Aim. A practical review of functional gastrointestinal disorder diagnosis in constipation patients and the rationale for opting treatment.

Key points. Functional constipation commonly afflicts different ages and negatively impacts the quality of life. The current diagnostic algorithm in chronic constipation includes the disease identification according to Rome Criteria IV, red-flag symptom detection and instrumental laboratory examination. Functional constipation is notably often associated with anorectal abnormalities that bear a diagnostic value to elaborate an apt treatment strategy. Anorectal manometry, rectal sensation and balloon expulsion tests are the well-studied and significant probing techniques for objective anorectal zone sensorimotor function assessment in patients with functional constipation. The article reviews modern diagnostic methods in functional defecation disorders.

Conclusion. The examination and treatment algorithms presented will help improve diagnosis and apply the most suitable management in a constipation-associated functional digestive pathology.

Aim. A methodological review on mesh implantation efficacy assessment in surgery for rectocele.

Key points. Specialised quiz surveys are among the most appropriate methods to assess surgical intervention efficacy. The questionnaires that enable pre- and postsurgery rectocele grading include PFDI-20 (Pelvic Floor Distress Inventory), the colonic evacuation disorder scale and Cleveland Constipation Scoring System. These surveys determine the surgical intervention efficacy dynamically in conjunction with instrumental surgery assessment techniques.

Conclusion. Clinical practice at the Ryzhikh National Medical Research Centre for Coloproctology combines the originally developed colonic evacuation disorder scale (2003) and PFDI-20. The combined scales allow for a comprehensive symptom assessment in patients with rectocele and other descending perineum syndrome manifestations prior to surgery, as well as symptom dynamics evaluation postoperatively, which, in link with defecography, enables a complete appraisal of the surgical effect.

Aim. A study of abdominal pain incidence in young adults in relation to dietary habits and psychological profile for advancement of health-promoting technologies.

Materials and methods. An anonymous quiz survey covered 3,634 students enrolled at Omsk State Medical University in higher and secondary vocational education programmes via online use of the GSRS and WHO CINDI programme questionnaires to assess eating patterns and dietary preferences, as well as a brief multifactor personality inventory scale. Respondents with abdominal pain were divided into subcohorts by pain severity according to GSRS scores (mild, moderate or severe pain).

Results. Abdominal pain was reported by 2,300 (63.29%) respondents, of whom 1,243 (54.0%) rated symptoms as mild, 996 (43.3%) and 61 (2.7%) — as moderate to severe. Abdominal pain complaints were more frequent in women (2I = 33.96, p <0.001), but gender had no effect on pain intensity. Pain associated with abdominal bloating and distention (57.65%), gastroesophageal reflux symptoms (38.75%), constipation (30.54%) or diarrhoea (28.4%). The presence and severity of abdominal pain was distinctive of individuals spending the most of average monthly income on food purchase and those actively consuming tea, coffee, added sugar, extra salt in cooked food, while having low intake of fruit and vegetables. A typical personality in severe abdominal pain is hypothymic depressive, hypochondriac in moderate and psychasthenic in mild pain.

Conclusion. Abdominal pain is common among medical students predominating in females, associates with the eating pattern, dietary habits and psychological profile.

Aim. A study of the clinical and morphological traits and cytokine profile of gastritis in schoolchildren with familial history of gastric cancer.

Materials and methods. A cross-sectional questionnaire survey was conducted in Siberian regions (Tuva, Even-kiya, Aginskiy Buryat National District, Krasnoyarsk). A total of 3,343 schoolchildren aged 7–17 were surveyed for gastrointestinal complaints and history of gastric cancer in their 1st–2nd degree kindred. Oesophagogastroduo-denoscopy (OGDS) with gastric mucosa biopsy were performed in 463 respondents with complaints. Gastritis was graded in the Sydney classification. Serum cytokine levels (IL-2, IL-4, IL-8, IL-18, IL-1β, IFN-α, TNM-α) were obtained in enzyme immunoassays (ELISA).

Results. Schoolchildren with gastritis and familial history of gastric cancer revealed a higher 59.8% rate of dyspeptic complaints vs. 40.8% in negative history (p = 0.001), as well as complaints of weekly heartburn in 14.2 and 8.3% cas-es (p = 0.019), respectively. In positive history and negative H. pylori tests, the cell immune response regulator IL-18 37 was revealed elevated in histology. In histologically verified H. pylori, no cross-cohort differences were observed in serum IL-18 by positive familial history of gastric cancer.

Conclusion. Gastritis in schoolchildren with familial predisposition to gastric cancer more often associates with GERD and dyspepsia usually presented in postprandial distress syndrome. The cytokine regulation properties of gastritis in schoolchildren with familial history of gastric cancer have been reported.

