medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2018-11-85-90medsovet-2507Research ArticleГАСТРОЭНТЕРОЛОГИЯGASTROENTEROLOGYВозможности использования пробиотиков в терапии запоров у детейProspects for using probiotics in the treatment of constipation in childrenЗахароваИ. Н.ZakharovaI. N.

д.м.н., профессор, заслуженный врач России, заведующая кафедрой педиатрии с курсом поликлинической педиатрии им. Г.Н. Сперанского ФГБОУ ДПО РМАНПО МЗ РФ, член Исполкома Союза педиатров России, почетный профессор НЦЗД РАН

ОсмановИ. М.OsmanovI. M.

д.м.н., профессор, главный врач Детской клинической больницы им. З.Л. Башляевой ДЗМ, директор Университетской клиники педиатрии ГБОУ ВПО РНИМУ им. И.И. Пирогова МЗ РФ, профессор кафедры госпитальной педиатрии № 1 ГБОУ ВПО РНИМУ им. Н.И. Пирогова МЗ РФ, главный педиатр г. Москвы, главный внештатный детский специалист-нефролог г. Москвы

БережнаяИ. В.BerezhnayaI. V.

к.м.н., окружной детский гастроэнтеролог СЗАО г. Москвы, доцент кафедры педиатрии с курсом поликлинической педиатрии им. Г.Н. Сперанского ФГБОУ ДПО РМАНПО МЗ РФ

КольцовК. А.KoltsovK. A.

кафедра педиатрии с курсом поликлинической педиатрии им. Г.Н. Сперанского ФГБОУ ДПО РМАНПО МЗ РФ

ДедиковаО. В.DedikovaO. V.

кафедра педиатрии с курсом поликлинической педиатрии им. Г.Н. Сперанского ФГБОУ ДПО РМАНПО МЗ РФ

КучинаА. Е.KuchinaA. E.

аспирант кафедры педиатрии с курсом поликлинической педиатрии им. Г.Н. Сперанского ФГБОУ ДПО РМАНПО МЗ РФ

СазановаЮ. О.SazanovaYu. O.

аспирант педиатрии с курсом поликлинической педиатрии им. Г.Н. Сперанского ФГБОУ ДПО РМАНПО МЗ РФ

ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, МоскваРоссияRussian Medical Academy of Continuing Postgraduate Education, Federal State Budgetary Educational Institution of Further Professional Education of the Ministry of Health of Russia, MoscowRussian FederationДетская городская клиническая больница им. З.А. Башляевой Департамента здравоохранения г. МосквыRussian Federation2018160720180118590Copyright © Захарова И.Н., Османов И.М., Бережная И.В., Кольцов К.А., Дедикова О.В., Кучина А.Е., Сазанова Ю.О., 20182018Захарова И.Н., Османов И.М., Бережная И.В., Кольцов К.А., Дедикова О.В., Кучина А.Е., Сазанова Ю.О.Zakharova I.N., Osmanov I.M., Berezhnaya I.V., Koltsov K.A., Dedikova O.V., Kuchina A.E., Sazanova Y.O.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/2507

Каждый педиатр в своей практике ежедневно сталкивается с проблемой диагностики и лечения запора у детей. По данным социологического опроса родителей и врачей, в среднем каждый третий ребенок имеет задержку опорожнения кишечника. Согласно Римским критериям VI 2016 года, для детей от 0 до 4 лет диагноз функционального запора ставится на основании диагностических признаков, которые отличаются для детей старше 4 лет. В данной статье рассмотрены механизмы развития запоров у детей разных возрастных групп, обсуждается влияние микробиоты на развитие моторных и нейросенсорных нарушений кишечника. Использование пробиотиков в терапии запоров до настоящего времени является спорным. В статье приведены последние исследования эффективности разных пробиотических штаммов при терапии запоров у детей. На сегодняшний день при использовании моноштаммовых пробиотиков доказан эффект при запорах только у Lactobacillus reuteri (DSM 17938).

Every paediatrician faces the problem of how to diagnose and treat constipation in children in the daily practice. According to the sociological survey of parents and doctors, on average every third child has a delay in evacuating stool. According to the 2016 Rome VI criteria, the diagnosis of functional constipation in children from 0 to 4 years of age is based on diagnostic signs that differ for children older than 4 years old. This article considers the mechanisms of constipation development in children of different age groups, and discusses the influence of microbiota on the development of motor and neurosensory intestinal disorders. The use of probiotics in constipation therapy is still controversial. The article presents recent studies of the efficacy of different probiotic strains in the treatment of constipation in children. So far, only Lactobacillus reuteri (DSM 17938) has a proven effect for the treatment of constipation in using monostam probiotics.

