AIM: to determine the diagnostic efficiency of magnetic resonance enterocolonography using inflammation indices (CDMI, MEGS) in assessing activity of the inflammatory process in the colon and small intestine in Crohn's disease.PATIENTS AND METHODS: the study included 42 patients with Crohn's disease (age ranged from 19 to 47 years). All patients underwent magnetic resonance enterocolonography (MRE) with intravenous contrast and diffusion-weighted images. According to the results of MRE, were determined MR indices of inflammation activity in the small and large intestine - CDMI and MEGS. The MR inflammatory activity indices CDMI and MEGS were compared with the endoscopic inflammatory activity index SES-CD.RESULTS: the MR inflammation activity index CDMI did not show a statistically significant diagnostic efficiency (p>0.05). The MR inflammation activity index MEGS showed a statistically significant diagnostic efficiency (p<0.0001). According to the nomogram, the MR inflammation activity index MEGS demonstrated a high predictive ability to determine the true activity of the inflammatory process in the small and large intestine. Correlation demonstrated direct strong relationship between the quantitative values of the MEGS inflammation indices and the endoscopic inflammation index (SES-CD) (r=0.843, p<0.0001).CONCLUSION: magnetic resonance enterocolonography using the MEGS activity index has a high diagnostic efficiency in assessing the activity of the inflammatory process in the small and large intestine in Crohn's disease. The MR inflammation activity index CDMI did not show statistically significant diagnostic efficacy. The results of the study should be considered preliminary and require further study of the possibilities of these indices of inflammation activity in a larger sample of patients.

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.

Background Patients with complicated Crohn’s disease are the most difficult cohort to make right decision in treatment and timing surgery. These patients are at risk for the long duration of operations, length of hospital stay, repeated urgent interventions because of complications and the need for a temporary stoma. In literature there is lack of information concerning the usage of prolonged antibiotics in such cases and results are conflicting in some studies. Single center non-randomized prospective study was held. Methods 120 patients were evaluated from 2012 to 2017. All patients had a complicated Crohn’s disease with abdominal mass, fistulas and stricture of the terminal ileum and all of them were operated on. In the first group there were 48 patients who received preoperative treatment with ciprofloxacin and metronidazole for at least 2.5 (1–4) months. In the second group patients also received the same treatment for the median time of 13 (1–33) days. Our hypothesis has been that prolonged treatment allows to reduce postoperative complications and the risk of stoma formation. To prove this statement, we did Chi-squared and Fisher’s exact test, univariant and multivariant analyses. The following criteria were included: prolonged treatment, gender, age, perianal lesion, laparoscopic operation, blood loss and duration of surgery. Results In the first group the complication rate was 4 (8.3%) and in 27 (56.2%) patients there was the need for stoma formation. In the second group – 18 (25%) and 58 (80.5%), respectively. First, we used Fisher’s test to see some correlations between the treatment and complications and the need of stoma formation. Prolonged treatment reduces the rate of complications in 4-fold (OR 0.25; x2= 5.34; p=0.02) and the need of stoma in 3-fold (OR 0.3; x2=8.24; p=0.004). In uni- and multivariant analyses prolonged treatment significantly reduces the complication rate and the risk for stoma creation (OR 2.73 CI 0.037–0.86; p= 0.02 and OR 0.310 CI 0.02–0.72 p=0.004, respectively). Gender, age, perianal lesion, laparoscopic operation, blood loss and duration of surgery were not statistically significant in multivariant analysis. Conclusion preoperative prolonged antibiotic treatment in complicated Crohn’s disease significantly reduced complications rate and the risk of stoma creation.

AIM: to evaluate the effect of cytomegalovirus (CMV) infection on the course of moderate and severe flare ups of ulcerative colitis (UC).PATIENTS AND METHODS: a prospective cohort single-center study was done in September 2018 — December 2020. The study included patients with moderate and severe flare ups of UC. All patients underwent colonoscopy with biopsy to quantify CMV DNA by polymerase chain reaction (PCR). Subsequently, the patients were divided into subgroups: with the presence of CMV (CMV+) and its absence (CMV–). In the CMV+ subgroup, antiviral therapy was carried out with an assessment of virological, clinical and endoscopic results on the 19th day of therapy, one month after its completion and after 6 months. In the CMV– subgroup these results were evaluated after 6 months only.RESULTS: the study included 126 patients. CMV was detected in 51 (40.5%). At the same time, its presence was not influenced by gender, age, or previous therapy. Laboratory indicators in both subgroups were comparable, as well as the severity of UC. A significant increase in the risk of developing steroid resistance was revealed in CMV+ patients with severe UC attack (OR 1.33, 95% CI: 1.059–19.4). The effectiveness of antiviral therapy was 60.8%. All patients who did not respond to antiviral therapy underwent surgery. At the same time, among patients in whom antiviral therapy was effective (virus eradication was achieved), there was no need for surgery.CONCLUSION: CMV infection significantly increases the likelihood of developing steroid resistance in patients with severe flare up of UC, while all patients who responded to antiviral therapy did not require surgery. Further multicenter randomized trials are needed.