The article provides information on the pathogenesis, classification and frequency of ophthalmic extra -intestinal manifestations in patients with inflammatory bowel diseases (IBD). A clinical observation of a patient with autoimmune uveitis and IBD is described, demonstrating the importance of early diagnosis of immuno-inflammatory diseases in the implementation of multidisciplinary management of patients with IBD and extraintestinal manidestations. The use of genetically engineered biological drugs helps to control the course of IBD, ophthalmic manifestations and prevents the development of complications.

In the process of evolution in the gastrointestinal tract, a system of protection against bacterial and food antigens from getting into the blood was formed. The causes of increased intestinal permeability (IIP) can be microbiota imbalance, use of antibiotics, non -steroidal anti-inflammatory drugs, stress, diet rich in fructose, glucose, sucrose and long -chain fatty acids. The appearance of IIP may be of paramount importance in the pathogenesis of autoimmune diseases. A diet low in fermentable oligodimonosaccharides and polyols, pre- and probiotics, polyphenols, vitamins, short -chain fatty acids, dietary fiber, glutamine contributes to the reduction of IIP. It has been established that the cytoprotector rebamipide strengthens the barrier function throughout the gastrointestinal tract, which is reflected in practical recommendations for its use in diseases accompanied by IIP. The study of this direction will contribute to the emergence of a new strategy for the treatment of internal diseases.

Diagnostics of enteropathy with membrane digestion disturbance (EMDD) is based on the evaluation of carbohydrase activity in duodenal mucosa (DM). There is no information about diagnostic value of ileum mucosa (IM) carbohydrases. Aim. Assess the diagnostic value of carbohydrases activity in mucous membrane of duodenum and distal ileum in patients with EMDD and irritable bowel syndrome (IBS). Materials and methods. The study includes 12 patients with EMDD, 16 patients with IBS and 12 relatively healthy persons (control group). Study design included analysis of food tolerance and evaluation of activity of sucrase, glucoamylase, maltase and lactase in mucous membrane of duodenum and ileum based on the method of Dahlquist with N.I. Belostotsky modification. Microsoft Office Excel and Statistica 10.0 were used for statistical evaluation of material. Mann–Whitney criterion was used to evaluate the differences between quantitative parameters. The differences were considered to be significant at p0.05. Control group was used for comparison. Results. In control group the carbohydrases activity in duodenum mucosa was not significantly statistically different from the one in IM. In patients of the IBS group, the activity of glucoamylase and maltase in the IM was significantly higher than in the duodenum: glucoamylase by 2.2 times, maltase by 2 times. In patients with EMDD the activity of glucoamylase, maltase and sucrase in IM is higher than in DM by 5.2, 3.8 and 2 times respectively, which signifies the formation of compensatory reaction of adaptive shift, initially described by A.M. Ugolev in 1985. Conclusion. The evaluation of carbohydrase activity in IM provides more information about pathogenesis of EMDD and its differential diagnosis with IBS.