запорыдетипребиотикипробиотикикороткоцепочечные жирные кислотыLactobacillus reuteri (DSM 17938)функциональные нарушения ЖКТРимские критерии IVconstipationchildrenprebioticsprobioticsshort chain fatty acidsLactobacillus reuteri (DSM 17938)functional disorders of the gastrointestinal tractRome VI criteriaReferencesЗаседание экспертного совета по проблеме хронических запоров. Российский журнал гастроэнтерологии, гепатологии, колопроктологии, 2011, 21(4): 90-1.The expert council meeting on the problem of chronic constipation. Rossiуskiу Zhurnal Gastroehnterologii, Gepatologii, Koloproktologii, 2011, 21 (4): 90-1.Прилепская С.И., Парфенов А.И., Лазебник Л.Б. и др. Распространенность и факторы риска запоров у взрослого населения Москвы по данным популяционного исследования «МУЗА». Экспериментальная и клин. гастроэнтерология, 2011, 3: 68-73.Prilepskaya SI, Parfenov AI, Lazebnik LB, et al. The prevalence and risk factors of constipation in the adult population of Moscow according to the MUZA population study. Eksperimentalnaya i Klin. Gastroehnterologiya, 2011, 3: 68-73.Эрдес С.И., Мацукатова Б.О. Распространенность и особенности запоров у детей в России: результаты популяционного исследования. Вопр. совр. педиатрии, 2010, 4: 50–56.Erdes SI, Matsukatova BO. Prevalence and features of constipation in children in Russia: the population study results. Vopr. Sovr. Pediatrii, 2010, 4: 50-56.Vandenplas Y, Levy E, Lemmens R, Devreker T. Functional constipation in children. Consilium Medicum. Pediatrics (adj.), 2017, 1: 66-73.Vandenplas Y, Levy E, Lemmens R, Devreker T. Functional constipation in children. Consilium Medicum. Pediatrics (adj.), 2017, 1: 66-73.Tabbers MM, DiLorenzo C, Berger MY et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr, 2014, 58(2): 258–74.Tabbers MM, DiLorenzo C, Berger MY et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr, 2014, 58(2): 258–74.Bassotti G, Villanacci V, Nascimbeni R, Cadei M, Manenti S, Antonelli E, Fanini L, Salerni B. Increase of Colonic Mast Cells in Obstructed Defecation and Their Relationship with Enteric Glia. Digestive Diseases and Sciences, 2012, 57(1): 65-71.Bassotti G, Villanacci V, Nascimbeni R, Cadei M, Manenti S, Antonelli E, Fanini L, Salerni B. Increase of Colonic Mast Cells in Obstructed Defecation and Their Relationship with Enteric Glia. Digestive Diseases and Sciences, 2012, 57(1): 65-71.Низяева Н.В., Щёголев А.И., Марей М.В., Сухих Г.Т. Интерстициальные пейсмейкерные клетки. Вестник РАМН. Актуальные вопросы физиологии, 2014, 7–8: 17–24Niazyaeva NV, Schego lev AI, Marey MV, Sukhikh GT. Interstitial pacemaker cells. Bulletin of the Russian Academy of Medical Sciences. Aktualnye Voprosy Fiziologii, 2014, 7-8: 17-24Mugie SM, Di Lorenzo C, Benninga MA. Constipation in childhood. Nature reviews Gastroenterol Hepatol, 2011, 8(9): 502–11.Mugie SM, Di Lorenzo C, Benninga MA. Constipation in childhood. Nature reviews Gastroenterol Hepatol, 2011, 8(9): 502–11.Knowles CH, Farrugia G. Gastrointestinal neuromuscular pathology in chronic constipation. Best Pract Res Clin Gastroenterol, 2011, 25(1): 43–57.Knowles CH, Farrugia G. Gastrointestinal neuromuscular pathology in chronic constipation. Best Pract Res Clin Gastroenterol, 2011, 25(1): 43–57.King SK, Sutcliffe JR, Ong SY et al. Substance P and vasoactive intestinal peptide are reduced in right transverse colon in pediatric slow-transit constipation. Neurogastroenterol Motil, 2010, 22(8): 883–92, е234.King SK, Sutcliffe JR, Ong SY et al. Substance P and vasoactive intestinal peptide are reduced in right transverse colon in pediatric slow-transit constipation. Neurogastroenterol Motil, 2010, 22(8): 883–92, е234.Sicherer