The aim: to highlight the main points of albumin synthesis, posttranslational modifications and functions in normal conditions and in patients with liver cirrhosis.
Key points. Albumin is the most abundant protein in blood plasma. Along with oncotic properties, albumin performs transport, antioxidant, immunomodulatory and endothelioprotective functions. Serum albumin in patient with liver cirrhosis undergoes modifications, leading to functional impairment. Human serum albumin is a compaund of human mercaptalbumin with cysteine residues having a reducing ability, and oxidized human non-mercaptalbumin. The proportion of irreversibly oxidized non-mercaptalbumin-2 with impaired functional activity increases in liver cirrhosis.
Conclusion. The conformational structure of the albumin molecule plays an important role in maintaining its non-oncotic functions. Non-oncotic functions depend on albumin conformation. Further investigation of albumin conformation and albumin functions in patients with hepatic insufficiency can serve as an additional criterion for assessing the severity of cirrhosis and predictor of complications may become an additional criterion to new clinical applications and treatment strategies of liver failure.

The purpose of the review. To systematize literature data on changes in the structure of the intestinal microbiota in patients with chronic pancreatitis (CP).
Key findings. The human intestinal microbiota is a dynamically changing system that is constantly undergoing qualitative and quantitative changes, especially in several pathological conditions of the digestive system. At present, the differences in the intestinal microbiota in pancreatic diseases are poorly understood. The severe CP is associated with impaired synthesis of antimicrobial peptides, bicarbonates, and digestive enzymes by the pancreas, which is a risk factor for dysbiotic changes in the intestinal microbiota, consisting in the development of small intestinal bacterial overgrowth (SIBO) and gut dysbiosis. The results of two large meta-analyses show that about a third of CP patients have SIBO. The colonic microbiota in patients with CP is also characterized by dysbiotic disorders, primarily in the reduction of alpha-diversity. Some studies have shown that these patients have an increase in Firmicutes, while Bacteroides and Faecalibacterium are reduced. In addition, as a rule, in patients with CP, the growth of Escherichia, Shigella and Streptococcus is recorded.
Conclusion. In general, scientific papers have revealed significant heterogeneity in the profiles of the intestinal microbiota in patients with CP. Thus, several questions remain open, prioritizing the further study of the intestinal microbiota in patients with CP for identifying the specifics of its structure that can personalize the selection of enzyme replacement therapy and restrict the unreasonable prescription of additional pharmacotherapy (the use of proton pump inhibitors and / or antibacterial drugs).

Background: Eosinophilic esophagitis (EoE) is the second most common cause of esophagitis. Topical steroids represent a promising group of drugs for inducing and maintaining clinical and histological remission in these patients.
Objective. To evaluate the effectiveness of topical steroids in inducing and maintaining clinical and histological remission in adolescent and adult patients with EoE.
Methods. A systematic literature search using defined keywords was performed up to March 20, 2021 in the MEDLINE / PubMed, EMBASE (Excerpta Medica), and Cochrane Central Register of Controlled Trials, ClinicalTrial.gov databases.
Results. 390 patients from 5 studies were included in this systematic review with meta-analysis. The meta-analysis showed that topical steroids, compared with placebo, was more effective in inducing (odds ratio (OR) 75.77; 95 % confidence interval (CI): (21.8; 263.41), p < 0.001) and maintaining complete histological remission (OR 103.65; 95 % CI: (36.05; 298.01), p < 0.001) in patients with EoE. Also, topical steroids significantly relieved disease symptoms compared with placebo in inducing and maintaining clinical remission (OR 4.86; 95 % CI: (1.4; 16.86), p = 0.01) and (OR 11.06; 95 % CI: (4.62; 26.45), p < 0.001) respectively.
Conclusions. Topical steroids represent an effective group of drugs for inducing and maintaining histologic and clinical remission in adolescent and adult patients with EoE.

