Aim. To present the materials of an Expert Council, which was held on September 23, 2019 in Istanbul (Turkey) under the auspices of a World Gastroenterology Organisation congress and the support of the Abbott company.
General provisions. During the work of the Expert Council, the role of motility disorders of the stomach and duodenum, intestines, gall bladder and the sphincter of Oddi in the development of functional diseases of the digestive system, such as functional dyspepsia (FD), irritable bowel syndrome (IBS), biliary dyskinesia (BD) was discussed, and the effectiveness of antispasmodics and prokinetics in their treatment was shown. At the same time, the advantages of the mebeverin antispasmodic drug, as well as the high efficiency and safety of the itopride hydrochloride prokinetic drug were noted. It is emphasized that, at the stage of a diagnostic search in the absence of “alarm symptoms” in patients with suspected FD, IBS, and BD, these drugs can be prescribed empirically.
Conclusions. When selecting pharmacotherapy for patients with motor impairment, it is extremely important to consider the nature of these disorders. The use of modern medical preparations, which are characterized by a high level of safety and the targeted action towards a specific motility disorder, allows optimal therapy results to be achieved with minimal risks for the patient.

Aim. To review available information on the use of low-temperature argon plasma in the treatment of postoperative and long-term non-healing wounds.
General findings. Low-temperature argon plasma is an ionised gas, one of the four classical aggregate states of matter. Its therapeutic effect is achieved by means of the gas-dynamic effect, i.e. an argon flow with a high heat content and wide-spectrum recombination radiation — from the vacuum ultraviolet region to the near infrared range, as well as by means of the pronounced catalytic properties of gaseous argon, which is important for a number of biochemical reactions. Low-temperature argon plasma has a pronounced antibacterial effect. In a number of studies, the wound healing effect of low-temperature argon plasma was demonstrated.
Conclusion. The use of low-temperature argon plasma can reduce the time of wound healing, the titre of clinically significant microorganisms and the time spent by patients in hospital. In addition, the use of low-temperature argon plasma can improve patients’ quality of life in the postoperative period.

Aim. To evaluate effects of ursodeoxycholic acid (UDCA) on inflammation, steatosis and liver fibrosis and atherogenesis factors in patients with non-alcoholic fatty liver disease (NAFLD).
Materials and methods. The study included 139 patients with NAFLD who received 15 mg/kg of UDCA (Ursosan®) per day for 24 weeks. Before and after the study, liver function and lipid metabolism, liver steatosis index FLI, intimamedia thickness (IMT) of the carotid arteries were determined. The cardiovascular risk was calculated according to the ASCVD 2013.
Results. The use of UDCA in patients with NAFLD led to a decrease in ALT (p < 0.001), AST (p < 0.001) and GGT (p < 0.001) activity; total cholesterol concentration (p < 0.001); triglycerides (p < 0.001); and LDL (p < 0.001) in the blood and the FLI liver steatosis index (p < 0.001). In addition, the rate of cardiovascular risk (p = 0.022) and IMT (р = 0.048) in women also decreased.
Conclusions. The use of UDCA in NAFLD reduces the activity of inflammatory processes in the liver, its steatosis, and also improves lipid metabolism and exerts potential anti-atherogenic effects. Against the background of UDCA administration, there was no progression of liver fibrosis. None of the participants in the observational programme reached a normal body mass by the end of the program; therefore, the attained positive changes should be attributed directly to the effects of UDCA.

Aim. The evaluation of long-term results of antiviral therapy (AVT) with ombitasvir/paritaprevir/ritonavir and dasabuvir in patients with noncompensated liver cirrhosis (LC) in the outcome of chronic hepatitis C.
Material and methods. A retrospective analysis included the data from patients with subcompensated liver cirrhosis (LC) of HCV etiology (genotype 1b) (7–9 points of the Child-Pugh score) having received interferon-free antiviral therapy (AVT) with ombitasvir/paritaprevir/ritonavir and dasabuvir during 12 weeks from September to December 2015. In total, 66 patients (27 men and 39 women) received such a therapy, the median age was 56.4 years.
Results. 147 weeks (IQR 56–156) following AVT completion, the long-term results were evaluated. At that time, 27 patients were available for observation. The assessment of liver function compensation using the Child-Pugh score showed improvement in 25 (93 %) patients. The assessment of laboratory data revealed a decrease in the median of total bilirubin by 13.6 μmol/l, as well as an increase in the median of serum albumin by 9.7 g/L and the median of platelets by 41,700/μl. Two deaths were reported due to hepatocellular cancer (HCC) and bleeding from esophageal varices. HCC was detected in 8 patients. Two patients underwent liver transplantation.
Conclusion. AVT in patients with LC of HCV etiology is associated with a high frequency of virologic response. Longterm follow-up results indicate a significant improvement of liver function, but also a continuing high risk of developing complications of underlying disease, primarily HCC.

