Aim: to summarize current clinical guidelines and meta-analyses data, and to present the main statements of the Expert Council of the Russian Gastroenterological Association regarding the optimization of endoscopic diagnosis, morphological verification, pharmacotherapy, and management strategies for patients with gastroesophageal reflux disease (GERD) and Barrett’s esophagus.
Key points. In the Russian Federation, GERD is a highly prevalent disease: according to a meta-analysis involving over 30,000 individuals, the frequency of heartburn and/or regurgitation occurring once a week or more is 25 %. Proton pump inhibitors (PPIs) represent the cornerstone drug class for the treatment of GERD. Rebamipide targets altered epithelial permeability and mucosal inflammation. Combination therapy with PPIs and rebamipide improves symptoms in patients with non-erosive reflux disease, leading to positive morphological changes in the esophageal mucosa and improved control of nocturnal esophageal acid exposure. Ursodeoxycholic acid (UDCA) may be added to GERD therapy in the presence of biliary reflux or reflux gastritis. The clinical significance of GERD is determined not only by its high prevalence, chronic relapsing course, and impaired quality of life, but also by its precancerous potential. In individuals with GERD, the prevalence of Barrett’s esophagus is approximately 7 %, while the incidence of adenocarcinoma and/or high-grade dysplasia in the presence of low-grade dysplasia is 1.73% annually. Risk factors for the development of Barrett’s esophagus include male sex, age over 50 years, frequent GERD symptoms, tobacco smoking, obesity, and a positive family history. The management of patients with Barrett’s esophagus requires strict adherence to endoscopic and histological diagnostic protocols. Long-term PPI pharmacotherapy remains the standard of chemoprevention against neoplastic progression, demonstrating superiority over surgical treatment. Timely screening of high-risk individuals and adherence to endoscopic surveillance intervals enable the detection of dysplasia and esophageal adenocarcinoma at early, treatable stages.
Conclusion. The Expert Council members proposed algorithms for the treatment of acute GERD exacerbation and maintenance therapy, as well as for the diagnosis and surveillance of patients with Barrett’s esophagus, taking into account current evidence and principles of evidence-based medicine. The literature review and the proposed algorithms aim to provide informational support for general practitioners, internists, gastroenterologists, and endoscopists in order to improve the quality of healthcare delivery and ensure effective prevention of esophageal adenocarcinoma.

Aim: to evaluate, based on an analysis of preclinical and clinical data, the efficacy and safety of fixed combinations of glycyrrhizic acid with phospholipids or ursodeoxycholic acid for the treatment of non-alcoholic fatty liver disease.
Key points. Glycyrrhizic acid exerts antisteatotic, anti-inflammatory, and antifibrotic effects through the activation of nuclear factor erythroid 2-related factor 2 (Nrf2), the inhibition of sterol regulatory element-binding protein 1c (SREBP-1c), nuclear factor κB (NF-κB), and the modulation of the farnesoid X receptor (FXR)/sirtuin-1 (SIRT1) pathway. The “glycyrrhizic acid + phospholipids” fixed-dose combination (IV for 14 days followed by PO for 10 weeks) is recommended to reduce steatosis and inflammation and to prevent fibrosis (strength of recommendation: B; level of evidence: 2). In clinical studies, a 2–3-month therapy with the drug led to the normalization of aminotransferase activity in the majority of patients, while a 12-month study demonstrated regression of advanced stages of liver fibrosis (F2–F4), up to the complete disappearance of signs of cirrhosis (F4) in all patients. The “glycyrrhizic acid + ursodeoxycholic acid” fixed combination (12 weeks; 15 mg/kg/day of ursodeoxycholic acid) is recommended for patients with non-alcoholic fatty liver disease and elevated aminotransferase levels to reduce inflammation (strength of recommendation: B; level of evidence: 2). Randomized clinical trials have shown more than a twofold reduction in aminotransferase activity, as well as improvements in quality of life. An analysis of more than 1.3 million prescriptions confirms a favorable safety profile for both combinations (overall incidence of adverse events: 0.01–1.4 %, predominantly mild gastrointestinal disturbances).
Conclusion. Fixed-dose combinations of “glycyrrhizic acid + phospholipids” and “glycyrrhizic acid + ursodeoxycholic acid” are effective and safe pharmacotherapeutic options for the treatment of non-alcoholic fatty liver disease, exhibiting antisteatotic, anti-inflammatory, and antifibrotic effect as supported by data from randomized clinical trials and post-marketing surveillance in the Russian Federation.

