The presented clinical practice guidelines of the Gastroenterological Scientific Society of Russia (GSSR), diagnostic, and therapeutic approaches for patients with digestive diseases during the COVID-19 pandemic. The guidelines were approved by the XXIII Congress of the GSSR and the 22nd International Slavonic-Baltic Scientifi c Forum “St. Petersburg - Gastro-2020 ON-LINE” (St. Petersburg, June 11, 2020). The presented clinical practice guidelines of the Russian Scientific Medical Society of Internal Medicine (RSMSIM) and the Gastroenterological Scientific Society of Russia (GSSR), diagnostic, and therapeutic approaches for patients with digestive diseases during the COVID-19 pandemic. The recommendations were approved at the XV National Congress of Internal Medicine, XXIII Congress of NOGR on the basis of the 1st edition, adopted at the 22nd International Slavic- Baltic Scientific Forum “St. Petersburg - Gastro-2020 ON-LINE”.

Justification The participants of the round table on diagnosis and treatment of acid - and Helicobacter-dependent diseases, held on November 20, 2020 at the XXIII congress of the Scientific Society of Gastroenterologists of Russia within the framework of the XV National Congress of Therapists (Authors) having discussed the status of the issue, decided on the need to harmonize measures and pool efforts to reduce the incidence of H. pylori infection by approaching the medical community with this Memorandum.

Justification Given the large number of reports on the peculiarities of liver lesions during the Sars-Cov-2 infection [1], a team of experts who participated in the 23rd Congress of the Scientific Society of Gastroenterologists of Russia and 15 National Congress of Therapists of November 19, 2020 decided to make additions to the Russian Consensus of “Hyperammonemia in Adults” published early 2020 [2, 3].

Research objective. То study the genotypes of Helicobacter pylori and their antibiotic sensitivity in patients with stable angina in combination with chronic gastritis. Material and methods. 46 patients with stable angina with a combination of chronic H. pylori-associated gastritis were included in the open prospective clinical study. To diagnose H. pylori, serological method of detection of antibodies in blood serum was used, PCR - diagnosis of H. pylori genes. Antibiotic sensitivity of H. pylori strains was studied by serial dilution method. Results. In the patients (n = 46) stable angina in combination with chronic gastritis in the endoscopic study by the EGDS method, gastrobioptates were obtained and further investigated. Chronic neatrophic gastritis was diagnosed in 54.3% of patients, atrophic gastritis - in 45.7%. It was found that the genotypes of H. pylori VacA had 8.7% of patients, CagA - 34.7%, HopQ - 13.1%, Oip - 30.4% of patients. Only 13.1% of patients had non-toxic genotypes. The absence of antibiotic resistance of the first line of erication therapy - clarithromycin and amoxicillin - was revealed. 45.7% of patients showed resistance, 39.1% showed weak sensitivity of H. pylori isolates to metronidazole. Conclusions. In patients with stable angina with a combination of chronic gastritis, H. pylori strains with toxigenic genotypes: CagA, Oip, Vac A, HopQ predominate. Resistance of H. pylori isolates to metronidazole was determined in 45.7% of patients.

Helicobacter pylori (H. pylori) infection is an important etiological factor in the development of diseases of the stomach: chronic gastritis, peptic ulcer, stomach MALT-lymphoma and gastric cancer. Aim. Assessment of the frequency of detection of H. pylori infection in patients with morphological changes in the gastric mucosa according to a histological study. Materials and Methods. A retrospective study of medical records. We evaluated the results of histological studies of a biopsy samples of the gastric mucosa in patients tested for the presence of H. pylori infection using a rapid urease test. Results. The study included 221 results of histological evaluation of samples of the gastric mucosa of patients with chronic gastritis, gastric ulcer, polyps, and adenocarcinoma. Of 210 histological descriptions of morphologically altered gastric mucosa, 86.2% were associated with the presence of H. pylori. In 11 patients, morphological changes in the gastric mucosa were not detected, relatively more often 6.4 times (p <0.001) among H. pylori-negative individuals. Conclusions: H. pylori infection detected in 86.2% of patients with morphological changes in the gastric mucosa. Persons infected with H. pylori are 6.4 times less likely to have morphological unchanged gastric mucosa than persons who are free of infection, 2.7% and 17.1%, respectively (p <0.001).

