Currently, functional dyspepsia (FD) and irritable bowel syndrome (IBS) are among the most common nosological  units in the structure of functional gastrointestinal  diseases in adults. An important problem of treatment of these diseases at the current stage of medicine is low efficiency of monotarget drugs, which is determined by multicomponent pathogenesis. Indeed, the currently available  methods of drug treatment of FD and IBS have suboptimal  efficacy, as illustrated  by recent meta-analyses demonstrating high rates of NNT (the average number of patients who need to be treated to achieve a certain favorable outcome). In addition, the frequent “overlap” of these diseases forces clinicians to prescribe several drugs with different pharmacological actions to the patient, which inevitably leads to a decrease in compliance. The optimal strategy for managing patients with FD and IBS is the tactics of multitarget drugs that act on several links in the pathogenesis of these pathologies and have a significant evidence base in the effectiveness and safety of use. STW 5 (Iberogast®), included  in the clinical  guidelines  of the Russian Gastroenterological Association on the diagnosis and treatment of patients with FD, published in 2017, has the above-mentioned characteristics, as well as the clinical guidelines of the Russian Gastroenterological Association in collaboration with the Russian Association of Coloproctologists on the diagnosis and treatment of IBS, published in 2021. The clinical effectiveness of Iberogast in the treatment of FD and IBS has been demonstrated in a number of randomized trials, the results of which showed high efficacy of the drug and its good tolerability.

Gastroesophageal reflux disease (GERD) is one of the most common causes of health care seeking at the primary care level in many countries. At an epidemiological level, GERD has been shown to be associated with a number of risk factors: obesity, tobacco smoking, alcohol abuse, certain patterns of eating behaviour, and the use of several medications. GERD is now regarded as a heterogeneous disease and includes different phenotypes (erosive reflux disease, non-erosive reflux disease, hypersensitive oesophagus, functional heartburn), the proper diagnosis of which improves the effectiveness of therapy in patients with heartburn symptoms. Daily impedance–pH monitoring is known to be an integral part of the diagnostic algorithm for GERD and is a functional diagnostic method to record all types of refluxes entering the oesophagus regardless of pH, to assess their association with symptoms, and to determine whether patients with heartburn symptoms belong to a particular phenotype. Esophageal manometry plays a key role in the evaluation of patients with heartburn symptoms, as it helps to rule out other conditions that may mimic GERD: achalasia cardia and scleroderma esophagus. This technique is used to assess thoracic esophageal motility and sphincter function and in the assessment of patients prior to antireflux surgery or in the refractory course of GERD. The article describes in detail GERD risk factors (triggers of heartburn), as well as diagnostic aspects, taking into account a differentiated approach to patients with heartburn based on daily impedance–pH monitoring data in accordance with the current guidelines and recommendations.

Introduction. Gastroesophageal reflux disease (GERD) is extremely common in the structure of gastroenterological diseases. Aim. To conduct a prospective observational post-marketing study of rabeprazole (Razo®) 20 mg taking once daily in patients with non-erosive reflux disease (NERD) after 2 and 4 weeks of therapy and esophagitis stage A and B after 4 weeks of therapy (GERBERA).

Materials and methods. 75 patients with GERD were included in the study (36 men and 39 women, mean age 41.7 ± 1.5 years). Clinical examination with the completion of standard questionnaires, assessment of the quality of life of patients were performed at three visits: before the start of the treatment, after 2 and 4 weeks of therapy. Fibroesophagogastroduodenoscopy was performed in all patients before treatment and in patients with esophagitis after 4 weeks of therapy. All patients received rabeprazole (Razo®) at a dose of 20 mg once a day for the treatment of GERD. The diagnosis of heartburn and sour eructation was carried out according to the recommendations of the Montreal Consensus, the diagnosis of esophagitis was performed based on the Los Angeles classification.

Results and discussion. Among patients with NERD, 74.1% of patients responded to Razo® therapy after 2 weeks of treatment, after 4 weeks  the proportion of responders increased to 94.4% (p = 0.008). Healing of erosions after  4 weeks  was observed  in 90.5% of patients with esophagitis. Razo® therapy was accompanied by a pronounced improvement in GERD patients in all parameters of quality of life and patient satisfaction with the results of Razo® treatment.

