Aim. The clinical guidelines are intended to provide information support for making decisions by gastroenterologists, general practitioners and internists that will improve the quality of medical care for patients with non-alcoholic fatty liver disease, taking into account the latest clinical data and principles of evidence-based medicine. Key points. Clinical guidelines contain information about current views on etiology, risk factors and pathogenesis of nonalcoholic fatty liver disease, peculiarities of its clinical course. Also given recommendations provide information on current methods of laboratory and instrumental diagnostics, invasive and non-invasive tools for nonalcoholic fatty liver disease and its clinical phenotypes assessment, approaches to its treatment, considering the presence of comorbidities, features of dispensary monitoring and prophylaxis. The information is illustrated with algorithms of differential diagnosis and physician's actions. In addition, there is information for the patient and criteria for assessing the quality of medical care. Conclusion. Awareness of specialists in the issues of diagnosis, treatment and follow-up of patients with nonalcoholic fatty liver disease contributes to the timely diagnosis and initiation of treatment, which in the long term will significantly affect their prognosis and quality of life.

Аim: to provide basic information on Whipple's disease necessary for timely diagnosis and treatment, using the example of clinical observation.Key points. Whipple's disease is a rare systemic infectious disease that internists, gastroenterologists, rheumatologists, and other physicians may encounter. The incidence of Whipple's disease is extremely low and amounts to 1 case per 1,000,000–10,000,000 people. The low prevalence of pathology can lead to underdiagnosis in favour of more common diseases. This, in turn, may worsen the patient's prognosis, as it will delay the time for establishing the correct diagnosis and initiating the necessary therapy. A 50-year-old man complained of losing 10 kg of weight over 5 months, abdominal pain and bloating, pain in the joints of feet, and shoulders, accompanied by swelling and hyperemia. The disease began with articular syndrome followed by diarrhea and manifestations of malabsorption (iron deficiency anemia, hypoalbuminemia, hypercholesterolemia). The diagnosis was established on the basis of morphological changes in biopsy samples of the postbulbar part of the duodenum. The identified changes were represented by thickening of the villi and accumulations in the stroma of large macrophages (CD68+) with wide light cytoplasm containing abundant accumulations of PAS-positive, negative when stained with carbol fuchsin according to Ziehl — Nielsen and auramine-rhodamine (under microscopy in luminescence mode) short rods, as well as numerous optically empty small and larger cavities. Treatment with intravenous injections of ceftriaxone 2 g per day for 14 days and trimethoprim/sulfamethoxazole 1920 mg per day for 8 months led to improved health, normalization of laboratory parameters, endoscopic and morphological findings. Treatment with trimethoprim/sulfamethoxazole is planned to be continued for up to 12 months or longer if necessary.Conclusion. Timely diagnosis and initiation of antibiotic therapy will help to avoid late complications of the disease, including death.

Аim : to provide basic information on Whipple's disease necessary for timely diagnosis and treatment, using the example of clinical observation. Key points. Whipple's disease is a rare systemic infectious disease that internists, gastroenterologists, rheumatologists, and other physicians may encounter. The incidence of Whipple's disease is extremely low and amounts to 1 case per 1,000,000–10,000,000 people. The low prevalence of pathology can lead to underdiagnosis in favour of more common diseases. This, in turn, may worsen the patient's prognosis, as it will delay the time for establishing the correct diagnosis and initiating the necessary therapy. A 50-year-old man complained of losing 10 kg of weight over 5 months, abdominal pain and bloating, pain in the joints of feet, and shoulders, accompanied by swelling and hyperemia. The disease began with articular syndrome followed by diarrhea and manifestations of malabsorption (iron deficiency anemia, hypoalbuminemia, hypercholesterolemia). The diagnosis was established on the basis of morphological changes in biopsy samples of the postbulbar part of the duodenum. The identified changes were represented by thickening of the villi and accumulations in the stroma of large macrophages (CD68 + ) with wide light cytoplasm containing abundant accumulations of PAS-positive, negative when stained with carbol fuchsin according to Ziehl — Nielsen and auramine-rhodamine (under microscopy in luminescence mode) short rods, as well as numerous optically empty small and larger cavities. Treatment with intravenous injections of ceftriaxone 2 g per day for 14 days and trimethoprim/sulfamethoxazole 1920 mg per day for 8 months led to improved health, normalization of laboratory parameters, endoscopic and morphological findings. Treatment with trimethoprim/sulfamethoxazole is planned to be continued for up to 12 months or longer if necessary. Conclusion . Timely diagnosis and initiation of antibiotic therapy will help to avoid late complications of the disease, including death.

