Recent years have seen an increase in the number of patients with malignant tumours of the liver. In this context, new treatment methods are being actively introduced into practice, one of which is liver radioembolization utilizing microspheres embedded with yttrium-90 (⁹⁰Y).

Aim. To review literature data on the history of radioembolization and its application for liver tumours.

Key findings. Annually, over 200 thousand patients with inoperable primary liver cancer and over 270 thousand patients with inoperable metastatic liver cancer are registered globally, for whom radioembolization is considered as the most suitable treatment method. ⁹⁰Y is a pure beta emitter without its own gamma line, which is characterized by a small average particle path in the tissue of 2.5 mm (the maximum level is 11 mm), a maximum beta particle energy of 2.27 MeV (average energy of 0.937 MeV) and a half-life of 64.1 hours. Clinical research into microspheres containing ⁹⁰Y has been actively conducted since 1977 all over the world. However, it was only in 2004 that the US FDA authorized the clinical use of glass microspheres containing ⁹⁰Y for the treatment of hepatocellular cancer and liver colorectal cancer metastases. Until recently, radioembolization has not been applied in Russia. In 2018, the joint efforts of the A. Tsyb Medical Radiological Research Centre (MRRC) — branch of the National Medical Research Radiological Centre and BEBIG LLC resulted in the production of Russian microspheres containing yttrium-90, which were subsequently introduced into routine clinical practice. The first liver embolization in Russia using microspheres containing domestic yttrium-90 (BEBIG LLC) to a patient with hepatocellular cancer was carried out by V.V. Kucherov and A.P. Petrosyan at the A. Tsyb RMMC on April, 25 in 2019.

Conclusion. The production of microspheres containing ⁹⁰Y in Russia, as well as a technical improvement of the procedure, will facilitate the introduction of liver radioembolization into the routine management of patients with malignant liver tumours.

Aim. To review data on the efficiency and safety of using Ustekinumab in patients with Crohn’s disease.

Key findings. Ustekinumab is a fully human monoclonal antibody of the IgG1k class to the p40 subunit of IL-12 and IL-23. The drug interrupts the cascade of humoral and cellular reactions leading to transmural inflammation of the intestinal wall by blocking the interaction of the p40 subunit with the IL-12Rβ1 chain on the surface of T-lymphocytes and NK cells. A number of placebo-controlled studies have demonstrated the effectiveness of Ustekinumab in the induction and the maintenance of remission in those patients with Crohn’s disease who showed no response to conventional therapy (glucocorticosteroids and immunosuppressants) and therapy with TNF-α antagonists. In addition, the efficiency of Ustekinumab in maintaining a clinical response and clinical remission over two years of therapy has been shown. The drug has a favourable safety profile and a low immunogenicity.

Conclusion. The reviewed studies show Ustekinumab to be an effective and safe drug for the induction and the maintenance of clinical remission in patients with Crohn’s disease.

Background. Acute pancreatitis is considered to be an important issue in modern medicine. The phosphatidylethanolamine-N-methyltransferase enzyme plays a significant role in the regulation of lipid metabolism by catalyzing the process of methylation of phosphatidylethanolamine to phosphatidylcholine. These lipids are key components of mitochondrial and cell membranes, providing their fluid and plastic properties and participating in the transport of fats, fatty acids and cholesterol. Along with its function in the synthesis of phosphatidylcholine, the methylation of phosphatidylethanolamine promotes the turnover of S-adenosylmethionine for the synthesis of cysteine and glutathione through transulphurisation. PEMT is a gene encoding the phosphatidylethanolamine-N-methyltransferase enzyme.

Aim. To determine the role of PEMT C/T rs12449964 polymorphism in the risk of developing acute pancreatitis and its complications among Russian residents in Central Russia.

Materials and methods. Whole blood samples were collected from 502 unrelated patients with acute non-biliary pancreatitis (97 women and 405 men) of Russian nationality who had been admitted to the surgical departments of the city of Kursk from 2015 to 2018, as well as from 513 unrelated individuals of Russian nationality without gastrointestinal diseases (101 women and 412 men). The average age of patients and healthy individuals was 48.9 ± 13.1 and 47.89 ± 12.1 years, respectively. Genomic DNA was isolated by a standard phenol-chloroform extraction method. Genotyping of rs12449964 polymorphism was performed using real-time PCR by allelic discrimination using a CFX96 Bio-Rad Laboratories amplifier (USA) with TaqMan probes and commercial TaqMan SNP Genotyping Assays reagents purchased from Applied Biosystems (USA).

Results. The study has shown that the frequency of the C allele and the C/C PEMT C/T rs12449964 genotype was higher in the group of patients with acute pancreatitis, while the C/T genotype was predominant in the control group. C/T — T/T genotypes demonstrated a protective effect on the development of infected pancreatic necrosis, purulent necrotic peripancreatitis and severe acute pancreatitis.

Conclusions. The disruption of phosphatidylethanolamine methylation processes increases the sensitivity of cells to oxidative stress, which can lead to the development of acute pancreatitis.

Aim. To study the contribution of biliary sludge (BS) to the development of chronic pancreatitis in patients with gallbladder sludge and verified chronic pancreatitis; to evaluate the clinical efficacy and safety of hymecromone therapy according to clinical and laboratory signs, as well as dynamics of gallbladder size and contractility.

