Aim. The present guidelines intended for primary care physicians are aimed at facilitating early diagnosis of malignant tumours of the digestive system, which can significantly improve the immediate and long-term results of their treatment.General provisions. The guidelines comprise sections devoted to esophageal adenocarcinoma, esophageal squamous cell carcinoma, gastric cancer, colorectal cancer, hepatocellular carcinoma and extrahepatic bile duct and gall bladder cancer, as well as pancreatic cancer. Each section contains information on risk factors and precancerous diseases, which allows a physician to identify whether a particular patient falls into the risk group of digestive system neoplasms. It is shown how digestive system cancers can be suspected on the basis of patients’ complaints and past medical history, as well as data obtained both from a direct examination and laboratory instrumental studies. Each section offers practical algorithms in cases of suspected esophageal adenocarcinoma, esophageal squamous cell carcinoma, gastric cancer, colorectal cancer, hepatocellular carcinoma and extrahepatic bile duct and gallbladder cancer, as well as pancreatic cancer.Conclusion. The knowledge of clinical manifestations and risk factors in the development of digestive system neoplasms allows a physician to suspect cancer and devise a timely and adequate diagnostic strategy, including laboratory and instrumental studies at specialised clinical centres.

Aim.The practical guidelines are intended for primary care physicians, general practitioners, paediatricians, gastroenterologists and general internists to advance the treatment and prevention of gastroenterological diseases in adults and children in therapies with probiotics, prebiotics, synbiotics and their enriched functional foods.Key points.Probiotics are live microorganisms that sustain health of the host when supplied in adequate amounts. Prebiotics include human-indigestible but accessible to gut microbiota substances expediting specific changes in the composition and/or activity of gastrointestinal microbiota that favour the host health. The mechanism of probiotic action comprises the quorum resistance maintenance, nutrient substrate metabolism and end metabolite recycling, macroorganism-sustaining substrate production, as well as the mediation of local and adaptive immune responses.The Russian Federation regulates market differently for biologically active food additives (BAFA), medicinal products (drugs) and functional food products (FFP). We overview the probiotic strains regulated in Russia as BAFAs, drugs and FFPs and provide recommendations on the use of these strains in treatment and prevention of gastroenterological diseases in children and adults.Conclusion.The clinical efficacy of probiotics, prebiotics, synbiotics and fortified functional foods depends on the prebiotic and strain properties and is verified in appropriate comparative clinical trials. Not all probiotics registered in Russia as BAFAs, drugs and FFPs have a strain identity, which provides no warranty of the clinical effect expected. The FFP legislation demands improved regulation mechanisms and control for therapeutic efficacy.

Aim. Current clinical recommendations are intended to supply gastroenterologists, physicians and general practitioners with modern methods for the diagnosis and treatment of constipation.Key points. Constipation is defined as primary (functional) and secondary form, the latter comprising a manifestation of another illness. The causes of constipation are diagnosed with colonoscopy, especially in patients aged over 50 having “anxiety symptoms” and hereditary colorectal oncological predisposition. Indications may also include the bowel transit time estimation with radiopaque markers, balloon expulsion test, anorectal manometry, defecography and electromyography. Therapy for constipation should be comprehensive and concern lifestyle, diet recommendations and use of medications (psyllium, macrogol, lactulose, lactitol, contact laxatives, prucalopride). Patients with a less effective conservative therapy and largely reduced quality of life should be considered for surgical intervention.Conclusion. An effective therapy for constipation requires a correct diagnosis of its causes.