Aim: to compare the efficacy of proton pump inhibitors and potassium-competitive acid blockers (P-CABs) in achieving and maintaining endoscopic remission in erosive gastroesophageal reflux disease.

Materials and methods. A systematic literature search using specified keywords was performed through June 17, 2025, in the MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases.

Results. A total of 2,758 patients from six studies were included in this systematic review and meta-analysis. The meta-analysis showed a trend in favor of P-CABs at week 4 of therapy, although the difference was not statistically significant: OR = 1.29; 95% CI: 0.93–1.80; p = 0.13. At week 8, P-CABs demonstrated a statistically significant advantage over proton pump inhibitors in achieving endoscopic remission: OR = 1.92; 95% CI: 1.39–2.64; p < 0.0001. P-CABs were also more effective than proton pump inhibitors in maintaining endoscopic remission: OR = 1.77; 95% CI: 1.42–2.21; p < 0.00001. Heterogeneity across these analyses was low (I² = 0–4 %).

Conclusion. P-CABs are an effective alternative to proton pump inhibitors for achieving and maintaining endoscopic remission in patients with erosive gastroesophageal reflux disease. Further prospective studies are needed to optimise treatment regimens, assess long-term safety, and compare the efficacy of different agents within the P-CAB class.

Aim: to evaluate the efficacy of an oral medical device — a fixed combination of hyaluronic acid, chondroitin sulphate, and the bioadhesive agent poloxamer 407 (Alfasoxx), on the incidence, course, and severity of radiation esophagitis symptoms in patients undergoing external beam radiotherapy for a primary malignancy.
Materials and methods. A total of 215 patients were enrolled in the study, of whom 210 were included in the statistical analysis. Patients were divided into two groups: a treatment group (patients with manifestations of radiation esophagitis at study entry) and a prophylaxis group (patients enrolled on the start date of external beam radiotherapy). Seventeen oncologists from nine Russian cities participated in the study. Assessment methods included clinical and demographic evaluation, analysis of the incidence and distribution of radiation esophagitis risk factors, evaluation of radiation esophagitis severity according to CTCAE v. 5.0, assessment of radiation dose delivered to the esophagus, Alfasoxx dosage accounting for compliance, evaluation of the time to radiation esophagitis onset and its duration, analysis of swallowing function using the EAT-10 questionnaire, assessment of overall health-related quality of life using the EORTC QLQ-C30 questionnaire, and monitoring of adverse events.
Results. Manifestations of radiation esophagitis were observed in 68.5 % of patients in the prophylaxis group; therefore, radiation esophagitis did not develop in 31.5 % of patients. Compared with the prophylaxis group, patients in the treatment group experienced a more severe course of the disease, with a mean radiation esophagitis severity score of 0.83 ± 0.53 vs. 0.52 ± 0.25 (p < 0.001). The mean EAT-10 score at baseline differed from that in the treatment group. However, from Visit 2 onward, mean scores aligned and demonstrated identical dynamics. A similar distribution was observed for overall quality of life as assessed by the EORTC QLQ-C30 questionnaire. The significant difference observed at the first visit (68.73 ± 15.69 points in the prophylaxis group vs. 58.24 ± 16.04 points in the treatment group; p < 0.001) was leveled by Visit 4 among patients who developed radiation esophagitis (79.96 ± 10.91 points in the prophylaxis group and 81.25 ± 11.03 points in the treatment group). Only one adverse event was identified during Alfasoxx administration: mild nausea after intake.
Conclusion. The prophylactic administration of Alfazox concurrently with the initiation of external beam radiotherapy reduces the mean severity of radiation-induced esophagitis and shortens the duration of symptom manifestation.

