Aim: to present the algorithm for differential diagnosis in patients with laryngopharyngeal symptoms, as well as diagnostic opportunities of the 24-hour hypopharyngeal-esophageal multichannel intraluminal pH-impedance monitoring using a special multichannel probe catheter for diagnosis of laryngopharyngeal reflux.

Key points. Laryngopharyngeal symptoms are symptoms that can be caused by retrograde reflux of gastric contents to the proximal segment esophagus, pharynx and larynx, the so-called laryngopharyngeal reflux. These symptoms include cough, sore throat, clearing the throat, excessive mucus production, hoarseness/voice change. Patients should report these complaints at least twice a week for more than 8 weeks. Isolated laryngopharyngeal reflux may be the main factor in the pathogenesis of laryngopharyngeal reflux disease — a disease of the pharynx and upper respiratory tract caused by the pathological flow of contents from the stomach into the larynx, which is manifested by laryngopharyngeal symptoms. In addition, laryngopharyngeal symptoms may be based on hypersensitivity of the laryngopharyngeal mucosa. When laryngopharyngeal symptoms are combined with heartburn and regurgitation, the physician should rule out extraesophageal manifestations of gastroesophageal reflux disease. Due to the nonspecific nature of laryngopharyngeal symptoms, the patient’s examination includes collecting complaints and medical history, filling out questionnaires, consulting specialists in related specialties, conducting laryngoscopy, esophagogastroduodenoscopy, 24-hour hypopharyngeal-esophageal multichannel intraluminal pH-impedance monitoring using a multichannel probe catheter, which is the main method in diagnostics of laryngopharyngeal reflux with an assessment of the symptom index, as well as the chemical and physical properties of the refluxate. The staff of the Department and Clinic of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology at Sechenov University has developed a new technology that includes a practical diagnostic algorithm and, for the first time in Russia, constructed the special probe catheter for hypopharyngeal-esophageal multichannel intraluminal 24-hour pH-impedance monitoring, which is registered as an invention in the Federal Service for Intellectual Property (Rospatent) as “The method for performing pH-impedance monitoring in the diagnosis of laryngopharyngeal reflux” (state registration number No. 2845916 dated August 27, 2025).

Conclusion. Differentiating between laryngopharyngeal reflux disease and extraesophageal manifestations of gastroesophageal reflux disease in patients with laryngopharyngeal symptoms based solely on clinical manifestations is challenging. To confirm the diagnosis, 24-hour pH-impedance monitoring with a specially designed laryngopharyngeal probe is necessary. This will determine further patient management, thereby improving the quality of medical care for patients with laryngopharyngeal reflux.

Aim: to examine the association between dengue infection and cholecystitis, particularly acute acalculous cholecystitis.

Key points. Evidence from 34 studies, including case reports, series, and observational cohorts, shows that acute acalculous cholecystitis is the most frequent gallbladder manifestation linked to dengue infection. This complication is characterized by gallbladder wall thickening on ultrasonography and is frequently accompanied by systemic alterations such as vascular leak, ascites, pleural effusion, and hepatic dysfunction. Pathophysiologically, mechanisms such as viral-induced endothelial dysfunction, immune-mediated inflammation, and capillary hyperpermeability are believed to contribute to gallbladder wall edema. These changes can mimic surgical acute abdomen, complicating clinical decisions in endemic areas. Management in most cases is conservative, with supportive measures including hydration, electrolyte monitoring, and careful clinical observation. However, surgical intervention — such as cholecystectomy or percutaneous drainage — is indicated when complications arise, including perforation, gangrene, or persistent sepsis unresponsive to conservative treatment. Multidisciplinary collaboration between infectious disease specialists, gastroenterologists, and surgeons is essential, especially in severe dengue or when diagnostic uncertainty exists. Importantly, early ultrasonography is a valuable tool to confirm the diagnosis and avoid unnecessary invasive procedures.

Conclusion. Dengue-associated acute acalculous cholecystitis represents a clinically significant but often reversible complication during epidemic outbreaks. Recognizing this association is crucial, as it allows timely diagnosis, tailored management, and the prevention of unnecessary surgeries. While supportive care is sufficient in the majority of cases, careful monitoring is required to promptly identify complications that warrant surgical intervention. Future prospective studies should focus on determining the incidence, identifying predictors of adverse outcomes, and establishing standardized protocols for the management of dengue-related acute acalculous cholecystitis.

Background. On May 20, 2025, a Council of Experts was held in Moscow. The aim of the meeting was to discuss current understanding of the pathogenesis and clinical significance of biliary sludge.

