Purpose of the study. To analyze in a memorial article the evolution of scientifi c ideas of one of the brightest representatives of the Russian scientifi c school of gastroenterologists — Professor V. V. Chernin (1935–2021).

Materials and methods. The main works of V. V. Chernin and his collaborators, including monographs, manuals for doctors, publications in scientifi c journals are critically evaluated.

Results. Considered the main results of the scientifi c activity of V. V. Chernin in the study of diseases of the upper digestive tract — peptic ulcer and its complications, variants of chronic gastritis and esophagitis. He reviewed digestive system diseases from the standpoint of neuroendocrine regulation of the functions of the esophagogastroduodenal zone, cause-and-effect relationships of the structure and function of the digestive tract organs, a combination of pathogenetic and sanogenic reactions, microbiocenoses of mucosal flora.

The disease SARS-CoV-2 has various symptoms, including from the gastrointestinal tract. The long-term consequences of this infection require careful study and generalization.

The purpose of the study: to clarify the frequency of gastrointestinal tract lesions in SARS-CoV-2 and its possible consequences. 503 patients with a positive test for COVID-19 were examined. A clinical examination, the study of clinical and biochemical blood tests, the level of fecal calprotectin, computed tomography of the chest, esophagogastroduodenoscopy (EGDS) and fi brocolonoscopy (FCS) with the study of biopsies of the colon mucosa were carried out.

It was found that gastroenterological complaints were present in 58% of patients. Of these, the most common symptom is diarrhea and abdominal pain. Endoscopic examination of the upper gastrointestinal tract revealed most often erosive and ulcerative changes in the mucous membrane of the stomach and duodenum. In some patients, abdominal pain and dyspepsia persisted for 4–6 months after the coronavirus infection, and during FCS erosive changes of the colon mucosa with pronounced infl ammatory infi ltration, crypt abscesses were noted, which indicates the need for medical examination of persons who have undergone SARS CoV-2, with more thorough clarifi cation of gastroenterological complaints and FCS if any.

Purpose of the study. to analyze cases of autoimmune gastritis, features of its clinical course, methods of laboratory diagnostics, typical endoscopic and morphological signs.

Materials and methods. 32 patients (25 women, 7 men) with confi rmed autoimmune gastritis, performed clinical and laboratory examination, esophagogastroduodenoscopy, morphological assessment according to OLGA.

Results. Autoimmune gastritis is characterized by a low-symptom course, the development of iron and B12-defi ciency states, low values of serum pepsinogens, hypergastrinemia, in 25% of cases it is combined with H. pylori- associated gastritis. In 59.38% of the examined, autoimmune gastritis proceeds with endoscopic signs of total atrophy of the gastric mucosa, according to OLGA stage II prevails — 55% and II degree — 75% of the examined. The development of gastric neuroendocrine tumors were recorded in 2 patients.

Anemias are often associated with the pathology of the digestive system. This literature review presents data on the etiology, pathogenesis, diagnosis and treatment of iron defi ciency, B12-defi ciency, folate defi ciency anemias, as well as anemia of chronic diseases and autoimmune hemolytic anemias associated with diseases of the gastrointestinal tract.

Study of comorbidity features of gastroesophageal refl ux disease (GERD) and cardiovascular diseases (CVD) due to their frequent occurrence and mutual infl uence is still urgent, which was the aim of our study. Overall 357 people (men — 26,9%; women — 73,1%) were interviewed. GERD was registered in 8.7% of cases (men — 13.5%; women — 6.5%). Its detection rate naturally increased with increasing age, as well as obesity, hypertension, coronary heart disease, heart rhythm disorders and chronic heart failure. GERD was signifi cantly more common in GERD than in the absence of GERD. Common risk factors (obesity, tobacco smoking and alcohol abuse) were signifi cantly more frequent in GERD and CVD compared to the absence of GERD. The highest comorbidity of GERD and CVD was found in patients with GERD under 5 years compared to those with a history of GERD of 5 years or more. This is associated with the fact that in the absence of GERD the incidence of CVD increased with increasing age and did not with GERD. The latter is explained by the fact that the registration of such common FRS of GERD and CVD, as obesity, tobacco smoking and alcohol abuse in the absence of GERD naturally increased with increasing age, while this did not occur in the presence of GERD. Close associative link between GERD and CVD was established. It was determined both by risk factors common for them (obesity, tobacco smoking and alcohol abuse) and by age of patients and duration of GERD.

