Abstract Topic Benign Disease: Gastro-Esophageal Reflux and Hiatal Hernia Background There is no specific symptoms of autoimmune gastritis, but these patients often present with symptoms of GERD. The Lyon Consensus recommends using AET greater than 6 as the main criterion for pathological reflux. Daily pH impedance monitoring is an ideal method for confirming gastroesophageal reflux, but this criterion is questionable in the absence of gastric acid production. The aim of our study was to evaluate gastroesophageal refluxes in symptomatic patients with autoimmune gastritis. Methods 33 patients with autoimmune gastritis who had symptoms of GERD were included in this study: 29 females and 4 males at the age from 36 to 75 y.o. Seven patients had heartburn, 14 – cough, 7 – burn and pain in throat, 4 - hoarsness, 5 – acidity in a mouth. All patients were underwent upper endoscopy after 2 weeks off-PPI, esophageal manometry and 24h ph impedance monitoring. We used special pH impedance probes to localize pH electrodes in a stomach, 5 cm above LES and 1 cm above upper esophageal sphincter. Results According to endoscopy we didn’t found erosive esophagitis. According to pH monitoring there we didn’t evaluate acidity in a stomach, therefore the acid exposure time was less than 4: 0,09%±0,21. All patients were divided into 3 groups: I group - the total number of refluxes was more than 80, II group – the total number of refluxes from 40 to 79, III group – the total number of refluxes was less than 39. Almost all refluxes were nonacid. Two patients included into group I: one person had 144 refluxes; another one had 102 refluxes and complaint. The group II consisted of 11 patients with mean total number of refluxes: 35,42±19,8, 3 of them had esophageal hypersensitivity. The group III were presented by 20 patients with mean total number of refluxes 23,9 ±9,2, 6 of them had relation between symptoms and gastroesophageal reflux. Conclusion Patients with autoimmune gastritis may complain of GERD symptoms, including extraesophageal symptoms. 24-hour pH impedance monitoring is an ideal method for diagnosing gastroesophageal reflux and its association with symptoms. In any case, it is necessary to assess the total number of refluxes rather than AET.

Abstract Topic Benign Disease: Gastro-Esophageal Reflux and Hiatal Hernia Background Gastroesophageal reflux disease is accompanied by severe emotional stress and high levels of anxiety and depression. Self-effectiveness is a person belief in their ability to act effectively. Self-effectiveness is important during preparation to the changes, associated with disease. The aim of our study was to investigate self-effectiveness as an adaptation factor and choosing coping-strategies. Methods 57 patients with GERD were included in this study: 22 females (38,6%) and 35 males (61,4%); the mean age 48,32 ± 14,42 y.o. After signing the voluntary informed consent, they filled the complex questionnaires: “Ways of coping behavior” questionnaire of Lazarus R. and Folkman S., a Short questionnaire on the perception of the disease by E. Broadbent, Self-Efficacy Questionnaire for illness of Rasskazov E. and Tkhostov A. All patients were devided into 2 groups according to the Self-Efficacy Questionnaire for illness: 1 group with high level of self-effectiveness (with score more than 41 points; group 2 – with score less than 41 points. Results The high level of self-effectiveness was evaluated in 31 pts (54,39%) and associated with patients’ confidence in their ability to cope with the disease and view it as a challenge rather than a devastating threat. Low level of self-effectiveness – in 26 pts (45,6%), they perceive their condition as chronic and have more doubts about their ability to control the course of their condition, and they react more emotionally to their symptoms. According to “Ways of coping behavior” questionnaire patients released a wide range of coping strategies: patients seek help from others (49.32±11.06 points), which implies access to social resources and a focus on interaction; the avoidance strategy (48.16±9.84), which focuses on distancing oneself from the problem and reducing emotional stress, was almost as common; the acceptance strategy (42.01±9.93) was the least used. We found a correlation between self-efficacy and personal control (rs = 0.450, p < 0.01). Conclusion The study of self-efficacy and coping behavior allows us to identify patients who need psychological correction and psychopharmacological treatment.

