Functional  dyspepsia, affecting  up to 20% of individuals worldwide, remains  both a cause  of decreased activity of patients’ daily life and an obvious economic burden  due to healthcare costs. Despite extensive research, the etiology of dyspepsia  is unknown  in most  patients. Intestinal motility dysfunction  has long been  considered the  major culprit, but recent  studies suggest  that  immune  pathophysiological and molecular  effects  in the  duodenum are far more likely predisposing factors. Eosinophilia  and an increase  in mast  cells in both  the  duodenum and gastric mucosa  are identified  in most patients with this disease. More and more data  on the significant  role of impaired  paracellular permeability of the intestinal mucosa are now available. It is associated with subclinical  inflammation in the submucosal layer in patients with functional  dyspepsia. This explains  the  poor effectiveness of the  treatments taken. The evidence  from practice  suggests that  symptoms  persist or return  after  eradication therapy  in most patients. Proton  pump inhibitors  and antidepressants do not ease  postprandial distress  syndrome.  Montelukast  and  cromolyn  therapy  has  been  proposed,  but  this  approach  is not  yet  widely popular. Therefore, there  is an obvious need  in finding other  therapeutic approaches. One of them  is the increased use of prokinetics, the most recent  of which is acotiamide.  Its mechanism  of action  is similar to that  of prior generation prokinetics  (inhibition of acetylcholinesterase activity), but is distinguished by the absence of impact on dopaminergy, due to which the drug has  far fewer  side  effects. In addition,  its effect  on the  production  of ghrelin, which physiological  role  is being  actively studied, is discussed.

Irritable  bowel syndrome  (IBS) is one of the  most common  diseases  of the  digestive  tract. IBS negatively  affects  the  quality of life and work ability of patients. It is generally  accepted that  IBS is an important medical  and social problem  associated with high financial  costs  both  on the  part of the  patient  and the  public health  system. The pathophysiology of the  disease involves the participation of many factors (genetic, dietary, psychosocial, infectious) and the mechanisms of their implementation, including  disruption  of interaction along  the  functional  “gut-brain axis”, visceral  hypersensitivity,  changes  in motility, low-grade  inflammation, increased permeability of the epithelial intestinal barrier, modulation of microbiota, changes  in neurohumoral  regulation and  processes of central  processing  of peripheral stimuli. Research  shows  an important role  for gut microbiota  in the development of IBS. Modulation of the intestinal microbiota  through  diet, the use of pre- and probiotics  or fecal microbiota transplantation is considered as a promising target  for disease  therapy. A reduction  in the number of bacteria of the genus  Bifidobacterium is described  as a universal  change  in the microbiota  in IBS, regardless of the clinical course and severity of the disease  and the possibility of using different  strains of Bifidobacterium in treatment regimens  for the disease  is of particular  interest. This article  provides  a review of the literature on modern  approaches to prescribing  probiotics  for IBS. Using our own clinical observations as an example, we demonstrated the effectiveness and safety of prolonged administration of the probiotic strain Bifidobacterium longum 35624®  for up to 12 weeks.

A review of current  data  on the management of patients with non-erosive reflux disease  (NERD) was made. Diagnosis of gastroesophageal reflux disease  (GERD) is based  on symptom analysis, endoscopic  evaluation of the esophageal mucosa, objective  evidence of gastric contents reflux into the esophagus during pH-impedancemetry, and response to therapeutic intervention. Treatment for GERD should include weight loss if overweight, lifestyle modification, and dietary modification. Current consensus recommends starting NERD treatment with once-daily proton pump inhibitors (PPIs), but only 50% of patients with this pathology respond to such therapy. Incomplete response to PPIs is a reason  to increase  the dose of PPI and add Gaviscon to treatment to neutralize the post-prandial “acid pocket”. Gaviscon is especially effective in patients with postprandial or nocturnal symptoms and in those with hiatal hernia. The mechanism  of action of Gaviscon is based  on the formation  of an alginate “raft” on the surface of the gastric contents, which neutralizes the acid and blocks its pathological effect to esophageal mucosa. A modern meta-analysis on the NERD treatment, which included  23 studies  and 10,735  patients, showed  the  efficacy of Gaviscon monotherapy comparable to PPIs in treatment for 4 weeks. The combination of a PPI with Gaviscon offers the opportunity to optimize response to treatment in NERD patients with an incomplete response to PPIs monotherapy. The Russian Gastroenterological Association thinks that alginates can be used both as monotherapy for mild clinical variants of NERD and in complex treatment regimens  for various GERD variants.

