The healthcare system is continuously being improved, including through the introduction of innovations. We analyzed several innovative research areas: artificial intelligence, virtual reality, telemedicine, microbiome, high-resolution endoscopy, and robotics. Artificial Intelligence: Used for data analysis, predicting disease outcomes, analysing endoscopic images in real time and after the procedure. It allows for improved diagnosis, patient stratification, and personalized treatment. It is also useful for scientific work (information search, text editing). Virtual reality: Promising for teaching students and surgeons (simulations), planning operations, reducing anxiety and pain in patients during procedures, as well as for rehabilitation (for example, in cases of gastrointestinal motility disorders). Telemedicine optimizes the management of patients, especially with chronic diseases, improves treatment adherence and ensures constant contact with a doctor. The importance of telemedicine has increased during the COVID‑19 pandemic. The study of the microbiome opens up new opportunities for understanding and treating diseases (for example, inflammatory bowel diseases and oncological pathology), the prospects of fecal microbiome transplantation, the use of autoprobiotics and metabiotics (targeted bacterial metabolites) in the complex treatment of patients with gastroenterological pathology are being considered. The introduction of high-resolution endoscopes, magnifying endoscopy, and other technical improvements improves diagnostic accuracy. Robotic systems are used for capsule endoscopy with magnetic navigation and therapeutic procedures. The introduction of innovations in gastroenterology does not replace a doctor, but significantly facilitates his work, improves the quality of diagnosis, treatment and patient care, and optimizes medical processes, can improve the training of doctors and patients, as well as patients' access to medical care.

This article reports a clinical case of intestinal tuberculosis initially misdiagnosed as Crohn's disease of the ileum. A correct diagnosis was only made five months after the start of symptoms, following surgery for intestinal obstruction and the subsequent appearance of hematogenous dissemination in the lungs exacerbated by steroid treatment. The article emphasizes the important clinical and diagnostic characteristics that aid in differentiating these entities.

Wilson – Konovalov disease (WKD) or hepatolenticular degeneration is a rare genetic disorder associated with a defect in copper metabolism, which in turn leads to liver dysfunction and degenerative changes in the basal ganglia of the brain. In the presented clinical case, the patient had a combination of symptoms of ulcerative colitis and WKD in the form of liver failure and neurological symptoms. There is no evidence in the world literature of a common genetic background between ulcerative colitis and Wilson's disease, but high copper levels are present in both diseases. The diagnosis of WKD was diagnosed a year after the onset of ulcerative colitis symptoms. UC did not respond to treatment with hormones and cytostatics. Regression of clinical symptoms was observed after the addition of biological therapy.

Relevance. Functional constipation (FC) is a common and urgent problem in pediatrics. The study of the effect of bacterial overgrowth syndrome (hydrogen–induced, H₂- and methanogenic, CH₄-SIBO) on the course of FC in children continues.

Purpose. To improve the quality of diagnostic and therapeutic approaches, evaluate the possible relationship between H₂- and SH₄-CIBR taking into account possible constipation in children.

Materials and methods. 82 patients were examined, including 33 patients with FC aged 8.0 [5.0:15.0] years, 15 (54.5 %) girls and 18 (45.5 %) boys, as well as 49 practically healthy children aged 9.0 [5.8:16.2] years, 27 (55.1 %) girls and 22 (44.9 %) boys. A standard clinical examination was performed. The determination of H₂- and CH₄-SIBO was performed using noninvasive methods: the «Lactofan» hydrogen breathing test (Russia) and the GastroCheckGastrolyzer hydrogen-methane test (UK). Statistical analysis is implemented in the StatTech program. v. 4.6.1 (Russia).

Results. SIBO of various types (31/93.9 % and 28/57.1 %, p<0.001) and H₂-SIBO (22/67.7 % and 18/36.7 %, p=0.008) were significantly more often detected in patients with FC than in the comparison group. The frequency of CH₄-SIBO (9/27.2 % and 10/20.4 %, p=0.47) did not significantly differ. In patients with FC, the concentration of H₂ (ppm) for 90 minutes. The respiratory rate was significantly higher than in the comparison group (42.09±29.85 and 15.08±12.69, p<0.001). A statistically significant correlation was obtained between the concentration of H₂ at 60 min (ρ=0.496, p=0.026) and 90 min studies (ρ=0.566, p=0.009) with the duration of the FC course, which reflects the increased metabolic activity of hydrogen-synthesizing microorganisms in the small intestine. There were no statistically significant correlations between the methane concentration and the duration of the FC (p>0.05).

