Энтеропатия с нарушением мембранного пищеварения и ребамипид
Энтеропатия с нарушением мембранного пищеварения и ребамипид
Парфенов А.И., Быкова С.В., Сабельникова Е.А. и др. Энтеропатия с нарушением мембранного пищеварения и ребамипид. Consilium Medicum. 2019; 21 (8): 49–57. DOI: 10.26442/20751753.2019.8.190504
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Parfenov A.I., Bykova S.V., Sabelnikova E.A. et al. Enteropathy with impaired membrane digestion and rebamipide. Consilium Medicum. 2019; 21 (8): 49–57. DOI: 10.26442/20751753.2019.8.190504
Энтеропатия с нарушением мембранного пищеварения и ребамипид
Парфенов А.И., Быкова С.В., Сабельникова Е.А. и др. Энтеропатия с нарушением мембранного пищеварения и ребамипид. Consilium Medicum. 2019; 21 (8): 49–57. DOI: 10.26442/20751753.2019.8.190504
________________________________________________
Parfenov A.I., Bykova S.V., Sabelnikova E.A. et al. Enteropathy with impaired membrane digestion and rebamipide. Consilium Medicum. 2019; 21 (8): 49–57. DOI: 10.26442/20751753.2019.8.190504
В статье описана энтеропатия с нарушением мембранного пищеварения (ЭНМП). В ее основе лежит снижение активности дисахаридаз и других мембранных ферментов слизистой оболочки тонкой кишки (СОТК). Причиной могут быть генетически детерминированные и приобретенные повреждения энтероцитов. Клинические симптомы ЭНМП связаны с пищевыми интолерантностями (боли и дискомфорт в животе, нарушения стула, метеоризм). Диагностика основана на биохимическом исследовании ферментов в СОТК. Дифференциальный диагноз следует проводить с функциональными заболеваниями кишечника, среди которых ЭНМП встречается особенно часто. Основу лечения составляют диеты с ограничением плохо переносимых продуктов, цитопротектор ребамипид, повышающий активность ферментов, и кишечные антисептики, подавляющие рост бактерий в тонкой кишке.
The article describes enteropathy with membrane digestion disturbance (EMDD). At the basis of the disorder underlies a decrease of disaccharides and other membrane enzymes of small intestine mucous membrane (SIMM) activity. It can be caused by genetically determined and acquired enterocyte damage. EMDD clinical symptoms are presented with alimentary intolerances (stomach discomfort and pain, stool disturbances, and bloating). The diagnosis is based on SIMM enzymes biochemical study. Differential diagnosis should be performed between intestinal tract functional disorders, among which EMDD occurs frequently. The treatment is based at dieting with limitation of badly tolerated foods, the use of cytoprotector rebamipide that increases enzymes activity and intestinal antiseptics that inhibit bacteria growth in small intestine.
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[Parfenov A.I., Akhmadullina O.V., Sabel'nikova E.A. et al. Disakharidaznaia nedostatochnost' i funktsional'nye zabolevaniia kishechnika.Therapeutic Archive. 2017; 89 (4): 45–52 (in Russian).]
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[Parfenov A.I., Belostotskii N.I., Khomeriki, S.G. et al. Rebamipid povyshaet aktivnost' disakharidaz u bol'nykh enteropatiei s narusheniem membrannogo pishchevareniia. Pilotnoe issledovanie. Therapeutic Archive. 2019; 91 (2): 25–31 (in Russian).]
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22. Trinder P. Depermination of glucosa in blood using glucosa oxidase with an alternative oxigen reception. J Ann Clin Biochem 1969; 6: 24–7.
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[Parfenov A.I., Akhmadullina O.V., Sabel'nikova E.A. et al. Disakharidaznaia nedostatochnost' i funktsional'nye zabolevaniia kishechnika. Therapeutic Archive. 2017; 89 (4): 45–52 (in Russian).]
