Purpose of research. Study of the frequency of detection of mutations in the α1 — antitrypsin SERPINA1 gene in non-alcoholic fatty liver disease (NAFLD) in comparison with individuals from the General population and assessment of features of metabolic disorders.

Materials and methods. 439 people were examined, including 114 patients with NAFLD and 325 individuals in the General population. All subjects were subjected to molecular genetic testing. The frequency of mutations of the Glu342Lys (PIZ) and Glu264Val (PIS) alleles of the serpina1 α1-antitrypsin gene was evaluated. All patients with NAFLD underwent a comprehensive examination, during which standard indicators of liver function, lipid, porphyrin metabolism and cytokine spectrum were determined.

Results. Mutations of the α1 — antitrypsin SERPINA1 gene are signifi cantly more common in patients with NAFLD compared to individuals in the General population. Violations of lipid, porphyrin metabolism and cytokine spectrum parameters in the presence of mutations of the α1-antitrypsin SERPINA1 gene or their absence were registered with the same frequency. Against the background of mutations of the α1 — antitrypsin SERPINA1 gene, deviations from the normal values of lipid, porphyrin metabolism and cytokine spectrum were more signifi cant. Violations of porphyrin metabolism and cytokine spectrum were found in the majority of patients (in 69.4% and 77.1% of cases, respectively).

Conclusion. Conducting molecular genetic studies in NAFLD allows you to clarify the degree of metabolic disorders and assess the prognosis of the disease.

The objective of the study: to establish the frequency of acute intestinal infections of viral etiology in the Novosibirsk region, their clinical and epidemiological features and molecular and genetic diversity to justify rational approaches to diagnosis and treatment.

Materials and methods: 1500 patients aged 18 to 91 years were hospitalized with a diagnosis of acute intestinal infection (AII) from January 2016 to February 2018. Along with conventional diagnostic methods, faeces were examined by PCR for the presence of astroviruses, as well as rotaviruses and noroviruses of the second genogroup.

Results: the Viral etiology of AII was established in 332 (22.1%) patients. Astrovirus infection (AII) was diagnosed in 27 patients (1.7%), second in frequency to noroviruses (NVI) (13.3%) and rotaviruses (RVI) (7%). Viral diarrhea were detected more often in women 56.9 per cent. The age of patients varied from 18 to 91 years and averaged (30.2 ± 1.9) years. In half of the cases of AVI (48.1%), the use of seafood on the eve of the disease was established. The moderate form was registered in 90.1% of patients with viral OCI, and in  9.9% — severe. Severe forms of NVI occurred in 13.6%, more often than in rvi-5 patients (4.7%); and AVI (3.7%). It was found that in the majority of patients (96.3%) with severe dehydration, recombinant strains of noroviruses (GII.P17/GII. 17, GII.Pe/GII.4 Sydney). In 93.1% of patients with viral OCI, the disease started with fever. The vast majority of patients with the viral etiology of OKI had multiple watery diarrhea (91.6%). In the hemogram of the majority of patients with viral OCI, the number of white blood cells was normal at admission. The average values of white blood cells in patients with AII of diff erent etiology did not differ.

Conclusion: The absence of specifi c manifestations of viral AII of various etiologies determines the need to introduce test systems for verifi cation of viral pathogens into clinical practice. It is advisable to determine the genotypes of noroviruses both from an epidemiological point of view and to predict the risk of severe forms in cases of detection of new, previously unknown, recombinant strains.

The study of 184 patients with chronic hepatitis (CH) of diff erent etiology was carried out. Skin and vascular lesions were detected in 129 of them. A comparative assessment of clinical manifestations of skin and vascular lesions, assessment of morphological changes according to the bio-PSIA of the skin and muscle fl ap, evaluation of hemostasis indicators, immunological tests depending on the etiology of HCG was carried out.
It was found that the most common cause of skin and vascular lesions are various forms of chronic viral hepatitis (CVI B+C) and CVI B. The predominant morphological feature of lesions is mixed-cell vasculitis of small and medium vessels. Analysis of hemostasis indicators and immunological tests showed an important role in the development of vasculitis in HVG immunological disorders and of disorders of hemostasis.

