Eating Habits, Anxiety and Depression in Patients with Irritable Bowel Syndrome: Clinical and Laboratory Comparisons

Aim: to assess the level of stress hormones (cortisol in saliva), neurotransmitters (serotonin in blood serum, dopamine in blood plasma) in relation to eating habits, anxiety and depression levels in patients with IBS.Materials and methods. An open cohort prospective study was conducted with the inclusion of 263 patients with an established diagnosis of IBS, among them 189 (71.9 %) women and 74 (28.1 %) men. The average age of patients with IBS was 29 [25; 35] years. The control group included 40 healthy volunteers. All individuals included in the study were assessed for diet and eating habits using the WHO CINDI program questionnaire, “Information on Nutrition and Eating Behavior”, the severity of anxiety and depression according to the HADS questionnaire, the level of specific anxiety in relation to gastrointestinal symptoms according to the VSI questionnaire, quality of life according to the IBS-QoL questionnaire. In addition, the enzyme immunoassay method was used to assess the levels of cortisol in the morning and evening portions of saliva, serotonin in the blood serum and dopamine in the blood plasma.Results. Among patients with IBS there is a statistically significantly higher level of cortisol in the morning and evening portions of saliva (U = 19.5, p < 0.001 and U = 111.5, p < 0.001, respectively), serotonin in blood serum (U = 269.0, p = 0.042) and lower plasma dopamine levels (U = 93.5, p = 0.0002) compared with controls. The mean salivary cortisol level among patients with IBS was 45.39 [29.86; 70.10] ng/ml in the morning and 19.21 [13.98; 23.50] ng/ml in the evening, while in the group of healthy individuals it was 19.0 [16.5; 21.7] and 9.7 [8.5; 10.5] ng/ml, respectively. The average content of serotonin in blood serum in patients with IBS was 188.78 [150.41; 230.32] ng/ml, among healthy individuals — 142.80 [130.52; 154.15] ng/ml. The average content of dopamine in blood plasma in patients with IBS was 28.83 [20.08; 41.54] ng/ml, in healthy individuals — 58.20 [48.15; 66.62] ng/ml.Conclusion. In patients with IBS the secretion of the stress hormone (cortisol) and neurotransmitters (serotonin, dopamine) is closely related to the nature of nutrition, the level of anxiety and depression, and is also associated with the clinical variant and severity of the course of the disease

The Role of the Microbiome and Intestinal Mucosal Barrier in the Development and Progression of Non-Alcoholic Fatty Liver Disease

Aim. To review available data on the role of the microbiome and intestinal mucosal barrier in the development and progression of non-alcoholic fatty liver disease (NAFLD).Key points. The role of the human microbiome in the development and progression of NAFLD is associated with its effects on the risk factors (obesity, insulin resistance, type 2 diabetes), permeability of the intestinal barrier and absorption of such substances as short-chain fatty acids, bile acids, choline and endogenous ethanol. Liver fibrosis constitutes the leading factor determining the prognosis of patients in NAFLD, including cases associated with cardiovascular complications. Changes in the microbiome composition were demonstrated for various degrees of fibrosis in NAFLD.Conclusion. The results of modern studies confirm the formation of a new concept in the pathophysiology of NAFLD, which encourages the development of new therapeutic strategies

