medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-360medsovet-7851Research ArticleЗАБОЛЕВАНИЯ КИШЕЧНИКАBOWEL DISEASESБолевой абдоминальный синдром у пациентов с синдромом раздраженного кишечника: особенности подбора терапииAbdominal pain syndrome in patients with irritable bowel syndrome: features of selection of therapyhttps://orcid.org/0000-0002-3125-6282ПахомоваИ. Г.PakhomovaI. G.

Пахомова Инна Григорьевна – кандидат медицинских наук, доцент.

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Inna G. Pakhomova - Cand. Sci. (Med.), Associate Professor, Almazov National  Medical Research  Centre.

2, Akkuratov St., St Petersburg, 197341

pakhomova-inna@yandex.ruНациональный медицинский исследовательский центр имени В.А. АлмазоваРоссияAlmazov National Medical Research CentreRussian Federation202302112023018101107Copyright © Пахомова И.Г., 20232023Пахомова И.Г.Pakhomova I.G.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/7851

Синдром раздраженного  кишечника  (СРК) является  важной  социальной  проблемой,  поскольку часто  диагностируется у лиц молодого трудоспособного  возраста, значительно  влияет на качество жизни пациентов  и наносит экономический ущерб обществу. СРК – это хроническое функциональное заболевание кишечника, основным проявлением  которого является боль в сочетании с изменением дефекации, частоты и характера  стула. Механизм формирования  болевого абдоминального  синдрома  обусловлен  нарушением  взаимодействия   по  оси  «мозг – кишечник», что приводит  к изменению регуляции моторной  функции кишечника и развитию висцеральной  гиперчувствительности (ВГЧ). Абдоминальная боль, как проявление  СРК, в первую очередь связана со спазмом гладкой мускулатуры кишечника. Препаратами  первой линии в купировании  болевого  синдрома  являются спазмолитики, снижающие  тонус и сократительную способность  гладкой мускулатуры кишечника, эффективно справляясь с болью в животе. Отечественный фармацевтический рынок представлен разными группами мышечных миорелаксантов,  среди  которых особую актуальность для пациентов  с СРК представляют блокаторы кальциевых каналов. Представителем  последних является препарат Отилония бромид, широко использующийся во всем мире, является эффективным и безопасным, хорошо переносится и превосходит плацебо в отношении уменьшения симптомов и предотвращения рецидива  болей у пациентов с СРК. Эффективность отилония бромида обусловлена тройным механизмом  действия: блокадой кальциевых каналов (купирование спазма), антагонизмом в отношении тахикиноновых  рецепторов   NK2 (влияние  на  ВГЧ)  и ингибированием  ацетилхолиновых  мускариновых  рецепторов   (М3–ХР) (уменьшение кишечной секреции). В данной статье представлен  небольшой обзор литературы по причинам и механизма развития боли при СРК, а также возможностям ее купирования, в первую очередь с применением  гладкомышечных миорелаксантов, а именно – отилония бромида.

Irritable  bowel  syndrome  (IBS) is an important social problem, since  it is often  diagnosed in people  of young working age, significantly affects  the quality of life of patients and causes  economic  damage  to society. IBS is a chronic functional  bowel disease,  the  main  manifestation of which  is pain  combined  with  changes  in bowel  movements, frequency  and  character of stool. The mechanism  of formation of abdominal  pain syndrome is due to a disruption in the interaction along the brain-gut axis, which leads  to changes  in the  regulation of intestinal motor  function  and the  development of visceral  hypersensitivity (VH). Abdominal pain as a manifestation of IBS is primarily associated with spasm of intestinal smooth muscles. The first-line drugs  for pain  relief  are  antispasmodics, which reduce  the  tone  and  contractility  of intestinal smooth  muscles, effectively coping  with  abdominal  pain. The domestic  pharmaceutical market  is represented by different  groups  of muscle  relaxants, among  which  calcium  channel  blockers  are  of particular  relevance for patients with  IBS. Representative  of the  latter  is the drug Otilonium bromide, which is widely used throughout the world, is effective  and safe, well tolerated and superior  to placebo  in reducing symptoms  and preventing relapse  of pain in patients with IBS. The effectiveness of otilonium  bromide is due to a triple  mechanism  of action: blockade  of calcium channels (relief of spasm), antagonism of tachykinone  NK2 receptors  (effect  on HHV) and  inhibition  of acetylcholine muscarinic  receptors (M3-ChR) (reduction  of intestinal secretion). This article  presents a short  review  of the  literature on the  causes  and  mechanism  of development of pain  in IBS, as well  as the possibilities  of its relief, primarily with the use of smooth  muscle relaxants, namely otilonium  bromide.

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