Bismuth belongs to the group of heavy metals, but it has the lowest toxicity among them, including due to its weak solubility in aqueous and biological media. At the same time, bismuth compounds are promising for use in medicine due to their high biological activity. These substances are used in the treatment of various diseases, including cancer, because they have antiproliferative activity (induce apoptosis, inhibit proteasomes, modulate signaling pathways). For the treatment of Helicobacter pylori infection, drugs are used, mainly based on bismuth tricalcium dicitrate, which demonstrates high efficacy and a low incidence of resistance to the pathogen. Problematic aspects used in H. eradication pylori schemes are their empirical choice in the absence of a routine personalized approach to it, a low level of eradication control by the methods recommended for this purpose, the sensitivity of the pharmacodynamic effects of the scheme components to the pharmaceutical properties of each other, and the mentioned resistance of the pathogen to antibacterial drugs. Preparations based on bismuth tricalcium dicitrate, which have their own bactericidal activity independent of environmental conditions, several mechanisms of action that do not induce known pathways of resistance development, when used as part of various eradication regimens, increase their effectiveness without reducing tolerability. The main results of numerous clinical studies confirm these statements. An additional advantage of bismuth compounds included in medicinal preparations is their gastroprotective effect, which makes it possible to expand the range of indications due to gastric pathology, accompanied by the formation of erosive and ulcerative defects of its mucous membrane (erosive gastritis, peptic ulcer, etc.), as well as an antidiarrhoeal effect, which is of clinical importance in irritable bowel syndrome and functional diarrhea. The safety of using bismuth tricalcium dicitrate in low doses and during short courses has been confirmed by large meta-analyses; serious side effects are extremely rare and are not associated with neurotoxicity. The presented set of data indicates the prospects for further study and clinical use of bismuth in antitumor, antibacterial and gastroenterological practice.

Helicobacter pylori (H. pylori) infection and autoimmune inflammation of the gastric mucosa are recognized as the leading etiologic factors of chronic atrophic gastritis. At the same time, the mechanisms of the development and progression of gastric mucosal atrophy associated with a risk of gastric cancer in these types of gastritis are highly heterogeneous, and need a more detailed study of this issue to work out a follow-up personalized approach to the management of patients. In recent years, there have been reports confirming that autoimmune gastritis (AIG) without concurrent H. pylori infection and without signs of significant inflammation of other etiologies has a relatively benign course and a low risk of neoplastic transformation of the gastric mucosa into gastric cancer. However, the emergence of reports that H. pylori infection may elicit autoimmunity toward parietal cells, which results in the atrophy of the gastric body mucosa makes the issue of management and identification of carcinogenesis risks in patients with chronic gastritis of mixed etiology more urgent. This scientific review aims to systematize the available data on AIG, the mechanisms of development of atrophy and atrophy-associated risks of carcinogenesis, both in isolated autoimmune inflammation and in persistent or previous H. pylori (“pure” AIG), persistent H. pylori infection, or in the post-eradication therapy period. Special attention is paid to the phenomenon of molecular mimicry between H. pylori antigens and epitopes of gastric parietal cells during the development of gastritis of mixed-etiology.

Introduction. Gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) are the most common diseases of the upper gastrointestinal tract (GIT). According to the literature, the prevalence of GERD in the world is 5–25%, in Russia – from 12% to 24%. Symptoms of GERD in patients with FD are observed in 1.6–8% of cases, and in some studies – up to 37%. FD is found in approximately 20% of the population. Dyspepsia syndrome is present in approximately 40% of patients with GERD.

Aim. To develop the “GeFest” questionnaire to identify isolated and combined forms of GERD and FD, and to evaluate its sensitivity, specificity, and application conveniences.

Materials and methods. 208 patients (67 men and 141 women) aged 18–65 years participated in the observational study. Participants completed the “GeFest” questionnaire daily for 7 days. Patients underwent laboratory and instrumental examinations, including esophagogastroduodenoscopy (EGDS) and 24-hour pH-impedancemetry of the upper gastrointestinal tract. The validity of the developed questionnaire was determined by comparing the questionnaire and examination results.

