Among chemotherapy-related adverse events, drug-induced liver injury (DILI) is one of the most prevalent. In some cases, DILI is accompanied by hyperammonaemia (HA), which can disrupt chemotherapy cycles, and is associated with 25–45% mortality rates when specific antitumor agents are used. Efficacy studies in cancer patients were only found for ornithine (L-ornithine L-aspartate, LOLA) among all ammonia-lowering strategies. The amino acids in LOLA help to detoxify ammonia in the liver and other tissues, while also having several other metabolic effects. The experts expressed their viewpoints on the conducted studies, reviewed the main directions for applying LOLA in current clinical practice, and identified prospects for further research.

The publication presents the findings of a multidisciplinary expert council convened to analyze data from clinical studies on morpholinium thiazotate (thiotriazoline) conducted with a focus on cardiovascular and liver disease, as well as their comorbidities. Thiotriazoline’s mechanism of action is based on its ability to mitigate oxidative stress by modulating NO synthase activity, improve endothelial function, and exert anti-inflammatory effects. Clinical studies have demonstrated its efficacy in treating cardiovascular diseases, liver disorders, and their combined presentations. Of particular interest is its potential as an adjunct therapy in oncology and phthisiopulmonology where cardiotoxicity and hepatotoxicity pose significant challenges. The expert council evaluated the available research and outlined key recommendations for thiotriazoline’s clinical use and further investigation. The drug can be recommended as either a primary or adjunctive therapy for: cardiovascular diseases (stable angina pectoris II– III functional class, chronic heart failure, drug-induced cardiotoxicity); combined liver and cardiovascular disorders, including non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease, and metabolic dysfunctionassociated liver injury (MET-ABP); reducing cardioand hepatotoxicity in oncology and antituberculosis treatмent. To strengthen the evidence base, further methodologically rigorous clinical trials are needed.

Introduction. Gastroesophageal reflux disease (GERD) is a common condition leading to a considerable decrease in the quality of life of patients. Proton pump inhibitors (PPI), including pantoprazole, represent the mainstay of medical treatment of GERD. This study assessed the efficacy and safety of pantoprazole (Nolpaza®) in clinical practice.

Aim. To evaluate the clinical efficacy, safety and tolerability of pantoprazole in patients with GERD, as well as the impact of therapy on quality of life and treatment adherence.

Materials and methods. A multicenter observational study included 10,883 patients with GERD (with and without esophagitis) who received pantoprazole (40 mg/day) for 4–8 weeks. The following parameters of treatment were assessed: changes in symptoms, check-up EGD findings, frequency of adverse reactions, physician and patient satisfaction, and treatment adherence. Results. The study results allowed us to evaluate the efficacy and safety of the therapy used. Improvement was noted in more than 99% of patients (complete disappearance of symptoms in 73.4%). According to EGDS, 74.45% achieved complete remission, 25.08% partial. Adverse events (AE) were registered in 0.28% (headache, constipation, abdominal discomfort). During therapy, adherence to the drug was more than 86%, satisfaction with treatment was more than 94% among doctors and more than 95% among patients.

Conclusions. Pantoprazole demonstrated high efficacy in relieving GERD symptoms and healing mucosal lesions, a high safety profile with a minimal risk of adverse events, as well as good tolerability and high patient adherence to this therapy. Our findings favoured the use of pantoprazole as a standard therapy for GERD in real-world clinical practice.

Introduction. Helicobacter pylori (H. pylori) and autoimmune inflammation are leading etiologic factors of chronic gastritis. Given the lack of etiological treatment for autoimmune gastritis (AIG), there is a need to consider the use of epithelial-protective therapy for this group of patients and analyze of its effectiveness.

Aim. To assess the effectiveness of therapy with the cytoprotector rebamipide in patients with AIG with different status of infection with H. pylori.

Materials and methods. An open, cohort randomized study was conducted involving 60 patients with chronic atrophic gastritis (CAG). Three groups were formed considering the etiologic factor of CAG: the main group of patients with AIG, comparison group 1 – with AIG in combination with H. pylori, comparison group 2 – with H. pylori-associated gastritis. Patients with AIG, some with AIG in combination with H. pylori and those with H. pylori-associated gastritis received rebamipide for 12 weeks. A statistical analysis of the control results of the dynamics of dyspepsia symptoms and a morphological study of gastrobiopsy samples, was performed.

Results. In groups of patients receiving rebamipide therapy, a statistically significant decrease in the severity and incidence of dyspepsia symptoms was observed by the 4th and 12th weeks of observation. When assessing the results of a control morphological study in the groups of patients with AIG and AIG in combination with H. pylori, a statistically significant trend towards a decrease in the degree of inflammation was observed. In the group of patients with H. pylori-associated gastritis, a statistically significant decrease in the degree of inflammation was also noted.

