Today, constipation is one of the most important medical and social problems of world health. Its prevalence, according to various estimates, exceeds 30%. There is no doubt that this pathology precedes the occurrence of a number of diseases and not only of the gastrointestinal tract. For example, studies conducted at La Trobe University in Australia have shown a link between chronic constipation and the development of cardiovascular diseases. In the management of a patient suffering from chronic constipation, in addition to knowledge about the regulation of intestinal secretion and motility, recognition and possible elimination of the cause of its development, the choice of therapy tactics, taking into account concomitant diseases, especially in the presence of pathology from the cardiovascular system, is of great importance. In the treatment regimens, it is customary to use drugs with a laxative effect and different mechanisms of their action, allowing achieving a rapid positive effect in a short time.

The review presents modern ideas about the pathophysiology of the anemia syndrome associated with celiac disease. Brief information is provided about the main proteins involved in iron metabolism and their role in maintaining homeostasis. Attention is paid to the multifactorial pathogenetic mechanisms of anemia in celiac disease, the state of the duodenal mucosa and ultrastructural changes in the villi of enterocytes with signs of atrophy, which play a key role in the regulation of iron absorption, and also provides information on the mechanisms of the development of functional iron deficiency and its role in the pathogenesis of anemia of chronic diseases.

The most frequent complication of endoscopic papillosphincterotomy (EPST) is acute pancreatitis. This complication is supposed to be based on mechanical, chemical, hydrostatic, enzymatic and thermal impact on pancreatic ducts and parenchyma. According to different literature data, the incidence of post-EPST pancreatitis (PEP) varies from 30 to 40%, and the mortality rate is 2–10%. The aim of the investigation was to expand information about peculiarities of early diagnostics and prevention of post-EST pancreatitis at the present stage. To reach the set goal we analyzed 559 case histories of patients with diagnosed cholelithiasis, 319 of them underwent EPST. During the study it was found out, that elevated neutrophils/ lymphocytes ratio over 4.96 (p = 0.001), high LDH level over 250 IU/ml (p = 0,010), as well as C-reactive to albumin index over 0,180 (p = 0.001) are reliable markers of early diagnosis. Also, indirect diagnostic markers of PEEP are biochemical signs of cholestasis and cytolysis of hepatocytes, as well as hyperglycemia combined with glucosuria. We consider the inclusion of intraoperative injections of papillotomy wound margins with epinephrine in combination with subsequent Somatostatin administration in combination with rectal diclofenac and intravenous hydration with Reamberin to be the most effective strategy for PEP prevention. Thus, we can conclude that despite the ongoing research and the search for effective algorithms for the prevention and early diagnosis of PEP, their data often contradict each other or simply do not confirm their effectiveness. The problem of prevention and diagnosis of PEP remains complex and requires further study. There are discrepancies, sometimes significant ones, in the current literature, which provides grounds for the development and research of new methods of early diagnosis and prevention.

A 27-year-old patient was transferred by an infectious disease doctor to the St. Petersburg Elizabethan Hospital with a long history of diarrhea and intoxication syndrome. A detailed examination revealed an infection with Clostridium difficile, which contributed to the progression of the disease, deterioration of well-being and, as a result, an increase in neuroticism. The clinical and endoscopic picture indicated ulcerative colitis. When reviewing the biopsy material, noncaseating epithelioid cell granulomas were found, which confirmed the diagnosis of Crohn's disease. This case demonstrates the complexity of the differential diagnosis of inflammatory bowel diseases, which determines the tactics of patient management.

The obesity epidemic in the world is accompanied by a significant increase in the number of cases of non-alcoholic fatty liver disease (NAFLD). One of the directions is bariatric surgery. The review article presents an analysis of the short-term and long-term effectiveness of the use of bariatric surgery methods in patients with NAFLD. Aspects of the influence of bariatric surgery on biochemical and histological parameters of liver fibrosis, changes in insulin resistance and lipid profile, intestinal microbiome involved in the homeostasis of the intestine-liver axis are noted. The role of gene polymorphisms in the progression of NAFLD, as well as protection from fibrotic changes in patients with postoperative period is presented.

Nutritional support is an important component of treatment in gastroenterology. This type of therapy is directly related to digestive and transport processes.

The aim. To investigate the possibility of optimizing the absorption processes in the small intestine when using various natural formulations for enteral alimentation.

Results. It is shown that the optimal degree of condensation of drugs is 4: 1. Inside the dry residue, you can change the ratio of proteins, lipids and carbohydrates. It is advisable to use hydrolytic digestive enzymes including the flokozim created by us. Antibacterial agents based on lactobacilli are also advisable.

Conclusions. 1) The optimal medium for suction is chyme. 2) The mixture should contain no more than 80% water and about 20% dry residue. 3) Floccules are the basis for the creation of the drug flokozim 4) Lactotherapy based on optimized mixtures for enteral.

Objective. Evaluation of a single vector of ultrasound assessment of changes in the liver parenchyma, taking into account the correct use of such physical concepts as stiffness, elasticity, elasticity, density.

Material and methods. On the basis of the Problem Research Laboratory ‘Diagnostic Research and Minimally Invasive Technologies’ a study was conducted with the participation of 112 patients of a multidisciplinary hospital. Multiparametric ultrasound examination (B-mode, quantitative liver steatometry, 2D shear wave elastography, complex format ‘liver protocol’) was performed by ultrasound doctors (n = 24) of the following groups: half-a-year residents in the specialty ‘ultrasound diagnostics’ (n = 9; 37.6%), doctors working in a multidisciplinary hospital of a medical organization of the regional center with work experience up to 5 years (n = 4; 16.6%), 6–10 years (n = 4; 16.6%), 11–20 years old (n = 3; 12.6%), 21 years or more (n = 4; 16.6%), of which 1 (4.2%) professor, 1 (4.2%) doctor of medical sciences, 3 (12.5%) candidates of medical sciences. An analysis of the protocols of ultrasound examination was carried out.

Results. The correct description of changes in the liver according to B-mode data, quantitative steatometry, 2D shear wave elastography and ‘liver protocol’ correct formulations were given by 9 (37.5%) specialists. In all cases, most of the correct protocols were provided by doctors from groups of 6–10 years of experience and 21 years of experience or more.

Conclusions. In the community of specialists in ultrasound diagnostics there is no agreement on a correct and unified approach to the description of diffuse liver changes using multiparametric ultrasound. To increase the level of knowledge, complex multidisciplinary interaction is necessary in the format of scientific and educational programs organized jointly with specialists in the field of medical physics.

To date, the main focus in the implementation of medical activities is focused on the organization of outpatient care for the population. It is at the level of primary health care, where it is possible to carry out primary prevention measures and the formation of a healthy lifestyle, these issues should be given special attention when providing medical care to the population. One of the main tasks of modern healthcare is to reduce the number of chronic non-communicable diseases of the adult population using modern tools of early preclinical diagnostics. To date, one of the most promising areas that have a significant impact on modern healthcare is digital telemedicine technologies based on artificial intelligence. They can be confidently attributed to the most popular and rapidly developing groups of services developed for primary health care for the purpose of primary diagnostics. Nevertheless, no matter how fast information technologies develop, the opinions of experts in the subject area remain relevant, which significantly enrich the results of the expert opinion.