Римские критерии V пересмотра (2026): преемственность и ключевые изменения

В 2026 г. опубликован V пересмотр Римских критериев (РК V), отражающий современную концепцию расстройств взаимодействия кишечника и головного мозга (РВКМ) как самостоятельной группы заболеваний, связанных с нарушениями висцеральной чувствительности, регуляции оси «кишечник – головной мозг», иммуновоспалительных и психофизиологических механизмов. Актуальность данного обзора определяется высокой распространенностью РВКМ, их частым сочетанием между собой, значимым влиянием на качество жизни пациентов и необходимостью адаптации новых международных диагностических подходов к практической гастроэнтерологии. Обзор основан на анализе публикаций Rome Foundation, консенсусных документов, клинических рекомендаций, систематических обзоров, метаанализов и оригинальных исследований, посвященных диагностике, патофизиологии и лечению РВКМ. Особое значение РК V связано с переходом от преимущественно симптомориентированного описания функциональных расстройств к клинико-инструментальной модели диагностики, основанной на сочетании симптоматических критериев, критериев исключения органической патологии и современных инструментальных стандартов. Лионский консенсус 2.0 и Чикагская классификация v4.0 теперь являются обязательными элементами диагностики функциональных расстройств пищевода. Функциональная импедансная планиметрия существенно повышает специфичность диагностики функциональной дисфагии. В синдром раздраженного кишечника (СРК) возвращены «дискомфорт» и более низкий порог частоты симптомов, что может повысить выявляемость заболевания в популяциях, где боль воспринимается или описывается менее интенсивно. Синдром невозможности отрыжки получил статус самостоятельной нозологии с конкретными диагностическими и терапевтическими критериями. Дополнительно в РК V уточнены подходы к хроническому запору, функциональной диарее, билиарным и аноректальным расстройствам, а также усилена роль поведенческих вмешательств, нейромодуляторов и мультидисциплинарного ведения пациентов.

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