606 patients (405 men and 201 women) with HP infection were examined, 121 (m 67; f 54) found clinical or clinical and laboratory signs of iron deficiency, the frequency of iron deficiency in the examined group of patients with HP was 19.9% (16.8-23.3; CI 95%). 25 (20.7%) were diagnosed with anaemia, 66 (54.5%) patients had a latent deficit of iron, 30 patients (24.8%) showed only a decrease in TS, which is typical for pre-latent iron deficiency. 38 (31.4%) patients had a «true» iron deficiency, 44 (36.4%) patients had a combined variant of iron deficiency, and 39 (32.2%) iron deficiency developed as a result of chronic inflammation. There was a significant difference in the level of hepcidin in patients with different options for iron deficiency. In patients with “isolated” iron deficiency, it was 12.4 ± 2.3 ng/ml, vs 48.2-± 20.2 ng/ml vs 189.7 ± 31.1 ng / ml in patients with a combined pathogenic variant of iron deficiency and in patients with iron deficiency of chronic inflammation, respectively.

Aim. To develop a model for the implementation of opioid - associated neurotoxicity in patients with pancreatic cancer based on an analysis of the relationship of clinical and genetic factors. Materials and methods. In 45 patients with pancreatic cancer, 54 clinical and genetic factors were studied for predicting the implementation of opioid-associated neurotoxicity, receiving a transdermal form of fentanyl. Results. A clinical genetic model of the implementation of opioid - associated neurotoxicity in patients with pancreatic cancer was developed using the example of a transdermal form of fentanyl Conclusion. The clinical genetic model for predicting the risk of opioid-associated neurotoxicity in patients with pancreatic cancer is important from the perspective of personalized medicine.

To date, a number of studies have been conducted on the relationship of HCV genotypes with complications such as liver cirrhosis, hepatocellular carcinoma, but research on the correlation of the genotype with extrahepatic clinical manifestations associated with HCV, especially rheumatic manifestations, is insufficient. The purpose of the study is to analyze the most common genotypes of viral hepatitis C in the Republic of Uzbekistan and study their correlation with rheumatic manifestations of HCV. Methods: This study involved 88 patients with HCV infection who received inpatient and subsequent ambulatornoe treatment in Scientific Research Institute of Epidemiology, Microbiology and Infectious diseases of the Republic of Uzbekistan. Diagnostics procedures at the initial level included a set of studies, i. e. clinical, rheumatological and laboratory studies, ultrasound of the joint. In addition, 88 samples of RNA - positive serum from patients diagnosed with HCV were genotyped. Results: the Results showed that genotype 1 of HCV (subtype 1b) is the main genetic variant of HCV in Uzbekistan. Based on the results obtained, the genotypic features of viruses can be markers of the development of extrahepatic clinical manifestations. There is a reliable direct correlation between the incidence and severity of associated arthritis in patients with chronic viral hepatitis C with genotype 1b of the virus according to our research. Conclusions: The results of the study can be provided to help the doctor of the polyclinic service as recommendations that patients with the 1b genotype of the virus have a greater adherence to associated arthritis, and in this case, timely targeted consultation of a specialist is necessary.

The purpose of the study is to analyze the state of liver function in patients with spondyloarthritis taking non-steroidal anti-inflammatory drugs continuously for 24 months. Materials and methods of the study include 198 patients with spondyloarthritis. The prospective study involved 36 patients with spondyloarthritis who took non-steroidal anti-inflammatory drugs (NSAIDs) prescribed by a physician in the community for 24 months. The level of liver enzymes in blood serum at admission and in dynamics was studied. The increase of liver enzymes was detected in 12 (6.06%) of 198 patients with spondyloarthritis. Among them 6 (50%) patients took methotrexate, 1 (8.33%) - genetically engineered drug, 2 (16.67%) patients-sulfasalazine and 3 (25%) - nonsteroidal anti - inflammatory drugs. 19.4% of patients were registered with a periodic increase of transaminase levels on the background of NSAIDs for the last 24 months. At the same time, no cases of acute liver damage or progressive deterioration of liver function requiring discontinuation of therapy were recorded during the entire follow-up period.

