Aim: to highlight current trends in the diagnosis and treatment of inflammatory bowel diseases in children.

Key points. The incidence of inflammatory bowel disease among children has increased significantly over the past three decades. Moreover, these diseases are often characterized by a severe course. At the same time, strategies for diagnosing and treating these patients are being improved: doctors began using high-definition endoscopy and video capsule endoscopy, the determination of fecal calprotectin, biological therapy (infliximab, adalimumab, vedolizumab, and ustekinumab) and drug monitoring. Particular attention is paid to the role of dietary recommendations.

Conclusion. Currently, there has been significant progress in the diagnosis and treatment of inflammatory bowel diseases in children.

Аim: to study the role of serum and ultrasonometric markers in the early diagnosis of malignant transformation of periductal fibrosis of the liver during the formation of cholangiocarcinoma against the background of chronic invasion of Opisthorchis felineus, in the population of endemic regions.

Methods. A comprehensive one-stage comparative study was conducted in a case-control design, using the assessment of biochemical parameters (lactate, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, alkaline phosphatase, glucose, direct and indirect bilirubin, high-density lipoproteins and low-density lipoproteins, triglycerides, urea and total protein), immunological parameters (transforming growth factor beta) and tumor markers (CA 19-9, СYFRA 21-1) in blood serum samples obtained from patients with O. felineus infection, with and without periductal fibrosis, O. felineus-infected patients with cholangiocarcinoma and representatives of control groups. During the analytical stage, the relationship between the structural features of the liver ac- cording to the results of ultrasound examination (presence of opisthorchiasis-associated periductal fibrosis), clinical parameters, parasitological study data (infection intensity), and changes in biochemical, immunological parameters and tumor markers in patients against the background of O. felineus infection was assessed. Statistical analysis was performed using the R programming language (version 3.6.1).

Results. Evaluation of the relationship between the presence of ultrasound signs of stage 1–2 opisthorchiasis-associated periductal fibrosis and changes in serum levels of the biochemical, immunologic parameters and oncomarkers in patients with O. felineus infection demonstrated that the levels of alkaline phosphatase, conjugated bilirubin, AST, glucose and CA 19-9 oncomarker were significantly higher in the serum of patients in the group with cholangio-carcinoma and opisthorchiasis (p < 0.01).

Conclusion. The first pilot data on the relationship between ultrasonometric signs of periductal liver fibrosis and the increase of CA 19-9 oncomarker as well as biochemical parameters (alkaline phosphatase, direct bilirubin, aspartate aminotransferase, glucose), which can be used for early diagnosis of malignant transformation of periductal liver fibrosis with the formation of cholangiocarcinoma in O. felineus-infected population in endemic regions, were obtained.

Aim. To study the functional activity of blood eosinophils in patients with Opisthorchis felineus (O. felineus) invasion.

Material and methods. A total of 328 patients with O. felineus invasion (120 men and 208 women, mean age 40.3 years) and 34 practically healthy patients (14 men and 20 women, mean age 41.1 years) aged 18 to 70 years were examined. The main method for diagnosing opisthorchiasis was the determination of eggs or bodies of adult parasites in the duodenal contents and/or feces, which was used in all 328 patients with opisthorchiasis. All patients underwent a complete blood count and biochemical blood test, esophagogastroduodenoscopy and ultrasound examination of the abdominal organs. The study of the functional activity of blood eosinophils was carried out in 42 patients with opisthorchiasis and 34 healthy individuals from the control group by chemiluminescent analysis with the measurement of the intensity of production of reactive oxygen species in spontaneous and zymosan-induced reactions in lucigenin- and luminol-dependent processes.

Results. The frequency of eosinophils in the complete blood count above 5% in the examined patients with opisthorchiasis was 19.5%. An increase in the content of eosinophils in the blood in patients with opisthorchiasis was associated with an increase in the frequency of complaints of pain in the right hypochondrium, pruritus, skin rashes, an increase in the proportion of leukopenia and neutropenia, an increase in the level of gamma-glutamyl transpeptidase in the blood, and an increase in the frequency of ultrasound signs of cholecystitis. At the same time, a pronounced increase in the functional activity of blood eosinophils, determined by the chemiluminescent method, was observed in patients with O. felineus invasion.

Conclusions. Patients with O. felineus invasion with an increase in the content of eosinophils in the blood due to the likelihood of an aggressive course of the pathology deserve the close attention of practitioners with the need for a thorough comprehensive examination of patients, including immunological methods.

Аim: analyze the results of an anonymous survey of patients with irritable bowel syndrome (IBS) to assess the degree of their satisfaction with the results of the therapy and, on this basis, determine the most optimal approaches to treatment. 