Results. The study demonstrated high sensitivity and specificity of the questionnaire (90–100%). The questionnaire effectively identified isolated and combined forms of GERD and FD. Study participants spent approximately 1 minute completing the questionnaire. Physicians and patients highly rated the questionnaire’s ease of use.

Conclusions. The “GeFest” questionnaire is an effective and reliable tool for the diagnosis and dynamic monitoring of GERD and FD. Use of the questionnaire can help reduce the cost of diagnosing these upper gastrointestinal diseases, including combined forms, reduce the need for invasive procedures, and facilitate the selection of drug therapy.

Introduction. The Maastricht VI international guidelines define the most effective methods for diagnosing and treating H. pylori-associated peptic ulcer disease (PUD). Less attention has been paid to the subsequent course of PUD after successful eradication.

Aim. To evaluate the impact of successful H. pylori eradication on the subsequent course of gastric ulcer disease (GUD).

Materials and methods. Twenty patients with PUD after successful H. pylori eradication with a triple drug combination underwent annual EGDS for 5 years, including H. pylori biopsies, endoscopic pH monitoring, clinical dynamics, and blood gastrin and somatostatin levels.

Results. Over a 5-year observation period, disease recurrences were detected: by clinical manifestations – in 50% of cases (in 83% of cases, relapses were low-symptom or asymptomatic), by EGDS – in 60% of cases (of which ulcers were recorded in 15% of cases and gastric erosions in 45%). Recurrence of H. pylori infection was recorded in 45% of patients (of which 15% – with gastric ulcers and 30% – with gastric erosions), and in 15% of patients, the cause of gastric erosions was the use of NSAIDs; it was accompanied by weak to moderate degrees of H. pylori contamination and gastrointestinal tract inflammation.

Conclusion. A 5-year follow-up of PUD after successful eradication showed that H. pylori recurrence occurred in 45% of cases, with changes in the course of PUD. Benign (low-symptom and asymptomatic) recurrence was predominant, accompanied by mild to moderate H. pylori contamination and GM inflammation.

Gastroesophageal reflux disease (GERD) is a chronic condition characterized by the presence of pathological gastroesophageal reflux (GER). The incidence of GERD increases with aging, with a prevalence of approximately 17% for people aged over 50 years and 26% for those aged over 60 years. The major factors contributing to the pathophysiology of reflux later in life include transient lower esophageal sphincter relaxation, impaired oesophageal volumetric and chemical clearance, hiatal hernia, a range of comorbidities, and polypragmasy. The course of GERD in the elderly is characterized by the absence of typical, acute clinical symptomatology alongside significant changes in the esophageal mucosa. The most common symptoms of the pathological reflux are dysphagia and odynophagia, as well as extraesophageal manifestations. Therefore, esophagogastroduodenoscopy should be considered the first-line instrumental examination in this category of patients. The management of GERD involves lifestyle and dietary modifications, pharmacological therapy, and, in some cases, antireflux surgery. Proton pump inhibitors represent the main group of antisecretory drugs for the treatment of GERD. However, it is recommended to add rebamipide to the pharmacological therapy to improve the effectiveness of treatment for patients with GERD, including the elderly. The combination of PPIs and rebamipide can more effectively relieve GERD symptoms and significantly reduce the frequency of relapses.

The article provides a comprehensive analysis of the relationship between diseases of the gastroduodenal zone and coronary artery disease (CAD), which frequently coexist in the same patient, share common pathogenetic mechanisms, and mutually aggravate the course of each other. The paper discusses current concepts of the systemic processes linking these conditions, including chronic low-grade inflammation, endothelial dysfunction, activation of lipid peroxidation, disturbances of carbohydrate and lipid metabolism, and the influence of infectious and immune factors. Special attention is given to Helicobacter pylori infection, which not only causes chronic inflammatory processes in the gastric and duodenal mucosa but also contributes to the development of atherosclerosis by increasing the levels of pro-inflammatory cytokines (IL-6, TNF-α), stimulating C-reactive protein production, and impairing vascular endothelial function. The role of gastrointestinal microbiota in the development of systemic inflammation, insulin resistance, and metabolic syndrome, which represent key links in the pathogenesis of CAD, is analyzed in detail. Particular attention is paid to liver diseases – nonalcoholic fatty liver disease and viral hepatitis – which are closely associated with cardiovascular pathology through shared metabolic, vascular, and inflammatory mechanisms. The article presents current approaches to the diagnosis and treatment of patients with combined pathology, including H. pylori eradication, microbiota normalization, correction of metabolic disorders, antioxidant and hypolipidemic therapy, taking into account the functional state of the liver and gastrointestinal tract. The importance of a multidisciplinary approach involving gastroenterologists, cardiologists, and general practitioners is emphasized, aiming at personalized patient management, prevention of complications, and improvement of quality of life.

