Aim. Assessment of the clinical impact of previous hepatitis B infection (PHB).

Key points. PHB is characterized by the presence of viral DNA in the organism (including intrahepatic cccDNA and integrated DNA). Possible virus persistence in the PHB patient's hepatocytes potentiates the agent transmission risk via haemotransfusion, organ transplantation and haemodialysis. Occult HBV infection in PHB individuals can reactivate at background immunosuppressive or chemotherapies. PHB with chronic liver diseases of various aetiology significantly rises the risk of cirrhosis and hepatic cancer. The PHB association with autoimmune liver diseases and extrahepatic gastrointestinal cancer needs a careful research to confirm the possible involvement of hepatitis B virus in morbid genesis.

Conclusion. No clinical signs of acute or chronic disease, HBsAg clearance and negative viral DNA load in blood of PHB individuals do not necessarily imply a complete disease eradication.

PHB elicitation improves accuracy of the overall prognosis, reduces the virus transmission risk and prevents the reactivation of HBV infection.

Aim. A literature review of intestinal permeability assessment techniques.

Key points. The intestinal barrier is a functional entity separating the intestinal lumen and internal body, and intestinal permeability is a measure of the barrier functionality. The intestinal barrier integrity and permeability assays differ by the application setting (in vivo or ex vivo), subject (human or animal), marker molecules used to assess permeability (ions, various size carbohydrates, macromolecules, antigens, bacterial products and bacteria), biomaterial for the marker concentration assays (peripheral blood, portal venous blood, urine, stool). Despite a great variety of methods for assessing intestinal permeability, their clinical application requires further studies due to a lack of standardisation, the complexity of selected techniques and occasional limited reliability of results.

Conclusion. Further investigation and improvement of intestinal permeability assays is required. The assay and result standardisation will facilitate practice in functional and organic intestinal diseases, as well as allergies, diabetes mellitus, non-alcoholic fatty liver disease and some other illnesses.

Aim. Estimation of the liver steatosis and fibrosis incidence with transient elastography and the controlled attenuation parameter in residents of St. Petersburg.

Materials and methods. A prospective open single-centre population study included history, anthropometric and laboratory data on 318 outpatients aged 24—89 years (mean age 52.6 ± 14.6 years). The degrees of steatosis (assessed with the controlled attenuation parameter as ultrasound amplitude dropdown quantification in liver) and fibrosis were determined with a Fibroscan 502 Touch unit (Echosens, France).

Results. Hepatic steatosis of predominantly high degree was revealed in 44.7%, combined fibrosis and steatosis — in 28%; isolated fibrosis of various stage — in 2.5%, no structural changes — in 24.8% individuals. The growth of body mass index and waist circumference significantly correlated in women with pronounced liver changes. Serum transaminase activity increased with more severe liver changes, being statistically significant for aspartic transaminase only.

Conclusion. A high incidence of primary liver steatosis and fibrosis in residents of St. Petersburg warrants improved diagnostic algorithms and routine preventive measures. Transient elastography with the controlled attenuation parameter estimation provides a convenient non-invasive screening for hepatic fibrosis and steatosis.

Aim. Improvement of refractory ascites (RA) outcomes in underlying cirrhotic portal hypertension (PH) through optimising the transjugular intrahepatic portosystemic shunting (TIPS) procedure among therapy measures.

Materials and methods. The survey included 107 patients with RA admitted to portal hypertension units of the Rostov State Medical University Surgical Clinic during 2007—2020. The patients were randomly assigned to two cohorts similar by gender, age, cirrhosis aetiology and condition severity. The control cohort had conventional paracentesis and albumin infusion. In cohort 2, 57 patients had minimally invasive endovascular TIPS surgery in a recommended setting.

Results. TIPS eliminated PH in all 57 patients of cohort 2. Cohort 1 was reported with progressive esophagogastric varices (EGV), their enlargement in 37 and rupture in 11 patients during the first 12 months. Cohort 2 revealed the grade 3—2 and 2—1 EGV reduction in 24 (41.1%) patients with shunt surgery and in 39 (68.4%) patients in one year. Esophagogastric variceal bleeding (EGVB) developed in 9 patients in cohort 1, with 7 lethal outcomes. No variceal bleeding was observed in cohort 2, with 7 patients having the portosystemic shunt dysfunction.

Conclusion. The TIPS procedure is justified in cirrhotic PH patients with RA for reducing the mortality rate in a one year follow-up.

Aim. An outline of the current potential of pantoprazole in treatment and prevention of upper gastrointestinal diseases.

Key points. Pantoprazole is widely applied in gastroesophageal reflux, peptic ulcer disease, Zollinger—Ellison syndrome and for Helicobacter pylori eradication. It minimally inhibits the CYP2C19 isoenzyme involved in the metabolism of many drugs. Pharmacokinetics of pantoprazole conditions a weaker drug interaction compared to other proton pump inhibitors (PPIs), which enables its use for gastrointestinal bleeding prevention in patients receiving dual antiplatelet therapy. The new coronaviral pandemic of COVID-19 urges the selection of PPIs that minimise the drug interference, such as pantoprazole, in therapy and prevention of acid-related upper gastrointestinal diseases. Pantoprazole has a good tolerance and low side effect rate.

Conclusion. Pantoprazole is considered among optimal PPIs for efficacy, safety and adherence on the basis of clinical trials for treatment and prevention of gastrointestinal diseases, systematic reviews and meta-analyses.

Aim. Assessment of the irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth syndrome (SIBO) interlinkage.