Material and methods. The work was carried out in 8 subjects of the North-Western Federal District of Russia. An anonymous survey was conducted in 422 patients with mild to moderate IBS. By assessing the number of people who noted the disappearance or significant decrease in the intensity of the main manifestations of the disease one and three months after treatment, the effectiveness of complex therapy was studied. Among the patients included in the study, people with a mixed variant of IBS with a predominance of pain syndrome (n = 206) self-assessed abdominal pain using a visual pain intensity scale. The rest (n = 216) completed a self-assessment of their condition using the frequency of bowel movements and the Bristol Stool Form Scale. In each of these groups, three subgroups were formed: Subgroup 1 — treatment of patients with gastroenterological drugs; Subgroup 2 — treatment with combined pharmacotherapy (with the appointment of psychotropic drugs); Subgroup 3 — treatment with a combination of gastroenterological and psychotropic drugs and the use of non-medicinal methods of psychotherapy.

Results. The maximum difference in the subjective satisfaction of patients with their treatment was noted three months after the completion of the course of treatment in Subgroup 3 (79 % — mild IBS, 71 % — moderate IBS). Patients of Subgroup 2 after three months positively assessed the results of their treatment in 34 and 27 % of cases, respectively. In patients of Subgroup 1, the considered indicators were even less significant — 28 % (mild IBS) and 22 % (moderate IBS).

Conclusion. The treatment complex for IBS patients can be considered optimal if, in addition to symptomatic medications, appropriate psychotropic medications are necessarily included in it basing on diagnostic assessment of the psychoemotional status of a particular patient, as well as the appointment of individually selected non-medicinal methods of psychological correction in accordance with psychosomatic symptoms. Full-time cycles on psychodiagnostics and psychotherapy should be included in the educational programs of advanced training of doctors working with IBS patients.

Аim: to improve the results of treatment of patients with rectal fistula.

Materials and methods. Twenty-eight patients with rectal fistulas were included in the study — 20 (71,4 %) men and 8 (28,6 %) women, average age — 40 (24–68) years. Based on examination and transrectal ultrasound data, 13 (46.4 %) patients had intrasphincteric fistulas and 15 (53.6 %) had transsphincteric fistulas. All patients underwent prehospital transrectal ultrasound and sphincterometry to assess the functional state of the anal sphincter, and the SF-36 quality of life questionnaire and Wexner scale assessing the functional status of the anal sphincter were analyzed. All patients, included in the study, had straight fistulous passage, without collections and significant scarring of the anal canal. Patients underwent two-stage surgical treatment using low-thrombin fibrin glue “Kriofit”. Follow-up of the patients was carried out on days 7, 14, 21 and included collection of complaints, examination of the perianal area, finger examination of the rectum. In the postoperative period, the intensity of pain syndrome was assessed using the visual analog scale of pain. On days 30 and 90 control transrectal ultrasound, sphincterometry, assessment of Wexner scale and patients' quality of life by SF-36 questionnaire on days 7 and 30 after the operation were performed.

Results. There were no intraoperative and early postoperative complications among patients. The average bed-day was 6.8 (5–11) days. The follow-up periods ranged from 1 to 42 months. Disease recurrences were diagnosed in 3 (10.7 %) patients. According to the sphincterometry data, no anal holding dysfunction was detected in any of 28 patients.

Conclusion. The results of our study have shown that the division of preliminary surgical treatment of the fistulous passage followed by local anti-inflammatory treatment and filling of the wound canal with two-component fibrin glue with low thrombin content “Kriofit” into two stages effectively increases the results of the proposed technique. The use of fibrin glue as a sphincter-preserving technique makes it possible to exclude the development of postoperative anal incontinence, and new technologies and materials reduce the risk of disease recurrence.

Аim: to analyze and evaluate the clinical and morphological manifestations of pilonidal sinus disease (PSD) as a part of follicular occlusion syndrome (FOS).

Materials and methods. In the Clinic of Coloproctology and Minimally Invasive Surgery, 80 patients with PSD underwent surgeries from November 2018 to December 2019: 62 (77.5 %) patients — with primary PSD, 18 (22.5 %) — with recurrence of the disease.

