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Современные подходы к лечению перекреста функциональных заболеваний желудочно-кишечного тракта
Современные подходы к лечению перекреста функциональных заболеваний желудочно-кишечного тракта
Самсонов А.А., Лобанова Е.Г., Михеева О.М. и др. Современные подходы к лечению перекреста функциональных заболеваний желудочно-кишечного тракта. Consilium Medicum. 2017; 19 (8.2. Гастроэнтерология): 17–26. DOI: 10.26442/2075-1753_19.8.2.17-26
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Аннотация
Цель обзора – отразить современные представления о патогенезе, клинических проявлениях и лечении функциональных заболеваний (ФЗ) желудочно-кишечного тракта (ЖКТ) и их сочетании. ФЗ ЖКТ – группа расстройств пищеварительной системы, характеризующихся изменением висцеральной чувствительности, моторики ЖКТ, ослаблением защитной функции слизистой оболочки, при которых симптомы не связаны с наличием структурных нарушений. Основной причиной развития расстройства принято считать нарушение координации между центральной нервной системой и автономной нервной системой кишечника (gut-brain interaction). Наиболее распространенные ФЗ ЖКТ – функциональная диспепсия (ФД) и синдром раздраженного кишечника (СРК). Согласно Римским критериям IV пересмотра, одной из проблем в лечении ФЗ ЖКТ является развитие синдрома перекреста. Наиболее часто (в 42–87% случаев) наблюдается перекрест СРК и ФД. ФЗ ЖКТ оказывают существенное воздействие на психологический статус и качество жизни пациента, в связи с чем особенное значение имеет эффективная терапия проявлений заболевания. Применение лекарственных средств симптоматического действия – спазмолитических препаратов, препаратов, купирующих запор/диарею, прокинетиков и растительных экстрактов – оказывает временный эффект и не всегда приводит к улучшению состояния пациентов. В качестве новых средств терапии целесообразно рассматривать комплексные препараты патогенетического действия для решения проблемы ФЗ ЖКТ, в частности СРК, ФД и их сочетания у одного пациента. ФЗ ЖКТ – полиэтиологическое заболевание, терапия которого представляет определенную сложность. Использование препарата Колофорт с доказанным действием на разные звенья патогенеза ФЗ ЖКТ позволяет эффективно купировать симптомы СРК и синдрома перекреста, обладает хорошей переносимостью, обеспечивает высокий уровень приверженности пациентов назначенной терапии.
Ключевые слова: синдром раздраженного кишечника, функциональная диспепсия, функциональные заболевания желудочно-кишечного тракта, синдром перекреста.
Key words: irritable bowel syndrome, functional dyspepsia, functional gastrointestinal diseases, overlap syndrome.
Ключевые слова: синдром раздраженного кишечника, функциональная диспепсия, функциональные заболевания желудочно-кишечного тракта, синдром перекреста.
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Key words: irritable bowel syndrome, functional dyspepsia, functional gastrointestinal diseases, overlap syndrome.
Полный текст
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4. Carabotti M, Scirocco A, Maselli MA, Severi C. The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Ann Gastroenterol 2015; 28: 203–2.
5. Kovacic K. Current concepts in functional gastrointestinal disorders. Curr Opin Pediatr 2015; 27 (5): 619–24.
6. De Palma G, Collins SM et al. The microbiota-gut-brain axis in gastrointestinal disorders: stressed bugs, stressed brain or both? J Physiol 2014; 592: 2989–97.
7. Morris-Yates A, Talley NJ, Boyce PM et al. Evidence of a genetic contribution to functional bowel disorder. Am J Gastroenterol 1998; 93: 1311–7.
8. Ивашкин В.Т., Маев И.В., Шептулин А.А. и др. Резолюция Экспертного совета: Как улучшить результаты лечения больных с функциональной диспепсией и синдромом раздраженного кишечника? Рос. журн. гастроэнтерологии, гепатологии, колопроктологии. 2016; 26 (2): 101–4. / Ivashkin V.T., Maev I.V., Sheptulin A.A. et al. The resolution of Advisory council: How to improve treatment results functional dyspepsia and irritable bowel syndrome? Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2016; 26 (2): 101–4. [in Russian]
9. Johanson JF, Kralstein J. Chronic constipation: A survey of the patient perspective. Aliment Pharmacol Ther 2007; 25 (5): 599–608.
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Авторы
А.А.Самсонов1, Е.Г.Лобанова1, О.М.Михеева2*, А.В.Яшина1, А.Г.Аксельрод1
1 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И.Евдокимова» Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1;
2 ГБУЗ «Московский клинический научно-практический центр им. А.С.Логинова» Департамента здравоохранения г. Москвы. 111123, Россия, Москва, ш. Энтузиастов, д. 86
*o.miheeva@mknc.ru
1 A.I.Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1;
2 A.S.Loginov Moscow Clinical Science-Research Center of the Department of Health of Moscow. 111123, Russian Federation, Moscow, sh. Entuziastov, d. 86
*o.miheeva@mknc.ru
1 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И.Евдокимова» Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1;
2 ГБУЗ «Московский клинический научно-практический центр им. А.С.Логинова» Департамента здравоохранения г. Москвы. 111123, Россия, Москва, ш. Энтузиастов, д. 86
*o.miheeva@mknc.ru
________________________________________________
1 A.I.Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1;
2 A.S.Loginov Moscow Clinical Science-Research Center of the Department of Health of Moscow. 111123, Russian Federation, Moscow, sh. Entuziastov, d. 86
*o.miheeva@mknc.ru
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