Objective: to assess the quality of life of patients and the state of the hepatopancreatobiliary system before and after cholecystectomy in the long-term period. Materials and methods: at the first stage, 107 people were examined after emergency, planned cholecystectomy (with symptomatic and asymptomatic course of GI). At the second stage, 90 people at different times after cholecystectomy for a more detailed examination of the external secretory function of the pancreas was performed. Results: the majority of patients, regardless of the type of surgery, had symptoms of dyspepsia associated with the development of functional disorders of the gastrointestinal tract (gastroesophageal reflux, duodenogastric reflux, sphincter Oddi dysfunction). A decrease in the external secretory function of the pancreas was shown regardless of the period after cholecystectomy. Conclusion: after cholecystectomy, functional disorders of the digestive system predominate in the long-term period due to loss of the physiological function of the gallbladder.

The aim is to study motor disorders of the gastrointestinal tract and biliary tract with erosion of the stomach. Materials and methods. Electromyography (EMG) of the gastrointestinal tract and biliary tract was performed in 35 patients with gastric erosions; the control group consisted of 10 patients with gastric ulcer. A morphological study of biopsies of the antrum of the stomach was carried out. Results. Patients with erosion of the stomach were characterized by severe hypermotor dyskinesia of the stomach with a decrease in the motor function of the small intestine and multidirectional changes in the motor function of the colon. Motility of the biliary tract is characterized by an increase in tonic activity with a slight increase in phase activity. Histological examination revealed areas of fibrinoid necrosis in its own plate and foci of destruction of the end sections of the pyloric glands. Conclusion. Motor function of patients with gastric erosion is characterized by a greater power of muscle contractions of the stomach, a smaller power of muscle contractions of the small intestine and multidirectional changes of the power contractions of various sections of the colon.

An experimental study of the beneficial effect of herbal preparations on acute toxic liver damage with carbon tetrachloride (CCl4) in animals was conducted The goal is to Compare the hepatoprotective effect of three water extracts of herbal preparations: (I) Trigonella foenum-graecum (seeds), (II) Cymbopogon proximus, (III) Asasia nilotica Material and methods. To simulate acute toxic liver damage, 50% CCl4 was administered once intraperitonally in doses of 0.6 ml, 0.3 ml, and 0.2 ml. Control groups: K1-1 group intact animals without injections; K2: groups 2, 3, 4. introduced saline solution (FR) without Ssl4 in the volume of 2 ml. Experimental groups: 5, 6, 7 and 8 studied the hepatoprotective properties of aqueous solutions of the studied drugs after intraperitoneal administration of Ssl4 or FR. Researched herbs: I, II, III, in different doses were administered 2 ml of an aqueous solution in breeding 1:10, observation period 5 days, the blood, for research stabilized solution of sodium citrate in the ratio of 1:10, studied the properties of blood cells hematological analyzer PCE-90Vet (USA). The content of total protein, albumin, total cholesterol, triglycerides, urea, creatinine and transaminase activity - ALT, AST-were recorded in the blood serum using an automatic analyzer of the company “ HUMASTAR 600 “(Germany)», Results and discussion. Water extracts of preparations I and II prevented the reduction of red blood cells and platelets, and activated the macrophage pool. All the herb extracts studied prevent platelet reduction, however, but do not bring them up to the indicators of intact animals. The use of solution III prevented the growth of the cytolysis enzyme-ALT. All studied extracts in acute carbon tetrachloride intoxication. they warned of an increase in hypertriglyceremia. The introduction of water extracts II, III in the 1:10 ratio prevented the development of necrotic changes in hepatocytes, inflammatory infiltration, manifestations of fatty dystrophy, and preserved the architectonics of the liver lobule.

The purpose of the review is to present an analysis of the current literature data on the pathogenesis and therapy of liver damage in Covid-19. Liver damage in COVID-19 patients can be caused by the direct cytopathogenic effect of SARS-CoV-2, an uncontrolled immune response, sepsis, severe hypoxia, or drug damage. In addition, COVID-19 can exacerbate and decompensate previously formed chronic liver diseases with the development of acute liver failure. Physicians should carefully assess the initial state of the liver, and after prescribing therapy, intensify monitoring of its functional state, especially in patients with severe COVID-19. In each clinical case, the doctor needs to establish the possible mechanisms of organ damage in order to select the most optimal patient management tactics, which would take into account all aspects of the COVID-19 course and liver damage. Currently, additional scientific information is required to uncover the features of liver damage during SARS-CoV-2 infection and in the postcovid period. Patients who have undergone COVID-19 need further monitoring to assess the long-term effects of the disease.

