Bariatric and metabolic surgery began in the mid-20th century and grew out of experimental surgical techniques for weight loss. In the process of research and improvement of surgical techniques, more physiological operations were identified, characterized by fewer complications, concepts of surgical treatment of atherogenic dyslipidemias and prevention of atherosclerosis development, reduction of the risk of metabolic or cardiovascular complications of severe obesity, the idea of metabolic surgery to achieve glycemic control. The article provides up-to-date information on modern metabolic operations, such as gastric banding, longitudinal gastric resection, gastric bypass or Roux-en-Y gastric bypass, biliopancreatic bypass. The paper presents data on the effectiveness of metabolic operations in the treatment of obesity and type 2 diabetes mellitus by creating a mechanical restriction for food intake in the upper gastrointestinal tract, reducing hunger by reducing the level of the hormone ghrelin, reducing the amount of visceral fat, the formation of malabsorption syndrome, incretin effect, hypotheses of the anterior (Foregut) and posterior (Hindgut) gut. It also discusses the effects of bariatric surgery on the cardiovascular system and non-alcoholic fatty liver disease.

The goal is to identify possible triggers for ASD by means of gas chromatography-mass spectrometry analysis using microbial blood markers. Materials and methods. The parietal microbiota of the small intestine was studied by GC-MC of blood (according to the author’s method of Osipov G. A.). 39 children aged 1 to 10 years were examined. They had various functional gastroenterological complaints. 26 children (group 1) had no signs of autism and other neuropsychiatric problems according to the psychologist’s opinion. 13 children (group 2) were followed up by a psychiatrist and diagnosed with ASD according to CARS. Statistical materials were processed on a personal computer with STATISTICA 12 software. ROC analysis was performed. Results. There were revealed significant differences in the small intestine microbiota among children with gastrointestinal symptoms and ASD and children with gastroenterological dysfunctions only: prevalence of Clostridium perfringens P=0.041, Clostridium ramosum P<0.001, Eggerthella lenta P=0.026 and Nocardia asteroides P=0.020. Conclusion. Clostridial overgrowth is representative for children with ASD.

Introduction. Exceeding the normative indicators of human body weight at a later age occurs metabolic disorders correlating with obesity. An increase in the incidence and spread of obesity and metabolic syndrome in cases of risk factors such as a sedentary lifestyle, overeating, the use of high-calorie foods and tobacco, a state of chronic stress. The most popular method for identifying the risks of developing obesity in children and adolescents is monitoring the dynamics of the body mass index of children and adolescents with the aim of early detection of an upward trend in order to justify and develop a set of measures aimed at maintaining weight within the normative indicators. The aim: to identify the frequency of the prevalence of obesity and overweight in the population of children, adolescents and adults from among the residents of St. Petersburg, followed by a comparative assessment of the data. Materials and methods: A team of authors carried out work to determine anthropometric indicators (body weight and height) and calculate body mass index in 74 children aged 9-12 years, 137 adolescents 13-18 years old and 55 adults, whose average age was 49.12 ± 17, 03 years old. The work was attended by students of secondary state educational institutions of St. Petersburg and adult patients who were being treated in the Saint Petersburg City Hospital of Saint Martyr Elizabeth. The sample was random: when collecting data from children and adolescents, the indicators of one of the classes in each parallel from 4 to 11 grades were taken into account, when collecting data from adult respondents, a blind sample of two people from each ward of the gastroenterological department of the Saint Petersburg City Hospital of Saint Martyr Elizabeth. Data collection carried out from August to December 2020. Statistical processing and analysis of the results performed by using the SPSS Statistics 17.0 software package. The results: An increase in body weight was detected in 6.8% of children (5.4% - overweight and 1.4% - obese of the 1st degree), in 14.6% of adolescents (11.7% - overweight and 2.9% - obesity of the 1st degree) and in 62% of adults (36% - overweight, 13% - obesity of the 1st degree, 7% - obesity of the 2nd degree, 6% - obese of the 3rd degree). During the correlation analysis, it was observed that the proportion of overweight people in the observed age categories increased with age (p <0.05). The conclusions: There is an increase in the incidence of overweight and obesity among residents of St. Petersburg during the age. Therefore, it is necessary to carry out communication among parents of preschoolers and schoolchildren in the field of health care aimed at the formation of a healthy lifestyle in order to prevent the early development of overweight.

