medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-5-155-164medsovet-6182Research ArticleЗАБОЛЕВАНИЯ КИШЕЧНИКАBOWEL DISEASESМесто спазмолитиков в лечении синдрома раздраженного кишечникаRole of antispasmodics in the treatment of irritable bowel syndromehttps://orcid.org/0000-0002-0535-2916ДроздовВ. Н.DrozdovV. N.

д.м.н., профессор, профессор кафедры клинической фармакологии и пропедевтики внутренних болезней, 

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Dr. Sci. (Med.), Professor of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, 

8, Bldg. 2, Trubetskaya St., Moscow, 119991

vndrozdov@yandex.ruhttps://orcid.org/0000-0003-1436-6671АрефьевК. И.ArefevK. I.

аспирант кафедры клинической фармакологии и пропедевтики внутренних болезней, 

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Graduate Student of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, 

8, Bldg. 2, Trubetskaya St., Moscow, 119991

kiarefev@gmail.comhttps://orcid.org/0000-0002-7163-7119СереброваС. Ю.SerebrovaS. Yu.

д.м.н., главный научный сотрудник, 127051, Москва, Петровский бульвар, д. 8, стр. 2;

профессор кафедры клинической фармакологии и  пропедевтики внутренних болезней, 119991, Москва, ул. Трубецкая, д. 8, стр. 2

Dr. Sci. (Med.), Chief Researcher, 8, Bldg. 2, Petrovsky Boulevard, Moscow, 127051;

Professor of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, 8, Bldg. 2, Trubetskaya St., Moscow, 119991

svetaserebrova@mail.ruhttps://orcid.org/0000-0001-5621-2721КомиссаренкоИ. А.KomissarenkoI. A.

д.м.н., профессор кафедры поликлинической терапии, 

127473, Москва, ул. Делегатская, д. 20, стр. 1

Dr. Sci. (Med.), Professor of the Department of Polyclinic Therapy, 

20, Bldg. 1, Delegatskaya St., Moscow, 127473

komisarenko@mail.ruhttps://orcid.org/0000-0001-6589-7654ШихЕ. В.ShikhE. V.

д.м.н., профессор, заведующая кафедрой клинической фармакологии и пропедевтики внутренних болезней,

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Dr. Sci. (Med.), Professor, Head of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, 

8, Bldg. 2, Trubetskaya St., Moscow, 119991

chih@mail.ruhttps://orcid.org/0000-0001-9842-4503СтародубцевА. К.StarodubtsevA. K.

д.м.н., профессор, профессор кафедры клинической фармакологии и пропедевтики внутренних болезней, 

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Dr. Sci. (Med.), Professor of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, 

8, Bldg. 2, Trubetskaya St., Moscow, 119991

9152340@mail.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical UniversityRussian FederationНаучный центр экспертизы средств медицинского применения; Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияScientific Centre for Expert Evaluation of Medicinal Products; Sechenov First Moscow State Medical UniversityRussian FederationМосковский государственный медикостоматологический университет имени А.И. ЕвдокимоваРоссияYevdokimov Moscow State University of Medicine and DentistryRussian FederationПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical UniversityRussian Federation20211305202105155164Copyright © Дроздов В.Н., Арефьев К.И., Сереброва С.Ю., Комиссаренко И.А., Ших Е.В., Стародубцев А.К., 20212021Дроздов В.Н., Арефьев К.И., Сереброва С.Ю., Комиссаренко И.А., Ших Е.В., Стародубцев А.К.Drozdov V.N., Arefev K.I., Serebrova S.Y., Komissarenko I.A., Shikh E.V., Starodubtsev A.K.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/6182Введение

Введение. Синдром раздраженного кишечника (СРК) – это функциональное расстройство кишечника, оказывающее значительное влияние на пациентов и социум, особенно с точки зрения качества жизни и медицинских расходов.

Патогенез

Патогенез. Считается, что патогенез СРК состоит из нескольких механизмов: синдрома перекрестка функциональных нарушений (кишечник – мозг), стресса, висцеральной гиперчувствительности и изменения моторики.

