nogrЭкспериментальная и клиническая гастроэнтерологияExperimental and Clinical Gastroenterology1682-8658«Global Media Technologies»10.31146/1682-8658-ecg-190-6-104-111nogr-1683Research ArticleДИСКУССИЯDISCUSSION«Гастроинтестинальная» коморбидность при синдроме раздраженного кишечника“Gastrointestinal” comorbidity in irritable bowel syndromehttps://orcid.org/0000-0001-9370-4768ГаусО. В.GausO. V.

Гаус Ольга Владимировна, к. м. н., доцент кафедры факультетской терапии и гастроэнтерологии

Россия, 644099, г. Омск, ул. Ленина, д. 12

Olga V. Gaus, Cand. Sci. (Med.), Associate Professor of the Department of Faculty Therapy and Gastroenterology. Scopus Author ID: 56598554900

12 Lenina street, 644099 Omsk, Russia

gaus_olga@bk.ruЛивзанМ. А.LivzanM. A.

Ливзан Мария Анатольевна, д. м. н., профессор, ректор, заведующий кафедрой факультетской терапии и гастроэнтерологии

Россия, 644099, г. Омск, ул. Ленина, д. 12

Maria A. Livzan, D. Sci. (Med.), Professor, Rector, Head of the Department of Faculty Therapy and Gastroenterology. Scopus Author ID: 24341682600

12 Lenina street, 644099 Omsk, Russia

ФГБОУ ВО «Омский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияFederal State Educational Establishment of Higher Education Omsk State Medical University of the Ministry of Health of the Russian FederationRussian Federation20213108202116104111Copyright © Гаус О.В., Ливзан М.А., 20212021Гаус О.В., Ливзан М.А.Gaus O.V., Livzan M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nogr.org/jour/article/view/1683

Среди многочисленной и гетерогенной группы больных с синдромом раздраженного кишечника (СРК) характерной чертой течения заболевания является наличие коморбидности, которая представляет собой актуальную проблему в реальной клинической практике. Гастроинтестинальная коморбидность больного с СРК связана с наличием общих патогенетических звеньев и представлена не только сочетанной патологией внутри функциональных расстройств, но также формированием «синдрома перекреста» с различными органическими заболеваниями. Нередко при коморбидном течении заболеваний наблюдается феномен «взаимного отягощения», в результате чего увеличивается тяжесть течения каждого из них. Все это требует оптимизации подходов к диагностике и лечению данной когорты больных. В частности, становится очевидным, что при коморбидном течении СРК целесообразно назначение лекарственных средств, воздействующих на общие звенья патогенеза, а не ориентированных на отдельные симптомы. В данной статье представлены современные сведения о гастроинтестинальной коморбидности больного с СРК.

Among the large and heterogeneous group of patients with irritable bowel syndrome (IBS) comorbidity is characteristic feature. Comorbidity is an urgent problem in real clinical practice. Gastrointestinal comorbidity of a patient with IBS is associated with the presence of common pathogenetic links and is represented by combined pathology with functional disorders and the formation of “overlap syndrome” with organic diseases. Often, with a comorbid course, the phenomenon of “mutual burdening” is observed, when the severity of the course of each of them increases. All this requires optimization of approaches to the diagnosis and treatment of this cohort of patients. Obviously, with a comorbid course of IBS, it is advisable to prescribe drugs that affect the general links of pathogenesis, rather than focusing on individual symptoms. This article presents modern information on the gastrointestinal comorbidity of a patient with IBS.

