gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1073Research ArticleНАЦИОНАЛЬНАЯ ШКОЛА ГАСТРОЭНТЕРОЛОГОВ, ГЕПАТОЛОГОВNATIONAL COLLEGE OF GASTROENTEROLOGISTS, HEPATOLOGISTSЗначение факторов питания при синдроме раздраженного кишечникаRole of nutritional factors at the irritable bowel syndromeШульпековаЮ. О.ShulpekovaYu. O.

Шульпекова Юлия Олеговна – доцент кафедры пропедевтики внутренних болезней лечебного факультета

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

Shulpekova Yulia O. – lecturer, Chair of internal diseases propedeutics, medical faculty

119991, Moscow, Pogodinskaya street, 1, bld 1

Juliash@mail333.comСедоваА. В.SedovaA. V.

Седова Алла Владимировна – ассистент кафедры пропедевтики внутренних болезней лечебного факультета

Sedova Alla V. – assistant-professor, Chair of internal diseases propedeutics, medical faculty

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 Federation20153010201525594100Copyright © Шульпекова Ю.О., Седова А.В., 20152015Шульпекова Ю.О., Седова А.В.Shulpekova Y.O., Sedova A.V.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/1073

Цель обзора. Рассмотреть действие отдельных видов пищи при синдроме раздраженого кишечника (СРК) и возможности уменьшения выраженности симптомов путем индивидуального подбора рациона.Основные положения. Особенности питания в большинстве случаев, несомненно, влияют на выраженность клинических проявлений СРК—боли, вздутия, нарушений стула. По всей видимости, отрицательное действие продуктов питания реализуется отчасти вследствие ферментации с избыточным образованием короткоцепочечных жирных кислот и газа, отчасти из-за влияния на состав микробиоты и энтероэндокринные клетки, отчасти за счет повышения содержания биогенных аминов.Ведение пищевого дневника помогает обнаружить «виновные» пищевые продукты. Наиболее четко проявляется влияние ферментируемых олиго-, ди-, моносахаридов и сахарных спиртов (FODMAPs), поэтому следует отдавать предпочтение продуктам с пониженным содержанием этих компонентов. В части случаев отрицательное действие оказывают продукты с высоким содержанием глютена, однако обусловлено ли это влиянием самого глютена или влиянием фруктанов, остается предметом дискуссий. В клинических исследованиях показана эффективность в коррекции симптомов СРК продуктов функционального питания, содержащих бактерии пробиотического штамма Bifidobacterium animalis sp. lactis DN-173 010.При обнаружении связи возникновения симптомов с употреблением определенных продуктов необходимо исключать пищевую аллергию и ферментопатии (например, лактазную недостаточность), которые следует выделять как самостоятельные заболевания под «маской» синдрома раздраженного кишечника.Заключение. Индивидуально подобранное питание составляет неотъемлемую часть лечения СРК. Прогресс, достигнутый в изучении вклада пищевых факторов в развитие симптомов, создает научную основу для рекомендаций по исключению из рациона тех или иных продуктов и одновременно способствует лучшему пониманию патогенеза болезни.

 

 

The aim of review

The aim of review. To discuss effect of certain types of food at irritable bowel syndrome (IBS) and options of reduction of symptom intensity by individual adjustment of ration.

Key points

Key points. Undoubtedly, dietary habits in the most cases influence severity of IBS symptoms: pain, flatulence, stool disorders. Most likely, negative action of food substances is realized partly due to fermentation with excessive production of short-chain fatty acids and intestinal gas, partly — because of effect on the microbiota spectrum and enteroendocrine cells, partly - due to elevation of biogenic amine content. Filling of food diary helps to find out relevant food substances. Effect of fermentable oligo-, di- and monosaccharides and sugar spirits (FODMAPs) is most obviously demonstrated, therefore it is necessary to choose products with decreased contents of these components. In some cases negative action is related to products with high gluten content, though whether it is caused by effect of gluten or action of fructans, remains equivocal. Efficacy of functional food products containing bacteria of probiotic strain Bifidobacterium animalis sp. lactis DN-173 010 for treatment of IBS symptoms is demonstrated in clinical trials. At detection of symptoms link to intake of specific products it is necessary to exclude food allergy and enzymopathies (e.g. lactase deficiency), which should be defined as independent diseases under the «mask» of irritable bowel syndrome.

Conclusion

Conclusion. Individually adjusted nutrition is an integral part of treatment of IBS. Progress achieved in studying of food factors contribution to symptom development, forms scientific basis for recommendation to eliminate certain nutrients from the ration and simultaneously promotes better understanding of disease pathogenesis.