SH. Clinical Aspects of Gastrointestinal Food Allergy in Childhood. Pediatrics, 2003, 111(6): 1609-1616.Sicherer SH. Clinical Aspects of Gastrointestinal Food Allergy in Childhood. Pediatrics, 2003, 111(6): 1609-1616.Palmer C, Bik E, DiGiulio D et al. Development of the human infant intestinal microbiota. PloS Biol, 2007, 5: e177.Palmer C, Bik E, DiGiulio D et al. Development of the human infant intestinal microbiota. PloS Biol, 2007, 5: e177.Hassan B, Butler R et al. Patterns of antropyloric motility in fed healthy preterm infants. Arch Dis Child Fetal Neonatal Ed, 2002, 87: 95-99.Hassan B, Butler R et al. Patterns of antropyloric motility in fed healthy preterm infants. Arch Dis Child Fetal Neonatal Ed, 2002, 87: 95-99.Barbara G, Stanghellini V, Brandi G et al. Interactions between commensal bacteria and gut sensorimotor function in health and disease. Am J Gastroenterol, 2005, 100: 2560-2568.Barbara G, Stanghellini V, Brandi G et al. Interactions between commensal bacteria and gut sensorimotor function in health and disease. Am J Gastroenterol, 2005, 100: 2560-2568.Codling C, O’Mahony L, Shanahan F et al. A molecular analysis of fecal and mucosal bacterial communities in irritable bowel syndrome. Dig Dis Sci, 2010, 55: 392-397.Codling C, O’Mahony L, Shanahan F et al. A molecular analysis of fecal and mucosal bacterial communities in irritable bowel syndrome. Dig Dis Sci, 2010, 55: 392-397.Neish A. Microbes in gastrointestinal health and disease. Gastroenterology, 2009, 136: 65-80.Neish A. Microbes in gastrointestinal health and disease. Gastroenterology, 2009, 136: 65-80.Triantafyllou K, Chang C, Pimentel M. Methanogens, Methane and Gastrointestinal Motility. J Neurogastroenterol Motil, 2014, 20: 31-40.Triantafyllou K, Chang C, Pimentel M. Methanogens, Methane and Gastrointestinal Motility. J Neurogastroenterol Motil, 2014, 20: 31-40.Deiteren, A, Camilleri M, Burton D, McKinzie S, Rao A, Zinsmeister AR. Effect of meal ingestion on ileocolonic and colonic transit in health and irritable bowel syndrome. Dig Dis Sci, 2010, 55: 384-91.Deiteren, A, Camilleri M, Burton D, McKinzie S, Rao A, Zinsmeister AR. Effect of meal ingestion on ileocolonic and colonic transit in health and irritable bowel syndrome. Dig Dis Sci, 2010, 55: 384-91.El-Salhy M, Seim I, Chopin L, Gundersen D, Hatlebakk JG, Hausken T. Irritable bowel syndrome: the role of gut neuroendocrine peptides. Front Biosci (Elite Ed), 2012, 1(4): 2783-800.El-Salhy M, Seim I, Chopin L, Gundersen D, Hatlebakk JG, Hausken T. Irritable bowel syndrome: the role of gut neuroendocrine peptides. Front Biosci (Elite Ed), 2012, 1(4): 2783-800.Abrahamsson H, Ostlund-Lindqvist AM, Nilsson R, Simrén M, Gillberg PG. Altered bile acid metabolism in patients with constipation-predominant irritable bowel syndrome and functional constipation. Scand J Gastroenterol, 2008, 43(12): 1483-8.Abrahamsson H, Ostlund-Lindqvist AM, Nilsson R, Simrén M, Gillberg PG. Altered bile acid metabolism in patients with constipation-predominant irritable bowel syndrome and functional constipation. Scand J Gastroenterol, 2008, 43(12): 1483-8.Piche T, Zerbib F, Varannes S et al. Modulation by colonic fermentation of LES function in humans. Am J Physiol Gastrointest Liver Physiol, 2000, 278: 578-584.Piche T, Zerbib F, Varannes S et al. Modulation by colonic fermentation of LES function in humans. Am J Physiol Gastrointest Liver Physiol, 2000, 278: 578-584.Ropert A, Cherbut C, Roze C et al. Colonic fermentation and proximal gastric tone in humans. Gastroenterology, 1996, 111: 289-296.Ropert A, Cherbut C, Roze C et al. Colonic fermentation and proximal gastric tone in humans. Gastroenterology, 