Aim: to present current data about the frequency and risk factors of upper gastrointestinal complications associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and the possibilities of preventing these complications.
Key points. The incidence of gastrointestinal complications associated with NSAIDs is 14.7–30.1 %, with the maximum risk noted in the first two weeks of their administration. The use of selective cyclooxygenase-2 inhibitors is associated with a reduced risk of gastrointestinal complications. All patients who are going to receive NSAIDs should be diagnosed with H. pylori and treated with eradication therapy if this infection is detected. Even in patients without risk factors for gastrointestinal complications and with short courses of therapy, coxibs or a combination of NSAIDs and proton pump inhibitors may be considered. Prevention of NSAID-associated lesions of the upper gastrointestinal tract is an indication for the appointment of omeprazole and esomeprazole in accordance with the instructions for medical use. Esomeprazole has a number of pharmacokinetic advantages — a large area under the pharmacokinetic curve, the ability to inhibit CYP4502C19, which determines the high efficiency of therapy in fast and ultrafast metabolizers. Previous clinical studies of esomeprazole for the prevention of NSAID-associated lesions of the upper gastrointestinal tract demonstrate high efficacy. In the randomized OBERON study the risk of gastric and duodenal ulcers after 3 months of low-dose acetylsalicylic acid treatment in the esomeprazole group was 7 times lower.
Conclusion. Assessment of risk factors, correction of modifiable risk factors, selection of safer NSAIDs and simultaneous administration of proton pump inhibitors (including esomeprazole) are effective prevention of NSAID-associated upper gastrointestinal lesions.

Aim: to study the prevalence of lysosomal acid lipase deficiency (Wolman disease and cholesteryl ester storage disease) among high-risk patients using selective biochemical screening.
Material and methods. Samples from 2805 patients are collected as dried blood spots on filter paper test forms. Biochemical study of the lysosomal acid lipase (LAL) enzyme activity was carried out according to Hamilton’s protocol of, using 4-methylumbelliferyl palmitate as a substrate and LAL inhibitor Lalistat-2. Changes in fluorescence in the wells were recorded on Wallac 1420 Multilabel Counter analyzer at absorption wavelength of 355 nm and emission wavelength of 460 nm. Sequencing of the LIPA gene (NM_001127605) was carried out on an Illumina MiSeq device (Illumina, USA) from dried blood spots from patients with reduced LAL enzyme activity to define genetic variations.
Results. As a result of biochemical screening for LAL deficiency among patients from high-risk groups, 20 patients with reduced values of LAL enzyme activity were found. For 17 patients, search for mutations in the LIPA gene was carried out using NGS. In 9 patients, pathogenic genetic variants were found that led to decrease in LAL activity and the manifestation of clinical symptoms. In 100 % of detected cases, genetic mutations in the LIPA gene included single nucleotide substitution c.894G>A. Along with this mutation, two previously undescribed mutations (c.35dup and c.176A>G) were discovered in a compound heterozygous state.
Conclusions. The variety of clinical symptoms and wide range of ages at which symptoms may begin (in the case of cholesteryl ester storage disease) can lead to errors in diagnosis. The c.894G>A variant is the most common variant worldwide among patients with a confirmed diagnosis of LAL deficiency and was present in all confirmed cases in this study, suggesting that this variant is the predominant mutation in the LIPA gene in Russian population. Pathogenicity status of previously undescribed discovered mutations (c.35dup and c.176A>G) needs to be determined.