Purpose of the study: to identify and evaluate the prognostic role of phenotypic and visceral stigmas of connective tissue dysplasia in the formation of gastroesophageal refl ux disease (GERD) associated with duodenogastroesophageal refl ux (DHER).

Materials and methods. In an analytical one-stage study 129 (42 men and 87 women) patients with GERD associated with DHER (GERD-DHER), verifi ed by the presence of refl ux esophagitis and the data of esophageal pH-metry, were examined to diagnose the presence / absence of a dysplastic- dependent phenotype and visceral signs of connective tissue dysplasia.

Results. In the adult population of GERD-DHER patients, phenotypic and visceral manifestations of connective tissue dysplasia occur in 45,7% of cases. The chance of developing the disease in persons with a dysplastic- dependent phenotype in the presence of a hiatal hernia increases by 3,7 times, with a combination of a hiatal hernia and anomalies in the shape of the gallbladder — 4,3 times; in the presence of cardia insuffi ciency, anomalies in the shape of the gallbladder and their combination — by 1,4–1,6 times.

The prevalenceand multifactorial etiology of duodenal ulcer disease (DUD) are of great interest to researchers. We have noticed that besidesthe usual symptoms of DUD, patients report aboutconditions what defi ned as a depressive episode, a decrease in quality of life, autonomic nervous system dysfunction, and sleep disorders. It was decided to compare the presence and severity of nonspecifi c symptoms in the complicated and uncomplicated form of DUD. We examined 110 patients divided into two groups of 55 people according to the form of the course of the disease. The examination included the collection of complaints, anamnesis, gastroenterologist’s examination, esophagogastroduodenoscopy, common blood test + glucose test, long-term monitoring of intragastric pH-metry, questionnaires for assessing the main nonspecifi c complaints of patients: HADS, questionnaire of the National Cardiologic Center of the Russian Academy of Medical Sciences in the Y. M. Rutgizer and A. G. Mikhailov’s modifi cation for patients with the digestive tract diseases, A. M. Vane and Ya. I. Levin’s questionnaire for scoring subjective sleep characteristics. We calculated the Kerdo index and used the A. D. Solovyova’s standard tables method, assessing autonomic dysfunction. We have obtained the following results: patients with a complicated course of DUD are diagnosed with depression twice as often as people with an uncomplicated course. Patients with a complicated course of DUD had the decreased quality of life almost twice as much. As for the departments of the autonomic nervous system imbalance, it was much more common in patients with a complicated form in comparison with the group of patients with an uncomplicated variant of DUD, sympathicotonia was represented by a large number of people. Appreciable sleep disorders were also associated with a complicated course of DUD. Comparing the parameters of the presence of a clinical or subclinical form of depression with the predominant variant of VT, we noticed a connection between depression and sympathicotonia with out reference to the complicated course of the disease. We should note that sleep disorders in DUD are diff erent from those in isolated depression. We found a link between a decrease in the quality of life and the need for treatment in patients with a complicated form of DUD; the disease severely restricts physical activity, as well as social and everyday aspects of life, which can lead to depression. A “viciouscircle” isforming.

Purpose of the study: to identify the features of clinical manifestation, sleep disorders and quality of life in patients with small hiatal hernias in gastroesophageal (GER) and duodenogastroesophageal refl ux (DGER).

Materials and methods. 120 patients with small (1–2 degrees) hiatal hernias and grade I–III refl ux esophagitis on the basis of predominantly GER (35 people) and DGER (85 people) refl ux were examined. Sleep disorders were assessed using the Yu. A. Aleksandrovsky scale, violations of the quality of life — the KSC RAMS questionnaire.

Results. Small hiatal hernias in all cases occur with a pronounced refl ux syndrome in the form of combination of esophageal and extraesophageal manifestations, developing both on the basis of GER and DGER. Esophageal manifestations of refl ux syndrome predominate in the presence of DHER and are combined with biliary dyspepsia. Extraesophageal manifestations do not depend on the type of refl ux. Dyssomnia was noted in every second patient with hiatal hernia, primarily presomnic and intrasomnic disorders, which were most pronounced in patients with GER. In the majority of patients with small hiatal hernias, the main reasons for the decrease in the quality of life, regardless of the type of refl ux into the esophagus, were the need for treatment, adherence to a diet, instrumental studies, and restriction of physical activity.