Results. There were 80 patients, 6 patients (9.7 %) with primary and one (5.6 %) patient with recurrent cyst had concomitant manifestations of follicular occlusion syndrome. Thus, the frequency of combination of PSD with other variants of FOS course amounted to 8.8 %. Hidradenitis suppurativa of axillary and inguinal areas was found in 5 out of 7 patients. Acne conglobata, as one of the components of FOS, was noted in three patients. Dissecting cellulitis of the scalp was diagnosed in one patient. Follicular occlusion triad was observed in two patients. Follicular occlusion tetrad was not noted in any observation. All patients were treated with excision of the pilonidal sinus disease with local tissue-plasty of the defect. At present, no recurrences have been noted in any of the cases, and the mean follow-up time was 14 ± 5.6 months (6–27 months). PSD as a manifestation of follicular occlusion syndrome is characterized by a more cranial and more superficial location of the cavity in the sacrococcygeal region. According to the data of histologic examination of patients with FOS, the morphologic picture is identical with patients with isolated PSD. All patients with confirmed FOS have received pathogenetic local and conservative therapy. After the therapy remission of combined diseases is noted.

Conclusion. Deroofing of the lining of the cavity, often used in dermatologic practice, along with complex treatment within the framework of multidisciplinary (together with a dermatologist) management of patients with FOS, looks promising.

Аim: to investigate the impact of COVID-19 on the course and prognosis of cirrhosis.

Materials and methods. This was a cohort study in patients with cirrhosis. We included patients with cirrhosis who underwent a medical examination at our center between September 2019 and March 2020. We determined which of these patients were infected with COVID-19, died of COVID-19, or died of cirrhosis complications within the follow-up period from April 2020 to September 2021. Thereafter, we conducted a second medical examination of these surviving patients with cirrhosis in September to December 2021.

Results. Among the 226 patients included in the study, 57 had COVID-19, among which 19 patients who died of the disease. Acute-on-chronic liver failure (ACLF) developed in 16 (28.1 %) patients with cirrhosis and COVID-19, 13 (81.3 %) of whom died. One of the COVID-19 survivors eventually died of liver decompensation. Twenty patients who did not have COVID-19 died of complications of cirrhosis (ACLF) during the follow-up period. The mortality rate in patients who were infected with COVID-19 was higher than that in patients who were not infected (35.1 % vs. 14.2 %; p = 0.001). COVID-19 was an independent risk factor for death in patients with cirrhosis. No liver-specific factors predisposing to COVID-19 infection were identified. A more impaired liver function in the pre-pandemic medical examination was a predisposing factor for death in patients who had COVID-19. Patients who died of COVID-19 had better liver function in the pre-pandemic medical examination than patients without COVID-19 who died of complications of cirrhosis during the follow-up period. The liver-related mortality rate and the incidence of liver decompensation or bleeding from esophageal varices during the follow-up period were not significantly different between patients who recovered from COVID-19 and patients with cirrhosis who did not have COVID-19. Among the analyzed survivors, no significant changes were found in the main indicators of liver function after the follow-up period between patients with and without COVID-19, except for the prothrombin index, which was higher in patients after COVID-19.

Conclusion. COVID-19 worsens the prognosis of patients with cirrhosis but does not substantially affect the course of cirrhosis after the recovery from this infection.

Аim: to present evidence justifying prescription of rebamipide during chronic gastritis.

Key points. Experimental and clinical studies have demonstrated that rebamipide increases concentration of prostaglandins (prostaglandin E2 and prostacyclin) and production of mucin, manages inflammation and oxidative stress, controls apoptosis and autophagy. Pleiotropic effects of rebamipide are aimed at restoration of epithelium barrier function and can be implemented during chronic gastritis for various indications. When added to the H. pylori eradication therapy, rebamipide increases its effectiveness and tolerability. During atrophic gastritis, long-term treatment with rebamipide has resulted in reduction of degree of atrophy and intestinal metaplasia. Effectiveness of rebamipide during erosive gastritis, for treatment and prevention of stomach and duodenum disorders associated with nonste- roidal anti-inflammatory drugs is proven. Rebamipide manages symptoms of dyspepsia during chronic gastritis and during functional dyspepsia.

Conclusion. Prescription of rebamipide during chronic gastritis for various indications is proved from the perspective of evidence-based medicine during H. pylori eradication therapy and for restoration of mucosa barrier function.

Аim: to provide basic information on Whipple's disease necessary for timely diagnosis and treatment, using the example of clinical observation.

