The article is devoted to one of the leaders of the Leningrad school of gastroenterologists of the second half of the last century. For almost two decades, he headed the oldest department of the Military Medical Academy — the Department of Hospital Therapy, turning it into one of the famous gastroenterological centers of the country of that period. The author offers the reader the complete biography of this famous scientist. One of the most important scientific merits of G.I. Dorofeev is the creation of an original scientific internist school. Many followers of it headed and continue to head the leading scientific centers of the country.

Аim: to describe modern approaches for screening and early diagnosis of hepatocellular carcinoma (HCC).

Key points. Screening for HCC in high-risk groups (cirrhosis of any etiology, patients with chronic viral hepatitis B and patients with F3 liver fibrosis) should be organized as regular (every 6 months) liver ultrasound in combination with determination of the serum alpha-fetoprotein (AFP) level. At an AFP level of ≥ 20 ng/ml, even in the absence of changes according to ultrasound data, it is advisable to perform MRI with a hepatospecific contrast agent (gadoxetic acid) which makes it possible to detect very small focal liver lesions. If focal liver lesions of 1–2 cm are detected on ultrasound, additional imaging of the liver using MRI with a hepatospecific contrast agent gadoxetic acid helps to identify HCC at an earlier stage or high degree dysplastic nodes. When planning surgical treatment and liver transplantation, it is preferable to use MRI with a hepatospecific contrast agent, since the presence of the hepatobiliary phase may allow the detection of additional smaller focal liver lesions and assess the nature of the focal liver lesion. When a patient is included in the waiting list for liver transplantation, the optimal frequency of liver MRI is 1 time in 3 months.

Conclusion. MRI with hepatospecific contrast agent gadoxetic acid is effective in screening, early diagnosis and treatment planning for HCC.

Aim. To present data of Russian and foreign studies on the prevalence, pathogenesis and clinical picture of gastrointestinal tract (GIT) pathology in patients with primary hyperparathyroidism (PHPT).

Key point. At the beginning of the 20th century PHPT was considered a severe endocrine disease with specific bone and kidney complications, however in 1957 W.T. St Goar proposed a mnemonic triad to recognize this pathology as “diseases of stones, bones and abdominal groans”. A high frequency of gastrointestinal complaints, peptic ulcer, pancreatitis, cholelithiasis in patients with PHPT has been reported. Hyperparathyroidism has been shown to cause smooth muscle atony with specific upper and lower GI symptoms such as nausea, heartburn and constipation. The prevalence of peptic ulcer in patients with PHPT, according to studies of the 50s–60s of the last century, ranged from 10 to 25 %. However, studies linking PHPT to peptic ulcer development were performed before the advent of proton 1). On the other hand, the development of pancreatitis in PHPT is one of the most studied pathologies. In developing countries its frequency can reach 10–20 % due to the absence of routine screening for blood calcium. Some authors report the impact of elevated parathyroid hormone levels on the formation of gallbladder stones by inhibiting of gallbladder emptying, hepatic bile secretion and mobility of the sphincter Oddi, and changing of the bile composition. A number of studies have found an increased risk of developing malignant neoplasms of the intestine, especially the colon, in patients with PHPT.

Conclusion. The digestive manifestations of parathyroid dysfunction in patients can often be overlooked, and serum calcium levels should be included in the routine examination in the presence of abdominal symptoms.

Aim: to analyze the dynamics of fibrosis and steatosis of the liver according to fibroelastometry in patients with chronic hep-atitis C (CHC) after ≥ 6 months from transient elastometry (TE) achieving a sustained virologic response (SVR) to antiviral therapy.

Materials and methods. At baseline, a prospective observational study included 628 CHC patients with known stage of liver fibrosis (F) before AVT, some of whom were phased out due to non-compliance with the inclusion criteria. The final analysis included 297 patients who had transient elastometry (TE) data with CAP™ technology on the severity of liver fibrosis (± steatosis) before treatment and after ≥ 6 months after reaching SVR (67 % – interferonfree regimens of therapy). Median follow-up from the moment SVR was confirmed was 3 years [2; 6].

