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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.

Aim. Current clinical recommendations accentuate current methods for the diagnosis and treatment of irritable bowel syndrome (IBS).Key points. IBS is a functional bowel disorder manifested with recurrent, at least weekly, abdominal pain with the following attributes (any two leastwise): link to defecation, its frequency or stool shape. The symptoms are expected to persist for at minimum three months in a total six-month follow-up. Similar to other functional gastrointestinal (GI) disorders, IBS can be diagnosed basing on the patient symptoms compliance with Rome IV criteria, provided the absence of potentially symptom-causative organic GI diseases. Due to challenging differential diagnosis, IBS can be appropriately established per exclusionem, with pre-examination as follows: general and biochemical blood tests; tissue transglutaminase IgA/IgG antibody tests; thyroid hormones test; faecal occult blood test; hydrogen glucose/ lactulose breath test for bacterial overgrowth; stool test for enteric bacterial pathogens and Clostridium difficile A/B toxins; stool calprotectin test; abdominal ultrasound; OGDS, with biopsy as appropriate; colonoscopy with biopsy. The IBS sequence is typically wavelike, with alternating remissions and exacerbations often triggered by psychoemotional stress. Treatment of IBS patients includes dietary and lifestyle adjustments, various-class drug agents prescription and psychotherapeutic measures.Conclusion. Adherence to clinical recommendations can facilitate timely diagnosis and improve medical aid quality in patients with different clinical IBS variants.

Inflammatory bowel diseases (IBD), which is a term for two conditions (ulcerative colitis and Crohn’s disease), are chronic inflammatory diseases of the gastrointestinal tract that are the subject of many studies and much discussion around the world. The global prevalence of IBD is 20.4 per 100 thousand for ulcerative colitis and 3.7 per 100 thousand for Crohn’s disease. Every year the number of patients is increasing, which may indicate improvement in diagnosis of IBD, but at the same time demonstrates certain disadvantages and difficulties in the diagnosis and treatment of this group of patients. However, despite the fact that IBD has been exercising the minds of scientists around the world for many decades, many issues of diagnosis and treatment of this pathology appear relevant. Due to the paucisymptomatic condition of patients at early stages and the similarity of its symptoms with other gastroenterological diseases, the diagnosis of IBD involves certain difficulties in many cases. Advanced forms of the disease, as well as complications of IBD, result from late diagnosis. Endoscopic ultrasound (EUS, endo-ultrasound), which includes endoscopic and ultrasound examinations, is a modern imaging technique for the diagnosis of gastrointestinal diseases. The article discusses various international and Russian studies on the use of EUS in various pathologies of the gastrointestinal tract. Despite the absence of EUS in the formal guidelines for IBD, the technique appears promising for diagnosis, differential diagnosis of ulcerative colitis and Crohn’s disease, as well as complications of these diseases, such as primary sclerosing cholangitis, chronic and autoimmune pancreatitis, autoimmune hepatitis, pancreatic cancer, etc.

Abstract The regulation of repair processes including base excision repair (BER) in the presence of DNA damage is implemented by a cellular signal: poly(ADP-ribosyl)ation (PARylation), which is catalysed by PARP1 and PARP2. Despite ample studies, it is far from clear how BER is regulated by PARPs and how the roles are distributed between the PARPs. Here, we investigated the effects of PARP1, PARP2 and PARylation on activities of the main BER enzymes (APE1, DNA polymerase β [Polβ] and DNA ligase IIIα [LigIIIα]) in combination with BER scaffold protein XRCC1 in the nucleosomal context. We constructed nucleosome core particles with midward- or outward-oriented damage. It was concluded that in most cases, the presence of PARP1 leads to the suppression of the activities of APE1, Polβ and to a lesser extent LigIIIα. PARylation by PARP1 attenuated this effect to various degrees depending on the enzyme. PARP2 had an influence predominantly on the last stage of BER: DNA sealing. Nonetheless, PARylation by PARP2 led to Polβ inhibition and to significant stimulation of LigIIIα activities in a NAD+-dependent manner. On the basis of the obtained and literature data, we suggest a hypothetical model of the contribution of PARP1 and PARP2 to BER.

Rationale: Extraintestinal manifestations (EIM) of an inflammatory bowel disease (IBD) are a sign of its more severe course. Joint lesions are most common among IBD EIM.Aim: To evaluate the prevalence and types of joint lesions in the population of IBD patients of the Moscow region.Materials and methods: We performed a retrospective analysis of medical files of the patients who were admitted to the Moscow Region Inflammatory Bowel Disease Center (MONIKI) for examination and treatment from August 1, 2019, to March 1, 2020. The study included 70 patients with confirmed diagnoses of IBD and confirmed or suspected involvement of the joints.Results: Thirty six of 70 patients with IBD and EIM (51.43%) had been diagnosed with Crohn's disease (CD), and 34 (48.57%) with ulcerative colitis (UC). The CD group included more men (n=21, 58.33%), whereas their proportion in the UC group was 47.02% (n=16). The mean age at CD diagnosis in the UC and CD groups was comparable: 38.3±13.7 years in men with CD and 40.5±12.8 years in men with UC, 37.7±11.1 years in women with CD and 35.7±14.0 in women with UC. The most prevalent among all IBD patients were X-ray negative peripheral arthralgias. Among joint lesions confirmed by radiological diagnostics, sacroileitis was most prevalent both in all IBD patients (24.3%), as well as in the UC group (17.6%), whereas in the CD patients its frequency was the same as that of ankylosing spondyloarthritis (AS) (30.6% of the cases). AS ranked second in the prevalence of joint lesions in the UC group (8.8%) and all IBD (20%). Psoriatic arthritis was diagnosed only in the CD patients (2 / 36). We describe a clinical case of CD with AS, complicated with psoriatic rash, treated with a monoclonal antibody to tumor necrosis factor alfa (anti-TNF-α).Conclusion: Peripheral arthropathias were most prevalent among all joint lesions in the group studied. EIM mirror a more aggressive phenotype of the disease and higher glucocorticosteroids requirements. Administration of anti-TNF-α agents allows for the control of both intestinal IBD manifestations and of the joint syndrome. However, drug-associated skin adverse event can occur during treatment with this drug class. In such a case, it is possible to switch the biological therapy to another class of drugs that we have demonstrated with the given clinical example.

