Introduction. Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are significant medical problems due to their chronic course and high complication rate. Ustekinumab, a genetically engineered biological drug that inhibits interleukins 12 and 23, has shown efficacy in international studies, while data on its use in the Russian population are still limited.

Objective. To evaluate the long-term efficacy and safety of ustekinumab in patients with IBD in real-life clinical practice in the Sverdlovsk region. Materials and methods. An observational study was conducted on 184 patients with IBD (110 CD, 74 UC) who received ustekinumab from 2010 to 2025. Evaluation criteria: clinical response, clinical remission, frequency of therapy discontinuation, adverse events (AE). Quality of life questionnaires (IBDQ, SF-36) were used.

Results. Efficacy: 58 % of patients received ustekinumab as first-line therapy, 38 % as second-line therapy. Clinical remission was achieved in most patients, 90 % continued treatment (median – 17.7 months). Only 4 % switched to other drugs (mainly vedolizumab). Safety: One case of Quincke's edema was registered. The discontinuation rate due to inefficiency was 3.3 %, allergy – 0.5 %. Quality of life: 85 % of patients noted improvement after 12 weeks of therapy.

Discussion. Ustekinumab demonstrated high efficacy and safety, surpassing anti-TNF drugs in tolerability. The results are consistent with international data, confirming the feasibility of its use in the Russian population.

Conclusions. Ustekinumab is a promising drug for long-term therapy of IBD due to high survival of therapy, minimal risk of AEs and positive impact on quality of life. Its expansion in regional practice is recommended.

Non-alcoholic fatty liver disease (NAFLD) and periodontitis have a number of common risk factors, such as obesity, insulin resistance (IR), and dyslipidemia, which contribute to the formation of systemic inflammation. The review articles notes that there is a bidirectional relationship between NAFLD and periodontitis, indicating that the formation of one disease can worsen the other. Today, NAFLD is considered as a systemic inflammation that can contribute to the progression of periodontitis by disrupting immune responses and exacerbating inflammatory processes in periodontal tissues. Human patients with NAFLD often have impaired lipid metabolism, which can affect the composition of the oral microbiota, leading to dysbiosis and increased susceptibility to periodontal diseases. Conversely, periodontitis is associated with the progression of NAFLD through mechanisms including systemic inflammation and oxidative stress. The formation of chronic periodontal inflammation can be accompanied by the release of pro-inflammatory cytokines and bacterial toxins into the bloodstream, which contributes to liver inflammation and exacerbates the course of liver steatosis. The relationship between NAFLD and periodontitis highlights the importance of comprehensive treatment strategies targeting both diseases.

Crohn's disease (CD) is a chronic inflammatory bowel disease of unknown etiology, characterized by a progressive course and the development of complications that require surgical intervention in a significant proportion of patients. The pathogenesis of the disease involves a disruption of gut microbiota, influenced by environmental factors, with diet playing a key role. Current evidence confirms the negative impact of ultra-processed foods on microbiota composition and the increased risk of developing CD. This article reviews modern approaches to dietary therapy and nutritional support for patients with CD, including assessment of nutritional status, macroand micronutrient requirements, and correction of identified deficiencies. It evaluates the effectiveness of exclusive enteral nutrition (EEN) and alternative dietary approaches, such as the Crohn’s Disease Exclusion Diet (CDED), in combination with specialized enteral nutrition in achieving remission, promoting mucosal healing, and reducing inflammation. Additionally, it explores dietary strategies for maintaining remission and optimizing perioperative nutritional support. It emphasizes the key role of dietitians in the multidisciplinary team managing CD patients and the need for an individualized approach to dietary therapy, considering cultural preferences and food habits. Based on a review of current evidence, the article concludes that nutritional support and dietary therapy should be integral components of comprehensive CD treatment, while further research is needed to optimize personalized dietary strategies.

Objective. To evaluate the perioperative period and results of peroral endoscopic myotomy (POEM) in patients with achalasia.

Material and methods. During the period 2017–2023, POEM was performed in 150 patients aged 15 to 80 years (mean age 53 ± 15,4 years) (94 women, 56 men). The duration of the disease ranged from 6 months to 40 years (mean value 5,8 ± 6,67 years). The average dysphagia value according to the Eckadt scale before surgery was 11.12±0.75.