Факторы патогенеза язвенного колита: мейнстрим-2020

 The causes of ulcerative colitis are still unknown. Scientists made important  advances in understanding the pathogenesis of this disease in the 21st century.  Complex involvement of an impaired immune response in relation to antigens  of the intestinal microbiota in genetically predisposed individuals under the  influence of certain environmental factors was revealed. The factors that disrupt  the epithelial barrier and alter the composition of the intestinal  microbiota trigger the onset of the disease, thereby stimulating an impaired  immune response. Recent studies have discovered completely new hypotheses  of its origin and development, gradually interpreting the already known pathogenetic mechanisms of the disease. In this review, we focused on the new concepts in the pathogenesis of ulcerative colitis. We examined genetic, environmental, barrier, and microbial factors. We went into detail on the structure and role of the epithelial barrier, identified specific genes that are  involved in the regulation of the intestinal epithelial barrier function in ulcerative  colitis. We studied the literature containing information on relevant  studies in PubMed and Google Scholar citation systems, using such key words  as ulcerative colitis, colon microbiota, barrier function, genetic predisposition, and predisposing factors.  Причины возникновения язвенного колита до сих пор неизвестны. Значительные успехи в понимании патогенеза этого заболевания достигнуты в ХХI в. и доказывают комплексное участие нарушенного иммунного ответа по отношению к антигенам собственной кишечной  микрофлоры у генетически предрасположенных лиц под воздействием определенных факторов внешней среды.  Дебют заболевания провоцируется факторами, которые  нарушают эпителиальный барьер и изменяют состав  микробиоты кишечника, тем самым стимулируя аномальный иммунный ответ. Исследования последних лет открывают как абсолютно новые гипотезы его возникновения и развития, так и подробно  расшифровывают уже известные механизмы патогенеза  болезни. В представленном обзоре мы сосредоточились на  новых концепциях патогенеза язвенного колита –  генетических, экологических, барьерных и микробиомных  факторах. Подробно представили строение и роль эпителиального барьера, обозначили специфические гены, которые участвуют в регуляции барьерной функции эпителия кишечника при язвенном колите. Поиск  литературы, содержащей информацию о соответствующих  исследованиях, проводился в системах PubMed и Google  Scholar по следующим ключевым словам: язвенный колит, микробиота толстой кишки, барьерная функция,  генетическая предрасположенность, предрасполагающие  факторы.

Язвенный колит: в фокусе резистентность слизистой оболочки толстой кишки

In recent decades, following cooperation between scientists in various specialties, new unique data on the pathogenesis of ulcerative colitis have been obtained. The role of an impaired immune response to antigens of gut microbiota in genetically predisposed individuals under the effect of certain environmental factors was proven. Assessing the interaction between the colonic mucosa and gut microbiota will help to understand the mechanisms of ulcerative colitis and develop new treatment strategies for the disease.This review presents modern views on the pathogenesis of ulcerative colitis with a focus on the imbalance between local protective and aggressive factors of the gastric and intestinal mucosa. The structure and role of the epithelial barrier both under normal conditions and in ulcerative colitis are considered in detail.The aim of this review was to summarize the data on resistance of the colonic mucosa and its damage in ulcerative colitis.В результате кооперации ученых различных специальностей в последние десятилетия получены новые уникальные данные о патогенезе язвенного колита, доказано участие нарушенного иммунного ответа по отношению к антигенам собственной кишечной микрофлоры у генетически предрасположенных лиц под воздействием определенных факторов внешней среды. Оценка взаимодействия слизистой оболочки толстой кишки и микробиоты кишечника поможет понять механизмы развития язвенного колита и разработать новые стратегии лечения.В обзоре мы представляем современные взгляды на патогенез язвенного колита, сосредоточив внимание на нарушении равновесия между местными факторами защиты и агрессии слизистой оболочки желудочно-кишечного тракта. Подробно рассматриваем строение и роль эпителиального барьера как в норме, так и при язвенном колите.Целью обзора является обобщение данных литературы о резистентности слизистой оболочки толстой кишки и ее повреждении при язвенном колите

Issues of diagnostics and treatment of abdominal pain at irritable bowel syndrome at outpatient stage of the healthcare

The aim of review. To present the diagnostic and treatment algorithm for abdominal pain at out-patient/ polyclinic healthcare institutions and to demonstrate potential of hyoscine butylbromide application during diagnostic process and for relief of abdominal pain at irritable bowel syndrome.Summary. From 20% to 50% of all admissions to medical institutions are related to abdominal spasms and pain caused by irritable bowel syndrome (IBS). According to the Clinical guidelines of the Russian gastroenterological association and abdominal pain management algorithm at outpatient reception, the doctor on the basis of interviewing, inspection and physical data first of all should exclude acute abdominal diseases (acute pain, parietal pain) requiring urgent examination by the surgeon or gynecologist and subsequent hospitalization. In the case of visceral pain the minimal range of laboratory and instrumental tests is indicated. If the history of visceral pain is more than 6 months and there are no alarm symptoms, doctor should define specific features of clinical presentation already during outpatient visit, taking into account pain location, that provides formulation of preliminary diagnosis. Epigastric pain (dyspepsia), biliary pain, abdominal pain which can be accompanied by impaired frequency and consistency of stool determine the further investigation plan. Implementation of diagnostic algorithm allows to distinguish the organic disease or to establishthe diagnosis of functional disease. Hyoscine butylbromide at short-term treatment will relieve abdominal spasm as a symptomatic agent. Course treatment effectively reduces intensity and frequency of abdominal pain at IBS. The rate of adverse events and tolerability of hyoscine butylbromide are comparable to that of placebo.Conclusion. Symptomatic treatment by antispasmodic drugs is justified from the moment of referral for medical aid to outpatient department. Hyoscine butylbromide can be prescribed for relief of acute and chronic pain at any stage of diagnostic process. Course intake of antispasmodics has proved its efficacy for pain relief at IBS

