Aim. The present article examines key methods of microbiota correction (antibiotic therapy; pro-, pre- and metabiotic therapy; faecal microbiota transplantation) used in treating inflammatory bowel disease, as well as compares the clinical trial results of these methods.

Key findings. Inflammatory bowel disease (IBD) is an umbrella term used to describe a group of chronic diseases of unknown aetiology. In the past, bacteriological methods based on the isolation of a pure bacterial culture were used to determine the microbiota composition. However, such methods did not provide complete information on the microbiota composition. In recent years, preference has been given to more accurate and faster molecular genetic methods allowing a more detailed study of the key mechanisms by which microbiota affects the intestine in Crohn’s disease (CD) and ulcerative colitis (UC), as well as of the effect of microbial metabolites on their pathogenesis. The article provides an overview of main microbiota metabolites and their role in regulating the intestinal barrier func

tion. One of the current issues consists in the development of personalised approaches to therapy and remission maintenance in IBD, including via methods for correcting the microbial composition: probiotic, prebiotic and metabiotic therapy, as well as faecal microbiota transplantation.

Conclusion. The use of probiotics, prebiotics, and metabiotics can enhance the effectiveness of therapeutic regimens and significantly improve the quality of life of patients with chronic IBD. The use of antibiotics and faecal microbiota transplantation in treating IBD is the subject of extensive discussion and debate. The safety of these methods has not been confirmed so far; therefore, it is vital to continue studying their influence on the clinical condition of patients.

The risk of thrombotic complications is known to be 3 times higher in patients with inflammatory bowel disease (IBD) than in healthy individuals, with the relative risk being 15 times higher during the periods of relapses.

Aim. To study and generalize literature data available on the prevention and treatment of IBD thrombotic complications.

Key findings. In the сonditions under study, the presence of chronic inflammation and increased bleeding of the intestinal wall is shown to activate the coagulation system, impair the fibrinolysis system and reduce the activity of natural anticoagulation mechanisms. The concentration of fibrinogen — a protein of the acute inflammation phase — increases significantly. This results in an imbalance of the blood coagulation system with a tendency to hypercoagulation, which significantly increases the risk of thrombotic complications and the disseminated intravascular coagulation syndrome. In turn, the activation of the coagulation cascade may trigger the inflammatory response, which eventually leads to the formation of a vicious circle between chronic inflammation and thrombosis. The pathogenesis of thrombosis in inflammatory colon diseases is a multifactor process, which remains to be understood.Conclusion.The management of patients with IBD in combination with thromboembolic complications requires an individual multidisciplinary approach. Taking into account the pathogenetic factors, the following options are possible in the prevention and treatment of thrombotic complications in IBD: strengthening the basic therapy of the primary disease; administration of prophylactic doses of anticoagulants under dynamic continuous laboratory control in the acute period using the methods of conservative therapy of thrombotic complications (elastic compression of the lower extremities) in the period of exacerbation of the primary disease.

Aim. To analyse and generalize available literature data on the problem of colorectal anastomotic leakage after rectal resection.

Key findings. Over the last decade, there has been an increasing trend towards sphincter-preserving operations in modern colorectal surgery. The widespread use of suturing devices of various diameters allows the formation of ultra-low anastomoses (at the level of the pelvic floor). One of the menacing complications after rectal resection is anastomotic leakage, which frequency can reach 21%. The mortality from anastomotic leakage can reach 40%. The analysed literature sources discuss a variety of risk factors, both preoperative and intraoperative, affecting the healing of the inter-intestinal anastomosis. In almost all studies, the height of the tumour and the anastomosis from the anus, preoperative radiotherapy and male sex are independent risk factors for the development of colorectal anastomotic leakage. Concerning other factors, there are conflicting opinions. The timely use of preventive measures and early diagnosis of colorectal anastomotic leakage can reduce the number and severity of postoperative complications.

Conclusion. Individual consideration of risk factors and their adequate assessment in terms of possible complications are decisive in the choice of the extent of surgical intervention, which will undoubtedly improve the immediate and long-term results of the surgical treatment of colorectal cancer.

Aim. The present articleidentifies possible correlations between new parameters for impedance–pH monitoring, such as mean nocturnal baseline impedance (MNBI); post-reflux swallow-induced peristaltic wave index (PSPW); and the main parameter, acid exposure time (AET), as well as esophageal motor function. The authors set out to assess the values of MNBI and the PSPW index as additional criteria improving the diagnostic efficacy of impedance-pH monitoring, the completeness of clinical phenotyping of gastroesophageal reflux disease (GERD), as well as determining the probability of a more severe disease course.

