Preview

Экспериментальная и клиническая гастроэнтерология

Расширенный поиск

Диарея при COVID-19 у взрослых

https://doi.org/10.31146/1682-8658-ecg-178-6-42-54

Аннотация

Настоящий обзор представляет систематизацию литературного материала по проблеме хронической диареи у взрослых, вопросам дифференциального диагноза и диагноза на этапе оказания первичной медико-санитарной помощи Хроническая диарея—это стойкое отклонение от нормы с консистенцией стула между типами 5 и 7 по Бристольской шкале стула и увеличение частоты более чем на 4 недели. Приводится классификация диареи с позиции частоты встречаемости (наиболее частые причины, нечастые и редкие), дана краткая характеристика клинических и лабораторных признаков наиболее часто встречающихся причин диареи в практике врача терапевта и гастроэнтеролога, представлен обзор литературы об особенностях диареи при COVID-19, предлагаются этапы диагностического поиска

Об авторах

А. С. Сарсенбаева
ФГБОУ ВО ЮУГМУ Минздрава России
Россия

кафедра терапии ИДПО, профессор, доктор медицинских наук,

454092, Уральский федеральный округ, Челябинская область, г. Челябинск, ул. Воровского, 64



Л. Б. Лазебник
Московский государственный медико-стоматологический университет им. АИ Евдокимова
Россия

кафедра Поликлинической терапии, профессор, доктор медицинских наук,

Москва, ул Вучетича 9а стр 1



Список литературы

1. Парфенов А. И. Энтерология / Руководство для врачей. Москва, «Триада-Х», 2002–744 с.

2. Клинические рекомендации Рак ободочной кишки и сигмовидной кишки КР 39, 2016.

3. Клинические рекомендации Целиакия у детей КР 404, 2016.

4. Клинические рекомендации Шигеллез у взрослых КР 498, 2016.

5. Клинические рекомендации РГА по ведению больных с Болезнью Крона, 2016.

6. Клинические рекомендации Амебиаз у детей, КР 556. 2016.

7. Клинические рекомендации (протокол) по оказанию скорой медицинской помощи при синдроме диареи инфекционного генеза (Национальные клинические рекомендации) (Общероссийская общественная организация «Российское общество скорой медицинской помощи». 2014.

8. А. И. Парфенов. Энтеропатия с нарушением мембранного пищеварения / Н. И. Белостоцкий, С. Р. Дбар, О. В. Ахмадуллина, С. В. Быкова, Е. А. Сабельникова. С. Г. Хомерики //Эффективная фармакотерапия. – 2018-№ 2- с. 20–26.

9. Wenzl HH, Fine KD, Schiller LR, et al. Determinants of decreased fecal consistency in patients with diarrhea. Gastroenterology 1995;108:1729–38. 10.1016/0016– 5085(95)90134–5

10. Fine KD, Schiller LR. AGA technical review on the evaluation and management of chronic diarrhea. Gastroenterology 1999;116:1464–86. 10.1016/S0016– 5085(99)70513–5.

11. Stotzer P-O, Abrahamsson H, Bajor A, et al. Are the definitions for chronic diarrhoea adequate? Evaluation of two different definitions in patients with chronic diarrhoea. United Eur Gastroenterol J 2015;3:381–6. 10.1177/2050640615580219.

12. Duncan A, Hill PG. A UK survey of laboratory-based gastrointestinal investigations. Ann Clin Biochem 1998;35(Pt 4):492–503. 10.1177/000456329803500403.

13. Arrambide KA, Santa Ana CA, Schiller LR, et al. Loss of absorptive capacity for sodium chloride as a cause of diarrhea following partial ileal and right colon resection. Dig Dis Sci 1989;34:193–201. 10.1007/BF01536050.

14. Ros E, Zambon D. Postcholecystectomy symptoms. A prospective study of gall stone patients before and two years aft er surgery. Gut 1987;28:1500–4. 10.1136/gut.28.11.1500.

15. Valdovinos MA, Camilleri M, Zimmerman BR. Chronic diarrhea in diabetes mellitus: mechanisms and an approach to diagnosis and treatment. Mayo Clin Proc 1993;68:691–702. 10.1016/S0025-6196(12)60606-5.

16. Person J. Alcohol and the small intestine. Scand J Gastroenterol 1991;26:3–15. 10.3109/00365529108996478.

17. Jain NK, Rosenberg DB, Ulahannan MJ, et al. Sorbitol intolerance in adults. Am J Gastroenterol 1985;80:678–81.

18. Elfstrand L, Florén CH. Management of chronic diarrhea in HIV-infected patients: current treatment options, challenges and future directions. HIV/AIDS2010;2:219– 24. 10.2147/HIV.S13191.

