Aim: to assess the prevalence and characteristics of erosive-ulcerative lesions of the gastrointestinal tract in patients with chronic coronary artery disease and acute myocardial infarction, determining the role of Helicobacter pylori (H. pylori) and other independent risk factors in their pathogenesis.Materials and methods. A single-center prospective cohort study analyzed data from 110 patients divided into two groups based on the clinical form of coronary artery disease (CAD). Group 1 (n = 56) included patients with acute myocardial infarction (AMI) after primary percutaneous coronary intervention (mean age — 62.0 years) and consisted predominantly of men (n = 41; 73.21 %). Group 2 (n = 54) included patients with stable CAD who had undergone percutaneous coronary intervention within the preceding year (mean age — 67.5 years), and there was also a predominance of men (n = 37; 72.55 %). All patients underwent a comprehensive examination, including the collection of clinical and anamnestic data and laboratory diagnostics. Esophagogastroduodenoscopy (EGD) was performed at different time points depending on clinical status: patients with stable CAD underwent EGD at the time of hospitalization, while for patients with AMI, the examination was conducted in a delayed manner to minimize risks. H. pylori infection was diagnosed using the 13C-urea breath test in AMI patients and via biopsy during EGD in stable CAD patients. The one-month follow-up examination included: esophagogastroduodenoscopy to assess the condition of the upper gastrointestinal mucosa, and the 13C-urea breath test for patients with baseline H. pylori infection to evaluate the efficacy of eradication therapy.Results. The prevalence of H. pylori was 46.4 % in the AMI group and 31.5 % in the stable CAD group. Planned EGD in patients with stable CAD before treatment revealed erosive-ulcerative lesions of the upper gastrointestinal tract in 51.9 % of cases, with 46.4 % of these lesions being associated with active H. pylori infection (p = 0.012). The application of active screening and preventive H. pylori eradication strategy in AMI patients resulted in successful eradication in 92.3 % of cases. At the 1-month follow-up EGD, mucosal changes persisted in 30.9 % of AMI patients; however, the majority of these findings were minimal and clinically insignificant (superficial gastritis, catarrhal bulbitis). True erosive-ulcerative lesions were detected in only 18.2 % of patients, indicating the role of the ulcerogenic effect of antiplatelet therapy in their pathogenesis. In patients with stable CAD, targeted therapy (eradication of H. pylori and prescription of proton pump inhibitors) led to a significant reduction in the frequency of erosive-ulcerative lesions from 51.9 to 7.4 % (p < 0.001). Multivariate analysis confirmed that in stable CAD, active H. pylori infection is an independent risk factor for gastrointestinal lesions (adjusted odds ratio [OR] — 4.32; 95 % CI: 1.22–18.20; p = 0.023). In contrast, in the AMI group after preventive eradication, this association completely lost statistical significance (OR = 0.84; 95 % CI: 0.22–3.20; p = 0.79).Conclusions. Erosive-ulcerative gastrointestinal lesions in patients with CAD are closely associated with H. pylori infection and can be effectively prevented through its early diagnosis and eradication. In patients with AMI, preventive H. pylori eradication is a mandatory but insufficient element of prophylaxis and must be complemented by measures to mitigate the risks associated with dual antiplatelet therapy. Thus, an individualized approach to gastroprotection, tailored to the clinical form of coronary artery disease, enhances the safety and efficacy of pharmacotherapy in these patient groups.
Aim: to present the results of an interdisciplinary international expert council on addressing the challenges of managing patients with non-alcoholic (metabolic dysfunction-associated) fatty liver disease in connection with the creation of a new nomenclature, the definition of diagnostic criteria, and the development of approaches to the diagnosis and treatment of fatty liver disease.Key points. The key role of metabolic dysfunction in non-alcoholic (metabolic dysfunction-associated) fatty liver disease has been proven. Therefore, in the nomenclature, non-alcoholic fatty liver disease (NAFLD) has been replaced by metabolic dysfunction-associated fatty liver disease, and non-alcoholic steatohepatitis has been replaced by metabolic dysfunction-associated steatohepatitis. It is noted that, according to research, the prevalence of fatty liver disease in Russia is high: one-third of patients seeking primary care have this diagnosis. The results of a study of two incretin mimetics, semaglutide and tirzepatide, are presented, along with an opinion on their rational combination with ursodeoxycholic acid. The comorbidity of fatty liver disease with cardiovascular, endocrine, and oncological diseases, chronic kidney disease, and other conditions is discussed.Conclusion. The expert council included leading specialists: gastroenterologists-hepatologists, cardiologists, internists, and endocrinologists. There were confirmed that treatment for fatty liver disease should be comprehensive and integrated into the overall concept of metabolic health. Algorithms for diagnosis and personalized treatment of fatty liver disease have to be developed for the Russian medical community.
