells and platelets for the diagnosis of comorbidity: erosive and ulcerative lesions of the gastroduodenal system in patients with arterial hypertension.

The obtained data allowed us to develop a mathematical formula for calculating the risk of erosive and ulcerative lesions of the gastroduodenal system in patients with arterial hypertension.

Conclusion: employees of locomotive crews have an increased risk of comorbid pathology-erosive and ulcerative lesions of the gastroduodenal zone in patients with arterial hypertension, which is accompanied by changes in a number of laboratory parameters. The most important of them are: the developed equation using the content of MSR-1 and endothelin-1, glucose and cholesterol, as well as the number of platelets and leukocytes in peripheral blood. Allows you to predict the risk of comorbid pathology.

Gastroesophageal reflux disease (GERD), non-alcoholic fatty liver disease (NAFLD) and obstructive sleep apnea syndrome (OSAS) are common diseases associated with obesity, abdominal obesity and metabolic syndrome. Each of the diseases has a negative effect on other organ systems, causing cardiovascular morbidity and mortality. Due to the commonality of etiopathogenetic mechanisms, the interrelationships of GERD, NAFLD, and OSAS are of research interest. Most of the work done on this issue demonstrates a relationship between them, independent of body mass index, waist circumference, lipid and carbohydrate metabolism. At the same time, NAFLD is considered as an independent predictor of symptoms of GERD and erosive esophagitis.  OSAS is signifi cantly associated with an increased risk of hepatic steatosis, its progression to steatohepatitis and liver fibrosis. GERD is associated with a more severe form of OSAS, and OSAS is associated with the development of Barrett’s esophagus and adenocarcinoma of the esophagus. Meanwhile, the numerous publications available in modern literature are controversial. The issues of combining GERD, NAFLD and OSAS from the standpoint of mutual causality and / or the impact of common risk factors have not been fully resolved. Some aspects of the influence of GERD on the possible progression of NAFLD and OSAS remain unclear.

The aim of the study: to study the prognostic value of biomarkers of non-alcoholic liver steatosis in assessing the expression of atherosclerosis of the general carotid artery in patients with stable angina and obesity.

Materials and methods of research. Two groups of patients were formed during the study. Group I was made up of patients with stable angina with concomitant obesity (n = 24). Group II (n = 35) were stable angina patients with normal body mass index (BMI). Liver function, carbohydrate and lipid exchanges, duplex scanning results of the extracranial brachyocephalic artery (BCA) were evaluated, and biomarkers of steatosis were calculated: hepatic steatosis index (HSI), TyG indices, BARD, BAAT, VAI. Ultrasound of the liver (ultrasound) was performed on all patients.

Results. 100% of group I patients showed liver steatosis based on ultrasound. Biomarkers of liver steatosis (HSI, TyG, BARD, BAAT, VAI) were more severe in group I patients and confi rmed the presence of liver steatosis. Also among the patients of group I found: more pronounced disorders of functional state of liver, more signifi cant hypertriglyceridemia. More signifi cant atherosclerotic changes in OCA were detected in group I patients. Atherosclerotic plaques were more frequently found in group I patients compared to group II patients (70.8% vs 40%). The proportion of patients with signifi cant stenosis (> 50% of the vessel lumen) in group I was signifi cantly higher and amounted to 33.3%.

Conclusion. In patients with stable angina combined with obesity, in case of liver functional parameters disorder, pronounced hypertriglyceridemia, non-invasive biomarkers of liver non-alcoholic steatosis screening allow confi rming the presence of early morphological liver changes, as well as predicting more pronounced atherosclerotic changes of the common carotid artery.

The aim of the study was to estimate the condition of gallbladder, extrahepatic bile ducts and liver in patients with morbid obesity before and after bariatric operations.

Materials and methods. 82 patients were operated on for obesity: 39 — for morbid obesity with a body mass index (BMI) of 40–49 and 43 — for super-obesity with a BMI of more than 50. Before and two years after the operation, the condition of the liver and bile ducts was studied based on ultrasound results.

