medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-5-22-28medsovet-6128Research ArticleФУНКЦИОНАЛЬНЫЕ ЗАБОЛЕВАНИЯ ЖКТFUNCTIONAL GASTROINTESTINAL DISEASESСовременные аспекты ведения пациентов с синдромом раздраженного кишечникаModern aspects of the management of patients with irritable bowel syndromehttps://orcid.org/0000-0002-9980-2294ЦукановВ. В.TsukanovV. V.

д.м.н., профессор, заведующий клиническим отделением патологии пищеварительной системы взрослых и детей,

660022, Красноярск, ул. Партизана Железняка, д. 3г

Dr. Sci. (Med.), Professor, Head of the Clinical Department of the Digestive System Pathology of Adults and Children, 

3g, Partizan Zheleznyak St., Krasnoyarsk, 660022

gastro@impn.ruhttps://orcid.org/0000-0002-6481-3196ВасютинА. В.VasyutinA. V.

к.м.н., старший научный сотрудник клинического отделения патологии пищеварительной системы взрослых и детей,

660022, Красноярск, ул. Партизана Железняка, д. 3г

Cand. Sci. (Med.), Senior Research fellow of the Clinical Department of the Digestive System Pathology of Adults and Children,

3g, Partizan Zheleznyak St., Krasnoyarsk, 660022

alexander@kraslan.ruhttps://orcid.org/0000-0001-7518-1895ТонкихЮ. Л.TonkikhJ. L.

к.м.н., ведущий научный сотрудник клинического отделения патологии пищеварительной системы взрослых и детей,

660022, Красноярск, ул. Партизана Железняка, д. 3г

Cand. Sci. (Med.), Leading Research Fellow of the Clinical Department of the Digestive System Pathology of Adults and Children,

3g, Partizan Zheleznyak St., Krasnoyarsk, 660022

tjulia@bk.ruКрасноярский научный центр Сибирского отделения Российской академии наук, Научно-исследовательский институт медицинских проблем СевераРоссияKrasnoyarsk Science Centre of the Siberian Branch of Russian Academy of Science, Scientific Research Institute of Medical Problems of the NorthRussian Federation202107052021052228Copyright © Цуканов В.В., Васютин А.В., Тонких Ю.Л., 20212021Цуканов В.В., Васютин А.В., Тонких Ю.Л.Tsukanov V.V., Vasyutin A.V., Tonkikh J.L.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/6128

В работе выполнен обзор современных данных по исследованию синдрома раздраженного кишечника (СРК). В США ежегодно обращаются за медицинской помощью 4 млн чел. с функциональными расстройствами кишечника, ежегодные затраты на ведение этих пациентов составляют 358 млн долл. В связи с актуальностью проблемы появляются новые разработки, среди которых следует выделить гайдлайн Американского колледжа гастроэнтерологии (ACG) по ведению пациентов с СРК. Для обследования пациентов с подозрением на СРК авторами гайдлайна ACG была предложена позитивная диагностическая стратегия, которая основывается на  внимательном изучении анамнеза, фокусировании на  ключевых симптомах связи абдоминальной боли и  функции кишечника при длительном течении заболевания (больше 6 мес.) и отсутствии тревожных симптомов при минимальном использовании инструментальных диагностических тестов. Для диагностики СРК авторы рекомендовали серологическое исследование на  целиакию, определение фекального кальпротектина и  С-реактивного белка для исключения воспалительных заболеваний кишечника, но при этом не считали необходимым рутинный анализ стула на кишечные патогены. С нашей точки зрения, отсутствие такого анализа совершенно неприменимо для России, т. к. в нашей стране частота выявления дифиллоботриоза, лямблиоза и описторхоза является весьма высокой. Консенсус ACG обратил внимание на необходимость расширения доказательной базы для применения некоторых стандартных препаратов для лечения СРК, предложил ряд новых лекарственных препаратов (лебипростон, линаклотид), рекомендовал использовать рифаксимин (для лечения СРК с преобладанием диареи) и трициклические антидепрессанты (для терапии СРК). Анализ современных международных рекомендаций позволяет считать, что клинические рекомендации Российской гастроэнтерологической ассоциации и Ассоциации колопроктологов России по диагностике и лечению СРК в настоящее время являются основным документом, регламентирующим ведение пациентов с СРК в нашей стране. 

