Aim. Assessment of efficacy and the mechanism of action of gastrointestinal mucosa (GM) protection in current treatment settings with methylmethionine-sulfonium chloride (vitamin U) to illustrate its applicability in erosive ulcerative lesions of various aetiologies.

Key points. Aside to damage prevention in exposure to aggressive agents, gastroprotection implies healing promotion under the preserved level of hydrochloric acid secretion. Prostaglandins (PG) and SH-antioxidants are key mediators of gastroprotection in acute and chronic damage. SH-containing endogenous substances (L-cysteine, D,L-methionine, GSH) and exogenous molecules (methylmethionine-sulfonium chloride (MMSC), N-acetylcysteine) prevent damage due to the ability to absorb/neutralise free radicals released in xenobiotic-triggered cell damage, inhibit TNF-α expression, reduce the aspirin-induced leukocyte-endothelium adhesion and stimulate mucin release. In experiment, MMSC prevented the ethanol-induced GM damage, stimulated mucin release and its redistribution on the GM surface; in clinical trials, MMSC effectively facilitated remission in duodenal ulcer.

Conclusion. Preparations exerting a protective effect on gastroduodenal mucosa, such as methylmethionine-sulfonium chloride (vitamin U), may improve basic treatment settings and facilitate remission in erosive ulcerative lesions of upper gastrointestinal tract.

Aim. Estimation of an optimal corticosteroid (CS, prednisone) dosage for the remission induction in patients with ulcerative colitis (UC) and Crohn’s disease (CD) based on the construction of a dose-effect relationship during the first and second courses of therapy.

Materials and methods. The study included 86 patients with moderate to severe active disease (61 with UC and 25 with CD) aged 18 to 65 years. To induce remission, all patients had the first course of prednisone at a starting dose of 30 to 60 mg/day, with a subsequent reduction. Prednisone was continued in a repeat course in 28 patients. The effect was evaluated past two weeks and at a time of complete withdrawal of prednisone using the generally accepted clinical response and remission criteria. The dose-effect relationship for prednisone was constructed using an original method. The method realises an adequate statistical transformation of primary clinical data in form of a quantitative expression of factual doses and registered alternative responses established with endpoint criteria into a visual efficacy function graph suitable for downstream analyses. The mean at each point was estimated with the regression kernel scoring method. The mean confidence intervals and significance values were estimated with the Student’s t-test.

Results. The dose-effect relationship constructed upon completion of the first prednisone course is a graph showing the plateau point of the efficacy function as a statistical measure of character saturation and a clinical measure of the highest expected drug effect. This graph is referred to as the optimal clinically effective dose (OCED). The first induction prednisone course had the OCED estimates of 50.70 ± 0.65 (49.41÷51.98) mg (p = 0.05). A highest expected effect for this dose was obtained in the interval of 82.21 ± 8.23 (66.08÷98.33)% (p = 0.05). The repeat prednisone course had OCED values of 51.43 ± 1.55 (48.24÷54.61) mg (p = 0.05), with the expected effect of 40.02 ± 12.86 (13.59÷66.45)% (p = 0.05).

Conclusion. In medium to severe UC and CD patients, the first induction prednisone course had OCED estimates of 50.70 ± 0.65 mg/day prescribed at the onset of therapy. The highest effect at this dose was 82%, and 18% of the patients did not respond to the prednisone treatment, accordingly. The repeat CS treatment had the same OCED values of 51.43 ± 1.55 mg/day, but a 42% lower expected effect compared to the first course. The effect did not exceed 40% suggesting its inadequacy in repeat CS treatments in this category of patients.

Aim. Causal analysis of a late diagnosis of chronic inflammatory bowel diseases (CIBD) in general medical practice.

Materials and methods. We continuously sampled 80 CIBD histories (44 of ulcerative colitis, UC, and 36 of Crohn’s disease, CD) to estimate the time and nature of first complaints, primary diagnosis, time lapse between the first physician visit and diagnosis and reasons for a late diagnosis.

Results. Only 63.6 % of patients with UC and 38.9 % with Crohn’s disease were correctly diagnosed during the first visit and subsequent examination. Abdominal pain in debut of CIBD was registered in 40.9 % of the UC and 75.0 % of CD patients (p < 0.01). Diarrhoea as a CIBD manifestation was significantly more common in the UC than in CD patients (88.6 and 55.5 % of cases, respectively; p < 0.01). Hematochesia was observed in 68.2 % of the UC and 22.2 % of CD cases (p < 0.01). Among the CD patients with primary symptoms, a correct follow-up diagnosis was less frequent compared to the UC patients (38.9 % of cases, p < 0.01). Only 30 patients with UC (68.2 %) and 18 patients with CD (50.0 %) had colonoscopy at a first outpatient visit. The main cause of late diagnoses in CIBD is a delayed ileocolonoscopy.

Conclusions. Ileocolonoscopy should be mandatory in all patients suspected for CIBD with clinical symptoms.

Aim. The study aims to evaluate the efficacy and safety of Kolofort administration in patients suffering from irritable bowel syndrome (IBS) and functional dyspepsia (FD), as well as the prevalence of somatic and polymorbid psychomental disorders (distress, depression, anxiety and somatisation) in these patient groups using questionnaires “7×7” and “4DSQ”.

Materials and methods. The study included 56 patients with IBS and FD diagnosed according to the Rome IV revision criteria and the Clinical Guidelines of the Russian Gastroenterological Association, the average age was 36.36 ± 6.42 years. All patients received Kolofort 2 times a day, 2 tablets per dose for 28 days.