Background: some researchers have demonstrated a link between the genetic polymorphism of certain pro-infl ammatory cytokines (IL-1β, IL-6) and the risk of developing precancerous diseases of the stomach and gastric cancer (GC).

Aim: to study the genotypes and alleles frequency of polymorphisms of –511C/T (rs16944) of the IL1B gene and 174G/C (rs1800795) of the IL6 gene in patients with serologically detected atrophic gastritis (AG) — the main precancerous lesions of the stomach.

Materials and methods. the study included 55 people (45 females and10 males) with an average age of 58.2 ± 11.5 years with signs of obvious or possible atrophy of diff erent parts of the gastric mucosa revealed by enzyme-linked immunosorbent assay (ELISA) with determination of pepsinogen levels I (PGI), PGII, the PGI / PGII ratio, gastrin-17 and IgG antibodies to H. pylori using the “GastroPanel” diagnostic kit (Biohit Plc, Helsinski, Finland). DNA was isolated from venous blood using the phenol-chloroform extraction method. DNA samples were genotyped according to published methods.

Results: in patients with severe AG (PGI level less than 30 μg/l), the combined variant with the rare T allele (T/T + C/T) was detected signifi cantly more often (68.8%) than the common homozygous C/C variant (31, 3%, p = 0.004). In individuals with a low PGI/PGII ratio (less than 3), which is also evidence of fundamental atrophy, the homozygous T/T variant was more common (29.6%) than the C/C genotype (7.4%, p = 0.04) The average PGI values were signifi cantly lower with the C/C genotype of the IL-6 gene compared with the heterozygous C/G variant (p = 0.03), however, in patients with morphologically confi rmed atrophy, the  combined variant with the rare G allele (G/G + C/G) of the IL6 gene was more common than the homozygous C/C variant (71.4% versus 28.6%, p = 001).

Conclusions: in patients with signs of corpus atrophy (low PGI, PGI PGII ratios), the homozygous variant with a rare T allele, which is associated with increased IL-1β production and the development of a hypoacid state, was 4 times more likely than the homozygous C/C variant (p = 0.04). The results obtained suggest a possible association of IL1B polymorphism (carriage of a rare T allele) with the formation of a cancer phenotype of gastritis. The contribution of IL6 polymorphism requires further refi nement.

The disorder of immunoregulation and activation of the immune response in relation to antigens of the  intestinal microfl ora in genetically predisposed individuals under the infl uence of certain environmental factors  is currently considered as the main theory of the infl ammatory bowel diseases pathogenesis. The morbidity and prevalence of ulcerative colitis (UC) is increasing simultaneously with the obesity pandemic. In recent years, information has appeared on the epidemiological interaction of predisposing factors for obesity and UC.

Study objective is to assess the prevalence of overweight and obesity in patients with UC in the Western Siberian region before the fi rst symptoms of the disease and during treatment, as well as to assess the body mass index (BMI) in patients with UC depending on gender, lesion length, severity, duration of the disease and biologic therapy.

Materials and methods: a case-control study was conducted with 127 patients having UC and 63 healthy  ones, comparable by sex and age. BMI was calculated by the formula: mass (kg)/weight (m²). 

Results: overweight and/or obesity were noted before the onset of the fi rst symptoms of the disease in 58% of patients with UC of the Western Siberian region. Moreover, a statistically signifi cant predominance of overweight and obesity was observed in men. Dynamic monitoring of patients with UC revealed a lower BMI in patients with total lesion, severe course of the disease, and also against the background of a long-term disease. Biologic therapy helps to increase the BMI.

The aim of the study is to optimize health-saving technologies, to study the prevalence of IBS-like symptoms in relation to the nature of nutrition and eating habits in the youth environment.

Materials and methods: an anonymous survey of 3634 students studying at the Omsk State Medical University under the programs of higher and secondary vocational education was conducted. The prevalence of IBS-like symptoms was assessed in relation to the nature of the diet and eating habits.