Aim: to study the levels of fatty acids in the membranes of erythrocytes and blood serum in patients with inflammatory bowel diseases (IBD) examined over time, as possible predictors of exacerbation of the disease.
Materials and methods. Over a period of 6–12 months, 24 patients (mean age — 38.2 ± 4.4 years) with IBD with of moderate and mild severity of the disease were examined, of which 10 patients had ulcerative colitis, 10 — Crohn’s disease, 4 — unclassified colitis: the first examination was in the acute stage, the second was in the remission stage. In 48 additionally examined patients with IBD in remission (25 patients with ulcerative colitis, 15 — with Crohn’s disease, 8 — with unclassified colitis), the course of the disease was monitored over the next 12 months. The comparison group included 53 people comparable to the main groups in age. The study of the composition of fatty acids (FAs) in the membranes of erythrocytes and blood serum was carried out using a gas chromatograph mass spectrometry system based on three quadrupoles Agilent 7000B (Agilent Technologies Inc., USA).
Results. In the acute stage, patients with IBD have a higher total content of saturated fatty acids (SFAs) in erythrocyte membranes compared to the control group (p = 0.006), and, on the contrary, lower levels of unsaturated fatty acids (UFAs) (p = 0.005), mainly due to polyunsaturated FAs (PUFAs) (p = 0.026), namely omega-6 PUFAs (p = 0.011).
Remission of IBD is associated with an increase in the level of a number of SFAs in the blood serum — margaric C17:0 (p = 0.024), arachidic acid (C20:0) — in erythrocyte membranes and serum (p = 0.0001 and p = 0.019, respectively), with a decrease in the total content of monounsaturated FAs in erythrocyte membranes (p = 0.022), an increase in the total concentration of PUFAs due to both omega-3 PUFAs (p = 0.0008) and omega-6 PUFAs (p = 0.033) in erythrocyte membranes compared with a group of healthy individuals.
The exacerbation stage in patients with IBD examined over time is associated with higher levels of stearic FA C18:0 (p = 0.005), SFA/UFA (p = 0.034) and SFA/PUFA (p = 0.039) ratios in erythrocyte membranes, serum level of arachidic FA C20:0 (p = 0.008), and, on the contrary, lower content of UFAs in erythrocyte membranes — eicosapentaenoic C20:5n-3 (p = 0.0023), eicosadienoic C20:2n-6 (p = 0.0027), hexadecadienoic C16:2n-6 (p = 0.006), docosatetraenoic C22:4n-6 (p = 0.008) and alpha-linolenic C18:3n-3 (p = 0.039).
A combined “panel” of fatty acids, including the levels of C20:2n-6, C18:0 in erythrocyte membranes and the content of C20:0 in blood serum, provided an AUC of 0.683 (95 % CI: 0.500–0.844), sensitivity 91.4 %, specificity 68.3 %.
Levels of C20:5n-3, C20:2n-6, C18:0, C16:2n-6, C22:4n-6, C18:3n-3 fatty acids, SFA/UFA and SFA/PUFA ratios in erythrocyte membranes and content C20:0 in blood serum, used as biomarkers — predictors of the development of exacerbation in patients with IBD who were in remission, predicted the development of exacerbation of IBD after 2–4 months in the case of maximally changed levels of FAs, after 6–8 months — with moderately changed levels FAs, maintaining remission for 12 months — with minimally changed FAs levels.
Conclusion. Fatty acids of erythrocyte membranes and blood serum should be considered as promising markers for further studies related to the diagnosis and prediction of exacerbation in IBD.

Aim: to optimize the provision of medical care to patients with small intestinal bacterial overgrowth (SIBO) in the Southern Federal District based on clarification of data on the epidemiology of the syndrome (disease), unification of approaches to diagnostics and treatment.
Materials and methods. We analysed the questionnaires sent to the main gastroenterologists of the federal subjects included in the Southern Federal District, which contained questions in epidemiology, diagnostics and treatment SIBO in different districts.
Results. A survey of chief gastroenterologists of the Southern Federal District has demonstrated that there is no accurate data on the prevalence of SIBO in the Southern Federal District. Verification of the diagnosis in all regions is carried out using various modifications of the breath test. Most often, SIBO is suspected and patients with functional gastrointestinal diseases (32.4 %) and diverticular disease (36.5 %) are sent for a breath test. In the group of people with a predominance of hydrogen-producing microbiota, there are fewer men than women (30.8 % vs. 69.2 %), in the group with a predominance of methane-producing microflora, the ratio of men and women was 27.4 % vs. 72.6 %, and in the group with a predominance of hydrogen- and methane-producing microbiota, this ratio was 16.6 % vs. 83.4 %, respectively.
Antibacterial therapy after confirmation of the diagnosis is carried out in accordance with national clinical guidelines; probiotics, mainly Saccharomyces boulardii, are prescribed to prevent antibiotic-associated diarrhea.
Conclusions. The widespread introduction of various versions of the breath test into the work of healthcare institutions will make it possible to overcome diagnostic difficulties in relation to verification of this diagnosis, substantiate and individualize the approach to prescribing antibacterial and probiotic therapy.

