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Summary Post- COVID syndrome refers to the long-term consequences of a new coronavirus infection COVID-19, which includes a set of symptoms that develop or persist after COVID-19. Symptoms of gastrointestinal disorders in post- COVID syndrome, due to chronic infl ammation, the consequences of organ damage, prolonged hospitalization, social isolation, and other causes, can be persistent and require a multidisciplinary approach. The presented clinical practice guidelines consider the main preventive and therapeutic and diagnostic approaches to the management of patients with gastroenterological manifestations of postCOVID syndrome. The Guidelines were approved by the 17th National Congress of Internal Medicine and the 25th Congress of Gastroenterological Scientifi c Society of Russia.

The authors consider diseases of internal organs as a reflection of the influence of various factors on the human exposome (as a complex symbiotic system) in the process of formation of the noosphere from the biosphere. At the same time, various exposome factors caused deep violations of the evolutionarily developed symbiotic relationships of a person with the environment and the internal environment with a violation of the basic systems of regulation and adaptation with the development of metabolic imbalance and the subsequent formation of various diseases. The important role of connective tissue in these processes, its various elements in the regulation of the structure of organs and cells, the near-cellular space, metabolism, immunity, ways of interaction with the microbiota and its network structures, decentralized forms of homeostasis regulation are considered.

The authors consider the nutriciology aspects of therapeutical problems from the perspectives of the General theory of medicine developed by them — the theory of noosphere–anthropogenic harmony. The authors consider the evolution aspects new scientifi c data on the molecular biology, microbiology and biotechnology as a part of biological culture, which determines the relationship of a person with the internal and external world and is one of the main factors in the evolution of the biosphere. The article analyzes the problems of qualitative and quantitative changes in nutrition parameters during the formation of diseases, their prevention and treatment.

To evaluate possibilities of aspirin-induced gastroduodenopathy treatment in the patients with chronic ischemic heart disease by means of applying the internal endogenous prostaglandins stimulant. Material and methods. 340 patients suffering from chronic coronary heart disease and receiving a long-term acetylsalicylic acid (ASA) therapy were examined on the base of the cardiovascular care unit of The Nizhny Novgorod Regional Clinical Hospital named after N.A. Semaschko. There were evaluated frequency, nature and severity of the aspirin-induced gastroduodenopathy. The patients with coronary heart disease and aspirin-induced gastroduodenopathy were divided in two groups. In the first group of patients there was applied rebamipide therapy (in a single daily dose 300 mg) in combination with the proton pump inhibitor (PPI) — pantoprazole. In the second group there was applied only pantoprazole therapy. For the purpose of specification of AIG pathogenetic mechanisms development, all the examined chronic coronary heart disease cases were tested on the prostaglandin E2 (PGE2) level in blood serum before the therapy beginning and after the treatment. The control group was formed of chronic coronary heart disease patients showing no AIG evidence. Statistical processing of the received data was fulfilled with the program «Statistika 10.0». Results. AIG was registered in 15% out of 340 chronic coronary heart disease patients. According to the endoscopic examination erosive disease of the body and antrum prevailed among the patients. The PGE2 level in the blood serum was significantly lower (р = 0,00087) in these patients in comparison with the control group. In association with PPI and rebamipide mixed therapy, esophagogastroduodenoscopy results showed no pathological findings in gastrointestinal mucosa and statistically significant (р = 0,00067) blood serum PGE2 level growing in all the treated patients. As a result of exclusive PPI therapy there was marked positive dynamics in endoscopic view in 19 out of 25 patients and a tendency to normalization of PGE2 level in the blood serum. However, PGE2 level growing was insignificant. Conclusion. The presented research demonstrates the possibility of AIG treatment with the use of internal endogenous prostaglandins stimulant — rebamipide in complex with proton pump inhibitor PPI therapy.

Introduction.Anemic syndrome (AS) is a common pathological condition in patients with chronic heart failure (CHF) and is recognized as an independent predictor of poor prognosis. A particular role is played by pathogenetically associated with CHF anemia. Mechanisms of its occurrence are being studied. An important role belongs to systemic inflammation, which is involved in the pathogenesis of anemia of chronic diseases (ACD). However, the contribution of cytokine-induced inflammation in patients with heart failure has not yet been fully investigated.Material and methods.A total of 873 cases of patients with CHF were prospectively analyzed on the basis of the cardiology department of the SBHCI NNR «Nizhny Novgorod Regional Clinical Hospital n.a. N.A. Semashko». The main group consisted of patients with anemia pathogenetically associated with heart failure (n = 96), the control group (CG) (n = 35) patients with heart failure without anemia. The indicators of ferrokinetics were assessed and the systemic inflammation was compared by indicators of interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and serum hepсidin.Results.Patients of the main group had signs of functional iron deficiency (ID) and significantly higher values of cytokines and hepsidin compared with the CG. The relationship between the level of cytokines and hepsidin with the severity of CHF, hemogobin and chronic kidney disease was revealed.Conclusion.An increase in the concentration of pro-inflammatory cytokines and hepcidin in patients with AS with decompensation of CHF is interrelated with functional ID and a decrease in hemoglobin level. This shows the role of cytokine-induced inflammation in the genesis of anemia in heart failure. The functional state of the kidneys makes a special contribution to these mechanisms. As CKD increases, the levels of inflammatory cytokines and hepcidin in these patients and their relationship with markers (CKD) increase.

