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Crohn’s disease (CD) is nonspecific granulomatous inflammatory disease of all layers of the intestinal wall, characterized by a variety of clinical forms, heterogeneity of age groups of children and extraintestinal manifestations. The diagnosis of the disease is difficult due to the presence of many symptoms specific to a number of other surgical diseases of the abdominal cavity organs. This diagnosis is often made intraoperatively. In this study we report a case of treatment of a teenage girl who was admitted with complaints of a mass in the right iliac region extruding above the skin surface, instability of body weight, an increase in body temperature to 37.2° C for one month. As a result of laboratory and instrumental examination, the etiology was not established. Laparoscopy revealed abdominal infiltrate, consisting of the cecum, the distal ileum and a part of the greater omentum, tightly fixed to the anterior abdominal wall, which led to the destruction ofthe peritoneum, muscle tissue and aponeurosis with further infiltration into the sub-cutaneous fat. Appendectomy and separation of the infiltrate were performed. After that, the girl was discharged due to the categorical refusal of the parents of the further treatment.Twelve days later the patient had abdominal pain again, the dynamics of the pain syndrome intensified, the body temperature was febrile. After examination and detection of signs of peritonitis, emergency laparotomy, subtotal resection of the greater omentum, separation of the abdominal infiltrate (repeated), sanitation and drainage of the abdominal cavity were performed. During the surgery, the access to the abdominal cavity was performed with technical difficulties due to the fact that a conglomerate of intestinal loops and omentum was fixed to the anterior abdominal wall from the interior. The conglomerate was separated from the anterior abdominal wall by blunt dissection. The size of the conglomerate was up to 12–15 cm, formed by the transverse colon, the ileum and the greater omentum. The walls of the transverse colon and ileum in the area of the conglomerate had the cartilaginous density. For the purpose of further examination and determination of tactics for further treatment, the child was transferred to the Gastroenterology Department with a diagnosis of “Terminal ileitis. Purulent omentitis. Serous peritonitis. Mild normochromic anemia of mixed origin. Crohn’s disease?” After the additional examination in a specialized hospital, the diagnosis of CD was confirmed.

Introduction and purpose Fecal microbiota transplantation (FMT) is a process of transferring gut microflora from a healthy donor to a recipient. It is indicated that the human distal gastrointestinal tract consists of more than 1000 species of bacteria, which have an impact on local and systemic processes related to immunity, nutrition and the gut-brain axis. The growth of new bacterial species, reduction of microbial variety or big changes in the ratio between them can lead to a dysbiosis. The relationship between intestinal microbiota and some systemic diseases is seen.The study aimed to present the state of knowledge on FMT in the treatment of intestinal diseases. Publications from the last 5 years from the Pubmed database were included.A brief description of the state of knowledgeIntestinal diseases constitute the main group of indications for FMT. FMT can be delivered via upper or lower gastrointestinal routes. The review presents different studies concerning the usage of FMT. Among them, recurrent Clostridium difficile infection, colitis ulcerosa, Crohn’s disease and irritable bowel syndrome are mainly indicated in the literature. FMT might find its application also in a treatment of multidrug-resistant organisms colonization, antibiotic-associated diarrhea, gut acute graft-versus-host disease and radiation enteritis. There is a possibility of the occurrence of adverse events from the digestive tract after FMT. However, the studies evaluate them as mostly mild and transient. In some cases it was necessary to repeat FMT to achieve a satisfactory final result.ConclusionsFecal microbiota transplantation gives hope for a safe and effective method of treatment of certain intestinal diseases. There is a need for conducting further analysis of the method.