At the moment the approach to the treatment of gastric ulcer (GU) does not depend on the location of the ulcer in one or another part of the stomach. We compared gastric secretion, duodenogastric refl ux characteristics and Helicobacter pylori infection in patients with “high” and “low” gastric ulcers. 96 patients with recurrent GU were examined; 71.9% of men and 28.1% of women. In 58 patients, a “high” localization of the ulcer was detected, and in 38 patients, a “low” (pyloroantral) ulcer was diagnosed. All patients underwent esophagogastroduodenoscopy and daily intragastric pH-metry prior to the appointment of antisecretory therapy. The data were compared with the results of healthy volunteers. The frequency of detection of Helicobacter pylori infection was comparable with diff erent localization of gastric ulcer. We were able to show that with “high” ulcers, intragastric acidity in terms of fundal and antral pH and its circadian dynamics were comparable to healthy people. With “high” ulcers, the frequency of duodenogastric refl ux was close to normal, but their total duration was higher due to an increase in the proportion of prolonged and high refl ux. With “low” gastric ulcers, we noted a very high and monotonous acidity in the body and antrum of the stomach, combined with a decrease in the frequency and duration of duodenogastric refl ux. Consequently, both “high” and “low” stomach ulcers suggest the appointment of antisecretory drugs. At the same time, the detection of “high” stomach ulcers associated with excessive duodenogastric refl ux can be considered as a basis for prescribing bismuth tricalium dicitrate, including as part of the Helicobacter pylori eradication therapy, or ursodeoxycholic acid.

Gastric polyps (GP) are a serious clinical problem due to the high prevalence and tendency to malignant transformation with nonspecifi c symptoms. The literature does not describe clinical and anamnestic markers that make it possible to suspect the presence of GP, and tactics for the management of patients with GP are not proposed.

Aim: a study the clinical, anamnestic features of patients with GP, infection with Helicobacter pylori.

Materials and methods: 61 patients with hyperplastic GP (HGP) and 41 with adenomatous GP (AGP) were examined. We conducted a general clinical study of patients’ complaints, also clarifi ed the duration and features of the course of the disease, the association with Helicobacter pylori (HP), endoscopic and ultrasound examination of abdominal organs.

Results: the clinical manifestations of GP are nonspecifi c: non-intense epigastric pain after eating or without connection with food intake, a combination of dyspeptic hyperacid complaints (heartburn) and dyskinetic (nausea, belching with air) character. Symptoms of chronic atrophic gastritis are typical for HGP. There was a high family burden on oncopathology — 21.4% of patients, one in ten had a burdened hereditary history of stomach cancer. In the group of HGP, polyps of other gastrointestinal tract localizations were detected in almost 40% of cases, with AGP in more than half — 25 (61%). Colon polyps and gallbladder polyps were detected in a quarter of patients with AGP. HP infection was detected in GP in more than half of the patients.

Conclusion: patients with chronic atrophic gastritis, cholelithiasis and pathology of the biliary tract, polyps of other localization, burdened with hereditary oncopathology, should be considered at risk of detection of GP. All patients with GP are shown a follow-up examination to detect chronic atrophic gastritis, patology of the biliary tract, polyps and neoplasms.

The aim. Microbiological monitoring of the digestive tract opportunistic microfl ora in underweight premature newborns to substantiate risk groups and the possibility of a personalized approach to manage such patients.

Materials and methods. A case-control observational study included 67 preterm infants (35 boys and 32 girls), divided into three groups according to the underweight degree: low (n = 21), very low (n = 21) and extremely low (n = 25) mass. A comprehensive examination was carried out with clinical- anamnestic, laboratory and clinical- functional diagnostic methods, consultation of a neurologist, ophthalmologist, cardiologist. Microbiological monitoring of opportunistic microfl ora (UPM) of the oral cavity and other biotopes (auricle surface, armpit, fetal part of the placenta) was carried out on the 1st, 3rd and 7^th days of life. Biochemical identifi cation was carried out using test systems “Erba Lachema”. Database creation and statistical processing were carried out using software packages of Microsoft® Offi ce® 2010, IBM® SPSS® Statistics 23.0, WinPEPI© 11.39.