Psoriasis (Ps), psoriatic arthritis (PsA), and inflammatory bowel diseases (IBDs) are characterized by a progressive course and commonly result in disability. Therefore, their early diagnosis with the assessment of a clinical phenotype and unfavorable prognostic factors and the timely initiation of therapy are important. The paper provides the expert consensus on the definition of the early stage of Ps, PsA, and IBDs, their treatment goals and main unfavorable prognostic factors. It also gives the rationale for the early use of biological agents in patients with immune-mediated inflammatory diseases.

Ulcerative colitis and Crohn’s disease are severe immune-mediated diseases. Extraintestinal manifestations of inflammatory bowel disease (IBD) significantly increase the burden to the patient. The most common extraintestinal manifestations include erythema nodosum, ankylosing spondylitis, and primary sclerosing cholangitis. Some of the extraintestinal manifestations depend on the activity of the inflammatory process in the intestine and can be reversed during treatment of IBD, while the others require specific therapy, since it does not depend on the degree of inflammation in the intestine. Patients with IBD are at increased risk of developing complications caused by other organ systems, such as osteoporosis, venous thromboembolism, and cardiovascular diseases. Immunemediated diseases such as multiple sclerosis and psoriasis have been associated with inflammatory bowel disease, but these conditions can also be complications of IBD therapy. In this regard, patients and healthcare providers should exercise vigilance in identifying extraintestinal manifestations and complications of IBD, and the therapy should be aimed both at treating the underlying disease and reversing extraintestinal manifestations as much as possible. Interleukin-12/23 is an important cytokine in the inflammatory process development in the immune-mediated diseases. Ustekinumab is effective in treating not only IBD, but also psoriasis by blocking interleukin 12/23. The drug shows a higher survival index of the therapy as compared to tumour necrosis factor-α inhibitors. The article describes the experience of using ustekinumab in severe concomitant pathology – Crohn’s disease in the form of ileocolitis and psoriasis vulgaris with initial manifestations of psoriatic arthritis against ineffectiveness of tumour necrosis factor-α inhibitors.

Psoriasis (Ps), psoriatic arthritis (PsA), and inflammatory bowel diseases (IBDs) are characterized by a progressive course and frequently lead to disability; therefore, their early diagnosis with the assessment of a clinical phenotype and unfavorable prognostic factors and the timely initiation of therapy are important tasks. The paper provides the experts agreed opinion on the definition of the early stage of Ps, PsA, and IBDs, the goals of therapy and main unfavorable prognostic factors for the course of these diseases and gives the rationale for the early use of biological agents in patients with immune-mediated inflammatory diseases.

Background: For a long time there has been a discussion about how chronic pancreatitis (CP) and diabetes mellitus (DM) are related to each other. If a patient has both conditions, should they be viewed as two separate disorders, or one of them is a plausible consequence of the other? If the latter is true, what are pathophysiological mechanisms of DM in CP? Current consensus documents by specialists in pancreatic diseases pay little attention to this issue, and their main statements have low level of evidence. The Russian consensus on the diagnosis and treatment of CP (2016) contains no statements on DM. In the Russian guidelines and consensus documents to be developed, it is necessary to include provisions on the pancreatogenic DM as an independent “other type DM’, with consideration of its pathophysiological mechanisms and clinical particulars.Aim: To characterize the state-of-the-art in pancreatogenic DM, to demonstrate its differences from DM types 1 and 2 from pathogenetic and clinical perspectives.Methods: The review is based on the results of meta-analyses, systematic reviews and main provisions of the existing clinical guidelines and consensus documents available from PubMed and E-library.Results: According to various sources, Type 3c DM, or latent impaired glucose tolerance in CP, can eventually develop in 25 to 80% patients with CP. Impaired glucose tolerance is found in 40 to 60% of patients with acute pancreatitis, with persistent hyperglycemia after acute episode seen in 15 to 18% of the patients. Exocrine pancreatic insufficiency is commonly seen in Type 1 and Type 2 diabetic patients, although the data on its prevalence are highly contradictory indicating a lack of knowledge in the field. Type 3c DM is characterized by its manifestation at later stages of CP, concomitant excretory deficiency of the pancreas, brittle course with proneness to hypoglycemia and no ketoacidosis. The highest risk group includes patients with longstanding CP, previous partial pancreatic resection and patients with early calcifying pancreatitis, mainly of the alcoholic origin. Optimal and rational medical treatment of pancreatogenic DM still remains disputable, while the evidence base of the efficacy and safety of various anti-diabetic agents in this disease is lacking, and no consensus on the issue has been yet reached. General treatment guidelines given in a number of international consensus documents are limited to cautious insulin administration.Conclusion: Pancreatogenic DM differs from Type 1 and Type 2 DM in a number of aspects, namely, mechanisms of hyperglycemia, hormonal profiles, clinical particulars and treatment approaches. Endocrine pancreatic insufficiency in CP is caused by secondary inflammatory injury of the pancreatic islets. The key to specifics of Type 3c DM lies in anatomical and physiological interplay of the exocrine and endocrine compartments of the pancreas. At presents, most provisions on pancreatogenic DM are empirical and seem to be rather declarative, because intrinsic mechanisms of this type of diabetes and moreover its pathogenetically based treatment have been poorly studied. Nevertheless, all patients with CP or other pancreatic diseases should be assessed for pancreatogenic DM.