This review focuses on the most current  information  on the pathogenesis, diagnosis  and treatment of sarcopenia and malnutrition in patients with liver disease. Sarcopenia  and malnutrition are common complications of liver diseases. Liver cirrhosis, as a stage  of the pathological process, serves as the main predisposing factor for the development of malnutrition and sarcopenia. The frequency  of sarcopenia in liver cirrhosis  is 30–50%  and  reaches  100% in decompensated patients. The main pathogenetic links are: impaired  proteostasis of skeletal  muscles, systemic  inflammation and changes  in gut microbiota. In recent   years, enough   data  have  been  accumulated  to  consider  these   conditions   as  a  prognostically unfavorable   factor in patients with liver cirrhosis of various etiologies,  affecting  their quality of life and survival, as well as worsening  the out-comes  of transplantation. This dictates  the  necessity  to  define  unified  approaches to  diagnostics and  correction  of these conditions. Currently, tests are used for diagnosis, which allow to assess muscle strength and function. Muscle mass is assessed using instrumental methods by measuring  individual  muscles  and calculating skeletal  muscle  indices. In patients with liver cirrhosis and concomitant sarcopenia and malnutrition, nutritional and lifestyle modification  strategies are applicable for correction  in addition  to therapy  aimed at elimination of the etiologic  factor. The aim of the review is to evaluate the problems of diagnosis and effective treatment of malnutrition and sarcopenia in patients with liver disease  based on literature data. The article presents an overview of the main strategies for the approach, diagnosis  and correction  of these  conditions.

Introduction. Recently, there  has been increased interest in the role of NK cells in viral hepatitis. An antifibrotic  effect of these cells has been  found, but the causes  of their dysfunction  leading  to the development of liver fibrosis remain unclear.

Aim. To study the  subpopulation composition  of blood NK cells by flow cytometry, depending on the  severity of clinical and morphological manifestations of chronic viral hepatitis C (CVHC) with genotype  1 or 3.

Materials  and methods.  Clinical, laboratory  examinations, determination of liver fibrosis by elastometry using  the  METAVIR scale and study of the subpopulation composition  of NK cells in the blood by flow cytometry (with definition  of markers CD3, CD16 and CD56) were carried out in 143 patients with CVHC, including 74 patients with genotype  1 and 69 individuals with genotype  3, and in 20 people  of the control group.

Results.  In  patients with  both  CVHC  genotypes 1  and  3, a  significant  decrease in  the  total  content of  NK cells,  CD3^-CD16⁺CD56^bright and CD3^-CD16⁺CD56^dim subpopulations in the blood among  individuals  with liver fibrosis F3-F4 according  to METAVIR was registered in comparison  with patients with liver fibrosis F0-F1 according  to METAVIR. In patients with CVHC genotype  3, there  was a decrease in the  total  content of NK cells  and  a subpopulation of CD3^-CD16⁺CD56^dim in the  blood of individuals  with  a  high  viral  load  compared  to  patients with  a  low  viral  load. This relationship was  not  determined in patients with CVHC genotype  1.

Conclusion. The obtained regularities emphasize the  significant  role  of NK cells  in the  pathogenesis of CVHC and  verify the idea of using NK cells activation  for immunotherapy of liver fibrosis in patients with CVHC.

Pain  in the  right  hypochondrium is one  of the  most  frequent  complaints  in patients with  diseases  of the  biliary system. According to statistics, every tenth  person experiences unpleasant sensations in the upper right abdomen  after drinking alcohol, fatty, fried or salty food, as well as after  psychoemotional and physical exertion. The most  common  of the  pathologies of the  biliary system  is the  sphincter  of Oddi dysfunction  (SOD). SOD is a clinical syndrome  caused  by a functional  disorder of sphincter  of Oddi (SO), which leads  to the  development of abdominal  pain syndrome, increased activity of liver and / or pancreatic enzymes, dilatation of the common bile duct and the main pancreatic duct. One of the methods of treatment of SOD is drug  therapy,  accompanied by the  following  groups  of drugs:  antispasmodics, nitrates,  choleretics,  antidepressants, etc. At the  same  time, many medications show low efficacy against  SOD, or cause  pronounced side  effects. At present,  for the treatment of sphincter  of Oddi dysfunction,  the  domestic  drug  from the  group  of myotropic  antispasmodics, hymecromon, Holicron, has the optimal  characteristics in terms  of price-quality  ratio in the Russian pharmacological market. The drug has a selective  antispasmodic effect  on SO, and also has a choleretic effect. Mechanism  of antispasmodic action  is an increase in the concentration of nitric oxide (II) and cyclic mononucleotides, which through  a cascade  of biochemical  reactions  leads to a decrease in the number of calcium ions in the cell and a decrease in the tone of smooth  myocytes of SO and gallbladder. The drug is absorbed  into the blood in a small amount, which excludes  its systemic effect and determines the selectivity of the effect on the biliary system. According to the results  of clinical testing  and consideration of a specific clinical case, it can be concluded that  the use of hymecromone (Holicron) reduces  the severity of pain syndrome  and reduces  dyspepsia  syndrome, good tolerability  and absence of side effects that  would require withdrawal  of the drug are also recorded.