Materials and methods. A total of 60 patients aged 19 to 71 (mean age 44.7 years) participated in the study: 30 patients with erosive reflux disease (ERD), 30 with non-erosive reflux disease (NERD) and 20 healthy volunteers aged

26 to 65 (mean age 45.2 years). All of them underwent 24-hour combined esophageal impedance–pH monitoring (Gastroscan-IAM, JSC RPE Istok-Sistema, Fryazino) and high-resolution esophageal manometry using a 22-channel water-perfusion catheter (Solar GI MMS, The Netherlands). The authors studied such parameters as AET, GER number, MNBI level, PSPW index, distal contractile integral (DCI), resting pressure in the lower esophageal sphincter (LES), peristaltic break. Statistical processing was performed using Statistica for Windows 10.0 (StatSoft Inc.) and Prism 8 (GraphPad).

Results. The examination of patients revealed that MNBI, the PSPW index and DCI significantly decrease with the development of more severe GERD (r = -0.79; p = 0.0000, r = -0.4; p = 0.0002, r = -0.49; p = 0.0000, respectively). A negative correlation was found between AET and the PSPW index (r = -0.38; p = 0.0003) and the MNBI level (r = -0.59; p = 0.0000). A correlation was determined between the value of MNBI and the following parameters: LES resting pressure (r = 0.26; p = 0.0006), DCI (r = 0.35; p = 0.00004), peristaltic break (r = -0.21; p = 0.007), the PSPW index (r = 0.41; p = 0.0000), and GER number (r = -0.59; p = 0.0). A correlation between the PSPW index and DCI (r = 0.22; p = 0.001) was found as well.

In the group of ERD patients, the median values of PSPW and MNBI constitute 0.23 [0.17; 0.33] and 1.13

[0.63; 1.53], respectively. Also, a correlation between AET and the MNBI level was found in this group of patients (r=-0.53; p=0.000036). In turn, MNBI correlated with LES resting pressure (r = 0.46; p = 0.0004), DCI (r = 0.36; p = 0.005), peristaltic break (r = -0.37; p = 0.004), and GER number (r = -0,42; p = 0,0000).

In the group of NERD patients, the median values of PSPW and MNBI constitute 0.56 [0.51; 0.75] and 3.3 [2.57;

4.8], respectively. A correlation was also found between the MNBI level and AET (r = -0.35; p = 0.005), GER number (r = -0.39; p = 0.00005), as well as between AET and the PSPW index (r = -0.26; p = 0.0000).

In the control group, the median values of PSPW and MNBI constitute 0.42 [0.3; 0.5] and 5.83 [5.21; 6.48], respectively. A statistically significant difference (p = 0.02) was found between the median values of MNBI in patients with ERD, NERD, and the control group. A statistically significant difference (p = 0.0) between the median values of the PSPW index in patients with ERD, NERD and the control group was found as well.

Conclusions. The revealed correlations between AET, esophageal motor function and new parameters for impedance-pH monitoring allow them to be used as additional criteria improving the diagnostic efficacy of impedance-pH monitoring and the completeness of GERD clinical phenotyping. A decrease in the level of these parameters in patients reflects the probability of a more severe disease course.

Aim. In this paper, the authors set out toascertain the prognostic value of the rheumatoid factor for the formation of gastroduodenal erosions and ulcers in patients with rheumatoid arthritis taking non-steroidal anti-inflammatory drugs (meloxicam).

Materials and methods. A prospective, randomized study of 138 patients with rheumatoid arthritis taking methotrexate (12.5 mg per week) and meloxicam — nonsteroidal anti-inflammatory drug — (15 mg per day) was conducted. The formation of gastroduodenal erosions and ulcers was recorded for 4–8 years during esophagogastroduo-denoscopy (at study entry, following three months, then once a year). The groups of seropositive and seronegative patients comprised 69 people each.

Results. During the period of patient monitoring, significant differences were found (P < 0.01) in the frequency of the formation of gastric and duodenal erosions and ulcers in patients with seropositive (79.7 %; 95 % CI: 70.2–89.2 %) and seronegative (4.4 %; 95 % CI: 0.01–9.2 %) rheumatoid arthritis (τ = 0.763; P < 0.01), taking meloxicam. In the course of monitoring patients (for 4–8 years) with rheumatoid arthritis who took meloxicam, the authors established high rates of the prognostic (rheumatoid) factor for predicting the formation of gastric and duodenal erosions and ulcers: forecast sensitivity — 94.8 %, forecast specificity — 82.5 %, the proportion of correct forecasts — 87.7 %.Conclusions. The rheumatoid factor is found to be a significant (P < 0.01) risk factor for gastroduodenal erosions and ulcers in patients with rheumatoid arthritis, who take non-steroidal anti-inflammatory drugs (meloxicam).

Aim. Tostudy the content and profile of short-chain fatty acids (SCFAs) in faeces of patients with bronchial asthma and healthy individuals, as well as to evaluate possible correlations between the SCFA spectrum and clinical phenotype of patients with bronchial asthma.