The modern pharmacological industry provides healthcare professionals and patients with the widest choice of medicines (drugs) and biologically active additives. At the same time, the choice of the drug, in addition to the instructions for use and clinical recommendations, is influenced by personal experience of use (both the doctor and the patient), the cost of the drug, advertising and other factors. The Register of Medicines of Russia contains about 30 hepatoprotectors and their combinations, represented by more than 130 original drugs and their generics. This article presents data on the epidemiology of liver diseases in the world and in Russia, the general stages of the pathogenesis of liver lesions and the key points of application of drugs, as well as the role of a new hepatoprotector (a combination of ursodeoxycholic acid with glycyrrhizic acid) in the treatment of liver diseases

Cholesterol pseudopolyps are the most common variant of gallbladder polyps (GP). Their development is pathogenetically connected with the components of metabolic syndrome, especially with dislipoproteinemia and nonalcoholic fatty liver disease (NAFLD). Lipid metabolism disorder in the form of increased levels of total cholesterol, low-density lipoproteins (LDL), decreased high-density lipoproteins (HDL), as well as steatosis and liver inflammation lead to disorders of enterohepatic circulation (EHC) of bile acids, changes in rheological properties of bile, which, eventually, can lead to uptake of excess bile cholesterol by epithelium of GP in form of micelles. Infiltration of microvilli with bile micelles causes activation of tissue macrophages and triggers subclinical microinflammation of GB wall. When neighboring microvilli, crowded with foamy cells, merge, cholesterol pseudopolyp is formed, which represents a focal form of GB cholesterosis. The main drug that influences the recovery of EHC and physicochemical properties of bile is ursodeoxycholic acid (UDCA). There is also evidence that UDCA can improve parameters of lipid metabolism, liver enzymes, reduce the severity of hepatic steatosis. The use of UDCA in patients with polyposis form of GB cholesterosis has demonstrated positive results against cholesterol polyps. Glycyrrhizic acid (GA), which has anti-inflammatory, antioxidant, antifibrotic, and other beneficial properties, can improve the effectiveness of therapy for GB polyps by acting on the subclinical microinflammation component of the GB wall. In a prospective observational study, the use of fixed combination of UDCA with GA in patients with cholesterol polyps of GB and NAFLD for 3 months resulted in reduction of polyp number and size in more than 50% of patients, which was accompanied by significant improvement of lipid spectrum and liver enzymes parameters. Further studies of UDCA+GA combination in the combination of these pathologies are required.

The gallbladder is an organ that plays an important role in maintaining effective enterohepatic circulation (EHC) of bile and preserving the metabolic homeostasis of lipids and bile acids. Despite modern ideas about the role of the gallbladder in the human body, especially in subjects with metabolic syndrome and non-alcoholic fatty liver disease (NAFLD), cholecystectomy (CE) remains one of the most common surgeries, including in this patient category. The review examines the following in patients with NAFLD: the gallbladder role, the association between NAFLD and cholelithiasis (C), indications for CE, as well as the consequences of this intervention. The authors discuss the issues of patient management with NAFLD after CE. Patients with C and NAFLD who have undergone CE need a number of diagnostic measures aimed at identifying and timely correction of disorders, as well as complex treatment, which includes the risk factors elimination, strict adherence to diet, exercise regime, the use of drugs improving the EHC state, lipid and carbohydrate metabolism, the metabolic function of hepatocytes and inhibiting the liver fibrogenesis. KEYWORDS: cholecystectomy, non-alcoholic fatty liver disease, cholelithiasis, ursodeoxycholic acid, metabolic syndrome, insulin resistance. FOR CITATION: Mekhtiev S.N., Mekhtieva O.A., Ukhova M.V., Ibragimova Z.M. Modern view of the importance of cholecystectomy in the prognosis of a patient with non-alcoholic fatty liver disease: follow-up algorithm and therapeutic approaches. Russian Medical Inquiry. 2021;5(6):438–445 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-438-445.

