The Ryazan gastroenterological school was formed in the sixties and seventies of the twentieth century. It was during these years that clinical schools of surgeons (Professor A. L. Gushcha), pediatricians (Professor N. V. Dmitrieva), therapists (Professor V. Ya. Garmash), and pharmacologists (Professor A. A. Nikulin) were formed in Ryazan. In 1967, Professor A. M. Nogaller came to Ryazan from the Astrakhan Medical Institute. (1920-2021), who from 1967 to 1993 headed the Department of Propaedeutics of Internal Diseases of the Ryazan Medical Institute / Academician I. P. Pavlov.

Relevance. In patients with acute viral hepatitis A and B, favorable conditions are created for the development of dysbiotic changes. As a result, the toxic load on the liver increases. For effective treatment of acute viral hepatitis A and B, the combined administration of probiotics and hepatoprotectors is necessary. Aim. To study the clinical course, the functional state of the liver, the intestinal microflora in patients with acute viral hepatitis A and B, and the effectasy of using a combination of probiotics and hepatoprotectors to correct the intestinal microflora. Materials and methods. The work used clinical and laboratory data of 74 patients with AVHA and AVHB. The main group of patients received complex therapy with probiotics and hepatoprotectors on the background of basic therapy. The comparison group patients were on conventional therapy. Clinical, biochemical, bacteriological parameters were observed before the start of therapy and 15 days later, serological markers - upon admission. Results. In patients with AVHA and AVHB of the main group, the main clinical manifestations disappeared significantly earlier than in the control group. Patients of the main group with AVHA after treatment had significantly lower values of ALT, total bilirubin, indirect bilirubin, cholesterol than in the control group. Patients with AVHB who received complex treatment, after its completion, had values of ALT, total, direct bilirubin and cholesterol significantly lower than control group. After the treatment in the main group, a significant increase in the total number of bifidobacteria was revealed, and in the main group, patients with AVHA after treatment showed a significant increase in the total number of E. coli. Conclusion. The use of combination therapy with probiotics and hepatoprotectors against the background of basic treatment in patients with acute viral hepatitis A and B has a positive effect on clinical parameters, the functional state of the liver and intestinal microbiocenosis.

The treatment of functional dyspepsia remains a complex and incompletely resolved issue of gastroenterology. Subjective sensations of the patient, described as a feeling of fullness in the epigastrium after eating, early satiety, pain in the epigastrium, may be a manifestation of dyspepsia associated with Helicobacter pylori (H. pylori) infection. Aim was evaluation of the effectiveness of standard triple eradication therapy enhanced with bismuth tripotassium dicitrate for the relief of symptoms of dyspepsia in patients with H. pylori-associated chronic gastritis. Materials and Methods. The study involved 38 patients with H. pylori-associated chronic gastritis with symptoms of dyspepsia. The Questionnaire “7 × 7” was used to describe the dynamics of symptoms of dyspepsia. Results. At the initial examination, dyspeptic disorders in most patients corresponded the criteria for mild and moderate severity, respectively - 44.7% and 28.9% of patients. The severity of pain in the stomach area on average corresponded to a moderate pain syndrome, and the burning sensation was of low intensity. A feeling of fullness in the stomach after eating and/or early satiety was experienced by 76.3% of patients, pain disorders were observed in 92.1% of individuals. Two months after successful eradication treatment, complete relief of dyspepsia symptoms was noted in 57.9% of patients, and significant relief of symptoms of the combined form of dyspepsia in 23.7% of individuals. Conclusions: Successful standard triple eradication therapy enhanced with bismuth tripotassium dicitrate is effective for the treatment of dyspeptic symptoms in patients with H. pylori-associated chronic gastritis.

