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Aim. These recommendations are developed for practitioners in order to familiarize them with modern diagnostic methods, management features and pharmacotherapy of patients with gastroesophageal reflux disease (GERD).General provisions. GERD is the most common reason for patients to visit clinics. There are esophageal and extraesophageal manifestations of GERD. Patients' complaints of heartburn and regurgitation remain the most sensitive and specific clinical manifestations of GERD. The diagnosis of GERD is established on the basis of anamnestic data, instrumental examination (detection of reflux esophagitis during upper gastrointestinal endoscopy, detection of pathological gastroesophageal reflux with 24-hour pH-metry or/and 24-hour pH-impedance monitoring). Patients with suspected GERD and the absence of erosive and ulcerative changes in the mucous membrane of the esophagus or the presence of erosive esophagitis of Grade A according to Los Angeles Classification of Gastroesophageal Reflux Disease are recommended to conduct 24-hour pH-metry on PPI off to exclude or confirm the diagnosis of GERD. Patients with extraesophageal manifestations of GERD without classic symptoms (heartburn, regurgitation) are recommended to undergo 24-hour pH-impedance monitoring with discontinuation of proton pump inhibitor therapy. When deciding on surgical treatment, all patients need to perform high-resolution esophageal manometry and 24-hour pH-impedance monitoring. Complications of GERD include bleeding, strictures, Barrett’s esophagus and esophageal adenocarcinoma. The main groups of medications used in the treatment of GERD are proton pump inhibitors (PPIs), potassium-competitive acid blockers (P-CABs), alginates, antacids, and prokinetics. PPIs are the drugs of choice in the treatment of both symptoms of gastroesophageal reflux disease and existing erosive esophagitis. Combination therapy Rebamipide with PPIs increases the effectiveness of relief of GERD symptoms, as well as reduces the frequency of relapses.Conclusion. These clinical recommendations will improve the quality of medical care for patients with GERD.

Background. Comorbidity as the presence of two or more pathological processes in a patient is one of the most discussed topics in medical forums around the world and in Russia. Meanwhile, the breadth of discussion of this problem carries the risk of losing the true meaning of comorbidity, set out by the ideologist of this problem, A. R. Fainstein, namely: a combination in one patient of two and/or more chronic diseases, pathogenetically interrelated. (with an unconditional understanding of the variety of options for these connections).Results. This article offers the reader a detailed look at comorbidity in its original/true understanding, based on a deep understanding of the pathogenesis of diseases and pathomorphological analysis of completed cases of comorbidity. Various options for comorbidity (causal, complicated, iatrogenic, specified and unspecified) with pathomorphological confirmation are considered. Pathomorphological illustrations of the analyzed variants are offered – preparations from the clinical and morphological archive of the Department of Therapy, Clinical Pharmacology and Emergency Medical Care of the Moscow State Medical and Dental University (now the Russian University of Medicine). Inseparable from the understanding of comorbidity is an accurate, uniform presentation of diagnoses – clinical and pathomorphological – by doctors of all specialties, to ensure continuity in the provision of medical care and improve the quality of diagnosis and treatment. The article updates the rules for formulating a clinical and pathomorphological diagnosis in a comorbid patient, namely: a clear reflection of the presence of the main disease and comorbid ones (competing, combined and background diseases), complications of the main disease and concomitant diseases. In the finale, algorithmized "comorbidity postulates" are proposed, facilitating the perception and use of the proposed methodological approaches.

The aim of this work was to study the risk factors for severe COVID-19, comorbid diseases, and the structure of mortality in patients who died in a hospital from a new coronavirus infection. The study included 180 patients with bilateral viral polysegmental pneumonia caused by SARS-CoV-2. In patients with viral pneumonia, the degree of lung tissue damage, the frequency and severity of comorbid diseases were studied: arterial hypertension, coronary heart disease, cerebrovascular diseases (chronic cerebral ischemia, cerebral stroke), atrial fibrillation, chronic heart failure, chronic kidney disease, diabetes mellitus type 2, obesity, malignancy and anemia. In patients with COVID-19-associated pneumonia, severe lung damage was observed – pneumonia with CT3 (36.1%) and CT4 (33.0%) prevailed, less often CT2 (30.9%). A high frequency of comorbid diseases was found in deceased patients with viral pneumonia: arterial hypertension (98.9%), cerebrovascular disease (96.9%), coronary heart disease (83.9%), chronic kidney disease (96.7%), type 2 diabetes mellitus and atrial fibrillation – in almost half of patients (42.2%), and in every third patient – obesity (36.6%). The main causes of death in patients with COVID-19-associated pneumonia were: acute respiratory distress syndrome (83.3%), less often acute myocardial infarction (7.2%), cerebral infarction and edema (5.6%), thromboembolism pulmonary artery (3.9%). In patients with viral pneumonia caused by SARS-CoV-2, there is a high frequency of comorbid conditions leading to a severe course of the disease: arterial hypertension, coronary heart disease, severe chronic heart failure, advanced age (> 75 years), lack of vaccination, chronic kidney disease, obesity of the 3rd degree, diabetes mellitus type 2. Among women who died from COVID-19-associated pneumonia, such risk factors as age over 75 years, type 2 diabetes, lack of vaccination, a history of myocardial infarction with the development of chronic heart failure stages 2A and 2B, and chronic microcytic anemia prevailed; among the dead men – obesity of the third degree, a history of cerebral stroke, lack of vaccination and severe chronic heart failure.

The purpose of the review: to summarize the main data of the literature and our own accumulated practical experience of everyday diagnosis of inflammatory bowel diseases (IBD) to better represent the morphological features and histological conclusions.Key points. The microscopic picture of IBD is often represented by a combination of basic histological characteristics that can be detected in other diseases and only in rare cases can be considered pathognomonic. No single histological feature can be used in isolation to diagnose ulcerative colitis or Crohn’s disease. Diagnostic accuracy is improved if several signs are taken into account at once, if changes within one or more parts of the intestine are analyzed, it is necessary to compare the identified changes with the clinical picture of the disease.Conclusion. The presented stages of the morphological study of biopsy specimens in patients with IBD and the exact characteristics of the detected changes will help to increase the diagnostic value of the study of ileo- and colonobiopsies, as well as improve mutual understanding between gastroenterologists and pathologists and, as a result of interaction between specialists, will increase the accuracy of the diagnosis.