Introduction.  Insulin  resistance (IR) is a key mechanism  in the  development of non-alcoholic fatty  liver disease  (NAFLD). To identify IR, various indices have been  proposed, but their comparative diagnostic  significance  is not sufficiently covered.

Aim. To conduct a comparative analysis of the diagnostic  role of the triglyceride-glucose index (TyG Index or TGI) and HOMA-IR in different  forms of NAFLD – hepatic  steatosis (SP) and steatohepatitis (SH).

Materials and methods.  194 patients with NAFLD were examined: 56 (28.9%) LS and 138 (71.1%)  SH. TGI, HOMA-IR, fragments of cytokeratin-18 (FCK-18), tumor  necrosis  factor alpha  (TNF-α), fibrosis index – NAFLD fibrosis index (NFS), traditional liver tests  were determined.

Results. TGI was increased in 43 (76.8%) patients with LS and  its average  level  was 9.0 ± 0.4, it positively correlated with obesity,  dyslipidemia,   HOMA-IR,  hepatocellular  damage   and   negatively   with   albumin   levels.  HOMA-IR was   elevated in 33 (58.9%) patients with SH, its level was 3.58 ± 1.7, it positively correlated with BMI, TGI and ESR. In SH, the level of TGI was increased in 125 (90.6%) patients, its level was 9.2 ± 0.6, it positively correlated with waist circumference,  dyslipidemia, ALT, and negatively  with albumin levels. HOMA-IR in SH increased in 111 (80.4%) patients, its level was 4.78 ± 1.8, it positively correlated with indicators  of abdominal  obesity, ALT, ESR, FCK-18 and NFS.

Conclusion. An increase  in TGI was detected in NAFLD more  often  – in 86.6% of patients than  an increase  in HOMA-IR – in 74.2% (p > 0.05). Both indices increased more often in SH than  in LS. TGI indirectly reflected the degree  of protein  metabolism disturbance and the  level of hepatic  cell necrosis, while HOMA-IR reflected the  level of hepatocyte apoptosis,  inflammation, and liver fibrosis in SH.

Introduction. A high prevalence of decreased liver density has been shown among patients with COVID-19, but there are no convincing data on the cause of this phenomenon. It is still debatable whether decreased liver attenuation is an independent risk factor for the severe course of COVID-19.

Aim. Assessment the prognostic value of liver attenuation on CT scan in patients with COVID-19.

Materials and methods. Retrospective cohort study. Data of COVID-19 outpatients were analyzed. Inclusion criteria: two chest CT scans, alanine aminotransferase (ALT), aspartate aminotransferase (AST) blood values, polymerase chain reaction to verify SARS-CoV-2. Four comparison groups were assigned according to the severity of lung lesions. Liver attenuation was analyzed by automatic segmentation, with values less than 40 HU being considered pathologic.

Results. Data from 499 patients was included. No correlation between ALT and AST and changes in liver attenuation was found. Groups differed in age and liver attenuation on both CT scans. On follow-up  CT, low liver density was seen in males (odds ratio (OR) 2.79 (95%  CI 1.42–5.47), p-value = 0.003) and in patients with a baseline reduced liver density (OR 60.59 (95%  CI 30.51–120.33), p-value < 0.001). Age over 60 years was associated with the development  of lung lesions (OR 1.04 (95%  CI 1.02–1.06)  for extent of lung injury < 25%, OR 1.08 (95%  CI 1.05–1.11)  for 25–50%, OR 1.1 (95%  CI 1.06–1.15)  for 25–50%, p-value < 0.001). Low liver attenuation  on the primary CT scan increased the odds of severe lung  injury (OR 6.9 (95%  CI 2.06–23.07), p-value = 0.002).