Severe nutritional deficiency was noted in children with cerebral palsy (CP) with severe motor dysfunctions, level IV-V on the GMFCS scale. Dysphagia is the most important cause of the progression malnutrition in children with CP. Objective: To assess the frequency of dysphagia and nutritional status of children with CP & dysphagia and their nutritional status (NS). Materials and Methods: NS & dysphagic complaints were assessed in 1266 people (728 boys): 396 domestic children (DCh) and 870 inmates of children’s homes for the disabled (ChH) (from 1.9 years to 17 years 9 months) with a verified diagnosis of cerebral palsy IV-V according to GMFCS. The study was carried out within the framework of research and development (R&D AAAA-A18-118113090077-0) “Screening of nutritional status in children with somatic, surgical and neurological pathology, the possibility of correction.” Statistical processing of the material was carried out using the application package IBM SPSS Statictics 26. For binary features, the odds ratio and 95% confidence interval were calculated. At p <0.05, the results were considered statistically significant. Results: Children from ChH more often showed stunted growth, underweight and low BMI (p <0.001). The groups were homogeneous in terms of the level of physical activity, mobility, and ability to eat. The same percentage of children in the sample were level V on the GMFCS scale; did not chew, ate for a long time. With individual care, children were more often fed on their knees, for a longer time, with different consistencies of dishes, less often they used exclusively branded mixtures for enteral nutrition. Parents more often noted the urge to vomit (19.4% versus 10%) and vomiting in children (9.8% versus 6.4%). More than a third of the caregivers experienced stress while feeding a patient with cerebral palsy and dysphagia. Conclusions: Adapted questionnaires help to quickly assess motor activity and the severity of dysphagic complaints. An increase in malnutrition occurs with an aggravation of the symptoms of dysphagia, severe motor impairments and a reduction in the time for eating. Children with symptoms of dysphagia, regardless of their place of residence, need an individual approach during feeding. Working with children with dysphagia should be teamwork: from a pediatrician, gastroenterologist, nutritionist, clinical speech therapist, to nursing staff or a parent caring for a child with dysphagia.

Objective: to identify correlations between the level of various microorganisms in the gut and clinical, endoscopic, morphological and psychosomatic manifestations of chronic gastroduodenitis (CGD) associated with Helicobacter pylori (HP). Materials and methods: We examined 103 patients with CGD associated with HP. All patients underwent a comprex examination, which included: assessment of complaints, endoscopic examination of the upper gastrointestinal tract with an assessment of hyperemia, edema, erosive changes in the gastric and duodenal mucosa, verification of HP infection (rapid urease test, histological examination, molecular genetic examination), histological examination of the body mucosa and antral stomach with the detection of neutrophil and lymphoplasmocytic infiltration, hemorrhage, edema, signs of atrophy, metaplasia, dysplasia), bacteriological examination of feces to assess the state of the gut microbiota, psychological testing to assess the level of anxiety and depression. To identify possible relationships between the manifestations of CGD and changes of the gut microbiota a correlation analysis was performed. Results: a decrease in the levels of obligate normoflora (bifidobacteria, lactobacilli) and an increase in the levels of opportunistic microorganisms, staphylococci and yeast-like fungi Candida in the gut were associated with an increase in the severity of clinical, endoscopic and histological signs of CGD, as well as an increase in anxiety and depression signs. Correlations between the degree of HP contamination of the gastric mucosa and the level of Bifidobacteria spp. and Candida spp. in the gut were revealed: the degree of HP contamination of the stomach body was lower with a sufficient content of Bifidobacteria spp. (r= -0.29, p=0.029) and increased both in the body (r=0.28, p=0.032) and in the antrum (r=0.30, p=0.006) with increasing of the number of Candida spp. in the gut. Conclusions: The identification of the relationship between the presence of HP in the stomach and disorders of the gut microbiota can contribute to the expansion of ideas about the pathogenesis of helicobacteriosis, as well as serve as a constructive basis for developing recommendations to improve the effectiveness and safety of treatment for diseases associated with HP infection, in particular, through the use of drugs for the correction of gut microbiota disorders.