Aim: to evaluate the efficacy and safety of dupilumab, a biologic therapy, in the treatment of refractory eosinophilic esophagitis complicated by esophageal strictures and food impaction, in patients who have failed prior therapy with proton pump inhibitors and topical glucocorticosteroids.
Materials and methods. In a prospective study conducted from July 2024 to February 2026, 19 patients (2 females, 17 males) aged 19 to 70 years with a previously confirmed diagnosis of eosinophilic esophagitis were administered dupilumab at a dose of 300 mg once weekly subcutaneously for 12 weeks. Indications for dupilumab administration included a complicated disease course (esophageal strictures and narrowing, esophageal dissection, recurrent episodes of acute food impaction) in the setting of resistance to prior therapy with topical glucocorticosteroids and/or proton pump inhibitors. Additional criteria for initiating biologic therapy included coexisting T2-associated diseases, such as bronchial asthma, chronic rhinosinusitis with nasal polyposis, and atopic dermatitis. All patients underwent assessment of dysphagia severity according to the Dysphagia Symptom Questionnaire (DSQ), calculation of the clinical and morphological disease activity index, esophagogastroduodenoscopy with esophageal biopsy (at least 6 biopsy specimens from the distal and middle/proximal esophagus), and histopathological examination of biopsy specimens both prior to treatment and at 12 weeks of therapy.
Results. At 12 weeks of dupilumab therapy, complete resolution of dysphagia was observed in 9 (75 %) of 12 patients with dysphagia at baseline, and clinical remission (absence of any complaints) was achieved in 12 (63.2 %) of 19 patients. The mean DSQ score, reflecting dysphagia severity, decreased from 32.01 to 7.12 (p < 0.05). Endoscopic disease activity, as assessed by the EREхFS score, decreased from 5.0 [4.0; 7.0] to 1.0 [1.0; 3.0] points (p < 0.0001). Although the proportion of patients with strictures did not change significantly, an increase in esophageal diameter at the stricture site was observed (from 13.1 ± 5.8 mm to 16.1 ± 2.0 mm; p < 0.05). Histological remission (< 15 eosinophils per HPF, ×400) was achieved in 18 (94.7 %) of 19 patients. Adverse events included upper extremity joint pain (1 patient, 5.3 %), conjunctival dryness (2 patients, 10.5 %), and peripheral blood eosinophilia with elevated liver enzymes up to 3–4 times the upper limit of normal (1 patient, 5.3 %).
Conclusions. Dupilumab therapy over 12 weeks leads to the achievement of clinical (63.2 %) and histological (94.7 %) remission in eosinophilic esophagitis.

Introduction. Hepatitis C virus (HCV) genotype 3 is associated with accelerated progression of liver disease; therefore, individuals infected with this genotype represent a clinically significant subgroup of patients. Despite the high efficacy of direct-acting antivirals, the optimal duration of therapy remains a subject of debate.

Aim. To evaluate, in a real-world clinical setting, the efficacy and safety of an 8-week treatment regimen consisting of ravidasvir (200 mg) and sofosbuvir (400 mg) once daily in treatment-naive patients with chronic hepatitis C virus genotype 3 (HCV-3) infection and F0–F2 liver fibrosis (according to the METAVIR score).

Materials and methods. This prospective, single-cohort, observational study (ClinicalTrials.gov, NCT07316842) enrolled 30 patients with HCV-3; the final per-protocol analysis included 29 patients who completed the full course of antiviral therapy and were available for the assessment of sustained virological response 12 weeks after treatment cessation (SVR12). The diagnosis of HCV-3 was verified in accordance with the Clinical Guidelines “Chronic Hepatitis C”, approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation. The mean age of the patients was 40.4 ± 7.1 years, and 65.5 % were men. The stage of liver fibrosis was determined by transient elastography using the FibroScan device (Echosens, France). The distribution of fibrosis stages was as follows: F0 — 44.8 %, F1 — 48.3 %, and F2 — 6.9 %. The primary endpoint was the achievement of SVR12, while the secondary endpoints included the achievement of aviremia 4 weeks after antiviral therapy completion (SVR4), viral load dynamics, changes in ALT and AST activity during treatment, as well as the safety and tolerability of the antiviral therapy.

