Background. In the last decade, the understanding of the pathogenesis of autoimmune hepatitis (AIH) has significantly deepened, based on the results of new clinical studies some diagnostic issues have been revised and immunosuppressive therapy regimens have been optimized.Materials and methods. The latest Russian clinical guidelines for the diagnosis and treatment of AIH were presented in 2013; and in 2017, the first Russian agreement on the diagnosis and treatment of AIH was held. Updating approaches to the management of patients with AIH necessitated next systematization for use in clinical practice. In February 2024, the final session was held to discuss the provisions of the second agreement on the diagnosis and treatment of AIH.Results. This publication presents the main discussion points of the agreement regarding methods and algorithms for detecting autoantibodies, the role of liver biopsy, revised morphological criteria for AIH, optimized immunosuppressive therapy regimens, updated criteria for assessing the response to therapy.Conclusions. The agreement was the result of the work of a group of experts on the diagnosis and treatment of AIH and represents the basis for the creation of updated federal clinical guidelines.

Aim: localization of the new nomenclature of steatotic liver disease in Russian clinical practice.Key points. In 2023, international consensus decided to introduce a new nomenclature for steatotic liver disease. The article discusses the reasons for the change in nomenclature and the new terms adopted: steatotic liver disease, metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction and alcohol associated steatotic liver disease. Adapting new terms to Russian healthcare poses a certain problem. The results of voting by Russian doctors on the introduction of new terms and their optimal translation are presented. A comparison of existing classifiers with new terms was carried out and the formulation of diagnoses was discussed taking into account the new nomenclature.Conclusions. Adaptation and implementation of new nomenclature into clinical practice is an important and complex task, in which it is necessary to maintain a balance between a progressive concept and the interests of practical healthcare.

The aim of the study. To analyze the course of COVID-19 infection in patients with primary biliary cholangitis (PBC).Materials and methods. In a single-center retrospective study, survey and analysis of medical records of 144 patients with PBC was carried out.Results. All patients (n = 144) received basic therapy with ursodeoxycholic acid (UDCA), 5 of them received fibrates as well. Response to therapy (EASL criteria) was obtained in 30 people. Between March 2020 and March 2021, 50 patients (34.7 %) suffered COVID-19, with mean age of 58.8 ± 10.7 years, 16 of which were diagnosed with liver cirrhosis. Mild COVID-19 was observed in 34 (68 %) people, moderate course — in 14 (28 %), severe — in 2 (4 %), cases of extremely severe course were not recorded. 12 patients were hospitalized, 8 of which received oxygen therapy due to a decrease in SpO2 < 94 %, there was no need for the use of other methods of oxygen therapy in any case. The duration of hospitalization was 11.4 ± 5.7 days. There was a higher initial activity of serum alkaline phosphatase (1.8 ± 1.0 versus 1.7 ± 1.4 times of the upper limit of normal, M ± SD, p = 0.04) in patients with COVID-19 infection and lack of UDCA therapy effectiveness was more prominent (40 % vs. 19.1 % of cases, p = 0.04) compared with patients who did not have COVID-19. There were no significant differences in characteristics of the course of PBC (stage, response to therapy) and age in correlation with severity of the course of COVID-19. Among hospitalized patients and those in need of oxygen support, large proportion were older patients (58.3 % and 62.5 %, respectively) and patients with concomitant diseases (62.5 % and 75 %, respectively). Patients who hadn`t previously responded to UDCA therapy were more likely to require oxygen support compared to patients responding to basic therapy (p < 0.01).Conclusion. PBC is not a risk factor for severe COVID-19. A protective effect of UDCA in SARS-CoV-2 infection is possible, which requires further investigation.

This review includes information about epidemiological data, development feature, phenotypes, principles of classification, diagnosis, and prognosis for drug-induced liver injury (DILI). Actual clinical recommendations regarding management of the DILI arising in the chemotherapy of cancer discussed. Drugs that can influence on individual pathogenetic mechanisms of growth and symptoms DILI are considered. Clinical studies for the prophylaxis and treatment of DILI associated with anticancer chemotherapy analyzed in detail. The prevention and treatment regimens for DILI in patients receiving chemotherapy and immunotherapy various localizations of cancer given both in research and in practical recommendations.

