Aim: to analyze current approaches to H. pylori eradication therapy in adults and present the materials of Experts Council held on December 9, 2022 in Moscow.

General statements. H. pylori infection is the main etiological factor of gastritis, peptic ulcer, and gastric cancer. Eradication of H. pylori is recognized as a necessary measure to reduce the incidence of these diseases. The approaches to selecting an eradication regimen should be optimized to take into account epidemiological trends and achieve better treatment outcomes. The updated Maastricht VI Consensus Report presents the means to overcome the difficulties in selecting an approach to the treatment of H. pylori infection. However, eradication therapy remains challenging due to adverse events (primarily antibiotic-associated diarrhea), poor treatment tolerance and patient compliance. Eradication therapy can be optimized by supplementing treatment regimens with strain-specific probiotics that reduce adverse events, improve patient compliance and eradication rates, such as Saccharomyces boulardii CNCM I-745 strain with established efficacy.

Conclusion. The inclusion of certain probiotics in eradication regimens improves treatment tolerance, reduces the risk of adverse events, improves patient compliance and eradication rates.

Aim: to analyze the safety and effectiveness of the method of cold snaring resection with preliminary hydropreparation when removing superficially colorectal epithelial neoplasms with a diameter of 5 to 25 mm.

Material and methods. The number of complications and disease recurrence after endoscopic excisions by “cold” snaring resection with preliminary hydropreparation of superficially neoplasms with a diameter of 5 to 25 mm was assessed.

Results. Neoplasms were removed in a single block in 89/122 (72.95 %) cases. Neoplasms with a diameter of 5 to 9 mm were excisions in a single block in 100 % of cases, with a diameter of 9 to 14 mm in 28/30 (93.33 %) cases, with a diameter of 15 to 19 mm in 12/38 (31.57 %) cases. According to the results of a lifetime pathoanatomic examination of the removed material, serrated dysplasia (serrated dysplasia, low grade) was detected in 76 cases; micro vesicular hyperplastic polyps (Hyperplastic polyp, micro vesicular type MVHP) were established in 9 cases; hyperplastic polyps containing goblet cells (Hyperplastic polyp, goblet cell GCHP) were in 5 cases; tubular adenoma with dysplasia (Tubular adenoma, low grade) was in 32 cases. Delayed bleeding and perforation of the intestinal wall, both at the time of resection, and in the delayed period was not observed. No local recurrence was detected in the groups of patients with neoplasms diameters of 5-9 and 10-14 mm. One case of local recurrence was detected in a group of patients with a neoplasms diameter from 15 to 19 mm (1/38 = 2.63 %) and one case in a group with a neoplasms diameter of 20-25 mm (1/5 = 20 %).

Conclusions. Cold endoscopic snaring resection of colorectal epithelial neoplasms with preliminary hydropreparation in the submucosa is a safe and effective method of excisions superficially epithelial neoplasms of the colon with a diameter of 5 to 19 mm.

Aim: to analyze the safety and effectiveness of the method of cold snaring resection with preliminary hydropreparation when removing superficially colorectal epithelial neoplasms with a diameter of 5 to 25 mm.

Material and methods. The number of complications and disease recurrence after endoscopic excisions by “cold” snaring resection with preliminary hydropreparation of superficially neoplasms with a diameter of 5 to 25 mm was assessed.

Results. Neoplasms were removed in a single block in 89/122 (72.95 %) cases. Neoplasms with a diameter of 5 to 9 mm were excisions in a single block in 100 % of cases, with a diameter of 9 to 14 mm in 28/30 (93.33 %) cases, with a diameter of 15 to 19 mm in 12/38 (31.57 %) cases. According to the results of a lifetime pathoanatomic examination of the removed material, serrated dysplasia (serrated dysplasia, low grade) was detected in 76 cases; micro vesicular hyperplastic polyps (Hyperplastic polyp, micro vesicular type MVHP) were established in 9 cases; hyperplastic polyps containing goblet cells (Hyperplastic polyp, goblet cell GCHP) were in 5 cases; tubular adenoma with dysplasia (Tubular adenoma, low grade) was in 32 cases. Delayed bleeding and perforation of the intestinal wall, both at the time of resection, and in the delayed period was not observed. No local recurrence was detected in the groups of patients with neoplasms diameters of 5-9 and 10-14 mm. One case of local recurrence was detected in a group of patients with a neoplasms diameter from 15 to 19 mm (1/38 = 2.63 %) and one case in a group with a neoplasms diameter of 20-25 mm (1/5 = 20 %).

