Study goal: Identify clinically significant stigmas of reduced esophageal mucosal resistance.

Materials and methods: The study included 181 patients aged 18–70 years with gastroesophageal refl ux disease (GERD).

Complaints, age, sex, history of the disease, life history, physical examination data, results of laboratory and instrumental examinations, data on medication intake at the time of enrollment of the patient for the main disease and concomitant pathology were noted in the individual registration card (IRC).

Results: The study demonstrated the presence of features suggesting with a higher degree of probability a reduced esophageal mucosal resistance in a certain group of patients with GERD. Individuals with early- onset GERD, males, young adults, smokers, and individuals with a high body mass index (BMI) have a higher risk of esophageal mucosal erosions. The presence of esophageal hernia of the diaphragm (EVD), intake of acetylsalicylic acid (ASA), calcium channel blockers (CCBs), or nonsteroidal anti-inflammatory drugs (NSAIDs) are factors that reduce esophageal mucosal resistance. The formation of erosive esophagitis is not associated with the subjective perception of GERD symptoms and does not affect the patient’s complaints.

Conclusion: Clinical manifestations of GERD are not associated with the degree of esophageal mucosal damage and cannot be a phenotypic sign of erosive esophagitis requiring mandatory prescription of an esophagoprotector. Clinically significant stigmas of decreased esophageal mucosal resistance were revealed. The need in research of expediency and efficacy of prescription of esophagoprotector in patients with GERD, having GVHD or regularly taking BCA, ASA and other NSAIDs, including obligatory estimation of therapy effi cacy taking into account patient gender and age, has been established.

The aim of the study was to determine the frequency and clinical and laboratory features of acute gastroenteritis (OGE) in adult residents of Novosibirsk hospitalized with a new coronavirus infection (COVID-19) in 2020.

Materials and methods. We examined 3581 patients aged 18 to 96 years with a diagnosis of “New coronavirus infection”, confirmed by the detection of SARS-CoV-2 RNA in the mucus from the oropharynx by PCR, hospitalized in the State Medical Institution NSO GICB No. 1 in 2020. Along with the generally accepted diagnostic methods, feces were examined by PCR in 50 patients with gastrointestinal syndrome to detect SARS-CoV-2 RNA using a set of original specific primers.

Results. Of the 3,581 hospitalized adult patients with COVID-19, 74% of cases were diagnosed with bilateral polysegmental pneumonia, and 26% of cases were diagnosed with acute respiratory infection. Manifestations of OGE were observed in 6.8% (n=243) of patients. In the group of 50 COVID-19 patients, in whom the disease began with symptoms of OGE, it came to the fore in the clinical picture of the disease in 20% of cases, and SARS-Co- V2 RNA in the feces was detected in 62% of patients.

Conclusion The established frequency of OGE in COVID-19 in adults shows the need to develop and implement in clinical practice test systems (PCR of SARS-CoV-2 RNA in feces) for the diagnosis of the intestinal form of a new coronavirus infection.

Purpose of the study. To investigate the features of lesions of the gastrointestinal tract in diff erent variants of the course of COVID-19 in children.

Materials and methods. A single-center prospective study was carried out to study the clinical and laboratory manifestations of gastrointestinal tract (GIT) lesions in different variants of the course of COVID-19 in children. The study was carried out in the following groups: group No. 1 — pediatric patients with a verified diagnosis (according to ICD 10) “U07.1. COVID-19 virus identified, confirmed by laboratory tests, regardless of the severity of clinical signs or symptoms ”, n = 524; group No. 2 — pediatric patients with a verified diagnosis (according to ICD 10) “U10.9 Multisystem inflammatory syndrome associated with COVID-19, unspecified”, n = 46. The article provides a brief description of the observations of the development of autoimmune pathologies (ulcerative colitis, autoimmune hepatitis) in pediatric patients, for whom a postponed COVID-19 infection could be a probable trigger.

