Aim: to present modern approaches to the differential diagnosis and treatment of anterior abdominal wall pain.

Key points. Pain in the anterior abdominal wall is a common reason for visiting a gastroenterologist and is often misinterpreted. Signs that distinguish it from visceral and parietal pain include local character, a positive Carnett sign and the effectiveness of local anesthetic injection. Among the main causes, it is necessary to highlight diseases that are not accompanied by a palpable mass in the anterior abdominal wall (anterior cutaneous nerve entrapment syndrome, ilioinguinal nerve syndrome, slipping rib syndrome, radiculopathy and myofascial pain syndrome). Another group of causes of pain in the anterior abdominal wall is represented by diseases in which areas of infiltration (tumors, endometriosis, infections) or hernial protrusions are determined, in which radiation methods play an important role in diagnosis.

Conclusion. Knowledge of pathognomonic clinical and instrumental signs is the basis for differential diagnosis and choice of treatment strategy for pathology of the anterior abdominal wall.

Аim: to show the clinical significance of nanomaterials in the diagnosis and treatment of acute pancreatitis.

Key points. It was possible to develop nanomaterials that improved the sensitivity of laboratory tests and the resolution of magnetic resonance imaging in the diagnosis of acute pancreatitis. The use of nanomaterials in the treatment of acute pancreatitis helps to relieve inflammation and reduce the degree of damage to the acinar cells of the pancreas. The use of nanoparticles can solve the problem of stable resistance of bacteria to antibacterial drugs.

Conclusion. Nanomaterials have shown high efficacy and safety in numerous in vitro and in vivo (animal) experiments in the diagnosis and treatment of acute pancreatitis.

Aim: description of modern methods of statistical evaluation of the world evidence base to determine the direction of promising scientific research in diagnosis and treatment of cholelithiasis and cholecystitis.

Materials and methods. The umbrella review of systematic reviews and meta-analyses of the Cochrane Library has been conducted, identifying topics for which further evidence-based research is needed. The information obtained by the Cochrane expert panels through Trial Sequential Analysis (TSA), Diversity-Adjusted Required Information Size (DARIS) calculations, and Z-curve monitoring on benefit, harm, or futility boundary plots is systematized.

Results. There were established multidirectional trends and significantly different levels of achievement of evidence-based results. These should be taken into account when determining the prospect of further evidence-based studies. In the context of bile duct injury between early and delayed laparoscopic cholecystectomy, number of complications between early and delayed laparoscopic cholecystectomy, small-incision cholecystectomy and laparoscopic cholecystectomy, single-port and standard four-ports cholecystectomy and low-pressure laparoscopy the required size of meta-analysis information is unlikely to be achieved — in current versions of Cochrane library DARIS is less than 1 % of required. The same applies to mortality, the probability of developing serious complications and the conversion rate of various minimally invasive procedures, as the required sample sizes (hundreds of thousands of observations) are difficult to achieve — currently range is from 0.03 to 21.9 %. On the contrary, the achieved values from the estimated DARIS in establishing the differences in the duration between minimally invasive surgery options (21.2 to 76 %), in some issues of pain management in the immediate postoperative period (43.6 to 92.6 %) and additional intraoperative anesthesia (13.7 to 14.9 %) and Z-curve monitoring give hope for their achievement in the foreseeable future. There is little prospect of continuing evidence-based studies to determine the need for intraperitoneal anesthetic instillation, differences in the duration of hospitalization after various minimally invasive surgeries, since new information is unlikely to change the conclusions of meta-analyses (the required information size has been achieved by 100 %).

Conclusion. It is necessary to take into account the results of a TSA analysis of Cochrane expert groups, when choosing research topics in patients with gallstone disease and acute cholecystitis.

Aim: to study the effectiveness and safety of using the drug Kolofort® in outpatients with irritable bowel syndrome (IBS) after a new coronavirus infection.

Materials and methods. An observational non-interventional program was conducted in patients with exacerbation of IBS symptoms after a new coronavirus infection. One hundred forty-one patients took part in the study. The final efficacy analysis included data from 127 study participants. All patients complained of increased/appearing gastrointestinal symptoms that appeared within 1–6 months after the infection (all patients had a history of COVID-19 infection). To assess the presence and severity of symptoms of the disease, the “7 × 7” questionnaire was used before the start of treatment and three months after the start of treatment.

Results. At the stage of inclusion in the program, the average total score on the “7 × 7” questionnaire was 17.36, which corresponded to a moderately severe disorder. During the treatment period, the average total score decreased to 6.14, which corresponded to borderline disorder. In addition, significant improvement was observed for each symptom separately. After three months of therapy, doctors rated the overall impression of the treatment on a 5-point Likert scale from “very effective” to “ineffective”. The average score was 4.24. In addition, no serious adverse events were identified while taking the drug.