Results and discussion: an analysis of the results revealed the presence of the following IBS-like symptoms  in the youth environment: abdominal pain — 2300 (63,29%), constipation — 1353 (37,23%), diarrhea — 1215  (33,43%) of the respondents. Abdominal pain, constipation and diarrhea were more common among university students than in college (2I = 24,45, p <0,001, 2I = 42,16, p <0,001, 2I = 49,00, p <0,001, respectively). Abdominal pain and constipation were more common among girls (2I = 33,96, p <0,001 and 2I = 5,79, p <0,05, respectively). When choosing food products people with IBS-like symptoms are guided by the possibilities of the family budget, but not by the quality and usefulness of the products. People with abdominal  pain statistically signifi cantly consumed more coff ee (U = 1544300,5, p = 0,0048), people with diarrhea consumed milk and dairy products (2I = 14,36, p <0,05). All IBS-like symptoms were associated with low consumption of fruits and vegetables (U = 1391865,5, p = 0,000, U = 1340501,5, p = 0.000, U = 1321122,5, p = 0,000 for abdominal pain, constipation and diarrhea, respectively). The habit of adding food to foods without tasting it was more often observed among people with abdominal pain and diarrhea (2I = 18,85, p <0,001 and 2I = 16,94, p <0,001). Respondents complaining of abdominal pain also had an addiction to spicy foods (2I = 7.76, p <0.001). The frequency of meals did not aff ect the presence of IBS-like symptoms.  However respondents with IBS-like symptoms more often reported a limited time for eating, frequent overeating and the inability to eat at the same time. 

Conclusion: a high frequency of IBS-like symptoms in the youth environment was revealed. IBS-like symptoms are closely interconnected with eating disorders and eating habits. In addition, IBS-like symptoms have gender characteristics, and are also more common in students enrolled in higher education programs.. IBS-like symptoms have gender characteristics and are also more common in students enrolled in higher education programs.

Aim of work is to study the features of the fatty acid (FA) composition of the membranes of erythrocytes (Er) and blood serum (BS) in patients with Crohn’s disease (CD) for possible use for diff erential diagnosis.

Materials and methods. Using a gas chromatography-mass spectrometric system (GC/MS) based on three Agilent 7000B quadrupoles (USA), the composition of erythrocytes (Er) and blood serum (SC) of 60 people was studied: 19 — with Crohn’s disease (CD, 34±6,2 years), 21 — with unclassifi ed colitis (UCC, 35,2±4,7 years) and 20 healthy individuals (32,9±5,7 years).

Results. It was found that the levels of most saturated, monounsaturated omega-9, omega-6 PUFAs were signifi cantly higher, and the content of the predominant part of omega-3, a number of omega-6 (linoleic, eicosadienoic, arachidonic) was lower than in healthy individuals. The relative content of FA in patients with unclassifi ed colitis turned out to be intermediate between those in patients with CD and healthy (p <0,0001–0,02). The obtained diff erentiating values of FA levels and their indices in the erythrocyte membranes made it possible to identify patients with suspected Crohn’s disease from those who were diagnosed with unclassifi ed colitis, which indicates the high potential of this approach for diff erential diagnosis.

 

Conclusion. The created diagnostic panels (FA of blood serum and erythrocyte membranes) made it possible to diff erentiate patients with CD from healthy individuals with fairly high levels of sensitivity and specifi city. The revealed features of the levels of FA membranes of Er and BS, as well as their ratio in patients with CD, are promising for the purposes of diff erential diagnosis, including in cases of unclassifi ed colitis.

Aim of work is to study the compositional features of fatty acids (FA) of erythrocyte membranes in patients with diff erent localization of the tumor in colorectal cancer (CRC).

Materials and methods. Using a chromatography-mass spectrometric system (GC/MS) Agilent 7000B based on three quadrupoles (USA), the composition of erythrocyte (Er) membranes of 129 patients with CRC was studied: (average age 63.2±9.4 years, of which 68 men and 61 women; 25 with proximal, 98 with distal tumor localization) and 35 people in the comparison group.

