These recommendations are intended for primary care professionals: internists, general practitioners, paramedics and include a statement of the basic requirements for the follow-up of patients with a number of diseases of the digestive system. The main material of the methodological recommendations is presented by adapted sections from modern clinical recommendations of specialized societies on certain nosological forms of diseases and current regulatory federal documents on dispensary supervision of the adult population. The guidelines were approved by the Perm Regional United Organization “Professional Medical Community of the Perm Region” and the Ministry of Health of the Perm Region. Also, the main provisions of the recommendations were presented and approved at the National Congress of the Society of Therapists (November 19, 2021).

The lack of efficiency in the diagnosis and treatment of chronic pancreatitis (CP) is associated with a number of objective and subjective reasons, one of which is insufficient knowledge about the pathogenesis of the disease, especially when it is combined with other internal diseases, in particular, with chronic obstructive pulmonary disease (COPD). The frequent combination of COPD and CP is associated not only with the frequency of these diseases, but also with the common links of pathogenesis, and a significant place in the pathogenesis of both diseases is occupied by the syndrome of excessive bacterial growth in the small intestine (SIBO). Aim: to increase the effectiveness of the treatment of CP in combination with COPD based on the inclusion of rifaximin and probiotic Subalin in the complex therapy of concomitant diseases. Materials and methods. We examined 128 patients with CP in the stage of exacerbation in combination with COPD in the stage of mild exacerbation, which were divided into two groups: the main group and the comparison group. The basic treatment of CP was carried out according to the clinical recommendations of the Russian Gastroenterological Association. Patients of the main group, in addition to basic therapy, received rifaximin (Alfa Normix) for 10 days, and then Subalin-forte for 2 weeks. Patients in the comparison group received only basic therapy. Results. Due to the treatment with the inclusion of rifaximin and Subalin, there is a significant suppression of the phenomenon of “evasion” of the pancreatic-specific enzyme into the blood, an improvement in the exocrine function of the pancreas according to the results of the fecal elastase test and the response of the pancreas to food intake according to the dynamics of uroamylase flow rates and endogenous pancreozymin induction coefficients. Under the influence of the main treatment option, there is an increase in the frequency of normalization of the echogenicity of the pancreas and less often than with traditional therapy, an increase in the pancreas or part of it, blurring and unevenness of the contours persist. In addition, the indicators of ultrasonic histography of the pancreas are significantly improved, and a more pronounced positive dynamics of the clinical manifestations of COPD is observed. Thus, the eradication of SIBO provides a significant increase in the effectiveness of the treatment of patients with a combination of CP and COPD.

Purpose. Identify the role of ONP rs16944 (-511C/T) of the IL1B gene and rs1143634 (+ 3954 C/T) of the IL1B gene in the development of acute pancreatitis. Material and methods. The study involved 296 people diagnosed with acute pancreatitis. There were 124 (41.89%) males and 172 (58.11%) females. By age, patients ranged from 24 to 83 years old, the average age was 44,3±12,6 years. Patients with mild severity OP - 103 (34.79%) people, moderate severity OP - 110 (37.16%) people, severe severity OP - 83 (28.05%) people. The control group amounted to 78 people. Genomic DNA was isolated by sorption method, the carrier of rs16944 (-511C/T) and rs1143634 (+ 3954C/T) of the IL1B gene was determined by real-time polymerase chain reaction using TaqMan allele discrimination technology and commercially available fluorescence probes. Results. Our study revealed a statistically significant increase in the frequency of carriage of the rs16944 (-511C/T) IL1B gene located in the promoter region of the functional polymorphism, which correlates with the severity of acute pancreatitis. It is known that this polymorphism enhances gene expression and leads to an increase in the level of proinflammatory cytokine. On the other hand, there is no correlation between the presence of the structural polymorphism rs1143634 (+ 3954 C/T), localized in exon 5 of the gene IL1B and the development of the disease, as well as the severity. Conclusions. Thus, it can be assumed that in residents of Krasnoyarsk, the carriage of the rs16944 (-511C/T) ONP gene IL1B is a predictor of the development of acute pancreatitis and severe disease, which coincides with the data obtained when compared with the European population of the NCBI base.