Aim: to evaluate the outcomes of surgical treatment of patients with multiple primary cancer of the colon and prostate.
Materials and methods. An observational retrospective study was conducted at the Clinic of Coloproctology and Minimally Invasive Surgery (I.M. Sechenov First Moscow State Medical University). A total of 3,640 protocols of the preoperative multidisciplinary team were studied from July 2018 to April 2024. The inclusion criterion was the diagnosis of multiple colorectal and prostate cancer. The medical documentation was collected in the database and analyzed.
Results. The study included 39 patients: 24 patients with a metachronous variant of multiple primary cancer and 15 patients with a synchronous variant of the disease, which amounted to 1.1 % of all patients who underwent a preoperative consultation during the specified period. There were no significant differences in age, localization of tumors in the colon, methods of their treatment, access in surgical treatment of colorectal cancer, frequency of conversions and postoperative complications (p > 0.05). Prostate cancer was verified first in the group with the metachronous variant of multiple primary cancer significantly more often than in the group with the synchronous variant (95.8 % vs. 40.0 %, respectively; p < 0.001), and was also significantly more often treated surgically (75.0 % vs. 33.3 %; p = 0.018). Radical prostatectomy was performed via laparotomy significantly less frequently in the group with the synchronous variant than in the group with the metachronous cancer (0 % vs. 58.8 %; p = 0.046). No significant differences were found when comparing overall and recurrence-free survival in groups with metachronous and synchronous variants of multiple primary cancer.
Conclusions. A clinician should be alert to multiple primary colorectal and prostate cancer. The first stage of therapy for the synchronous variant should be surgical treatment of colorectal cancer. The history of surgical treatment of one of the tumors is not a contraindication for the use of minimally invasive techniques, however, the choice of surgical approach should be individualized. The presence of prostate cancer may be another factor in favor of performing lateral lymph node dissection in patients with synchronous rectal cancer.

Aim: to reduce the number of paracolostomy complications and improve the quality stoma patients’ life by justifying the use of a comprehensive approach to the end colostomy, including preoperative marking, taking into account the variants of the structure of the muscular-aponeurotic frame of the anterior abdominal wall, as well as the individual features of vascularity and topography of the intestine section undergoing ostomy surgery.
Materials and methods. To confirm the effectiveness of the proposed algorithm, an analysis of 52 clinical observations in patients who underwent surgeries with the formation of an end colostomy was carried out, which made up two clinical groups. In group 1 (n = 25) the developed therapeutic and diagnostic algorithm was applied, which included a rational choice of the colostomy localization site, taking into account individual features of the anterior abdominal wall structure, the quality of vascularity of the ostomy intestine, the terminal portion of its mesentery, the length and topography of the end section. Group 2 of patients (n = 27) underwent ostomy creation surgery using traditional techniques, without considering individual features.
Results. The obtained results indicate the possibility of reducing the number of early (group 1 — 16 %, group 2 — 40.7 %; p < 0.05) and late (group 1 — 8 %, group 2 — 29.6 %; p < 0.05) paracolostomy complications, decreasing the number of repeated surgical interventions (three cases of re-creation of the stoma in the early postoperative period in group 2 and no indication for repeated interventions in group 1) and improving the quality of life in stoma patient through the application of the developed personalized algorithm. The assessment of the psychological (group 1 — 33.24, group 2 — 53.41) and physical (group 1 — 32.46, group 2 — 54.78) components of health based on the results of the SF-36 survey confirmed the advantages of the proposed tactics and therapeutic and diagnostic algorithm in group 1. The average number of hospital-stay days was also less in patients of clinical group 1 — 12.1 ± 3.4 days vs. 16 ± 4.7 in group 2.
Conclusions. The use of patient-centered complex approach to determining the place and method of formation of an end colostomy, which includes taking into account the individual structure of the muscular-aponeurotic frame of the anterior abdominal wall, and the peculiarities of vascularity and topography of the intestine section undergoing ostomy surgery, is accompanied by a low number of early and late paracolostomy complications.

