Aim. An up-to-date review of the prevalence, pathogenesis, diagnosis and management of hepatological complications of type 1 diabetes mellitus (T1D).

Key points. Diabetes type 1 causes a markedly more common liver injury than traditionally assumed. Three types of hepatic damage have been described to date in T1D patients, steatosis, glycogen hepatopathy and diabetic hepatosclerosis, with the latter two apparently pathognomonic of this diabetes type. Their pathogenesis is complex and not fully understood. Its important link is a likely inherited non-physiological insulin supply to the tissue, especially at marked glycaemic fluctuations. An adequate glycaemic control is the main prevention and treatment measure in these conditions. The practitioner’s understanding of liver damage in T1D is an earnest to avoid unnecessary tests and ineffective medications.

Conclusion. Both endocrinologists and internists ought to contemplate the possibility of liver involvement in T1D for improving the patient outcomes.

Aim. A current overview of non-pharmacological and drug-based approaches to non-alcoholic fatty liver disease (NAFLD) combined with type 2 diabetes mellitus (T2D).

Key points. NAFLD is associated with an increased cardiovascular risk (due to association with “metabolic syndrome”) and the risks of liver cirrhosis and hepatocellular carcinoma. Macro- and microvascular complications in T2D comorbidity entail a higher overall mortality. A conjunction of lifestyle change and rational medication strategies to reach the target levels of glycosylated haemoglobin, low-density lipoprotein cholesterol, systolic and diastolic blood pressure is key in management of such patients. A body weight loss by 5–7 % or more (through caloric restriction or a bariatric surgery) promotes a marked reduction in liver fat and even reversal of steatohepatitis. Metered exercise exerts this effect even at insignificant weight loss. Minimising alcohol consumption and smoking is critical. A hepatotropic drug therapy is most essential in moderate fibrotic NAFLD. It includes antidiabetic agents (metformin, thiazolidinediones, glucagon-like peptide-1 receptor agonists, sodium-glucose co-transporter-2 inhibitors), bile acid preparations (e.g., 24-nor-ursodeoxycholic acid), farnesoid X receptor agonists (obeticholic acid, tropifexor), statins, acetylsalicylic acid. Combinations are superior to individual-drug schemes.

Conclusion. The management of combined NAFLD-T2D requires a close inter-specialty involvement from hepatology, gastroenterology, endocrinology and cardiology. This interdisciplinary problem can be tackled through persuasive lifestyle recommendations and choosing rational medication strategies with a proved hepatoprotective efficacy.

Aim. A study of atrophic gastritis severity and rate in patients with gastric polyps (GP).

Materials and methods. The study enrolled 61 patients with hyperplastic (HGP) and 41 — with adenomatous GP (AGP). All patients had 24-h gastric pH-metry, control of the pepsinogen I, II and gastrin-17 levels, in addition to a general clinical, endoscopic, histological examination and testing for Helicobacter pylori.

Results. GP patients had benign manifestations prevailed with epigastric heaviness and overflow, and a scarce history of H. pylori testing at no control of rendered eradication therapy. A symptomatic proton pump inhibitor treatment in GP was either prescribed or voluntary. Focal atrophic gastritis in endoscopy was revealed in 12 (19.7 %) HGP and 16 (39.0 %) AGP patients, diffused atrophic gastritis — in 49 (80.3 %) HGP and 25 (60.9 %) AGP patients. Low-grade chronic gastritis in histology prevailed in HGP, moderate — in AGP, and severe — in 21.9 % cases. Moderate (27.9 %) to severe (65.6 %) atrophy of gastric mucosa was registered in HGP, with 53.7 and 39.0 % respective AGP cases. Polyp dysplasia was detected in 20 % HGP and 75.6 % AGP cases. Pepsinogen I <25 µg/L at a pepsinogen I/II ratio ><3 was observed in 38 (62.3 %) HGP and 18 (43.9 %) AGP patients. Hypo- and anacidic were 65.6 % HGP and 31.7 % AGP patients. >H. pylori-positive were 52.5 % HGP and 70.7 % AGP cases.

Conclusion. A largely similar aetiopathogenesis of gastric polyps and chronic atrophic gastritis warrants the H. pylori diagnosis and a more detailed patient control for chronic gastritis grading and staging, functional insufficiency of gastric mucosa and the severity of hyperplastic and dysplastic change. The H. pylori eradication, in contrast to anti-secretory therapy, allows the containment of chronic gastritis and is a critical measure in gastric cancer prevention.

Aim. A study of monocyte chemiluminescent activity at variant stages of gastric cancer.

Materials and methods. The study enrolled 90 gastric cancer patients and 70 healthy donors. Spontaneous and induced chemiluminescence in monocytes was assessed for 90 min with a “BLM 3607” 36-channel chemiluminescence analyser (Russia). Opsonized zymosan-induced chemiluminescence enhancement was measured as a ratio of the areas under the induced vs. spontaneous chemiluminescence curves, the activation index. Statistical significance was estimated with the Mann—Whitney criterion (p < 0.05).

Results. The maximal spontaneous monocyte chemiluminescence intensity significantly decreased in stage IV gastric cancer patients compared to the control cohort (p = 0.035). Time to maximum in spontaneous chemiluminescence increased in all gastric cancer patients vs. control (p = 0.001), and in stage IV gastric cancer vs. stage I patients (p = 0.043). The areas under a curve in spontaneous and induced monocyte chemiluminescence increased in all gastric cancer patients vs. control (p = 0.001), and in stage IV gastric cancer vs. stage I patients (p = 0.037). The activation index was higher in all gastric cancer cases compared to control (p = 0.001).

