Introduction. Functional dyspepsia (FD) and irritable bowel syndrome (IBS) overlap is an adverse clinical situation, as patients with this syndrome have more severe clinical manifestations resulting in significant reductions in quality of life. For now, there are no meta-analytical papers that would summarize the frequency of FD – IBS overlap using the revised Rome IV criteria. Objective. To organize data on the prevalence of FD – IBS overlap using the revised Rome IV criteria.

Materials and methods. A search for studies was conducted in MEDLINE / PubMed, EMBASE, Cochrane electronic databases. The search depth was 6 years (from January 2016 to February 2021). The final analysis included original publications from peerreviewed periodicals that used the revised Rome IV criteria as a method for diagnosing FD and IBS in the adult population with detailed descriptive statistics allowing to include resulting data in the meta-analysis.

Results and discussion. The final analysis included 6 studies involving 1,180 patients with PD and 600 patients with IBS. The generalized prevalence of IBS in patients with PD was 41.511% (95% CI: 22.203–62.288). The analysis was undertaken by using a random-effects model, as there was significant heterogeneity among results (p < 0.0001; I2 = 94.28%). The generalized prevalence of PD in patients with IBS was 38.791% (95% CI: 9.438–73.710). The analysis was undertaken by using a random-effects model, as there was significant heterogeneity among results (p < 0.0001; I2 = 99.25%).

Сonclusion. The complete meta-analysis showed that the frequency of FD - IBS overlap using the revised Rome IV criteria is quite high and accounts for about 40%. At the same time, further large studies of more homogeneous structure are needed to verify these results and study the potential pathogenetic relationship between PD and IBS. 

A review of modern data from the study of functional disorders of the digestive tract is performed. In the United States, 4 million people with functional bowel disorders seek medical care annually, and the annual cost of managing these patients is $ 358 million. Due to the urgency of the problem, new developments appear, among which it is necessary to highlight the American College of Gastroenterology (ACG) guidelines for the management of patients with IBS. To examine patients with suspected IBS, the authors of the ACG guideline proposed a positive diagnostic strategy, which is based on a careful study of the anamnesis, focusing on the key symptoms of the relationship between abdominal pain and bowel function during a long course of the disease (more than 6 months) and the absence of alarming symptoms with minimal use of instrumental diagnostic tests. For the diagnosis of IBS, the  authors recommended serological testing for  celiac disease, determination of  fecal calprotectin  and C-reactive protein  to exclude inflammatory bowel diseases, but they did not consider it necessary to routinely analyze stool for intestinal pathogens. From our point of view, the absence of routine stool analysis for intestinal pathogens is completely inapplicable for Russia, since in our country the frequency of detection of diphyllobothriasis, giardiasis and opisthorchiasis is very high. The ACG consensus drew attention to the need to expand the evidence base for the use of some standard drugs for the treatment of IBS, proposed a number of new drugs (lebiprostone, linaclotide), recommended the use of rifaximin (for the treatment of IBS with a predominance of diarrhea) and tricyclic antidepressants (for the treatment of IBS). Analysis of modern international recommendations suggests that the clinical guidelines of the Russian Gastroenterological Association and the Association of Coloproctologists of Russia for the diagnosis and treatment of IBS are currently the main document governing the management of these patients in our country.

Proton pump inhibitors (PPIs) are baseline drugs for induction and maintenance of remission in gastroesophageal reflux disease (GERD). PPIs have proven to be highly effective in healing esophageal mucosal lesions and relieving the symptoms of the disease in most cases. However, according to the literature data, the incidence rate of clinical ineffectiveness of PPIs in the form of partial or complete persistence of current symptoms during administration of standard doses of PPIs ranges from 10 to 40%. Optimization of GERD therapy in PPI refractory patients is a significant challenge. In most cases, experts advise to increase a dose / dosage frequency of PPIs, switch to CYP2C19-independent PPIs (rabeprazole, esomeprazole, dexlansoprazole), add an esophagoprotective or promotility agents to therapy. At the same time, these recommendations have a limited effect in some patients, which opens up opportunities for looking for new solutions related to the optimization of GERD therapy. Today there is growing evidence of the relevance of the role of disruption of the cytoprotective and barrier properties of the esophageal mucosa in the genesis of GERD and the formation of refractoriness. Intercellular contacts ensure the integrity of the barrier function of the esophageal mucosa to protect it from various exogenous intraluminal substances with detergent properties. Acid-peptic attack in patients with GERD leads to alteration of the expression of some tight junction proteins in epithelial cells of the esophageal mucosa. The latter leads to increased mucosal permeability, which facilitates the penetration of hydrogen ions and other substances into the submucosal layer, where they stimulate the terminals of nerve fibers playing a role in the induction and persistence of the symptoms of the disease. The above evidence brought up to date the effectiveness study of the cytoprotective drugs with tropism to the gastrointestinal tract, as part of the combination therapy of GERD.