Aim: to review the pathogenesis of thrombocytopenia and possible ways of its correction in patients with liver cirrhosis before elective surgical interventions or invasive procedures to optimize clinical practice.
Key points. Thrombocytopenia is a common hematological complication of liver cirrhosis, affecting up to 75–86 % of patients with decompensated cirrhosis. Thrombocytopenia is associated with increased risks of bleeding and mortality. It complicates the management of patients, especially those who require invasive procedures, many of which carry a risk of bleeding. This risk of bleeding varies with the severity of thrombocytopenia, coagulation status, and type of invasive procedure.
Moderate-to-severe thrombocytopenia can interfere with life-saving interventions, such as invasive procedures/surgeries. Delayed care is associated with longer hospital stays and greater medical costs. Thrombopoietin receptor agonists (avatrombopag) should be considered for the management of cirrhotic patients with severe thrombocytopenia undergoing elective invasive interventions with a high risk of bleeding.
Conclusion. Thrombopoietin receptor agonists (avatrombopag) have demonstrated high efficacy and safety and are considered a promising first-line option for the management of severe thrombocytopenia in patients with liver cirrhosis undergoing elective surgical interventions or invasive procedures.

Aim: to demonstrate difficulties of differential diagnostics in the case of combined autoimmune pancreatitis, sclerosing cholangitis and ulcerative colitis. Colonic lesions that initially had low grade of inflammation were resistant to immunosuppressive therapy.
Key points. A 28-year-old female patient was admitted to the clinic for jaundice associated with pruritis. Based on the characteristic beaded appearance of the intrahepatic bile ducts at magnetic resonance cholangiopancreatography, primary sclerosing cholangitis (PSC) was diagnosed. Subsequent examination revealed focal pancreatitis and total colitis with histological pattern, consistent with ulcerative colitis (UC). To determine the etiology of pancreatitis IgG4 serum level was examined, that showed over 2-fold elevation. This required differential diagnostics between PSC with IgG4 elevation, UC and type 2 autoimmune pancreatitis (AIP) (more common in European population) on one hand and IgG4-associated systemic disease (more common in Asian population) with bile ducts, pancreas and large intestine involvement on the other. Liver histology failed to reveal histological signs characteristic of any type of cholangitis, pancreatic biopsy was not performed. Immunosuppressive therapy (steroids followed by thiopurines) resulted in rapid improvement of the pancreatic changes while no response was achieved for bile ducts and the colon that was in favor of the first concept (PSC + type 2 AIP + UC). The patient was recommended to receive biologic therapy for UC remission induction.
Conclusion. Differential diagnostics of combined autoimmune lesions of the liver, the pancreas and colon may be complicated and carried out ex juvantibus according to response to immunosuppressive therapy.