Key points. The following definition of biliary sludge has been established: echogenic fluid within the gallbladder cavity without a clear acoustic shadow, which shifts with changes in body position without fragmentation into fine particles. The absence of an acoustic shadow distinguishes sludge from gallstones. The International Consensus of Experts in Pancreatobiliary Diseases (2023) proposed distinguishing between biliary sludge, microlithiasis (echogenic stones ≤ 5 mm with acoustic shadowing), and larger gallstones in the gallbladder and/or ducts. When managing a patient with biliary sludge, it is important to identify the underlying disease or condition predisposing to the development of sludge. The most important factors are genetic and demographic ones, dietary habits, conditions associated with rapid weight loss, and medications that affect bile composition or gallbladder function. Biliary sludge can be asymptomatic, with dyspeptic symptoms, or lead to complications typical of gallstones. Some data suggest that sludge is associated with idiopathic pancreatitis. The primary diagnostic method for sludge is transabdominal ultrasound. If clinical manifestations characteristic of cholelithiasis complications develop, the common bile duct becomes dilated, or stones are detected in the common bile duct, additional diagnostic testing using magnetic resonance cholangiopancreatography and/or endoscopic ultrasound is recommended. Clinical observations also suggest the potential for sludge to transform into gallstones. However, the view that biliary sludge is the first stage of gallstone disease was not shared by all Council members due to the high incidence of reversible sludge. At this stage, it is proposed to consider biliary sludge more as a risk factor or a specific form of gallstone disease. The only medication shown to dissolve biliary sludge is ursodeoxycholic acid.

Conclusion. The Expert Council adopted a resolution, the provisions of which emphasize the need for accurate diagnosis, individual assessment of risk factors for the development of biliary sludge, the feasibility of developing a scoring system for assessing biliary sludge, determining the location of ursodeoxycholic acid therapy for sludge, and the need to supplement the Clinical Guidelines of the Russian Ministry of Health for the diagnosis and treatment of cholelithiasis with sections devoted to the diagnosis and treatment of biliary sludge.

Aim: to analyze current aspects of prognosis, differential diagnosis, and spasmolytic therapy in gallstone disease.

Key points. The prevalence of gallstone disease in the Russian Federation remains considerably high. Cholelithiasis is associated with cardiovascular disorders and an increased risk of malignancies, including gastric, hepatic, renal, and gallbladder cancer. Several studies emphasize the correlation between the presence and size of gallbladder polyps and the development of gallbladder carcinoma. The current paradigm of biliary pathology postulates that the combined influence of Lith gene polymorphisms, motility disorders, chronic inflammation, and metabolic factors initiates lithogenesis, which in turn promotes chronic cholecystitis and may contribute to gallbladder carcinogenesis. Abdominal pain predominantly localized in the right upper quadrant is the leading clinical manifestation of biliary dyskinesia, chronic cholecystitis, and cholelithiasis. Spasmolytic therapy is considered appropriate for the relief of biliary pain. Clinical studies have demonstrated that the use of the selective spasmolytic agent mebeverine in patients with biliary tract disorders effectively alleviates right upper quadrant pain, improves functional status of the biliary tract, and indirectly facilitates the elimination of biliary sludge.

Conclusion. Gallstone disease represents a key nosological entity within the biliary continuum, characterized by the sequential development of pathogenetically related disorders of the biliary tract. Management of biliary system disorders should focus on relieving biliary pain, restoring motility of the biliary tract, and normalizing the physico-chemical properties of bile.

Aim: to assess the prevalence of hepatocellular carcinoma in patients at moderate and high risk in the Krasnoyarsk Territory during screening activities carried out by the oncology service.

Materials and methods. To implement a risk-based approach, the study included men and women aged 40– 70 years with F3–F4 fibrosis or cirrhosis of the liver, regardless of etiology, who signed an informed consent to participate in the study and those with a previously diagnosed hepatocellular carcinoma. The development program and routing algorithms were developed by the Interdisciplinary Society of Liver Tumor Specialists and approved by the Ministry of Health of the Krasnoyarsk Territory. The screening was conducted at the Krasnoyarsk Regional Oncology Dispensary. Methods used: a questionnaire to collect information about risk factors (the presence of cirrhosis, its causes, concomitant diseases, bad habits); blood sampling to determine the level of AFP (alpha-fetoprotein) + PIVKA-II (protein induced by vitamin K absence or antagonist-II) (Cobas, Roche, Switzerland); the use of the GAAD algorithm, combining gender, age, AFP and PIVKA-II levels with further risk stratification for differentiation of risk groups; instrumental diagnosis — MRI with hepatospecific contrast (gadoxetic acid). The data was processed using Statistica and StatTech statistical packages. The normal distribution was evaluated using the Shapiro — Wilk and Kolmogorov — Smirnov criteria. The results are described by averages, standard deviations, median, and quartiles.