Conclusion. Based on the results of our study, we obtained high efficacy of Razo® at a dose of 20 mg once a day for the treatment of patients with NERD and erosive esophagitis.

Introduction. The growth of gastrointestinal diseases associated with gastroesophageal reflux disease (GERD) dictates the need to develop methodological approaches for early outpatient diagnosis of comorbid gastrointestinal conditions using generally available methods, including transabdominal ultrasound (USR).

Aim. To determine significant sonographic parameters of colon lesions in patients with polymorbid GERD, associated with clinical and metabolic concomitant changes, in order to improve transsyndromic diagnosis at an outpatient appointment.

Materials and methods. The study included 150  outpatients  with  GERD  (60  men  and  90  women)  with  an  average  age of 40.2 ± 3.1 years old. All patients underwent clinical and laboratory examination, esophagogastroduodenoscopy, colonoscopy, ultrasound of the gastrointestinal tract with the calculation of the volume of gastroesophageal (GE) refluctate.

Results  and discussion. In patients with GERD, the criteria reflecting the pathological conditions  of the colon  according  to  the data of colonoscopy and ultrasound had a direct correlation. Statistically significant relationships between ultrasound signs of lesions of various segments of the colon with gender, age of patients, body mass index, erosive reflex disease and the volume of GE refluctate, as well as with lactase and vitamin D deficiency, the presence of yeast-like fungi and an increase in the level of fecal calprotectin are shown.

Conclusions. The practical significance of the work lies in the possibility of diagnosing morphofunctional disorders of the colon in GERD patients with comorbid gastrointestinal pathology, associated not only with the main, but also with concomitant diseases by the ultrasound technique at the place of medical care. Tuning of gastrointestinal sonography, aimed at the immediate integration of ultrasound images into the patient management plan, involves the expansion of transsyndromic diagnostics and the substantiation of therapeutic tactic at an outpatient appointment.

Clarification of the term dyspepsia is associated with the development of ideas about functional diseases of the gastrointestinal tract (GIT) and the development and implementation of the Rome criteria for these diseases. Dyspepsia is a complex of symptoms related to the gastroduodenal region and includes epigastric pain and burning sensation, epigastric fullness after eating, and early satiety. Dyspepsia is widespread, with about 20% of the adult population having these symptoms. It is important to note that in the majority of individuals with dyspepsia (up to 80%), the organic, systemic or metabolic cause of symptoms cannot be identified using traditional diagnostic methods, indicating its functional nature. In H. pylori-infected patients with dyspepsia, symptoms may be associated with gastritis if successful eradication is followed by sustained remission (H. pylori-associated dyspepsia). If dyspepsia persists after etiological treatment of bacterial gastritis, a diagnosis of functional dyspepsia should be established. A feature of functional dyspepsia is the frequent overlap of its clinical variants (postprandial distress syndrome (PPDS) and epigastric pain syndrome SBE) in one patient, as well as the frequent combination with other functional diseases (for example, irritable bowel syndrome (IBS)) and gastroesophageal reflux disease (GERD). For the symptomatic treatment of functional dyspepsia, drugs of various groups are prescribed: gastric acid supressants, prokinetics, selective serotonin reuptake inhibitors, tricyclic antidepressants, as well as new drugs for this indication (H1 blockers, budesonide). The effectiveness of proton pump inhibitors, including in combination with prokinetics, has a high level of scientific evidence.

Preparations of glycyrrhizic acid (GA) and ursodeoxycholic acid (UDCA) are effective in the treatment of various forms of non-alcoholic fatty liver disease (NAFLD) and gastroesophageal reflux disease (GERD) occurring against the background of duodeno-gastroesophageal reflux. However, their effectiveness in the treatment of hologenic diarrhea and reflux gastritis has not been sufficiently studied. Currently, there are no clinical guidelines for the diagnosis and treatment of patients with hologenic diarrhea and reflux gastritis, including those with obesity and NAFLD. It is assumed that the combined administration of GA and UDCA can be accompanied by a mutual potentiation of the effect of the drugs. The article presents a clinical case of a patient with NAFLD, obesity, dyslipidemia, GERD, refractory to treatment with proton pump inhibitors, associated with duodenogastroesophageal reflux, reflux gastritis and hologenic diarrhea. It was shown that GERD, reflux gastritis, and hologenic diarrhea developed in the long-term period after cholecystectomy. At the same time, the appointment of a complex preparation containing GA (35 mg) and UDCA (250 mg) made it possible to stop the manifestations of a typical reflux syndrome in patients with a form of GERD refractory to proton pump inhibitors, reflux gastritis, and diarrheal syndrome associated with an excess of bile acids, improve lipid profile parameters. It has been shown that the administration of GA (35 mg) and UDCA (250 mg) can improve the parameters of the intestinal microbiome and lipid metabolism, which can be used in the treatment of patients with atherogenic dyslipidemia. At the same time, patients with comorbid pathology, including NAFLD, GERD, reflux esophagitis, hologenic diarrhea, and dyslipidemia require long-term maintenance therapy with GA (35 mg) and UDCA (250 mg).