Objective: to evaluate the effectiveness of alpha-glutamyl-tryptophan (Regasthym Gastro) in restoring acid-forming function of the stomach according to daily pH-metry in patients with chronic H. pylori-associated atrophic gastritis (CAG). Materials and methods: we conduct the double-blind placebo-controlled randomized study was conducted in parallel groups in three treatment centres. 116 patients aged 40-76 years (average age 58.1±0.8) with a diagnosis of CAG, confirmed by endoscopic, histological examination, pH-metry data on the presence of a hypoacidic condition (pH more than 5.0) were examined. All patients underwent daily pH-metry before and after the therapy (Gastroscan-24 device) with an assessment of the minimum pH value, average pH value, aggressiveness index (AgI) and acidity index (AcI). Patients received standard eradication therapy and were then randomized into 2 groups in a 1:1 ratio (58 patients each) depending on the subsequent therapy. The main group of patients took alpha-glutamyl-tryptophan powder for gel preparation (Regasthym Gastro) orally for 28 days; the comparison group - placebo. Data were compared before and after treatment between groups of patients receiving the study drug and placebo. Statistical analysis was made in “Statistica 12.0 for Windows”. The study was approved by the Ministry of Health of the Russian Federation, the Ethics Committee at the Ministry of Health of the Russian Federation and local ethics committees. Results: when comparing the results before and after treatment while taking alpha-glutamyl-tryptophan (Regasthym Gastro) compared with placebo, we saw the statistically significant improvement in pH metrics: a shift in the acidic side of the average pH value (from 4.3 to 2.7 in the main group, from 4.35 to 3.6 in the placebo group), an improvement in AgI (from 4.8 to 3.25 in the main group, from 4.9 to 4.15 in the placebo group), an increase in AcI (from 8.95 to 48.7 in the main group, from 22.8 up to 16.55 in the placebo group) (p<0.05). Conclusions: this study shown the presence of the studied drug activity in the restoration of the acid-forming function of the stomach in CAG patients.

The aim of the study was to assess the effect of the portal hypertension (PH) severity on the systemic inflammation development and the acute chronic liver failure (ACLF) incidence in patients with acute decompensation of alcoholic liver cirrhosis (ALC). Materials and methods. We examined 119 decompensated ALC patients: with mild symptoms of PH (group I, n = 43-36.1%) and with severe symptoms of PH (group II, n = 76-63.9%). We determined cytokines TNF-α, IL-1β, IL-4, IL-6, IL-8 and the marker of hepatocytic apoptosis - fragments of cytokeratin-18 (FCK-18) by ELISA. The presence and degree of ACLF were determined using an online calculator https://www.clifresearch.com/ToolsCalculators.aspx. Results. In patients of group II, the indicators of hepatocellular inflammation were significantly higher - alanine aminotransferase, aspartate aminotransferase, FCK-18; higher systemic inflammation markers - leukocytes, C-reactive protein, TNF-α, IL-6, IL-8, below IL-4; were worse markers of hepatocellular failure - albumin, cholesterol, international normalized ratio and markers of extrahepatic organ failure - renal, cerebral, circulatory, coagulation. In patients of group II, ACLF developed significantly more often - in 32.9%, the ACLF index was higher - 56.1 ± 6.9 points and short-term mortality rate was higher - 21.1% than those in patients of group II - 18.6%, 49.5 ± 3.6 and 4.6% (p<0.05), respectively. Conclusion. The progression of portal hypertension in decompensated alcoholic liver cirrhosis was accompanied by a significant increase in the incidence of ACLF and short-term mortality.

Despite the success of medicine, the problem of cholelithiasis does not lose its relevance, the prevalence of the disease is constantly growing, it’s “rejuvenation” is observed. The leading place in the pathogenesis of cholelithiasis is occupied by an excess of cholesterol in the bile, a lack of bile acids and a change in their ratio. This article discusses the role of bile acids in individual parts of the metabolism and the features of bile acid metabolism in cholelithiasis. The article also presents the results of an original study, during which the levels of bile acids in the blood plasma and in the cystic bile of patients with cholelithiasis were determined by chromatography-mass spectrometry.