Results. The leading symptoms of the gastrointestinal tract in patients of group No. 1 were symptoms of acute gastroenteritis, registered in 37.6% of cases. Diarrhea was detected in 21.2% of cases, vomiting — in 16.5%; abdominal pain syndrome — 9.2%. These manifestations were statistically more significant in patients under one year of age, as well as in children of the first three years of life (p≤0.05). Gastrointestinal syndrome in patients of group No. 2 was registered in 67.4% of cases, with vomiting — 60.9% of cases, diarrheal syndrome — 23.9% of cases, abdominal pain syndrome — 82.6%. Other manifestations of the gastrointestinal tract in patients of this group were: reactive hepatitis — 69.6% of cases (average ALT — 98 (47; 347); AST — 107 (34; 347)), reactive pancreatitis — 60.8% of cases (average values of amylase — 127 (28; 269); lipase — 196 (47; 107)). These lesions were of a reactive inflammatory nature, with a probable immune development mechanism.

Background. Inflammatory bowel diseases (ulcerative colitis and Crohn’s disease) are serious problem in modern gastroenterology, as these diseases affect the working population, have a progressive chronic course, a high risk of disabling complications and require significant costs for the drug management.

Aim. We wanted to assess the inflammatory bowel diseases structure and features of the use of basic drugs in outpatient and inpatient treatment in St. Petersburg, Russia.

Materials and methods. A cross-sectional study was performed. Data about drug therapy, disease features and demographic from 42 outpatient institutions and from 6 city hospitals for the period 2018–2020 in St. Petersburg was collected. The analysis included data from 617 patients with ulcerative colitis and 455 patients with Crohn’s disease.

Results. The median age of patients with ulcerative colitis was 44 years, which was statistically significant more than with Crohn’s disease (39 years). In ulcerative colitis, the left-sided localization of colon lesions (56%) prevailed over total colitis (23%) and proctitis (21%) In Crohn’s disease, the prevalence of ilecocolitis (36%) was approximately equal to the prevalence of colitis (35%), the frequency of terminal ileitis was significantly less (26%), other variants of gastrointestinal lesions were found in 3% cases. In Crohn’s disease compared to ulcerative colitis, the proportion of patients with mild disease was similar (36.6% and 38.2% respectively), but in in Crohn’s disease the frequency of severe disease there was more than three times compared to ulcerative colitis. There has been a significantly higher incidence of surgery in the past for Crohn’s disease compared to ulcerative colitis (14.8% and 2.6%, respectively). The vast majority of patients (more than 80%) received therapy with oral 5-aminosalycilic acid drugs. Topical formulas of 5-aminosalycilic acid drugs in ulcerative colitis were prescribed in about 50% of cases (it was significantly less than commonly used in Crohn’s disease). Corticosteroids were used in the treatment of 16.6% of ulcerative colitis patients and in 24.4% Crohn’s disease patients. In both diseases in the conditions of inpatient treatment, this group of drugs was used several times more often than in outpatient observation. Immunosuppressants (tyopurines, methotrexate) were administered in 6.9% ulcerative colitis patients with and in 17.0% Crohn’s disease patients.

Conclusion. Clinical features of inflammatory bowel diseases in St. Petersburg and the features of basic therapy in comparison with the nationwide indicators in Russia demonstrate similar trends. The key problem points of therapy of inflammatory bowel diseases remains the widespread use of drugs of the group of 5-aminosalycilic acid in Crohn’s disease, insufficient use of rectal forms of 5-aminosalycilic acid in ulcerative colitis, a relatively small frequency of use of immunosupressors to maintain remission in Crohn’s disease. The solution to the problem of optimizing the therapy of patients with inflammatory bowel diseases within the framework of routine practice includes educational activities, as well as the creation of a regional register of patients with inflammatory bowel diseases in St. Petersburg.

Purpose of the work: to present a method for diagnosing the activity of inflammatory bowel diseases based on a combination of electrical and viscoelastic parameters of erythrocytes and the level of fecal calprotectin.

Materials and methods. We examined 109 patients (37.7±11.7 years) with IBD (50 with ulcerative colitis, 41 with Crohn’s disease, 18 patients with unclassified colitis), of which 36 patients were examined in dynamics for 0.5–1 years, and 53 surveyed comparison groups. Taking into account the observation in dynamics in 109 cases, the presence of exacerbation of IBD was established and in 36 cases — remission of the diseases. The electrical and viscoelastic parameters of erythrocytes were studied by dielectrophoresis. The level of fecal calprotectin was determined by ELISA (R-Biopharm, Germany).

