An analysis of the most important changes and provisions of the Maastricht VI consensus published in August 2022 is presented. 41 experts from 29 countries took part in the creation of the consensus. Recommendations have been developed in five areas: (1) indications for treatment and clinical associations of Helicobacter pylori (H. pylori) infection, (2) diagnosis, (3) treatment, (4) prevention of gastric cancer, (5) H. pylori and gastric microbiota -intestinal tract (GIT), taking into account the level of evidence and the strength of recommendations. Emphasis is placed on molecular testing, which is becoming an increasingly accessible research method in the world to identify both H. pylori itself and its sensitivity to antibiotics. The growing resistance of H. pylori strains to previously effective antibacterial agents requires a treatment strategy that implies the ability to determine the sensitivity of H. pylori to antibacterial agents both in the population and in a particular individual. The use of modern diagnostic tests expands the possibilities of individualization of therapy, since it allows determining not only the presence of H. pylori in the gastric mucosa, but also the sensitivity of the infection to antibacterial drugs. Along with individual approaches to treatment, the most effective empirical therapy regimens are given in case of impossibility to determine individual resistance to antibiotics. New data on the effectiveness and results of the use of primary and secondary preventive strategies for gastric cancer are presented. Given the important role of the entire microbiome of the gastrointestinal tract in the functioning of the body, the question of the interaction of H. pylori with other microorganisms is discussed. The critical issues of the near future are related to the global prevention of gastric cancer; the need to control antibiotic resistance, and the development of new methods of therapy and prevention of Helicobacter pylori infection.

Stomach cancer occupies a leading position in oncological morbidity and mortality worldwide. Approximately 800,000 people die from stomach cancer every year. In two-thirds of patients gastric cancer is diagnosed at a late stage, when radical treatment becomes impossible. Helicobacter pylori (H. pylori) infection is considered as the main etiological factor for gastric cancer. To stratify the risk of developing gastric cancer an assessment of morphological changes in the gastric mucosa using the Operative Link for Gastritis Assessment of Atrophic Gastritis (OLGA) system is used. The stage of gastritis plays a key role in determining an individual’s risk of developing stomach cancer. H. pylori eradication therapy is an effective method for preventing gastric cancer. However not in all patients the elimination of the infection can prevent the development of gastric cancer in the future. It is extremely important to identify a group of people with ex-helicobacter gastritis, who have a high risk of developing stomach cancer, and to take timely preventive measures in them. The purpose of this publication is to summarize and systematize the currently available data on the risk of developing gastric cancer in patients with H. pylori-associated gastritis, including those after successful eradication.

The article is a critical analysis of the world scientific literature devoted to the search for risk factors for stomach cancer for the timely prognosis of this disease and the implementation of cancer prevention measures. The paper presents data from numerous studies to determine the role of environmental factors, including unfavorable ecology, as well as gender, age, smoking, alcohol abuse. The authors’ opinions are presented on the essential role of the alimentary factor in the genesis of neoplasms in the stomach, including the predominance of animal fats in food, the abuse of overcooked, pickled foods rich in nitrosoamines, foods saturated with spices, the use of too hot food, the use of foods infected with mycotoxins in nutrition. The role of environmental factors in the prognosis of gastric cancer is noted: the state of secretory activity of the stomach, the dynamics of inflammatory and atrophic processes in the mucous membrane. A special role for the prognosis of stomach cancer is assigned by many authors to the pyloric helicobacter, as well as the quantitative indicator of glycated blood hemoglobin and its dynamics. The significance of genetic changes in the genesis of gastric cancer and their role as prognostic factors of the disease is ambiguous. The article draws attention to the multidirectional results of many authors in understanding a large number of factors they have studied that could be used as prognostic witnesses of stomach cancer. The expediency of searching for the most significant regional factors for the prognosis of gastric cancer is substantiated, on the basis of which it is very important to create registers of patients with precancerous diseases of the stomach for the organization and implementation of personalized and effective measures of cancer prevention.

A single-stage retrospective observational comparative study was conducted to find the most significant risk factors for stomach cancer. The analysis of 36 risk factors for stomach cancer in 143 patients aged 32 to 83 years, indigenous residents of cities, regions and republics of the Northwestern Federal District of Russia who underwent complex, including surgical treatment of this disease. The control group consisted of 128 people who underwent in-depth medical examination in the amount necessary for the program of this study. The ranking of the studied risk factors for gastric cancer according to their degree of prognostic significance is presented as follows: the presence of precancerous diseases accompanied by progressive atrophy of the gastric mucosa, intestinal metaplasia and/or dysplasia in combination with prolonged gastric helicobacteriosis; a decrease in the blood content of pepsinogen I and stimulated gastrin-17, as well as a decrease in the ratio of PG I/PG II; prolonged presence of anemia, leukopenia, neutropenia, lymphopenia, thrombocytopenia, especially in men over 50 years of age with bad habits (smoking, alcohol abuse); presence in patients with diabetes mellitus and obesity, especially when combined with them and under the condition of an increased index of glycosed hemoglobin; gross and multiple disorders of the rhythm of nutrition and the content of the diet. Using the obtained data, a mathematical assessment of the prognostic significance of each of the studied signs can be carried out, an algorithm for predicting stomach cancer and making individualized medical decisions is developed, without which it is impossible to create an effective and convenient register of patients with precancerous diseases at all stages of medical care for organizing and conducting personalized and effective cancer prevention measures.