Peripheral arthritis is one of the most common manifestations of articular syndrome, not always associated with rheumatic diseases. Determination of its nosological affiliation and rational therapy at an early stage (early arthritis) present a complex clinical and diagnostic problem requiring an interdisciplinary approach. The review presents the differential diagnosis of early arthritis in diseases of the gastrointestinal tract such as inflammatory bowel disease, celiac disease, PPP syndrome (Pancreatitis, panniculitis and polyarthritis (PPP-) syndrome), etc., manifested by similar clinical symptoms with rheumatic diseases such as early rheumatoid arthritis and spondylitis. Most of the immuno-inflammatory diseases presented in the review are multisystemic and heterogeneous in clinical symptoms, course and outcomes. Therefore, the diagnostic process, especially in case of early arthritis with typical multisystem involvement, is comprehensive and cognitive in nature and requires the synthesis of many data that are usually not taken into account in a simple algorithm based on a set of classification criteria.

The purpose of the review is to analyze the real benefits of the use of traditional probiotics and to highlight the issues of the possibility of creating and using new generation probiotics in the treatment of gastroenterological pathology. Questions of effectiveness of therapy with traditional probiotics of functional and organic diseases of the gastrointestinal tract in children and adults from the points of view of evidence-based medicine are analyzed, insufficient number of studies in children and frequent absence of significant differences in the effect of probiotics compared to placebo are emphasized. New generation probiotic candidates are described, which could become potential sources of new drugs for various diseases, including gastroenterological pathology. The main problems in the way of creation and introduction of new probiotics are outlined. Data on an alternative approach of probiotic therapy based on use to restore microbiocenosis of own bacteria, which are grown as pure genetically characterized cultures and can be used as probiotic products, are presented.

Aim of the study: Using the example of a clinical case, to show the importance of dynamic observation by means of various diagnostic methods of intestinal imaging, in combination with a pathomorphological confirmation method for setting the correct clinical diagnosis. Materials and methods: The studies were performed on multislice computed tomographs Brilliance CT and ICT (Philips Medical Systems) and magnetic resonance imaging machines (GE), with intravenous contrast enhancement. We used special methods of contrasting the lumen of the intestine with gradual and retrograde filling it with water. The surgical material fixed in 10% neutral formuline for 10-24 hours. Tissue fragments were processed in a Leica TP1020 histoprocessor (Leica BioSystems, Germany) according to a standard protocol, after which it was embedded in paraffin blocks. Histological sections with a thickness of 3-5 μm were made by a Leica RM2245 microtome (Leica BioSystems, Germany). The prepared histological preparations were stained with hematoxylin and eosin in a Leica Autosteiner XL histostiner (Leica BioSystems, Germany). Results: From 2013 to 2020 patient K. underwent 4 colonoscopies, 5 esophagogastroduodenoscopies, 1 Х-ray examination with small bowel series, 3 MRI studies and 5 CT studies, including those with intravenous contrast enhancement, with a total radiation exposure of 187 mSv. The diagnosis was revised from ulcerative colitis, Crohn’s disease to NC. The final diagnosis was made by the pathologist’s analysis of materials. Conclusion: The clinical case presented by us clearly demonstrates the importance of dynamic observation by computed and magnetic resonance imaging, in combination with a pathomorphological confirmation method.

The article presents a clinical case of massive recurrent bleeding from angioectasias of the jejunum in a 66-year-old patient. Within 13 months in the conditions of the GBUZ KKB No. 2, Krasnodar, the patient underwent: 1 video capsule examination of the small intestine, 3 esophagogastroduodenoscopy, 3 colonoscopy, 3 balloon-assisted enteroscopy. At the place of residence, the patient repeatedly underwent blood transfusions, as well as endoscopic examinations of the upper and lower parts of the digestive tract. In our facility, the patient underwent diagnostic laparoscopy, and twice-resection of the jejunum area that carries vascular malformation.