Results. Differentiating values have been established for a number of erythrocyte parameters: average cell diameter, polarizability at a frequency of 106 Hz, the velocity of movement of cells towards electrodes, amplitude of erythrocyte deformation at a frequency of 106 Hz, the summarized indicators of rigidity, viscosity, electrical conductivity, position of the crossover frequency and the level of fecal calprotectin to distinguish patients with IBD in stages of exacerbation and remission. The proposed method for the combined use of erythrocyte parameters and the level of fecal calprotectin provided sufficient diagnostic accuracy: sensitivity 91.9%, specificity 93.1%, accuracy index 92.3%. The advantages of this approach are minimally invasiveness, high productivity, independence of the definition from the qualifications and experience of a specialist, low cost and labor intensity, and acceptability for the patient. This approach allows to establish the presence of exacerbation or remission, regardless of the nosological form of IBD.

Conclusion. The combined use of electrical and viscoelastic parameters of erythrocytes and the level of fecal calprotectin is promising for determining the activity of the disease in patients with IBD.

To optimize non-drug methods of treatment of patients with irritable bowel syndrome (IBS) against the background of obesity to identify the peculiarities of food preferences and permeability of the intestinal wall.

Materials and methods: An anonymous questionnaire survey of 52 IBS patients was carried out using the author’s set of dietary assessment questions “Nutrition Information and Food Behavior” developed at the Department of Hygiene, Human Nutrition of Omsk State Medical University. The study of the level of zonulin in the feces was carried out at the Central Research Laboratory of the Federal State Budgetary Educational Institution of Higher Professional Education Omsk State Medical University of the Ministry of Health of Russia by enzyme immunoassay using the IDK Zonulin ELISA test system (Immundiagnostik, Germany).

Results: The eating habits of IBS patients with BMI ≥25 kg/m2 diff er from those of normal weight patients and can be considered a component of the phenotype of this patient cohort. IBS patients with BMI ≥25 kg/m2 have a higher level of intestinal permeability as assessed by zonulin content in feces.

The aim is to study the effect and safety of using the antispasmodic and synbiotic (Lactobacillus paracasei CNCM I-1572 in combination with fructooligosaccharides) in patients with irritable bowel syndrome with constipation.

Materials and methods — prospective randomized controlled trial of 80 patients with irritable bowel syndrome with constipation. Patients in the main group (40 people) took mebeverine hydrochloride 200 mg 2 times a day and synbiotic (5x109 CFU Lactobacillus paracasei CNCM I-1572 and 5.2 g fructooligosaccharides) during 28 days. Patients in the control group (40 people) received mebeverine hydrochloride 200 mg 2 times a day during 28 days. Before and after treatment, patients underwent the GSPS questionnaire.

Results — in control group clinical remission was achieved in 52.6% of patients. In the main group clinical remission was established in 92.3%, the increase was 39.7% (p <0.01). The relative risk of clinical remission when synbiotic included in the treatment for patients with irritable bowel syndrome with constipation is 1.75 (95% CI 1.28–2.4; p <0.01). When analyzing adverse events of the compared treatment regimens, no statistically significant differences were found (p = 0.75).

Conclusion — the results of study demonstrate a significant increase in the effectiveness of therapy in patients with irritable bowel syndrome with constipation with the combined use of antispasmodic and synbiotic.

Purpose of the study. The aim of the study was to study the morphogenesis of granulomatous inflammation in the liver in newborn animals and in remote periods of life.

Materials and methods. The experiment was carried out on 70 newborn C57BL / 6 mice, divided into two groups. On the first day after birth, mice of the 1st (experimental) group were injected intraperitoneally with a solution of the BCG vaccine at a dose of 0.02 mg / kg. On the fi rst day of the beginning of the experiment, the mice of the 2nd (control) group were injected intraperitoneally with 0.02 ml of physiological solution. Liver samples were subjected to morphological and morphometric study: the body weight of mice (g), the volumetric density (Vv) of dystrophy and necrosis of hepatocytes, foci of extramedullary hematopoiesis, the number density (Nai) of binuclear hepatocytes, mitotic figures, the diameter of granulomas (μm), and the number density were calculated (Nai) granulomas in test area.