Aim: to assess effects of esophageal protector Alfasoxx on extraesophageal symptoms in patients with GERD.
Materials and methods. A prospective open multicenter post-registration observational study was conducted. The study included 546 patients aged 6 to 85 years (the average age of patients is 42.4 ± 16.9 years) with a verified diagnosis of GERD (endoscopically and/or pH-metrically), the presence of extraesophageal symptoms of the disease (according to the results of an objective examination and consultations of specialists), to whom the attending physician prescribed a course of treatment with a medical device Alfasoxx in accordance with the instructions for medical use. The patients were recruited by 51 researchers in 26 cities of Russia. The study in chronological order consisted of a screening visit and two recorded visits (the observation period within the framework of the use of the Alfasoxx esophagoprotector). The screening visit was conducted on the day of the patient's admission. Visit 1 could be conducted on the same day as the screening visit, whereas visit 2 was conducted 4–5 weeks after visit 1 at the end of the course of treatment.
Results. According to the results obtained, at the end of the study, 42.7 % (95 % CI: 38.5–46.9) had complete disappearance of extraesophageal GERD symptoms (questionnaire RSI = 0 points). When comparing the average values of the total RSI score before and after treatment, there was also a statistically significant regression from 13.8 points (95 % CI: 13.2–14.4) at visit 1 to 2.0 points (95 % CI: 1.8–2.2) at visit 2. Thus, the decrease in the total score was significant and exceeded 80 % of the initial value. When analyzing the dynamics of individual indicators of the RSI scale before and after treatment, a significant regression in the severity of all symptoms of the disease was noted. In addition, the results showed that the proportion of patients taking antacid-containing drugs at visit 1 significantly decreased from 58.2 % (95 % CI: 54.0–62.4) to 15.2 % (95 % CI: 12.1–18.3) by visit 2. The average score on the Likert scale of satisfaction with treatment was 4.8 (95 % CI: 4.8–4.9), whereas the convenience of using Alfasoxx is 4.7.
Conclusion. This prospective observational multicenter study demonstrated that the addition of Alfasoxx to standard GERD therapy contributes to a significant regression of both esophageal and extraesophageal symptoms, as well as a decrease in the need for antacid medications.

Aim: to study fatty acid levels in erythrocyte membranes (RBC) and blood serum (BS) in patients with inflammatory bowel diseases (IBDs) to develop differential diagnostic models including fatty acids as biomarkers to distinguish between nosological entities of IBDs (ulcerative colitis — UC, Crohn's disease — CD, unclassified colitis — UCC).
Materials and methods. We examined 110 patients (mean age 37,7 ± 12,1 years) with IBDs and 53 healthy patients in control group (43,3 ± 11,7 years). The IBDs group included 50 patients with UC, 41 patients with CD, 19 patients with UCC. An exacerbation of the disease was revealed in 42 patients (84 %) with UC, 34 patients with CD (82.9 %) and 11 people with UCC (57.9 %). The study of fatty acids (FA) composition of RBC membranes and BS was carried out using GC/MS system based on three Agilent 7000B quadrupoles (USA).
Results. The most significant for distinguishing active UC from CD exacerbation were serum levels of elaidin (p = 0.0006); docosatetraenoic (n-6) (p = 0.004); docodienic (n-6) (p = 0.009); omega-3/omega-6 ratio (p = 0.02); docosapentaenoic (n-3) (p = 0.03); the sum of eicosapentaenoic and docosahexaenoic (p = 0.03), as well as the content of RBC lauric FA (p = 0.04) (AUC — 0.89, sensitivity — 0.91, specificity — 0.89, diagnostic accuracy — 0.91). To distinguish active UC from the same of UCC, the following serum FA were found to be significant: alpha-linolenic; saturated (pentadecanoic, palmitic, stearic, arachidic); monounsaturated (palmitoleic, oleic); omega-6 (hexadecadienic, arachidonic) (p = 0.00000011—0.03300000) (AUC — 0.995, sensitivity — 0.98, specificity — 0.96, diagnostic accuracy — 0.97). The most significant in distinguishing patients with active CD from UCC exacerbation were levels of the following FA: alpha-linolenic; palmitoleic; oleic; the amount of saturated fatty acids (SFA); total unsaturated fatty acids (UFA); stearic; monounsaturated fatty acids (MUFA) amount; SFA/UFA; SFA/PUFA (polyunsaturated fatty acids); linoleic; total PUFA n6; lauric; arachidic acid (p = 0.0000000017–0.030000000) (AUC — 0.914, sensitivity — 0.90, specificity — 0.87, diagnostic accuracy — 0.91).
Conclusion. The study of FA levels in groups with different nosological forms of IBDs using complex statistical analysis, including machine learning methods, made it possible to create diagnostic models that differentiate CD, UC and UCC in the acute stage with high accuracy. The proposed approach is promising for the purposes of differential diagnosis of nosological forms of IBDs.

