Preview

Experimental and Clinical Gastroenterology

Advanced search

THE EFFECTIVENESS OF PSYLLIUM AND LACTULOSE IN TREATMENT OF FUNCTIONAL CONSTIPATION WHEN COMBINED WITH NONALCOHOLIC STEATOHEPATITIS

Abstract

The aim of the study was to Evaluate the effectiveness of long-term therapy dietary fiber (DF) or lactulose on the course of functional constipation when combined with nonalcoholic steatohepatitis (NASH) Material and methods. Was conducted an open prospective comparative study in parallel groups with the inclusion of 102 patients with NASH, among whom were allocated to patients with symptoms of functional constipation. The main group consisted of 70 people (NASH and functional constipation), a comparison group of 32 people with just NASH. The main group patients were randomized into two equal subgroups of 30 people IA and IB, differentiated by the treatment of functional constipation: patients of subgroup IA in addition to modification of lifestyle was prescribed the drug lactulose, patients IB - preparation of dietary fiber (psyllium). All patients 1 time per 3 months was carried out dynamic assessment of specific markers of functional constipation, frequency of defecation, stool type, indicators of quality of life, check bacterial overgrowth syndrome. The observation period of the patients was 6 months. Results. For the period 6-month observation the most significant regression of markers of functional constipation (natureline, frequency of defecation), better tolerance of therapy, including less pronounced side effects significantly greater reduction of bacterial overgrowth syndrome (p < 0.05) was achieved only in the subgroup of dietary fiber, which is reflected in a statistically more significant improvement in quality of life than in the subgroup of lactulose. Conclusion: long-term treatment of functional constipation with psyllium is characterized by a more pronounced laxative effect, better tolerated, reduces the severity bacterial overgrowth syndrome that regularly impact on improving the quality of life compared with lactulose.

About the Authors

E. A. Maevskaya
Moscow state medical dental University named A. I. Evdokimov Ministry of health of the Russian Federation
Russian Federation


Y. A. Cucheryavy
Moscow state medical dental University named A. I. Evdokimov Ministry of health of the Russian Federation
Russian Federation


S. V. Cheremushkin
Moscow state medical dental University named A. I. Evdokimov Ministry of health of the Russian Federation
Russian Federation


V. A. Shestakov
Moscow state medical dental University named A. I. Evdokimov Ministry of health of the Russian Federation
Russian Federation


I. V. Mayev
Moscow state medical dental University named A. I. Evdokimov Ministry of health of the Russian Federation
Russian Federation


References

1. Overweight and gastrointestinal symptoms among adults of working age in Iaşi City, Romania / I. Chirila, VL. Drug, FD. Petrariu [et al.] // Rev Med Chir Soc Med Nat Iasi. - 2012. - Vol.116, № 1. - P. 268-73.

2. Talley, NJ. Functional gastrointestinal disorders as a public health problem / N. J. Talley // Neurogastroenterol Motil. - 2008. - Vol. 20(Suppl 1). - P. 121-9.

3. Клинические рекомендации Российской гастроэнтерологической ассоциации по диагностике и лечению взрослых пациентов с хроническим запором / В. Т. Ивашкин, С. Р. Абдулхаков, Е. К. Баранская [и др.] // Росс. журн. гастроэнтерол., гепатол., колопроктол. - 2014. - № 5. - С. 69-75.

4. Pare, P. The approach to diagnosis and treatment of chronic constipation: suggestions for a general practitioner / P. Pare // Can. J. Gastroenterol. - 2011. - 25 (Suppl B). - P. 36B-40B.

5. Locke, G.III. American Gastroenterological Association Medical Position Statement: guidelaines on constipation / G.III. Locke, J. Pemberton, S. Philips // Gastroenterology. - 2000. - Vol. 119, № 6. - P. 1761-1766.

6. Опыт применения препарата Мукофальк в комплексной терапии у пациентов с ожирением и метаболическим синдромом. Отчет НИИ диетологии и диетотерапии [Электронный ресурс] / И. В. Губарева, Т. Е. Чембарова, М. М. Гинзбург [и др.] // Самара, 2010. - Режим доступа: www.mucofalk.ru/download/ginsburg.pdf

7. Чиркин, В. И. Долгосрочные эффекты препарата пищевых волокон псиллума (Мукофальк) у пациентов с метаболическим синдромом / В. И. Чиркин, И. А. Лазарев, М. Д. Ардатская // Клин. перспективы гастроэнтерол., гепатол. - 2012. - № 1. - С. 34-42.