Conclusion. The use of epithelium-protective therapy in patients with AIG has a beneficial effect on the manifestations of dyspepsia syndrome. A statistically significant trend towards a decrease in the severity of inflammatory changes in the gastric mucosa in patients with AIG was observed while taking rebamipide. Further studies are required regarding the effectiveness of rebamipide in patients with AIG with a long follow-up period.

Gastroparesis is a symptomatic chronic stomach disease characterized by objective sings of delayed gastric emptying in the absence of mechanical obstruction. Gastroparesis is rarely documented in routine clinical practice. This disease is usually suspected, examined and diagnosed in patients with a syndrome of intense and prolonged nausea, vomiting, early satiety, epigastric pain, which occur as a result of muscular, nervous or rhythmic abnormalities of gastric functioning. Although delayed gastric emptying is a determining feature of gastroparesis, other aspects of gastric neuromuscular dysfunction, such as maladaptation and visceral hypersensitivity, may also contribute to the symptoms of gastroparesis. The symptoms of gastroparesis often overlap with those of other functional gastrointestinal disorders, including chronic unexplained nausea and vomiting syndrome, cyclic vomiting syndrome, various impaired "gut-brain" interactions, and, first of all, functional dyspepsia. This article presents a review of different examinations in gastroparesis from a gastric motility perspective. In clinical gastroenterological practice, gastroparesis is considered one of the most complex conditions due to the disagreements regarding the definition, range of symptoms, diagnosis and optimal therapeutic strategy, particularly due to the lack of treatment methods with proven efficacy. The article reviews current data on epidemiology, etiologic factors, pathophysiological concepts, and substantiates the need for proper diagnosis of gastroparesis. The methods for treating functional gastroparesis such as diet therapy, prokinetics, antiemetics and symptom relief drugs are described in detail. In addition, the rationale for the use of itopride prokinetic and rebamipide gastroprotector is presented.

The presented clinical case examines the interaction between two microorganisms, Candida albicans and Helicobacter pylori, and their possible impact on the effectiveness of eradication therapy. Eradication therapy is a set of measures aimed at destroying pathogenic microorganisms in the human body. However, in some cases, achieving complete eradication may be difficult due to interactions with other microorganisms, such as Candida. In the presented clinical case, we are faced with a situation where standard eradication therapy regimens do not allow for complete elimination of H. pylori. The patient has both C. albicans and H. pylori, which can lead to deterioration of the condition and lack of remission of symptoms. In addition, antibiotic resistance may develop. When eradication therapy is prescribed, the patient notes a decrease in clinical symptoms, while a repeat test for H. pylori is positive. After the additional examination (stool for dysbacteriosis with determination of sensitivity to antibacterial drugs, antibodies to parietal cells of the stomach) the therapy was adjusted due to the detection of C. albicans with subsequent control of laboratory parameters to assess the effectiveness of the prescribed therapy. Repeated analysis for H. pylori showed positive dynamics, which indicates the correct choice of patient management tactics. In this regard, it can be concluded that timely diagnosis of candidiasis plays an important role in increasing the effectiveness of treatment and improving the quality of life of a patient with chronic gastritis. This clinical case emphasizes the importance of taking into account the interaction between various microorganisms during eradication therapy. This can help increase its effectiveness and improve the treatment results for patients with infections caused by Helicobacter pylori.

The high prevalence of gastroesophageal reflux disease (GERD) and ageing of the population makes the issue of GERD pharmacotherapy a challenge for a comorbid patient, taking into account the choice of an effective proton pump inhibitor (PPI) that has a stable and long-term acid suppression, metabolic neutrality and a low risk of drug interactions. The combination of classic esophageal manifestations of GERD, such as heartburn and regurgitation with extraesophageal manifestations due to high gastroesophageal reflux resulting in the development of ENT and respiratory symptoms, contributes to the complexity of issues of differential diagnosis and pharmacotherapy. The occurrence of chest pain and heart rhythm disturbances in a patient with GERD requires differentiation from cardiovascular diseases and the choice of therapy affecting all pathogenetic components in the context of comorbidity. Proton pump inhibitors as the mainstay of pharmacological acid suppression in GERD treatment regimens should be prescribed as the primary therapeutic course and part of maintenance therapy regimens, the duration of which is determined on a patient-by-patient basis and often amounts to years of use, which should take into account not only the effectiveness, but also the safety of a particular drug. Pantoprazole is a selective PPI for the gastric parietal cells, in which the pH reaches the lowest values, provides a long-term acid-reducing effect and is metabolically neutral when administered together with other drugs in comorbid patients. Evaluation of the safety of long-term use of the drug for up to 15 years based on the results of clinical studies showed the absence of a risk of malignant neoplasms. Moderate hypergastrinemia was not accompanied by clinically significant changes in the mucous membrane throughout the entire period of pantoprazole therapy. In conclusion, daily maintenance therapy with pantoprazole for up to 15 years is effective, well tolerated and does not raise safety concerns.

