Abstract Introduction. Modern gastroenterology is characterized by the combined (comorbid) nature of the diseases. In treatment, this promotes polypharmacy and increases complications (drug lesions, allergic reactions, exacerbation of diseases of other organs and systems), and, importantly, increases the cost of pharmacotherapy.

Aim. To compare two pharmacotherapy options for patients with gallstone disease at the stage of biliary sludge and patients with biliary sludge combined with irritable bowel syndrome.

Materials and methods. In the work, based on the experience of treating 170 patients, two options for pharmacotherapy are considered, which may well turn out to be rational in all respects. Option 1 - monotherapy aimed at one of the components that form a complex pathogenetic symptom complex. The basis for offering this treatment option is the biological concept of the “regulatory cascade”. Option 2  – “stepwise” (stepwise) therapy with the  choice of  the “base” drug for  the  first step. Evaluation of the effectiveness and rational correction for the second step of treatment and subsequent ones – if necessary.

 Results. The biliary sludge was eliminated or reduced in patients who received the UDCA monotherapy against the background of recovery of gastrointestinal motility. The overall treatment effect (for each nosology) in patients with biliary sludge and irritable bowel syndrome using the complex therapy (UDCA and mebeverin) was 84 and 87.8% respectively.

Conclusions. Both options are rational today: 1st requires further study; 2nd – active use. Both options exclude polypharmacy and other adverse effects.

Introduction. Tofacitinib is the first member of a new class of targeted synthetic anti-inflammatory drugs for the treatment of ulcerative colitis (UC). The article presents a three-year Russian experience of tofacitinib use for the treatment of moderate and severe UC.

Aim of the study. To evaluate the efficacy and safety of tofacitinib therapy in real clinical practice in moderate to severe UC patients during three years of follow-up.  

Methods. The study included 56 patients with UC who had moderate (60.7%) and severe (35.8%) states of disease, the total lesion was diagnosed in 67.8%, and extraintestinal manifestations in 57.1% of patients. Early achievement of clinical response, clinical and endoscopic, corticosteroid-free remission, and safety were evaluated.

Results. Early response to tofacitinib therapy was obtained in 47 (83.9%) patients. Clinical remission was achieved in 36 (64.3%) at week 8 of therapy and clinical response was achieved in 13 (23.2%) patients. The majority of patients who achieved clinical remission at weeks 8 and 12 achieved healing of colon mucosa at week 24. Clinical and endoscopic remission rates after 24 weeks – 44 (78.6%) patients, clinical response in 7 (12.5%) patients, 5 (8.9%) did not respond to TFCB therapy. Corticosteroidfree remission was 77.6%. After 2 years of tofacitinib therapy, remission of UC was maintained in 46 (82.1%). After 36 months, remission of UC was maintained in 45 (80.3%) of the 56 patients who had been started on tofacitinib therapy. The cumulative effect of survival in the treatment of tofacitinib in UC was 87.5% after 6 months and persisted for one year, 82.1% after 2 years, and 80.3% after 3 years.

Conclusions. The administration of tofacitinib in UC is effective in achieving rapid clinical response, clinical remission, and mucosal healing in patients who do not respond well to biological therapy. 

Introduction. Chronic gastritis is one of the most common problems in gastroenterology and general medical practice. In this study, we tried to analyze the actions of therapists in relation to patients with symptoms of dyspepsia, to assess how different symptom complex affects the choice of therapy and the diagnostics.

Aim. Identifying the process of a preliminary diagnosis by symptoms, determining the ability of physicians to differentiate clinical syndromes, and determining the approaches to empirical therapy at first visit and following the “test and treat” strategy aimed at identifying the H. pylori infection.

Materials and methods. The study was conducted using the CAWI (Computer-assisted Web Interview) method. Each physician who agreed to participate in the study received a link to take the survey and independently entered the answers to the questions formulated by the researcher. The descriptions of three profiles of adult patients with suspected gastritis diagnosis who applied for the first time were suggested: 1) a patient with a pain syndrome and dyspepsia symptoms; 2) a patient with dyspepsia symptoms; 3) a patient with a pain syndrome.