синдром раздраженного кишечникакоморбидностьфункциональные гастроинтестинальные расстройствафункциональная диспепсиягастроэзофагельная рефлюксная болезньвоспалительные заболевания кишечникаirritable bowel syndromecomorbidityfunctional gastrointestinal disordersfunctional dyspepsiagastroesophageal reflux diseaseinflammatory bowel diseaseГрант Президента РФ для государственной поддержки молодых российских ученых — кандидатов наук (МК-1679.2020.7) «Разработка превентивной индивидуализированной стратегии ведения больных с синдромом раздраженного кишечника», соглашение № 075–15–2020–138 от 17 марта 2020 годаGrant of the President of the Russian Federation for state support of young Russian scientists — candidates of sciences (MK-1679.2020.7) “Development of a preventive individualized strategy for the management of patients with irritable bowel syndrome”, agreement No. 075–15–2020–138 dated March 17, 2020 of the yearReferencesГаус О. В., Ливзан М. А. Синдром раздраженного кишечника: что мы знаем о симптомах сегодня? Consilium Medicum. 2019, Т. 21, № 8, С. 42–48.Gaus O. V., Livzan M. A. SRK: Chto mi znaem o simptomah segodnya [IBS: what do we know about the symptoms to day?]. Consilium Medicum. 2019, vol. 21, no. 8, pp. 42–48. (in Russ.)Ливзан М. А., Осипенко М. Ф. Синдром перекреста функциональных заболеваний пищеварительного тракта. РМЖ. 2012, Т. 20, № 15, С. 768–770.Livzan M.A., Osipenko M. F. Sindrom perecresta functcional’nih zabolevanii pishevaritel’nogo tracta [Overlapsyndrome of functional diseases of the digestive tract.]. RMJ. 2012, vol. 20, no. 15, pp. 768–770. (in Russ.)Ивашкин В. Т., Шелыгин Ю. А., Баранская Е. К. и др. Клинические рекомендации Российской гастроэнтерологической ассоциации, Ассоциации колопроктологов России по диагностике и лечению больных с синдромом раздраженного кишечника. Росс. журн. гастроэнтерол. гепатол. колопроктол. 2017, Т. 27, № 5, С. 76–93.Ivashkin V.T., Shelygin Yu.A., Baranskaya E. K. et al. Klinicheskiye recommendacii Rossiiskoy gastroenterologicheskoi assotciatcii, Assotciatcii coloproctologov Rossii po diagnostike i lecheniyu bol’nih s sindromom razdrazhennogo kishechnika [Clinical recommendations of the Russian Gastroenterological Association, the Association of Coloproctologists of Russia on the diagnosis and treatment of patients with irritable bowel syndrome]. Rossiiskii zhurnal gastroenterologii, gepatologii, koloproctologii – Russian Journal of Gastroenterology of Hepatology Coloproctology. 2017, vol. 27, no. 5, pp. 76–93. (in Russ.)Vakil N., Stelwagon M., Shea E. P., Miller S. Symptom burden and consulting behavior in patients with overlapping functional disorders in the US population. United European Gastroenterol. J. 2015, vol. 4, no. 3, pp. 413–422.Vakil N., Stelwagon M., Shea E. P., Miller S. Symptom burden and consulting behavior in patients with overlapping functional disorders in the US population. United European Gastroenterol. J. 2015, vol. 4, no. 3, pp. 413–422.Häuser W., Marschall U., Layer P., Grobe T. The prevalence, comorbidity, management and costs of irritable bowel syndrome – an observational study using routine health insurance data. Dtsch. Arztebl. Int. 2019, no. 116, pp. 463–470.Häuser W., Marschall U., Layer P., Grobe T. The prevalence, comorbidity, management and costs of irritable bowel syndrome – an observational study using routine health insurance data. Dtsch. Arztebl. Int. 2019, no. 116, pp. 463–470.Cenac, N., Christophe, A., Jean- Paul, M. et al. Potentiation of TRPV4 signalling by histamine and serotonin: an important mechanism for visceral hypersensitivity. Gut. 2010, no. 59, pp. 481.Cenac, N., Christophe, A., Jean- Paul, M. et al. Potentiation of TRPV4 signalling by histamine and serotonin: an important mechanism for visceral hypersensitivity. Gut. 2010, no. 59, pp. 481.