The creation of a system for predicting the nature of the course of the acute phase of ulcerative colitis (UC) would be able to block possible complications and other life-threatening variants of the development of the pathological process with timely preventive therapy. The purpose of the study. To formulate an effective methodology and create effective decisive rules for predicting the nature of the course of diseases of the digestive system in the phase of acute phenomena of the pathological process on the example of UC for justification based on the prognostic conclusion of the volume, content and intensity of individual therapy. Material, methods and results of the study. 366 patients with UC were examined (men - 213, women - 153). Age of patients: from 18 to 78 years. Patients with distal colitis - 211, with left-sided colitis - 68, with subtotal - 66, with total - 21. Acute course of UC occurred in 167 patients. All other 199 patients had a relapse of the chronic course of UC. At the same time, 140 patients had a rare recurrence of the disease, and 59 patients often had a recurrent course. We observed a chronic continuously recurrent course of UC in 14 patients out of 59 patients. The use of mathematical forecasting methods in the form of an inhomogeneous sequential procedure, discriminant and cluster analyses used in the construction of the prognostic program made it possible to identify from a large number of clinical signs of UC 28 the most significant symptoms of the acute phase of the disease for prognosis and to give them an appropriate quantitative characteristic. The developed computer program, which individually summarizes the prognostic coefficients of each patient, provides the clinician with information about the degree of risk of developing an “unfavorable” course of the disease (complications, hormonal resistance, hormonal dependence, extra-intestinal manifestations, etc.) or assumes a “favorable” course of UC: a rapid adequate response of the body to standard therapeutic measures. Conclusion. The materials of the article allow us to accurately predict the course of UC in the acute phase of the disease, which can serve as a methodological and methodological basis for further progressive scientific movement in solving more significant and global problems in gastroenterology

Purpose of this study is to research contribution of chronic non-communicable diseases (CNCDs) risk factors (RF) to the prevalence rate of digestive organs diseases and risks of digestive system malignant neoplasms development in the context of Omsk region municipal districts. Material and methods: the analysis includes following risk factors (RF): unhealthy diets, overweight, harmful use of alcohol, physical inactivity with proved causal relationship with of digestive organs diseases such as stomach and duodenal ulcer, gastritis and duodenitis, liver fibrosis and liver cirrhosis, and with digestive organs malignant neoplasms (MNP): esophageal cancer, stomach cancer, colon cancer, rectal cancer, liver cancer and intrahepatic bile ducts cancer. This research used Russian Federation Federal State Statistics Service statistic material. Statistic material processing was conducted using traditional correlation analysis and the estimation of reliability of data differences method. Correlation analysis was carried out using online-calculator of statistics on the www.medstatistic.ru website. Results: the group of region municipal districts with the most unfavorable population mortality rates for malignant neoplasms has “unhealthy diets” RF associated with high risk of stomach cancer development, “overweight” RF associated with high risk of colorectal cancer and liver cancer development, “harmful use of alcohol” RF associated with high risk of stomach cancer and pancreatic cancer development, “physical inactivity” RF associated with high risk of stomach cancer development. Conclusion: the analysis made it possible to determine priorities in primary prevention of oncological diseases strategy in Omsk region municipal districts and to form key MNP development risk groups among region population to be targeted by preventive measures.

