Aim: to  present key data on the role of gastrointestinal motility dysfunction in the pathogenesis of functional and organic diseases and the importance of acotiamide in the correction of these disorders and to introduce a resolution of the expert council of the Russian Gastroenterological Association and the Russian Society of Neurogastroenterology and Motility.

Key points. Gastrointestinal motility dysfunction represents a key pathogenetic factor that determines the development and clinical course of a broad range of diseases. Functional dyspepsia and gastroesophageal reflux disease are highly prevalent conditions, and motility impairments, such as impaired gastric accommodation and delayed gastric emptying, account for their frequent co-occurrence in the same patient. For the pharmacotherapy of these diseases, drug products with a prokinetic effect are of substantial importance. Acotiamide has a proven prokinetic effect, improves gastric accommodation and emptying, and reduces the severity of symptoms of postprandial distress syndrome and overlapping manifestations of gastroesophageal reflux disease. In a multicenter Russian study, a response to acotiamide therapy was noted in 74.1 % of patients with postprandial distress syndrome versus 51.9 % in the placebo group (p < 0.001). Dysmotility and its association with gastrointestinal symptoms in H. pylori-associated dyspepsia, reflux gastritis, and autoimmune gastritis, as well as therapeutic measures to correct these disorders and alleviate symptoms, require further research.

Conclusion. Further research into motility disorders of the gastrointestinal tract will help to elucidate the pathogenesis of a number of functional and organic gastroenterological diseases. The body of evidence from international and local studies confirms the clinical efficacy and safety of acotiamide. Its inclusion in national clinical guidelines justifies the use of the drug product in patients with functional dyspepsia and gastric motility disorders, including cases in combination with gastroesophageal reflux disease.

Aim: to present modern data on the efficacy and safety of using potassium-competitive acid blockers (P-CAB) using tegoprazan as an example in patients with gastroesophageal reflux disease.

Key points. Potassium-competitive blockers of hydrochloric acid secretion, according to clinical studies, have demonstrated high clinical efficacy and safety in patients with gastroesophageal reflux disease. The advantages of this class of drugs include a faster and longer-lasting antisecretory effect, which does not depend on food intake, as well as the absence of the influence of genetic polymorphisms of the CYP2C19 isoenzyme on pharmacokinetics and the risk of drug interactions. In patients with nocturnal heartburn, the potassium-competitive acid blocker tegoprazan may be the drug of choice to achieve a faster and longer-lasting clinical effect and improve sleep quality. Tegoprazan is effective against nocturnal acid breakthroughs. In several studies, tegoprazan was superior to placebo and proton pump inhibitors (PPIs) in eliminating major symptoms in patients with nonerosive reflux disease and to PPIs in treating erosive esophagitis. P-CABs are considered the drugs of choice in the treatment of gastroesophageal reflux disease refractory to PPIs.

Conclusion. Further studies are needed, including in the Russian Federation, to confirm the high efficacy and safety of tegoprazan.

Aim: to present current research data on the epidemiology and carcinogenesis of colorectal cancer.

Key points. Colorectal cancer (CRC) ranks third in the incidence of malignant tumors in most countries of the world, including Russia. At the same time, the incidence rate continues to grow both globally and in Russia, where CRC accounts for 12.2 % of the total oncological incidence. It is possible to stop the growth and achieve a significant reduction in the incidence of CRC only by identifying proven causes and risk factors for CRC and introducing effective measures for its prevention into the healthcare system. The review includes three sections of research: 1) CRC prevalence in populations and the dynamics of CRC incidence; 2) causes and modifiable and non-modifiable risk factors of CRC; 3) mechanisms of CRC carcinogenesis. The majority of CRC cases, 90 to 95 %, are sporadic and largely due to a combination of modifiable environmental and lifestyle risk factors, such as certain dietary characteristics, gut microbiota, body weight, physical activity, alcohol consumption, tobacco use, precancerous diseases of the colon and rectum, and the level of knowledge about the causes of CRC and measures to prevent them. It is estimated that approximately 30 % of CRC cases are due to varying degrees of genetic predisposition or non-modifiable risk factors, but only 5 % of all CRC cases develop in the context of known genetic syndromes that are caused by a specific germline mutation.

Conclusion. The information presented in the review on proven modifiable and non-modifiable risk factors for CRC and the mechanisms of their participation in CRC carcinogenesis will contribute to the development of effective methods for the prevention of CRC and their implementation in practical health care.

