Since the isolation of Crohn's disease as a separate pathology, significant progress has been made both in the diagnosis of the disease and in approaches to the treatment of patients with this pathology. The active introduction of biologics and the top-down approach into clinical practice in patients with negative prognosis factors has led to a significant improvement in treatment results and prognosis in patients. The use of the most effective anti-inflammatory therapy during the «therapeutic window of opportunity» – up to 18 months – is the key to achieving remission, or minimal activity of Crohn's disease by suppressing inflammation and preventing irreversible structural damage to the intestinal wall and, as a result, the development of complications. The article presents an excursion into the history of the discovery of this disease, which is still far from its completion. The approaches to the treatment of patients with this pathology are highlighted with an explanation of the current position based on data from meta-analyses and systematic reviews. A demonstration of a patient with a penetrating phenotype of Crohn's disease in the form of a perianal lesion and a history of oncopathology is presented. Ustekinumab therapy can be considered as an optimal management strategy for patients with Crohn's disease with unfavorable prognosis factors.

The aim. To evaluate the features of the endoscopic picture of the upper gastrointestinal tract (GI tract) in Helicobacter pylori-infected patients of different ages.

Materials and methods. The study involved 126 adult patients aged 18 to 76 years (mean age 44.75±15.05 years) and 19 children aged 9 to 17 years (mean age 14.26±2.68 years) infected with H. pylori. All subjects underwent gastroscopy with an assessment of inflammatory and atrophic changes in the mucous membrane of the upper gastrointestinal tract, cardia insufficiency, sliding hernia of the esophageal orifice of the diaphragm (HE), duodenogastric reflux (DGR), as well as the presence of H. pylori (rapid urease test). Statistical data processing was carried out using the SPSS Statistics 27.0.1 program.

 Results. According to the endocropic data, in adult patients, signs of catarrhal esophagitis were detected in the esophagus: in 32.7% of cases, esophageal erosion was detected in 4.8% of the examined patients, HE occurred in 15.6%, and cardia insufficiency – in 23.3% of patients. When visualizing the gastric mucosa, its atrophy and hyperemia were observed in 8.8% and 77.9% of cases, respectively, erosive changes were detected in 2.8% of patients. Endoscopic signs of atrophy of the mucous membrane of the antrum of the stomach occurred in 34.0%, hyperemia – in 85.5%, and erosive changes – in 10.95% of the examined, DGR was observed in 8% of cases, pyloric deformity was detected in 13.5% of patients. Pathology of the mucous membrane of the duodenal bulb (duodenum) was noted in 89.9% of cases: signs of mucosal atrophy were detected in 2%, hyperemia in 79%, erosion in 21% of the examined, ulcerative defects of the mucosa were detected in 44% of patients: ulcer on the anterior wall – 47.8%, on the posterior wall – 25.4%, along the upper wall – 16.4%, ulcer of unspecified localization – 10.5%, two or more ulcers were detected in 9% of cases. According to the endoscopic data, the following changes in the esophagus were detected in children: 31.5% of patients showed signs of HE, cardia insufficiency and catarrhal esophagitis – in 57.9% and 15.8% of patients, respectively. When visualizing the mucous membrane of the stomach body, it was revealed: in 10.5% of cases – atrophic changes, in 63.2% of cases – signs of hyperemia. Hyperemia of the mucous membrane of the antrum of the stomach occurred in 100% of children. The frequency of detection of DGR was 42.1% of cases. Hyperemia of the mucous membrane of the BPC bulb was present in 84.2% of cases. No other changes were observed. A comparative analysis of the frequency of detection of gastrointestinal pathology in adults and children found that patients infected with H. pylori in childhood and adolescence are more likely to have cardia insufficiency (p<0.0001) and DHR (p<0.001). At the same time, the detection of erosions and ulcers of the mucous membrane of the BPC bulb was higher in patients over 18 years of age (p=0.023 and p<0.001, respectively).

Conclusion. The age-related features of the endoscopic picture in patients infected with H. pylori are characterized by a predisposition of children and adolescents to impaired motility of the digestive tube, and adults to erosive and ulcerative changes, which may be a consequence of higher acid production. The fairly frequent detection of endoscopic signs of atrophy of the gastric mucosa dictates the need for histological examination in this category of patients using the OLGA system to establish the degree and stage of pathological changes, determine management tactics and follow-up of patients.

