medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2017-5-85-92medsovet-1798Research ArticleГАСТРОЭНТЕРОЛОГИЯGASTROENTEROLOGYСИНДРОМ РАЗДРАЖЕННОГО КИШЕЧНИКА И ЕГО СВЯЗЬ С КИШЕЧНОЙ МИКРОФЛОРОЙIRRITABLE BOWEL SYNDROME AND ITS RELATIONSHIP WITH INTESTINAL MICROFLORAПлотниковаЕ. Ю.PlotnikovaE. Y.

Доктор медицинских наук,  профессор

MD, Prof.

ЗахароваЮ. В.ZakharovaY. V.

Кандидат медицинских наук

PhD  in medicine

СухихА. С.SukhikhA. S.

Кандидат медицинских наук

PhD in medicine

ГрачеваТ. Ю.GrachevaT. Y.

Доктор медицинских наук, профессор

MD, Prof. 

Кемеровский государственный медицинский университетРоссияKemerovo State Medical UniversityRussian Federation201711052017058592Copyright © Плотникова Е.Ю., Захарова Ю.В., Сухих А.С., Грачева Т.Ю., 20172017Плотникова Е.Ю., Захарова Ю.В., Сухих А.С., Грачева Т.Ю.Plotnikova E.Y., Zakharova Y.V., Sukhikh A.S., Gracheva T.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/1798

В последнее десятилетие наблюдается очень активное изучение огромного микробного сообщества, которое находится в кишечнике человека. Появилась концепция, объясняющая развитие и персистирование симптомов при синдроме раздраженного кишечника  за счет нарушения кишечного  микробного пейзажа. Манипулирование  микрофлорой кишечника представляет новую стратегию для лечения этого полиэтиологического заболевания. Модулирование кишечной бактериальной композиции – при этом увеличиваются полезные (Lactobacilli и Bifidobacteria) и сокращаются патогенные бактерии (Clostridium, Escherichiacoli, Salmonella, Shigella и Pseudomonas) – должно уменьшать симптомы синдрома раздраженного кишечника. В этой концептуальной основе пробиотики являются оптимальным вариантом с точки зрения эффективности и безопасности, а также особое внимание специалистов привлекают пребиотики, синбиотики, антибиотики и фекальная трансплантация.

In the last decade there has been a very active study of large microbial community in the human gut. The concept appeared explaining the development and persistence of symptoms in irritable bowel syndrome due to disturbances of the intestinal microbial landscape. Manipulation of the intestinal microflora represents a new strategy for treatment of this polietiologic disease. The modulation of the intestinal bacterial  at which beneficial (Lactobacilli and Bifidobacteria) bacteria are increased and pathogenic bacteria (Clostridium, Escherichia coli, Salmonella, Shigella and Pseudomonas) are reduced should reduce the symptoms of the irritable bowel syndrome.  In this conceptual framework, probiotics are the optimal option in terms of efficacy and safety, and they attract the attention of specialists prebiotics, synbiotics, antibiotics and fecal transplantation.

