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Introduction. Serological diagnosis of inflammatory bowel diseases (IBD) is an additional tool not only for differential diagnosis, but also for individual prediction of the clinical course and long-term outcomes of Crohn’s disease (CD) and ulcerative colitis (UC).The objective was to assess the occurrence and capabilities of determining antibodies to Saccharomyces cerevisiae (ASCA) and antineutrophil cytoplasmic antibodies (ANCA) in predicting the clinical outcomes of IBD.Methods and materials. The study included 71 patients with CD, 26 with UC, and 21 with and 21 with IBD unclassified (IBDU). The comparison group consisted of 35 patients with other gastrointestinal diseases (irritable bowel syndrome with diarrhea (IBS-D), celiac disease, autoimmune gastritis (AIG)); the control group consisted of 24 apparently healthy individuals. The level of antibodies to ASCA IgA and IgG was measured by the ELISA method (ORGENTEC Diagnostika GmbH, Germany), ANCA IgG was determined by the IIF method of the Granulocyte Mosaic test system (EUROIMMUN AG, Germany).Results. The occurrence of ASCA IgA and IgG in patients with CD was 25 % and 38 %, which is significantly higher compared to patients with UC (0 % and 3.8 %), IBDU (5 % and 5 %), AIG (0 % and 5.3 %) respectively (p

Aim. To improve the results of surgical treatment for patients with severe non-cancerous diseases of the colon by developing and implementing the new type of pelvic small intestine reservoirs. Materials and methods. A new type of pelvic small intestine reservoirs has been developed and introduced into clinical practice to improve processes of intestinal digestion, absorption, anal retention after radical surgery for ulcerative colitis, Crohn’s disease with total colon involvement, familial adenomatous polyposis. Each of the reservoirs has been adapted to anatomical relationships between the small intestine and the debuccalized surgical anal canal depending on a radical surgery extent and a functional state of the small intestine. Pelvic small intestine reservoirs of a new type were used in 39 patients of the main study group, 21 (53.8 %) men and 18 (46.2 %) women. The patients’ age ranged from 21 to 43 years. The comparison group consisted of 42 patients. The patient groups were identical in terms of sex, age, diagnosis and complications of the underlying disease. Patients in the comparison group differed in that they underwent the well-known “J”-shaped pelvic small intestine reservoir procedures. Results. The number of postoperative complications was statistically significantly higher in patients of the comparison group due to acute and chronic complications, 33.2 % and 10.4 %, respectively. Indicators of intestinal digestion, absorption and anal retention were statistically significantly better in the majority of patients of the study group. The number of patients with I (mild) degree of pathological post-colectomy syndrome was significantly higher in the study group, and the number of patients with diarrheal syndrome and secondary anal incontinence syndrome was significantly lower. Positive results after the introduction of a new type of pelvic small intestine reservoirs were obtained by applying the following basic principles of their formation: the use of only known factors of physiological delay in the passage of contents through the small intestine, preservation of the small intestine wall anatomical integrity, location of the small intestine reservoir at a certain distance from the upper border of the rectal sphincters, as well as the reasonable expediency of choosing a method of forming the pelvic small intestine reservoir depending on the patient’s anatomy. Conclusions. The use of physiological factors of delayed passage of the contents in the small intestine, small intestine wall anatomical integrity preservation in the formation of pelvic small intestine reservoirs of the new type, the reservoir location at a certain distance from the upper border of the rectal sphincters has resulted in significant improvements in the functions of intestinal digestion, absorption, and anal retention. Practical application of the new type of pelvic small intestine reservoirs has helped to significantly decrease the incidence of postoperative complications from 33.2 % to 10.4 %, increase the number of patients with post-colectomy syndrome of the I (mild) degree from 47.4 % to 86.4 %, reduce the number of patients with diarrheal syndrome from 55.3 % to 8.1 %, and secondary anal incontinence syndrome from 36.8 % to 5.4 %.

Nowadays, an urgent problem of pediatric gastroenterology is the study of inflammatory bowel diseases with very early onset (VEO-IBD), which have unique genetic, clinical, immunological, morphological, and laboratory sings. Early VEO-IBD is usually considered as monogenic disease, especially in combination with congenital immune defects, which leads to difficulties in diagnosis and management this pathology. Despite this, systematization of information about this group of nosological forms of IBD is practically not carried out. This article presents a review of the available information on etiological factors, course variants, and therapeutic options for VEO-IBD.

The role of infectious agents in gastrointestinal diseases is becoming greater, because normally the human intestines have many bacteria with an increased concentration in the lower parts of the gastrointestinal tract. The most common among the colonizing microorganisms are the so-called problematic gram-negative bacteria. In recent years, the role of one microbe in the progression of gastrointestinal diseases - Klebsiella pneumoniae - has been increasing. This bacterium is often isolated from patients with autoimmune and oncological problems such as Crohn's disease, ulcerative colitis and colorectal carcinoma. The aim of the present review is to show the role of Klebsiella pneumoniae as a potential pathogen in intestinal carriage. [ABSTRACT FROM AUTHOR]

Introdution: Crohn's disease is a chronic inflammatory disease of the gastrointestinal tract, characterized by the cyclical onset and resolution of symptoms. It is a progressive disease that leads to intestinal damage and even disability. This disease can occur in any segment of the digestive system, from the mouth to the anus. The typical symptom is segmental inflammation in the small or large intestine, which is separated by healthy sections. The inflammation usually starts in the mucosa but, over time, spreads to the entire thickness of the intestinal wall, which can lead to intestinal damage, scarring, and the subsequent formation of fistulas and strictures. Inflammatory lesions most often occur in the last segment of the ileum, followed in order by the small and large intestines and the large intestine itself. Aim of the study: The purpose of this paper is to provide a general overview of Crohn's disease, focusing on oral symptoms. Materials and methods: An analysis of scientific articles available in Pubmed and Google Scholar databases was conducted. The study used publications from recent years that were most pertinent to the topic under discussion. The search process consisted of using the following keywords: “crohn's disease”, “oral manifestations”, “oral healh”, “Crohn's disease symptoms”. Results: In addition to the classic intestinal symptomatology, Crohn's disease can also manifest in the oral cavity. Symptoms that appear in the oral cavity may be early harbingers of Crohn's disease, occur concurrently with its onset, or manifest themselves several years after the onset of the condition. They most commonly involve the lips, buccal mucosa and gums. According to Malins and colleagues, these lesions can be divided into specific and non-specific ones. Conclusions: Crohn’s disease diagnoses are increasing, and early awareness of symptoms is crucial for timely diagnosis and prevention of complications.

Background. Inflammatory bowel diseases (IBD) (ulcerative colitis and Crohn's disease) are an unresolved problem in gastroenterology due to increasing incidence, progressive course, severe complications, and expensive treatment.The aim of the study was to analyze data on patients with IBD in the Kabardino-Balkarian Republic (KBR), including clinical and demographic characteristics, frequency of use of different classes of medications, and response to treatment.Material and methods. An analysis of the socio-demographic and clinical characteristics of patients with IBD who were treated in gastroenterological hospitals for the period of 2020–2022 was carried out. The analysis included data from 143 patients with ulcerative colitis and Crohn's disease.Results. Analysis of gender characteristics of the prevalence of IBD over time showed an increase in the proportion of female patients. During the study period, there was a tendency for the incidence of IBD to increase in younger age groups (20–29 and 30–39 years old). Moreover, CD was more common in young age groups than UC. IBD onset peaked between ages 20–29 years, with a slight downward trend. There was a high frequency of severe and moderate forms of IBD (78.8%) in the KBR due, in the authors’ opinion, to late diagnosis and not to the characteristics of the patient population. Extraintestinal manifestations were recorded in 37.5%, i. e. more than according to statistical data for the Russian Federation. The vast majority of patients with UC (84.8%) and CD (42.9%) received therapy with oral 5-aminosalicylic acid. Glucocorticoids were used in the treatment of 69.7% of patients with UC and 39.0% of patients with CD. 16.7% of patients with UC and 24.7% of patients with CD received immunosuppressants. In the first 2 years of the study, GEBDs were prescribed to a small number of IBD patients. GEBDs were more often used in the treatment of CD, with Infliximab being the most frequently used drug. The results of the study indicate that over the 3 years of the study, the treatment of patients became more consistent with the recommended approaches.Conclusion. The study of regional features of the course and treatment of IBD will help improve the quality and efficiency of medical care for patients both at the inpatient and outpatient stages. Creation of a regional registry of patients with IBD in the KBR will be the first step to improving the situation.

