medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-391medsovet-9448Research ArticleЗАБОЛЕВАНИЯ КИШЕЧНИКАBOWEL DISEASESАбдоминальная боль как основной симптом синдрома раздраженного кишечника: обоснование выбора отилония бромидаAbdominal pain as the main symptom of irritable bowel syndrome: Rationale for the choice of otilonium bromidehttps://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, Almazov National Medical Research Center.

2, Akkuratov St., St Petersburg, 197341

pakhomova-inna@yandex.ruНациональный медицинский исследовательский центр имени В.А. АлмазоваРоссияAlmazov National Medical Research CentreRussian Federation202517102025015156162Copyright © Пахомова И.Г., 20252025Пахомова 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/9448

Абдоминальная боль (АБ) – серьезная проблема внутренних болезней и гастроэнтерологии. Точность диагностики причин АБ к началу 21 в. составляла чуть более 50%. При их выявлении врач сталкивается с определенными сложностями, т. к. необходимо исключить широкий спектр гастроэнтерологических и негастроэнтерологических заболеваний. Часто АБ протекает как спастическая.АБ как проявление синдрома раздраженного кишечника (СРК) в первую очередь связана со спазмом гладкой мускулатуры кишечника. Для СРК, хронического функционального заболевания кишечника, именно АБ является основным проявлением и может сочетаться с нарушением дефекации, изменением 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). С клинической точки зрения АБ при СРК относится к висцеральной, т. е. возникающей при раздражении болевых рецепторов кишечника (ноцицепторов), расположенных в мышечной стенке. Важно отметить многокомпонентный характер интеграции ноцицептивной информации при СРК, что объясняет изменчивость восприятия и обработки АБ и, как следствие, трудности в подборе эффективной фармакотерапии. Препаратами первой линии в купировании АБ являются спазмолитики, которые снижают тонус и сократительную способность гладкой мускулатуры кишечника. Отечественный фармацевтический рынок представлен разными группами спазмолитиков, среди которых можно выделить селективные блокаторы кальциевых каналов. Представителем последних является препарат отилония бромид, широко использующийся в мире, эффективный и безопасный. Он хорошо переносится и превосходит плацебо в снижении выраженности симптомов и предотвращении рецидивов боли 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). Важны селективность действия и низкая абсорбция препарата в кишечнике, обуславливающие минимальное количество побочных эффектов и возможности применения отилония бромида у коморбидных пациентов.

Abdominal pain is a serious problem of internal medicine and gastroenterology. The accuracy of diagnosing the causes of abdominal pain by the beginning of the 21st century was slightly more than 50%. Identifying them the doctor faces certain difficulties when it is necessary to exclude a wide range of gastroenterological and non-gastroenterological diseases. Often abdominal pain occurs in a spastic form. Abdominal pain, as a manifestation of irritable bowel syndrome (IBS), is primarily associated with spasm of the smooth muscles of the intestine. IBS is a chronic functional bowel disease, for which abdominal pain is the main manifestation, and can be combined with changes in bowel movements, frequency and nature 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). From a clinical point of view, abdominal pain in IBS is visceral, that is, it occurs when the pain receptors of the intestine (nociceptors) located in the muscular wall are irritated. It is important to note the multicomponent integration of nociceptive information in IBS, which explains the variability in the perception and processing of abdominal pain, and, as a result, the difficulties in selecting effective pharmacotherapy. The first-line drugs for the relief of abdominal pain are antispasmodics, which reduce the tone and contractility of the smooth muscles of the intestine. The domestic pharmaceutical market is represented by various groups of antispasmodics, among which selective calcium channel blockers can be distinguished. 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). It is also important to emphasize the selectivity of action and low absorption of the drug in the intestine, which determines the minimal number of side effects and the possibility of using otilonium bromide in comorbid patients.

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