Cardiovascular Diseases and Non-Alcoholic Fatty Liver Disease: Relationship and Pathogenetic Aspects of Pharmacotherapy

The association of non-alcoholic fatty liver disease (NAFLD) and cardiovascular risk is currently one of the actively studied areas. The incidence of non-alcoholic fatty  liver disease continues to grow worldwide. In the structure of mortality rate of patients with non-alcoholic fatty  liver disease,  the first place is occupied by cardiovascular events: stroke and myocardial infarction. Studies have shown that the presence of severe liver fibrosis (F3-4) in NAFLD not only increases the risk of cardiovascular diseases (CVD), but also increases the risk  of  overall  mortality  by  69%  due  to mortality from cardiovascular causes. The degree of increased risk is associated with the degree of activity of non-alcoholic steatohepatitis (NASH). Despite the large number of works on this topic, we do not have a clear opinion on the impact on cardiovascular risk, interaction and the contribution of various factors, as well as algorithms for managing patients with non-alcoholic fatty liver disease to reduce the risk of cardiovascular diseases. This article describes the pathogenetic factors of formation of cardiovascular risks in patients with non-alcoholic fatty liver disease, proposed the idea of stratification of cardiovascular risks in these patients, taking into account changes in the structure of the liver (fibrosis) and function (clinical and biochemical activity) and also it describes the main directions of drug therapy, taking into account the common pathogenetic mechanisms for non-alcoholic fatty liver disease and cardiovascular diseases. The role of obesity, local fat depots, adipokines, and endothelial dysfunction as the leading pathogenetic factors of increased cardiovascular risk in patients with NAFLD is discussed. Among pathogenetically justified drugs in conditions of poly and comorbidity, hypolipidemic (statins, fibrates), angiotensin II receptor antagonists, beta-blockers, etc. can be considered. According to numerous studies, it becomes obvious that the assessment of cardiovascular risks in patients with NAFLD will probably allow prescribing cardiological drugs, selecting individualized therapy regimens, taking into account the form of NAFLD, and on the other hand, building curation taking into account the identified cardiovascular risks

Microbiota and Cardiovascular Diseases: Mechanisms of Influence and Correction Possibilities

The term "microbiota"  refers to the microbial  community  occupying a specific  habitat  with  defined  physical  and  chemical  properties  and  forming specific  ecological  niches.  The adult  intestinal  microbiota  is diverse.  It mainly  consists  of bacteria  of Bacteroidetes  and  Firmicutes  types.  The link between the gut microbiota  and cardiovascular disease (CVD) is being actively discussed.  Rapid progress  in this field is explained  by the development of new generation  sequencing methods and the use of sterile gut mice in experiments.  More and more data are being published about the influence of microbiota  on the development  and course of hypertension, coronary  heart disease (IHD), myocardial  hypertrophy, chronic heart failure (CHF) and atrial fibrillation (AF). Diet therapy,  antibacterial drugs,  pro- and prebiotics are successfully  used as tools to correct the structure of the gut microbiota of the macroorganism. Correction  of gut microbiota  in an experiment  on rats with coronary  occlusion  demonstrates  a significant  reduction in necrotic area. A study  involving  patients  suffering  from  CHF  reveals a significant  reduction  in the level of uric acid,  highly  sensitive C-reactive protein,  and creatinine. In addition to structural and laboratory changes  in patients with CVD when modifying the microbiota  of the gut, also revealed the effect on the course of arterial hypertension. Correction  of gut microbiota  has a beneficial  effect on the course of AF. We assume  that further active study of issues of influence and interaction of gut microbiota  and macroorganism may in the foreseeable future make significant  adjustments  in approaches to treatment of such patients