Results. In patients with HCV-3 and F0–F2 liver fibrosis (according to the METAVIR score), SVR12 was registered in 28 out of 29 patients (96.6 %; 95% CI: 82.8–99.4). SVR4 was achieved in 24 out of 25 patients with available data (96.0 %; 95% CI: 80.5–99.3). The median viral load decreased from 8.3 × 10⁵ IU/mL at baseline to an undetectable level after 4 weeks of treatment and remained at this level at the time of SVR12 assessment. The median ALT activity decreased from 115.2 to 18.0 U/L, and AST activity decreased from 66.0 to 23.3 U/L (p < 0.001 for both parameters). No serious adverse events or treatment discontinuations due to adverse events were registered.

Conclusion. The shortened 8-week antiviral therapy regimen with a combination of ravidasvir (200 mg) and sofosbuvir (400 mg) once daily in patients with HCV-3 without advanced liver fibrosis demonstrates high efficacy and a favourable safety profile in this cohort.

Aim: to assess the risk of anaphylaxis associated with percutaneous methods in the treatment of patients with hydatid liver echinococcosis.
Materials and methods. From 2004 to 2025, 117 patients aged 17 to 84 years with hydatid liver echinococcosis were treated using percutaneous methods. The study cohort included 83 (71.0 %) women and 34 (29.0 %) men. Nine (7.6 %) patients had recurrent echinococcal cysts, and 15 (12.8 %) had complicated cysts. Sixty-three (53.9 %) patients had single echinococcal cysts, and 54 (46.1 %) had multiple cysts. A total of 217 echinococcal cysts were identified in 117 patients. Indications for percutaneous treatment included echinococcal cysts types CE 1, CE 2, CE 3a, CE 3b, suppurated cysts CE 4, as well as cysts CE 5 with partial calcification of the fibrous capsule. Echinococcal cysts type CE 5 with complete calcification of the fibrous capsule were considered an absolute contraindication. In total, 183 percutaneous interventions were performed, including 141 drainages and 42 punctures.
Results. Anaphylaxis developed in 7 (5.9 %) patients during the percutaneous intervention. Two (1.7 %) patients developed the typical variant of anaphylaxis (generalized urticaria), and 5 (4.2 %) developed the hemodynamic variant (anaphylactic shock). No anaphylaxis-related mortality was reported. Anaphylaxis developed only during percutaneous drainage. No cases of anaphylaxis occurred during the 42 percutaneous punctures.
Conclusions. The risk of anaphylaxis associated with percutaneous treatment of hydatid liver echinococcosis was 5.9 % (with the typical variant accounting for 1.7 %, and the hemodynamic variant for 4.2 %). The risk of anaphylaxis during percutaneous drainage of an echinococcal cyst is significantly higher than during percutaneous puncture. A combination of criteria, such as positive ELISA result for echinococcosis, elevated total IgE level, and echinococcal cyst type CE 1 or CE 2, predicts the risk of anaphylaxis during percutaneous intervention.

Aim. To compare the efficacy and safety of interleukin (IL)-23 and IL-12/23 inhibitors during the induction and maintenance phases of Crohn’s disease using a Bayesian network meta-analysis.
Materials and methods. Randomized controlled trials (RCTs) comparing guselkumab (GUS), risankizumab (RIS), ustekinumab (UST), mirikizumab (MIR), briakinumab (BRI), brazikumab (BRA), apilimod mesylate (API) and placebo (PBO) were analyzed. Outcomes included clinical and endoscopic remission/response, adverse events (AEs), and serious adverse events (SAEs). Bayesian random-effects models were used to estimate pooled odds ratios (ORs) with 95 % credible intervals (CrIs). Treatment rankings were determined using the surface under the cumulative ranking curve (SUCRA).
Results. Twenty-one RCTs were included. During the induction phase, GUS ranked highest for clinical remission and clinical response, followed by RIS, MIR, and UST, with all agents demonstrating significant efficacy compared with PBO. RIS and MIR achieved significant improvements in endoscopic outcomes over PBO. GUS had the most favorable profile for AEs during induction, whereas RIS achieved greatest reduction in SAEs. During the maintenance phase, RIS was the only agent with demonstrated statistically significant efficacy for clinical remission compared with PBO. No agent achieved statistically significant endoscopic outcomes during maintenance; nevertheless, MIR and GUS ranked highest. Rates of AEs and SAEs were comparable across all active treatments.
Conclusion. Guselkumab and risankizumab emerged as the most efficacious and safest IL-23 inhibitors for induction therapy, whereas risankizumab demonstrated the most sustained efficacy in maintenance phase.