Purpose of the study: to clarify the effect of the concentration of motilin in the blood on the clinical symptoms of functional dyspepsia. Materials and methods. A prospective examination of 90 people aged 22,3±0,17 years was carried out, divided into 3 groups: patients with postprandial distress syndrome (PDS), patients with epigastric pain syndrome (EPS), practically healthy. All subjects were questioned according to the GSRS questionnaire, and the concentration of motilin in their blood was determined before and after the drinking test. Statistical processing included the calculation of mean values, their errors, Student’s t-test, Pearson’s correlation test, factor analysis. Results. In patients with PDS, the intensity of abdominal pain (2,47±0,38 points) does not differ from healthy ones (2,19±0,22 points), in patients with EPS it is higher (4,33±0,51 points). Dyspeptic syndrome is more typical for patients with PDS (2,07±0,12 points) than for EPS (1,10±0,04 points). The concentration of motilin in the blood on an empty stomach with PDS (9605,47±167,64 pg/ml) is higher than with EPS (8780,67±232,27 pg/ml). After the drinking test, the level of motilin in the blood of patients with EPS increased to 9367,33±145,78 pg/ml, the PDS decreased to 9323,33±239,04 pg/ml. With PDS, the severity of reflux syndrome directly correlates with the concentration of motilin in the blood. In EPS, the initial level of motilin correlates inversely with the severity of reflux syndrome, constipation syndrome, and the volume of water drunk. After the drinking test, there is an inverse correlation between the level of motilin and the severity of diarrheal and dyspeptic syndromes, and a direct correlation with the intensity of abdominal pain. The initial level of motilin in the blood brings the greatest factor load into the “factor of motor disorders”. Conclusion. The initial level of motilin and its dynamics during water load play an essential role in the formation of the clinical picture of functional dyspepsia.

The aim of the study was to evaluate gene expression of proinflammatory cytokines in esophageal mucosa in patients with erosive esophagitis (EE) and non-erosive form (NERD) of gastroesophageal reflux disease (GERD) and perform correlation analysis between the genes expression and types and number of gastroesophageal refluxes. Methods. This was a single-center prospective study. Esophageal mucosa samples were taken from lower part of the esophagus during endoscopy. Expression of IL-1b, IL-10, IL-18, TNFA, TLR4, GATA3, CD68 and beta-2 macroglobulin genes was assessed with ImmunoQuantex assays. Multichannel intraluminal esophageal pH-impedance studies were performed with Ohmega recorder and 2pH-6impedance catheters. Results. Data of 60 patients (females - 34; mean age (M±SD) 54.6 years, 20 - with erosive esophagitis) were available for the analysis. In those with EE, there was higher expression of IL-18 (5.89±0.4 vs 5.28±1.1, p=0.04), GATA3 (2.92±0.86 vs 2.23±0.96, p=0.03) genes, and inflammatory index (92.12±32.41% vs 70.1±30.8%, p=0.02) compared to NERD. Direct correlation was found between acid exposure time and expression of IL-1b (Spearman rank R = 0.29), IL-18 (R=0.31), TNFA (R=0.35), GATA3 (R=0.34), TLR4 (R=0.29), CD68 (R=0.37) genes and inflammatory index (R=0.3). Indirect correlation was revealed between mean рН and expressions of IL-18 (R= -0.28), TNFA (R= -0.33), GATA3 (R= -0.28), TLR4 (R= -0.28), CD68 (R= -0.39) genes and inflammatory index (R= -0.17). No correlation was found between the genes’ expression and number of gastroesophageal refluxes. Conclusions: Expression of proinflammatory cytokines’ genes differ in patients with EE and NERD. There is a correlation between expression of studied genes and esophageal acidity.

Purpose: to evaluate the efficacy and safety of the use of rebamipide (Rebamipide-SZ, Severnaya Zvezda NAO) during 8-week therapy in patients with functional dyspepsia (FD) and/or irritable bowel syndrome (IBS). Materials and methods: 60 patients of both sexes aged 18 to 40 years with confirmed FD and/or IBS were examined. All patients received basic therapy for functional gastrointestinal disease. Patients of the main group were additionally prescribed rebamipide 100 mg 3 times a day. All patients were tested according to the 7x7 questionnaire to assess the severity of FD and IBS symptoms; the severity of anxiety and depression symptoms was assessed according to the Hospital Anxiety and Depression Scale (HADS); the level of zonulin in blood was determined by the ELISA method at baseline and after 8 weeks of therapy. Results: in the main group of patients, taking rebamipide led to a more pronounced decrease in the average score on the scales of the 7x7 questionnaire, such as feeling full (0 [0; 0] points vs 1 [1; 1] points, p=0.000), early satiety (0 [0; 0] points vs 0.5 [0; 1] points, p=0.005), bloating (0 [0; 2] points vs 2 [2; 2] points, p=0.001). Only patients of the main group showed a significant decrease in blood zonulin levels both in the FD subgroup (Δ%= -49%) and in the FD+IBS subgroup (Δ%= -20.85%). Conclusions: the use of rebamipide at the dose of 100 mg 3 times a day for 8 weeks as part of the basic therapy of patients with functional dyspepsia and/ord irritable bowel syndrome leads to a statistically significant improvement in the clinical condition of patients and a significant decrease in the level of zonulin in blood serum.