Background. Over the past decade, innovations in haemorrhoid surgery particularly laser haemorrhoidoplasty, stapled haemorrhoidopexy, and Doppler-guided haemorrhoidal artery ligation (DG-HAL) have gained increasing attention due to their potential to reduce postoperative pain, recurrence, and improve patient quality of life. Despite this progress, a comprehensive bibliometric analysis of the global research trends in these techniques has not yet been conducted.

Aim: to analyse the global scientific literature on innovative haemorrhoid treatments from 2015 to 2025 using bibliometric methods, and to identify key trends in authorship, institutional and geographic contributions, citation impact, and thematic evolution.

Methods. A bibliometric search was conducted using the Scopus database for publications between 2015 and 2025. The search included terms related to “laser haemorrhoidoplasty”, “stapled haemorrhoidopexy”, and “Doppler-guided haemorrhoidal artery ligation”. Data were exported, cleaned, and analysed using Microsoft Excel and VOSviewer (v. 1.6.19). Co-authorship networks, country collaborations, keyword co-occurrence, citation density, and institutional productivity were visualised and interpreted.

Results. A total of 273 articles were identified. Publication output increased steadily, peaking in 2021. Italy emerged as the leading contributor in terms of publications and international collaborations. Most cited articles focused on clinical guidelines and randomised trials comparing innovative with conventional techniques. Keyword analysis revealed a shift from traditional surgery towards minimally invasive procedures, with increasing focus on patient-centered outcomes such as pain and quality of life.

Conclusion. There has been significant global academic interest in innovative haemorrhoid treatments over the past decade, with laser and Doppler-guided methods gaining prominence. Research is concentrated in high-income countries, particularly Italy, with limited representation from low- and middle-income countries. Future studies should address global equity, long-term outcomes, and cost-effectiveness through broader collaborations and implementation science.

Aim: to assess the microsatellite instability status in gastric mucosa to determine the possibility of its use as a predictive marker of carcinogenesis.
Material and methods. The study included two groups of gastric mucosa specimens: Group 1 — 155 mucosa fragments of the distant tumor growth zone obtained from stomachs resected for malignant neoplasms; Group 2 — 100 fragments with chronic gastritis taken from patients with dyspeptic complaints. Gastrobiopsy specimens were examined histologically, immunohistochemically using mouse monoclonal antibodies (Diagnostic BioSystems, USA) to the MMR system proteins: MLH-1 (clone G168-15, dilution 1:50), MSH2 (clone DBM15.82, dilution 1:100), MSH6 (clone 44, dilution 1:50), PMS2 (clone A16-4, ready to use). MSI was studied with multiplex PCR evaluation of DNA microsatellites (NR-21, NR-24, NR-27, BAT-25, BAT-26) from paraffin sections, their analysis with capillary electrophoresis. The obtained data were processed with the Statistica 10.0 (StatSoft Inc., USA), presented using descriptive, analytical statistics.
Results. Immunohistochemical examination revealed 8 microsatellite-unstable cases in gastric mucosa specimens of Group 1 and 0 cases in Group 2 (statistically significant differences, p = 0.024). All studied gastric tissue samples were assessed as microsatellite-stable based on PCR results.
Conclusion. Detection of MMR deficiency in gastric mucosa of the distant tumor growth zone and its absence in morphologically comparable specimens obtained from patients with chronic gastritis may be considered as confirmation of the hypothesis of disturbances in the MMR system as an early event in carcinogenesis. This, in turn, may indicate the potential for studying MMR status as a component of a decision support system for assessing the risk of developing microsatellite-associated gastric cancer.