19. Isaac-Renton JL. Laboratory diagnosis of giardiasis. Clin Lab Med 1991;11:811–27.

20. Rosenblatt JE, Sloan LM, Schneider SK. Evaluation of an enzyme-linked immunosorbent assay for the detection of Giardia lamblia in stool specimens. Diagn Microbiol Infect Dis 1993;16:337–41. 10.1016/0732-8893(93)90086-M.

21. Mank TG, Zaat JOM, Deelder AM, et al. Sensitivity of microscopy versus enzyme immunoassay in the laboratory diagnosis of giardiasis. Eur J Clin Microbiol Infect Dis 1997;16:615–9. 10.1007/BF02447929.

22. Zaat JOM, Mank TG, Assendelft WJJ. A systematic review on the treatment of giardiasis. Trop Med Int Health 1997;2:63–82. 10.1046/j.1365-3156.1997.d01-132.x.

23. Dhanalakshmi S, Meenachi C, Parija SC. Indirect haemagglutination test in comparison with ELISA for detection of antibodies against invasive amoebiasis. J Clin Diagn Res 2016;10: DC05–8. 10.7860/JCDR/2016/21566.8326.

24. Cornely OA, Crook DW, Esposito R, et al. Fidaxomicin versus vancomycin for infection with Clostridium diffi cile in Europe, Canada, and the USA: a double-blind, non-inferiority, randomised controlled trial. Lancet Infect Dis 2012;12:281–9. 10.1016/S1473-3099(11)70374-7.

25. Louie TJ, Miller MA, Mullane KM, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med Overseas Ed 2011;364:422–31. 10.1056/NEJMoa0910812.

26. Wilcox MH, Gerding DN, Poxton IR, et al. Bezlotoxumab for prevention of recurrent Clostridium difficile infection. N Engl J Med Overseas Ed 2017;376:305–17. 10.1056/NEJMoa1602615.

27. Davies KA, Longshaw CM, Davis GL, et al. Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID). Lancet Infect Dis 2014;14:1208–19. 10.1016/S1473-3099(14)70991-0.

28. Wadhwa A, Al Nahhas MF, Dierkhising RA, et al. High risk of post-infectious irritable bowel syndrome in patients with Clostridium difficile infection. Aliment Pharmacol Ther 2016;44:576–82. 10.1111/apt.13737.

29. Waugh N, Cummins E, Royle P, et al. Faecal calprotectin testing for differentiating amongst inflammatory and non-inflammatory bowel diseases: systematic review and economic evaluation. Health Technol Assess 2013;17: xv–xix. 10.3310/hta17550.

30. Dhaliwal A, Zeino Z, Tomkins C, et al. Utility of faecal calprotectin in inflammatory bowel disease (IBD): what cut-off s should we apply? Frontline Gastroenterol 2015;6:14–19. 10.1136/flgastro-2013-100420.

31. McFarlane M, Chambers S, Malik A, et al. Clinical outcomes at 12 months and risk of inflammatory bowel disease in patients with an intermediate raised fecal calprotectin: a ‘real-world’ view. BMJ Open 2016;6: e011041 10.1136/bmjopen-2016-011041.

32. Karsa Lv, Lignini TA, Patnick J, et al. Th e dimensions of the CRC problem. Best Pract Res Clin Gastroenterol 2010;24:381–96. 10.1016/j.bpg.2010.06.004.

33. Mowat C, Digby J, Strachan JA, et al. Faecal haemoglobin and faecal calprotectin as indicators of bowel disease in patients presenting to primary care with bowel symptoms. Gut 2016;65:1463–9. 10.1136/gutjnl-2015-309579.

34. Quyn AJ, Steele RJ, Digby J, et al. Application of NICE guideline NG12 to the initial assessment of patients with lower gastrointestinal symptoms: not FIT for purpose? Ann Clin Biochem 2018;55:69–76. 10.1177/0004563217707981.

35. Ross S, D’Mello M, Anand SS, et al. Effect of bile acid sequestrants on the risk of cardiovascular events: a mendelian randomization analysis. Circ Cardiovasc Genet 2015;8:618–27. 10.1161/CIRCGENETICS.114.000952.

36. Langner C, Aust D, Ensari A, et al. Histology of microscopic colitis-review with a practical approach for pathologists. Histopathology 2015;66:613–26. 10.1111/his.12592.

37. Böhmer CJM, Tuynman HARE. Th e eff ect of a lactose-restricted diet in patients with a positive lactose tolerance test, earlier diagnosed as irritable bowel syndrome: a 5-year follow-up study. Eur J Gastroenterol Hepatol 2001;13:941–4. 10.1097/00042737-200108000-00011.