Key points. Whipple's disease is a rare systemic infectious disease that internists, gastroenterologists, rheumatologists, and other physicians may encounter. The incidence of Whipple's disease is extremely low and amounts to 1 case per 1,000,000–10,000,000 people. The low prevalence of pathology can lead to underdiagnosis in favour of more common diseases. This, in turn, may worsen the patient's prognosis, as it will delay the time for establishing the correct diagnosis and initiating the necessary therapy. A 50-year-old man complained of losing 10 kg of weight over 5 months, abdominal pain and bloating, pain in the joints of feet, and shoulders, accompanied by swelling and hyperemia. The disease began with articular syndrome followed by diarrhea and manifestations of malabsorption (iron deficiency anemia, hypoalbuminemia, hypercholesterolemia). The diagnosis was established on the basis of morphological changes in biopsy samples of the postbulbar part of the duodenum. The identified changes were represented by thickening of the villi and accumulations in the stroma of large macrophages (CD68⁺) with wide light cytoplasm containing abundant accumulations of PAS-positive, negative when stained with carbol fuchsin according to Ziehl — Nielsen and auramine-rhodamine (under microscopy in luminescence mode) short rods, as well as numerous optically empty small and larger cavities. Treatment with intravenous injections of ceftriaxone 2 g per day for 14 days and trimethoprim/sulfamethoxazole 1920 mg per day for 8 months led to improved health, normalization of laboratory parameters, endoscopic and morphological findings. Treatment with trimethoprim/sulfamethoxazole is planned to be continued for up to 12 months or longer if necessary.

Conclusion. Timely diagnosis and initiation of antibiotic therapy will help to avoid late complications of the disease, including death.

Аim: to draw attention to the diagnosis and treatment of a rare complication of chronic pancreatitis — pancreaticopleural fistula with subtotal enzymatic exudative pleurisy, as well as the possible connection between exacerbation of chronic pancreatitis and pneumonia caused by SARS-CoV-2.

Key points. In primary chronic pancreatitis, pancreaticopleural fistulas develop extremely rarely, while abdominal symptoms may not be expressed, and pleural effusion syndrome comes first in the clinical picture, so it is difficult to establish the true cause of exudative pleurisy in such a situation. The causative agent of COVID-19 has a high affinity for angiotensin-converting enzyme 2 receptors, which are present in large numbers on acinar, ductal, and secretory cells of the pancreas. Obviously, this infection can influence the course of the inflammatory process in chronic pancreatitis.

This clinical observation presents a rare case of exacerbation of chronic pancreatitis with the formation of a pancreaticopleural fistula with subtotal enzymatic pleurisy on the left, which was preceded by pneumonia caused by SARS-CoV-2 in a 47-year-old man who abused alcohol. The study of exudate for amylase content helped to identify the enzymatic cause of pleurisy. Multislice computed tomography of the abdominal organs with bolus enhancement revealed a mass formation in the head of the pancreas with ectasia of the Wirsung duct and common bile duct. It was possible to restore the normal passage of bile and pancreatic secretions, as well as to stop the functioning of the pancreaticopleural fistula using pancreatoduodenal resection. A morphological examination of the macroscopic specimen revealed a diagnosis of pseudotumorous capitate chronic pancreatitis in the acute stage. After surgical treatment, according to ultrasound control, pleurisy was cured. The patient was examined a year later; his condition was consistent with the surgery. There were no clinical, physical, or instrumental data for left-sided pancreaticogenic pleurisy, hypertension of the extrahepatic and pancreatic ducts.

Conclusion. Recurrent exudative pleurisy in chronic pancreatitis with rapid accumulation of exudate in a large volume with a high amylase content is a sign of pancreaticopleural fistula. The development of exacerbation of chronic pancreatitis was influenced by a combination of factors, including coronavirus infection, which suggests further accumulation of clinical material with this combination of pathological processes.

Аim: to present the difficulties of surgical treatment of patients with multiple and combined echinococcal lesions. 

Key points. A 47-year-old patient who lived in Central Asia for up to 29 years of age was diagnosed with multiple echinococcosis of the abdominal cavity (CE1-2): II, Ivb, V, VI, VII segments of the liver, upper and lower poles of the spleen, lesser and greater omentum, small intestine, subphrenic space, area of the hepatoduodenal ligament, gastrocolic ligament. Surgical intervention was performed: atypical resection of liver segments V, VI, VII, subtotal pericystectomy, cholecystectomy, subtotal pericystectomy of cysts of II and IVb liver segments, subtotal pericystectomy of splenic cysts, resection of the greater omentum, echinococcectomy of the lesser omentum, mesentery of the small intestine, hepatoduodenal ligament, gastrocolic ligament, drainage of the abdominal cavity. Pericystectomy was carried out according to the technique of the National Medical Research Center of Surgery named after A. Vishnevsky.

Conclusion. Due to the peculiarities of the course of helminthiasis and the pronounced variability of the lesion, it is extremely difficult to develop universal and effective treatment algorithms. The presented clinical observation demonstrates an example of the successful use of special surgical tactics for the treatment of “complex” echinococcosis of the abdominal cavity with good long-term follow-up results.