Results. The study involved 205 physicians from 33 cities of Russia. The most commonly assumed diagnosis was gastritis: 50% of responders suggested it for patient 1, 51% – for patient 2, and 40% – for patient 3. Despite the unambiguous description of the delayed motility symptoms in patients 1 and 2, the most commonly assumed diagnoses did not reflect the presence of a problem. At the same time, physicians did not conduct diagnostic tests for H. pylori infection in case of patients 1 and 3 with obvious symptoms of gastritis. In case of infection, physicians suggest prescribing eradication drugs to each patient, and the most popular pharmacological group suggested were PPIs (91%). However, every tenth physician suggested eradication without PPIs.

Conclusion. The results of the survey indicate a lack of awareness among therapists about the symptoms of delayed motility. This leads to the symptomatic pharmacotherapy, which does not provide the rupture of pathogenetic mechanisms

The definition of gastritis is based on the histological features of the gastric mucosa. This is not the erythema observed during gastroscopy, and there are no specific clinical manifestations or symptoms that determine it. The modern classification of gastritis is based on time (acute and chronic), histological features, anatomical distribution and the main pathological mechanisms. Acute gastritis will develop into chronic if left untreated. Helicobacter pylori (H. pylori) is the most common cause of gastritis worldwide. However, from 60 to 70% H. pylori-negative subjects with functional dyspepsia or non-erosive gastroesophageal reflux were also found to have gastritis. H. pylori-negative gastritis is considered when a person meets all four of these criteria: negative triple staining of biopsies of the gastric mucosa, no history of treatment of H. pylori. In these patients, the cause of gastritis may be associated with tobacco smoking, alcohol consumption and / or the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or steroids. Other causes of gastritis include autoimmune gastritis associated with antibodies of serum anti-parietal and anti-internal factor; organisms other than H. pylori, such as Mycobacterium avium intracellulare, Herpes simplex and Cytomegalovirus; gastritis caused by acid reflux; Rare causes of gastritis include collagen gastritis, sarcoidosis, eosinophilic gastritis and lymphocytic gastritis. The clinical picture, laboratory studies, gastroscopy, as well as histological and microbiological examination of tissue biopsies are important for the diagnosis of gastritis and its causes. Treatment of gastritis caused by H. pylori leads to the rapid disappearance of polymorphic-nuclear infiltration and a decrease in chronic inflammatory infiltrate with gradual normalization of the mucous membrane. Other types of gastritis should be treated based on their etiology.

Laryngopharyngeal reflux (LPR) is an actual, modern problem for the practice of an ENT doctor, because majority of complaints lead the patient, first of all, to an otorhinolaryngologist. LPR is an extraesophageal manifestation of gastroesophageal reflux disease (GERD), which leads to a recurrent course of symptoms resulting from the direct action of gastric contents on the mucous membrane of the laryngopharynx when ingested through the upper esophageal sphincter, as well as a decrease in the quality of life. Patients with LPR represent 4% to 10% of outpatients visiting an ENT physician. The main problem of diagnosing of LPR is that there are not any exact researches for this disease, such as PCR-test or biopsy. GERD diagnostic methods performed by gastroenterologists include: assessment of complaints, esophagogastroduodenoscopy (EGDS), intraesophageal pH-metry, esophageal manometry, impedance-pH-metry with the placement of 2 probes in the esophagus and pharynx, gastrointestinal fluoroscopy (GI) with barium, gastroesophageal scintigraphy, abdominal ultrasound (abdominal ultrasound), and pepsin test. All these tests are widely using for diagnosis and sometimes helps us. But the question remains: do all these research methods allow to establish the presence of LPR? Interpretation of existing studies is difficult due to the ambiguous diagnostic criteria for LPR, varying rates of response to treatment, and the significant effect of placebo treatment. Therefore, diagnostic methods for LFR require further study and development.