Aim: Creation of a patient registry in the Republic of Dagestan to study various aspects of the course and outcomes of IBD, depending on the age and gender of patients.
Materials and methods. We have created a register of IBD patients in the Republic of Dagestan. It included 168 IBD patients aged 17 to 70 years, 69 males and 99 females, the average age of patients with IBD was 38.1 ± 2.5 years with an average duration of illness of 6.19 ± 0.71 years. The diagnosis of IBD was established on the basis of the characteristic clinical picture of the disease, objective status, results of laboratory, endoscopic, X-ray and morphological research in accordance with Russian Clinical Guidelines
Results. The prevalence of IBD in the Republic of Dagestan is 5.41 cases per 100,000 population. The progression of IBD is more often observed in women, aged 30 to 39 years, residents of rural areas. Anemia (mainly chronic iron deficiency) was registered in 66.1 %, more often in women, its maximum frequency was noted in patients aged 20–29 years (80 %). Disability due to IBD was registered in 55.4 % of patients.
Conclusions. The creation of a register of IBD patients in the Republic of Dagestan is aimed at monitoring the state of health, timely monitoring of the effectiveness of therapy and improving the quality of medical care.

Aim. To determine lenvatinib treatment outcomes in patients with advanced unresectable hepatocellular carcinoma (uHCC) in real clinical practice.
Patients and methods. A multicenter retrospective observational study included 58 patients with a confirmed uHCC diagnosis receiving lenvatinib. At baseline, ECOG, Child-Pugh and BCLC scores were assessed. The objective response rate (ORR), disease control rate (DCR), median overall survival (OS) and median progression-free survival (PFS) rates were assessed. In addition, adverse effects (AE) during treatment were monitored.
Results. The median OS and PFS comprised 14.6 (95 % CI 10.6–18.6) and 11.1 months (95 % CI 8.31–13.8), respectively. The ORR amounted to 32.8 %, while DCR reached the level of 79.3 %. The levels of ORR and DCR were not statistically significantly different between the patients with stages B and C according to the BCLC staging system, with grades 0 and 1 according to ECOG, with classes A and B according to the Child-Pugh score, with viral and non-viral HCC etiology, with and without extrahepatic spread, and with and without portal vein invasion. Patients with alpha-fetoprotein (AFP) blood levels <200 ng/mL showed significantly higher ORR and DCR compared to those with AFP levels >200 ng/mL (44.4 % vs. 13.6 %, p = 0.015; and 88.9 % vs. 63.6 %, p = 0.021, respectively). The uHCC stage according to BCLC, ECOG functional status, Child-Pugh class, presence or absence of extrahepatic spread and viral etiology had no effect on the OS and PFS median levels. Patients with macroscopic portal vein invasion had a significantly lower PFS compared with those lacking this complication: 3.97 (0.00-8.07) vs. 11.1 (8.46-13.7), p = 0.053. AFP levels ≥200 ng/mL adversely affected survival rates: median OS comprised 12.0 (5.95-18.9) months in the group of patients with AFP ≥200 ng/mL vs. 16.1 (8.73-23.5) months in the group of patients having AFP <200 ng/mL, p = 0.020. AEs were registered in 81.0% (n = 47) of patients. Among the most common AEs were arterial hypertension (32.8 %), weakness (24.1 %), weight loss (12.1 %) and appetite loss (10.3 %). Due to AEs, Lenvatinib was withdrawn in 5 (8.6 %) patients.
Conclusion. Lenvatinib confirmed its efficacy and safety in patients with uHCC in real clinical practice. The treatment outcome might be affected by AFP levels and the presence of macroscopic portal vein invasion. Further comparative studies into treatment regimens applied in real clinical practice are required.