Abstract Topic Benign Disease: Esophageal Function and Motility Background Spastic esophageal diseases are rare, but they can worsen quality of life. Patients with esophagospasm often have a high level of anxiety. Treatment with antidepressants relieves symptoms, but does not improve esophageal motility. Therefore, the aim of the study was to evaluate the effectiveness of anxiolitics and antidepressants in treatment of spastic disorders. Methods 50 patients with distal esophageal spasm on esophageal manometry were included in our study (38 females and 12 males at the age from 24 to 63 y.o.). All patients filled the questionnaires: The Beck anxiety inventory, The Beck depression inventory, hospital anxiety and depression scale. They were randomly divided into 2 groups: the first group took etifoxine 50 mg 3 times a day 3 months, the second group took duloxetine 30 mg a day 3 months. The esophageal manometry was repeated after treatment in 22 patients from group 1 and 20 patients from group 2. 8 patients were excluded because of refusal of the study. Results 18 patients complaint of dysphagia in each group, chest pain was evaluated in 10 patients from group 1 and 18 patients from group 2. The frequency of dysphagia reduced in 66% of patients from group 1 and 2 after 3 months of tretament. The frequency of chest pain reduced in 60% subject from group 1 and 66% from group 2. We observed a reduce of anxiety and depression scales according to HADS and the Beck’s questionnaires in 63,7% of patients from group 1 and 90% patients from group 2. The remaining patients didn’t show an improvement of mental condition. However, esophageal manometry revealed normal manometry or positive manometric changes in 63,7% of patients from group 1 and in 40% of patients from group 2. We didn’t observed the correlation between questionnaire scales and manometric changes. Conclusion The anxiolytic therapy with etifoxine in patients with DES demonstrated a positive effect on esophageal manometry comparing to duloxetine. Even though the antidepressants were beneficial in improving of mental condition of patients.

BACKGROUND & AIM:Malnutrition is common in pancreatic ductal adenocarcinoma (PDAC) and may compromise chemotherapy delivery. We investigated whether baseline nutritional status and quality of life (QoL) predict chemotherapy relative dose intensity (RDI) and survival in advanced PDAC. METHODS:In this multicenter prospective cohort, adults with locally advanced or metastatic PDAC planned for first-line chemotherapy underwent baseline nutritional and QoL assessments, including the Mini Nutritional Assessment (MNA), European Organisation for Research and Treatment of Cancer-Pancreas 26 (EORTC-PAN26), and Functional Assessment of Anorexia/Cachexia Therapy subscale (FAACT-A/CS). The primary outcome was chemotherapy delivery during the first 12 weeks, expressed as RDI. Secondary outcomes included overall survival (OS). Associations between baseline scores, RDI, and OS were analyzed using regression models adjusted for age, sex, disease stage, and center. Kaplan-Meier and Cox models assessed survival. RESULTS:Of 140 enrolled patients, 105 started chemotherapy. Malnutrition was frequent (55.7 % at risk, 33.6 % malnourished). Higher MNA and EORTC-PAN26 scores were associated with better RDI (r = 0.31, p = 0.001; r = 0.30, p = 0.002), whereas FAACT-A/CS showed no correlation. In multivariable analysis, higher MNA scores [odds ratio (OR) 0.55; 95 % confidence interval (CI) 0.32-0.96; p = 0.036] and metastatic disease (OR 0.36; 95 % CI 0.13-0.99; p = 0.048) independently predicted RDI ≥80 %. Reduced RDI (hazard ratio [HR] 2.05; 95 % CI 1.20-3.50; p = 0.009) and FAACT-A/CS < 28 (HR 1.90; 95 % CI 1.04-3.49) were independently associated with shorter OS. CONCLUSIONS:Baseline nutritional status and QoL, particularly assessed by MNA and EORTC-PAN26, predict chemotherapy delivery in advanced PDAC. Reduced RDI and anorexia/cachexia symptoms are linked to poorer survival, supporting systematic nutritional assessment and targeted interventions to optimize outcomes.

Objective: The objective of this study is to assess the dynamics of Helicobacter pylori infection prevalence among adults in Russia. Methods: A systematic search was conducted in MEDLINE/PubMed, EMBASE, Cochrane, RSCI, and Google Scholar for studies published between 1985 and 27 February 2025, following PRISMA guidelines. The meta-analysis was registered in PROSPERO (CRD420251011643). Results: Twenty studies were included (n = 117,841; weighted mean age: 43.71 ± 16.23 years), all using validated diagnostic methods. The pooled prevalence from 1994 to 2024 was 62.847% (95% CI: 55.101–70.274), including 45.143% (95% CI: 41.390–48.923) by the 13C-urea breath test and 75.806% (95% CI: 64.213–85.742) by serology. Prevalence declined over time: it was 79.334% before 2005, 74.074% in 2006–2011, and 66.319% in 2012–2017, and it has been 42.949% since 2018. Meta-regression confirmed a significant decrease (coefficient: −3.773% per year, p < 0.001). Conclusions: A significant decline in the prevalence of H. pylori has been observed, however, it remains relatively high and requires continued efforts aimed at diagnosis and eradication.

