Aim. To review the main indications for probiotics prescription in patients with irritable bowel syndrome and to present the materials of an Expert Council, which was held on 18 March 2022 in Moscow.

Key points. Gut microbiota disturbance is an integral part of irritable bowel syndrome (IBS) pathogenesis. Changes of colonic microbiota composition are associated with its functional potential modification, which leads to an increasing of the pro-inflammatory immune response, as well as to an exacerbation of the disease symptoms and quality of life decreasing in patients with IBS. The novel coronavirus infection (COVID-19) is an independent risk factor for both exacerbation and onset of IBS, which predispose to increase IBS incidence. Correction of gut microbiota composition with probiotics seems to be a promising therapeutic target for IBS treatment optimizing. The optimal probiotic should be effective, safe, strain-specific, and its dose and duration of administration should be confirmed by the results of clinical studies. Some of the probiotics with proven efficacy in IBS are Alflorex® and Enterol®.

Conclusion. Prescription of certain probiotics in IBS is advisable to normalize the frequency and consistency of stools, relieve abdominal pain and bloating, as well as improve patients’ quality of life.

Aim: To review the main methods of intestinal microbiota studying.

Key points. Currently, molecular genetic methods are used mainly for basic research and do not have a unified protocol for data analysis, which makes it difficult to implement them in clinical practice. Measurement of short chain fatty acids (SCFA) concentrations in plasma provides the data, which can serve as an indirect biomarker of the colonic microbiota composition. However, currently available evidence is insufficient to relate the obtained values (SCFA levels and ratio) to a particular disease with a high degree of certainty. Trimethylamine N-oxide (TMAO) levels in the blood plasma and urine can also reflect the presence of specific bacterial clusters containing genes Cut, CntA/CntB and YeaW/YeaX. Therefore, further studies are required to reveal possible correlations between certain disorders and such parameters as the composition of gut microbiota, dietary patterns and TMAO concentration. Gas biomarkers, i.e. hydrogen, methane and hydrogen sulphide, have been studied in more detail and are better understood as compared to other biomarkers of the gut microbiome composition and functionality. The main advantage of gas biomarkers is that they can be measured multiple times using non-invasive techniques. These measurements provide information on the relative proportion of hydrogenic (i.e. hydrogen producing) and hydrogenotrophic (i.e. methanogenic and sulfate-reducing) microorganisms. In its turn, this opens up the possibility of developing new approaches to correction of individual microbiota components.

Conclusions. Integration of the data obtained by gut microbiota studies at the genome, transcriptome and metabolome levels would allow a comprehensive analysis of microbial community function and its interaction with the human organism. This approach may increase our understanding of the pathogenesis of various diseases as well open up new opportunities for prevention and treatment.

Aim: evaluation of the effectiveness of the nutraceutical “Standard Zdorovia: Gastro” (“SZ Gastro”) in the treatment of patients with irritable bowel syndrome (IBS).

Materials and methods. 52 patients (62 % women) diagnosed with IBS and IBS in combination with functional dyspepsia (FD) were included in the study and divided into two groups. Both groups received basic therapy according to the guidelines. The experimental group received as add-on the nutraceutical “SZ Gastro” (containing a standardized amount of menthol, gingerol and D-limonene); patients in the control group — placebo. The duration of the study was 30 days. The severity of somatic symptoms was assessed with the 7×7 questionnaire. Emotional state was assessed with the Four Dimensional Distress, Depression, Anxiety, and Somatization Questionnaire (4DSQ).

Results. Patients of the experimental and control groups did not differ from each other either in terms of demographics, basic treatment, or in the severity of symptoms at the beginning of the study.

The effectiveness of the treatment in the patients, who received add-on “SZ Gastro” was significantly higher than in the patients of the control group: in the control group the percentage of improvement of somatic symptoms was 22.35 %, in the experimental group it amounted to 49.18 % (χ² = 15.9; p = 0.0001). The percentage of patients with significant decrease of emotional disturbances was also higher in the experimental group: distress (χ² = 18.7; p = 0.0000), anxiety (χ² = 6.9; p = 0.0097) and somatization (χ² = 14.99; p = 0.0001). No significant side effects were registered in any of the groups.

Conclusions. Add-on of nutraceutical “SZ Gastro” to basic treatment is safe and significantly increases effectiveness of the therapy in the patients with IBS and IBS in combination with PD.

Aim. To evaluate the safety and accuracy of percutaneous transhepatic biliary biopsy in patients with suspected Klatskin tumor.

Materials and methods. Between 2013–2020, percutaneous transhepatic biliary drainage (PTBD) was performed in 52 patients with Klatskin tumor, complicated by obstructive jaundice. After successful PTBD, the diagnosis was verified by antegrade access. 74 procedures were performed: brush (n = 36; 48.6 %) or forceps biopsies (n = 38; 51.4 %).