Conclusions. Cold endoscopic snaring resection of colorectal epithelial neoplasms with preliminary hydropreparation in the submucosa is a safe and effective method of excisions superficially epithelial neoplasms of the colon with a diameter of 5 to 19 mm.

Aim: to investigate the clinical efficacy of two methods of oral dosing of prednisolone (in mg and mg/kg) for the induction of remission for patients with ulcerative colitis (UC) and Crohn's disease (CD) using the technology of constructing and evaluating the effectiveness function (dose-effect relationship).

Material and methods. In this study were included 86 patients aged from 18 to 65 years with moderate or severe active inflammatory bowel disease (61 — UC, 25 — CD). All patients were treated with prednisolone at an initial daily dose from 30 to 60 mg with a subsequent tapering of dose. The clinical response to treatment was evaluated at the time of complete withdrawal of prednisolone using the generally accepted criteria. Two efficiency functions were constructed, compared and analyzed: the first — at the initial dosage of prednisolone in mg and the second calculating the dose in mg/kg of patient weight. The patients' body weight ranged from 41 to 98 kg. The “dose-effect” relationship for prednisolone was constructed with statistical transformation of the baseline clinical data and a quantitative expression of the actual doses and alternative responses into a graph of the effectiveness function. The mean value at each point was estimated based on the regression kernel scoring method.

Results. Two graphs of the “dose-effect” of prednisolone in mg and mg/kg of patient weight were constructed. The optimal clinically effective dose (OCED) when calculated in mg/kg of weight was 0.70 ± 0.01 (0.68 + 0.72) mg/kg with the corresponding effect 79.25 ± 6.26 (66.62 91.88) %. When two graphs in mg and mg / kg of weight were superimposed, it is shown that when an initial dose of 40 mg is prescribed without taking into account the patient's weight, the effect of therapy will be 25 % lower. Prescribing a dose of 60 mg per day without weight will be optimal for patients with a body weight of 85-90 kg. With a lower body weight, the clinical effect will not decrease, but the likelihood of recognized side effects of prednisolone should be expected in proportion to the decrease in body weight.

Conclusion. The clinical efficacy of two methods of prednisolone dosing (mg and mg/kg) for patients with IBD during the first induction course was compared.

Using a new technology for constructing and evaluating the effectiveness function (dose-effect relationship) allowed us to prove a reliable relationship between the body weight of patients with the clinical effect of prednisolone in patients with UC and CD. Based on the analysis of the dose-effect relationship, the optimal clinically effective dose of prednisolone for patients with UC and CD during the first induction course was established, equal to 0.70 mg/kg, which can be recommended for use in clinical practice for calculating individual doses.

Aim: to compare the efficacy of different therapeutic regimens for managing functional dyspepsia in outpatients after COVID-19 infection.

Materials and methods. 42 post-COVID-19 outpatients (age: 26–47 years) diagnosed with functional dyspepsia (FD) according to the Rome IV Criteria were enrolled in two parallel groups. All patients were divided in 2 groups by randomization: Group 1 received omeprazole at a dose of 80 mg/day, Group 2 received a combination of omeprazole and Kolofort® (a combined action drug product containing technologically processed antibodies to S100, TNF-alpha, and histamine) at a dose of 80 mg/day. At baseline and after treatment, a 10-point VAS was used to measure symptoms and an SF-36 questionnaire to evaluate the quality of life.

Results. By Day 28 of the treatment, the intensity of epigastric pain (VAS score) in the group receiving proton-pump inhibitor (PPI) + Kolofort® was significantly lower. In both groups, fully resolved dyspeptic syndrome was observed in up to 90 % of patients, without significant differences (p < 0.06). According to the SF-36 data, a combination treatment resulted in higher scores (pain and general health subscales) as compared to the PPI alone.

Conclusion. Kolofort® relieves symptoms and improves the quality of life when added to the treatment regimen against functional dyspepsia in post-COVID-19 patients.

Aim: to analyze the publications devoted to the modern possibilities of determining the level of faecal calprotectin (FCP) in the diagnosis of various diseases.

Key points. In patients with already established diagnosis of inflammatory bowel diseases (IBD), dynamic monitoring of the level of FCP allows to assess the course and prognosis of the disease, as well as the effectiveness of treatment. The determining of FCP helps in the primary diagnosis of IBD (ulcerative colitis, Crohn's disease, microscopic colitis), contributing to their differentiation from functional bowel disorders, as well as in assessing the course of diverticular intestinal disease and celiac disease. The possibility of using FCP as a marker of colorectal cancer (CRC) and adenomatous polyps of the colon is also discussed.