A review of modern data from the study of functional disorders of the digestive tract is performed. In the United States, 4 million people with functional bowel disorders seek medical care annually, and the annual cost of managing these patients is $ 358 million. Due to the urgency of the problem, new developments appear, among which it is necessary to highlight the American College of Gastroenterology (ACG) guidelines for the management of patients with IBS. To examine patients with suspected IBS, the authors of the ACG guideline proposed a positive diagnostic strategy, which is based on a careful study of the anamnesis, focusing on the key symptoms of the relationship between abdominal pain and bowel function during a long course of the disease (more than 6 months) and the absence of alarming symptoms with minimal use of instrumental diagnostic tests. For the diagnosis of IBS, the  authors recommended serological testing for  celiac disease, determination of  fecal calprotectin  and C-reactive protein  to exclude inflammatory bowel diseases, but they did not consider it necessary to routinely analyze stool for intestinal pathogens. From our point of view, the absence of routine stool analysis for intestinal pathogens is completely inapplicable for Russia, since in our country the frequency of detection of diphyllobothriasis, giardiasis and opisthorchiasis is very high. The ACG consensus drew attention to the need to expand the evidence base for the use of some standard drugs for the treatment of IBS, proposed a number of new drugs (lebiprostone, linaclotide), recommended the use of rifaximin (for the treatment of IBS with a predominance of diarrhea) and tricyclic antidepressants (for the treatment of IBS). Analysis of modern international recommendations suggests that the clinical guidelines of the Russian Gastroenterological Association and the Association of Coloproctologists of Russia for the diagnosis and treatment of IBS are currently the main document governing the management of these patients in our country.

