Aim. A general review of treatment approaches to ulcerative colitis (UC) and the importance of oral 5-aminosalicylic acid (5-ASA) for its routine outpatient management.

Key points. The choice of drug therapy for UC remission induction and maintenance is linked to the intestinal lesion extent and disease attack severity. The 5-ASA therapy remains the mainstay UC treatment in routine outpatient practice, with prescription rate of 80–90%. Oral 5-ASA drugs are often used in monotherapy or when oral and rectal 5-ASAs are recommended in combination. As a sustained-release medication, the MMX mesalazine multi-matrix delivery system provides for higher active substance dosages along entire colonic mucosa, including its distal portions. A higher active substance dosage per tablet reduces the number of intakes and ensures a better patient adherence, both in terms of daily and long-term therapy.

Conclusion. The 5-ASA drugs are most commonly prescribed in outpatient practice. Sustained-release 5-ASAs provide for a more effective active ingredient distribution at higher dosages along colonic mucosa. 

Introduction. Publications demonstrate some limitations of National Early Warning Score 2 (NEWS-2) accuracy in assessment on coronavirus infection severity.

The purpose of this study was to determine the value of the patient’s age and routine laboratory parameters in the assessment of patient’s general condition in coronavirus pneumonia and their relation to NEWS-2 scale parameters.

Materials and methods. 50 case reports of patients with COVID-19 infection observed in the Sechenov University in January–March 2021 were analyzed. 34 % of patients were males aged 31 to 89 years (average age 55 years) and 66 % — females aged 40 to 91 (mean age 63). The diagnosis of pneumonia was confirmed by computed tomography. NEWS-2 scale total score was assessed.

Results. According to the physician’s subjective assessment the condition was significantly more often assessed as moderate and severe. There was only a weak correlation between the blood oxygen saturation and the total NEWS-2 score (r = 0.165, α = 0.1). We found a mild correlation (r = 0.341, α = 0.1) between the patient’s age and NEWS2 score. Among the most significantly interrelated parameters were age, neutrophil count, serum creatinine, CRP, fibrinogen level. Seven interrelated parameters (age, body temperature, blood oxygen saturation, the neutrophils count, creatinine, CRP, fibrinogen), for which a reliable relation with other tests has been shown, were assigned with its special index according to their contribution to the assessment of the overall condition severity. An aggregated score (criterion X) was proposed for assessment of disease severity according to equation. The proportions of mild, moderate, and severe cases according to criterion X were 12 %, 64 % and 24 %.

Conclusion. The preliminary results obtained in the study emphasize the importance of routine laboratory tests in assessment of coronavirus infection severity. An evident discrepancy between NEWS-2 score and X criterion may be very important for practice. 

Aim. A psychometric comparison in patients with previous irritable bowel syndrome (IBS) vs. those with IBS presenting six months or later since COVID-19 infection.

Materials and methods. The study included patients having had COVID-19 infection over 6 months ago and complying with Rome IV criteria (2016). The study cohort was 100 patients with gastrointestinal symptoms. Fourteen patients (cohort 1) complied with the IBS criteria, 5 males and 9 females. A comparison cohort was 40 patients with IBS verified prior to the COVID-19 pandemic (cohort 2), 12 males and 28 females. Data were obtained from the SIPSITEST 9.0 DBMS resource. The control cohort comprised 50 healthy respondents (cohort 3), 23 males and 27 females. Depression was scored with the Beck Inventory, anxiety — with Spielberger—Khanin (adapted STAI) questionnaire; childhood psychogeny has also been assessed.

Results. In statistical analysis of cohort 1, mean depression, personality and reactive anxiety scores were 11 ± 2.27, 43.8 ± 1.93 and 46.7 ± 2.05, respectively. Mean values in cohort 2: personality anxiety 47.3 ± 1.46, reactive anxiety 50.7 ± 1.96 and depression 12.85 ± 1.13. With childhood psychogeny, positive answers to at least one question were reported in 9 of 14 (65%) patients in cohort 1 and 33 (82.5%) — in cohort 2. No study inter-cohort differences have been observed for personality or reactive anxiety and depression, nor for the history of childhood psychogeny.

Conclusion. The new coronavirus infection entails postinfectious IBS in 6 months after COVID-19. 

Aim: to increase the efficiency of endoscopic diagnosis of serrated and non-serrated histological types of colon polyps in real time.

Materials and methods. From September 2017 to February 2018, 63 polyps were detected among 51 patients (male 11, women 40, aged between 30–78 years, average age 52.2 ± 12.5 years) in all parts of the colon.Polyps were found in all parts of colon, sizes varied: 24 (38.1 %) ≤5 mm, 31 (49.2 %) 6–10 mm, 8 (12.7 %) ≥10 mm. The macroscopic types 0–IIa were 44 (69.8 %), and 0–Is — 19 (30.2 %). During colonoscopy, 1.5%-acetic acid, 5 ml, was sprayed onto the identified polyps. Additionally was blowed 40 ml of air jet. Mucosa was observed endoscopically for 2 minutes. Then polyps were removed and sent for pathology.