Results. The frequency of opportunistic microfl ora isolated from the oral cavity of underweight newborns was signifi cantly higher on the 1st, 3rd days (Fisher’s exact test, p = 0.037) and was characterized by a wider spectrum compared to other studiedbiotopes. The dominant representative of opportunistic microfl ora in most biotopes was S. epidermidis, as well as K. pneumoniae, C. krusei, Burkholderia cepacia complex, and S. maltophilia. There was revealed a correlation link between the qualitative and quantitative parameters of opportunistic microfl ora, as well as the number of opportunistic microfl ora contaminated biotopes with the level of body weight and resistance indicators of underweight premature newborns.

Conclusion. Microbiological monitoring of opportunistic microfl ora of the oral cavity and the inner surface of the auricle biotope makes it possible to consider these microecological parameters as a prognostic criterion for the course and outcomes in premature infants with underweight, as well as to scientifi cally substantiate a personalized approach to the management of such patients, the formation of risk groups, the appointment of corrective and preventive measures to form adequate profileof microbial colonization, prevent of infectious pathology and the decrease risk of an unfavorable outcome.

In recent years, attention has been growing to assessing the role of the state of intestinal microbiocenosis in the development of cardiovascular diseases, including arterial hypertension (AH) and metabolic syndrome (MS), the individual components of which are more or less associated with the state of the microbiota. In this regard, we made an attempt to clarify the features of the intestinal microbiota in hypertensive patients with MS in a comparative aspect with those with isolated hypertension. A microbiological study of feces was carried out in 86 patients, of which 46 with AH (comparison group) and 40 with AH and MS (main group). The microbiota of patients’ faeces was investigated using the classical bacteriological method and the biochemical method for express diagnostics of dysbiosis. For fecal microbiota in AH with MS, in comparison with AH, a lower release of representatives of normal microfl ora (bacteroids, latobacilli, bifi dobacteria), with the exception of Escherichia coli, is characteristic, more frequent excretion of facultative microfl ora (enterococci, Klebsiella, peptostreptococcus, staphylococcus protrusion)., II and III degree of dysbiosis (versus I and II with hypertension). The study revealed that the composition of the intestinal microbiota in patients with hypertension is associated with MS both in terms of a decrease in individual representatives of normal microfl ora and in terms of the greater presence and appearance of new representatives of opportunistic microfl ora, forming a high degree of dysbiosis in hypertensive patients with MS.

This work analyzes the sensitivity of the resident and facultative microbiota of the oral cavity, stomach and duodenum of patients with infl ammatory and erosive — ulcerative diseases of the gastrointestinal tract to probiotic drugs with active ingredients: Bacilus subtilis 534, Lactobacillus acidophilus, Bifi dobacterium bifi dum and Bifi dobacterium longum. The studied microbiota showed a diff erent degree of sensitivity to the Lactobacillus acidophilus, and Bacilus subtilis 534, as well as absolute resistance to Bifi dobacterium bifi dum и Bifi dobacterium longum. Clinicians need to take into account that not all probiotic preparations can be eff ectively used in the treatment of dysbiosis of the digestive tract.

Chronic yersinioses are “therapeutic” infections with predominant symptoms of a somatic pathology while the typical manifestations of the infectious process are absent.

Рurpose. Тo analyze the features of clinical manifestations of chronic yersinioses in children and to evaluate the eff ectiveness of diagnostic methods for detecting the disease.

Characteristics of children and research methods. Laboratory confi rmation of the diagnosis of yersiniosеs was the criterion for including patients in the study group. As a result the group of patients with chronic yersiniosis infection included 131 children, 68 boys and 63 girls aged 2 years 8 months to 17 years 11 months (the average age of the group was 10 years) with typical gastroenterological pathology Laboratory confi rmation of the diagnosis of pseudotuberculosis and intestinal yersiniosis was carried out using the PCR to detect pathogenic yersinia in feces, specifi c antibodies were determined by a set of methods.

