Х ронический панкреатит (ХП)-хроническое непрерывно прогрессирующее заболевание поджелудочной железы (ПЖ) воспалительной природы, характеризующееся фиброзированием ткани органа и формированием экзокринной и эндокринной панкреатической недостаточности [1]. Распространенность ХП-50 случаев на 100 000 населения, заболеваемость-5-12 случаев в год на 100 000 [17]. В последние десятилетия отмечается рост заболеваемости ХП более чем в 2 раза, снижение среднего возраста заболевших до 39 лет [4, 5]. При длительности заболевания около 10 лет появляются признаки внешнесекреторной недостаточности ПЖ (ВСНПЖ). Один из механизмов ВСНПЖзамещение соединительной тканью более 90-95 % стромы железы [12]. К диагностически значимым методам верификации ВСНПЖ относят определение уровня эластазы-1 в кале [14]. В последние годы все большее внимание клиницисты уделяют роли системного воспаления в развитии ХП [15]. Структурные и функциональные нарушения затрагивают не только ПЖ, но и другие органы желудочно-кишечного тракта: полость рта, пищевод,

The aim is to evaluate the effectiveness of complex therapy with the inclusion of the drug Saccharomyces boulardii in patients with non-alcoholic steatohepatitis (NASH) and intestinal dysfunction. Material and methods. An open prospective comparative study of the effectiveness of complex therapy of intestinal dysfunction in patients with non-alcoholic steatohepatitis was carried out. The study included two groups of 36 patients with NASH with symptoms of intestinal dysfunction, established intestinal dysbiosis, structural changes in the mucous membrane of the colon. Results and discussion. It was found that the complex therapy of intestinal dysfunction with the inclusion of the drug Saccharomyces boulardii against the background of NASH reduces the frequency of abdominal pain associated with the intestines, normalizes stool, reduces the degree of dysbiosis, promotes epithelialization of microerosions, and reduces the frequency of neutrophilic infiltration of the colon mucosa. Conclusion. The results of the study indicate the effectiveness of complex therapy with the addition of Saccharomyces boulardii in patients with NASH and intestinal dysfunction

Objective: to clarify the clinical and diagnostic features of arterial hypertension in patients with mild and moderate forms of COVID-19, taking into account the elapsed time. Material and methods. We examined 116 patients aged 44-60 years who were admitted to the hospital with uncontrolled stage 2 arterial hypertension, 96 of them had mild and moderate COVID-19. The patients were divided into two groups: the first group up to 12 weeks after suffering COVID-19 and the second group after 12 weeks. The examination included echocardiography and ambulatory blood pressure (BP) monitoring. Results. In post-COVID-19 patients, the ratio of daytime to nighttime systolic BP was statistically significantly lower than in disease-free patients (p <0,001, p1 =0,015). There was a decrease in the daily BP index in the group 1 and group 2 (11.6±0.8% and 12.2±1.2%, respectively, p=0,001). Among patients after COVID-19, non-dippers were detected, more often in group 1 (9 people (17.6%) versus 2 people (4.4%) (x2=4.18, p=0.042). Conclusion. Arterial hypertension in patients who underwent mild and moderate COVID-19 was characterized by an insufficient decrease in systolic blood pressure at night, the presence of non-dippers with positive dynamics after 12 weeks from the onset of the infectious process.

Pathology of the liver and gallbladder is one of the extra-intestinal manifestations of inflammatory bowel diseases (IBD). Targeted examination indicates clinical, laboratory, and structural changes in the liver and gallbladder in 30% of patients with IBD. However, information about the state of the hepatobiliary zone in comparison with the IBD phenotype, the features of the course, and the nature of therapy are few, and their results are contradictory. The aim − to study the frequency of occurrence, to analyze the structural and functional features of the liver and gallbladder in relation to the phenotype, clinical and endoscopic activity of the process, the nature of the course, and the effectiveness of IBD therapy. Material and methods. A simple, open, single-stage, non-randomized study involved 157 patients with ulcerative colitis (UC) and 37 patients with Crohn's disease (CD) who were treated in the Gastroenterology Department of the City Clinical Hospital No. 5 in Saratov in the period of 2016−2019. Complex clinical, biochemical, and instrumental studies were performed (ultrasound examination of the abdominal organs, fibrogastroduodenoscopy and colonoscopy, general morphological examination of colonobioptates). Results. Non-alcoholic fatty liver disease (NAFLD) was verified in 10.8% of patients with UC (3.8% had non-alcoholic steаthohepatitis (NASH), 7% − liver steatosis) and in 27% of patients with CD (NASH – 5.4% of cases, liver steatosis – 21.6%). Dysfunctional disorders and structural changes of the gallbladder were detected in 14.3% of patients with UC and 20.8% with CD. Of these, cholelithiasis was found in 9.5% of patients with UC and 10.8% with CD. When analyzing the association of risk factors for hepatobiliary pathology with a variant of IBD, NAFLD was associated with the type of IBD course (recurrent course for CD), localization of the process (in UC – with left-sided colitis, in CD – with terminal ileitis), an operational history on the intestine in CD, the duration of CD for more than five years, overweight in UC, and the effects of basic therapy (steroid resistance). The pathology of the gallbladder is associated with the duration of IBD for more than three years, the continuous course of UC, and surgical interventions on the intestine in CD. When analyzing laboratory and structural markers of steatosis, it was noted that high values of the steatosis index prevailed in UC (according to J.H. Lee). Abdominal ultrasound revealed mild (41% in UC, 40% in CD) and moderate (47.1% in UC, 50% in CD) liver steatosis more often. When analyzing the clinical features of the hepatobiliary system, it was found that liver pathology was detected by instrumental and laboratory criteria, and gallbladder pathology was characterized clinically by symptoms of biliary dyspepsia in the absence of biliary colic attacks. Conclusion. The features of liver and gallbladder pathology identified during the study can be used to optimize the management of patients with IBD

Purpose of the study: to establish the clinical and diagnostic signifi cance of structural and functional changes in the colon in NAFLD against the background of obesity, type 2 diabetes, arterial hypertension.Materials and methods: 138 patients with NAFLD and intestinal pathology, 36 patients without intestinal dysfunction were examined. The clinical and endoscopic features of lesions of the colon mucosa in patients with NAFLD were studied, taking into account the underlying pathology (obesity, type 2 diabetes, arterial hypertension). Changes in intestinal microbiocenosis were revealed in patients with NAFLD, depending on the underlying pathology. The morphometric parameters of the expression of colonocytes immunopositive to the vascular endothelial growth factor, as well as to leptin, were studied in comparison with the clinical and endoscopic features of the colon and liver, and the presence of a background disease.Results: It has been established that the background diseases in NAFLD — type 2 diabetes and obesity — make a certain contribution to the structural and functional changes in the colon. In turn, changes in the intestinal microbiota in NAFLD against the background of obesity, type 2 diabetes lead to aggravation of dyslipidemia, glycemia with the progression of chronic systemic infl ammation and fi brosis in the liver.