The review analyzes preclinical and clinical studies of thiotriazoline in liver and heart diseases, and their combination, highlighting the most promising areas for further research. Thiotriazoline (morpholinium thiazotate, morpholine-4-ium 2-(5-methyl1H-1,2,4-triazol-3-ylsulfanyl)acetate) is an organic salt derived from heterocycles of morpholine (tetrahydro-1,4-oxazine) and 1,2,4-triazole. It has the ability to reduce oxidative and nitrosative stress, justifying its broad clinical use. The capacity of thiotriazoline to suppress nitrotyrosine and peroxynitrite production is relevant for both cardiovascular diseases and liver diseases. Several studies demonstrate its efficacy in treating heart conditions by improving endothelial dysfunction and enhancing myocardial hemodynamics. These properties have been confirmed in randomized clinical trials (RCTs) and meta-analyses, including patients with chronic coronary artery disease and acute coronary syndrome. Notably, thiotriazoline has shown promising results in patients with non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (AFLD), where atherosclerotic cardiovascular disease (e.g., hypertension, ischemic heart disease, heart failure) is a major comorbidity. The underlying mechanisms include insulin resistance, chronic inflammation, and dyslipidemia. Thiotriazoline improves microcirculation in the liver and heart, reduces oxidative stress, and mitigates inflammation. Clinical trials report symptom relief, improved liver function tests, and enhanced physical functioning in these patients. The review also discusses thiotriazoline’s role in managing cardioand hepatotoxicity induced by chemotherapy and anti-tuberculosis treatment. In some cases, its use allowed patients to continue and complete therapy, indirectly improving prognosis. Finally, the review outlines limitations of existing studies and identifies key areas for future research on thiotriazoline in modern clinical practice.

Metabolically associated fatty liver disease as one of the most common liver pathologies in the world, which ranges from simple steatosis to more severe forms such as steatohepatitis, which can progress to liver fibrosis, cirrhosis and hepatocellular carcinoma. The stage of fibrosis in hepatic tissue is associated with an increased risk of overall mortality, cardiovascular disease, hepatocellular carcinoma and extrahepatic malignancies, especially in the elderly, when there is an increased predisposition to metabolic disorders, which may lead to the development of fatty liver dystrophy and progression of fibrosis. Histologic methods of liver examination, including liver biopsies are highly informative, making this method of diagnosing liver pathology crucial in verifying the diagnosis; however, these procedures may have rare but potentially serious complications. In this regard, the relevance of using various non-invasive methods to assess the severity of fibrotic processes in liver tissue, including existing scales and algorithms such as FIB-4 and NAFLD Fibrosis Score, BARD and BAAT scales, APRI index and ultrasound elastography is undeniable. This review study examines the use of modern non-invasive approaches to assess the degree of fibrosis in patients with metabolically associated fatty liver disease, including elderly patients. Thus, as a first step the use of calculated fibrosis indices, such as FIB-4 index, NFS scale, followed, if necessary, by ultrasound diagnostic methods, especially liver elastography, is very relevant.

Sarcopenia is a syndrome characterized by a progressive and generalized loss of skeletal muscle mass, strength, and function, that exists in a primary and a secondary form. Secondary sarcopenia complicates chronic liver disease with a prevalence ranging from 30 to 100% depending on the nature of disease, its severity, and compensation status. The presence of sarcopenia limits normal daily activity, reduces work capacity, diminishes quality of life, may lead to disability, and increases all-cause mortality risk. Despite the evident medical and social burden of this condition, as of today, no agents for its treatment have proven to be both effective and safe. Significant attention of the scientific community has recently been drawn to molecules that improve and normalize the somatotropic axis function, which is found to be impaired in all types of sarcopenia. L-ornithine and its salts (L-aspartate, α-ketoglutarate) are not only capable of direct hepatoprotection and facilitation of ammonia clearance, but also modulate the somatotropic axis as well as have a number of pleiotropic metabolic effects. Preclinical studies have found L-ornithine to act as an indirect growth hormone secretagogue and enhance the activity of its main effector molecule, insulin-like growth factor 1. In clinical trials, course treatment with L-ornithine L-aspartate as an add-on to standard therapy increased the levels of circulating growth hormone, promoted arm muscle growth, improved handgrip strength and standing balance. L-ornithine α-ketoglutarate increased appetite and skeletal muscle gain in malnourished older adults, mitigated glutamine loss by skeletal muscle following major surgery, and improved quality of life in elderly convalescent subjects. The available data suggest potential effectiveness of L-ornithine formulations for the treatment of sarcopenia associated with chronic liver disease, and highlight this indication as an important field for future research.