Aim: to compare the fecal short-chain fatty acid (SCFA) profile in patients with Crohn’s disease (CD) and ulcerative colitis (UC) and to evaluate the potential of these indicators in differentiating between the two diseases.
Materials and methods. This prospective cohort study included 34 patients with CD and 29 patients with UC (mean age 40.15 ± 14.07 years and 42.97 ± 14.36 years, respectively; p = 0.435). Patients who met the inclusion criteria underwent comparative analysis of the fecal SCFA profile using gas-liquid chromatography. The analyzed parameters included the monocarboxylic acids acetic (C2), propionic (C3), and butyric (C4), as well as the total content of their branched-chain isomers (isobutyric, isovaleric, and isocaproic). The calculated parameters included the total concentration of all SCFA fractions with isomers and the anaerobic index.
Results. SCFA concentrations were statistically significantly higher in patients with CD than in those with UC. The mean fecal acetic acid concentration was 3.29 ± 1.40 mg/g in the CD group and 1.61 ± 0.80 mg/g in the UC group (p < 0.001). The median propionic acid concentration was 1.11 [0.75; 1.71] mg/g in the CD group and 0.47 [0.33; 0.79] mg/g in the UC group (p < 0.001). Similarly, the median butyric acid concentration was higher in patients with CD than in those with UC: 1.12 [0.65; 1.63] mg/g vs. 0.46 [0.23; 0.65] mg/g (p < 0.001). The total concentration of all SCFA fractions with isomers was also statistically significantly higher in patients with CD than in those with UC (6.44 ± 3.06 mg/g vs. 3.34 ± 1.79 mg/g, respectively; p < 0.001). No significant differences were observed between the groups in the mean anaerobic index or the median total concentration of branched-chain SCFA isomers. A predictive tool for estimating the probability of IBD type was developed using binary logistic regression based on the number of extraintestinal manifestations and fecal acetic acid concentration. Each additional extraintestinal manifestation was associated with an 8.6-fold decrease in the odds of UC, while each 1 mg/g increase in acetic acid concentration was associated with a 5.3-fold decrease in the odds of UC. The estimated probability (P) was a statistically significant predictor of UC (AUC = 0.931; 95% CI: 0.863–0.999; p < 0.001). The predictive tool demonstrated a sensitivity of 93.1 % and a specificity of 88.2 %.
Conclusions. The fecal SCFA profile and the number of extraintestinal manifestations differ significantly in patients with CD and UC. The developed predictive tool enables high-probability prediction of IBD type and may serve as an additional method to improve the differential diagnosis of CD and UC; however, it cannot replace comprehensive clinical, endoscopic, radiological, and morphological assessment.