1996, 111: 289-296.Lamine F, Firoamonti J, Bueno L et al. Nitric oxide released by Lactobacillus farciminis improves TNBS-induced colitis in rats. Scand J Gastroenterol, 2004, 39: 37-45.Lamine F, Firoamonti J, Bueno L et al. Nitric oxide released by Lactobacillus farciminis improves TNBS-induced colitis in rats. Scand J Gastroenterol, 2004, 39: 37-45.Verdu E, Bercik P, Verma-Gandhu M et al. Specific probiotic therapy attenuates antibiotic induced visceral hypersensitivity in mice. Gut, 2006, 55: 182-190.Verdu E, Bercik P, Verma-Gandhu M et al. Specific probiotic therapy attenuates antibiotic induced visceral hypersensitivity in mice. Gut, 2006, 55: 182-190.Rousseaux C, Thuru X et al. Lactobacillus acidophilus modulates intestinal pain and induces opioid and cannabinoid receptors. Nature Med, 2007, 13: 35-37.Rousseaux C, Thuru X et al. Lactobacillus acidophilus modulates intestinal pain and induces opioid and cannabinoid receptors. Nature Med, 2007, 13: 35-37.Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features, and Rome IV. Gastroenterology, 2016, 150(6): 1262-1279.Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features, and Rome IV. Gastroenterology, 2016, 150(6): 1262-1279.Ванденплас И., Захарова И.Н., Дмитриева Ю.А. Гастроинтестинальные проявления пищевой аллергии или функциональные нарушения желудочно-кишечного тракта. Принципы дифференциальной диагностики и диетотерапии, 2016, 16: 110-114Vandenplas I, Zakharova IN, Dmitrieva YuA. Gastrointestinal manifestations of food allergies or functional disorders of the gastrointestinal tract. Principy Differencialnoy Diagnostiki I Dietoterapii, 2016, 16: 110-114Vandenplas Y, Koletzko S, Isolauri E, Hill D, Oranje AP, Brueton M, Staiano A, Dupont C. Guidelines for the diagnosis and management of cow’s milk protein allergy in infants. Arch Dis Child, 2007, 92: 902-8.Vandenplas Y, Koletzko S, Isolauri E, Hill D, Oranje AP, Brueton M, Staiano A, Dupont C. Guidelines for the diagnosis and management of cow’s milk protein allergy in infants. Arch Dis Child, 2007, 92: 902-8.Tuck CJ, Muir JG, Barrett JS, Gibson PR. Fermen table oligosaccharides, disaccharides, monosaccharides and polyols: Role in irritable bowel syndrome. Exp Rev Gastroenterol Hepatol, 2014, 15: 1-16.Tuck CJ, Muir JG, Barrett JS, Gibson PR. Fermen table oligosaccharides, disaccharides, monosaccharides and polyols: Role in irritable bowel syndrome. Exp Rev Gastroenterol Hepatol, 2014, 15: 1-16.Шептулин А.А., Визе-Хрипунова М.А. Римские критерии синдрома раздраженного кишечника IV пересмотра: есть ли принципиальные изменения? Рос журн гастроэнтерол гепатол колопроктол, 2016, 26(5): 99-103Sheptulin AA, Vise-Khripunova MA. Rome IV criteria for irritable bowel syndrome: are there any fundamental changes? Ros Zhurn Gastroehnterol Gepatol Koloproktol, 2016, 26 (5): 99-103.Miller MK, Dowd MD, Friesen CA, Walsh-Kelly CM. A randomized trial of enema versus polyethylene glycol 3350 for fecal disimpaction in children presenting to an emergency department. Pediatr Emerg Care, 2012, 28(2): 115–9.Miller MK, Dowd MD, Friesen CA, Walsh-Kelly CM. A randomized trial of enema versus polyethylene glycol 3350 for fecal disimpaction in children presenting to an emergency department. Pediatr Emerg Care, 2012, 28(2): 115–9.Pijpers MA, Bongers ME, Benninga MA, Berger MY. Functional constipation in children: a systematic review on prognosis and predictive factors. J Pediatr Gastroenterol Nutr, 2010, 50(3): 256–68.Pijpers MA, Bongers ME, Benninga MA, Berger MY. Functional constipation in children: a systematic review on prognosis and predictive factors. J Pediatr Gastroenterol Nutr, 2010, 50(3): 256–68.Bu LN, Chang