Chronic pancreatitis is a multifactorial disease in which repeated episodes of inflammation of the pancreas contribute to the development of fibrous tissue, leading to chronic pain, as well as exocrine and endocrine insufficiency. The incidence and prevalence of chronic pancreatitis in the world are growing, as evidenced by current statistics. In addition, the annual costs associated with the treatment of exocrine and endocrine insufficiency are also increasing. In the United States alone, the annual cost of treating these complications is $ 75.1 million. Exocrine insufficiency is one of the most frequent complications, which is characterized by a deficiency of pancreatic enzymes, leading to the development of malabsorption syndrome (impaired absorption of nutrients, vitamins and minerals). Due to the increased incidence and deterioration of the quality of life associated with this condition, the goal of treatment is to compensate for the deficiency of exocrine enzymes with oral pancreatic enzyme replacement therapy. The core of this therapy is to deliver activated, unbroken enzymes directly to the small intestine during a meal. Many studies have shown that prescribing enzyme replacement therapy improves symptoms associated with exocrine insufficiency, reduces the progression of osteopenia, and improves survival in such patients. The use of pancreatin contributes to the correction of exocrine insufficiency in patients with chronic pancreatitis. The data presented in the article indicate that the drug is a safe and effective agent, meets all modern standards and requirements, and can be used to correct enzymatic pancreatic insufficiency.

The relationship between metabolic non-alcoholic fatty liver disease (NAFLD) and gallstone disease (GSD) is complex and seemingly interrelated. There is no doubt that there is an increased risk of cholelithiasis in patients with NAFLD, which is primarily associated with general pathogenetic mechanisms. These include central and peripheral insulin resistance, changes in the expression of transcription factors (hepatic X-receptor, farnesoid X-receptor (FXR) and membrane bile acid receptors (TGR5)). At the same time, the effect of gallstone disease on the course of NAFLD is assumed, although the pathogenetic factors of this association are still insufficient. There are accumulating data on an increased risk of other pathologies of the biliary tract in patients with NAFLD, in particular, of gallbladder polyps and tumors of the biliary tract. Recently there have been convincing data on the role of cholecystectomy in the progression of NAFLD, which may be due to disruption of endocrine balance and signaling function of  bile acids, as well as the  development of  bacterial overgrowth in  the  small intestine. General therapeutic approaches to the treatment of interrelated hepatobiliary pathology may include new generation insulinsensitizers, FXR agonists, and ursodeoxycholic acid. The link between NAFLD and the pathology of the biliary tract is complex and multifaceted, and its further study opens up prospects for the development of new methods of treatment.

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of liver disease in highly developed countries. The risk of developing NAFLD and associated complications varies greatly among people of different nationalities and is determined by environmental and genetic factors. Genome-wide studies have revealed strong and reproducible associations between gene variations such as PNPLA3, TM6SF2, MBOAT7, GCKR, HSD17B1, and NAFLD. In this article, we consider the influence of genes and environmental factors on the pathophysiological features of NAFLD. The use of a sufficient population sample with the analysis of SNP arrays and the use of sequencing methods (exome and genome as a whole) will lead to the discovery of additional genetic variants, will inevitably improve the understanding of the pathogenesis of NAFLD, and will allow the development of a technology for personalized risk in assessing the disease in a patient. The aim of our study was to study the genetic predictors of NAFLD based on literature data with the interpretation of the studies. There is now strong evidence that specific variants of genetic risk have a large effect on NAFLD, and their effect is comparable to that of major metabolic risk factors such as obesity and type 2 diabetes. The increased risk extends to the onset and progression of the entire spectrum of NAFLD manifestations, including overall mortality due to liver disease. Currently, individual genetic variants do not allow the creation of a personalized risk profile; therefore, the most expedient approach today is the development of polygenic risk assessments. The number of genetic loci associated with the prevalence and outcome of NAFLD remains limited. The use of a sufficient population sample with the analysis of SNP arrays and the use of sequencing methods (exome and genome as a whole) will lead to the discovery of additional genetic variants and will inevitably improve the understanding of the pathogenesis of NAFLD and will allow the development of a technology for personalized risk in the assessment of the disease.

Thyroid gland (TG) and the liver are in a complex relationship in both physiological and pathological conditions. Thyroid hormones accelerate metabolic processes, intensify the synthesis of proteins and vitamins, play an important role in the development and differentiation of all cells, including hepatocytes. In addition to the central role in the deiodination of thyroid hormones with the formation of their more active and inactivated forms, the liver also carries out their transport. Dysfunction of TG can lead to changes in liver function, and in liver diseases, abnormalities in the metabolism of thyroid hormones can occur. Most often, liver pathology in diseases of TG is manifested by an increase in the serum activity of enzymes of cytolysis and/or cholestasis. Changes in liver function tests are often observed in patients with thyrotoxicosis. They are based on oxidative stress or cholestasis. The increased activity of osteoblasts in hyperthyroidism leads to an increase in the bone fraction of alkaline phosphatase, which must be taken into account in the differential diagnosis. Hepatotoxicity of thyreostatic drugs is relatively common, ranging from minimal hepatocellular damage to fulminant liver failure. In the case of hypothyroidism, the pathophysiological mechanisms are mainly represented by lipid metabolism disorders leading to fatty degeneration. It should be remembered that severe hypothyroidism can be manifested by hyperammonemia and edematous-ascitic syndrome, requiring differential diagnosis with liver failure. Treatment of liver pathology in TG diseases includes normalization of thyroid status, and in cases of drug hepatitis – temporary withdrawal of a potentially hepatotoxic drug. The data on the association of hypothyroidism and non-alcoholic fatty liver disease in the aspect of developing new therapies are very interesting.