Aim of investigation: to evaluate the effectiveness and safety of the use of dietary supplement "Tummy ease" in the treatment of patients with functional constipation and IBS with a predominance of constipation. Materials and methods: The treatment of 33 patients was analyzed. 18 patients with FС (2 men and 16 women, mean age 50.6 ± 4.0 g) and 15 patients with IBS-C (2 men, 13 women, mean age 51.8 ± 4.5 years). Patients received Tummy ease 2-3 capsules/day for 28 days. The safety of treatment was assessed by the dynamics of biochemical parameters, the frequency and presence of side effects. To evaluate the effectiveness, we studied: the time of the carbolenic test, the dynamics of constipation symptoms according to the sum of points of the counting scale for assessing the severity of constipation and the PAC-SYM questionnaire, the dynamics of symptoms of the gastrointestinal tract according to the GIS questionnaire, the dynamics of quality of life according to the GSRS questionnaire. Results of the study: in patients with FC and IBS, there was a significant decrease in the symptoms of constipation (difficulty/pain during defecation, feeling of incomplete emptying, abdominal pain, time spent in the toilet, assistance with defecation, unsuccessful attempts to empty) and an increase in the frequency of defecation. According to the PAC-SYM questionnaire, patients with FC and IBS-C showed a significant decrease in abdominal discomfort, bloating, straining, feeling of incomplete emptying, defecation scarcity and difficulty, and the total symptom score. Patients with IBS-C additionally noted a decrease in abdominal pain, painful bowel movements and the number of false urges. The time of the carbolenic test significantly decreased in patients with FC from 49.4 ± 3.8 to 30.0 ± 2.3 hours (p = 0.00003), in patients with IBS-C from 62.7 ± 6.9 to 43.8 ± 6.4 hours (p= 0.002). In patients with FC and IBS-C, there was a significant positive dynamics of the symptoms of the gastrointestinal tract according to the GIS questionnaire and a significant improvement in the quality of life according to the GSRS questionnaire. Conclusion: The drug (BAA) Tummy ease is effective and safe in the treatment of patients with functional constipation and IBS-C and can be used as an alternative therapy.

Objective: the aim of our study was to study the relationship between constipation syndrome and obesity in gastroenterological patients. Materials and Methods: the study included 55 patients of the gastroenterology department of St. Petersburg State Budgetary Institution of Health “Elizavetinskaya Hospital”. Each patient was questioned according to the author’s questionnaire, which included the following indicators: age, height, body weight, body mass index (BMI), stool frequency (number a week), stool type according to the Bristol scale (1-7). Statistical processing was carried out using the SPSS8.0 software package. Results: The study revealed the following correlations: 1. BMI-age. BMI increases with age r=0.329 (p=0.014) 2. Stool frequency-age. With age, there is a decrease in the frequency of stools r= -0.651 (p<0.001) 3. Type of stool according to the Bristol scale-Age. With age, the type of stool shifts towards constipation r= -0.515 (p<0.001) 4. Type of stool according to the Bristol scale-BMI. With an increase n BMI, the stool shifts towards constipation r= -0.307 (p=0.023). Conclusions: according to the results of our study, we found the relationship between body mass index and constipation syndrome. It is necessary to pay special attention to patients with overweight in relation to complaints of constipation, as well as to made dynamic monitoring in order to prevent the development of colorectal cancer in patients with constipation.

Lithium salts are used in medicine as normotimics. An important aspect of the action of any medicine, incl. lithium salts is their effect on the human microbiota (microbiome). This work presents the results of a comparative chemomicrobiome analysis of organic lithium salts: ascorbate, comenate, nicotinate, oxybutyrate, aspartate and lithium orotate, carried out using modern technologies for the analysis of “big data”. For each of the studied lithium salts, estimates of the values of the area under the growth curve (AUC) were obtained for a representative sample of human microbiota, which included 38 commensal bacteria (including various species of bifidobacteria and lactobacilli) and the values of the minimum inhibitory concentrations (MIC) for 120 pathogenic bacteria. On average, over a representative sample of microbiota, lithium ascorbate supported the growth of all commensal bacteria to a somewhat greater extent (AUC = 0.57 ± 0.15) than comenat (AUC = 0.47 ± 0.17), nicotinate (AUC = 0.45 ± 0.22), lithium oxybutyrate (AUC = 0.22 ± 0.17), lithium aspartate (AUC = 0.31 ± 0.14) and lithium orotate (AUC = 0.50 ± 0.21). In the case of pathogens, MIC values were significantly lower for ascorbate (4.50 ± 3.69 μg/ml) than for comenat (6.31 ± 5.58 μg/ml), nicotinate (10.98 ± 9.37 μg/ml), oxybutyrate (7.45 ± 4.73 μg/ml), aspartate (6.37 ± 4.71 μg/ml) and lithium orotate (7.27 ± 5.81 μg/ml). Thus, lithium ascorbate is more effective in supporting commensal bacteria of a positive microbiota than the other three lithium salts and is characterized by certain antibacterial properties against pathogenic bacteria. At the same time, the ubiquitous lithium carbonate, which does not contain any fragments of organic molecules, will not have any positive effect on the state of the microbiota.