Introduction. Chronic gastritis remains one of the most prevalent disorders of the upper gastrointestinal tract, with H. pylori playing a key role in its pathogenesis.

Aim. To provide a comprehensive clinical, morphological, and serological assessment of the gastric mucosa in patients with chronic gastritis presenting with dyspepsia.

Materials and methods. This prospective single-center study (Moscow, 2021–2025) enrolled 309 patients presenting with dyspepsia. All participants underwent a standardized diagnostic algorithm comprising a 13C-urea breath test (13C-UBT); esophagogastroduodenoscopy (EGD) with multifocal biopsies and OLGA staging; the GastroPanel® serological test (pepsinogen I, pepsinogen II, gastrin-17, and IgG antibodies to H. pylori); and the 7×7 symptom scale.

Results. H. pylori infection was confirmed in 147/309 patients (47.6%). Among H. pylori-positive patients, atrophic chronic gastritis predominated (69.4%), whereas in H. pylori-negative patients superficial (non-atrophic) gastritis was most frequent (91.4%) (p < 0.0001). Within H. pylori-associated atrophic gastritis, early OLGA stages I-II prevailed (86.0%). In the H. pylori-negative subgroup with atrophic gastritis, median PGI was reduced versus superficial gastritis (35.9 vs 78.3 µg/L; p < 0.0001) with moderate changes in PGII and a tendency toward higher G-17. In H. pylori-positive patients, eradication therapy was followed by a significant decrease in total 7×7 scores. ROC analysis of the PGI/PGII ratio for detecting advanced atrophy (OLGA III/IV) yielded an AUC of 0.820 (95% CI, 0.748–0.878), sensitivity 80.0%, and specificity 81.1% at a cut-off ≤ 2. The per-protocol eradication rate was 85.42% (82/96); the safety profile was predominantly mild to moderate (adverse events in 26.0%).

Conclusions. An integrated approach combining OLGA staging, GastroPanel® biomarkers, and the 7×7 scale provides consistent, reproducible stratification of chronic gastritis and optimizes selection for invasive verification. The PGI/PGII ratio shows high diagnostic value for identifying advanced stages of gastric mucosal atrophy (OLGA III/IV), and H. pylori eradication is associated with clinically meaningful symptom improvement.

The article is an analytical review of the concept of pharmacological gastroprotection. The authors emphasize that the integrity of the gastric mucosa is maintained due to a complex balance between the factors of aggression (hydrochloric acid, pepsin, NSAIDs, H. pylori) and protection (mucus, bicarbonates, prostaglandins, adequate microcirculation, mucosal regeneration). The main mechanisms of damage to the gastric mucosa are listed and a classification of protective factors is given. The terms “cytoprotection” and “gastroprotection” are considered. It is substantiated that true gastroprotection is defined as a pharmacological enhancement of the protective properties of the mucosa, and not the suppression of acid aggression. In this regard, proton pump inhibitors (PPIs), which remain the “gold standard” for the prevention of dangerous complications (bleeding, perforation), do not belong to true gastroprotectors, since they act on the aggression factor. The criteria for assessing the risk of gastrointestinal bleeding and the approach to prescribing gastroprotectors are presented. The authors classify bismuth preparations, misoprostol and rebamipide as true drugs with proven gastroprotective properties. However, each of them has serious limitations: the risk of bismuth accumulation with long-term use, pronounced side effects of misoprostol (diarrhea, abortive effect) and an insufficiently strong evidence base for rebamipide for widespread use. The key problem of clinical practice is the low frequency of gastroprotection use even among high-risk patients (elderly age, taking anticoagulants and NSAIDs, ulcer history), for whom it is indicated first and foremost. The main conclusion of the work is that classical gastroprotection has given way to antisecretory therapy not because of inefficiency, but because of the simplicity, predictability and strong evidence base of PPIs in preventing life-threatening complications. A paradigm shift will require the development of a new drug with clear advantages over existing standard therapy.

