In 2019, on the eve of Vladimir Ivashkin’s 80th birthday, we conducted our first interview with him. Now, on the eve of his 85th birthday, Professor Ivashkin again kindly agreed to talk with us and share his thoughts, emotions and impressions about the key events of the past five years.

Aim: to discuss current views on the clinical significance, diagnostic opportunities, and therapeutic approaches in the treatment of small intestinal bacterial overgrowth (SIBO) as an important component in the gut microbiota function assessment, to assess the awareness of physicians and the opportunities in the diagnosis and treatment of this disease in patients in the Federal districts of the Russian Federation, as well as to present the proceedings of the Expert Council held on December 16, 2023 in Moscow.

Key points. SIBO is a common syndrome often associated with irritable bowel syndrome, liver cirrhosis, asthma, and congestive heart failure, being also a predictor of early death in the elderly. Today, in many regions of the Russian Federation, there are limitations for instrumental diagnosis of this disease — lack of awareness among doctors, unavailability of gas analyzers for diagnosing SIBO, lack of information about the need to diagnose SIBO in the standards of compulsory health insurance. Rifaximin is the first-line treatment due to the highest therapeutic efficacy. One of the ways to increase the efficacy of SIBO treatment is to include strain-specific probiotics in the treatment regimen. Saccharomyces boulardii CNCM I-745 is thought to be the most studied, promising probiotic. The review also presents statistical data on the issues in the diagnosis and treatment of SIBO in the regions of the Russian Federation.

Conclusion. Optimization of approaches to the diagnosis and treatment of SIBO, the development of domestic gas analyzers, increasing the awareness of physicians in all regions of the Russian Federation, as well as the development and optimization of clinical recommendations appear to be necessary measures to increase the effectiveness of medical care, the duration and quality of life of the Russian population. These goals can be achieved within the framework of Federal programs under the supervision of specialized reference centers of the Ministry of Health of the Russian Federation.

Aim: localization of the new nomenclature of steatotic liver disease in Russian clinical practice.

Key points. In 2023, international consensus decided to introduce a new nomenclature for steatotic liver disease. The article discusses the reasons for the change in nomenclature and the new terms adopted: steatotic liver disease, metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction and alcohol associated steatotic liver disease. Adapting new terms to Russian healthcare poses a certain problem. The results of voting by Russian doctors on the introduction of new terms and their optimal translation are presented. A comparison of existing classifiers with new terms was carried out and the formulation of diagnoses was discussed taking into account the new nomenclature.

Conclusions. Adaptation and implementation of new nomenclature into clinical practice is an important and complex task, in which it is necessary to maintain a balance between a progressive concept and the interests of practical healthcare.

Aim: in the retrospective study to assess the frequency of various gastritis variants based on the results of morphological examination of gastric biopsies over a 5-year observation period.

Methods. The study included 3162 individuals who underwent esophagogastroduodenoscopy with biopsy collection between 2017 and 2022. Pathological examination of biopsies was conducted using the updated Sydney system, determining the histological variant and, when possible, the etiology of gastritis. In some cases, chronic gastritis was assessed using the OLGA/OLGIM system.

Results. The most frequently diagnosed type was active H. pylori-associated gastritis (36.7 %), followed by chronic atrophic gastritis with intestinal metaplasia in cases where H. pylori infection was not detected (28.4 %), including immunohistochemical examination, classified as gastritis after successful H. pylori eradication. Atrophic forms of chronic gastritis constituted 34.8 %. Minimal or mild changes close to normal histological characteristics were оbserved in 19.2 % of patients. Reactive gastropathy was present in 7.6 % of cases. Autoimmune gastritis ranked fourth in frequency, with a relatively high percentage of observations (8.6 %).

Conclusion. According to the analysis of gastric biopsies in the Russian population, a high frequency of H. pylori-associated gastritis was observed, and autoimmune gastritis is not uncommon. The high prevalence of atrophic gastritis emphasizes the importance of dynamic patient monitoring within cancer prevention programs.

Aim: to evaluate, using the “GastroPanel®”, the frequency of detection of H. pylori infection and associated gastric diseases among doctors and medical staff of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Moscow.

Materials and methods. Employees of three branches of the National Medical Research Radiological Centre (n = 434, mean age — 48.5 ± 0.6 years) were examined using laboratory tests “GastroPanel®” (Biohit Oyj, Finland). The test results make it possible to identify infection of the stomach with H. pylori, hypo- and hyperacid conditions, as well as atrophic gastritis of the antrum and body of the stomach, as its precancerous conditions. Esophagogastroduodenoscopy (EGDS) for suspected atrophic gastritis was performed with an Olympus GIF-HQ190 video endoscope (Japan) in a narrow-spectrum mode with close focus (NBI Dual Focus).

