Aim: to characterize the incidence, clinical features, pathophysiological mechanisms, diagnosis and treatment of patients with idiopathic gastroparesis.

Material and methods. The search for sources was carried out in publicly available databases of peer-reviewed scientific literature RSCI, CyberLeninka, PubMed/MEDLINE, Google Scholar in 1990–2025 using the keywords  “idiopathic gastroparesis”, “symptoms”, “pathophysiology”, “diagnosis”, “treatment”, “consensus”.

Results. The Consensus of the United European Gastroenterology and European Society for Neurogastroenterology and Motility on gastroparesis (2021) and the Rome Foundation and International Neurogastroenterology and Motility Societies Consensus on idiopathic gastroparesis (2025) define idiopathic gastroparesis (gastroparesis of unknown etiology) as symptoms of nausea and vomiting, often accompanied by postprandial fullness and early satiety, associated with delayed gastric emptying in the absence of mechanical obstruction. According to expert estimates, the incidence of gastroparesis in the USA is 0.16–4 %. Among the possible pathophysiological mechanisms of idiopathic gastroparesis (dysfunction of n. vagus and smooth muscle cells, loss of interstitial cells of Cajal, nNOS, macrophages, expressing heme oxygenase-1, abnormalities of syncytium of PDGFRα⁺-cells, etc.), autonomic neuropathy with loss of enteric nerves is the most proven. In the diagnosis of idiopathic gastroparesis, 4-hour scintigraphy and 13C breath test are preferred. Consensus recommendations for the idiopathic gastroparesis treatment: nutritional support, from the spectrum of pharmacological and surgical interventions, prokinetics and antiemetics are potentially useful. However, the results of treatment often do not adequately address clinical needs.

Conclusion. Large-scale prospective studies of alternative approaches to diagnosis and to individualized methods of idiopathic gastroparesis treatment are needed.

Aim. Acute-on-chronic liver failure (ACLF) is the most severe form of acute decompensation with intense systemic inflammation and immune dysfunction. IL-4 polarizes macrophages toward the M2 phenotype. CD206 can identify inflammatory peritoneal macrophages in cirrhotic patients and could be linked to prognosis in ACLF. We investigated the predictive value of serum IL-4 and ascitic soluble CD206 in patients with acute decompensation and ACLF and their relation to morbidity and early mortality.

Materials and methods. We included 60 patients with ACLF and acute decompensation as well as 30 cirrhotic controls. Clinical data were collected, and survival was followed for 1 and 3 months. Blood samples were analyzed at admission for liver and renal function tests as well as serum IL-4 and ascitic soluble CD206 levels. Correlation with liver function indicators and prognosis was assessed.

Results. IL-4 and CD206 were significantly higher in acute decompensation and ACLF patients compared to control and were positively correlated with each other’s Child — Pugh score, MELD-Na, and ACLF severity scores. Multivariate regression showed that baseline Child — Pugh score, ascitic soluble CD206, and serum IL-4 level are the only independent predictors of 1-month as well as 3-month mortality.

Conclusion. Serum IL-4 and ascitic soluble CD206 (macrophage markers) could predict early mortality in acute decompensation and ACLF. Incorporation of these markers into the traditional liver disease scores can improve their prognostic/predictive performance.

Aim: to investigate the interrelationships between the severity of clinical symptoms, features of tryptophan metabolism, gut microbiota composition, quality of life, psychoemotional and cognitive status in female patients with functional constipation (FC), and to assess the ability of prucalopride as monotherapy and in combination with a multistrain probiotic to influence these parameters.

Materials and methods. The study included 70 female patients with FC, who were randomized into two equal groups: patients of Group FC-P received prucalopride at a dose of 2 mg daily for 8 weeks, and patients of Group  FC-PP received prucalopride at a similar dose together with a multi-strain probiotic (Bifidobacterium bifidum, Bifidobacterium longum, Bifidobacterium infantis, Lactobacillus rhamnosus, not less than 1×10⁹ CFU of each strain per capsule), 1 capsule 3 times a day for 8 weeks. At baseline, as well as after 2, 4, and 8 weeks, the groups were assessed for the number of defecations per week, stool form (Bristol Stool Scale, BSS), severity of abdominal bloating and abdominal pain against the background of bloating (Visual Analog Scale, VAS), as well as the presence

of the need for additional straining, sensation of incomplete and difficult defecation. Before and after treatment, all subjects were assessed for levels of interleukin-1β, cortisol, brain-derived neurotrophic factor, tryptophan, kynurenine, kynurenic acid, serum and platelet serotonin, psychoemotional status (Spielberger — Hanin test, STAI), Hamilton Depression Rating Scale (HDRS), Four-Dimensional Symptom Questionnaire (4DSQ)), cognitive status (Brief Assessment of Cognition in Schizophrenia, BACS), quality of life (SF-36), and gut microbiota composition in stool samples (16S rRNA sequencing).

