Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii最新文献

{"title":"Modern Approaches in the Morphological Diagnosis of Inflammatory Bowel Diseases","authors":"A. S. Tertychnyy, Kh. M. Akhriyeva, E. Kogan, O. Zayratyants, L. S. Selivanova","doi":"10.22416/1382-4376-2022-32-2-73-84","DOIUrl":"https://doi.org/10.22416/1382-4376-2022-32-2-73-84","url":null,"abstract":"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.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81631218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Opportunity of Using Diode Laser with the Length of 1940 nm in the Treatment of Hemorrhoids","authors":"S. Frolov, A. M. Kuzminov, D. V. Vyshegorodtsev, O. A. Mainovskaya, Y. L. Trubacheva, O. Fomenko, V. Korolik, I. S. Bogormistrov, I. A. Mukhin, A. M. Battalova, E. Bogdanova","doi":"10.22416/1382-4376-2022-32-2-63-72","DOIUrl":"https://doi.org/10.22416/1382-4376-2022-32-2-63-72","url":null,"abstract":"Aim: to improve the results of treatment of patients with hemorrhoidal disease of the 2nd and 3rd stages by using a diode laser with a wavelength of 1940 nm.Materials and methods. The study included 28 patients with hemorrhoids of the second or third stage. A new treatment method based on the use of a diode laser with a wavelength of 1940 nm was applied to all patients. This technique (laser hemorrhoidoplasty) provides for the thermal effect of laser radiation on the cavernous tissue of the internal hemorrhoid node and the terminal branches of the upper rectal artery. The intensity of postoperative pain syndrome was assessed and the clinical symptoms of hemorrhoidal disease manifestations were studied before and after surgery. To study the effectiveness of the proposed method and to assess the depth of thermal exposure to laser radiation, transrectal ultrasound with Dopplerography and pathomorphological examination were performed. The functional state of the rectal locking apparatus before surgery and in the postoperative period was assessed using sphincterometry. The quality of life of patients who underwent laser hemorrhoidoplasty was studied according to the SF 36 questionnaire.Results. Surgical intervention was performed under both local and spinal anesthesia. Intraoperative complications in the form of hemorrhoidal node bleeding were noted in 3 patients. In the early postoperative period, inflammatory edema of external hemorrhoids was diagnosed in 4 patients. The intensity of the pain syndrome was assessed on the VAS scale and by day 7 in 93 % of patients it did not exceed 1 point. All 28 patients were followed up within 1 to 6 months after the operation. All had no complaints characteristic of hemorrhoidal disease, no relapse of the disease was detected in any observation. Transrectal ultrasound with Dopplerography was performed, which made it possible to diagnose a 2–3-fold decrease in blood flow along the terminal branches of the upper rectal artery, and internal hemorrhoids determined earlier, before surgery, were not visualized already 1 month after surgery. According to sphincterometry, no violations of anal retention function were detected in all 28 patients.Conclusion. Surgical treatment of hemorrhoids of the 2nd and 3rd stages with the use of a diode laser with a wavelength of 1940 nm. with proper technical performance and the choice of optimal energy, it allows to achieve a good clinical effect. The proposed method of intervention ensures the absence of a pronounced pain syndrome, which does not lead to a significant decrease in the quality of life already in the early postoperative period and allows to shorten the period of labor rehabilitation. Laser hemorrhoidoplasty is a highly effective method of treating hemorrhoids at stages 2 and 3 of the disease and opens up the possibility of treatment on an outpatient basis. ","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87808285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Pandemic and Irritable Bowel Syndrome — is there a Relationship?","authors":"V. Akhmedov","doi":"10.22416/1382-4376-2022-32-2-85-92","DOIUrl":"https://doi.org/10.22416/1382-4376-2022-32-2-85-92","url":null,"abstract":"The aim: to reflect the features of the course of irritable bowel syndrome during the COVID-19 pandemic.Key points. It has been noted that the COVID-19 may contribute to the formation of post-infectious functional gastrointestinal diseases, given that angiotensin-converting enzyme-2 (ACE-2) receptors, the site of binding of the SARS-CoV-2 virus to human cells, are also present in epithelial intestinal cells; virus was found in feces in about half of patients, gastrointestinal symptoms, including diarrhea occur in about one fifth of patients, fecal calprotectin, a marker of GI inflammation is elevated in patients with COVID-19, macroscopically as well as histologically, patients show signs of damage mucous membrane of the gastrointestinal tract, and also, as noted above, they have a dysbiosis