Rationale: Mild and moderate ulcerative colitis (UC) is conventionally treated with oral and rectal 5-aminosalicylic acid (5-ASA) formulations and, if ineffective, with systemic glucocorticosteroids. A huge disadvantage of systemic steroids is that with highly efficacy they have severe side effects and the development of hormone-dependency requiring their withdrawal. The main goal of UC treatment is to achieve clinical and endoscopic remission, and possibility to stop steroids. The introduction of multimatrix (MMX) budesonide (Cortiment®), a new topical steroid for UC treatment, widens the therapeutic armamentarium and allows in some cases to refrain from systemic agents, avoiding their side effects and achieving the necessary treatment goals.Aim: To evaluate the efficacy of topical steroid budesonide MMX for remission induction of UC in the real clinical practice.Materials and methods: We have analyzed 122 specially designed case report forms filled in from September 2018 to March 2019 in healthcare centers of Moscow, Voronezh, Lipetsk, Krasnodar, and Krasnoyarsk Regions of Russian Federation. The case report forms included anonymized data on the UC patients treated with budesonide MMX. The results of treatment were analyzed for various severity and extension of UC and depending on budesonide MMX monotherapy or combined therapy with rectal 5-ASA formulations. Treatment was considered effective if clinical and endoscopic remission was achieved.Results: Total efficacy in terms of improvement of clinical parameters (improvement/remission) after 4 weeks of treatment was 95% (118 patients), with clinical remission induced in 42.6% (52 patients). Positive changes over time in the endoscopic findings (improvement/remission) within the same time period were observed in 93% (60 patients), with endoscopic remission in 24.1% (21 patients).Conclusion: Budesonide MMX allows for a rapid clinical improvement and/or clinical remission in the majority of the patients with mild and moderate UC of predominantly left-sided location.

Psoriasis, psoriatic arthritis (PsA) and inflammatory bowel disease (IBD) are multifactorial chronic immunoinflammatory disorders with characteristic common genetic markers that determine their common pathophysiology and similar immune abnormalities. In particular, IL12/23 signaling pathway of the immune pathogenesis of the above mentioned diseases is related to the IL23R gene polymorphism. Common pathophysiological features, in their turn, produce a high risk and prevalence of comorbidity. Clinicians' unawareness of these particulars of the immunoinflammatory disorders might lead to the absence of interdisciplinary collaboration, late diagnosis of one of these disorders and polypharmacy, because each specialist (i.e., a dermatologist, a rheumatologist, a gastroenterologist) would administer his/hers treatments independently. In this context, the issues of the multidisciplinary approach to this problem are becoming highly relevant for earlier diagnosis and adequate treatment choice that is optimal for all disorders which contribute to the pathological process, taking into account common mechanism of their development. Therefore, there is the necessity to establish an interdisciplinary working group consisting of the leading specialists of the Russian Federation in rheumatology, dermatology, and gastroenterology, with a purpose to elaborate a consensus on the immunoinflammatory comorbidities. At the discretion of the Russian Association of Rheumatologists (RAR), Russian Society of Dermatovenerologists and Cosmetologists (RSDVC), Russian IBD Study Society (RIBDS), such a group has been formed of 11 experts corresponding to their scientific expertise in the area. The main aim of the Working Group was to develop a universal interdisciplinary questionnaire for detection of the signs and symptoms of the immunoinflammatory disorders (psoriasis, PsA, IBD), as well as development of a draft project of the interdisciplinary guidelines on the early diagnosis, methods of activity assessment and indications to the use of genetically engineered biological agents in patients with comorbid immunoinflammatory comorbidities (psoriasis, PsA, IBD). Procedure of the interdisciplinary guidelines elaboration. The Working Group elaborated a draft project of the up-to-date evidence-based guidelines and proposed a multidisciplinary questionnaire. An interdisciplinary expert council of specialists in dermatology, rheumatology and gastroenterology discussed each position of the proposed guidelines and was adopted by a simple majority of votes through an open votingat the Second Russian Debates “Dermatology, Rheumatology, Gastroenterology: focus on the interdisciplinary interaction” (Moscow, December 12–13, 2017). Results: 1. A universal interdisciplinary questionnaire to detect clinical signs of immunoinflammatory disorders (psoriasis, PsA, IBD) hasbeen created. It contains the main questions the answers to which are needed for a specialist physician (a dermatologist, a rheumatologist or a gastroenterologist) to suspect comorbidity and to refer the patient to a corresponding specialist. The questionnaire has three parts, each of them with questions to the patient aimed at the detection of the symptoms of psoriasis, PsA, and IBD. 2. An algorithm for interaction between dermatologists, rheumatologists and gastroenterologists has been developed aimed at optimal management of patients with comorbid immunoinflammatory disorders. 3. Goals of treatment of immunoinflammatory disorders (psoriasis, PsA, Crohn's disease) have been formulated according to the “treat-to-target” (Т2Т) concept. 4. Criteria for assessment of activity and severity of the immunoinflammatory disorders (psoriasis, PsA, and Crohn's disease) have been formulated. 5. The draft describes the indications for the administration of genetically engineered biological agents (GEBA), factors influencing the choice of treatment, criteria for GEBA efficacy assessment, indications to a change of a GEBA in primary or secondary treatment failure. Conclusion: In accordance with the results of discussion with specialists from various regions of the Russian Federation and with the decision ofthe Expert Council, it is planned to validate thequestionnaire, with subsequent inclusion of the position of the draft project into the clinical guidelines on the management of patients with psoriasis, PsA, and Crohn's disease.