MH, Ni YH, Chen HL, Cheng CC. Lactobacillus casei rhamnosus Lcr35 in children with chronic constipation. Pediatr Int, 2007, 49(4): 485-90.Bu LN, Chang MH, Ni YH, Chen HL, Cheng CC. Lacto-bacillus casei rhamnosus Lcr35 in children with chronic constipation. Pediatr Int, 2007, 49(4): 485-90.Horvath A, Szajewska H. Probiotics, Prebiotics, and Dietary Fiber in the Management of Functional Gastrointestinal Disorders. Probiotics, Prebiotics, Dietary Fiber and FGD, 2013, 108: 40–48. doi: 10.1159/000351483.Horvath A, Szajewska H. Probiotics, Prebiotics, and Dietary Fiber in the Management of Functional Gastrointestinal Disorders. Probiotics, Prebiotics, Dietary Fiber and FGD, 2013, 108: 40–48. doi: 10.1159/000351483.Tabbers MM, Chmielewska A, Roseboom MG, Crastes N, Perrin C, Reitsma JB, Norbruis O, Szajewska H, Benninga MA. Fermented milk containing Bifidobacterium lactis DN-173 010 in childhood constipation: a randomized, double-blind, controlled trial. Pediatrics, 2011, 127(6): 1392-9. doi: 10.1542/peds.2010-2590.Tabbers MM, Chmielewska A, Roseboom MG, Crastes N, Perrin C, Reitsma JB, Norbruis O, Szajewska H, Benninga MA. Fermented milk containing Bifidobacterium lactis DN-173 010 in childhood constipation: a randomized, double-blind, controlled trial. Pediatrics, 2011, 127(6): 1392-9. doi: 10.1542/peds.2010-2590.Coccorullo P, Strisciuglio C, Martinelli M, Miele E, Greco L, Staiano A. Lactobacillus reuteri (DSM 17938) in Infants with Functional Chronic Constipation: A Double-Blind, Randomized, Placebo-Controlled Study. J Pediatr, 2010, 157(4): 598-602. doi: 10.1016/j.jpeds.2010.04.066.Coccorullo P, Strisciuglio C, Martinelli M, Miele E, Greco L, Staiano A. Lactobacillus reuteri (DSM 17938) in Infants with Functional Chronic Constipation: A Double-Blind, Randomized, Placebo-Controlled Study. J Pediatr, 2010, 157(4): 598-602. doi: 10.1016/j.jpeds.2010.04.066.Szajewska H, Gyrczuk E, Horvath A. Lactobacillus reuteri DSM 17938 for the management of infantile colic in breastfed infants: a randomized, double-blind, placebo-controlled trial. J Pediatr, 2013, 162(2): 257-62. doi: 10.1016/j.jpeds.2012.08.004.Szajewska H, Gyrczuk E, Horvath A. Lactobacillus reuteri DSM 17938 for the management of infantile colic in breastfed infants: a randomized, double-blind, placebo-controlled trial. J Pediatr, 2013, 162(2): 257-62. doi: 10.1016/j.jpeds.2012.08.004.Morita H, Toh H, Fukuda S, Horikawa H, Oshima K, Suzuki T, Murakami M, Hisamatsu S, Kato Y, Takizawa T, Fukuoka H, Yoshimura T, Itoh K, O’Sullivan DJ, McKay LL, Ohno H, Kikuchi J, Masaoka T, Hattori M. Comparative genome analysis of Lactobacillus reuteri and Lactobacillus fermentum reveal a genomic island for reuterin and cobalamin production. DNA Res, 2008, 30, 15(3): 151-61. doi: 10.1093/dnares/dsn009.Morita H, Toh H, Fukuda S, Horikawa H, Oshima K, Suzuki T, Murakami M, Hisamatsu S, Kato Y, Takizawa T, Fukuoka H, Yoshimura T, Itoh K, O’Sullivan DJ, McKay LL, Ohno H, Kikuchi J, Masaoka T, Hattori M. Comparative genome analysis of Lactobacillus reuteri and Lactobacillus fermentum reveal a genomic island for reuterin and cobalamin production. DNA Res, 2008, 30, 15(3): 151-61. doi: 10.1093/dnares/dsn009.Castiblanco GA, Yucel-Lindberg T, Roos S, Twetman S. Effect of Lactobacillus reuteri on Cell Viability and PGE2 Production in Human Gingival Fibro blasts. Probiotics and Antimicrobial Proteins, 2017, 9(3): 278–283.Castiblanco GA, Yucel-Lindberg T, Roos S, Twetman S. Effect of Lactobacillus reuteri on Cell Viability and PGE2 Production in Human Gingival Fibro blasts. Pro-biotics and Antimicrobial Proteins, 2017, 9(3): 278–283.

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