синдром раздраженного кишечникадиагностикалечениеспазмолитикипробиотикиrritable bowel syndromediagnosistreatmentantispasmodicsprobioticsReferencesSperber A.D., Bangdiwala S.I., Drossman D.A., Ghoshal U.C., Simren M., Tack J. et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology. 2021;160(1):99.e3–114.e3. doi: 10.1053/j.gastro.2020.04.014.Sperber A.D., Bangdiwala S.I., Drossman D.A., Ghoshal U.C., Simren M., Tack J. et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology. 2021;160(1):99.e3–114.e3. doi: 10.1053/j.gastro.2020.04.014.Ma C., Congly S.E., Novak K.L., Belletrutti P.J., Raman M., Woo M. et al. Epidemiologic Burden and Treatment of Chronic Symptomatic Functional Bowel Disorders in the United States: A Nationwide Analysis. Gastroenterology. 2021;160(1):88.e4–98.e4. doi: 10.1053/j.gastro.2020.09.041.Ma C., Congly S.E., Novak K.L., Belletrutti P.J., Raman M., Woo M. et al. Epidemiologic Burden and Treatment of Chronic Symptomatic Functional Bowel Disorders in the United States: A Nationwide Analysis. Gastroenterology. 2021;160(1):88.e4–98.e4. doi: 10.1053/j.gastro.2020.09.041.Camilleri M. Irritable Bowel Syndrome: Straightening the road from the Rome criteria. Neurogastroenterol Motil. 2020;32(11):e13957. doi: 10.1111/nmo.13957.Camilleri M. Irritable Bowel Syndrome: Straightening the road from the Rome criteria. Neurogastroenterol Motil. 2020;32(11):e13957. doi: 10.1111/nmo.13957.Smalley W., Falck-Ytter C., Carrasco-Labra A., Wani S., Lytvyn L., Falck-Ytter Y. AGA Clinical Practice Guidelines on the Laboratory Evaluation of Functional Diarrhea and Diarrhea-Predominant Irritable Bowel Syndrome in Adults (IBS- D). Gastroenterology. 2019;157(3):851–854. doi: 10.1053/j.gastro.2019.07.004.Smalley W., Falck-Ytter C., Carrasco-Labra A., Wani S., Lytvyn L., Falck-Ytter Y. AGA Clinical Practice Guidelines on the Laboratory Evaluation of Functional Diarrhea and Diarrhea-Predominant Irritable Bowel Syndrome in Adults (IBS- D). Gastroenterology. 2019;157(3):851–854. doi: 10.1053/j.gastro.2019.07.004.Su G.L., Ko C.W., Bercik P., Falck-Ytter Y., Sultan S., Weizman A.V., Morgan R.L. AGA Clinical Practice Guidelines on the Role of Probiotics in the Management of Gastrointestinal Disorders. Gastroenterology. 2020;159(2):697–705. doi: 10.1053/j.gastro.2020.05.059.Su G.L., Ko C.W., Bercik P., Falck-Ytter Y., Sultan S., Weizman A.V., Morgan R.L. AGA Clinical Practice Guidelines on the Role of Probiotics in the Management of Gastrointestinal Disorders. Gastroenterology. 2020;159(2):697–705. doi: 10.1053/j.gastro.2020.05.059.Chey W.D., Keefer L., Whelan K., Gibson P.R. Behavioral and Diet Therapies in Integrated Care for Patients with Irritable Bowel Syndrome. Gastroenterology. 2021;160(1):47–62. doi: 10.1053/j.gastro.2020.06.099.Chey W.D., Keefer L., Whelan K., Gibson P.R. Behavioral and Diet Therapies in Integrated Care for Patients with Irritable Bowel Syndrome. Gastroenterology. 2021;160(1):47–62. doi: 10.1053/j.gastro.2020.06.099.Brenner D.M., Sayuk G.S. Current US Food and Drug AdministrationApproved Pharmacologic Therapies for the Treatment of Irritable Bowel Syndrome with Diarrhea. Adv Ther. 2020;37(1):83–96. doi: 10.1007/s12325-019-01116-z.Brenner D.M., Sayuk G.S. Current US Food and Drug Administration-Approved Pharmacologic Therapies for the Treatment of Irritable Bowel Syndrome with Diarrhea. Adv Ther. 2020;37(1):83–96. doi: 10.1007/s12325-019-01116-z.Lacy B.E., Pimentel M., Brenner D.M., Chey W.D., Keefer L.A., Long M.D, Moshiree B. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2021;116(1):17–44. doi: 10.14309/ajg.0000000000001036.Lacy B.E., Pimentel M., Brenner D.M., Chey W.D., Keefer L.A., Long M.D, Moshiree B. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2021;116(1):17–44. doi: 10.14309/ajg.0000000000001036.Ford A.C., Lacy B.E., Talley N.J. Irritable Bowel Syndrome. N Engl J Med. 2017;376(26):2566–2578. doi: 10.1056/NEJMra1607547.Ford A.C., Lacy B.E., Talley N.J. Irritable Bowel Syndrome. N Engl J Med. 2017;376(26):2566–2578. doi: 10.1056/NEJMra1607547.Lacy B.E., Mearin F., Chang L., Chey W.D., Lembo A.J., Simren M., Spiller R. Bowel Disorders. Gastroenterology. 2016;150(6):1393–1407. doi: 10.1053/j.gastro.2016.02.031.Lacy B.E., Mearin F., Chang L., Chey W.D., Lembo A.J., Simren M., Spiller R. Bowel Disorders. Gastroenterology. 2016;150(6):1393–1407. doi: 10.1053/j.gastro.2016.02.031.Sood R., Camilleri M., Gracie D.J., Gold M.J., To N., Law G.R., Ford A.C. Enhancing Diagnostic Performance of Symptom-Based Criteria for Irritable Bowel Syndrome by Additional History and Limited Diagnostic Evaluation. Am J Gastroenterol. 2016;111(10):1446–1454. doi: 10.1038/ajg.2016.308.Sood R., Camilleri M., Gracie D.J., Gold M.J., To N., Law G.R., Ford A.C. Enhancing Diagnostic Performance of Symptom-Based Criteria for Irritable Bowel Syndrome by Additional History and Limited Diagnostic Evaluation. Am J Gastroenterol. 2016;111(10):1446–1454. doi: 10.1038/ajg.2016.308.Begtrup L.M., Engsbro A.L., Kjeldsen J., Larsen P.V., de Muckadell O.S., Bytzer P., Jarbøl D.E. A Positive Diagnostic Strategy Is Noninferior to a Strategy of Exclusion for Patients with Irritable Bowel Syndrome. Clin Gastroenterol Hepatol. 2013;11(8):956.e1–962.e1. doi: 10.1016/j.cgh.2012.12.038.Begtrup L.M., Engsbro A.L., Kjeldsen J., Larsen P.V., de Muckadell O.S., Bytzer P., Jarbøl D.E. A Positive Diagnostic Strategy Is Noninferior to a Strategy of Exclusion for Patients with Irritable Bowel Syndrome. Clin Gastroenterol Hepatol. 2013;11(8):956.e1–962.e1. doi: 10.1016/j.cgh.2012.12.038.Enck P., Aziz Q., Barbara G., Farmer A.D., Fukudo S., Mayer E.A. et al. Irritable Bowel Syndrome. Nat Rev Dis Primers. 2016;2:16014. doi: 10.1038/nrdp.2016.14.Enck P., Aziz Q., Barbara G., Farmer A.D., Fukudo S., Mayer E.A. et al. Irritable Bowel Syndrome. Nat Rev Dis Primers. 2016;2:16014. doi: 10.1038/nrdp.2016.14.Ивашкин В.Т., Шелыгин Ю.А., Баранская Е.К., Белоусова Е.А., Бениашвили А.Г., Васильев С.В. и др. Клинические рекомендации Российской гастроэнтерологической ассоциации и Ассоциации колопроктологов России по диагностике и лечению синдрома раздраженного кишечника. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2017;27(5):76–93. doi: 10.22416/1382-4376-2017-27-5-76-93.Ivashkin V.T., Shelygin Yu.A., Baranskaya E.K., Belousova Y.A., Beniashvili A.G., Vasilyev S.V. et al. Diagnosis and Treatment of the Irritable Bowel Syndrome: Clinical Guidelines of the Russian Gastroenterological Association and Russian Association of Coloproctology. Rossiyskiy zhurnal gastroehnterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2017;27(5):76–93. (In Russ.) doi: 10.22416/1382-4376-2017-27-5-76-93.Singh P., Arora A., Strand T.A., Leffler D.A., Catassi C., Green P.H. et al. Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2018;16(6):823.e2–836.e2. doi: 10.1016/j.cgh.2017.06.037.Singh P., Arora A., Strand T.A., Leffler D.A., Catassi C., Green P.H. et al. Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2018;16(6):823.e2–836.e2. doi: 10.1016/j.cgh.2017.06.037.Spiegel B.M., DeRosa V.P., Gralnek I.M., Wang V., Dulai G.S. Testing for Celiac Sprue in Irritable Bowel Syndrome with Predominant Diarrhea: A CostEffectiveness analysis. Gastroenterology. 2004;126(7):1721–1732. doi: 10.1053/j.gastro.2004.03.012.Spiegel B.M., DeRosa V.P., Gralnek I.M., Wang V., Dulai G.S. Testing for Celiac Sprue in Irritable Bowel Syndrome with Predominant Diarrhea: A CostEffectiveness analysis. Gastroenterology. 2004;126(7):1721–1732. doi: 10.1053/j.gastro.2004.03.012.Porter C.K., Cash B.D., Pimentel M., Akinseye A., Riddle M.S. Risk of Inflammatory Bowel Disease Following a Diagnosis of Irritable Bowel Syndrome. BMC Gastroenterol. 