Trukhan DI, Goloshubina VV. Irritable bowel syndrome: current aspects of etiology, pathogenesis, clinic and treatment: A review. Consilium Medicum. 2022;24(5):297–305. DOI: 10.26442/20751753.2022.5.201861
Синдром раздраженного кишечника: актуальные аспекты этиологии, патогенеза, клиники и лечения
Трухан Д.И., Голошубина В.В. Синдром раздраженного кишечника: актуальные аспекты этиологии, патогенеза, клиники и лечения. Consilium Medicum. 2022;24(5):297–305.
DOI: 10.26442/20751753.2022.5.201861
Trukhan DI, Goloshubina VV. Irritable bowel syndrome: current aspects of etiology, pathogenesis, clinic and treatment: A review. Consilium Medicum. 2022;24(5):297–305. DOI: 10.26442/20751753.2022.5.201861
Среди функциональных гастроинтестинальных расстройств синдром раздраженного кишечника (СРК) по праву продолжает сохранять ведущие позиции. СРК является своеобразным эталоном для понимания патогенетической сути функциональных заболеваний органов пищеварения, поскольку это наиболее распространенная, изученная и изучаемая патология. Так, по запросу «Irritable Bowel Syndrome» в электронной базе PubMed на 30.07.2022 найдено 16 599 источников, а по запросу «синдром раздраженного кишечника» в научной электронной библиотеке eLIBRARY.RU – 6316. В первой части обзора рассматриваются актуальные аспекты этиологии, патогенеза и клиники СРК. Актуальность проблемы СРК связана со значительным снижением качества жизни пациентов. В обзоре сделан акцент на роли психоэмоциональных расстройств, изменений, локализованных на уровне кишечной стенки, а также на роли COVID-19 в развитии СРК. Абдоминальная боль как ведущее проявление СРК связана в первую очередь со спазмом. В этом контексте спазмолитические препараты можно рассматривать не только как симптоматические, но и как средства патогенетической терапии СРК. Во второй части обзора подробно рассмотрены возможности одного из миотропных спазмолитиков в лечении СРК – мебеверина гидрохлорида.
Among functional gastrointestinal disorders, Irritable bowel syndrome (IBS) rightfully continues to maintain its leading position. IBS is a kind of standard for understanding the pathogenetic essence of functional diseases of the digestive system, since it is the most common, studied and studied pathology. So, for the query "Irritable Bowel Syndrome" in the electronic database PubMed – as of July 30, 2022, 16 599 sources were found, and for the query "Irritable Bowel Syndrome" in the scientific electronic library eLIBRARY.RU – 6316. The first part of the review deals with topical aspects of the etiology, pathogenesis and clinical presentation of IBS. The urgency of the problem of IBS is associated with a significant decrease in the quality of life of patients. The review focuses on the role of psycho-emotional disorders, changes localized at the level of the intestinal wall; and a new coronavirus infection COVID-19 in the development of IBS. Abdominal pain as the leading manifestation of IBS is associated primarily with spasm. In this context, antispasmodic drugs can be considered not only as symptomatic agents, but also as pathogenetic therapy for IBS. In the second part of the review, the possibilities of one of the myotropic antispasmodics, mebeverine hydrochloride, in the treatment of IBS are considered in detail.
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63. Lee KJ, Kim NY, Kwon JK, et al. Efficacy of ramosetron in the treatment of male patients with irritable bowel syndrome with diarrhea: a multicenter, randomized clinical trial, compared with mebeverine. Neurogastroenterol Motil. 2011;23(12):1098-104. DOI:10.1111/j.1365-2982.2011.01771.x
64. Hou X, Chen S, Zhang Y, et al. Quality of life in patients with Irritable Bowel Syndrome (IBS), assessed using the IBS-Quality of Life (IBS-QOL) measure after 4 and 8 weeks of treatment with mebeverine hydrochloride or pinaverium bromide: results of an international prospective observational cohort study in Poland, Egypt, Mexico and China. Clin Drug Investig. 2014;34(11):783-93. DOI:10.1007/s40261-014-0233-y
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67. Poynard T, Naveau S, Mory B, Chaput JC. Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 1994;8(5):499-510. DOI:10.1111/j.1365-2036.1994.tb00322.x