Results. 75 patients (91.4%) were diagnosed with metabolic syndrome. The incidence of cholelithiasis in both groups was the same and in general was 32.93%. According to the results of the ultrasound examination in patients with morbid obesity, the utrasonographic fatty liver indicator (US-FLI) ranged from two to six points, with 61.54% of cases diagnosed with mild steatosis, 33.33% — with moderate severity, and 5.13% — with severe steatosis. In patients with superobesity, the US-FLI ranged from six to eight. Moderate steatosis was diagnosed in 41.86%, severe — in 58.14%.

Two years later, in group 1, 15 patients (38.36%) had no ultrasound signs of steatosis, and the remaining 24 (61.54%) had mild steatosis. In group 2, mild steatosis was detected in 48.84% of cases, moderate — in 39.53% and severe — in 11.63%.

Conclusion. The incidence of gallstone disease in patients with extreme degrees of obesity is 32.93% and does not depend on the body mass index. Correction of liver steatosis is more eff ective in patients with morbid obesity compared to patients with superobesity. In 11.63% of cases with superobesity and severe steatosis, the liver condition does not improve after bariatric surgery according to ultrasound data.

This article provides all the information to date about the role of micro-RNA in the development of liver fibrosis and the degree of inflammation in chronic viral liver diseases. To write the article, information was searched using the databases Scopus, Web of Science, MedLine, PubMed, and Google Scholar. Circulating microRNA-122 were evaluated as potential non-invasive biomarkers of liver fibrosis activation and prognosis in patients with chronic viral hepatitis.

Micro-RNAs are potential markers for the diagnosis and monitoring of liver tissue, including the processes of fibrosis and carcinogenesis. The therapeutic effectiveness and advantages of using UDCA on microRNA-122 expression are considered.

Objective. To evaluate the results of management and the quality of life in patients with postcholecystectomy syndrome depending on the functional condition of the sphincter of Oddi and the bile outflow.

Materials and methods. Quality of life was evaluated using the SF-36 questionnaire in 68 patients 1–3 years after examination and treatment of 116 patients with postcholecystectomy syndrome. The diagnosis was established with a scoring system for the data of clinical, laboratory and instrumental methods.

The dynamics of the bile outfl ow was determined by hepatobiliary scintigraphy (HBSG) on a Segams-9100 gamma cam-era using a ^99mTc-bromeside for 90 minutes with a choleretic test.

A statistical study was carried out using the Statistica 10 computer program. The relationship of the signs was deter-mined by multivariate correlation analysis, and the correlation coefficients (r) were calculated. Differences in values were consideredsignifi cant at p <0.05.

Results. Patients after transabdominal operations compared with patients after endoscopic interventions had the best values of psychological (MH) (47.0 ± 2.8 versus 41.7 ± 2.3 p = 0.03) and physical (PH) (46.5 ± 2.4 versus 45.8 ± 2.1; p> 0.05) health components. The level of role functioning (RP) and vital activity (VT) in patients with timely bile outflow was higher than in patients with the sphincter Oddi‘s insufficiency (75.0 ± 11.0 versus 33.3 ± 13.2; p = 0.006 and 71, 3 ± 3.1 versus 58.9 ± 6.5; p = 0.005, respectively). In patients with the sphincter Oddi’s insufficiency the pain factor (BP) was reduced (62.7 ± 7.4 versus 79.1 ± 6.3, p = 0.02)

Conclusion. An objective assessment of the bile outflow and a differentiated correction of functional and organic disorders improve the quality of life in patients independently of the surgical approaches.

Aime: to evaluate clinical and laboratory liver syndromes and markers of fibrosis in individuals with different severity of liver damage in the form of steatosis, steatohepatitis, and cirrhosis against the background of harmful alcohol consumption.

Materials and methods. 181 patients with alcoholic liver disease (ALD) were examined, the control group consisted of 92 healthy people. The survey included patient questionnaires, assessment of clinical status, biochemical tests, general blood analysis, ultrasound of the abdominal cavity, ultrasound elastography. Determination of the concentration of hyaluronic acid (HA) in blood serum was carried out by the ELISA method using a set of reagents from the manufacturer “VSM Diagnostics” (USA) on the Stat Fax device (USA). Statistical processing of the results was performed using the “Statistika 10” package.

