Aim. Presentation of the Forum “Deprescribing and optimal selection of proton pump inhibitors” held in Moscow on 29 September 2020 during the 26th United Russian Gastroenterology Week.
Key points. The Forum was aimed at discussing issues associated with improving the proton pump inhibitor (PPIs) therapy in treatment and prevention of acid-related diseases and upper gastrointestinal tract (GIT) disorders induced by non-steroidal anti-inflammatory drugs (NSAIDs) and antiplatelet medications. Deprescribing is considered to be an effective strategy of a motivated reduction of the PPI dosage, duration of therapy and the patient’s transfer from a regular to on-demand intake regimen. The choice of PPI may condition an optimal therapy for acid-related diseases.
Conclusion. PPIs prevail in therapies for acid-related diseases and NSAID-induced upper GIT lesions. PPI deprescribing should be a strategy of choice if medically indicated. A non-enzymatic metabolism, high acid suppression, stable antisecretory effect from day 1 of therapy and cytoprotective action justify the application of rabeprazole (Pariet®) for optimising therapies for acid-related diseases and implementing the deprescribing strategy.

Aim. A summarising review of national and international practices in enhanced recovery after surgery (ERAS) for gastric cancer.
Key points. Although ERAS is a routine protocol in colorectal surgery, little agreement exists on its effectiveness and safety in upper gastrointestinal surgery, particularly, for gastric cancer (GC). General recommendations are being widely followed in clinical practice, whilst the adherence to GC-specific measures is still limited. The review highlights the specific measures of perioperative nutrition, surgical approach, early postoperative diet, phase-out of routine nasogastric or nasojejunal tubes, audit of results. The GC-specific protocols include the early detection of postoperative complications, especially the oesophagojejunal anastomosis leakage, to facilitate the ERAS safety and early oral nutrition.
Conclusion. Current evidence suggests a strong association of ERAS with improved outcomes and quality of life in the early postoperative period. The long-term impact of ERAS remains understudied but is expected to reduce complications and their severity in oncological surgery.

Aim. Analysis of clinical manifestations, laboratory and instrumental examination data in SARS-CoV-2 patients with taking into account the disease severity and outcome.
Materials and methods. The study included 92 patients with confirmed coronavirus infection, including 15 lethal cases, hospitalised at the Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology of the Sechenov University in April 2020. The analysis included demographic data, the presence of concomitant diseases, chest computed tomography (CT) results, laboratory tests (including SARS-CoV-2-diagnostic PCR, general and metabolic blood panels, coagulogram) and the duration of disease.
Results. Patients infected with SARS-CoV-2 usually exhibit lymphopenia (p ≤ 0.001), leucocytosis, the elevated neutrophils (p ≤ 0.05), neutrophil-lymphocyte ratio (p ≤0,05), C-reactive protein (p ≤ 0.05), ferritin (p ≤ 0.05), D-dimer (p ≤ 0.05) and fibrinogen (p ≤ 0.05), altered prothrombin time (p ≤ 0.05) and INR (p ≤ 0.05). In a critical coronavirus infection, the pulmonary lesion exceeds 50% (corresponds to CT3 — CT4). The risk of critical SARS-CoV-2 infection increases with elder age (p ≤ 0.001), associates with the male gender and presence of concomitant diseases, such as obesity (p < 0.01), diabetes mellitus (p < 0.001), hypertension (p ≤ 0.001), CHD (p ≤ 0.001) and atrial fibrillation (p <0.05).
Conclusion. The risk of severe and adverse coronavirus infection is significantly higher in elder comorbid patients.

Aim. Estimation of the contribution of rs1799930 (590G>A) polymorphism of gene NAT2 to the development of acute alcoholic pancreatitis.
Materials and methods. DNA samples were obtained from 547 unrelated patients with acute alcoholic pancreatitis and 573 unrelated individuals without gastrointestinal diseases. A survey selected individuals with the alcohol consumption of >200 g/week pure ethanol two times a week or more during 10 or more years. Genotyping was performed with PCR using TaqMan allelic discrimination assays.
Results. No association was observed between the NAT2 allelic rs1799930 (590G>A) polymorphism, risk of acute alcoholic pancreatitis, duration and rate of alcohol consumption. The 590G>A variant of rs1799930 in gene NAT2 correlated with an increased risk of acute alcoholic pancreatitis (odds ratio 2.16; 95% confidence interval 1.13–4.12) under alcohol consumption >200 g/week pure ethanol.
Conclusion. The rs1799930 G/A polymorphism of gene NAT2 increases the risk of acute pancreatitis under alcohol consumption >200 g/week pure ethanol.