Results. The introduction of the BCG vaccine to newborn mice on the 1st day led to a delay in their development and a lack of body weight. With the introduction of the BCG vaccine to newborn mice of the C57B1 / 6 line, a delayed formation of granulomas is noted, starting from the 10th day after the administration of the BCG vaccine, and a subsequent increase by 56 days in both the number and size of granulomas. The foci of extramedullary hematopoiesis in the liver of mice after the administration of the BCG vaccine persist for a longer period (up to 28 days), which is probably due to the participation of cells of the foci of hematopoiesis in the inflammatory process in the liver parenchyma. With the introduction of the BCG vaccine, pronounced destructive changes in hepatocytes in mice at all age periods are noted with reduced rates of reparative liver regeneration. Conclusion. The introduction of BCG vaccine to newborn mice led to the formation of tuberculous granulomas in the liver during the adult period of life with the development of destructive changes in hepatocytes and a reduced reparative ability of the liver.

In the literature devoted to the problems of liver transplantation, there is no clearly indicated attitude of the authors to intraoperative epidural blocks, although theoretically the benefits of a sympathetic block are considered. Some sources recommend prophylactic sodium bicarbonate infusion to alleviate post-reperfusion syndrome, but its effectiveness is questionable.

Purpose: to present the physiological, biochemical and hematological characteristics of recipients at the stages of orthotopic liver transplantation with an assessment of the feasibility of using sodium bicarbonate for the prevention of reperfusion complications.

Materials and methods. An observational study, contains an analysis of data from 39 participants operated on in 2020 in the volume of: hepatectomy, an orthotopic liver transplantation, with an initial assessment on the Child- Turcott- Pugh scale of 11 points. All participants were operated on under general inhalation anesthesia with sevoflurane and thoracic epidural three- component anesthesia according to the Breivik- Niemi method. There are 3 stages of data registration: the beginning of the anhepatic stage; the beginning of the neohepatic stage; the end of the operation.

Results and discussion. Significant fluctuations in hemodynamics, violations of the acid-base state and energy metabolism were not revealed; a decrease in hepatic protein synthesis, a shift of the P50 point to the left, and moderate metabolic acidosis did not exceed the levels described in the literature. The dynamics of acidosis, РСО2 and natremia did not depend on the infusion of soda. There was no close correlation between arterial blood pH and lactate concentration.

Conclusion. The benefits and safety of epidural anesthesia in orthotopic liver transplants are obvious and make it possible to recommend this component as a routine element of anesthesia during these operations. The indications for sodium bicarbonate infusion should be narrowed and consensus is needed to determine the critical pH value for sodium bicarbonate infusion.

The aim of the study is the evaluation of results of endoscopic tunnel interventions in submucosal tumors and achalasia.

Material and methods. Endoscopic tunnel interventions during 2017–2020 years were performed in 80 patients (34-men, 46-women). The duration of the age ranged from 15 to 72 years. The indications for interventions were: achalasia in 53, subepithelial tumors in 27.

Results. During the intervention, complications occurred in 22 patients. Among the complications: carboxyperitoneum in 16 cases, carboxytorax in 2, esophageal mucosa perforation in 2, bleeding moderate intensity bleeding in 2. Most of the complications (20) were in patients with esophageal achalasia. Postoperative complications were observed in two patients operated for esophageal achalasia (bleeding and hematoma, esophageal mucosa necrosis). All patients were treated by using conservative methods. The results of the interventions were assessed in terms of 1 month to 3 years. There were no violations of food or liquid the passage through the cardia. Patients after operation for submucous tumors of the esophagus had no complaints. The main complaint of patients after myotomy was heartburn. Endoscopic examination revealed erosive reflux esophagitis (A-C) in 18 patients.

Conclusion. Tunnel endoscopic interventions in patients with esophageal achalasia and submucous tumors are highly effective and low-traumatic, allowing relatively safe restoration of the patency of the cardia and removal of the subepithelial neoplasm. The problem of gastroesophageal reflux after oral endoscopic myotomy requires further accumulation of data in order to develop optimal tactics. The limiting factor for the these operations performance is the material and technical equipment of medical institutions and the lack of trained specialists.

Introduction. The prevalence of colorectal cancer in the world is increasing every year. In more than 40% of patients, the disease debuts with a clinical picture of acute intestinal obstruction, while in one third of cases the tumor is located in the right half of the colon. This leads to the necessity to perform colon resection or bypass surgery, the main stage of which is making entero- colic anastomosis. However, up to 15% of these anastomoses has a leakage. Development of methods of forming a reliable anastomosis is thus critical.