синдром разраженного кишечникагистаминолибераторыFODMAPsглютенпробиотические продукты функционального питанияirritable bowel syndromehistamine liberatorsFODMAPsglutenprobiotic products of functional nutritionReferencesEl-Salhy M., Gundersen D. Diet in irritable bowel syndrome. Nutr J 2015; 14:36.El-Salhy M., Gundersen D. Diet in irritable bowel syndrome. Nutr J 2015; 14:36.El-Salhy M. Irritable bowel syndrome: diagnosis and pathogenesis. World J Gastroenterol 2012; 18:5151-63.El-Salhy M. Irritable bowel syndrome: diagnosis and pathogenesis. World J Gastroenterol 2012; 18:5151-63.Boettcher E., Crowe S.E. Dietary proteins and functional gastrointestinal disorders. Am J Gastroenterol 2013; 108:728-36.Boettcher E., Crowe S.E. Dietary proteins and functional gastrointestinal disorders. Am J Gastroenterol 2013; 108:728-36.Manabe N., et al. Pathophysiology underlying irritable bowel syndrome - from the viewpoint of dysfunction of autonomic nervous system activity. J Smooth Muscle Res 2009; 45(1):15-23.Manabe N., et al. Pathophysiology underlying irritable bowel syndrome - from the viewpoint of dysfunction of autonomic nervous system activity. J Smooth Muscle Res 2009; 45(1):15-23.Patman G. IBS: Mast cells cause nerves to sprout in patients with IBS. Nat Rev Gastroenterol Hepatol 2015; 12(4):189.Patman G. IBS: Mast cells cause nerves to sprout in patients with IBS. Nat Rev Gastroenterol Hepatol 2015; 12(4):189.Joneja J.M. Histamine intolerance, diamine oxidase activity, and probiotics. Интернет-страница http://www. allergynutrition.com/wp-content/uploads/2014/05/ Histamine-DAO-and-Probiotics-Revised.pdf. 20 мая 2015 г.Joneja J.M. Histamine intolerance, diamine oxidase activity, and probiotics. Интернет-страница http://www. allergynutrition.com/wp-content/uploads/2014/05/ Histamine-DAO-and-Probiotics-Revised.pdf. 20 мая 2015 г.Marsh A., et al. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and metaanalysis. Eur J Nutr 2015 May 17 [Epub ahead of print].Marsh A., et al. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and metaanalysis. Eur J Nutr 2015 May 17 [Epub ahead of print].Halmos E.P., et al. Diets that differ in their FODMAP content alter the colonic luminal microenvironment. Gut 2015; 64:93-100.Halmos E.P., et al. Diets that differ in their FODMAP content alter the colonic luminal microenvironment. Gut 2015; 64:93-100.Mazzawi T., et al. Normalization of large intestinal endocrine cells following dietary management in patients with irritable bowel syndrome. Eur J Clin Nutr. in press 2015.Mazzawi T., et al. Normalization of large intestinal endocrine cells following dietary management in patients with irritable bowel syndrome. Eur J Clin Nutr. in press 2015.Francis C.Y., Whorwell P.J. Bran and irritable bowel syndrome: time for reappraisal. Lancet 1994; 344:39-40.Francis C.Y., Whorwell P.J. Bran and irritable bowel syndrome: time for reappraisal. Lancet 1994; 344:39-40.Bijkerk C.J., et al. Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther 2004; 19:245-51.Bijkerk C.J., et al. Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther 2004; 19:245-51.Sapone A., et al. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med 2011; 9:23.Sapone A., et al. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med 2011; 9:23.Campanella J., et al. Clinical response to gluten withdrawal is not an indicator of coeliac disease. Scand J Gastroenterol 2008; 43:1311-4.Campanella J., et al. Clinical response to gluten withdrawal is not an indicator of coeliac disease. Scand J Gastroenterol 2008; 43:1311-4.Vazquez-Roque M.I., et al. A controlled trial of glutenfree diet in patients with irritable bowel syndrome-diarrhea: effects on bowel frequency and intestinal function. Gastroenterology 2013; 144:903-11.Vazquez-Roque M.I., et al. A controlled trial of glutenfree diet in patients with irritable bowel syndrome-diarrhea: effects on bowel frequency and intestinal function. Gastroenterology 2013; 144:903-11.Carroccio A., et al. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol 2012; 107:1898-906.Carroccio A., et al. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol 2012; 107:1898-906.Nijeboer P., et al. Non-celiac gluten sensitivity. Is it in the gluten or the grain? J Gastrointestin Liver Dis 2013; 22:435-40.Nijeboer P., et al. Non-celiac gluten sensitivity. Is it in the gluten or the grain? J Gastrointestin Liver Dis 2013; 22:435-40.Biesiekierski J.R., et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, shortchain carbohydrates. Gastroenterology 2013; 145:320-8.Biesiekierski J.R., et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, shortchain carbohydrates. Gastroenterology 2013; 145:320-8.Gibson P.R., et al. Other Dietary Confounders: FODMAPS et al. Dig Dis 2015; 33(2):269-76.Gibson P.R., et al. Other Dietary Confounders: FODMAPS et al. Dig Dis 2015; 33(2):269-76.Biesiekierski J.R., Iven J. Non-coeliac gluten sensitivity: piecing the puzzle together. United Eur Gastroenterol J 2015; 3(2):160-5.Biesiekierski J.R., Iven J. Non-coeliac gluten sensitivity: piecing the puzzle together. United Eur Gastroenterol J 2015; 3(2):160-5.Полуэктова Е.А., Кучумова С.Ю., Шептулин А.А., Ивашкин В.Т. Лечение синдрома раздраженного кишечника с позиций современных представлений о патогенезе заболевания. Рос журн гастроэнтерол гепатол колопроктол 2013; 23(1):57-65.Poluektova Ye.A., Kuchumova S.Yu., Sheptulin A.A., Ivashkin V.T. Treatment of irritable bowel syndrome from standpoints of modern concept of pathogenesis. Ros zhurn gastroenterol gepatol koloproktol 2013; 23 (1):57-65.Полуэктова Е.А., Кучумова С.Ю., Шифрин О.С., Шептулин А.А., Ивашкин В.Т. Патогенетическое значение изменений кишечной микрофлоры у больных с синдромом раздраженного кишечника и возможности их коррекции. Рос журн гастроэнтерол гепатол колопроктол 2014; 24(6):89-97.Poluektova Ye.A., Kuchumova S.Yu., Shifrin O.S., Sheptulin A.A., Ivashkin V.T. Pathogenic role of intestinal microflora changes at irritable bowel syndrome and potential of their treatment. Ros zhurn gastroenterol gepatol koloproktol 2014; 24(6):89-97.Diaz Heijtz R., Wang S., Anuar F. Normal gut microbiota modulates brain development and behavior. Proc Natl Acad Sci USA 2011;108(7):3047-52. 23. El-Salhy M., et al. Effects of a health program comprising reassurance, diet management, probiotic administration and regular exercise on symptoms and quality of life in patients with irritable bowel syndrome. Gastroenterology Insights. 2010; 2:21-6.Diaz Heijtz R., Wang S., Anuar F. Normal gut microbiota modulates brain development and behavior. Proc Natl Acad Sci USA 2011;108(7):3047-52. 23. El-Salhy M., et al. Effects of a health program comprising reassurance, diet management, probiotic administration and regular exercise on symptoms and quality of life in patients with irritable bowel syndrome. Gastroenterology Insights. 2010; 2:21-6.Marteau P., et al. Bifidobacterium animalis strain DN-173 010 shortens the colonic transit time in healthy women: a double-blind, randomized, controlled study. Aliment Pharmacol Ther 2002; 16:587-93.Marteau P., et al. Bifidobacterium animalis strain DN-173 010 shortens the colonic transit time in healthy women: a double-blind, randomized, controlled study. Aliment Pharmacol Ther 2002; 16:587-93.Agrawal A., et al. Clinical trial: the effects of a fermented milk product containing Bifidobacterium lactis DN-173 010 on abdominal distension and gastrointestinal transit in irritable bowel syndrome with constipation. Aliment Pharmacol Ther 2009; 29(1):104-14.Agrawal A., et al. Clinical trial: the effects of a fermented milk product containing Bifidobacterium lactis DN-173 010 on abdominal distension and gastrointestinal transit in irritable bowel syndrome with constipation. Aliment Pharmacol Ther 2009; 29(1):104-14.Guyonnet D., et al. Effect of a fermented milk containing Bifidobacterium animalis DN-173 010 on the health-related quality of life and symptoms in irritable bowel syndrome in adults in primary care: a multicentre, randomized, double-blind, controlled trial. Aliment Pharmacol Ther 2007; 26(3):475-86.Guyonnet D., et al. Effect of a fermented milk containing Bifidobacterium animalis DN-173 010 on the health-related quality of life and symptoms in irritable bowel syndrome in adults in primary care: a multicentre, randomized, double-blind, controlled trial. Aliment Pharmacol Ther 2007; 26(3):475-86.

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