8. Pal, S. Effects of psyllium on metabolic syndrome risk factors / S. Pal, S. Radavelli-Bagatini // Obes Rev. - 2012. - Vol. 13, № 11. - P. 1034-47.

9. Полевая, Е. В. Энтеросорбционные свойства псиллиума (Мукофалька) и возможные механизмы его действия при кишечных инфекциях / Е. В. Полевая, Т. Я. Вахитов, С. И. Ситкин // Клин. перспективы гастроэнтерол., гепатол. - 2011. - № 2. - С. 35-39.

10. Особенности течения неалкогольного стеатогепатита, ассоциированного с хроническим запором / Маевская Е. А., Маев И. В., Кучерявый Ю. А. [и др.] // Экспериментальная и клиническая гастроэнтерология. - 2015. - № 9. - С. 36-44.

11. Оценка влияния лактулозы или пищевых волокон на динамику показателей липидного профиля у пациентов с функциональным запором и неалкогольным стеатогепатитом / Маевская Е. А., Маев И. В., Кучерявый Ю. А. [и др.] // Лечащий врач. - 2016. - № 4. - С. 1-6.

12. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association / N. Chalasani, Z. Younossi, JE. Lavine [et al.] // Hepatology. - 2012. - Vol. 55, № 6. - P. 2005-23.

13. Drossman DA. The Functional Gastrointestinal Disorders and the Rome III Process // Gastroenterology. - 2006. - Vol. 130. - P. 1377-1390.

14. Маевская М. В., Шульпекова О. Ю., Буеверов О. А. и соавт. Диагностика и лечение неалкогольной жировой болезни печени / Под ред.Ивашкина В. Т. Методические рекомендации для врачей. М., 2015. 32 с.

15. World Gastroenterology Organisation global guidelines: Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis / LaBrecque D. R., Abbas Z., Anania F. [et al]. // J Clin Gastroenterol. - 2014. - Vol.48, № 6. - P. 467-473.

16. World Gastroenterology Organisation Global Guidelines// Constipation: a global perspective. November 2010. www.worldgastroenterology.org/constipation. Html.

17. Ware JE, Kosinski M, Keller SD. SF-36 Physical and Mental Health Summary Scales: A User’s Manual. Boston, MA: Th e Health Institute; 1994.

18. Development and validation of the Patient Assessment of Constipation Quality of Life questionnaire / P. Marquis, C. De La Loge, D. Dubois [et al.] // Scand J Gastroenterol. - 2005. - Vol. 40, № 5. - P. 540-51.

19. Черемушкин, С. В. Доказательная медицина и лечение хронического запора / С. В. Черемушкин, Ю. А. Кучерявый // Врач. - 2012. - № 10. - С. 42-47.

20. Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation (part II: treatment) / A. Bove, M. Bellini, E. Battaglia [et al.] // World J Gastroenterol. - 2012. - Vol. 18, № 36. - P. 4994-5013.

21. Liu, L. W. Chronic constipation: current treatment options / L. W. Liu // Can. J. Gastroenterol. - 2011. - Vol. 25 (Suppl B). - P. 22-28.

22. Primary Care Management of Chronic Constipation in Asia: The ANMA Chronic Constipation Tool / KA. Gwee, UC. Ghoshal, S. Gonlachanvit [et al.] // J Neurogastroenterol Motil. - 2013. - Vol. 19, № 2. - Р. 149-60.

23. Pare, P. Systematic review of stimulant and nonstimulant laxatives for the treatment of functional constipation / P. Pare, RN. Fedorak // Can J Gastroenterol Hepatol. - 2014. - Vol. 28, № 10. - P. 549-57.

24. Mueller-Lissner, SA. Constipation in adults [Электронный ресурс] / SA. Mueller-Lissner, A. Wald // BMJ Clin Evid. - 2010. - Vol. 2010. - P. 0413. - Режим доступа: www.ncbi.nlm.nih.gov/pmc/articles/PMC 3217654/

25. Randomised, controlled comparison of low-dose polyethylene glycol 3350 plus electrolytes with Ispaghula Husk in the treatment of adults with chronic functional constipation / H. J. Wang, X. M. Liang, Z. L. Yu [et al.] // Clin Drug Investig. - 2004. - Vol. 24, № 10. - P. 569-76.