Introduction. The problem of gastric ulcer is of particular socio-economic importance and has a tremendous impact on the quality of life of people. The relevance of our study is due to an increase in the incidence of peptic ulcer in the population, the variability of the clinical picture depending on the age category of patients, and the peculiarities of the treatment of this gastrointestinal pathology.

The aim of the study is to study the features of the course of gastric ulcer in different age groups of patients under dispensary supervision in the outpatient department of the State Budgetary Healthcare Institution of the Republic of Moldova “Republican Clinical Hospital No. 5” in the period from 2017 to 2020.

Materials and methods. A retrospective analysis of outpatient records of 100 patients of different age groups with gastric ulcer who were under dispensary observation at the outpatient clinic of the Republican Clinical Hospital No. 5 in Saransk in 2017– 2020 was carried out. Statistical analysis of the data obtained was carried out using the Microsoft Office Excel program.

Results and discussion. It was found that gastric ulcer is more often observed in middle-aged and elderly patients and is accompanied by blurring of the clinical picture of the disease, in contrast to young people, who have vivid clinical manifestations of this disease. Ulcerative defects in  young and middle-aged patients are more often small in  size and are located mainly in the area of the stomach angle, and in elderly and senile patients, ulcers are localized mainly in the cardiac region, can be gigantic and often lead to the development of complications (primarily gastrointestinal intestinal bleeding).

Conclusions. The blurring of the clinical picture, the absence of pathognomonic symptoms in elderly patients determine the late diagnosis of gastric ulcer, which ultimately leads to a high incidence of complications requiring surgical intervention. In clinical practice, it is necessary to take into account these features of the course of peptic ulcer disease in elderly patients and to prescribe the necessary complex of laboratory and instrumental studies and preventive therapy in a timely manner. 

One of the main symptoms of gastroesophageal reflux disease is heartburn, for the relief of which proton pump inhibitors are traditionally prescribed. However, there are frequent cases of heartburn, refractory to antisecretory therapy, when there is no complete relief of the symptom or only a partial clinical effect. The reason for an unsatisfactory response may be the functional genesis of heartburn. The purpose of the presented clinical observation is to demonstrate the heterogeneity of patients with heartburn, the role of functional research methods in the differential diagnosis of various conditions that accompany this symptom. A 42-year-old patient was admitted for an additional clinical examination with complaints of heartburn refractory to antisecretory therapy, which included high-resolution esophageal manometry, 24-hours pH-impedance. The manometric assessment of the structure and function of the lower esophageal sphincter, as well as the contractility of the thoracic esophagus, revealed no violations. The data of 24-hours pH-impedance demonstrated the absence of pathological reflux and the association of active symptoms with refluxes, which determined the functional nature of heartburn and explained the ineffectiveness of treatment with proton pump inhibitors. Heartburn can be functional in  nature and significantly reduce the  quality of  life of  patients. Functional heartburn requires different management tactics from gastroesophageal reflux disease, which is based on an adequate differential diagnosis, including functional research methods such as high-resolution esophageal manometry and 24-hours pH-impedance measurement, which allow to exclude other conditions accompanied by similar symptoms. 

Similar abdominal pain of biliary type in functional disorders of biliary tract and chronic acalculous cholecystitis causes objective difficulties to differentiate not only between each other, but also with other diseases of gastrointestinal tract. The  clinical picture is so homogeneous and difficult to distinguish from cholelithiasis that some patients undergo unreasonable surgical interventions for CAC and FDBT. Individual publications pushing for such an aggressive strategy are sporadic and need to be clarified in larger studies. The first choice drugs for treatment of FDBT are spasmolytics; ursodeoxycholic acid drugs are used as adjuvant agents. In CAC, the initial therapy will be similar, but the treatment regimen can be expanded with targeted etiotropic (if the cause of cholecystitis is identified – giardiasis, opisthorchiasis, etc.) or empirical antimicrobial/antiparasitic therapy. The greatest interest today is caused by hymecromone – a drug with proven by both experimental and controlled studies combined choleretic, selective spasmolytic action, mediated effect of reducing bile lithogenicity and possible anti-inflammatory action. Hymecromone effectively relieves biliary pain without causing gallbladder contractions, which determines the possibility of its wide application both in CAC and FDBT, both in monotherapy and in combination with other agents, primarily with UDCA. In this article the issues of optimization of diagnostic and therapeutic strategy of management of patients with biliary pain to avoid unreasonable cholecystectomies in acalculous diseases of the biliary tract are considered. 