Aim: to evaluate the efficacy and safety of Kolofort® in patients with irritable bowel syndrome accompanied by an anxiety-depressive disorder.Materials and methods. A total of 70 patients with irritable bowel syndrome confirmed by Rome IV criteria and a HADS (Hospital Anxiety and Depression Scale) score of ≥ 8 points were included in an open, prospective, observational, non-interventional program. Patients received Kolofort® at a dose of 2 tablets twice daily for 8 weeks. The efficacy of the therapy was assessed according to the HADS, the Visual Analogue Scale for pain (VAS), and the Epworth Sleepiness Scale.Results. After 8 weeks of therapy, the severity of anxiety and depression was significantly reduced (p < 0.0001): the mean score on the anxiety subscale decreased from 11.1 ± 2.4 to 5.3 ± 3.0, and from 7.6 ± 3.3 to 3.5 ± 2.8 on the depression subscale. The intensity of abdominal pain according to the VAS decreased from 4.8 ± 1.8 to 1.0 ± 1.0 (p < 0.0001). Clinically significant pain reduction (≥30 % from baseline) was recorded in 92.9 % of patients. The level of daytime sleepiness according to the Epworth scale decreased from 6.7 ± 4.2 to 4.0 ± 2.2 (p < 0.0001). Analysis of variance showed an association between reduced anxiety and decreased abdominal pain (p = 0.0058).Conclusion. The results of the observational program demonstrate the efficacy and safety of Kolofort® in the treatment of irritable bowel syndrome accompanied by elevated anxiety and/or depression. The synergistic effect of the drug components provides improvement in both somatic and psycho-emotional symptoms of irritable bowel syndrome.
Aim: to analyze the results of studies that examined volatile organic compounds of various analytes (exhaled air, feces, urine) for the diagnosis of inflammatory bowel diseases.Materials and methods. A systematic electronic literature search was conducted (without restrictions on the language or type of publication) using the Medline/PubMed, Embase, Scopus and Web of Science databases using keywords.In the process of analyzing the published articles, the quality of the created diagnostic models was evaluated.Results. To study volatile organic compounds, metabolomic methods involving the quantification of compounds and so-called “electronic noses” are used — various types of sensors to create a “pattern” of metabolites. It has been shown that the determination of volatile organic compounds in exhaled air, feces, urine is inexpensive, affordable, acceptable to patients and doctors, has high diagnostic accuracy, allowing to distinguish patients with inflammatory bowel diseases from healthy individuals, differentiate nosological forms — ulcerative colitis and Crohn’s disease, the activity of the disease, monitor the nature of its course. Sensitivity and specificity indicators for solving different diagnostic tasks vary depending on the method used (the combined sensitivity and specificity of volatile orga- nic compounds as biomarkers for distinguishing patients with inflammatory bowel diseases from healthy individuals were 87 % (95 % confidence interval (CI): 0.79–0.92) and 83 % (95 % CI: 0.73–0.90), respectively, with an AUC of 0.92), the analyte under study, the number of volatile organic compounds analyzed, the number of patients examined, and consideration of influencing factors.Conclusion. Volatile organic compounds demonstrate great potential as noninvasive biomarkers of inflammatory bowel diseases. In the future, more extensive multicenter prospective studies are needed to develop optimal approaches to sampling, standardizing the analysis and interpretation of volatile organic compounds data in solving various diagnostic tasks in patients with inflammatory bowel diseases.