The aim of the study was to evaluate the role of the polymorphisms rs11546155 and rs6119534 of the GGT7 gene in predicting the risk of complications and outcome of AAP. The material of the study was DNA samples obtained from 471 patients with acute alcoholic-alimentary pancreatitis and 573 healthy individuals. The disease was diagnosed using clinical guidelines developed by the working group of the Russian Society of Surgeons. Statistical analysis was carried out using the Statistica 10.0 and the SNPStats programs. Results. The study found that for rs6119534 GGT7, the C/T genotype was associated with an increased risk of developing acute alimentary-alcohol pancreatitis (OR=1.94; 95% CI=1.41-2.68; P<0.0001); the T/T rs6119534 GGT7 genotype was over five times more common among patients with severe disease and was associated with an increased risk of infected pancreatic necrosis (OR=7.99; 95%CI 1.35-47.18; P=0.017). For rs11546155 GGT7, allele A was a predictor of an increased risk of developing pancreatic necrosis (OR=1.92; 95%CI 1.22-3.03; P=0.004); carriers of the A/A genotype had the highest level of leukocytes in the blood and a predisposition to the development of arrosive bleeding (OR=20.16; 95% CI 1.82-223.37; P=0.05); genotypes G/A-A/A were associated with an increased risk of infected pancreatic necrosis (OR=1.82; 95%CI 1.06-3.12; P=0.03). Conclusion. SNPs can be used as diagnostic and prognostic markers of AAP.

The aim of the study is to study changes in immune status indicators and cytoarchitectonics of neutrophil granulocytes in patients with a severe course of acute necrotic pancreatitis. Materials and methods. The subject of the study was 32 patients aged 37 to 59 years, diagnosed with acute necrotizing pancreatitis, severe course, early phase. The control group was 30 donors, comparable by sex and age to the main group. Upon admission, atomic force microscopy of neurophilic granulocytes was performed to determine its shape, state of the membrane, geometric dimensions, and the immune status and chemical composition of the neutrophil were also evaluated. Results. During the development of severe acute pancreatitis in the early phase, immune inhibition along the cell link is recorded, a decrease in the concentration of immunoglobulins A and M. During atomic force microscopy, violations of the structural organization of the neutrophil granulocyte were found. Changes in the chemical state of the neutrophil were recorded, a significant decrease in the content of oxygen, sodium and calcium was revealed, which confirms the role of cellular hypoxia and apoptosis in the development of systemic inflammation. With an increase in the degree of severity of mechanical jaundice, the neutrophil acquired a convex shape, the number of nucleus segments increased, the cell membrane became not even, the neutrophil volume reached 61.58 ± 4.65 μm3. The value of neutrophil adhesion forces fell by 31% in severe pancreatitis. Conclusion. The severity of acute pancreatitis is due to the inhibition of the immune system and the functional capabilities of neutrophil granulocytes, leading to the generalization of the inflammatory reaction and the development of multi-organ insufficiency.

The purpose of the study is to study the effectiveness and safety of using therapeutic physical factors in rehabilitation treatment of patients with chronic pancreatitis in hospitals. Material and methods. There has been carried out an open randomized controlled trial which included 95 patients with chronic biliary pancreatitis of stage II-III, moderate severity, in the stage of exacerbation, not requiring surgical treatment. Two groups were formed by simple randomization. The patients of the control group (n = 46) had stationary treatment in accordance with Russian clinical guidelines; in the main group (n = 49) the patients were prescribed low-mineralized mineral water in the form of ingestion and electrophoretics according to the mitigated methods in addition to the treatment complex. Results. The inclusion of low-mineralized sulphate-hydrocarbonate calcium-sodium mineral waters in the treatment complex of patients with chronic pancreatitis in hospitals, their ability to enhance pharmacological potential of the used drugs at the stationary stage provided a significant reduction of clinical and ultrasound indicators with 76.56% of the patients at reduction of pain syndrome in 3.56 (p < 0.01) times, diarrhea - 1.94 (p < 0.01), decrease in enzymatic activity - 3.16 (p < 0.01), acute-phase blood values - in 3.14 (p < 0.01), improvement of metabolic status - in 2.29 (p < 0.01) times. This helped to reduce the length of stay in a 24-hour hospital by 2.7 days, reliably significant in comparison with the data in the control group based on the treatment in accordance with Russian clinical recommendations. In addition, a comparable number of adverse drug reactions were detected in both groups (8.13% verses 10.63%), which indicates equal safety of the used medical technologies. Conclusion. Inclusion of therapeutic physical factors in the complex of treatment of patients with chronic pancreatitis in hospitals provides reliably significant increase of therapeutic measures effectiveness.

