The authors consider the nutriciology aspects of therapeutical problems from the perspectives of the General theory of medicine developed by them — the theory of noosphere–anthropogenic harmony. The authors consider the evolution aspects new scientifi c data on the molecular biology, microbiology and biotechnology as a part of biological culture, which determines the relationship of a person with the internal and external world and is one of the main factors in the evolution of the biosphere. The article analyzes the problems of qualitative and quantitative changes in nutrition parameters during the formation of diseases, their prevention and treatment.

The Small Intestine Bacterial Overgrowth syndrome ( SIBO) is a widespread pathology both independently and in combination with other diseases of the gastrointestinal tract, therefore, its timely and accurate diagnosis remains a very urgent task.

Aim. Purpose of the study: comparative assessment of the diagnostic information content of two methods for diagnosing SIBO—hydrogen-methane breath test (HMBT) and stool analysis for short-chain fatty acids (SCFA).

Material and Methods: 65 patients aged from 18 to 76 years were examined. 40 made up the main group, with clinical symptoms of SIBO, and 25—the control group. All patients underwent HMBT with the «SIBRTEST» test kit and stool analysis for SCFA. For both tests, diagnostic sensitivity, specifi city, and accuracy were calculated and comparatively evaluated.

Results: HMBT showed sensitivity 90.24%, specifi city 95.83%, accuracy 92.3%. The analysis of feces for SCFA showed, respectively, a sensitivity of 90.24%, a specifi city of 50.0% and an accuracy of 75.38%.

Conclusion: HMBT with the SIBRTEST test kit can be recommended in the diagnosis of SIBO. The SCFA test should be treated with caution due to the high probability of false positive results.

Objective. To study the state of the enteral parietal microbiota and to assess the conjugacy of its changes with motor-evacuation disorder of the gastrointestinal tract (gastrointestinal tract) in chronic duodenal insufficiency.

Materials and methods. The study included 40 patients with chronic duodenal insufficiency (CDN). Of these, 21 (52.5%) were women, 19 (47.5%) were men, the average age was 37.1± 13.8 years. CDN was diagnosed using anamnestic and physical data, X-ray and endoscopic examinations, intracavitary manometry. Enzyme immunoassay determined vitamin B12, 25-OH Vitamin D, transferrin. The study of the motor function of the gastrointestinal tract was carried out using the gastroenteromonitor “Gastroscan-GEM”. The method of gas chromatography with mass spectrometry was used to study the enteral wall microbiota.

The results of the study. The blood showed a decrease in fat-soluble vitamins B12 and 25-OH vitamin D in relation to control. There was a decrease in the transferrin saturation coefficient (13.2%) compared to the control group (34.7%, p=0.04). Gastroenteromonitoring on the device “Gastroscan-GEM” showed a decrease in the coefficients of rhythmicity in the stomach and DPC in the fasting and postprandial periods. Chromass spectrometric analysis of resident microflora in patients with CDN revealed a significant decrease in Lactobacillus spp 1245.3± 0.21 cl/g x 10^3 and Bifidobacterium spp 1453.2± 0.18cl/g x 10^3 against the background of pronounced growth of bacteria of the genus Clostridium, Eggerthella lenta 412.3± 0.84cl/g x 10^3, Propionibacterium acnes 58.6± 0.32cl /g x 10^3, Propionibacterium freudenreichii 2388.7± 0.62 cl/g x 10^3, Propionibacterium jenseni 146.6±0.32 cl/g x 10^3, Staphylococcus spp 658.4± 0.28 cl/g x 10^3, Streptococcus mutans (anaerobic) 494.3±0.74 cl/g x 10^3, Streptomyces spp. 305.3±0.26 cl/g x 10^3. It was shown that the increased growth of pathogenic microflora was associated with a violation of the rhythm of duodenal motility.

Conclusion. In patients with chronic duodenal insufficiency, a pronounced growth of parietal pathogenic microflora was detected, depending on the state of motor activity of the duodenum.

Biliary diseases are one of the most common pathologies of the digestive system in the world. However, assessing the prevalence of biliary diseases is difficult, due to the asymptomatic course of the disease in some cases. Biliary diseases are a diagnostic problem, especially if a complicated course of the disease is suspected, and when the etiology cannot be established after laboratory examination and ultrasound imaging. Magnetic resonance imaging (MRI) is a highly specific non-invasive method for examining the gallbladder and imaging the bile ducts to identify gallstones, biliary strictures, tumors, and detect the level of obstruction. Magnetic resonance cholangiography/cholangiopancreatography (MRCP) is currently considered to be the most accurate non-invasive procedure for detecting bile duct stones, with high sensitivity, which allows to obtain a detailed image of the biliary tract. MRI is an established imaging technique for the biliary tract, has better contrast resolution, and is an excellent diagnostic tool. The choice of method to start the diagnosis with depends on many factors and requires careful interaction between the gastroenterologist and the radiologist to optimize the imaging technique.