2012;12:55. doi: 10.1186/1471-230X-12-55.Porter C.K., Cash B.D., Pimentel M., Akinseye A., Riddle M.S. Risk of Inflammatory Bowel Disease Following a Diagnosis of Irritable Bowel Syndrome. BMC Gastroenterol. 2012;12:55. doi: 10.1186/1471-230X-12-55.Menees S.B., Powell C., Kurlander J., Goel A., Chey W.D. A Meta-Analysis of the Utility of C-Reactive Protein, Erythrocyte Sedimentation Rate, Fecal Calprotectin, and Fecal Lactoferrin to Exclude Inflammatory Bowel Disease in Adults with IBS. Am J Gastroenterol. 2015;110(3):444–454. doi: 10.1038/ajg.2015.6.Menees S.B., Powell C., Kurlander J., Goel A., Chey W.D. A Meta-Analysis of the Utility of C-Reactive Protein, Erythrocyte Sedimentation Rate, Fecal Calprotectin, and Fecal Lactoferrin to Exclude Inflammatory Bowel Disease in Adults with IBS. Am J Gastroenterol. 2015;110(3):444–454. doi: 10.1038/ajg.2015.6.Carrasco-Labra A., Lytvyn L., Falck-Ytter Y., Surawicz C.M., Chey W.D. AGA Technical Review on the Evaluation of Functional Diarrhea and Diarrhea-Predominant Irritable Bowel Syndrome in Adults (IBS-D). Gastroenterology. 2019;157(3):859–880. doi: 10.1053/j.gastro.2019.06.014.Carrasco-Labra A., Lytvyn L., Falck-Ytter Y., Surawicz C.M., Chey W.D. AGA Technical Review on the Evaluation of Functional Diarrhea and Diarrhea-Predominant Irritable Bowel Syndrome in Adults (IBS-D). Gastroenterology. 2019;157(3):859–880. doi: 10.1053/j.gastro.2019.06.014.Цуканов В.В., Тонких Ю.Л., Гилюк А.В., Васютин А.В., Коленчукова О.А., Ржавичева О.С. и др. Диагностика, клиника и лечение описторхоза. Доктор.Ру. 2019;(8):49–53. doi: 10.31550/1727-2378-2019-163-8-49-53.Tsukanov V.V., Tonkikh Yu.L., Gilyuk A.V., Vasyutin A.V., Kolenchukova O.A., Rzhavicheva O.S. et al. Opisthorchiasis: diagnostics, Clinical Manifestations, and Management. Doctor.Ru. 2019;(8):49–53. (In Russ.) doi: 10.31550/1727-2378-2019-163-8-49-53.Ruepert L., Quartero A.O., de Wit N.J., van der Heijden G.J., Rubin G., Muris J.W. Bulking Agents, Antispasmodics and Antidepressants for the Treatment of Irritable Bowel Syndrome. Cochrane Database Syst Rev. 2011;(8):CD003460. doi: 10.1002/14651858.CD003460.pub3.Ruepert L., Quartero A.O., de Wit N.J., van der Heijden G.J., Rubin G., Muris J.W. Bulking Agents, Antispasmodics and Antidepressants for the Treatment of Irritable Bowel Syndrome. Cochrane Database Syst Rev. 2011;(8):CD003460. doi: 10.1002/14651858.CD003460.pub3.Moayyedi P., Mearin F., Azpiroz F., Andresen V., Barbara G., Corsetti M. et al. Irritable Bowel Syndrome Diagnosis and Management: A Simplified Algorithm for Clinical Practice. United European Gastroenterol J. 2017;5(6):773–788. doi: 10.1177/2050640617731968.Moayyedi P., Mearin F., Azpiroz F., Andresen V., Barbara G., Corsetti M. et al. Irritable Bowel Syndrome Diagnosis and Management: A Simplified Algorithm for Clinical Practice. United European Gastroenterol J. 2017;5(6):773–788. doi: 10.1177/2050640617731968.Simrén M., Törnblom H., Palsson O.S., Whitehead W.E. Management of the Multiple Symptoms of Irritable Bowel Syndrome. Lancet Gastroenterol Hepatol. 2017;2(2):112–122. doi: 10.1016/S2468-1253(16)30116-9.Simrén M., Törnblom H., Palsson O.S., Whitehead W.E. Management of the Multiple Symptoms of Irritable Bowel Syndrome. Lancet Gastroenterol Hepatol. 2017;2(2):112–122. doi: 10.1016/S2468-1253(16)30116-9.Ford A.C., Sperber A.D., Corsetti M., Camilleri M. Irritable Bowel Syndrome. Lancet. 2020;396(10263):1675–1688. doi: 10.1016/S0140-6736(20)31548-8.Ford A.C., Sperber A.D., Corsetti M., Camilleri M. Irritable Bowel Syndrome. Lancet. 