The presented review evaluates the effectiveness of various antispasmodics in the treatment of abdominal pain in irritable bowel syndrome (IBS) and IBS-like syndrome. Based on the study, it was concluded that the most significant effectiveness of myotropic antispasmodics, and in particular, mebeverin in the treatment of pain syndrome and other clinical manifestations of IBS and IBS-like syndrome and the absence of significant adverse events regardless of the duration of therapy.

Liver cirrhosis (LC) is highly prevalent in the modern population and is the leading cause of death among all gastrointestinal tract diseases. The course of cirrhosis can be aggravated by a number of conditions that makes the management of patients with this pathology even more challenging. One of these conditions is hepatorenal syndrome (HRS) type 2. This condition is a special form of chronic kidney disease (CKD), in which it is believed that changes in the kidneys are largely functional and reversible. Diagnosis and treatment of HRS type 2 in LC require special approaches.

The purpose of the study. To establish possible differences in fetal hemoglobin (HbF) indicators in patients with structural damage to kidney tissue in CKD and renal dysfunction associated with the development of type 2 HRS in patients with LC.

Materials and methods. Participants were recruited among patients of the therapeutic and gastroenterological departments of the State Healthcare Institution of the Astrakhan Regional Clinical Hospital in Astrakhan. The study included 40 patients with Child-Pugh B, C LC without signs of HRS, 21 with LC and HRS type 2, 92 with CKD of stages 3, 4, 5, and 43 healthy donors in the control group (CG). HbF analysis was performed by rocket electrophoresis in agar gel with sodium dodecyl sulfate using pure HbF preparations and the author's monospecific antisera to Hb F. Results. To identify additional criteria for the differential diagnosis of HRS type 2 and CKD, a study of the HbF level was conducted in these groups of patients, as well as their comparison by this indicator LC without HRS and CG. The study revealed a statistically significant decrease in HbF in the CKD group compared to patients with LC with type 2 HRS, LC without HRS, and GC.

Conclusion. The identified changes allow using quantitative determination of the HbF level for differential diagnostics of organic kidney damage, characteristic of CKD, from renal dysfunction in type 2 HRS in patients with cirrhosis. The presence of CKD in a patient is indicated by a reliable decrease in HbF parameters, compared with the norm, while in cirrhosis with type 2 HRS they exceed normal values.

Introduction. The initial diagnosis of ulcerative colitis and Crohn's disease – inflammatory bowel diseases (IBD) – is quite difficult, requiring a comprehensive evaluation of clinical and anamnesis data, the results of ilecolonoscopy with multifocal biopsy and, results of imaging diagnostic methods (in some cases).

The aim of the study: to estimate the duration of the time period required to establish the IBD diagnosis of and to assess the potential consequences of untimely establishment of this diagnosis.

Materials and methods. The data of 253 patients with ulcerative colitis and 263 patients with Crohn's disease who applied to the city center of St. Petersburg.

Results. In 59 % of ulcerative colitis patients with and in 65 % Crohn's disease patients the diagnosis was established within 3 months from first clinical sighs appearance. Evaluation of the possible association between the duration of the period required to establish the diagnosis of IBD and features of the course of IBD after diagnosis did not reveal a statistically significant association with the rate of recurrence and the risk of developing non-life-threatening complications. When studying the development of life-threatening complications of IBD it was found that only 59 % of such complications occurred after the diagnosis of IBD, while in the remaining cases they occurred either before or caused the diagnosis. Untimely diagnosis of IBD increased the risk of life-threatening complications by 18 times in patients with ulcerative colitis, and by 13 times in patients with Crohn's disease, compared to the situation when the diagnosis was established timely and specific IBD therapy for was initiated.

Conclusion. The majority of IBD patients, who suffered a life-threatening complication before the diagnosis was established, potentially had a temporary «window of opportunity», when on the basis of clinical data it was possible to suspect the presence of IBD, establish the diagnosis with the subsequent timely initiation of specific therapy to prevent a complicated course of the disease.

The issues of optimizing the management of patients infected with Helicobacter pylori have remained relevant in clinical therapy and gastroenterology for many years. This is due both to the high prevalence of H. pylori infection in Russia: depending on the region, it is 35–60 %, and to the potential carcinogenicity of the microorganism in relation to the development of stomach cancer. According to clinical recommendations, when conducting an endoscopic examination of the upper gastrointestinal tract, a rapid urease test with a biopsy from the antrum and the body of the stomach or polymerase chain reaction (PCR) with a biopsy of the stomach may be recommended as a method of primary diagnosis of infection. Enhanced molecular genetic typing of the microbe can increase the effectiveness of diagnosis, with the identification of several genes encoding the synthesis of pathogenicity factors H. pylori, as well as the analysis of microbial resistance to antibiotics (detection of genes encoding mutations associated with microbial resistance). Thanks to a set of studies that include not only verification of the pathogen, but also molecular genetic typing of infection by PCR, it is possible to significantly optimize the management tactics of patients infected with H. pylori and provide a personalized approach to antihelicobacter therapy depending on the virulence and resistance of the strain of the pathogen with which a person is infected. The relevance and breadth of the use of full-genome H. pylori sequencing is increasing, however, this study is not used in routine medical practice, including due to the high cost.

Post-infectious irritable bowel syndrome (PI–IBS) is the first phenotype of the disease described in the literature and the most studied to date. The prevalence of PI–IBS in the population continues to grow steadily especially in the post-COVID-19 pandemic period. Taking into account the accumulated scientific and clinical data dysfunction of the functional axis «microbiota-gut-brain» associated with the formation of visceral hypersensitivity and intestinal motor disorders due to abnormal serotonin metabolism, increased intestinal permeability and low-grade inflammation is considered as a key pathogenetic factor underlying the development and persistence of PI–IBS symptoms. This review article analyzes and summarizes information on the mechanisms of PI–IBS associated with changes in neurohumoral regulation, as well as the qualitative and quantitative composition of the intestinal microbiota. In addition, data on the possibility of using probiotic therapy in the complex therapy of patients with PI–IBS are presented.

SUMMARY

Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases. Its comorbid course with various diseases is noted. It has been established that bone disorders are often detected in NAFLD.

The purpose of the study. To clarify the effect of NAFLD on the condition of bone tissue, the dependence of changes in BMD and the severity of the pathological process in the liver.

Materials and methods. 98 women were examined, with an average age of 53.3±6.24 years. All individuals underwent a clinical examination, body mass index was calculated, ultrasound examination (ultrasound) of the abdominal cavity, two-energy X-ray absorptimetry of the lumbar spine (LS) and femoral neck (FN) with clarification of the value of the T-criterion, esophagogastroduodenoscopy, biochemical blood analysis were performed. All patients were divided into 3 groups: the first group consisted of 47 people with liver steatosis, the second group included 25 people with steatohepatitis. The control group included 26 women with the results of biochemical blood parameters within the reference values and unchanged liver ultrasound data. Results. The analysis of clinical symptoms showed the presence of asthenic syndrome/chronic fatigue in all patients with NAFLD, while the severity of symptoms increased with steatohepatitis. According to densitometry, the average values of the T-criterion in both SB and POP did not significantly differ in patients with liver steatosis and the control group. In patients with steatohepatitis, there was a significant decrease in the T-criterion in both study areas. The prevalence of osteoporosis (OP) and osteopenia in the first and control groups did not differ statistically. In steatohepatitis, OP was detected twice as often as in liver steatosis.

Conclusions. The presented data indicate that asthenic syndrome dominates the clinical picture of NAFLD. The results of the study confirm the comorbid course of NAFLD at the stage of steatohepatitis and OP.