Роль желчных кислот в патогенезе функциональной диспепсии: незаполненная терапевтическая ниша
Роль желчных кислот в патогенезе функциональной диспепсии: незаполненная терапевтическая ниша
Кучерявый Ю.А., Андреев Д.Н., Андреев Н.Г. Роль желчных кислот в патогенезе функциональной диспепсии: незаполненная терапевтическая ниша. Consilium Medicum. 2020; 22 (8): 46–50. DOI: 10.26442/20751753.2020.8.200400
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Kucheryavyy Y.A., Andreev D.N., Andreev N.G. The role of bile acids in the pathogenesis of functional dyspepsia: an unfilled therapeutic niche. Consilium Medicum. 2020; 22 (8): 46–50. DOI: 10.26442/20751753.2020.8.200400
Роль желчных кислот в патогенезе функциональной диспепсии: незаполненная терапевтическая ниша
Кучерявый Ю.А., Андреев Д.Н., Андреев Н.Г. Роль желчных кислот в патогенезе функциональной диспепсии: незаполненная терапевтическая ниша. Consilium Medicum. 2020; 22 (8): 46–50. DOI: 10.26442/20751753.2020.8.200400
________________________________________________
Kucheryavyy Y.A., Andreev D.N., Andreev N.G. The role of bile acids in the pathogenesis of functional dyspepsia: an unfilled therapeutic niche. Consilium Medicum. 2020; 22 (8): 46–50. DOI: 10.26442/20751753.2020.8.200400
На настоящий момент этиопатогенез функциональной диспепсии (ФД) рассматривается как сложный многогранный и мозаичный процесс, причинно-следственные связи которого продолжают активно изучаться. Предполагается, что генез моторных и сенситивных нарушений желудка, свойственных для ФД, может заключаться в комплексных механизмах, базирующихся на изменениях качественного и количественного состава микрофлоры желудка и тонкой кишки под воздействием нарушений моторики нижележащих отделов желудочно-кишечного тракта и изменения композиции и времени экспозиции компонентов желчи в полости тонкой кишки и желудка. Последующая альтерация барьерной функции эпителия слизистой оболочки с активацией эффекторных резидентных иммунокомпетентных клеток (тучные клетки, эозинофилы) в собственной пластинке слизистой индуцирует формирование висцеральной гиперчувствительности и/или моторно-тонических нарушений гастродуоденальной зоны. Теоретическая база перспектив применения препаратов урсодезоксихолевой кислоты при ФД подчеркивается не только частой ассоциацией ФД с билиарными расстройствами, но и данными недавних контролируемых исследований.
Currently, the etiopathogenesis of functional dyspepsia (FD) is considered as a complex multifaceted and mosaic process, the cause-and-effect relationships of which are being actively studied. It is assumed that the genesis of FD-associated motor and sensory disorders of the stomach may involve complex mechanisms based on qualitative and quantitative changes in the composition of stomach and small intestine microflora caused by alterations in the motility of the lower parts of the gastrointestinal tract as well as changes in the composition and exposure time of bile components in the small intestine and stomach. Following alteration in the barrier function of the mucosal epithelium with the activation of effector resident immunocompetent cells (mast cells, eosinophils) in the lamina propria induces visceral hypersensitivity and/or motor-tonic disorders of the gastroduodenal region. The theoretical basis of the prospects for the use of ursodeoxycholic acid drugs in FD is emphasized not only by the frequent association of FD with biliary disorders, but also by data from recent controlled studies.
Key words: dyspepsia, functional dyspepsia, microbiota, bacterial overgrowth syndrome, functional disorder of the gallbladder, ursodeoxycholic acid.
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1. Andreev D.N., Zaborovskii A.V., Trukhmanov A.S. et al. Evoliutsiia predstavlenii o funktsional'nykh zabolevaniiakh zheludochno-kishechnogo trakta v svete Rimskikh kriteriev IV peresmotra (2016 g.). RZhGGK. 2017; 1: 4–11 (in Russian).