Background: Epidemiological studies performed in different countries have identified a number of trends that allow to predict the problems related to the prevalence of inflammatory bowel diseases (IBD), their severity and healthcare resources utilization. Aim: To present comparative results of two large epidemiological studies of IBD in the Russian Federation (RF), i.e. ESCApe and ESCApe-2. Materials and methods: Two multicenter cross-sectional cohort studies with a similar design were performed at three-year interval. The studies had the common aim: to identify social and demographic and clinical particulars of ulcerative colitis (UC) and Crohn’s disease (CD) in RF, as well as treatment options. Twenty (20) centers of gastroenterology from 17 RF regions participated in the ESCApe (2010–2011) and 8 centers from 7 RF regions in the ESCApe-2 study (2013–2014). Results: The ESCApe study included 1797 patients (1254 UC and 543 CD), whereas the ESCApe-2 included 1000 patients (667 UC and 333 CD). Patient demographic and social characteristics: In both studies, female: male ratio was similar in UC and CD. Patients’ age was almost identical: in UC, median age was 38 years and 40 years in ESCApe and ESCApe-2, respectively; in CD the corresponding values were 36 and 35 years. In ESCApe, the peak UC onset was at the age of 21 to 40 years, whereas in CD it was shifted towards younger age (22.5% of the patients manifested before 20 years) and the peak incidence was in three age groups (below 20 years, 21 to 30 and 31 to 40 years). A statistically significant difference between CD and UC was found only in the age group of 11 to 20 years (22.5% vs. 13.6%, respectively, p < 0.01). In ESCApe-2, median age of disease onset in UC and CD was approximately 30 years. In both studies, urban:rural ratio for UC and CD was 4:1. In ESCApe, the proportion of current smokers among CD patients was almost two-fold higher than among those with UC (15.6 and 8.8%, respectively, p < 0.001); the same trend was found in ESCApe-2 (15 and 7.3%, p < 0.001). Socioeconomic characteristics of patients in both studies were similar: 50 to 60% were at work (professional occupation and income levels were not studied); in ESCApe 30.9% of UC patients and 40.9% of CD patients had legal disability due to various reasons (including that related to UC and CD in 12,6 and 14.9%, respectively), whereas in ESCApe-2 the respective proportions were 35.7 and 51.1%. Clinical characteristics of patients: The time from the first UC symptoms to diagnosis was similar in both studies (median, 5 months in ESCApe and 4 months in ESCApe-2); in CD patients these parameters were significantly different in both studies (12 vs. 1 month). As for the severity of the disease, the UC patients in ESCApe had mild disease in 16%, moderate in 53%, and severe in 31%, whereas the respective proportions among the CD patients were 21, 44, and 35%. In ESCApe-2, there were no patients with severe disease; mild and moderate UC were diagnosed in 51.3 and 46.6% of the patients, respectively, and mild and moderate CD, in 52.3 and 47.3%. The frequency of left-side UC was similar: 38% in ESCApе and 34% in ESCApе-2. Proctitis was more frequent in the first study (33 vs. 11%, p < 0.01), and total UC was more frequent in the second study (29 vs. 55%, p < 0.02). There were no significant differences between ESCApe and ESCApe-2 in the main CD localizations: terminal ileitis was seen in 31.3 and 35.4% of the patients, respectively, ileocolitis in 33.4 and 37.8%, colitis in 25.6 and 32.1%. The upper gastrointestinal involvement In ESCApе was found 4.4%, and mixed involvement in 5.3%. In both studies, extra-intestinal manifestations were more frequent in CD, than in UC: in ESCApe, 33.1% and 23% (р < 0.05), and in ESCApe-2 in 41.7 and 29.4%, respectively (р < 0.05). Peripheral arthropathies were most frequent. Ankylosing spondylitis was found in CD only, and primary sclerosing cholangitis, only in UC. Aphthous stomatitis was significantly more prevalent in CD in both studies. There were no significant differences in all other extra-intestinal symptoms (eye and skin involvement). Treatment characteristics: Treatment options before the study entry, as well as at the study inclusion visit were analyzed. In ESCApe, the majority of the patients had not been given any treatment before the study entry (49.1% with UC and 40.5% with CD). Three years later the situation was changing: in ESCApe-2, the proportion of treatment-naïve patients was 2.5 to 3-fold lower (15.3% with UC and 14.4% with CD), which was most probably related to increasing awareness of physicians. Before the study entry, most patients (40 to 70%) had been treated with 5-aminosalicylic acid (5-ASA). Before the second study, the patients were more frequently treated with glucocorticosteroids (GCS), immunosuppressors and genetically engineered biological agents (GEBA), but with no significant differences from the first study. 5-ASA prevailed also among the agents that were administered during the inclusion visits in both studies (80 to 90% UC patients and about 70% of CD patients). Compared to ESCApe, in ESCApe-2 there was a trend towards lower rate of GCS administration in UC and CD, but the differences did not reach the significance level. It may be explained by the absence of severe IBD types in ESCApe-2. In ESCApe, immunosuppressors were rarely used (in 14.4% of the UC patients and in 26.8% of the CD patients); however, in ESCApe-2 there were administered more frequently: up to 35.9% of the UC patients and 55.1% of the CD patients (р < 0.01 for both cases). It was unknown if immunosuppressors were used as monotherapy or in combination with GCS. Three years later, the rate of GEBA administration was also higher, but this increase was significant only in CD: 28.3% in ESCApe-2 vs. 9.2% in ESCApe (р < 0.01). According to the results of ESCApe, in the UC patients steroid resistance was seen in 23% and steroid dependency in 21%, whereas in the CD patients these values were 24 and 27%, respectively. In ESCApe-2 these parameters were not assessed. Conclusion: Both studies showed a number of patterns coinciding with the world trends, such as age and gender distribution of UC and CD patients, age at manifestation, the proportion of urban to rural residents, smoking status, prevalence and types of extra-intestinal symptoms. Unlike in European countries, moderate and severe forms of UC with extensive involvement are prevalent in RF. Low prevalence of mild and limited types of IBD is to be explained by underdiagnosis. Of note is the high proportion of patients with UC and CD treated with 5-ASA, although in CD these agents have demonstrated low efficacy. The rates of immunosuppressors and GEBA administration significantly increased in the second study, most likely, due to the implementation of a system of educational measures. Nevertheless, the rate of GEBA use in IBD remains low, which is to be related to their insufficient availability. In total, steroid resistance / steroid dependency rate amount to almost half of UC and CD cases. In general, some positive changes in the patient management are obvious in the second study. However, monitoring these changes over time could only be possible if similar studies would be performed at regular intervals.