Results. At the end of the study, the average age of patients was 49 ± 12 years, of which 53 % were men. In the long-term period after reaching SVR, regression of liver fibrosis was diagnosed in 80 % of cases (including in patients with cirrhosis), and the progression of fibrosis was in 3 % of patient. At the same time, regression of liver steatosis was detected only in 31 % of the patient, worsening of the results was in 23 % (26 % of them had the appearance of steatosis (S) of the liver of 1–3 degrees in persons with no fatty liver before the start of AVT). In the group of patients with liver steatosis, the proportion of men was significantly higher (p = 0.004). Clinically significant stages of fibrosis F3–F4 were significantly more often recorded in patients with hepatic steatosis, both before treatment (46 % S1–S3 and 22 % S0, p < 0.001) and after ≥ 6 months after reaching SVR (19 % S1–S3 and 9 % S0, p = 0.023).

Conclusion. In patients with chronic hepatitis C with SVR achieved in the long term, despite a significant regression of liver fibrosis, a high prevalence of hepatic steatosis remains. The data obtained indicate the feasibility of routine diagnosis of both fibrosis and steatosis of the liver in the management of patients with chronic HCV infection before and after successful antiviral therapy.

Aim: to study the significance of prognostic scales in a target group of patients with primary sclerosing cholangitis (PSC) living in the Chelyabinsk region.

Materials and methods. The study included 21 patients with a confirmed diagnosis of primary sclerosing cholangitis (PSC) and a disease duration of at least two years. The primary endpoint studied was death. The MELD, Mayo Risk Score, Amsterdam-Oxford PSC Score, PREsTo score, and UK-PSC Score scales were calculated based on the medical records. Statistical processing was carried out using the SPSS Statistics v.22 application.

Results. A retrospective assessment of the risk of mortality using the MELD, Mayo Risk Score and Amsterdam-

Oxford PSC Score did not reveal a statistically significant difference between deceased and surviving patients. The UK-PSC Score scale showed the highest predictive value (p = 0.046).

Conclusion. The new predictive model UK-PSC Score showed advantages in predicting death in PSC patients compared to other scales.

Aim: to compare the results of ¹³C-UBT with the data of morphological analysis of the gastric and duodenal mucosa obtained during gastroduodenoscopy in gastritis and peptic ulcer. To analyze the dependence of the results of diode laser spectroscopy (DLS) based ¹³C-UBT on age, nosology, activity and severity of the inflammatory process, the degree of atrophy and metaplasia.

Materials and methods. The ¹³C-UBT DLS was performed in 525 patients before the start of eradication therapy and in 196 patients 10–12 weeks after its completion. The breath test was carried out according to a standard protocol using the BSIA patent kit (Great Britain). During endoscopy, 134 patients underwent a biopsy from the upper third of the body of the stomach, the antrum (within 5 cm from the pylorus along the greater curvature) and the duodenal bulb with histological examination with hematoxylin-eosin staining, PAS-reaction and Giemsa. Histological assessment of the state of the gastric mucosa was carried out according to a modified Sydney system with an assessment of morphological changes according to a 4-point visual analog scale (0 to 3+).

Results. A total of 525 patients (301 men and 224 women) aged 15–80 years (median 39.8 ± 15.1 years) were examined. 239 (45.5 %) patients were diagnosed with chronic gastritis, chronic duodenitis (including erosive forms). In 286 (54.5 %) patients, peptic ulcer was diagnosed with localization in the stomach — in 42 (8 %), in the duodenum – in 238 (45.3 %), combined lesions — in 9 (1.7 %) cases. Based on the results of ¹³C-UDT DLS, H. рylori infection was detected in 447 patients. H. рylori was not found in erosive gastritis in 15 %, erosive duodenitis in 21 % and chronic non-erosive gastritis in 23 %. In peptic ulcer of the stomach and duodenum, H. pylori was detected in 93 % and 97 %.