Aim: to present two clinical cases of low-grade appendiceal mucinous neoplasms (LAMN) and evaluate the oncological adequacy of ileocecectomy with ileoascending anastomosis in patients with cecal involvement.Key points. Appendiceal mucinous neoplasms are rare tumors detected either during radiological examinations conducted for other reasons, intraoperatively in patients operated on with a diagnosis of appendicitis, or during histopathological examination of the appendectomy specimen. In 2025, two male patients, aged 36 and 70 years, with the aforementioned diagnosis were operated on at the Oncology Clinic of Azerbaijan Medical University. The neoplasm in the 36-year-old patient was discovered during intraoperative revision for suspected appendicitis at a district hospital. In the other patient, the tumor was detected preoperatively during a CT scan performed to stage an endoscopically and histopathologically confirmed sigmoid colon carcinoma. Both patients underwent an ileocecectomy with an ileoascending anastomosis for the appendiceal mucinous neoplasms. The postoperative period was uneventful, and histopathological examination of the resected specimens confirmed a low-grade appendiceal mucinous neoplasm (LAMN) in both cases.Conclusion. In patients with LAMN adherent to or infiltrating the cecum, an ileocecectomy with ileoascending anastomosis can be performed as an adequate surgical procedure. Although this volume of surgery is less extensive than a right hemicolectomy, it can theoretically be compared with it in terms of providing oncological radicality.
Aim: to present a clinical case of simultaneous thrombosis of the hepatic veins and total thrombosis of the vessels of the portal system in a myeloproliferative neoplasm.Key points. The patient was admitted to the gastroenterology department with complaints of abdominal distension, abdominal pain syndrome, and hyperthermia. An examination revealed widespread thrombosis of the hepatic veins and the portal system. Conservative therapy with diuretics, low-molecular-weight heparins, and albumin preparations proved ineffective. The patient was referred to a federal clinic for verification of the diagnosis of myeloproliferative neoplasm. As a result of the examination, a diagnosis of essential thrombocythemia was established. Against the background of comprehensive conservative therapy, a regression of refractory ascites was achieved. The patient is under dynamic observation of a hematologist, a hepatologist, hepatobiliary surgeon, and a transplantologist.
Introduction. Assessing the quality of life of patients with various chronic diseases, including celiac disease, is an important component of scientific research, determining the rationale and effectiveness of treatment and rehabilitation strategies. Few studies have examined the quality of life of children with celiac disease on a gluten-free diet. Furthermore, all of these studies utilized a variety of questionnaires.Aim: to study the quality of life of children and adolescents with celiac disease on a gluten-free diet using a validated Russian-language version of the CD-QOL questionnaire.Materials and methods. A cross-sectional study surveyed 599 children and adolescents with celiac disease (aged 2–22 years) using a validated Russian-language version of the CD-QOL questionnaire; the impact of diet on social functioning was also assessed. Comparisons were made using Student’s t-test (Welch’s test was used if homogeneity of variances was not met). For age groups, one-way analysis of variance (ANOVA) was used, with a preliminary check for homogeneity of variances using Levene’s test; in case of homogeneity, Tukey’s post-hoc test was performed. In cases of deviations from normality, the nonparametric Mann — Whitney test was used to compare independent groups. Multiple linear regression was used to assess the influence of factors on indicator levels; associations between variables were additionally assessed using the Pearson or Spearman correlation. The significance level was p < 0.05.Results. The mean subscale scores for 599 respondents were: “social-emotional limitations” — 3.39 (SD = 0.96),“anxiety/fear for health” — 3.16 (SD = 1.07). A moderately strong positive correlation was found between the subscales (r = 0.649; p < 0.001). No gender differences were found (p = 0.956 and p = 0.970 for both subscales). In the analysis by age groups, a statistical trend was observed for the “limitations” component (ANOVA: F(3,590) = 2.63; p = 0.053). For the anxiety component, with confirmed homogeneity of variances using Levene’s test, significant between-group differences were revealed (ANOVA: F(3,590) = 8.84; p < 0.001). Tukey’s post-hoc comparisons revealed higher values in younger groups compared to adolescents and adults. Linear regression showed that anxiety was most strongly associated with the severity of socioemotional limitations (β = 0.636; p < 0.001) with an independent negative effect of age (β ≈ –0.24; p < 0.01). The model explained 44.4 % of the variance (R2 = 0.444); VIF < 1.1. Psychometric analysis confirmed the two-factor structure with high internal consistency of the subscales (α = 0.904 and α = 0.874).Conclusions. The quality of life of children and adolescents with celiac disease on a gluten-free diet is characterized by moderate "restriction burden" and associated anxiety. Anxiety is higher in younger age groups; no gender differences were found. The priority of medical and social support is to reduce daily limitations through organizational and environmental measures (in educational and leisure contexts, when eating out), supplemented by psychoeducational support for families, especially in younger age groups. According to the study, such measures are associated with reduced anxiety and improved daily functioning.