Conclusions. The majority of patients with FC had small intestinal bacterial overgrowth (93.9 %). The shown correlation relationship, the regression dependence of H₂-SIBO with the duration of the course of FC, in the absence of such a relationship with the level of CH₄, dictates the need for respiratory diagnosis on SIBO and its further therapeutic correction.

This article provides an overview of the current state of the problem of diverticular disease of the small intestine, as well as a clinical case of complicated course of this pathology. Small intestinal diverticula (SID) occur in the population with a frequency of 0.3 to 2.3 % and in most cases do not manifest clinical symptoms. With excessive proliferation of bacteria in the small intestine, patients may develop maldigestion syndrome with clinical manifestations. In about 10 % of cases, small intestinal diverticula manifest acute clinical symptoms requiring urgent surgical intervention. Ultrasound, radiation and endoscopic methods of examination play a crucial role in the diagnosis of SID. Treatment of diverticular disease of the small intestine includes the use of intraluminal antiseptics and antibiotics, and in case of severe complications – surgical intervention. The article presents a clinical case of acute diverticulitis of the small intestine with perforation and development of paraintestinal infiltrate.

Conclusion. Diverticular disease of the small intestine is a dangerous disease due to the difficulties in diagnosis. Often, complications of diverticular disease of the small intestine are mistaken for other diseases. Routine diagnostic methods cannot always provide accurate visualization and understanding of the pathological picture. Given the diversity of patient complaints and objective examination data, therapists and surgeons must be especially vigilant and not forget about the presence of this pathology.

Helicobacter pylori (H. pylori) infection remains one of the most extensively studied pathogens involved in the development of gastroduodenal diseases. However, recent data suggest its potential role in the pathogenesis of systemic and dermatological conditions. This literature review explores the possible association between H. pylori and various skin diseases, including rosacea, acne, atopic dermatitis, and psoriasis. According to current meta-analyses, H. pylori infection is more frequently detected in patients with rosacea and psoriasis, and the bacterium may contribute to a more severe course of these dermatoses. Findings regarding acne and atopic dermatitis are inconsistent: some studies indicate a link with infection, while others suggest a protective effect or no significant correlation. The most thoroughly studied hypothesis involves H. pylori 's role in the pathogenesis of skin disorders through immunoinflammatory mechanisms, alterations in the microbiota, and pro-inflammatory cytokine activation. Nevertheless, the clinical significance of these associations remains a subject of debate. In conclusion, the review emphasizes the need for further large-scale and controlled studies to establish causal relationships between H. pylori infection and dermatological conditions. The findings may have practical implications for managing patients with chronic skin diseases and comorbid gastrointestinal disorders.  

Relevance. The decrease in the effectiveness of eradication therapy for Helicobacter pylori (H.pylori) infection is associated not only with an increase in resistance to antibacterial drugs, but also with the role of genetic polymorphism of CYP2C19 in the effectiveness of proton pump inhibitors (PPIs), which are mandatory components of all treatment regimens.

The aim of the study was to study the effect of CYP2C19 gene polymorphism on the efficacy of eradication therapy among patients in Novosibirsk.

Materials and methods. The study included 60 people with an indication for H. pylori eradication therapy: 25 men (41.7 %) and 35 women (58.3 %). The average age of the participants was 51.6±12.6 years, men were younger than women (47.6±11.6 years versus 54.4±12.7 years, p=0.04). Study participants were randomized by sex and age into two groups of 30 each depending on inclusion in a two-week eradication regimen as a proton pump inhibitor (PPI) of rabeprazole (group 1) or lansoprazole (Lancid® Kit, group 2). A clinical and laboratory study was conducted, the status of H. pylori infection was determined by two or more standardized diagnostic tests. Genetic polymorphism of CYP2C19*2 (*3, *17) gene was investigated using the reagent kit for detection of allelic variants in the human CYP2C19 gene – «GenTest CYP2C19» (HOMOTEK, Russia) by real-time PCR.