This article provides an overview of the data on postcholecystectomy syndrome (PCES). The entire period of study of this frequent complication (up to 40%) can be divided into 2 periods: surgical and therapeutic. Surgical complications of cholecystectomy accounted for 10% and were studied by surgeons. This study led to the correction of surgical treatment, formulated the examination program and reduced and minimized surgical complications. The second part of the complications is made up of functional disorders of the sphincter of Oddi, which today are the leading ones and, apparently, remain so. The article gives an idea of PCES as a dynamic disorder of the sphincter of Oddi, gives the last definition of PCES given by the IV Roman Concensus, suggests an algorithm for diagnosis and treatment. As a clinical illustration, the authors present their own data on the diagnosis and treatment of 60 patients with PCES, which confirmed the point of view proposed by the international gastroenterological community. The authors separated two types of postcholecystectomy syndrome: one with a predominance of sphincter of Oddi (SO) spasm and another with a predominance of sphincter of Oddi hypotension. The drug of choice in the spastic type is the selective antispasmodic gimecromone, in which case a dose is of the essence. In case of a hypotonic type of postcholecystectomy syndrome, motor regulators to increase the SO tone should be used. The therapy should be stepwise with an assessment of the effect and correction of the next step of treatment. This treatment option for patients with postcholecystectomy syndrome we see today as the leading one. The features of treatment associated with the developing syndrome of bacterial overgrowth (SIBO) and chronic biliary insufficiency (CBI), which require constant monitoring (diagnosis) and permanent treatment, are considered.

Hepatic encephalopathy (HE) remains one of the most serious complications of liver cirrhosis. Its clinical spectrum sometimes creates difficulties in the optimal diagnosis at the patient’s bedside and treatment. To present new data on the field of clinical management of cirrhotic patients with hepatic encephalopathy. The role of ammonia in the diagnosis of HE is still under discussion. In clinical practice, in patients with suspected overt HE, normal ammonia concentration can be used to exclude this diagnosis. In contrast, a high concentration of ammonia in the absence of clinical signs of HE should not serve as a criterion for this diagnosis and as a guide for treatment. A separate issue for discussion is the covert HE. The simplest and most affordable test for screening for covert HE and evaluating the effectiveness of therapy is the animal naming test, which can be done on bedside by physician or caregivers. Patients with covert HE need treatment that is similar in approach to overt HE. The diagnosis of overt HE and the methods of its therapy are well known. According to Russian recommendations, depending on the disease course in a certain patient, lactulose, rifaximin, L-ornithine L-aspartate can be used as first-line drugs, which is applicable to the treatment of both overt and latent PE. The main issues on the management of HE in liver cirrhosis relate to the diagnostic role of ammonia, optimal diagnosis and treatment strategy for covert HE, therapy of choice for both overt and latent HE. There are expert opinions and consensus documents on all these issues. Treatment of overt and latent PE is carried out according to the same principles. Drugs of choice: lactulose, rifaximin and L-Ornithine L-Aspartate.

Medicinal liver damage is an important problem not only in the framework of hepatology and gastroenterology, but also for internal medicine in  general, which is due to the  difficulties of  correct and timely diagnosis of  this pathology. In  the  first part of the review, the main mechanisms of liver tissue damage and clinical and formological manifestations of drug-induced liver damage are considered.