The purpose of this publication is to update knowledge about esophageal stenting in incurable cancer patients suffering from dysphagia. As well as highlighting the experience of using self-expanding stents on the basis of the endoscopic department of Omsk Clinical Oncological Dispensary. Stenting with self-healing plastic stents for malignant neoplasms of the esophagus, cardiac stomach refers to modern minimally invasive methods of palliative care for incurable patients, improving the quality of life of the patient, and as a consequence reducing the severity of dysphagia.

Objective: To improve the treatment and diagnostic algorithm for acute adhesive intestinal obstruction. Materials and methods: We have studied the results of surgical treatment of 114 patients with OCD, which included spiral computed tomography using phytocomposite in the preoperative examination complex. Results: The inclusion of CT examinations in the ТDA allowed patients of the 1st main group to operate in 21 (70%) cases in the first 6 hours after hospitalization, in the 2nd group, where patients were traditionally examined only in 6 patients (13%) Conclusion: The developed diagnostic algorithm for acute adhesive intestinal obstruction, including computed tomography in the examination, reduced the number of intraoperative, early postoperative complications and fatal cases in the main group by 1.6 times than in the 2 control group 2 (p>0.05), and by 1.4 times than in the 1 control group (p>0.05).

Prevention strategies aim to change environmental and lifestyle risk factors that contribute to the development of cancer. Screening detects abnormalities before they become clinically apparent, allowing intervention either before cancer develops or at an early stage when treatment is most likely to be effective. Despite reliable data on factors that reduce the risk of neoplasms, in routine clinical practice, the effectiveness of cancer prevention is still not high enough. This determines the high importance of the topic of this review, which summarizes the current scientific data on risk factors for the development of oncopathology and ways to influence them. Such risk factors as lifestyle, alcohol and tobacco use, physical activity, nutrition and other environmental factors are considered. A large role is given to infections, which is also considered in this review. The article highlights the intake of vitamins and microelements for the purpose of cancer prevention, as well as the influence of certain drugs taken to treat non-oncological diseases on the development of oncopathology. The purpose of the review is to present an analysis of current literature data on the methods of cancer prevention.

The purpose of the review is to present an analysis of current literature data on tumor immunology, effector mechanisms of antitumor immunity, and prospects for the development of new immunotherapeutic approaches to cancer treatment. Immunological surveillance is the intellectual basis of the idea of tumor immunology. No one doubts the role of immunological mechanisms in protection against tumors. However, tumor cells have a variety of mechanisms that allow them to avoid the action of immune surveillance factors. Some of these factors are aimed at making it difficult to recognize foreign components in the tumor and trigger immune processes. Other mechanisms prevent the implementation of effector mechanisms. Understanding the mechanisms of immunological escape may suggest immune therapy mechanisms that will be widely applicable to different types of cancer.

A characteristic feature of inflammatory bowel diseases (IBD) is an increased risk of neoplasia and colorectal cancer (CRC). The introduction of screening programs, as well as modern advances in therapy and endoscopic technologies, awareness of the risk factors of IBD-associated CRC will contribute to reducing the frequency of this dangerous complication of IBD. The presented review describes epidemiological data on the incidence of IBD-associated CRC, established risk factors for CRC, as well as modern methods of prevention, screening and early diagnosis. Literature search was conducted in PubMed and Google Scholar systems by keywords: inflammatory bowel diseases, ulcerative colitis, Crohn’s disease, colorectal cancer, risk factors, screening, endoscopy, dysplasia.

The purpose of this publication is to update knowledge about chronic autoimmune gastritis and about cases of hyperplasia of enterochromaffin-like (ECL) cells as precursors of the development of neuroendocrine gastric tumor type 1 due to clinical example’s demonstration. Discussion: the types and main characteristics of neuroendocrine tumors of the stomach were discussed, in particular tumors type 1 associated with autoimmune gastritis. The mechanisms of formation of neuroendocrine tumors in the stomach against the background of an autoimmune process were presented, two clinical examples presenting the algorithm of diagnosis of autoimmune gastritis and associated neuroendocrine tumors were presented. Both clinical examples demonstrated the presence of subepithelial formations of the stomach body according to FGDS, which have not been morphologically identified. Timely repeated FGDS with sampling of biopsies according to the OLGA standard made it possible to verify the formations, and the serological markers helped in clarifying the diagnosis and morphological nature of tumors. Conclusion: analysis of clinical data, anamnesis and esophagoduodenoscopy with morphological evaluation of the gastric mucosa biopsy may help to find out the cause and nature of chronic inflammation in the gastric mucosa. Atrophy of the glands in the stomach body, pseudopiloric metaplasia, hyperplasia of enterochromaffin (ECL) cells are sufficient morphological criteria for autoimmune gastritis. The study of the level of chromogranin A in blood serum can be considered as a marker of the development of type 1 neuroendocrine gastric tumor in patients with autoimmune gastritis and the presence of polyps in the stomach body.