Introduction. Helicobacter pylori colonization significantly affects not only the gastric microenvironment, but also the intestinal microbiota. Numerous studies have shown that proton pump inhibitors (PPIs) can alter the intestinal flora of patients. This article examines the available data on the relationship between gastritis, Helicobacter pylori (Hp) infection, and small intestinal bacterial overgrowth (SIBO).

Aim. To compare the level of comorbidity and severity of SIBO in patients with chronic gastritis of various origin – Hp-positive (Hp+) and Hp-negative (Hp-).

Materials and methods. In our study, we examined the medical data of 122 patients (24 men and 98 women) aged 20 to 60 years (mean age 51 years). Of these, 62 had Hp+ gastritis and 60 had Hp-. All patients also underwent lactulose hydrogen breath testing to detect SIBO.

Results and discussion. SIBO was diagnosed in half of the patients (32 patients, 51.6%) in the Hp+ group and in one-third of the patients with Hp-gastritis (18 patients, 30%) (p ≤ 0.05). In our study, repeated testing didn’t detect SIBO after anti-Helicobacter therapy in patients from the Hp+ group.

Conclusions. The patients on regular PPI therapy, with Hp+ and Hp-gastritis and symptoms of intestinal indigestion should undergo diagnostic testing for SIBO. Hp eradication in patients with gastritis combined with SIBO contributes to the successful small intestine decontamination.

Gastric cancer (GC) is a major social issue that is particularly acute in East Asia, Eastern Europe, and South America. Russia, where morbidity and mortality rates are higher than the global averages, still has no national GC screening, early detection and prevention programs. The aim of this review is to analyze current literature data on the incidence, mortality, and screening methods of gastric cancer (GC) in different countries of the world and in Russia. The average age-standardized rate (ASR) of GC incidence worldwide is 9.2 per 100,000 population, ASR of mortality is 6.1 per 100,000, and five-year survival for 2000–2014 varies from 20% to 40%. In Russia, the incidence and mortality rates of GC are 13.7 per 100,000 and 9.2 per 100,000, respectively. Unfavorable epidemiological indicators of GC are observed in Republic of Tyva: the ASR of incidence in this region is 24.56 per 100,000 population, and the ASR of mortality is 18.75 per 100,000 population. Population screening programs for GC, implemented in only two countries in the world (South Korea and Japan), have significantly increased the five-year survival rate for GC in these countries to 68.9% and 60.3%, respectively, while in the USA and Russia this figure is 33.1% and 21%, respectively. The leading method of population and opportunistic screening of GC in the world and in Russia is endoscopy in individuals over 50 years of age. For opportunistic and population screening, it is recommended to use esophagogastroscopy in individuals over 50 years of age once every 3 years and serological tests to determine the level of pepsinogens I and II, and IgG to Helicobacter pylori. High rates of morbidity and mortality from GC in Russia, low five-year survival rate determine the relevance of the development and implementation of a national strategy for population screening of GC.

In 2023, a new nomenclature and pathophysiology were developed, a definition and diagnostic criteria for MASLD (metabolic dysfunction-associated steatotic liver disease) were proposed. The diagnostic criteria for MASLD were recommended to be the presence of liver steatosis and at least one of five cardiometabolic factors: 1) Quetelet index >25; waist circumference >94 cm for men and >80 cm for women; 2) fasting glucose content >5.6 mmol/l; 3) blood pressure >130/85 mm Hg; 4) blood triglyceride levels >1.7 mmol/l; 5) blood high-density lipoprotein cholesterol < 1 mmol/l. Basic treatment of patients with MASLD includes diet modification, increased physical activity and weight loss. Drug therapy is mainly required for patients with a high probability of disease progression (the presence of comorbid conditions, diagnosis of steatohepatitis and severe liver fibrosis). The first drug approved by the FDA for the treatment of metabolically associated steatohepatitis (MASH) was the THR-β agonist resmetirom. The above innovations have led to a desire to revise the prescription of pioglitazone, metformin, vitamin E and drugs with cytoprotective activity for the treatment of MASH in new international guidelines. At the same time, the 2024 Russian guidelines for the management of patients with MASLD leave room for the use of a large group of drugs for the treatment of various phenotypes of MASLD. In this review, we draw attention to polyunsaturated fatty acid (PUFA) drugs, one of which is Essentiale forte N, which have a broad evidence base. The potential use of PUFAs in the treatment of MASH is discussed in the 2024 European Association for the Study of the Liver guidelines and the new 2025 international consensus on MASH.