Results. The study was completed by 34 patients in Group FC-P and 30 patients in Group FC-PP. Abdominal bloating directly correlated with the severity of somatization (r = 0.25; p < 0.005) and inversely — with cortisol levels (r = –0.29; p < 0.05). The severity of abdominal pain directly correlated with the levels of state and trait anxiety (STAI), distress, anxiety, and somatization (4DSQ) (r = 0.32, p < 0.05; r = 0.28, p < 0.05; r = 0.31, p < 0.05; r = 0.26, p < 0.05; r = 0.35, p < 0.005, respectively) and inversely — with the indicators of vitality, emotional role functioning, and mental health (SF-36) (r = –0.28, p < 0.05; r = –0.32, p < 0.01; r = –0.30, p < 0.05, respectively). Stool form type inversely correlated with the level of kynurenine (r = –0.27; p < 0.05) and kynurenic acid (r = –0.26; p < 0.05). The sensation of incomplete evacuation correlated with the severity of depression according to HDRS (r = 0.27, p < 0.05) and state anxiety (r = 0.25; p < 0.05), while the sensation of difficult evacuation directly correlated with the level of interleukin-1β (r = 0.25; p < 0.05) and distress (r = 0.27; p < 0.05) and inversely with the ratio of plasma serotonin to kynurenine  (r = –0.27; p < 0.05). The number of defecations per week and the presence of the need for additional straining did not show statistically significant correlations with any of the variables. The age of the subjects, duration of the disease, and cognitive indicators did not demonstrate a reliable correlation with the severity of FC symptoms. When assessing the gut microbiota composition, various correlations with FC symptoms were identified, the most significant of which was a direct correlation between the level of bacteria from the Ruminococcaceae family and the severity of abdominal bloating (r = 0.39; p < 0.05). After randomization, the formed groups did not differ significantly in the assessed clinical, laboratory, and psychometric parameters, quality of life, age, and disease duration (p > 0.05). During treatment, both groups showed significant improvement in all clinical parameters; however, Group FC-P showed a more pronounced reduction in abdominal pain (p < 0.005) and sensation of incomplete evacuation (p < 0.05). Only in Group FC-P was a significant improvement in cognitive function observed, with the total score and the results of the BACS subtests “Semantic and Phonemic Verbal Fluency”, “Digit Sequencing”, and “Tower of London” being significantly higher than in Group FC-PP (p < 0.0001, p < 0.05, p < 0.05, and p < 0.0001, respectively). Quality of life, on the contrary, was significantly higher in Group FC-PP due to the indicators “Vitality” (p < 0.05), “Emotional Role Functioning” (p < 0.001), and “Mental Health” (p < 0.05). A key difference in gut microbiota composition between the groups at the end of treatment was a change in the abundance of representatives of the order Lactobacillales, specifically the family Streptococcaceae, which increased in Group FC-P and decreased in Group FC-PP (p < 0.05). In Group FC-PP, the number of representatives of the Ruminococcaceae family (p < 0.05) and other bacteria capable of synthesizing short-chain fatty acids also increased significantly. No adverse events during therapy were reported in either group throughout the entire observation period.

Conclusion. Disruption of the components of the “microbiota — gut — brain” axis in FC is closely associated with the symptoms of the disease. The efficacy of prucalopride as monotherapy and in combination with a multistrain probiotic regarding the symptoms of FC develops through influence on components of the “microbiota — gut — brain” axis not directly related to the pathogenesis of FC, while these approaches have divergent effects on cognitive function, quality of life, and the abundance of individual representatives of the phylum Firmicutes (Bacillota).

Aim: to assess the interim results of a prospective multicenter randomized study comparing laser destruction in combination with pit-picking and excision with Bascom II flap reconstruction in the treatment of pilonidal sinus.

Materials and methods. Patient recruitment was conducted from November 2022 to April 2024. The study included 62 patients (31 patients in each group): the first group underwent surgical excision of pilonidal cyst with Bascom II flap reconstruction, while the second group underwent laser destruction (LD) in combination with pit-picking. An interim analysis of the results was performed after half of the sample size was reached. The primary endpoint of the study was incidence of disease recurrence after surgical treatment. Secondary endpoints were: the severity of pain on days 1, 3, 5, 7, 10, 14, and 21 of the postoperative period; the quality of life of patients before surgery and 1, 3, and 6 months after surgery according to the SF-12 questionnaire (The 12-Item Short Form Survey); the frequency and nature of intraoperative complications; the frequency and nature of postoperative complications; complete postoperative wound healing, defined as full epithelialization and scar formation.