Gallbladder cancer (GBC) is a rare but highly malignant neoplasm. Most cases are discovered incidentally in patients undergoing evaluation for gallstone disease. It is believed that an unfavorable prognosis associated with RZD is associated with a late stage at diagnosis, which is due to both the anatomical position of the gallbladder and the vagueness and non-specificity of symptoms, which increases the relevance of studying and highlighting this topic. Although the available evidence supports a decline in the overall incidence of RZD over the past 30 years, the incidence may be increasing in younger people. Globally, the burden of gallbladder and other biliary tract cancers has increased over the past 30 years. Several risk factors have been identified for RGB, many of which share the characteristics of chronic gallbladder inflammation. The article discusses the main risk factors and diseases that precede the development of cancer. The purpose of the review is to present an analysis of current literature data on the epidemiology of this disease and risk factors.

The purpose of the review is to present an analysis of current literature data on the prospects of using the oncoprotective effect of metformin in colorectal cancer. Metformin is a drug with a long history, it is a first-line drug for the treatment of type 2 diabetes mellitus (DM2), as well as the most commonly prescribed drug worldwide. Modern researches show that in addition to its role in glucose control, metformin can reduce the risk and mortality from some malignancies and improve the response of patients with DM2 to certain types of cancer treatment. Accumulated data indicate that metformin could be a candidate drug for drug prevention of colorectal cancer.

Pancreatic cancer (PC) is the fourth leading cause of death among all types of cancer. PC is very aggressive with a low 5-year overall survival rate. The highest prevalence of diabetes mellitus (DM), significantly exceeding the average population, is registered among patients with prostate cancer Recommendations for systemic screening of patients with diabetes for the detection of PC are not standardized. The purpose of this review is to present an analysis of current literature data on pathogenetic relationships between DM and PC and prospects for PC screening. Research data indicate that there is a bidirectional relationship between DM and PC, in which DM can act either as a risk factor for PC or as a marker of paraneoplastic syndrome of PC. In the differential diagnosis of type 2 diabetes, pancreatogenic diabetes and diabetes associated with PC, a set of clinical signs can be used. Patients with DM who have additional signs/symptoms of increased risk can be considered as a group subject to mandatory screening. Numerous studies of various proteomic, metabolomic, genetic and transcriptomic biomarkers PC have been published. The search for an easy-to-use clinically useful and cost-effective PC marker is still ongoing.

Colorectal cancer is an urgent health problem in Russia and other countries. The aim is to present up-to-date data on CRC screening programs. A review of current recommendations has shown the effectiveness of screening programs using occult blood tests and fibrocolonoscopy in reducing morbidity and mortality from colorectal cancer. The implementation of screening programs in Russia is presented as part of the development of preventive medicine in general.

The connective tissue dysplasia attracts the attention of researchers all around the world. Cardio-hemodynamic syndromes, non-inflammatory structural cardiovascular diseases (extension of the aortic root, prolapse of heart valves, etc.) play the leading role in the clinical picture of connective tissue dysplasia. Meanwhile, the cancer circumspection is necessary as well in this cohort of patients due to an increased risk of malignancies. The leading role in the development of cancerous and precancerous changes belongs to the transforming growth factor-β, which can act as a proto-oncogene in patients with syndromic forms of connective tissue dysplasia. In undifferentiated connective tissue dysplasia, there is also a risk of malignancies of various localizations. The aim of this review is to systematize data to assess whether patients with connective tissue dysplasia are at increased risk of malignancies or not. The team of authors analyzed 57 domestic and foreign publications devoted to the study of the prevalence and clinical features of malignancies in patients with connective tissue dysplasia. Systematization of current data suggests that patients with hereditary disorders and undifferentiated connective tissue dysplasia have an increased risk of malignancies of various localizations, including due to dysregulation of TGF-β in various mechanisms of the pathogenesis of connective tissue dysplasia. In this regard, the active identification by medical specialists of the phenotypic signs of hereditary connective tissue disorders and undifferentiated connective tissue dysplasia and awareness of the risk of malignancies developing in this cohort of patients will contribute to cancer circumspection and the implementation of active measures for cancer prevention.