of the intestinal microbiota.Conclusion. It was shown that during the pandemic, more than 90 % of the interviewed patients with IBS had an exacerbation of IBS with an increase in symptoms such as bloating and cramps, and 75 % of them said that the exacerbation of symptoms was reflected in the activity of patients in everyday life. These factors dictate the need for an integrated approach in the management of such a group of patients with the use of modern multi-target drugs that affect the pathogenetic factors in the formation of functional gastrointestinal diseases, one of which is the Kolofort drug due to the triple multi-target mechanism of action on the pathogenesis of functional gastrointestinal diseases. ","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83352628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct and Indirect Methods for Studying Human Gut Microbiota","authors":"V. Ivashkin, O. Medvedev, E. Poluektova, A. Kudryavtseva, I. Bakhtogarimov, A. Karchevskaya","doi":"10.22416/1382-4376-2022-32-2-19-34","DOIUrl":"https://doi.org/10.22416/1382-4376-2022-32-2-19-34","url":null,"abstract":"Aim: To review the main methods of intestinal microbiota studying.Key points. Currently, molecular genetic methods are used mainly for basic research and do not have a unified protocol for data analysis, which makes it difficult to implement them in clinical practice. Measurement of short chain fatty acids (SCFA) concentrations in plasma provides the data, which can serve as an indirect biomarker of the colonic microbiota composition. However, currently available evidence is insufficient to relate the obtained values (SCFA levels and ratio) to a particular disease with a high degree of certainty. Trimethylamine N-oxide (TMAO) levels in the blood plasma and urine can also reflect the presence of specific bacterial clusters containing genes Cut, CntA/CntB and YeaW/YeaX. Therefore, further studies are required to reveal possible correlations between certain disorders and such parameters as the composition of gut microbiota, dietary patterns and TMAO concentration. Gas biomarkers, i.e. hydrogen, methane and hydrogen sulphide, have been studied in more detail and are better understood as compared to other biomarkers of the gut microbiome composition and functionality. The main advantage of gas biomarkers is that they can be measured multiple times using non-invasive techniques. These measurements provide information on the relative proportion of hydrogenic (i.e. hydrogen producing) and hydrogenotrophic (i.e. methanogenic and sulfate-reducing) microorganisms. In its turn, this opens up the possibility of developing new approaches to correction of individual microbiota components.Conclusions. Integration of the data obtained by gut microbiota studies at the genome, transcriptome and metabolome levels would allow a comprehensive analysis of microbial community function and its interaction with the human organism. This approach may increase our understanding of the pathogenesis of various diseases as well open up new opportunities for prevention and treatment.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87875066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hiatal hernia surgery: laparoscopic versus robotic approach?","authors":"R. Komarov, S. Osminin, I. R. Bilyalov","doi":"10.22416/1382-4376-2022-32-1-15-23","DOIUrl":"https://doi.org/10.22416/1382-4376-2022-32-1-15-23","url":null,"abstract":"Aim. Evaluate the advantages and disadvantages of laparoscopic and robot-assisted anti-reflux operations.General findings. Reflux esophagitis in the association with hiatal hernia on the third place in the structure of gastroenterological diseases. The development of minimally invasive surgical technologies has led to an increase in the number of laparoscopic and robot-assisted anti-reflux operations. The literature review includes 12 studies, the results of which were published from 2002 to 2020, with a total number of patients 1633. In most of them, when comparing laparoscopic and robot-assisted anti-reflux operations, the advantages of one or another technique were not revealed. In some studies, the high cost and duration of the operation were noted when using the da Vinci robotic surgical complex. Other studies have reported possible improvements in the treatment outcomes of patients with large or recurrent hiatal hernias due to the high precision of movement and improved visualization characteristic of therobot-assisted surgeries.Conclusion. It is necessary to conduct more researches on this problem to develop indications for the choice of a particular surgical approach, as well as to create a single transparent algorithm for the surgical treatment of patients with reflux esophagitis and hiatal hernia.