Conclusion. In real clinical practice, the drug Kolofort® demonstrated high clinical efficacy in the treatment of patients with IBS after COVID-19 infection.

Objective. Cytokine release syndrome (CRS) is a dangerous complication of the new coronavirus infection (COVID-19). The study aimed to compare sarilumab (SAR group) with tocilizumab (TOC group) and patients without anticytokine treatment (CON group) in treatment of CRS in COVID-19.

Methods. The retrospective real life study included COVID-19 patients with C-reactive protein(CRP)  level >60 mg/l.

Results. We enrolled 24 patients in SAR group, 27 patients in TOC group and 47 patients in CON group. Mortality was lower in SAR and TOC groups than in CON group (12.5% and 14.8% vs. 31.9%; p=0.021 and p=0.031) with no difference between SAR and TOC groups (p=0.389).  SAR patients unlike TOC patients required intensive care unit admission less frequently then CON patients (16.7% and 25.9% vs. 46.3%; p=0.013 and p=0.077). An increase in oxygen saturation was observed in SAR and TOC groups (p=0.001 and p=0.004; greater in SAR group [p=0.022]), but not in CON group (p=0.764) in 7-10 days after administration of these drugs. The decrease in CRP level was greater in  SAR and TOC groups than in CON group (p=0.016 and p<0.011), with no difference between SAR and TOC groups (p=0.236).

Conclusion. Sarilumab is not inferior to tocilizumab in COVID-19

Aim: to evaluate the characteristics of Crohn's disea depending on the age of the disease onset in patients observed in a specialized City Center for Inflammatory Bowel Diseases Diagnosis and Treatment.

Materials and methods. We observed 180 patients with an established diagnosis of Crohn's disease for 52 weeks, followed by a retrospective assessment. Patients were divided into three groups depending on the age of the onset of the disease according to the Paris classification (A1, A2, A3). The visits included: the collection of complaints, medical history, objective examination, clinical blood testing; biochemical blood testing (C-reactive protein); fecal calprotectin; ileocolonoscopy. Statistical processing of the obtained data was carried out using Excel, RStudio and the R language; for categorical data, the Pearson chi-square test or Fisher's exact test was used (for 2 × 2 tables with small samples). For categorical and quantitative, the Mann – Whitney t-test was used. Student's t-test was used to test the equality of means.

Results. The gender distribution and the average duration of the disease were comparable in all groups. At the time of diagnosis, ileocolitis (p = 0.01), inflammatory form of Crohn's disease (p < 0.05), and the upper gastrointestinal tract involvement (p < 0.05) were more frequently detected in group A1. Isolated colonic Crohn’s disease predominated in group A3 (p < 0.001). No significant difference between the groups in the incidence of extraintestinal manifestations of the disease was found (p = 0.32). In group A1, there was a positive correlation between smoking and lack of response to therapy. In group A2, endoscopic remission was observed less frequently among smokers at the end of the study (p < 0.05). Anal fissures were noted as the most common perianal disease in all groups. In group A1, there was a positive correlation between clinical, laboratory and endoscopic remission and the absence of perianal disease. At the end of the follow-up, the worsening of endoscopic SES-CD level was observed more frequently in the patients with the onset before 30 years old in group A2 (p = 0.01).

Conclusions. Not only pediatric onset, but also the onset of Crohn's disease before the age of 40 is a risk factor for the progression of the disease and its more severe course.

Aim: to study the effect of L-menthol on duodenal peristalsis, the results of cannulation of the papilla, the effectiveness and safety of endoscopic retrograde transpapillary interventions (ERTI).

Materials and methods. A prospective two-center randomized placebo-controlled trial was carried out from January to November 2022 in two centers. The study included 126 patients, 69 (54.8 %) men and 57 (45.2 %) women, mean age — 62.1 ± 1.8 years. The inclusion criteria were age 18–75 years, indications for ERTI, absence of previous endoscopic papillotomy, absence of allergy to menthol, consent to participate in the study. After randomization, the main group (“L”) included 70 patients, the control group — 56. Patients in group “L” were irrigated with 25 mL (160 mg) of L-menthol (Spectavium), patients in the control group — with 25 mL of saline solution. Peristaltic activity was studied before and three minutes after administration of the drug. The intensity of peristalsis was assessed according to a modified Hiki scale: 0 points — complete absence of peristalsis; 1 point — single peristaltic waves; 2 points — intense peristalsis, little amenable to straightening at maximum insufflation; 3 points — pronounced peristalsis.