Results. In ALD, more pronounced clinical manifestations and changes in laboratory tests were found in individuals with a greater severity of liver damage, which is associated with a greater alcohol load. The maximum number of reliable correlations was found between functional liver tests in alcoholic cirrhosis of the liver (ALC) — 16 tests, with steatohepatitis-7, with steatosis only between AST and direct bilirubin. The median concentration of ha in all groups was significantly higher than the control: in patients with steatosis, it was 31.1 [21.5; 49], in steatohepatitis with hyperfermentaemia — 45.55 [31.5; 69.9] ng / ml, in patients with cirrhosis of the liver — 145.7 [116.8; 377.8], significant differences in ALC were found with both steatosis and steatohepatitis. In ALC, all fibrosis tests: AST/ALT, APRI and HA correlated with all the studied liver samples, with less pronounced liver lesions on the background of ALD, there were almost no correlations. The relationship of indirect fibrosis tests — the ratio of AST/ALT and the APRI index with the level of HA was also not revealed.

Conclusion. HA, as a non-invasive direct marker, is the most informative early test of liver fibrosis. It allows you to accurately and simply diagnose the presence of fibrosis in ALD at the stage of steatosis, steatohepatitis and cirrhosis. Traditional indirect markers of fibrosis AST/ALT ratio and APRI index are ineffective, with the exception of ALC.

Objective: to analyze the actual nutrition of pregnant women in order to identify the prevalence of deficiency of selenium and zinc, as well as to trace the relationship of the deficiency of these trace elements with the development of intrahepatic cholestasis.

Materials and methods. A qualitative assessment of actual nutrition during pregnancy was carried out on the basis of profi les of 417 women in the first trimester of pregnancy. The second stage of the study evaluated the serum content of selenium, zinc and vitamin D3 in 35 patients using inductively coupled plasma spectrometry, the pregnancy of which was complicated by intrahepatic cholestasis (main group) compared with women with physiological pregnancy (50 people).

Results. It was shown that a deficiency of selenium and zinc is associated with a risk of developing HCB, as evidenced by an increase in the relative risk indicator (RR = 1.456 and RR = 1.252 with a deficiency of selenium and zinc, respectively). The prevalence of vitamin D3 deficiency is currently ubiquitous, we noted lower rates in the group of patients with HCB compared with uncomplicated gestation (10.6 ± 2.1 ng / ml and 25.8 ± 1.8 ng / ml, respectively), between groups confirmed significant differences (p <0,0). However, no infl uence on the risk of developing HCB was detected (RR = 0.909).

With a combined deficiency of selenium, zinc and vitamin D3, the risk of developing intrahepatic cholestasis is significantly increased (RR = 5.694).

Findings. A promising direction for the prevention of obstetric complications, including in relation to the pathology of internal organs, and not only the placental complex, is the eff ect on the socalled controlled factors, which include the correction of nutrient deficiencies.

Objective: to analyze the nutritional status in patients with stenotic diseases of the esophagus.

Materials and methods. Indicators of nutritional status were determined in 32 patients with benign and malignant diseases of the esophagus using bioimpedance analysis (BIA) and skinfold thickness measurement.

Results. The patients were predominantly male — 24 (75%), aged 59.8±13.0 (median 62.5) years, with a body mass index of 16.4–32.3 kg/m², an average of 23.6±4.4 kg/m². Body mass deficiency in patients with malignant strictures was in 32%, with benign — in 8%. In 19% BIA revealed muscle deficiency, only in patients with malignant strictures. Adipose tissue deficiency was determined in 28%, in combination with sarcopenia — in 12.5% of all patients and in 21% — with malignant strictures. Increased fat content was in 28%, sarcopenic obesity — in 5%. Increased fat content with normal muscle mass was in 31% of patients with benign strictures and in 16% of patients with malignant diseases. The basal metabolic rate was 2566 ± 408 kcal. There was a decrease in bone mass in 12.5%, total body water — in 9%, an increased visceral fat — in 25%.

The metabolic age was on average 9.2 years lower in 81% of patients. In patients with esophagus diseases the skinfolds thickness was lower on the iliac crest, on biceps and triceps and medial calf (p = 0.02).

Conclusion. To assess the nutritional status, identify sarcopenia and other predictors of the outcomes in order to correct them, the analysis of body composition is necessary.