синдром раздраженного кишечникакишечная микрофлора«Римские критерии IV»пробиотикивисмута трикалия дицитратirritable bowel syndromeintestinal microfloraRoman Criteria IVprobioticsbismuth tripotassium dicitrateReferencesBrian E, Mearin F, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R. Bowel Disorders. Gastroenterology, 2016, 150(6): 1393-1407.Brian E, Mearin F, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R. Bowel Disorders. Gastroenterology, 2016, 150(6): 1393-1407.Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol, 2012, 10: 712-721.Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol, 2012, 10: 712-721.Simrén M, Svedlund J, Posserud I, Björnsson ES, Abrahamsson H. Health-related quality of life in patients attending a gastroenterology outpatient clinic: functional disorders versus organic diseases. Clin Gastroenterol Hepatol, 2006, 4:187–195.Simrén M, Svedlund J, Posserud I, Björnsson ES, Abrahamsson H. Health-related quality of life in patients attending a gastroenterology outpatient clinic: functional disorders versus organic diseases. Clin Gastroenterol Hepatol, 2006, 4:187–195.Mayer EA, Gebhart GF. Basic and clinical aspects of visceral hyperalgesia. Gastroenterology, 1994, 107: 271–293.Mayer EA, Gebhart GF. Basic and clinical aspects of visceral hyperalgesia. Gastroenterology, 1994, 107: 271–293.Distrutti E, Salvioli B, Azpiroz F, Malagelada JR. Rectal function and bowel habit in irritable bowel syndrome. Am J Gastroenterol, 2004, 99: 131–137.Distrutti E, Salvioli B, Azpiroz F, Malagelada JR. Rectal function and bowel habit in irritable bowel syndrome. Am J Gastroenterol, 2004, 99: 131–137.De Giorgio R, Barbara G. Is irritable bowel syndrome an inflammatory disorder? Curr Gastroenterol Rep, 2008, 10: 385–390.De Giorgio R, Barbara G. Is irritable bowel syndrome an inflammatory disorder? Curr Gastroenterol Rep, 2008, 10: 385–390.Kiank C, Taché Y, Larauche M. Stress-related modulation of inflammation in experimental models of bowel disease and post-infectious irritable bowel syndrome: role of corticotropinreleasing factor receptors. Brain Behav Immun, 2010, 24: 41–48.Kiank C, Taché Y, Larauche M. Stress-related modulation of inflammation in experimental models of bowel disease and post-infectious irritable bowel syndrome: role of corticotropinreleasing factor receptors. Brain Behav Immun, 2010, 24: 41–48.Camilleri M, Lasch K, Zhou W. Irritable bowel syndrome: methods, mechanisms, and pathophysiology. The confluence of increased permeability, inflammation, and pain in irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol, 2012, 303: G775–G785.Camilleri M, Lasch K, Zhou W. Irritable bowel syndrome: methods, mechanisms, and pathophysiology. The confluence of increased permeability, inflammation, and pain in irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol, 2012, 303: G775–G785.Savage DC. Microbial ecology of the gastrointestinal tract. Annu Rev Microbiol. 1977, 31:107–133.Savage DC. Microbial ecology of the gastrointestinal tract. Annu Rev Microbiol. 1977, 31:107–133.Qin J, Li R, Raes J, Arumugam M, Burgdorf KS, Manichanh C, Nielsen T, Pons N, Levenez F, Yamada T, et al. A human gut microbial gene catalogue established by metagenomic sequencing. Nature, 2010, 464: 59–65.Qin J, Li R, Raes J, Arumugam M, Burgdorf KS, Manichanh C, Nielsen T, Pons N, Levenez F, Yamada T, et al. A human gut microbial gene catalogue established by metagenomic sequencing. Nature, 2010, 464: 59–65.International Human Genome Sequencing Consortium. Finishing the euchromatic sequence of the human genome. Nature, 2004, 431: 931–945.International Human Genome Sequencing Consortium. Finishing the euchromatic sequence of the human genome. Nature, 2004, 431: 931–945.Murgas Torrazza R, Neu J. The developing intestinal microbiome and its relationship to health and disease in the neonate. J Perinatol, 2011, 31(1): S29–S34.Murgas Torrazza R, Neu J. The developing intestinal microbiome and its relationship to health and disease in the neonate. J Perinatol, 2011, 31(1): S29–S34.Ley RE, Turnbaugh PJ, Klein S, Gordon JI. Microbial ecology: human gut microbes associated with obesity. Nature, 2006, 444: 1022–1023.Ley RE, Turnbaugh PJ, Klein S, Gordon JI. Microbial ecology: human gut microbes associated with obesity. Nature, 2006, 444: 1022–1023.Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature, 2006, 444: 1027–1031.Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature, 2006, 444: 1027–1031.Round JL, Lee SM, Li J, Tran G, Jabri B, Chatila TA, Mazmanian SK. The Toll-like receptor 2 pathway establishes colonization by a commensal of the human microbiota. Science, 2011, 332: 974–977.Round JL, Lee SM, Li J, Tran G, Jabri B, Chatila TA, Mazmanian SK. The Toll-like receptor 2 pathway establishes colonization by a commensal of the human microbiota. Science, 2011, 332: 974–977.Ivanov II, Atarashi K, Manel N, Brodie EL, Shima T, Karaoz U, Wei D, Goldfarb KC, Santee CA, Lynch SV, et al. Induction of intestinal Th17 cells by segmented filamentous bacteria. Cell, 2009, 139: 485–498.Ivanov II, Atarashi K, Manel N, Brodie EL, Shima T, Karaoz U, Wei D, Goldfarb KC, Santee CA, Lynch SV, et al. Induction of intestinal Th17 cells by segmented filamentous bacteria. Cell, 2009, 139: 485–498.Fukuda S, Toh H, Hase K, Oshima K, Nakanishi Y, Yoshimura K, Tobe T, Clarke JM, Topping DL, Suzuki T, et al. Bifidobacteria can protect from enteropathogenic infection through production of acetate. Nature, 2011, 469: 543–547.Fukuda S, Toh H, Hase K, Oshima K, Nakanishi Y, Yoshimura K, Tobe T, Clarke JM, Topping DL, Suzuki T, et al. Bifidobacteria can protect from enteropathogenic infection through production of acetate. Nature, 2011, 469: 543–547.Плотникова Е.Ю., Краснов О.А. Связь микробного пейзажа кишечника с метаболическим синдромом. Фарматека, 2015, 15: 11-21.Плотникова Е.Ю., Краснов О.А. Связь микробного пейзажа кишечника с метаболическим синдромом. Фарматека, 2015, 15: 11-21.Wikoff WR, Anfora AT, Liu J, Schultz PG, Lesley SA, Peters EC, Siuzdak G. Metabolomics analysis reveals large effects of gut microflora on mammalian blood metabolites. Proc Natl Acad Sci USA, 2009, 106: 3698–3703.Wikoff WR, Anfora AT, Liu J, Schultz PG, Lesley SA, Peters EC, Siuzdak G. Metabolomics analysis reveals large effects of gut microflora on mammalian blood metabolites. Proc Natl Acad Sci USA, 2009, 106: 3698–3703.Antunes LC, Han J, Ferreira RB, Lolić P, Borchers CH, Finlay BB. Effect of antibiotic treatment on the intestinal metabolome. Antimicrob Agents Chemother, 2011, 55: 1494–1503.Antunes LC, Han J, Ferreira RB, Lolić P, Borchers CH, Finlay BB. Effect of antibiotic treatment on the intestinal metabolome. Antimicrob Agents Chemother, 2011, 55: 1494–1503.Tremaroli V, Bäckhed F. Functional interactions between the gut microbiota and host metabolism. Nature, 2012, 489: 242–249.Tremaroli V, Bäckhed F. Functional interactions between the gut microbiota and host metabolism. Nature, 2012, 489: 242–249.Marcobal A, Kashyap PC, Nelson TA, Aronov PA, Donia MS, Spormann A, Fischbach MA, Sonnenburg JL. A metabolomic view of how the human gut microbiota impacts the host metabolome using humanized and gnotobiotic mice. ISME J, 2013, 7: 1933–1943.Marcobal A, Kashyap PC, Nelson TA, Aronov PA, Donia MS, Spormann A, Fischbach MA, Sonnenburg JL. A metabolomic view of how the human gut microbiota impacts the host metabolome using humanized and gnotobiotic mice. ISME J, 2013, 7: 1933–1943.Matsumoto M, Kibe R, Ooga T, Aiba Y, Sawaki E, Koga Y, Benno Y. Cerebral low-molecular metabolites influenced by intestinal microbiota: a pilot study. Front Syst Neurosci, 2013, 7: 9.Matsumoto M, Kibe R, Ooga T, Aiba Y, Sawaki E, Koga Y, Benno Y. Cerebral low-molecular metabolites influenced by intestinal microbiota: a pilot study. Front Syst Neurosci, 2013, 7: 9.Cryan JF, Dinan TG. Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour. Nat Rev Neurosci, 2012, 13: 701–712.Cryan JF, Dinan TG. Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour. Nat Rev Neurosci, 2012, 13: 701–712.Forsythe P, Kunze WA. Voices from within: gut microbes and the CNS. Cell Mol Life Sci, 2013, 70: 55–69.Forsythe P, Kunze WA. Voices from within: gut microbes and the CNS. Cell Mol Life Sci, 2013, 70: 55–69.Asano Y, Hiramoto T, Nishino R, Aiba Y, Kimura T, Yoshihara K, Koga Y, Sudo N. Critical role of gut microbiota in the production of biologically active, free catecholamines in the gut lumen of mice. Am J Physiol Gastrointest Liver Physiol, 2012, 303: G1288–G1295Asano Y, Hiramoto T, Nishino R, Aiba Y, Kimura T, Yoshihara K, Koga Y, Sudo N. Critical role of gut microbiota in the production of biologically active, free catecholamines in the gut lumen of mice. Am J Physiol Gastrointest Liver Physiol, 2012, 303: G1288–G1295Barrett E, Ross RP, O’Toole PW, Fitzgerald GF, Stanton C. γ-Aminobutyric acid production by culturable bacteria from the human intestine. J Appl Microbiol, 2012, 113: 411–417.Barrett E, Ross RP, O’Toole PW, Fitzgerald GF, Stanton C. γ-Aminobutyric acid production by culturable bacteria from the human intestine. J Appl Microbiol, 2012, 113: 411–417.Rousseaux C, Thuru X, Gelot A, Barnich N, Neut C, Dubuquoy L, Dubuquoy C, Merour E, Geboes K, Chamaillard M, et al. Lactobacillus acidophilus modulates intestinal pain and induces opioid and cannabinoid receptors. Nat Med, 2007, 13: 35–37.Rousseaux C, Thuru