BACKGROUND:Exposure to COVID-19 has been shown previously to be associated with a higher risk for irritable bowel syndrome (IBS). This study aimed to better explain this relationship using mediation analysis. METHODS:This post hoc analysis of a multicenter cohort study includes 623 patients with and without COVID-19 infection. All participants completed the ROME IV criteria, gastrointestinal symptom rating scale (GSRS), and hospital anxiety and depression scale (HADS) over 1 year. Mediation analysis utilized the PROCESS macro and Baron and Kenny's method for parametric and nonparametric mediating variables, respectively. KEY RESULTS:The impact of COVID-19 on the development of post-COVID-19 IBS is completely mediated by dyspnea at baseline (adjusted OR = 3.561, p = 0.012), severity of acid regurgitation at 1 month [indirect effect, log-odds metric = 0.090, 95% CI (0.006-0.180)], hunger pains at 1 [indirect effect, log-odds metric = 0.094, 95% CI (0.024-0.178)], and 6 months [indirect effect, log-odds metric = 0.074, 95% CI (0.003-0.150)], depression at 6 [indirect effect, log-odds metric = 0.106, 95% CI (0.009-0.225)] and 12 months [indirect effect, log-odds metric = 0.146, 95% CI (0.016-0.311)] as well as borborygmus [indirect effect, log-odds metric = 0.095, 95% CI (0.009-0.203)], abdominal distention [indirect effect, log-odds metric = 0.162, 95% CI (0.047-0.303)], and increased flatus [indirect effect, log-odds metric = 0.110, 95% CI (0.005-0.234)] at 12 months. CONCLUSIONS AND INFERENCES:Our findings provide evidence for psychological and clinical mediators between COVID-19 and post-COVID-19 IBS, which may be promising targets for interventions tailored for treating or preventing depression. The presence of specific GI symptoms at COVID-19 onset and their persistence should increase awareness of a potential new onset of IBS diagnosis.

Objective: This study aimed to provide the first umbrella review to systematically evaluate the evidence for the efficacy of personalized susceptibility-guided tailored therapy (TT) versus empirical therapy (ET) for Helicobacter pylori eradication. Methods: An umbrella review was conducted following Joanna Briggs Institute standards, registered in PROSPERO (CRD420251104335). A comprehensive literature search across MEDLINE/PubMed, EMBASE, RSCI, and Google Scholar identified systematic reviews and meta-analyses published between 1 January 1985 and 10 June 2025. Studies comparing TT and ET were included. Methodological quality was assessed using a modified AMSTAR-2 tool, GRADE, and the risk of bias was evaluated using the ROBIS tool. Data were synthesized using a random-effects model, with heterogeneity assessed using the I2 statistic. Results: A total of 7 systematic reviews and meta-analyses were included, covering 66 primary studies. TT was associated with a significantly higher eradication rate compared to ET (RR = 1.265; 95% CI: 1.137–1.407). In first-line treatment, TT showed consistent superiority (RR = 1.156; 95% CI: 1.117–1.196), which was further supported by high-quality meta-analyses (RR = 1.288; 95% CI: 1.022–1.624). The benefit in second-line therapy did not reach statistical significance (RR = 1.291; 95% CI: 0.834–1.999). The absolute eradication rates were 84.31% (95% CI: 80.94–87.41) for TT and 67.80% (95% CI: 58.48–76.46) for ET. Conclusions: TT is more effective than ET in the first-line H. pylori eradication regimen. However, the benefit is less evident in second-line regimens.