Aim:to present modern methods of diagnosis and treatment of chronic pancreatitis for gastroenterologists, general practitioners and physicians.Chronic pancreatitis (CP) is a long-term inflammatory disease of the pancreas, manifested by irreversible morphological changes in the parenchyma and pancreatic ducts, which cause pain and/or persistent impairment of function. Current concept on the etiology of CP is reflected by the TIGAR-O classification. The criteria for establishing the diagnosis of CP include typical attacks of abdominal pain and/or clinical and laboratory signs of exocrine, endocrine insufficiency with the mandatory detection of characteristic morphological changes (calcifications in the parenchyma and pancreatic ductal stones, dilatation of the main pancreatic duct and its branches). CT, MRCP, and pancreatobiliary endosonography are recommended as the methods of choice to verify the diagnosis of CP. Conservative treatment of patients with CP is provided for symptom relief and prevention of complications. Individual cases with severe non-interactable abdominal pain, as well as a complicated course of the disease (development of ductal hypertension due to main pancreatic duct stones or strictures, obstructive jaundice caused by compression of the common bile duct, symptomatic postnecrotic cysts, portal hypertension due to compression of the portal vein or thrombosis of the splenic vein, persistent duodenal obstruction, pseudoaneurysm of the celiac trunk basin and the superior mesenteric artery) serve as an indication for endoscopic or surgical treatment. The Guidelines set out modern approaches to the diagnosis, conservative, endoscopic and surgical treatment of CP, and the prevention of its complications.Conclusion.The implementation of clinical guidelines can contribute to the timely diagnosis and improve the quality of medical care for patients with chronic pancreatitis.

Aim. To optimize the choice of treatment strategies by physicians and gastroenterologists to improve treatment and prevention of small intestinal bacterial overgrowth (SIBO) in adults.Key points. SIBO is a condition characterized by an increased amount and/or abnormal composition of the microbiota in the small intestine. Clinically, the syndrome is manifested by nonspecific gastroenterological complaints and the development of malabsorption syndrome. Most often, SIBO is associated with various chronic non- infectious diseases (both diseases of the gastrointestinal tract, and the cardiovascular system and the neuromuscular apparatus) and can affect the severity of their symptoms. Specific methods for diagnosing SIBO are the culture method and breath tests. The main approaches to the treatment of SIBO include the elimination of the underlying cause of its occurrence, the use of antibacterial drugs and adherence to dietary recommendations (elemental diet).Conclusion. Small intestinal bacterial overgrowth is common in patients with various diseases, but has non-specific manifestations, so proper diagnosis of this condition is required. SIBO therapy involves prescription of antibacterial agents, the most studied of which is the non-absorbable antibiotic rifaximin-α.

Aim. To provide practical recommendations on the use of probiotics for the treatment and prevention of gastroenterological diseases in adults.General provisions. Probiotics are living microorganisms that benefit the health of the host when administered in adequate amounts. The main functions of probiotics include the support for colonisation resistance, the metabolism of food substrates and utilisation of end metabolites, the production of substrates necessary for the macro-organism, as well as the regulation of local and adaptive immune responses. Probiotics can be registered in the Russian Federation as biologically active food additives (BAFA) or as pharmaceutical products (drugs) in accordance with the microbiological standards and legislative requirements of the Russian Federation. The probiotics registered in the Russian Federation as BAFA for adults include bacteria of the Lactobacillus, Bifidobacterium, Enterococcus, Pediococcus, Lactococcus, Streptococcus, Bacillus, and Escherichia genera, and fungi of the Saccharomyces genus; probiotics registered as drugs — bacteria of Lactobid, Lactobacid, Escherichia and Enterococcus genera and fungi of the Saccharomyces genus. Some probiotics registered in the Russian Federation include probiotic strains that have proved to be effective for the prevention and treatment of antibiotic-associated diarrhea, the prevention of C. difficile-associated disease, the eradication of H. pylori infection, as well as for the treatment of irritable bowel syndrome and functional constipation.Conclusions. The clinical efficacy of probiotics depends on the probiotic strains included in their composition and is confirmed by a comparative analysis of the results of appropriate clinical studies. Not all probiotics registered in the Russian Federation as BAFA or drugs contain bacterial or fungal strains; as a result, the expected clinical effect may not be achieved.