Background. Inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn’s disease (CD), are the focus of attention of researchers and practitioners around the world due to the progressive course, the high risk of developing disabling complications and the difficulties of therapy. In St. Petersburg, the prevalence of CD is about 72 cases per 100 thousand people, the prevalence of UC is about 90 cases per 100 thousand people. Aim. Evaluation of the basic treatment regimens used in outpatient and inpatient practice of basic therapy of IBD in St. Petersburg, Russia. Materials and methods. The multicenter 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 2018-2020in St. Petersburg was collected. The analysis included retrospective data of 874 patients (CD - 43.7%, UC - 56.3%) and was not included data from the specialized IBD city hospital department. To assess the degree of heterogeneity of approaches to the appointment of immunosuppressants and glucocorticoids in various institutions, a neural network analysis was performed. Results of the study. As a result of the assessment of the structure of IBD therapy, four main combinations of therapy used were identified: therapy with 5-aminosalycilic acid drugs alone (oral and/or rectal) without other drugs using (CD - 67.5% and 46.3%, UC - 84.2% and 37.5% in outpatient and inpatient practice, respectively); glucocorticoid therapy in combination with any 5-aminosalycilic acid drugs or as monotherapy (CD - 8.6% and 32.5%, UC - 6.9% and 36.8% in outpatient and inpatient practice, respectively); immunosuppressive therapy in combination with any other drugs, with the exception of biologics, or as monotherapy (CD - 12.9% and 11.3%, UC - 3.7% and 11.8% in outpatient and inpatient practice, respectively); biologics as monotherapy or in combination with any other drugs (CD - 8.3% and 5.0%, UC - 1.1% and 4.2% in outpatient and inpatient practice, respectively). Based on the neural network analysis of the use of glucocorticoids and/or immunosuppressants in the treatment of IBD, the heterogeneity of therapeutic approaches between outpatient and polyclinic institutions was revealed: the patient’s belonging to a particular medical institution for patients with UC was of paramount importance compared to the severity of the disease, the characteristics of gastrointestinal lesions and other factors for making a decision on the appointment of glucocorticoids and/or immunosuppressants, and for patients with CD was second in degree of influence only to the severity of the course of the disease. Conclusion. Features of the treatment of IBD in St. Petersburg, Russia in routine clinical practice are characterized by the predominance of the use of various forms of 5-aminosalicylic acid in the treatment of both UC and CD, the relatively rare use of immunosuppressants in outpatient management, various approaches of outpatient medical institutions to the appointment of glucocorticoids and/or immunosuppressants. Optimization of therapy of patients with IBD within the framework of routine practice is possible through educational activities aimed at improving the practical knowledge in the field of IBD of gastroenterologists, therapists and general practitioners, as well as through the creation of a regional register of IBD patients.

Bifidobacterium B.longum BB536 is a safe multifunctional probiotic with proven clinical efficacy. By modulating the composition of the intestinal microbiome, the BB536 strain exhibits anti-inflammatory, antiallergic, antiviral, antibacterial, fungicidal properties, shown in experimental and clinical studies. The effectiveness of the use of strain BB536 in the treatment of intestinal pathology (for stool normalization, in the treatment of ulcerative colitis, irritable bowel syndrome, etc.), as well as for normalizing the lipid profile of blood and fat metabolism, has been shown.

Helicobacter pylori infection is detected in more than half of the population and may be associated with hematological diseases. The review presents an analysis of literature on communication Helicobacter pylori infection with MALT-lymphoma, iron deficiency anemia, B12-deficiency anemia, idiopathic thrombocytopenic purpura and other hematological pathology.

One of the major advances in understanding the role of gut permeability is the discovery of a human analogue of the zonula occludens toxin called zonulin. This literature review describes various diseases, including COVID-19 infection, in the pathogenesis of which the only known physiological modulator of intercellular tight junctions, zonulin, is involved. The possible role of zonulin in the development of multymorbidity is discussed.

The article presents data on the features of the lesion of the esophagus in the framework of the postcholecystectomy syndrome in patients with undergone cholecystectomy. The conditions that form after cholecystectomy, which lead to an increase in the frequency of duodenogastric reflux and the occurrence of duodenogastroesophageal reflux, are considered. The data on the physiology of bile acids, the role of bile acids and other components of duodenogastroesophageal reflux in the pathogenesis of gastroesophageal reflux disease, Barrett’s esophagus and adenocarcinoma of the esophagus, as well as methods for diagnosing duodenogastroesophageal reflux using dynamic hepatico-biliary scinophageal reflux and daily impedance-pH-meter. The main approaches to the drug correction of duodenogastroesophageal reflux are considered, including the appointment of proton pump inhibitors, prokinetics, ursodeoxycholic acid preparations, alginates, esophago-gastroprotectors, bile acid sequestrants.