Variants of the UGT1A1 gene are associated with impaired bilirubin metabolism, which is clinically expressed in Gilbert's syndrome (GS), Crigler-Najjar syndrome types I and II, as well as increased toxicity intaking certain drugs (indinavir, irinotecan, atazanavir, sorafenib, tocilizumab, belinostat, and paracetamol). A common manifestation of these conditions is unconjugated hyperbilirubinemia. The most common variant in the UGT1A1 gene associated with GS (the most common pathology caused by UGT1A1 gene variants) is the UGT1A1*28 variant, which is an increased number of TA repeats in the promoter of the UGT1A1 gene up to 7. However, the UGT1A1*28 variant is not the only gene variant capable of causing unconjugated hyperbilirubinemia. It is known that the variants UGT1A*7, UGT1A*6, and UGT1A*27 were found in the Asian population, which also causes GS with a high frequency. For Caucasians, the UGT1A1*28 variant remains the only common variant that causes GS. At the same time, even the carriage of the UGT1A1*28 variant in the homozygous state does not always lead to the appearance of clinical symptoms. While in the heterozygous form of the UGT1A1*28 variant, high unconjugated hyperbilirubinemia can be observed. Thus, other molecular genetic markers probably explain the incomplete penetrance and variable expressivity of the clinical manifestations of the UGT1A1 gene variants

The aim of the study was to analyze the patterns associated with the risk of developing gallstone disease. Material and methods. The selection of signs of metabolic syndrome among patients of the hospital contingent with cholelithiasis, depending on gender and age, was carried out. There are 271 patients in the general population, of which 227 are women and 49 are men. Statistical processing of research results using the Statistica 8.0 applied software package. Results. Differences in etiology and pathogenesis lead to divergence of the phenotype of patients with cholelithiasis. At the same time, the conservatism of significant risk factors for the development of the disease remains. These include ethnic and sexual dimorphism: Caucasians are twice as likely to suffer from gallstone disease than the Khakass (7.3 and 3.4%, respectively). The incidence of gallstones in women is 8.6% (Caucasians - 10.9%; Khakaski - 6.2%). The indicators for women are 4.6 times higher than for men - 1.9% (Caucasians - 2.5%; Khakass - 1.3%). Older age: after 60 years, the number of patients increases exponentially, gender differences decrease. In the rating of comorbidities, the following are most often recorded: abdominal obesity (92.3% of patients), excess body weight (87.8%); violation of carbohydrate metabolism (86.4%), hypertension (81.7%), atherogenic dyslipidemia (50.6%) and NAFLD (23.6%). Conclusion. Together with conservative factors of susceptibility to gallstones that cannot be modified (age increase, female sex, heredity), a pathological phenotype known as metabolic syndrome is often formed. An increase in the frequency of gallstones is associated with variable combinations of metabolic syndrome components. Early detection of these signs can be used to predict and prevent the disease, since they are all modified to one degree or another. In addition, along with the conventional criteria for metabolic syndrome, the expression of gallstone disease has been established, which makes it possible to consider it a full-fledged sign.