Introduction. Patients with acute viral hepatitis B (AVHB) during the peak may develop erosions and ulcers of the mucous membrane of the upper gastrointestinal tract, which are difficult to diagnose clinically. Aim. The differences in clinical and laboratory manifestations of acute viral hepatitis B, depending on the presence or absence of erosive and ulcerative defects of the mucous membrane of the upper gastrointestinal tract has studied. Materials and methods. The work used clinical and laboratory data and the results of endoscopic examination of 44 patients with AVHB. All patients underwent a comprehensive clinical and laboratory examination, supplemented by fibroesophagogastroduodenoscopy (FEGDS). Results. Among 44 patients with AVHB, complaints of a dyspeptic character occurred in 79.6% (35 patients) and did not depend on the severity of the course of AVHВ. FEGDS of patients with AVHB revealed various pathological changes in the mucous membrane from superficial gastritis and gastroduodenitis (61.4%) to erosive gastroduodenitis and acute ulcers of the mucous membrane of the duodenal bulb (38.6%). Erosive and ulcerative defects of the mucous membrane of the upper gastrointestinal tract (ММUGIT) were more often diagnosed in the first 9 days from the onset of AVHB and was acute. Еrosions and ulcers of the GIТ tract with AVHB were less often than non-erosive gastritis/gastroduodenitis accompanied by such dyspeptic complaints as epigastric pain, nausea, and vomiting, which excludes dyspeptic syndrome as an evidence-based clinical landmark in diagnosing the degree of damage to the mucous membrane of the upper gastrointestinal tract. However, patients with AVHB with erosive and ulcerative defects of the ММUGIT had a significantly higher level of ALT at admission than patients with EVHV with gastritis/gastroduodenitis (1860 U/l (1030.2889) vs. 910 U/l (325.1749), p< 0 .05). Conclusion: In order to identify erosive-ulcerative defects of the mucous membrane of the upper gastrointestinal tract in patients with AVHB the FEGDS should be performed in the first 9 days of the disease in the presence of high ALT activity, which will allow to correct the tactics of managing patients with AVHВ earlier.

Despite the study of the epidemiology of tuberculosis and its co-infection over the past decades, a number of questions remain, including those related to the impact of co-infection on survival depending on the chosen tuberculosis treatment regimen, the likelihood of adverse outcomes in the form of gastrointestinal bleeding and cirrhosis of the liver and their relationship with the therapy of the underlying disease. The purpose of the study: to evaluate the survival of patients with tuberculosis who have co-infection (viral hepatitis B and C) and receive multicomponent chemotherapy. Materials and Methods: The study included all patients who received treatment for active tuberculosis and had viral hepatitis B and/or C from 01/01/2004 to 12/31/2020. A total of 1687 patients were included. Twenty-two patients were lost to follow-up, and attempts to ascertain their clinical status were unsuccessful. Vital status was assessed in all patients. The mean duration of follow-up was 10.5±3.0 years. Median follow-up was 11.3 years (95% confidence interval (CI) 8.2-14.3). The average age of the cohort was 53.3±7.7 years. The study assessed survival and all-cause mortality annually. Results: The frequency of chronic hepatitis B in the group of patients with active tuberculosis was 3.8%, hepatitis C - 14.8%, hepatitis B and C - 0.5% of cases. Such an incidence of viral hepatitis is associated with a high frequency of illicit drug users (62.4%). It should be noted that the frequency of hepatitis treatment was low and amounted to 8.7%. When assessing the contribution of hepatitis B and C to the mortality of patients with active tuberculosis, it was found that hepatitis is not a predictor of death in patients. At the same time, patients who did not receive hepatitis therapy had a higher risk of death (unadjusted odds ratio (OR) - 1.28, 95% CI 1.04-1.65). The adjusted OR for hepatitis B was - 1.87 95% CI 0.67-1.52, C - 1.24 95% CI 0.90-2.18, B and C - 1.72 95% CI 0.99-2.02. Conclusion: The presence of chronic viral hepatitis B and/or C in patients with active tuberculosis did not affect mortality from all causes and regardless of the type of virus during a long period of observation. Patients who did not receive treatment for viral hepatitis and who had a history of tuberculosis had a higher risk of death from all causes (OR 1.28, 95% CI 1.04-1.65).