A direct linear relationship between the results of the breath test and the quantitative content of H. рylori on the surface of the gastric mucosa was obtained. The parameters of laser ¹³C-UBT clearly correlate with the degree of severity of mononuclear infiltration of the mucosa (the strength of the connection is 0.78). When comparing the average values of laser ¹³C-UBT with the total assessment of the degree of mucosal neutrophilic infiltration, no significant relationship was found. With a slight severity of mucosal atrophy, the result of laser based ¹³C-UBT practically does not change; there is a tendency of a decrease in the breath test with an increase in atrophic changes.

Conclusion. Indicators of ¹³C-UBT correlate with the quantitative content of H. pylori bacteria in the gastric mucosa, the severity of mononuclear infiltration of the gastroduodenal mucous, the severity of atrophic changes. 

Aim: to study the course of COVID-19 in patients with inflammatory bowel diseases (IBD) using the example of the region of the Republic of Tatarstan.

Material and methods. The study included 101 patients diagnosed with IBD and COVID-19, who were observed in two infectious diseases hospitals in Kazan (Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan and City Clinical Hospital No. 7) and on an outpatient basis from April 2020 to March 2022. All patients underwent physical examination, laboratory and instrumental diagnostic methods, including a PCR test for SARSCoV-2. Chest computed tomography was performed in patients with clinical signs of moderate to severe COVID-19.

Results. Ulcerative colitis (UC) was diagnosed in 60 (59.4 %) patients, Crohn's disease (CD) — in 41 (40.6 %) patients. The mean age of the patients was 41.0 ± 14.7 years, of which 59 (58.4 %) were men and 42 (41.6 %) were women. A comparative analysis of patients with and without IBD and CT-verified lung disease was carried out. It was found that the development of viral pneumonia was influenced by age over 55 years (39.2 ± 9.7 vs. 46.3 ± 10.6, p < 0.05), increased Body Mass Index (BMI) (23.1 ± 5.35 vs. 30.25 ± 6.17, p < 0.05), hypertension (6 (8.3 %) vs. 8 (27.6 %), p < 0.05), diabetes mellitus (2 (2.7 %) vs. 5 (17.2 %), p < 0.05), the use of corticosteroids in the treatment of IBD (8 (11.1 %) vs. 10 (34.5 %), p < 0.05). In a comparative analysis of patients with IBD and COVID-19 from the SECURE-IBD database and own data, it was found that the average age of patients was comparable (42.7 vs 41.0). At the same time, in our group of male patients, there were slightly more people with DM, increased BMI, and an active course of IBD. The proportion of hospitalized patients was higher. In our cohort, there were fewer patients receiving biological therapy, but more patients on 5-aminosalicylic acid (5-ASA) and systemic corticosteroids. At the same time, lethal outcomes were comparable.

Conclusion. In patients with IBD, the development of viral pneumonia was influenced by known risk factors for COVID-19: age over 55 years (p < 0.05, odds ratio (OR) 3.153), increased BMI (p < 0.05, OR 1.667), hypertension  (p < 0.05, OR 2.724), diabetes (p < 0.05, OR 1.489), as well as the use of systemic corticosteroids (p < 0.05, OR 1.5).

Aim: to present an analysis of the published materials of the consensus “Maastricht-VI” on the management of patients with Helicobacter pylori (H. рylori) infection.

Key points. The content of the new consensus “Maastricht-VI” largely corresponds to that of the previous “Maastricht-V” consensus. This refers to the methods of diagnostics of this infection, indications for eradication. The introduction of eradication schemes of the 3rd and 4th lines, as well as a double scheme with increased doses of proton pump inhibitors (PPI) and amoxicillin can be considered new. The important role of measures that increase the effectiveness of eradication (14-day duration of the course, increasing the dose of PPI, the use of probiotics) is emphasized.

Conclusion. The publication of materials of the new consensus “Maastricht-VI” will contribute to improving the results of H. рylori eradication therapy.

Aim: to provide information on the results of recent scientific research in the field of non-alcoholic fatty liver disease (NAFLD) metabolomic profiling.