Results. The Kolofort therapy improved the clinical symptoms according to the “7x7” questionnaire; the primary mean total score was 17.7 ± 3.6, decreased to 10.3 ± 2.5 past 14 days (p < 0.0001) and to 7.6 ± 1.5 - past 28 days of therapy (p < 0.0001). On the 28th day of therapy, a 4DSQ survey revealed a 49.9% growth in patients with absent distress, a 29.3% decrease in moderate and 20.6% — in high distress cases (p < 0.0001). On the same term, the number of patients without depression increased by 21.4%, decreased by 17.9% with moderate depression and by 3.4% - with severe depression (p = 0.003); the number of patients without anxiety increased by 32.0%, decreased by 8.9% with moderate and by 23.1% — with severe anxiety (p < 0.0001); the number of patients with absent somatisation increased by 53.9%, decreased by 37.1% with moderate and by 18.6% — with severe somatisation (p < 0.0001).

Conclusion. Patients with combined IBS and FD exhibit a high prevalence and severity of both somatic and polymorbid mental symptoms. The Kolofort therapy effectively suppresses clinical symptoms and reduces distress, depression, anxiety and somatisation.

Aim. To review available data on the role of the microbiome and intestinal mucosal barrier in the development and progression of non-alcoholic fatty liver disease (NAFLD).

Key points. The role of the human microbiome in the development and progression of NAFLD is associated with its effects on the risk factors (obesity, insulin resistance, type 2 diabetes), permeability of the intestinal barrier and absorption of such substances as short-chain fatty acids, bile acids, choline and endogenous ethanol. Liver fibrosis constitutes the leading factor determining the prognosis of patients in NAFLD, including cases associated with cardiovascular complications. Changes in the microbiome composition were demonstrated for various degrees of fibrosis in NAFLD.

Conclusion. The results of modern studies confirm the formation of a new concept in the pathophysiology of NAFLD, which encourages the development of new therapeutic strategies.

Aim. Current clinical recommendations aim to provide gastroenterologists, general practitioners (family doctors), endoscopists and infectionists with modern methods for diagnosis and treatment of infectious esophagitis.

Key points. Infectious esophagitis is an esophageal disease of fungal, viral, bacterial or parasitic origin. Esophagus may be affected per se or conjointly in a common gastrointestinal infection. All patients suspected for infectious esophagitis, unless contraindicated, are advised an esophagogastroduodenoscopy with biopsy to confirm diagnosis. Selected incidents of infectious esophagitis require a histological, immunohistochemical examination or polymerase chain reaction-based diagnosis to verify the infectious agent. Uncomplicated infectious esophagitis requires a conservative therapy, mostly on an outpatient basis. However, cases of severe odynophagia, dysphagia, severe pain syndrome, high complication risks (e.g., esophageal ulcer bleeding in thrombocytopenia), severe immunodeficiency, generalised forms of disease and severe concomitant disorders are considered for hospital care. The clinical recommendations outline criteria for the medical care quality assessment and provide relevant information to the patient.

Conclusion. Diagnosis of infectious esophagitis capitalises on the clinical picture (odynophagia, dysphagia), presence of immunosuppression, endoscopic and histological evidence. All patients with infectious esophagitis of verified origin are recommended a suitable etiotropic therapy.

Aim. To describe a clinical case of pregnancy and healthy labour in a young female patient with uncomplicated diverticular disease (DD).

Key points. In recent years, DD is more frequently observed in younger patients. A 37-yo woman manifested the symptoms of periodic intense abdominal pain and constant abdominal discomfort. Colonic DD was diagnosed with irrigoscopy. A high-fibre diet, rifaximin-α at 400 mg twice a day for one week, once a month for six months, and topical anti-inflammatory therapy were prescribed. Clinical symptoms were eradicated upon the treatment. Unaware of pregnancy, the patient had another course of rifaximin-α at the second week of gestation, after which the therapy was stopped. Rifaximin-α, which has a poor intestinal absorption, did not affect the foetal development. A caesarean childbirth was healthy, the newborn was delivered on term with no complications (Apgar score 8).

Conclusion. DD should be included in differential diagnosis for patients with non-specific symptoms (abdominal pain, bloating and discomfort), regardless of young age. No protocols are currently accepted for the DD management during gestation. In the clinical case reported, a patient having diverticular disease and a rifaximin-α therapy at an early term of gestation proceeded without complications for herself and the foetus.

Aim. To present a clinical case of the Abernethy syndrome.

Key points. Abernethy syndrome is a rare vascular anomaly associated with a congenital absence of the portal vein, as a result of which portal blood from the intestines and spleen drains directly into the systemic circulation bypassing the liver though a complete or partial shunt. In the vast majority of cases, Abernethy syndrome is manifested during the newborn period by jaundice syndrome, hypergalactosemia and encephalopathy. In rare cases, this vascular malformation is diagnosed in older patients during ultrasound screening. A 31 year-old patient sought medical attention with the complaints of sleep disturbance and fatigue. The conducted instrumental observation revealed echo-signs of malformation (agenesia) of the portal vein, which was further confirmed by both X-ray-contrast computed tomography and the pathohistological analysis of liver biopsy slides. The genotype UGT1A1•28 confirmed Gilbert's syndrome. Neutropenia (0.8 × 109/L) with a drop in the level of segmented neutrophils up to 27% was regarded as shunt neutropenia. Number connection test confirmed shunt encephalopathy. Conservative therapy for correcting hepatic encephalopathy was prescribed, followed by a dynamic monitoring of the patient’s condition.

Conclusion. Diagnosis of Abernethy malformation is important for choosing the right treatment for the timely correction of complications of the disease and early detection of adenoma or hepatocellular carcinoma.