Endoscopic screening is the main method of colon examination. An important factor for the accurate diagnosis of various pathological changes in the mucous membrane of the lower part of the digestive tract is the degree of its visualization, which directly depends on the quality of preparation for colonoscopy. There are many colon cleansers, but the peristaltic motion of the gut slows down in various diseases and syndromes, which results in the reduced accuracy of endoscopy.The paper presents the analysis of colon preparation quality using Phospho-soda (Casen Recordati, S.L., Spain) for colonoscopy in 198 patients with pathological conditions that impedes passage of all bowel contents: inflammatory bowel disease, acromegaly, and hypotonia of the large intestine. The authors carried out a comparative analysis with a control group, which included 106 patients without factors that slowed down the peristaltic motion of the intestine, who were preparing for endoscopic examination according to a similar scheme.The study showed that using Phospho-soda to prepare for endoscopic examination in patients with decreased colonic tone resulted in the efficacy of the drug comparable with its efficacy in a group of patients without dysmotility.

The TerraneChrone® (LA-ICP-MS) technique has been applied to carry out an integrated study of detrital zircons in sandstones sampled from the basal horizons of the stratotypical Riphean sequence in the Southern Urals, specifically the Navysh and Chudin suites of the Ai Formation of the Burzyan Group in the Bashkir Uplift. The concentrations of trace elements in the detrital zircons suggest that the role of oceanic or marginal-marine complexes among the primary sources of zircons was insignificant, and show a better agreement with the intra-continental rather than passive-margin origin of the Riphean basin, whose basal levels are composed by the Ai Formation. The U/Pb ages of zircons from samples K13-206 and M08-16-1 are generally similar: the Paleoproterozoic zircons predominate (the dominant peaks are actually coincident, 2063 and 2055 Ma), and only a few grains of the Archean age are present. Despite the similar U/Pb ages of the detrital zircons, these two samples considerably differ in their Hf isotopic features and the concentrations of trace elements, which means that the zircons in the studied sandstones are of different geodynamic origin. The characteristics of these zircons can be explained by a model showing the Ai Formation in the Navysh graben that is a rift structure and a predecessor of the Kama-Belaya aulacogene in the inner Volga-Ural region of the Paleoproterozoic supercontinent Columbia. At the initial stage of rifting, the granitoid complexes with a lower total silicic acidity, which composed the graben walls, had been eroded; as a result of erosion, coarse clastic rocks accumulated within the Navysh graben and formed the Navysh suite. A specific “carbonatitic” complex containing zircons (about 2.0, 2.5, 2.85 and 3.6 Ga) and the Palaeoarchean crustal material in the substrate of their parent rocks was also eroded. In the final stage of rifting, already at the initial stages of the development of the Kama-Belaya aulacogen (Chudin suite), the erosion products from the paleo-aquifers occupying vast areas began to be transported into the rift. The primary sources of clastics for the Chudin suite were both granitoids of the lower and normal silicic acidity. Besides, a specific “carbonatitic” complex containing juvenile zircons (about 2.05 Ga) was eroded. However, by that time, significant areas of the Archaean basement of the Volga-Ural region might have become hidden underneath a proto-cover and thus not eroded, so the Archean detritus in the Chudin suite is poorly represented in comparison with the Navysh suite, considering both the amounts and ages of detrital zircons. As of today, the Precambrian carbonatite rocks within both the Taratash complex (composing the basement of the Navysh graben) and the southeastern segment of the East-European Platform have not yet been described. The source of the “carbonatite” zircons remains unknown and can be discovered as more and more data on the basement rocks is accumulated.