The purpose of this study was to study the effectiveness of ustekinumab (UST) depending on the dosage regimen (90 mg subcutaneously once every 8 or 12 weeks) in patients with Crohn's disease (CD) who have unfavorable prognosis factors. Material and methods. To assess the effectiveness of the drug, we included in the study 38 patients with CD who had unfavorable prognosis factors, who were randomized into two groups of patients who received the drug in a 90 mg subcutaneous regimen once every 12 weeks (1-st group, n = 20) and 90 mg subcutaneously once every 8 weeks (2-nd group, n = 18). The gender and age of the patient were analyzed, including at the time of diagnosis, the severity and prevalence of CD; the presence of intestinal complications; the presence and localization of extra-intestinal manifestations; previous treatment was analyzed. Results. Clinical response and clinical remission were achieved in 19 (95.0%) patients of the first group and 18 (100.0%) patients of the second group (p > 0.05). Clinical remission was maintained (without the need for optimization of therapy) by the 52 week of follow-up in 18 (90.0%) patients, in the second group – 18 (100.0%) patients (p = 0.516). In the 1-st group 10 (50.0%) patients achieved and maintained endoscopic remission by the 52 week of follow-up, in the 2-nd group – 16 (88.9%) patients (p = 0.01492). During one year of follow-up, 10 (50.0%) patients of the 1-st group maintained clinical and endoscopic remission of CD, 8 (40.0%) patients maintained clinical response and clinical remission (a decrease of ≥ 100 points from the initial CDAI), 16 (88.9%) patients in the 2-nd group maintained clinical and endoscopic remission of CD. Clinical response and clinical remission were maintained in 2 (11.1%) patients. Clinical and endoscopic remission in patients with CD receiving the drug was achieved in the 2-nd group (p = 0.01492). Without steroidal remission in patients in 1-st group was 65.0%, and in in 2-nd group about 95% (p = 0.04502). Conclusion. This clinical observation demonstrated statistically significantly higher therapeutic efficacy (clinico-endoscopic, without steroidal remission) in CD patients with adverse prognosis factors receiving UST 90 mg subcutaneously every 8 weeks.

Background. Stress, individual characteristics of each patient, visceral hypersensitivity and intestinal motility have the key importance in the pathogenesis of irritable bowel syndrome (IBS). In recent years, there has been growing interest in the use of selective serotonin and norepinephrine reuptake inhibitors (SNRIs) in the complex therapy of IBS patients with somatoform disorders. Aim. To examine the effectiveness of the SNRIs antidepressant therapy in the treatment of patients with IBS and diarrhea (IBS-D) with extraintestinal manifestations. Materials and methods. 42 patients with severe IBS and diarrhea (IBS-D) were examined, among them 22 female with a median age of 32 years old (22; 38), and 20 male with a median age of 31 years old (25; 35). Treatment with duloxetine 60 mg/day was prescribed. The effectiveness of the therapy was assessed after eight weeks. The IBS clinical symptoms dynamics were assessed by the intensity of pain syndrome and bloating, which were determined using Visual Analogue Pain Scale (VAS), stool frequency and shape based on the Bristol stool scale; Visceral sensitivity threshold was assessed according to the Balloon dilatation test. There was studied the effect of the duloxetine on the extraintestinal manifestations of IBS. The psycho-emotional state was assessed using the Beck scale of anxiety and depression and the SpielbergerKhanin scale by psychiatrist, neurologist-vegetol. Results. All patients showed positive dynamics after eight weeks duloxetine treatment: the decrease of pain syndrome from 9 (9; 10) to 2 (2; 3) points, bloating from 8 (8; 9) points to 2,5 (1; 3) points according to VAS, and defecation frequency from 10 (9; 12) to 2 (1; 2) times a day; the change of stool consistency from 6th (6; 7) to 3rd (3; 4) type. The visceral sensitivity threshold increased: the time of appearance of the first urge to defecate increased from 56 (34; 74) ml to 95 (80; 98) ml. Significantly decreased extraintestinal manifestations of IBS. In reassessing each patients individual characteristics there were the decrease of the depression level according to the Beck scale from 26 (23; 32) to 11.5 (10; 13) points and personal personal anxiety level according to the SpielbergerKhanin scale from 42.5 (35; 53) to 22 (20; 24) points, as well as the decrease of situational anxiety from 40 (37; 49) to 22 (21; 36) points. Conclusion. The severe course of IBS-D is mainly associated with the patients individual characteristics and anxiety or anxiety-depressive syndromes. The positive impact of duloxetine therapy in severe IBS-D with extraintestinal manifestations is associated with the regulation of serotonergic and noradrenergic activity of the central.