Introduction. Hepatotoxicity is one of the common side effects of drug therapy. Drug-induced liver injury (DILI) accounts for up to 10% of the total number of adverse reactions, amounting to 13.9–19.1 per 100,000 prescriptions. Succinate-containing drugs are widely used to correct intoxications of various origins, including DILI.

Aim. To evaluate of the efficacy and safety of succinate-containing preparations: inosine + meglumine + methionine + nicotinamide + succinic acid and meglumine sodium succinate for DILI.

Materials and methods. A systematic review of the research results was conducted according to the criteria of PRISMA 2020. The search for publications was carried out using PubMed, MEDLINE databases, as well as Russian scientific electronic libraries eLIBRARY.RU and RSCI. The risk of bias in the results was assessed using the RoB 2 and ROBBINS-I tools.

Results and discussion. As part of the systematic review, 13 publications were analyzed. The use of the RoB 2 and ROBINSI scales demonstrated a moderate risk of systematic error in all the analyzed papers. The vast majority of articles evaluated the dynamics of alanine aminotransferase and aspartate aminotransferase in patients, alkaline phosphatase, total bilirubin and direct bilirubin, total protein and gamma-glutamyltransferase. To a lesser extent, the following indicators were taken into account in the studies: ECOG scale, de Ritis coefficient, albumin. Individual studies took into account the Shaposhnikov scale, the Karnovsky scale, and the CTCAE, ECOG, and indirect bilirubin scales. In 23.08% of publications, adverse drug reactions to inosine + meglumine + methionine + nicotinamide + succinic acid were evaluated. All authors noted the positive effect of the use of succinates, as well as the expediency of their inclusion in therapeutic regimens.

Conclusion. Inosine + meglumine + methionine + nicotinamide + succinic acid and meglumine sodium succinate should be used in treatment with DILI, as they help to reduce the level of hepatotoxicity markers (fixed combination to a greater extent than a single drug) and their use is safe.

Given the new diagnostic possibilities using endoultrasonography, the authors propose to supplement the definition of “gall-stone disease” (GSD), i.e. to consider it as a chronic hepatobiliary disease, in which not only stones, but also microcholelithiasis (microcholecysto- and/or microcholedocholithiasis), and biliary sludge are forming in the bile ducts. The article discusses a new draft classification of GSD, diagnostic criteria, and features of the clinical course of different stages of GSD. The therapy with a fixed-dose combination of GA and UDCA has become one of the promising approaches to the treatment of GSD, which reduces the risk of progression and complications of the disease at all its stages, as well as after cholecystectomy. Based on the analysis of available research papers and our own clinical experience, this topical article discusses a new draft classification of GSD based on new diagnostic methods, which is proposed for consideration by surgical and non-surgical specialists. The work presents diagnostic criteria, features of the clinical course of different stages of GSD, and points to the fact that complications such as acute pancreatitis and cholangitis may develop even with stage I GSD. Attention was also being given to the question of incorporating a section on different post-cholecystectomy conditions into the classification of GSD. The article presents the principles of pharmacotherapy for GSD based on the pathogenetic mechanisms by which it develops. The ursodeoxycholic acid is a multi-purpose combination drug, whose effect is potentiated by glycyrrhizic acid added to it. Improvement of the classification of GSD, including its stage I and the post-cholecystectomy condition, is needed to study the features of the clinical picture, prognosis for stone formation and the risks for complications, as well as optimization of disease management.

