Purpose of the study. Evaluation of the clinical effectiveness of combination therapy for FGID with overlap syndrome – gastroesophageal reflux disease (GERD), functional dyspepsia (FD) and irritable bowel syndrome (IBS) using the PPI omeprazole and the myotropic antispasmodic mebeverine hydrochloride in extended-release capsules (Meberin ML, Micro Labs Limited, India) on clinical manifestations and motor-evacuation function of the gastrointestinal tract in patients with FGID with overlap syndrome – GERD, FD with gastric hypersecretion and IBS.

Materials and methods. We examined 27 patients with FGID with overlap syndrome of GERD, FD with gastric hypersecretion of hydrochloric acid and IBS.

Results and conclusion. It has been established that combination therapy with these drugs for two weeks in 97 % of cases eliminates the clinical symptoms of the syndromes, improves the quality of life of patients, normalizes intestinal motility and myoelectric activity of the gastrointestinal tract.

Ulcerative colitis (UC) is one of the most serious and poor-studied problems of modern gastroenterology. This nosology is a diffuse inflammation of the intestinal mucosa, limited to the colon with a predominant lesion of the rectum and sigmoid colon. Due to the progressive nature of the disease, patients require lifelong drug therapy and monitoring. Extra-intestinal manifestations are often found in patients with UC and represent a complex problem that requires the close attention of specialists and the appointment of modern pathogenetically-based treatment, including genetically engineered biological drugs. This clinical observation reflects the importance of early diagnosis of UC with extra-intestinal manifestations – primary sclerosing cholangitis and arthropathy, as well as the effectiveness of treatment with ustekinumab.

The aim. Assessment of clinical manifestations of biliary dysfunction, duodenal hypertension. The analysis of data on the effect of drugs of various pharmacological groups on the motor function of the gallbladder is carried out.

Materials and methods. We were examined 60 patients (18–50 years old, mean age 41±4.6 years), mostly women (44). All patients underwent a general clinical examination, including blood and urine tests, biochemical blood parameters, ultrasound examination of the abdominal organs and monitoring of gallbladder contractility, esophagogastroduodenoscopy. The examined patients were divided into 2 groups of 30 patients.

Results and conclusion. The use of choleretics for spasm of the sphincter of Oddi and symptoms of duodenal hypertension is not always justified. The leading link in the treatment of this type of biliary dysfunction are antispasmodics, which eliminate spasm of the sphincter zones, which restores the passage of bile through the biliary tract and reduces the phenomena of biliary insufficiency. Mebeverine hydrochloride also eliminates the phenomena of duodenal hypertension, which facilitates the removal of bile from the biliary tract. When choleretics are prescribed for the treatment of patients with biliary dysfunction with spasm of the sphincter of Oddi, it is quite possible that the course of this pathology will worsen.

Cholelithiasis is a fairly common disease of the digestive system, affecting from 10 % to 15 % of the adult population. Despite many studies devoted to this problem, the mechanisms of formation of gallstone disease have not been fully elucidated. Recently, aspects of the influence of the intestinal microbiota on the mechanisms of formation of various pathologies of the gastrointestinal tract such as non-alcoholic fatty liver disease, inflammatory bowel diseases, irritable bowel syndrome, pancreatic diseases, gastroesophageal reflux disease have been considered. The presented review article examines the possible involvement of the gastrointestinal microbiome in the pathogenesis of gallstone disease. The article discusses the role of microorganisms and their metabolites in the formation of gallstones.

Numerous studies show that in the pathogenesis of ulcerative colitis (UC), a significant role is played by a change in the diversity of the intestinal microflora, which is associated with fewer bacteria producing short-chain fatty acids (SCFAs). SCFCS affect the differentiation and activation of cells of the immune system, play a protective role in maintaining the integrity of the epithelial barrier, participate in the regulation of intestinal peristalsis and blood supply to its wall, muscle anabolism, bioavailability of amino acids.

The aim of the study. To evaluate the content of SCLC in the feces of UC patients with varying degrees of severity of the current attack, as well as to investigate the relationship between the content of SCLC with dietary characteristics, body mass index (BMI), and dyspenia.

Materials and methods. The study involved 80 UC patients, conducted a survey, objective examination, filling out medical history and outpatient records, blood and stool sampling. The content of SCLC was determined in feces. The study of nutritional characteristics in patients with UC was conducted using a standardized questionnaire of the WHO CINDI program. Statistical methods: median (Me), upper and lower quartiles (P₂₅, P₇₅) were calculated; Mann-Whitney criterion; Kolmogorov-Smirnov criterion; nonparametric correlation analysis was performed.

Results. The absolute content of SCFCS in the feces of patients with UC is lower than the reference values. The relative content of propionic acid in the subgroup with severe attack was significantly lower than in the remission subgroup, in the subgroup with mild and moderate attack of the disease. In patients with body weight deficiency, the relative content of propionic acid is lower than in UC patients with normal or overweight. A positive relationship was found between the total content of SCFCS in feces and the amount of dietary fiber consumed in the form of fruits and vegetables. In patients with dinapenia, the relative content of butyric acid in feces is significantly lower than in patients without dinapenia.

Background. Alcoholic liver disease (ALD) – is a disease that leads to the development of liver cirrhosis (LC) with a high mortality rate. N-terminal type lll procollagen peptide (PIIINP) is one of the optimal biomarkers for assessing fibrogenesis.

Objective: to determine the clinical significance of PIIINP blood level in patients with ALD.