Drug-induced liver damage is a pressing issue in modern pharmacotherapy. The importance of studying this issue is especially high in the current conditions of polypharmacy, hypoor hyperdiagnosis of diseases with insufficiently justified prescription of drugs and their combinations. The article presents a clinical observation of a patient with developed decompensated liver cirrhosis after pulse therapy with methylprednisolone. The patient complained of severe pain and weakness in the lower extremities, was examined by a neurologist due to suspected multiple sclerosis – the diagnosis was not confirmed. Later, she was hospitalized for further diagnostics, an MRI study was performed with the detection of a few focal changes, which were interpreted as a demyelinating disease of the central nervous system, as a result of which pulse therapy with methylprednisolone was prescribed. She was discharged with positive dynamics, was observed on an outpatient basis in the multiple sclerosis office, did not lead a healthy lifestyle, there were episodes of drinking alcoholic beverages. Four months after the last hospitalization, the patient’s condition worsened, weakness and shortness of breath appeared. She was hospitalized and after a long diagnostic search, the final diagnosis was established: Unspecified liver cirrhosis. MELD = 22 points, Child-Pugh class B. The described clinical case is an example of the development of severe drug-induced liver injury induced by pulse therapy with methylprednisolone. Multiple sclerosis has a number of common features with other pathologies, therefore, to establish a diagnosis, it is necessary to conduct a detailed and comprehensive examination of the patient. It is important to exclude other possible diseases. Unreasonable and premature administration of corticosteroids can lead to drug-induced liver injury.

Alcoholic liver disease (ALD) is a global health issue that annually claims the lives of millions and leads to disabilities. According to the WHO, alcohol accounts for 5.9% of all deaths and 5.1% of global disease burden. In Russia, high alcohol consumption persists, with more than 1 million patients suffering from alcohol dependence. ALD includes a range of conditions, from steatosis to cirrhosis, the progression of which is influenced by factors such as dose, frequency, genetics, gender, and concomitant illnesses. The article details the pathogenesis of ALD, including toxic effects of alcohol, oxidative stress, and inflammation. Diagnostic methods are based on clinical data, laboratory tests, and imaging. Special attention is given to standardized alcohol dosages for risk assessments and safe consumption limits. Treatment of ALD requires a holistic approach, ranging from abstinence to medications like glucocorticoids and hepatoprotectants, and in severe cases, liver transplants. Essential phospholipids play (EFL) a crucial role in therapy. EFL restore hepatocyte membranes, reduce stress, suppress inflammation, prevent fibrosis. Studies have shown that EFL improves clinical and biochemical markers, such as bilirubin, liver enzyme activity (AsAT, ALAT), and lipid metabolism. The medication is well-tolerated and recommended for ALD treatment.

Introduction. Non-alcoholic fatty liver disease (NAFLD) is a global public health challenge. Study data show that all-cause mortality rates increase significantly with liver fibrosis F ≥ 2; therefore, predictive indices (PI) are critical for the primary diagnosis of liver fibrosis and steatosis.

Aim. To assess the diagnostic accuracy of steatosis (FLI, ST) and liver fibrosis (FIB-4, APRI, NFS) PI for detecting liver fibrosis and steatosis as compared with transient elastography (TE) in patients with NAFLD.

Materials and methods. A total of 142 patients with NAFLD were included in the study. The computation of the above PI, TE-CAP was performed for all patients. The diagnostic accuracy of liver fibrosis and steatosis PI was compared with TE using a respondent-driven sampling. All patients underwent hand grip strength (HGS) measurement using a hand dynamometer.

