medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-546medsovet-8833Research ArticleГАСТРОЭНТЕРОЛОГИЯGASTROENTEROLOGYОсобенности ведения пациентов с сочетанным течением гастроэзофагеальной рефлюксной болезни и синдромом раздраженного кишечникаFeatures of management of patients with combined gastroesophageal reflux disease and irritable bowel syndromehttps://orcid.org/0000-0002-3125-6282ПахомоваИ. Г.PakhomovaI. G.

Пахомова Инна Григорьевна - к.м.н., доцент кафедры факультетской терапии с клиникой.

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

Inna G. Pakhomova - Cand. Sci. (Med.), Associate Professor of the Department of Faculty Therapy with Clinic.

2, Akkuratov St., St Petersburg, 197341

pakhomova-inna@yandex.ruhttps://orcid.org/0009-0003-7625-404XЛеляковаА. А.LelyakovaA. A.

Лелякова Александра Андреевна - врач-терапевт.

196006, Санкт-Петербург, Лиговский проспект, д. 274а

Alexandra A. Lelyakova – Therapist.

274a, Ligovsky Ave., St Petersburg, 196006

lukakrosseray@gmail.comНациональный медицинский исследовательский центр имени В.А. АлмазоваРоссияAlmazov National Medical Research CenterRussian FederationКлиника «Будь здоров»РоссияClinic “Bud Zdorov”Russian Federation202422012025023104111Copyright © Пахомова И.Г., Лелякова А.А., 20242024Пахомова И.Г., Лелякова А.А.Pakhomova I.G., Lelyakova A.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8833

Течение такого широко распространенного заболевания, как гастроэзофагеальная рефлюксная болезнь (ГЭРБ), усугубляется сочетанием с другими заболеваниями, в том числе с функциональной патологией желудочно-кишечного тракта, например, с функциональной диспепсией или с синдромом раздраженного кишечника (СРК). Данное сочетание влияет не только на клинические особенности течения заболеваний, но и на эффективность терапии ГЭРБ, когда отмечаются случаи неполного ответа на ингибиторы протонной помпы (ИПП). И врач стоит перед выбором препаратов для комплексного лечения ГЭРБ. Например, в случае сочетания ГЭРБ и СРК в комплексной терапии необходимо рассмотреть применение спазмолитиков или нормокинетиков. С другой стороны, назначая тот или иной ИПП, важно помнить, что данные препараты сами могут влиять на ответ лечения у пациентов с сочетанием ГЭРБ и СРК, особенно с диарейным или смешанным вариантами, поскольку у части пациентов может возникнуть реакция на дополнительные компоненты ИПП, которые необходимы для улучшения биодоступности препарата. Так, наличие сорбитола, маннитола, лактозы может усугубить течение СРК, усилив проявления диареи. Отсутствие данных добавок в составе пантопразола позволяет назначать его в коррекции ГЭРБ в сочетании с СРК вне зависимости от варианта последнего. В данной статье представлен клинический пример пациента с сочетанным течением ГЭРБ и СРК. Взаимоотягощающее влияние обоих заболеваний рассмотрено не только с точки зрения патогенетических механизмов, но и влияния фармакотерапии ИПП, что особенно актуально при СРК с диареей. Рассмотрены подходы к терапии, в первую очередь назначение антисекреторной терапии на примере пантопразола.

The course of Gastroesophageal reflux disease (GERD), which is a widespread disease, is aggravated by a combination with other diseases, including functional pathology of the gastrointestinal tract, for example, functional dyspepsia or irritable bowel syndrome (IBS). This combination affects not only the clinical features of the disease, but also the effectiveness of GERD therapy, when there are cases of incomplete response to proton pump inhibitors (PPIs). And the doctor is faced with the choice of drugs for the complex treatment of GERD. For example, in the case of a combination of GERD and IBS in complex therapy, it is necessary to consider the use of antispasmodics or normokinetics. On the other hand, when prescribing this or that PPI, it is important to remember that these drugs themselves can affect the treatment response in patients with a combination of GERD and IBS, especially with diarrheal or mixed variants, since some patients may have a reaction to additional PPI components that are necessary for improvement bioavailability of the drug. Thus, the presence of sorbitol, mannitol, and lactose can aggravate the course of IBS, increasing the manifestations of diarrhea. The absence of these additives in the pantoprazole drug allows it to be prescribed for the correction of GERD in combination with IBS, regardless of the variant of the latter. This article will present a clinical example of a patient with a combined course of GERD and IBS, the mutually aggravating influence of both diseases not only from the point of view of patho genetic mechanisms, but also the influence of PPI pharmacotherapy, which is especially important in IBS with diarrhea. Approaches to therapy are considered, primarily the prescription of antisecretory therapy using pantoprazole as an example.

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