Background. Inflammatory bowel disease (IBD) is defined as an “inflammatory conditions of the colon and small intestine”. The main forms of IBD are ulcerative colitis and Crohn’s disease. The study aims to evaluate fecal calprotectin with albumin and C-reactive protein as non-invasive indicators of (IBD), mainly in patients with digestive symptoms, who are offered for endoscopic-assessment. Methods. The study includes 104 participants, who are divided into the control, Crohn’s disease, and ulcerative colitis groups. Gender, age, BMI, albumin, C-reactive protein (CRP), as well as fecal calprotectin are measured. Results. The results show a significant increase in C-reactive protein and calprotectin (26.77 ± 1.485 mg/l and 419.8 ± 16.99 µg/mg, respectively) in patients with ulcerative colitis, compared to the control group, which shows a mean value of 6.567 ± 1.802 mg/l and 92.98 ± 10.94 µg/mg for C-reactive protein and fecal calprotectin, respectively. The highest value of the CRP result in patients with Crohn’s disease is 40.82 ± 2.191 mg/l and the highest significant difference in calprotectin value is 296.2 ± 17.87 µg/mg, related to the control. Conclusion. The results show high and significant differences in serum C-reactive protein and fecal calprotectin in the patients with ulcerative colitis and Crohn’s disease compared to the healthy people in the control group. In addition, the results show a significant difference in serum C-reactive protein and fecal calprotectin between the ulcerative colitis and Crohn’s disease groups. The results of the study suggest the use of these tests as non-invasive indicators to assess the diagnosis and its differentiation.

The causes and development of inflammatory bowel disease (IBD) are not fully understood and can be influenced by various factors such as genetic, environmental, and immune system dysfunction. With chronicity, IBD requires long-term medication use. Therefore, strictly adhering to the prescribed treatment regimen is essential to prevent relapses and achieve remission. This review article evaluates the relationship between treatment adherence (also compliance) and quality of life (QoL) in patients with IBD. We conducted a literature search using databases such as PubMed, Scopus, Web of Science, Embase, and eLibrary to analyze scientific articles published between 2013 and 2023. We included articles that presented the results of assessing quality of life and/or adherence to treatment in patients with IBD. We excluded articles that evaluated patients with other concomitant conditions or provided incomplete data.

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.

From the beginning of 2000s, there has been a significant increase in the incidence of inflammatory bowel diseases (IBD) and primary immunodeficiency disorders (PIDs) in adults and children in many countries around the world. The aim of the review is to summarize the state-of-the-art on diverse clinical types of PIDs with gastrointestinal manifestations and their differential diagnostic algorithms. Atypical PIDs with “blunted” clinical manifestations are challenging for the timely diagnosis. Some types of PIDs with gastrointestinal involvement are also difficult to differentiate with classical IBDs. Molecular genetic studies have allowed for selection of a specific group of monogenic IBD-like diseases, represented mainly by PIDs. The authors discuss current classification of PIDs and their main clinical types imitating IBD, with important clinical and laboratory aspects. High level of information and awareness of practicing specialists working with IBD patients would be helpful in the selection of a patient cohort with possible PIDs and in the performance of extended laboratory assessment or referring for genetic tests. Timely diagnosis of PIDs would ensure quick administration of target therapy or hematopoietic stem cell transplantation, which in most cases would allow for the achievement of the disease remission, improvement of quality and duration of life.

The global burden of inflammatory bowel disease (IBD) is currently significant and continues to grow due to the increasing prevalence of ulcerative colitis (UC) and Crohn's disease (CD), the increasing costs of diagnosis and treatment, and the high level of disability in patients with this disease. Categories, which leads to the search for risk factors and predictors of aggressive course and extraintestinal manifestations. According to the latest data, the prevalence of UC in Russia is 16.6 per 100 000 population, the annual registered increase is 11.3%; the prevalence of CD is 5.6 per 100 000 population, and the increase is 13.7%. In the Russian population of patients with IBD, the average age of disease onset is 35.3 years for UC and 31.2 years for CD. Moreover, in 89.3% of patients with UC, it took at least 2 years to verify the diagnosis, and in CD, within 2 years from the onset of clinical symptoms, the diagnosis was established in only 72.6% of patients. One of the dominant characteristics of IBD is its multisystem nature, which leads to the development of extraintestinal manifestations (ECM), which can be observed in 50–60% of patients, while up to 25% of patients with IBD have several EMC and the most common variants are joint lesions. A higher frequency of extraintestinal manifestations is observed in CD (up to 45% of patients), in female patients, in smokers and with a longer duration of the disease. To predict clinical remission, the level of fecal calprotectin and CRP, the need for glucocorticosteroids are important, to predict endoscopic remission – the level of fecal calprotectin, and to predict histological remission, an endoscopic Schroeder index value of ≤1 is important. The absolute risk of developing colorectal cancer in IBD remains relatively low, ranging from 1.1 to 5.4% after 20 years of disease. The main risk factors for IBD are total intestinal damage, high inflammatory activity, the stricturing phenotype of CD and the presence of primary sclerosing cholangitis.

In most cases Tuberculosis (TB) affects the lungs, but 10–15% of patients have extrapulmonary TB localisations, that is difficult to diagnose. TB is more spread among patients having the human immunodeficiency virus and among those who receive immunosuppressive therapy, specifically in patients with inflammatory bowel disease requiring long-term treatment with immunosuppressants and/or biologics. The symptoms of intestinal TB are nonspecific and may include chronic diarrhea, weight loss, fever and ascites. Differential diagnosis includes Crohn's disease, malignant neoplasms, periappendiceal abscesses, yersiniosis, etc. The article presents cases showing similarity of the intestinal form of TB with Crohn's disease, complexity dealing, diagnosing and treating patients with inflammatory bowel disease also having latent tuberculosis infection

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 improve the effectiveness of cancer prevention and the results of surgical treatment in diffuse inflammatory diseases of the colon by identifying and using risk factors for malignancy, improving diagnostic methods, surgical strategy and tactics. Materials and methods. Using generally accepted oncological standards, 36 patients with diffuse inflammatory diseases of the colon were operated on. There were 20 (55.6 %) patients with ulcerative colitis and 16 (44.4 %) with Crohn’s disease of the colon. There were 19 (52.7 %) men and 17 (47.3 %) women. The patients’ age ranged from 21 to 56 years. When performing surgical interventions, we were guided by the studied risk factors for malignancy, the provisions of the surgical strategy and tactics, that included the indication choice, the surgical intervention extent, and the ensuring of oncoprevention. Results. The use of oncological standards, provisions of surgical strategy and tactics prevented the occurrence of postoperative mortality, malignancy of precancerous conditions, contributed to a decrease in the incidence of early postoperative complications to 5 (13.9 %), locoregional recurrence to 1 (2.8 %). Conclusions. Determination of risk factors for malignancy, improvement of diagnostic methods, surgical strategy and tactics in diffuse inflammatory diseases of the colon contribute to the timely detection of precancerous conditions, malignancy and colon cancer, justification for the feasibility of performing surgical interventions using generally accepted oncological standards. Performing surgical interventions with the use of generally accepted oncological standards, proven provisions of strategy and tactics have made it possible to prevent the occurrence of malignization of precancerous conditions, cases of postoperative mortality, reduce the frequency of early postoperative complications to 5 (13.9 %) and locoregional recurrences to 1 (2.8 %).