2020;396(10263):1675–1688. doi: 10.1016/S0140-6736(20)31548-8.Ford A.C., Harris L.A., Lacy B.E., Quigley E.M.M., Moayyedi P. Systematic Review with Meta-Analysis: the Efficacy of Prebiotics, Probiotics, Synbiotics and Antibiotics in Irritable Bowel Syndrome. Aliment Pharmacol Ther. 2018;48(10):1044–1060. doi: 10.1111/apt.15001.Ford A.C., Harris L.A., Lacy B.E., Quigley E.M.M., Moayyedi P. Systematic Review with Meta-Analysis: the Efficacy of Prebiotics, Probiotics, Synbiotics and Antibiotics in Irritable Bowel Syndrome. Aliment Pharmacol Ther. 2018;48(10):1044–1060. doi: 10.1111/apt.15001.Nobaek S., Johansson M.L., 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(5):1231–1238. doi: 10.1111/j.1572-0241.2000.02015.x.Nobaek S., Johansson M.L., 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(5):1231–1238. doi: 10.1111/j.1572-0241.2000.02015.x.Ducrotté P., Sawant P., Jayanthi V. Clinical Trial: Lactobacillus plantarum 299v (DSM 9843) Improves Symptoms of Irritable Bowel Syndrome. World J Gastroenterol. 2012;18(30):4012–4018. doi: 10.3748/wjg.v18.i30.4012.Ducrotté P., Sawant P., Jayanthi V. Clinical Trial: Lactobacillus plantarum 299v (DSM 9843) Improves Symptoms of Irritable Bowel Syndrome. World J Gastroenterol. 2012;18(30):4012–4018. doi: 10.3748/wjg.v18.i30.4012.Kruis W., Chrubasik S., Boehm S., Stange C., Schulze J. A Double-Blind PlaceboControlled Trial to Study Therapeutic Effects of Probiotic Escherichia coli Nissle 1917 in Subgroups of Patients with Irritable Bowel Syndrome. Int J Colorectal Dis. 2012;27(4):467–474. doi: 10.1007/s00384-011-1363-9.Kruis W., Chrubasik S., Boehm S., Stange C., Schulze J. A Double-Blind PlaceboControlled Trial to Study Therapeutic Effects of Probiotic Escherichia coli Nissle 1917 in Subgroups of Patients with Irritable Bowel Syndrome. Int J Colorectal Dis. 2012;27(4):467–474. doi: 10.1007/s00384-011-1363-9.Enck P., Zimmermann K., Menke G., Klosterhalfen S. Randomized Controlled Treatment Trial of Irritable Bowel Syndrome with a Probiotic E.-coli Preparation (DSM17252) Compared to Placebo. Z Gastroenterol. 2014;52(1):64. doi: 10.1055/s-0034-1366796.Enck P., Zimmermann K., Menke G., Klosterhalfen S. Randomized Controlled Treatment Trial of Irritable Bowel Syndrome with a Probiotic E.-coli Preparation (DSM17252) Compared to Placebo. Z Gastroenterol. 2014;52(1):64. doi: 10.1055/s-0034-1366796.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(1):23–26. doi: 10.3109/02813438909103666.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(1):23–26. doi: 10.3109/02813438909103666.Sisson G., Ayis S., Sherwood R.A., Bjarnason I. Randomised Clinical Trial: A Liquid Multi-Strain Probiotic vs. Placebo in the Irritable Bowel Syndrome – A 12 Week Double-Blind Study. Aliment Pharmacol Ther. 2014;40(1):51–62. doi: 10.1111/apt.12787.Sisson G., Ayis S., Sherwood R.A., Bjarnason I. Randomised Clinical Trial: A Liquid Multi-Strain Probiotic vs. Placebo in the Irritable Bowel Syndrome – A 12 Week Double-Blind Study. Aliment Pharmacol Ther. 2014;40(1):51–62. doi: 10.1111/apt.12787.Ludidi S., Jonkers D.M., Koning C.J., Kruimel J.W., Mulder L., van der Vaart I.B. et al. Randomized Clinical Trial on the Effect of a Multispecies Probiotic on Visceroperception in Hypersensitive IBS Patients. Neurogastroenterol Motil. 2014;26(5):705–714. doi: 10.1111/nmo.12320.Ludidi S., Jonkers D.M., Koning C.J., Kruimel J.W., Mulder L., van der Vaart I.B. et al. Randomized Clinical Trial on the Effect of a Multispecies Probiotic on Visceroperception in Hypersensitive IBS Patients. Neurogastroenterol Motil. 2014;26(5):705–714. doi: 10.1111/nmo.12320.Cha B.K., Jung S.M., Choi C.H., Song I.D., Lee H.W., Kim H.J. et al. The Effect of a Multispecies Probiotic Mixture on the Symptoms and Fecal Microbiota in Diarrhea-Dominant Irritable Bowel Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial. J Clin Gastroenterol. 2012;46(3):220– 227. doi: 10.1097/MCG.0b013e31823712b1.Cha B.K., Jung S.M., Choi C.H., Song I.D., Lee H.W., Kim H.J. et al. The Effect of a Multispecies Probiotic Mixture on the Symptoms and Fecal Microbiota in Diarrhea-Dominant Irritable Bowel Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial. J Clin Gastroenterol. 