X, Gelot A, Barnich N, Neut C, Dubuquoy L, Dubuquoy C, Merour E, Geboes K, Chamaillard M, et al. Lactobacillus acidophilus modulates intestinal pain and induces opioid and cannabinoid receptors. Nat Med, 2007, 13: 35–37.Medani M, Collins D, Docherty NG, Baird AW, O’Connell PR, Winter DC. Emerging role of hydrogen sulfide in colonic physiology and pathophysiology. Inflamm Bowel Dis, 2011, 17: 1620–1625.Medani M, Collins D, Docherty NG, Baird AW, O’Connell PR, Winter DC. Emerging role of hydrogen sulfide in colonic physiology and pathophysiology. Inflamm Bowel Dis, 2011, 17: 1620–1625.Distrutti E. Hydrogen sulphide and pain. Inflamm Allergy Drug Targets, 2011, 10: 123–132.Distrutti E. Hydrogen sulphide and pain. Inflamm Allergy Drug Targets, 2011, 10: 123–132.Chadwick VS, Chen W, Shu D, Paulus B, Bethwaite P, Tie A, Wilson I. Activation of the mucosal immune system in irritable bowel syndrome. Gastroenterology, 2002, 122: 1778–1783.Chadwick VS, Chen W, Shu D, Paulus B, Bethwaite P, Tie A, Wilson I. Activation of the mucosal immune system in irritable bowel syndrome. Gastroenterology, 2002, 122: 1778–1783.Chadwick VS, Chen W, Shu D, Paulus B, Bethwaite P, Tie A, Wilson I. Activation of the mucosal immune system in irritable bowel syndrome. Gastroenterology, 2002, 122: 1778–1783.Chadwick VS, Chen W, Shu D, Paulus B, Bethwaite P, Tie A, Wilson I. Activation of the mucosal immune system in irritable bowel syndrome. Gastroenterology, 2002, 122: 1778–1783.Guilarte M, Santos J, de Torres I, Alonso C, Vicario M, Ramos L, Martínez C, Casellas F, Saperas E, Malagelada JR. Diarrhoeapredominant IBS patients show mast cell activation and hyperplasia in the jejunum. Gut, 2007, 56: 203–209.Guilarte M, Santos J, de Torres I, Alonso C, Vicario M, Ramos L, Martínez C, Casellas F, Saperas E, Malagelada JR. Diarrhoeapredominant IBS patients show mast cell activation and hyperplasia in the jejunum. Gut, 2007, 56: 203–209.Spiller RC, Jenkins D, Thornley JP, Hebden JM, Wright T, Skinner M, Neal KR. Increased rectal mucosal enteroendocrine cells, T lymphocytes, and increased gut permeability following acute Campylobacter enteritis and in postdysenteric irritable bowel syndrome. Gut, 2000, 47: 804–811.Spiller RC, Jenkins D, Thornley JP, Hebden JM, Wright T, Skinner M, Neal KR. Increased rectal mucosal enteroendocrine cells, T lymphocytes, and increased gut permeability following acute Campylobacter enteritis and in postdysenteric irritable bowel syndrome. Gut, 2000, 47: 804–811.He Q, Wang L, Wang F, Li Q. Role of gut microbiota in a zebrafish model with chemically induced enterocolitis involving toll-like receptor signaling pathways. Zebrafish, 2014, 11: 255–264.He Q, Wang L, Wang F, Li Q. Role of gut microbiota in a zebrafish model with chemically induced enterocolitis involving toll-like receptor signaling pathways. Zebrafish, 2014, 11: 255–264.Spiller R, Garsed K. Postinfectious irritable bowel syndrome. Gastroenterology, 2009, 136: 1979–1988.Spiller R, Garsed K. Postinfectious irritable bowel syndrome. Gastroenterology, 2009, 136: 1979–1988.Jalanka-Tuovinen J, Salojärvi J, Salonen A, Immonen O, Garsed K, Kelly FM, Zaitoun A, Palva A, Spiller RC, de Vos WM. Faecal microbiota composition and host-microbe crosstalk following gastroenteritis and in postinfectious irritable bowel syndrome. Gut, 2014, 63: 1737–1745.Jalanka-Tuovinen J, Salojärvi J, Salonen A, Immonen O, Garsed K, Kelly FM, Zaitoun A, Palva A, Spiller RC, de Vos WM. Faecal microbiota composition and host-microbe crosstalk following gastroenteritis and in postinfectious irritable bowel syndrome. Gut, 2014, 63: 1737–1745.Villarreal AA, Aberger FJ, Benrud R, Gundrum JD. Use of broad-spectrum antibiotics and the development of irritable bowel syndrome. WMJ, 2012, 111: 17–20.Villarreal AA, Aberger FJ, Benrud R, Gundrum JD. Use of broad-spectrum antibiotics and the development of irritable bowel syndrome. WMJ, 2012, 111: 17–20.Rajilić-Stojanović M, Jonkers DM, Salonen A, Hanevik K, Raes J, Jalanka J, de Vos WM, Manichanh C, Golic N, Enck P, et al. Intestinal microbiota and diet in IBS: causes, consequences, or epiphenomena? Am J Gastroenterol, 2015, 110: 278–287.Rajilić-Stojanović M, Jonkers DM, Salonen A, Hanevik K, Raes J, Jalanka J, de Vos WM, Manichanh C, Golic N, Enck P, et al. Intestinal microbiota and diet in IBS: causes, consequences, or epiphenomena? Am J Gastroenterol, 2015, 110: 278–287.Mayer EA, Knight R, Mazmanian SK, Cryan JF, Tillisch K. Gut microbes and the brain: paradigm shift in neuroscience. J Neurosci, 2014, 34: 15490–15496.Mayer EA, Knight R, Mazmanian SK, Cryan JF, Tillisch K. Gut microbes and the brain: paradigm shift in neuroscience. J Neurosci, 2014, 34: 