Background. Chronic postoperative inguinal pain (CPIP) remains one of the most disabling complications following Lichtenstein hernioplasty and can adversely affect functional recovery and quality of life. Ilioinguinal neurectomy has been proposed as a method to reduce CPIP, but concerns regarding long-term sensory deficits have limited universal adoption.
Aim. To evaluate the effectiveness of prophylactic ilioinguinal neurectomy in reducing postoperative pain and to assess associated sensory outcomes and quality of life following open mesh repair of inguinal hernia.
Materials and methods. This prospective comparative study included 60 patients undergoing Lichtenstein hernioplasty after ethical approval (IEC No. 2022/789). Patients were randomized into two cohorts — neurectomy group (n = 30) and nerve-preservation group (n = 30). Postoperative pain (at rest, walking, moderate and vigorous activity), sensory changes (hypoesthesia/hyperesthesia), and quality-of-life scores (SF-36) were assessed at 1, 3, and 6 months.
Results. Pain scores were consistently lower in the neurectomy group at all follow-up points. Significant reductions were observed during moderate activity (p = 0.008), vigorous activity (p = 0.004), and walking (p = 0.001) at 1 month. At 6 months, no patient in the neurectomy group reported pain during normal or moderate activity, while residual pain persisted in the nerve-preservation group. Early postoperative hypoesthesia was more common after neurectomy (26.7 %), but progressively declined to 10 % by 6 months, indicating no persistent sensory impairment. Quality-of-life domains showed better overall outcomes in the neurectomy group, although not statistically significant. The patients who underwent neurectomy developed sensation in the affected area after 3 months, attributable to overlapping dermatomal (collateral) nerve supply.
Conclusion. Prophylactic ilioinguinal neurectomy significantly reduces postoperative activity-related pain after Lichtenstein hernia repair without adversely affecting long-term sensation or quality of life. The procedure may be safely recommended as an adjunct to improve postoperative comfort and functional recovery.

Introduction. Oxidative stress represents an imbalance between the production of reactive oxygen species and the body’s antioxidant defense system. One of the main causes of this condition is the inflammatory process. Collectively, oxidative stress and systemic inflammation are the key pathogenic mechanisms of numerous diseases. The intake of plant antioxidants can reduce oxidative stress and can be used for prevention.
Aim: To analyze studies investigating the antioxidant properties of three plant components: peppermint essential oil, D-limonene (a component of citrus peel), and gingerol (a component of ginger).
Key points. Modern research confirms the presence of pronounced antioxidant properties of peppermint essential oils, D-limonene, and gingerol in vitro, in experimental animal models, and in human cell cultures. These plant components have been shown to increase the quantity and activity of antioxidant enzymes, neutralize reactive oxygen species, reduce cellular damage, inhibit the synthesis of pro-inflammatory cytokines, and prevent apoptosis. Notably, in tumor cell cultures and animal models, D-limonene and gingerol demonstrate anti-tumor activity by increasing oxidative stress in cancer cells.
Conclusion. Peppermint essential oil, D-limonene, and gingerol show promise as agents for the prevention and comprehensive treatment of various diseases associated with systemic inflammation and oxidative stress. However, further clinical research is necessary to confirm their efficacy and safety in humans.

Aim: to demonstrate the feasibility of intraductal contact lithotripsy using a holmium laser under peroral transpapillary cholangioscopy (POCS) guidance for radical endoscopic treatment of a patient with type IV Mirizzi syndrome.
Key points. A 58-year-old female patient with a 5-year history of cholelithiasis was admitted on an emergency basis one year earlier with clinical signs of obstructive jaundice. At that time, endoscopic intervention was performed, including endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy, and biliary duodenal stenting. ERCP revealed a 4.0 × 2.0-cm calculus completely obstructing the common bile duct lumen, and a cholecystobiliary fistula was suspected. During the current hospitalization, the first stage of treatment consisted of balloon dilation of the previously performed endoscopic sphincterotomy followed by POCS using the SpyGlass DS II system. Complete obstruction of the common bile duct lumen by the calculus was confirmed, together with pronounced inflammatory changes in the bile duct wall at the site of the cholecystobiliary fistula. Contact lithotripsy of the biliary calculus was performed using a holmium laser, with fragmentation of both the intraductal and gallbladder portions of the calculus, followed by extraction of the fragments and placement of a nasobiliary drain. At the second stage, complete clearance of the main bile ducts and the gallbladder cavity was achieved under POCS guidance. A procedural complication — impaction and breakage of the extraction basket in the distal common bile duct — was also successfully managed by contact holmium laser lithotripsy performed through the basket mesh, followed by basket removal after fragmentation of the impacted biliary stone. Repeat stenting and cholecystectomy were not performed due to a shrunken gallbladder and complete clearance of the biliary tract, including the gallbladder.
Conclusion. The endoscopic approach enabled radical treatment and obviated the need for surgery, demonstrating its potential in the management of complex forms of choledocholithiasis, including Mirizzi syndrome.