Aim. An efficacy assessment of steroid therapy in SARS-CoV-2 patients aged over 50 years with lung damage over 50 % (grade 3–4).

Materials and methods. A retrospective study of 158 SARS-CoV-2 patients hospitalised in April—June 2020 was conducted under the inclusion criteria: age over 50 years, chest computed tomography (CT) for COVID-19-asso-ciated pneumonia, C-reactive protein (CRP) >50 mg/L, anticoagulant therapy, no contraindications to steroids, no biologic therapy. Cohort 1 patients (n = 96) received dexamethasone 4–12 mg/day, cohort 2 (n = 62) — a standard non-dexamethasone therapy.

Results. Dexamethasone treatment associated with a significant alleviation of COVID-19-associated pneumonia in CT score (p = 0.001), reduced fibrinogen (p = 0.001), a trend to CRP reduction by day 8–10 and lower demand for oxygen therapy, including ventilatory support (p = 0.001). Mortality rate was 19.8 and 75.8 % in cohorts 1 and 2, respectively (p = 0.001).

Conclusion. Dexamethasone therapy 4–12 mg/day in SARS-CoV-2 patients aged 50+ years with grade 3–4 CT changes receiving LMWH from start of hospitalisation significantly improved CT scores and reduced mortality.

Aim. An evidence review on use of bismuth in irritable bowel syndrome.

Key points. Irritable bowel syndrome (IBS) is a common functional disorder significantly impacting the quality of life and social status, i.a., through frequent manifestations of diarrhea. Postinfectious IBS emerges after a bacterial, pro-tozoan or viral intestinal disease. The new coronavirus pandemic supposedly affects most factors involved in functional disorder developments and may serve a fuelling cause of postinfectious IBS. Bismuth salts accumulate cytoprotective, anti-inflammatory and antibacterial properties. Therapeutic efficacy of bismuth compounds has been demonstrated in treatment of diarrhea-accompanied diseases of   various etiology, including postinfectious IBS. The use of therapeutic-dosed bismuth preparations is safe and well tolerated by patients.

Conclusion. Use of bismuth may be considered a treatment and prevention approach in diarrhea-predominant IBS, both in monotherapy and combined regimens.

Aim. A clinical case description to highlight challenges in diagnosing MALT lymphoma presented in infiltrative ulcer-ative lesions.

Key points. A 60-yo patient was admitted to the Loginov Moscow Clinical Scientific Centre with epigastric pain and an 18 kg weight loss over past 4 months. A history of repeated outpatient endoscopic examinations revealing subse-quently ulcerative and infiltrative ulcerative gastric lesions of unestablished origin. A complex examination combin-ing oesophagogastroduodenoscopy (OGDS), endosonography (EUS), multislice computed tomography (MSCT), morphological and immunohistochemical (IHC) assays elicited the MALT gastric lymphoma IIE stage involving para-gastric and intraperitoneal lymph nodes. The first treatment stage included line-1 eradication therapy, rabeprazole 20 mg x 2 times a day, amoxicillin 1000 mg x 2 times a day, clarithromycin 500 mg x 2 times a day, bismuth tripotas-sium dicitrate 240 mg x 2 times a day — for 14 days. Accounting for the process prevalence and stage, six courses of R-CHOP polychemotherapy (PCT) were ordered by haematologist.

Conclusion. This observation demonstrates a targeted-biopsy endoscopic examination followed by morphological, IHC, EUS (for invasion depth) and MSCT (for process advancement) assays to be decisive in differential diagnosis of ulcerative and infiltrative ulcerative gastric lesions.

Aim. The clinical observation highlights plausible compound origins of diarrhoea, fever and neutrophilic leucocytosis in COVID-19 and the rationale to exclude Clostridium difficile infection in such patients.

Key points. A 57-yo female patient was admitted in May 2020 with the complaints of 39 °C fever, general weakness, polymyalgia, diarrhoea to 3–4 times a day (mushy stool, no morbid inclusions). Initial diarrhoea was non-severe and likely triggered by the coronavirus infection. A background antibiotic and putative-immunosuppressive therapy proceeded with watery diarrhoea to 7–8 times a day and C. difficile toxins A and B detected in stool. The C. difficile infection relapsed on day 10 of vancomycin withdrawal and associated with elevated body temperature, diarrhoea and neutrophil leucocytosis; signs of colitis determined in ultrasound and CT. Exacerbation was successfully treated in a repeated metronidazole-combined vancomycin course.

Conclusion. Patients with COVID-19 are at risk of clostridial colitis due to massive antibiotic, systemic glucocorticoid and biologics-based therapy they receive. The opportunistic bacterial infection of C. difficile often proceeds undetected due to its potential mirroring of COVID-19 presentation. A screening algorithm in COVID-19 patients with diarrhoea should imply steps for C. difficile detection.