Introduction. Video capsule endoscopy (VSE) is a gold standard diagnostic method for small bowel diseases and is widely used in clinical practice. The presented analysis of the VCE results demonstrates the possibilities of this diagnostic tool and is the largest one of the analysis that were recently published in Russia. Aim. To demonstrate the possibilities of video capsule endoscopy in the diagnosis of small bowel diseases. Materials and methods. A total of 300 video capsule endoscopies were performed in patients with suspected and already established small bowel diseases between 2014 and 2022. All patients who underwent a video capsule endoscopy in the settings of the National Medical Research Center of Coloproctology named after A.N. Ryzhikh were over 18 years old. The study cohort included 158 men and 142 women. The average age of patients at the time of the video capsule endoscopy was 42 ± 15.4 years. The patients were recommended a standard preparation regimen: 3 days before the study, a protein diet was prescribed, and the day before, a two-stage administration of a PEGbased drug (“split dose”). To reduce gas production and decrease the amount of foamy intestinal contents, which worsens the quality of the endoscopic image, oral administration of an antifoam agent simethicone was prescribed: 80 mg on the eve of the endoscopy and 80 mg on the day of the endoscopy. Results. The video capsule endoscopy demonstrated high information value in the diagnosis of inflammatory bowel diseases: its sensitivity was 86%, and specificity – 90%. Similar results were obtained during video capsule endoscopy used to diagnose the source of possible bleeding: sensitivity and specificity were 87 and 68%, respectively. Conclusion. Video capsule endoscopy is an effective, safe and well-tolerated tool for diagnosing small bowel diseases. The video capsule endoscopy findings contribute to establishing a correct diagnosis and selecting treatment strategies.

Aim: to present the principles of functioning of the regional registry of inflammatory bowel disease (IBD) patients in Saint Petersburg on the basis of the City Health Information System (Saint Petersburg IBD Registry).Key points. The Saint Petersburg IBD Registry consists of General Statistical Module and Clinical Module. The General Statistical Module is intended to analyze the prevalence of ulcerative colitis and Crohn's disease, the number of patient visits to medical institutions; to assess the burden on the healthcare system, demographic characteristics, routing and mortality for the whole region. The Clinical Module allows to assess the IBD features in prospective observation. The register case report form is integrated into the patient's status in the Medical Information System of the medical institution. Saint Petersburg IBD Registry operates on the basis of the Saint Petersburg Medical Center of Information and Analysis within the framework of the Regional Medical Data Collection System of the Russian state information system “Regional Fragment of the Unified State Information System in the Healthcare Branch”. The accumulation of prospective data in the Clinical Module continues, which in the near future will make it possible to test and configure the automated analytical block of the registry.Conclusion. The functioning of the Saint Petersburg IBD Registry allows to achieve following primary goals within region: assessment of the epidemiological features of IBD in Saint Petersburg; dynamic assessment of the disease features; assessment and planning of health care resources required to provide care to IBD patients; improvement of approaches to the treatment taking into account the specifics of the region; assessment of the effectiveness and tolerability of specific treatment including biologics.

Pyoderma gangrenosum is a rare neutrophilic dermatosis associated with a number of immune-mediated disorders, most frequently with inflammatory bowel disease and rheumatoid arthritis. Despite significant success in the treatment in inflammatory bowel disease, the problem of multidisciplinary management of patients with extraintestinal manifestations in routine medical practice remains unsolved. The paper presents a clinical case of a 32-year old female patient with a life-threatening extraintestinal manifestation of Crohn's disease, i. e. pyoderma gangrenosum. Late diagnosis of Crohn's disease, underestimation of the inflammation activity in the gut and respective lack of disease-modifying treatment were the reasons for the occurrence of pyoderma gangrenosum and its uncontrolled course. The untimely diagnosis of the skin purulent wound as an extraintestinal manifestation of Crohn's disease has led to delay in the immunosuppressive therapy required. The patient needed an intensive course of systemic glucocorticosteroids, prompt addition of a tumor necrosis factor-alpha inhibitor and surgery as a circulatory autodermoplasty.

Systemic juvenile idiopathic arthritis (SJIA) accounts for 10–15% of juvenile arthritis cases. The incidence of inflammatory bowel disease (IBD) is generally higher in SJIA patients than in the general pediatric population; however, the association of IBD with SJIA is rare. Among 65 patients with SJIA managed in two pediatric rheumatology centers, IBD was detected in 3 patients 3, 8, and 10 years from the SJIA onset. The clinical presentation of IBD in patients with SJIA is rather scanty; the diagnosis is mainly based on the colonoscopy and biopsy results. In 2 patients, Crohn's disease was diagnosed, and undifferentiated colitis in 1 patient.

Relevance. This study is related to the study of the etiology, pathogenesis and clinic of inflammatory bowel diseases (IBD). In a number of patients with IBD who are refractory to anti-inflammatory/immunosuppressive therapy, there are signs of current or transferred yersiniosis infection, not diagnosed by routine methods.Aim. According to the scientific literature and the results of our own research, to identify the presence and assess the nature of the influence of yersinia on the occurrence and development of IBD.Materials Methods. In our study, we conducted a bacteriological examination of feces by polymerase chain reaction (PCR) in patients with a diagnosis of IBD (UC and CD) in the acute phase (MMDAI ≥ 4 points for UC and Best index ≥ 150 points for CD), as well as immunological diagnostics using enzyme immunoassay (IFA) in the version of line-blotting (IB). Using the results obtained, clinical and instrumental semiotics were evaluated in subgroups of individuals suffering from IBD with confirmed yersiniosis ("IBD+ IER+") and without it ("IBC+ IER–"). We also assessed the role of intestinal infection by determining the effectiveness of initial antibacterial therapy in the treatment of exacerbation of IBD.Results. A significant part (in the case of our sample – 45%) of patients with IBD, when examined by high-tech methods, demonstrate the presence of markers of a transferred or current yersiniosis infection. Its role in the initiation and development of autoimmune intestinal inflammatory process requires further clarification.Conclusions. In 45% of patients with IBD, high-precision examination reveals markers of transferred or current yersiniosis infection. Routine clinical methods for the diagnosis of yersiniosis have low sensitivity and do not allow us to convincingly assess the role of this bacterial agent as a trigger factor for the onset or recurrence of IBD. There is a tendency for greater manifestation in the debut of IBD in patients with markers of systemic yersiniosis. The fact of improvement against the background of empirical antibacterial therapy in 24% of patients with IBD, achievement of early clinical remission in 57% of patients receiving antibiotic therapy, indicates a significant role of bacterial enterocolopathogens in the genesis of chronic intestinal inflammation in a number of patients.

Intraepithelial lymphocytes (IEL) play a critical role in maintaining the immune balance of the gut and provide the first line of mucosal defense against luminal antigens as well as rapidly respond to epithelial injury. Recently, IEL have received a lot of attention as key mediators of aberrant immune response resulted in persistent immune activation, inflammation and altered intestinal barrier function, seen in Crohn's disease (CD). This study describes for the first time subsets of colonic IEL in CD patients as compared to healthy controls aimed at characterization of altered IEL contribution to the pathogenesis of Crohn's disease.The peripheral venous blood and colon tissues were obtained from 10 CD patients and 6 donors. IEL were isolated from the mucosa by incubation the tissue in a predigesting solution. Lymphoid cells phenotype was investigated using monoclonal antibodies and flow cytometry.The majority of colonic IEL was identified as СD3+T lymphocytes and no significant differences were found in their numbers in investigated groups. However, changes in T cell subsets composition have been shown: the ratio of СD3+СD4+IEL and СD3+СD8+IEL was 1:1 in colon of CD patients and correlated with T cells in peripheral blood (R = 0.7; p < 0.05) while donor tissues were characterized by expected СD3+СD8+T killers prevalence and the ratio reached 1:2 (p < 0.05). The increase of unconventional γδIEL (mainly due to V81+T cells) and СD161+T cells in association with TNK cells decrease were revealed in colon (p < 0.01) as well as in peripheral blood (p < 0.05) of CD patients as compared to donors. Moreover, the number of colonic γδIEL was correlated with disease location (R = -0.6; p < 0.05), and disease behavior (R = 0.7; p < 0.01) according to Montreal classification.The observed data indicates changes in colonic IEL composition in CD patients that may provide valuable insight into the contribution of T helpers, γδT cells and mucosa-associated СD161+T cells in autoimmune intestinal inflammation but need further possible mechanisms discussion.

Introduction: Inflammatory bowel disease (IBD) is a chronic nonspecific inflammatory disease of the gastrointestinal tract that includes ulcerative colitis (UC) and Crohn's disease (CD). Both disease entities have many features in common, such as a basis of chronic inflammation, similar clinical symptoms as well as periods of remission and relapse. The difference between them lies in the lesions location. Treatment of IBD is primarily based on reducing inflammation and maintaining as long a remission time as possible. Increasing evidence is being attributed to the therapeutic potential of probiotics in IBD. Purpose: This review aims to present the preventive and therapeutic effects of probiotic use in IBS through an analysis of recent studies. Methods: A review of recent literature was conducted to investigate the impact of probiotic use on the treatment of IBD. Results: In studies, probiotics help induce and maintain remission in patients with mild to moderate ulcerative colitis, especially when used in combination therapy. In contrast, the usage of probiotics in Crohn's disease does not provide due benefit: it does not induce or prolong remission. Conclusions: In conclusion, the effect of probiotics on IBD is inconclusive. Some probiotics, particularly the VSL#3 probiotic blend, have shown decent effects on induction and remission in patients with mild to moderate UC. However, no therapeutic effect has been demonstrated in patients with Crohn's Disease. Therefore studies under more restrictive and standardized conditions are required.