2012;46(3):220– 227. doi: 10.1097/MCG.0b013e31823712b1.Ishaque S.M., Khosruzzaman S.M., Ahmed D.S., Sah M.P. A Randomized PlaceboControlled Clinical Trial of a Multi-Strain Probiotic Formulation (Bio-Kult®) in the Management of Diarrhea-Predominant Irritable Bowel Syndrome. BMC Gastroenterol. 2018;18(1):71. doi: 10.1186/s12876-018-0788-9.Ishaque S.M., Khosruzzaman S.M., Ahmed D.S., Sah M.P. A Randomized PlaceboControlled Clinical Trial of a Multi-Strain Probiotic Formulation (Bio-Kult®) in the Management of Diarrhea-Predominant Irritable Bowel Syndrome. BMC Gastroenterol. 2018;18(1):71. doi: 10.1186/s12876-018-0788-9.Lyra A., Hillilä M., Huttunen T., Männikkö S., Taalikka M., Tennilä J. et al. Irritable Bowel Syndrome Symptom Severity Improves Equally with Probiotic and Placebo. World J Gastroenterol. 2016;22(48):10631–10642. doi: 10.3748/wjg.v22.i48.10631.Lyra A., Hillilä M., Huttunen T., Männikkö S., Taalikka M., Tennilä J. et al. Irritable Bowel Syndrome Symptom Severity Improves Equally with Probiotic and Placebo. World J Gastroenterol. 2016;22(48):10631–10642. doi: 10.3748/wjg.v22.i48.10631.Ford A.C., Quigley E.M., Lacy B.E., Lembo A.J., Saito Y.A., Schiller L.R. et al. Efficacy of Prebiotics, Probiotics, and Synbiotics in Irritable Bowel Syndrome and Chronic Idiopathic Constipation: Systematic Review and Meta-Analysis. Am J Gastroenterol. 2014;109(10):1547–1561. doi: 10.1038/ajg.2014.202.Ford A.C., Quigley E.M., Lacy B.E., Lembo A.J., Saito Y.A., Schiller L.R. et al. Efficacy of Prebiotics, Probiotics, and Synbiotics in Irritable Bowel Syndrome and Chronic Idiopathic Constipation: Systematic Review and Meta-Analysis. Am J Gastroenterol. 2014;109(10):1547–1561. doi: 10.1038/ajg.2014.202.Tiequn B., Guanqun C., Shuo Z. Therapeutic Effects of Lactobacillus in Treating Irritable Bowel Syndrome: A Meta-Analysis. Intern Med. 2015;54(3):243–249. doi: 10.2169/internalmedicine.54.2710.Tiequn B., Guanqun C., Shuo Z. Therapeutic Effects of Lactobacillus in Treating Irritable Bowel Syndrome: A Meta-Analysis. Intern Med. 2015;54(3):243–249. doi: 10.2169/internalmedicine.54.2710.Ивашкин В.Т., Маев И.В., Абдулганиева Д.И., Алексеенко С.А., Ивашкина Н.Ю., Корочанская Н.В. и др. Практические рекомендации Научного сообщества по содействию клиническому изучению микробиома человека (НСОИМ) и Российской гастроэнтерологической ассоциации (РГА) по применению пробиотиков для лечения и профилактики заболеваний гастроэнтерологического профиля у взрослых. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2020;30(2):76–89. doi: 10.22416/1382-4376-2020-30-2-76-89.Ivashkin V.T., Mayev I.V., Abdulganieva D.I., Alekseenko S.A., Ivashkina N.Yu., Korochanskaya N.V. et al. Practical Recommendations of Scientific Society for the Study of Human Microbiome and Russian Gastroenterological Association (RGA) for Probiotics in Treatment and Prevention of Gastroenterological Diseases in Adults. Rossiyskiy zhurnal gastroehnterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2020;30(2):76–89. (In Russ.) doi: 10.22416/1382-4376-2020-30-2-76-89.Ford A.C., Moayyedi P., Chey W.D., Harris L.A., Lacy B.E., Saito Y.A., Quigley E.M.M. American College of Gastroenterology Monograph on Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2018;113 (2 Suppl.):1–18. doi: 10.1038/s41395-018-0084-x.Ford A.C., Moayyedi P., Chey W.D., Harris L.A., Lacy B.E., Saito Y.A., Quigley E.M.M. American College of Gastroenterology Monograph on Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2018;113 (2 Suppl.):1–18. doi: 10.1038/s41395-018-0084-x.Xie C., Tang Y., Wang Y., Yu T., Wang Y., Jiang L., Lin L. Efficacy and Safety of Antidepressants for the Treatment of Irritable Bowel Syndrome: A MetaAnalysis. PLoS One. 2015;10(8):e0127815. doi: 10.1371/journal.pone.0127815.Xie C., Tang Y., Wang Y., Yu T., Wang Y., Jiang L., Lin L. Efficacy and Safety of Antidepressants for the Treatment of Irritable Bowel Syndrome: A MetaAnalysis. PLoS One. 2015;10(8):e0127815. doi: 10.1371/journal.pone.0127815.Shah E.D., Kim H.M., Schoenfeld P. Efficacy and Tolerability of Guanylate Cyclase-C Agonists for Irritable Bowel Syndrome with Constipation and Chronic Idiopathic Constipation: A Systematic Review and Meta-Analysis. Am J Gastroenterol. 