Relevance: PB is a dynamic state, regression and progression of the disease are possible in the same patient against the background of a long period of observation. Materials and methods. The study was conducted on the basis of the MMC BR in Moscow in the period from 2013 to 2023, both retrospectively and prospectively. The diagnosis of BE was established on the basis of the endoscopic picture (according to the Prague criteria) and the data of the morphological study of the biopsy material. As a result of the analysis, 122 patients were selected who were on inpatient and outpatient treatment, as well as dynamic observation. Examination of patients included: clinical data with an assessment of comorbid pathology, endoscopic examination with sampling of biopsy material, morphological, including immunohistochemical studies of biopsy material: determination of mutations in the P53, P63 genes and the nuclear proliferation marker Ki-67. The treatment was carried out in accordance with the clinical recommendations of the Russian Gastroenterological Association based on the developed algorithm and included conservative therapy for BE and identified comorbid pathology, as well as in groups of patients with low-grade dysplasia, endoscopic intraluminal treatment-argon plasma coagulation. Results. Analysis of the results made it possible to conclude that the applied algorithm was highly effective: high scores on the goal achievement scale were achieved in 88% of patients. Moreover, the greatest success was achieved in groups with low-grade dysplasia due to the use of personalized methods of treating patients with BE based on a deep clinical and morphological analysis, including, in addition to generally accepted, gender and age characteristics, assessment of comorbid pathology and the dynamics of P53, P63 and Ki-67 in determining the timing of dynamic follow-up of patients.

The review summarize existing international recommendations for managing patients with atrophic gastritis, intestinal metaplasia and gastric dysplasia. It is shown that patients with chronic anthropic gastritis or intestinal metaplasia have an increased risk of stomach adenocarcinoma development. Helicobacter pylori eradication tends to relieve indications of chronic nonatrophic gastritis and can lead to partial regression of atrophic gastritis, and reduces the risk of stomach cancer development.

Justification The participants of the round table on diagnosis and treatment of acid - and Helicobacter-dependent diseases, held on November 20, 2020 at the XXIII congress of the Scientific Society of Gastroenterologists of Russia within the framework of the XV National Congress of Therapists (Authors) having discussed the status of the issue, decided on the need to harmonize measures and pool efforts to reduce the incidence of H. pylori infection by approaching the medical community with this Memorandum.

According to domestic and foreign literature, COVID-19 (short for COronaVIrus Disease 2019), previously coronavirus infection 2019-nCoV is a potentially severe acute respiratory infection caused by SARS-CoV-2 coronavirus (2019-nCoV). It is a dangerous disease that can occur both in the form of an acute respiratory viral infection of a mild course and in a severe form, specifi c complications of which may include viral pneumonia, which entails acute respiratory distress syndrome or respiratory failure with the risk of death The most common symptoms of the disease include fever, fatigue, and dry cough. The virus spreads by airborne droplets through inhalation of droplets of the virus sprayed in the air during coughing or sneezing, as well as through the spread of the virus on the surface and then into the eyes, nose or mouth. The disease is caused by a new virus, to which there is no acquired immunity, and susceptibility does not depend on age and gender diff erences. All this creates a high degree of risk of infection for both medical professionals and patients in visiting medical institutions. The risk of infection is especially high during any interventional manipulations and operations related to the respiratory system and the gastrointestinal tract. Such interventions are primarily endoscopic. The situation is aggravated by the fact that at the moment there are no Sanitary and epidemiological regulations on prevention of COVID-19. At present, hospitals are guided in their work by the orders and instructions of the Ministry of Health of the Russian Federation and Russian Federal Consumer Rights Protection and Human Health Control Service (Rospotrebnadzor). The usual anti-epidemic measures require adjustment in the new conditions. First of all to introduce zoning in hospitals, especially in endoscopic departments, to collect an epidemiological history before endoscopy, and audio monitoring in the further management of patience. It is extremely important to create relevant guidelines on the prevention of coronavirus infection using novel experience and scientifi c information including the existing orders and regulations of the healthcare system.