Purpose of the study. The study of gastrointestinal disorders in patients with Parkinson’s disease (PD), an assessment of their relationship with other clinical manifestations and serum galanin levels.

Materials and methods. A comprehensive examination of 70 patients with PD and 17 people from the control group was conducted. A neurological examination was used in the work, testing using the following scales was used: a questionnaire for identifying autonomic disorders in patients with PD, cognitive questionnaires MMSE and MoCA, a Beck scale for detecting depression, a questionnaire for quality of life SF-36. Serum galanin level was determined by ELISA.

Results. Among non-motor manifestations in PD, gastrointestinal disturbances, mild cognitive impairment, and mild depression are dominant, which significantly reduces the quality of patient’s life. Correlation analysis revealed an association of the severity of gastrointestinal disturbances with the level of depression, cognitive decline, quality of life, and other autonomic manifestations. Serum galanine content in PD patients was lower than in healthy volunteers. The degree of decrease in humoral galanin in patients with PD is associated with the severity of gastrointestinal disorders.

Conclusion. Gastrointestinal disorders are observed in most patients with PD and are associated with other autonomic disorders, cognitive impairment, depression, which aff ects the quality of patients life. A reduced amount of galanin contributes to the formation of gastrointestinal disorders in PD and can be used for their objective diagnosis.

A clinical case of successful application of selective extracorporeal endotoxin LPS-adsorption in the complex treatment of severe gram-negative sepsis of obstetric etiology, complicated by systemic multiple organ failure, in late terms was presented.

The purpose of the study was to assess the impact of comorbidity on esophagoplasty outcomes.

Materials and methods. The outcomes of 289 patients undergoing esophagoplasty for cancer (251) and benign diseases of the esophagus (48) were analyzed, the comorbidity, Charlson index and prognostic nutritional index were calculated.

Results. Comorbid diseases were detected in 92 patients (31.8%), the Charlson index in this group was 2.4±1.1. In the group without comorbidity it was 1.1±0.8. Postoperative somatic complications developed in 57 cases (19.7%), in comorbid-ity group — 22 patients (23.9%), without comorbidity — 35 people (17.8%). 32 patients died (11.1%). Cardiopulmonary complications occurred in all 12 fatal outcomes in comorbid patients, in half of them they became the main cause of death.

Somatic complications were in 15 (75%) of 20 fatal outcomes in patients without comorbidity, they became the cause of death in 6 (30%). The Charlson index in comorbid group was 2.0±1.2 versus 1.4±1.1 in the other patients (p=0.01). The presence of comorbidity and the Charlson index significantly infl uenced the outcome of the disease (p=0.02) with logistic probability of 0.6 and a smaller logit spread, as well as the occurrence of complications in the postoperative period (p = 0.04) with values of 0.9 and 0.7, respectively. The logistic probability of a fatal outcome was 0.96 in cardiovascular pathology, 0.3 in pulmonary pathology, and 0.04 in hepatitis (p = 0.0006). The logistic probability of postoperative complications in cardiovascular pathology was 0.85, in pulmonary pathology — 0.64, in hepatitis — 0.09 (p = 0.02). The logistic probability of a fatal outcome with the development of pulmonary complications was 0.02, cardiovascular complications — 0.09 (p = 0.0001). The Onodera’s prognostic nutritional index in comorbid patients was 43±9, in others — 44±4 (p = 0.5).

Conclusion: comorbidity was detected in one third of patients who underwent esophagoplasty. Cardiopulmonary complications cause death in half of the deceased patients with comorbidity. The Charlson Index proved to be the most sensitive and objective predictor of outcomes in patients with comorbid diseases.

Objective: to identify markers of tissue hypoxia in ulcerative colitis and methods for overcoming it.

Materials and methods: 77 children with ulcerative colitis (UC) aged 1 year to 18 years were examined. Retrospectively analyzed biopsy samples in patients with verifi ed course of ulcerative colitis, including those operated on, during initial hospitalization.

Histological, histomorphometric and immunohistochemical analysis of biopsy samples of the mucous membrane of the colon and ileum was performed.

Results: morphological markers of tissue hypoxia in UC were revealed: increased fi broplastic activity, small focal lipomases, small intestinal metaplasia in the distal colon, determined by the presence of Paneth cells, changes in the distal ileum in the colon type.