The article represents articular extraintestinal manifestations in inflammatory bowel diseases. Joint damage is the most common extraintestinal manifestation in Crohn’s disease and ulcerative colitis and are in the focus of attention of gastroenterologists and rheumatologists. The spectrum of clinical situations accompanied by the development of joint involvement includes peripheral and axial arthropathy, arthropathy with concomitant immunoinflammatory diseases and joint lesions as therapy’s adverse effect. So it requires a differentiated approach to the tactics of patient management. The article describes the main clinical and differential diagnostic features of atropathy in inflammatory bowel diseases and main approaches to therapy. In this context, the article presents the possibilities of using ustekinumab - one of the most effective drugs of biological therapy, the point of application of which is the common subunit p40 of cytokines IL-12 and IL-23. Clinical situations in which the use of this drug is the most effective are described.

In recent decades, a significant number of scientific papers have been published on the study of the specific physicochemical properties of a special sugar, trehalose, and its role in living systems. Trehalose is widely distributed in nature. This unique disaccharide, consisting of two glucose molecules, protects proteins and cell membranes from inactivation or denaturation caused by various stress conditions, including desiccation, dehydration, heat, cold, oxidation, heat shock, hypoxia, prolonged absence of oxygen. Trehalose enhances autophagy, protecting cells of organisms from various stress influences; is a modifier of abnormal protein accumulation in human neurodegenerative diseases; has a favorable effect on vascular endothelium; positively affects metabolic processes in the body, including the course of type 2 diabetes - and this is only a few of the positive effects that trehalose has on the body.

Metabolic syndrome (MS) is a term that unites a group of interrelated metabolic disorders that include abdominal obesity, insulin resistance, arterial hypertension, and atherogenic dyslipidemia. The presence of MS is associated with an increased risk of developing type 2 diabetes mellitus and cardiovascular complications. In the pathogenesis of MS, the leading role is played by the pro-inflammatory state, characterized by increased activity of inflammatory cytokines, and ultimately leading to severe cardiovascular complications. Due to the exponential rise in obesity around the world, MS has recently become increasingly important. In the presented article, the epidemiology and pathogenesis of metabolic syndrome, the role of inflammation in the development of metabolic disorders are considered, and special attention is paid to drug therapy with the use of taurine. Taurine is a sulfur-containing amino acid that is not involved in protein synthesis and is found in most animal tissues. With its unique properties, taurine affects many cellular functions, including antioxidant, as well as osmoregulation, ion transport and conjugation of bile acids. Taurine has an anti-inflammatory effect in diabetes mellitus, and by suppressing the renin-angiotensin system, it has a positive effect on the cardiovascular system. Dibikor® is a domestic drug based on taurine, the level of which decreases in obesity, diabetes mellitus, and non-alcoholic fatty liver disease. Dibikor® replenishes taurine deficiency and, thereby, helps to reduce the risk of developing these diseases.

Functional diseases of the gastrointestinal tract are disorders of the digestive tract that are not associated with organic lesions and include a number of individual idiopathic disorders that affect on various departments associated with visceral hypersensitivity and motor function disorders. This review considers the most common functional disorders of the gastrointestinal tract. It is shown that the main mechanism of their occurrence is a disorder in the interaction of the gastrointestinal tract and the central nervous system.

Abdominal pain syndrome is an urgent problem for a practicing doctor, especially for a surgeon. It is on the shoulders of the surgeon that the responsibility for making a decision about the need for intervention in abdominal pain falls, and often such a decision is not easy. This article presents a clinical observation of a patient who was admitted to the surgical department with abdominal pain syndrome. The case demonstrates the difficulties of differential diagnosis of diseases accompanied by abdominal pain, including when the patient has a combination of different diseases, each of which can contribute to the formation of abdominal pain syndrome; reflects the difficulties of managing such a patient and selecting therapy for pain relief.

Despite the success of medicine and the improvement of diagnostic methods, the recognition of the tuberculosis process, especially with its extrapulmonary manifestations, often presents difficulties. This article presents a clinical case of diagnosis of abdominal tuberculosis in a patient with unspecified intestinal bleeding, demonstrating the difficulties of establishing a diagnosis in surgery in patients without anamnesis of tuberculosis. Only a multidisciplinary approach can ensure success in the treatment of such patients.

The authors present a unique model of the unified diagnostic decision-support system in the form of alphanumeric characters, which has been developed based on the digestive endoscopy data and is used to interpret the digestive tract lesions resulting from NSAIDs and ATDs treatment (Moscow Classification).