Materials and methods. 97 patients with ALD were examined. The age of the patients was 48,5±9,9 years, there were 30 women, 67 men. Steatosis was diagnosed in 12 patients, 11 – alcoholic hepatitis (AH), 74 – LC. In group with LC, 16 patients was diagnosed AH against confirmed cirrhosis. PIIINP blood level determined by ELISA. Control group consisted of 22 healthy volunteers who have not consumed alcohol in hepatotoxic doses.

Results. In all patients, PIIINP blood level was increased. In steatosis PIIINP slightly increased the norm, indicating the beginning of fibrogenesis. In LC, PIIINP blood level was higher than in patients with steatosis, which reflected increasing of fibrosis and progression of the disease. The highest levels of PIIINP were observed in cases with AH. Levels PIIINP in patients with AH but without LC and in patients with AH against the background of the formed LC did not differ. In Maddray index of more than 32 (9 patients), the PIIINP level was higher than in 18 patients with index values <32, which confirmed the role of AH in development of fibrosis and decompensation of liver function.

Conclusion. Determination of PIIINP blood level in patients with ALD will allow predict the activity of fibrogenesis and the severity of subsequent changes in liver tissue. In cases of severe AH, PIIINP may be an additional criterion determining the severity and prognosis of hepatitis outcomes.

Proton pump inhibitors (PPIs) are the most effective drugs for treating acid-related diseases. In recent decades, the use of PPIs has increased exponentially. For a long time, PPIs were considered completely safe drugs for both short-term and long-term use. However, modern clinical guidelines note that when prescribing PPIs in large doses for a long period, the possibility of side effects should be taken into account. In recent years, a number of foreign reviews have been published that examine the associations between PPIs and a number of diseases/conditions. We searched the PubMed and Scopus information databases for publications on the safety of PPI use, including sources up to January 30, 2024. In this review, we examined the effect of long-term use of PPIs on the urinary system. This review demonstrates possible changes in the urinary system and an increased risk of developing nephrolithiasis, acute interstitial nephritis, acute kidney injury, chronic kidney disease, end-stage renal failure with long-term use of PPIs, which should certainly be taken into account when prescribing them for a long period, especially in patients with comorbid pathology.

Renal colic is a condition caused by the passage of a concretion from the kidney through the ureter into the bladder, which is accompanied by a pronounced pain syndrome. Patients with renal colic often seek emergency help with complaints of severe pain, nausea, dysuria. However, there is a category of people who, for various reasons, cannot verbally express their feelings. Such patients are called nonverbal. Nonverbal patients are people with severe cognitive impairments or those who are temporarily unable to speak due to surgery or illness, but they can still demonstrate pain using nonverbal signals.In this article, we present an observation of an atypical clinical picture of renal colic in a nonverbal elderly patient. In the observed woman, an acute attack of renal colic lasted 5 days and passed first under the «mask» of acute pancreatitis. Without receiving pathogenetic therapy, the patient developed acute obstructive pyelonephritis, septic shock, which was initially mistaken for an acute violation of cerebral circulation. The performed computed tomography (CT) helped to identify a concretion in the upper third of the ureter on the left, a violation of the outflow of urine from the left kidney. The patient urgently had a stent installed in the pelvis of the left kidney, urine outflow was restored, anti-inflammatory, detoxification, litolytic therapy was prescribed. After that, the patient's condition improved significantly, and after 3 months, a decrease in the size and fragmentation of the concretion was observed during the control CT scan.

Conclusion. Nonverbal patients are a special group of patients whose clinical picture may be blurred or atypical. Assessment of pain symptoms in nonverbal patients is difficult, which can lead to an incorrect diagnosis and lengthen the period of diagnosis of the disease. The timely diagnosis of renal colic in nonverbal patients is also affected by the localization of pain, since its irradiating nature can direct the diagnostic search «on the wrong track».

Acute kidney failure is a polyetiological disease that is often occurs in patients, which requires a rapid therapeutic response to avoid progression of the condition. Magnetic resonance imaging of the kidneys (MRI) improves the understanding and assessment of pathological processes, supplementing the mandatory diagnostic minimum information in the study of kidney pathology.

Objective. To evaluate the clinical diagnostic capabilities of kidney imaging biomarkers using diffusion-weighted imaging (DWI) and ASL-perfusion data for intensive care unit patients.

Materials and methods. At the first Clinical Hospital in Smolensk 54 patients were examined who were inpatient treatment and in the intensive care unit. All patients underwent ultrasound examination of the kidneys with assessment of blood flow in the main kidney vessels, MRI of the kidneys, with DWI of the kidney parenchyma and ASL-perfusion included in the study protocol. MRI was carried with assessed b-factor 800 and was drawn apparent diffusion coefficient (ADC) maps. When carried ASL perfusion, the field of view covered the area of the parenchyma of both kidneys. The reference method was glomerular filtration rate for all of the patients. The control group was represented by healthy people (n=59). Consent to participate in the study was obtained from patients or their legal representatives. All stages of the study comply with the normative and regulatory documentation of Ministry of Health ща the Russian Federation.

Results. It was concluded that there is a significant difference in ADC for prerenal causes and in ASL for renal causes. In 9 (16.7 %) patients, kidney ADC was 1.5±0.3 mm²/sec, ASL – perfusion – ≤ 250 ml/100g/min, compared with the control group. In this group, negative dynamics were observed within a week, тnegative laboratory dynamics correlates with radiation-based kidney biomarkers (r=0,965).

Conclusion. The criteria of DWI and ASL-perfusion allow us to suspect or confirm the cause of acute kidney failure. A high correlation has been established between radiation biomarkers and laboratory criteria of functional damages (r=0.998), direct correlation between imaging biomarkers and organic kidney disease (r=0,901). These biomarkers make it possible to predict the first stage of acute kidney failure (AUROC 0,995, DI 0,867–0,999).