Results. Variants of the CYP2C19 *2 gene with a minor allele affecting the decrease in enzyme activity (slow metabolizers) were detected in 21.7 % of cases. The frequency of the CYP2C19*2 minor allele was 13.1 %. In more than half of the cases (53.3 %), a heterozygous variant of CYP2C19*17 with increased enzyme function was detected, and in another 10.0 % of cases, a homozygous variant with ultrafast enzyme function, which confirms the predominance of fast metabolizers among Caucasians. The frequency of the CYP2C19*17 minor allele was 26.8 %. The efficacy of eradication therapy was higher in the lansoprazole (LancidKit) group and amounted to 90 %, with no significant difference between the groups. Non-effective eradication (positive stool antigen test for H. pylori) was less common in those with slow metabolism (CYP2C19 * 2 minor allele variant) compared to the normal variant (CYP2C19 * 1) in the general group (22.2 vs. 77.8 %, p=0.03) and in the rabeprazole group (16.7 vs 83.3 %, p=0.04), with no significant difference for lansoprazole (Lancid® Kit). Cases of ineffective eradication were more frequent compared to effective treatment with rapid metabolism (variants of the CYP2C19*17 genotype with a minor allele) in the general group (88.9 vs. 11.1 %, p=0.004), in the group with rabeprazole (83.3 vs. 16.7 %, p=0.04) and in all 3 cases in the group with lansoprazole p= 0.07)

Conclusion. Thus, in patients from Novosibirsk, the frequency of minor alleles affecting metabolic rate corresponds to the frequencies typical of Caucasians. A positive H. pylori antigen test in the stool after treatment, indicating ineffective eradication, was less common in individuals with slow metabolism compared to those with normal metabolism in the overall group and in the group treated with rabeprazole, with no significant difference for lansoprazole (Lansid® Kit). In rapid metabolizers, ineffective therapy was observed more often in comparison with effective treatment, both in the general and in the compared groups. To obtain unambiguous conclusions on the effectiveness of PPIs in the eradication of H. pylori infection, depending on the genetic polymorphism of CYP2C19, it is necessary to give.

Introduction. Currently, considerable attention of researchers is attracted to the study of the state and therapeutic significance of the human gut microbiota (GM), the imbalance of which can lead to the occurrence or aggravation of existing diseases and syndromes.

The purpose of the study. To systematize the literature data on GM and its pathogenetic significance for humans, the possibilities of using probiotics – psychobiotics in general clinical practice and in some gastroenterological diseases.

Materials and methods. The research was based on publications by domestic and foreign authors, available in specialized databases (PubMed, Scopus, eLibrary). An analysis of original and review articles, meta-analyses, and clinical cases on this issue has been performed.

Results and discussions. The gut microflora performs a number of important functions for the body: digestive, barrier, metabolic, immune, regulatory (mood, stress and anxiety levels). The intestine constantly receives regulatory signals from the central nervous system and vice versa, on the basis of which the term «enterocerebral axis» arose, which includes afferent and efferent nervous, endocrine, immunological and nutritional connections between the gastrointestinal tract and the central nervous system, which cause disorders of many systems. Probiotics-рsychobiotics containing lactobacilli-have been associated with reduced abdominal pain, flatulence, and quality of life, while Bifidobacterium improved imperative urges and general symptoms of IBS. In another study, a probiotic psychobiotic based on Bifidobacterium longum NCC 3001 led to a decrease in depression rates and a decrease in reactions in the amygdala and frontolimbic regions.

Conclusion. The use of psychobiotics as an additional, and sometimes alternative, treatment method for gastroenterological diseases such as irritable bowel syndrome and obesity shows significant positive effects, especially when associated with the underlying disease of depressive syndrome.

The purpose of this review. To summarize the accumulated literature data at the present stage on the consequences of cholecystectomy (CE) for cholelithiasis (CD).