Conclusion. In COVID-19, patients with low liver attenuation are more likely to develop severe lung damage.

The prevalence of non-alcoholic fatty liver disease  (NAFLD) and metabolic  associated liver disease  (MAFLD) is growing world-wide. A new terminology  (MAFLD) allows us not only to focus on the “metabolic” genesis  of this pathology, but also to take into account  other  factors  affecting  damage  to hepatocytes, such as alcohol  consumption in low doses, viral and toxic hepatitis. Currently, obesity is a pathology, that is growing with MAFLD and causes  of various non-communicable diseases. Most deaths in patients with  NAFLD/MAFLD  are  caused,  firstly, by adverse  cardiovascular  events,  secondly, by malignant tumors  of both the digestive  organs  (liver, intestine, esophagus, stomach  and pancreas)  and other  localizations (kidney cancer  in men, breast cancer  in women) and, thirdly, by development of hepatic  complications (cirrhosis, hepatocellular carcinoma  – HCC). Because of the  pandemic  growth  of MAFLD and its association with cardiovascular  diseases  and obesity, the  question about  properly clinical management of patients suffered from comorbid pathology to reduce the risks of deaths  is timely and very relevant. This review has been prepared to systematize the available  literature dates  about association of NAFLD/MAFLD with the malignant tumors. A literature searches were  conducted,  modern  epidemiological dates  about  the  prevalence of NAFLD/MAFLD  in the population and their complicated forms were presented. The risk of HCC formation  both with and without  cirrhosis in NAFLD was assessed.  It was found that  the severity of liver fibrosis can be useful predictor  of the future risk of not only the adverse cardiovascular  events,  but  also  the  malignant tumors  in patients with  NAFLD/MAFLD. Possible  targets  for treatment were discussed,  the  impact  on which is useful  for the  treatment and prevention of progressive  forms of the  disease.  One of the possible  therapeutic molecules is essential phospholipids, which are  currently  included  in the  consent  documents for the managment of patients with NAFLD.

Introduction.  Alcoholic steatosis, which is a reversible  condition, is currently considered a significant  risk factor for the  progression  of diffuse liver pathology, therefore understanding of its mechanisms at the molecular  level is essential.

Aim. To study the features  of the fatty acid profile of erythrocyte  membranes in patients with fatty liver disease  of alcoholic origin for possible  use of fatty acids (FAs) as biomarkers  and potential therapeutic targets.

Materials and methods. A total of 31 men with alcoholic fatty liver disease  (AFLD) (average age of 45.1 ± 17.1 years) and 28 men of comparable age without AFLD and symptomatic  pathology of internal  organs were examined. The FA composition  and levels of erythrocyte  membranes (ER) were studied  using Agilent 7000B (USA) triple quadrupole gas chromatography/mass spectrometry.

Results and discussion.  A  higher  level  of a  range  of saturated FAs (lauric, margaric,  pentadecane), monounsaturated  FAs (MUFAs), which are additional factors for the progression of AFLD (palmitoleic, total monounsaturated acids), n-6/n-3  polyun-saturated FAs  ratio (PUFAs), alpha-linolenic FA was detected in patients with AFL vs the  control  group (p = 0.00002–0.05). In contrast,  the  levels  of arachidic  and docosahexaenoic acids, total  eicosapentaenoic and docosahexaenoic n-3 PUFAs, and total  n-3 PUFAs were lower in patients with AFLD than  in healthy  men (p = 0.003–0.01), which is associated with increased ethanol induced  adipose  tissue  lipolysis  via PDE3B-AMPK axis. The use  of FAs panel  (C16:1;9, sum  MUFA, n-6/n-3  PUFA, C22:6n3, C20:0) to distinguish  patients with AFLD from healthy  ones  ensured  high levels  of sensitivity (79%), and specificity (81%) (AUC 0.808). Multidirectional  associations of FA levels  in erythrocyte  membranes with each  other  and liver tests  and lipid profile results  were revealed.

Conclusion. Thus, the features  of erythrocytes  membrane FAs in patients with AFLD and the potential to use them as biomarkers for differentiation of people  with AFLD from healthy individuals have been  identified.