Aim: To evaluate the incidence of diseases associated with primary biliary cholangitis (PBC) and the differences in clinical and laboratory parameters in the combination of primary biliary cholangitis with an associated disease. Materials and methods. From 2021 to 2022, 40 patients diagnosed with primary biliary cholangitis/liver cirrhosis as a result of primary biliary cholangitis (PBC / liver cirrhosis as a result of PBC) were examined by the authors of the article. 23 patients had no associated disease, and 17 patients had primary biliary cholangitis/ liver cirrhosis as a result of primary biliary cholangitis (PBC / liver cirrhosis as a result of PBC) in combination with an associated disease. Ten patients from the second group (25%), when included in the study, had a proven diagnosis of autoimmune thyroiditis (AIT); there were three cases (7, 5%) of autoimmune hepatitis (AIH); there were also individual cases of other autoimmune diseases such as rheumatoid arthritis (RA), Crohn’s disease (CD), psoriatic arthritis, as well as the combination of primary biliary cholangitis with autoimmune thyroiditis and autoimmune hepatitis (PBC+AIT+AIH). The experimental group consisted of 23 patients with primary biliary cholangitis (PBC) without the associated disease. Statistical data were analyzed by the IBM SPSS Statistics 22.0 application package. Results. The median hemoglobin level in both groups was 116 g/l, and besides that hypoalbuminemia and accelerated ESR were noted in both groups (Table 1). The medians of liver enzymes and cholestasis markers exceeded normal values in both groups. However, these figures were twice as high in the experimental group which allows us to conclude that the course of disease associated with PBC is accompanied by more pronounced cholestasis and cytolysis than in the presence of isolated primary biliary cholangitis/liver cirrhosis as a result of primary biliary cholangitis (PBC/LC as a result of PBC). Findings. The results of the clinical picture at the onset of the disease in both groups are presented in figure 9. Since the calculated value of the Mann-Whitney test is less than the critical one, an alternative hypothesis is accepted: the differences in laboratory test scores are statistically significant (Table 3). Thus, we concluded that diseases associated with primary biliary cholangitis (PBC) occur with more pronounced clinical and laboratory manifestations of cytolysis and cholestasis syndromes. Patients with isolated primary biliary cholangitis had a higher risk of mortality in the next three months compared with the experimental group. Since 65% of the patients were not additionally examined at the onset of the disease, it is impossible to determine whether primary biliary cholangitis/liver cirrhosis as a result of primary biliary cholangitis (PBC /liver cirrhosis as a result of PBC) is a background for the development of associated diseases or these diseases develop initially.

Modern genetic studies of the prevalence of Wilson-Konovalov disease show that the disease is much more common than previously thought. Of particular importance for early diagnosis is the knowledge of the first manifestations of the disease. The article discusses the features of the debut and clinical course, diagnostic approaches to various forms of Wilson-Konovalov disease. A survey, retrospective analysis and subsequent two-year follow-up of 24 patients with Wilson-Konovalov disease were carried out. During the observation, two variants of the debut of the hepatic form were identified: abdominal with severe pain in the abdomen, liver enlargement, pronounced cytolysis syndrome and high activity of alkaline phosphatase, and the second, manifested by a picture of chronic hepatitis with a moderate increase in the activity of aminotransferases, alkaline phosphatase and bilirubin levels. A feature of the course of the latent hepatic form was portal hypertension with an enlargement of the spleen to a huge size. With a mixed form of neurological and hepatic Wilson-Konovalov disease, four patients were diagnosed with “unexplained” encephalopathy caused by brain damage caused by Wilson-Konovalov’s disease.