Functional disorders of the liver in chronic acalculous cholecystitis, manifested by intrahepatic cholestasis, require therapeutic correction. The aim of the study was to assess the functional state of the liver in patients with chronic acalculous cholecystitis and to develop therapeutic approaches to the identified changes. Materials and methods: 123 patients with chronic heart failure were examined on the basis of the gastroenterology department among the patients there were 90 women and 33 men with the duration of the disease from 5 to 10 years. The average age of patients was 43.74±1.26 years. To clarify the effect of cholestasis on the course of chronic acalculous cholecystitis, all examined patients were divided into two groups: patients chronic acalculous cholecystitis with cholestasis and patients chronic acalculous cholecystitis without cholestasis. The group of patients with cholestasis consisted of 84 people, whose average age was 46.46 (32.67; 60.25) years old, 22.62% were men, 77.38% were women. The group of patients without cholestasis consisted of 39 people with an average age of 43, 56 (28.44; 53.68) years, 13 (33.33%) men and 26 (66.66%) women. Results: the clinical course of chronic acalculous cholecystitis is determined by the presence or absence of intrahepatic cholestasis. Dyskinetic disorders of the gastrointestinal tract and the sphincter apparatus of the biliary tract are more common in patients with cholestasis, which in turn is formed against the background of gallbladder abnormalities in the form of various deformities, and leads to intrahepatic bile stagnation, biliary hypertension. Conclusion: the combined use of metronidazole, hemicromone and ademethionine contributes to the resolution of congestion in the intrahepatic bile ducts, normalization of tone and motor function of the gallbladder and sphincter apparatus of the hepatobiliary tract and reduction of clinical manifestations.

Purpose: to analyze the results of diagnosis and treatment of tumors of the small intestine, which served as a source of small bowel bleeding. Materials and methods: 35 patients were analyzed: men - 19 (59.4%), women - 16 (41.6%) aged 19 to 85 years, with tumors and tumor-like lesions of the jejunum and ileum. The main indication for examination of the small intestine in these patients was the search for a source of bleeding that was not identified by standard diagnostic methods (esophagogastroduodenoscopy and colonoscopy). After analyzing the clinical picture in 5 examined patients with identified tumors of the small intestine, 3 (15.5%) clinical symptoms were manifested by obvious intestinal bleeding characterized by melena or hematochezia, and in 2 (10.5%) patients the course was latent. Conclusion: After analyzing the results of the diagnosis of small intestine tumors complicated by bleeding in young and middle-aged patients, the survey data demonstrate the importance of enteroscopy techniques in patients with iron deficiency anemia and chronic recurrent bleeding

The aim of the study was to assess the prognostic significance of dynamic changes in the surrogate noninvasive liver fibrosis marker FIB-4 in relation to the development of adverse cardiovascular events in patients with high and very high cardiovascular risk (CVR). Materials and Methods. Men and women aged 40-67 years with high and very high CVR were included in the study. Fibrosis-4 index (FIB-4) was used as a noninvasive marker of liver fibrosis. The combined end point was death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, and coronary revascularization. Results. 105 patients with high and very high CVR were included in the study. The duration of the follow-up period was 34.6 (15.0; 52.3) months. Events constituting the combined end point occurred in 26 (24.7%) patients. During the follow-up period, FIB-4 index values of <1.45 (0.90 (0.68; 1.23) at study inclusion changed to ≥1.45 (1.66 (1.61; 1.90) in 13 (12.4%) patients. Over the follow-up period, the median FIB-4 change was -23.0% (-1.81; 11.5) and by the end of the follow-up period, the median FIB-4 values were 1.17 (0.97; 1.47). According to Kaplan-Meier analysis, the cumulative risk of events constituting the combined end point was found to be significantly higher in patients with an increase in FIB-4. By Cox single-factor regression analysis, an increase in FIB-4 (from values <1.45 to ≥1.45) was associated with a 4.42-fold increase in the relative risk (RR) of events constituting the combined end point (95% CI 1.33-14.7; p=0.015). Conclusion. In patients with high and very high CVR over 40 years of age, an increase in FIB-4 liver fibrosis index from values <1.45 to ≥1.45 during 2.8 years of follow-up was associated with a 4.42-fold increase in the RR of adverse cardiovascular events (95% CI 1.33-14.7; p=0.015).