Mortality from cardiovascular and oncological diseases has remained at record highs for many years. Clinicians pay attention to the frequent combination of these two pathologies. Naturally, the question arises, what unites seemingly different diseases among themselves? Modern cancer therapy has allowed many people to achieve a cure or a stable remission, but at the same time led to the appearance of cardiac pathology. The relationship between the development of cardiotoxic events after antitumor therapy has been well studied, but undeservedly little time is allocated in real clinical practice to study vasculotoxicity in patients. This approach can be considered as the earliest predictor of damage to the microvasculature as a result of specific therapy. The analysis of groups of anticancer drugs that cause chronic heart failure and damage to the vascular endothelium to the greatest extent was carried out. The main approaches to risk stratification in cardio-oncological patients are considered. The principles used in the prevention and treatment of cardio- and vasculotoxicity have been studied.

With gastric and duodenal peptic ulcer disease, a chronic inflammatory process develops, in which cell adhesion molecules are actively involved. Currently, as a result of genome-wide association studies (GWAS), more than 20 polymorphic variants involved in determining their level have been identified, including rs505922 of the ABO gene. At the same time, this polymorphic variant, according to GWAS, is associated with an increased risk of developing peptic ulcer disease (PUD). It should also be noted that the association of the O(I) blood group according to the ABO system with an increased risk of developing PUD has long been known. Therefore, the genetic determinants of cell adhesion molecules are of interest for studying as candidate genes for peptic ulcer disease.

Colorectal cancer is a global health problem, which is an economic and humanistic burden for both patients and the state. A growing body of evidence suggests that dysbiosis of intestinal bacteria can contribute to the emergence and development of colorectal cancer by the formation of harmful metabolites and changes in the physiological processes of the host. The aim of the review is to summarize studies on the properties of the intestinal microbiome and mechanisms associated with colorectal carcinogenesis, including inflammation, bacterial pathogenicity factors, biofilm formation, bacterial metabolites and genotoxins, as well as oxidative stress.

The development of gastroenteritis caused by non-typhoidal Salmonella (NTS) is mediated by the action of effectors that belong to the Type three secretory systems (T3SS) of Salmonella enterica. These effectors are expressed by Salmonella pathogenicity islands 1 and 2 located in the genome. The effectors of T3SS-1 provide invasion of salmonella into host cell, take part in the development of inflammatory diarrhea some and may act as a predisposing factor in oncogenesis leading to the development of colorectal cancer (CRC). The T3SS-2 effectors provide intracellular survival of bacteria in the host cell and evading from the host adaptive immune response that may lead to the prolonged persistence.

The aim of the review is to highlight the principle of action, effectiveness and prospects for the development of targeted therapy in the treatment of patients with malignant neoplasms based on recent clinical studies. Thanks to the active study of tumor biology, specific target molecules have been discovered and it has become possible to target tumor cells with targeted drugs. Today, targeted drugs are used in the treatment of malignant tumors of various organs and continue to demonstrate their effectiveness, improve overall survival and progression-free time, compared with previous standards of treatment.

This review presents literature data on the prevalence, clinical picture, risk factors of development and modern approaches to diet therapy of the disease caused by Clostridium difficile (С. difficile). Particular attention is paid to modern methods of medical nutrition, taking into account the symptoms and factors of intoxication of the organism. Data on the possibility of using domestic products of dietary nutrition treatment for the restoration of the functions of the organism, the state of the microbiome, the detoxification of the organism and its rehydration have been analyzed.

In recent years, due to the widespread introduction of molecular genetic methods for the study of the intestinal microbiome and the proof of its role in the development of many socially significant diseases, strategies for influencing human health by correcting the microbiota and its functions have become especially in demand. For this purpose, probiotics are commonly used, which are living microorganisms that improve the health of the host. They have certain indications and, in general, good tolerability. But extremely rarely, their reception can be complicated by the development of bacteremia, especially in immunocompromissive patients. The condition for the preservation of live functionally active bacteria is not always achievable. This prompts the search for possibilities for the use of non-living bacterial cells, called paraprobiotics, or components of microbial cells and their metabolites - postbiotics. Studies show that paraprobiotics in terms of effects on the immune system and intestinal barrier are not inferior to the effect of probiotic, but are better and safe. Postbiotics also approach the action of probiotics in many respects and are more stable. However, optimal technologies for the production of paraprobiotics and postbiotics, as well as indications for them, have not yet been clearly developed. This requires further research.

The article shows the main causes of functional and organic abdominal pain and its specific types during pregnancy. The author presents the tactics of patient management, the peculiarities of the interpretation of laboratory data in case of suspected acute surgical pathology and “alarm symptoms” in case of abdominal pain in pregnant women. She emphasized the importance of imaging techniques in the differential diagnosis of acute abdomen syndrome in the gestational period. Article also substantiates safety and the need for magnetic resonance imaging in patients with persistent abdominal pain. It discusses a clinical case of paralytic intestinal obstruction in a pregnant woman. It analyzes the drug therapy for abdominal pain, taking into account the prevalence of the expected benefit to the mother over the potential risk to the fetus. The author demonstrates that the management of abdominal pain relies on a conservative approach due to the lack of evidence base on the safety of drugs for the fetus and clinical guidelines for the management of pregnant women with abdominal pathology. Author also emphasizes the need for legal registration of the appointment of magnetic resonance imaging and computed tomography, as well as off-label pharmacotherapy the instructions during gestation.

