gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1002Research ArticleНАЦИОНАЛЬНАЯ ШКОЛА ГАСТРОЭНТЕРОЛОГОВ, ГЕПАТОЛОГОВNATIONAL COLLEGE OF GASTROENTEROLOGISTS, HEPATOLOGISTSОбоснование применения и оценка эффективности пробиотиков у пациентов с воспалительными заболеваниями кишечникаSubstantiation of application and estimation of efficacy of probiotics at inflammatory bowel diseasesПолуэктоваЕ. А.PoluektovaYe. A.

Полуэктова Елена Александровна – кандидат медицинских наук, ведущий научный сотрудник НОКЦ «Инновационной терапии», врач-терапевт отделения хронических заболеваний кишечника и поджелудочной железы

119991, Москва, ул. Погодинская, д. 1, стр. 1

Poluektova Elena A. — MD, leading research associate, Scientific and educational clinical center of innovative therapy, doctor of department of chronic bowel and pancreatic diseases

119991, Moscow, Pogodinskaya street, 1, bld 1

polouektova@rambler.ruСидоринаЮ. О.SidorinaYu. O.КучумоваС. Ю.KuchumovaS. Yu.КоролевА. В.KorolevA. V.ШифринО. С.ShifrinO. S.

Шифрин Олег Самуилович – доктор медицинских наук, профессор, заведующий отделением заболеваний кишечника и поджелудочной железы 

119991, Москва, ул. Погодинская, д. 1, стр. 1

Shifrin Oleg S. — MD, PhD, professor, head of department of chronic bowel and pancreatic diseases

119991, Moscow, Pogodinskaya street, 1, bld 1.

oleg_shifrin@mail.ruИвашкинВ. Т.ГБОУ ВПО «Первый Московский государственный медицинский университет им И. М. Сеченова» Минздрава РоссииРоссияState educational government-financed institution of higher professional education «Sechenov First Moscow state medical university»Russian FederationГБОУ ВПО «Первый Московский государственный медицинский университет им И. М. Сеченова» Минздрава РоссииRussian Federation2015010520152525868Copyright © Полуэктова Е.А., Сидорина Ю.О., Кучумова С.Ю., Королев А.В., Шифрин О.С., Ивашкин В.Т., 20152015Полуэктова Е.А., Сидорина Ю.О., Кучумова С.Ю., Королев А.В., Шифрин О.С., Ивашкин В.Т.Poluektova Y.A., Sidorina Y.O., Kuchumova S.Y., Korolev A.V., Shifrin O.S., Ивашкин В.Т.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1002

Цель обзора. Обосновать правомочность применения пробиотиков и проанализировать данные оригинальных исследований, выполненных для оценки эффективности различных пробиотических препаратов в терапии воспалительных заболеваний кишечника (ВЗК).Основные положения. Роль микрофлоры в патогенезе данной группы заболеваний становится все более очевидной. У пациентов с ВЗК кишечный микробиом отличается по количественному и качественному составу от микробиома здоровых лиц в сторону увеличения содержания условно-патогенных и патогенных микроорганизмов. Изменения микробиома приводят к инициации целого каскада патологических реакций иммунной системы хозяина в связи с наличием генетически обусловленных дефектов последней, что, в свою очередь, способствует формированию клинических симптомов и морфологических изменений в стенке кишки. В последние годы активно изучается возможность влияния на микрофлору при помощи пробиотических средств, в том числе у пациентов с ВЗК.Заключение. Наибольшей эффективностью пробиотики, содержащие бифидуми лактобактерии, обладают для достижения и поддержания ремиссии резервуарного илеита (паучита). Включение в схему лечения пробиотиков достоверно увеличивает вероятность клинического улучшения и, на уровне статистической тенденции, наступления клинической ремиссии у больных язвенным колитом. Для поддержания ремиссии заболевания эффективность исследованных пробиотических препаратов сравнима с эффективностью поддерживающих доз месалазина. Не доказана эффективность пробиотиков при их включении в схему стандартной терапии, применяемой для достижения и поддержания ремиссии болезни Крона.

The aim of review

The aim of review. To prove competency of application of probiotics and to analyze data of the original studies of efficacy of various probiotic agents in treatment of inflammatory bowel diseases (IBD).

Summary

Summary. The role of microflora in pathogenesis of this group of diseases becomes more and more obvious. At patients with IBD the intestinal microbiome have quantitative and qualitative differences from microbiome of healthy patients aside of increase in contents of opportunistic and pathogenic microorganisms. Microbiome changes result in initiation of cascade of pathological immune reactions of the host in related to presence of genetical defects, that, in turn, promotes development of clinical symptoms and morphological changes in intestinal wall. Potential of probiotic agents effect on microflora is actively studied in the last years, including patients with IBD.

Conclusion

Conclusion. The highest efficacy the Bifidum and Lactobacilli-containing probiotics, possess at advance and maintenance of remission of reservoir ileitis (pouchitis). Addition of probiotics in mode of treatment significantly increases probability of clinical improvement and, at level of the statistical trend, achievement of clinical remission at ulcerative colitis. In remission maintenance efficacy of the studied probiotic drugs is comparable to efficacy of maintenance dozes of mesalazine. Efficacy of probiotics is not proved at their addition in the mode of standard therapy used for achievement and maintenance of remission of a Crohn's disease.

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