Results. The article describes the clinical variants of chronic yersiniosis infections in children caused by Yersinia pseudotuberculosis and pathogenic Yersinia enterocolitica. Мost organs of the gastrointestinal tract (stomach, pancreas, liver, small and large intestines, mesenteric lymph nodes) can be aff ected in the course of chronic yersiniosis infection in children. A recurrent course of chronic yersiniosis infection is possible in children with hypogammaglobulinemia A.

Conclusion. The chronic yersinioses can be suspected in the absence or insignifi cant eff ect of standard therapy of somatic pathology (gastritis, pancreatitis, irritable bowel syndrome, functional dyspepsia, etc.). The irritable bowel syndrome and functional dyspepsia are most common clinical variants of chronic yersiniosis infection in children. The immunoblotting is the most effective method to confi rm the diagnosis of chronic yersinioses.

Objective: The study aimed to evaluate the possible association of PTGS1 gene polymorphisms (rs10306135, rs12353214) with the clinical effi cacy and safety of ketorolac in relation to postoperative pain.

Materials and methods: The study included 107 patients after video laparoscopic cholecystectomy, who received ketorolac 30 mg as postoperative pain relief 2.0 x 3 times a day. All patients were genotyped for PTGS1 (rs10306135, rs12353214). The pain syndrome was assessed using the Visual Analog scale (VAS), the McGill pain questionnaire. The profi le of adverse reactions was assessed by the dynamics of red blood counts, as a possible trigger for the development of gastrointestinal bleeding according to the method of global assessment of triggers (GTT).

Results: According to the VAS and the McGill pain questionnaire, there were no statistically signifi cant diff erences in the intensity of pain between the two groups. There were also no statistically signifi cant diff erences in the dynamics of red blood counts.

Conclusion: We did not fi nd an association between the carriage of the PTGS1 genotype (rs10306135, rs12353214) and the effectiveness of postoperative anesthesia with ketorolac, and we did not fi nd an association with the risk of developing adverse reactions after ketorolac anesthesia.

Ectopia of the pancreas is a rare malformation that requires an individual approach to treatment. We present our experience in the diagnosis and treatment of 119 patients with EPI in the gastroduodenal zone. The main indication for surgical treatment is with a long-term intractable pain symptom. 28 (23.5%) patients were operated on, most of them from the laparoscopic approach. To determine the enzymatic activity of the gland, an assessment of the vegetative status was used. Vagotonia can be one of the causes of exocrine activity and hyperperistalsis of the stomach and duodenum. Among the operated patients, the parasympathetic type of autonomic nervous regulation was more common. Evaluation of the histostructure of the removed EPG macro- preparations indicated the predominance of type 3, indicating the presence of all components similar in structure to the tissue of a normal pancreas.

Aim. To study the pathogenetic mechanisms of the development of acute adhesive small bowel obstruction.

Material and methods. An analysis is given of the results of a comprehensive examination of 50 patients with acute adhesive small bowel obstruction. In 46 (92%) observations out of 50 (100%) patients, the causes of acute adhesive small bowel obstruction were various pathologies of the abdominal cavity organs, which had a history of diff erent types of surgery and volume of surgical interventions, and in 4 (8%) cases it was primary, without carrying out surgical interventions.

Results. The results of the study showed a signifi cant decrease in the level of serotonin in biopsies of the mucous membrane of the small intestine and in the blood serum with the progression of oxidative stress and cytokine activity in patients with acute adhesive small bowel obstruction, who had a history of various surgical interventions on the abdominal and pelvic organs, and there were also infl ammatory processes in the small intestine. This leads to disruption of the motor function of the small intestine, the development of intestinal paresis. Depending on the extent of the lesion and the occurrence of pathomorphological changes in the walls of the small intestine, single or multiple viscero- visceral and viscero- parietal adhesions are subsequently formed with the development of acute adhesive small bowel obstruction.

Conclusion. Thus, in the pathogenesis of acute adhesive small bowel obstruction, the leading place is given to a decrease in the number and qualitative composition of EC-cells of the small intestine mucosa producing serotonin due to oxidative stress and cytokine activity.

Objective. To substantiate and develop in the experimental conditions the methods of hemorrhage stopping in various wounds of the spleen depending on the nature and size of its damage.