Ливзан М. А. Болевой синдром в гастроэнтерологии – алгоритм терапии. Медицинский совет. 2010, № 3–4, С. 69–71.Livzan M. A. Bolevoy sindrom v gastroenterologii – algoritm terapii [Pain syndrome in gastroenterology – therapy algorithm.]. Medicinskii sovet – Medical advice. 2010, № 3–4, pp. 69–71. (in Russ.)Carco C., Young W., Gear R. B., et al. Increasing Evidence That Irritable Bowel Syndrome and Functional Gastrointestinal Disorders Have a Microbial Pathogenesis. Frontiers in Cellular and Infection Microbiology. 2020, no. 10, p. 468.Carco C., Young W., Gear R. B., et al. Increasing Evidence That Irritable Bowel Syndrome and Functional Gastrointestinal Disorders Have a Microbial Pathogenesis. Frontiers in Cellular and Infection Microbiology. 2020, no. 10, p. 468.Camilleri M. The Leaky Gut: Mechanisms, Measurement and Clinical Implications in Humans. Gut. 2019, vol. 68, no. 8, pp. 1516–1526.Camilleri M. The Leaky Gut: Mechanisms, Measurement and Clinical Implications in Humans. Gut. 2019, vol. 68, no. 8, pp. 1516–1526.Odenwald M.A., Turner J. R. The intestinal epithelial barrier: a therapeutic target? Nat. Rev. Gastroenterol. Hepatol. 2017, no. 14, pp. 9–21.Odenwald M.A., Turner J. R. The intestinal epithelial barrier: a therapeutic target? Nat. Rev. Gastroenterol. Hepatol. 2017, no. 14, pp. 9–21.Quigley E. M. Leaky gut – concept or clinical entity? Curr. Opin. Gastroenterol. 2016, no. 32, pp. 74–79.Quigley E. M. Leaky gut – concept or clinical entity? Curr. Opin. Gastroenterol. 2016, no. 32, pp. 74–79.Cryan J.F., O’Riordan K.J., Cowan C. S. et al. The microbiota-gut-brain axis. Physiol Rev. 2019, no. 99, pp. 1877–2013.Cryan J.F., O’Riordan K.J., Cowan C. S. et al. The microbiota-gut-brain axis. Physiol Rev. 2019, no. 99, pp. 1877–2013.Wang A., Liao X., Xiong L., et al. The clinical overlap between functional dyspepsia and irritable bowel syndrome based on Rome III criteria. BMC Gastroenterol. 2008, no. 8, p. 43.Wang A., Liao X., Xiong L., et al. The clinical overlap between functional dyspepsia and irritable bowel syndrome based on Rome III criteria. BMC Gastroenterol. 2008, no. 8, p. 43.Ghoshal U.C., Singh R. Frequency and risk factors of functional gastro- intestinal disorders in a rural Indian population. J. Gastroenterol. Hepatol. 2017, no. 32, pp. 378–387.Ghoshal U.C., Singh R. Frequency and risk factors of functional gastro- intestinal disorders in a rural Indian population. J. Gastroenterol. Hepatol. 2017, no. 32, pp. 378–387.Okumura T., Tanno S., Ohhira M., Tanno S. Prevalence of functional dyspepsia in an outpatient clinic with primary care physicians in Japan. J. Gastroenterol. 2010, no. 45, pp. 187–194.Okumura T., Tanno S., Ohhira M., Tanno S. Prevalence of functional dyspepsia in an outpatient clinic with primary care physicians in Japan. J. Gastroenterol. 2010, no. 45, pp. 187–194.Steinsvik Е.К., Valeur J., Hausken Т., Gilja О. Н. Postprandial Symptoms in Patients with Functional Dyspepsia and Irritable Bowel Syndrome: Relations to Ultrasound Measurements and Psychological Factors. J. Neurogastroenterol. Motil. 