Aim: to perform a systematic review and meta-analysis of the efficacy of Saccharomyces boulardii CNCM I-745 in the prevention of antibiotic-associated diarrhea (AAD) in adults and children.Materials and methods. The protocol for this systematic review and meta-analysis was prospectively registered in the international PROSPERO database (CRD420261296647). In accordance with the PRISMA 2020 guidelines, a systematic literature search was conducted in MEDLINE/PubMed, Embase, the Cochrane Library, Scopus, and RSCI (Russian Science Citation Index) from the time first publications appeared to February 6, 2026. Studies evaluating the efficacy of S. boulardii CNCM I-745 (Enterol®) in the primary prevention of AAD and Clostridioides difficile infection (CDI) in adults and children were included.Results. A total of 29 studies met the inclusion criteria and were included in the meta-analysis. The use of S. boulardii CNCM I-745 was associated with a statistically significant reduction in the incidence of AAD compared with control in the overall pooled analysis (OR 0.38; 95 % CI 0.32–0.45). Subgroup analysis confirmed the efficacy of the probiotic in both adults (20 studies, n = 3937; OR 0.45; 95 % CI 0.33–0.61) and children, in whom the effect was even more pronounced (7 studies, n = 1608; OR 0.31; 95 % CI 0.23–0.41). In the analysis of studies in which S. boulardii CNCM I-745 was used as part of Helicobacter pylori eradication regimens, a statistically significant reduction in AAD risk was also observed (13 studies, n = 2333; OR 0.36; 95 % CI 0.25–0.52). Additional analysis demonstrated a significant reduction in CDI risk with S. boulardii CNCM I-745 use (8 studies, n = 18,426; OR 0.67; 95 % CI 0.49–0.92).Conclusions. The results of this meta-analysis demonstrate the high efficacy of S. boulardii CNCM I-745 in the prevention of AAD in adults and children, as well as in reducing the risk of CDI during antibiotic therapy from the very firstday of treatment.
Aim: to compare the effectiveness and oncological safety of colon preparation for surgical treatment in patients with colorectal cancer complicated with obstructive colonic ileus using endoscopic stenting and protective ostomy.Materials and methods. A prospective, single-center, randomized study was carried out. All patients with colorectal cancer complicated with obstructive colonic ileus consecutively admitted to the Proctology Clinic of the University Clinical Hospital No. 2 of the Sechenov University were included in the study. Patients were randomized into two groups: Group 1 (study group) included patients who underwent endoscopic placement of a self-expanding metal stent to resolve obstructive colonic ileus; Group 2 (control group) included patients who underwent protective ostomy.Results. Endoscopic stenting requires less general anesthesia and can be performed outside the operating room. The duration of decompression surgery is statistically significantly shorter with stenting compared to ostomy: 23 [20–30] and 50 [40–60] min, respectively (p < 0.001). The rehabilitation period, which is also the period of preparation for the main surgical intervention, with stenting was 4 [3–5] days, which was statistically significantly shorter compared to the control group (p < 0.001). Satisfactory quality of colon preparation after decompression in the study group was noted in 92.9 % of cases, in the control group — in 50 % of cases (p < 0.001). The result of nutritional correction in both groups was assessed as positive, however, in intergroup comparison, the level of serum albumin was statistically significantly higher in the group of stented patients (p = 0.015). The duration of the main surgery was statistically significantly longer in the ostomy group than in the study group: 300 [270–320] vs. 180 [160–220] min, respectively (p < 0.001). The results of the data indicating the oncological safety of both decompression methods were similar.Conclusion. Endoscopic stenting of tumor stenosis in obstructive colonic ileus may be considered a preferable option for preoperative colon decompression compared to unloading stoma in the treatment of complicated forms of colorectal cancer within a single hospitalization.