Currently, there are limited national data on the dose-dependent effect and long-term results of glucocorticosteroid (GCS) therapy in severe attacks of ulcerative colitis (UC). Approximately 20% of UC patients have chronic active disease, which requires the appointment of several courses of systemic GCS to achieve remission but with a decrease in the dose of corticosteroids or soon after their cancellation, a relapse of UC occurs. The determination of the optimal duration of therapy and dosing of GCS remains an unresolved and controversial scientific problem to achieve disease remission and prevention of steroid dependence and steroid resistance while minimizing the side effects of steroid therapy.

The article systematizes the results of research in key areas of the problem of diarrhea, associated with COVID-19, analyzes the current ideas about the clinical characteristics, pathogenic mechanisms and relationships with the development of dysbiotic changes and inflammatory bowel diseases, accepted in practice and promising treatment strategies.

Relevance. Non-alcoholic fatty liver disease (NAFLD) is a multidisciplinary problem and occupies a significant place among chronic non-communicable diseases (CNCDs). The main causes of death from this nosology are cardiovascular pathology and neoplasms. This article discusses the main problems of underestimation of diagnosis in patients with high cardiovascular risk of NAFLD. In particular, attention is paid to the risks of developing hepatocellular carcinoma without previous cirrhosis. The aim of the study was to describe a typical portrait of a patient with a very high cardiovascular risk (CVR) with NAFLD and the features of the prevention of hepatocellular carcinoma (HC) in this category of patients. Research materials. The case history of a patient with stage 3 arterial hypertension, functional class II (FC) angina pectoris, postinfarction cardiosclerosis in combination with NAFLD in the stage of liver steatosis, stage 1 obesity, and impaired carbohydrate tolerance is presented. Results. Against the background of corrected antihypertensive therapy, blood pressure and heart rate returned to normal. The level of transaminases approached the reference values, there was a tendency to reduce total cholesterol, low density lipoproteins, triglycerides. According to volumetric sphygmography, vascular age began to approach the passport age, the augmentation index became within negative values, the ankle-brachial index remained unchanged, and an increase in endothelial function was observed. Conclusion. This clinical case provides an example of successful treatment of NAFLD and dyslipidaemia in a patient with very high CV risk. With this in mind, it is necessary to timely use drugs that directly affect the stages of the formation and progression of NAFLD, which should be actively prescribed for the prevention of GC.

Non-alcoholic fatty liver disease (NAFLD) is recognized as an interdisciplinary problem at the intersection of therapy, gastroenterology and endocrinology. In recent years, there has been a significant increase in interest in NAFLD as an accomplice of cardiovascular disease (CVD) and type 2 diabetes mellitus (DM2). The article discusses the mechanisms of NAFLD in the development and progression of cardiovascular diseases depending on risk factors and comorbidity, including a clinical case. The proven clear association of NAFLD with obesity, DM 2, CVD suggests that these comorbid diseases are interdependent in their natural course. Pathogenetically substantiated management of NAFLD can positively influence the course of comorbid conditions. The role of ursodeoxycholic acid drugs in the treatment of NAFLD and the effect of this therapy on the course of associated diseases and conditions are discussed.

Ulcerative colitis is inflammatory bowel disease which characterized by inflammation of the colon and rectum: only 20-30% of UC patients have pancolitis, while proctitis and left-sided colon lesions are more common. There is a variant of localization of ulcerative colitis in patients with proctitis and left-sided colon lesion, which changes the rule of continuity of the lesion and is described as an additional periappendicular lesion. The article have been presented the own clinical observation of a patient with distal ulcerative colitis with periappendicular lesion. If a periappendicular lesion have been detected during endoscopy in a typical clinic for distal ulcerative colitis and doubts arise about the correctness of the previously established diagnosis, it is necessary to re-analyze the anamnesis, symptoms, instrumental and histological picture and, taking into account new knowledge about the course of ulcerative colitis in some patients with periappendicular lesion, confirm the initial diagnosis and continue therapy. Such a finding, according to the available literature data, does not require escalation of ulcerative colitis therapy and, as a rule, does not mean the spread of the disease to all parts of the colon.

Clinical case presents a rare manifestation of celiac disease with alopecia areata being the primary symptom. This was the reason for misdiagnosis and long-term treatment of the patient which led to a decrease in the quality of life. Gluten intolerance is still difficult to diagnose; it has many clinical “masks” and needs a multidisciplinary approach to patient management.