Results. Technical difficulties with tunnel formation due to the presence of fibrosis of varying severity were noted in 24 (16.1 %) patients. The presence of fibrosis resulted in a slight increase in the duration of the intervention at the tunnel formation stage 85.0 (80.0; 120.0) minutes versus 95 (80.0; 120.0) (p=0.87554). Adverse events during the procedure were observed in 5 (3.33 %) patients: no differences were noted between patients with stages II–III and IV of the disease (3 versus 2) (p=0.22). No differences were found in the frequency of complications between patients with or without fibrosis in the submucosal layer (p=0.1922). Oral food and fluid intake were restored in all patients. The Eckadt scale score ranged from 0 to 4 (mean 1.48±0.98). There was no statistically significant difference in the frequency of esophagitis in patients with stages II–III of the disease and stage IV (26 versus 5) (p=0.49).

Conclusion. POEM in patients with esophageal achalasia is an effective intervention, regardless of the stage of the disease with a low frequency of intraand postoperative complications. Previous treatment is not a predictor of the occurrence of fibrosis in the submucosal layer, does not affect the frequency of intraoperative complications and does not significantly increase the duration of the intervention. The stage of the disease does not affect the frequency of intraoperative complications and erosive esophagitis.

Background. One in five people worldwide has symptoms of dyspepsia, which causes a high incidence of these symptoms in real clinical practice. To help practitioners in the world, questionnaires have been repeatedly created to identify or control symptoms of dyspepsia, but most of them are complex, difficult, and provide subjective information about symptoms for the previous period. In the presented study, we have developed an original «Dyspepsia Questionnaire» considering the most common combination of symptoms in the framework of dyspeptic syndrome and comorbid nosologies.

Aim – to develop a «Dyspepsia Questionnaire» considering comorbid nosologies to optimize the management of patients with unspecified dyspepsia syndrome.

Materials and methods. The design of the study included three stages. During the first stage, 856 patients with unspecified dyspepsia were included, who underwent a 13C-Urea Breath test. According to its results, 342 patients with H. pylori (Hp) infection were excluded from the study. 514 patients with negative Hp status underwent esophagogastroduodenoscopy (EGDS) and ultrasound of the abdominal cavity. 129 patients were diagnosed with organic pathology, and they were also excluded from the research. Of the 385 patients without organic pathology, 208 people agreed to undergo a full laboratory and instrumental examination. At the second stage, the «Dyspepsia Questionnaire» was developed. At the third stage, 208 patients filled out a questionnaire retrospectively and prospectively (simultaneously for the previous 7 days and daily for 7 days) and underwent additional examination: experimental psychological testing: Beck, generalized anxiety disorder questionnaires-7 (GAD-7), Short Form (SF)-36 and laboratory and instrumental examination: pepsinogen level I, pepsinogen II, gastrin-17 and IgG to H. serum pylori, EGDS with biopsy and pathomorphological assessment using the Operative Link for Gastritis Assessment (OLGA) system, daily pH-impedansometry of the esophagus, radiography of the esophagus and stomach. At the end of the third stage, the correspondence of the diagnosis according to the questionnaire and the final diagnosis according to the results of laboratory and instrumental examination was determined. Patients appreciated the simplicity, convenience and time of filling out the questionnaire, two hundred doctors appreciated the informative content of the questionnaire, convenience and time to analyze the results.

Results. The most frequent nosologic variants of secondary dyspepsia in patients were biliary stone disease – 37 (28.6 %) patients, duodenal ulcer disease – 26 (20 %) patients and erosive esophagitis of grade B, C and D according to LA classification – 24 (18.6 %) patients. Laboratory and instrumental examinations of 208 patients showed that more than half of the patients (112 patients, 54 %) had functional dyspepsia (FD) combined with gastroesophageal reflux disease (GERD): non-erosive esophagitis – 81 (72 %) or erosive esophagitis A degree according to LA classification – 31 (28 %). The most frequent diagnoses were the combination of two forms of PD – 49 (23.5 %) patients and combination of GERD and PD with epigastric pain syndrome (EPS) – 47 (22.5 %) patients. To calculate the accuracy, sensitivity and specificity of the test for each diagnosis, the results of prospective completion of the questionnaire were compared with the final diagnosis. Daily prospective completion of the dyspepsia questionnaire showed higher comparability with the final diagnosis than retrospective completion: sensitivity for prospective completion was 95.7 %, specificity 99.4 %, accuracy 98.7 %, sensitivity for retrospective completion was 73.1 %, specificity 95.5 %, accuracy 91.5 %.