Aim: to analyze the prevalence of Helicobacter pylori (H. pylori) clarithromycin resistance mutations across the Russian Federation based on molecular genetic studies.
Materials and methods. A systematic literature review was conducted in accordance with PRISMA 2020 guidelines. Searches were performed in PubMed, Google Scholar, and the Russian Science Citation Index (RSCI) for studies published between 1985 and 2025. Analyses focused on point mutations in the 23S rRNA gene, including A2142G (referred as A2146G), A2143G (referred as A2147G), A2144G, T2182C, and T2717C.
Results. Nine eligible studies encompassing 639 H. pylori isolates (collected between 2009 and 2024) were included. The pooled prevalence of clarithromycin resistance based on molecular genetic studies was 25.1 % (95% confidence interval: 15.7–36.0). The most prevalent mutation was A2143G (78.2 %), followed by A2142G (15.7 %) and T2717C (13.6 %). Significant heterogeneity was observed among studies (I2 = 88.6 %). No publication bias was detected via Begg’s and Egger’s tests.
Conclusion. This meta-analysis demonstrated that the pooled clarithromycin resistance rate of H. pylori strains in Russian studies conducted between 2009 and 2024 using molecular-genetic methods exceeds 25 %. Clarithromycin resistance among H. pylori strains in Russia is primarily driven by the A2143G mutation. These data are highly relevant for the design of local PCR diagnostic systems aimed at promptly identifying clarithromycin resistance in H. pylori, enabling clinicians to select personalized eradication regimens based on genetic profiles.

Aim: to investigate the relationship between tryptophan metabolism features, gut microbiota composition, systemic inflammation markers, cortisol levels, quality of life, and psychoemotional and cognitive status in female patients with functional constipation (FC).
Materials and methods. The study included 64 female patients with FC and 26 age- and BMI-matched women without FC (p > 0.05). All participants underwent assessment of gut microbiota composition in stool samples (via 16S rRNA sequencing), health-related quality of life (SF-36), psychoemotional status (4DSQ, Spielberger — Hanin test, Hamilton scale), and cognitive function (BACS cognitive tests). Tryptophan metabolism was evaluated by measuring levels of interleukin-1β, cortisol, brain-derived neurotrophic factor (BDNF), tryptophan, kynurenine, kynurenic acid, and serum and platelet serotonin.
Results. Compared to women without FC, female patients with FC had higher levels of cortisol (325 [266; 403] vs. 275 [255; 304] nmol/L; p = 0.025), interleukin-1β (10.0 [9.2; 11.2] vs. 7.2 [6.5; 7.8] pg/mL; p < 0.001), and blood kynurenine (0.65 [0.54; 0.82] vs. 0.44 [0.35; 0.48] μg/mL; p < 0.001), as well as lower plasma serotonin levels (108 [85; 134] vs. 163 [117; 190] ng/mL; p < 0.001). No differences were found between groups in plasma tryptophan, BDNF, kynurenic acid, or platelet serotonin. Patients with FC exhibited more pronounced depression (Hamilton scale: 8 [6; 9] vs. 3 [2; 3] points; p < 0.001) and somatization (9 [7; 12] vs. 5 [3; 9] points; p < 0.001); lower cognitive function scores (50 [45; 54] vs. 54 [53; 56] points; p < 0.001), particularly in auditory-verbal memory (p < 0.001) and information processing speed (p < 0.001); and reduced quality of life (SF-36) in physical functioning (90 [83; 95] vs. 95 [95; 95] points; p < 0.001) and bodily pain (60 [50; 70] vs. 75 [56; 85] points; p < 0.001). Cortisol levels positively correlated with bodily pain (r = 0.379; p = 0.003), while interleukin-1β levels inversely correlated with bodily pain (r = –0.391; p = 0.002), physical functioning (r = –0.448; p < 0.001), and verbal memory (r = –0.252; p = 0.046), and positively correlated with depression (r = 0.311; p = 0.013) and somatization (r = 0.266; p = 0.035). Cortisol levels correlated positively with Oscillospira (r = 0.45; p = 0.01), while kynurenine levels correlated with Alistipes (r = 0.36; p = 0.04) abundance. Plasma serotonin positively correlated with Haemophilus (r = 0.37; p = 0.03) and inversely with Bacteroides plebeius (r = –0.40; p = 0.02) abundance. Physical functioning (SF-36) positively correlated with Lachnospiraceae NK4B4 group (r = 0.35; p = 0.04), while depression severity (4DSQ) inversely correlated with Alistipes abundance (r = –0.37; p = 0.03). Information processing speed is inversely correlated with abundance of Bacilli (r = –0.48; p = 0.004), Lactobacillales (r = –0.48; p = 0.004), Pasteurellales (r = –0.36; p = 0.03), Pasteurellaceae (r = –0.36; p = 0.03), Streptococcaceae (r = –0.47; p = 0.006), Haemophilus (r = –0.41; p = 0.02), and Streptococcus (r = –0.38; p = 0.02).
Conclusion. The findings indicate that women with functional constipation exhibit altered tryptophan metabolism and gut microbiota dysbiosis, associated with depression, somatization, cognitive impairment, and reduced health-related quality of life.