The purpose of the  review is to  analyze  the  data  of  the  latest  scientific studies  assessing  the  diagnostic and  predictive  value of the indicator of the ratio of neutrophils to lymphocytes (NLR) in patients with diseases of the gastrointestinal tract and liver. Patients with non-alcoholic  fatty  liver  disease  (NAFLD)  have  the  increased  ratio  of  neutrophils  to  lymphocytes  correlated with the severity of fibrosis and the activity of the disease, and also made it possible to differentiate patients with steatosis and non-alcoholic steatohepatitis (NASH). NLR of patients with liver cirrhosis has shown its prognostic significance in the development  of death, comparable to the MELD and Child – Pugh scales, and in some studies even surpassed them. Contradictory data have been obtained regarding its predictive value at risk of infectious complications in this category of patients. In patients with Crohn’s disease (CD) and ulcerative colitis (UC), an increased value of NLR was associated with the activity of the disease. NLR serves as a predictor of death and a more severe course of acute pancreatitis. In patients with acute appendicitis, NLR has shown its diagnostic significance in identifying its severe forms. NLR has also shown its prognostic value in the development of death among patients with gastrointestinal cancer. NLR serves as a marker of systemic inflammation, which can be calculated using the parameters of the simple clinical bloode test, which is available in everyday clinical practice. The value of NLR is due to its non-invasiveness and low cost. The analysis of the literature showed its predictive and diagnostic value in certain diseases of the gastrointestinal tract and liver.  The higher the indicator under study, the worse the prognosis of the disease and/or life of the patient. However, there is no consensus on the gradation of NLR and cut-off levels fluctuate in various studies, and their results are often contradictory. Also, most studies are retrospective, so it is necessary to conduct major prospective studies in this direction.

Today, nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) account for more than 50% of chronic liver diseases and cirrhosis in developed countries. The clinical significance of these pathologies lies in the formation of liver fibrosis and, therefore, in the increased risk of liver cirrhosis and hepatocellular carcinoma, which are life-threatening conditions. NAFLD is based on obesity and insulin resistance, whereas alcohol consumption is central to the etiopathogenesis of ALD. Recently, the role of the gut-liver microbiota axis in the genesis of NAFLD and ALD has also received increasing attention. Changes in qualitative and quantitative composition of intestinal microbiota and alterations of barrier function of intestinal mucosa can lead to entry of intraluminal antigens through portal vein system into the liver, inducing damage to hepatocytes and activation of proinflammatory processes. It is shown that in patients with CLD (NAFLD and ALD) there is an increase in  the permeability of the intestinal mucosa and dysbiotic changes of the intestinal microbiome. The role of the gut-liver microbiota axis is well described in the genesis of NAFLD and ALD. Chronic alcohol consumption leads to increased colonies of Gram-negative bacteria in the intestinal mucosa and, therefore, to the accumulation of endotoxins (lipopolysaccharide components of bacterial cell membranes). Acetaldehyde produced by ADH of the intestinal epithelium stimulates tyrosine phosphorylation of tight cell contacts, increasing intestinal mucosal permeability, which leads to translocation of endotoxins into the portal bloodstream. Obesity is a major risk factor for NAFLD, which is also associated with dysbiotic changes in the intestinal microbiome. Obese individuals have increased Firmicutes, decreased Bacteroidetes, mediated reduction of short-chain fatty acid synthesis and increased intestinal wall permeability due to disruption of intercellular dense contacts, which leads  to increased translocation of bacteria and endotoxins into the systemic bloodstream.

Introduction. The diagnosis of alcohol-related liver disease is limited by the lack of a tool to reliably identify whether the present deterioration in the patient’s condition is due to alcohol consumption or other causes.