Introduction. According to the available data from literature, non-alcoholic fatty liver disease (NAFLD) is the most common liver pathology in Russia and worldwide. The stage of liver fibrosis (LF) determines the prognosis for patients. Liver fibrogenesis is a potentially reversible process and requires timely initiation of therapy.

Aim. To provide current information on the prevalence of LF, the mechanisms of its development and therapeutic options in patients with NAFLD, as well as practical evaluation of the antifibrotic effects of essential phospholipid (EP) combined with glycyrrhizic acid (GA).

Materials and methods. A total of 83 people (mean age 61.4 ± 3.27 years, a male-to-female ratio 65:18, body mass index no more than 40 kg/m²) were included in the study. The stage of liver fibrotic changes was evaluated using dynamic ultrasound transient shear-wave fibroelastography before therapy initiation, at 6 and 12 months of therapy. The patients were divided into 2 groups: group 1 (n = 39) received a fixed-dose combination of EP/GA, group 2 (n = 44) received EP. Liver steatosis was the predominant condition in 59 individuals, while non-alcoholic steatohepatitis was present in 24 patients.

Results. The evaluation of six-month fixed-dose EP/GA therapy showed significant regression of LF indicators in group 1, which was mainly observed in fibrotic changes F2. After 12 months of fixed-dose EP/GA therapy, the number of patients with LF F2 and LF F3 also significantly regressed from 49% to 31% and from 38% to 23%, respectively. The EP monotherapy only demonstrated its efficacy in patients with fibrotic changes F1.

Conclusion. The fibrogenesis processes may be slowed down, and in some cases regressed, during the long-term use of the combination drug EP/GA, which demonstrated its efficacy and safety in clinical trials and in real-life clinical practice.

The liver is involved in the metabolism and detoxification of xenobiotics, as well as in maintaining homeostasis. Impaired liver function has been linked with diseases such as alcoholic liver disease, metabolically associated fatty liver disease, hepatitis, cirrhosis, and liver cancer. Drug-induced liver injury remains a significant challenge. These liver diseases are collectively responsible for the significant mortality worldwide. Although traditional treatments help control symptoms and slow down the progression of liver diseases, they are frequently hindered by issues such as drug resistance and side effects. The treatment of liver diseases with herbal medicinal products offers a way for addressing these limitations, as numerous plant-based medicines exhibit hepatoprotective properties due to their bioactive compounds, such as alkaloids, glycosides, and flavonoids. These natural agents not only mitigate liver injury, but also stimulate immune processes that underlie the treatment of chronic diseases. This article examines the hepatobiliary injury mechanisms and highlights the therapeutic potential of traditionally used medicinal plants in treating and preventing the liver diseases. Published evidence on the therapeutic properties of herbal medicinal products show the importance of the integration of traditional medical knowledge with modern advancements, particularly in the areas of hepatoprotection, immunomodulation, and the treatment of chronic liver diseases. This article was aimed to evaluate the therapeutic potential of herbal medicinal products as part of the complex treatment of major liver diseases. The article explores the biological activity of individual herbal medicinal products, identifies their biologically active compounds, and determines the pathways by which they mitigate liver injury.

Introduction. Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, which affects approximately a quarter of the world's population and has become a global health problem.

Aim. To determine the prevalence of NAFLD among patients of Moscow multi-speciality hospitals.

Materials and methods. The study was conducted by random screening of patients. In addition to steatosis, the presence of at least two cardiometabolic risks was a necessary criterion for diagnosing NAFLD. All patients underwent abdominal ultrasound imaging and transient elastography (TE) with controlled attenuation parameter (CAP). Hand grip strength (HGS) was measured using a handgrip test. Male patients’ erectile dysfunction (ED) was assessed using the IIEF-5 (International Index of Erectile Function) criteria.

