Vol 27, No 5 (2025): GASTROENTEROLOGY

The aspects of using various adjuvant therapy options for Helicobacter pylori infection considered in the article are of great practical importance and ensure the optimization of the management of patients infected with this microorganism. For patients with erosive and ulcerative lesions of the gastric mucosa, bismuth tripotassium dicitrate may be the drug of choice, for patients with chronic atrophic gastritis, alpha-glutamyl-tryptophan will help to provide local cytoprotection and regression of gastric mucosa atrophy, rebamipide may be effective for restoring epithelial permeability, and probiotics and prebiotics provide both increased effectiveness of pathogen eradication and a decrease in side effects and improvement of patients' health by correcting disorders of the microbiota of the gastrointestinal tract, the health and balance of which is the key to human health. It is also important to find the best probiotic / sinbiotic / autoprobiotic strain / combination of several indigenous strains for each patient for the best clinical result and eradication rate. It is the actual aim for next investigations.

Background. Atherosclerosis is a major cause of cardiovascular morbidity and mortality, closely associated with chronic vascular inflammation.

Aim. To evaluate the impact of inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), on the risk of early atherosclerosis.

Materials and methods. A single-center cohort study was conducted between 2022 and 2024 at the Gastroenterology Department of Clinical Hospital №1 of Sechenov First Moscow State Medical University (Sechenov University). The study included 115 participants: 44 patients with UC, 37 with CD and 34 healthy controls. Inclusion criteria were age ≥18 years and confirmed UC or CD diagnosis based on clinical, endoscopic and histological findings. Exclusion criteria were severe concomitant diseases, high cardiovascular risk, previously diagnosed cardiovascular diseases and other systemic inflammatory conditions. Vascular changes were evaluated through ultrasound Doppler imaging of brachiocephalic arteries (intima–media thickness, presence of plaques), sphygmometry (Cardio-Ankle Vascular Index – CAVI, Ankle Brachial Index – ABI) and biochemical inflammatory markers (C-reactive protein – CRP, fibrinogen), as well as lipid profiles. Primary endpoints included carotid intima-media thickness and inflammatory marker levels.

Results. Patients with UC and CD showed significantly increased carotid intima-media thickness compared to controls (0.07–0.08 cm vs. 0.06 cm; p<0.05), along with elevated levels of CRP (highest in CD; p<0.01) and fibrinogen (p<0.05). Lipid profiles did not differ significantly between groups, emphasizing inflammation as the primary factor contributing to early atherosclerosis in IBD.

Conclusion. Patients with IBD have increased levels of CRP and fibrinogen, thickening of the intima–media complex of the carotid arteries, and a trend to more frequent occurrence of atherosclerotic plaques. The lipid profile in such patients may remain within the normal range, which confirms that inflammation plays a crucial role in the initiation of atherosclerosis in IBD.

Background. The article presents the data of the Delphi consensus of world scientific communities on the new nomenclature of steatotic liver disease discussion, published in the summer of 2023, European clinical guidelines for the management of patients with steatotic liver disease associated with metabolic dysfunction in 2024, World clinical guidelines for the use of ultrasound in medicine and biology for multiparametric liver examination in 2024 and data with an emphasis on the features of instrumental diagnostics in new conditions, taking into account the characteristics of healthcare in the Russian Federation (based on the results of our own research).

Aim. To assess the possibilities of the instrumental research methods integrated application for the diagnosis of steatotic liver disease associated with metabolic dysfunction at the stages of steatosis, inflammation, fibrosis.

Materials and methods. Five hundred forty nine patients were examined – 252 (45.9%) men, 297 (54.1%) women aged 18 to 78 years. Inclusion criteria: the presence of liver steatosis according to at least one imaging method (ultrasound, MDCT, MRI), assessed retrospectively and at least 1 cardiometabolic criterion. The control group included 278 patients without signs of liver steatosis according to instrumental research methods, including 144 (51.8%) men, 40 (48.2%) women aged 18 to 68 years. All patients were examined with a single diagnostic algorithm consisting of 5 stages: clinical and laboratory stage, physical examination, ultrasound, dual-energy X-ray absorptiometry in the “Whole Body” mode, retrospective analysis of MDCT and/or MRI studies. Liver biopsy with subsequent histological examination according to the SAF scale was performed in 38 patients.