Purpose. to conduct a comparative assessment of the clinical and diagnostic significance of liver function biochemical indicators (AST, ALT, GGT, ALP) and their calculated derivatives (AST/ALT, GGT/ALP, GGT/GGTn, ALP/ALPn) as markers of alcohol consumption in patients with alcoholic liver cirrhosis.

Material and methods. The observational study included 112 men over 18 years of age with alcohol-related liver cirrhosis. The patients were assessed the severity of liver cirrhosis according to the Child-Pugh scale, performed general and biochemical blood tests, coagulation test, assessment of the fact of alcohol consumption by the level of phosphatidylethanol. An analysis was made of the relationship between alcohol consumption and changes in laboratory parameters of liver function, with the determination of their sensitivity and specificity.

Results. Patients with Child-Pugh B cirrhosis who consumed alcohol on phosphatidylethanol had higher levels of plasma albumin, GGT, and lower values of creatinine, direct and total bilirubin, urea, and aPTT compared with patients who did not drink alcohol (p < 0.05). Alcohol-drinking patients with class C cirrhosis have higher ALT levels compared with abstinent patients with the same severity of cirrhosis (p < 0.05). The relationship between the fact of alcohol consumption, determined by the level of phosphatidylethanol, and the ratio of GGT of patients to the normal GGT value, as well as between the ratio of GGT to alkaline phosphatase and the degree of increase in GGT, turned out to be statistically significant. To assess the fact of alcohol consumption, the level of serum GGT > 65 IU/ l (75.5%) has the highest sensitivity, the highest specificity is the ratio of the patient’s GGT to the normal value of GGT > 2 (82.9%).

Conclusion. Compared with the known 100% sensitivity and > 92% specificity of Peth as a alcohol biomarker, among the biochemical indicators of liver function and their calculated derivatives, GGT > 65 IU/l have the greatest sensitivity or specificity (respectively, 75.5% and 65%) and GGTnorm. > 2 (37.7% and 82.9%, respectively), which makes it possible to use the totality of these parameters as an indicator of the continued impact on the patient of the main etiological factor of alcohol-related liver cirrhosis in the routine practice of most medical organizations of the Russian Federation.

Gallstone disease (GSD) is currently one of the most common diseases of the gastrointestinal tract, especially among people of working age, and has a clear tendency to increase and expand the age range towards rejuvenation. To date, the possible links in the pathogenesis of cholelithiasis have been well studied and described, risk factors and clinical manifestations have been studied and described, among which the asymptomatic course of cholelithiasis, which is often noted at the first latent stage of the disease, is important. It is at this stage that preventive conservative treatment allows most patients to avoid stone formation. However, after ascertaining biliary sludge, therapeutic correction is not carried out. Among the drugs used as oral litholytic therapy, ursodeoxycholic acid (UDCA) is used, which is effective for predominantly cholesterol (X-ray negative) calculi up to 15–18 mm in size or biliary sludge in the form of putty bile. It is known that UDCA changes the ratio of cholesterol/bile acids in bile, which contributes to the mobilization of cholesterol from gallstones and cause their partial or complete dissolution, and prevent the formation of new calculi. At the same time, the use of oral litholytic therapy is also possible at stage 2 of cholelithiasis with asymptomatic or rare attacks of biliary colic, the absence  of violations of the patency of the extrahepatic bile ducts, and also if        the patient does not agree to cholecystectomy in order to stabilize the process of stone formation. This article presents a review of the literature on the etiopathogenetic, clinical features of cholelithiasis, as well as the treatment of cholelithiasis, primarily with an emphasis on the prevention of this disease. An analysis of a clinical case is given with a discussion of rational pharmacocorrection in cholelithiasis.