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84548925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reassessment of disease severity routine laboratory tests in the COVID-19 infection","authors":"A. A. Simushev, E. Medvedeva, Y. Shulpekova, V. M. Nechaev, M. Skhirtladze, I. Popova, V. Ivashkin","doi":"10.22416/1382-4376-2021-31-6-16-22","DOIUrl":"https://doi.org/10.22416/1382-4376-2021-31-6-16-22","url":null,"abstract":"Introduction. Publications demonstrate some limitations of National Early Warning Score 2 (NEWS-2) accuracy in assessment on coronavirus infection severity.The purpose of this study was to determine the value of the patient’s age and routine laboratory parameters in the assessment of patient’s general condition in coronavirus pneumonia and their relation to NEWS-2 scale parameters.Materials and methods. 50 case reports of patients with COVID-19 infection observed in the Sechenov University in January–March 2021 were analyzed. 34 % of patients were males aged 31 to 89 years (average age 55 years) and 66 % — females aged 40 to 91 (mean age 63). The diagnosis of pneumonia was confirmed by computed tomography. NEWS-2 scale total score was assessed.Results. According to the physician’s subjective assessment the condition was significantly more often assessed as moderate and severe. There was only a weak correlation between the blood oxygen saturation and the total NEWS-2 score (r = 0.165, α = 0.1). We found a mild correlation (r = 0.341, α = 0.1) between the patient’s age and NEWS2 score. Among the most significantly interrelated parameters were age, neutrophil count, serum creatinine, CRP, fibrinogen level. Seven interrelated parameters (age, body temperature, blood oxygen saturation, the neutrophils count, creatinine, CRP, fibrinogen), for which a reliable relation with other tests has been shown, were assigned with its special index according to their contribution to the assessment of the overall condition severity. An aggregated score (criterion X) was proposed for assessment of disease severity according to equation. The proportions of mild, moderate, and severe cases according to criterion X were 12 %, 64 % and 24 %.Conclusion. The preliminary results obtained in the study emphasize the importance of routine laboratory tests in assessment of coronavirus infection severity. An evident discrepancy between NEWS-2 score and X criterion may be very important for practice. ","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83425784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Gastroenterology Need Artificial Intelligence?","authors":"S. M. Kurbatsky","doi":"10.22416/1382-4376-2021-31-6-103-105","DOIUrl":"https://doi.org/10.22416/1382-4376-2021-31-6-103-105","url":null,"abstract":"Aim. An outlook of trends and perspectives in gastroenterology in the age of digital healthcare.Key points. Diagnosis gradually transforms to the task of image recognition. Tuning a diagnostic algorithm (DA) necessarily requires a statistically representative training set of images. In transition towards electronic medical records (EMR), such data will be generated automatically. Advances in machine image recognition and the upcoming availability of a large amount of medical data suitable for configuring DA both pave the way towards efficient computerassisted diagnosis.Conclusion. The growing volumes of medical data enforce, and advances in machine image recognition enable, the transition towards computer-assisted medical diagnosis. ","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"110 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77967192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Irritable Bowel Syndrome Onset after New Coronavirus Infection COVID-19","authors":"I. Y. Feklina, M. Mnatsakanyan, A. Pogromov, O. V. Tashchyаn","doi":"10.22416/1382-4376-2021-31-6-23-28","DOIUrl":"https://doi.org/10.22416/1382-4376-2021-31-6-23-28","url":null,"abstract":"Aim. A psychometric comparison in patients with previous irritable bowel syndrome (IBS) vs. those with IBS presenting six months or later since COVID-19 infection.Materials and methods. The study included patients having had COVID-19 infection over 6 months ago and complying with Rome IV criteria (2016). The study cohort was 100 patients with gastrointestinal symptoms. Fourteen patients (cohort 1) complied with the IBS criteria, 5 males and 9 females. A comparison cohort was 40 patients with IBS verified prior to the COVID-19 pandemic (cohort 2), 12 males and 28 females. Data were obtained from the SIPSITEST 9.0 DBMS resource. The control cohort comprised 50 healthy respondents (cohort 3), 23 males and 27 females. Depression was scored with the Beck Inventory, anxiety — with Spielberger—Khanin (adapted STAI) questionnaire; childhood psychogeny has also been assessed.Results. In statistical analysis of cohort 1, mean depression, personality and reactive anxiety scores were 11 ± 2.27, 43.8 ± 1.93 and 46.7 ± 2.05, respectively. Mean values in cohort 2: personality anxiety 47.3 ± 1.46, reactive anxiety 50.7 ± 1.96 and depression 12.85 ± 1.13. With childhood