Results. There were no adverse events associated with a brush biopsy. Only grade I complications were after the forceps technique: 3 patients (7.9 %) developed hemobilia, which was corrected conservatively. Malignant lesions of the biliary tract were detected by forceps technique in 79.0 %, brush biopsy in 66.7 % (p >0,05). The degree of tumor differentiation was determined in 60.0 % (n = 18) vs 12.5 % (n = 3) (p < 0,01), respectively.

Sensitivity and specificity of forceps biopsy were slightly higher than in brush: 82.4 % and 75.0 % vs 73.3 % and 66.7 % (p >0,05).

Conclusions. Antegrade percutaneous transhepatic biliary biopsy is safe for both brush and forceps techniques. However, forceps biopsy has higher sensitivity and specificity in the diagnosis Klatskin tumor and better possibility of determining the degree of malignancy differentiation.

Aim. To evaluate the antitoxic activity of chicory herb extract fractions in rats with toxic hepatitis.

Materials and methods. There were 64 male rats were divided into groups of 6 animals that received the whole chicory herb extract, its fractions, or the reference drug (RD) and 2 groups did not receive any drug. The Silimar substance (a dry purified extract obtained from the fruits of milk thistle [Silybum marianum]) was chosen as RD. Animals from one of the groups that did not receive the drug (control group) and the groups that received drugs were injected with CCl₄ to simulate toxic liver damage. The last group of animals received neither drugs nor CCl₄ (intact animals). The changes in the activity of biotransformation enzymes (cytochrome P₄₅₀ [cytР₄₅₀] and glutathione transferase [GT]) in hepatocytes and serum liver enzymes (AST, ALT and AP) were assessed.

Results. There was a decrease in cytР₄₅₀ and GT activity in the liver microsomes of control rats (having CCl₄ hepatitis without treatment) compared with intact animals. These parameters were more in the animals that were administrated with chicory herb extract, its fractions, and RD than in control animals. The administration of the whole extract, aqueous fraction, and RD led to an increase in the activity of cytP₄₅₀ and GT enzymes almost to the level of the same indicators in intact animals. Pronounced grown in the activity of serum liver enzymes (ALT, AST and AP) were found after CCl₄ injection. Administration of common chicory herb fractions before toxic liver damage caused a decrease in the grown of the activity of these enzymes. The greatest inhibitory effect on the grown of the activity of these liver enzymes had RD, aqueous and butanolic fractions of chicory herb. Despite a significant decrease in hyperfermentemia found in groups of animals treated with fractions of chicory herb, AST, ALT and AP activities did not reach the level that was in the intact animal group.

Conclusion. The aqueous and butanolic fractions of the chicory herb extract had the highest antitoxic activity in experimental animal toxic liver injury.

Aim: to improve the results of treatment of patients with hemorrhoidal disease of the 2nd and 3rd stages by using a diode laser with a wavelength of 1940 nm.

Materials and methods. The study included 28 patients with hemorrhoids of the second or third stage. A new treatment method based on the use of a diode laser with a wavelength of 1940 nm was applied to all patients. This technique (laser hemorrhoidoplasty) provides for the thermal effect of laser radiation on the cavernous tissue of the internal hemorrhoid node and the terminal branches of the upper rectal artery. The intensity of postoperative pain syndrome was assessed and the clinical symptoms of hemorrhoidal disease manifestations were studied before and after surgery. To study the effectiveness of the proposed method and to assess the depth of thermal exposure to laser radiation, transrectal ultrasound with Dopplerography and pathomorphological examination were performed. The functional state of the rectal locking apparatus before surgery and in the postoperative period was assessed using sphincterometry. The quality of life of patients who underwent laser hemorrhoidoplasty was studied according to the SF 36 questionnaire.

Results. Surgical intervention was performed under both local and spinal anesthesia. Intraoperative complications in the form of hemorrhoidal node bleeding were noted in 3 patients. In the early postoperative period, inflammatory edema of external hemorrhoids was diagnosed in 4 patients. The intensity of the pain syndrome was assessed on the VAS scale and by day 7 in 93 % of patients it did not exceed 1 point. All 28 patients were followed up within 1 to 6 months after the operation. All had no complaints characteristic of hemorrhoidal disease, no relapse of the disease was detected in any observation. Transrectal ultrasound with Dopplerography was performed, which made it possible to diagnose a 2–3-fold decrease in blood flow along the terminal branches of the upper rectal artery, and internal hemorrhoids determined earlier, before surgery, were not visualized already 1 month after surgery. According to sphincterometry, no violations of anal retention function were detected in all 28 patients.

Conclusion. Surgical treatment of hemorrhoids of the 2nd and 3rd stages with the use of a diode laser with a wavelength of 1940 nm. with proper technical performance and the choice of optimal energy, it allows to achieve a good clinical effect. The proposed method of intervention ensures the absence of a pronounced pain syndrome, which does not lead to a significant decrease in the quality of life already in the early postoperative period and allows to shorten the period of labor rehabilitation. Laser hemorrhoidoplasty is a highly effective method of treating hemorrhoids at stages 2 and 3 of the disease and opens up the possibility of treatment on an outpatient basis. 