Conclusion. All patients with gastric adenocarcinoma, irrespective of the stage, revealed changes in the monocyte chemiluminescence activity, i.e. a longer time to maximum in spontaneous chemiluminescence and larger area under the curve of spontaneous and induced chemiluminescence, the activation index. Maximal monocyte spontaneous chemiluminescence intensity diminished in stage IV gastric cancer compared to the control cohort. Immune activity reflected in monocyte chemiluminescence correlates with the stage of gastric adenocarcinoma.

Aim. A review of the agreement issued by the European Society of Neurogastroenterology and Motility consensus meeting on functional dyspepsia in 2020.

Key points. Expert votes at the consensus meeting generally confirmed the main statements of the Rome Criteria Revision IV on the definition of functional dyspepsia, its aetiology and pathogenesis, diagnosis and treatment, as well as those of the Kyoto Consensus covering the possible association of dyspeptic complaints with H. pylori infection. An absent consensus on certain statements, especially in drug efficacy evaluation, demonstrates insufficient knowledge of many issues in disease.

Conclusion. Functional dyspepsia demands further investigation.

Aim. A clinical description of gastroesophageal reflux disease (GERD) complicated by Barrett’s oesophagus (BO) at inadequate antisecretory therapy and the assessment of functional tests in control of conservative treatment.

Key points. A 63-yo patient with no complaints in a proton pump inhibitor (PPI) therapy was admitted for a follow-up examination for BO-complicated GERD using oesophagogastroduodenoscopy (OGDS) with biopsy, high-resolution oesophageal manometry and 24-h pH-impedance. Endoscopy revealed signs of BO (long segment C1M3), erosive reflux oesophagitis (grade B in Los Angeles classification). Non-contractile oesophagus in manometry. Antisecretory therapy was stated ineffective and subject to correction in 24-h pH-impedance.

Conclusion. Asymptomatic BO-complicated GERD patients comprise a special cohort. The main challenge to prevent progression into oesophageal adenocarcinoma is an adequate personalised patient management leveraging the modern diagnostic techniques, control of antisecretory treatment and its correction a situ.

Aim. A clinical demonstration of the feasibility of novel superpulsed thulium fibre laser in contact intraductal lithotripsy in patients with choledocholithiasis and pancreatic lithiasis.

Key points. We describe two clinically successful ablations of large biliary and pancreatic calculi using a FiberLase U2 superpulse fibre thulium laser appliance (IRE-Polus, Russia) during oral transpapillary cholangiopancreaticoscopy in patients with technically unfeasible conventional minimally invasive treatment for choledocho- and pancreatic lithiasis. A 72-yo patient was urgently admitted with acute mechanical jaundice, cholangitis and a history of endoscopic papillosphincterotomy (EPST) and bilioduodenal stenting with a plastic implant for technically impractical lithotripsy and lithoextraction. An ineffective extracorporeal lithotripsy attempt was followed on day 3 by a second retrograde intervention and endoscopic contact laser lithotripsy controlled in oral transpapillary cholangioscopy with FiberLase U2. A 50-yo patient was admitted with clinical signs of chronic calculous pancreatitis and a history of EPST, pancreatic ductotomy and plastic pancreatic stenting. The first endoscopy stage comprised the encrusted pancreatic stent removal, retrograde pancreaticography, pancreatic ductotomy, narrowed terminal Wirsung’s duct bougienage with mechanical dilators and additional balloon-assisted dilation of the excision area and pancreatic stricture. Mechanical intraductal lithotripsy was unsuccessful. Contact lithotripsy with a novel superpulsed fibre thulium laser has been rendered. The technique presented ensures a complete sanation of the duct at no mucosal damage.

Conclusion. We present the fully successful first national and world experience of the superpulsed fibre thulium laser application in contact lithotripsy of large calculi in common bile and main pancreatic ducts.

Aim. The practical guidelines are intended for primary care physicians, general practitioners, paediatricians, gastroenterologists and general internists to advance the treatment and prevention of gastroenterological diseases in adults and children in therapies with probiotics, prebiotics, synbiotics and their enriched functional foods.

Key points. Probiotics are live microorganisms that sustain health of the host when supplied in adequate amounts. Prebiotics include human-indigestible but accessible to gut microbiota substances expediting specific changes in the composition and/or activity of gastrointestinal microbiota that favour the host health. The mechanism of probiotic action comprises the quorum resistance maintenance, nutrient substrate metabolism and end metabolite recycling, macroorganism-sustaining substrate production, as well as the mediation of local and adaptive immune responses.

The Russian Federation regulates market differently for biologically active food additives (BAFA), medicinal products (drugs) and functional food products (FFP). We overview the probiotic strains regulated in Russia as BAFAs, drugs and FFPs and provide recommendations on the use of these strains in treatment and prevention of gastroenterological diseases in children and adults.

Conclusion. The clinical efficacy of probiotics, prebiotics, synbiotics and fortified functional foods depends on the prebiotic and strain properties and is verified in appropriate comparative clinical trials. Not all probiotics registered in Russia as BAFAs, drugs and FFPs have a strain identity, which provides no warranty of the clinical effect expected. The FFP legislation demands improved regulation mechanisms and control for therapeutic efficacy.