psychogeny, positive answers to at least one question were reported in 9 of 14 (65%) patients in cohort 1 and 33 (82.5%) — in cohort 2. No study inter-cohort differences have been observed for personality or reactive anxiety and depression, nor for the history of childhood psychogeny.Conclusion. The new coronavirus infection entails postinfectious IBS in 6 months after COVID-19. ","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80009521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acetic Acid Chromoendoscopy in the Preliminary Diagnosis of Histological Type of Colon Polyp during Colonoscopy","authors":"N. Ageykina, E. Fedorov, P. Malkov, T. V. Nikolaychuk, N. Oleynikova","doi":"10.22416/1382-4376-2021-31-6-29-40","DOIUrl":"https://doi.org/10.22416/1382-4376-2021-31-6-29-40","url":null,"abstract":"Aim: to increase the efficiency of endoscopic diagnosis of serrated and non-serrated histological types of colon polyps in real time.Materials and methods. From September 2017 to February 2018, 63 polyps were detected among 51 patients (male 11, women 40, aged between 30–78 years, average age 52.2 ± 12.5 years) in all parts of the colon.Polyps were found in all parts of colon, sizes varied: 24 (38.1 %) ≤5 mm, 31 (49.2 %) 6–10 mm, 8 (12.7 %) ≥10 mm. The macroscopic types 0–IIa were 44 (69.8 %), and 0–Is — 19 (30.2 %). During colonoscopy, 1.5%-acetic acid, 5 ml, was sprayed onto the identified polyps. Additionally was blowed 40 ml of air jet. Mucosa was observed endoscopically for 2 minutes. Then polyps were removed and sent for pathology.Results. Use of acetic acid leads to fast acetowhitening reaction of lesions and surrounding mucosa. 2 groups were distinguished (table): 1) Loss of acetowhitening (LAW) of polyps occurs earlier than LAW of surrounding mucosa — «acetowhitening negative». 2) LAW of polyps occurs later than LAW of surrounding mucosa — «acetowhitening positive». Group 1 includes 25 (39.7%) polyps, 88.0% of which were non-serrated: 18(72.0%) — tubular adenoma; 4 (16.0%) — tubular-villous adenoma, one of which had high-grade dysplasia. Only 3(12.0%) polyps were serrated — hyperplastic polyps. Group 2 includes 38 (60.3%) polyps, 97.4% of which were serrated: 24 (63.2%) — hyperplastic polyp; 12 (31.6%) — sessile serrated polyp, including one with low-grade dysplasia, 1 (2.6%) - traditional serrated adenoma. Only 1 (2.6%) polyp was non-serrated — tubular adenoma. This suggests that LAW of non-serrated polyps occurs faster than LAW of surrounding mucosa — «acetowhitening negative». On the contrary, the LAW of serrated polyps is delayed compared to the LAW of the surrounding mucosa «acetowhitening positive». LAW of 4(6.3%) polyps was atypical. The reason for this phenomenon requires further study.Conclusion. Acetic acid chromoendoscopy can be used as a diagnostic method to determine the histological type of polyps during colonoscopy. ","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90597734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammation, impaired motor function and visceral hypersensitivity: the main mechanisms of functional disorders of the gastrointestinal tract (materials of the Expert Council and literature review)","authors":"V. Ivashkin, I. Maev, A. Trukhmanov, A. Sheptulin, T. Lapina, V. Simanenkov, K. A. Sokolov","doi":"10.22416/1382-4376-2022-32-1-7-14","DOIUrl":"https://doi.org/10.22416/1382-4376-2022-32-1-7-14","url":null,"abstract":"Aim. To review the main mechanisms of functional disorders of the gastrointestinal tract and to present the materials of an Expert Council, which was held on 10 December 2021 in Moscow.Key points. The pathogenesis of the most common functional diseases of the gastrointestinal tract — functional dyspepsia (FD) and irritable bowel syndrome (IBS) is multifactorial and includes motor disorders of various parts of the gastrointestinal tract, visceral hypersensitivity, changes in the intestinal microbiome, impairment of the permeability of the protective barrier, low-grade inflammation of the gastrointestinal mucosa, etc. This often leads to the prescription of a complex of various medications to such patients, which increases the risk of undesirable drug interactions and side effects. Multitargeted therapy involves the use of drugs that simultaneously affect different pathogenetic links. One of these drugs is Iberogast®, which normalizes gastrointestinal motility and visceral sensitivity, has an anti-inflammatory action and is highly effective in treatment of FD and IBS.Conclusion. In the treatment of functional gastrointestinal diseases characterized by multifactorial pathogenesis, preference should be given to multi-targeted therapy with the use of drugs that have an effect on its various links.","PeriodicalId":33798,"journal":{"name":"Rossiiskii zhurnal gastroenterologii gepatologii koloproktologii","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90881215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}