Material and methods: The experiments were carried out on 39 dogs. All operations were divided into 4 series. In the 1^st series models of the linear wounds of various length and depth were created; in the 2nd and 3rd — the models of the crushed and scalped wounds and the wounds after the planar and transverse resections; in the 4th series — the wound models after the splenic marginal and wedge resections. To close the presented wound models we used newly developed methods to stop bleeding. We used angiographic, physical, morphological and statistical methods of investigation at 1,3,5,7,14, 30, 90 days to assess their eff ectiveness.

Results: The carried out researches have shown a good tightness of the investigated ways of the spleen wounds suturing. Morphological investigations at diff erent terms after the spleen operation revealed the absence of the signs of infl ammation and development of the secondary complications. There were no signs of the gastric fl ap rejection and blood oozing through its wall. Histological examination of the gastric fl ap revealed its good plastic and revascularizing properties.

Conclusion: The developed ways of the bleeding stop have a reliable air-tightness that provides a reliable hemostasis and prevention of the development of secondary complications. The applied new principle of the wound closure depending on its size minimized using of both additional sutures and lining materials.

The glands of the digestive tract secrete secrets, secretions and excretions into their ducts, into the cavity of organs, into the lymph and blood fl ow. A signifi cant part of the secreted hydrolytic enzymes is absorbed from the small intestine into the lymph and circulating bloodstream. The enzymes found in the blood plasma in free and adsorbed by its proteins, corpuscular elements, the endothelium of blood capillaries, inhibitors are rectifi ed by the glandulocytes of the glands into the chyme, take multiple participation in the hydrolysis of food nutrients and secretions, that is, they are recycled in the macroorganism. Hydrolases have the properties of signaling molecules, have regulatory and modulating eff ects on the processes of secretion and recreation of enzymes, on the organization of food and chyme motility adapted to the nutrient composition of food intake. In the urgent enzymatic adaptation of the secretion of the digestive glands, an essential role is played by the principle of the morphofunctional organization of the activity of the digestive secretory- transport modules. Each of them has specialized sensory, conductive aff erent and eff erent elements, and in the gland itself — specialized microregions and a system of secretion ducts with a microreservoir- valve apparatus.

This review presents generalized data of modern Russian and foreign researchers on the relationship between the development of chronic diseases of the cardiovascular, respiratory, and digestive systems in adults and metabolic disorders with changes in the composition and metabolic activity of the intestinal microbiota. Particular attention was paid to the analysis of the results of studies of young people (from 18 to 35 years old), also in the article, as an eff ective comparison, data on children of adolescence and youth are given. The studied data are of scientifi c interest from the point of view of the search for new targets and treatment schemes for the prevention of somatic diseases and their therapy through the restoration of the ecosystem of the gastrointestinal tract.

One of the most important rules of the modern approach to the treatment of H. pylori infection is to provide eradication therapy to all those infected. Unfortunately, in real clinical practice, doctors and patients often have concerns about the administration of antibiotics, their possible side eff ects and the duration of standard protocols. The increase in antibiotic resistance observed in diff erent countries is also a serious problem, which explains the need to search for alternative therapeutic options for the treatment of Helicobacter infection. In this regard, the search and analysis of the accumulated scientifi c information about the eff ects of including probiotics in the eradication therapy of H. pylori infection is of particular relevance. We have studied the available data on the effi cacy of diff erent probiotic strains in patients infected with H. pylori. Thus, to date, there is strong evidence that the use of probiotics leads to a reduction in the adhesive properties of H. pylori, reduces the degree of bacterial colonization and the severity of infl ammation of the gastric mucosa. Probiotics can be considered a useful adjuvant to standard protocols including antibiotics and proton pump inhibitors, and can be used not only to improve eradication effi cacy, but most importantly to reduce the incidence of gastrointestinal symptoms, which are a frequent cause of reduced adherence and treatment drop-out. We found support for the suggestion that multistrain probiotics are more eff ective than mono-strain probiotics in optimizing eradication therapy in adults and children.

Aim. Revealing the level and signifi cance of Helicobacter pylori (H. pylori) in the normobiocenosis and disbacteriosis of mucosal microbiota in the esophagus, stomach and duodenum.

Material and methods. Qualitative and quantitative composition of the mucosal microbiota was defi ned in biopsy specimens from diff erent parts of esophagus, stomach and duodenum in addition to clinical and histological examination in 50 healthy volunteers, 106 ulcer duodenum patients, 24 patients with gastric ulcer, 36 with chronic gastritis and 24 with chronic esophagitis.