2020, vol. 26 no. 1, pp. 96–105.Steinsvik Е.К., Valeur J., Hausken Т., Gilja О. Н. Postprandial Symptoms in Patients with Functional Dyspepsia and Irritable Bowel Syndrome: Relations to Ultrasound Measurements and Psychological Factors. J. Neurogastroenterol. Motil. 2020, vol. 26 no. 1, pp. 96–105.Barberio B., Yiannakou Y., Houghton L. A., et al. Overlap of Rome IV Irritable Bowel Syndrome and Functional Dyspepsia and Effect on Natural History: A Longitudinal Follow-up Study. Clin. Gastroenterol. Hepatol. 2021, no. 4, S1542–3565(21)00445–6.Barberio B., Yiannakou Y., Houghton L. A., et al. Overlap of Rome IV Irritable Bowel Syndrome and Functional Dyspepsia and Effect on Natural History: A Longitudinal Follow-up Study. Clin. Gastroenterol. Hepatol. 2021, no. 4, S1542–3565(21)00445–6.Kim Y.J., Chung W. C., Kim B. W., et al. Is Helicobacter pylori Associated Functional Dyspepsia Correlated with Dysbiosis? J. Neurogastroenterol. Motil. 2017, no. 23, pp. 504–516.Kim Y.J., Chung W. C., Kim B. W., et al. Is Helicobacter pylori Associated Functional Dyspepsia Correlated with Dysbiosis? J. Neurogastroenterol. Motil. 2017, no. 23, pp. 504–516.Yang Y., Chen L. F. Role of Helicobacter pylori Eradication in Diarrhea- predominant Irritable Bowel Syndrome. Wei. Chang. Bing. Xue. 2017, no. 22, pp. 482–485.Yang Y., Chen L. F. Role of Helicobacter pylori Eradication in Diarrhea- predominant Irritable Bowel Syndrome. Wei. Chang. Bing. Xue. 2017, no. 22, pp. 482–485.Hooi J.K.Y., Lai W. Y., Ng W. K., et al. Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis. Gastroenterology. 2017, no. 153, pp. 420–429.Hooi J.K.Y., Lai W. Y., Ng W. K., et al. Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis. Gastroenterology. 2017, no. 153, pp. 420–429.Ng Q.X., Foo N. X., Loke W., et al. Is there an association between Helicobacter pylori infection and irritable bowel syndrome? A meta-analysis. World J. Gastroenterol. 2019, Vol. 25, no. 37, pp. 5702–5710.Ng Q.X., Foo N. X., Loke W., et al. Is there an association between Helicobacter pylori infection and irritable bowel syndrome? A meta-analysis. World J. Gastroenterol. 2019, Vol. 25, no. 37, pp. 5702–5710.O’Sullivan M., Clayton N., Breslin N. P., et al. Increased mast cells in the irritable bowel syndrome. Neurogastroenterol. Motil. 2000, no. 12, pp. 449–457.O’Sullivan M., Clayton N., Breslin N. P., et al. Increased mast cells in the irritable bowel syndrome. Neurogastroenterol. Motil. 2000, no. 12, pp. 449–457.Montemurro P., Nishioka H., Dundon W. G., et al. The neutrophil-activating protein (HP-NAP) of Helicobacter pylori is a potent stimulant of mast cells. Eur. J. Immunol. 2002, no. 32, pp. 671–676.Montemurro P., Nishioka H., Dundon W. G., et al. The neutrophil-activating protein (HP-NAP) of Helicobacter pylori is a potent stimulant of mast cells. Eur. J. Immunol. 2002, no. 32, pp. 671–676.Supajatura V., Ushio H., Wada A., et al. Cutting edge: VacA, a vacuolating cytotoxin of Helicobacter pylori, directly activates mast cells for migration and production of proinfl ammatory cytokines. J. Immunol. 2002, no. 168, pp. 2603–2607.Supajatura V., Ushio H., Wada A., et al. Cutting edge: VacA, a vacuolating cytotoxin of Helicobacter pylori, directly activates mast cells for migration and production of proinfl ammatory cytokines. J. Immunol. 