Potential of nutraceutical products for irritable bowel syndrome remission maintenance

Aim of review. To summarize the modern data on pathogenesis of symptoms irritable bowel syndrome (IBS) symptoms, to present nutraceutical product «Standart zdorovya: GASTRO» as an agent for IBS remission maintenance. Summary. Recent data indicate essential changes of intestinal microbiota in IBS in comparison to healthy population. These changes may be associated to development of inflammatory processes of intestinal wall. Long-term inflammation may result in nociceptor hypersensitivity i.e. peripheral sensitization that in turn, lead to the central sensitization and indirectly - to gastrointestinal tract (GIT) motility disorders. Besides, change of intestinal microbiota may impact the development of emotional disorders (e.g.: impaired capacity of affected intestinal microbiota to produce neurotransmitters). Therefore, according to the results of available studies, intestinal microbiota changes in IBS is a key factor for the cascade of events including intestinal wall inflammation, changes of gastrointestinal motility, decreased threshold of gastrointestinal receptor sensitivity, as well as emotional disorders resulting in development of disease symptoms. Medical preparation for IBS remission induction and remission maintenance should possess probiotic/prebiotic and anti-inflammatory properties, reduce visceral sensitivity, normalize intestinal motility and modulate patients’ emotional sphere. Due to capacity of «Standart zdorovya: GASTRO» components to deliver above-listed effects it can be promising for administration in patients with IBS

Dysphoric spectrum of emotional disorders at irritable bowel syndrome

Aim of review. The role of emotional disorders of dysphoric range (irritability, strain, hostility etc.) in clinical presentation of the irritable bowel syndrome (IBS). Summary. Systematic literature search on severity of dysphoric disorders and their relation to somatic symptoms at IBS was carried out in the PubMed scientific database and Russian Science Citation Index (RSCI). Overall 42 articles were selected. The results of analysis has demonstrated that dysphoric emotional disorders are typical for IBS patients. These disorders are manifested as tendency to react by discontent and irritation in stressful situations. Somatic manifestations of IBS are associated to dysphoric experience indicating their potential pathogenic value. Imbalance between the scope of data on emotional disorders at IBS and the number of studies devoted to psychopharmacotherapy efficacy assessment at emotional disorders was revealed. Dysphoric disorders are not regarded as independent target for therapeutic actions. Conclusion. The chronic discontent and trend to react by anger to stressful situations are traits of IBS patients, and is the basis of the development and persistance of the somatic symtpoms. They have to be considered as an independent targets for medical care

Возможности применения Опросника «7х7» (7 симптомов за 7 дней) для оценки динамики симптомов функциональной диспепсии и синдрома раздраженного кишечника

Aim of investigation. To study potential of «7×7» questionnaire to assess dynamics of patient’s state throughout treatment course at irritable bowel syndrome (IBS), functional dyspepsia (FD) and combination of these diseases. Material and methods. Original study included 50 patients (36 men and 16 women) aged 18 to 64 years with confirmed diagnoses of IBS, FD and their combination. Basic manifestations of above-mentioned diseases, presence and severity of symptoms initially (visit 1) and their development in 28 days after treatment onset (Visit 2) were estimated by Questionnaire «7×7». Correlation between the results of «7×7» Questionnaire and data of the General clinical impression scale (CGI-s; CGI-i) was evaluated. Results. According to the «7×7» questionnaire most of the patients estimated severity of their state as moderate disorder during the Visit 1. Statistically significant moderate correlation was revealed between the Questionnaire data and General clinical impression scale. During Visit 2, according to attending physician examination (General clinical impression scale), in 40% of patients symptoms have improved. At the same time during Visit 2 according to the «7×7» Questionnaire most of the patients (48%) estimated their state as borderline disorder. Statistically significant moderate correlation similar to that, obtained for Visit 1 was found between results of the Questionnaire and General clinical impression scale. Most of patients and doctors involved in the study highly appreciated convenience of Questionnaire utilization. Conclusions. Application of the «7×7» Questionnaire in clinical practice allows to estimate adequately severity of symptoms of FD and IBS and their dynamics along the treatment process. These results correlate well with results of the General impression scale (CGI-s; CGI-i). Most of the patients and physicians estimate convenience of «7×7» Questionnaire as good or excellent

Treatment of autonomous intestinal neuropathy in critical care by prucalopride and multistrain probiotic

