[Inflammatory bowel diseases: Transformation of representations. A review].

The global burden of inflammatory bowel disease (IBD) is currently significant and continues to grow due to the increasing prevalence of ulcerative colitis (UC) and Crohn's disease (CD), the increasing costs of diagnosis and treatment, and the high level of disability in patients with this disease. Categories, which leads to the search for risk factors and predictors of aggressive course and extraintestinal manifestations. According to the latest data, the prevalence of UC in Russia is 16.6 per 100 000 population, the annual registered increase is 11.3%; the prevalence of CD is 5.6 per 100 000 population, and the increase is 13.7%. In the Russian population of patients with IBD, the average age of disease onset is 35.3 years for UC and 31.2 years for CD. Moreover, in 89.3% of patients with UC, it took at least 2 years to verify the diagnosis, and in CD, within 2 years from the onset of clinical symptoms, the diagnosis was established in only 72.6% of patients. One of the dominant characteristics of IBD is its multisystem nature, which leads to the development of extraintestinal manifestations (ECM), which can be observed in 50-60% of patients, while up to 25% of patients with IBD have several EMC and the most common variants are joint lesions. A higher frequency of extraintestinal manifestations is observed in CD (up to 45% of patients), in female patients, in smokers and with a longer duration of the disease. To predict clinical remission, the level of fecal calprotectin and CRP, the need for glucocorticosteroids are important, to predict endoscopic remission - the level of fecal calprotectin, and to predict histological remission, an endoscopic Schroeder index value of ≤1 is important. The absolute risk of developing colorectal cancer in IBD remains relatively low, ranging from 1.1 to 5.4% after 20 years of disease. The main risk factors for IBD are total intestinal damage, high inflammatory activity, the stricturing phenotype of CD and the presence of primary sclerosing cholangitis.

[Pharmacotherapy of inflammatory bowel diseases: efficacy performance and safety management].

Treatment of inflammatory bowel diseases IBD (Crohns disease, ulcerative colitis) is aimed at achieving clinical, endoscopic and histological remission, minimizing surgical complications, and ensuring a normal quality of life. However, the use of medical treatment is potentially associated with various adverse events, among which infectious complications, malignant neoplasms, as well as myelotoxicity, hepatotoxicity, skin lesions and others. The risk of side effects depends on the type of drug therapy (5-aminosalicylates, thiopurines, biologicals, etc.), the duration of treatment, the presence of extra-intestinal manifestations, etc. The article provides an overview of data on both the effectiveness and frequency of various side effects of the main classes of drugs in IBD, presents methods of investigation which can predict the effectiveness and development of side effects, the implementation of which can be considered as a variant of personalized therapy in IBD.

[Liver cirrosis and complication risk management].

Liver cirrhosis (LC) takes the main place in the structure of the pathology of the digestive system in terms of the frequency of mortality, as well as in the development of fatal and poorly controlled complications, which requires the search for effective methods for preventing the progression of the disease and the development of complications. The article provides updated information on the role of the intestinal microbiota, as well as endotoxemia and increased intestinal permeability syndromes in the pathophysiology of LC and its complications. The results of recent meta-analyses of the impact of dysbiotic disorders on the prognosis of the LC and the options for their correction are presented. Understanding of the significance of involvement of gut microbiota in the pathogenesis of LC has become one of the levers of management of the risks of complications of LC. In this case, the livergut axis can be considered to be the leading link to the formation of most of the main complications of LC.

[The prevalence of bacterial overgrowth syndrome and its associated factors in patients with inflammatory bowel diseases (according to the data of the Novosibirsk registry)]. / Rasprostranennost' sindroma izbytochnogo bakterial'-nogo rosta i assotsiirovannye s nim faktory u bol'nykh vospalitel'nymi zabolevaniyami kishechnika (po dannym Novosibirskogo registra).