Chronic non-viral liver diseases are one of the most pressing problems of modern internal medicine. Over the past two decades, there has been a steady increase in diseases of this group due to the widespread prevalence of major risk factors, such as obesity, diabetes mellitus, physical inactivity, alcohol abuse, irrational use of medications, etc. Since most of the patients represent the most able-bodied and active part of the population, this circumstance inevitably leads to significant financial, economic and humanitarian losses, which gives the problem acute social significance. The purpose of the study. To develop mathematical prognostic models of the development of the most common chronic non-viral liver pathology using the most important predictors of these diseases. Material and methods. The contingent included in the study consisted of 412 young and middle-aged men, 138 of them with non-alcoholic fatty liver disease, 50 with alcoholic liver disease, 157 with alcoholic-metabolic fatty liver disease and 67 people without pathology. The subjects were measured anthropometric indicators (height, body weight, calculation of body mass index, waist circumference), determination of the type of alcohol consumption according to the AUDIT questionnaire, the level of physical activity according to the IPAQ questionnaire. In the biochemical study of blood serum, the parameters of alanine and aspartate aminotransferase, total and direct bilirubin, alkaline phosphatase, gamma-glutamyltranspeptidase, glucose, insulin, and lipid spectrum were determined. The study of the qualitative and quantitative composition of the intestinal microbiome was carried out by sowing feces on nutrient media, followed by the determination of the species of microorganisms and the assessment of their quantitative content using microscopy. Ultrasound examination of the hepatobiliary zone included measuring the main sizes of the right and left lobes of the liver, as well as identifying the main signs of diffuse liver damage. To assess steatosis and liver fibrosis, a FibroScan 530 device was used with the functions of evaluating the parameter of controlled attenuation of ultrasound and transient elastography by controlled vibration. Statistical processing and analysis of the results obtained were performed using the StatTech 2.8.8 program. Results. Mathematical prognostic models have been developed to determine the probability of developing non-alcoholic fatty liver disease, alcoholic fatty liver disease and alcoholic-metabolic fatty liver disease. All the regression models obtained were statistically significant with sensitivity and specificity of more than 90%. AUROC diagnostic accuracy values exceeded 0.9 units, which characterizes the quality of diagnostic models as excellent. Conclusions. The use of mathematical prognostic models using publicly available data from objective and laboratory research methods allows optimizing the diagnosis of chronic non-viral liver diseases.

The state of human microbiome is closely related to higher nervous activity. Studies of the relationship between the state of the microbiome and the formation of neuropsychiatric disorders represent a very promising field of research. This work presents the results of a comparative analysis of the profiles of microbiome indicators in 36 ± 12-year-old patients with mental and behavioral disorders (n = 30) and in healthy volunteers (n = 10). The profiles of microbiome indicators were measured on the basis of blood analysis by mass chromatospectrometry. Numerous significant differences were found in microbiome patterns between patients and controls. On the basis of the established differences, two point scales were proposed and verified, which can be regarded as a kind of indices of “psychopathogenicity of the microbiome”. These scales make it possible not only to distinguish patients from controls, but also to rank the subjects according to the degree of “psychopathogenicity” of the microbiome profile.

The aim of the study. Assessment of markers of early complications in patients with acute pancreatitis. Materials and methods. Observation was carried out for 151 patients who were in the clinic from 2011 to 2019, with a diagnosis of acute pancreatitis (OP). The average age of patients (47.8±1.5) years. The patients were divided into 2 groups: group I - 78 patients with developing pancreatic pseudocyst (PP) and group II - 73 patients with free fluid accumulations (FFA) of the abdominal cavity. All patients underwent comprehensive examinations, including histology of emerging cysts, clinical and biochemical blood tests, sonography and computed tomography, bacteriological and enzyme immunoassays with assessment of the level of endogenous intoxication, procalcitonin, microbial contamination and cytokines. Results. In comparison with group I patients with developing PP, the observed group II patients with FFA showed a significant increase in the degree of endogenous intoxication. A 3.0-fold increase in the level of procalcitonin in 26.8% of group I patients and in 67.1% of group II patients (p<0.05) with a directly proportional dependence of this indicator on the level of bacterial contamination (r=+0.51; p<0.05) indicated the activation of infection processes in general and, to a greater extent, in group II patients. At the same time, the condition of their last worsened due to the transition of the inflammatory process to the parapancreatic region and into the retroperitoneal space. The high level of proinflammatory cytokines IL-6, TNF-α in patients of group II compared with group I, an imbalance and a decrease in the activity of the anti-inflammatory mediator IL-10 determined a significantly greater (p<0.05) activity of the inflammatory process in patients with SFS, and were associated with an unfavorable prognosis. Conclusion. The formation of a PP is a relatively favorable outcome of acute pancreatitis, accompanied by significantly less pronounced toxemia and infection rate in comparison with patients with free fluid accumulations of the abdominal cavity.