The wide use of titanium alloys is often due to their unique properties. Availability of a wide variety of mechanical, physical and chemical properties is associated with a large number of polymorphic modifications of titanium alloys. During the last decade, the metastable omega phase piques the largest interest among all titanium modifications. This study attempts to explain the different wear behavior of some titanium alloys with different Nb content during dry friction impact.

Based on the results of a comprehensive study of 35 people aged from 19 to 52 years, among them 20 women and 15 men with celiac disease features of their physiological status were studied, reflecting the severity of the disease and quality of life. The diagnosis was based on the clinical and anamnestic data, endoscopy, histomorphological, immunological and genetic exams. Psychophysiological analysis showed that in celiac disease is characterized by the formation reactions with anxiety, anxiety-phobic, neurotic, affective, and hypochondriacal symptoms. The results of the study emphasized the importance of adaptive physiological capacity of the body to build tolerance to the development of psycho-vegetative, hypochondriacaldepressive and other disorders.

This paper presents an analytical review of A. Ugolev's scientific heritage (the theory of adequate nutrition, all-purpose functional blocks, the unity of natural and artificial technologies, the discovery of membrane digestion, new doctrine--trophology) to explain trophological aspects of noospherogenesis. The authors have presented their specific views for the development of these ideas; the theory of therapeutic infections, the holistic theory of nutrition, the endoecological deficiency syndrome, the activation of all-purpose functional blocks, evasion receptors, new principles of treatment with the effects on microbiota, combining the essence of the diseases and their treatment.

The group of liver autoimmune diseases (LAD) includes autoimmune hepatitis (AIH), Primary biliary cirrhosis (PBC) and Primary sclerosing cholangitis (PSC) The guidelines on clinical diagnosis and management of patients based on a review and analysis of recent publications on this topic in the global and domestic literature and on the authors'experience in treating patients with autoimmune liver disease.

According to the World Health Organization, it is recorded steady growth of the number of chronic liver diseases, including nonalcoholic fatty liver disease (NAFLD), in recent years. As an independent nosological entity, NAFLD is one of the risk factors for cardiovascular diseases, associated with abdominal-visceral obesity, peripheral insulin resistance (IR), and is regarded as the hepatic component of Metabolic syndrome (MS). Nowadays there are no generally accepted national standards for diagnosis and treatment of NAFLD for physicians, gen- eral practitioners, gastroenterologists in Russia. This was the essential reason in their development. The main reason of The guidelines development is the absence of generally accepted national standards for diagnosis and treatment of NAFLD for physicians, general practitioners, gastroenterologists in Russia. These guidelines are based on the global and local data of treatment experience of NAFLD, recently published in reviews, analytical studies in the literature. Guidelines are intended for physicians, general practitioners, gastroenterologists and contain the description of the preferred approaches to the provision of diagnostic, curative and preventive care of patients NAFLD. The quality of recommendations was grading according to the GRADE approach.

Endogenic microflora (microbiota) is one of the determinative factors of the human health. In the article new doctrine is proposed and 11 principles of microbiota's structural and functional organization are developed.

The aim of the study was the improvement of technologies of treatment of patients with the lung cancer receiving chemotherapy on the basis of using with the complex therapy of the combined probiotic based on the Bacillus subtilis strain.30 patients with the lung cancer receiving the first and second line of the first cycle of chemotherapy were included. The age of patients varied from 49 to 73 years, the average duration of the disease was 1 year. Patients of the main group (n = 21) received the combined probiotic based on the Bacillus subtilis strain together with the chemotherapy course. Patients of control group (n = 9) received only chemotherapeutic preparations. All patients were observed before and after treatment: the standardized inquiry for detection of intestinal complaints, microbiological research of feces (definition of qualitative and quantitative characteristics of gut microbiota), the research of metabolites of intestinal microorganisms in blood by the method of the gas-liquid chromatography - mass-spectrometry by G. A. Osipov's method. The efficiency of probiotic therapy was evaluated by results of studied indicators dynamics.Main symptoms of the intestinal dyspepsia were observed in patients with the lung cancer receiving chemotherapy such as constipation and intestinal microflora violations (decreased quantity of Lactobacillus, Bifidobacterium, Bacteroides and increased quantity of different pathogenic microorganisms). It was noted decreased rate of intestinal dyspepsia symptoms and improvement of intestinal microflora composition after the treatment course by the combined probiotic based on the Bacillus subtilis strain.Using of probiotic medicines with the chemotherapy in lung cancer patients is promising to reduce the frequency of gastrointestinal complaints and prevent deterioration of the gut microflora.