The aim of the study was to evaluate the genetic characteristics of the pathological process in patients with biopsy-proven PB. Materials and methods: Dynamic observation and treatment of patients with morphologically confi rmed diagnosis of Barrett’s esophagus (PB) was performed at the Bank of Russia Multidisciplinary medical center in Moscow in the period from 2014 to 2019.the study included 52 patients. Among them, men — 33 (63.4%) and women –19 (36.5%) aged from 28 to 70 years, the peak incidence was mainly in the age range from 50–71 years. As a result, morphological types of PB epithelium were identifi ed at the time of the study: cardiac — 8(15.3%), small — bowel — 25 (48%), large-bowel without dysplasia-17 (32.6%) and large-bowel with mild dysplasia foci –2 (3.8%). The expression of the p53, P63, and Ki-67 genes responsible for cell proliferation and diff erentiation was studied using an immunohistochemical method. Results. As a result of the study, it was found that genetic changes in patients with morphologically confi rmed PB increase from the cardiac type of epithelium in the segment to the detection of dysplasia foci on the background of colonic metaplasia. An exception is tokokishechnaya metaplasia, which may be an indirect sign of the development of highly diff erentiated epithelium in response to gastroesophageal or duodenogastroesophageal refl ux Summary. 1. Mutation of the p 53 genes responsible for regulating cell transcription and activating apoptosis and the P63 gene responsible for cell diff erentiation occurs in all morphological types of PB, with the number of mutations increasing as metastatic changes progress in accordance with the Correa cascade 2. The combination of p53 and P63 gene mutations in almost equal proportions indicates parallel processes of cell proliferation and diff erentiation disorders. 3. Ki-67 expression increases from the cardiac type of epithelium in the segment to the detection of dysplasia foci on the background of metaplastic epithelium. An exception is tokokishechnaya metaplasia, which may be an indirect sign of the development of highly diff erentiated epithelium in response to gastroesophageal or duodenogastroesophageal refl ux. Conclusion. Studies have shown that there are a number of genetic features of the pathological process in patients with morphologically confi rmed PB, the combination of which is more reliable and reliable assessment of the risk of neoplastic changes than individual indicators. To date, it remains relevant to develop a marker panel that is suitable for use in clinical practice, informative for both assessing individual risk and stratifying risk groups, and useful for monitoring the eff ectiveness of treatment.

In order to develop an algorithm for managing patients receiving NSAIDs and anti-thrombotic therapy, as well as classification of lesions of the mucosa of the digestive tract, against the background of the treatment, we used the experience of foreign colleagues and information resources: PubMed, Cochrane Library, MDConsult, DynaMed, Google Scholar, TRIP Database, which today is the most comprehensive in terms of coverage by the public meta-search system, which has an advanced document sorting system, existing normative documents, as well as own experience. The algorythm for management of patients cured with NSAIDs or АТА included assessment of the patient’s condition before the start of treatment, dynamic monitoring of complications based on clinical and laboratory data, endoscopic diagnostic data, and a decision support system in the form of the “Russian classification” of esophagogastroduodenoenterocolatopathy. The developed “Moscow classification” of multifocal lesions of the mucosa of the digestive tract with nonsteroidal anti-inflammatory and antithrombotic agents is presented in the form of a cascade that includes a common scale, an expanded (specifying) scale, and a stratification of the risks of recurrence of bleeding and thromboembolic complications. Тhe proposed “Moscow classification” of lesions of the mucosa of the digestive tract with non-steroidal anti-inflammatory drugs and drugs for lowering blood clotting (L. B. Lazebnik, G. V. Belova) is a testament to the medicine of “Three P” - personified, preventive and predictive, accounting for a significant number of gender, anamnesis, functional and clinical-laboratory indicators. The application of the Russian classification refers to the decision-support system for the tactics of conducting an extremely complex category of patients with severe comorbid pathology.

The purpose of the study is to examine the degree of influence of metabolic syndrome (MS) on the course of Barrett’s esophagus (SP) depending on gender characteristics and morphological patterns. Materials and methods. The study included 151 patients with Barrett’s esophagus (men 75 (49,6 %) and 76 women (50,3 %) aged 26 to 90 years). The patients were divided into two groups depending on the presence/ absence of metabolic syndrome. Flow analysis of PB was carried out taking into account gender characteristics and severity of morphological changes of the mucosa in segments of Barrett’s in two groups before and after treatment. Methods of research were endoscopy in various versions, data of morphological research of biopsy material, clinical and laboratory parameters. Results. The main peak of the presence of comorbid pathology, including PB and MS account for the age between 50-70 years, mainly in women in postmenopausal period. Before the start of the treatment the more pronounced morphological changes were revealed in the 2nd group of patients (PB+MS), but in the same group were obtained and better treatment results: epithelialization segment squamous epithelium occurred in 43,5 % and 48 % respectively. Conclusion. The presence of PB patients with comorbid pathology, particularly of the metabolic syndrome, contributes to more pronounced morphological changes in the mucosa of the esophagus. However, adequate therapy of concomitant pathology allows to achieve the best results. This fact confirms the claim that PB is a condition which can depend on many factors, including the presence of comorbid pathology. In this regard, the therapy “is not illness, but patient” can help to optimize the treatment of the most severe complications of gastroesophageal reflux disease, recognized as a disease of the XXI century