Abdominal pain is a symptom that determines the accuracy and timeliness of diagnosis, treatment, and prognosis. The article describes the causes of acute and chronic abdominal pain, particularly the pain in the abdominal wall, and the challenges in recognizing them. The pathogenetic features of visceral, parietal, referred, and psychogenic pain and the principles of symptomatic therapy are addressed. It is emphasized that complex invasive examinations of the abdominal organs are especially relevant for elderly patients who often have conditions that require computed tomography, including contrast-enhanced scans. Without losing the importance of modern examination methods used in clinical practice, the author states that a detailed medical history and a thorough physical examination can significantly narrow the work-up. Endoscopic and other instrumental invasive examinations should be strictly justified and applied with a cost-effective rational approach.

In most cases Tuberculosis (TB) affects the lungs, but 10–15% of patients have extrapulmonary TB localisations, that is difficult to diagnose. TB is more spread among patients having the human immunodeficiency virus and among those who receive immunosuppressive therapy, specifically in patients with inflammatory bowel disease requiring long-term treatment with immunosuppressants and/or biologics. The symptoms of intestinal TB are nonspecific and may include chronic diarrhea, weight loss, fever and ascites. Differential diagnosis includes Crohn's disease, malignant neoplasms, periappendiceal abscesses, yersiniosis, etc. The article presents cases showing similarity of the intestinal form of TB with Crohn's disease, complexity dealing, diagnosing and treating patients with inflammatory bowel disease also having latent tuberculosis infection

In real clinical practice, unlike in the registered controlled trials, the analytical group includes all patients who are being treated with a drug. The aim is to evaluate the efficacy and safety of vedolizumab (VDMB) therapy in real clinical practice in patients with ulcerative colitis (UC) for five years. Material and methods. The study included 136 patients with UC (men 53.7%, women 46.3%), average age – 33.8 ± 4.4 years, duration of the disease – 3.1 ± 0.4 years (52.9% of patients with moderate severity, 72.1% with total lesion and 64.4% with chronic recurrent course, in 17.6% of cases – extra-intestinal manifestations). Results. After 12 weeks, 53 (38.9%) patients with UC achieved a clinical response, 72 (52.9%) achieved clinical remission, 13 (9.5%) did not respond or did not respond sufficiently to therapy. After 24 weeks, clinical remission reached 72.1%, clinical response – 18.4% of patients. Of 112 patients who underwent colonoscopy (CS), 68 (60.7%) had clinical and endoscopic remission at week 24. After 52 weeks of therapy, endoscopic remission persisted in 68 (60.7%) patients, endoscopic response – in 40 (36.6%), clinical remission – in 112 (82.3%) and clinical response – in 21 (15.4%). After five years of VDMB therapy, endoscopic remission persisted in 70 (51.5%) patients, endoscopic response in 36 (26.5%), clinical remission in 105 (77.2%) and clinical response in 19 (14.0%). The survival rate of VDMB therapy in patients with UC was 90.4% after 12 months and persisted for a year, 82.3% after two years, 81.6% after five years. Steroidal remission was 91.0%. The regression of extra-intestinal manifestations after 24 weeks was noted in 58.3% of patients with UC. Conclusion. Our clinical observation of 136 patients with UC demonstrated the high efficacy and safety of VDMB

A clinical case of the observation of a patient with chronic diarrhea, occurred after a resection of the small intestine with an ileoileal anastomosis, is described further. The resection of the small intestine, including the ileum, where the conversion and reabsorption of bile acids (BA) usually occur, leads to their excessive influx into the large intestine, causing chologenic diarrhea. The increased amount of BA has a detrimental effect on the activity of the intestinal microbiota in the anatomically altered intestine and can cause the biliary insufficiency. The exclusion of the ileocecal zone, especially the Bauhinia valve, from the passage of chyme, disrupts the motor activity of the large intestine, reduces water and ion absorption, and promotes regurgitation of intestinal contents from the cecum into the small intestine. Difficulties in identifying the chologenic factor in the development of diarrhea are exacerbated by the lack of available diagnostic methods. Identification of individual pathogenetically significant factors contributing to the development of diarrhea syndrome and their adequate therapeutic correction is the key to successful rehabilitation of patients with post-resection short bowel syndrome.