INTRODUCTION:To evaluate the prescription patterns, effectiveness, and safety of adding probiotics to Helicobacter pylori eradication therapy, in Europe. METHODS:International, prospective, noninterventional registry of the clinical practice of the European gastroenterologists. Data were collected and quality reviewed until March 2021 at AEG-REDCap. The effectiveness was evaluated by modified intention-to-treat analysis, differentiating by geographic areas. Adverse events (AEs) were categorized as mild, moderate, and severe. RESULTS:Overall, 36,699 treatments were recorded, where 8,233 (22%) were prescribed with probiotics. Probiotics use was associated with higher effectiveness in the overall analysis (odds ratio [OR] 1.631, 95% confidence interval [CI] 1.456-1.828), as well as in triple (OR 1.702, 95% CI 1.403-2.065), quadruple (OR 1.383, 95% CI 0.996-1.920), bismuth quadruple (OR 1.248, 95% CI 1.003-1.554), and sequential therapies (OR 3.690, 95% CI 2.686-5.069). Lactobacillus genus was associated with a higher therapy effectiveness in Eastern Europe when triple (OR 2.625, 95% CI 1.911-3.606) and bismuth quadruple (OR 1.587, 95% CI 1.117-2.254) first-line therapies were prescribed. In Central Europe, the use of probiotics was associated with a decrease in both the overall incidence of AEs (OR 0.656, 95% CI 0.516-0.888) and severe AEs (OR 0.312, 95% CI 0.217-0.449). Bifidobacterium genus was associated with lower overall (OR 0.725, 95% CI 0.592-0.888) and severe (OR 0.254, 95% CI 0.185-0.347) AEs, and Saccharomyces was associated with reduced overall (OR 0.54, 95% CI 0.32-0.91) and severe (OR 0.257, 95% CI 0.123-0.536) AEs under quadruple-bismuth regimen. DISCUSSION:In Europe, the use of probiotics was associated with higher effectiveness and safety of H. pylori eradication therapy. Lactobacillus improved treatment effectiveness, whereas Bifidobacterium and Saccharomyces were associated with a better safety profile.

Aim. To evaluate the possibility of using serum markers of atrophy (pepsinogens – PG I and II) to form high-risk groups for gastric cancer (Operative Link for Gastritis Assessment – OLGA stage III–IV) depending on the etiology of gastritis. Materials and methods. A total of 237 (56 men and 181 women) patients were examined. All patients underwent a 13C-urea breath test, a blood test for GastroPanel (PG I, PG II, gastrin-17, antibodies to Helicobacter pylori immunoglobulin G), a blood test for antibodies to gastric parietal cells. All patients underwent esophagogastroduodenoscopy with a biopsy of the gastric mucosa from 5 standard points according to the Sydney system and a histomorphological study according to the OLGA system, as well as a biopsy to detect H. pylori infection using the polymerase chain reaction. The patients were divided into 3 groups depending on the etiology of gastritis: Group 1 included 55 patients with chronic gastritis, autoimmune gastritis and associated with H. pylori gastritis (AIG+HP+); Group 2 – 47 patients with AIG and negative tests for H. pylori infection (AIG+HP-); Group 3 – 135 patients with chronic gastritis associated with H. pylori and negative markers of AIG (AIG-HP+). Results. The analysis showed that in patients with AIG (group 2), the most reliable serological markers of atrophy predicted severe atrophy (OLGA stage III–IV): when the ratio PG I/PG II was ≤ 3, it was detected in 70.21% of cases, and when PG I decreased to ≤ 30 μg/L, it was found in 68.08%. In group 1, stages III–IV according to OLGA were diagnosed in 20% of cases with PG I/PG II indicators ≤ 3; and in 18.18% with a decrease in PG I ≤ 30 μg/L. When analyzing the diagnostic accuracy of GastroPanel biomarkers in identifying severe atrophy (OLGA stages III–IV) in the total sample of patients (all 3 groups), it was possible to achieve cut-off indicators as close as possible to the reference values while maintaining a relatively high sensitivity and specificity – 75.81% and 81.50% for PG I ≤ 30 μg/L and 85.48% and 64.50% for PG I/PG II ≤ 3, respectively. The optimal cut-off in the study population for the PG I indicator was 22.5 μg/L (sensitivity – 72.58%, specificity – 88.00%), and for the PG I/PG II ratio ≤ 2 (sensitivity – 80.65%, specificity – 78.50%). Conclusion. Serum pepsinogens can be used in the Moscow population as a non-invasive marker of gastric mucosa atrophy for the formation of high-risk patient groups for gastric cancer requiring endoscopic examination.

Helicobacter pylori (H. pylori) infection and autoimmune inflammation of the gastric mucosa are recognized as the leading etiological factors of chronic atrophic gastritis. The mechanisms of atrophy formation and progression with the risk of gastric cancer development are heterogeneous, which requires a deeper study of the molecular mechanisms of relationship, peculiarities of the course of autoimmune gastritis both in combination with H. pylori and after eradication, as well as without H. pylori infection (naïve AIG). This article presents the specific molecular and cellular patterns in the formation of these related conditions.