Purpose of the study. Search for the relationship between cardiometabolic risk factors and 25(OH)D levels in young men with NAFLD. Materials and methods. A one-time study was carried out. The study included 102 men aged 18 to 44 years with no complaints and a verified diagnosis of NAFLD. NAFLD was confirmed in 70 people. All patients were divided into two groups: group I - persons with NAFLD (n=70); group II - persons without NAFLD (n=32); age differences are not statistically significant. All patients included in the study underwent laboratory and instrumental examination. Results. In 68.6% of men aged 18 to 44 years who had no previous complaints and a verified diagnosis of NAFLD, this diagnosis was made, of which steatosis of the liver was diagnosed in 100% of cases, NASH was diagnosed in 60.0%, in 34, 3% liver fibrosis on the background of steatosis and NASH, pathological changes in the liver in most cases were of a combined nature and increased with the progression of steatosis. Cardiometabolic risk factors such as abdominal obesity, NASH, and arterial hypertension predominate in patients with NAFLD. Patients with NAFLD showed a significant increase in laboratory markers of cardiometabolic risk against the background of insufficient supply of 25(OH)D; these disorders worsen as steatosis progresses. The identified relationships indicate a high cardiovascular risk and a worse prognosis for the life of young men with NAFLD. In patients with NAFLD, the number of laboratory markers of cardiometabolic risk is 4 or more in one patient, while their peers without NAFLD have no more than 2 components. Conclusion. Expanding our understanding of the role of vitamin D in pathological mechanisms in young people with NAFLD will make it possible to control the progression of insulin resistance through timely screening and vitamin D supplementation.

Aim: development and testing of a technically simple method for the formation of portal hypertension in the body of a domestic pig, which makes it possible to obtain a model that is close in key parameters to humans. Materials and methods. The material of the study was the results of an experiment conducted in the vivarium of the Ryazan State Medical University on 12 domestic pigs. Results. A method for modeling portal hypertension in the body of a domestic pig by dosed compression of the hepatoduodenal ligament with a plastic clamp was developed and tested. Conclusions. A model of portal hypertension was obtained, which makes it possible to obtain scientific data easily extended to humans, due to the similarity of the anatomy, physiology, and size of the used laboratory animal with those of humans.

Cells of the Caco-2 line have the basic properties of enterocytes of the small intestine, and therefore can be used to study the absorption of medicinal substances. Aim. To characterize the properties of the Caco-2 cell line from the Institute of Cytology of the Russian Academy of Sciences and to evaluate with its help the mechanism of absorption of the original domestic drug - ethylmethylhydroxypyridine succinate (EMGPS). Materials and methods. The study was performed on Caco2 cells that were cultured for 21 days, since at this time their spontaneous differentiation into polarized cells similar to enterocytes of the small intestine occurs. The density of the cell monolayer was estimated by the value of transepithelial resistance. The number of major efflux proteins of glycoprotein-P transporters (Pgp) and breast cancer resistance protein (BCRP) in Caco-2 cells was analyzed using enzyme immunoassay. In specialized transwell systems, the transport of the Pgp substrate fexofenadine (40, 150 and 300 microns), the BCRP substrate methotrexate (5, 10, 50 microns) and EMGPS (10, 100 and 250 microns) through the cell monolayer was studied. The results of the study. By day 21 of cultivation, cells of the Caco2 line formed a merging monolayer with pronounced dense contacts. The amount of Pgp and BCRP was 110.8±14.1 ng/mg and 4.39±0.12 ng/mg, respectively, which correlates with the amount of these proteins in the human small intestine. Transport of fexofenadine (40, 150 and 300 microns) and methotrexate (5 microns) from the basolateral chamber to the apical chamber (corresponding to transport from enterocytes to the intestinal lumen) prevailed over transport in the opposite direction, which is associated with the work of Pgp and BCRP. The transport of EMGPS significantly exceeded the transport of fexofenadine and methotrexate and was symmetrical with respect to the cellular monolayer. Conclusion. Thus, the cells of the Caco-2 line, commercially available in the Russian Federation, have the basic properties of enterocytes of the small intestine, and can be used to study the absorption of medicinal substances in vitro. EMGPS quickly passes through the cellular monolayer, and the mechanism of its absorption is passive diffusion, without the participation of specific transporters.