Results. Use of acetic acid leads to fast acetowhitening reaction of lesions and surrounding mucosa. 2 groups were distinguished (table): 1) Loss of acetowhitening (LAW) of polyps occurs earlier than LAW of surrounding mucosa — «acetowhitening negative». 2) LAW of polyps occurs later than LAW of surrounding mucosa — «acetowhitening positive». Group 1 includes 25 (39.7%) polyps, 88.0% of which were non-serrated: 18(72.0%) — tubular adenoma; 4 (16.0%) — tubular-villous adenoma, one of which had high-grade dysplasia. Only 3(12.0%) polyps were serrated — hyperplastic polyps. Group 2 includes 38 (60.3%) polyps, 97.4% of which were serrated: 24 (63.2%) — hyperplastic polyp; 12 (31.6%) — sessile serrated polyp, including one with low-grade dysplasia, 1 (2.6%) - traditional serrated adenoma. Only 1 (2.6%) polyp was non-serrated — tubular adenoma. This suggests that LAW of non-serrated polyps occurs faster than LAW of surrounding mucosa — «acetowhitening negative». On the contrary, the LAW of serrated polyps is delayed compared to the LAW of the surrounding mucosa «acetowhitening positive». LAW of 4(6.3%) polyps was atypical. The reason for this phenomenon requires further study.

Conclusion. Acetic acid chromoendoscopy can be used as a diagnostic method to determine the histological type of polyps during colonoscopy. 

Aim. An analysis of polemic and open topics in epidemiology, pathogenesis, clinic, diagnosis and treatment of postinfectious irritable bowel syndrome (IBS).

Key points. The incidence of postinfectious IBS links to aetiological factors underlying the development of acute infectious gastroenteritis (bacteria, viruses or protozoans). The risk factors of postinfectious IBS have been identified: female gender, excessive anxiety, depression and somatisation, a severe sequence of acute infectious gastroenteritis, etc. The diagnosis of postinfectious IBS implies exclusion of organic diseases with similar clinical presentations. A specific postinfectious IBS treatment is currently lacking and adheres to non-postinfectious IBS strategies.

Conclusion. The postinfectious IBS problematic is poorly understood and requires further research. 

Aim. Systemic amyloidosis caused by the synthesis and deposition of immunoglobulin light chains (AL amyloidosis) is a relatively rare disease that involves heart, kidneys, peripheral nervous system, gastrointestinal tract, and has a large number of various clinical manifestations. We present a clinical case of systemic AL amyloidosis with a predominant involvement of liver, stomach, intestines, and heart in a Caucasian female.

Key points. A Caucasian woman presented to clinic with severe general weakness, abdominal pain, diarrhea, sudden weight loss, and palpitation. Initial examination revealed a duodenal bulb ulcer complicated by bleeding and polyps in the retrobulbar part of duodenum. Decreased hemoglobin levels, elevated levels of alkaline phosphatase, gamma-glutamyltransferase, and N-terminal prohormone of brain natriuretic peptide, signs of heart failure with preserved ejection fraction, and hepatomegaly became the basis for a clinical suspicion of AL amyloidosis and puncture liver biopsy. Histochemical and immunohistochemical studies of liver, stomach, and duodenum biopsy specimens confirmed AL amyloidosis. Timely diagnosis made it possible to conduct a specific therapy with melphalan plus dexamethasone, get a satisfactory response and improve the patient’s condition.

Conclusion. A thorough examination of patients along with a pathomorphological and immunohistochemical study of the biopsy specimens is the basis for confirming the diagnosis of AL amyloidosis, selecting the proper therapy, improving the condition of patients and their survival. 

Aim. Current clinical recommendations are intended to supply gastroenterologists, physicians and general practitioners with modern methods for the diagnosis and treatment of liver cirrhosis and fibrosis.

Key points. Liver fibrosis develops with connective tissue accumulation in liver in the outcome of various chronic diseases, including alcohol misuse, viral hepatitises, autoimmune and more rare hereditary liver diseases. Liver cirrhosis is the final stage of most chronic diffuse liver diseases. The recommendations present current opinions on pathogenesis of liver fibrosis and cirrhosis, principles of diagnosis, treatment and prevention of their main complications: hepatic encephalopathy, oesophageal and gastric variceal bleeding, acute kidney injury/hepatorenal syndrome, infectious complications (i.a. spontaneous bacterial peritonitis), hyponatraemia, pulmonary complications, etc.

Conclusion. Timely diagnosis and adequate therapy in cirrhosis can prevent life-threatening complications and improve the patients’ prognosis and quality of life. 

Aim. An outlook of trends and perspectives in gastroenterology in the age of digital healthcare.

Key points. Diagnosis gradually transforms to the task of image recognition. Tuning a diagnostic algorithm (DA) necessarily requires a statistically representative training set of images. In transition towards electronic medical records (EMR), such data will be generated automatically. Advances in machine image recognition and the upcoming availability of a large amount of medical data suitable for configuring DA both pave the way towards efficient computerassisted diagnosis.

Conclusion. The growing volumes of medical data enforce, and advances in machine image recognition enable, the transition towards computer-assisted medical diagnosis.