Non-calculous  cholecystitis is a form of cholecystitis caused  by dysfunction  or hypokinesis of the gallbladder. The polyetiology and multiplicity of the pathogenesis of this disease  requires  different  approaches to its correction. In this situation, phytopreparations containing components of origin provide special  attention in combination with the main therapy. Curcumin has a strong protective  effect against  cholestasis through farnesoid X receptors, resulting  in a release of bile acid homeostasis and counteracting inflammatory  inflammation and as a manifestation of cholestasis. Several studies  show that  curcumin requires a contraction of the gallbladder. Despite the presence of many useful properties,  the widespread use of curcumin in medical practice was limited by its limited bioavailability. Forms with increased bioavailability have been synthesized, such as kavacarcumin. The use of artichoke leaf extract  in gastroenterology is based on its strong antidyspeptic effect, mediated by choleretic activity. As study  show, the  choleretic effect  of the  artichoke  was  more  pronounced than  that  of the  reference drug. In the  description,  there  is no direct effect  of chamomile  phytocomponents on the  state  of bile compatibility  and the  function of bile outflow, however, an indirect effect on its work is possible. The results  make chamomile  flower extract  a good addition to therapy. Thus, due to the occurrence  of synergistic components, the complex is found in individuals, in patients with chronic diseases  of the biliary tract, with functional  disorders, the period of treatment in long-term complex therapy, with the prevention  of exacerbation and prolongation of remission, as well as in healthy individuals for the prevention of these  diseases.

Irritable  bowel  syndrome  (IBS) is an important social problem, since  it is often  diagnosed in people  of young working age, significantly affects  the quality of life of patients and causes  economic  damage  to society. IBS is a chronic functional  bowel disease,  the  main  manifestation of which  is pain  combined  with  changes  in bowel  movements, frequency  and  character of stool. The mechanism  of formation of abdominal  pain syndrome is due to a disruption in the interaction along the brain-gut axis, which leads  to changes  in the  regulation of intestinal motor  function  and the  development of visceral  hypersensitivity (VH). Abdominal pain as a manifestation of IBS is primarily associated with spasm of intestinal smooth muscles. The first-line drugs  for pain  relief  are  antispasmodics, which reduce  the  tone  and  contractility  of intestinal smooth  muscles, effectively coping  with  abdominal  pain. The domestic  pharmaceutical market  is represented by different  groups  of muscle  relaxants, among  which  calcium  channel  blockers  are  of particular  relevance for patients with  IBS. Representative  of the  latter  is the drug Otilonium bromide, which is widely used throughout the world, is effective  and safe, well tolerated and superior  to placebo  in reducing symptoms  and preventing relapse  of pain in patients with IBS. The effectiveness of otilonium  bromide is due to a triple  mechanism  of action: blockade  of calcium channels (relief of spasm), antagonism of tachykinone  NK2 receptors  (effect  on HHV) and  inhibition  of acetylcholine muscarinic  receptors (M3-ChR) (reduction  of intestinal secretion). This article  presents a short  review  of the  literature on the  causes  and  mechanism  of development of pain  in IBS, as well  as the possibilities  of its relief, primarily with the use of smooth  muscle relaxants, namely otilonium  bromide.

Celiac disease  is a chronic gluten-induced autoimmune enteropathy in genetically predisposed individuals with specific HLA genotypes carrying the  DQ2 (DQA1*0501 and DQB1*0201) or DQ8 (DQA1*0301 and DQB1*0302) alleles. The overall  global prevalence of celiac  disease  is 0.7–1.4%. The increase  in the  incidence  rate  is associated with  significant  consumption of gluten  over the  last  century, which has a peculiar  effect  on the  small intestine mucosa. Atrophic processes in the  intestine mucosa contribute to malabsorption and development of gluten-dependent clinical symptoms, however, the manifestation of the disease  can occur at any age. The small intestine disease  with the development of hyper-regenerative atrophy of the small intestine mucosa  is recognized  as a systemic  disease  accompanied by various deficiency conditions  both  with and  without atrophy of the small intestine mucosa. Long-term adherence to a gluten-free diet entails  certain deficiency conditions, such as vitamins B, vitamin D, calcium, iron, and folic acid deficiencies, as well as a decrease in body mass index. To ensure  adequate nutritional intake, patients with celiac disease  require additional resources, namely specialized  dietary nutrition  products. The issues  of understanding the  need  for enteral nutrition  in the  management of patients with celiac disease  are stressed.  The article  presents a clinical observation of the  nutritional support  for a female  patient  with a typical course  of celiac disease, grade 2 protein-energy malnutrition, which demonstrated that the use of specialized  food products  as additional nutrition  can significantly improve the nutritional status  and somatometric indicators  in a patient  with celiac disease  on a gluten-free diet.