2002, no. 168, pp. 2603–2607.Schulz C., Koch N., Schü tte K., et al. H. pylori and its modulation of gastrointestinal microbiota. J. Dig. Dis. 2015, no. 16, pp. 109–117.Schulz C., Koch N., Schü tte K., et al. H. pylori and its modulation of gastrointestinal microbiota. J. Dig. Dis. 2015, no. 16, pp. 109–117.Lovell R.M., Ford A. C. Prevalence of gastro- esophageal reflux-type symptoms in individuals with irritable bowel syndrome in the community: a meta-analysi. Am. J. Gastroenterol. 2012, no. 107, pp. 1793–1801.Lovell R.M., Ford A. C. Prevalence of gastro- esophageal reflux-type symptoms in individuals with irritable bowel syndrome in the community: a meta-analysi. Am. J. Gastroenterol. 2012, no. 107, pp. 1793–1801.de Bortoli N., Tolone S., Frazzoni M., et al. Gastroesophageal refl ux disease, functional dyspepsia and irritable bowel syndrome: common overlapping gastrointestinal disorders. Ann. Gastroenterol. 2018, Vol. 31, no. 6, pp. 639–648.de Bortoli N., Tolone S., Frazzoni M., et al. Gastroesophageal refl ux disease, functional dyspepsia and irritable bowel syndrome: common overlapping gastrointestinal disorders. Ann. Gastroenterol. 2018, Vol. 31, no. 6, pp. 639–648.Martinucci I., de Bortoli N., Di Fluri G., et al. Diagnosis of NERD in a population of patients with and without IBS: a pH-MII study. Dig. Liv. Dis. 2011, no. 43, S168.Martinucci I., de Bortoli N., Di Fluri G., et al. Diagnosis of NERD in a population of patients with and without IBS: a pH-MII study. Dig. Liv. Dis. 2011, no. 43, S168.Garros A., Mion F., Marjoux S., et al. Factors associated with nonresponse to proton pump inhibitors therapy in patients referred for esophageal pH-impedance monitoring. Dis. Esophagus. 2016, no. 29, pp. 787–793.Garros A., Mion F., Marjoux S., et al. Factors associated with nonresponse to proton pump inhibitors therapy in patients referred for esophageal pH-impedance monitoring. Dis. Esophagus. 2016, no. 29, pp. 787–793.El‐SalhY M., Gilja O. H., Hatlebakk J. G. Overlapping of irritable bowel syndrome with erosive esophagitis and the performance of Rome criteria in diagnosing IBS in a clinical setting. Mol. Med. Rep. 2019, no. 20, pp. 787–794.El‐SalhY M., Gilja O. H., Hatlebakk J. G. Overlapping of irritable bowel syndrome with erosive esophagitis and the performance of Rome criteria in diagnosing IBS in a clinical setting. Mol. Med. Rep. 2019, no. 20, pp. 787–794.Isgar B., Harman M., Kaye M. D., Whorwell P. J. Symptoms of irritable bowel syndrome in ulcerative colitis in remission. Gut. 1983, no. 24, pp. 190–192.Isgar B., Harman M., Kaye M. D., Whorwell P. J. Symptoms of irritable bowel syndrome in ulcerative colitis in remission. Gut. 1983, no. 24, pp. 190–192.Tomita T., Kato Y., Takimoto M., et al. Prevalence of Irritable Bowel Syndrome–like Symptoms in Japanese Patients with Inactive Inflammatory Bowel Disease. J. Neurogastroenterol Motil. 2016, vol. 22 no. 4: 661–669.Tomita T., Kato Y., Takimoto M., et al. Prevalence of Irritable Bowel Syndrome–like Symptoms in Japanese Patients with Inactive Inflammatory Bowel Disease. J. Neurogastroenterol Motil. 2016, vol. 22 no. 4: 661–669.Spiler R., Lam C. Update on post-infectious irritable bowel syndrome: role of genetics, immune activation, serotonin and altered microbiome. J. Neurogastroenterol. Motil. 2012, vol. 18, no. 3, pp. 258–268.Spiler R., Lam C. Update on post-infectious irritable bowel syndrome: role of genetics, immune activation, serotonin and altered microbiome. J. Neurogastroenterol. Motil. 