Materials and methods. 37 patients with acute intestinal obstruction, divided into 2 groups (17 and 20 people), are included into the study. All of them, as a surgical stage of treatment, underwent a right hemicolectomy with the formation of an entero- colic anastomosis or a bypass surgery. A double-row side-to-side anastomosis was used in the comparison group, and a single-row “end-to-side” anastomosis in the main group (patent No. 2709253). The incidence of anastomotic leakage and mortality were assessed. Comparison was performed using Fisher’s exact test.

Results. There were no cases of anastomotic leakage and mortality in the main group. In the comparison group, there were 5 leakages and 1 death.

Discussion. When a modified entero-colic anastomosis is formed, adequate blood flow is maintained in the walls of the anastomosed intestinal loops, which contributes to adequate regeneration.

Conclusion. The first clinical experience with the modified end-to-side entero- colic anastomosis is successful. It is planned to further recruit patients and study the features of the postoperative period.

The surface of the intestinal tract in healthy people is free of bacteria in all segments of the intestine. Thus, the attachment of bacteria to epithelial cells is a sign of infection. Unlike the mucous membrane, the intestinal lumen is never sterile. The reason for this is the polymicrobial nature of the gut microbiota. In the intestine, segments such as the stomach or small intestine, where bacteria are actively suppressed, the microbiota is random in appearance, composition, and concentration. However, the situation is completely different in the colon, where the growth of bacteria increases and their suppression is suspended. The concentration and diversity of bacteria in the colon reaches astronomical numbers. Some of these bacteria are required for the colon to function. Many of the local bacteria in the colon are potential pathogens: Bacteroides, Enterobacteriaceae, Enterococci, and Clostridium histolyticum. Control of pathogens in the colon is achieved through an impenetrable mucus layer. Inflammatory bowel disease is a polymicrobial infection characterized by persistent disruption of the mucosal barrier, subsequent migration of bacteria to the mucous membrane, and overgrowth of a complex bacterial biofilm on the surface of the epithelium, resulting in invasive and cytopathological effects. As long as the mucosal barrier function is impaired, the inflammatory process cannot successfully remove bacteria from the mucosal surface, and inflammation itself is detrimental. Due to the inflammatory reaction, the composition and structure of the fecal microbiota changes. Based on the biostructure of the fecal casts, active Crohn’s disease and ulcerative colitis can be distinguished from each other and from other gastrointestinal diseases. The relationship between the gut microbiome and various dermatological diseases (psoriasis, acne, rosacea, atopic dermatitis) is discussed.

The category of newborns with congenital malformations is considered the most difficult to treat. The influence of “stress”factors on the body in a short period of time triggers a pathogenetically determined chain reaction that leads to the development of multiple organ failure syndrome. The forecasting methodology determines the timeliness and directions of intensive care to approach and achieve positive results in this group of patients.

The aim of the study: is to show the diagnostic and practical value of metabolic markers and functional indicators of homeokinesis in newborns with congenital malformations of the gastrointestinal tract.

Materials and methods. An observational study of 81 patients in the neonatal period. The prognostic assessment of functional parameters and biochemical markers was performed by ROC analysis.

Results. In newborns with malformations of the gastrointestinal tract, the course of the pre-and early postoperative period is associated with cardiopulmonary maladaptation, which requires the protection of vital functions. By the end of the first week, priority is given to therapy aimed at restoring the motility of the gastrointestinal tract. The prognostic value of the adverse outcome was determined: stress index greater than 3503 Sp = 98.36% (95%CI 86.3–99.2) and Se = 99.2% (95%CI 87.3–100), lactatemia level greater than 3.3 mmol/L Sp = 73.7% (95% CI 59.6–84.7) and Se = 93.6% (95% CI 78.9–100). The control of the infectious process and the selection of antibacterial therapy is important, since the risks of developing septic shock are high. Prolonged epidural analgesia is the optimal method of analgesia and is indicated in suspected cases of failure to achieve 75% of the volume of enteral nutrition by the week of the postoperative period Sp 85.42% (95%CI 48.2–97.7), Se 46.8% (95% CI 62.0–84.2).

Conclusions. Prognostic models allow predicting the outcome of critical conditions and timely adjusting the volume of therapy.