68. Boisson J, Coudert P, Dupuis J, et al. Tolérance de la mébévérine à long terme. Act Ther. 1987;16(4):289-92.
69. Iwase M, Nishimura Y, Kurata N, et al. Inhibitory Effects of Gastrointestinal Drugs on CYP Activities in Human Liver Microsomes. Biol Pharm Bull. 2017;40(10):1654-60. DOI:10.1248/bpb.b17-00118
70. Schiariti M, Saladini A, Placanica A, et al. QT Interval Prolongation and Atypical Proarrhythmia: Monomorphic Ventricular Tachycardia with Trimebutine. Open Pharmacol J. 2009;3:32-6. DOI:10.2174/1874143600903010032
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72. Dumitrascu DL, Chira A, Bataga S, et al. Romanian Society of Neurogastroenterology. The use of mebeverine in irritable bowel syndrome. A Position paper of the Romanian Society of Neurogastroenterology based on evidence. J Gastrointestin Liver Dis. 2014;23(4):431-5. DOI:10.15403/jgld.2014.1121.234.mibs
73. Полунина Т.Е. Синдром раздраженного кишечника и патология билиарного тракта. Клинический разбор. Медицинский Совет. 2020;(15):28-38 [Polunina TE. Irritable bowel syndrome and biliary tract pathology. Clinical analysis. Meditsinskiy sovet=Medical Council. 2020;(15):28-38 (in Russian)]. DOI:10.21518/2079-701X-2020-15-28-38
74. Connell AM. Physiological and clinical assessment of the effect of the musculotropic agent mebeverine on the human colon. Br Med J. 1965;2(5466):848-51. DOI:10.1136/bmj.2.5466.848
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77. Тарасова Л.В., Трухан Д.И. Лекарственная безопасность в гастроэнтерологии. Экспериментальная и клиническая гастроэнтерология. 2013;4:81-7 [Tarasova LV, Trukhan DI. Lekarstvennaia bezopasnost' v gastroenterologii. Eksperimental'naia i klinicheskaia gastroenterologiia. 2013;4:81-7 (in Russian)].
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79. Беккер Р.А., Быков Ю.В. Эглонил®: замечательное триединство – атипичный антипсихотик, психосоматический препарат и антидепрессант. К 50-летию создания препарата. Психиатрия и психофармакотерапия. 2019;21(6):32-40 [Bekker RA, Bykov YuV. Eglonil®: a wonderful trinity – an atypical antipsychotic, a psychosomatic drug and an antidepressant. To the 50th anniversary of the start of its clinical use. Psychiatry and Psychopharmacotherapy. 2019;21(6):32-40 (in Russian)].
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66. Stockis A, Guelen PJ, de Vos D. Identification of mebeverine acid as the main circulating metabolite of mebeverine in man. J Pharm Biomed Anal. 2002;29(1-2):335-40. DOI:10.1016/s0731-7085(02)00023-7
67. Poynard T, Naveau S, Mory B, Chaput JC. Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 1994;8(5):499-510. DOI:10.1111/j.1365-2036.1994.tb00322.x
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73. Polunina TE. Irritable bowel syndrome and biliary tract pathology. Clinical analysis. Meditsinskiy sovet=Medical Council. 2020;(15):28-38 (in Russian).
DOI:10.21518/2079-701X-2020-15-28-38
74. Connell AM. Physiological and clinical assessment of the effect of the musculotropic agent mebeverine on the human colon. Br Med J. 1965;2(5466):848-51. DOI:10.1136/bmj.2.5466.848
75. Trukhan DI. Originaly i generiki: perezagruzka v svete ekonomicheskogo krizisa. Spravochnik poliklinicheskogo vracha. 2012;4:32-6 (in Russian).
76. Trukhan DI. Ratsional'naia farmakoterapiia v gastroenterologii. Spravochnik poliklinicheskogo vracha. 2012;10:18-24 (in Russian).
77. Tarasova LV, Trukhan DI. Lekarstvennaia bezopasnost' v gastroenterologii. Eksperimental'naia i klinicheskaia gastroenterologiia. 2013;4:81-7 (in Russian).
78. Trukhan DI, Tarasova LV. Lekarstvennaia bezopasnost' i ratsional'naia farmakoterapiia v gastroenterologicheskoi praktike. Klinicheskie perspektivy gastroenterologii, gepatologii. 2013;5:9-16 (in Russian).
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Авторы
Д.И. Трухан*, В.В. Голошубина
ФГБОУ ВО «Омский государственный медицинский университет» Минздрава России, Омск, Россия
*dmitry_trukhan@mail.ru