The search for common links of etiology and pathogenesis in the formation of comorbid pathology in modern patients opens up additional opportunities for increasing the effectiveness of their treatment and is an important problem in scientific and practical medicine. The extreme prevalence of chronic persistence of immunotropic viruses, such as herpes genotypes 4,5,6 types, requires a study of its consequences in the human body and the involvement in its infectious-dependent morbidity, such as the formation of multiple chronic foci of infection in the ear, nose and throat with frequent and prolonged exacerbations. The work shows that chronic sinusitis, nasopharyngitis, tonsillitis associated with chronic herpesvirus persistence form the status of frequently and long-term ill people against the background of pronounced immuno-compromise with quantitative and functional T- and B-cell deficiency, insufficient resources of α and γ- interferon. The study presents a positive experience of replenishing the deficiency of α and γ-interferons with recombinant drugs of the same name in comorbid ENT patients. The aim of the study was to increase the efficiency of treatment of patients with concomitant chronic focal infection in the ear, nose and throat against the background of chronic persistence of herpesvirus infection. Materials and methods: Comprehensive clinical and laboratory examination of 45 carriers of herpes simplex virus genotypes 4,5, 6 at the age of 29 to 52 years made it possible to establish in them a comorbid chronic focal infection in the LOR organs: chronic sinusitis, chronic nasopharyngitis, chronic tonsillitis. Results: The observed patients had a statistically significant (p < 0.01) deficiency of NK cells with receptors CD16+, CD56+ and B cells with markers CD19+, CD5+ against the background of peripheral blood lymphocytosis with an increase in the content of cytotoxic T lymphocytes (CD8 +) marker in some patients. All patients showed a significant decrease in interferon system resources (p < 0.01). Replacement therapy with recombinant preparations of α- and γ-interferons led to restoration of interferon system parameters and was accompanied by improvement of immunological blood indices, both quantitative and functional characteristics of T-and B-lymphocytes, mononuclear phagocytes, this dynamics was matched by improvement of patients, confirmed by results of questionnaire. Conclusions: Thus, the positive experience of antiviral therapy by restoring the resources of the interferon system and immune recovery with recombinant interferon drugs indicates the important role of herpes virus carrier in the formation of comorbidity and the need for etiological treatment to improve the condition and quality of life of patients.

Introduction. The prevalence of functional biliary disorders continues to increase with insufficient effectiveness of existing treatment approaches. Among them, functional biliary disorders of sphincter of Oddi account for at least 50%.Objective. To study efficacy, safety and tolerability of a fixed combination of glycyrrhizic acid and ursodeoxycholic acid (Fosfogliv Urso) in capsule form in patients with functional biliary disorders of sphincter of Oddi.Materials and Methods. The study included 32 patients diagnosed with functional biliary sphincter of Oddi disorders established according to the Rome Criteria IV revision (2016). Patients received Fosfogliv Urso (250 mg ursodeoxycholic acid and 35 mg glycyrrhizic acid) 1 capsule 3 times a day for 8 weeks. Prior to treatment, all study participants underwent a standard set of laboratory and instrumental examinations.Results. Against the background of Fosfogliv Urso treatment, statistically significant decrease of biliary pain prevalence up to 48.3% (p < 0.001); intense biliary pain up to 11.4% (p < 0.0001); intensity of pain syndrome on visual analogue scale down to 1.7 ± 0.9 cm was registered (p < 0.0001). Alanine aminotransferase activity significantly decreased to 34.0 ± 4.0 U/L (p < 0.001). There was a tendency of choledochal diameter decrease to 0.57 ± 0.01 cm. Treatment efficacy was rated by patients as very good and good in 83.4% of cases. The safety profile was assessed as favorable and tolerability as satisfactory.Discussion. The results obtained were superior to those previously obtained for ursodeoxycholic acid monotherapy and confirmed the data of the previously conducted phase III study. The rationality of the combination is due to the mutual complementation and possible synergism of the pharmacological effects of glycyrrhizinic and ursodeoxycholic acids.Conclusion. The results obtained allow to recommend the prescription of Fosfogliv Urso in the complex scheme of treatment and prophylaxis of functional biliary disorders of sphincter of Oddi.