Among the large and heterogeneous group of patients with irritable bowel syndrome (IBS) comorbidity is characteristic feature. Comorbidity is an urgent problem in real clinical practice. Gastrointestinal comorbidity of a patient with IBS is associated with the presence of common pathogenetic links and is represented by combined pathology with functional disorders and the formation of “overlap syndrome” with organic diseases. Often, with a comorbid course, the phenomenon of “mutual burdening” is observed, when the severity of the course of each of them increases. All this requires optimization of approaches to the diagnosis and treatment of this cohort of patients. Obviously, with a comorbid course of IBS, it is advisable to prescribe drugs that affect the general links of pathogenesis, rather than focusing on individual symptoms. This article presents modern information on the gastrointestinal comorbidity of a patient with IBS.

In recent years, there has been a steady increase in the incidence of inflammatory bowel disease (IBD) worldwide. Treatment of ulcerative colitis and Crohn’s disease has become more effective thanks to the emergence of biological therapies, increased access to specialized care and a “treat to target” approach. However, with an increase in the life expectancy of patients with IBD, there is an increase in the number of persons with comorbidity, primarily with a combination of IBD with cardiovascular pathology. Environmental factors lead to a change in the diversity and density of colonization of the intestinal microbiota, a violation of its barrier function, immune dysregulation, which in turn leads to the development of chronic inflammatory diseases and atherosclerosis. Levels of proinflammatory cytokines, C-reactive protein, and homocysteine increase in IBD, leading to endothelial dysfunction and atherosclerosis. In addition, inflammatory processes in IBD promote hypercoagulation, which occurs both in the thromboembolic complications and in the pathogenesis of the disease itself. It has been suggested that medical pathogenetic therapy for IBD is also associated with the risk of cardiovascular disease. In this review, we systematize the available data on the risks of cardiovascular diseases in patients with IBD. A literature search containing information on relevant studies was carried out in PubMed and Google Scholar systems with the keywords: inflammatory bowel disease, cardiovascular disease, inflammation, atherosclerosis.

With the advent of modern cellular and genomic technologies, we have become participants in the integration of such areas as personalized, predictive, preventive, and precision medicine (referred to as 4P-medicine), into practical healthcare. In replace of the classic methods of diagnosis and treatment of diseases comes medicine, which makes it possible to predict (anticipate) the disease, and a personalized approach to each patient, taking into account their genetic, biochemical and physiological uniqueness. Precision medicine aims to improve the quality of medical care by opening up an individual approach to the patient and covers a wide range of areas, including drug therapy, genetics, and cause-and-effect relationships in order to make the right decisions based on evidence. 4P-medicine combines knowledge in the field of proteomics, metabolomics, genomics, bioinformatics with classical approaches of anatomy, therapy, laboratory and instrumental diagnostics as well as public health. The purpose of this review is to analyze and summarize the information available to date and to present examples of the application of modern approaches of medicine into clinical practice by diving into the example of inflammatory bowel diseases (IBD). The search for literature containing scientific information about relevant studies was conducted in the PubMed and Google Scholar systems with the use of the following keywords: precision medicine, 4P medicine, inflammatory bowel diseases. Despite significant progress in medicine in general, there is still a long way to go before implementing the principles of precision medicine in the field of IBD, since many clinicians continue to treat patients with IBD symptomatically. However, the use of specific biomarkers and new treatment strategies as described in the review, can significantly accelerate this path and contribute to the improvement of diagnostic and therapeutic approaches.

A rare clinical case of a malignant epithelial tumor in an adolescent, 16 old — mucinous adenocarcinoma of the colon with invasion of the intestinal wall, growth into the mesentery, retroperitoneal space and regional lymph node is presented. The article presents data on epidemiology, features of the clinical course, predisposing factors in malignant epithelial tumors of the gastrointestinal tract in children and adolescents.

The article presents a clinical case of a 38-year-old patient with revealed polyps of the stomach body and iron deficiency anemia on the background of chronic atrophic gastritis. On the example of this observation, variants of the course were demonstrated, including endoscopic and histological manifestations of autoimmune (atrophic corpus) gastritis (AIG). In parallel, the issues of diagnosis and management of patients with the most common polyps in the stomach are discussed. The problem of timely diagnosis of AIG and the advantages of non-invasive methods for assessing the functional state of the stomach is also being actualized.