2018;113(3):329–338. doi: 10.1038/ajg.2017.495.Shah E.D., Kim H.M., Schoenfeld P. Efficacy and Tolerability of Guanylate Cyclase-C Agonists for Irritable Bowel Syndrome with Constipation and Chronic Idiopathic Constipation: A Systematic Review and Meta-Analysis. Am J Gastroenterol. 2018;113(3):329–338. doi: 10.1038/ajg.2017.495.Atluri D.K., Chandar A.K., Bharucha A.E., Falck-Ytter Y. Effect of Linaclotide in Irritable Bowel Syndrome with Constipation (IBS-C): A Systematic Review and Meta-Analysis. Neurogastroenterol Motil. 2014;26(4):499–509. doi: 10.1111/nmo.12292.Atluri D.K., Chandar A.K., Bharucha A.E., Falck-Ytter Y. Effect of Linaclotide in Irritable Bowel Syndrome with Constipation (IBS-C): A Systematic Review and Meta-Analysis. Neurogastroenterol Motil. 2014;26(4):499–509. doi: 10.1111/nmo.12292.Dimidi E., Whelan K. Food Supplements and Diet as Treatment Options in Irritable Bowel Syndrome. Neurogastroenterol Motil. 2020;32(8):e13951. doi: 10.1111/nmo.13951.Dimidi E., Whelan K. Food Supplements and Diet as Treatment Options in Irritable Bowel Syndrome. Neurogastroenterol Motil. 2020;32(8):e13951. doi: 10.1111/nmo.13951.Singh R., Salem A., Nanavati J., Mullin G.E. The Role of Diet in the Treatment of Irritable Bowel Syndrome: A Systematic Review. Gastroenterol Clin North Am. 2018;47(1):107–137. doi: 10.1016/j.gtc.2017.10.003.Singh R., Salem A., Nanavati J., Mullin G.E. The Role of Diet in the Treatment of Irritable Bowel Syndrome: A Systematic Review. Gastroenterol Clin North Am. 2018;47(1):107–137. doi: 10.1016/j.gtc.2017.10.003.Moayyedi P., Quigley E.M., Lacy B.E., Lembo A.J., Saito Y.A., Schiller L.R. et al. The Effect of Fiber Supplementation on Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis. Am J Gastroenterol. 2014;109(9):1367– 1374. doi: 10.1038/ajg.2014.195.Moayyedi P., Quigley E.M., Lacy B.E., Lembo A.J., Saito Y.A., Schiller L.R. et al. The Effect of Fiber Supplementation on Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis. Am J Gastroenterol. 2014;109(9):1367– 1374. doi: 10.1038/ajg.2014.195.Eswaran S., Muir J., Chey W.D. Fiber and Functional Gastrointestinal Disorders. Am J Gastroenterol. 2013;108:718–727. doi: 10.1038/ajg.2013.63.Eswaran S., Muir J., Chey W.D. Fiber and Functional Gastrointestinal Disorders. Am J Gastroenterol. 2013;108:718–727. doi: 10.1038/ajg.2013.63.El-Salhy M., Ystad S.O., Mazzawi T., Gundersen D. Dietary Fiber in Irritable Bowel Syndrome (Review). Int J Mol Med. 2017;40(3):607–613. doi: 10.3892/ijmm.2017.3072.El-Salhy M., Ystad S.O., Mazzawi T., Gundersen D. Dietary Fiber in Irritable Bowel Syndrome (Review). Int J Mol Med. 2017;40(3):607–613. doi: 10.3892/ijmm.2017.3072.Плотникова Е.Ю., Грачева Т.Ю., Синькова М.Н., Исаков Л.К. Роль пищевых волокон в коррекции пищеварения и запоров различной этиологии. Медицинский совет. 2019;(14):99–106. doi: 10.21518/2079-701X-2019-14-99-106.Plotnikova E.Yu., Gracheva T.Yu., Sinkovа M.N., Isakov L.K. The Role of Dietary Fiber in the Correction of Digestion and Constipation of Various Etiologies. Meditsinskiy sovet = Medical Council. 2019;(14):99–106. (In Russ.) doi: 10.21518/2079-701X-2019-14-99-106.Camilleri M. Diagnosis and Treatment of Irritable Bowel Syndrome: A Review. JAMA. 2021;325(9):865–877. doi: 10.1001/jama.2020.22532Camilleri M. Diagnosis and Treatment of Irritable Bowel Syndrome: A Review. JAMA. 2021;325(9):865–877. doi: 10.1001/jama.2020.22532.

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