Vol 97, No 2 (2025): Вопросы гастроэнтерологии

This article addresses theoretical and clinical aspects of radiation-induced intestinal injuries, which complicate radiation therapy for malignant neoplasms of the abdominal and pelvic organs. Many clinical aspects of this issue remain unknown due to the lack of awareness among doctors and patients. Further study of radiation-induced intestinal injuries and the development of personalized approaches to their prevention and treatment represent a relevant direction in internal medicine.

Aim. To study the interaction of hormonal factors and indicators of vegetative homeostasis in violation of the motor evacuation function of the duodenum in chronic duodenal insufficiency (CDI).

Materials and methods. 70 patients with CDI were under observation. The average age of patients was 35.7±11.4 years, women were 32 (45.7%), men – 38 (54.3%). The control group included 31 healthy individuals [average age 39.1±12.3 years; there were 15 women (48.3%), 16 men (51.7%)]. Cardiorhythmographic examination and analysis of heart rate variability with the ”Varicard 2.51” complex were used to study the ANS. To study the intramural nervous apparatus of the duodenum, a biopsy piece of its wall from the lower horizontal section was examined. Electrochemiluminescence analysis made it possible to determine the content of gastrin, insulin, cortisol, and somatostatin in the blood. To diagnose motor disorders of the gastroduodenal zone, peripheral electrogastroenterography was performed using the gastroenteromonitor GEM-01 ”Gastroscan-GEM”.

Results. In patients with CDI, in addition to changes in the clinical and electrophysiological picture, changes in the vegetative status were revealed. This condition correlates with the following electrophysiological signs in CDI – hypomotor duodenum leads to a greater increase in the ratio P_i/P_{i + 1} stomach / duodenum after food stimulation (17.43±2.46) in this group of patients (p=0.000). The study of the basal hormone content in CDI showed a significant increase in gastrin, cortisol and a decrease in insulin and somatostatin in comparison with the control group. The relationship between them and vegetative-electrophysiological indicators is revealed.

Conclusion. Comprehensive studies of myoelectric activity, the functional state of the autonomic nervous system and hormonal regulatory factors, followed by the analysis of multidimensional statistics data, revealed new pathophysiological patterns in duodenal motility disorders in CDI.

Aim. To evaluate the associated effects of dynapenia and overweight in patients with ulcerative colitis (UC).

Materials and methods. Single-center observational cross-sectional case-control study. 80 patients with UC were divided into groups: 14 UC patients with dinapenia and overweight/obesity; UC and dinapenia patients with normal body weight/body weight deficiency (n=12); overweight/obese UC patients (n=24); UC patients with normal body weight/weight deficiency bodies (n=30). The protocol included: the study of nutrition, physical activity, the risk of nutritional insufficiency, measurement of body mass index, blood pressure, dynamometry, duplex scanning of extracranial vessels, determination of the insulin resistance index (HOMA-IR). The assessment of blood composition parameters included studies of blood lipid composition, C-reactive protein, TNF-α, glucose, insulin, C-peptide, leptin, adiponectin, leptin receptors. Zonulin has been studied in feces. Statistical methods: median (Me), upper and lower quartiles (Q₂₅, Q₇₅); fraction and standard error of the fraction; Mann–Whitney criterion; Kruskal–Wallis criterion; Pearson's χ². To identify the statistical relationship, Spearman's correlation coefficient was calculated. Statistical indicators are calculated using Statistica 10.01.1011.

Results. Dinapenia in combination with obesity/overweight is observed in 17.5% of patients with UC, most of them patients with low physical activity. Dinapenic obesity is associated with metainflammation and increased permeability of the epithelial barrier, as evidenced by significantly higher rates of C-reactive protein, TNF-α, HOMA-IR and fecal zonulin. In patients with dinapenia in combination with overweight/obesity, higher leptin levels were determined, and the leptin receptors level was lower than in participants of other groups.

Conclusion. The mechanisms of dinapenia in overweight/obese UC patients include a synergistic effect of inflammation, insulin resistance and increased epithelial permeability.

Aim. To review the results of the open observational study Makhaon on the use of a fixed combination of glycyrrhizic acid (GA) and ursodeoxycholic acid (UDCA) (Phosphogliv Urso) for the treatment of abdominal pain, assessment of contractile function of the gallbladder and bile rheology in patients with stage I cholelithiasis.

Materials and methods. The study included 330 subjects, 44.5% males and 55.5% females. The study participants were 18–70 years old, with a mean age of 43.8±0.6 years. In 2021–2022, patients were treated in 14 clinical centers in 10 cities of the Russian Federation: Moscow, St. Petersburg, Stavropol, Volgograd, Perm, Samara, Ufa, Omsk, Novosibirsk, Tomsk. All patients received Phosphogliv Urso (UDCA 250 mg + sodium glycyrrhizinate 35 mg), 1 capsule 3 times daily with food for 6 months.

Results. Based on the clear improvement, therapy with a combination of GA and UDCA has demonstrated high efficacy and safety and appears to be optimal for the treatment of abdominal pain, improvement of the contractile function of the gallbladder, and physicochemical properties of bile in patients with stage I cholelithiasis.

Conclusion. Treating all variants of baseline changes in the bile rheology is an urgent task of modern biliology. Universal drugs for stage I cholelithiasis are UDCA and its fixed combination with GA.

Aim. To evaluate the contribution of cardiometabolicfactors and PNPLA3 I148M (rs738409 C>G) gene polymorphism to the development of compensated advanced chronic liver disease (cACLD) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).

Materials and methods. 108 patients with MASLD were enrolled and formed the internal validation group; 30 patients with MASLD were selected for external validation. Anamnestic data, anthropometric and laboratory parameters and the presence of PNPLA3 gene polymorphism I148M (rs738409 C>G) were assessed. Steatosis was detected by assessing the controlled attenuation parameter. Liver elasticity was assessed by transient elastography. cACLD was detected when the liver stiffness was ≥8 kPa.