Conclusion. Determining the level of FCP plays an important role in the diagnosis and assessment of the course of a number of gastroenterological diseases (primarily IBD). The significance of FCP as a marker of CRC requires further research.

Aim: to present a clinical case of antiphospholipid syndrome (APS) manifested as recurrent portal vein thrombosis in a man with a medical history of other thromboses.

Key points. APS is a syndrome that includes venous and/or arterial thrombosis, various forms of obstetric pathology, thrombocytopenia, as well as a variety of neurological, skin, cardiovascular and hematological disorders. The article presents a clinical case of a male patient with several episodes of vascular thrombosis, two of which (thrombophlebitis of the veins of the lower extremities and stroke) developed at the age of 39 years, and recurrent thrombosis of the portal vein since 2018. For several years, the patient had the diagnosis of cirrhosis based on the presence of signs of portal hypertension. However, the patient's liver function remained practically intact all the time. During the current examination, APS was suspected, and the result of a blood test for antibodies against phospholipids was positive.

Conclusion. This clinical case of APS reflects the difficulties in diagnosing this disease. It should be remembered that cases of thrombosis at a young age may be due to APS.

Aim: to present the value of interventional radiology techniques in the treatment of a patient with liver metastasis of colorectal cancer.

Key points. In 2013, a 60-year-old patient with stage IIIB sigmoid colon cancer, pT3N2M0 underwent resection of the sigmoid colon with the formation of hardware rectosigmoanastomosis, 6 courses of adjuvant chemotherapy were performed. In 2015, a control examination revealed metastatic liver damage. Liver resection could not be performed due to the small future residual volume, and systemic chemotherapy was not effective. The patient underwent 3 cycles of regional chemotherapy. Taking into account the pronounced positive dynamics, in the form of a decrease in tumor size and a decrease in cancer markers, the patient managed to perform an extended right-sided hemihepatectomy. No progression of the tumor process was detected during the follow-up.

Conclusion. Modern possibilities of X-ray endovascular methods allow to achieve results in the treatment of patients with colorectal cancer metastases in the liver such as a decrease in metastases in size, that make liver resection possible.

Aim: bring to the attention of practitioners indications for anti-Helicobacter therapy, methods and procedure for diagnostics and eradication therapy of Н. pylori infection.

Key points. Chronic gastritis caused by Н. pylori infection, including asymptomatic persons, may be considered as an indication for eradication therapy of Н. pylori as etiological therapy and opportunistic screening for gastric cancer prevention. Indications, for obligatory anti-Helicobacter therapy include peptic ulcer, gastric MALT lymphoma, early gastric cancer (EGC) with endoscopic resection. H. pylori primary diagnostics methods include ¹³C-urea breath test, H. pylori stool antigen lab test, rapid urease test and serological method. The serological method cannot be used after anti-Helicobacter therapy.

In Russia H. pylori strains' resistance to clarithromycin does not exceed 15 % in most regional studies. The first line therapy for Н. pylori infection eradication is the standard triple therapy including a proton pump inhibitor (PPI), clarithromycin and amoxicillin, enhanced with bismuthate tripotassium dicitrate. A classic four-component therapy based on bismuthate tripotassium dicitrate or quadrotherapy without bismuth drug products which includes PPI, amoxicillin, clarithromycin and metronidazole, may be used as alternative to the first line eradication therapy. The standard triple therapy may be prescribed for 14 days only in those regions, where it has been proven to be effective. Quadrotherapy with bismuthate tripotassium dicitrate is also used as main second line therapy in case of standard triple therapy, bismuth enhanced standard triple therapy or combined therapy failure. Another second line therapy includes PPI, levofloxacin and amoxicillin, to which a bismuth-containing drug product may be added. The third line therapy is selected individually based on previously used treatment settings.

Conclusion. In each case of H. pylori infection the decision for eradication therapy should be made, which is especially relevant as eradication of H. pylori has been recognized as an effective measure for the prevention of gastric cancer.

On October 21, 22, 23, 2022, within the framework of the 122nd International Session of the National School of Gastroenterology, Hepatology (NSGH) of the Russian Gastroenterological Association (RGA), the First Russian Gastroenterology Olympiad was held.