Human population actively forms noosphere from the biosphere which leads to a change in biological nature of man and the range of diseases that affect him. The use of molecular predictors derived from genome, metabolome, proteome, and microbiome in clinical practice opens up an opportunity to pass to more effective predictive--protective personified medicine.

According to the 1996 WHO Report, the world is heading for a major crisis in public health as outbreaks of new and re-emerging infectious diseases are striking at increasing frequencies within the past 10 to 15 years. The given information is true not only for an infection. On the other side eventually a food of the persons considerably changes. The urgent question which needs to be addressed is the nutrition modification and optimization for public health improvement.

To assess prevalence of gastroesophageal reflux disease (GERD) in Russia in MEGRE trial in 6 cities of the Russian Federatiion (Kazan, Kemerovo, Krasnoyarsk, Ryazan, St-Petersburg, Saransk).Mayo Clinic questionnaire (USA) adapted for Russia was used to question 7812 people over 18 years of age from of random population sample. The symptoms (heartburn and regurgitation) were classified as frequent if they arose once a week and more often for the last 12 months, rare symptoms arose less often than once a week. The responders with frequent heartburn and/or regurgitation were regarded as persons with epidemiological quantitative criteria of GERD.Heartburn occurred in 47.5% responders: frequent in 9%, rare in 38.5%. Regurgitation occurred in 42.9%: frequent in 7.6%, rare in 35.3%. GERD prevalence was 13.3% (city range 11.3-14.3%). Frequent GERD symptoms are associated with frequent gaseous eructation (24.3%), chronic cough (22.9%), chest pain (15.1%), dysphonia (11.4%.). To stop heartburn, 88% responders took antacids, 32%--blockers of histamine H2-receptors and only 23%--inhibitors of proton pump. Only 52.8% responders with frequent chest pain and 29.3% those with frequent heartburn visited a doctor.The population-based trial MEGRE conducted by international methodology in 6 cities of Russia demonstrated that GERD prevalence is 13.3%. Most of the patients pay little attention to the symptoms, do not seek medical advice and, therefore, receive no adequate treatment.

The aim of the clinical research was to study the efficacy of Saccharomyces boulardii in treatment of patients with Inflammatory Bowel Diseases. Results of investigation demonstrate more rapid regression of intestinal dyspepsia symptoms, decreasing clinical activity of IBD and improvement of intestinal microbiota composition in IBD patients have been treated by Saccharomyces boulardii. Lyophilized Saccharomyces boulardii are compatible with medical agents of the standard IBD therapy and have high level of safety.

We aimed to determine the prevalence and clinical spectrum of GERD in the urban population of 6 cities in different parts of Russia (St. Petersburg, Ryazan, Kazan, Kemerovo, Krasnoyarsk and Saransk). A previously validated reflux questionnaire developed at the Mayo Clinic was translated into Russian, culturally adapted and administered. Data was collected from 7812 randomly selected subjects greater than 18 years old with the assistance of the yellow pages. 'Frequent symptoms' were defined as a major symptom (heartburn and/or regurgitation) occurring at least once a week or more. "Occasional symptoms" were defined as an episode of one of the major symptoms occurring less than once a week within the past 12 months. Patients were defined as having GERD if they reported frequent heartburn and/or regurgitation. The average prevalence of frequent and occasional GERD symptoms in Russia was 9% and 38.5% for heartburn and 7.6% and 35.3% for regurgitation respectively within the last 12 months. The average prevalence of GERD in Russia was 13.3% (11.3-14.3%). The prevalence of frequent heartburn decreased with age (r = -0.3); however, frequent regurgitation increased (r = 0.7) with age. As a result, we found that prevalence of GERD increased with age. The average prevalence of GERD was statistically the same in men (12.5%) and in women (13.9%). This prevalence didn't change with age in men but did increase with age in elderly women to 24%. Frequent heartburn and regurgitation (GERD) were significantly associated with frequent belching (24.3%), chronic cough (22.9%), dyspepsia (19.8%), non-cardiac chest pain (15.1%), nausea (14.9%), hoarseness (11.4%), dysphagia (8.1%), odynophagia (7.3%) and constipation (37.8%). Alcohol consumption (prevalence of 60.4% among respondents) and smoking (prevalence of 25.4% among respondents) didn't yield any significant difference in subjects with frequent symptoms. Importantly, we also found that only 52.8% of subjects with frequent chest pain and 29.3% of respondents with frequent heartburn had seen a physician for these symptoms.