Conclusions. Given the vastness of nosological variants of dyspeptic syndrome, the detection of a high percentage of a combination of GERD and PD, both variants of PD, the «Dyspepsia Questionnaire» can be a tool for optimizing the management of patients with unspecified dyspepsia, further differential diagnosis, and a tool for controlling symptoms before and during therapy. The «Dyspepsia Questionnaire» is simple, convenient and informative for the patient to fill out and interpret by the doctor in written and online formats.

Introduction. The qualitative and quantitative uniqueness of the cationic-anionic composition of mineral waters (MW) suggests the presence of specificity of their effects on individual components of the pathogenesis of diseases of the digestive system. In this regard, the study of the bacteriotropic effect of MW on the indigenous microbiota of the intestinal biotope and, accordingly, the assessment of the expediency of their use in dysbiotic conditions is relevant.

Objective. In vitro study of the effect of mineral waters «Klyuchi» and «Ust-Kachkinskaya» on model representatives of the genera Bifidobacterium, Lactobacillus and Escherichia.

Materials and methods. A comparative study of the effect of MW «Klyuchi» and «Ust-Kachkinskaya» on probiotic strains L. plantarum 8P-A3 and B. bifidum 1 was carried out. The level of biomass accumulation, activity of acid formation and utilization of the carbohydrate component during cultivation on a «hungry» nutrient medium was evaluated. A bioluminescence test was used to determine the effect of MW on the physiological state of cells of the E. coli lum+ indicator strain. A comparative study of the kinetics of its luminescence after rehydration from the lyophilized state with various solvents has been carried out.

Results. Both types of MW had a stimulating effect on lactobacilli. The increase in biomass of the tested strain on a «hungry» nutrient medium in both cases was close in magnitude and significantly exceeded the control level. The acid formation activity of lactobacilli was also enhanced by both MW with a more pronounced effect in the «Ust-Kachkinskaya» water. At the same time, MW «Klyuchi» had a significant stimulating effect on the accumulation of biomass and acid formation of bifidobacteria in the absence of these effects in MW “Ust-Kachkinskaya”. The presence of the stimulating effect of MW was confirmed by an increase in the consumption of the carbohydrate component of the nutrient medium. The result of the bioluminescence test also demonstrated a more pronounced stimulating effect of MW «Klyuchi» on the restoration of intracellular metabolic processes after rehydration of the indicator strain E. coli lum+. The level of its luminescence in this sample exceeded by more than two times the luminescence intensity of the samples from MW «Ust-Kachkinskaya» and the control with saline solution.

Conclusion. The positive effect of the studied MW on model representatives of the indigenous microbiota was revealed with a more pronounced stimulating effect of drinking low-mineralized MW “Klyuchi” in comparison with the medium-mineralized MW «Ust-Kachkinskaya».

Background. The new coronavirus infection (COVID-19) is characterized not only by respiratory manifestations but also by GI disorders. In particular, 0.17–12.5 % of survivors develop postinfectious irritable bowel syndrome (PI–IBS) associated with the infection. Psychosocial factors, such as anxiety and depression, which were exacerbated during the pandemic, play an important role in its occurrence. The study of the relationship between COVID-19, psychosocial factors and PI–IBS is of considerable scientific and practical interest.

Aim. To conduct a comparative analysis of psychovegetative status in patients with previously diagnosed irritable bowel syndrome (IBS); patients who developed IBS after coronavirus infection (COVID-19) and COVID-19 patients who did not developed IBS.

Materials and methods. The study was conducted at the University Clinical Hospital No. 1. Patients who had COVID-19 infection more than 6 months ago and met the diagnostic criteria for IBS were included in the study. Thirty patients (group 1) met the criteria of IBS. The following groups were recruited as comparison groups: group 2–40 patients with a verified diagnosis of IBS before the COVID-19 pandemic; this information was taken from the database (SPSITEST 9.0 DBMS program); group 3–30 patients who had undergone COVID-19 and did not form IBS. The control group (group 4) included 32 healthy respondents. The study assessed depression on the BEC scale, personality and reactive anxiety on the Spielberg-Hanin questionnaire.

