Background Zonulin is a protein, reversibly increasing the permeability of the intestinal wall by changing the structure of tight junctions of the lateral surfaces of intestinal epithelial cells. Fecal zonulin is used for noninvasive assessment of increased intestinal permeability. Normal values of zonulin in stool (≤ 110 ng/ml) indicate the absence of damage of the intestinal villous mucosal surface and normal density of intercellular contacts. The aim of the study was to determine the level of fecal zonulin (FZ) in the feces of ulcerative colitis (UC) patients with exacerbation of the disease and the presence of COVID-19 in the acute period and without COVID-19 to assess the degree of intestinal permeability. Methods 46 patients with IBD without COVID-19 (Me age — 36 years) and 31 patients with UC with the presence of COVID-19 infection in the acute period (Me age — 42 years) were examined. Untreated stool samples of patients were frozen and stored at a temperature of 80 °C. FZ was measured by ELISA (IDK ® Zonulin ELISA Kit, Immunodiagnostik AG, Germany) in ng/ml. Reference values: < 83.15 ng/ml - a variant of the norm, 83.15-110 ng/ml - an elevated level, 110 ng/ml - a high level Results In the stool samples of patients with UC exacerbation without COVID-19 FZ was detected from 172.6 to 460.8 ng/ml (Me - 316), the average value was 322.4±14.6 ng/ml. In the stool samples of patients with UC exacerbation and COVID-19 infection, FZ was detected from 354.8 to 628.3 ng/ml (Me – 489.9), the average value was 472.9±18.4 ng/ml (p=0.000001). Conclusion FZ concentration in the feces of UC patients is significantly higher in UC patients with the presence of COVID-19 infection in the acute period, which indicates a higher permeability of the intestinal wall.

AIM: to evaluate the effectiveness of tofacitinib as a second line treatment.PATIENTS AND METHODS: the study included 12 patients, 4 (33.34%) males and 8 (66.66%) females. The median age was 41 ± 5 years. All patients admitted to the hospital with a severe flare-up of ulcerative colitis, which was the inclusion criterion in this study. Clinical manifestations, laboratory parameters, and colonoscopy were done at the time of administration of tofacitinib, on days 3 and 7, and after 12 weeks.RESULTS: a fast clinical response on 3 day of treatment, reduction in stool frequency, decrease blood in stool was noted in 10 (83.3%) patients. After 7 days from the start of TFCS therapy, all patients showed a decrease from severe activity to mild activity, as well as a decrease in inflammatory blood markers and hemoglobin levels. During the follow-up for 12 weeks, 100% of patients showed positive clinical and laboratory changes. In 10 (83.4%) patients, remission or maintenance of negligible minimal activity was noted.CONCLUSION: the results obtained show that the use of TFTB in hormone-resistant patients can be effective as a second line of “rescue therapy”.

The article introduces two clinical cases of successful treatment of Crohn’s disease (CD) of the upper gastrointestinal tract (UGT) with TNF inhibitors. Besides that, the article presentes the review, devoted to diagnostics and treat the same injury of patients with CD. It should be mentioned, that number of publications in worldwide and national literature is quite insignificant. One fact that is more important is the unavailability of unificational approach to treatment of such group of patients. We suppose that epidemiological research is necessary to define the true prevalence of lesions of the upper gastrointestinal tract in CD, risk factors and prognosis for this patient group, and to output the diagnostic and therapeutic tactics.

AIM: to improve the results of treatment of patients with «extremely severe» ulcerative colitis (UC).PATIENTS AND METHODS: A multicenter observational prospective «case-control» study was conducted. The study included 71 patients with «extremely» severe UC from June 2019 to October 2021. All patients underwent conservative therapy in accordance with current clinical guidelines. Evaluation of the effectiveness of treatment was carried out on the 3rd and 7th days of therapy, a "response" or "no response" to steroid therapy was stated.RESULTS: A total of 48 (68%) patients underwent surgical treatment during the follow-up period during hospitalization. 23 (32%) patients "responded" to conservative therapy and were discharged without colectomy. A reliable independent predictor of colectomy at the time of hospitalization was the level of albumin less than 29 g/l (OR – 8,6 95% CI: 2,5 – 39,9, p=0,002). On day 3, the reliable predictors were the level of C-reactive protein over 15.5 mg/l (OR – 9 95% CI: 2.4 – 46.1, p=0.003) and the value of the Mayo index above 7 points (OR – 13.3 95% CI: 3.3 – 75.7, p=0.0009).CONCLUSION: The study has demonstrated that the only reliable and independent predictor of colectomy at admission to the clinic is the level of albumin less than 29 g/l. Reliable factors that make it possible to evaluate and predict the effectiveness of therapy are the level of C-reactive protein more than 15.5 mg/l and the value of the Mayo index above 7 points on the 3rd day of therapy, as well as the level of C-reactive protein above 29 mg/l on the 7th day.