Results. The absence of pathological signs detected by “GastroPanel®” was established in 23.3 % of cases, hyperacid state — in 18.4 %, and hypoacid state — in 5.2 %. These disorders are classified as functional. Consequently, the conditional norm in total was identified in 46.9 % of observations. An increased level of antibodies to H. pylori was found in 43.3 % of those examined. Atrophic gastritis in the body of the stomach according to the results of the “GastroPanel®” was detected in 4.8 % of cases (median age — 59 years), in the antrum (or increased secretion of hydrochloric acid) — also in 4.8 % of cases (median age — 52 years). Within two months after laboratory diagnostics, EGDS was performed for 10 out of 15 patients examined at the P. Hertsen Moscow Oncology Research Institute in whom, based on the results of the “GastroPanel®”, the presence of atrophic gastritis in the antrum (or increased secretion of hydrochloric acid) was suspected. In 6 out of 10 cases, atrophic gastritis of the antrum was confirmed (in two of them, the atrophy extended to the body of the stomach and was assessed as severe). Of the 11 people with the “GastroPanel®” conclusion “Atrophic gastritis of the body of the stomach,” an endoscopic examination was carried out in 7 persons, and in all these cases the diagnosis was confirmed, and in two people the conclusion was made of severe atrophic pangastritis.

Conclusion. “GastroPanel®” confirmed its high significance in identifying H. pylori infection and precancerous atrophic changes in the gastric mucosa. Regarding the occupational risks of infection among medical workers, we consider it advisable to conduct such screening without selecting an asymptomatic population.

Aim: to assess the composition of the microbiota of the mucous membrane of the body and the antrum of the stomach.

Materials and methods. Sixty patients with dyspeptic symptoms were included into the study. Two biopsy samples of the gastric mucosa (from the body of the stomach and the antrum) were obtained from each patient. The presence of H. pylori infection was confirmed by PCR; RNA was isolated and then libraries were prepared for metatranscriptomic analysis of the 16S rRNA gene. Sequencing was performed on MiSeq (Illumina, USA) using MiSeq Reagent Kit v3 (600-cycle) (Illumina, USA).

Results. The bacterial diversity decreases with the predominance of Helicobacter pylori species in H. pylori-positive patients. These results were confirmed by the Shannon index, the average value of which was 3.6 in the H. pylori-positive group and 5.4 in the H. pylori-negative group. In H. pylori-negative patients an increase in the representation of Streptococcus, Prevotella and Alloprevotella genera was observed. The level of H. pylori contamination of the gastric mucosa varies in the antrum and body of the stomach, in some cases reaching a 3.5-fold difference. Representation of other bacteria in the body and antrum of the stomach does not differ significantly.

Conclusion. The bacterial composition of the stomach is dependent on the presence of H. pylori. H. pylori leads to the decrease of the bacterial diversity with the predominance of H. pylori in gastric microbiome.

Aim. Given the potential for physiological alterations in the gastrointestinal tract following appendix removal, which may influence carcinogenesis, we embarked on a systematic review and meta-analysis to explore the possible association between appendectomy and the subsequent risk of colorectal cancer (CRC).

Methods. Our systematic investigation utilized sources including the Cochrane Library, Embase, PubMed, ClinicalTrials.gov, and Web of Science, covering research up to February 1, 2023. We assessed the impact of appendectomy on colorectal cancer, employing a random effects model to calculate the pooled hazard ratio (HR) for developing CRC post-appendectomy and its 95 % confidence interval (CI).

Results. This review and meta-analysis incorporated a total of 10 studies, comprising 1,001,693 cases of appendectomy and 39,463 instances of CRC. The meta-analysis revealed a pooled HR of 1.04 (95 % CI: 1.0–1.08) for developing CRC following appendectomy. Notably, the HR for CRC development increased to 1.20 (95 % CI: 0.69–1.69) when considering only cases with more than 10 years of follow-up.

Conclusion. The findings indicate a marginally increased risk of colorectal cancer in cases without a specified follow-up period. However, this elevated risk did not persist over the long term (exceeding 10 years). The heterogeneity of the included studies appears to have influenced our results. Nevertheless, it is advisable for physicians to weigh the potential benefits of alternative therapies and consider the future complications that may arise from an unnecessary appendectomy.

Aim: to present a clinical observation of a patient with Whipple's disease, demonstrating the difficulties in diagnosing the disease.

Key points. A clinical observation of Whipple's disease in a 61-year-old man is described. The onset of the disease was manifested as polyarthritis three years before diagnosis. The further course of the disease occurred during the pandemic of a new coronavirus infection COVID-19, which made the diagnostic search difficult. Clinical manifestations of fever, arthralgias, diarrhea, lymphadenopathy, anaemia and weight loss raised suspicion of Whipple's disease. Key to the diagnosis were endoscopic studies with multiple small bowel biopsies, which allowed histological identification of PAS-positive macrophages in the small bowel mucosa. Therapy with ceftriaxone for 14 days, therapy with trimethoprim-sulfamethoxazole (160 mg/800 mg twice a day) for 14 months resulted in positive clinical dynamics, improvement of laboratory parameters, disappearance of PAS-positive macrophages in the small intestinal mucosa, indicating remission of the disease.

Aim. The guidelines set out the modern methods of diagnostics and treatment of peptic ulcer and are created for gastroenterologists, primary care physicians, general practitioners, surgeons, endoscopists.

Key points. The clinical guidelines contain modern views on the etiology and pathogenesis of peptic ulcer, its clinical features, methods of laboratory and instrumental diagnostics, the main approaches to conservative and surgical treatment. They include the criteria for assessment of the quality of medical care, the algorithm of the doctor's actions, as well as information for the patient.

Conclusion. Knowledge of modern methods of diagnostics and therapy of peptic ulcers will contribute to improving the results of its treatment.