Key points. Metabolites of microbial origin are important biological molecules involved in many specific reactions of the human body. This literature review presents the results of recent studies in the field of metabolomics in patients with NAFLD. A more detailed understanding of the role of individual metabolites or their combinations in the NAFLD pathogenesis will allow us to determine the vector of further diagnostic and therapeutic approaches for this nosology. The research results of the probiotics effect on the levels of certain metabolites are currently being discussed.

Conclusion. New research data in the field of studying the human metabolomic profile are presented. The results allow us to summarize the effects of microbial agents and their metabolites in the formation of changes in the liver parenchyma in the context of NAFLD. Changes in the level of endogenous ethanol, secondary bile acids, aromatic amino acids, branched chain amino acids, etc. have been described. Correlation between metabolites and certain bacterial strains has been established. A correlation between the ratio of bacteria types and clinical/laboratory parameters was noted in patients taking prebiotics.

Aim: to present a clinical case of a patient with a complicated course of acute pancreatitis.

Key points. A 31-year-old patient was admitted to the surgical department with a clinical picture of acute alcoholic pancreatitis. Signs of anemia were regarded as a consequence of gastrointestinal bleeding. Computed tomography with contrast enhancement, along with an increase in the size of the pancreas, the presence of foci of pancreatic necrosis with multiple fluid accumulations in the parapancreatic space, revealed smoothed gaustration and thickening of the walls of the predominantly transverse colon. During colonoscopy, ischemic changes of the colon mucosa were detected in a timely manner. Negative results of analysis for toxins A and B of Clostridioides difficile and pathogenic intestinal flora were obtained. By the means of intensive care, it was possible to achieve complete stabilization of the patient's condition, normalization of laboratory blood parameters and relief of ischemic processes in the colon wall.

Conclusion. Ischemic changes of the colon can serve as a complication of acute pancreatitis. A thorough analysis of the results of computed tomography at the first signs of colon lesion and colonoscopy contributed to the rapid detection of complications and prevention of irreversible colon ischemia.

Aim: to demonstrate the management of a patient with somatization disorder and irritable bowel syndrome.

Key points. A 41-yo female patient was admitted with complains of spastic lower abdomen pain, hard stool once every 1–2 days under laxative treatment (macrogol), bloating, anxiety, waiting for confirmation of a life threatening illness, internal stress, difficulty in falling asleep, shallow sleep. Has a long history of disease, characterized by the appearance of a variety of somatic symptoms (headache, tachycardia, joint pain, stool disorders, abdominal pain, etc.) during periods of emotional tension, lack of data suggesting organic disease. No abnormal changes were detected in examination at the clinic (complete blood count, serum chemistry tests, urinalysis or fecal tests, hydrogen and methane breath tests with lactulose, abdominal ultrasound, esophagogastroduodenoscopy, colonoscopy). With the prior agreement of patient, she was consulted by a psychiatrist and diagnosed with somatization disorder and mild anxiety disorder. On discharge from hospital recommended cognitive-behavioral therapy, continue taking macrogol, as well as treatment with Kolofort. After 3 months of complex treatment, there was a significant decrease in the severity of both the symptoms of irritable bowel syndrome and anxiety disorder.

Conclusion. For patients whose complaints meet the diagnostic criteria for IBS, a two-stage differential diagnosis may be justified: at the first stage, differentiation of IBS and organic diseases of the gastrointestinal tract is carried out; at the second stage - IBS and somatization disorder. Kolofort can be the drug of choice both in patients with IBS and the pharmacological part of therapy in patients with somatization disorder.

Aim: to present an analysis of the Russian abstracts published in the materials of the 30th. United European Gastroenterology Week (UEGW).

Key points. In the materials of 30 UEGW, 17 abstracts of Russian authors from Moscow, St. Petersburg, Novosibirsk, Kazan and other cities were published. The abstracts were devoted to topical issues of pathogenesis, diagnosis and treatment of intestinal liver and pancreatic diseases.

Conclusion. Analysis of the published abstracts testifies to the high scientific level and large practical significance of the conducted research.