Materials and methods. An open single-centre clinical trial included 30 patients with chronic pancreatitis (CP), which was diagnosed according to the Cambridge criteria. All patients received hymocromone (Odeston®) 400 mg tid for 3 weeks. An analysis of the efficacy and safety of the studied drug was performed on the 21st day of treatment based on the results of laboratory tests, abdominal ultrasound, cholecystography and endosonography of the pancreatobiliary zone, quality-of-life assessment according to the SF-36 questionnaire, the frequency and severity of adverse effects (AE).

Results. CP signs were found in 6.3 % of patients with gallbladder BS. CP was significantly more frequent in patients with putty-like bile (33.3 %, χ2 = 38.21, p < 0.00001). The area of the major duodenal papilla (MDP) was below normal in 78% of patients. According to factor analysis, monotherapy with hymocromone resulted in a decrease in abdominal pain, nausea, heaviness in the abdomen and bloating. By the end of the therapy, the quality of life according to the “BP” bodily pain scale of the SF-36 questionnaire significantly increased.

Conclusions. Biliary sludge (including undiagnosed forms during routine examination) was found to be a factor in the development of CP. The medical correction of biliary disorders in CP should include selective antispasmodics. Hymecromone therapy demonstrates a good level of tolerability and safety, normalizes the motor function of the biliary tract and sphincter tone over a short period of time, and relieves CP symptoms.

Aim. To evaluate the efficacy of transarterial chemoembolization in patients with metastases of colorectal cancer in the liver.

Materials and methods. A study aimed at investigating the effect of selective transarterial chemoembolization (TACE) of the hepatic artery on liver metastases in colorectal cancer was conducted at the Oncology Centre of the RZhD Central Clinical Hospital No. 2 named after N.A. Semashko, Moscow. The research basis included data for 10 patients, who had undergone chemoembolization of the hepatic arteries using Biosphere microspheres 50– 100 µm — 25 mg and doxorubicin 50 mg.

Results. Both immediate and long-term results of up to 12 months were evaluated using the RECIST 1.1 scale. A partial response was achieved after 4 TACE treatments in 22.2 % of cases. The stabilization of the oncological process in the liver was observed after 9 TACE treatments in 50 % of cases. Disease progression was noted after 5 procedures in 27.8 % of cases.

Conclusions. Transarterial chemoembolization of metastatic liver lesions in patients with colorectal cancer can be used according to certain indications in specialized centres providing endovascular treatment services.

Aim. To review available literature data on the relationship between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS).

Key findings. Current publications on IBD and IBS present different viewpoints on their relationship. Thus, researchers have noted a high incidence of IBD against the background of IBS, frequent persistence of IBS-like symptoms after achieving IBD remission, as well as the possibility of overlapping the diseases. According to literature data, IBD and IBS should be treated as different forms of the same disease. An opinion is expressed that IBS-like complaints in patients with IBD remission should be considered as a separate disease referred to as “irritated inflammatory intestinal syndrome”. Treatment of IBS-like symptoms in patients with IBD remission has thus far not been developed.

Conclusion. The problem of the relationship between IBD and IBS is currently controversial, thus requiring further clarification.

Aim. To present a rare clinical observation of invagination of the adductor loop of the small intestine into the lumen of the gastric stump after pancreatoduodenal resection. Results. A 69-year-old patient complained of paroxysmal abdominal pain, nausea, vomiting without relief. The patient also reported an episode of black stools 7 years after pancreatoduodenal resection for pancreatic head cancer and 3 years after reconstructive surgery by performing choledochoenteroanastomosis. The invagination of the adductor loop of the small intestine into the lumen of the gastric stump was identified. The mobilization and resection of a fragment of the jejunum with an invagination zone was performed followed by suturing of the distal end of the intestine. Conclusions. Small bowel invagination after abdominal surgery occurs in 1–5% of cases. This case of invagination of the blind end of the adductor loop into the gastric stump through gastroenteroanastomosis caused an acute adductor loop syndrome in the patient. No similar cases have been reported in Russian and foreign publications.

Aim. The present guidelines intended for primary care physicians are aimed at facilitating early diagnosis of malignant tumours of the digestive system, which can significantly improve the immediate and long-term results of their treatment.

General provisions. The guidelines comprise sections devoted to esophageal adenocarcinoma, esophageal squamous cell carcinoma, gastric cancer, colorectal cancer, hepatocellular carcinoma and extrahepatic bile duct and gall bladder cancer, as well as pancreatic cancer. Each section contains information on risk factors and precancerous diseases, which allows a physician to identify whether a particular patient falls into the risk group of digestive system neoplasms. It is shown how digestive system cancers can be suspected on the basis of patients’ complaints and past medical history, as well as data obtained both from a direct examination and laboratory instrumental studies. Each section offers practical algorithms in cases of suspected esophageal adenocarcinoma, esophageal squamous cell carcinoma, gastric cancer, colorectal cancer, hepatocellular carcinoma and extrahepatic bile duct and gallbladder cancer, as well as pancreatic cancer.

Conclusion. The knowledge of clinical manifestations and risk factors in the development of digestive system neoplasms allows a physician to suspect cancer and devise a timely and adequate diagnostic strategy, including laboratory and instrumental studies at specialised clinical centres.