2. Maev I.V., Andreev D.N., Kucheryavyy Yu.A. Functional dyspepsia. Moscow: Remedium, 2019 (in Russian).
3. Mahadeva S, Ford AC. Clinical and epidemiological differences in functional dyspepsia between the East and the West. Neurogastroenterol Motil 2016; 28 (2): 167–74.
4. Stanghellini V, Chan FK, Hasler WL et al. Gastroduodenal Disorders. Gastroenterology 2016; 150 (6): 1380–92.
5. Maev I.V., Andreev D.N., Kucheriavyy Iu.A. et al. Sovremennye predstavleniia o patofiziologicheskikh osnovakh sindroma funktsional'noi dispepsii. RZhGGK. 2015; 4: 15–22 (in Russian).
6. Vanheel H, Farré R. Changes in gastrointestinal tract function and structure in functional dyspepsia. Nat Rev Gastroenterol Hepatol 2013; 10 (3): 142–9.
7. Miwa H, Watari J, Fukui H et al. Current understanding of pathogenesis of functional dyspepsia. J Gastroenterol Hepatol 2011; 26 (Suppl. 3): 53–60.
8. Kucheriavyy Iu.A., Andreev D.N. Klinicheskie i patogeneticheskie paralleli funktsional'noi dispepsii i sindroma izbytochnogo bakterial'nogo rosta v tonkoi kishke. Effektivnaia farmakoterapiia. 2020; 16 (24): 40–4. DOI: 10.33978/2307-3586-2020-16-24-40-44 (in Russian).
9. Miyatani H, Mashima H, Sekine M, Matsumoto S. Clinical course of biliary-type sphincter of Oddi dysfunction: endoscopic sphincterotomy and functional dyspepsia as affecting factors. Ther Adv Gastrointest Endosc 2019; 12: 2631774519867184. doi: 10.1177/2631774519867184
10. Ford AC, Marwaha A, Lim A, Moayyedi P. Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia. Clin Gastroenterol Hepatol 2010; 8: 401–9.
11. Chojnacki CJ, Konrad P, Błońska A et al. Usefulness of the hydrogen breath test in patients with functional dyspepsia. Gastroenterol Rev 2020; 15. DOI: 10.5114/pg.2020.92690
12. Pimentel M, Saad RJ, Long MD, Rao SSC. ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth. Am J Gastroenterol 2020; 115 (2): 165–78. DOI: 10.14309/ajg.0000000000000501
13. Costa MB, Azeredo IL, Marciano RD et al. Evaluation of small intestine bacterial overgrowth in patients with functional dyspepsia through H2 breath test. Arq Gastroenterol 2012; 49 (4): 279–83. DOI: 10.1590/s0004-28032012000400009
14. Ramanathan S, Karunakaran P, Shaikh Mohamed K et al. A study on the role of small intestinal bacterial overgrowth in patients with functional dyspepsia. IAIM 2017; 4 (5): 88–97.
15. Petzold G, Amanzada A, Gress TM et al . High Prevalence of Pathological Hydrogen Breath Tests in Patients with Functional Dyspepsia. Digestion 2019; 100 (3): 186–91. DOI: 10.1159/000494718
16. Nojkov B, Baker J, Watts L et al. Small Intestinal Bacterial Overgrowth (SIBO) in Functional Dyspepsia (FD): Does Dyspeptic Symptom Pattern Make a Difference? Am J Gastroenterol 2019; 114: S293–S294. DOI: 10.14309/01.ajg.0000591544.75510.8d
17. Adriana B, Antonio B, Matthew D et al. Gastric Fermentation in Functional Dyspepsia. Gastroenterol Hepatol Int J 2019; 4 (1). DOI: 10.23880/ghij-16000145
18. Shimura S, Ishimura N, Mikami H et al. Small Intestinal Bacterial Overgrowth in Patients with Refractory Functional Gastrointestinal Disorders. J Neurogastroenterol Motil 2016; 22 (1): 60–8. DOI: 10.5056/jnm15116
19. Losurdo G, Salvatore D'Abramo F, Indellicati G et al. The Influence of Small Intestinal Bacterial Overgrowth in Digestive and Extra-Intestinal Disorders. Int J Mol Sci 2020; 21 (10): 3531. DOI: 10.3390/ijms21103531
20. Tziatzios G, Giamarellos-Bourboulis EJ, Papanikolaou IS et al. Is small intestinal bacterial overgrowth involved in the pathogenesis of functional dyspepsia? Med Hypotheses 2017; 106: 26–32. DOI: 10.1016/j.mehy.2017.07.005
21. Andreev D.N. The role of alterations in permeability of the intestinal mucosa in the genesis of functional gastrointestinal disorders. Consilium Medicum. 2019; 21 (8): 29–34. DOI: 10.26442/20751753.2019.8.190539 (in Russian).