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32. Min H, Kim J, Lee S et al. Rebamipide prevents peripheral arthritis and intestinal inflammation by reciprocally regulating Th17/Treg cell imbalance in mice with curdlan-induced spondyloarthritis. J Transl Med 2016; 14: 190. DOI 10.1186/s12967-016-0942-5
________________________________________________
1. Ensari A, Мarsh M. Exploring the villus. Gastroenterol Hepatol Bed Bench 2018; 11 (3): 181–90.
2. Helander HF, Fändriks L. Surface area of the digestive tract–revisited. Scand J Gastroenterol 2014; 49 (6): 681–9.
3. Torrente F, Ashwood P, Day R et al. Small intestinal enteropathy with epithelial IgG and complement deposition in children with regressive autism. Mol Psychiatry 2002; 7: 375–82.
4. Williams BL, Hornig M, Buie T et al. Impaired Carbohydrate Digestion and Transport and Mucosal Dysbiosis in the Intestines of Children with Autism and Gastrointestinal Disturbances. PLoS One 2011; 6 (9): e24585. DOI: 1371/journal.pone.0024585
5. König J, Wells J, Cani P et al. Human Intestinal Barrier Function in Health and Disease. Clin Translation Gastroenterol 2016; 7: e196.
6. https://meduniver.com/Medical/Physiology/funkcii_plotnix_kontaktov_kishechnika.html MedUniver
7. Oshima T, Miwa H. Gastrointestinal mucosal barrier function and diseases. J Gastroenterol 2016; 51 (8): 768–78.
8. Safonova E.A., Parfenov A.I., Mazo V.K. et al. Sravnitel'naia otsenka narushenii pronitsaemosti kishechnika pri organicheskikh i funktsional'nykh zabolevaniiakh. Ros. gastroenterologicheskii zhurn. 2000; 4: 145–9 (in Russian).
9. Bertiaux-Vandaële N. The expression and the cellular distribution of the tight junction proteins are altered in irritable bowel syndrome patients with differences according to the disease subtype. Am J Gastroenterol 2011; 106 (12): 2165–73.
10. Martínez C et al. The Jejunum of Diarrhea-Predominant Irritable Bowel Syndrome Shows Molecular Alterations in the Tight Junction Signaling Pathway That Are Associated With Mucosal Pathobiology and Clinical Manifestations. Am J Gastroenterol 2012; 107 (5): 736–46.
11. Farré R, Vicario M. Abnormal Barrier Function in Gastrointestinal Disorders. Hand Exp Pharmacol 2017; 239: 193–217.
12. Parfenov A.I. Enteropathy with impaired membrane digestion. Moscow: Medkongress, 2019; 208 p. (in Russian).
13. Parfenov A.I., Ruchkina I.N., Ataullakhanov R.I., Belaia O.F. Postinfektsionnyi sindrom razdrazhennogo kishechnika. Therapeutic Archive. 2009; 81 (2): 39–45 (in Russian).
14. Parfenov A.I., Akhmadullina O.V., Sabel'nikova E.A. et al. Disakharidaznaia nedostatochnost' i funktsional'nye zabolevaniia kishechnika.Therapeutic Archive. 2017; 89 (4): 45–52 (in Russian).
15. Frol'kis A.V. Enteric insufficiency. Moscow: Nauka, 1989 (in Russian).
16. Metel'skii S.T. Transport processes and membrane digestion in the mucous membrane of the small intestine. Electrophysiological model. Moscow: Anakharsis, 2007 (in Russian).
17. Popov V.A. Membrane digestion in surgical pathology. Moscow: Meditsina, 1982 (in Russian).
18. Bogomolov P.O., Eremina E.Iu, Timofeeva N.M. et al. Aktivnost' pishchevaritel'nykh fermentov v bioptatakh tonkoi kishki pri patologii ZhKT. RZhGGK. 1996; 5 (3): 87–8 (in Russian).