Aim: to discuss the clinical presentation, management, and outcome of the clinical case of solid pseudopapillary tumour of the pancreas (SPTP).
Key points. SPTPs are rare tumours known for their low malignant potential. They are predominantly found in younger females, typically occurring in the tail of the pancreas. Surgical resection of SPTP with negative margins is associated with improved survival rates and lower chances of recurrence. In this study, we discuss the case of a 69-year-old woman diagnosed with an SPTP originating from the tail of the pancreas, which had spread to the hilum of the spleen. A radical resection was performed, successfully obtaining negative surgical margins. However, the patient subsequently developed metastasis to the liver and lungs, prompting the initiation of systemic chemotherapy. The patient died seven months after the development of metastasis and 39 months following the primary diagnosis. This case underscores that, despite initial successful surgical outcomes, high-risk histopathological features can lead to recurrence and metastasis, necessitating reassessment of treatment strategies.
Conclusion. Negative surgical margins are critical for a favourable prognosis in the treatment of SPTPs; however, close monitoring for potential recurrence is essential. Our findings highlight that even after achieving negative margins, patients with high-risk features should undergo rigorous follow-up and consider postoperative systemic chemotherapy. This clinical case emphasizes the complexity of managing SPTP and the need for individualized treatment strategies, as early detection of recurrence can significantly influence survival outcomes.

Background. In the last decade, the understanding of the pathogenesis of autoimmune hepatitis (AIH) has significantly deepened, based on the results of new clinical studies some diagnostic issues have been revised and immunosuppressive therapy regimens have been optimized.
Materials and methods. The latest Russian clinical guidelines for the diagnosis and treatment of AIH were presented in 2013; and in 2017, the first Russian agreement on the diagnosis and treatment of AIH was held. Updating approaches to the management of patients with AIH necessitated next systematization for use in clinical practice. In February 2024, the final session was held to discuss the provisions of the second agreement on the diagnosis and treatment of AIH.
Results. This publication presents the main discussion points of the agreement regarding methods and algorithms for detecting autoantibodies, the role of liver biopsy, revised morphological criteria for AIH, optimized immunosuppressive therapy regimens, updated criteria for assessing the response to therapy.
Conclusions. The agreement was the result of the work of a group of experts on the diagnosis and treatment of AIH and represents the basis for the creation of updated federal clinical guidelines.

Aim: to familiarize gastroenterologists, therapists, functional diagnostics and general practitioners (family doctors), radiologists, and endoscopists with modern methods of diagnosis and treatment of achalasia of the cardia.
Key points. Achalasia is an idiopathic neuromuscular disease manifested by a functional disorder of the patency of the cardia due to a lack of coordination between swallowing, reflex opening of the lower esophageal sphincter, and the motor and tonic activity of the smooth muscles of the esophagus. The etiology of achalasia remains unclear. However, it is believed that the key role belongs to the changes in the myenteric (Auerbach’s) intermuscular plexus of the enteric nervous system of the esophagus, leading to loss of neuronal function. The following hypotheses have been proposed as the main mechanisms for the development of achalasia: genetic predisposition, exposure to viral infections, and idiopathic autoimmune triggers. Patients with suspected achalasia require a comprehensive instrumental examination, including esophagogastroduodenoscopy, timed barium esophagogram, and esophageal manometry. In recent years, high-resolution esophageal manometry has been recognized as the gold standard for achalasia diagnostics. To analyse the obtained data, the Chicago classification is recommended — it allows to ascertain the type of achalasia, which determines the choice of treatment method and the assessment of the prognosis of the therapy effectiveness. Treatment of achalasia can be pharmacological, endoscopic (pneumatic balloon dilation, peroral endoscopic myotomy, botulinum toxin injection), aimed at regulating the tone and motility of the esophagus and cardia while preserving all anatomical structures, and surgical (laparoscopic esophagocardiomyotomy, esophagectomy), in which the muscle fibers of the esophagus and esophagogastric junction are intersected or the altered esophagus is completely removed with simultaneous formation of an artificial esophagus from the stomach or colon (esophagoplasty).
Conclusion. Implementation of the developed clinical guidelines can help to establish a diagnosis in a timely manner, which will lead to an improvement in the quality of medical care for patients with achalasia.