Results. The FIB-4 (cut-off point > 1.94) showed AUC = 0.643, a sensitivity of 34.78% and specificity of 90.62 for differentiation between severe LF and cirrhosis (F3-F4). The APRI (cut-off point > 0.44) showed AUC = 0.615, a sensitivity of 54.35%, and specificity of 67.71 for differentiation between severe LF and cirrhosis (F3-F4). The NFS (cut-off point > 26.38) showed AUC = 0.681, a sensitivity of 58.7% and specificity of 79.1 for differentiation between severe LF and cirrhosis (F3-F4). The ST (cut-off point > 0.054) showed AUC = 0.713, a sensitivity of 45.63% and specificity of 87.18 for differentiation of severe liver steatosis (S2-S3). For HGS, a significant inverse correlation between HGS, based on hand dynamometer values, and the quantitative indicator of liver parenchyma density, based on TE (kPa) values, was found (r = -0.2879, p = 0.0005).

Conclusions. The FIB-4 and NFS indices showed the highest diagnostic accuracy for detecting severe AF and cirrhosis (F3-F4). The FLI and ST indices demonstrated the significant diagnostic accuracy for detecting severe liver steatosis (S2-S3). HGS can be used as an additional non-invasive method for the differentiation of patients with severe fibrosis and cirrhosis (F3-F4).

Introduction. Clinical manifestations of Opisthorchis felineus (O. felineus) invasion are characterized by pronounced polymorphism and can include lesions of various organs and systems, including the development of hepatitis and cirrhosis of the liver. Aim. To study the frequency of clinical manifestations of O. felineus invasion in patients with opisthorchiasis with a FIB-4 index value of more than 1.45.

Materials and methods. A total of 360 patients with O. felineus invasion (158 men and 202 women, average age 40.6 years) aged 18 to 70 years were examined. Clinical examination of patients was carried out using standard questionnaires that allowed assessing the frequency and intensity of symptoms. O. felineus invasion was diagnosed using duodenal bile microscopy and coproovoscopy. All patients underwent esophagogastroduodenoscopy, abdominal ultrasound, complete blood count and biochemical blood assay. The FIB-4 index was calculated, the value of which was more than 1.45 indicated a high probability of liver fibrosis.

Results. In patients with opisthorchiasis with FIB-4 index more than 1.45, weekly pain in the right hypochondrium, obesity, erosions of the stomach and duodenum, hepatomegaly, liver steatosis, signs of cholecystitis by ultrasound, biliary sludge, polyps in the gallbladder, increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the blood were more often registered compared to individuals with FIB-4 index less than 1.45. Hepatomegaly was associated with weekly pain in the right hypochondrium, obesity, liver steatosis, signs of cholecystitis, the presence of biliary sludge, cholecystectomy, neutropenia, elevated ALT and AST levels, FIB-4 index above 1.45.

Conclusions. The FIB-4 index is a useful diagnostic tool, since it is easily calculated from the indicators of routine blood tests. Patients with elevated FIB-4 values and hepatomegaly have more pronounced intensity of clinical symptoms of the disease and require active diagnostic and therapeutic measures to prevent complications.

Introduction. Toxic liver injury is widespread among patients, especially those with comorbidities and polypharmacy. The non-specific clinical manifestations and significant variability in liver and systemic changes complicate timely diagnosis and initiation of treatment.

Aim. To evaluate the effectiveness of therapy for toxic (drug-induced) liver injury using a hepatoprotective agent containing inosine, meglumine, methionine, nicotinamide and succinic acid.

Materials and methods. A total of 178 patients (152 men, 26 women) with confirmed drug-induced liver injury were examined. The main group (n = 104) received hepatoprotective agent containing inosine, meglumine, methionine, nicotinamide and succinic acid intravenously (400–800 ml, up to 14 days) in addition to standard therapy. The control group received conventional detoxification and symptomatic treatment. Clinical and laboratory evaluation was performed, including assessment of liver function biochemical markers.

Results. By day 21, the main group showed a statistically significant improvement: ALT decreased from 531 ± 112 to 46 ± 25 U/L, AST from 587 ± 126 to 41 ± 35 U/L, ALP from 378 ± 76 to 86 ± 44 U/L, GGT from 418 ± 92 to 58 ± 24 U/L; albumin increased from 29 ± 4 to 41 ± 3 g/L, and the prothrombin index from 54 ± 12 to 94 ± 6% (p < 0.001). Improvements in the control group were less pronounced.

Conclusion. Hepatoprotective agent containing inosine, meglumine, methionine, nicotinamide and succinic acid demonstrated efficacy by reducing several adverse clinical manifestations of toxic (drug-induced) liver injury, including resolution of cytolysis and cholestasis syndromes, restoration of protein-synthetic liver function, and improvement of hematological parameters.

Introduction. The high prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) requires timely diagnosis of its progressive forms. Recently developed for this purpose FibroScan-AST (FAST) and Agile 3+ indices have shown good diagnostic capabilities, but have not been validated in a Russian cohort.