Introduction. The  course of  opisthorchiasis is accompanied by clinically diverse symptoms and severe complications up to the development of cholangiocarcinoma. The role of oxidative stress in the development of liver fibrosis is not well understood. Aim. To determine the association of clinical manifestations and indicators of oxidative stress in the blood with liver fibrosis in patients with Opisthorchis felineus invasion.

Materials and methods. We examined 103 patients with chronic opisthorchiasis and 51 practically healthy patients. All patients underwent general clinical examinations, esophagogastroduodenoscopy and ultrasound examination of the abdominal organs, elastometry to assess liver fibrosis using the METAVIR system, and the content of malondialdehyde, catalase and superoxide dismutase in blood serum was determined by the immunoassay method.

Results and discussion. Asthenic-vegetative syndrome, pain in the right hypochondrium, articular syndrome, cytolytic and cholestatic syndromes, hepatomegaly and signs of  chronic cholecystitis were more often detected in  patients with invasion of  Opisthorchis felineus and liver fibrosis F3-F4  according to METAVIR. The  content of  malondialdehyde in  the  blood was 296.5 ng/ml in patients with liver fibrosis F3-F4 according to METAVIR and 69.5 ng/ml in patients with liver fibrosis F0-F1 according to METAVIR (p < 0.001). The content of superoxide dismutase and catalase did not differ significantly in the groups of patients with liver fibrosis F0-F1  according to METAVIR and F3-F4  according to METAVIR, which indicated insufficient effectiveness of antioxidant protection.

Conclusion. The revealed changes indicate the presence in patients with opisthorchiasis of a pronounced association between the severity of the clinical course, the development of biochemical cytolysis syndromes and the severity of liver fibrosis and oxidative stress, which may be a promoter of inflammation, cell DNA damage and carcinogenesis. 

Introduction. NAFLD is an urgent health problem, its prevalence reaches 45%. NAFLD increases the risk of cardiovascular diseases by 3 times, the risk of death from them by 2 times and increases the risk of developing diabetes by 5 times. NAS occupies up to 20% of the structure of NAFLD and has a high potential for progression, and the violation of endogenous glycemic regulation and the development of DM2 accelerates the rate of disease progression.

The goal was to determine the frequency of development of prediabetes (PD) and type 2 diabetes mellitus (T2DM) in NASH patients and the effect of impaired glycemic status on the clinical features of NASH.

Materials and methods: 211 NASH patients were examined: 148 (70.1%) men, 63 (29.9%) women, 48.3 ± 10.2 years old. The diagnosis was established on the basis of clinical, laboratory, ultrasound and histological data. By enzyme immunoassay were determined: TNF-α, cytokeratin-18 fragments (CKF-18), insulin; were calculated HOMA-IR and NAFLD fibrosis score (NAFLD FS).

Results and discussion. PD was detected in 39 (18.5%) patients, T2DM - in 33 (15.6%) patients. In PD patients, in contrast to patients with normoglycemia, the following indicators were significantly higher: waist circumference (WC), body mass index (BMI), cholesterol levels (Ch), LDL, ESR, TNF-α, NAFLD FS and lower albumin and platelet levels. In patients with T2DM, in contrast to those with normoglycemia, the following indicators were significantly higher: WC, BMI, alanine aminotransferase, alkaline phosphatase (APh), Ch, ESR, CKF-18 and NAFLD FS. In T2DM patients in contrast to those with PD, the following indicators were significantly higher: aminotransferases, APh and lower albumin level.

Conclusions. Prediabetes and T2DM were detected with almost the same frequency among patients with NASH – in 18.5% and 15.6%, respectively. Disturbance of glycemic status was associated with a significance increase in waist circumference, markers of inflammation, dyslipidemia, fibrosis, hepatocytic necrosis, apoptosis, intrahepatic cholestasis and a decrease in albumin level. 