15490–15496.Tillisch K, Labus J, Kilpatrick L, Jiang Z, Stains J, Ebrat B, Guyonnet D, Legrain-Raspaud S, Trotin B, Naliboff B, et al. Consumption of fer mented milk product with probiotic modulates brain activity. Gastroenterology, 2013, 144: 1394–1401.Tillisch K, Labus J, Kilpatrick L, Jiang Z, Stains J, Ebrat B, Guyonnet D, Legrain-Raspaud S, Trotin B, Naliboff B, et al. Consumption of fer mented milk product with probiotic modulates brain activity. Gastroenterology, 2013, 144: 1394–1401.Fond G, Loundou A, Hamdani N, Boukouaci W, Dargel A, Oliveira J, Roger M, Tamouza R, Leboyer M, Boyer L. Anxiety and depression comorbidities in irritable bowel syndrome (IBS): a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci, 2014, 264: 651–660.Fond G, Loundou A, Hamdani N, Boukouaci W, Dargel A, Oliveira J, Roger M, Tamouza R, Leboyer M, Boyer L. Anxiety and depression comorbidities in irritable bowel syndrome (IBS): a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci, 2014, 264: 651–660.Silk DB, Davis A, Vulevic J, Tzortzis G, Gibson GR. Clinical trial: the effects of a trans-galactooligosaccharide prebiotic on faecal microbiota and symptoms in irritable bowel syndrome. Aliment Pharmacol Ther, 2009, 29: 508–518.Silk DB, Davis A, Vulevic J, Tzortzis G, Gibson GR. Clinical trial: the effects of a trans-galactooligosaccharide prebiotic on faecal microbiota and symptoms in irritable bowel syndrome. Aliment Pharmacol Ther, 2009, 29: 508–518.Guarino MP, Altomare A, Stasi E, Marignani M, Severi C, Alloni R, Dicuonzo G, Morelli L, Coppola R, Cicala M. Effect of acute mucosal exposure to Lactobacillus rhamnosus GG on human colonic smooth muscle cells. J Clin Gastroenterol, 2008, 42(3), Pt2: S185–S190.Guarino MP, Altomare A, Stasi E, Marignani M, Severi C, Alloni R, Dicuonzo G, Morelli L, Coppola R, Cicala M. Effect of acute mucosal exposure to Lactobacillus rhamnosus GG on human colonic smooth muscle cells. J Clin Gastroenterol, 2008, 42(3), Pt2: S185–S190.Mayer EA. Emerging disease model for functional gastrointestinal disorders. Am J Med, 1999, 107: 12S–19S.Mayer EA. Emerging disease model for functional gastrointestinal disorders. Am J Med, 1999, 107: 12S–19S.Grundy D, Al-Chaer ED, Aziz Q, Collins SM, Ke M, Taché Y, Wood JD. Fundamentals of neurogastroenterology: basic science. Gastroenterology, 2006, 130: 1391–1411.Grundy D, Al-Chaer ED, Aziz Q, Collins SM, Ke M, Taché Y, Wood JD. Fundamentals of neurogastroenterology: basic science. Gastroenterology, 2006, 130: 1391–1411.Grundy D, Al-Chaer ED, Aziz Q, Collins SM, Ke M, Taché Y, Wood JD. Fundamentals of neurogastroenterology: basic science. Gastroenterology, 2006, 130: 1391–1411.Grundy D, Al-Chaer ED, Aziz Q, Collins SM, Ke M, Taché Y, Wood JD. Fundamentals of neurogastroenterology: basic science. Gastroenterology, 2006, 130: 1391–1411.Ritchie JA, Ardran GM, Truelove SC. Observations on experimentally induced colonic pain. Gut, 1972, 13: 841.Ritchie JA, Ardran GM, Truelove SC. Observations on experimentally induced colonic pain. Gut, 1972, 13: 841.Mertz H, Naliboff B, Munakata J, Niazi N, Mayer EA. Altered rectal perception is a biological marker of patients with irritable bowel syndrome. Gastroenterology, 1995, 109: 40–52.Mertz H, Naliboff B, Munakata J, Niazi N, Mayer EA. Altered rectal perception is a biological marker of patients with irritable bowel syndrome. Gastroenterology, 1995, 109: 40–52.Prior A, Maxton DG, Whorwell PJ. Anorectal manometry in irritable bowel syndrome: differences between diarrhoea and constipation predominant subjects. Gut, 1990, 31: 458–462.Prior A, Maxton DG, Whorwell PJ. Anorectal manometry in irritable bowel syndrome: differences between diarrhoea and constipation predominant subjects. Gut, 1990, 31: 458–462.Zar S, Benson MJ, Kumar D. Rectal afferent hypersensitivity and compliance in irritable bowel syndrome: differences between diarrhoea-predominant and constipation-predominant subgroups. Eur J Gastroenterol Hepatol, 2006, 18: 151–158.Zar S, Benson MJ, Kumar D. Rectal afferent hypersensitivity and compliance in irritable bowel syndrome: differences between diarrhoea-predominant and constipation-predominant subgroups. Eur J Gastroenterol Hepatol, 2006, 18: 151–158.Caldarella MP, Milano A, Laterza F, Sacco F, Balatsinou C, Lapenna D, Pierdomenico SD, Cuccurullo F, Neri M. Visceral sensitivity and symptoms in patients with constipationor diarrhea-predominant irritable bowel syndrome (IBS): effect of a low-fat intraduodenal infusion. Am J Gastroenterol, 2005, 100: 383–389.Caldarella MP, Milano A, Laterza F, Sacco F, Balatsinou C, Lapenna D, Pierdomenico SD, Cuccurullo F, Neri M. Visceral sensitivity and symptoms in patients with