Conclusion: when identifying markers of tissue hypoxia, leading to a worsening prognosis of UC and the ineff ectiveness of therapeutic treatment, it is necessary to use accelerated “step-up” therapy, including the early administration of anticytokine drugs and use the hyperbaric oxygenation method.

The aim of the report is to present the case of successful use of endoscopic transpapillary stenting of the main pancreatic duct in a patient with severe pancreatic necrosis complications resistant to surgical treatment.

Materials and methods. A case report of a patient with complications of pancreatic necrosis treated by endoscopic trans-papillary stenting.

Results. Endoscopic transpapillary intervention clarifi ed the diagnosis, confi rmed the communication of the pancreatic ductal system with a pancreatic cyst and at the same time restored the pancreatic juice outfl ow which reduced the ab-dominal fl uid collections and the patient’s recovery.

Conclusion. Endoscopic management of complications of acute and chronic pancreatitis are an alternative to traditional surgical treatment and can improve its results.

Aim of the research: The research aims to study destructive processes of pancreatic tissue, extrapancreatic lesion in experimental sharp destructive pancreatitis (ESDP) with immune-correcting medication, protease inhibitor, non-steroidal antiinfl ammatory agent.

Materials and methods. Modelling of ESDP was carried out on laboratory rodents and involved peroral use of 1.0–1.5 ml of proof spirit 40% during 90 days, with the follow-up (after 60 days) introduction of fad nutrition. The research engaged three groups: group 1 was treatment group (index group) and groups 2 and 3 were experimental groups. The group 1 did not get any pharmacological treatment. Group No.2 got daily i ntravenous dose of 1.0 1000 KIU of aprotinin into the tail vein and peroral azoximer bromide of 3 mg. Group 3 was treated with daily intramuscular injection of diclofenac of 0.1 ml 2.5% into femoral region and intravenous dose of 1.0 1000 KIU of aprotinin. Removal from the experiment was made in 60th and 90th days with the pathomorphological study of lesion in cells of pancreas, parapancreatic structures, kidneys, peritoneum, mesentery.

Research results and discussion.   In histopathological examination of tissues of pancreas the overt edema, paravasal neu-trophil infi ltration, focal areas of subtotal necrosis were observed on the 60th day of experiment in treatment (index) group 1, whereas groups 2 and 3 showed less evident  pathomorphologicallesion and pancreatic necrosis was of focus nature. In histopathological examination of tissues on the 90th day, the pancreatic necrosis was retained and  extrapancreatic compli-cations in kidneys, kidneys, intestine, peritoneum and mesentery were observable in groups 1 and 2. Pathomorphological lesion was less overt in group 3.

Conclusions. Combination of pharmacological medication has a significant impact on destructive processes in pancreas and the development of extrapancreatic complications. One way to develop endogenic impairment is enterogenous that is less responsive to medical treatment.

The gut microbiome is increasingly recognized for its role in human health and disease. Initial evidence indicates that gut microbial dysbiosis is associated with several pancreatic diseases. Although it is not known if these associations are causative, gut dysbiosis is hypothesized to mediate chronic pro-infl ammatory changes in the pancreas. Further mechanistic and epidemiological studies of the microbiome are needed. Ultimately, targeted modulation of the microbiota could have therapeutic value.

In recent years, with the improvement of laboratory diagnostics, fundamentally new serum and fecal markers have ap-peared that allow increasing the accuracy of the diagnosis of ulcerative colitis, assessing the degree of disease activity, the effectiveness of treatment, and screening for colorectal cancer. The article presents current data on genetic, fecal, and serum markers that may be included in modern valuable diagnostic panels for the diagnosis of ulcerative colitis in the future.

Objective: to describe non-specifi c morphological manifestations of listeriosis infection in early stages of the disease in case of postnatal fetal death.

Fundamentals. A key feature of listeriosis is possibility of pathogen penetration through placental barrier followed by development of severe systemic lesions and negative perinatal outcomes.

Conclusion. Non-specifi c clinical symptoms of listeriosis infection stipulate impossibility of the use of etiologic therapy and lead to intrauterine infection, including process with minimal morphological manifestations.