Key points. SIBO may represent a "peripheral" mechanism of IBS, aside to nonspecific inflammation, increased epithelial permeability and local immune system activation. In various assays, the SIBO rate in IBS patients was 4-46% vs. 0-13% in an intact cohort. A limited diagnosability of SIBO obscures the SIBO-IBS causal interplay. Impaired motility in IBS may predispose to the SIBO development. Proinflammatory cytokines and mediators in SIBO, in turn, provoke visceral hypersensitivity and intense motility, the key IBS factors. Both conditions relate to qualitative and quantitative changes in microbiota, which warrants the application of probiotic Lactobacillus and Bifidobacterium strains.

Conclusion. Further research into the SIBO-IBS interface is required for developing optimal probiotic-based therapies.

Aim. A clinical description of end-stage hereditary haemochromatosis manifested with chronic alcohol abuse.

Key points. A 50-yo patient referred with marked general weakness as a major complaint. The patient had a history of long-term alcohol consumption at toxic doses, putative cirrhosis, paroxysmal atrial fibrillation, type 2 diabetes mellitus. The patient's severity on admission was conditioned by marked hypotension. Further examination aimed at excluding occult gastrointestinal bleeding, adrenal insufficiency, decompensated heart failure. Bronze skin and icteric sclerae were positive. Blood tests revealed severe macrocytic hyperchromic anaemia, thrombocytopae-nia, hyperbilirubinaemia, hypoalbuminaemia, hypocoagulation, elevated transaminases, hyponatraemia, elevated creatinine (CKD DPI 63 mL/min), severe hyperferritinaemia. Faecal occult blood test and EGDS for bleeding were negative. Abdominal ultrasound exposed signs of liver cirrhosis and portal hypertension (ascites, splenomegaly). Echocardiographic evidence of dilated cardiomyopathy of all chambers, a reduced 24% ejection fraction at absent acute myocardial infarction. Primary haemochromatosis was suspected upon high ferritin, transferrin iron saturation and multiple organ dysfunction. Genotyping revealed the HFE 845G > A variant diagnostic of haemochromatosis type 1. Clinical diagnosis: Primary disease: haemochromatosis (homozygous variant HFE 845G > A (A/A)): liver cirrhosis, Child-Pugh class C. Portal hypertension: splenomegaly, ascites. Dilated cardiomyopathy. Diabetes mellitus. Complications: multiple organ dysfunction (SOFA 16). Liver failure: jaundice, hypoalbuminaemia, hypocoagulation. Cardiac rhythm and conduction disorder: paroxysmal atrial fibrillation. Acute cardiac failure with underlying CHF IIb, NYHA class 3. Acute renal failure (anuria) with underlying CKD stage 3 (CKD DPI 63 mL/min). Moderate macrocytic hyperchromic anaemia. Acute and chronic adrenal failure. Despite a cardiovascular and renal failure compensation therapy and albumin transfusion, the patient died. Autopsy revealed a marked organ infiltration with haemosiderin (heart, stomach, liver, pancreas, lungs, kidneys, adrenal glands).

Conclusion. The case describes a classical clinical manifestation of haemochromatosis: bronze skin hyperpigmentation, liver cirrhosis, diabetes mellitus, cardiomyopathy, adrenal insufficiency. Terminal haemochromatosis, severe cardiac and renal failure decompensation precluded phlebotomy and chelation therapy. A lethal outcome was conditioned by multiple organ dysfunction with underlying massive haemosiderin deposition in most organs.

Aim. Description of the endoscopic and clinical traits of heterotopic gastric mucosa (HGM) observed in cervical oesophagus.

Key points. HGM in proximal oesophagus can be asymptomatic or have various clinical manifestations. A 40-yo female patient consulted a gastroenterologist with complaints of cough and globus sensation. For several years she was visiting an otorhinolaryngologist and psychotherapist, with therapy ineffective. Esophagogastroduodenoscopy (EGDS) at the last visit revealed several foci of HGM in cervical oesophagus of 1.2 x 0.8 cm maximal size. The patient was prescribed a combined prokinetic — proton pump inhibitor therapy, which relieved the symptoms. EGDS in a 21-yo patient without active complaints revealed a 2 cm-wide HGM of 4/5 cervical oesophageal lining with acidproducing zones.

Conclusion. Two different scenarios of cervical oesophageal HGM are described, the first one manifested with laryngopharyngeal reflux, and the second devoid of clinical manifestations despite a large heterotopic site.

The overall objective of these guidelines is to provide evidence-based recommendations for the diagnosis and management of immunoglobulin G4 (IgG4)-related digestive disease in adults and children. IgG4-related digestive disease can be diagnosed only with a comprehensive work-up that includes histology, organ morphology at imaging, serology, search for other organ involvement, and response to glucocorticoid treatment. Indications for treatment are symptomatic patients with obstructive jaundice, abdominal pain, posterior pancreatic pain, and involvement of extra-pancreatic digestive organs, including IgG4-related cholangitis. Treatment with glucocorticoids should be weight-based and initiated at a dose of 0.6-0.8 mg/kg body weight/day orally (typical starting dose 30-40 mg/day prednisone equivalent) for 1 month to induce remission and then be tapered within two additional months. Response to initial treatment should be assessed at week 2-4 with clinical, biochemical and morphological markers. Maintenance treatment with glucocorticoids should be considered in multi-organ disease or history of relapse. If there is no change in disease activity and burden within 3 months, the diagnosis should be reconsidered. If the disease relapsed during the 3 months of treatment, immunosuppressive drugs should be added.