Introduction and purpose: The human body hosts a diverse ecosystem of commensal microbes, known as the human microbiome. This review aims to asses the current state of knowledge regarding the effectiveness, mechanisms of action, and potential benefits of probiotic supplementation in patients with inflammatory bowel diseases. Materials and methods: A literature review was conducted using the “PubMed” and “Google Scholar” databases with the keywords “Probiotics”, “Gut Microbiome”, “Probiotics and the treatment of Crohns Disease”, “Probiotics and the treatment of Colitis Ulcerosa”. State of knowledge: Dysbiosis is known to disrupt the function of the intestinal mucosis and has been associated with chronic tissue inflammation. The use of probiotics is a promising method to improve the state of gut microbiota. It is known that the gut microbiome is disrupted in inflammatory bowel diseases. Summary: The use of probiotics in Ulcerative Colitis is supported by a significant amount of evidence supporting its effectiveness. In the case of Crohn’s Disease there is a lack of evidence to definitively determine whether the use of probiotics yields therapeutic benefits. Therefore there is a need for further research in this area.

Aim. To improve the results of surgical treatment for patients with non-neoplastic colonic diseases by optimizing the choice of radical surgery extent. Materials and methods. The study material was the analysis of radical surgical interventions performed in 87 patients with non-neoplastic colonic diseases: ulcerative colitis, Crohn’s disease, familial adenomatous polyposis, chronic colonic and coloproctogenic stasis, diverticular colon disease. The age of the operated patients was 20–72 years. There were 49 (56.3 %) men and 38 (43.7 %) women. The criteria for choosing the radical surgery extent for these diseases were defined and substantiated. Results. There were 3 postoperative mortalities (3.4 %) among patients operated on absolute indications for acute complications of ulcerative colitis and Crohn’s disease. Recurrences of ulcerative colitis, Crohn’s disease and familial adenomatous polyposis occurred in 16 (18.4 %) operated patients in the area of the retained rectal stump and terminal ileum. Malignant transformation of the rectal stump occurred in 5 (5.7 %) patients with these recurrences. The extent of radical surgery in non-neoplastic colonic diseases depended on the diagnosis of the underlying disease, the presence of complications, the depth of wall lesions and the extent of the pathological process, the risk of recurrence in the anatomical parts of the small and large intestine. Conclusions. Deciding on the extent of the radical stage of surgical intervention depended on the diagnosis, features of the clinical course of non-neoplastic colorectal diseases, recurrences, the general condition of a patient, the pathological process extent and severity. Performing the optimal extent of radical surgery for non-neoplastic colonic diseases helped reduce the number of recurrences in the terminal part of the small intestine to 4 (4.6 %), in the area of the rectal stump to 7 (8.1 %), improved functional outcomes and quality of life in 76 (87.3 %) operated patients.

Aim: to investigate the clinical efficacy of two methods of oral dosing of prednisolone (in mg and mg/kg) for the induction of remission for patients with ulcerative colitis (UC) and Crohn's disease (CD) using the technology of constructing and evaluating the effectiveness function (dose-effect relationship).Material and methods. In this study were included 86 patients aged from 18 to 65 years with moderate or severe active inflammatory bowel disease (61 — UC, 25 — CD). All patients were treated with prednisolone at an initial daily dose from 30 to 60 mg with a subsequent tapering of dose. The clinical response to treatment was evaluated at the time of complete withdrawal of prednisolone using the generally accepted criteria. Two efficiency functions were constructed, compared and analyzed: the first — at the initial dosage of prednisolone in mg and the second calculating the dose in mg/kg of patient weight. The patients' body weight ranged from 41 to 98 kg. The “dose-effect” relationship for prednisolone was constructed with statistical transformation of the baseline clinical data and a quantitative expression of the actual doses and alternative responses into a graph of the effectiveness function. The mean value at each point was estimated based on the regression kernel scoring method.Results. Two graphs of the “dose-effect” of prednisolone in mg and mg/kg of patient weight were constructed. The optimal clinically effective dose (OCED) when calculated in mg/kg of weight was 0.70 ± 0.01 (0.68 + 0.72) mg/kg with the corresponding effect 79.25 ± 6.26 (66.62 91.88) %. When two graphs in mg and mg / kg of weight were superimposed, it is shown that when an initial dose of 40 mg is prescribed without taking into account the patient's weight, the effect of therapy will be 25 % lower. Prescribing a dose of 60 mg per day without weight will be optimal for patients with a body weight of 85-90 kg. With a lower body weight, the clinical effect will not decrease, but the likelihood of recognized side effects of prednisolone should be expected in proportion to the decrease in body weight.Conclusion. The clinical efficacy of two methods of prednisolone dosing (mg and mg/kg) for patients with IBD during the first induction course was compared.Using a new technology for constructing and evaluating the effectiveness function (dose-effect relationship) allowed us to prove a reliable relationship between the body weight of patients with the clinical effect of prednisolone in patients with UC and CD. Based on the analysis of the dose-effect relationship, the optimal clinically effective dose of prednisolone for patients with UC and CD during the first induction course was established, equal to 0.70 mg/kg, which can be recommended for use in clinical practice for calculating individual doses.

Aim. To evaluate the content of calprotectin and volatile fatty acids (VFAs) in feces of patients with inflammatory bowel disease (IBD). Materials and methods. 61 patients (33 men and 28 women) with IBD aged 20 to 66 years (the mean indicator was 41.80 ± 1.14 years) were examined. The patients were treated in the Department of Intestinal Diseases of SI “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”. All the patients were divided into two groups: Group I – 46 patients with ulcerative colitis (UC) and Group II – 15 patients with Crohn’s disease (CD). The control group consisted of 10 practically healthy people (donors). Calprotectin detection in fecal samples was carried out using a kit “Immundiagnostik”, Germany. Fecal VFAs were analyzed using a hardware-software complex for medical research with a gas chromatograph Chromatek-Crystal 5000. Results. A significant increase in the content of fecal calprotectin was found. Its amount depended on the disease nosology and was more expressed in patients with UC (3.5 times higher (P < 0.05) than that in patients with CD). The observed changes were accompanied by an increase in the content of propionic (C3) acid and a decrease in acetic (C2), butyric (C4) acids in coprofiltrates of the examined patients. The detected imbalance in the fecal content of VFAs in patients led to an increase in the amount of fatty acids, which was more pronounced in patients with CD. An association between calprotectin levels and fecal VFA content was identified. Thus, correlation analysis allowed to establish a relationship between calprotectin levels and propionic acid content in patients with IBD (r = 0.370; P = 0.046). Conclusions. In the case of active bowel inflammation, there is the increase in the fecal content of calprotectin and the decrease in VFAs (acetic and butyric acids) in accordance with the degree of disease activity, which allows the use of these indicators to assess the efficacy of therapies.

Background. X-linked lymphoproliferative (XLP) syndrome is hereditary disease with the incidence of 1-3 per 1 million born boys. This clinical case demonstrates a rare picture of XLP type 2 manifestation without prior Epstein-Barr virus.Clinical case description. Boy D., 15 years old, was admitted to Morozovskaya Children's City Hospital with complaints on fever, abdominal pain, loose stools, weight loss. The past medical history included hemophagocytic syndrome (remission) and acute erythema nodosum. We have performed several studies: abdominal ultrasound (hepatomegaly, dynamic changes in the intestine: parts of the small intestine were enlarged and walls were thickened, mass peristalsis, walls of transverse colon and descending colon are thickened up to 5 mm, mesenteric lymphadenopathy), rectosigmoidoscopy (high-activity ulcerative proctosigmoiditis corresponds to Crohn's disease), biochemical and clinical blood tests (active hemophagocytic syndrome), coagulogram (secondary hypocoagulation), myelogram (no data on hemoblastosis or aplastic condition). Virological blood tests (CMV, EBV, HHV-VI): negative. Laboratory and instrumental tests have revealed recurrence of hemophagocytic syndrome and Crohn's disease. The child was consulted by rheumatologist, hematologist, gastroenterologist, geneticist, neurologist, and clinical pharmacologist. The primary immune deficiency disease was suspected in this patient due to his medical history. Molecular genetic study was performed (deletion including the XIAP gene was revealed) and the diagnosis of primary immune deficiency was verified: X-linked lymphoproliferative syndrome type 2. Thus, allogeneic haematopoietic stem cell transplantation (HSCT) was performed.Conclusion. XLP diagnosis and management require multidisciplinary approach. The early diagnosis is crucial due to the high risk of secondary complications development that can significantly worsen the disease's prognosis. Allogeneic HSCT is the only effective treatment for the disease.