Introduction: Barrett’s esophagus (PB) was recognized as one of the most serious complications of gastroesophageal reflux disease, an obligate precancer with a high malignancy index: 20-30 %. The aim of the study was to analyze the literature data and the changed notions about Barrett’s esophagus. Materials and methods: the literature sources were selected using the TRIP Database information retrieval system for the UpToDate, DynaMed, PubMed databases. We selected 4 clinical guidelines and 4 systematic reviews and meta-analyzes, the analysis of which was presented in the article. Conclusion: It should be noted that up to the present time many people’s efforts are aimed at developing an «ideal» universal medical technology for diagnosis and treatment of patients with ambiguous diagnosis of Barrett’s esophagus.

The article presents the possible indicators of quality of endoscopy departments (cabinet) activities, developed on the basis of the experience of foreign colleagues using information resource: PubMed, Cochrane Library, MDConsult, DynaMed, Google Schola and search engine TRIP Database www.tripdatabase.com, existing regulations as well as their own experience.

In article the main indications and conditions for the most successful endoscopic treatment of patients with chronic pancreatitis, especially in the presence of the burdened anamnesis, based on data of the world literature and own experience are formulated.

Background. According to Correa’s cascade, intestinal metaplasia is the main precursor of intestinal cancer, Helicobacter рylori being its most important etiological factor. Aim: to analyze molecular and physiological events, contributing to precancerous progression during anti-helicobacter therapy. Materials and methods: gastric mucosal biopsy samples from 173 patients were investigated with immunomorphologic assay to evaluate proteins, contributing to proliferation (PCNA, Ki-67, p53) and apoptosis (bcl-2, Bax), as well as protein C-erb B2 and mucins Muc-2, Muc-5AC. Results: Anti-helicobacter therapy resulted in statistically significant reduction of mean level of proliferation and apoptosis markers, reduced rate of C-erb B2 and Muc-2expression, and elevation of Muc-5AC expression. Nevertheless, in patients with early gastric cancer and in 5 patients with high-grade dysplasia besides positive morphological trend, Muc-5AC was significantly decreased (pbcl-2 and Bax ratio was disturbed, evidencing persistent DNA damage. These patients were referred to the group of high risk for intestinal type metachronous cancer, who warranted close follow-up every 6 months with endoscopic targeted multiple biopsies of suspicious zones. Conclusion: Hр infection causes mismatch between proliferation and apoptosis processes in gastric mucosa and is well established risk factor of gastric cancer. Hр eradication in patients with precancerous alterations in gastric mucosa can reduce the oncologic risk. Nevertheless, Hp-induced gastric cancerogenesis may persist after anti-helicobacter therapy. Close follow-up every 6 months with endoscopic targeted multiple biopsies of suspicious zones is recommended for patients with persistently high oncomarkers.

The problem of nonneoplastic stenosis of major duodenal papilla is on joint of gastroenterology and surgery and present a challenge for physicians. This article reviews what is known about the pathogenesis, epidemiology and diagnostics of papillostenosis and sphincter of Oddi dysfunction.

The article contains results of a continuous prospective investigation of the normal course of the major duodenal papilla stenosis in 167 patients. It was revealed that the course of the disease was benign, pain syndrome became inconsiderable in the course of time, the degree of changes in biochemical analysis of blood was not significant. The development of complications (choledocholithiasis, acute pancreatitis, jaundice) was noted in 6-14% of the patients, depending on the presence or absence of GID. The data obtained allow suggestion of an algorithm of managing the patients.

The problem of nonneoplastic stenosis of major duodenal papilla is on joint of gastroenterology and surgery and present a challenge for physicians. This article reviews what is known about the pathogenesis, epidemiology and diagnostics of papillostenosis and sphincter of Oddi dysfunction.