Since the first description in the middle of the 1990’s of last century, it has been steadily increasing the number of literary data concerning IgG4-related disease. The process involved more organs and tissues with predominance of pancreas, salivary glands, and lymph nodes affection. There are several documented cases arising in the gastrointestinal tract. The salient clinical features include a predisposition to affect middle-age men who present with the only symptoms referable to a mass lesion at one or more sites, without inflammation, hyperemia and other constitutional symptoms. Common laboratory features are elevated serum globulin, IgG, IgG4, and IgE subtypes and low titers of autoantibodies such as rheumatoid factor and ANA. Histological features vary depending on the affected organ. But there are some common features of extranodal sites: lymphoplasmacytic infiltration with lymphoid follicle formation, sclerosis, phlebitis, and significant tissue IgG4+ -plasmocytosis. The arteries usually are not involved in the inflammatory process. The most common features in the lymph nodes are follicular hyperplasia, interfollicular expansion and Castelman-like appearance. There are proposed by Cheuk and Chan criteria for the diagnosis such as >50 IgG4 plasma cells per HPF and IgG4+ / IgG+>40 % ratio. The calculation is based on the assessment of the 3 fields of view with the greatest color intensity and correlates with the area of 0.196 mm2/ The pancreas, salivary glands, hepatobiliary tract, orbit and lymph nodes are cites most frequently, although other sites such as the aorta, skin, central nervous system, breast, kidney, prostate, lung, and thyroid have also been occasionally reported. There are 6 cases reports of involving the GIT, 2 of them were described in the stomach, one case in esophagus, jejune, cecum and sigmoid colon. Most cases took the form of a circumscribed nodule, variably affecting the mucosa, submucosa, muscularis propria, and subserosa. Microscopically it was formed by paucicellular hyalinized fibrous tissue with patchy chronic inflammatory infiltrate compound with plasma cells and lymphocytes. The proposed by Cheuk and Chan criteria were present in 4 of these cases. In the case with involving the jejune there were diagnosed serum IgG4 elevation at 800 mg/dL, phlebitis and necrotizing mesenteric arteritis. IgG4+ plasma cells also were seen within the interfollicular region of mesenteric lymph nodes. In this report, we present the case of IgG4-related disease involving stomach, omentum and mesenteric lymph nodes. A previously well 29-year-old man presented with a 1-year history of intermittent epigastric pain, nausea and sometimes vomiting. Because of orsening and suspicion of cancer resection of stomach was made. Morphological investigation of stomach tissue revealed a chronic ulcer associated with transmural inflammatory infiltrate rich in IgG4-positiv plasma sells. Abundant IgG4+ interfollicular plasma cell were also identified in a lymph node in stomach serosa, lymph nodes of omentum and mesenteric lymph node. In view of sensitivity to steroids, this condition should be considered in the differential diagnosis of stomach ulcers and gastritis with severe plasma cell infiltration, especially in case of negative H. Pylori and absence of response to ordinary anti-inflammatory treatment. Our observation of IgG4-releated sclerosing disease of the stomach in 29-year-old male was carried out in context of modern information about IgG4-releated pathology of different organs. Data of clinical, laboratory, and pathomorphological studies which help to substantiate the diagnosis were presented.

On the basis of epidemiological and demographic data, hygienic indicators of the quality of drinking water and computer software STATISTICA 6.0 an intestinal infections database was developed. The effectiveness of its usage for social and hygienic monitoring and epidemiological inspection of intestinal infections was proved.

Aim: To compare the effect of a diet low in fermentable oligo-, di-, monosaccharides and polyols (fermentable oligosaccharides, disaccharides, monosaccharides and polyols - FODMAP) and rebamipide on carbohydrate tolerance and disaccharidases activity in patients with maldigestive enteropathy (ENMP)., Materials and Methods: The study included 61 patients with ENMP with reduced small intestine carbohydrases. Their glucoamylase activity was 100 ng glucose/mg tissue × min (quartile 53, 72), maltase - 504 (quartile 258, 708), sucrase - 43 (quartile 25, 58), lactase - 8 (quartile 4, 20). Group 1 included 19 people on a low FODMAP diet. The 2nd group included 42 patients who were on a normal diet and received rebamipide 300 mg/day. Patients were monitored weekly for 8 weeks., Results: In 16 patients of the 1st group, abdominal pain and stool disorders decreased, in 15 patients, swelling and rumbling in the abdomen stopped. Glucoamylase activity increased to 196 (quartile 133, 446, р <0.024) ng glucose/mg tissue × min, maltase activity increased to 889 (quartile 554, 1555, p <0.145), sucrase activity increased to 67 (quartile 43, 175, p <0.039), lactase activity increased to 13 (quartile 9, 21, p <0.02). After the diet was discontinued, intestinal symptoms in patients of group 1 resumed. In 27 patients of the 2nd group after 4 weeks dyspeptic manifestations decreased, in 34 patients the tolerability of products containing FODMAP improved. Continuation of treatment up to 8 weeks contributed to a further improvement in well-being. Glucoamylase activity increased after 4 and 8 weeks to 189 (quartile 107, 357, p <0.013) and 203 (quartile 160, 536, p <0.005), respectively; maltase - up to 812 (quartile 487, 915, p <0.005) and 966 (quartile 621, 2195, р <0.0012); sucrases - up to 60 (quartile 34, 105, p <0.013) and 75 (quartile 52, 245, р =0.003); lactase - up to 12 (quartile 8, 12, p <0.132) and 15 ng glucose/mg tissue × min (quartile 10, 20, р <0.092)., Conclusion: The clinical symptoms of fermentable carbohydrate intolerance and increased membrane enzyme activity are reduced by a low FODMAP diet in patients with ENMT, but clinical symptoms of food intolerance reappear when switching to a normal diet. Treatment with rebamipide improves food tolerance and consistently increases the activity of TSOTS enzymes after 4 and 8 weeks.