Diseases associated with damage to such vital organs of the digestive system as the liver and pancreas are an urgent problem of world health. Non-alcoholic fatty liver disease (NAFLD) is a worldwide epidemic; the problem of type 2 diabetes (T2D) mellitus becomes more acute every year; hepatocellular carcinoma (HCC) is the third leading cause of cancer death worldwide. In spite of progress in identifying risk factors, at the moment there is no generally accepted strategy for a complete cure for these pathologies. Mitochondria, with multiple functions, are key cell organelles. VDAC1, a channel in the outer membrane of mitochondria, is involved in the regulation of cell energy homeostasis, cellular stress, Ca²⁺ concentration, plays an important role in mitochondria-mediated apoptosis, and also interacts with more than 100 proteins. Numerous channel functions make peptides containing the VDAC1 sequence attractive for therapeutic use. In this article, we consider the VDAC1-based peptide (R-Tf-D-LP4) as a promising method for the treatment of metabolic disorders, and we present possible mechanisms by which the peptide affects the metabolism of fats and carbohydrates. R-Tf-D-LP4 is able to restore normal liver morphology (reducing manifestations of fatty degeneration of hepatocytes, inflammation and fibrosis), is able to slow down the growth of hepatocellular carcinoma by inducing apoptosis and bring blood glucose levels close to normal due to restoration of the normal morphological structure of the pancreas.

Introduction. There is a discussion about which genotype of viral hepatitis C (HCV) is the most aggressive. Some authors consider that the 1st genotype is  the  most  aggressive, others  define  the  3rd  HCV genotype  as  a  factor  that  determines the high activity of the pathological process. The solution of this issue is important for optimizing the tactics of patient management.

Aim. To compare the clinical and laboratory characteristics and the incidence of liver fibrosis in patients with chronic viral hepatitis C of the first and third genotypes.

Materials and methods. 297 patients with genotype 1 of HCV and 231 patients with genotype 3 of HCV were examined.     The diagnosis of chronic viral hepatitis C was established according to the recommendations of the European Association    for the Study of the Liver (2016, 2018). Liver fibrosis was studied by shear wave transient elastometry with METAVIR score.

Results and discussion. The frequency of elevated ALT in the blood prevailed in patients with HCV genotype 3 compared with persons with HCV genotype 1 (90.5% vs. 82.8%, p = 0.02). ALT levels above 3 norms were registered in 29.0% of patients with genotype 3 and in 16.8% patients with HCV genotype 1 (p = 0.001). The frequency of liver fibrosis F2 according to METAVIR was 11.8% in patients with genotype 1 and 21.2% in patients with genotype 3 of HCV (p = 0.005); the frequency of liver fibrosis F3–F4 according to METAVIR  was 20.5% in patients with genotype 1 and 32.5% in patients with genotype 3 of HCV (p = 0.003). The combination of high viral load and high inflammatory activity, which was associated with liver fibrosis F3–F4 according to METAVIR  in both compared groups, was determined in 16.9% of patients with genotype 3 and only in 10.4% of patients with genotype 1 of HCV (p = 0.04).

Conclusion. The obtained data allow us to consider that in the surveyed population the course of chronic viral hepatitis C with genotype 3 is clearly more aggressive than in persons with genotype 1 of HCV.

Alcohol-related liver diseases are one of the leading causes of death worldwide, primarily due to complications of liver cirrhosis (LC). Early detection of alcohol-induced liver fibrosis (LF) is a difficult task, since often  alcoholic liver disease (ALD) is clinically manifested only at late stages. Given that not all alcoholic suffer from ALD, the widespread use of liver biopsy to verify the diagnosis is not advisable. Despite the variety of proposed non-invasive methods for assessing the severity of LF in patients with ALD, none of them has sufficient validation and therefore cannot be recommended for widespread use in clinical practice. The most well-studied transient elastography, due to its suboptimal specificity, can be effectively used only to exclude clinically significant LF or LC. The only proven approach to treat ALD is persistent and total alcohol abstinence. While the therapeutic options for patients with severe forms of acute hepatitis remain unchanged since the 70s of the last century and are based mainly on the use of corticosteroids, currently, there are no approaches to antifibrotic therapy of ALD approved by the guidelines. At the same time, modern achievements in understanding the pathophysiological mechanisms  of this disease  have served  as an impetus  for  the development  of ways to solve  the problem. In particular, providing intestinal eubiosis may be an important goal for the prevention and treatment of alcohol-induced LF. Randomized controlled multicenter trials involving a large number of patients are needed to confirm this and other hypotheses related to antifibrotic therapy of ALD and to accept them as a standard of medical care.