The pandemic of COVID-19 is changing the usual clinical practice. Most of the drugs used for the etiotropic and pathogenetic therapy of COVID-19 do not have a sufficient evidence base, approaches to therapy of liver, gastrointestinal tract and other body systems damage in the structure of COVID-19 and post COVID-19 syndrome are under development. Coronavirus infection is more severe in  obese patients with associated diseases; the  liver plays an important role in  this process. Retrospective analysis of  the  medical histories of  patients with a  new coronavirus infection hospitalized in  the  clinic of North-Western State Medical University named after I.I. Mechnikov identified that 34.7% of patients were overweight, 51.3% obese, 77% abdominal obesity (alanine aminotransferase (ALAT) was on average 76.2 ± 58.8 U/L, aspartate aminotransferase (ACAT) 60.7 ± 48.6 U/L). At the time of hospitalization, increased transaminases was detected in 71% of patients and correlated with markers of the severe course of COVID-19 (the level of C-reactive protein, ferritin, % of blood oxygen saturation). In patients with severe new coronavirus infection, receiving therapy with JAK-kinase inhibitors and/or biological drugs, often was a  significant increase of  ALAT and ASAT up to 5–10  upper limits of  the  norm. In  the  process of  histological examination of the liver tissue of patients who died of extremely severe course of infection, characteristic fatty degeneration of hepatocytes was revealed. Therapy with a multicomponent drug containing inosine, meglumine, methionine, nicotinamide and succinic acid contributed to a dynamic decrease of transaminases and an improvement in the course of the new coronavirus infection. 

The 2019 outbreak of coronavirus disease (COVID-19) caused by severe acute coronavirus 2 respiratory syndrome (SARS-CoV-2) has been a  global concern since December 2019. Although most patients with COVID-19  have mild clinical manifestations, in about 5% of these patients the disease eventually progresses to severe lung injury or even multiple organ dysfunction. This situation presents various problems for hepatology. In the context of liver damage in patients with COVID-19, several key problems need to be addressed. For example, it is important to determine whether a SARS-CoV-2 can directly enter the liver, especially when it appears that ACE2 is marginally expressed in hepatocytes. In addition, the mechanisms underlying liver dysfunction in patients with COVID-19 are multifactorial and are associated with hyperinflammation, dysregulated immune responses, abnormal coagulation, and drugs. The  article describes the  potential pathogenesis of  liver damage associated with COVID-19. Histopathological evidence suggests a marked disruption of the intrahepatic network of blood vessels secondary to systemic changes caused by a virus that can trigger a coagulation cascade and damage the endothelial layer of blood vessels. There is also a clinical case of polyethylene damage to the liver in a young man who led to death. Against the background of infection COVID-19 he developed massive thrombosis of the liver vessels, followed by the development of necrosis — fibrosis — cirrhosis — acute liver failure, which caused death.

In the article we analysed the difficulties of differential diagnosis of portal hypertension, considers a clinical case that illustrates the presented theoretical material. In the presented clinical observation, the patient’s disease was manifested by bleeding from the varicose veins of the esophagus. In most cases, portal hypertension syndrome in practicing clinicians is associated with liver cirrhosis, however, it is necessary to remember about the possibility of developing subhepatic portal hypertension, in particular as a result of the formation of portal vein thrombosis. If there are signs of portal hypertension, it is necessary to specify the level of obstruction to blood flow, that is, the form of portal hypertension (subhepatic, hepatic, suprahepatic). Often, portal vein thrombosis can be formed due to undiagnosed blood diseases that occur without any clinical symptoms. The provided clinical example demonstrates a case of portal hypertension in the outcome of a chronic form of myeloproliferative syndrome. Portal cavernoma is quite rare and it is formed due to multiple small-diameter venous structures that gradually replace the occluded vessel with a system of collaterals proximal and distal to the portal vein thrombosis site. In the formation of the diagnosis the main are radiation research methods, but the conclusions should be considered only in conjunction with the clinical evidence. The clinical case is interesting because a large cavernoma of the portal vein in a patient with subhepatic portal hypertension was regarded as a «solid formation» according to magnetic resonance tomography. According to the literature data, cavernous transformation has an external similarity to the tumor process, which expands the range of differential diagnosis and requires the exclusion of oncological formations. 

Introduction. The prevalence of functional biliary disorders continues to increase with insufficient effectiveness of existing treatment approaches. Among them, functional biliary disorders of sphincter of Oddi account for at least 50%.