In this work, we compared composition of the intestinal microbiota of healthy volunteers and patients with irritable bowel syndrome (IBS) in Hanoi residents before and after therapy with a probiotic starter culture based on the bacteriocinogenic strain Enterococcus faecium L3 (L3), which is successfully used to correct dysbiosis and treat IBS in Russia.
In IBS patients (IBS group) α-diversity was higher than in the control group (Healthy) and in IBS patients after probiotic therapy (IBS + L3 group). Phylogenetic analysis of the studied samples refl ected the division of the studied communities into 2 clusters, one of which grouped samples, mainly taken for IBS before therapy. Principal component analysis (PCoA) showed that most of the samples from the IBS group are located on the graph in a separate sector, far from the adjacent IBS + L3 and Нealthy samples.
A study of the microbiome of Vietnamese patients with IBS after taking probiotic at the level of types (phyls) revealed a tendency towards an increase in the representation of Firmicutes. The introduction of L3 led to an increase in the population of members of the family Lachnospiraceae, such as butyrate- producing Roseburia and acetate-producing Blautia. At the same time, the percentage of staphylococci and bacteria belonging to the Enterobacteriaceae family was decreased. In addition to positive changes in the functioning of the gastrointestinal tract, revealed on the basis of clinical data, the features of the intestinal microbiota of IBS residents of Hanoi compared with healthy volunteers and in the same patients after probiotic therapy were revealed by metagenomic analysis of 16S rRNA genes. Positive shifts in the intestinal microbiome of IBS patients in Vietnam after therapy with a probiotic starter culture based on L3 do not fundamentally diff er from the previously described eff ects noted by the authors when using this probiotic in Russia, which creates the preconditions for expanding the possibility of its use in the Asian region.

The aim of the study was to identify the features of the influence of autoprobiotic and probiotic E. faecium strains on clinical and laboratory parameters in children with functional gastroenterological pathology.

Patients and methods. In the period 2020–2021. 35 children over 3 years of age with functional gastrointestinal disorders (FGID) were observed on an outpatient basis, who were prescribed an autoprobiotic or probiotic strain E. faecium for therapeutic purposes and recommended a diet.
The study protocol provided for clinical and anamnestic screening, FGID diagnostics; analysis of coprograms and assessment of the composition of the intestinal microbiota in children before and after a course of probiotics. The study of intestinal microbiota was carried out by RT-PCR in feces using a set of primers “Colonoflor”. One patient was excluded from the study due to refusal to take the autoprobiotic.
The rest of the patients formed two groups: group 1 (n = 16)—children who received the autoprobiotic strain and group 2 (n = 18)—children who received the conditionally “reference” strain E. faecium L3. Probiotics were used in the form of a liquid form (which is a starter culture based on soy protein isolates containing 10⁹  CFU in 1 ml) at a dose of 25 ml 2 times a day for 10 days.
The results of using probiotic strains were evaluated on the basis of data from a survey of parents about the state of children and the dynamics of clinical manifestations, as well as changes in the values of indicators of coprograms and the composition of the intestinal microbiota.
Statistical processing of the results was carried out using Student’s t-test, Mann-Whitney U-test; Wilcoxon test. The results were considered reliable at a significance level of p <0.05.

Results. Studies of the effect of prescribing E. faecium L3 strain and an autoprobiotic strain to children with FROP revealed a positive effect on the clinical symptoms of the disease (in 29.4% and 25%, respectively) in the absence of undesirable side effects. Analysis of the dynamics of coprograms revealed an equivalent positive dynamics in the form of improvement in most of the studied stool characteristics. The study of the composition of the intestinal microbiota in the observed children revealed a low level of Lactobacilli and Enterococcus before and after the administration of probiotics. After the course of the E. faecium L3 strain, a significant increase in the content of F. prausnitzii was noted. The use of an autoprobiotic strain contributed to a significant decrease in the frequency of isolation of conditionally pathogenic bacteria in large numbers

Conclusion. The course appointment of autoprobiotic and probiotic E. faecium strains in children with FGID has a positive effect on clinical symptoms, improvement of most coprogram indices and normalization of the intestinal microbiota composition.