The objective of the study is to identify the clinical features of inflammatory bowel disease (IBD) in elderly and senile patients in St. Petersburg. A retrospective analysis of medical charts of 208 patients with IBD over 60 years old has been carried out. Sixty percent of the patients had ulcerative colitis (UC), and forty percent had Crohn's disease (CD). The control group consisted of 867 patients aged up to 60 years (524 patients with UC, 60.4%, and 343 patients with CD, 29.6%). Concomitant cardiovascular and broncho-pulmonary diseases, diseases of bones and joints, pathology of the kidneys and urinary tract, and pathology of the liver were detected in 87, 25, 35, 26.5, and 44% of patients. The onset and recurrence of IBD were often accompanied (33.6%) by a deterioration in the course of somatic pathology (versus 8.7% in other age groups of patients). The period from the first signs of the disease to verification of the IBD diagnosis in older patients was longer than in young and middle-aged patients. Distal localization of the pathological process (proctitis and left-sided colitis) prevailed among patients with UC, and the inflammatory form of the disease dominated in patients with CD.

Introduction . The increase in serum transaminases (ALT and AST) and the persistence of their high values is associated with morbidity and mortality from liver diseases. Bicyclol has anti-inflammatory and antioxidant effects, which formed the basis for this study. Materials and methods . The study enrolled 51 patients (MELD < 19); hepatitis stage – 84.4%, cirrhosis – 15.6%. Treatment: Bicyclol 75 mg/day for 12 weeks. Criteria of efficacy: dynamics of ALT, AST, CRP; general well-being (D-FIS scale). Results . After 4 weeks of treatment the share of patients with ALT normalization was 50,9% (p < 0,001); with AST normalization – 62.7% (p < 0.001); after 12 weeks - 79,5% and 89,7% respectively (p < 0,001). CRP decreased statistically significantly after 2 and 4 weeks from the beginning of treatment. The D-FIS questionnaire was filled in by 36 patients at the beginning of the study, in 4 weeks - by 35 patients, in 12 weeks – by 32 patients. Median D-FIS decreased from 12 (8.2; 32.2) to 8 (5; 29) points (p < 0,001) after 4 weeks of treatment, after 12 weeks – to 6.5 (3; 28.5) points (p < 0.001). The CRP was positively correlated with the D-FIS value. Fibrosis (“Fibromax”, “Fibroscan”) was studied in 10 additional patients, the dose of Bicyclol was 150/75 mg/day during 6 months, the result was statistically significant (p < 0.001). Conclusion . Application of Bicyclol leads to reduction of fatigue, local and systemic inflammation, fibrosis in chronic diffuse liver diseases regardless of etiology.

Introduction. The increase in serum transaminases (ALT and AST) and the persistence of their high values is associated with morbidity and mortality from liver diseases. Bicyclol has anti-inflammatory and antioxidant effects, which formed the basis for this study.Materials and methods. The study enrolled 51 patients (MELD < 19); hepatitis stage – 84.4%, cirrhosis – 15.6%. Treatment: Bicyclol 75 mg/day for 12 weeks. Criteria of efficacy: dynamics of ALT, AST, CRP; general well-being (D-FIS scale).Results. After 4 weeks of treatment the share of patients with ALT normalization was 50,9% (p < 0,001); with AST normalization – 62.7% (p < 0.001); after 12 weeks - 79,5% and 89,7% respectively (p < 0,001). CRP decreased statistically significantly after 2 and 4 weeks from the beginning of treatment. The D-FIS questionnaire was filled in by 36 patients at the beginning of the study, in 4 weeks - by 35 patients, in 12 weeks – by 32 patients. Median D-FIS decreased from 12 (8.2; 32.2) to 8 (5; 29) points (p < 0,001) after 4 weeks of treatment, after 12 weeks – to 6.5 (3; 28.5) points (p < 0.001). The CRP was positively correlated with the D-FIS value. Fibrosis (“Fibromax”, “Fibroscan”) was studied in 10 additional patients, the dose of Bicyclol was 150/75 mg/day during 6 months, the result was statistically significant (p < 0.001).Conclusion. Application of Bicyclol leads to reduction of fatigue, local and systemic inflammation, fibrosis in chronic diffuse liver diseases regardless of etiology.