Crohn's disease is a chronic disease. It most often begins between the ages of 15 and 35 and lasts a lifetime. The earliest radiographic findings are aphthous ulcers. It can cause mouth-to-anal lesions and extra-intestinal complications. Typical symptoms are diarrhoea, abdominal pain, rectal bleeding, fever, weight loss and fatigue. Many different tests, including laboratory tests, are important in the diagnosis of the disease. Fecal calprotection is a direct marker of inflammation in the intestinal mucosa. Endoscopic examination remains the basic diagnostic method of Crohn's disease. In order to assess the small intestine, MRI or CT should be performed. In the case of acute disease progression, ileocolonoscopy should be the examination. The disease requires long-term treatment, both pharmacological and often surgical.

Background. Chronic diarrhea can be a symptom of a wide variety of diseases, either of which requires special therapy approaches. The diagnosis of rare causes of chronic diarrhea is especially difficulty as it may be associated with inflammatory bowel disease (IBD) with very early (under 1 year of age) debut.Clinical case description. Boy E. had chronic diarrhea manifested on the first year of life. Ulcerative colitis was diagnosed at the age of 1.5 years, then the diagnosis was changed to Crohn’s disease at the age of 2.5 years. The results of 6-years-follow-up of the patient were presented, as well as analysis of diagnosis and treatment difficulties was carried out.Conclusion. The clinical case of Crohn’s disease with diarrhea as the leading clinical manifestation at the disease onset is described. Sequential diagnostic search allowed us to establish the diagnosis of IBD and to exclude other causes of chronic diarrhea that determined the correct therapeutic strategy.

Aim: to study the course of COVID-19 in patients with inflammatory bowel diseases (IBD) using the example of the region of the Republic of Tatarstan.Material and methods. The study included 101 patients diagnosed with IBD and COVID-19, who were observed in two infectious diseases hospitals in Kazan (Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan and City Clinical Hospital No. 7) and on an outpatient basis from April 2020 to March 2022. All patients underwent physical examination, laboratory and instrumental diagnostic methods, including a PCR test for SARSCoV-2. Chest computed tomography was performed in patients with clinical signs of moderate to severe COVID-19.Results. Ulcerative colitis (UC) was diagnosed in 60 (59.4 %) patients, Crohn's disease (CD) — in 41 (40.6 %) patients. The mean age of the patients was 41.0 ± 14.7 years, of which 59 (58.4 %) were men and 42 (41.6 %) were women. A comparative analysis of patients with and without IBD and CT-verified lung disease was carried out. It was found that the development of viral pneumonia was influenced by age over 55 years (39.2 ± 9.7 vs. 46.3 ± 10.6, p < 0.05), increased Body Mass Index (BMI) (23.1 ± 5.35 vs. 30.25 ± 6.17, p < 0.05), hypertension (6 (8.3 %) vs. 8 (27.6 %), p < 0.05), diabetes mellitus (2 (2.7 %) vs. 5 (17.2 %), p < 0.05), the use of corticosteroids in the treatment of IBD (8 (11.1 %) vs. 10 (34.5 %), p < 0.05). In a comparative analysis of patients with IBD and COVID-19 from the SECURE-IBD database and own data, it was found that the average age of patients was comparable (42.7 vs 41.0). At the same time, in our group of male patients, there were slightly more people with DM, increased BMI, and an active course of IBD. The proportion of hospitalized patients was higher. In our cohort, there were fewer patients receiving biological therapy, but more patients on 5-aminosalicylic acid (5-ASA) and systemic corticosteroids. At the same time, lethal outcomes were comparable.Conclusion. In patients with IBD, the development of viral pneumonia was influenced by known risk factors for COVID-19: age over 55 years (p < 0.05, odds ratio (OR) 3.153), increased BMI (p < 0.05, OR 1.667), hypertension (p < 0.05, OR 2.724), diabetes (p < 0.05, OR 1.489), as well as the use of systemic corticosteroids (p < 0.05, OR 1.5).

Crohns disease with localization in the upper gastrointestinal tract, terminal ileum, or colon is diagnosed based on visualization of the lesion area using endoscopic methods and histological examination. In cases of damage to the small intestine, when endoscopy methods are not informative enough and the use of videocapsular endoscopy has a number of contraindications, it is advised to use radiation diagnostic methods, such as multispiral computed tomography and/or magnetic resonance enterography, to make a diagnosis. We present a clinical case of ambiguous clinical manifestations of Crohns disease with small intestine and rectal involvement. Tomographic imaging was used to confirm the diagnosis. A 44-year-old patient presented with complaints of non-pronounced abdominal pain, dyspepsia. The lab panel showed indirect signs of malabsorption, an increase in fecal calprotectin. An endoscopic examination with histological verification revealed a picture of proctitis. After performing computed tomography and/or magnetic resonance enterography multiple lesions of the small intestine were revealed. This clinical case demonstrates an atypical clinical picture of Crohns disease with jejunal, iliac, and rectal lesions. The patient had no characteristic complaints; the results of endoscopic and morphological studies were not informative. Imaging by means of computed and magnetic resonance tomography has played a crucial role in the diagnosis and successful treatment.

Crohn’s disease (CD) is a chronic recurrent inflammatory bowel disease with a wide variety of clinical manifestations – from classical gastrointestinal phenotypes to predominance of extraintestinal symptoms. Atypical course of CD is observed relatively often and is manifested with a damage to almost all body systems, including hepatobiliary, immune, hematopoietic, cardiovascular, nervous, as well as eyes, skin, lungs and kidneys. Atypical manifestation often precedes intestinal, making diagnosis difficult. The presence of various clinical manifestations of CD, often an atypical course, as well as the absence of standardized diagnostic criteria can be an obstacle for physicians in the timely detection of the disease and effective treatment. Aim: to describe a clinical case of a diagnostically difficult patient of our clinic with an atypical course of CD and complications incompatible with life; highlight the problem of monitoring and possible solutions. Results. In the presented clinical case the patient with an atypical course of CD, with the prevailing displays of defeat of nervous and vascular systems is described. During hospitalization, a full range of diagnostic tests was performed, consultations with related specialists were obtained, but no direct data of inflammatory bowel disease were found. At the same time, the impossibility of performing a colonoscopy with a biopsy, due to the severity of the patient’s condition, delayed the timely diagnosis of CD and contributed to the development of complications incompatible with life. The diagnosis was made posthumously. The patient died as a result of intoxication due to the development of complications of CD – perforation of the intestine, intestinal abscess, development of peritonitis, septicemia. Conclusions. In the described clinical case CD is considered as a complex interdisciplinary problem, and emphasizes the importance of doctor’s awareness of the variants of atypical manifestations and course of inflammatory bowel disease, methods for their assessment and ways of effective management. This case also presents the latest epidemiological data on the prevalence of atypical manifestations of CD, identifies key areas of diagnostic search in case of a difficult patient.