Results. A total of 746 patients took part in the risk-oriented early diagnosis program; hepatocellular cancer was detected in 14 patients, with 50 % of cases occurring at early stages (I–II), indicating the high sensitivity of the chosen approach. The detection rate of malignant tumors during the conducted measures was 1.88 %. The pilot screening project influenced the unification of specialists into a multidisciplinary team, which in turn contributed to an increase in the number of surgical methods for treating hepatocellular carcinoma by 16.5 % and the number of liver biopsies by 33.2 %.

Conclusions. The introduction of a risk-based approach for a high-risk group using more sensitive diagnostic methods helps to increase the proportion of early stages and timely initiation of specialized treatment. The GAAD calculator is an effective method for identifying a high-risk group for hepatocellular carcinoma, where the use of MRI is justified as a sensitive method for early diagnosis of liver cancer.

Aim: to analyze both consultative and current diagnostic biopsy materials to determine the diagnostic value of ileal biopsies and the possible spectrum of morphological changes observed in patients with suspected Crohn’s disease.  

Materials and methods. We analyzed the results of ileal biopsy examinations (n = 202) received at the centralized pathological anatomy department of the Clinical Center of Sechenov University from 2022 to 2024, performed both for current diagnostics and for consultations on pre-prepared histological slides. During this period, 568 ileal biopsies from 154 patients were examined, and an additional 200 pre-prepared histological slides from 48 consultative patients were reviewed.

Results. Among the examined ileal biopsies, a histological variant of normal tissue was confirmed in 97 patients, focal active ileitis was identified in 42 cases, and chronic active ileitis — in 63 cases. Chronic active ileitis with morphological changes highly suspicious for Crohn’s disease was found in 47 (23 %) cases. These findings suggest that the likelihood of diagnosing Crohn’s disease based on ileal biopsy results remains low.

Conclusions. Diagnosing chronic ileitis requires pathologists to identify reliable signs of chronicity. In addition to structural remodeling and plasma cell infiltration, which are not always easily recognizable in unoriented biopsies and have poor interobserver reproducibility, key indicators include pseudopyloric metaplasia, hypersecretion, microgranulomas, and epithelioid granulomas. The identification of these changes strongly supports the diagnosis of regional ileitis in Crohn’s disease. However, the final interpretation of these findings must be made in the context of clinical information and corroborative imaging data.

Aim: to improve treatment outcomes in patients with grade 2–3 hemorrhoids.

Materials and methods. Currently 91 patients with grade 2–3 hemorrhoids who met the inclusion criteria are enrolled in a single-center prospective randomized study. Of these, 48 patients underwent transdermal laser submucosal destruction of internal hemorrhoidal nodes using a water-absorbing laser with a wavelength of 1940 nm according to our proposed technique. Forty-three patients underwent sclerotherapy of internal hemorrhoidal nodes using the traditional method (injections of 3 % polidocanol (Aethoxysklerol®, Kreussler Pharma) into three internal hemorrhoidal nodes in a single session). Due to intraoperative bleeding, one patient was excluded from the laser group and underwent hemorrhoidectomy. The primary endpoints of the study were the absence of cavernous tissue in internal hemorrhoidal nodes one month after surgery and the frequency of disease recurrence 6–12 months postoperatively. The effectiveness of the technique was assessed using anoscopy and rectal ultrasound with spectral Doppler imaging at 1, 3, 6, and 12 months after surgery. During the same periods, quality of life and severity of hemorrhoidal symptoms were evaluated using the SF-36 scale and a clinical symptom scoring system. In the first 7 days after surgery, pain intensity was assessed using the Visual Analog Scale (VAS). To evaluate the potential impact of these minimally invasive techniques on rectal sphincter function, sphincterometry was performed in all patients before and one month after surgery. Intraand postoperative complications, as well as recurrence rates, were recorded over a 12-month follow-up period in both groups.