Results. A greater degree of decrease in the levels of saturated, monounsaturated FAs (MUFAs), and, conversely, an increase in the levels of polyunsaturated FAs (PUFAs) in patients with distal tumor localization compared to healthy ones, was established than the same ratio in the pair “proximal localization of tumor RCC — healthy”. A greater degree of increase in the level of omega-3 PUFAs was noted than omega-6, which aff ected the ratio n-6 / n-3, which was signifi cantly reduced in cancer patients, to a greater extent with distal tumor localization.
The most signifi cant for distinguishing tumors located in diff erent parts of the intestine were: saturated fatty acids — myristic C14:0 (p<0,001) and pentadecanoic C15:0 (p=0,012), omega-3 a-linolenic (C18:3; n-3) (p=0,02), whose levels were signifi cantly higher and, conversely, most of the omega-6 PUFAs (C18:2 n-6, C20:3 n-6, C20:4 n-6) and one omega-3 PUFAs — C22:6 n-3 (p<0,05), whose levels were signifi cantly lower with proximal localization of the tumor than with distal.

Conclusion. The results obtained indicate the importance of taking into account the localization of the tumor in patients with CRC when conducti ng studies of metabolic profiles. 

Aim study. To study the etiology, nosological structure and pathomorphological changes in the liver and gastrointestinal tract in deceased newborns with perinatal infectious diseases.

Materials and methods. In total, 48 protocols of pathological autopsy of the deceased newborns were studied in 2018 and 2019. Gender, age of newborns, maternal gestational age, post-mortem bacteriological studies, as well  as macroand microscopic changes in the gastrointestinal tract and liver were evaluated. 

Results. Hepatitis and enterocolitis were part of generalized intrauterine infection and early neonatal sepsis — 19 cases each (39.6%), mainly in preterm infants (93.8%). Positive results of bacteriological studies of autopsy material were noted in 12% of cases. The most common causative agent in post-mortem bacteriological examination in early and late neonatal sepsis was Klebsiella pneumoniae. The main morphological manifestations of hepatitis in newborns were lobular hepatitis of various degrees of activity — 63.8%, as well as fetal giant cell hepatitis — 21.4%. Morphological changes in gastroenterocolitis were characterized mainly by the development of  erosive-ulcerative enterocolitis (37.8%), productive enterocolitis (46.9%), less often serous-catarrhal, ulcerative-necrotic enterocolitis (6.25%).

Objective: to compare socio-demographic indicators, clinical symptoms, results of a psychiatrist consultation and psychometric testing, quality of life studies of patients with diverticular colon disease (DBTK) and irritable bowel syndrome (IBS).

Materials and methods: 112 patients with colon diverticulosis (DOC), clinically severe diverticulosis (CVD) and diverticular disease (DB) were examined, of which 26 were men, 86 were women, the average age was 64 ±10.7 years and 112 were patients with irritable syndrome intestines (IBS) (31 men, 81 women), average age — 37.2 ±12.6 years. Applied: irrigoscopy, colonoscopy, fecal fecal calprotectin analysis, in-person psychiatrist  consultation, SCL-90-K questionnaire and SF-36 questionnaire.

Results: Mental disorders, mainly of a nosogenic nature, were detected in 80 (71.4%) patients with DOC, CVD, and DB. A correlation was established between the severity of mental pathology and the stage of diverticulosis. With IBS, in 107 (95.5%) mental changes were determined mainly with depressive syndromes of various structures. Somatic manifestations did not show noticeable diff erences. The indices of FC were the same for IBS and PKD and exceeded for CVD and especially for DB.

Conclusion: Diff erences in DBTK and IBS were revealed in the fi eld of mental disorders of varying severity, which requires diff erentiated therapy. Clinical manifestations did not show signifi cant diff erences.