Results. The data of ultrasound steatometry and shear wave elastography, dual-energy X-ray absorptiometry in the “Whole Body” mode, as well as MDCT of the abdominal organs are compared with expert opinions and meta-analyses. Dissonance was found between the draft Russian clinical guidelines for non-alcoholic fatty liver disease of 2022, where the diagnostic part is based on the methods that were the main ones 10–20 years ago.

Conclusion. The draft Russian clinical guidelines lack sufficient data on optimizing the assessment of liver steatosis using modern imaging methods. A multidisciplinary discussion is proposed to develop balanced, personalized, unified diagnostic approaches.

Acute decompensation of heart failure (ADHF) is a period of the course of chronic heart failure (CHF), which is characterised by rapid aggravation/appearance of heart failure (HF) symptoms, requiring emergency hospitalisation of the patient and intensive care. ADHF is an urgent problem for modern healthcare and is associated with unfavourable prognosis and high mortality in this group of patients.

Aim. To evaluate the safety of allopurinol prescription in patients with ADHF, hyperuricaemia and reduced level of glomerular filtration rate irrespective of left ventricular ejection fraction.

Materials and methods. The results of standard therapy of HF with diuretic therapy in combination with xanthine oxidase inhibitor – allopurinol in the starting dose of 50 mg in 36 patients with ADHF of functional class II–IV, hyperuricemia, reduced renal filtration function calculated by the CKD-EPI formula are presented. Patients were hospitalised from February 2023 to January 2024 in the department of myocardial diseases and heart failure of FGBU ‘E.I. Chazov NMICC’ of the Ministry of Health of Russia. The study included 36 patients, the mean age was 71.6±9.8 years. Of them 72% of patients were male. The indices at the moment of inclusion in the study and at achievement of HF compensation were analysed.

Results. The median number of days spent in hospital was 14.7±5.7. On the background of optimal drug therapy of CHF in combination with allopurinol by the time of discharge the level of uric acid statistically significantly decreased – median before treatment 509 [460; 563], after 384 [330; 418] μmol/l, р<0.0001; decreased concentrations of N-terminal precursor of brain natriuretic peptide: pre-treatment median 3972 [2322; 9272], post 2132 [983; 3867] pg/ml, p=0.0001; decreased Creatine Kinase median pre-treatment 73 [55; 108], post 63 [47; 83] U/L, p=0.0011; decreased urea concentration pre-treatment 8.4 [7; 11], after 8.3 [7; 10] mmol/L, p=0.01; decreased total bilirubin median pre-therapy 23.2 [15.5; 28.8], after 18.5 [15; 25.6] µmol/L, p=0.025; C-Reactive Protein – median before treatment 4.3 [2; 14.2] mg/l, after 2.8 [1.1; 11.2] mg/l, p=0.036; there was a significant increase in distance test – six minute walk (T6X) – median before treatment 158 [149; 185], after 301 [283; 321], р<0.0001. No acute kidney injury and progression of Chronic Kidney Disease were observed during the period of hospitalisation. No dyspeptic phenomena and allergic reactions were noted on the background of allopurinol administration. Statistically significant reductions in echocardiographic parameters were observed in NPV measurement – median before therapy 2.3 [2; 2.5] cm, after 2 [1.9; 2.4] cm, p=0.0002; decrease in Systolic Pulmonary Artery Pressure before therapy 50±14.8 mmHg, after 44±13.2 mmHg, p=0.0001; statistically significant increase in LVEF-median pre-therapy 30 [25; 53], after 34 [27;55]%, p=0.0002.

Conclusion. The use of allopurinol reduces uric acid concentration, which is accompanied by improvement of renal function as HF signs are compensated, and also has a favourable safety profile when used in patients with ADHF, hyperuricemia and Chronic Kidney Disease.