The immune inflammatory reaction is involved in the formation of structural damage in organs with low immune resistance, but the causal stages of the formation of this reaction are poorly understood. Clinicians are faced with the fact that in patients with acute and chronic pancreatitis of alcoholic etiology, a reactive inflammatory reaction is observed in the mucous membrane (MM) of the stomach and / or duodenum. This effect was the reason that experimental studies were carried out on 45 white Wistar rats weighing 180-220 g. and duodenum (DOD). For this, a classical immunization scheme was used. Rats were taken out of the experiment on days 5, 10, and 17; after autopsy, morphological studies of the pancreas, gastric mucosa, and SOD were performed. Undoubtedly, the emerging immune response of the macroorganism to damage contributes to the development of an autoimmune reaction, in response to destruction and an inflammatory reaction, as a result, structural and functional damage to its own tissues occurs. The involvement of several organs in the inflammatory reaction depends on the local immune tolerance of the organ to endoantigens. A decrease in tolerance leads to a combined pathology, the impetus for which is damage to the “primary” organ, which is not always possible to identify. At the same time, antibodies to endoantigens are formed from damaged cellular structures.

Aim of the research: The aim of the study to conduct the histomorphological study of structural and cellular changes in the tissues of the pancreas, adrenal gland, spleen, liver, kidney in experimental alcoholic and drug-induced pancreatitis. Materials and methods. A model of experimental alcoholic and drug-induced pancreatitis was created on white mongrel rats aged 2-3 months, weighing 25-30 g. The animals were divided into 3 groups (control group No. 1, comparison groups No. 2 and No. 3). A control group (n=10) that did not receive any substances. The second comparison group (n=10) was injected daily with 1 ml of 40% ethanol solution for 10 days. The third comparison group (n=10) was administered intragastric tyrosol daily at the rate of 5 mg per 100 g of body weight for 10 days. Withdrawal from the experiment was performed on the 10^th day from the beginning of the experiment. Laboratory animals were slaughtered by decapitation. Pancreas, spleen and liver, kidneys with adrenal glands were taken for pathomorphological examination. Research results and discussion. During histological examination of the pancreas on the 10th day of the experiment, no changes were noted in the control group, in comparison groups No. 2, No. 3, pathomorphological changes were noted, indicating an inflammatory and dystrophic process in the pancreas. During histological examination of tissues, complications in the liver, spleen, kidneys and adrenal glands were also observed on day 10. Conclusions. The above facts indicate that comparison group No. 2 developed chronic experimental alcoholic pancreatitis induced by ethanol solution; comparison group No. 3 induced experimental drug-induced pancreatitis. One of the main ways of endogenous insufficiency is the enteral pathway, the least dependent on pharmacological correction.

Syndrome of increased epithelial permeability (SPEP) is considered as one of the universal mechanisms that determine the subsequent development of chronic systemic inflammation of varying severity. Studies carried out in the last 10 years have shown the important role of SPEP in the pathogenesis of many diseases of internal organs, and, first of all, of the gastrointestinal diseases. The article discusses possible ways of correcting impaired epithelial permeability from the point of view of the cytoprotective effects of drugs most often prescribed to patients with gastrontestinal diseases.

The purpose of the pilot study was to study the possibility of using Cytoflavin in the treatment regimen for patients with functional dyspepsia. Materials and methods: data of 65 patients aged 25-56 years with a diagnosis of “K-30. Functional dyspepsia” were analyzed, which, depending on the treatment regimen, were divided into 2 groups: cytoflavin (orally 2 tablets 2 times a day, course 25 days) and control (n=35) - standard therapy. The study design included 2 outpatient visits. The survey part was carried out with the help of a survey and assessment of complaints of pain, burning sensation, overflow in the epigastrium, a feeling of fullness. Quality of life was assessed using the SF-36 Questionnaire, the Asthenic Condition Scale (ASS), and the Hospital Anxiety and Depression Scale (HADS). The instrumental part of the study included cardiointervalography to assess heart rate variability. Statistical processing was performed in the IBM SPSS v23.0 environment. Results: statistical analysis of the data revealed: a significant improvement in the quality of life in terms of physical functioning, pain intensity, role functioning, physical component; a decrease in the level of anxiety, reaching significant values; indirect signs of a decrease in the number of complaints of pain, burning and fullness. Conclusions: the results obtained can serve as a basis for further in-depth research in this direction.