Aim. To evaluate the diagnostic efficiency of the FAST and Agile 3+ scores in Russian patients with MASLD.

Materials and methods. The medical records of 43 patients with histologically verified MASLD and transient elastography (TE) performed were analyzed. Non-invasive indices of progressive MASLD were calculated: FIB-4, FAST and Agile 3+.

Results. All the studied methods demonstrated good diagnostic ability. FAST demonstrated the best results for detecting non-alcoholic steatohepatitis (NASH) + NAS ≥ 4 + F ≥ 2 compared to TE and FIB-4. The area under the ROC curve (AUROC) for FAST was 0.827 ± 0.064 (95% CI: 0.701–0.952, p < 0.0001); for FIB-4 and TE – 0.786 ± 0.069 (95% CI: 0.651–0.920, p = 0.001) and 0.758 ± 0.075 (95% CI: 0.610–0.905, p = 0.004), respectively. However, the standard FAST cutoff values (≤0.35 and ≥0.67) had low sensitivity in the study cohort: the number of indeterminate results was 60.5%. Optimization of the FAST cutoff values (≤0.41 and ≥0.52) reduced the proportion of indeterminate cases to 23.25% and increased the number of correctly classified patients (from 37.2% to 62.8%, p = 0.0012). For the diagnosis of progressive fibrosis (F ≥ 3), the Agile 3+ score showed the best result (AUROC = 0.825 ± 0.077 (95% CI: 0.675–0.976, p = 0.003)) compared to FIB-4 and TE, but recalculation of the threshold values did not lead to a significant improvement in the diagnostic ability of the Agile 3+.

Conclusions. The FAST and Agile 3+ scores are effective for diagnosing progressive MASLD, but the FAST threshold values require adaptation for the Russian population.

Irritable bowel syndrome (IBS) is a chronic functional bowel disorder that is common among young and working-age individuals and can significantly impact quality of life. Among the etiopathogenetic aspects of IBS development, the most important are intestinal motility disorders, visceral hypersensitivity, and intestinal microbiome disorders. A previous acute intestinal infection can have a significant impact on the latter, subsequently forming a post-infectious variant of IBS (PI-IBS), the frequency of which depends on what etiological factor led to the development of acute infectious gastroenteritis (bacteria, viruses, protozoa). Risk factors for the development of PI-IBS have been studied and described, among which are the severity of intestinal infection, duration of diarrhea for more than 7 days, female gender, level of anxiety and depression. Approaches to the treatment of PI-IBS have not been developed. It is proposed to use treatment options that are consistent with approaches to non-infectious IBS in accordance with the Rome Consensus IV. The first-line drugs for pain relief are antispasmodics, which reduce the tone and contractility of the smooth muscles of the intestine, effectively coping with abdominal pain. The drug of choice for patients with PI-IBS are calcium channel blockers, namely Otilonium bromide, which is widely used worldwide, is effective and safe, has additional antibacterial and antimycotic properties, is well tolerated and is superior to placebo in reducing symptoms and preventing relapse of pain in patients with IBS. In the therapy of PI-IBS, the use of rifaximin and probiotic preparations for at least 12 weeks is of great importance. This article provides a review of the literature on the prevalence and etiopathogenetic aspects of PI-IBS, as well as possible approaches to the treatment of such patients. A clinical case is presented.

Introduction. The pathogenesis of ulcerative colitis (UC) is based on damage to the intestinal mucosa, increased expression of proinflammatory cytokines, and activation of inflammatory cells, including neutrophils. The degree of neutrophil infiltration of the intestinal mucosa determines the severity of clinical manifestations, endoscopic findings, and systemic manifestations of inflammation.

Aim. The study was to compare the parameters of the systemic inflammatory response with changes in the ability of neutrophils to form extracellular traps in patients with ulcerative colitis (UC).

Materials and methods. The study included 33 patients with UC (group UC), the control group consisted of 20 healthy volunteers (group Control). The ability of neutrophils to form extracellular neutrophil traps (NETs) ex vivo in both groups was determined. The result of stimulation was evaluated by luminescent microscopy, determining the percentage of intact neutrophils, neutrophils of varying degrees of activation, early netosis cells, extracellular traps in the form of a cloud surrounding neutrophil – cloud-shaped NETs, extracellular traps in the form of filaments – filamentous NETs. The capture coefficient of extracellular traps was calculated.