The aim was to evaluate the activity of intestinal carbohydrases in patients with irritable bowel syndrome (IBS) with symptoms of food intolerance. Material and methods. 126 patients with IBS (83 women and 43 men, median age – 32.0 years (Q1–Q3: 27–38 years)) were examined. The diagnosis of IBS was established on the basis of Roman Criteria IV. A questionnaire was conducted for all patients to identify food intolerances, according to the results of which the patients were divided into three groups: the first – patients with isolated intolerance to foods with a high content of FODMAP; the second – patients with isolated intolerance to milk and dairy products; the third – patients with combined intolerance. To determine the activity of intestinal carbohydrates: lactase, sucrose, maltase and glucoamylase, all patients underwent esophagogastroduodenoscopy with biopsy samples from the duodenum. The activity of carbohydrases was determined by the Dahlquist method in the modification of N.I. Belostotsky. The control group consisted of 30 conditionally healthy people (10 men and 20 women, median age – 33.9 years (Q1–Q3: 24–35)), comparable in age and gender with patients with IBS. The activity of intestinal enzymes in this group was within the reference values. Statistical data processing was carried out using the computer program Statistica 8.0. Results. According to the results of the survey, it was found that out of 126 patients with IBS, 52 (41.3%) patients believed that they had food intolerance to certain foods. Isolated intolerance to foods with a high content of FODMAP was noted by 13 (10.3%) patients, 16 (12.7%) patients believed that they had isolated intolerance to milk and dairy products, and 23 (18.3%) patients indicated combined intolerance. In patients with IBS and isolated intolerance to foods high in FODMAP, the median activity of glucoamylase was 120.0 (68.5–209.2) ng/mg of glucose per 1 mg of tissue per minute (ng/mg × min), maltase – 630.5 (480.7–951.0) ng/mg × min, sucrose – 50.0 (32.8–68.8) ng/mg × min, lactase – 10.5 (5.5–40.5) ng/mg × min. Comparing the activity of carbohydrases with the control group revealed the statistically significant difference (p < 0.05) for each enzyme studied.In the group of patients with IBS and isolated intolerance to milk and dairy products, the median activity of all the intestinal enzymes studied was also lower than that in the control group: the activity of glucoamylase was 107.0 (64.0–174.0) ng/mg × min, maltase – 622.0 (481.5–887.0) ng/mg × min, sucrose – 48.0 (35.5-60.0) ng/mg × min, lactase – 8.0 (3.0–22.5) ng/mg × min. Among patients with IBS and the presence of combined intolerance to foods (with a high content of FODMAP and dairy products), the median activity of all enzymes significantly differed from the control group (p < 0.05). The activity of glucoamylase was 107.5 (57.5–194.2) ng/mg × min, maltase – 627.0 (480.7–911.7) ng/mg × min, sucrose - 47.5(34.8–61.5) ng/mg × min, lactase - 9.0 (4.0–28.8) ng/mg × min. Conclusion. Food intolerance was noted in 52 (41.3%) patients with IBS. Among the patients who noted the presence of all the studied food intolerances (isolated or combined intolerance to milk and dairy products, as well as products with a high content of FODMAP), a significant decrease in the activity of intestinal enzymes (glucoamylase, lactase, sucrose and maltase) was found compared with the control (p < 0.05), which may indicate the presence of they have disaccharidase deficiency