Results. A total of 449 patients were examined. Of these, 213 (47.4%) were diagnosed with NAFLD. Among the NAFLD patients, 143 were men and 70 were women. The mean age of the examined patients was 49,3 ± 11,6 years. According to TE findings, mean fibrosis score was 8.9 kPa and mean steatosis score was 294.2 dB/m. Distribution of patients by stages of fibrosis: F0–1 – 75 patients (35.2%), F2 – 69 patients (32.4%), F3 – 47 patients (22.1%), F4 – 22 patients (10.3%). Distribution of patients by stages of liver steatosis: S1 – 70 (32,9%), S2 – 81 (38%), S3 – 62 (29,1%). The mean hand grip strength (HGS) was 33.9 kg, sarcopenia was diagnosed in 30 patients (14.1%). ED was diagnosed in 33 (23.1%) male patients. Distribution of patients by comorbid conditions: impaired glucose tolerance – 74 people (34.7%), type 2 diabetes mellitus – 9 (27.7%), dyslipidemia – 128 (60.1%), high blood pressure – 80 (37.6%), coronary artery disease – 29 (13.6%), gastroesophageal reflux disease – 57 (26.7%), gallbladder disease (cholelithiasis, biliary sludge) – 58 (27.2%), gout – 26 (12.2%), ED (based on IIEF-5 questionnaire scores) – 56 (39.2%).

Conclusion. The study has shown that NAFLD is an extremely common disease in multi-speciality hospital settings.

Abdominal pain is a serious problem of internal medicine and gastroenterology. The accuracy of diagnosing the causes of abdominal pain by the beginning of the 21st century was slightly more than 50%. Identifying them the doctor faces certain difficulties when it is necessary to exclude a wide range of gastroenterological and non-gastroenterological diseases. Often abdominal pain occurs in a spastic form. Abdominal pain, as a manifestation of irritable bowel syndrome (IBS), is primarily associated with spasm of the smooth muscles of the intestine. IBS is a chronic functional bowel disease, for which abdominal pain is the main manifestation, and can be combined with changes in bowel movements, frequency and nature of stool. The mechanism of formation of abdominal pain syndrome is due to a disruption in the interaction along the brain-gut axis, which leads to changes in the regulation of intestinal motor function and the development of visceral hypersensitivity (VH). From a clinical point of view, abdominal pain in IBS is visceral, that is, it occurs when the pain receptors of the intestine (nociceptors) located in the muscular wall are irritated. It is important to note the multicomponent integration of nociceptive information in IBS, which explains the variability in the perception and processing of abdominal pain, and, as a result, the difficulties in selecting effective pharmacotherapy. The first-line drugs for the relief of abdominal pain are antispasmodics, which reduce the tone and contractility of the smooth muscles of the intestine. The domestic pharmaceutical market is represented by various groups of antispasmodics, among which selective calcium channel blockers can be distinguished. Representative of the latter is the drug Otilonium bromide, which is widely used throughout the world, is effective and safe, well tolerated and superior to placebo in reducing symptoms and preventing relapse of pain in patients with IBS.The effectiveness of otilonium bromide is due to a triple mechanism of action: blockade of calcium channels (relief of spasm), antagonism of tachykinone NK2 receptors (effect on HHV) and inhibition of acetylcholine muscarinic receptors (M3-ChR) (reduction of intestinal secretion). It is also important to emphasize the selectivity of action and low absorption of the drug in the intestine, which determines the minimal number of side effects and the possibility of using otilonium bromide in comorbid patients.

Introduction. Chronic immunoinflammatory diseases contribute to modification of circulating lipoproteins, forming atherogenic dyslipidemia, including in the absence of an increase in total and low-density lipoprotein cholesterol (LDL-C). Small Dense Low-Density Lipoprotein-Cholesterol (sdLDL-C) are involved in atherogenic dyslipidemia in patients with inflammatory bowel diseases (IBD). SdLDL-C is a calculated indicator. An LDL-C / Apo B ratio of less than 1.2 indicates the presence of sdLDL-C.

Aim. To evaluate the frequency of a decrease in the LDL-C / Apo B ratio of less than 1.2 and to determine the factors associated with the presence of sdLDL-C in patients with IBD.

Materials and methods. A cross-sectional study was conducted, which included patients with ulcerative colitis and Crohn’s disease aged 40 to 64 years. LDL-C, high-density lipoprotein cholesterol (HDL-C), triglycerides, and ApoB were determined in addition to the standard examination.