The article discusses the current understanding of risk factors, mechanisms of development, diagnostic criteria, therapy for various types of functional disorders of the biliary tract. Paying special attention for the adaptation of diagnostic and treatment algorithms which were described in the Rome criteria, rev. IV, for ambulant practice to provide effective medical assistance to patients with the pathalogy. The authors proposed the scheme of treatment and prophylaxis of functional disorders for using in clinical practice.

Introduction. Statistical data indicate a frequent combination of functional biliary disorders with non-alcoholic fatty liver disease.Aim. To study the efficacy and safety of Phosphogliv® URSO in patients with functional disorders of the gall-bladder, biliary sludge in combination with fatty hepatosis in comparison with the group receiving monotherapy ursodeoxycholic acid (UDCA).Materials and methods. The study included 30 patients with a diagnosis of functional gall-bladder disorder, biliary sludge in combination with non-alcoholic fatty liver disease. Patients of the main group received monotherapy with Phosphogliv® URSO. The comparison group received monotherapy UDCA. After three-month therapy, the dynamics of clinical symptoms, laboratory parameters, and ultrasound parameters were assessed.Results. Positive dynamics of clinical manifestations of functional disorders of the gallbladder, as well as parameters of cholestatic syndrome and bilirubin level was observed in both groups. In patients taking Phosphogliv® URSO, a significant decrease in cytolysis syndrome indicators was recorded, a significant difference was revealed in relation to an increase in HDL levels and a decrease in the atherogenic coefficient in the main group. When assessing the ultrasound parameters of the gall-bladder in patients of group 1, a significant decrease in the thickness of its wall, reverse development of biliary sludge, an improvement in the contractile function of the gall-bladder in comparison with the UDCA monotherapy group were revealed.Conclusion. The use of a combined medicine containing glycyrrhizic acid and UDCA (Phosphogliv® URSO) can be recommended for patients with functional disorders of the gallbladder, biliary sludge and non-alcoholic fatty liver disease, given its more pronounced anticytolytic effect, restoration of functional disorders of the gallbladder and resolution of biliary sludge in comparison with monotherapy UDCA.

Objective: To optimize the diagnostic and therapeutic approaches in polymorbid patients with fatty hepatosis in the practice of general practitioner. The medical tactics of treatment of polymorbidit patient with fatty liver, is considered in regards of the course of concomitant diseases, especially the cardiovascular system. Substantiates the necessity of determination of, in relation to the patient's prognosis, not only the degree of steatosis, but also the liver fibrosis stage changes, developing due to apoptosis of hepatocytes that leads to the progression of endothelial dysfunction A working version of the treatment of hepatic steatosis, designed to reduce progression of fatty degeneration, reducing the risk of steatohepatitis and fibrosis body changes is proposed in the paper. Ursodeoxycholic acid and glycyrrhizin are the most promising medication.

Aim of study. To examine the possibility of adjuvant therapy in the treatment of autoimmune hepatitis. The theoretical background and the existing research on the use of hepatotropic drugs in autoimmune hepatitis have been considered. We discuss the situation when the therapy of autoimmune hepatitis can be supplemented by non-conventional medicines. It must be assumed that the treatment of autoimmune hepatitis should not always be limited to immunosuppression schemes, and in some cases may be enhanced by drugs that provide additional effects. The most promising agents for adjuvant therapy of autoimmune hepatitis are ursodeoxycholic and glycyrrhiziс acids.

Experts’ consensus on the interdisciplinary approach towards the management, diagnostics, and treatment of patients with metabolic syndrome.

The absence of clinical, biochemical, and instrumental signs that characterize the morphological pattern of the liver presents an urgent problem in the diagnosis of alcoholic hepatitis (AH). Sixty-one patients (mean age 41.7 +/- 8.7 years) were examined to study relationships between the histomorphological parameters and laboratory and instrumental findings in patients with AH on combined treatment including alpha-lipoic acid (Berlition). Indirect assessment of the histological activity of the disease may use the parameters of the serum activity of aspartate aminotransferase and gamma-glutamine aminotransferase, the stages of hepatic fibrosis-ultrasound symptoms: the splenic index at the early stages of the disease, the diameter of the splenic vein in moderate and severe fibrosis. The supplementation of Berlition in the combined therapy for AH decreases the severity of fatty hepatocytic dystrophy, hepatic inflammatory and necrotic changes, no increase or a decrease in the stage of fibrotic changes in the liver tissue.