AIM: To assess the prevalence of bacterial overgrowth syndrome (BOS) and its risk factors in patients with inflammatory bowel diseases (IBD). SUBJECTS AND METHODS: The patients from the Novosibirsk IBD registry, who had undergone a hydrogen breath test (HBT) using a Gastro+ device, were examined. RESULTS: In 93 IBD patients who had undergone a HBD, the prevalence of BOS was 48% (46.2% for ulcerative colitis and 51.2% for Crohn's disease). There was a strong correlation between abdominal bloating, abdominal rumbling, and positive HBT results in both patient groups. During the HBT, the patients with BOS frequently complained of diarrhea, borborygmi, belching, and anxiety. CONCLUSION: The findings suggest that BOS is highly prevalent among patients with IBD. BOS is associated with clinical symptoms, such as abdominal bloating, abdominal rumbling, tearfulness, and irritability.

THE VALUE OF THE REGISTER WITH INFLAMMATORY BOWEL DISEASE TO ASSESS THE EFFECTIVENESS OF DIAGNOSTIC AND TREATMENT ACTIVITIES.

Inflammatory bowel diseases (IBD) are chronic recurrent immune-mediated inflammation of the gastrointestinal tract. Now it is not unified system of monitoring patients with IBD in Russia, but there is information from different regions about the prevalence of disease. There are the registers in few big cities. From 2003 the registers of IBO have been done in Novosibirsk. The register data can give us the possibility to estimate the various real-time data of the disease, to analyze the effect of the treatment, to evaluate risk factors for the disease in real clinical practice. Among the patients with ulcerative colitis decreased the number ofpatients with recurrent and continuous increase in the number of patients with distal forms, which is probably due to the more skillful conduct of patients. in general, it decreased the number of patients with Crohns disease with continuously relapsing course option, reflecting, perhaps, improved treatment. Decline in the proportion of persons with the localization process, only in the colon, which is associated with greater availability of diagnostic methods for destruction of the small intestine. The registry was created in April 2012 and includes patients registered up to October 2015.

[CLINICAL CASE OF CROHN'S DISEASE: A DIFFICULT PATH TO DIAGNOSIS].

This article presents a case of Crohn's disease in a man who was veracity of 30 years from the onset of the disease. This case demonstrating complexity of diagnostic search, even with the classic version of the disease. And it demonstrates the need for a thorough medical history, differential diagnosis.

[MICROSCOPIC COLITIS: THE CLINICAL CASE].

During past years incidence and prevalence of microscopic colitis (MC) have increased, that is possible caused to the improvement of knowledge of doctors about the disease. This article contain modern views on epidemiology, diagnostic and variant of microscopic colitis treatment. A typical clinical picture of MC in the form of recurrent a watery diarrhea, with the absence of pathologic changes at roentgenologic and endoscopic investigations is described with the example of a clinical case.

[Fecal calprotectin concentration in the differential diagnosis of bowel diseases].

AIM: To estimate the informative value of a noninvasive fecal (calprotectin) test in the differential diagnosis of bowel diseases. SUBJECTS AND METHODS: One hundred and forty-two patients who had visited their physicians with intestinal disorders (a change in stool frequency and patterns, abdominal pain) were examined in an open-label multicenter cross-sectional study. The examinees' mean age was 35 ± 2.43 years. Gender- and age-matched comparison groups consisted of healthy individuals and patients with irritable bowel syndrome. Fecal calprotectin (FCP) was determined using a BUHLMANN Calprotectin ELISA kit. All the patients underwent colonoscopy. RESULTS: In the patients with organic bowel diseases (ulcerative colitis, Crohn's disease, lymphocytic colitis, colonic diverticular disease, colonic adenomas, celiac disease), the concentration of FCP was found to be substantially higher than that in the healthy individuals and patients with irritable bowel syndrome. The highest calprotectin levels were noted in the patients with inflammatory bowel diseases. CONCLUSION: This study demonstrated the high diagnostic value of the calprotectin test for the differential diagnosis of organic and functional bowel diseases.