Key points. CD is one of the most common diseases of the biliary tract, the incidence of which in the world averages up to 20 %. The most important etiologic factors associated with the high incidence of cholesterol gallstones are: an increase in the average age of the world's population, an increase in metabolic disorders; the spreading trend of Western-style nutrition; starvation; physical inactivity; rapid weight loss; heredity; taking certain medications, etc. CE, as one of the most frequently used methods of treating cholelithiasis, leads to various consequences. The frequency of various symptoms after CE (various types of pain and gastrointestinal symptoms) among those operated on for cholelithiasis, at different times, varies from 5 to 40 %. Symptoms that bother patients after CE are usually referred to as postcholecystectomy syndrome (PCS). The manifestations of PСS may hide surgical complications, usually detected in the early postoperative periods; organic and functional pathology, previously not diagnosed, or occurring for the first time – provoked by CE; concern the pathology of the biliary tract, as well as other organs of the digestive system. A significant role in the development of symptoms after CE is played by changes in the regulation of enterohepatic circulation of bile acids, affecting changes in the intestinal microbiota, epithelial permeability of the intestine. Today it is known that through various mechanisms the gallbladder also plays a metabolic role, regulating energy, fat, carbohydrate metabolism, and CE, as an independent factor, aggravates the risks of metabolic disorders, leading to weight gain, insulin resistance, lipid metabolism disorders and the development of non-alcoholic fatty liver disease, mortality from all causes, including cardiovascular pathology.

Conclusions. CE cannot be considered a harmless method of treatment, and the tactics of managing patients with cholelithiasis should be selective, the choice in favor of surgical treatment should strictly correspond to the indications.

In critically ill patients admitted to intensive care units (ICUs), monitoring the «target organ» – the intestines – becomes particularly important, as impaired intestinal function can exacerbate the underlying disease and contribute to the development of multiple organ failure.

Objective. To determine the capabilities of magnetic resonance spectroscopy (MRS) in detecting bowel metabolic disorders in critically ill patients.

Materials and methods. Thirty-two (32) critically ill patients hospitalized in the ICU of the «Clinical Hospital No. 1» in Smolensk underwent magnetic resonance imaging (MRI) of the bowel. The examination followed a standard protocol for magnetic resonance imaging of the abdomen, with the mandatory inclusion of proton magnetic resonance spectroscopy ('H-MRS) for the major metabolites of the intestinal wall. The comparison group included twenty-one (n=21) healthy volunteers without any gastrointestinal diseases. The following major metabolites of the intestinal wall were assessed using MRS: choline, creatine, lipids, glutamine/glutamate, citrate, lactate, aspartate, and N-acetylaspartate (NAA).

Results. The MRS-detected decrease in the concentration of choline, creatine, and lipids in the intestinal wall within 24–48 hours leads to an imbalance in the redox balance of the critically ill macroorganism, which triggers the development or progression of hepatocellular failure. For predicting the development of paralytic ileus or visceral hypersensitivity in patients during the early postoperative period, a «scissors effect» was evaluated: an increase in citrate levels with negative lactate levels indicates paralytic ileus; the opposite pattern indicates visceral hypersensitivity.

Conclusion. Pilot study confirmed that magnetic resonance spectroscopy (MRS) is a highly informative method for the early diagnosis of bowel metabolic disorders in critically ill patients. A decrease in the levels of choline, creatine, and lipids in the intestinal wall is detected within the first hours of admission to the ICU. A differential «scissors effect» (citrate/lactate ratio) was identified, enabling differentiation between paralytic ileus and visceral hypersensitivity (AUC=0.94). The dynamics of N-acetylaspartate serve as a marker of impaired oxidative homeostasis. The methodology, based on a standard MRI protocol, allows for a transition to the targeted correction of the identified metabolic deficiencies.

The purpose of the study is to find out the effect of duodenogastral reflux (DGR) on the clinical manifestations of chronic erosive gastritis (HAG), the prevalence of Helicobacter infection among patients with the HAG and DGR association and the possibilities of eradication therapy.

Materials and methods. Explored 59 patients with HAG, average age 34.6±8.13 years. Patients were divided into two groups: 28 people with exacerbation of the HAG and the presence of the DGR and 31 people who had a HAG without the DGR.

Results and discussion. It was established that patients suffering from HAG in combination with the DGR revealed a brighter clinical symptoms with pronounced pain and dyspepsic syndromes. With HAG without DGR, there was often no clinical symptoms. For Hag with DGR, characters are frequent relapses of the disease with the lack of their seasonality. Erosive lesions of the stomach in patients with the DGR were more often multiple in nature and were mainly antral localization. The detection of helyicobacter infection in patients with HAG and DGR is significantly less than in patients without DGR, but this microorganism had a higher resistance to clarithromycin.

Conclusions. The HAG and DGR association has certain clinical features, characterized by frequent exacerbations with the absence of seasonality, a lower frequency of detection of HP and higher resistance to clarithromycin.