Statins (β-hydroxy-β-methyl-glutaryl-CoA reductase inhibitors) are the main class of drugs for the treatment of dyslipidemia. To improve the safety of therapy with their use, a test system is needed to assess their penetration into hepatocytes using OATP1B1/OATP1B3 transporter proteins. The aim of the study was to develop a method for assessing the penetration of statins into hepatocytes on HepG2 cells (human hepatocellular carcinoma). Materials and methods. Cells were cultured in 6- and 24-well plates. The presence of OATP1B1 in HepG2 cells was assessed using the Western blot method. Penetration of statins into cells was analyzed using atorvastatin as an example. It was added to the cell monolayer at concentrations of 1 and 10 μM and incubated for 30 minutes. The cells were then removed from the wells, lysed in various ways, and the amount of atorvastatin was determined by high performance liquid chromatography with tandem mass selective detection (HPLC-MS/MS). Results. Western blot showed the presence of OATP1B1 in HepG2 cells, the main protein that transports statins into hepatocytes. The best way to lyse the cells was a three-cycle freeze-thaw cycle at -80 °C. The analytical range of the method for the quantitative determination of atorvastatin in the lysate of HepG2 cells by HPLC-MS/MS was 0.5-200 nmol/l, which made it possible to perform transport experiments with the addition of atorvastatin at a concentration of 1 μM and incubation for up to 30 min. The use of the OATP1B1/OATP1B3 inhibitor rifampicin (100 μM) reduced the penetration of atorvastatin into HepG2 cells, which confirms the adequacy of the proposed method. Conclusions. A technique for assessing the penetration of statins into hepatocytes on HepG2 cells has been developed.

Aim of the investigation. Evaluation of significance of a number of clinical predictors of complicated course of perioperative period in patients with rectal cancer and rectosigmoid junction. Materials and Methods. Retrospective analysis of 170 patients with rectal cancer or rectosigmoid junction. Patients with adenocarcinoma of rectum or rectosigmoid junction which were operated in combination to partial or total mesorectumectomy were included to the study. In all cases an anastomosis was formed. There were 54.7% of men and 45.3% of women. The mean age of the patients was 63 years. Preoperative treatment was performed in 54 patients. Influence of various factors (gender, age, BMI, anatomical risk factors, neoadjuvant therapy, type of operation, ligation level of the inferior mesenteric artery, forced mobilization of the splenic flexure of the colon, surgical access, anastomosis type, anastomosis protection, duration of operation, preventive stoma) on the risk of perioperative complications and separately inconsistent anastomosis suture was estimated. Results. Neoadjuvant chemoradiotherapy increases the risk of intraoperative complications by 3.4 times. Risk of anastomosis inconsistency is 3,35 times increased in men, 2,6 times for forced mobilization of the splenic flexure of the large intestine and 10 times for intraoperative perforation of the large intestine. Predictors of complicated course of the postoperative period are adhesions, narrow pelvis, short mesentery of the sigmoid colon, dolichosygma (p<0,05). Conclusion. Presence of the above risk factors must lead to application of measures on prevention and elimination of consequences of perioperative complications.

The aim of the study is to study the features of diagnosis and treatment of children with doubling of the digestive tract. Materials and methods. The 50-year experience of treating 46 children with a doubling of the digestive tract was analyzed. Results. Of all the children with a doubling of the digestive tract, 39 were diagnosed with intestinal obstruction. The diagnosis is most often established during surgery and after histological examination. A clinical observation is given. Conclusion. There is no typical clinical picture of the doubling of the digestive tract in children. Most children with a doubling of the digestive tract are diagnosed with intestinal obstruction. The double and the main organ have a common wall and a common blood supply, which creates difficulties and risks of damage to the main organ during surgery.

Purpose. To study the results of surgical treatment of NEC in newborns. Material and methods. Over 7 years, 18 newborns with NEC were observed. Surgical treatment was performed by everyone. Anamnesis, clinical and laboratory data, ultrasound, X-ray examinations were used in the diagnosis. Results and discussion. Laparostomy was performed in 7 children, resection of the small intestine and ileostomy - in 11 children. 7 children (40%) survived. A clinical observation is given. Conclusions. Upon admission to the clinic, newborns with NEC need to undergo antibacterial and detoxification therapy. If there is no improvement within 1 day (stage II B according to Bell) - raise the question of surgical treatment.