The purpose of the review: to summarize the main data of the literature and our own accumulated practical experience of everyday diagnosis of inflammatory bowel diseases (IBD) to better represent the morphological features and histological conclusions.

Key points. The microscopic picture of IBD is often represented by a combination of basic histological characteristics that can be detected in other diseases and only in rare cases can be considered pathognomonic. No single histological feature can be used in isolation to diagnose ulcerative colitis or Crohn’s disease. Diagnostic accuracy is improved if several signs are taken into account at once, if changes within one or more parts of the intestine are analyzed, it is necessary to compare the identified changes with the clinical picture of the disease.

Conclusion. The presented stages of the morphological study of biopsy specimens in patients with IBD and the exact characteristics of the detected changes will help to increase the diagnostic value of the study of ileo- and colonobiopsies, as well as improve mutual understanding between gastroenterologists and pathologists and, as a result of interaction between specialists, will increase the accuracy of the diagnosis.

The aim: to reflect the features of the course of irritable bowel syndrome during the COVID-19 pandemic.

Key points. It has been noted that the COVID-19 may contribute to the formation of post-infectious functional gastrointestinal diseases, given that angiotensin-converting enzyme-2 (ACE-2) receptors, the site of binding of the SARS-CoV-2 virus to human cells, are also present in epithelial intestinal cells; virus was found in feces in about half of patients, gastrointestinal symptoms, including diarrhea occur in about one fifth of patients, fecal calprotectin, a marker of GI inflammation is elevated in patients with COVID-19, macroscopically as well as histologically, patients show signs of damage mucous membrane of the gastrointestinal tract, and also, as noted above, they have a dysbiosis of the intestinal microbiota.

Conclusion. It was shown that during the pandemic, more than 90 % of the interviewed patients with IBS had an exacerbation of IBS with an increase in symptoms such as bloating and cramps, and 75 % of them said that the exacerbation of symptoms was reflected in the activity of patients in everyday life. These factors dictate the need for an integrated approach in the management of such a group of patients with the use of modern multi-target drugs that affect the pathogenetic factors in the formation of functional gastrointestinal diseases, one of which is the Kolofort drug due to the triple multi-target mechanism of action on the pathogenesis of functional gastrointestinal diseases. 

Aim. To present a clinical case of a 91-year-old patient with a severe course of diverticulitis combined with the development of Clostridioides difficile-associated disease.

Key points. On admission the patient complained of pain in the left iliac region, increased body temperature, constipation and bloating. The medical history showed that constipation increased on the background of prolonged bed rest and discontinuation of psyllium. According to the laboratory and instrumental examinations, the patient had signs of acute diverticulitis, antibacterial therapy was corrected twice, positive dynamics of the condition was noted. However, a few days later, the patient developed a clinic of C. difficile-associated disease, which required the prescription of anticlostridial therapy (vancomycin), until the laboratory confirmation of the accession of this infection was obtained. Combined therapy of exacerbation of diverticular disease and C. difficile-associated disease made it possible to achieve a steady improvement of the condition.

Conclusion. The exclusion of possible development of C. difficile-associated disease on the background or prior antibiotic therapy is an important condition for correct and adequate management of a patient with exacerbation of diverticular disease. If the patient develops a clinical picture of C. difficile-associated disease, treatment may be initiated before laboratory confirmation.

Aim: to present modern methods of diagnosis and treatment of chronic pancreatitis for gastroenterologists, general practitioners and physicians.

Chronic pancreatitis (CP) is a long-term inflammatory disease of the pancreas, manifested by irreversible morphological changes in the parenchyma and pancreatic ducts, which cause pain and/or persistent impairment of function. Current concept on the etiology of CP is reflected by the TIGAR-O classification. The criteria for establishing the diagnosis of CP include typical attacks of abdominal pain and/or clinical and laboratory signs of exocrine, endocrine insufficiency with the mandatory detection of characteristic morphological changes (calcifications in the parenchyma and pancreatic ductal stones, dilatation of the main pancreatic duct and its branches). CT, MRCP, and pancreatobiliary endosonography are recommended as the methods of choice to verify the diagnosis of CP. Conservative treatment of patients with CP is provided for symptom relief and prevention of complications. Individual cases with severe non-interactable abdominal pain, as well as a complicated course of the disease (development of ductal hypertension due to main pancreatic duct stones or strictures, obstructive jaundice caused by compression of the common bile duct, symptomatic postnecrotic cysts, portal hypertension due to compression of the portal vein or thrombosis of the splenic vein, persistent duodenal obstruction, pseudoaneurysm of the celiac trunk basin and the superior mesenteric artery) serve as an indication for endoscopic or surgical treatment. The Guidelines set out modern approaches to the diagnosis, conservative, endoscopic and surgical treatment of CP, and the prevention of its complications.

Conclusion. The implementation of clinical guidelines can contribute to the timely diagnosis and improve the quality of medical care for patients with chronic pancreatitis.