Aim: to provide data on the pathogenesis of functional biliary pain and provide rationale for the use of trimebutine for this indication.Key points. Biliary pain is one of the most frequent reasons for patients to see a doctor. The diagnosis of functional disorder of the gallbladder and Oddi's sphincter is legitimate only after the exclusion of organic causes from both the gastrointestinal tract and other organs and systems. The initial appeal to surgeons with a complaint of pain in the epigastrium or right hypochondrium may lead to unjustified surgical intervention that does not bring relief to the patient's suffering. The consequences of cholecystectomy also have an anatomical and physiological justification for the occurrence or preservation of biliary pain. Currently, two main hypotheses are being considered to explain its cause: increased intraluminal pressure due to morphological and functional obstacles to bile outflow and visceral hypersensitivity. In the multilevel system of regulation of the gallbladder and sphincter apparatus, the opioid system occupies a special place. The agonist of peripheral receptors of the enkephalinergic system, trimebutine, in clinical studies led to the relief of biliary pain in more than 80 % of patients with functional biliary disorders, while a significant decrease in the severity of diarrhea, dyspeptic, and constipation syndromes was revealed.Conclusion. The prescription of the peripheral receptor agonist of the enkephalinergic system, trimebutine, is pathogenetically justified for functional biliary pain.

In 2019, on the eve of Vladimir Ivashkin’s 80th birthday, we conducted our first interview with him. Now, on the eve of his 85th birthday, Professor Ivashkin again kindly agreed to talk with us and share his thoughts, emotions and impressions about the key events of the past five years.

As many research works show, vitamin D has pleiotropic effects, including the immune regulation and pathogenesis of Crohn’s disease. Therefore, concentrations of the active vitamin D metabolite might be associated with the development, progression and severity of the disease. The skeletal and extraskeletal effects of vitamin D are realised through its active metabolite – 1.25(OH)2D, which is a steroid hormone. The objective of the work: to analyse the accumulated evidence demonstrative of a multiple contribution of vitamin D in the pathogenesis of Crohn’s disease, and to determine the possible perspectives of using the vitamin as part of comprehensive therapy of this disease. Despite the fact, that data of in vitro and animal studies are demonstrative of multiple effects of vitamin D in the pathogenesis of Crohn’s disease, the currently available evidence based on the underlying clinical trials are insufficient yet for including vitamin D in clinical guidelines on management of Crohn’s disease. Further research work is necessary. Key words: Crohn’s disease, vitamin D, calciferol, vitamin D axis, extraskeletal effects

Аcute respiratory infection (ARI) is one of the most prevalent diseases worldwide. The disease occurs in any age, so its course could be associated with complications and poor outcome. Prevention and treatment of ARI and complications are important problems in clinical practice. Recent researches of human microbiome composition and functions have aroused a great interest to this field in order to prevent ARIs. In this review, the authors discuss non-specific mechanisms of human innate antiviral defense and available data about a role of symbiontic intestinal microflora for ARI prevention. Typically, main biological properties of probiotic bacteria are considered in the context of modulating effects on the inflammatory immune response. Published data demonstrated reduction in the risk, severity and duration of ARI under the treatment with probiotic agents both in the children and in adults. The strain-specific effect and potential molecular antiviral mechanisms of probiotics enhancing the antiviral response of symbiontic bacteria are also discussed in the review.

Aim. To justify the need to include colorectal cancer (CRC) in the circle of differential diagnostic search for suspected irritable bowel syndrome (IBS).Background. In accordance with the latest Rome IV criteria for IBS, its diagnosis is mainly based on the assessment of clinical symptoms and objective examination data with a very limited list of additional studies. In this case, colonoscopy for suspected IBS is performed only in patients aged over 50 years old, provided a hereditary predisposition to CRC and the “alarm symptoms” are detected. It has been recently shown that CRC can proceed under the “mask” of IBS. However, colorectal and rectal tumours are often found in patients younger than 50 years old in the absence of hereditary predisposition to CRC and “anxiety symptoms”. This makes it necessary to conduct colonoscopy for all patients with suspected IBS.Conclusion. The list of diseases requiring differential diagnostics in patients with suspected IBS should always include CRC.

Aim. This work is aimed at studying the role of the small bowel bacterial overgrowth syndrome (SBBOS) in the pathogenesis of bronchial asthma (BA).Materials and methods. The study included 80 BA patients (45 and 35 patients allergic and non-allergic BA forms, respectively). Conventional laboratory and instrumental studies were conducted. SBBOS was confirmed by a hydrogen breath test with lactulose. Patients received conventional basal therapy with combined drugs (long-acting β2-adrenomimetics, and inhaled glucocorticoids). For SBBOS treatment, rifaximin (23 patients) or rifaximin followed by probiotic (B. bifidum, B. longum, B. infantis, L. rhamnosus) for 1 month (22 patients) was administered. Control studies were conducted on the 14th day and following 1 month of treatment.Results. A frequent combination of the small bowel bacterial overgrowth syndrome and bronchial asthma was revealed. 67 % and 43 % of the patients with the allergic form and non-allergic asthma form, respectively, are shown to suffer from SBBOS, p = 0.028. High levels of IgE (p < 0.01) and eosinophils in sputum (p < 0.001), combined with severe impairment of the function of external respiration (p < 0.01) in the case of SBBOS with allergic asthma reflect a more pronounced degree of sensitization of these patients. The correction of composition disorders of the intestinal microflora is accompanied by a statistically significant decrease in the immune response (p < 0.01) and improvement in the function of external respiration (p < 0.001).Conclusion. SBBOS is a significant factor, aggravating the course of bronchial asthma and playing an important role in the development and maintenance of sensitization of patients.

The aim of review. To discuss effect of certain types of food at irritable bowel syndrome (IBS) and options of reduction of symptom intensity by individual adjustment of ration.Key points. Undoubtedly, dietary habits in the most cases influence severity of IBS symptoms: pain, flatulence, stool disorders. Most likely, negative action of food substances is realized partly due to fermentation with excessive production of short-chain fatty acids and intestinal gas, partly — because of effect on the microbiota spectrum and enteroendocrine cells, partly - due to elevation of biogenic amine content. Filling of food diary helps to find out relevant food substances. Effect of fermentable oligo-, di- and monosaccharides and sugar spirits (FODMAPs) is most obviously demonstrated, therefore it is necessary to choose products with decreased contents of these components. In some cases negative action is related to products with high gluten content, though whether it is caused by effect of gluten or action of fructans, remains equivocal. Efficacy of functional food products containing bacteria of probiotic strain Bifidobacterium animalis sp. lactis DN-173 010 for treatment of IBS symptoms is demonstrated in clinical trials. At detection of symptoms link to intake of specific products it is necessary to exclude food allergy and enzymopathies (e.g. lactase deficiency), which should be defined as independent diseases under the «mask» of irritable bowel syndrome.Conclusion. Individually adjusted nutrition is an integral part of treatment of IBS. Progress achieved in studying of food factors contribution to symptom development, forms scientific basis for recommendation to eliminate certain nutrients from the ration and simultaneously promotes better understanding of disease pathogenesis.