The aim of clinical case presentation. To analyze the options of autonomous intestinal neuropathy treatment in critical state patients. Key points. The clinical cases of autonomous intestinal neuropathy of various etiology are presented. Patient A., 19-year-old patient presented with constipation for up to 3 days, progressive feeling of abdominal distention and general weakness. In the past history patient underwent surgery for chronic left-side achillobursitis. In postoperative period antibacterial treatment was prescribed that included first-generation cephalosporin. At the 4thday after onset of antibiotic treatment the patient developed chronic abdominal pain that increased progressively, diarrhea up to 10 times per day and fever of 39 °C. Subsequent investigation revealed positive stool test for C. difficile toxins A and B. Urgent colonoscopy detected pseudomembranes at colonic mucosa. Histological examination of biopsy specimens from affected sites demonstrated focal cystic dilation of crypts with epithelium desquamation, severe edema of lamina propria. Pseudomembranous colitis was diagnosed and vancomycin 125 mg qid in combined to metronidazole 500 mg tid for 10 days were prescribed. At the background of treatment stool frequency gradually decreased up to 2 times per day, hematochezia stopped. However at the 7-8th days patient developed constipation, feeling of abdominal distention and progressive general weakness. The state was regarded as development of C. difficile toxin-associated autonomous intestinal neuropathy. Patient I., 54 year-old admitted to the hospital; presenting complaints included flatulence, constipation for up to three days and severe general weakness. According to the past history in 2014 patient was diagnosed to have adenocarcinoma of the right breast gland with subsequent right-sided radical mastectomy followed by radiation therapy and chemotherapy. In May 2017 patient developed boring pain in the right lumbar area, frequent small-volume urination, febrile fever and progressive general weakness. Laboratory and instrumental investigation revealed obstructive right-sided abscessing pyelohephritis with development of sepsis; antibacterial therapy included meropenem in daily dose of 3.0 g along with correction of hypoalbuminemia and detoxication therapy. At the 3rd day of treatment patient noticed improvement in the state of health: decrease in right-sided lumbar pain and general weakness, decrease in body temperature up to subfebrile level. Catheter-collected urine sample contained no admixture of pus. However in the same day patient developed constipation along with progressive abdominal distention. The most likely cause for development of ileus in this case is development of autonomous intestinal neuropathy associated to severe intoxication. Basic mechanisms for development of autonomous intestinal neuropathy are discussed: suppression of smooth muscular contractility by C. difficile toxins A and B (in the first of presented cases) and combined autoimmune neuronal damage by immune cells due to expression of proteins by neoplastic cells (in the second case). Therapeutic approaches including prescription of prokinetic drug prucalopride and multistrain probiotic containing bifido-and lactobacilli are presented (Bifidobacterium bifidum, B. longum, B. infantis, Lactobacillus rhamnosus). Prescription of prucalopride and multistrain probiotic provided resolution of neuropathy and recovery of adequate intestinal motility due to resumption neuromuscular intestinal complex activity and correction of intestinal microbiota spectrum. Conclusion. Combination of prokinetic drug (prucalopride) and multistrain probiotic medication (Bifidobacterium bifidum, B. longum, B. infantis, Lactobacillus rhamnosus) can be effective in the treatment of autonomous intestinal neuropathy in critical care

Efficacy of drugs most commonly prescribed at functional gastrointestinal diseases (functional dyspepsia syndrome and irritable bowel syndrome) observational study results

Aim of investigation. To estimate the frequency of prescription of motility regulators and probiotics in the functional gastrointestinal diseases. To define efficacy of these agents according to results of «7×7» questionnaire (7 symptoms per 7 days) at treatment of functional dyspepsia (FD), irritable bowel syndrome (IBS) and combination of these diseases. Material and methods. Overall 502 patients aged 18 to 65 with symptoms complying to the «Rome-III» criteria and absence of «alarm symptoms» with the preliminary diagnosis of the functional gastrointestinal disorder: IBS, FD or combination of these diseases were started. During the first visit to the doctor patient was proposed to complete «7×7» questionnaire for baseline assessment of presence and severity of symptoms typical for FD and IBS. Later all patients underwent a set of laboratory and instrumental tests required according to «Guidelines on diagnostics and treatment of the irritable bowel syndrome in adults» of the Russian gastroenterological association and Russian Association of coloproctology and to «Clinical guidelines on diagnostics and treatment of the functional dyspepsia» of the Russian gastroenterological association. After primary investigation 108 patients were excluded from the study due to diagnosis change. Primary documentation data of 11 patients were unsuitable for statistical processing. The analysis of primary documentation and results symptom assessment of 383 patients with verified diagnosis of functional gastrointestinal disease by «7×7» questionnaire was carried out. Treatment algorithms, their conformity to establish diagnosis and efficacy were analyzed as well. Results. Motility regulator trimebutine was prescribed to 258 (67,4%) patients with various diseases: 30 (60%) IBS patients, 67 (73,6%) FD patients, and 157 (64,8%) patients with combination of both disorders. Modes of treatment which included trimebutine demonstrated higher efficacy in comparison to treatment algorithms, which included antispasmodic medications with respect to relief of all symptoms (according to the «7×7» questionnaire data), except for constipation and in disorders of stool consistency (firm stool): efficacy of trimebutinecontaining moods for those symptoms was comparable to those with application of spasmolytic drugs. Probiotic agents with various content in combination to other group drugs were prescribed to 127 patients: 29 FD patients (22,3%); 20 IBS patients (14,5%), and 78 FD to IBS combination (60%). It is established that presence of probiotic in the treatment mode leads to significant reduction in main symptoms severity typical both for FD and IBS according to the «7×7» questionnaire

Diagnostics and treatment of chronic constipation in adults: clinical guidelines of the Russian gastroenterological association

Aim of publication. To present the modern concept on etiology and pathogenesis of constipation, its classification, basic diagnostic and treatment methods to general practitioners. Summary. The prevalence of constipation in general population is quite high and averages 12 to 19%. Two types of constipation are usually distinguished: primary (functional) and secondary that is related to mechanical obstruction of the intestinal passage of bowel content, neurologic and endocrine diseases, systemic diseases of connective tissue, intake of drugs etc. At diagnosing of functional constipation early detection of «alarm symptoms» which require thorough patient investigation is important. Moreover, insufficient treatment response require step-by-step instrumental diagnostics. Constipation treatment has to be comprehensive and include general recommendations (intensification of physical activity, increase in dietary fiber in daily ration etc.), intake of psyllium, laxatives, including first of all of polyethyleneglycol, at insufficient response enterokinetic agents. Conclusion. Successful treatment of constipation requires correct detection of its cause, following essential dietary recommendations and stepwise application of pharmaceutical agents