Objective. To study efficacy, safety and tolerability of a fixed combination of glycyrrhizic acid and ursodeoxycholic acid (Fosfogliv Urso) in capsule form in patients with functional biliary disorders of sphincter of Oddi.

Materials and Methods. The study included 32 patients diagnosed with functional biliary sphincter of Oddi disorders established according to the Rome Criteria IV revision (2016). Patients received Fosfogliv Urso (250 mg ursodeoxycholic acid and 35 mg glycyrrhizic acid) 1 capsule 3 times a day for 8 weeks. Prior to treatment, all study participants underwent a standard set of laboratory and instrumental examinations.

Results. Against the background of Fosfogliv Urso treatment, statistically significant decrease of biliary pain prevalence up to 48.3% (p < 0.001); intense biliary pain up to 11.4% (p < 0.0001); intensity of pain syndrome on visual analogue scale down to 1.7 ± 0.9 cm was registered (p < 0.0001). Alanine aminotransferase activity significantly decreased to 34.0 ± 4.0 U/L (p < 0.001). There was a tendency of choledochal diameter decrease to 0.57 ± 0.01 cm. Treatment efficacy was rated by patients as very good and good in 83.4% of cases. The safety profile was assessed as favorable and tolerability as satisfactory.

Discussion. The results obtained were superior to those previously obtained for ursodeoxycholic acid monotherapy and confirmed the data of the previously conducted phase III study. The rationality of the combination is due to the mutual complementation and possible synergism of the pharmacological effects of glycyrrhizinic and ursodeoxycholic acids.

Conclusion. The results obtained allow to recommend the prescription of Fosfogliv Urso in the complex scheme of treatment and prophylaxis of functional biliary disorders of sphincter of Oddi. 

Introduction. Treatment of patients with ulcerative colitis (UC) requires continuous anti-relapse therapy. Mesalazines are the firstline disease-modifying drugs for the treatment of mild to moderate UC to manage exacerbations and to induce and maintain remission.

This paper is aimed at comparing the efficacy of treatment of patients with pancolitis and left-sided ulcerative colitis of moderate severity, who received MMX mesalazine as monotherapy and MMX mesalazine combined with mesalazines in the form of microclysters and suppositories.

Materials and methods. A comparative clinical evaluation of the outcomes of treatment of patients with moderate UC who received MMX mesalazine as monotherapy (group 1) and MMX mesalazine combined with topical mesalazine (microclysters, suppositories) (group 2) was carried out. 40 patients with UC (group 1) and 46 (group 2) were examined.

Results and discussion. Two weeks after MMX mesalazine therapy initiation, 92.8% of patients in group 1 responded to MMX mesalazine therapy and continued using the drugs as monotherapy (without microclysters and suppositories). In group 1, 95.6% of patients responded to MMX mesalazine therapy and continued treatment with topical mesalazines (microclysters and suppositories). At week 12, 54.3% of 35 patients in group 1, who responded to MMX mesalazine therapy, achieved clinical remission, 45.7% achieved clinical endoscopic remission. The Mayo Score decreased from 8.0 ± 0.17 to 2.3 ± 0.3 points. At week 12, 57.1% of patients with UC in group 2, who responded to MMX mesalazine therapy, achieved clinical remission, and 42.9% achieved clinical and endoscopic remission. The Mayo Score decreased from 7.85 ± 0.14 to 2.4 ± 0.3 points. There was no statistically significant difference in the level of laboratory findings between the groups of patients at 12 weeks and at 52 weeks (p> 0.05).

Conclusion. The long-term continuous administration of MMX mesalazine in patients with pancolitis and left-sided ulcerative colitis of moderate severity as monotherapy during the year is comparable in its efficacy with combined MMX mesalazine therapy and topical forms of mesalazine. 