Results of the study. In statistical analyses of group 1, the mean values of personal and reactive anxiety were 45.07±1.47 and 45.73±1.62, respectively; the mean value of depression was 10.87±1.31. The results of the mean value in group 2 were obtained: personal anxiety – 47.30±1.46, reactive anxiety – 50.73±1.96, depression – 12.85±1.13. In group 3, the mean values of personal and reactive anxiety were 44.23±1.79 and 40.67±1.77, respectively; the mean value of depression index was 9.23±1.34. In the control group (group 4) the index of personal anxiety amounted to – 36,84±0,98, reactive anxiety – 35,19±1,16, depression – 5,00±0,72. The results of examinations and analysis of psychometric indices show that both patients with IBS after new coronavirus infection (group 1) and patients with IBS diagnosed before COVID-19 pandemic (group 2) have significantly higher anxiety and depression indices than in the groups of healthy respondents (group 4) and COVID-19 survivors who did not form IBS (group 3).

Conclusion. The results of examinations and analysis of psychometric indices show that both patients with IBS after new coronavirus infection (group 1) and patients with IBS diagnosed before COVID-19 pandemic (group 2) have significantly higher anxiety and depression indices than in the groups of healthy respondents (group 4) and COVID-19 survivors who did not form IBS (group 3).Postinfectious IBS developed in 8.6 % of patients after a new COVID-19 coronavirus infection. The average age of patients was 52 years, which indicates the predominance of older patients. The key risk factors were female gender, anxiety and depressive disorders, and stress during the pandemic. It can be suggested that the new COVID-19 coronavirus infection is only a trigger for the development of IBS in predisposed individuals.

Relevance. The course of complete erosions (CE) of gastric mucosa (GM) is associated with long-term recurrent inflammation, but in patients with chronic heart failure (CHF), who are forced to take antitrombotic therapy, is also with hidden gastrointestinal bleeding (GIB). Standart antisecretory drugs are not always effective in the treatment of complete erosions. The influence of drug interactions has not been excluded.

Materials and methods. The study included 185 patients in the main group (MG) with CE and 183 patients in the control group (CG) with acute erosions (AE) of the GM. Patients in both groups had CHF II–III FC according to NYHA, with a predominance of elderly men. Depending on the presence or absence of Hpinfection, patients of the MG and CG are divided into 2 subgroups. The first subgroup with a positive reaction to Hp was prescribed standard triple first-line eradication therapy for a period of 14 days in combination with Rebamipide for 3 months, after eradication for 2,5 months. 40 mg Pantoprazole once per day was prescribed as maintenance therapy. The second subgroup with a negative reaction to Hp was prescribed pantoprazole 40 mg twice per day in combination with rebamipide for 1 month, after which patients were transferred to maintenance therapy lasting 2 months: pantoprazole 40 mg once per day in combination with rebamipide. Evaluation of the effectiveness of the treatment based on the results of EGDS and clinical manifestations was performed 1, 2 and 3 months after the start of therapy.

Results. By the end of the three-month course of therapy, dyspepsia had completely disappeared in the first subgroup, and only two patients in the second subgroup complained of a feeling of heaviness in the epigastrium and belching of air. Control EGDS after 1 and 2 months of treatment showed long term epithelialization dynamics of СE in both subgroups and after 3 months, fibrin plaque on the tips of erosions was observed in 47.7 % of patients in subgroup 1 and 44.1 % in subgroup 2. On the contrary, in both subgroups of CG, there was a significant improvement in the endoscopic picture during three months of treatment and complete epithelialization of AE by the end of the course in all patients.

Conclusion. Regardless of the therapy used, patients with CHF showed a long-term recurrent course, despite the significant positive dynamics of clinical manifestations in all patients.

A clinical case of an 18-year-old patient with primary sclerosing cholangitis, observed from 2021 to 2025, was analyzed. Condition after retrograde bile duct endoprosthetics, laparoscopic cholecystectomy. In 2021, after a new coronavirus infection, the level of total bilirubin, ALAT, GGT and ALP activity increased for the first time. After examination, the following diagnosis was made: Cholestatic hepatitis with a moderate degree of activity against the background of stenosis of the common bile duct. Cholangitis. Biliary sludge. Symptomatic therapy was prescribed. A year later, the condition was unchanged. Retrograde endoprosthetics of the bile ducts was performed, after which the condition improved, the biochemical parameters returned to normal. After 3 months, the stent was removed using a loop. An increase in GGT levels was noted again. A puncture biopsy was performed. Histologically: The degree of fibrosis according to the METAVIR scale is F3. The diagnosis was made: Chronic cholangitis. Condition after stenting. Most likely, the onset of primary sclerosing cholangitis (PSC). A year later, the diagnosis was made: Chronic active hepatitis. Primary sclerosing cholangitis, fibrosis stage F3 according to the METAVIR scale. Therapy was prescribed. The patient is currently under observation and treatment.