Results. 78 patients with IBD were included. A decrease in LDL-C / Apo B of less than 1.2 was detected in 17 (21.8%) patients. A significant decrease in LDL-C/Apo B was found in patients with attack/exacerbation of IBD compared with patients without attack/exacerbation (p = 0.003). An inverse correlation was found between the ratio of LDL-C/Apo B and the endoscopic activity of IBD (r = -0.342; p = 0.002), ESR (r = -0.302; p = 0.012), the number of leukocytes (r = -0.296; p = 0.011) and the concentration of C-reactive protein (r = -0.327; p = 0.007).

Conclusion. The decrease in the LDL-C / apoB ratio was associated with greater endoscopic activity of the disease and an increase in laboratory indicators of inflammation. The share of sdLDL in total LDL-C concentration directly correlated with laboratory and endoscopic indicators of inflammation activity.

Enterosorption as a therapeutic method has a long experience of application in medicine, is recognized as a component of detoxification and pathogenetic therapy for diseases of the gastrointestinal tract, intestinal infections, antibiotic-associated diarrhea, allergic diseases in children and adults. In clinical trials and in real-world practice, the positive effects of enterosorption have been noted: binding of toxic products, bacterial toxins, microorganisms and their fragments, products of impaired intestinal metabolism and inflammation, xenobiotics, etc. A large number of enterosorbents of various origins with different mechanisms of action and application points have been proposed. The article examines the main mechanisms of action of enterosorbents, taking into account their nature, presents a classification of modern enterosorbents, and analyzes the results of the use of enterosorption in diseases of the gastrointestinal tract and associated diseases/conditions. The review focuses on complex enterosorbents with components of various origins, which allows us to summarize the positive effects of the components, providing a comprehensive effect and reducing the risks of side effects. The combination of microcrystalline cellulose and silicon dioxide (White charcoal Extra) has been analyzed in detail, and such a combination has extensive experience in gastroenterological pathology. The results of the combined enterosorbent application are presented, including randomized clinical trials and clinical observations of the last 15 years. The positive effect of the combination of microcrystalline cellulose and silicon dioxide on both objective and subjective manifestations of intestinal, liver, and pancreatic diseases, as well as on laboratory markers, has been shown. The acceleration of relief of pathological symptoms was noted with the introduction of the combination in question into treatment regimens, prolongation of remission in chronic diseases, and an impact on the quality of life of patients. The prospects of using a combination of microcrystalline cellulose and silicon dioxide in the practice of a gastroenterologist are outlined.

Introduction. A range of diseases that require differential diagnostic search in persistent joint syndrome in children include juvenile idiopathic arthritis (JIA) and joint lesions in inflammatory bowel diseases (IBD).

Aim. To analyze and compare the nature of joint syndrome in children with JIA and Crohn’s disease (CD) with joint lesions.

Materials and methods. The joint syndrome was analyzed in a group that included 23 children with JIA and 24 children with Crohn’s disease with joint lesions. Statistical data were processed using parametric tests and exact formulas for percentage-based relationships.

Results. JIA typically affected the knee, ankle, hip, and wrist joints (21 (91.3%), 14 (60.9%), 15 (65.2%), and 5 (21.7%) children, respectively). Enthesopathies were detected in 4 (17.4%) children. CD caused spondyloarthritis in 5 children (10.8%) and peripheral joint lesions in 15 patients (58.3%). Knees, hips, and small joints of the hands and feet were affected most frequently (14 (58.3%), 13 (54.2%), 9 (37.5%), and 4 (16.7%) children, respectively). Enthesopathies were detected in 10 children (41.7%). An analysis of the comparative frequency of joint lesions in JIA and CD showed that the knee, ankle, and wrist joints were significantly more often involved in JIA, while enthesitis were significantly more often detected in CD (p < 0.05). 5 patients (10.8%) had CD-associated spondyloarthritis. Antinuclear antibodies were identified significantly more often in patients with JIA (p < 0.05). The article is also illustrated with two clinical case reports.

Conclusions. The data presented demonstrate differences in the nature of joint syndrome in children with JIA and CD. A detailed history taking, physical examination, and assessment of the nature of the joint syndrome make it possible to establish a correct diagnosis and select a rational approach to the management of patients.