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most informative and often in-demand methods for the detection and treatment of pathology of the biliary tract, its diagnostic value is 79-98%. A significant disadvantage of the method are side effects and various complications (acute pancreatitis, bleeding, retroduodenal perforation, cholangitis, acute cholecystitis, etc.). Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common and severe complication of intraluminal endoscopic operations on the large duodenal papilla, its etiology is multifactorial, and the pathophysiology has not yet been fully studied. According to many randomized, controlled studies, the incidence of PEP ranges from 2.7 to 37%. Despite all the possibilities of modern medicine and the introduction of new methods, mortality with the development of PEP remains at a very high level: it reaches 7-15%, and with the development of destructive forms - 40-70%. The problems of prevention of PEP are still the subject of discussions and numerous studies by leading clinics around the world. In this paper, we conducted a review of the literature over the past decade using the sources of major medical libraries Medline, eLibrary, PubMed. The article discusses current modern pathogenetic mechanisms and the main risk factors for the development of PEP, related to both the characteristics of the patient and the procedure being performed, technical options for performing ERCP. The article also presents currently used and recommended by most authors methods of drug prevention of PEP and various technical solutions related to this complication. Thus, the not entirely satisfactory results of the proposed methods of prevention of PEP force the authors to search for safer and more effective solutions to this urgent problem at the present time.

Preconceptional genetic screening (genetic testing of individuals at the stages of family planning and birth of a healthy child) has an important place in the prevention of hereditary diseases. This review focuses on the preconceptional prevention of cystic fibrosis (CF), one of the most common hereditary diseases of the Caucasian race. The first part highlights the general principles of screening for hereditary diseases, including CF, the advantages and disadvantages of pan-ethnic screening for CF, and the economic rationale for the programme, using international studies and guidelines, as illustrated by international sources.

This text is a continuation of a review of international studies and guidelines/recommendations for primary prevention of cystic fibrosis (CF). This section reviews the selection of pathogenic variants for different CF mutation carrier screening programmes to form panels, taking into account the geographical and ethnic characteristics of the couples being screened, describes the monitoring of couples at intermediate risk of carrier, presents the relationship between carrier screening and neonatal screening, highlights the importance of timely information, including medical and genetic counselling for stakeholders, taking into account the psychosocial status. Separately, we present studies that have found a reduction in the rate of CF births in France, Italy and Israel after the introduction of CF carrier screening.

The article presents modern data on the formation and manifestations of multiple metabolic disorders with an emphasis on the features of pathology in old age. Age-related changes in nutrition, physical activity, carbohydrate and lipid metabolism are additional risk factors for the development of metabolic syndrome and determine the high prevalence of this pathology in old age. Multiple metabolic disorders aggravate the course of each of them and worsen the prognosis due to high risks of cardiovascular and other types of mortality. Timely diagnosis and effective correction of metabolic syndrome manifestations will reduce these risks and increase life expectancy while improving its quality. In order to increase the effectiveness of basic therapy of metabolic disorders, the use of drugs capable of positively affecting multiple metabolic disorders has been shown. In particular, this paper provides an evidence base for the effectiveness of taurine in patients with metabolic syndrome. When using taurine in addition to basic standard therapy, there is a significant decrease in blood pressure, glucose levels, insulin, serum lipid spectrum, body mass index.