A number of human and animal studies have demonstrated that the hyperglycemia-lowering effects of metformin may result from modulation of the gut microbiota population. Metformin changes the Firmicutes/Bacteroidetes ratio and enhances the growth of some bacteria, such as Akkermansia muciniphila, Escherichia spp. or Lactobacillus and reduce the levels of others such as Intestinibacter. Moreover, in the intestine, metformin not only improves glucose absorption, but also promotes the production of short-chain fatty acids (SCFAs), regulates the secretion of the glucose-lowering hormone glucagon-like peptide 1 (GLP‑1) and other intestinal peptides, inhibits the Farnesoid-X-receptor (FXR) and resorption of the bile acid pool, and may reduce intestinal permeability barrier by increasing the expression of mucin and tight junction proteins, modulates the immune response, has an anti-inflammatory effect, etc. Thus, research results indicate that the intestinal microbiota is involved not only in the hypoglycemic effect of metformin in diabetes mellitus type 2, but also in the implementation of its numerous pleiotropic effects.

Currently, the term sarcopenia is primarily understood as a decrease in muscle strength as a key characteristic of sarcopenia, taking into account that the most unfavorable clinical outcomes occur in patients with a combination of impaired muscle strength and function. In particular, grip strength combined with evaluation of the end-stage liver disease (MELD) model is the best predictive model among widely used methods for diagnosing sarcopenia in patients with cirrhosis of the liver. Given that muscle mass does not always correlate well with muscle strength or function in the population of patients with cirrhosis of the liver, there is a need for a comprehensive diagnosis of sarcopenia based on a combination of functional research methods with modern instrumental methods. The presented review article highlights current information on the diagnosis of sarcopenia in patients with chronic diffuse liver diseases. Aspects of antrometric methods, functional tests, methods for evaluating muscle strength and mass, and physical performance are reflected. Special attention is paid to the advantages of modern methods of instrumental diagnosis of sarcopenia in patients with diffuse liver diseases. The advantages and disadvantages of each of the methods of instrumental diagnostics are noted.

Relevance. Ursodeoxycholic acid (UDCA) is a natural hydrophilic bile acid, which initially found its use in the treatment of a number of liver diseases as a first–line therapy. UDCA reduces the secretion of cholesterol into bile and is actively used in the treatment and prevention of gallstone disease; UDCA also has the ability to stimulate hepatobiliary secretion, which is important for patients with primary biliary cholangitis and primary sclerosing cholangitis. More recent studies have shown the pleiotropy of the effects of UDCA, in terms of effects on pathophysiological processes in the liver and the entire hepatobiliary complex, for example, anti-inflammatory and antifibrotic effects, immunomodulatory and anticarcinogenic effects. Even more interesting and important were the complex mechanisms of the effect of UDCA on the development and progression of non-alcoholic fatty liver disease (NAFLD) and, further, on the pathogenetic relationships of NAFLD and cardio-vascular pathology. The article examines the possibilities of using UDCA in diseases of the gastrointestinal tract and, more broadly, the possibilities of the drug in influencing NAFLD and the development and progression of cardiovascular and metabolic diseases.

In recent decades, the medical community around the world has been searching for ways to combat morbid obesity, and despite the variety of methods and techniques, great progress has been noted in recent years in the field of bariatric surgery. Despite its effectiveness, bariatric surgery still has a large number of questions related to the effectiveness of certain methods, their long-term results and the choice of surgery. The purpose of this literature review: to consider the mechanisms of formation, development and course of osteopenia and osteoporosis after bariatric surgery, as well as the frequency of their occurrence depending on the type of bariatric procedure (sleeve gastrectomy, Roux-en-Y gastric bypass, gastric banding, biliopancreatic diversion). To achieve this goal, a literature search on this issue was conducted on the PubMed, eLIBRARY.RU, Google scholar platforms. The material was summarized and analyzed in order to find previously unexplored links in the pathogenesis of osteopenia and osteoporosis and, in general, the mechanisms of mineral metabolism disorders in the postoperative period in patients who underwent bariatric surgeries of varying volumes.

The article analyzes the problem of clinic and diagnosis of chronic small intestinal obstruction. Two women who had been undergoing longterm radiation therapy for gynecologic malignant neoplasms were observed. Endoscopic methods of investigation proved to be uninformative. The diagnosis was verified by radiological examination, and the localization of the process was specified. In one patient chronic small intestinal obstruction was provoked by a foreign body.

Malignant diseases remain an important medical problem, and its solution depends on the effectiveness of identifying the early stages of cancer at the outpatient stage, including the therapeutic level of medical care. Formation of oncological alertness skills in primary care physicians is necessary for early detection and reduction of the incidence of advanced tumor stages and earlier initiation of specialized treatment. Identification of symptoms suspicious for malignant neoplasms using algorithmic approaches and subsequent consultation of the patient by a specialist surgeon or oncologist should improve treatment outcomes. The article considers the principles of oncological alertness applicable at the outpatient stage by therapists and general practitioners using colorectal cancer as an example. A set of specially developed printed materials facilitating the implementation of the principles of oncological alertness is proposed.