Results. Three minutes post-irrigation, the suppression of peristaltic waves was noted in the experimental group “L”: 0 points — 63 (90 %) patients, 1 point — 6 (8.6 %) patients, compared to the control, with no change in peristalsis (p < 0.05). Successful selective cannulation was achieved in 64 (91.4 %) patients of group “L” and in 41 (73.2 %) — of the control group (p < 0.05). Non-cannulation endoscopic papillotomy had to be used in 6 (8.5 %) cases in group “L” and in 14 (25 %) cases in the control group. In general, successful cannulation was achieved in 100 % of patients in group “L”, and in 94.5 % — in the control group (p < 0.05). The duration of the intervention was significantly reduced in group “L” — 40 ± 2.5 vs. 50.3 ± 3.6 min. Among the complications, only intraoperative bleeding was registered (2 (2.9 %) — group “L”, 5 (8.9 %) — the control group), which was eliminated endoscopically in all cases.

Conclusion. The use of L-menthol during ERTI helps to achieve noticeable inhibition of peristalsis, promotes successful cannulation, reduces the intervention time, minimizes the risk of intraoperative complications. Thus, L-menthol has demonstrated its effectiveness and safety, which makes it possible to use it in the arsenal of combating enhanced peristalsis during ERTI.

Aim: evaluation of long-term results of injection of botulinum toxin type A into the internal anal sphincter and performing lateral internal sphincterotomy in combination with excision of chronic anal fissure.

Materials and methods. The study included 176 patients (73 (41.5 %) men and 103 (58.5 %) women) older than 18 years; randomization into the compared groups was carried out by random number generation in a computer program. Patients, researchers and surgeons were not blinded. Patients of the main group underwent fissure excision in combination with relaxation of the internal anal sphincter by botulinum toxin type A (BTA) at a dosage of 40 units, patients of the control group underwent lateral internal sphincterotomy (LIS) with excision of chronic anal fissure. Long-term results of complex treatment were studied in 126 patients (54 (43 %) men and 72 (57 %) women), the median follow-up was 12.3 (12.2; 15.7) months. Statistical analysis was carried out in the program Statistica 13.3 (TIBCO Software Inc., USA).

Results. In the long-term postoperative period, the indicators of mean resting anal pressure were lower in the LIS group (p = 0.04). The compared groups were comparable in terms of the level mean squeeze anal pressure (p = 0.69); however, in patients of the BTA group, the level of this indicator increased over time (p = 0.001). None of the patients of the compared groups had anal incontinence and relapse of the disease.

Discussion. In the framework of the performed study, in some patients from the compared groups, spasm of the internal anal sphincter persisted throughout the observation period, and in some patients it occurred again, while no signs of relapse fissure were detected. The functional and clinical results of treatment obtained by us cast doubt on the exclusivity of the increased tone of the internal anal sphincter as the main link in the pathogenesis of chronic anal fissure in some patients and indicates the presence of other factors in combination with which the course of the disease is determined. The above facts do not exclude the possibility of recurrence of anal fissure in a more distant period of observation.

Conclusion. Medical relaxation with botulinum toxin type A at a dosage of 40 units can serve as an alternative to lateral internal sphincterotomy as a method of eliminating spasm of the internal anal sphincter

Aim: to present the main statements of Kyoto International Consensus report on anatomy, pathophysiology, and clinical significance of the gastroesophageal junction.

Key points. The experts reviewed and adopted 28 statements concerning (1) the definition of the gastroesophageal junction (GEJ); (2) the definition of the GEJ zone, covering the area located 1 cm proximal and 1 cm distal in relation to gastroesophageal junction; (3) the assessment of chemical and bacterial (Helicobacter pylori) factors leading to the development of inflammation, metaplasia and neoplasia of the mucosa of the GEJ; and (4) a new definition of Barrett’s esophagus.

Conclusion. The new definitions of GEJ, GEJ zone and Barrett’s esophagus adopted by the International Consensus will be used in subsequent studies, which will contribute to improving the results of treatment of diseases of this area.

Aim: to present a clinical case of post-COVID bronchiolitis in an adult.

Key points. A 54-year-old female patient with a long history of smoking was hospitalized in the pulmonology department of the Clinic with a leading complaint of progressive shortness of breath after a COVID-19 infection. The diagnosis was established: bilateral bronchiolitis associated with a new coronavirus infection (SARS-CoV-2 polymerase chain reaction — positive); chronic obstructive pulmonary disease stage II according to GOLD (Global Initiative for Chronic Obstructive Lung Disease), exacerbation. Against the background of the therapy, there was a significant positive dynamics in well-being and in CT-picture of bronchiolitis. The patient was discharged for outpatient follow-up treatment. One of the most common symptoms of post-COVID syndrome is shortness of breath. Diagnosis of bronchiolitis, in which this symptom may be the only one, is difficult, especially in patients with a long history of smoking and the presence of comorbid pulmonary pathology.

Conclusion. A clinical case of bilateral bronchiolitis in the framework of the post-COVID syndrome is presented. The key to successful diagnosis of bronchiolitis is a thorough differential analysis of the totality of anamnestic and clinical laboratory data, as well as a characteristic CT pattern.