Introduction. Most modern classifi cations of chronic benign diseases of the anorectal region are based on an assessment of the severity of the morphological changes that occur with these diseases. However, the direct relationship between the stage of the disease and the severity of its clinical manifestations is not always traced. Thus, there is a need to develop a tool for assessing the severity of the disease as a complement to the current morphological classifi cation.

Material and methods. The study was carried out in 2018–2019, 239 patients (110 men, 129 women) were included. The median age was 35 years (ranging from 19 to 70 years). Nosological composition: 175 patients with chronic hemorrhoids, 37 with chronic anal fi ssure, 19 patients with a combination of anal fi ssure and hemorrhoids, 8 patients with idiopathic anal itching. All patients were interviewed for the main symptoms of anorectum diseases. After that, it was proposed to evaluate their condition on a visual analogue scale (VAS), from 0 to 10. Then, a model was constructed for the dependence of the severity of the disease on the frequency of symptoms in the form of a linear regression equation with calculation of regression coefficients.

Results. The data obtained is a score for the contribution of each of the symptoms, which can be used as a scale for assessing the severity of anorectum diseases.

Discussion. The results of our study provide an opportunity to stratify the symptoms of participation in the formation of the clinical picture of the disease. The contribution of each symptom was evaluated individually using mathematical modeling methods. Such a combination would make it possible to give an exhaustive description of the condition, including both the organic manifestations of the disease and clinical symptoms.

Conclusions. The results of this study made it possible to create an assessment tool — a scale for determining the severity of chronic benign diseases of the rectum as an addition to the existing classifi cations based on morphological changes. 

The aim: to analyze the eff ectiveness of laparoscopic sleeve gastrectomy with transit bipartition in patients with obesity, weighted type II diabetes mellitus and gastroesophageal refl ux.

Material and methods: 22 patients were operated on from 12.2017 to 02.2020. The average BMI is 44 ± 4.6 kg / m2. M: F — 1: 4. The average age is 45 ± 7.1 years. The terms of postoperative observation ranged from 1 to 24 months. The analysis of the immediate and long-term results of surgical treatment.

Results: Laparoscopic sleeve gastrectomy with double transit is an eff ective and relatively simple operation for the treatment of patients with obesity, type II diabetes mellitus and gastroesophageal refl ux, the eff ect is comparable to gastric bypass, Sadi operation, at the same time leads to early saturation, rapid loss of body weight and low malabsorption eff ect.

The actual problem of modern medicine is the search for links between non-alcoholic fatty liver disease and cardiovascular diseases. The real clinical practice needs to deepen knowledge about the mutual infl uence of  these two diseases and develop algorithms to accompany these patients.
A review of current literature shows data on increasing cardiovascular risks and accelerating progression of liver  pathology in the combination of non-alcoholic fatty liver disease and cardiovascular disease. The article describes the links of pathogenesis of non-alcoholic fatty liver disease aff ecting the development of cardiovascular diseases (insulin resistance, hypoadiponectinemia, hyperleptinemia, lipid metabolism disorders, activation of infl ammation, etc.). The role of infl ammation, hormonal changes and the infl uence of intestinal microbiota on the course of both diseases has been demonstrated. 
The review presents data on the infl uence of common risk factors (lipid metabolism disorder, carbohydrate metabolism disorder, obesity, etc.) on the course of both pathologies. The review presents the literature data on the connection of non-alcoholic fatty liver disease with the development of arterial hypertension (primarily due to an increase in vascular wall stiff ness), coronary heart disease (primarily due to endothelial dysfunction and hyperlipidemia), heart rhythm disorders, heart failure, cerebrovascular diseases. It has been shown that the connection between non-alcoholic fatty liver disease and cardiovascular diseases is bilateral and cardiovascular diseases can aggravate the course of liver diseases.
The importance of further study of this issue is due to the mutual infl uence of non-alcoholic fatty liver disease and  cardiovascular disease not only on the prognosis, but also on the tactics of patient management.