Introduction. In the spa treatment of patients, especially with the pathology of the digestive system, mineral waters (MW) are widely used, the biological effect of which on the body consists of the interaction of all components. Among them, a special place is occupied by trace elements involved in enzymatic catalysis, which, during internal consumption of CF, have an effect on the neuroendocrine and immune mechanisms of the body, as well as on metabolic processes in the digestive system. However, these issues, today, remain the least studied, which was the topic of this article. The quantity and quality of food consumed are important factors that determine a person’s health and quality of life. Among the nutrients necessary for a person, vitamins and minerals play an important role. They are actively involved in the assimilation of proteins, fats and carbohydrates, the regulation of physical functions, the implementation of the growth and development of the body. Trace elements change the conformation of the substrate molecule, participate in the stabilization of the active center of enzymes, and in the transfer of electrons. Food is the only source of minerals in the body. However, most people, according to domestic and foreign literature, have their deficiency in the body. Purpose of the study. To prepare a literature review using Russian and foreign sources and to present data from modern studies on the mechanism of action of drinking MV in the gastrointestinal tract. Conclusion. In the light of the above, it is natural to use various natural mineral waters as carriers of microelements, as well as for therapeutic and prophylactic purposes in patients with various pathologies, especially in diseases of the digestive system. Currently, various modes of CF intake are used, designed for certain metabolic processes in the gastrointestinal tract, and the emphasis is mainly on the state of the acid-forming function of the stomach. At the same time, little attention is paid to the influence of the micronutrient composition of CF on various aspects of the digestive process. Since until now many questions of the use of CF, their metabolism in the gastrointestinal tract (influence on digestion, absorption, interaction with vitamins, etc.), remain open and are interpreted differently, this was the reason to once again turn to this problem.

A clinical case of a patient who underwent a thymusectomy for thymoma at the age of 50 is presented. Subsequently, the patient developed immune dysfunction with recurrent esophageal candidiasis and oropharyngeal candidiasis caused by Candida albicans. The patient also suffers from persistent widespread mycosis of the skin and nail plates caused by Trichophyton rubrum, autoimmune gastritis and benign neoplasms of the oral cavity and intestines. Repeated courses of treatment with fluconazole led to the emergence of Candida albicans resistance to azole antimycotics. Treatment with irrigation of Amphotericin solution B in the oropharynx and in the esophagus was effective.

The aim of the study is to observe a patient with vascular malformation of the ileum complicated by recurrent bleeding. Materials and methods: the article presents a clinical case of small intestine bleeding from ileum angiectasia in a 64-year-old patient. At the patient's place of residence, a video capsule endoscopy of the gastrointestinal tract was performed, angiectasia of the ileum was detected, from which fresh blood was received. Upon admission, the patient has iron deficiency anemia, and hematocheesia. In our institution, the patient underwent diagnostic egophagogastroduodenoscopy, video colonoscopy, balloon-assisted enteroscopy (BAE). According to BAE, vascular malformation with a diameter of up to 10 mm is viuzalized in the ileum Results: The patient underwent endoscopic treatment: one endoclypse was applied to the identified vascular malformation. Conclusion: The capabilities of clinicians in the differential diagnosis of pathological conditions of the small intestine are enhanced by the availability of modern equipment in medical and preventive institutions, as well as to perform minimally invasive treatment, reducing the rehabilitation time due to the reduction of surgical trauma.

Objective. On the example of a clinical case, the difficulties of timely diagnosis of acute pancreatitis are considered. Main points. Acute pancreatitis is an actual problem of modern medicine due to its wide prevalence and high mortality rates. A clinical observation of a 48-year-old patient with dyspeptic complaints and intestinal manifestations is presented. Conclusion. The presented clinical case illustrates not only the difficulty of timely diagnosis of acute pancreatitis, but also confirms that patients with existing pain, dyspeptic and asthenovegetative syndromes after a viral intestinal infection require special attention and are at risk of developing acute pancreatitis.

Article is dedicated to the 400th anniversary of the discovery of lacteals by the Italian surgeon and anatomist Gaspare Aselli (1581-1626). The author's translation of a fragment of Aselli's original text "De lactibus sive lacteis venis quarto vasorum mesaraicorum genere novo invento" with a description of the circumstances of the discovery is provided. A brief biographical note of the scientist is given.