Abdominal pain is a symptom that determines the accuracy and timeliness of diagnosis, treatment, and prognosis. The article describes the causes of acute and chronic abdominal pain, particularly the pain in the abdominal wall, and the challenges in recognizing them. The pathogenetic features of visceral, parietal, referred, and psychogenic pain and the principles of symptomatic therapy are addressed. It is emphasized that complex invasive examinations of the abdominal organs are especially relevant for elderly patients who often have conditions that require computed tomography, including contrast-enhanced scans. Without losing the importance of modern examination methods used in clinical practice, the author states that a detailed medical history and a thorough physical examination can significantly narrow the work-up. Endoscopic and other instrumental invasive examinations should be strictly justified and applied with a cost-effective rational approach.Боль в животе является симптомом, от качества оценки которого зависят точность и своевременность диагноза, лечения и прогноз. В статье описаны причины острой и хронической боли в животе, в частности брюшной стенке, и сложности в их распознавании. Показаны особенности патогенеза висцеральной, париетальной, рефлекторной, психогенной боли и принципы симптоматической терапии. Подчеркивается, что сложные инвазивные исследования органов брюшной полости особенно необходимы при обследовании пожилых пациентов, чаще имеющих заболевания, требующие компьютерной томографии, в том числе с внутривенным контрастированием. Не уменьшая значимости современных методов исследования, применяемых в клинической практике, автор напоминает, что подробный анамнез болезни и тщательный физический осмотр могут значительно сузить объем исследований. Эндоскопические и другие инструментальные инвазивные исследования должны быть строго обоснованы и применяться в рамках рационального экономически эффективного подхода.

The article describes the historical milestones in the study of Crohn's disease from the time of its original description in the 17th century, the revolution in the medical community after the landmark paper in 1932, to the present day. The history of Crohn's disease testifies to the discoveries of the past years, which open up to us the advantages of a scientific approach to the diagnosis and treatment of this disease.

This article presents a clinical case of thrombophilia in a patient with short bowel syndrome. Thrombophilia is characterized by a disorder of the blood clotting system, in which the risk of thrombosis increases. Thrombophilia, local vascular insufficiency, intestinal obstruction with fistula formation requiring intestinal resection play a significant role in the pathogenesis of short bowel syndrome. The patient was admitted with the diagnosis “thrombophilia, resection of the small intestine (residual small intestine 17 cm), ileostoma”. Condition after multiple surgical interventions on the abdominal cavity. Surgeries performed: atypical gastric resection, resection of the greater omentum, jejunostomy, resection of the cardial and antral parts of the stomach, derivation of duodenostomy, esophagostomy, derivation of loop jejunostomy, Braun enteroanastomosis, perforation of the colon, suturing, derivation of colostomy, cholecystectomy, GI reconstruction, Roux esophagoenteroanastomosis, resection of the sigmoid colon, small intestine, bearing intestinal fistulas, removal of double-barrel ileostomy, abdominal cavity drainage, relaparotomy, closure of ileal perforation, retrograde intubation of the small intestine, determination of indications for intestinal transplantation. The following tests were performed: CT-enterography, colonoscopy with subsequent morphological examination, abdominal ultrasound, enterogastroscopy, clinical and biochemical blood tests, PCR, coagulogram, urinalysis, percussion and auscultation of the chest. Morphological examination showed fragments of the wall of the colon – with erosion, fragments of fatty tissue – with immature granulation tissue, fragment of stroma covered with multilayer flat keratinized epithelium with the focus of epithelized slit-like ulcer. Clexane was administered as part of the treatment complex, nutritional support additionally included Micrazyme capsules 25000 units, teduglutide, remabipid. Rebamipid and Teduglutide allowed to stabilize the patient's condition and improve the condition of the perioperative area tissues. In case of ineffectiveness of the therapy used the indications for liver transplantation are determined.