The purpose of the study is to study the technical aspects of surgical treatment of borderline-resectable pancreatic head tumors Materials and methods. An analysis of the implementation of the DA was performed in 102 patients with borderline-resectable pancreatic head cancer. In 20% of patients, the tumor grows in the region of the celiac-mesenteric gap of the tumor (mesopancreas germination). In 25.6%, the tumor grows on the wall of the portal-superior mesenteric segment. In 12.7%, the tumor tightly covers the walls of the branches of the celiac trunk or superior mesenteric artery by less than 180 degrees, extending to the fascial sheath and adventitia of the vessel. Results. During the implementation of the DA with various methods of access to the IWL, no significant differences were revealed in the early postoperative period. Conclusion. The choice of access is determined by the “anatomy” of the spread of the tumor. AMS rear access is most convenient for IPDA isolation and ligation. Mesenteric access allows the most secure ligation of PDJV

Aim. To evaluate associations of polymorphic variants of some genes with such clinical aspects of colorectal cancer as gender, age of manifestation of the disease, localization of the tumor, the stage of the process at the time of manifestation. Materials and methods. Polymorphic variants of TNF and MMP1 genes were evaluated in 178 patients. The main group consisted of 110 patients with colorectal cancer, the control group consisted of 68 healthy volunteers. Genotyping was performed by DNA isolation from leukocytes of venous blood of the subjects followed by PCR with electrophoretic detection of the result. Description and comparison of differences in the frequencies of qualitative traits in independent groups was performed using Pearson’s χ2 criterion. Odds ratios (OR, 95% confidence interval) were also calculated for polymorphism variants that showed a correlation relationship. Differences at p<0.05 were considered statistically significant in the analysis. Results. Polymorphic variants of TNF gene (G308A) showed association with colorectal cancer in men and women, age of manifestation 50-59 and 60-69, 70 and older, localization of tumor in rectum and colon, I-III stages of tumor process. Polymorphic variants of MMP1 gene (1607 1G/2G) are associated with the development of colorectal cancer in women, age of manifestation 60-69 years old, colorectal cancer stage I-III. Conclusion. The results obtained suggest that not only risk factors influence the development of colorectal cancer, but also the human genetic status itself contributes to the development of tumors of these localizations.

Nicotinamide (niacin) is a PP (Pellagra-Preventive) vitamer necessary for the synthesis of nicotinamide adenine dinucleotide (NAD). The NAD molecule is a coenzyme of proteins involved in the synthesis of ATP from fats and carbohydrates. For more than 50 years, nicotinamide has been used as an antihyperlipidemic agent and to improve blood microcirculation. The results of a systematic analysis of 70417 publications on the pharmacology of nicotinamide made it possible to clarify the molecular mechanisms of the vasoprotective action of nicotinamide (including anti-inflammatory action), to summarize the results of experimental and clinical studies of anti-atherosclerotic effects (including the treatment of steatohepatosis and counteraction to obesity) and the cardioprotective properties of nicotinamide. The prospects for the combined use of statins and nicotinamide are shown, which allows to reduce the dosage of statins.

Numerous scientific studies conducted over the past years expand our understanding of the physiological and pathophysiological effects of bilirubin. In this review of the literature, the authors, using the example of Gilbert’s syndrome, as a classic condition occurring with hyperbilirubinemia, discuss the results of clinical and experimental studies demonstrating the protective mechanisms and the protective role of elevated bilirubin concentration in relation to diseases accompanied by metabolic inflammation, oncological diseases, and a number of others. The authors focus on the hormonal function of bilirubin and its potential therapeutic effect discussed in recent scientific works. The purpose of this review of the literature is to expand the understanding of bilirubin from the clinician’s usual in the context of the end product of heme and antioxidant metabolism to a signaling molecule involved in the pathophysiology of many diseases.

The aim of the study is to evaluate and describe the frequency of referrals of patients with gastrointestinal disorders during the COVID-19 pandemic. A comparative analysis of clinical cases of outpatient access to a gastroenterologist is carried out for the corresponding periods from December 2019 to December 2021.