Background. Repeated surgical interventions aimed at the colostomy closure and restoration of intestinal continuity after obstructive resections are traumatic and complex reconstructive operations on the colon. The complications of recovery operations largely feature wound abscesses (30–60 %) and anastomotic leakage (5–23 %), with the mortality levels from these complications reaching 0.4–2.8 %. Pronounced dysbiotic changes, the progression of catarrhal or erosive diversion colitis and proctosigmoiditis are the risk factors for anastomotic leakage and postoperative bowel dysfunction. This determines the need for a therapeutic algorithm of intestine sanitation and the introduction of methods for preventing the anastomotic leakage after obstructive resection of the distal colon (Hartmann’s operation). 
Aim. To evaluate the capability and efficiency of the intraluminal application of rifaximin-α (Alfa Normix® preparation, Alphasigma company) as a sanitising intestinal antiseptic for relieving diversion colitis and prevening postoperative complications of restorative operations after obstructive resection of the colon (Hartmann’s operation).
Material and methods. A prospective comparative controlled study of the results of surgical treatment in 63 patients was conducted. The patients were divided into 2 groups, which were compared using the case-control principle. The operations included the colostomy closure and the restoration of intestinal continuity by applying a colonic anastomosis. In group I (main group, 30 patients), the original “Method of postoperative prevention of colonic anastomotic leakage” (Russian patent No. 2523822) was applied. In the control group (33 patients), routine methods for preventing anastomotic leakage and antibiotic prophylaxis were used. A comparative analysis of the number and severity of purulent-septic complications (taking into account the possibility of their relief), as well as the quality and rate of intestinal dysbiosis relief and the manifestations of diversion proctitis, was carried out.
Results. The main group indicated the best results in terms of the main analysed parameters, fewer complications and anastomotic leakage. Thus, the total number of complications in groups I and II was 16.7 % and 27.3 %, respectively. The proportion of complications associated with the anastomotic leakage, inflammatory changes in this area and impaired patency in groups I and II was 6.7 % and 12.1 %, respectively. Rifaximin-α (Alpha Normix®) intolerance and pathological reactions associated with its use were not observed. The possibility for effective relief of the violations of quantitative and qualitative composition of the microflora in the colon stump was revealed. The main group showed better results in terms of eliminating local manifestations of diversion colitis and anorectal dysfunction compared to group II, where traditional schemes of postoperative therapy were used.
Conclusions. Intraluminal dosed use of the Alpha Normix® suspension with the rifaximin concentration of 100 mg per 5 ml is an effective method of postoperative prevention of purulent-septic complications associated with anastomotic leakage during reconstructive operations on the distal colon. The introduction of Alpha Normix® in the scheme of postoperative treatment allows its results to be stabilised due to the sanitation of the intestinal lumen, the elimination of dysbiosis, the relief of inflammatory reaction and the elimination of factors supporting the development of diversion proctitis.

Aim. To describe modern approaches to the diagnosis and treatment of neuroendocrine gastric tumours associated with chronic autoimmune gastritis on the example of a clinical case.
General provisions. Patient H., born in 1948, suffered from a dyspepsia syndrome, the presence of chronic exhelicobacter gastritis and neuroendocrine tumour of unclear histogenesis in the upper third of the stomach body. The patient also suffered from systemic lupus erythematosus with skin lesions (discoid rash, palmar and plantar capillaries) and joint lesions (migrating polyarthritis). A general clinical examination revealed mild chronic iron deficiency anemia and increased neuron-specific enolase (NSE). An EGDS examination using expert-class equipment with the NBI function of close focus identified subepithelial formations of the stomach body. The histological results showed a morphological pattern consistent with a highly differentiated neuroendocrine tumour (G1), type 1, associated with chronic autoimmune gastritis.
Conclusion. The autoimmune genesis of the chronic inflammation of the gastric mucosa may serve as a background for the development of neuroendocrine tumours of the stomach, which determines the management tactics in such conditions.

Aim. To present a clinical case describing the management of a patient with Crohn’s disease complicated by recurrent intestinal bleeding and autoimmune hemophilia A.
General provisions: A 21-year-old patient was admitted to St. Petersburg City Hospital No. 26 and diagnosed with Crohn’s disease with the lesions of the ileum, sigmoid and rectum in inflammatory form and continuously recurrent course. Upon admission, the patient demonstrated an elongated activated partial thromboplastin time (aPTT). In this connection, the levels of VIII (FVIII) and IX (FIX) coagulation factors and the content of von Willebrand factor antigen were determined. A study was conducted to the antibodies to these factors connecting von Willebrand factor capabilities with type I and III collagen. A 7 % decrease in the FVIII level and the presence of FVIII antibodies were detected. The patient was diagnosed with autoimmune hemophilia A. On August 14 in 2019, pulse therapy with methylprednisolone of 1000 mg per day by intravenous drip was started. After the first infusion, the aPTT index returned to normal and comprised 30 seconds, while the FVIII activity increased to 255 %.
Conclusion. The presented clinical case demonstrates the importance of timely diagnosis and treatment of acquired coagulopathy. Acquired hemophilia A can be a life-threatening condition. When acquired coagulopathy develops in a patient with bleeding against the background of an inflammatory bowel disease, it aggravates the course of the disease and worsens the prognosis.