2012, vol. 18, no. 3, pp. 258–268.Teruel C., Garrido E., Mesonero F. Diagnosis and management of functional symptoms in inflammatory bowel disease in remission. World J. Gastrointest. Pharmacol. Ther. 2016, vol. 7, no. 1, pp. 78–90.Teruel C., Garrido E., Mesonero F. Diagnosis and management of functional symptoms in inflammatory bowel disease in remission. World J. Gastrointest. Pharmacol. Ther. 2016, vol. 7, no. 1, pp. 78–90.Ливзан М. А., Макейкина М. А. Воспалительные заболевания кишечника: современные аспекты диагностики и лечения. Гастроэнтерология. Приложение к журналу Consilium Medicum. 2010, № 2, С. 60–65.Livzan M.A., Makeykina M. A. Vospalitel’niye zabo levaniya kishechnika: sovremenniye aspecti diagnostiki i lecheniya [Inf lammatory bowel disease: modern aspects of diagnosis and treatment]. Gastroenterologiya. Prilozheniye k zhurnalu Consilium Medicum – Gastroenterology. Supplement to Consilium Medicum. 2010, no. 2, pp. 60–65. (in Russ.)Tozlu M., Cash B., Younes M., Ertan A. Dilemma in post- IBD patients with IBS-D symptoms: A 2020 overview. Expert Rev. Gastroenterol. Hepatol. 2021, vol. 15, no. 1, pp. 5–8.Tozlu M., Cash B., Younes M., Ertan A. Dilemma in post- IBD patients with IBS-D symptoms: A 2020 overview. Expert Rev. Gastroenterol. Hepatol. 2021, vol. 15, no. 1, pp. 5–8.Farrokhyar F., Marshall J. K., Easterbrook B., Irvine E. J. Functional gastrointestinal disorders and mood disorders in patients with inactive inflammatory bowel disease: prevalence and impact on health. Inflamm. Bowel Dis. 2006, vol. 12, pp. 38–46.Farrokhyar F., Marshall J. K., Easterbrook B., Irvine E. J. Functional gastrointestinal disorders and mood disorders in patients with inactive inflammatory bowel disease: prevalence and impact on health. Inflamm. Bowel Dis. 2006, vol. 12, pp. 38–46.Stanisic V., Quigley E. M.M. Th e overlap between IBS and IBD: what is it and what does it mean? Expert Rev. Gastroenterol. Hepatol. 2014, vol. 8, no. 2, pp. 139–45.Stanisic V., Quigley E. M.M. Th e overlap between IBS and IBD: what is it and what does it mean? Expert Rev. Gastroenterol. Hepatol. 2014, vol. 8, no. 2, pp. 139–45.Шептулин А. А., Виноградская К. Э. Воспалительные заболевания кишечника и синдром раздраженного кишечника: сочетание двух нозологических форм или разные варианты одного заболевания? Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2019, № 29(5), С. 43–48.Sheptulin A.A., Vinogradskaya K. E. Inflammatory Bowel Diseases and Irritable Bowel Syndrome: Overlap of Two Nosological Forms or Two Variants of the Same Disease? Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2019, no. 29 (5), pp. 43–48. (in Russ.)Оганов Р. Г., Симаненков В. И, Бакулин И. Г. и др. Клинические рекомендации. Коморбидная патология в клинической практике. Алгоритмы диагностики и лечения. Кардиоваскулярная терапия и профилактика. 2019, № 18(1), С. 5–66.Oganov R. G., Simanenkov V. I., Bakulin I. G. et al. Comorbidities in clinical practice. Algorithms for diagnostics and treatment. Cardiovascular Therapy and Prevention. 2019, no. 18(1), pp. 5–66. (in Russ.)Schmulson M.J., Drossman D. A. What Is New in Rome IV. J. Neurogastroenterol. Motil. 2017, vol. 23, no. 2, pp. 151–163.Schmulson M.J., Drossman D. A. What Is New in Rome IV. J. Neurogastroenterol. Motil. 2017, vol. 23, no. 2, pp. 151–163.

The authors declare that there are no conflicts of interest present.