TNF-α has been known since 1985. It is a multifunctional proinflammatory cytokine, synthesized mainly by monocytes and macrophages. Since its discovery, many studies have been conducted that have proven that it provides homeostatic function and regulates many biological processes in the body. Violation of its regulation in humans is associated with the development of many autoimmune diseases. The intensive studies that led to the understanding of its polyfunctionality and its role in the immunopathogenesis of a number of diseases served as the basis for the development of anti-cytokine therapy with monoclonal antibodies. In 1975, a technique for producing such antibodies was developed. The first antibodies against TNF-α obtained were chimeric, consisting of 30% mouse protein. Because of this feature, drugs based on chimeric antibodies had immunogenicity, which was manifested in the formation of antibodies to the drug, which led to a decrease in their effectiveness. To reduce immunogenicity, scientists in 1990 created the first fully human monoclonal antibody based on a technology called phage display. This is how adalimumab was born, the  first fully human multi-clonal antibody to TNF-α. Humira®  (adalimumab) is currently considered a widely studied drug from the group of TNF-α inhibitors, with a good safety and efficacy profile. The article presents current data that demonstrate that the drug significantly improves the course of diseases such as rheumatoid and psoriatic arthritis, and will allow for long-term remission in Crohn’s disease. 

This article discusses ways to improve the effectiveness of treatment of irritable bowel syndrome (IBS), one of the most common functional gastrointestinal disorders (FGID). The significance of this issue is caused by high frequency of pathology detection among the young employable population and the difficulties in choosing an effective treatment that relieves not only the symptom severity, but also the frequency of relapses. Inadequate therapy reduces patients’ compliance with treatment and significantly worsens their quality of life. The choice of a drug that fails to provide a positive effect on all factors that form the pain syndrome is the most common reason for ineffective treatment. In addition, the measures aimed at managing such pathogenic factors as intestinal microbiota dysbiosis are often not taken. Meanwhile, numerous studies have shown that the intestinal microbiota imbalance is accompanied by increased intestinal permeability, which leads to the penetration of aggressive agents through extended intercellular spaces. This is accompanied by the occurrence of subclinical inflammation in the submucosal layer, which results in impaired motor function and increased visceral sensitivity. Thus, the intestinal microflora imbalance is one of the most important factors that form clinical symptoms of IBS. The article substantiates the advantages of using trimebutin, a gastrointestinal tract motility regulator, in functional gastrointestinal diseases from the standpoint of evidence-based medicine. The modern scientific knowledge on the  effectiveness of  microbiota  adjustment in  alleviating IBS symptoms is presented. In  particular, the  double-blind, placebo-controlled study has shown the efficacy of a multi-strain probiotic complex in relieving clinical symptom severity of IBS. The optimal treatment regimen for a patient with IBS should include a drug regulating the gastrointestinal motility and reducing visceral hypersensitivity and a probiotic complex containing bacterial strains that have proved their efficacy in this group of patients. 

Constipation is a serious medical and social problem due to the widespread prevalence of this condition, a decrease in the quality of life and social activity of patients. For the successful treatment of constipation, it is necessary to establish the causes leading to the violation of the stool in the patient. And this task is a priority for the doctor at the outpatient stage.

The clinical features of constipation largely depend on their cause, duration, severity and characteristics of intestinal damage. Constipation is often accompanied by general somatic and other gastroenterological symptoms.

Within the framework of the review article, the main conditions and diseases are considered, in the clinical picture of which there is constipation syndrome, which must be considered by the doctor at the outpatient stage when conducting differential diagnosis and prescribing appropriate treatment, which also presupposes impact on causal factors. Currently, drugs based on high molecular weight polyethylene glycol 4000 are widely used to treat chronic constipation in adults and children in most countries of the world. Preparations based on polyethylene glycol 4000 are affordable and easy to use, they can be used both on an outpatient basis and in a hospital. Polyethylene glycol 4000 preparations act quickly, are highly effective and well tolerated, have a  high safety profile  (practically does not affect homeostasis) both for  adult patients and in  pediatric practice. International clinical trials have shown the possibility of long-term use of polyethylene glycol 4000 preparations.

Current international clinical guidelines and domestic clinical guidelines for the treatment of constipation recommend the use of  polyethylene glycol 4000  preparations instead of  lactulose and volume-forming laxatives in  the  symptomatic treatment of constipation in children and adults. In the second part of the review, the possibilities of polyethylene glycol 4000 and the first domestic drug polyethylene glycol 4000 in the treatment of chronic constipation are considered. 

Introduction. IBS is a functional bowel disorder that has a significant impact on patients and society, especially in terms of quality of life and medical costs.

Pathogenesis. It is believed that the pathogenesis of IBS consists of several mechanisms: the syndrome of intersection of functional disorders (gut-brain), stress, visceral hypersensitivity and changes in motor skills.

