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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">medsovet</journal-id><journal-title-group><journal-title xml:lang="ru">Медицинский Совет</journal-title><trans-title-group xml:lang="en"><trans-title>Meditsinskiy sovet = Medical Council</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2079-701X</issn><issn pub-type="epub">2658-5790</issn><publisher><publisher-name>REMEDIUM GROUP Ltd.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.21518/2079-701X-2019-14-88-92</article-id><article-id custom-type="elpub" pub-id-type="custom">medsovet-4263</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ЗАБОЛЕВАНИЯ КИШЕЧНИКА</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>BOWEL DISEASES</subject></subj-group></article-categories><title-group><article-title>Сложный пациент. Ведение больных с резистентными запорами</article-title><trans-title-group xml:lang="en"><trans-title>Difficult patient. Management of resistant constipation</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8445-8363</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Сас</surname><given-names>Е. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Sas</surname><given-names>E. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Сас Евгений Иванович – доктор медицинских наук, профессор 2-й кафедры терапии (усовершенствования врачей) Федерального государственного бюджетного военного образовательного учреждения высшего образования «Военно-медицинская академия имени С.М. Кирова» Министерства обороны Российской Федерации</p><p>194044, Санкт-Петербург, ул. Академика Лебедева, д. 6, </p><p>194100, Санкт-Петербург, ул. Литовская, д. 2 </p></bio><bio xml:lang="en"><p>Sas Evgeny Ivanovich, Dr. of Sci. (Med.), Professor, the 2nd Chair for Therapy (Continuing Medical Education), Federal State Budgetary Military Educational Institution of Higher Education «Kirov Military Medical Academy» of the Ministry of Defence of the Russian Federation</p><p>194044, Saint-Petersburg, 6, Akademika Lebedev Street, </p><p>194100, Saint-Petersburg, 2, Litovskaya St. </p><p> </p><p> </p></bio><email xlink:type="simple">doctorsas@rambler.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1095-8787</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Гриневич</surname><given-names>В. Б.</given-names></name><name name-style="western" xml:lang="en"><surname>Grinevich</surname><given-names>V. В.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Гриневич Владимир Борисович – доктор медицинских наук, профессор, полковник медицинской службы, заведующий 2-й кафедрой терапии (усовершенствования врачей) Федерального государственного бюджетного военного образовательного учреждения высшего образования «Военно- медицинская академия имени С.М. Кирова» Министерства обороны Российской Федерации; вице-президент Научного общества гастроэнтерологов России (НОГР) – президент Панкреатического клуба</p><p>194044, Санкт-Петербург, ул. Академика Лебедева, д. 6 </p></bio><bio xml:lang="en"><p>Grinevich Vladimir Borisovich, Dr. of Sci. (Med.), Professor, Colonel of Military Medical Service, Head of the 2nd Chair for Therapy (Continuing Medical Education), Federal State Budgetary Military Educational Institution of Higher Education «Kirov Military Medical Academy» of the Ministry of Defence of the Russian Federation; Vice-President Gastroenterological Scientific Society of Russia (NOGR) – President of Pancreatic Club</p><p>194044, Saint-Petersburg, 6, Akademika Lebedev Street</p><p> </p></bio><email xlink:type="simple">grinevich_vb@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Военно-медицинская академия имени С.М. Кирова;&#13;
Санкт-Петербургский государственный педиатрический медицинский университет</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Federal State Budgetary Military Educational Institution of Higher Education «Military Medical Academy named after S.M. Kirov» of the Ministry of Defence of the Russian Federation;&#13;
Federal State Budgetary Educational Institution of Higher Education «St. Petersburg State Pediatric Medical University» of the Ministry of Health of the Russian Federation</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Военно-медицинская академия имени С.М. Кирова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Federal State Budgetary Military Educational Institution of Higher Education «Military Medical Academy named after S.M. Kirov» of the Ministry of Defence of the Russian Federation</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2019</year></pub-date><pub-date pub-type="epub"><day>11</day><month>10</month><year>2019</year></pub-date><volume>0</volume><issue>14</issue><fpage>88</fpage><lpage>92</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Сас Е.И., Гриневич В.Б., 2019</copyright-statement><copyright-year>2019</copyright-year><copyright-holder xml:lang="ru">Сас Е.И., Гриневич В.Б.</copyright-holder><copyright-holder xml:lang="en">Sas E.I., Grinevich V.В.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.med-sovet.pro/jour/article/view/4263">https://www.med-sovet.pro/jour/article/view/4263</self-uri><abstract><p>Запор, как и подавляющее большинство заболеваний, в настоящее время ассоциируется с цивилизацией и урбанизацией. Согласно эпидемиологическим данным, этой нозологией страдают до 30% взрослого населения экономически развитых стран, среди которых превалируют женщины. Известно, что только один из четырех пациентов, страдающих задержкой стула, обращается к специалисту. Остальные ограничиваются советами знакомых, чтением популярной медицинской литературы либо консультацией фармацевта в аптеке. Таким образом, лишь 25% наших пациентов получают врачебную помощь (мы не можем говорить о качестве, тем не менее она врачебная), а 75%, как правило, лишь периодически пытаются компенсировать это состояние. Запор опасен развитием осложнений: вторичного колита, проктосигмоидита, геморроя, анальных трещин, парапроктита и самого грозного заболевания – колоректального рака. Терапия запора должна в первую очередь начинаться с изменения образа жизни. Наиболее часто употребляемыми являются препараты, раздражающие средства, усиливающие секрецию, потому что они очень быстро и надежно достигают эффекта. Так, препараты пикосульфата натрия (Регулакс®) являются одними из наиболее часто употребляемых и эффективных.</p></abstract><trans-abstract xml:lang="en"><p>Just like the vast majority of diseases, constipation is now associated with civilization and urbanization. According to epidemiological data, up to 30% of the adult population of economically developed countries suffer from this nosology, among which women predominate. It is known that only one of four patients suffering from stool retention visit a specialist. The rest confine themselves to the advice of friends, reading of popular medical literature or consulting a pharmacist at the pharmacy. Thus, only 25% of our patients receive medical care (we cannot talk about quality, nevertheless, the care is medical), and 75%, as a rule, only periodically try to set off this condition. Constipation is dangerous as it may cause the development of complications: secondary colitis, proctosigmoiditis, hemorrhoids, anal fissures, paraproctitis and the most threatening disease – colorectal cancer. Therapy for constipation should first begin with lifestyle changes. The irritating agents that enhance secretion are the drugs that are most frequently used, because they very quickly and reliably achieve the effect. Thus, among the most commonly used and effective ones are sodium picosulfate (Regulax®) preparations.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>запор</kwd><kwd>терапия</kwd><kwd>нарушения двигательной функции кишечника</kwd><kwd>пикосульфат натрия</kwd></kwd-group><kwd-group xml:lang="en"><kwd>constipation</kwd><kwd>therapy</kwd><kwd>intestinal motor dysfunction</kwd><kwd>sodium picosulfate</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Маев И.В., Самсонов А.А., Дичева Д.Т., Андреев Д.Н. Обстипационный синдром. Медицинский вестник МВД. 2012;(4):42–45. Режим доступа: https://elibrary.ru/item.asp?id=17861889.</mixed-citation><mixed-citation xml:lang="en">Mayev I., Samsonov A., Dicheva D., Andreyev D. Оbstipation syndrome. Meditsinskiy vestnik MVD = MIA Medical Bulletin. 2012;(4):42–45. (In Russ.) 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