Diarrhea is one of the most common syndromes  encountered in the practice  of a general  practitioner,  a general  practitioner, a pediatrician at the  stage  of providing  primary health  care, as well as a gastroenterologist, an infectious  disease  specialist and a surgeon  at the  stage  of providing  specialized  medical  care. The first part  of the  review is devoted  to the  differential diagnosis of diarrhea, the main pathological conditions  and nosological  forms in which the development of diarrhea syndrome is possible  in real clinical practice  are considered.

The second  part of the review is devoted  to a promising  active method  in gastroenterological practice-enterosorption. The main requirements for modern enterosorbents are met by the domestic enterosorbent based on silica (colloidal silicon dioxide) Polysorb®   MP. Its properties are  considered,  data  of comparative studies  with  other  enterosorbents are  given. The studies demonstrating the efficacy and safety of the use of enterosorbent Polysorb®  MP in the complex therapy of infectious  diarrhea in adult patients and in pediatric practice are presented. Diarrhea is one of the most common gastrointestinal symptoms in the new coronavirus  infection  COVID-19.  A number  of studies  have  noted  the  effectiveness of the  use of colloidal  silicon dioxide (Polysorb® MP) in the complex treatment of adults  and children with COVID-19 and as part of the post-COVID syndrome. The use of Polysorb®   MP helps  to reduce  the viral load in the intestine, reduce  diarrhea  and other  clinical symptoms  of gastrointestinal lesions  in COVID-19.

Availability of modern  effective and safe enterosorbent Polysorb®  MP in the arsenal  of a doctor at the stage  of providing primary health  care will optimize  drug therapy in patients with diarrhea  syndrome and other comorbid somatic pathologies.

The paper  highlights  the issues  of antibiotic-associated diarrhea  (AAD) of mild severity in the treatment of surgical patients, its epidemiology, etiology, features  of the clinical picture and approaches to therapy. The mild course of AAD includes diarrhea without  signs  of intoxication,  leukocytosis  and  fever. Stool  disorder  in patients receiving  antibiotics  who are  in a surgical hospital  is an urgent  medical  problem, since  this pathology  prolongs  the  time  of hospitalization, increases  economic  costs, reduces  the quality of life and can even be the cause of the patient’s death. According to various authors, AAD develops  in 40% of people  receiving antibacterial therapy. A clinical example  of the management of a patient  with AAD and injury of the musculoskeletal system is considered in detail.The abolition of antibiotics  is not a method  of solving this problem, since the severity of the patient’s injuries requires  further surgical treatment and prevention of purulent-septic complications. The key point in the  treatment of mild AAD will be the  appointment of probiotic  drugs, which have  an effect  on the  pathogenetic  links of AAD. Probiotics  are  microorganisms that  have  been  known  since  ancient  times  and  are  purposefully  used  for health improvement and longevity. One of the first probiotic drugs used before the era of the discovery of antibiotics  can be considered  Mechnikov curdled  milk with  unique  medicinal  properties.  Prescribing  probiotic  therapy  from the  first day of taking antibiotics, without  waiting for the results  of laboratory examination, will significantly reduce  the prevalence of clinical manifestations of both clostridial  diarrhea  and idiopathic AAD.

Among the  defecating disorders  with  constipation or diarrhea,  there  is a  group  of major  intestinal disorders  defined  by the  Rome IV Diagnostic  Criteria (2016): irritable  bowel  syndrome, functional  constipation, functional  diarrhea. The presence of several updates of the Rome criteria is due to the current  lack of objective signs of the listed disorders while many options for describing  subjective  sensation by patients from different  countries. It calls for their terminological multilingual  standardization. Both constipation and diarrhea  can be caused  by a variety of exogenous and endogenous factors and have different pathogenetic mechanisms,  but they cannot  be identified  properly using modern  clinical and laboratory  methods for functional intestinal disorders. However, the  high prevalence of these  syndromes, characterized by the  presence of complaints  that reduce  patients’ quality of life, necessitates their  correction. The drug choice for defecation disorders  and abdominal  pain is often limited by contradictions from international clinical guidelines and national  regulations.Therefore, the Recommendations of the  Russian Gastroenterological Association for the  treatment of functional  intestinal diseases  contain  many instructions on general  therapeutic and dietary measures. The pain syndrome treatment is based on the spasmolytics. Among the laxatives that  have long been  used in the treatment of chronic constipation, sodium picosulfate has long been  successfully used. This drug has high efficacy and safety profiles; the instructions for its medical  use allow to prescribe  it in patients suffered  from irritable  bowel syndrome with constipation. The use of sodium picosulfate for IBS is regulated by many clinical recommendations. However, this  drug  may be ineffective  against  abdominal  pain. It is incorrect  to assign  the  mission  of pain  relief  to a laxative  because of multifactorial pathogenesis of IBS pain with constipation or diarrhea  and uncertainty of methods for its pharmacological control.

