This original article discusses the main concomitant diseases and psychological problems of patients with morbid obesity seeking help from bariatric (metabolic) surgeons. The study was conducted on the basis of St. Petersburg State Medical University n. a. I. P. Pavlov, it was the most voluminous laboratory-instrumental and psychological examination, on the basis of which a peculiar portrait of a Russian patient with morbid obesity was compiled. Gastroenterological symptoms were predominant in patients with morbid obesity. Heartburn was the most common complaint. Non-erosive reflux disease was diagnosed in 35.0 % of patients, erosive esophagitis in 20.5 %, hiatal hernia of the 1st degree in 41.2 %, of the 2nd degree in 32.3 % of patients.

The article presents data on modern views on the problem of duodenogastroesophageal reflux, examines the key features of the physiology of bile acids, the role of bile acids in the patho- genesis of gastroesophageal reflux disease, Barrett's esophagus and esophageal adenocarcinoma. The review presents current methods for diagnosing duodenogastroesophageal reflux, discusses treatment approaches.

The cardinal transformation of the intestinal microbiota in composition, quantity and metabolic products negatively affects the effectiveness of therapy in patients with extreme severity of the disease. Dysfunction of the intestinal microbiota is a prognostic parameter and one of the main causes of complications, infections and the development of sepsis. Currently, scales are used that assess the condition and prognosis of patients, but the microbiota is not included in this list of the studied parameters. In the last 10 years, it has become possible to study and
characterize intestinal microorganisms in more detail. This review provides an analysis of the literature on the importance of intestinal bacteria in patients with extreme severity of the disease, information on possible complications and treatment of disorders associated with dysfunction of the intestinal microbiota.

The article is devoted to one of the most important problems in modern gastroenterology a violation of nutritional status and glycaemia in chronic pancreatitis.

The comorbidity of various diseases requires the use of drugs that affect common etiological and pathogenetic aspects, which reduces polypharmacy and the risk of side-effect.

Purpose of the study. Find out the state of calcium regulating system, calcium-phosphorus balance in the comorbidity of ulcer disease (UD) with osteoporosis (OP), and the effect of their shifts on the acid secretion and regional microcirculation. To determine the effectiveness of bisphosphonates in the complex treatment of these pathologies.

Materials and methods. We examined 77 people with recurrent UD, 10 of whom revealed its comorbidity with OP. All patients underwent clinical and endoscopic studies, pH-metry, X-ray densitometry. The levels of parathyroid hormone, calcitonin, calcium and phosphorus in the blood were studied

Results. Recurrent of ulcer was characterized by a increase in para- thyroid hormone and calcium, a decrease in blood phosphorus. These changes were more pronounced in patients with a comorbidity of UD with OP and were accompanied by an increase in acid secretion and regional microcirculation. The use of etidronic acid in the treatment UD was characterized by a positive clinical result, normalization of secretion and regional microcirculation.

Conclusion. The comorbidity of UD with OP is accompanied by functional changes in calcium regulating system. Correction of these changes with the use of bisphosphonates in the treatment of relapse of ulcer demonstrates clinical efficacy.

Inflammatory bowel disease (IBD) has been always associated by clinicians with impaired absorption of nutrients, chronic blood loss from mucosal defects, asthenic syndrome and weight deficit. In recent decades the incidence of IBD has significantly increased, especially in developed countries, and this is believed to be partly due to diet and lifestyle global changes. The prevalence of obesity has increased in parallel with the growth of IBD. In the course of epidemiological and clinical studies was found that obesity affects the course of the disease and the response to therapy in patients with IBD. There is an increasing evidence of the active role of adipokines in pro – and anti-inflammatory processes in both obesity and autoimmune disease in the gastrointestinal tract. Despite the fact that the data found on the subject of coherence between IBD and obesity was contradictory, most studies confirm the correlation between obesity and high risks of surgery on the intestine, deterioration of drug absorption, and the development of perianal complications in patients with IBD. The clinical significance of this problem in the context of a steady increase of the incidences of obesity and IBD in Russia and the world as a whole, as well as research data, indicate in favor of the mutual burden of these diseases. The present article demonstrates results of the сore researches conducted on the subject and identifies current, unresolved issues, which demonstrate necessity of further experimental and clinical studies.

The article is devoted to the description of rare changes in the skin of a patient with cirrhosis of the liver. The causes of skin changes in liver diseases are analyzed. A brief review of the literature on this problem is presented.

Parasitic nematodes of the genus Toxocara are socio-economically important zoonotic pathogens. These parasites are usually directly transmitted to the human host through the fecal-oral route and can cause toxocariasis and related complications, including allergic and neurological disorders. Although tens of millions of people are estimated to have been exposed to Toxocara spp. or are infected with them, global epidemiological information on the relationship between seropositivity and toxocariasis is limited. Recent results show that in some countries the impact of toxocariasis on human health is increasing. The purpose of this review was to analyze modern data on the epidemiology, pathogenesis, clinical and laboratory manifestations and therapy of toxocariasis. Material and methods. The analysis of publications in PubMed, EMBASE and Web of Science systems in the period from January 1950 to September 2020, highlighting studies documenting the epidemiological, pathogenetic, clinical and laboratory aspects of toxocariasis. In addition, we analyzed clinical cases of toxocariasis among patients of the departments of the Pediatric Research and Clinical Center for Infectious Diseases. The article discusses the basic information about toxocars, summarizes the key aspects of the pathogenesis, diagnosis and treatment of toxocariasis, its prevalence, and gives recommendations for the prevention and control of this disease.