Background. Inflammatory bowel disease (IBD) is a global problem today, with a growing prevalence in the world. It significantly increases the economic burden on the health care system. Recently, many studies indicate the important role of immunoglobulin G4 (IgG4) in the formation of chronic inflammation in IBD and the possibility of using it as a biomarker of the inflammatory process. The purpose was to improve the diagnosis of chronic inflammatory bowel diseases by studying the status of IgG4-positive plasma cells in the mucous membrane of the colon in patients with ulcerative colitis (UC) and Crohn’s disease (CD). Materials and methods. We have examined 34 patients with IBD, 25 with UC and 9 with CD, of them 20 women and 14 men, with an average age of (38.8 ± 3.0) and (38.2 ± 3.7) years, respectively. Patients were divided into groups depending on the noso­logy and severity of the disease. All patients underwent endoscopic examination of the colon to establish or clarify the diagnosis, and biopsy specimens were taken for histological and immunohistochemical examination. Results. In 13 (38.3 %) of 34 examined patients, a positive result for the presence of tissue IgG4 (≥ 10 cells in the field of view) was found. Among patients with UC, 48 % have a positive result of immunohistochemical examination of tissue IgG4, in people with CD, this figure is 11.1 %. This gives us reason to say that in UC, elevation of tissue IgG4 levels occurs 4.4 times more often. Positive tissue IgG4 in patients with moderate UC was found 1.1 times more often than in severe UC. Among patients with mildly active disease, tissue IgG4 was not detected. Conclusions. In UC, IgG4-positive cells in the mucous layer of the colon are more common than in CD, which makes it possible to use this indicator for the differential diagnosis of ulcerative colitis and Crohn’s disease. Positive tissue IgG4 is more common in moderate form than in severe one.

The article deals with nosologies that are complex for diagnostic search and management of the patient — ulce­rative colitis and Crohn’s disease. To date, the main diagnostic procedure for these diseases is endoscopy with biopsy and histo­logy. However, there are limitations in their conduct and in the assessment of complications and proximal spread of CD. European guidelines for the diagnosis of UC and CD recommend additional imaging methods to diagnose and determine the location, degree and complications, namely ultrasound of the gastrointestinal tract. The article presents clinical cases of UC and CD, in patients who underwent ultrasound of the intestine and shows its high diagnostic value.

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. The pathogenesis of chronic inflammatory bowel disease (IBD) is still not fully clarified. It is known that disorders of the intestinal microbiota lead to an increased intestinal permeability, activation of mucous and adaptive immunity, impaired production and intestinal absorption of short-chain fatty acids (SCFA). The ratio of acetic, propionic, butyric acids is an important indicator of the integrity of the intestinal microbial community. Thus, the study of the composition of the intestinal microbiota and the concentrations of fecal SCFA is a very promi­sing approach to broadening the understanding of IBD pathoge­nesis. The purpose of our study was to determine the features of the production of fecal SCFA and the composition of colon microbiota in patients with IBD. Materials and methods. The study, which was carried out at the Department of Intestinal Diseases of the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine, involved 74 patients with IBD with an average age of (43.2 ± 1.8) years, who according to nosology were divided into 2 groups: group I — those with ulcerative colitis (UC) (n = 66), group II — individuals with Crohn’s disease (CD) (n = 8). The diagnoses of CD and UC were established accor­ding to generally accepted diagnostic standards in gastroenterology. Determination of fecal SCFA was carried out by chromatographic method with the use of hardware-software complex for medical researches on the basis of the gas chromatographer Chromateс Crystal 5000. The intestinal microflora was evaluated using a microbiological study of the colon content. Results. Patients with IBD had significant changes in the spectrum of SCFA, which were similar in both UC and CD: a decrease in acetic acid in the UC group by 5.7 times, in the CD group by 10.5 times (p < 0.05), butyric acid in the UC group by 1.6 times, in the CD group by 1.5 times (p < 0.05), and an increase in propionic acid in the UC group by 4 times and in the CD group by 3.3 times (p < 0.05) compared with the control group. There was also a significant increase in the anaerobic index in patients with IBD. Microbiological study of feces showed a significant decrease in Lactobacillus, which was observed in all patients with IBD, as well as a decrease in Bifidobacterium in 19.7 % of those with UC and in 37.5 % with CD. There was a decrease of other representatives of the normal microflora: Enterococci (in 15.2 % in the UC group and 25 % in the CD group) and Escherichia coli (in 15.2 % in the UC group and 12.5 % in the CD group). Excessive growth of opportunistic flora was also detected: hemolytic Escherichia coli was increased in 19.7 % of patients with UC and in 12.5 % of those with CD; Proteus was detected in 12.1 % of people with UC and in 37.5 % with CD. The excessive growth of Candida was found in 43.9 % of patients in the UC group and in 87.5 % of indivi­duals with CD. Conclusions. Quantitative and qualitative deviations of the intestinal microbiota, such as a decrease in the number of major symbionts and an increase in the number of opportunistic pathogens, were observed in all examined patients with IBD. The obtained results showed that changes in SCFA concentrations in both nosologies of IBD differed significantly from those in the control group, which in combination with primary genetic defects of the barrier function of the epithelium and its regenerative abi­lity can lead to deterioration in the course and prognosis of IBD. Evalua­tion of the ratio of SCFA fractions with the calculation of the anaerobic index may be useful for the diagnosis of intestinal dysbiosis in patients with IBD.

Синдром подразненого кишечника (СПК) є найчастіше діагностованим шлунково-кишковим захворюванням у XXI столітті, а також найпоширенішою причиною направлення до гастроентерологічних клінік. Були запропоновані різні механізми і теорії щодо його етіології, але біопсихосоціальна модель є найбільш прийнятою в даний час для СПК, згідно з якою СПК являє собою результат взаємодії між психологічними, поведінковими, психосоціальними і екологічними факторами. Не існує специфічних тестів для діагностики СПК. Діагноз встановлюється за допомогою критеріїв, заснованих на клінічних симптомах, таких як Римські критерії, за умови, що пацієнт пред’являє типові скарги. Сьогодні Римські критерії IV є найбільш оптимальним стандартом діагностики СПК. На даний час не існує специфічних лабораторних маркерів для постановки діагнозу СПК. Однак останніми роками був продемонстрований ряд різних симптомів у пацієнтів із СПК, деякі з яких можуть бути використані в майбутньому як діагностичні критерії. Одним із них є метод оцінки фекального кальпротектину, який показав високу діагностичну цінність, що може бути використано як маркер запалення при диференційній діагностиці між запальними захворюваннями кишечника і функціональними шлунково-кишковими розладами.