38. Corlew-Roath M, Di Palma JA. Clinical impact of identifying lactose maldigestion or fructose malabsorption in irritable bowel syndrome or other conditions. South Med J 2009;102:1010–2. 10.1097/SMJ.0b013e3181b64c7f.

39. Hauer-Jensen M, Denham JW, Andreyev HJN. Radiation enteropathy: pathogenesis, treatment and prevention. Nat Rev Gastroenterol Hepatol 2014;11:470–9. 10.1038/nrgastro.2014.46.

40. Dinning PG, Szczesniak MM, Cook IJ. Twenty-four hour spatiotemporal mapping of colonic propagating sequences provides pathophysiological insight into constipation. Neurogastroenterol Motil 2008;20:1017–21. 10.1111/j.1365-2982.2008.01147.x.

41. Lindberg G, Tornblom H, Iwarzon M, et al. Full-thickness biopsy findings in chronic intestinal pseudo-obstruction and enteric dysmotility. Gut 2009;58:1084–90. 10.1136/gut.2008.148296.

42. Posserud I, Stotzer P-O, Bjornsson ES, et al. Small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Gut 2007;56:802–8. 10.1136/gut.2006.108712.

43. Soff er EE, Bruck R, Bar-Meir S. Th e role of short-term multilumen duodenojejunal manometry in patients with intestinal motor dysfunction. Gastroenterol Clin Biol 1988;12:123–5.

44. Stanghellini V, Cogliandro R, Cogliandro L, et al. Clinical use of manometry for the diagnosis of intestinal motor abnormalities. Dig Liver Dis 2000;32:532–41. 10.1016/ S1590-8658(00)80011-0.

45. Marciani L, Cox EF, Hoad CL, et al. Postprandial changes in small bowel water content in healthy subjects and patients with irritable bowel syndrome. Gastroenterology 2010;138:469–77. 77 e1 10.1053/j.gastro.2009.10.055.

46. Armbrecht U, Lundell L, Lindstedt G, et al. Causes of malabsorption after total gastrectomy with Roux-en-Y reconstruction. Acta Chir Scand 1988;154:37–41.

47. Swan RW. Stagnant loop syndrome resulting from small-bowel irradiation injury and intestinal by-pass. Gynecol Oncol 1974;2:441–5. 10.1016/0090-8258(74)90052-3.

48. Castiglione F, Del Vecchio Blanco G, Rispo A, et al. Orocecal transit time and bacterial overgrowth in patients with Crohn’s disease. J Clin Gastroenterol 2000;31:63–6. 10.1097/00004836-200007000-00015.

49. Mekhjian HS, O’Dorisio TM. VIPoma syndrome. Semin Oncol 1987;14:282–91.

50. Ganguli PC, Cullen DR, Irvine WJ. Radioimmunoassay of plasmagastrin in pernicious anaemia, achlorhydria without pernicious anaemia, hypochlorhydria, and in controls. Lancet 1971;1:155–8. 10.1016/S0140-6736(71)91932-5

51. Ramage JK, Ahmed A, Ardill J, et al. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours (NETs). Gut 2012;61:6–32. 10.1136/gutjnl-2011-300831.

52. Halperin DM, Shen C, Dasari A, et al. Frequency of carcinoid syndrome at neuroendocrine tumour diagnosis: a population-based study. Lancet Oncol 2017;18:525–34. 10.1016/S1470–2045(17)30110-9.

53. Afzalpurkar RG, Schiller LR, Little KH, et al. Th e self-limited nature of chronic idiopathic diarrhea. N Engl J Med 1992;327:1849–52. 10.1056/NEJM199212243272605.

54. Hungin AP, Paxman L, Koenig K, et al. Prevalence, symptom patterns and management of episodic diarrhoea in the community: a population-based survey in 11 countries. Aliment Pharmacol Ther 2016;43:586–95. 10.1111/apt.13513

55. Wang D, Ju X, Xie F. et al. Clinical analysis of 31 cases of 2019 novel coronavirus infection in children from six provinces (autonomous region) of northern China. Zhonghua Er Ke Za Zhi 2020;58: E011 (in Chinese).

56. Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong. Donnelly CA, Ghani AC, Leung GM, et al. Lancet. 2003:1761–1766.

57. Yang Z, Li G, Dai X, Liu G, Li G, Jie Y. Th ree cases of novel coronavirus pneumonia with viral nucleic acids still positive in stool aft er throat swab detection turned negative. Chin J Dig. 2020;40: E002–E002 (in Chinese). 10.3760/cma.j.issn.0254-1432.2020.0002.