The pandemic of the new coronavirus infection (COVID-19), spread by the SARS-CoV-2 virus, has become a challenge to health systems around the world. The global clinical experience gained over the past year in the management of patients with a new coronavirus infection makes it possible to highlight a number of relevant clinical aspects, one of which is drug-induced liver damage associated with the treatment of COVID-19. In the second part of the review, the possible mechanisms of influence of COVID-19 on the hepatobiliary system are considered, which include viral cytotoxicity, a secondary effect of immune dysregulation; hypoxia as a result of respiratory failure and subsequent ischemic liver damage; reactivation of already existing liver pathology and drug damage to the liver. It has been established that a large number of drugs used to treat COVID-19 - antiviral agents, antibacterials, non-steroidal anti-inflammatory drugs, steroids and others - have hepatoxic effects and can cause liver damage. In the context of the COVID-19 pandemic, for patients with a new coronavirus infection and drug-induced liver damage, a rational, pathogenetically justified choice of a hepatoprotective drug is of particular importance. In the final part of the review, the possibilities of the polyionic succinate-methionine complex in the treatment of drug-induced liver damage are considered and a clinical example of the drug application in a patient with drug-induced liver damage during treatment with COVID-19 is given.

In  the  structure of  gastrointestinal diseases, the  pathology of  the  hepatobiliary system currently ranks second in  frequency of occurrence. The stages of diseases of the biliary system can be combined into the so-called “biliary continuum”, when one patient has a consistent development of pathogenetically related diseases of the biliary tract. The progressive course of functional motility disorders of the biliary tract gradually leads to the development of organic pathology, including chronic cholecystitis, the subsequent development of gallstone disease and possible postcholecystectomy complications. Among the diseases of the biliary system, one of the most frequently used diagnoses is chronic cholecystitis. The development of chronic cholecystitis is associated with repeated attacks of acute inflammation or prolonged irritation of large gallstones. The clinical aspects of chronic cholecystitis and other pathologies included in the the «biliary continuum» largely depends on concomitant dyskinesia. There are several directions for the treatment of pathologies of the biliary system: diet therapy, medication, endoscopic and surgical treatment. According to the latest guidelines, the most important direction in modern therapy of diseases of the biliary system is the restoration of the motility of the biliary tract and the normalization of the physicochemical properties of bile. The central place in the treatment of diseases of the “biliary continuum” is given to antispasmodic drugs. The administration of antispasmodics is recommended in order to relieve biliary pain and dyspeptic symptoms caused by spasm of smooth muscles, as well as to control the inflammatory process due to a decrease in the release of pro-inflammatory substances. This article describes in detail the importance of the recovery of the biliary tract motor activity and the improvement of the physico-chemical properties of bile acids.

This article reviewed the mechanisms of action of probiotics and the possible effects of individual strains on the general wellbeing if they are taken daily.

The content and activity of bacteria in food products should be regulated by special guidelines. The balanced nutrition allows us to get healthy strains in a natural way. Daily consumption of certain strains as part of functional food products is promising for the prevention of obesity, type 2 diabetes mellitus, non-alcoholic fatty liver disease, functional intestinal disorders, colon cancer, cardiovascular diseases and depression. The issues of safety of novel probiotic strains newly introduced in clinical practice require careful consideration. Synbiotics can comprise probiotic strains of bacteria (Lactobacillus acidophilus La-14, Lactobacillus rhamnosus Lr-32, Bifidobacterium lactis Bl-04) with tolerance to acid, pepsin and bile salts, as well as the prebiotic inulin and vitamins B1, B2, B6 and B12 contributing to survival of beneficial bacteria. L. acidophilus is a common probiotic that occurs in the natural environment and food products, no cases of antibiotic resistance of this species have been established. Strains Lactobacillus acidophilus La-14, Lactobacillus rhamnosus Lr-32, Bifidobacterium lactis Bl-04 have a high adhesion capacity, strong inhibitory effects on intestinal pathogens, including fungi, anti-inflammatory effects, help to eliminate oxalates. As can be seen from the above, the use of probiotics and synbiotics is one of the most promising preventive fields of medicine.

Introduction. Ulcerative colitis (UC) is one of the severe therapeutic diseases. High doses of oral granular mesalazine are required to maintain clinical and endoscopic remission of UC, which may be sufficient and supposedly more acceptable for patients, as some studies showed that adherence to topical therapy is significantly lower than to oral 5-ASA drugs.

Objective of the study. To evaluate the efficacy of therapy of patients with moderate left-sided ulcerative colitis (UC) and pancolitis receiving prolonged-release ethylcellulose-coated mesalazine.