The effect of alabaster mixtures to spectral-polarization characteristics of the pasty carbon materials in the optical and near-band wavelength λ = 440 ... 2440 nm is studied. A correlation obtained spectral polarization characteristics with the same characteristics of natural objects is shown.

Inflammatory bowel diseases (IBD) are commonly associated with extraintestinal manifestations, hematological disorders being the most special among them. In some cases, they dominate the clinical picture masking the intestinal manifestations of the underlying disease. Aplastic anemia is an extremely rare extraintestinal IBD manifestation. There are only two clinical cases of aplastic anemia associated with ulcerative colitis and non with Crohn's disease reported in the literature. Combination of Crohn's disease and В₁₂-deficient anemia is more prevalent, but is seen usually only after more than 20 cm of the ileus has been resected. The first clinical case presented in this paper is a combination of severe fistula-forming Crohn's disease with a constriction in the terminal part of the ileus and profound pancytopenia as an outcome of aplastic anemia. This profound pancytopenia is associated with an extremely high risk of life-threatening complications both of surgical treatment, as well as of several chemotherapeutic agents, which made the management of this patient difficult. The second clinical case demonstrates the manifestation of Crohn's disease as ileocolitis starting from the symptoms of cobalamin deficiency: severe В₁₂-deficient anemia, funicular myelosis and sensory ataxia, with blunted intestinal symptoms. This made the initial diagnosis and timely treatment difficult. Replacement therapy with cobalamin injections and treatment with glucocorticoids and antibacterials led to endoscopically confirmed remission of Crohn's disease and normalization of hematological parameters, with persistent polyneuropathy. Thus, management of patients with Crohn's disease should be multidisciplinary. In the case of anemia, leucopenia and/or thrombocytopenia in IBD patients it is necessary to exclude potential myelodysplasia and bone marrow aplasia. In the event of megaloblastic anemia and/or progressive polyneuropathy one should bear in mind potential cobalamin deficiency. However, in severe anemia it is important to perform diagnostic assessment for IBD, first of all, for Crohn's disease, especially, if any intestinal symptoms are present.

The article provides major reasons of diarrheal syndrome development, major approaches to mechanisms of diarrhea development are formulated as well as algorithm of actions for successful treatment of the patient.

Background: The incidence of colorectal cancer ranks the third among all cancer incidence rates. Rectal neoplasms are frequently considered as a separate nosological entity. The incidence of rectal cancer (RC) can be influenced by patient age, gender, lifestyle, diet, genetic factors, as well as by the organization and quality of preventive activities in medical institutions focused on the early cancer diagnosis. Aim: To study changes in RC incidence among residents of the Moscow Region from 2010 to 2014. Materials and methods: The incidence rate of RC was estimated based on the state statistical report data on newly diagnosed cancers in the population of the Moscow Region in 2010–2014. The intensive incidence rates were calculated per 100,000 of respective population in six age and gender groups. Results: From 2010 to 2014, 6079 new RC cases were identified in the Moscow Region, among them 47% men and 53% women. More than half of all RC cases were in the age group of 60 to 79 years old (61.7% of men and 59.2% of women). During the 5-year period, the incidence rate of RC decreased from 18.3 to 17 per 100,000 of the male population and increased from 15.7 to 17.5 per 100,000 among the female population. There was a clear correlation between the RC incidence and the patient age. The peak incidence in men and women was seen in the age group of 70 to 79 years. From the age group of 50 to 59 years and on, the incidence of RC in men was higher than that in women. Conclusion: The results of this study can be used to optimize activities in the public healthcare system aimed at reduction of morbidity and mortality related to RC. Among the priority actions should be allocated to the development and implementation of primary prevention measures, in particular, undergo screening tests (fecal occult blood test or colonoscopy) in age groups at high risk.

Background: Increased growth hormone production in acromegaly results in enlargement of inner organs, their dysfunction and morphological abnormalities. Of special interest are patients with newly diagnosed acromegaly, because their gastrointestinal mucosa can be assessed without consideration of the influence of medications used for the treatment of the underlying disorder. Aim: To describe characteristic features of upper and lower gastrointestinal tract disorders in patient with treatment-naive acromegaly. Materials and methods: We examined 37 patients with newly diagnosed acromegaly, aged from 22 to 73 years (mean age, 49.9 ± 2.1 years). All patients underwent esophagogastroduodenoscopy with biopsy for identification of Helicobacter pylori, colonoscopy, morphological examination of biopsy samples taken from neoplasms of the upper gastrointestinal tract, as well as of the colon. The control group included 35 individuals without acromegaly who were ageand gender compatible with the patients of the main group. Results: Cardiac insufficiency was diagnosed in 23 patients with acromegaly and in 13 in the control group (p < 0.05), simultaneous lesions of the stomach and duodenal bulb (erosions), in 7 and 2 patients, respectively (p > 0.05), gastric polypoids, in 6 patients of the main group and in no patient from the control group (p < 0.05). There were no significant differences between groups on esophagitis Savary Miller Grade 1 and 2 (grading, Grade 1 in 7 and 5 patients and Grade 2 in 3 and 2, respectively), as well as on contamination with Helicobacter pylori (19 patients in each of the groups). Colon abnormalities were found in patients with acromegaly more frequently than in the control group: dolichosigma, in 12 and 4 (p < 0.05), colonic polyps, in 13 and 2, respectively (p < 0.01). Diverticles were found in 9 with acromegaly and in 3 in the control group (p > 0.05). At histological examination, hyperplastic gastric polyps were found only in patients with acromegaly (6 patients, p < 0.05), colonic polyps in 8 patients from the main group and in 2 from the control one (p > 0.05). Tubular adenomas were diagnosed only in patients with acromegaly, in 2 of them they were located in the stomach (p > 0.05) and in 5, in the colon (p < 0.05). Conclusion: Right from the diagnosis, patients with acromegaly should undergo an examination of upper and lower gastrointestinal tract, because of the high probability of various disorders under high production of the growth hormone.