Introduction. Crohn's disease (CD) is a chronic inflammation of various parts of the gastrointestinal tract with an increased proportion of Escherichia coli. However, the role of E. coli in disease remains unclear. This study aims to evaluate the competitive abilities of E. coli strains from CD patients and healthy volunteers, and to identify the biochemical and genetic determinants underlying these features. Materials and methods. The antagonistic activity was assessed by co-cultivation of 11 clinical E. coli strains inhibiting the growth of the K-12, with Enterobacter cloacae, Klebsiella pneumonia and Salmonella enterica. To elucidate the mechanism of antagonistic activity, the evaluation of biochemical properties and a comparative genomic analysis were used. Results and discussion. Genes of bacteriocin production systems were identified in genomes of 11 strains from CD patients and healthy volunteers active against the E. coli K-12 strain. Three strains from healthy individuals demonstrated activity against several Enterobacteriaceae bacteria. The strains biochemical properties were typical of representatives of E. coli. Strains 1_34_12, active against E. cloacae, and 1_45_11, inhibiting all tested enterobacteria, are phylogenetically related to the laboratory strain K-12. Strain 1_39_1, active against K. pneumonia and S. enterica, is phylogenetically close to the Nissle1917, contains the genes for colibactin biosynthesis and a variant of the fimH gene that increases the adhesive ability of bacteria. Conclusion. The identified E. coli strains are able to displace Enterobacteriaceae bacteria and can be used to study the bacteria-bacteria and host-bacteria interactions, to understand their role in gut homeostasis and intestinal inflammation.

Rationale: At present, there is no established standard for the differential diagnosis of Crohn's disease (CD) and ulcerative colitis (UC). Five to 15% of the patients have clinical, endoscopic, morphological, and radiological signs both of UC and CD and are therefore diagnosed with indeterminate colitis. However, the timely and correct diagnosis is essential for the choice of treatment strategy. Aim: To evaluate the potential of endoscopic ultrasound examination (EUS) for the differential diagnosis of UC and CD and to identify the most pathognomonic criteria for each of the disorders. Materials and methods: This was a prospective single center controlled study including 50 in-patients who were treated in the Department of Gastroenterology for inflammatory bowel disease (IBD) exacerbation. The inclusion criteria were an established diagnosis of IBD, absence of strictures, colon tumors, and infectious diseases. The control group consisted of 15 patients without IBD. In all patients, colon EUS with a radial ultrasound sensor and measurement of the intestinal wall thickness, assessment of the degree of intestinal wall vascularization by color Doppler mapping and measurement of the wall density by compression elastography were performed. Results: From 50 patients of the study group, 28 (16 men and 12 women aged 18 to 49 years) had CD of the colon and 22 (8 men and 14 women aged 22 to 60 years) had total UC. In CD, the colon wall thickness was 2-fold higher than in the control group (5.66 0.36 vs 2.62 0.11; р 0.001) and 1.5-fold higher than in the UC patients (5.66 0.36 vs 3.96 0.13; p = 0.002). In UC, the intestinal wall was thickened mainly due to its mucosal and submucosal layers (in 82% of the cases, р 0.001 compared to that in the CD patients; diagnostic sensitivity 82%, specificity 93%). In CD, transmural thickening of the intestinal wall was more common (in 68% of the cases, p 0.001 compared to that in UC; sensitivity 68%, specificity 91%), as differentiation of the intestinal wall layers was absent (in 68% of the cases, p 0.001 compared to UC, sensitivity 68%, specificity 100%). The intestinal wall in most cases of UC was less well vascularized that in the control group (54.6% of the cases, p 0.001), whereas in CD, on the contrary, the vascularization was increased (71.4% of the cases, р 0.001); the sensitivity and specificity of this parameter being 54.6 and 82%, for UC vs 71.4 and 77.3% for CD, respectively). Compression elastometry showed that in CD, type 2 staining (E. Ueno classification) was more frequent (45%) compared to UC (22%) and the control group (6%; p = 0.002), which indicates a more dense structure of the intestinal wall in CD patients. Conclusion: The differences in the intestinal wall structure (its thickness, density and degree of vascularization) identified by EUS UC and CD can be the differential diagnostic criteria between these diseases.

In Russia, amebiasis is sporadically registered mainly in the southern regions. An endemic area is the Republic of Dagestan. We describe a clinical case, which illustrates challenges in the diagnosis of amebial colitis related to low awareness of physicians of parasitic diseases in non-endemic regions. A 38-year old female patient living in Moscow was initially misdiagnosed with Crohn's disease. Erosive and ulcerative colonic lesions found at colonoscopy were interpreted by a gastroenterologist as symptoms of an inflammatory bowel disease. No differential diagnosis with infections and parasitic diseases was performed. Long (2 years) persistence of symptoms despite treatment with 5-aminosalicylic agents for suspected Crohn's disease, absence of any significant laboratory abnormalities and no history of travelling to Asian countries were the reason for subsequent additional diagnostic work-up. After the patient was finally diagnosed with intestinal amebiasis, she was treated with metronidazole with some positive effect of decreased abdominal bloating and bowel growling. At the control colonoscopy, there was a positive trend seen in colonic mucosa, with healing of ulcers without any scarring. No protozoan cysts were any more found in her feces. According to the recommendations, the patient is regularly seen by a specialist in infectious diseases and a gastroenterologist. Expansion of amebiasis outside endemic regions points to the necessity to perform a wider diagnostic work-up in cases of mucosal lesions found at colonoscopy.

Aim. To determine morphological and morphometric changes in the structure of the mucous membrane of the large intestine and their relationship with the content of short-chain volatile fatty acids and fecal calprotectin in patients with inflammatory bowel disease. Materials and methods. We examined 68 patients with inflammatory bowel disease, including 30 women and 38 men aged 20–66 years, 55 patients were with ulcerative colitis and 13 patients – with Crohn’s disease. Histological examination focused on changes in the mucous membrane of the large intestine. Determination of short-chain volatile fatty acids in feces was performed using gas chromatography. Calprotectin content was measured in fecal samples by enzyme-linked immunosorbent assay. Results. Significant correlations were found between epithelial disruption and changes in crypt architecture, infiltration density, and histological activity. The higher degree of inflammation in patients with severe course was combined with a lower level of tissue nonspecific protection, which was detected by the number of goblet cells, eosinophilic and neutrophilic leukocytes. There was a decrease in the fecal concentration of butyric acid in patients with nonspecific ulcerative colitis and Crohn’s disease compared with controls, but a more significant decrease was observed in patients with severe nonspecific ulcerative colitis. The data have confirmed the association between inflammatory bowel disease and the content of short-chain volatile fatty acids, fecal calprotectin in coprofiltrate, which was evidenced by the presence of correlations between low content of short-chain volatile fatty acids and eosinophilic infiltration (r = -0.412; fecal calprotectin levels and disease severity (r = 0.589; P = 0.001), atrophy (r = 0.458; Р < 0.05), infiltration density (r = 0.434; Р < 0.05). Conclusions. All patients with inflammatory bowel disease are characterized by a specific histological picture, which reflected the different degrees of inflammation. Morphometric parameters more accurately show significant atrophic changes in the mucous membrane of the large intestine. The data have confirmed the association between inflammatory bowel disease and the content of short-chain volatile fatty acids and calprotectin in coprofiltrate.

Currently, there is an increase in the incidence of inflammatory bowel disease in children, including Crohn’s disease. Detection of typical endoscopic signs is the gold endoscopic standard for this disease diagnosis. When such endoscopic picture is accompanied by chronic diarrhea, abdominal pain, weight loss, and laboratory changes in the form of increased levels of faecal calprotectin and C-reactive protein, the diagnosis of Crohn’s disease becomes apparent and the diagnostic search is stopped. But there are other diseases, including of infectious type, that may have similar clinical, laboratory and endoscopic symptoms, which should be included in the scope of diagnostic search. Aim. To acquaint physicians with the features of diagnosis and monitoring of a patient with Yersinia infection on the background of lactase deficiency, clinically reminiscent of Crohn’s disease. Clinical case. A boy, 14 years old, complained of abdominal pain, recurrent diarrhea, weakness, lack of weight gain. A mother considered the child sick for 9 months, when periodic abdominal pain, diarrhea up to 10–12 times a day, sometimes nausea and vomiting occurred. Over time, episodes of diarrhea became more frequent, mainly after drinking milk. Four months after the disease onset, the child lost appetite, developed weakness, abdominal pain, recurrent diarrhea, no weight gain with increasing body length. Eight months after presenting complaints, the child was admitted to a hospital with acute disease manifestations (fever, abdominal pain, vomiting, diarrhea for 10 days). The boy was examined by a surgeon and a pediatric gastroenterologist. During colonoscopy, terminal ileitis was detected. The boy received non-specific treatment (mesalazine 3 g/day, etc.), there was a rapid improvement: abdominal pain disappeared, asthenic syndrome regressed, diarrhea reduced. Although amnestic, clinical, laboratory and instrumental data were very characteristic of Crohn’s disease, the diagnosis was questionable due to the lack of inflammatory changes in the general blood test and the fact that spontaneous remission of such severe exacerbation, for which mesalazine was usually ineffective. It was necessary to exclude other causes of inflammation of the small intestine (intestinal infections, tuberculosis). RNGA with pseudotuberculosis diagnosticum gave a positive result (intestinal yersiniosis diagnosticum O3). Conclusions. In children with suspected inflammatory bowel disease, intestinal infections, namely yersinia infection, should be ruled out as the cause of symptoms. Even with clear manifestations of terminal ileitis, which is characteristic of Crohn’s disease, the results of intestinal endoscopy may be relatively nonspecific, so the disease history, a correspondence with laboratory results, serological markers of some infectious diseases should also be taken into account in the diagnostic process for the ileitis etiology.