The study of genetic polymorphism and associations of certain alleles and genotypes in chronic diffuse liver diseases is becoming more widespread and, in some cases, reveals some patterns that make it possible to clarify the nature of the pathological process. Understanding the genetic foundations of chronic diffuse liver diseases provides promising opportunities in understanding the pathogenetic mechanism of the disease. It also allows you to develop new approaches to their diagnosis, treatment and prevention.

Nutritional support is one of the most important non-drug therapies for patients with chronic liver disease. In the lecture the authors consider the signifi cance of this way of therapy, methods for detecting nutritional disorders in patients with chronic liver diseases, and diet therapy issues as well. Recent studies have shown that nutritional support for chronic liver diseases is a rapidly growing fi eld of medicine and an object of increasing clinical interest. It should be recognized that studies in the fi eld of nutritional support for chronic liver diseases are based on generally accepted recommendations for patients with another diseases. Therefore, many questions remain unanswered and demands on new investigations.

The aim of the study was to estimate the clinical characteristics of extraintestinal (dermatological) symptoms of celiac disease and malabsorption syndrome.

Materials and methods: the work is based on the results of the determination of antibodies to deamidated  peptides of gliadin (AGA IgA, IgG) and tissue transglutaminase (tTG IgA, IgG) in whole blood by enzyme  immunoassay method (ELISA). During the three-year period, 1367 patients with common chronically dermatoses were examined.

Results: Positive reactions to antibodies to deamidated peptides of gliadin and/or tissue transglutaminase were detected in 229 patients (117 men and 112 women aged from 18 to 70 years), which accounted for 16.8% of the total number of patients examined. Of the 229 seropositive patients, 47 suff ered from psoriasis, 27 — allergic dermatitis, 24 — lichen planus, 21 — atopic dermatitis, 19 — eczema, 14 — acne, 13 — focal neurodermatitis, 11 — herpetiform Düring dermatitis, 11 — seborrheic dermatitis, 9 — urticaria, 9 — alopecia, 9 — scleroderma, 8 — rosacea, 7 — discoid lupus erythematosus. Clinical signs of celiac disease (nausea, loose stools with foul odor, bloating) were observed only in 149 out of 229 seropositive patients (65%). In 80 patients (35%) there were no clinical signs of gastrointestinal tract damage.

Conclusion: in some cases, celiac disease is latent and atypical, often dermatological symptoms are the fi rst and only clinical manifestations of the syndrome of malabsorption and celiac disease. The most common symptoms in patients with celiac disease are: Dühring dermatitis; xerosis and peeling of the skin, follicular hyperkeratosis, fi ssures, pellagroid pigmentation, nail atrophy, focal alopecia; severe, often relapsing course  of psoriasis, allergic and atopic dermatitis, eczema, lichen planus.

A large number of scientifi c studies are devoted to the role of diet in the treatment of irritable bowel syndrome (IBS). A signifi cant proportion of patients associate the appearance of the IBS symptoms with the intake of certain foods. Many medical communities have recognized nutrition management as an important tool in treating the disease. The article discusses the existing dietary approaches in the management of patients with IBS based on generalized data available in the modern literature. An assessment of the nature and nutrition and identifi cation of the most common types of food intolerance are considered as a “fi rstling” approach. When IBS symptoms persist, consideration should be given to applying extended recommendations such as a low-FODMAP diet. The purpose of the low-FODMAP diet is to sequentially identify specifi c triggers to control disease symptoms.