It is known that normal intestinal activity is a fundamental circadian rhythm associated with the sleep — wake cycle, the frequency of which should be at least 7 times a week. Currently, a sufficient number of clinical studies have accumulated, confirming the fact that constipation increases the risk of developing not only diseases of the digestive, but also cardiovascular, endocrine, immune, and other systems of the human body. Early diagnosis and treatment of bradienteria syndrome, as a proven predictor of a number of diseases of the internal organs, contributes to the prevention of their development and progression. It is important that the diagnosis of bradienteria syndrome should be carried out taking into account the presence of three clinical stages, since stages, II and I are 10 times more common than stage III.

Nutrition occupies one of the important places in the programs of prevention and non-drug therapy of CHF and associated diseases. At the same time, the validity of dietary recommendations to patients regarding salt intake, dietary habits and the use of individual nutraceuticals is questionable. The purpose of this review is to present up-to-date data of clinical and experimental studies concerning sodium restriction, the use of various diets, nutraceuticals, and means for correcting intestinal dysbiosis in CHF. Materials and methods: the articles are searched in the databases eLibraryRU and Medline by key terms and their combinations: “heart failure”, “diet”, “sodium restriction”, “nutraceuticals”, “nutrition”, “cardiac cachexia”, “nutritional support”, “salt”, “dietary supplement”, “probiotic”, “prebiotic”, “enteral nutrition” in Russian and English. We select articles containing the results of clinical and experimental studies published from 1997 to 2021. The research data indicate that the pathogenesis of anorexia, malnutrition and “metabolic remodeling” of the myocardium in CHF is based on complex mechanisms determined by stagnant phenomena in the liver, impaired permeability of the edematous intestinal wall, dysbiosis and chronic systemic infl ammation. The recommendations on the consumption of sodium from 2 to 2.5 g/day and table salt from 5 to 6 g/day in patients with CHF are justified. Limitation of fluid intake is relevant only for decompensation of CHF. The use of the Mediterranean and antihypertensive (DASH) diets is recognized by most authors as a promising direction for the prevention and treatment of CHF. The enrichment of the diet of patients with CHF with ω-3 polyunsaturated fatty acids, coenzyme Q10, dietary fibers, polyphenols and saponins is justified. The benefits of enteral nutrition and the complex use of nutraceuticals in order to slow the progression of weight loss, reduce the severity of neurohormonal and pro-inflammatory shifts are shown. Promising trends of research are the creation of personalized diets taking into account the peculiarities of the course of CHF, the nutritional status, the composition of the intestinal microbiota and its metabolites.

The review presents modern ideas about changes in the quantitative and qualitative composition of the human intestinal microbiome and their role in the development of stress-induced mental and neurological disorders, eating disorders, autism, etc. The dualism of the role of the commensal representatives of the microbiome, which have the ability to modulate metabolic and signaling reactions in conditionally healthy people and patients suffering from various neurological, psychoemotional and cognitive disorders associated with the development of neuroinflammation, is shown. The favorable and negative effects established by foreign researchers are associated with the presence of specific surface membrane proteins in the intestinal microbiota, the production of certain short-chain fatty acids, mucin degradation, changes in the intestinal barrier function, endotoxin production, as well as the synthesis of certain neurotransmitters. The prospects and difficulties of searching for new microbial biomarkers for predicting the development of stress-induced diseases, as well as for creating new microbial nutraceuticals and new-generation medicines based on living bacteria are considered.

The purpose of the review is to present an analysis of modern literature data on the pathogenesis, diagnosis and therapy of primary systemic amyloidosis of immunoglobulin light chains (AL-amyloidosis), to reveal the features of gastroenterological manifestations of the disease. AL-amyloidosis is caused by overproduction of immunoglobulin light chains by a clone of plasma cells located in the bone marrow, followed by the formation of amyloid.
Deposition of amyloid in target organs (heart, kidneys, liver, gastrointestinal tract, peripheral and autonomic nervous systems, soft tissues) is accompanied by direct and indirect cytotoxic effects on organs and tissues. Gastrointestinal manifestations of AL-amyloidosis include liver damage, gastrointestinal bleeding, pseudo-obstruction of the small intestine and colon, the appearance of polyp-, diverticul-, tumor-like formations, malabsorption, impaired motility of the gastrointestinal tract, protein-losing gastropathy. Liver damage in patients with AL-amyloidosis, as a rule, is accompanied by minimal clinical manifestations, an increase of the level of alkaline phosphatase without any other reasons for this change. A detailed analysis of the Mayo Clinic’s practical guidelines for the diagnosis and treatment of AL-amyloidosis is presented. Diagnosis of gastrointestinal AL-amyloidosis is based on histomicroscopic analysis of biopsies of target organs with Congo red and subsequent examination in polarized light; mass spectrometry is the gold standard of diagnostic. Modern pharmacotherapy of AL-amyloidosis includes a combination of high-dose chemotherapy with monoclonal antibodies, proteasome inhibitors, cytostatics, hormones, as well as performing autologous stem cell transplantation. Correction of gastroenterological manifestations of the disease is based on the symptomatic therapy. Life expectancy of patients with AL-amyloidosis is determined by several prognostic models; the Boston University model, based on the definition of two markers, is most convenient for clinical use.