22. Andreev D.N., Dicheva D.T. A breach in the intestinal permeability as a factor of etiopathogenesis of functional gastrointestinal diseases. Medical Council. 2020; 5: 87–95. DOI: 10.21518/2079-701X-2020-5-87-95 (in Russian).
23. Farré R, Vicario M. Abnormal Barrier Function in Gastrointestinal Disorders. Handb Exp Pharmacol 2017; 239: 193–17. DOI: 10.1007/164_2016_107
24. Du L, Shen J, Kim JJ et al. Impact of gluten consumption in patients with functional dyspepsia: A case-control study. J Gastroenterol Hepatol 2018; 33 (1): 128–33. DOI: 10.1111/jgh.13813
25. Vanheel H, Vicario M, Vanuytsel T et al. Impaired duodenal mucosal integrity and low-grade inflammation in functional dyspepsia. Gut 2014; 63 (2): 262–71.
26. Du L, Chen B, Kim JJ et al. Micro-inflammation in functional dyspepsia: A systematic review and meta-analysis. Neurogastroenterol Motil 2018; 30 (4): e13304. DOI: 10.1111/nmo.13304
27. Miwa H, Oshima T, Tomita T et al. Recent understanding of the pathophysiology of functional dyspepsia: role of the duodenum as the pathogenic center. J Gastroenterol 2019; 54 (4): 305–11. doi: 10.1007/s00535-019-01550-4
28. Van den Bossche L, Hindryckx P, Devisscher L et al. Ursodeoxycholic Acid and Its Taurine- or Glycine-Conjugated Species Reduce Colitogenic Dysbiosis and Equally Suppress Experimental Colitis in Mice. Appl Environ Microbiol 2017; 83 (7): e02766–16. DOI: 10.1128/AEM.02766-16
29. Wang W, Zhao J, Gui W et al. Tauroursodeoxycholic acid inhibits intestinal inflammation and barrier disruption in mice with non-alcoholic fatty liver disease. Br J Pharmacol 2018; 175 (3): 469–4. DOI: 10.1111/bph.14095
30. Szadkowski K, Romanowski M, Chojnacki C. The diagnostic value of 24-hour bile reflux monitoring in patients with functional dyspepsia. Pol Merkur Lekarski 2009; 26 (155): 378–81. PMID: 19606678.
31. Igarashi M, Nakae H, Matsuoka T et al. Alteration in the gastric microbiota and its restoration by probiotics in patients with functional dyspepsia. BMJ Open Gastroenterol 2017; 4 (1): e000144.
32. Fukui A, Takagi T, Naito Y et al. Higher Levels of Streptococcus in Upper Gastrointestinal Mucosa Associated with Symptoms in Patients with Functional Dyspepsia. Digestion 2020; 101 (1): 38–45. DOI: 10.1159/000504090
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Авторы
Ю.А. Кучерявый, Д.Н. Андреев*, Н.Г. Андреев
ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия
*dna-mit8@mail.ru
________________________________________________
Yury A. Kucheryavyy, Dmitrii N. Andreev*, Nikolai G. Andreev
Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
*dna-mit8@mail.ru