Results. After stimulation, significantly large proportions of early netosis cells (p = 0.0003), cloud-shaped NETs (p < 0.0001), filamentous NETs (p = 0.0048) and hyperactivated neutrophils were visualized in the neutrophil preparation of patients with UC in comparison with similar indicators determined in the comparison group. In UC patients, the percentage of intact and hypoactivated neutrophils was significantly lower (p < 0.0001; p = 0.0012, respectively), and the extracellular traps capture coefficient in the UC group was significantly lower (p = 0.0078).

Conclusions. The study confirms that the analysis of the ability of neutrophils to form extracellular traps in patients with UC has diagnostic and prognostic value. It allows us to assess not only the severity of inflammation, but also to identify the mechanisms of abnormal immunity in autoimmune pathologies, including UC. Monitoring of netosis helps to determine the depth of remission, which is important for the prevention of complications of the disease. Integrating this approach into diagnostic algorithms can optimize patient monitoring and improve treatment outcomes.

Chronic constipation is a generally recognized medical and social problem and occupies a leading place in the number of requests for outpatient medical care among patients with a gastroenterological profile in many countries of the world. The persistent trend in recent years towards an increase in global prevalence regardless of gender, age and socioeconomic status emphasizes the relevance of studying and systematizing data on the causes of chronic constipation and optimal approaches to diagnosis in order to improve the effectiveness of treatment of patients. A particular difficulty in managing patients with chronic constipation is identifying the etiological factor due to the presence of a wide range of possible causes. This often increases the time of diagnosis and complicates the timely initiation of rational therapy. According to etiology, chronic constipation is classified as primary (functional) – an independent disease in the absence of organic or metabolic disorders and secondary – as a symptom of another pathology or associated with a known factor. In clinical practice, the majority of cases are patients with primary chronic constipation, namely, with functional constipation and irritable bowel syndrome with a predominance of constipation. The diagnostic algorithm for chronic constipation should be aimed at assessing “alarm symptoms”, excluding organic pathology and other secondary causes. This involves a thorough collection of complaints, anamnesis of the disease and life, physical examination and the appointment of the necessary laboratory and instrumental examination methods, the scope of which is determined individually. The basis of therapy for a patient with primary chronic constipation is lifestyle modification. In the absence of a positive effect from non-drug methods, it is advisable to prescribe laxatives – osmotic action as first-line therapy, stimulating or agonists of 5HT4 receptors in case of insufficient response to the former. One of the stimulant laxatives that has shown its effectiveness and a reliable safety profile in the treatment of patients with primary chronic constipation is sodium picosulfate.

Introduction. Inflammatory bowel diseases (IBD) including Crohn's disease (CD) and ulcerative colitis (UC) are chronic relapsing conditions with gastrointestinal mucosa injuries and potential local and systemic complications. The incidence of osteoporosis (OP) in patients with IBD is very variable according to data from different studies.

Aim. To evaluate changes in bone mineral density (BMD) and bone remodelling parameters in young patients with IBD for early detection of changes in the bone tissue.

Materials and methods. The study included 123 patients with verified diagnoses of UC (n = 70) and CD (n = 53), who were observed at the State Autonomous Healthcare Institution Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan from March 2023 to December 2024. All patients underwent a detailed clinical history and physical examination. Bone metabolism and its regulators such as osteocalcin (ng/ml), Beta-Cross Laps (ng/ml), P1NP (ng/ml), and vitamin D levels (ng/ml) were assessed. All patients underwent measurements of BMD using dual-energy X-ray absorptiometry to detect OP.

Results. Of 123 young patients with IBD, 13.8% (17 patients) had bone mass below age-matched reference values based on dual-energy X-ray absorptiometry findings. Bone remodelling parameters assessment revealed changes in 31% (39 patients), and decrease in vitamin D levels in all patients of the study.

Conclusions. Of 123 young patients with IBD examined, 13.8% (17) of patients had bone mass below age-matched reference values. The bone remodelling parameters were changed in a larger percentage of patients (31%). All patients with IBD had low vitamin D levels. The presence of moderate and severe IBD, low body mass index, systemic glucocorticoids in the IBD treatment protocol, as well as acute course of UC and presence of ileocolitis in CD significantly contribute to the decrease in Z-scores, and accordingly, the decrease in BMD.

Introduction. The mainstay of treatment of constipation-predominant irritable bowel syndrome (IBS-C) are antispasmodic and laxative drugs. The use of biofeedback therapy is effective in patients with IBS-C, when dyssynergic defecation (DD) is detected.

Aim. To evaluate the efficacy of additional biofeedback therapy in patients with IBS-C and dyssynergic defecation versus conventional pharmacotherapy.