The review article presents current data on the possible connection between the occurrence of allergies and disorders in the intestinal microbiota. The role of the intestinal microbiota in the development of the immune system of a child, as well as the maintenance of its immune tolerance, is discussed. Factors whose effects can be associated with changes in the intestinal microbiota and the development of allergic diseases are considered.

The literature review is devoted to biologically active metabolites of casein — the results of its hydrolysis — oligopeptides casomorphins. These peptides with a chain length of 4 to 11 amino acids are derived from milk β-casein and are released during digestion, both in vivo and in vitro. Caseomorphins exhibit opioid and pharmacological activity due to binding to μ-receptors located in the central nervous system, gastrointestinal tract and some immune cells. Understanding the biological role of caseomorphins in the milk of mammals, including humans, and their effect on organs and systems, will bring specialists closer to deciphering the etiology of a whole group of diseases.

The second part of the review on casomorphins is devoted to the role of these biologically active peptides — products of phosphoprotein hydrolysis. Convincing data on the eff ect on the immune system, anti-oncogenic effect, on the motility and tone of smooth muscle fibers, the ability to control other aspects of the gastrointestinal tract activity—the transport function of the intestinal epithelium, water absorption, etc. The effect of β-casomorphins on the endocrine system, primarily on release of insulin and somatostatin. Particular attention should be paid to the question of the effect of β-casomorphins on the maternal organism during pregnancy and breastfeeding of the newborn. This is important because β-casomorphins can enter the central nervous system, being one of the factors in postpartum psychosis and depression. The study of the mechanisms of action of β-casomorphins will bring scientists closer to understanding the genesis and pathogenesis of a signifi cant spectrum of pathologies.

Currently, gluten enteropathy (celiac disease) is one of the most urgent diseases with a genetically determined, autoimmune profile, which significantly reduces the social adaptation and quality of life of patients. In recent years, there has been increased interest in studying the relationship between celiac disease and female reproductive dysfunction, but the available data are contradictory. It is necessary to further study the prevalence and mechanisms of the disease pathogenesis, diagnostic capabilities and preventive measures for celiac disease in women with reproductive insufficiency.

Chronic pancreatitis is accompanied by both small intestinal bacterial overgrowth and dysbiosis of the gut microbiota. The most typical changes in the gut microbiota in chronic pancreatitis are a decrease in microbial diversity, an increase in the abundance of Proteobacteria, a decrease in the abundance of Bacteroidetes, Actinobacteria, and Firmicutes, especially butyrate-producing bacteria such as Faecalibacterium, a significant association with infectious pathways (KEGG analysis]), concomitant metabolic disorders (diabetes mellitus) and exocrine pancreatic insufficiency. Changes in the gut microbiota in children with chronic pancreatitis are like those in adults and are characterized by a decrease in α-diversity and the loss of shortchain fatty acid producers: butyrate-producing Faecalibacterium, Subdoligranulum, and Eubacterium, propionate-producing Phascolarctobacterium, acetate- and lactate-producing Collinsella, and probiotic Bifidobacterium. Dysbiotic changes in the gut microbiome, including a decrease in the abundance of commensal symbionts, are significantly associated with the severity of chronic pancreatitis. The most important factor influencing the intestinal microbiota is the pancreatic exocrine function, a decrease which leads to a switch from enterotype 1 (Bacteroides predominance) to enterotype 2 (Prevotella predominance) and a decrease in phylogenetic diversity (α-diversity index). Modulation of the dysbiotic gut microbiota can be carried out with probiotics, prebiotics, bacterial metabolites such as butyrate, pancreatic enzymes and should become a full-fledged therapeutic option in patients with chronic pancreatitis.