The  number   of  patients  complaining   of  indigestion  is  increasing   every  year.  Made  a  significant   contribution  to  this the COVID-19 pandemic, which has been  going on for almost  3 years, led to this, the drugs used to treat  the infection  and its complications have  a negative  effect  on the  gastrointestinal tract, not  to mention  the  most  damaging  effect  of the  virus. Against  the  backdrop  of an increasing  number  of patients with indigestion as a result  of COVID-19, it is important not  to forget  about  other  diseases  that  do not lie on the surface  and do not always have typical manifestations. A relatively young disease, but increasingly common among patients with diarrhea, is microscopic colitis (MC). This article presents a clinical case of microscopic colitis of incomplete collagen  type in combination with lactase  deficiency. MC is a chronic inflammatory bowel disease  of unknown  etiology, characterized by chronic watery diarrhea,  the  absence of macroscopic  signs  of colon  damage in the presence of specific pathomorphological changes. Based on the histological result, two main forms are distinguished: collagenous and lymphocytic colitis. According to the latest  data presented in the European guidelines, the overall prevalence of MC is 119.4 cases  per 100 thousand people,  and the  incidence  is 11.4 cases  per 100 thousand population per year. The progressive  increase  in the  incidence,  and even  the  prevalence of MC over patients with inflammatory  bowel  disease  (IBD) in some countries  in the group over 60 years of age, has led to an increase  in clinical interest in this problem, improvement of diagnostic  methods and revision of clinical guidelines in February 2021. Given the increase  in the incidence  of MC, the difficult diagnostic  search  for this  diagnosis,  age  variation, and  the  description of clinical  cases  that  differ from the  average portraits  of a “typical patient” with microscopic colitis are of clinical interest.

Inflammatory bowel disease  (IBD) is a chronic, relapsing, systemic and immune-mediated conditiondis  that  frequently  involve extraintestinal manifestations. Latest  studies  showed  increased risk of cardiovascular  complications,  which is the  main cause of death  in developed countries, in chronic inflammatory disorders, especially during IBD relapses. IBD patients are at increased risk of conditions  such as early atherosclerosis, ischaemic heart  disease, myocardial infarction, stroke, venous thrombosis, heart failure, аtrial fibrillation. Hypotheses  for the  mechanism  underlying  the  association of IBD and atherosclerotic cardiovascular diseases  include adverse  effects of both the IBD itself (chronic inflammation, еndothelium dysfunction, dyslipidemia, thrombocytosis, gut microbiome  dysfunction) and its treatment. The predominant role in atherogenesis is currently assigned  to disruption of the endothelium. Endothelium plays an important role in physiologic regulation of vascular tone, cell adhesion, migration and resistance to thrombosis. Also, its dysfunction  is associated with increased risk of atherosclerosis development. Early multifocal atherosclerosis is a serious complication  of ulcerative  colitis and can occur in young people  without  traditional cardiovascular  risk factors. Untimely diagnosis,  lack of pathogenetic treatment, correction  of basic anti-inflammatory therapy  and comprehensive consideration of a problem  of high cardiovascular  risk can lead to acute  myocardial infarction  and stroke and disability of a patient  of working age. The authors  present a case  report  of multifocal  atherosclerosis complicated by acute coronary syndrome in a young man with ulcerative  colitis, who required  a radical revision of the therapy.