Results. H. pylori is involved into normomicrobiocenosis of the mocosal microbiota and take part of main defensive function of gastroduodenal tract. Excerbation of peptic ulcer, chronic gastritis and esophagitis is accompanied with the reduction H. pylori in most cases, though the scar formation occurs both with and without presence of H. pylori.

Conclusion. The colonization of the esophagus, stomach and duodenum by H. pylori has no infection process and play the independent role in the development of the ulcer disease, gastritis and esophagitis and does not require the eradication.

This article provides a brief description of acute appendicitis, methods of its diagnosis, discusses typical clinical cases, examples of tactics for managing patients with acute appendicitis. The sequence of management of a patient with acute appendicitis, steps to a speedy recovery of the patient, including surgical interventions, his discharge with positive dynamics are summarized. Special attention is paid to the course and further development of complications of acute appendicitis during the COVID-19 pandemic. The need for timely treatment of the population for medical care is emphasized in order to avoid the development of complications (in particular, from acute conditions), for a qualitatively better prognosis and a speedy recovery in the postoperative period.

Aim of the research: to identify possible complications and course of appendicitis in a pandemic coronavirus infection.

Objectives: to study and analyze clinical cases in patients with appendicitis during a pandemic coronavirus infection.

Materials and methods: clinical cases, case histories, educational literature.

Conclusions: the course of acute appendicitis was accompanied by various complications that developed due to untimely medical care, due to the huge burden on the sphere of health protection of the Russian Federation. There was a tendency for the transition of acute appendicitis to peritonitis, abscess of the stump of the appendix, pilefl ebitis, due to coronavirus infection. Pathological activity of the immune system was also revealed in patients with appendicitis (lymphatic infi ltration of appendix tissues).

The article discusses clinical case of a new coronavirus infection in a patient with a severe course of Crohn’s disease (CD) in a long anamnesis. The issues of the complexity of diagnosing Crohn’s disease in an atypical course (gastroduodenal form), the algorithm for selecting basic therapy for a severe course of the disease are considered. The second problem in the article is the tactics of managing patients with COVID-19 against the background of combined basic immunosuppressive therapy for autoimmune diseases.

Congenital chloride diarrhea is an autosomal recessive congenital disease caused by a mutation in the SLC26A3 gene mapped to chromosome 7 (locus 7q22-q31). At the beginning of the 21st century, more than 250 cases of congenital chloride diarrhea have been reported, mostly in Finland, Poland, Kuwait, and Saudi Arabia, single cases appear all over the world.

SLC26A3 gene encodes an intestinal Cl–/HCO3 – exchanger, а defect of which causes malabsorption of Cl– in the ileum and colon. The disease can be revealed during pregnancy by polyhydramnios, dilated intestinal loops of the fetus on sonography.Most children are born prematurely. Visualization of distended bowel loops and the absence of meconium after birth often leads to unnecessary surgical intervention due to suspected intestinal obstruction or Hirschprung’s disease. The main features of the disease are watery diarrhea, dehydration, failure to thrive, hypochloremia, hyponatremia, hypokalemia and metabolic alkalosis. Fecal chloride excretion is higher than total sodium and potassium excretion. Treatment consists of potassium chloride and sodium chloride replacement therapy. Nowadays patients with adequate treatment reach adulthood but the long-term prognosis is unknown. Therapy stops electrolyte disturbances, but diarrhea persists.

Since 2003, we have observed 3 patients with clinical signs of congenital chloride diarrhea with further confi rmation of a mutation in the SLC26A3 gene. All the children were born prematurely, the mothers had polyhydramnios during pregnancy, and the fetus had dilated bowel loops on ultrasound examination in utero. Two patients underwent surgical treatment because of suspected intestinal obstruction or Hirschsprung’s disease in early neonatal period. Before salt substitution therapy, all children had watery diarrhea, failure to thrive and delayed psychomotor development. We have been observing one of our patients for fi ve years from the moment of diagnosis until now. The girl receives therapy with sodium chloride and potassium chloride, her physical and psychomotor development corresponds to her age, there are no electrolyte abnormalities.