Aim. To present up-to-date information on the possibility of using statins in patients with inflammatory bowel disease (IBD).

Highlights. Statins exhibit immunomodulatory effects, which are of particular importance with regard to IBD treatment. Experimental studies, which demonstrate positive effects of statins on various characteristics of the IBD course, were reviewed. The use of statins led to a decrease in the histological activity in models with DSS- and TNBSinduced colitis. Pravastatin was shown to decrease both the epithelial permeability and crypts. Simvastatin changed the composition of the intestinal microflora, which had a potential anti-inflammatory effect. According to the results of clinical studies, atorvastatin administration to IBD patients resulted in a statistically significant decrease in the serum markers of inflammation and the activity index of ulcerative colitis. Retrospective clinical studies demonstrated different effects of statins on the risk of IBD.

Conclusions. A number of potentially protective effects of statins on inflammatory bowel diseases have been identified. However, well-planned randomised clinical trials are needed to evaluate the effects of statins in IBD.

Aim. This observational (non-interventional) study was aimed at obtaining data on practitioners’ commitment to prescribing rifaximin-α therapy to patients with uncomplicated diverticular disease (UDD), to assess patients’ adherence to such prescriptions, as well as to assess physicians’ and patients’ satisfaction with this drug under the conditions of outpatient practice.

Materials and methods. 27 research physicians in 22 research centres located in 15 Russian cities and 250 patients participated in an open, prospective multicentre observational study. The observation lasted for 6 months with an interim assessment after 3 months. Physicians’ prescription of rifaximin-α (dose, duration of administration, number of prescribed courses) was evaluated, as well as patients’ compliance expressed as the ratio of the actual number of taken pills to the number of prescribed pills during each course according to the MMAS-4 scale. Such symptoms, as abdominal pain, constipation, diarrhea, flatulence and tenesmus were evaluated using a 4-score scale. At the end of the study, physicians’ and patients’ satisfaction with the treatment was evaluated using a 5-score scale.

Results. One fifth — 52 patients (20.8%)—had received rifaximin-α therapy prior to inclusion in the study. Most frequently, rifaximin-α therapy was prescribed monthly at a dose of 400 mg 2 times a day for 7 days. 67.6% of patients received 6 courses of treatment during the study period. The proportion of patients who received more than one course of treatment over 6 months was 97.6%. During almost all treatment courses (97.5%), patients’ compliance was more than 80%. The total score of symptom intensity decreased from 5.6 at the inclusion visit, to 2.2 points at the second visit and to 0.9 points at the end of the observation. A statistically significant (p <0.05) positive dynamics was observed in relation to all evaluated symptoms (abdominal pain, constipation, diarrhea, flatulence, tenesmus). By the end of the study, 59.6% of patients and 68.8% of physicians rated the treatment results as “excellent”, 25.2% of patients and 20.4% of doctors as “good”.

Conclusions. During the observation, a significant decrease in the severity of UDD symptoms, such as abdominal pain, constipation, diarrhea, flatulence and tenesmus was noted. No adverse effects associated with rifaximin-α were reported. The data obtained confirm the previously published results of randomized controlled trials on the efficacy and safety of rifaximin-α in UDD.

Aim. To investigate the feasibility of correcting the content and profile of short-chain fatty acids (SCFA) in feces of patients suffering from allergic bronchial asthma.

Materials and methods. The study included 30 patients with allergic bronchial asthma (BA). All patients underwent a generally accepted range of clinical laboratory tests, functional respiratory tests and a hydrogen breath test with lactulose to detect SIBO. The SCFA spectrum was determined by gas-liquid chromatographic analysis. All patients with BA underwent standard basic therapy with combined preparations containing long-acting beta-2-adre nergic agonists and inhaled glucocorticoids. For the treatment of SIBO, 10 patients were prescribed rifaximin-α at a dose of 200 mg × 3 times a day for 7 days, 10 patients were prescribed rifaximin-α at the same dose, followed by the administration of the Lactobalans drug containing at least 3.0×109 CFU/caps. probiotic microorganisms (Lactobacillus gassery KS-13, Lactobacillus gasser LAC-343, Lactobacillus ramnosus LCS-742, Bifi dobacterium bifi dum G9-1, Bifi dobacterium longum MM-2, Bifi dobacterium longum BB536 Strain M, Bifi dobacterium biumidum BB536 Strain M. Bifi dobacterium biumidum biumidum BB536 Strain M. lactis B1-04) in 1 capsule once a day for 1 month. A probiotic course of 1 month was assigned to 10 patients without SIBO as part of the complex treatment of BA. The study of SCFA was carried out in all groups immediately after the end of probiotic therapy (after 1 month).

Results. All patients demonstrated normalisation of the SCFA spectrum and anaerobic index. In patients without SIBO, during a probiotic therapy, an increase in the total content of SCFA (p <0.001), acetic and butyric acid (p <0.001) was revealed. The administration of a probiotic after a course of rifaximin-α led to a decrease in the relative amount of isoacids and the isoacids/acids ratio in comparison with patients who received rifaximin-α only for treatment of SIBO (p <0.05).

Conclusion. The obtained results demonstrate the potential of drugs in affecting the composition and number of active bacterial metabolites of the intestinal biotope, which indicates the restoration of intestinal microbiocenosis.

Aim. To study the functioning of the anal sphincter after performing anterior rectum resection in cancer patients.