Infective endocarditis (IE) is an infectious and inflammatory  disease of the endocardium that is associated with a high incidence of complications  and mortality. Elderly patients are the most vulnerable  age group for the IE. Infective endocarditis caused by E. coli is a rare disease due to both bacteria life-cycle and human immune system protection. Nevertheless, recent years the incidence of IE associated with E. coli has been increasing in the group of elderly patients. It seems important to reassess the indications  for antibiotic prophylaxis  in certain categories of patients (including  the elderly patients with an unobvious but increased risk of IE). This clinical case demonstrates a native valve endocarditis caused by E. coli developed after bowel preparation with osmotic laxatives and endoscopic procedure in an 85 year-old male without significant chronic diseases. Despite the fact that the patient did not belong to the category of increased risk of IE, he had the predisposing  conditions for the development of IE (weaked immune system, bacteremia, heart valve sclerosis), that realized in the active manifest disease. Treatment with antibiotics led to an improvement  in the patient’s condition and regression of infectious vegetations on the valve. Repeat blood cultures were negative. When planning endoscopic procedure for patients at risks (elderly person, weakened immune system, minimal aortic valve lesions), antibacterial prophylaxis should be considered. Additional research is required to develop clear algorithms for antibacterial prophylaxis.

Chronic kidney disease  is kidney damage  that persists  for three  months  or more due to the action of various etiological  factors, the anatomical basis of which is the process  of replacement of normal anatomical structures with fibrosis, leading  to its dysfunction. This nosology is quite common in the modern world; it can progress  and lead to disability of patients and a decrease in their  quality of life. The mortality  rate  for this disease  also remains  high. About 3/4  of patients with this pathology  have a terminal  stage  of the process, which is characterized by the development of protein-energy deficiency (due to uremia, malnutrition, acidosis and persistent inflammatory  process), which significantly worsens  the prognosis. Currently, the available  literature  contains  a small number  of works devoted  to this problem, therefore an important part of the  management of patients with chronic kidney disease  (especially  those  on hemodialysis)  is the  assessment and correction  of nutritional status. In this article, the authors  highlight  aspects  of the development of protein-energy malnutrition, its possible  methods of diagnosis and correction. Electrolyte disturbances, especially hyperkalemia  and hyperphosphatemia, are also common complications of chronic kidney disease.  Correction  of these  conditions,  in turn, can  lead  to the  development of deficiency  of vitamins  and  other microelements. According to studies presented in the literature, nutritional status  is one of the main factors determining the survival and degree  of rehabilitation of patients on renal replacement therapy, as well as the effectiveness of dialysis treatment. Thus, a clinician’s knowledge  of the nutritional status  of this group of patients can improve their prognosis  and quality of life.

Introdiction.   Systemic  chemotherapy  (CT)  based   on  oxaliplatin,   5-fluorouracil,  capecitabine  is  the   standard  of  treatment for advanced  gastric, colorectal  and rectal cancer, which is characterized by frequent  development of severe adverse  events  (AEs). The results of translational studies in the Russian patient  population are limited, it is necessary to study pharmacogenetic markers. Aim. To study the frequency of carrying allelic variants  of DPYD, GSTP1, MTHFR, XPC, ERCC1, TYMS genes  and their association with the development of AEs during palliative  treatment with FOLFOX/XELOX.

Materials and methods.  A total  of 166  patients (67 gastric  cancer, 99 colorectal  cancer)  were  included  in the  prospective observational study. All patients underwent pharmacogenetic testing  by hybridization  analysis  on  biological  microarrays (DPYD (rs2297595  and rs75017182), MTHFR (rs1801133), XPC (rs2228001), TYMS (rs11280056), ERCC1 (rs3212986)) and PCR (GSTP1 (rs1695), ERCC1 (rs11615)) before  starting  CT. The genotype  frequency distribution was analyzed  between the groups of patients with and without  the development of severe AEs.

Results. AEs developed in 97.7% of patients, severe  AEs accounting for 54.2%. According to the results  of univariate  analysis, TC genotype  of DPYD gene  rs2297595  OR = 3.0 (95% CI 1.2–7.3, p = 0.025), GG genotype  of GSTP1 gene  rs1695  OR = 2.9 (95%   CI 1.02–8.6,  p = 0.038) were  associated with  the  development of severe  neutropenia. In multivariate analysis  TT genotype   rs2297595   of the  DPYD gene  remained   the  only predictor  of severe  neutropenia (B ± SE = -1.103  ± 0.503; DI [-2.090; -0.116]; p = 0.028).

Conclusions. The results  of this study allowed  us to identify possible  markers of toxicity of FOLFOX/XELOX chemotherapy.