Reactive arthritis is an autoimmune disease from the group of seronegative arthritis known as spondyloarthropathy. Two types of the disease are designated by this term, namely post-enter- itic (Reiter's syndrome) and venereal (urogenital) (Reiter's disease). Irrespective of the infectious agent, both types of the disorder can be associated with various symptoms including skin and mucosal lesions and heart. However, the post-enteritic type of reactive arthritis is associated also with intestinal problems and the venereal one (mostly being of chlamydial origin), – with gen- itourinary disorders. Due to highly variable clinical manifestations of reactive arthritis, patients frequently receive only symptomatic treatment that temporarily eliminates some symptoms. We describe a clinical example of diagnostic approach to this complex disease, that allowed for putting the defnite diagnosis and perform diferential diagnosis with other similar disorders including urogenital reactive arthritis. This paper could be of interest for practitioners in various specialties, frst, for dermatovenereologists, rheumatologists, gastroenterologists, internists and rehabilitation specialists.

Background: There is no published data on changes in the endoscopic activity index within first weeks of treatment with various pharmaceutical forms of mesalazine.Aim: Comparative assessment of clinical efficacy and safety of various pharmaceutical forms of mesalazine (tablets, enemas and foam) in the treatment of left-sided ulcerative colitis.Materials and methods: Thirty patients with chronic relapsing left-sided moderate ulcerative colitis participated in the study. They were administered mesalazine either orally (group 1, n = 10) or rectally in micro-enemas (group 2, n = 10) and as foam (group 3, n = 10). Activity of ulcerative colitis was accessed before and after the treatment, along with collecting of patient responses regarding the ease of their use.Results: The mean index of ulcerative colitis activity among all patients before treatment was 7.2 ± 0.8 points. After 1 week of treatment with oral mesalazine, the index of ulcerative colitis activity decreased to 5.2 points and in those patients who were using microenemas and foam, to 4.6 and 3.4 points, respectively, with the difference before/after treatment being significant only in the group 3 (p < 0.05). At 2 weeks of treatment, the activity index decreased more than 2-fold in all groups (p < 0.05). According to the questionnaire, 83.3% of patients accepted the oral intake of the agent as the most convenient one. The highest proportion of compliant patients was in the group using the foam. Conclusion: Mesalazine is highly effective, as shown by a 2-fold decrease in the ulcerative colitis activity index after 2 weeks of treatment. The endoscopic activity index shows more rapid decrease after the use of mesalazine foam (already at 1 week of treatment).

Rationale: Chronic pancreatitis is characterized by progression with gradual insufficiency of pancreas and can be associated with complications. Various clinical signs and symptoms of the disease may affect patient's quality of life.Aim: To assess quality of life in various groups of patients with chronic pancreatitis, living in the Moscow Region, who have uncomplicated and complicated course of the disease, depending on their compliance level, compared to that in patients regularly seen by doctors of other specialities.Materials and methods: One hundred patients with chronic pancreatitis living in the Moscow Region completed the Medical Outcomes Study – Short Form (MOS SF-36) questionnaire.Results: In chronic pancreatitis patients, there was a clear decrease in quality of life parameters on all subscales. It was found that the presence of any complications did not contribute to deterioration of quality of life, with no significant difference in quality of life parameters in any subscale (р > 0.05). Quality of life was better in the patients who were fully adherent to their treatment (n = 28). In non-compliant patients (n = 72), there was a significant decrease (р < 0,05) of the following quality of life parameters: physical role functioning (29 points), emotional role functioning (45 points), as well as general health (32 points), pain intensity (44 points) and social functioning (51 point). Patients who were regularly seen by a gastroenterologist, had better quality of life (р < 0.05), compared to those seen by an internist, on the following subscales: physical role functioning (56 and 29 points, respectively), pain (60 and 45), general health (46 and 31), vitality (48 and 32), social functioning (69 and 52), emotional functioning (75 and 46). In patients who had not been regularly seen by any doctor, there was a statistically significant decrease in quality of life (р < 0.05) on the same subscales (0, 24, 17, 22, 35, 17 points, respectively). Conclusion: To improve quality of life in patients with chronic pancreatitis, it is necessary to increase the level of doctor's knowledge in pancreatology, to improve patient adherence to treatment, to ensure regular visit to doctors, as well as to establish the continuity of treatment from an in-patient to an out-patient unit.

The article presents most recent data on antibiotic-associated intestinal disorders. The author reviews epidemiology and causative microorganisms in antibiotic-induced diarrhea and pseudomembranous colitis as well as clinical variants of antibiotic-associated disorders. Diagnosis methods are decribed at length with special attention to most sensitive and informative tests. Treatment of different clinical variants of antibiotic-induced disorders is discussed in detail.