Aim: to analyse the document of the European Society for Neurogastroenterology and Motility consensus on gastroparesis, held in 2020.
Key findings. The evaluation of the voting results on the submitted statements of the consensus meeting shows that there is a high level of agreement among the experts regarding the definition of gastroparesis, the main diseases in which it occurs, and the existing diagnostic methods. At the same time, there is a divergence of views regarding the role of individual pathogenetic factors of gastroparesis and their relationship with clinical symptoms, as well as the effectiveness of drugs of various groups and other treatment methods.
Conclusion. The pathophysiological mechanisms of gastroparesis and the effectiveness of various treatment methods need further research.

Aim: to review the common risk factors and links in the pathogenesis of functional gastrointestinal disorders (FGID) to optimize therapy of patients with a combination of multiple FGID.
Key points. FGID occurs in more than 40 % of people globally, mainly affecting the working-age population in young and middle-aged subjects. At the same time, more than 30 % of patients have a combination of 2 or more functional gastrointestinal (GI) disorders i.e. overlap syndrome. Common links in the pathogenesis of FGID include disorders of gut-brain interaction, visceral hypersensitivity, changes in intestinal microbiota, overproduction of proinflammatory cytokines, impaired epithelial permeability and motor activity of the gastrointestinal tract. The combination of FGID in various gastrointestinal segments is associated with more pronounced clinical symptoms (mutual burden syndrome). Common risk factors and pathogenetic links of the functional disorders enables reducing the number of prescribed medications when several FGIDs overlap in one patient, which also increases adherence to therapy. Treatment of FGID includes adjustment of risk factors and drug therapy. As a pathogenetically justified pharmacotherapy of overlap syndrome, Kolofort, highly diluted antibodies to TNF-α, histamine and brain-specific protein S-100, is of interest.
Conclusion. Kolofort has demonstrated high efficacy and safety including among patients with overlap FGID enabling to consider it as the treatment of choice in these patients.

Aim: present clinical guidelines, aimed at general practitioners, gastroenterologists, cardiologists, endocrinologists, comprise up-to-date methods of diagnosis and treatment of non-alcoholic fatty liver disease.
Key points. Nonalcoholic fatty liver disease, the most wide-spread chronic liver disease, is characterized by accumulation of fat by more than 5 % of hepatocytes and presented by two histological forms: steatosis and nonalcoholic steatohepatitis. Clinical guidelines provide current views on pathogenesis of nonalcoholic fatty liver disease as a multisystem disease, methods of invasive and noninvasive diagnosis of steatosis and liver fibrosis, principles of nondrug treatment and pharmacotherapy of nonalcoholic fatty liver disease and associated conditions. Complications of nonalcoholic fatty liver disease include aggravation of cardiometabolic risks, development of hepatocellular cancer, progression of liver fibrosis to cirrhotic stage.
Conclusion. Progression of liver disease can be avoided, cardiometabolic risks can be reduced and patients' prognosis — improved by the timely recognition of diagnosis of nonalcoholic fatty liver disease and associated comorbidities and competent multidisciplinary management of these patients.