Primary sclerosing cholangitis (PSC) is a chronic progressive cholestatic liver disease with unknown etiology. In recent years, there is steady increase in the incidence of PSC. However, this disease is poorly known to practitioners still. Within last 10 years, leading hepatological associations have developed or updated the current recommendations on PSC. That allowed to standardize approaches to diagnosis and treatment of the disease. However, there are still more questions than answers in the understanding of PSC, and it remains a scientific and clinical problem. Primary diagnosis and treatment of the disease are the sharpest issues. The purpose of this review was to summarize current and advanced concepts in the diagnosis and treatment of the disease. We analyzed recommendations of the leading gastroenterological (hepatological) associations on PSC. As a result, we have received the most complete comprehension on the features of diagnosis and treatment modalities for PSC at the present stage of the development of medicine. Currently, none of the medicinal products are proved to be effective on patient's survival rate, and liver transplantation remains the only treatment that improves prognosis of the patients with PSC. At the same time, there are many observations on effectiveness of ursodeoxycholic acid in PSC, which explains its wide use in this group of patients. We also presented our own experience in diagnosing and treating of a patient with PSC.

AIM:To investigate the expression of transforming growth factor-beta 1 (TGF-beta1) in the liver tissue of patients with autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), and chronic hepatitis C (CHC).MATERIALS AND METHODS:Liver biopsy specimens were histologically and immunohistologically examined in 37 patients with verified liver diseases (12 with AIH, 15 with PBC, and 10 with CHC).RESULTS:The expression of TGF-beta1 in the non-parenchymal liver cells of the patients with AIH and PBC with liver cirrhosis was statistically significantly higher than in those without the latter (p = 0.01 and p = 0.04, respectively). There was a positive relationship between the stage of fibrosis and the absolute content TGF-beta1 and CD68+ cells in the portal tracts (r = 0.51). The higher expression of TGF-beta1 was found in the patients with HCV and AIH than in those with PBC (p = 0.03 and p < 0.05, respectively). There were no differences in the expression of TGF-beta1 in the patients with AIH as compared to those with CHC (p = 0.55). The number of CD68-positive macrophages was higher in CHC than in AIH and PBC (p = 0.004 and p = 0.01, respectively). In autoimmune liver diseases, TGF-beta1 was mainly expressed by the macrophages located in the portal tracts and, in CHC, within the hepatic lobules.CONCLUSION:The enhanced TGF-beta1 expression in the nonparenchymal liver cells in AIH and PBC with liver cirrhosis confirms the role of this cytokine in development of fibrosis in autoimmune liver diseases. That in hepatitis of various etiologies versus PBC suggests that the TGF-beta1 signaling pathway may play an important role in an inappropriate immune response in hepatitides; and the variations found in the location of the macrophages expressing TGF-beta1 reflect a difference in the mechanisms of lesions.

This review article presents the historical background and the main characteristics of tumor necrosis as well as its role in the development of autoimmune disorders. The results of international studies of this cytokine in autoimmune hepatitis and primary biliary cirrhosis are also provided.

A survey of existing methods of pathogenetic and symptomatic treatment of primary biliary cirrhosis has been made and it has reviewed prospective directions of its therapy. Is also presents a retrospective analysis of our own data of S-adenosylmethionine (Heptral) in 27 patients PBC receiving UDCA basic therapy. In its application intravenously of 400 mg 2 times daily for 3 weeks showed a reduction in the severity of pruritus, assessed by visual analogue scale, a subjective decrease fatigability and a decrease level of serum bilirubin.