Background. Ulcerative colitis (UC) is a chronic inflammatory disease characterized by relapsing episodes that require accurate evaluation of disease activity to guide therapeutic decisions. Although endoscopy remains the gold standard for assessing mucosal inflammation, its invasive nature limits frequent use. The serum immune-inflammation index (SII), derived from routine blood counts, has emerged as a potential non-invasive biomarker of systemic inflammation.Aim: to evaluate the role of SII in assessing disease activity and severity in UC patients.Materials and methods. This cross-sectional study included 80 adult UC patients attending Ain Shams University Hospitals. Clinical evaluation, laboratory testing (C-reactive protein, fecal calprotectin, and complete blood count), and colonoscopic assessment using the Mayo Endoscopic Subscore were performed on the same day. SII was calculated as (platelet count × neutrophil count) / lymphocyte count.Results. Of the 80 patients, 25 (31.25 %) were in remission and 55 (68.75 %) had active disease. SII values were significantly higher in patients with active UC compared to those in remission (1357.97 ± 831.17 vs. 582.86 ± 188.88; p < 0.001). SII positively correlated with C-reactive protein and fecal calprotectin, and negatively with lymphocyte count. At a cutoff of > 838.76, SII discriminated active disease from remission with 70.91 % sensitivity, 96.00 % specificity, and 86.1 % accuracy. A cutoff of > 1148.67 distinguished moderate-to-severe from mild disease with 78.00 % accuracy.Conclusion. The SII is a simple, cost-effective, and reliable non-invasive marker for assessing disease activity and severity in UC. Its incorporation into routine monitoring may reduce dependence on frequent endoscopic evaluation.
Aim: to determine the safest and most effective parameters for the laser coagulation method of uncomplicated pilonidal sinus.Materials and methods. Three single-center randomized pilot studies were conducted, involving 21 patients with chronic inflammation of the pilonidal sinus. During the operation, depending on the randomization group, fiber laser devices with wavelengths of 970, 1560, and 1940 nm were used, with end or radial light guides and varying amounts of energy. To determine the effectiveness, safety, and characteristics of laser exposure, the sinus tract was excised, and the removed specimen was subjected to morphological examination. This study demonstrated the depth of thermal laser exposure on the structures of the pilonidal sinus at different wavelengths, amounts of energy transferred, and types of fiber instruments.Results. Lasers with wavelengths of 970, 1560, and 1940 nm can be used for laser coagulation of the pilonidal sinus. The use of end-face and radial light guides is acceptable, but from the point of view of technical characteristics and safety, the use of an end-face type is most justified. The study demonstrated a direct relationship between the level of energy delivered and an increase in the depth of thermal damage, but it is not possible to definitively determine the optimal amount of energy per 1 cm of pilonidal sinus length due to the small sample of patients.Conclusions. Laser coagulation is a minimally invasive, highly effective method of treating the pilonidal sinus, with an efficiency rate of 90–97 %. The results of the studies showed that lasers of different wavelengths can be used for this surgical method. But considering the penetration depth of laser radiation with a wavelength of 1940 nm, its use is preferable. The use of an end-face light guide is the most appropriate in terms of its technical characteristics, safety, and ease of use. The results of the study also demonstrated a direct relationship between the level of energy delivered and the depth of thermal impact on tissue.
Aim: to determine the frequency of detection of nonsteroidal anti-inflammatory drug-induced (NSAID-induced) gastropathy in patients with rheumatoid arthritis depending on risk factors.Materials and methods. A total of 97 patients with rheumatoid arthritis were examined. The control group consisted of 35 virtually healthy individuals who did not take NSAIDs and were matched for age and sex with the main group. A questionnaire survey was conducted to evaluate seven risk factors (one point for a positive response). All patients underwent esophagogastroduodenoscopy with the assessment of gastropathy severity using the F.L. Lanza scale for quantitative evaluation of erosive and ulcerative lesion severity.Results. The analysis showed that the number of patients with rheumatoid arthritis who had no risk factors was small and amounted to 7 individuals (7.2 % of the total number of patients in the group). At the same time, gastropathy was detected in 5 (71.4 %) cases even among these individuals. Gastropathy was detected in 73 (81.1 %) out of 90 patients with ≥ 1 risk factor, but the difference with the group without risk factors was statistically insignificant (χ2 = 0.39; p > 0.05; odds ratio (OR) = 1.718; 95% confidence interval (95% CI): 0.307–9.618). In the group of patients with ≥ 2 risk factors, gastropathy was detected in 70 (84.3 %) out of 83 patients; the difference with the group with ≤ 1 risk factor was statistically significant (χ2 = 5.62; p < 0.05; OR = 4.038; 95% CI: 1.201–13.581). In patients with ≥ 3 risk factors, gastropathy was detected in 58 (89.2 %) out of 65 cases; the difference with the group with ≤ 2 risk factors was statistically significant (χ2 = 9.73; p < 0.05; OR = 4.971; 95% CI: 1.719–14.374).Conclusions. The calculation of the odds ratio with a 95% confidence interval shows that the absence of risk factors does not exclude the presence of gastropathy in a patient; however, the risk of its development increases statistically significantly with the accumulation of two or more factors.