To date, sufficiently reliable data have been accumulated on the involvement of various cytokine genes, the products of which are directly involved in the regulation of the immune response in inflammatory processes of the gastric mucosa. However, among these works, studies devoted to the genetic mechanisms of the formation of inflammatory and ulcerative lesions of the stomach are few in number, and the data obtained are contradictory. Meanwhile, the identification of predisposing factors that can modulate the progression of the inflammatory process leading to the development of stomach ulcers is very important in terms of developing their early prognostic criteria, and, at the same time, preventive and therapeutic strategies.

The sweat eccrine and apocrine glands of human skin secrete many functionally significant substances, including hydrolytic enzymes, onto its surface through the mechanisms of secretion, excretion and recruitment. Shown is their recreational origin as a secretory product of the digestive glands—pepsinogen by the stomach glands, α-amylase—by the pancreas. Hydrolases in the epidermal barrier of the skin provide hydrolysis of proteins, carbohydrates and fats have antibacterial, antiviral and antidehydration eff ects. The functional role and importance of digestive gland hydrolases in the sweat of human skin requires special research.

Introduction. Gastroesophageal reflux disease (GERD) can be accompanied by a triad of cardiac symptoms (arrhythmia, cardialgia, signs of autonomic dysfunction). This syndrome is called gastro-cardiac or Remheld syndrome. The most common rhythm disturbances in Remheld syndrome are atrial fibrillation, supraventricular extrasystole. In the clinical case we have described, a rare variant of Remheld’s syndrome is presented: paroxysmal ventricular tachycardia with GERD.

Description of the clinical case. Patient V., 48 years old, applied to a cardiologist on 21.04.21 with complaints of attacks of sudden palpitations, disturbing for six months. From the anamnesis it is known that since 2017 he has been suffering from GERD, he does not take drugs for stopping reflux attacks for 6 months, canceling it on his own. According to Holter ECG monitoring from 03/20/21, paroxysmal ventricular tachycardia was revealed. According to echocardioscopy data from 04/26/21, no structural changes that could be the cause of this life-threatening rhythm disturbance were found. Video gastroscopy from 04/28/21: distal reflux esophagitis. Endoscopic signs of hiatal hernia. Lack of cardia 2 tbsp. Gastroesophageal prolapse. At the consultation with a gastroenterologist, the patient was prescribed both non-drug (lifestyle correction) and drug treatment: rabeprozole, clarithromycin, amoxicillin and others. In addition for the relief of paroxysmal ventricular tachycardia—amiodarone, telmisartan.

Discussion. According to studies, one of the mechanisms of arrhythmia in GERD is associated with the excitation of the distal esophagus by refluctate with the development of viscero-visceral reflexes mediated through n. vagus. Increased activation of n. vagus creates an arrhythmogenic substrate for the re-entry mechanism, and thus increases the risk of arrhythmias. Antiarrhythmic therapy along with the treatment of GERD led to the elimination of VT paroxysms. Later, 2 months after the withdrawal of antiarrhythmic drugs against the background of ongoing GERD therapy, paroxysms of VT were not recorded. This was also a confirmation of the pathogenetic relationship between GERD and paroxysmal VT.

Conclusion. The case is of interest to the development of a life-threatening rhythm disturbance: paroxysmal ventricular tachycardia against the background of GERD, which is a very rare variant of Remkheld’s syndrome and is not found in the available literature.

Hyperammonemia is an acute or chronic intoxication with ammonia and ammonium associated with elevated ammonia levels in serum due to either its increased production and/or decreased detoxification. Hyperammonemia can result from a variety of causes and clinically presents with unspecific signs and symptoms, including asthenia, encephalopathy, liver steatosis or fibrosis, and sarcopenia. With impaired liver function, hyperammonemia most frequently manifests in (micro)encephalopathy. Thus in case of unexpect change in mental status hyperammonemia must be excluded as fast as possible. An express method of photometric assay is informative enough to determine the ammonia levels. The following hyperammonemia classification is proposed: a) by ammonia levels (normal level: ≤ 60 μmol/L; mild (Grade 1): ≤ 100 μmol/L; moderate (Grade 2): ≤ 200 μmol/L; and severe (Grade 3): > 200 μmol/L); b) by etiopathogenesis (hereditary (congenital), functional (physiological), acquired (hepatic, extrahepatic, mixed)); c) by clinical presentation (transient, recurrent or persistent, constant (stable, without treatment), covert). Treatment for hyperammonemia is aimed at treating the primary disease and includes a diet that is restricted in animal protein but contains sufficient vegetable protein, limited physical activities, and use of intestinal non-absorbable antibiotics (rifaximin- alpha) as well as pre- and probiotics. L-ornithine- L-aspartate (LOLA) is a baseline therapeutic product administered in a number of scenarios to correct the level of hyperammonemia.