Aim: to evaluate the impact of the drugs Alfaxim® (rifaximin) and Neobutin Retard® (trimebutine) on symptom severity and quality of life in patients with uncomplicated diverticular disease.
Materials and methods. A multicenter non-interventional prospective observational study was conducted, involving 100 patients diagnosed with uncomplicated diverticular disease. Patients received Alfaxim® (rifaximin) at 400 mg 2–3 times daily for 7 days monthly over 6 months and Neobutin Retard® (trimebutine) at 300 mg twice daily for 4 weeks, in addition to standard therapy. Symptom severity (abdominal pain, constipation, diarrhea, bloating, tenesmus) was assessed using a 3-point scale. Quality of life was evaluated using the SF-12 questionnaire. Patient adherence to treatment was measured using the Morisky — Green Compliance Scale.
Results. Cyclic therapy with Alfaxim® and Neobutin Retard® showed statistically significant (p < 0.001) positive effects on all assessed symptoms. Over half of the patients (55 %) achieved remission by the end of the observation period. Analysis of SF-12 scores revealed a significant improvement in quality of life (p < 0.001). Most patients demonstrated high treatment adherence throughout the study. No adverse events were recorded during the observation period.
Conclusions. The use of Alfaxim® (rifaximin) and Neobutin Retard® (trimebutine) reduces symptom severity and improves quality of life in patients with uncomplicated diverticular disease. The drugs have a favorable safety profile.

Aim: to analyze the works published in the literature on the possible association of symptoms of functional dyspepsia (FD) with changes in the microbiota of the stomach and duodenum.

Key points. The data published in the literature indicate that there are significant differences between the composition of the microbiota of the stomach and duodenum in patients with FD and in healthy individuals. It is believed that changes in this composition can lead to an impairment of the integrity of the gastroduodenal mucosa with subsequent effects on the main pathogenetic factors of FD. Some studies have shown the effectiveness of probiotics in the treatment of FD patients. At the same time, the insufficient evidence base of the results does not currently allow us to give them an unambiguous assessment.

Conclusion. The relationship between changes in the microbiota of the stomach and duodenum requires further research.

Aim: to present a clinical observation of paraneoplastic manifestations of Hodgkin’s lymphoma — liver damage in the development of vanishing bile duct syndrome.
Clinical case. Patient Sh., 18-years-old female, was admitted with complaints of yellowing of the skin and sclera, severe general weakness, and fever. Mechanical jaundice, viral hepatitis, Wilson — Konovalov disease, autoimmune hepatitis, and infections were excluded. A hypothesis was put forward about drug-induced hepatitis; some improvement was noted against the background of therapy with ursodeoxycholic acid and prednisolone, but fever and neutrophilic leukocytosis persisted. Physical examination and imaging revealed enlarged lymph nodes in various groups on both sides of the diaphragm, enlarged liver and spleen. PET-CT revealed active accumulation of 18F-fluorodeoxyglucose in the enlarged lymph nodes and bone marrow; lymphoproliferative disease was suspected. During follow- up, laboratory signs of cytolysis and cholestasis persisted, severe jaundice, decreased liver protein-synthetic function, and signs of portal hypertension were noted. A liver biopsy was performed, which revealed ductopenia in most portal tracts, without signs of inflammation (vanishing bile duct syndrome). The presence of splenomegaly, supra- and subdiaphragmatic lymphadenopathy contradicted the diagnosis of “drug-induced cholestasis”. A septic process was excluded. According to the examination, including histological examination of the enlarged lymph node, Hodgkin’s lymphoma, nodular sclerosis, with damage to the supra- and subdiaphragmatic lymph nodes, liver (“vanishing bile duct syndrome” — paraneoplastic reaction) and spleen, stage IIIB according to the Ann Arbor classification, were diagnosed. After polychemotherapy, the fever resolved, and laboratory parameters showed significant positive dynamics. Control PET-CT did not reveal foci of pathological accumulation of 18F-fluorodeoxyglucose. The patient continues to take ursodeoxycholic acid.
Conclusion. Liver involvement in Hodgkin’s lymphoma may manifest as vanishing bile duct syndrome, which is essentially a manifestation of paraneoplastic syndrome. Achieving complete remission and ursodeoxycholic acid therapy are considered to be the key to resolving ductopenia.