Crohn’s disease (CD) is a severe immune-mediated disease with segmental transmural inflammation and ulcers in gastrointestinal tract most often in terminal ileum and colon. The disease is often associated with severe complications such as fistulas and strictures that require aggressive treatment or surgery. CD treatment remains the unresolved and one of the most serious problems in gastroenterology. Glucocorticosteroids (GCS) are the essential treatment options for many years but unfortunately the frequency of steroid resistance and steroid dependence are constantly increasing. In the cases of steroid refractory CD treatment options include biologics of different classes: tumour necrosis factor alfa - inhibitors (iTNF-α), α4β7 integrin inhibitor (vedolizumab), IL-12/23 inhibitor (ustekinumab). Any of these drugs can be used in bio-naïve CD patients, however secondary loss of response was noted for all biologics over time.

In the cases of the first line treatment failure the problem of correct choice of the second and subsequent lines of biologics appears, since some biologics may show lower efficacy in the second line of treatment. Real clinical practice will allow us to make a more correct choice of next biologic. Ustekinumab, a human interleukin -12/23 monoclonal antibody is one of biologics that is highly effective in the first-line CD therapy and remains effective in the subsequent lines of treatment. We present a clinical case of complicated CD in young female with negative disease prognosis and loss of response to three iTNF-α. In this case the high efficacy of ustekinumab after multiple iTNF-α failure was demonstrated.

Introdiction. In recent years, many new technologies for the management of patients with short bowel syndrom (SBS), including SBS-IF (short bowel syndrom with intestinal failor), have appeared. The implemented surgical techniques are aimed at slowing down the progress of intestinal contents (antiperistaltic inserts, the creation of artificial valves in the small intestine, loops or pockets from the small intestine, etc.); surgical elongation of the small intestine (the most common STEP, Bianchy technique); intestinal transplantation. At the same time, when the intestine is shortened to 1.5–2,0 m, the adaptive rearrangements are still able to provide (albeit suppressed), but partially preserved absorption processes (in 80% of cases, the surface of the intestine is sufficient for slow transport of nutrients from the intestine to the blood). Therefore, it is important to increase the efficiency of adaptive rearrangements in any conservative way shown.

Аim. Тo evaluate the role of hormonal stimulation of adaptive rearrangements in the residual bowel stump.

Materials and methods. Рarameters of the well-known alimentary-volemic diagnosis, assessment of adaptive changes in the gastrointestinal tract (performed by determining citruline and GLP-2, as well as by morphological method). To stimulate the regulation of adaptive processes, a hormone preparation GLP-2 (teduglutide) was used in the nutritional support program.

Results. It was shown that the length of the intestinal stump up to 1.5–2.0 m allows for digestive and transport processes due to adaptive rearrangements of the intestinal epithelium. With a super-short intestine, it is advisable to choose surgical methods of correction.

Conclusion. For conservative correction of adaptive processes in the intestine, it is advisable to use a GLP-2 hormone preparation, in particular, teduglutide.

The problem of interaction between a person and the intestinal microbiome is surrounded by many secrets and mysteries. The bacterial flora of the gastrointestinal tract has a local and systemic effect not only on the digestive system, but also on  the entire body as a whole. Numerous studies have proved the pathogenetic relationship of the state of the intestinal biocenosis not only with diseases of the gastrointestinal tract, but also with pathological processes from other organs and systems of the body. In terms of its role in maintaining homeostasis, the intestinal microflora is not inferior to any other vital organ. In the presented review, the current aspects of the terminology and clinic of disorders of intestinal microbiocenosis are considered. Probiotics occupy an important place in the complex therapy of intestinal microbiocenosis disorders and the corresponding clinical manifestations. The review considers the main mechanisms of probiotic / host interaction, non-immunological and immunological effects of probiotics and the requirements for them, the main directions of use of representatives of the normal microflora Bifidobacterium and Lactobacillus. The data of meta-analyzes and systematic reviews, testifying to the expansion of indications for the appointment of probiotics, are considered the possibilities of probiotics in the complex therapy of Helicobacter pylori infection, syndrome of increased epithelial intestinal permeability, and the prevention of respiratory infections.

The review concludes with the results of a search in the PubMed database on the possibility of using probiotics in the prevention and treatment of a new coronavirus infection COVID-19. The availability of modern, effective and safe probiotics in the arsenal of a practical doctor (primarily a general practitioner and general practitioner), and their use, contributes to the optimization of drug therapy not only in gastroenterological patients, but also in patients with other somatic pathologies, including those with new coronavirus infection COVID-19.