Results. In the group of transdermal laser submucosal destruction, the pain intensity on postoperative day 7 was 0 points on the VAS in 28 patients (59.6 %), while in the sclerotherapy group, this was observed in 31 (72.1 %) patients. Intraoperative complications occurred only in the main group: 1 (2.1 %) patient experienced bleeding, and 4 (8.5 %) patients developed submucosal hematomas. In the early postoperative period, thrombosis of external hemorrhoidal nodes occurred in 3 (6.4 %) patients in the main group and in 1 (2.3 %) patient in the control group. On days 5–7 after the procedure, mucosal ulceration at the site of the internal hemorrhoidal node was observed in one patient from each group; both cases were managed conservatively. Internal hemorrhoidal nodes, which had been identified prior to the intervention, were no longer visualized one month after treatment in 45 (95.7 %) patients in the main group and 36 (83.7 %) patients in the control group, as confirmed by both anoscopy and transrectal ultrasonography. This effect persisted consistently at 3, 6, and 12 months postoperatively. Spectral wave Doppler imaging demonstrated a sustained reduction in blood flow through the terminal branches of the superior rectal artery by a factor of 4 in the main group and by a factor of 3 in the control group up to 12 months post-intervention. Sphincterometric evaluation revealed no significant changes in anorectal sphincter function compared to preoperative values. At 6 months postoperatively, 1 (2.3 %) patient in the control group was diagnosed with recurrent hemorrhoidal disease. Analysis indicated that the recurrence was associated with an insufficient volume of the sclerosing agent administered.

Conclusion. The preliminary results of the study demonstrate higher efficacy of laser submucosal destruction compared to sclerotherapy in the treatment of grade 2–3 hemorrhoids. During the 12-month follow-up period, no cases of recurrence of hemorrhoidal symptoms were observed in the laser group, whereas 1 (2.3 %) case of recurrence occurred in the sclerotherapy group six months after the procedure. However, it should be noted that laser destruction is a more invasive technique compared to sclerotherapy, as evidenced by a higher incidence of intraand postoperative complications and the requirement for anesthesia during the procedure.

Aim: to present current information on serological screening approaches for precancerous gastric diseases and early gastric cancer.

Key points. Gastric cancer is one of the most common malignant tumors. Advanced stage of the tumor at the time of diagnosis determines an unfavorable prognosis in a significant proportion of patients. A real strategy for reducing both the incidence of gastric cancer and mortality rate is the introduction of cost-effective screening methods for atrophic gastritis associated with Helicobacter pylori (H. pylori) as a precancerous condition of the stomach. As an alternative to endoscopic examination of the stomach, approaches based on the evaluation of serological markers associated with H. pylori infection and reflecting the state of the gastric mucosa are currently proposed for laboratory screening: serum levels of antibodies to H. pylori, pepsinogen I, pepsinogen II and gastrin 17. Tests combining these markers, GastroPanel®, ABC and New ABC methods, as well as some of their modifications, are currently being widely studied as a tool for atrophic gastritis or gastric cancer risk group selection for further endoscopic examination.

Conclusion. An ensemble of serological markers, pepsinogen I, pepsinogen II, gastrin 17, and antibodies to H. pylori, allows for identifying atrophic gastritis with relatively high reliability, and considering additional factors, a high-risk group for the presence of gastric cancer. To achieve optimal medical and economic efficiency, it is necessary to improve the criteria for interpreting test results and including subjects in screening programs.

This article presents three rare clinical cases of prostate cancer metastasis to the mesosigmoid lymph nodes in patients with primary multiple prostate and sigmoid colon cancer. We were able to find descriptions of only three similar cases in international literature. In all cases, the source of metastasis was confirmed by immunohistochemistry: expression of prostate biomarkers and the absence of expression of intestinal adenocarcinoma markers were detected. Furthermore, we describe a case of the so-called “collision phenomenon” in one of the lymph nodes. The detection of prostate cancer metastases to the mesocolic region demonstrates the interconnection between the lymphatic collectors of the colon and the prostate gland. Therefore, it is important to conduct a thorough pathological examination of the surgical specimen, and in ambiguous cases, immunohistochemistry is indicated for accurate diagnosis and treatment planning. Further studies are needed to investigate the relationship between lymphatic drainage pathways from the prostate and distal colon.

Aim: to demonstrate the directions of differential diagnosis of diarrheal syndrome in a polymorbid patient.

Key points. Diarrhea is one of the most common syndromes found in the practice of a clinician. Known pathophysiological mechanisms of diarrhea more often cover diseases that are familiar for diagnosis by gastroenterologists and infectious diseases specialists. Severe thyroid dysfunction can manifest itself as diarrhea syndrome. This article presents a clinical case of a 67-year-old male patient with severe amiodarone-induced thyrotoxicosis type 2 (with the development of thyrotoxic protein-losing enteropathy and thyrotoxic heart). The first-line drug of pharmacotherapy for this condition, prednisolone, had a timely positive effect. The patient is currently under the supervision of an endocrinologist and a cardiologist.

Conclusion. The presented clinical case shows the need to include thyrotoxicosis in the differential diagnostic search for the causes of diarrhea syndrome in an elderly patient, recalls the need to control the level of thyroid hormones and adjust the dose of amiodarone, considering polymorbidity and possible drug interactions.