Materials and methods. A total of 28 patients aged 30 to 40 years with IBS-C and concomitant DD were included in the study. The subjects were divided into two groups: standard pharmacotherapy (Group 1) and standard pharmacotherapy combined with biofeedback therapy (Group 2). The subjects underwent assessment of the clinical picture, and findings of the evacuation test (ET) and anorectal manometry (AM).

Results. After treatment the frequency of defecations per week in Group 1 increased to 3.13 (95% CI 2.67–3.59), and in Group 2 to 4.3 (95% CI 3.68–4.93). AM data showed a decrease in average resting pressure in the anal canal to 80.33 (95% CI 72.97– 87.69) (Group 1), and to 77.15 (95% CI 72.07–82.23) mm Hg (Group 2), an increase in intrarectal pressure to 78.06 (95% CI 69.30–86.82) (group 1) and to 70.76 (95% CI 63.08–78.44) mm Hg (Group 2). In Group 2, the defecation index increased to 2.61 (95% CI 2.0-3.22) versus 1.19 (95% CI 0.92-1.44) in Group 1, positive ET was reported in 5 of 15 subjects (33.33%) in Group 1, and in 10 of 13 subjects (76.92%) in Group 2.

Conclusions. This study shows that conventional pharmacotherapy combined with biofeedback therapy demonstrated greater efficacy than standard pharmacotherapy in patients with IBS-C and DD.

Introduction. The small intestinal bacterial overgrowth (SIBO) with low levels of fecal elastase-1 (FE-1) often mimics the symptoms of of exocrine pancreatic insufficiency (EPI). In this case, enzyme replacement therapy with pancreatin preparations proves ineffective.

Aim. To study the therapeutic efficacy of rifaximin alfa in patients with low FE-1 levels without imaging findings of pancreatic injury.

Materials and methods. The study included 35 outpatients with low FE-1 levels (less than 200 μg/g), refractory clinical manifestations specific to lower gastrointestinal tract diseases, and no signs of pancreatic injuries seen on cross sectional imaging. The total duration of treatment was 15 weeks, during which patients received 6 alternating cycles each lasting 14 days: rifaximin alfa and a probiotic. Rifaximin alfa was administered at a dose of 1,200 mg per day split in 3 doses of 400 mg each for 14 days. Probiotic therapy for 14 days included Lacticaseibacillus paracasei DG (L. paracasei DG) due to the fact that patients had both diarrhea and constipation. L. paracasei DG without prebiotic was prescribed to patients with diarrheapredominant irritable bowel syndrome. L. paracasei DG with a prebiotic was recommended to patients with constipationpredominant irritable bowel syndrome at a dose of 1 capsule/sachet once a day for 3 weeks.

Results. A statistically significant regression (p < 0.05) of all primary complaints was observed. The median FE-1 levels significantly increased from 76.0 (95% CI: 48.9–113.0) to 290 (95% CI: 260.0–332.3) μg/g (p < 0.0001). Normalization of FE-1 levels was observed in 32 patients (91.4%) (p < 0.0001).

Conclusion. SIBO can be one of the dominant causes of low FE-1 levels in patients with intestinal symptoms and no objective signs of pancreatic injuries. Cyclic therapy with rifaximin-alpha and probiotic based on the strain L. paracasei DG allowed to achieve regression of clinical manifestations, improve the quality of life and normalize FE-1 levels after 15-week therapy in most patients.

This article presents a clinical case of chronic abdominal ischemic syndrome caused by occlusion of both the superior and inferior mesenteric arteries, combined with infrarenal aortic occlusion and iliac artery involvement, secondary to atherosclerosis of the visceral aortic branches and lower extremity arteries. Chronic abdominal ischemic syndrome is a pathological process characterized by chronic hypoperfusion of abdominal organs due to hemodynamically significant stenosis or occlusion of the visceral branches of the abdominal aorta. This syndrome is a rare cause of abdominal pain, but it is associated with high mortality and often presents a diagnostic problem for physicians. A distinctive feature of this condition is its nonspecific clinical presentation, which may mimic various gastrointestinal disorders, as demonstrated in this case report. Consequently, to reduce the number of diagnostic errors and provide timely therapy, vascular imaging modalities, such as computed tomography (CT) angiography, should be incorporated into the diagnostic algorithm for elderly patients presenting with chronic abdominal pain and weight loss, particularly those with atherosclerotic risk factors. CT angiography revealed occlusion of the infrarenal aorta, occlusion of the superior mesenteric artery and inferior mesenteric artery, and stenosis of the celiac trunk up to 30%. A unique aspect of this case was the simultaneous surgical reconstruction involving superior mesenteric artery bypass and aortobifemoral grafting via a single operative approach, highlighting advanced capabilities in modern vascular surgery.