Introduction. Celiac disease is a chronic autoimmune disease requiring a lifelong gluten-free diet. Despite the effectiveness of the diet in controlling symptoms, patients’ quality of life remains at risk due to limitations in social, emotional, and gastronomic spheres.Aim: to analyze current approaches to assessing the quality of life of patients with celiac disease in order to optimise strategies for providing care to this category of patients.Key points. Current research emphasizes the importance of not only clinical control, but also of psychosocial support for patients This review describes validated tools for assessing life quality in patients with celiac disease, highlighting the differential impact of the disease on children and adults, the specifics of adherence to and perceptions of a gluten-free diet, and regional and cultural differences in access to support and gluten-free products. An unfavorable psychological state can reduce adherence to a gluten-free diet, creating a vicious cycle. A comparison with other chronic diseases showed that with strict adherence to a gluten-free diet, celiac disease may have a lesser impact on quality of life.Conclusion. Optimizing quality of life requires a multidisciplinary approach — from cultural adaptation of life quality scales to psychological and social support for these patients and normalizing nutrition outside the home.
Aim: to review current understanding of the role of intestinal microbiota in the pathogenesis of irritable bowel syndrome (IBS), anxiety and depressive disorders, and to present the materials of the Expert Council, which met on April 19, 2025, in Moscow.Key points. A likely unifying factor in the development of IBS, anxiety, and depressive disorders is a change in the composition of the intestinal microbiota, which causes disruption of neuroendocrine, immune, and metabolic signaling pathways of interaction between the gut and brain (components of the gut-brain axis). The intestinal microbiota plays a coordinating role in maintaining the physiological constancy of these pathways. However, when its composition is disrupted, pathogenic mechanisms are activated, leading to the combined development of both IBS and anxiety and depressive disorders. Recent data have shown that patients with IBS, as well as those suffering from anxiety and depressive disorders, exhibit a unidirectional change in the composition of the intestinal microbiota, characterized by a decrease in the number of Bifidobacterium bacteria, suggesting their key role in the pathogenesis of these diseases. A pathogenetically substantiated therapeutic strategy for the combination of IBS and mental disorders includes modifying the gut microbiota using strain-specific pro biotics containing Bifidobacterium type species. Bifidobacterium longum 35624 and Bifidobacterium longum 1714 strains have demonstrated clinical efficacy in reducing the severity of IBS symptoms, anxiety, and depression.Conclusion. Prescribing a combination of Bifidobacterium longum 35624 and Bifidobacterium longum 1714 probiotic strains to patients with IBS, including those with comorbid mental disorders, is clinically justified. This combination of strains holds promise for inclusion in clinical guidelines for the management of patients with irritable bowel syndrome and mental and behavioral disorders.
Aim: to demonstrate the utility of ultrasound in evaluating of Crohn’s disease with multiple extraintestinal manifestations after restorative proctocolectomy.Key points: Patient S., a 40-year-old female, was admitted to the clinic presenting with frequent bloody stools, abdominal pain in left lower quadrant and fever. She had a history of ulcerative colitis diagnosed in 2005. In 2021, the disease was complicated by toxic megacolon requiring a colectomy and an end ileostomy. In 2022, the second stage of surgical treatment was performed: proctectomy with ileal pouch-anal anastomosis. In 2023, the patient developed extraintestinal manifestations: aphthous stomatitis, erythema nodosum, and left ankle arthritis. Examination revealed ultrasound signs of Crohn’s disease: significant thickening of the bowel wall (predominantly of the muscularis propria and submucosa) with loss of wall stratification, as well as pathological vascularization of the ileoanal anastomosis, indicating transmural inflammation. Ileoscopy revealed linear ulcers, and histology showed inflammatory infiltration extending to the muscular layer, confirming the diagnosis of Crohn’s disease. Therapy with ustekinumab was initiated with positive clinical response and disease remission.Conclusion. Ultrasound has revealed signs of transmural inflammation of the ileal pouch and allowed to suspect Crohn’s disease, which has been subsequently confirmed by endoscopic and histological examinations.