Materials and methods. The evaluation of the outcomes of treatment of UC patients who received prolonged-release mesalazine was carried out. We examined 87 patients with UC who received granular ethylcellulose-coated mesalazine, of those 38 (43.7%) men and 49 (56.3%) women. The average age of the enrolled patients was 38.3 ± 12.6 years.

Results and discussion. After 2 weeks from the beginning of therapy with prolonged-release mesalazine, the majority of patients – 71 (81.6%) responded to the therapy. After 12 weeks, 71 (81.6%) of 87 UC patients, who responded to therapy with prolongedrelease mesalazine, remained in clinical remission. On average, the Mayo score in the group decreased from 7.6 ± 0.99 to 2.6 ± 0.25 points. There was a significant decrease in CRP, ESR, leukocytosis, and fecal calprotectin. After 26 weeks, Mayo score in the group of patients remained on average at the level of 2.2–2.3 points. The number of UC patients with colon mucosal healing was 32 (36.8%) patients. A year after the start of therapy with prolonged-release mesalazine, 69 (79.3%) UC patients who responded to therapy had a clinical remission, of those 32 (36.8%) patients had a clinical and endoscopic remission. During the year of observation, no case of surgical intervention or re-hospitalization due to exacerbation of the disease was recorded in patients with UC who achieved remission.

Conclusions. Treatment of moderate active UC should begin with oral mesalazine ≥ 3 g per day in combination with topical mesalazine. The prolonged-release mesalazines are the most preferred

Introduction. The study of the problem of irritable bowel syndrome (IBS) in recent years has been very dynamic. In the Rome IV criteria, new criteria for the diagnosis of this pathology were proposed. Along with the existence of ethnic and geographic differ­ences, this has led to an increase in the activity of studies on the prevalence of IBS.

Aim. To study the prevalence and risk factors of irritable bowel syndrome in Irkutsk.

Materials and methods. A single-stage observational non-randomized study was performed on the basis of three medical institu­tions in Irkutsk. Interviewing and clinical examination were performed in 1 529 people: 724 men and 805 women, average age 51.0 years. The questionnaire contained questions to determine the presence of alarm symptoms. The diagnosis of IBS was based on the Rome IV criteria. IBS with a predominance of diarrhea, IBS with a predominance of constipation and mixed and undiffer­entiated IBS were distinguished. Taking into account the position of the Rome IV criteria and the recommendations of the American College of Gastroenterology (2021), we used a positive diagnosis of IBS in our study and did not perform an instrumental examination of patients.

Results. The prevalence of IBS was 12.3%. Among the subtypes of IBS, IBS prevailed with a predominance of constipation (preva­lence 5.7%) and IBS of mixed and undifferentiated type (prevalence 4.6%). Risk factors for IBS were female sex (OR = 0.73; CI 0.53-0.99; p = 0.05), age over 50 years (OR = 0.66; CI 0.48-0.90; p = 0.01) and obesity (OR = 0.46; CI 0.31-0.69; p < 0.001). Risk factors for IBS with a predominance of constipation were female sex (OR = 0.46; CI 0.29-0.73; p = 0.001), age over 50 years (OR = 0.46; CI 0.29-0.73; p = 0.001) and obesity (OR = 0.41; CI 0.23-0.72; p = 0.002).

Conclusions. In general, our results are consistent with data from other regions of the world. It should be emphasized that the prevalence of IBS in Irkutsk is quite high, which requires careful attention to this problem.