The problem of entero-colonic anastomosis leakage in emergency surgery has always been under close medical community attention. The more proximal intestinal sutures are located, the more severe the consequences are. In case of a left half of the colon the solution of the problem is relatively safe colostomy. Treating a patient with entero-colonic anastomosis leakage, the question arises about the ileostomy, which leads to more serious consequences (water-electrolyte disbalance). Most of these patients get treatment for complicated colon cancer, which worsens the prognosis. In general, the risk of entero-colonic anastomosis leakage in emergency surgery reaches 12.7%. The risks are: inadequate assessment of blood fl ow in the suture line, peritonitis, diabetes, smoking, severe ileus, intraoperative blood transfusion, a small experience of a surgeon in performing these operations.
Nowadays there are many ways to prevent anastomosis leakage. They are: application of compression devices of Ni-Ti with simultaneous U-shaped ileostomy, biodegradable rings, consolidation of intestinal sutures with «TachoComb» biopolymer substance application, various adhesive compositions, gland. Oblique intersection of the intestinal wall also uses to increase blood fl ow on the suture line, correction of infusion therapy is discussed with inclusion of hydroxyethyl starch. However, the zero frequency of the leakage in the clinic still cannot be achieved.
Accordingly, nowadays, the problem of optimal entero-colonic anastomosis technique remains open. It should meet the following requirements: ideally, a zero frequency of leakage; a technical simplicity of the operation; preferably, without using expensive materials; as far as possible — a valve to prevent refl ux ileitis.

Recently, studies comparing various variants of operations to establish the optimal method of surgical treatment  or chronic pancreatitis with pancreatic head lesions from the point of view of evidence-based medicine have been  carried out in the world. However, these comparative studies do not take into account diff erences in the clinical and morphological forms of the disease, in particular, chronic pancreatitis with a predominant and isolated lesion of the head.
Thus, performing a subtotal resection of the pancreatic head with longitudinal pancreatojejunoanastomosis or Frey  surgery, which is advisable for chronic pancreatitis with predominant head lesion, in case of an isolated  lesion of the head will be an excess of the volume of surgical intervention due to the fact that the outfl ow of secretion along the main pancreatic duct of the distal part of the gland does not disturb, the parenchyma of this part of the body practically does not participate in the pathological process and is changed minimally, and can  respond to such an operation with pancreatic necrosis. 
Based on the studies performed, it is impossible to say with certainty about the reliable advantages of one type of operations on another.
To obtain reliable results, it’s necessary to conduct evidence-based studies comparing subtotal resection of the  pancreatic head with longitudinal pancreatojejunostomy with other types of interventions o nly for chronic  pancreatitis with a isolated head lesion, excluding from the study patients with chronic pancreatitis with predominant head lesion.

Infl ammatory bowel disease (IBD) has been in the researchers’ focus of attention for at least two decades and is one of the most studied human pathologies. On the one hand, advances in scientifi c knowledge about the pathophysiology of IBD have contributed to the development of new drugs. But on the other hand, the etiology of these diseases remains unknown. And we have the right to call IBD “the mystery of modern gastroenterology”. Obviously, the increase in the number of patients with ulcerative colitis (UC) and Crohn’s disease (CD) occurs simultaneously with the change in lifestyle and basic approaches to nutrition in modern society, the so-called “Western lifestyle”. IBD became more common around the same time that the obesity pandemic began. At fi rst glance, the relationship between IBD and obesity can be questioned. However, with a detailed analysis of predisposing factors and the prevalence of these diseases, many common features can be found. Obesity is becoming more common among patients with IBD and plays an important role both in development and in progress of UC and CD. It has been argued that adipocytes, release of pro-infl ammatory cytokines, imbalance of leptin and adiponectin, decrease in mucin synthesis, induction of intestinal permeability, bacterial translocation are involved in the pathogenesis of IBD. Changes in the composition of the intestinal microbiota are probably an important pathogenetic link between obesity and IBD. We present this review to physicians and gastroenterologists for information purposes, focusing on studies conducted over the past years. Literature was searched in PubMed and Google Scholar using the following Keywords: ulcerative colitis, obesity, colonic microbiota, leptin, adiponectin.

The article presents a clinical case of a 63-year-old patient with anemia with chronic atrophic gastritis and treatment failure with iron preparations. Using the example of this observation, the errors that occur during the diagnosis and management of patients with autoimmune (corpus atrophic) gastritis (AIG) are analyzed. At the same time, the pathogenesis of AIG and the relationship with Helicobacter pylori (H. pyloi) infection are being discussed. The problem of timely diagnosis of AIG and the benefi ts of non-invasive methods for assessing the functional state of the stomach are becoming relevant.