The pandemic of new coronavirus infection continues affecting many areas of public life. Against the background of arising variations, occur changes in people's psychological condition and in belief systems and attitudes to many fields of human knowledge, including medicine. The purpose of the study is to evaluate potential effect of COVID-19 pandemic on developing civil liability of the population of the Russian Federation regarding anti-epidemic activities to fight infectious diseases., Materials and Methods: The special anonymous on-line questionnaire was developed and placed on popular social platforms in open access. The questionnaire included two parts and contained 27 closed alternative questions with only one alternative to answer. The respondents included persons older than 18 years agreed to participate in survey. The data gathering provided for three subsequent stages. The final sampling consisted of 1350 respondents, out of them 1230 were citizen of the Russian Federation and 120 representatives of the near abroad., Results and Discussion: More than 65% of respondents confirmed positive changes of one's attitude to sanitary hygienic activities to better sense. Among them, 63.3% began to wash hands more regularly and 62.2% began to apply hand antiseptic more often. The comparing of study results by individual characteristics revealed a significant effect of primary hygienic status of respondents on magnitude of fixed changes. It is established that during 5 months the population readiness to be vaccinated by one of the registered national vaccines was increasing and level of uncertainty was decreasing. Among respondents 73.5% marked increasing of individual responsibility of citizens for hygienic practices., Conclusion: The study demonstrated significant improvement of population attitude to sanitary hygienic practices after onset of pandemic. The greatest changes are observed in individuals with initially sufficient levels of hygienic commitment. On the basis of study results, the conclusion can be made about significant increasing of civil liability of the population of the Russian Federation for hygienic practices, especially against the background of COVID-19 pandemic.

Chronic intestinal pseudo-obstruction a rare violation of the motor skills of the gastrointestinal complex, similar to mechanical obstruction, but without a mechanical obstacle. The development of chronic intestinal pseudo-obstruction is caused by a disturbance on the part of the smooth muscles and the nervous system of the gastrointestinal system. Common symptoms include constipation, abdominal pain, nausea, vomiting, bloating. Violation of peristalsis leads to food stagnation in the hinges of the small intestine, their dilation, the development of bacterial insemination syndrome. Eating disorders, bacterial contamination syndrome (CDDs) lead to impaired suction syndrome, cahexia. Treatment is aimed at providing adequate nutrition, the use of drugs that activate motor skills, suppress the growth of microbes in the small intestine, the implementation of intestinal decompression. Surgical treatment: resection of the affected segment of the gut. In the refractory course of the disease intestinal transplantation.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used drugs in the world, and their side effects are very high. First of all, these are NSAID gastropathy, but in the long term, 5070% of NSAIDs cause damage to the small intestine (NSAID enteropathy), sometimes with serious consequences. To date, no drugs have been proposed with proven effectiveness to prevent this side effect. Apparently, this is not due to the fully clarified mechanism of pathogenesis. The most promising is the hypothesis of the participation of individual representatives of microflora in the development of enteropathy. Therefore, modulating the intestinal flora with the help of probiotics can be the basic therapeutic strategy for the prevention and treatment of such damage.

Aim: Detection of nucleotide sequences of genes controlling synthesis of pathogenicity factors in clinical strains of opportunistic enterobacteria isolated from children with acute intestinal infections (AII), as well as their association with resistance to antibiotics and the course of the infectious process., Materials and Methods: 175 clinical strains obtained from children with AII undergoing treatment in Irkutsk state infectious diseases hospital (2007-2010) were studied. Primers to a number of genes detected in Escherichia coli pathogenicity islands, controlling type S and type 1 adhesion; formation of hemolysins; iron-regulatory protein synthesis; capsule formation were used in the study. PCR products analysis was performed by agar gel electrophoresis., Results: Genetic determinants of pathogenicity were detected in bacteria genera Klebsiella, Citrobacter, Enterobacter, Proteus, Kluyvera, Morganella, Pantoea, Serratia. Fragments of hlyA and hlyB genes (hemolysin production) were detected more frequently; less frequently--sfaA, sfaG, fimA (adhesion), as well as irp-2 gene (synthesis of iron-regulatory protein). The largest set of genetic determinants of pathogenicity was noted in clinical strains of Klebsiella spp. Cultures with DNA fragments specific to genes of E. coli pathogenicity clusters were obtained predominately from children aged up to 3 years, had multiple antibiotic resistance and were isolated significantly more frequently in severe forms of AII when compared with strains in which these determinants were not detected., Conclusion: The studies performed showed that clinical strains of opportunistic bacteria isolated from patients with AII have a certain pathogenic potential, as evidenced by the presence of genetic pathogenicity markers in them.