Abdominal Pain in Young Adults

Aim. A study of abdominal pain incidence in young adults in relation to dietary habits and psychological profile for advancement of health-promoting technologies.Materials and methods. An anonymous quiz survey covered 3,634 students enrolled at Omsk State Medical University in higher and secondary vocational education programmes via online use of the GSRS and WHO CINDI programme questionnaires to assess eating patterns and dietary preferences, as well as a brief multifactor personality inventory scale. Respondents with abdominal pain were divided into subcohorts by pain severity according to GSRS scores (mild, moderate or severe pain).Results. Abdominal pain was reported by 2,300 (63.29%) respondents, of whom 1,243 (54.0%) rated symptoms as mild, 996 (43.3%) and 61 (2.7%) — as moderate to severe. Abdominal pain complaints were more frequent in women (2I = 33.96, p <0.001), but gender had no effect on pain intensity. Pain associated with abdominal bloating and distention (57.65%), gastroesophageal reflux symptoms (38.75%), constipation (30.54%) or diarrhoea (28.4%). The presence and severity of abdominal pain was distinctive of individuals spending the most of average monthly income on food purchase and those actively consuming tea, coffee, added sugar, extra salt in cooked food, while having low intake of fruit and vegetables. A typical personality in severe abdominal pain is hypothymic depressive, hypochondriac in moderate and psychasthenic in mild pain.Conclusion. Abdominal pain is common among medical students predominating in females, associates with the eating pattern, dietary habits and psychological profile

Приверженность лечению больных воспалительными заболеваниями кишечника

Inflammatory bowel disease (IBD) is a common pathology that reduces the quality and duration of a patient’s life. The cornerstone of treatment of IBD patients is polypharmacotherapy based on the use of salicylates, antibiotics, immunomodulatory and biological drugs, and topical dosage forms. Multicomponent treatment has shown to reduce the quality of life and negatively affect adherence to drug therapy in IBD patients.One of the leading causes of treatment failure is low treatment adherence, which leads to disease progression, disability, and increased financial costs. Currently, there are many factors that affect adherence to therapy, some of them are modifiable, which creates opportunities to improve the effectiveness of existing medical interventions. However, the available data on the level of adherence in IBD patients are not numerous and homogeneous, so a low level of adherence to drug therapy in IBD patients is registered in 7–72% of cases.An important issue in understanding adherence in IBD patients is a lack of research on the level of adherence to counselling and lifestyle modification. However, the course of IBD, treatment features related to the duration of therapy and necessary lifestyle modifications (nutrition), as well as regular monitoring of laboratory and instrumental parameters determine the need to assess adherence to lifestyle modification and counselling along with adherence to drug therapy.Воспалительные заболевания кишечника (ВЗК) – это распространенная патология, снижающая качество и продолжительность жизни пациента. Краеугольным камнем лечения больных ВЗК является полифармакотерапия, основанная на применении салицилатов, антибиотиков, иммуномодулирующих и биологических препаратов, использовании местных лекарственных форм. Показано, что сложные схемы лечения снижают качество жизни и отрицательно сказываются на приверженности лекарственной терапии больных ВЗК.Одной из ведущих причин неэффективности лечения является низкий уровень приверженности, что приводит к прогрессированию заболевания, инвалидизации и увеличению финансовых затрат. В настоящий момент известно много факторов, влияющих на приверженность терапии, часть из них модифицируема, что создает возможности для повышения эффективности существующих медицинских вмешательств. Однако имеющиеся данные об уровне приверженности больных ВЗК не отличаются многочисленностью и однородностью. Так, низкий уровень приверженности лекарственной терапии больных ВЗК регистрируется в 7–72% случаев.Важной проблемой понимания приверженности больных ВЗК является отсутствие исследований об уровне приверженности медицинскому сопровождению и модификации образа жизни. Тогда как течение ВЗК и особенности лечения, связанные с длительностью терапии, необходимой модификацией образа жизни (питания), а также регулярный контроль лабораторных и инструментальных параметров диктуют необходимость оценки приверженности модификации образа жизни и медицинскому сопровождению наряду с приверженностью лекарственной терапии