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.