RETRACTED ARTICLEWe present the clinical case of patient Z., 31 years, old with exacerbation of Crohn's disease during pregnancy. Although treatment was given, the pregnancy ended in stillbirth (29 weeks). The degree of activity of the disease determines the occurrence of complications during pregnancy. That is why pre-pregnancy preparation is necessary, especially when the disease is in remission.

The purpose of the review: to summarize the main data of the literature and our own accumulated practical experience of everyday diagnosis of inflammatory bowel diseases (IBD) to better represent the morphological features and histological conclusions.Key points. The microscopic picture of IBD is often represented by a combination of basic histological characteristics that can be detected in other diseases and only in rare cases can be considered pathognomonic. No single histological feature can be used in isolation to diagnose ulcerative colitis or Crohn’s disease. Diagnostic accuracy is improved if several signs are taken into account at once, if changes within one or more parts of the intestine are analyzed, it is necessary to compare the identified changes with the clinical picture of the disease.Conclusion. The presented stages of the morphological study of biopsy specimens in patients with IBD and the exact characteristics of the detected changes will help to increase the diagnostic value of the study of ileo- and colonobiopsies, as well as improve mutual understanding between gastroenterologists and pathologists and, as a result of interaction between specialists, will increase the accuracy of the diagnosis.

We present a clinical case of intestinal tuberculosis in a young patient with a clinical simulation of Crohn's disease. The article addresses clinical presentation, challenges of differential diagnostics of intestinal tuberculosis, and nonsurgical and surgical treatment approaches.

Introduction: Crohn's disease (CD) is an inflammatory bowel disease that can affect any part of the digestive tract. Onset, progression, complications and treatment are influenced by many genetic, environmental and dietary factors. Dietary management is very useful in a variety of gastrointestinal diseases, including CD. Some nutrients have been studied in animal models to exacerbate the disease, while others have strong scientific evidence from large studies in human populations, allowing conclusions to be drawn about their impact on the disease. Dietary management is now a well-established and important part of treatment, in addition to the use of systemic corticosteroids, aminosalicylates, immunomodulators (e.g. azathioprine, 6-mercaptopurine, cyclosporine, tacrolimus) or biologic therapies. State of knowledge: To test the associations between the intake of specific macronutrients and the course of CD, we searched the PubMed database focusing on articles about the effects of consumed food components and stimulants on the onset and progression of CD. Conclusion: Nutritional treatment plays an important role in the management of CD. An appropriate diet can make a significant contribution to reducing inflammation and attenuating the course and exacerbations of the disease. The intake of proteins, fats, carbohydrates, fiber and certain food additives has been shown in studies to influence the onset and course of CD.

Introduction and objective: Inflammatory bowel diseases (IBD) are a group of chronic inflammatory diseases. Usually they affect young people, often during pregnancy. Insufficient knowledge about the evolution of the disease during pregnancy, as well as the effects of drugs used, often result in resignation from motherhood, while unfamiliarity with the principles of therapy or discontinuation of treatment during pregnancy are significant causes of obstetric failures. The aim of the study was to summarize the data available in the literature as well as recent reports, to enable a better understanding of the disease and care of pregnant women with IBD. Materials and methods: The literature was reviewed in the Pubmed database, in the Via Medica Journals database, and in the guidelines of the Polish Society of Gastroenterology with the use of keywords. State of knowledge: 85% of women with IBD become pregnant without complications, but the inflammation has a negative impact on both the course of pregnancy and the fetus itself. Complications, which often depend on the activity of the disease before and during pregnancy, may occur: i.e. premature birth, inadequate fetal weight, miscarriage, as well as complications in the child itself and flares of the underlying disease. Therefore, it is important to know rules of safe pharmacotherapy that apply before and after pregnancy in order to prevent the negative effects of the disease. Special situations caused by IBD, i.e. surgical or endoscopic procedures, can be successfully performed in pregnant patients with the observance of certain rules. Conclusions: Understanding the causes of complications that may occur in the patient and the child allows them to be prevented. Both for the mother's health and for a positive course of pregnancy, education and pregnancy planning, preceded by the change of medications to safe for the fetus, are extremely important.

Introduction and Purpose: Crons’ disease is a chronic illness of the digestive system. Its etiology is multifactorial and one of the factors is nutrition. That is why the researchers are trying to labour the valuable types of dietary therapy, which could be used in treatment of pediatric CD. The purpose of our review is to point out the impact of dietary therapy on achieving remission in pediatric Crohn’s disease. Materials and methods: We have reviewed the literature from the PubMed database searching for clinical trials, meta analysis and randomized controlled trials from the past years. The keywords we agreed on offered us the most informative articles and made us hope for the further development of our article. Brief Description Of The State Of Knowledge: Steroid therapy is the principle of CD treatment, but it has a number of side effects that influence the quality of pediatric patients’ life. It has been shown that the use of dietary therapies (EEN, CDED+PEN, SCD) enables the achievement of clinical and biochemical remission, mucosal healing and regulation of dysbiosis. There are many hypotheses explaining this effect, probably the reason of this is the exclusion from the diet of food products that provoke inflammatory processes. Summary: Despite its effectiveness, dietary therapies require motivation and full commitment from patients in order to achieve results. That is why it is so important to conduct further research in this area so that the selected therapy is as acceptable and tolerated by the patient as possible. In addition, education of children and parents, psychological and dietary support are also crucial in the treatment process.

Crohn’s disease (CD) is a severe immune-mediated disease with segmental transmural inflammation and ulcers in gastrointestinal tract most often in terminal ileum and colon. The disease is often associated with severe complications such as fistulas and strictures that require aggressive treatment or surgery. CD treatment remains the unresolved and one of the most serious problems in gastroenterology. Glucocorticosteroids (GCS) are the essential treatment options for many years but unfortunately the frequency of steroid resistance and steroid dependence are constantly increasing. In the cases of steroid refractory CD treatment options include biologics of different classes: tumour necrosis factor alfa - inhibitors (iTNF-α), α4β7 integrin inhibitor (vedolizumab), IL-12/23 inhibitor (ustekinumab). Any of these drugs can be used in bio-naïve CD patients, however secondary loss of response was noted for all biologics over time.In the cases of the first line treatment failure the problem of correct choice of the second and subsequent lines of biologics appears, since some biologics may show lower efficacy in the second line of treatment. Real clinical practice will allow us to make a more correct choice of next biologic. Ustekinumab, a human interleukin -12/23 monoclonal antibody is one of biologics that is highly effective in the first-line CD therapy and remains effective in the subsequent lines of treatment. We present a clinical case of complicated CD in young female with negative disease prognosis and loss of response to three iTNF-α. In this case the high efficacy of ustekinumab after multiple iTNF-α failure was demonstrated.