26. The treatment of chronic constipation in adults. A systematic review / S. M. Tramonte, M. B. Brand, C. D. Mulrow [et al.] // J. Gen. Intern. Med. - 1997. - Vol. 12. - P. 15-24.

27. Randomised clinical trial: dried plums (prunes) vs. psyllium for constipation / A. Attaluri, R. Danahoe, J. Valestin [et al.] // Aliment Pharmacol Ther. - 2011. - Vol. 33, № 7. - P. 822-8.

28. Effect of dietary fiber on constipation: a meta analysis / J. Yang, H. P. Wang, L. Zhou [et al.] // World J Gastroenterol. - 2012. - Vol. 18, № 48. - P. 7378-83.

29. Ruiz-López, MC. Quality of life in patients with different constipation subtypes based on the Rome III criteria / MC. Ruiz-López, E. Coss-Adame // Rev Gastroenterol Mex. - 2015. - Vol. 80, № 1. - P. 13-20.

30. Sanchez, MI. Epidemiology and burden of chronic constipation / MI, Sanchez, P. Bercik // Can J Gastroenterol. - 2011. - Vol. 25(Suppl B). - P. 11B-15B.

31. Неалкогольный стеатогепатит и кишечная микрофлора: есть ли потенциал пребиотических препаратов в лечении?/ Ю. А. Кучерявый, Е. А. Маевская, М. Л. Ахтаева [и др.] // Мед. совет. - 2013. - № 3 (2). - С. 46-51.

32. Маевская, Е. А. Кишечная микрофлора и неалкогольный стеатогепатит: от механизмов патогенеза к терапии / Е. А. Маевская, Ю. А. Кучерявый, И. В. Маев // Леч. Врач. - 2014. - № 8. - С. 45-51.

33. Буеверов, А. О. Цитокиновый взрыв и прогрессирование неалкогольного стеатогепатита / А. О. Буеверов, П. О. Богомолов // Клин. перспективы гастроэнтерол., гепатол. - 2012. - № 5. - С. 12-18.

34. Obesity and functional constipation; a community-based study in Iran / MA. Pourhoseingholi, SA. Kaboli, A. Pourhoseingholi [et al.] // J Gastrointestin Liver Dis. - 2009. - Vol.18, № 2. - P. 151-5.

35. Mozaffari, S. The safety of novel drugs used to treat irritable bowel syndrome / S. Mozaffari, S. Nikfar, M. Abdollahi // Expert Opin Drug Saf. - 2014. - Vol. 13, № 5. - P. 625-38.

36. The efficacy and safety of rifaximin for the irritable bowel syndrome: a systematic review and meta-analysis / SB. Menees, M. Maneerattannaporn, HM. Kim [et al.] // Am J Gastroenterol. - 2012. - Vol. 107, № 1. - P. 28-35.

37. Small intestinal bacterial overgrowth syndrome / J. Bures, J. Cyrany, D. Kohoutova [et al.] // World J. Gastroenterol. - 2010. - Vol. 16, № 24 - Р. 2978-2990.

38. Abnormal breath testing in IBS: a meta-analysis / Shah ED, Basseri RJ, Chong K [et al.] // Dig Dis Sci. - 2010. - Vol.55, № 9. - P. 441-9.

39. Psyllium improves fecal consistency and prevents enhanced secretory responses in jejunal tissues of piglets infected with ETEC / U.L Hayden., S.M McGuirk., S. E. West [et al.] // Dig. Dis. Sci. - 1998. - Vol. 43, № 11. - P. 2536-2541.

40. Salminen, S. Lactulose, lactic acid bacteria, intestinal microecology and mucosal protection / S. Salminen, E. Salminen // Scand. J. Gastroenterol. - 1997. - Vol. 222. - Р. 45-48.

41. Panesar, P. S. Lactulose: production, purification and potential applications / P.S Panesar, S. Kumari // Biotechnol. Adv. - 2011. - Vol. 29, № 6. - Р. 940-948.


Review

For citations:


Maevskaya E.A., Cucheryavy Y.A., Cheremushkin S.V., Shestakov V.A., Mayev I.V. THE EFFECTIVENESS OF PSYLLIUM AND LACTULOSE IN TREATMENT OF FUNCTIONAL CONSTIPATION WHEN COMBINED WITH NONALCOHOLIC STEATOHEPATITIS. Experimental and Clinical Gastroenterology. 2017;(3):38-47. (In Russ.)

Views: 1618


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1682-8658 (Print)