Materials and methods. The anal sphincter function was studied in 144 patients with colorectal cancer, equally in 72 men and 72 women. The study was carried out at the Rostov Cancer Research Institute. All patients underwent R0 anterior rectum resection with the total mesorectumectomy and the formation of a preventive ileostomy. An assessment of the retention function was performed by sphincterometry using a manometric complex with a nonperfusion water-filling sensor according to the generally accepted method.

Results. Disturbances in the normal functioning of the sphincter were noted in 24 (16.7 %) patients. The use of sphincterometry allowed disturbances in the functioning of the internal and external anal sphincters in men and women to be identified, along with differences between the groups. The results indicate a higher incidence of anal incontinence (AI) in women compared to men (t ≥ 2, the differences are significant). In addition, patients with a lower localisation of the anastomosis demonstrated a higher incidence of AI and more pronounced AI manifestations.

Conclusions. The obtained data on the functioning of the anal sphincter after anterior rectum resection in cancer patients indicate gender differences in the incidence of late complications after surgery, as well as the importance of taking into account the localisation of the tumour for selecting an adequate amount of surgical intervention.  

Aim. To present of a clinical case of a rare complication of Meckel’s diverticulum (MD).

General findings. Diseases caused by the presence of MD present one of the most common causes of an “acute abdomen” in children: up to 60% of cases of their manifestation occur in children under 10 years of age. The most common MD manifestations involve complications, such as intestinal obstruction, bleeding, diverticulitis and Litre hernia. A 9-year-old girl with abdominal pain and vomiting having appeared several hours before hospitalization was admitted to a paediatric surgical department. A few hours later, the child was operated. In the course of surgery, a strangulated intestinal obstruction was found on the mesodiverticular ligament connecting Meckel’s diverticulum with the root of the small intestine mesentery. As a result, a diverticulum resection and bowel obstruction were performed. The child was discharged with recovery.

Conclusions. An inversion of the intestine around the mesodiverticular ligament appears to be one of the most rare complications of MD. In this case, the delayed diagnosis results in the development of formidable complications in the form of necrosis and intestinal perforation, which makes Meckel’s diverticulum one of the most dangerous conditions in children.

Aim. To present up-to-date information on the role of microbiota and its disorders in the development of various diseases of the gastrointestinal tract (GIT), including functional diseases, as well as to consider current methods of correction and maintenance of normal microbiota.

General findings. The human microbiome affects many organs at the biochemical, molecular and genetic levels. It has been confirmed that the microbiome participates in the development of inflammatory and functional diseases of the gastrointestinal tract, affects the immune system, central nervous system and mental status. An important problem of everyday medical practice consists in the management of patients with functional disorders of the gastrointestinal tract. The “7 × 7” questionnaire created in 2014 by a group of specialists from I.M. Sechenov First Moscow State Medical University in collaboration with Valenta Pharm allows dynamic evaluation of the clinical course of functional gastrointestinal diseases. The most frequent functional gastrointestinal disorder – irritable bowel syndrome (IBS) – is characterized by a quantitative and qualitative change in the intestinal microflora, which, together with inflammatory changes in the intestinal wall, may act as a trigger for the onset of symptoms, as well as lead to a functional change in the receptor apparatus of pain pathways. Over the
last decade, the number of studies on the use of probiotics for the treatment of various gastrointestinal diseases has increased significantly. The pathogenetic effect of the change in the normal ratio of microorganisms in the intestine proves the inclusion of probiotics in the complex treatment of functional disorders of the gastrointestinal tract to be reasonable.

Conclusion. Improved methods for assessing the microbiome state allows evaluation of the composition of the human intestine microflora in various diseases, thus facilitating the search for new approaches to correcting and maintaining the normal ratio of microorganisms for managing patients with various gastrointestinal diseases.

Aim. These clinical recommendations present up-to-date methods for the diagnosis and treatment of peptic ulcer. The recommendations are intended for gastroenterologists and general practitioners.

General provisions. Peptic ulcer (PU) represents a chronic relapsing disease occurring with alternating periods of exacerbation and remission. The main manifestation of the disease is the formation of a defect (ulcer) in the wall of the stomach and duodenum. Most cases of peptic ulcer are pathogenetically associated with the infection of H. pylori. PU can be an independent disease or represent symptomatic ulcers of the stomach and duodenum (medicinal, as a result of stress or endocrine pathologies, associated with chronic diseases of internal organs). In the absence of contraindications, esophagogastroduodenoscopy is recommended for all patients with suspected ulcer with the purpose of confirming the diagnosis. In order to determine indications for eradication therapy, all ulcer patients should be tested for the presence of H. pylori using a 13C-breath test or a stool antigen test. In the case of simultaneous endoscopy, rapid urease test can be used. For the prevention of subsequent relapses of ulcer, all PU patients with confirmed H. pylori should undergo eradication therapy. In addition, in order to achieve ulcer healing, 4–6 week antisecretory therapy with proton pump inhibitors is recommended. Clinical recommendations contain criteria for assessing the quality of medical care, an algorithm of the doctor’s actions, as well as information for patients.

Conclusions. These clinical recommendations present modern ideas about the etiology and pathogenesis of peptic ulcer disease, its clinical manifestations, methods of laboratory and instrumental diagnostics and basic approaches to conservative and surgical treatment.