RATIONALE Hollow organ perforation is an urgent problem in abdominal surgery. According to the literature, the incidence of perforation is from 0.37% to 2.3% of cases among various acute surgical pathologies of the abdominal organs. The greatest attention in the literature is paid to the problem of perforated gastroduodenal ulcers. At the same time, a much smaller number of publications, both Russia and foreign, are devoted to other, more rare types of perforations. This situation is most likely explained by the low prevalence of other types of perforations, which, in turn, does not make them a less urgent problem in emergency surgery, which requires a modern approach to the treatment of this group of patients.PURPOSE OF THE STUDY Analysis of domestic and foreign literature on the diagnosis and treatment of rare types of benign intestinal perforations.MATERIAL AND METHODS A literature review was performed for the period from 1994 to 2020 in Russian and in English, available on Pubmed, Medline, Springer, Scopus, E-library, on topics such as perforated diverticula of the small intestine, perforation of Meckel’s diverticulum, perforated ulcers of the small intestine, perforation of the intestine by a foreign body. RESUltS With all the variety of surgical techniques for various types of perforation of the gastrointestinal tract, currently in the literature there are no specific criteria for choosing a particular method of intervention with regard to the cause, level, and duration of perforation.CONCLUSION The lack of unified approaches in the diagnosis and treatment of patients with rare GIT perforations dictates the need for a more in-depth study of this issue in order to apply and optimize the technique of videolaparoscopic approach, develop a treatment and diagnostic algorithm for patients with suspected perforations of the gastrointestinal tract using the video laparoscopic method.

The OBJECTIVE of the study was to assess the possibility of using laser technologies in the treatment of perianal Crohn’s disease.METHODS AND MATERIALS. The study included 18 patients with perianal Crohn’s disease who were treated in Surgery Department ¹ 3 of the Clinic of the Research Institute of Surgery and Emergency Medicine of Pavlov University. The study was conducted in 2 stages. The first stage consisted in placing the draining seton (ligature) in the main fistulous canal. The second stage was performed in 3 months. The seton was removed with further laser destruction of the fistulous canal. On the background of surgical treatment, the patients received conservative therapy according to the recommendations of gastroenterologists.RESULTS. Every stage of surgical treatment lasted no more than 30 minutes, under intravenous anesthesia. Intraoperative blood loss did not exceed 5 ml. Due to the absence of complications, the bed-day of each stage varied from 0 to 2 days. 3 months after surgical treatment, the examination showed the complete closure of the fistula canals. The maximum period of relapse-free course was 24 months. All patients received anti-inflammatory therapy, 63 % of patients continued to receive genetically engineered biological therapy.CONCLUSION. The use of sphincter-preserving techniques proved to be effective in patients with perianal Crohn’s disease. It improves the quality of life and reduces the risk of patients’ disablement.

Background. Inflammatory bowel diseases (IBD) are characterized by chronic immune inflammation of the mucous membrane and/or the thickness of the intestinal wall, and are also accompanied by disorders of the blood clotting system and the development of a hypercoagulation state. Aim. To identify the frequency of thromboembolic complications (TEC) in IBD patients and to determine the influence of acquired and inherited hypercoagulation factors that contribute to the development of TEС. Materials and methods. The clinical status of 1,238 IBD patients who were treated in 2019 was evaluated. Of these, 748 patients with ulcerative colitis (UC) and 490 patients with Crohn's disease (CD). Among UC patients, there were 369 (49.3%) men and 379 (50.7%) women. In 10.1% of patients with UC, there were clinically significant feasibility studies. There were 227 (46.3%) men and 263 (53.7%) women among patients with CD; 7.3% of patients with CD had clinically significant feasibility studies. Results. In general 112 (9.0%) of 1,238 IBD patients had clinically significant feasibility studies. Among patients with UC (n=748), 76 (10.2%) showed clinically significant feasibility studies. Among patients with CD (n=490), 36 (7.3%) had a feasibility study. Of 112 IBD patients with clinically significant TEC, 45 (40.2%) had genetic polymorphisms that increase affinity for fibrinogen, increase platelet aggregation, and contribute to a decrease in the activity of folate cycle enzymes, including methylenetetrahydrofolate reductase, which may be manifested by a moderate increase in homocysteine levels. Of the 45 IBD patients with clinically significant TEC due to inherited factors, 30 (66.6%) patients had UC, 15 (33.7%) patients had CD (hazard ratio 1.038, 95% confidence interval 0.7461.444; 2=0.049; p=0.83921); 67 (59.8%) patients with IBD who had clinically significant TEC did not have genetic polymorphisms leading to hypercoagulation. Conclusion. Based on the analysis, we can conclude that such risk factors for the development of TEC as the status of a smoker, long bed rest, taking hormonal contraceptives, varicose veins of the lower extremities, high activity of the disease, glucocorticoids therapy, the extent of intestinal damage in patients with IBD, genetic factors, should be taken into account by gastroenterologists in the treatment of patients with UC and CD. The hereditary factor of hypercoagulation equally affects the development of TEC, both in patients with UC and CD.

Aim. An algorithm development for joint pain differential diagnosis in patients with inflammatory bowel disorders (IBD) and its validation in clinical practice.Materials and methods. A total of 349 IBD patients hospitalised for gastroenterological complaints at the Chelyabinsk Regional Clinical Hospital during 2017–2020 have been examined.Results. Upon survey, 97 (27.8%) IBD patients complained of joint pain. Ulcerative colitis (UC) predominated (79 patients; 81.4%), Crohn’s disease (CD) had a 18.6% incidence. In survey, 27% UC and 32.1% CD patients reported joint pain (p = 0.26). Among IBD patients, 52.6% had mechanical, and 47.4% — inflammatory pain. The inflammatory back pain (IBP) rate in survey cohort was 23.7%. Use of a diagnostic algorithm allowed concomitant rheumatic disease detection in 7 (7.2%) patients from the IBD–joint pain cohort: 2 patients were diagnosed with psoriatic spondyloarthritis, 2 — rheumatoid arthritis, 1 — gout and 2 — with ankylosing spondylitis. IBD-associated arthritis was diagnosed in 41 (42.3%) cases, osteoarthritis — in 38 (39.2%) IBD patients with joint pain, arthralgia with no objective inflammation, impaired joint function or lesions in X-ray and/or ultrasound — in 13 (13.4%) patients.Conclusion. Joint pain complaints are common in IBD patients and require a multispecialty rheumatologists-involving approach to proceed with differential diagnosis and opting for treatment tactics. A clinically verified algorithm coupled with laboratory tests and instrumental imaging facilitates diagnosis and optimal therapy selection in IBD patients with complaints of joint pain.

An observation from practice was devoted to the experience of an interdisciplinary approach in the diagnosis and surgical treatment of a patient with complicated course of Crohn’s disease against the background of the formation of a stricture of the terminal ileum, an enterovesical fistula, the penetration into the mesentery of the sigmoid colon.

The differential diagnosis of intestinal tuberculosis and Crohn’s disease is a difficult task for most specialists due to their high similarity in clinical manifestations, instrumental diagnosis and histological pattern.The aim: to consider the clinical and diagnostic features of intestinal tuberculosis and Crohn’s disease, to show the role of various methods of their diagnosis (CT of the abdominal cavity, CT-enterography, colonoscopy with biopsy).A clinical example shows a case illustrating the difficulties of diagnosing intestinal tuberculosis, initially diagnosed as Crohn’s disease. The features of the course, complex diagnosis and treatment of intestinal tuberculosis and its complications during immunosuppression are demonstrated. At the first stage of treatment, the patient’s data related to CT of the chest organs, colonoscopy and histological examination of biopsy samples were incorrectly interpreted. As a result, a wrong diagnosis of Crohn’s disease was made, and immunosuppressive therapy was prescribed that provoked a generalization of the existing tuberculosis process. Subsequently, repeated surgical interventions were performed for complications of intestinal tuberculosis – perforation of tuberculous ulcers, peritonitis. Based on the analysis of the literature data and our own observation, it is shown that granulomatous inflammation in the study of intestinal biopsies doesn’t always allow us to make a clear diagnosis, first of all, there are intestinal tuberculosis and Crohn’s disease in the differential diagnostic series. The use of histobacterioscopy according to Ziehl – Neelsen, the study of fecal matter by luminescent microscopy, as well as molecular genetic methods for detecting DNA MTB allow us to verify the diagnosis. If Crohn’s disease is misdiagnosed as intestinal tuberculosis, then the prescribed anti-tuberculosis therapy can cause harm and lead to a delay in the underlying disease treatment. The reverse misdiagnosis is potentially more dangerous: if tuberculosis is misdiagnosed as Crohn’s disease, then the appointment of immunosuppressive therapy can lead to the generalization of tuberculosis and the development of fatal complications.

The article discusses the difficulties of differential diagnosis of early arthritis and inflammatory bowel diseases with a predominant clinical picture of extraintestinal manifestations, in particular, articular syndrome. The clinical observation demonstrates features of the course of such conditions, a long diagnostic search and a wide list of diseases included in differential diagnostics range.