Висцеральная гиперчувствительность. Изменение висцеральной чувствительности при СРК характеризуется центральными аномалиями в областях коры головного мозга. Нарушение моторики при СРК проявляется в виде аномальной миоэлектрической активности толстой кишки, приводящей к повторяющимся сокращениям тонкой и толстой кишки, что, по-видимому, вызывает боль.

Микрофлора кишечника

Микрофлора кишечника. FODMAP в больших количествах присутствуют в некоторых фруктах, искусственных подсластителях, бобовых и зеленых овощах и плохо усваиваются у всех людей. FODMAP обладают ферментативным и осмотическим действиями, которые могут способствовать появлению симптомов у некоторых пациентов.

Принципы терапии СРК

Принципы терапии СРК. Лечение СРК должно основываться на типе и тяжести симптомов. В терапии используют препараты различных фармакологических групп в зависимости от преобладающей симптоматики. К ним можно отнести агонисты опиоидных рецепторов, секвестранты желчных кислот, агонисты гуанилатциклазы, активаторы хлорных каналов, а также антибиотики, пробиотики, антидепрессанты, антагонисты 5-HT3-рецепторов и спазмолитики.

Миотропные спазмолитики

Миотропные спазмолитики. Препараты со спазмолитической активностью используются для лечения функциональных и органических заболеваний органов ЖКТ в  качестве базисной терапии или по  требованию. Мебеверин быстро и  эффективно снимает спазм, боль и весь комплекс кишечных симптомов; кроме того, препарат снижает висцеральную гиперчувствительность за счет местного анестетического эффекта. Препарат обладает высоким профилем безопасности и имеет ряд преимуществ перед препаратами той же фармакологической группы.

Заключение

Заключение. Миотропные спазмолитики продемонстрировали высокую эффективность в лечении СРК. Особое место среди них занимает мебеверин. Его сочетанное действие обусловливает выраженную спазмолитическую активность наряду с высоким профилем безопасности. 

Introduction

Introduction. IBS is a functional bowel disorder that has a significant impact on patients and society, especially in terms of quality of life and medical costs.

Pathogenesis

Pathogenesis. It is believed that the pathogenesis of IBS consists of several mechanisms: the syndrome of intersection of functional disorders (gut-brain), stress, visceral hypersensitivity and changes in motor skills.

Visceral hypersensitivity. Changes in visceral sensitivity in IBS are characterized by central abnormalities in areas of the cerebral cortex. Motility impairment in IBS manifests itself as abnormal myoelectric activity in the colon, resulting in repetitive contractions of the small intestine and colon, which appear to cause pain.

Intestinal microflora

Intestinal microflora. FODMAPs are found in high amounts in some fruits, artificial sweeteners, legumes, and green vegetables and are poorly absorbed by all people. FODMAPs have enzymatic and osmotic effects that may contribute to the onset of symptoms in some patients.

The principles of IBS therapy. Treatment for IBS should be based on the type and severity of symptoms. For the treatment of IBS, drugs of various pharmacological groups are used, depending on the prevailing symptoms. These include opioid receptor agonists, bile acid sequestrants, guanylate cyclase agonists, chlorine channel activators, as well as antibiotics, probiotics, antidepressants, 5-HT3 receptor antagonists, and antispasmodics.

Myotropic antispasmodics

Myotropic antispasmodics. Drugs with antispasmodic activity are used to treat functional and organic diseases of the gastrointestinal tract as a basic therapy or «on demand». Mebeverine quickly and effectively relieves spasm, pain and the entire complex of intestinal symptoms, in addition, the drug reduces visceral hypersensitivity due to a local anesthetic effect. The drug has a high safety profile and has a number of advantages over drugs of the same pharmacological group.

Conclusion

Conclusion. Myotropic antispasmodics have been shown to be highly effective in the treatment of IBS. Mebeverine occupies a special place among myotropic antispasmodics. Its combined action provides a pronounced antispasmodic activity along with a high safety profile. 

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