constipationor diarrhea-predominant irritable bowel syndrome (IBS): effect of a low-fat intraduodenal infusion. Am J Gastroenterol, 2005, 100: 383–389.Silverman DH, Munakata JA, Ennes H, Mandelkern MA, Hoh CK, Mayer EA. Regional cerebral activity in normal and pathological perception of visceral pain. Gastroenterology, 1997, 112: 64–72.Silverman DH, Munakata JA, Ennes H, Mandelkern MA, Hoh CK, Mayer EA. Regional cerebral activity in normal and pathological perception of visceral pain. Gastroenterology, 1997, 112: 64–72.Hertig VL, Cain KC, Jarrett ME, Burr RL, Heitkemper MM. Daily stress and gastrointestinal symptoms in women with irritable bowel syndrome. Nurs Res, 2007, 56: 399–406.Hertig VL, Cain KC, Jarrett ME, Burr RL, Heitkemper MM. Daily stress and gastrointestinal symptoms in women with irritable bowel syndrome. Nurs Res, 2007, 56: 399–406.Aguilera M, Cerdà-Cuéllar M, Martínez V. Antibiotic-induced dysbiosis alters host-bacterial interactions and leads to colonic sensory and motor changes in mice. Gut Microbes, 2015, 6:10–23.Aguilera M, Cerdà-Cuéllar M, Martínez V. Antibiotic-induced dysbiosis alters host-bacterial interactions and leads to colonic sensory and motor changes in mice. Gut Microbes, 2015, 6:10–23.Theodorou V, Ait Belgnaoui A, Agostini S, Eutamene H. Effect of commensals and probiotics on visceral sensitivity and pain in irritable bowel syndrome. Gut Microbes, 2014, 5: 430–436.Theodorou V, Ait Belgnaoui A, Agostini S, Eutamene H. Effect of commensals and probiotics on visceral sensitivity and pain in irritable bowel syndrome. Gut Microbes, 2014, 5: 430–436.Mao YK, Kasper DL, Wang B, Forsythe P, Bienenstock J, Kunze WA. Bacteroides fragilis polysaccharide A is necessary and sufficient for acute activation of intestinal sensory neurons. Nat Commun, 2013, 4: 1465.Mao YK, Kasper DL, Wang B, Forsythe P, Bienenstock J, Kunze WA. Bacteroides fragilis polysaccharide A is necessary and sufficient for acute activation of intestinal sensory neurons. Nat Commun, 2013, 4: 1465.Carabotti M, Scirocco A, Maselli MA, Severi C. The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Ann Gastroenterol, 2015, 28: 203–209.Carabotti M, Scirocco A, Maselli MA, Severi C. The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Ann Gastroenterol, 2015, 28: 203–209.Tsigos C, Chrousos GP. Hypothalamic-pituitaryadrenal axis, neuroendocrine factors and stress. J Psychosom Res, 2002, 53: 865–871.Tsigos C, Chrousos GP. Hypothalamic-pituitaryadrenal axis, neuroendocrine factors and stress. J Psychosom Res, 2002, 53: 865–871.Rhee SH, Pothoulakis C, Mayer EA. Principles and clinical implications of the brain-gutenteric microbiota axis. Nat Rev Gastroenterol Hepatol, 2009, 6: 306–314.Rhee SH, Pothoulakis C, Mayer EA. Principles and clinical implications of the brain-gutenteric microbiota axis. Nat Rev Gastroenterol Hepatol, 2009, 6: 306–314.Collins J, Borojevic R, Verdu EF, Huizinga JD, Ratcliffe EM. Intestinal microbiota influence the early postnatal development of the enteric nervous system. Neurogastroenterol Motil, 2014, 26: 98–107.Collins J, Borojevic R, Verdu EF, Huizinga JD, Ratcliffe EM. Intestinal microbiota influence the early postnatal development of the enteric nervous system. Neurogastroenterol Motil, 2014, 26: 98–107.Neufeld KM, Kang N, Bienenstock J, Foster JA. Reduced anxiety-like behavior and central neurochemical change in germ-free mice. Neurogastroenterol Motil, 2011, 23: 255–264.Neufeld KM, Kang N, Bienenstock J, Foster JA. Reduced anxiety-like behavior and central neurochemical change in germ-free mice. Neurogastroenterol Motil, 2011, 23: 255–264.Koloski NA, Jones M, Kalantar J, Weltman M, Zaguirre J, Talley NJ. The brain–gut pathway in functional gastrointestinal disorders is bidirectional: a 12-year prospective population-based study. Gut, 2012, 61: 1284–1290.Koloski NA, Jones M, Kalantar J, Weltman M, Zaguirre J, Talley NJ. The brain–gut pathway in functional gastrointestinal disorders is bidirectional: a 12-year prospective population-based study. Gut, 2012, 61: 1284–1290.Mayer EA, Savidge T, Shulman RJ. Brain-gut microbiome interactions and functional bowel disorders. Gastroenterology, 2014, 146: 1500–1512.Mayer EA, Savidge T, Shulman RJ. Brain-gut microbiome interactions and functional bowel disorders. Gastroenterology, 2014, 146: 1500–1512.Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B, Morelli L, Canani RB, Flint HJ, Salminen S, et al. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol, 2014, 11: 506–514.Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B, Morelli L, Canani RB, Flint HJ, Salminen S, et al. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol, 2014, 11: 506–514.Food and Agriculture Organization/World Health Organization. Evaluation of health and nutritional properties of probiotics in food, including powder milk with the live lactic acid bacteria. Report of a Joint FAO/WHO Expert Consultation on evaluation of health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria. Available from:http://www.who.int/foodsafety/ publications/fs_management/en/probiotics.pdf.Food and Agriculture Organization/World Health Organization. Evaluation of health and nutritional properties of probiotics in food, including powder milk with the live lactic acid bacteria. Report of a Joint FAO/WHO Expert Consultation on evaluation of health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria. Available from:http://www.who.int/foodsafety/ publications/fs_management/en/probiotics.pdf.Distrutti E, Monaldi L, Ricci P, Fiorucci S. Gut microbiota role in irritable bowel syndrome: New therapeutic strategies. World J Gastroenterol, 2016, Feb 21, 22(7): 2219–2241.Distrutti E, Monaldi L, Ricci P, Fiorucci S. Gut microbiota role in irritable bowel syndrome: New therapeutic strategies. World J Gastroenterol, 2016, Feb 21, 22(7): 2219–2241.Moayyedi P, Ford AC, Talley NJ, Cremonini F, Foxx-Orenstein AE, Brandt LJ, Quigley EM. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut, 2010, 59: 325–332.Moayyedi P, Ford AC, Talley NJ, Cremonini F, Foxx-Orenstein AE, Brandt LJ, Quigley EM. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut, 2010, 59: 325–332.Niedzielin K, Kordecki H, Birkenfeld B. A controlled, double-blind, randomized study on the efficacy of Lactobacillus plantarum 299V in patients with irritable bowel syndrome. Eur J Gastroenterol Hepatol, 2001, 13: 1143–1147.Niedzielin K, Kordecki H, Birkenfeld B. A controlled, double-blind, randomized study on the efficacy of Lactobacillus plantarum 299V in patients with irritable bowel syndrome. Eur J Gastroenterol Hepatol, 2001, 13: 1143–1147.Nobaek S, Johansson ML, Molin G, Ahrné S, Jeppsson B. Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Am J Gastroenterol, 2000, 95: 1231–1238.Nobaek S, Johansson ML, Molin G, Ahrné S, Jeppsson B. Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Am J Gastroenterol, 2000, 95: 1231–1238.Sinn DH, Song JH, Kim HJ, Lee JH, Son HJ, Chang DK, Kim YH, Kim JJ, Rhee JC, Rhee PL. Therapeutic effect of Lactobacillus acidophilus-SDC 2012, 2013 in patients with irritable bowel syndrome. Dig Dis Sci, 2008, 53: 2714–2718.Sinn DH, Song JH, Kim HJ, Lee JH, Son HJ, Chang DK, Kim YH, Kim JJ, Rhee JC, Rhee PL. Therapeutic effect of Lactobacillus acidophilus-SDC 2012, 2013 in patients with irritable bowel syndrome. Dig Dis Sci, 2008, 53: 2714–2718.Long ZR, Yu CH, Yang Y, Wang HN, Chi XX. Clinical observation on acupuncture combined with microorganism pharmaceutical preparations for treatment of irritable bowel syndrome of constipation type. Zhongguo Zhenjiu, 2006, 26: 403–405.Long ZR, Yu CH, Yang Y, Wang HN, Chi XX. Clinical observation on acupuncture combined with microorganism pharmaceutical preparations for treatment of irritable bowel syndrome of constipation type. Zhongguo Zhenjiu, 2006, 26: 403–405.Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, O’Mahony L, Kiely B, Shanahan F, Quigley EM. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol, 2006, 101: 1581–1590.Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, O’Mahony L, Kiely B, Shanahan F, Quigley EM. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol, 2006, 101: 1581–1590.Gade J, Thorn P. Paraghurt for patients with irritable bowel syndrome. A controlled clinical investigation from general practice. Scand J Prim Health Care, 1989, 7: 23–26.Gade J, Thorn P. Paraghurt for patients with irritable bowel syndrome. A controlled clinical investigation from general practice. Scand J Prim Health Care, 1989, 7: 23–26.Kim HJ, Camilleri M, McKinzie S, Lempke MB, Burton DD, Thomforde GM, Zinsmeister AR. A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther, 2003, 17: 895–904.Kim HJ, Camilleri M, McKinzie S, Lempke MB, Burton DD, Thomforde GM, Zinsmeister AR. A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther, 2003, 17: 895–904.Kajander K, Hatakka K, Poussa T, Färkkilä M, Korpela R. A probiotic mixture alleviates symptoms in irritable bowel syndrome patients: a controlled 6-month intervention. Aliment Pharmacol Ther, 2005, 22: 387–394.Kajander K, Hatakka K, Poussa T, Färkkilä M, Korpela R. A probiotic mixture alleviates symptoms in irritable bowel syndrome patients: a controlled 6-month intervention. Aliment Pharmacol Ther, 2005, 22: 387–394.Lorenzo-Zúñiga V, Llop E, Suárez C, Alvarez B, Abreu L, Espadaler J, Serra J. I.31, a new combination of probiotics, improves irritable bowel syndrome-related quality of life. World J Gastroenterol, 2014, 20: 8709–8716.Lorenzo-Zúñiga V, Llop E, Suárez C, Alvarez B, Abreu L, Espadaler J, Serra J. I.31, a new combination of probiotics, improves irritable bowel syndrome-related quality of life. World J Gastroenterol, 2014, 20: 8709–8716.Drouault-Holowacz S, Bieuvelet S, Burckel A, Cazaubiel M, Dray X, Marteau P. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol Clin Biol, 2008, 32: 147–152.Drouault-Holowacz S, Bieuvelet S, Burckel A, Cazaubiel M, Dray X, Marteau P. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol Clin Biol, 2008, 32: 147–152.Clarke G, Cryan JF, Dinan TG, Quigley EM. Review article: probiotics for the treatment of irritable bowel syndrome–focus on lactic acid bacteria. Aliment Pharmacol Ther, 2012, 35: 403–413.Clarke G, Cryan JF, Dinan TG, Quigley EM. Review article: probiotics for the treatment of irritable bowel syndrome–focus on lactic acid bacteria. Aliment Pharmacol Ther, 2012, 35: 403–413.Brenner DM, Moeller MJ, Chey WD, Schoenfeld PS. The utility of probiotics in the treatment of irritable bowel syndrome: a systematic review. Am J Gastroenterol, 2009, 104: 1033–1049.Brenner DM, Moeller MJ, Chey WD, Schoenfeld PS. The utility of probiotics in the treatment of irritable bowel syndrome: a systematic review. Am J Gastroenterol, 2009, 104: 1033–1049.Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, O’Mahony L, Kiely B, Shanahan F, Quigley EM. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol, 2006, 101: 1581–1590.Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, O’Mahony L, Kiely B, Shanahan F, Quigley EM. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol, 2006, 101: 1581–1590.Hungin AP, Mulligan C, Pot B, Whorwell P, Agréus L, Fracasso P, Lionis C, Mendive J, Philippart de Foy JM, Rubin G, Winchester C, de Wit N. Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice – an evidence-based international guide. Aliment Pharmacol Ther, 2013, 38: 864–886.Hungin AP, Mulligan C, Pot B, Whorwell P, Agréus L, Fracasso P, Lionis C, Mendive J, Philippart de Foy JM, Rubin G, Winchester C, de Wit N. Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice – an evidence-based international guide. Aliment Pharmacol Ther, 2013, 38: 864–886.Didari T, Mozaffari S, Nikfar S, Abdollahi M. Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis. World J Gastroenterol, 2015, 21: 3072–3084.Didari T, Mozaffari S, Nikfar S, Abdollahi M. Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis. World J Gastroenterol, 2015, 21: 3072–3084.Stevenson C, Blaauw R, Fredericks E, Visser J, Roux S. Randomized clinical trial: effect of Lactobacillus plantarum 299 v on symptoms of irritable bowel syndrome. Nutrition, 2014, 30: 1151–1157.Stevenson C, Blaauw R, Fredericks E, Visser J, Roux S. Randomized clinical trial: effect of Lactobacillus plantarum 299 v on symptoms of irritable bowel syndrome. Nutrition, 2014, 30: 1151–1157.Hong YS, Hong KS, Park MH, Ahn YT, Lee JH, Huh CS, Lee J, Kim IK, Hwang GS, Kim JS. Metabonomic understanding of probiotic effects in humans with irritable bowel syndrome. J Clin Gastroenterol, 2011, 45: 415–425.Hong YS, Hong KS, Park MH, Ahn YT, Lee JH, Huh CS, Lee J, Kim IK, Hwang GS, Kim JS. Metabonomic understanding of probiotic effects in humans with irritable bowel syndrome. J Clin Gastroenterol, 2011, 45: 415–425.Приказ №774н от 9 ноября 2012 года «Об утверждении стандарта специализированной медицинской помощи при синдроме раздраженного кишечника (с диареей)». URL: https:// www.rosminzdrav.ru/.Приказ №774н от 9 ноября 2012 года «Об утверждении стандарта специализированной медицинской помощи при синдроме раздраженного кишечника (с диареей)». URL: https:// www.rosminzdrav.ru/.Приказ №1420н от 24 декабря 2012 года «Об утверждении стандарта специализированной медицинской помощи при синдроме раздраженного кишечника (без диареи)». URL: https://www.rosminzdrav.ru/.Приказ №1420н от 24 декабря 2012 года «Об утверждении стандарта специализированной медицинской помощи при синдроме раздраженного кишечника (без диареи)». URL: https://www.rosminzdrav.ru/.Плотникова Е.Ю., Сухих А.С. Препараты висмуты в практике врача. Лечащий врач, 2016, 2:60-66.Плотникова Е.Ю., Сухих А.С. Препараты висмуты в практике врача. Лечащий врач, 2016, 2:60-66.Плотникова Е.Ю., Захарова Ю.В., Грачева Т.Ю. Что общего между функциональной диспепсией и синдромом избыточного бактериального роста? Лечащий врач, 2016, 8: 6-14.Плотникова Е.Ю., Захарова Ю.В., Грачева Т.Ю. Что общего между функциональной диспепсией и синдромом избыточного бактериального роста? Лечащий врач, 2016, 8: 6-14.

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