Currently, patients quite often and often uncontrollably take antibacterial drugs, which leads to the development of various complications from many organs and systems. One of the most common adverse reactions to taking antibiotics is antibiotic-associated diarrhea. Moreover, such a pathological condition is due to both the direct effect of the drug, and a change in the composition of the intestinal microflora. Despite the frequent occurrence of antibiotic-associated diarrhea, this problem raises many questions among practitioners, since the risk factors for its development and methods of prevention have not been fully studied. This is especially important in patients who have undergone surgical interventions, since the combination in this contingent of the appointment of broad-spectrum antibacterial drugs and altered body reactivity in most cases leads to the development of adverse effects.

Аннотация В настоящее время существенно возросла заболеваемость желчнокаменной болезнью, и холецистэктомия является одним из наиболее часто выполняемых оперативных вмешательств. При этом после проведения хирургического лечения желчнокаменной болезни примерно у половины больных развивается постхолецистэктомический синдром, обусловленный в большинстве случаев развитием функциональных расстройств сфинктера Одди и кишечника. В рамках данного исследования рассматриваются вопросы амбулаторного лечения пациентов с отягощенным аллергоанамнезом, перенесшим холецистэктомию. В сравнении с больными, не имеющими хронических аллергозаболеваний, в данном случае отмечается более частое развитие функциональных расстройств с более выраженным диспепсическим синдромом. Кроме того, в случае развития постхолецистэктомического синдрома у пациентов с отягощенным аллергоанамнезом чаще встречаются нарушения качественного и количественного состава кишечной микробиоты с избыточным ростом условно-патогенной микрофлоры, способствующие развитию диареи. В свою очередь это приводит к ухудшению качества жизни и требует более длительной и массивной медикаментозной терапии, увеличивая стоимость лечения.

The pandemic of a new coronavirus infection in recent years has led to more frequent and aggressive prescription of antibiotic therapy, which could not but affect the intestinal microbiota. In addition, the direct effect of coronavirus on enterocytes leads to the development of subclinical inflammation in the intestinal wall, contributing to the disruption of the qualitative and quantitative composition of the normal intestinal microflora. Against this background, the number of patients with antibiotic-associated diarrhea, including diarrhea caused by C. difficile, including severe ones. Moreover, the number of clostridial diarrhea resistant to classical vancomycin therapy has increased, which dictates the need to find new ways to treat patients and methods for further prevention of such conditions.

Aim: to compare the efficacy of different therapeutic regimens for managing functional dyspepsia in outpatients after COVID-19 infection.Materials and methods. 42 post-COVID-19 outpatients (age: 26–47 years) diagnosed with functional dyspepsia (FD) according to the Rome IV Criteria were enrolled in two parallel groups. All patients were divided in 2 groups by randomization: Group 1 received omeprazole at a dose of 80 mg/day, Group 2 received a combination of omeprazole and Kolofort® (a combined action drug product containing technologically processed antibodies to S100, TNF-alpha, and histamine) at a dose of 80 mg/day. At baseline and after treatment, a 10-point VAS was used to measure symptoms and an SF-36 questionnaire to evaluate the quality of life.Results. By Day 28 of the treatment, the intensity of epigastric pain (VAS score) in the group receiving proton-pump inhibitor (PPI) + Kolofort® was significantly lower. In both groups, fully resolved dyspeptic syndrome was observed in up to 90 % of patients, without significant differences (p < 0.06). According to the SF-36 data, a combination treatment resulted in higher scores (pain and general health subscales) as compared to the PPI alone.Conclusion. Kolofort® relieves symptoms and improves the quality of life when added to the treatment regimen against functional dyspepsia in post-COVID-19 patients.

Aim. To evaluate the potential and effectiveness of antegrade X-ray surgical interventions as treatment choice to eliminate the cholecysto- and choledocholithiasis in the complicated cholelithiasis.Materials and methods. We carried out an analysis of the results of staged X-ray surgical treatment of 29 patients with cholecysto- and/or choledocholithiasis having relative or absolute counterindications to the implementation of laparoscopy, open surgery or endoscopy. Thirteen patients (44.8%) were revealed to have diverticulum of the major duodenal papilla; seven (24.1%) – coronary heart disease with chronic heart failure. Five patients (17.2%) had previously undergone gastrectomy. Severe diseases of the respiratory organs were detected in four cases (13.7%). The primary intervention included percutaneous microcholecystostomy and percutaneous transhepatic cholangiostomy. The drainage channel formation was followed by cholecysto- and choledocholangioscopy, mechanical and pneumatic lithotripsy, lithoextraction.Results. A total of 34 percutaneous minimally invasive interventions were performed. Percutaneous transhepatic biliary drainage was performed in 23 cases (67.6%), percutaneous microcholecystostomy – in seven (20.5%), and percutaneous drainage of peri- and intrahepatic abscesses was additionally carried out in four cases (11.9%). At the second stage, seven patients (24.4%) underwent cholecystoscopy and 20 (68.8%) – choledocholangioscopy. Both interventions were used in two cases (6.8%). In all cases, the work resulted in eliminating the complications of cholelithiasis, cholecystosis and/or choledocholithiasis with restorating the bile passage by means of percutaneous minimally invasive technologies. No fatal outcomes or complications were recorded.Conclusion. Antegrade X-ray surgical technologies are effective minimally invasive choice treatment to eliminate the cholecysto- and choledocholithiasis with counterindications to other surgical treatments in the complicated cholelithiasis.