BACKGROUND & AIMS:Type 1 autoimmune pancreatitis (AIP) is a relapsing remitting disorder that often requires multiple treatment courses. Our aims were to assess the efficacy of maintenance treatment in preventing relapse and to develop the PrescrAIP risk score predicting relapse risk and the benefit of maintenance treatment. METHODS:We retrospectively analyzed patients meeting international diagnostic criteria for type 1 AIP who reached partial or complete remission after initial treatment. The primary outcome was disease relapse, defined as recurrence of symptoms and/or radiologic findings. We developed a multivariable prediction model using Cox proportional hazards regression, performed internal and internal-external validation, and built a predictive nomogram. RESULTS:We included 577 patients (68% male). During a median follow-up of 34 months (interquartile range, 13-69 months), we observed 154 relapses. The overall 3-year relapse risk was 28% (95% confidence interval [CI], 24%-32%), lower in patients receiving maintenance treatment than in those without (22% vs 35%; P < .001). The final PrescrAIP model incorporated protective factors (maintenance treatment, prior surgery, focal mass, female sex) and risk factors (biliary involvement, other organ involvement, IgG4 elevation, allergy, jaundice, acute pancreatitis). The model showed moderate discrimination (Concordance index, 0.69) and good calibration. Internal-external validation yielded Concordance index values ranging from 0.64 to 0.71. Maintenance treatment significantly reduced relapse in patients with a PrescrAIP score >155, but not in those with lower scores. CONCLUSIONS:Maintenance therapy reduced relapse only in patients at high relapse risk. Once externally validated, the PrescrAIP score may guide personalized maintenance treatment decisions.

BACKGROUND:The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has highlighted the potential exacerbation of gastrointestinal symptoms in patients with disorders of gut-brain interaction (DGBIs). However, the distinct symptom trajectories and psychological burden in patients with post-COVID-19 DGBIs compared with patients with pre-existing irritable bowel syndrome (IBS)/functional dyspepsia (FD) and non-DGBI controls remain poorly understood. OBJECTIVES:To examine the long-term gastrointestinal symptom progression and psychological comorbidities in patients with post-COVID-19 DGBI, patients with pre-existing IBS/FD and non-DGBI controls. METHODS:This post hoc analysis of a prospective multicenter cohort study reviewed patient charts for demographic data and medical history. Participants completed the Gastrointestinal Symptom Rating Scale at four time points: baseline, 1, 6, and 12 months, and the Hospital Anxiety and Depression Scale at 6 and 12 months. The cohort was divided into three groups: (1) post-COVID-19 DGBIs (2) non-DGBI, and (3) pre-existing IBS/FD, with the post-COVID-19 DGBIs group compared to the latter two control groups. RESULTS:Among 599 eligible patients, 27 (4.5%) were identified as post-COVID-19 DGBI. This group experienced worsening abdominal pain, hunger pain, heartburn, and acid regurgitation, unlike symptom improvement or stability in non-DGBI controls (p < 0.001 for all symptoms, except hunger pain, p = 0.001). While patients with pre-existing IBS/FD improved in most gastrointestinal symptoms but worsened in constipation and incomplete evacuation, patients with post-COVID-19 DGBI exhibited consistent symptom deterioration across multiple gastrointestinal domains. Anxiety and depression remained unchanged in patients with post-COVID-19 DGBI, contrasting with significant reductions in controls (non-DGBI: p = 0.003 and p = 0.057; pre-existing IBS/FD: p = 0.019 and p = 0.007, respectively). CONCLUSIONS:COVID-19 infection is associated with the development of newly diagnosed DGBIs and distinct symptom trajectories when compared with patients with pre-existing IBS/FD. Patients with post-COVID-19 DGBI experience progressive gastrointestinal symptom deterioration and persistent psychological distress, underscoring the need for tailored management strategies for this unique subgroup.

For more than a century, physicians have noted the relationship of chronic gastritis with the development of gastric cancer, which prompted great interest in the study and systematization of chronic gastritis in order to better understand the prognosis and develop approaches for cancer prevention. The accumulated knowledge about the etiology, pathogenesis and morphology of gastritis has made it possible to coordinate the general ideas about gastritis in the classifications used by practicing physicians today, and the systems developed and implemented into practice for assessing atrophy/intestinal metaplasia (OLGA/OLGIM) undoubtedly can help the doctor in determining the tactics of curation of the patient.