Materials and methods. 44 patients with asthma and 17 healthy volunteers participated in the study. All participants underwent a generally accepted range of clinical and laboratory studies, as well as functional respiratory tests. The SCFA spectrum was determined using gas-liquid chromatographic analysis. The results of patients with asthma showed a significant decrease in the total fatty acid content in faeces (p <0.001); changes in the absolute concentrations of individual acids, such as acetate (p <0.001), propionate (p <0.001) and butyrate (p <0.001); as well as a change in the total isoacid content (p <0.001). In 83% of the cases, the anaerobic type of the SCFA spectrum was detected. The aerobic type of the SCFA metabolic profile was detected in 17% of the cases. The change in the metabolic profile did not depend on the phenotype of the disease.

Conclusion. Changes in SCFAs indicate pronounced disorders in the microbiocenosis of the intestinal biotope. The values of the anaerobic index in the context of various changes in the acid metabolic profile indicate the disturbance of the microorganism’s habitat, contributing to the growth of anaerobic or aerobic microflora populations.

Oral sulphate solution(OSS: sodium sulphate, potassium sulphate and magnesium sulphate) is a low-volume osmotic agent for cleansing the intestines.

Aim: in a multicentre, prospective, randomized, 3rd phase study with two parallel groups, the effectiveness, safety and tolerability of OSS was evaluated in comparison with Macrogol 4000 with electrolytes (a reference preparation for bowel cleansing in Russia) in adult patients who were scheduled for routine diagnostic colonoscopy.

Methods. This study was conducted in three Russian research centres during the March–December, 2015 period. Men and women over the age of 18 scheduled to undergo routine diagnostic colonoscopy were randomly assigned either to the OSS group or to the Macrogol group with a fractional use mode before the colonoscopy. The colonoscopy researchers were not aware of which preparation had been taken by the patients. Anonymized video records were centrally analysed by three experts. The primary end point was the proportion of patients with a successful bowel preparation for colonoscopy ≥ 6 points, as determined by the Boston Bowel Preparation Scale of quality assessment (BBPS scale).

Results. 296 patients were randomized in the study (147 patients were treated with OSS, 149 patients received Macrogol); 294 participants were included in the Intention to Treat population (ITT-population), and 274 participants were included in the population of patients who completed the study according to the protocol (Per-Protocol; PP-population) (139 patients received OSS, 135 patients received Macrogol). The proportion of patients with a successful bowel preparation (BBPS ≥6 scores) was high in both groups (OSS [PP-population]: 97.2 % (95 % confidence interval [CI] 89.5–99.3), Macrogol [PP-population]: 97.7 % (95 % CI: 90.7–99.4)). The corrected difference between the groups was -0.5 % (95 % CI: -4.2–3.3), thereby demonstrating “no less effective” of OSS as compared to Macrogol. Compliance with the drug use regime was higher in the OSS group than in the Macrogol group (95.7 % versus 82.3 %, respectively, p-value = 0.0011, ITT-population).

The most common symptom reported in patients was nausea (27.9 % in the OSS group and 12.9 % in the Macrogol group). The proportion of patients who developed nausea was significantly higher in the OSS group than in the Macrogol group (25.2 % compared with 10.2 % when taking the first dose of the preparation (p = 0.0008) and 19.7 % compared with 6.8 % when taking the second dose of the preparation (p = 0.0016)). Differences in other symptoms (bloating, abdominal pain or abdominal discomfort) between the groups were not significant, with the severity of symptoms being generally mild. The safety profile of the investigated preparations in patients withinflammatory bowel disease (IBD) in remission did not differ from that in the general patient population.

The differences in terms of secondary endpoints were not identified, including BBPS assessment for different sections of the colon, the level of polyp detection, the duration and completeness of colonoscopy, and the investigator’s satisfaction with the procedure. The analysis by subgroups also did not reveal any significant differences.Conclusion. In this study, the “not less effectiveness” of the sulphate solution was demonstrated as compared to Macrogol in a fractional use mode. Both preparations were well tolerated. Despite the higher incidence of nausea in the OSS group, the patients showed significantly higher compliance with the OSS mode as compared to that of Macrogol.

This study is registered with the ClinicalTrials.gov Registry of Clinical Trials, No. NCT02321462.

Conflict of interest: this study was sponsored by Ipsen Pharma.

Acknowledgements: the authors express their sincere gratitude to all the patients who participated in the study, as well as to specialists having provided medical care for the patients, researchers and employees of the participant research centres.

The authors also express their appreciation to Olga Kapitonova, an employee of the Almedis company (Moscow, Russia) for her assistance in compiling medical texts, which activity was carried out under the financial support of the Ipsen company (Moscow, Russia) in accordance with the Good Publication Practice (GPP).

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.