The presentations of dyspepsia include a range of clinical symptoms, each of which has different mechanisms of development, and, therefore, requires different approaches to the correction. In this context, the combination preparations containing components of natural origin with polymodal action on the gastrointestinal tract deserve special attention. Combination of synergistic components: highly bioavailable curcumin and prebiotic fibers; artichoke leaf extract and chamomile flower extract provide simultaneous effects on three key digestive organs: stomach, pancreas and liver. Curcumin has an anti-inflammatory effect, helps to normalize acidity and restore microflora; epithelialization of ulcers; normalization of the gallbladder function; elimination of toxins. It inhibits the processes of primary tumour formation and prevents the development of metastatic processes in gastrointestinal cancer. Pharmaceutical technologies using cyclodextrin as an excipient increase curcumin’s water solubility, dispersibility and absorption, which has been confirmed in several comparative bioavailability studies in healthy volunteers. Chamomile flower extract has anti-inflammatory, antimicrobial, antispasmodic, antiulcer, wound healing and astringent effects. Chamomile is rich in slimy substances that envelop and protect the inflamed mucous membrane, including the stomach, from irritation with hydrochloric acid, bile components, food, and drugs. Mucous substances also have an anti-inflammatory effect and improve digestion. The artichoke facilitates the outflow of bile, affects the secretion of gastric glands, pancreas, increases the enzymatic activity of gastric juice, enhances intestinal motility during its atony, and has a hepatoprotective effect. As can be seen from the above, a combination of these synergistic components can be used in patients with chronic diseases, functional disorders as part of combination therapy, as well as for the prevention of gastrointestinal diseases in healthy people.

The review article describes the epidemiology, clinical picture, pathogenesis, approaches to the diagnosis and treatment of chronic gastritis and functional dyspepsia. Chronic gastritis is an unreasonably common diagnosis in our clinical practice, which is diagnosed in patients with disturbing dyspeptic complaints. According to the agreement documents, chronic gastritis is primarily a morphological concept. Chronic gastritis has no pathognomonic clinical signs and should be diagnosed during the histological examination of the gastric mucosa. Functional dyspepsia is a diagnosis that reflects the presence of a certain symptom complex (pain  or burning sensation in  the  epigastrium, a  feeling of  fullness or early satiety) in  the  absence of  diseases that could explain the symptoms. Secondary dyspepsia is diagnosed in patients with organic diseases of the upper gastrointestinal tract, metabolic or systemic diseases that cause dyspeptic syndrome. In the process of examining a patient with disturbing dyspeptic complaints, it is advisable for the doctor to use the diagnosis “unspecified dyspepsia” – a preliminary diagnosis before laboratory and instrumental examination aimed at identifying the cause of the dyspeptic syndrome. Dyspepsia associated with H. pylori is diagnosed in patients with H. pylori infection. The diagnosis is revised over time and is competent if complaints have been relieved within 6 months after effective H. pylori eradication.

The main drugs for the treatment of patients with dyspeptic complaints are proton pump inhibitors and prokinetics. Omeprazole with domperidone sustained release (SR) in a fixed dose combination is characterized by optimal efficacy and a good safety profile in patients with both functional and secondary dyspepsia and ensures a high level of treatment adherence.

Introduction. The paper presents modern literature and clinical research data on the efficacy and safety of dietary therapeutic and prophylactic foods in the complex therapy of diseases associated with Helicobacter pylori. Aim. To assess the efficacy and safety of the use of dietary therapeutic and prophylactic food products in the complex therapy of diseases of the gastrointestinal tract associated with Helicobacter pylori. Materials and methods. To evaluate the efficacy of dietary therapeutic and prophylactic food products such as Vegetable Puree Soup with Herbs and Oatmeal, Oatmeal Porridge with Herbs and Flax Seed, Protein-Sea Buckthorn Cocktail (LEOVIT Nutrio LLC), the main group of patients with gastrointestinal diseases (n = 41) was formed, which was further divided into four subgroups. Each of three subgroups received one specialty food product, and the fourth subgroup received all three products. Changes in complete blood count were evaluated using Sysmex XT-2000i analyzer, those in proteinograms – using SAS1, SAS2 protein fraction analyser and those in metabolic liver disorders, lipid profile and glucose level – using Konelab PRIME 30i (Thermo Fisher Scientific) analyzer. All parameters were studied three times: before use, 14 and 60 days after use of the products. Results and discussion. After 14 days, complaints of lack of appetite decreased in the main group, discomfort in the epigastrium, feeling of heaviness and nausea decreased. After 60 days, 100% of patients reported no heartburn, belching, nausea, pain, rumbling in the abdomen, appetite and stool returned to normal. There was a marked significant (p < 0.05) decrease in the level of alpha-1 globulin against the background of an increase in albumin, a decrease in the concentration of CRP and ESR, the levels of leukocytes and neutrophils in all subgroups of the main group after 60 days. Conclusions. The investigated products are safe, no adverse reactions were noted, including the phenomena of intolerance and allergies, and are recommended for use in dis[1]eases of the gastrointestinal tract associated with Helicobacter pylori.