Aim. Investigation of hepatic microhaemocirculation effects in experimental extrahepatic cholestasis.
Materials and Methods. Experiments were carried out with a mixed group of 48 white mongrel male rats. Extrahepatic cholestasis was modelled in rats with via the ligation of common bile duct.
Results. Animals with ligated common bile duct showed abnormalities in peripheral hepatic circulation manifested by a complex of intravascular, vascular and paravascular changes, hepatic angioarchitectonics disturbance, a marked growth of parenchymal dystrophic lesions in the form of post-haemorrhagic foci. The disturbance was pronounced towards a virtual degradation of hepatic parenchyma and the growth of “numb” zones with ceased circulation.
Conclusion. The trials revealed microcirculatory changes in the liver associated with rheological disturbance of blood and, subsequently, the toxic impact of failed metabolism.

Aim. Revision of possible causes of diarrhoea in patients with the COVID-19 infection.
Key points. Apart from respiratory symptoms, patients with the COVID-19 infection may also express gastrointestinal complaints, more frequently of diarrhoea (2–40% incidence rate). The causes of diarrhoea may relate to the virus direct interaction with the angiotensin-converting enzyme 2 (ACE2) receptors in mucosa, its impact on the intestinal microbiota and therapeutic side effects. The possible occurrence of diarrhoea as a leading clinical manifestation of the coronavirus infection hampers its timely diagnosis. Published evidence on the impact of diarrhoea on the course of COVID-19 is contradictory.
Conclusion. Epidemiological and clinical aspects of this problem require further research.

Aim. A clinical case description of abdominal pain as the first manifestation of the new coronavirus infection COVID-19.
Key points. A 80-yo patient was admitted to a surgical unit with growing epigastric pain and fever. Acute abdomen was diagnosed negative, chest computed tomography (CT) revealed two-sided ground-glass opacity, discharged. Hospitalised in a severe condition with presumed new coronavirus infection at the Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology, the Sechenov University. COVID-19 agent RNA was detected with PCR. Diagnosis: new coronavirus infection COVID-19, severe degree, community-acquired bilateral polysegmental pneumonia, severe degree, respiratory failure type 1. Therapy with azithromycin, hydroxychloroquine, enoxaparin subcutaneously. Respiratory distress increased on day 7 at the clinic, with 50–75% lesion in chest CT, which required ordering of dexamethasone intravenously, with a subsequent dose reduction and withdrawal, and levofloxacin. Upon the treatment, abdominal pain was eliminated, body temperature normalised and the volume of affected parenchyma decreased. The patient was discharged for outpatient care. Patients with SARS-CoV-2 may have abdominal complaints that may require exclusion of an acute surgical pathology. These circumstances inevitably waste time of assisting patients suffering the new coronavirus infection and worsen the prognosis due to severe pneumonia.
Conclusion. A gastroenterological debut of the new coronavirus infection with the main symptoms of abdominal pain has been presented. The currently continued unfavourable epidemiological situation demands diagnosis for SARSCoV-2 and COVID-19-associated pneumonia upon the exclusion of peritoneal symptoms even in absence of respiratory complaints.

Aim. A clinical description of disseminated skin melanoma with endoscopic observation of its pathognomonic pigmented metastases into the stomach.
Key points. A 66-yo patient was hospitalised with dyspnoea, general weakness, cough and suspected community-acquired pneumonia. The patient had a complex examination, including computed tomography, which revealed a presumed malignancy of the right lung with secondary changes in the chest and abdominal organs. Esophagogastroduodenoscopy (EGDS) visualised multiple pigmented spots and raised black plaques in cardia and the gastric body diagnosed as a metastasising melanoma in stomach. Endoscopic verification of the metastases confirmed the correct diagnosis of primary skin melanoma.
Conclusion. Metastatic melanoma of the gastrointestinal tract has non-specific symptoms and most often occurs during the dissemination process. Endoscopy should be used to correctly verify pigmented mucosal lesions, necessarily allowing for non-pigmented gastric neoplasms in patients with skin melanoma in history.

Aim. Current clinical recommendations are intended to supply gastroenterologists, physicians and general practitioners with modern methods for the diagnosis and treatment of constipation.
Key points. Constipation is defined as primary (functional) and secondary form, the latter comprising a manifestation of another illness. The causes of constipation are diagnosed with colonoscopy, especially in patients aged over 50 having “anxiety symptoms” and hereditary colorectal oncological predisposition. Indications may also include the bowel transit time estimation with radiopaque markers, balloon expulsion test, anorectal manometry, defecography and electromyography. Therapy for constipation should be comprehensive and concern lifestyle, diet recommendations and use of medications (psyllium, macrogol, lactulose, lactitol, contact laxatives, prucalopride). Patients with a less effective conservative therapy and largely reduced quality of life should be considered for surgical intervention.
Conclusion. An effective therapy for constipation requires a correct diagnosis of its causes.