The aim of the article is to improve the differential diagnosis of specific and nonspecific inflammatory bowel diseases. In Russia, this scientific direction is associated with the name of G.F. Lang, who performed in 1901–1902 the study „On ulcerative inflammation of the large intestine caused by balantidiasis“. The etiology of specific colitis is associated with infection with parasites, bacteria and viruses that cause inflammation of the intestinal wall, diarrhea, often with an admixture of mucus, pus and blood. Specific colitis (SC) may be accompanied by fever, abdominal pain, and tenesmus. Bacterial colitis is commonly caused by Salmonella, Shigella, Escherichia coli, Clostridium difficile, Campylobacter jejuni, Yersinia enterocolitica, and Mycobacterium tuberculosis. Viral colitis is caused by rotavirus, adenovirus, cytomegalovirus, and norovirus. Parasitic colitis can be caused by Entamoeba histolytica and balantidia. In gay people, SC can cause sexually transmitted infections: Neisseria gonorrhoeae, Chlamydia trachomatis, and treponema pallidum, affecting the rectum. Stool microscopy, culture, and endoscopy are used to establish the diagnosis. Stool culture helps in the diagnosis of bacterial colitis in 50% of patients, and endoscopic studies reveal only nonspecific pathological changes. Differential diagnosis of SC should be carried out with immune-inflammatory bowel diseases (ulcerative colitis, Crohn's disease, undifferentiated colitis), radiation colitis and other iatrogenic bowel lesions. The principles of diagnosis and therapy of inflammatory bowel diseases associated with various etiological

The etiology of inflammatory bowel diseases (IBD), which includes ulcerative colitis (UC) and Crohn’s disease (CD), is not fully resolved. Considering that the interaction of genetic and immunological features, environmental factors, and intestinal microflora leads to the development of the disease, patients with UC and CD especially need a personalized approach to be able to predict the course of the disease and select therapy. The basis of IBD pathogenesis includes changes in the following processes: autophagy, endoplasmic reticulum stress, and the interaction of microflora with intestinal epithelial cells. Polymorphisms in the FUT2, NOD2, HLA, IL1β, and other genes are responsible for the regulation of such processes. The use of NGS sequencing has shown that there is a much wider molecular spectrum than previously known. Further research on epigenetic factors associated with IBD may lead to new therapeutic strategies. Particular attention should be paid to a number of potential clinical applications of epigenetics, such as the use of biomarkers to confirm the diagnosis, predict the course of the disease, and assess the risk of developing malignancies, as well as response to therapy.

Abdominal pain is a symptom that determines the accuracy and timeliness of diagnosis, treatment, and prognosis. The article describes the causes of acute and chronic abdominal pain, particularly the pain in the abdominal wall, and the challenges in recognizing them. The pathogenetic features of visceral, parietal, referred, and psychogenic pain and the principles of symptomatic therapy are addressed. It is emphasized that complex invasive examinations of the abdominal organs are especially relevant for elderly patients who often have conditions that require computed tomography, including contrast-enhanced scans. Without losing the importance of modern examination methods used in clinical practice, the author states that a detailed medical history and a thorough physical examination can significantly narrow the work-up. Endoscopic and other instrumental invasive examinations should be strictly justified and applied with a cost-effective rational approach.

ENMP (enteropathy with impaired membrane digestion) is a new nosological form of pathology of the small intestine, which is based on a decrease in the activity of small intestine carbohydraz. The clinical picture of ENMA is very similar to irritable bowel syndrome, but it differs in the etiotropic relationship of symptoms with intolerance to products containing a lot of fermentable oligo -, di- and monosaccharides and polyols. The basis of the treatment of this pathology is the FODMAP diet, but this therapy only allows you to reduce the load on the enzymatic transport complexes, and not restore them. A new direction in the treatment of patients with EMF is our proposed system for restoring the activity of enzymes of the small intestine mucosa under the influence of the cytoprotector rebamipid. The use of rebamipid in the complex therapy of INMP contributes to an increase in the activity of small intestine carbohydraz and a decrease in symptoms associated with intolerance to short-chain carbohydrates FODMAP. The persistent positive effect of the drug is observed gradually over 8 weeks in patients who received the drug at a dose of 300 mg/day. With this treatment regimen, patients have an improvement in the tolerability of carbohydrate-containing foods, a decrease in flatulence, pain syndrome, and a tendency to normalize the stool has also been noted.