Results. Statistically significant difference was observed in the internal validation group during comparison of the incidence of cACLD depending on the presence of arterial hypertension (odds ratio – OR 5.58; 95% confidence interval – CI 1.21–25.71), type 2 diabetes mellitus – T2DM (OR 4.58; 95% CI 1.59–13.21), obesity (OR 3.13; 95% CI 1.1–8.9), dyslipidemia (OR 6.12; 95% CI 1.33–28.19) and the mutant G allele of the PNPLA3 gene (OR 3.9; 95% CI 1.28–11.88). Patients with cACLD had significantly higher mean values of waist circumference (WC), alanine aminotransaminase, aspartate aminotransaminase, gamma-glutamyl transferase and triglycerides, non-invasive markers of steatosis and fibrosis. The compiled prognostic model demonstrated a direct relationship between the likelihood of developing cACLD and the presence of T2DM (adjusted odds ratio – AOR 3.28; 95% CI 0.62–17.33), dyslipidemia (AOR 5.89; 95% CI 1.21–28.67) and WC value (AOR 1.05; 95% CI 1.01–1.11). PNPLA3 I148M gene polymorphism did not significantly affect the development of late stages of the disease. External validation of the model showed its moderate diagnostic ability.

Conclusion. T2DM, dyslipidemia and WC values are the determining factors in the development of cACLD in patients with MASLD. The PNPLA3 I148M gene polymorphism has no leading importance for the development of the progressive course of MASLD in the studied cohort.

Aim. To determine the trends of primary antibiotic resistance of Helicobacter pylori strains isolated from patients living in Moscow.

Materials and methods. As part of a clinical and laboratory study, 123 gastric biopsy specimens from H. pylori-infected patients were analyzed from 2015 to 2024. H. pylori infection was verified by a rapid urease test and a ¹³C-urease breath test. The anaerobic culture technique was used. After identifying a pure culture, its susceptibility to four antibacterial agents (amoxicillin – AMC, clarithromycin – CLR, metronidazole – MET, tetracycline – TET) was determined by the disc diffusion method.

Results. According to the data, the resistance in the overall pool (n=123) of the test samples to AMC was 4.88%, CLR 16.26%, TET 3.25%, and MET 46.34%. Dual resistance to CLR and MET was detected in 4.06% of strains. Among strains collected from 2015 to 2019 (n=28), resistance to AMC was 0.0%, CLR 10.71%, TET 0.0%, and MET 50.0%. The structure of antibiotic resistance of strains collected from 2020 to 2024 (n=95) was as follows: AMC – 6.32%, CLR – 17.89%, TET – 4.21%, MET – 45.26%.

Conclusion. There is a gradual tendency to increase the resistance of H. pylori to antibacterial agents such as AMC, CLR, and TET in Moscow, which is consistent with the data of other studies. This negative trend may eventually lead to decreased effectiveness of currently used eradication therapy regimens in Russia.

Irritable bowel syndrome (IBS) is a widespread bowel disease, associated with a significant decrease in patients’ quality of life. The etiology, pathogenesis, clinical symptoms and treatment strategies of IBS have not been studied sufficiently. Current clinical guidelines list antispasmodics as medications for abdominal pain management, the main symptom of IBS. Both in Russian and foreign clinical guidelines of IBS, among the antispasmodic drugs, hyoscine butylbromide is regarded as an effective and safe medicine for abdominal pain management. Hyoscine butylbromide has a broad spectrum of applications in gastroenterology. This fact determines its advantages in terms of drug choice for treating patients with comorbidities involving digestive system pathologies. The use of hyoscine butylbromide is especially relevant in light of the frequent occurrence of a combination of IBS and functional disorders of the biliary tract, since the antispasmodic is also recommended for biliary pain management.

Сase report of late radiation damage to the small intestine in a patient who underwent laparoscopic extirpation of uterine cancer and radiation therapy is presented. The article shows the clinical manifestations of chronic post-radiation enteritis with a long progressive course and the development of partial intestinal obstruction, demonstrating the importance of timely diagnosis and the implementation of a multidisciplinary approach in the treatment of patients with late radiation damage to the intestine.

The Russian Cross-disciplinary Consensus on the diagnositic and treatment of spondyloarthritis (SpA) in inflammatory bowel diseases (IBD) was prepared on the initiative of the Loginov Moscow Clinical Scientific Center, using the Delphic system. Its purpose was to consolidate the opinions of experts on the most actual issues of diagnosis and treatment of concomitant immuno-inflammatory diseases (SpA and IBD). An interdisciplinary approach is provided by the participation of leading gastroenterologists and rheumatologists. The working group analyzed domestic and foreign publications on the problem of curation of patients with SpA and IBD. There have been 17 statements and 2 treatment algorithms formulated. Statements 1–3 reflect the fundamental principles of management of patients with SpA and IBD. The principles of early diagnosis of SpA and IBD, including the diagnosis of complications of therapy, are described below. Eleven statements are devoted to current methods of treatment, on the basis of which 2 treatment algorithms have been developed. The statements of the Consensus were submitted to the Expert Council for consideration, edits were made, after which an online vote took place. This paper presents current recommendations for the management, diagnosis and treatment of patients with SpA and IBD.

The article discusses the main milestones in the development of enterology in the clinic of internal diseases. The review of the important stages of the study of diseases of the small and large intestine, its main achievements, discoveries resulting from the scientific and clinical work of outstanding Russian scientists. A deep understanding of pathological processes in diseases of the small intestine is discussed, diagnostic criteria and the possibility of identifying new nosological forms are considered.