Introduction - It was found that the frequency of symptoms from the gastrointestinal tract (gastrointestinal tract) in COVID-19 infection varies between 11.4-50. Cases of manifestation of the disease with gastroenterological symptoms are reported, appearing on average 1-5 days before the development of respiratory symptoms. The course of the disease with the presence of diarrhea and vomiting without fever and other classical manifestations is described. The purpose is to review the scientific literature on the analysis of the leading pathogenetic factors in the formation of intestinal syndrome in a new coronavirus infection. Material and methods. The scientific literature was searched in the Web of Science, Scopus, PubMed and RSCI databases for the following keywords: coronavirus infection, intestinal syndrome. Search depth - 3 years. Results. The study revealed clinical manifestations of the gastrointestinal tract (gastrointestinal tract) in COVID-19 infection, their main mechanisms and the frequency of occurrence of certain symptoms in practice

It has been proven that the virus of the new coronavirus infection SARS-CoV-2 enters the body not only through the respiratory tract, but also through the cells of the gastrointestinal tract, on the surface of which receptors (or entry gates) for the virus are also found, which leads to damage to the mucous membrane gastrointestinal tract. For the treatment of a new coronavirus infection, schemes are used to protect the mucous membrane, including gastroprotective drugs.

The novel coronavirus infection (COVID-19) is accompanied, among others, by the damage of the digestive system, in particular, the formation of biliary dysfunctions. The article presents the data of observation and treatment of patients with post-covid phenomena of biliary insufficiency.

Recently accumulating evidence suggests that if patients have existing diffuse liver disease, the risk of developing serious complications both for the liver itself and for the course of COVID-19 increases significantly. The presented article provides information on the impact of the COVID-19 pandemic on the social aspects of human life, changes in the daily routine, which has a particularly unfavorable course on non-alcoholic fatty liver disease. In turn, a relationship has been found between progressive liver fibrosis in NAFLD patients and the severe course of COVID-19. It is noted that in patients with alcoholic liver disease the incidence of which increases with self-isolation, cases of severe bilateral pneumonia and acute respiratory distress syndrome with unfavorable outcomes, including cardiopulmonary and multiple organ failure, have been described. It is shown that patients with cirrhosis of the liver, especially those with decompensated form, are the most vulnerable group of patients, since immune dysfunction makes them prone to any type of infection, including COVID-19, with potentially serious consequences. It was noted that the risk of detecting liver cancer at later stages increased in about 25% of patients with a biologically aggressive type of disease against the background of the COVID-19 pandemic.

A review of domestic and foreign literature on the disease and Caroli syndrome is presented. The review includes a historical background and a modern view on the etiology and pathogenesis of the disease, its place among fibrocystic diseases of the liver. Caroli’s disease is a rare genetic pathology, characterized by a wide clinical and morphological polymorphism from severe variants with fibrosis in the neonatal period to cases with manifestation at a late age. The genetic causes of pathology, in particular, mutations associated with autosomal recessive and autosomal dominant forms of polycystic kidney disease, have been studied. A large number of described mutations and the predominance of complex heterozygotes among patients explains the diversity of clinical forms of pathology. The relationship between the genotype and phenotypic variants of pathology has not been determined. In Caroli’s disease, in addition to cystic changes in the liver and kidneys, damage to other organs and systems, in particular cerebral vessels, can be observed. Extrahepatic and extrarenal symptoms of the disease are described, as well as combinations with various genetic diseases. A clinical case of Caroli syndrome in a child observed by the authors from birth is presented. The disease manifested as congenital cystic transformation of the kidney. Hepatic pathology was detected at the age of 5 years. Subsequently, there was a rapid progression of liver damage with the development of severe complications: cirrhosis of the liver, portal hypertension, edematous syndrome, hepatic encephalopathy. At the age of 11 years, the patient successfully underwent orthotopic liver transplantation. The presented case demonstrates the late detection of hepatic damage, its rapid progression. Despite the presence of severe complications, liver transplantation was a success and the patient is currently in a stable condition compensated for all functions.

Thyrotoxic hepatitis develops in 55-60% of patients with hyperthyroidism, it is often asymptomatic and diagnosed incidentally. The article describes a clinical case of thyrotoxic hepatitis in a 50-year-old female. The case seems to be rare as the overt signs of hyperthyroidism manifested in the patient 5 months later than the changes in liver function tests in blood. The current data on the epidemiology, pathogenesis and clinical picture of liver damage in thyrotoxicosis are represented in discussion.

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.

The article presents a translation of the chapters of the work “Onomatologia anatomica” (1880) by the Austrian anatomist Josef Hyrtl, devoted to terminology in small intestine anatomy; namely “Duodenum”, “Ileum”, “Jejunum” and “Intestinum”.