58. Ling Y, Xu SB, Lin YX. et al. Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients. Chin Med J (Engl). 2020. Published online Feb 28. 10.1097/CM9.0000000000000774.

59. Zhang J, Wang S, Xue Y. Fecal specimen diagnosis 2019 novel coronavirus-infected pneumonia. J Med Virol. 2020. Published online Mar 3. 10.1002/jmv.25742.

60. Read NW, Krejs GJ, Read MG, et al. Chronic diarrhea of unknown origin. Gastroenterology 1980;78:264–71.

61. Ackerman Z, Eliakim R, Stalnikowicz R, et al. Role of small bowel biopsy in the endoscopic evaluation of adults with iron deficiency anemia. Am J Gastroenterol 1996;91:2099–102.

62. Isaac-Renton JL. Laboratory diagnosis of giardiasis. Clin Lab Med 1991;11:811–27.

63. Ranesh P Arasaradnam, Steven Guidelines for the investigation of chronic diarroea in adults British Sosiety of Gastroenterology, 3 rd edition Gut. 2018 aug 67 (8) 1380–1399. Published online 2018 Apr 13

64. Eriksson B, Arnberg H, Lindgren PG, et al. Neuroendocrine pancreatic tumours: clinical presentation, biochemical and histopathological findings in 84 patients. J Intern Med 1990;228:103–13. 10.1111/j.1365-2796.1990.tb00202.x.

65. Talley NJ, Weaver AL, Zinsmeister AR, et al. Onset and disappearance of gastrointestinal symptoms and functional gastrointestinal disorders. Am J Epidemiol 1992;136:165– 77. 10.1093/oxfordjournals.aje.a116483.

66. Canavan C, West J, Card T. Th e epidemiology of irritable bowel syndrome. Clin Epidemiol 2014;6:71–80. 10.2147/ CLEP.S40245 4. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol 2012;10:712–21. 10.1016/j.cgh.2012.02.029

67. American Gastroenterological Association. Medical position statement: celiac sprue. Gastroenterology 2001;120:1522– 5.

68. West J, et al. Seroprevalence, correlates, and characteristics of undetected coeliac disease in England. Gut 2003;52:960– 5. 10.1136/gut.52.7.960.

69. Fasano A, Berti I, Gerarduzzi T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States. Arch Intern Med 2003;163:286–92. 10.1001/archinte.163.3.286.

70. Green PH, Jabri B. Coeliac disease. Lancet 2003;362:383–91. 10.1016/S0140-6736(03)14027-5.

71. Catassi C, Kryszak D, Bhatti B, et al. Natural history of celiac disease autoimmunity in a USA cohort followed since 1974. Ann Med 2010;42:530–8. 10.3109/07853890.2010.514285.

72. Lohi S, Mustalahti K, Kaukinen K, et al. Increasing prevalence of coeliac disease over time. Aliment Pharmacol Th er 2007;26:1217–25. 10.1111/j.1365-2036.2007.03502.x.

73. Rubio–Tapia A, Kyle RA, Kaplan EL, et al. Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology 2009;137:88–93. 10.1053/j.gastro.2009.03.059.

74. Fernández-Bañares F, Esteve M, Salas A, et al. Systematic evaluation of the causes of chronic watery diarrhea with functional characteristics. Am J Gastroenterol 2007;102:2520–8. 10.1111/j.1572-0241.2007.01438.x.

75. Hopper AD, Cross SS, Hurlstone DP, et al. Pre-endoscopy serological testing for coeliac disease: evaluation of a clinical decision tool. BMJ 2007;334:729 10.1136/bmj.39133.668681.BE.

76. Storhaug CL, Fosse SK, Fadnes LT. Country, regional, and global estimates for lactose malabsorption in adults: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2017;2:738–46. 10.1016/S2468-1253(17)30154-1.

77. Zheng X, Chu H, Cong Y, et al. Self-reported lactose intolerance in clinic patients with functional gastrointestinal symptoms: prevalence, risk factors, and impact on food choices. Neurogastroenterol Motil 2015;27:1138–46. 10.1111/nmo.12602

78. O’Donnell LJ, Virjee J, Heaton KW. Detection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate. BMJ 1990;300:439–40. 10.1136/bmj.300.6722.439.

79. Madoff RD, Williams JG, Caushaj PF. Fecal incontinence. N Engl J Med 1992;326:1002–7. 10.1056/NEJM199204093261507.

80. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in wuhan, China. JAMA. 2020;323:1061. doi: 10.1001/jama.2020.1585.

81. Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. [Internet]. Lancet Infect Dis. 2020;0[cited 2020 Apr 16] Available from: http://www.ncbi.nlm.nih.gov/pubmed/32087114.

82. Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China [Internet]. N Engl J Med. 2020; NEJMoa2002032.[cited 2020 Apr 16] Available from: http://www.nejm.org/doi/10.1056/NEJMoa2002032.

83. Jin X, Lian J-S, Hu J-H, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. [Internet]. Gut 2020; gutjnl-2020–320926. [cited 2020 Apr 13] Available from: http://gut.bmj.com/lookup/doi/10.1136/gutjnl-2020–320926.

84. Pan L, Mu M, Yang P, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study [Internet]. [cited 2020 Apr 13] Available from: https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf.

85. Zhou P., Yang X. L., Wang X. G., et al. Discovery of a novel coronavirus associated with the recent pneumonia outbreak in humans and its potential bat origin[J/OL]. 2020[2020–01–23]. https://www.biorxiv.org/content/10.1101/2020.01.22.914952v2. DOI:10.1101/2020.01.22.914952.

86. Zhang H., Kang Z., Gong H. The digestive system is a potential route of 2019-ncov infection: A bioinformatics analysis -based on single – cell transcriptomes [J] J bioRxiv. 2020 https://www.biorxiv.org/content/10.110 1/2020.01.30.927806v1. DOI:10.1101/2020.01.30.927806 [2020–01–31]

87. Tang X. F., M, Zheng X., Liu Y., Li X., Shan H. Evidence for gastrointestinal infection of SARS – CoV – 2, Gastroenterology (2020), doi: https://doi.org/10.1053/j.gastro.2020.02.055.

88. Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARSCoV-2 Cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor [Internet]. Cell. 2020; [cited 2020 Apr 13] Available from: http://www.ncbi.nlm.nih.gov/pubmed/32142651.

89. Hung I. F., Cheng V. C., Wu A. K. Viral loads in clinical specimens and SARS manifestations. Emerg Infect Dis. 2004;10:1550–1557.

90. Zhou J., Li C., Zhao G. Human intestinal tract serves as an alternative infection route for Middle East respiratory syndrome coronavirus. Sci Adv. 2017;3 eaao4966.

91. Holshue M. L., DeBolt C., Lindquist S. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020;382(10):929–936.

92. Tisoncik J. R., Korth M. J., Simmons C. P. Into the eye of the cytokine storm [J] Microbiol. Mol Biol Rev. 2012;76(1) doi: 10.1128/MMBR.Th e05015–11. 16 and 32.

93. Tocilizumab in COVID-19 Pneumonia (TOCIVID-19)— Full text view – clinical trials.gov.https://clinicaltrials.gov/ct2/show/NCT04317092. Accessed April 12, 2020.

94. Evaluation of the Efficacy and Safety of Sarilumab in Hospitalized Patients with COVID-19 – Full Text View – Clinicaltrials.gov. https://clinicaltrials.gov/ct2/show/NCT04315298. Accessed April 12, 2020

95. Monteleone G, Ardizzone S. Are patients with inflammatory bowel disease at increased risk for COVID-19 Infection? J Crohn’s and Colitis. 2020; [Online ahead of print].

96. Rubin D, Feuerstein J, Wang, et al. AGA clinical practice update on management of inflammatory bowel disease during the COVID-19 pandemic: expert commentary. Gastroenterology. 2020; [Online ahead of print].

97. Yuan Tian et al. Rewier article: gastrointestinal features in COVID-19 and the possibility of faecal transmission|Aliment Pharmacol Th er 2020 May 51 (9): 843–851

98. Liat S. Gutin, et al. Going Viral: Management of IBD in the Era of the COVID-19 Pandemic. Dig Dis Sci. 2020 May 4: 1–5

99. Yuhao Zhang et al. New understanding of the damage of SARS-CoV-2 – infection outside the respiratory system Biomed Pharmacother. 2020 Apr 28 110195 doi 10.1016/biopha.2020.110195


Рецензия

Для цитирования:


Сарсенбаева А.С., Лазебник Л.Б. Диарея при COVID-19 у взрослых. Экспериментальная и клиническая гастроэнтерология. 2020;(6):42-54. https://doi.org/10.31146/1682-8658-ecg-178-6-42-54

For citation:


Sarsenbaevа A.S., Lazebnik L.B. Diarrhea when COVID-19 in adults. Experimental and Clinical Gastroenterology. 2020;(6):42-54. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-178-6-42-54

Просмотров: 1984


Creative Commons License
Контент доступен под лицензией Creative Commons Attribution 4.0 License.


ISSN 1682-8658 (Print)