Holistic nutrition theory takes into account: Not only nutrition, but regulatory, sensory, landmark properties of food. Individual characteristics of people. Climatic, ethnic, social, occupational, religious, familial, aesthetic, ethical terms, and traditions; Conditions for use of new products including genetically modified. Food, as part of a biological culture, defining the correct behavior of man in the biosphere and noosphere.

In this article the comparative analysis of various methods of Helicobacter pylori verification is shown. Also algorithm of optimization of helicobacteriosis diagnostic, developed on the basis of a comparative estimation of results of various diagnostic techniques is presented. According to this algorithm, for increase of accuracy of helicobacteriosis diagnostic it is recommended to use at least two, and it is better three diagnostic methods: the combination of fast urease test or Helic-test with a histologic method (biopsy material from a stomach corpus) or polymerase chain reaction (ureC gene detection) is preferable. For an efficiency estimation of eradication therapy we recommend "Helic-test" as an effective noninvasive method that is especially important for children.

Characteristics of Bacillus subtilis metabolites contained in supernatants of its broth cultures are described. Metabolites contained bacterium-produced biologically active components ensuring cells growth and propagation. These components had bacteriostatic and bactericidal effect on gram-positive and gram-negative pathogenic and conditionally pathogenic microflora of gastrointestinal tract of human and animals. Enzymes produced by the bacterium (amylase, protease, cellulose-decomposing enzyme, lipase, pectinase) increased antagonistic properties of preparation and promote its probiotic effect.

This article describes the role of the intestinal microbiocenosis in the development of metabolic, immunologic, morphologic disorders of the gastrointestinal tract as well as mechanisms of the association of the intestinal endoecology and bacterial metabolites with the mental status, intellectual characteristics and social functions of people.

The article is a review of data, revealing scientifically proven approaches to correction of human microbiocenosis disturbances with the help of microbe probiotics, produced on the basis of synergic components and properties of B. subtilis culture 3.

We examined 50 children at the age of 4-17 suffering from chronic gastritis. AntiH+/K+-ATPhase antibodies of gastric parietal cells, anti-EBV antibodies IgG EA and IgM VCA were determined with the help of immune-enzyme analysis methods. The first group comprised 28 children with a high level of antiparietal antibodies in the blood serum, and 22 children with a normal level of antiparietal antibodies made up the second group. The HP identification was carried out for all children. Anti-EBV antibodies IgG EA were found in 72% of children, and there were no statistical differences in the frequency and level of antibodies IgG EA. IgM VCA were not found in any of the patients. However, HP-infection was revealed in 64.3% in the first group vs. 22.7% in the second group (p0,05); the combination of HB and chronic EBV infection was also more frequent in the first group than in the second group (42.8% and 18.1%, respectively, p0,05).

We examined: 1 group--16 children with chronic gastritis (CG) and autoimmune thyroiditis (AT); 2 group--41 children with functional thyroidal pathologies; 3 group--23 children with CG only. The average age in all groups was 11.17 +/- 2.98. HP (68%) was revealed equally frequently in all the groups. Antibodies to H+/K(+)-ATPase of parietal cells were revealed in the first and second groups only (31-36%), p0.05 as compared to the third group. CG of the stomach body was more frequently revealed in the first group using endoscopic and histological tests. The second group had more frequent and more apparent lesions of the antral part. Thus, in case of concomitant diseases of the thyroid gland CG has an autoimmune nature of an inflammation of the mucous coat of the stomach.

54 children at the age of 3-15 suffering from HP-associated CG were examined. Antibodies to H+/K(+)-ATPase of gastric parietal cells were determined with the help of the immune-enzyme analysis method. It was discovered that antibodies to H+/K(+)-ATPase are found in 27.7% of children. Concomitant autoimmune diseases, pangastritis, morphologic symptoms of the pre-atrophic stage of autoimmune gastritis as well as the drop of secretion at the fasting phase were discovered more often in antibody-positive patients. The successful eradication of HP in two children resulted in the disappearance of anti-parietal autoantibodies.