Visceral hypersensitivity. Changes in visceral sensitivity in IBS are characterized by central abnormalities in areas of the cerebral cortex. Motility impairment in IBS manifests itself as abnormal myoelectric activity in the colon, resulting in repetitive contractions of the small intestine and colon, which appear to cause pain.

Intestinal microflora. FODMAPs are found in high amounts in some fruits, artificial sweeteners, legumes, and green vegetables and are poorly absorbed by all people. FODMAPs have enzymatic and osmotic effects that may contribute to the onset of symptoms in some patients.

The principles of IBS therapy. Treatment for IBS should be based on the type and severity of symptoms. For the treatment of IBS, drugs of various pharmacological groups are used, depending on the prevailing symptoms. These include opioid receptor agonists, bile acid sequestrants, guanylate cyclase agonists, chlorine channel activators, as well as antibiotics, probiotics, antidepressants, 5-HT3 receptor antagonists, and antispasmodics.

Myotropic antispasmodics. Drugs with antispasmodic activity are used to treat functional and organic diseases of the gastrointestinal tract as a basic therapy or «on demand». Mebeverine quickly and effectively relieves spasm, pain and the entire complex of intestinal symptoms, in addition, the drug reduces visceral hypersensitivity due to a local anesthetic effect. The drug has a high safety profile and has a number of advantages over drugs of the same pharmacological group.

Conclusion. Myotropic antispasmodics have been shown to be highly effective in the treatment of IBS. Mebeverine occupies a special place among myotropic antispasmodics. Its combined action provides a pronounced antispasmodic activity along with a high safety profile. 

The human gut microbiota has been a major focus of scientific research in recent years. Studies based on metagenomic methods have revealed the multifaceted abilities of gut microbes, from metabolic functions to immunomodulation, from antipathogenic activity to behavioral formation. Since the gut microbiota plays a crucial role in maintaining human health, more or less specific changes in the gut microbiota are associated with various gastrointestinal diseases. These data strongly support the use of gut microbiota modulators, such as antibiotics, prebiotics and probiotics, as the choice for almost all gastrointestinal disorders. The traditional use of antibiotics in clinical practice is to counteract local or systemic infections. It can be assumed that antibiotics have a detrimental effect on the intestinal ecology. However, this is not true for all antibiotics.

Rifaximin is a non-systemic oral antibiotic derived from rifampin and is characterized by a broad spectrum of antibacterial activity against Gram-positive and negative, aerobic and anaerobic bacteria. Rifaximin was first approved in Italy in 1987 and then in many other countries of the world for the treatment of several gastrointestinal diseases. This review presents the pharmacology and pharmacodynamics of rifaximin, describing various actions beyond its antibacterial activity, such as altering virulence, preventing intestinal mucosal adhesion and bacterial translocation. Key studies on the different uses of rifaximin are also described. In addition, rifaximin has some anti-inflammatory effects with minimal impact on the overall composition of the gut microbiota. All of these properties make rifaximin a good candidate for the treatment of various gastrointestinal diseases.

Inflammatory bowel diseases (IBD), which is a term for two conditions (ulcerative colitis and Crohn’s disease), are chronic inflammatory diseases of the gastrointestinal tract that are the subject of many studies and much discussion around the world. The global prevalence of IBD is 20.4 per 100 thousand for ulcerative colitis and 3.7 per 100 thousand for Crohn’s disease. Every year the number of patients is increasing, which may indicate improvement in diagnosis of IBD, but at the same time demonstrates certain disadvantages and difficulties in the diagnosis and treatment of this group of patients. However, despite the fact that IBD has been exercising the minds of scientists around the world for many decades, many issues of diagnosis and treatment of this pathology appear relevant. Due to the paucisymptomatic condition of patients at early stages and the similarity of its symptoms with other gastroenterological diseases, the diagnosis of IBD involves certain difficulties in many cases. Advanced forms of the disease, as well as complications of IBD, result from late diagnosis. Endoscopic ultrasound (EUS, endo-ultrasound), which includes endoscopic and ultrasound examinations, is a modern imaging technique for the diagnosis of gastrointestinal diseases. The article discusses various international and Russian studies on the use of EUS in various pathologies of the gastrointestinal tract. Despite the absence of EUS in the formal guidelines for IBD, the technique appears promising for diagnosis, differential diagnosis of ulcerative colitis and Crohn’s disease, as well as complications of these diseases, such as primary sclerosing cholangitis, chronic and autoimmune pancreatitis, autoimmune hepatitis, pancreatic cancer, etc.