Rationale: According to prognosis made by World Health Organization experts, by mid-21st century gastrointestinal disorders will be among the leaders, partially due to lifestyle of a modern man (stress, unhealthy diet, lack of physical exercise, unhealthy habits), environmental pollution, genetically modified and low quality foods.Aim: To provide informational support of activities aimed at improvement of organization of medical care to patients with gastrointestinal disorders and at further development of specialized gastroenterological care to the population of the Moscow Region, its better availability and higher efficacy and quality.Materials and methods: We calculated and analyzed gastrointestinal morbidity in 2014 (according to referrals) among the main age categories (children, adolescents, adults) of the population of the Moscow Region, as well as hospitalization rates and in-hospital mortality. The information was taken from the Federal Statistical Surveillance report forms # 12 and # 14.Results: In 2014, the highest prevalence of gastrointestinal disorders was registered in adolescents, being by 42.7% higher than that in adults and by 11.7% higher than that in children. The leading causes of referrals in all age categories were gastritis and duodenitis, as well as gall bladder and bile tract disorders. The structure of morbidity was characterized by a high proportion of pancreatic disorders, stomach and duodenal ulcers in adults. The rate of hospitalizations due to gastrointestinal disorders was 17.8 cases per 1000 patients, being 17.4‰ in adults and 19.8‰ in children and adolescents. The main reasons for hospitalization in adults were diseases of pancreas (23.9% of all hospitalization due to gastrointestinal disorders), gall bladder and bile tract disorders (16.3%). In children and adolescents, the main reasons for hospitalizations were intestinal disorders (36.4%), gastritis and duodenitis (17.9%). In-hospital mortality from gastrointestinal disorders in adults was 3.3%, in children, 0.02%.Conclusion: The statistical data obtained, as well as the results of the analysis of organization, quality and efficacy of medical care to patients with gastrointestinal disorders can be used for improvement of gastroenterological care at all levels and further development of this service in the region.

Background: In the past decade, incidence of chronic pancreatitis among different age groups has been growing globally and in Russia. Chronic pancreatitis is a progressive disease characterized by development of complications and decrease of exocrine function of pancreas. Treatment should be initiated early, before the complications occur; therapy should account for international experience and established Russian guidelines. Continuous usage of high-dose enzyme preparations preferably in modern dosage forms (microgranules, minimicrospheres or microtablets) is one of the key principles in the management of chronic pancreatitis. Patient’s cooperative behavior and good compliance is crucial for achieving treatment targets. Aim: To assess treatment compliance among patients with chronic pancreatitis in the Moscow Region and to identify sources of information on the disease used by the patients. Materials and methods: One hundred patients with chronic pancreatitis in Moscow Region were questionnaired anonymously on their adherence to the medical recommendations for diet, alcohol consumption and medications, particularly enzyme preparations. Patients’ sources of information on the disease were also determined. Results: Poor compliance results were shown: only 28% of patients were fully adherent to medical recommendations; other patients took their medications irregularly, changed drug doses or preparations choosing less expensive and effective drugs. The majority of patients (89%) were aware of the main treatment principles, though, 53% didn’t adhere to them. Patients used varied sources of information on the disease including special literature and the web; nevertheless, the information could be incorrectly understood. Only some patients received disease-related information from their physician, and many of the patients described physician-derived information as insufficient. As a result, treatment was often inadequate. Conclusion: Improved patients’ compliance is a crucial factor in achieving treatment targets in chronic pancreatitis. Two-way interventions are needed: 1. training of physicians in the disease field and in presenting clear and correct information to patients. 2. multimodal patients’ education.

Background: Over the past decade, the epidemiology of Clostridium difficile infection has shown a remarkable increase in incidence in both hospital and community settings. Up to the last time, inappropriate antibiotic usage was considered as the main cause of the infection. The growth of morbidity and mortality rate of C. difficile infection is partly due to the worldwide dissemination of new and more virulent C. difficile strains, and is associated with increase in severity and related health care costs. Aim: To study the prevalence of C. difficile infection in the department of gastroenterology. Materials and methods: The prevalence of C. difficile infection in patients with gastrointestinal diseases with diarrheal syndrome who has not received antibiotics within the previous 6 months was investigated. The studied group included 238 diarrheal patients with an inflammatory bowel disease, chronic pancreatitis with excretory pancreas insufficiency, and several other diseases. To identify C. difficile infection, A and B toxins in patients’ stool were determined using immunochromatography method. Results: The prevalence of C. difficile infection in the group studied was found to be 39.1% and didn’t significantly differ from that of patients with different diseases (ulcerative colitis – 37.2%, Crohn’s disease – 31.6%, chronic pancreatitis – 36.2%). After etiotropic therapy, complete resolution of diarrhea was obtained in majority of patients, none of them tested positive for A and B toxins. Conclusion: Taking into account high frequency of C. difficile infection in diarrheal patients in department of gastroenterology authors recommend mandatory detection of C. difficile toxins in all hospitalized patients with diarrhea in gastroenterology, therapeutic, surgical departments.

The study focuses on the evaluation of the use of biologically active additives in pharmacies in Belgorod on the basis of pharmacoeconomic analyzes. We have identified preferred groups in terms of economic profitability.

Chronic pancreatitis (CP) is one of the priority healthcare problems. Conservative therapy of CP today remains a challenge due to a variety of etiologies and pathogenetic mechanisms. Currently, there are no well-established algorithms for the treatment of CP; healthcare practitioner has to choose the most effective drug combinations for the treatment of the particular patient.