19. Parfenov A.I., Sabel'nikova E.A., Belostotskii N.I. et al. Aktivnost' karbogidraz kak marker vosstanovleniia slizistoi obolochki tonkoi kishki u bol'nykh tseliakiei. Therapeutic Archive. 2015; 87 (2): 24–9 (in Russian).
20. Parfenov A.I., Belostotskii N.I., Khomeriki, S.G. et al. Rebamipid povyshaet aktivnost' disakharidaz u bol'nykh enteropatiei s narusheniem membrannogo pishchevareniia. Pilotnoe issledovanie. Therapeutic Archive. 2019; 91 (2): 25–31 (in Russian).
21. Dahlqvist A. Specificity of the human intestinal disaccharidases and implications for hereditary disaccharide intolerance. J Clin Investig 1962; 41: 3–8.
22. Trinder P. Depermination of glucosa in blood using glucosa oxidase with an alternative oxigen reception. J Ann Clin Biochem 1969; 6: 24–7.
23. Parfenov A.I., Akhmadullina O.V., Sabel'nikova E.A. et al. Disakharidaznaia nedostatochnost' i funktsional'nye zabolevaniia kishechnika. Therapeutic Archive. 2017; 89 (4): 45–52 (in Russian).
24. Staudacher HM, Whelan K, Irving PM, Lomer MC. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutrition Dietet 2011; 24: 487–95. DOI: 10.1111/j.1365-277X.2011.01162.x
25. Parfenov A.I., Belostotskii N.I., Dbar S.R. et al. Enteropatiia s narusheniem membrannogo pishchevareniia. Effektivnaia farmakoterapiia. Gastroenterologiia. 2018; 16: 20–7 (in Russian).
26. Arakawa T, Kobayashi K, Yoshikawa T et al. Rebamipide: overview of its mechanisms of action and efficacy in mucosal protection and ulcer healing. Dig Dis Sci 1998; 43: 5S–13S.
27. Tarnawski A, ArakawaT, Kobayashi K. Rebamipide treatment activates epidermal growth factor and its receptor expression in normal and ulcerated gastric mucosa in rats: one mechanism for its ulcer healing action? Dig Dis Sci 1998; 43 (Suppl.): 90S–98S.
28. Tarnawski AS, Chai J, Pai R, Chiou SK. Rebamipide activates gene encoding angiogenic growth factors and COX2 and stimulates angiogenesis: a key to its ulcer healing action? Dig Dis Sci 2004; 49 (2): 202–9.
29. Koyama N, Sasabe H, Miyamoto G. Involvement of cytochrome P450 in the metabolism of rebamipide by the human liver. Xenobiotica 2002; 32: 573–86.
30. Maev I.V., Kaziulin A.N. Novye vozmozhnosti profilaktiki raka zheludka. Therapeutic Archive. 2017; 89 (4): 101–9 (in Russian).
31. Makiyama K, Takeshima F, Kawasaki H, Zea-Iriarte WL. Antiinflammatory effect of rebamipide enema on proctitis type ulcerative colitis: a novel therapeutic alternative. Am J Gastroenterol 2000; 95: 1838–9.
32. Min H, Kim J, Lee S et al. Rebamipide prevents peripheral arthritis and intestinal inflammation by reciprocally regulating Th17/Treg cell imbalance in mice with curdlan-induced spondyloarthritis. J Transl Med 2016; 14: 190. DOI 10.1186/s12967-016-0942-5
ГБУЗ «Московский клинический научный центр им. А.С. Логинова» Департамента здравоохранения г. Москвы, Москва, Россия
*asfold@mail.ru
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Asfold I. Parfenov*, Svetlana V. Bykova, Elena A. Sabelnikova, Nikolai I. Belostotskii, Sergei G. Khomeriki, Olga V. Akhmadullina, M.Iu. Zviaglova, Saria R. Dbar
Loginov Moscow Clinical Scientific Center, Moscow, Russia
*asfold@mail.ru