Results. Both groups were comparable in terms of gender, age, and body mass index. Surgery duration and blood loss were statistically significantly lower in the LD + pit-picking group (p < 0.001). The number of postoperative bed days was statistically significantly higher in the Bascom II group (p < 0.01). The visual analogue scale scores were statistically significantly higher in the Bascom II group on days 1–10 after surgery (p < 0.05). Postoperative wound healing with complete epithelialization occurred statistically significantly faster in the Bascom II group compared to the LD + pit-picking group — in 24 (16–33) and 35 (28–45) days, respectively (p = 0.002). The number of visits was statistically significantly lower in the Bascom II group (p < 0.001). Patients returned to daily physical activity after 14 (11–16) and 4 (3–4) days in the Bascom II and LD + pit-picking groups, respectively (p < 0.001). According  to SF-12, one month after surgery, the LD + pit-picking group showed better results in physical and mental health indicators (p < 0.001). Six months after surgery, the Bascom II group showed better results in both indicators (p < 0.001). The recurrence rate requiring repeat surgery was higher in the LD + pit-picking group — 0 vs. 5 (16.1 %) cases in the Bascom II group (p = 0.053).

Conclusions. Laser destruction combined with pit-picking demonstrates advantages in the form of a lower rate of early postoperative complications and faster recovery of physical activity in patients. However, this method is associated with prolonged outpatient follow-up and a higher recurrence rate compared to the Bascom II flap reconstruction.

Aim: to present a clinical case of celiac disease with intestinal and extraintestinal manifestations, as well as demonstrate the possibilities of endoscopic diagnosis in assessing the mucosal recovery of the small intestine on a gluten-free diet.

Key points. Celiac disease is a genetically determined disease of the small intestine with a wide range of intestinal and extraintestinal clinical manifestations associated with gluten intake. The main treatment strategy for this disease is strict adherence to a gluten-free diet. The therapeutic goal of a gluten-free diet is to achieve healing of the small intestinal mucosa, which occurs slowly and, according to research, is recorded in only a third of patients. Celiac disease was revealed during esophagogastroduodenoscopy in 30-year-old female patient with symptoms of dyspepsia, anemia and suspected localized scleroderma, morphologically confirmed total atrophy of Marsh 3C villi, and received serological verification of the diagnosis. Two and a half years later complete mucosal recovery was detected on strict gluten-free diet.

Conclusions. Achieving and controlling remission of celiac disease has important role in the treatment strategy of patients. The gluten-free diet has demonstrated successful results within the expected timeframe. Today, modern endoscopic technologies and use of prognostic classifications of the severity of atrophy have great diagnostic value in assessing the mucosal recovery of small intestine.

Aim: to present a clinical case of a patient with sacroiliitis preceding the development of the typical clinical picture of Crohn’s disease with colonic involvement.

Key points. Patient K., 39 years old, was admitted to the clinic with complaints of pain in the sacral area lasting for 13 years, which was later joined by pain in the left iliac region, unstable stool (alternating diarrhea and constipation), hematochezia. Examination revealed signs of Crohn’s disease with colonic involvement and bilateral sacroiliitis. Therapy with adalimumab was initiated with a good clinical effect. Follow-up examination achieved endoscopic remission of the disease; however, residual MRI signs of bilateral sacroiliitis persist.

Conclusion. This clinical case describes the outcome of adalimumab therapy in a patient with colonic Crohn’s disease, whose initial manifestation was the development of sacroiliitis. Adalimumab is well-established as an effective treatment for both Crohn’s disease and sacroiliitis, including when they occur concomitantly. 

Aim. The clinical guidelines are intended to provide information support for making decisions by gastroenterologists, general practitioners and internists that will improve the quality of medical care for patients with drug-induced liver injury, taking into account the latest clinical data and principles of evidence-based medicine.

Key points. Clinical guidelines contain information about current views on etiology, risk factors and pathogenesis of drug-induced liver injury, peculiarities of its clinical course. Also, the recommendations provide information on current methods of laboratory and instrumental diagnostics, invasive and non-invasive tools for drug-induced liver injury disease and its clinical phenotypes assessment; approaches to its treatment, considering the presence of comorbidities, features of dispensary monitoring and prophylaxis. The information is illustrated with algorithms of differential diagnosis and physician’s actions. In addition, there is information for the patient and criteria for assessing the quality of medical care.

Conclusion. Awareness of specialists in the issues of diagnosis, treatment and follow-up of patients with drug- induced liver injury contributes to the timely diagnosis and initiation of treatment, which in the long term will significantly affect their prognosis and quality of life.