Aim: to identify the frequency of secondary hepatosiderosis not related to hereditary hemochromatosis, depending on the etiology of chronic diffuse liver disease, in a retrospective study based on the results of morphological examination of liver biopsies.Materials and methods. The study included 227 patients with chronic diffuse liver diseases of various etiologies (viral (HCV, HBV), metabolic, alcoholic), the average age of patients was 35.3 ± 11.9 years, among those examined there were 153 (67 %) men, 74 (33 %) women. All patients underwent laboratory and instrumental examination: clinical blood test, coagulation test, biochemical blood test (alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, alkaline phosphatase, total bilirubin, albumin, lipid phenotyping), virological research methods (HBsAg, HCV antibodies, HCV-RNA, HBV-DNA in blood serum and liver biopsies, expression of HCV non-structural proteins, HBsAg, HBcorAg in liver biopsies), markers of autoimmune liver diseases (ANA, AMA), iron metabolism indices (serum iron, ferritin), as well as hepatobiopsy with morphological examination of biopsy specimens and assessment of the histological activity index (Knodell, 1994), fibrosis stage (Desmet, 1994), Perls staining to detect iron deposits.Results. Histological examination of hepatobiopsy specimens from patients with chronic liver diseases of various etiologies revealed the presence of iron overload syndrome in 36.1 % of cases. Most often, iron deposits in liver tissue were detected in a combination of viral and alcohol-associated liver diseases (chronic hepatitis C + alcoholic steatohepatitis — 69.6 %; chronic hepatitis B + alcoholic steatohepatitis — 66.7 %), in combination with chronic hepatitis C with metabolically associated fatty liver disease at the stage of steatohepatitis (50 %), with autoimmune hepatitis (50 %); with significant frequency — with alcohol-associated liver diseases (47.5 %), and virus-associated liver diseases — chronic hepatitis B (44.4 %), chronic hepatitis C (38.9 %). Iron overload syndrome in the liver was observed significantly less frequently in non-alcoholic steatohepatitis (25 %). Iron deposits in the form of hemosiderin in secondary hepatosiderosis against the background of chronic liver diseases were localized in hepatocytes of the I–II acinar zones, less often in Kupffer cells. Patients with hepatosiderosis, regardless of etiology, had higher histological activity of inflammation in liver tissue. More severe degrees of hepatosiderosis were detected in liver biopsies of patients with alcohol-associated liver diseases.Conclusion. The high frequency of secondary hepatosiderosis detected in patients with chronic liver diseases of various etiologies indicates the need to improve treatment and diagnostic algorithms: conducting additional examinations to identify iron metabolism disorders, optimizing pathogenetic therapy.
Aim: to assess the efficacy of dietary treatment regimens in eosinophilic esophagitis patients.Materials and methods. Twenty-seven patients (1 woman and 26 men) aged 24 to 61 years with a previously confirmed diagnosis of eosinophilic esophagitis (according to esophagogastroduodenoscopy with esophageal biopsy: > 15 eosinophils per high-power field, ×400) off therapy were instructed on dietary exclusions as the only treatment method. Three patients were placed on a targeted diet based on allergy testing; 17 patients followed a two-food elimination diet; and 7 patients followed a six-food elimination diet. All patients underwent esophagogastroduodenoscopy with esophageal biopsy (6 specimens from the distal and middle/proximal portions) and histopathological examination of biopsy specimens, as well as questionnaire-based assessment of dysphagia severity before and after 12 weeks of dietary therapy.Results. After 12 weeks of dietary therapy, histological remission was achieved in 3 of 7 (42.9 %) patients who followed the six-food elimination diet, in 7 of 17 (41.2 %) patients who followed two-food elimination diet, and in 1 of 3 (33.3 %) patients on a target diet (differences were not statistically significant). Complete resolution of dysphagia was ob served in 1 (33.3 %) patient who followed a target diet, in 8 of 14 (57.1 %) patients with dysphagia in the two-food elimination diet group, and in 3 of 5 (60 %) patients with dysphagia on the six-food elimination diet (differences were not statistically significant).Conclusions. The efficacy of two-food and six-food elimination diets is comparable and allows histological remis sion to be achieved in 41.2–42.9 % of patients with eosinophilic esophagitis.
Aim: to improve the surgical treatment outcomes for patients with chronic anal fissure through the new surgical ap proach application.Materials and methods. A prospective study including 33 patients with chronic anal fissure undergoing a new surgical approach treatment was conducted. This approach involved the dissection of the internal and external anal sphincters, as well as the perianal tissues film from a thin, dense connective tissue film that envelops and fixes the lat ter structures, preventing the sphincter from fully relaxing and contracting. In 14 patients, the connective tissue film and surrounding tissues film were stained with aqueous dye — trypan blue 0.06 %, used in ophthalmic surgery for better fibrous tissue film identification. In 19 patients, the fissure was combined with a fistula originating from the fissure itself.Results. The application of the new surgical approach in patients with chronic anal fissure results in complete sphincter’s relaxation and its contractile function restoration, significantly reducing the intensity of anal pain in postoperative period and creating conditions for surgical wound healing within acceptable time frames.Conclusion. The new surgical approach aiming isolation of the anal sphincters from the connective tissue film and scars fully leads to the restoration and preservation of the sphincter function, thus enabling the complete avoidance of sphincterotomy in such patients.
Aim: to review the current literature on the potential link between Helicobacter pylori (H. pylori) infection and iron deficiency and vitamin B12 deficiency anemia.Key points. Published studies have shown that iron deficiency anemia of unknown cause may be due to H. pylori infection, especially in pediatric practice. This infection can lead to impaired iron absorption through various mechanisms. Eradicating H. pylori infection can contribute to restoring normal red blood cell parameters. Additionally, patients infected with H. pylori have lower blood levels of vitamin B12 compared to uninfected individuals. The mechanisms contributing to impaired vitamin B12 absorption in patients with H. pylori infection may be associated with the progression of multifocal atrophic gastritis, as well as the production of antibodies against parietal cells and intrinsic factor. Many national gastroenterology societies and consensus meetings recommend testing for H. pylori infection patients with iron deficiency anemia or B12 deficiency anemia of unknown origin and, if positive, eradicating it.Conclusion. There is a positive association between H. pylori infection and the development of unexplained iron deficiency anemia. The relationship between H. pylori infection and vitamin B12 deficiency anemia has not been sufficiently studied and requires further research.
Aim: comprehensive assessment of the efficacy and safety of hymecromone in the treatment of biliary tract dysfunction.Materials and methods. A systematic review and meta-analysis of observational studies (n = 1117) selected from 5 databases (Central Scientific Medical Library, eLibrary, PubMed, Google Academy, Cochrane Library) without restrictions on publication date, devoted to the study of the use of hymecromone in patients with biliary tract dysfunction, including gallstone disease.Results. During the meta-analysis, it was found that three-week therapy with hymecromone, 1200 mg/day, was accompanied by a change in pain intensity by –48.51 mm (95 % confidence interval (95% CI): –56.97…–40.05) on the Visual Analog Scale. Improvement in quality of life was observed according to the “Bodily Pain” subscale of the 36-Item Short-Form Health Survey (SF-36) with a mean increase of 21.69 points (95% CI: 18.23–25.16). Following three-week therapy with hymecromone, 1200 mg/day, the proportion of patients with abdominal pain relief was 70.0 % (95% CI: 59.0–81.0), flatulence — 77.0 % (95% CI: 60.0–95.0), bitter taste — 74.0 % (95% CI: 54.0–93.0). The proportion of patients with improvement of gallbladder motility was 91.0 % (95% CI: 82.0–100.0), and the proportion of patients with restoration of bile homogenicity was 70.0 % (95 % CI: 43.0–98.0). The proportion of patients with normal stool frequency increased from 60.0 % (95% CI: 9.0–100.0) to 78.0 % (95% CI: 34.0–100.0) after 3 weeks of hymecromone therapy (1200 mg/day). Monotherapy with hymecromone at doses of 600–1200 mg/day had a favorable safety profile. The probability of persistent unformed stool after 3 weeks of therapy was dose-dependent: at the end of treatment, the symptom persisted in 23.0 and 0 % of patients receiving 1200 or 600 mg/day of hymecromone, respectively.Conclusions. Course therapy with hymecromone at the full therapeutic dose of 1200 mg/day results in regression of key clinical manifestations, including biliary pain and dyspeptic symptoms. The drug contributes to the restoration of gallbladder motility and improvement of bile rheological properties while demonstrating a favorable tolerability profile. These findings support the pathophysiological rationale for the use of hymecromone in biliary tract disorders and reinforce its applicability in routine clinical practice.
