gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2017-27-1-4-11gastro-j-117Research ArticleЛЕКЦИИ И ОБЗОРЫLECTURES AND REVIEWSЭволюция представлений о функциональных заболеваниях желудочно-кишечного тракта в свете Римских критериев IV пересмотра (2016 г.)Evaluation of the functional gastrointestinal diseases concept from standpoints of Rome IV (2016) diagnostic criteria (review)АндреевД. Н.AndreyevD. N.dna-mit8@mail.ruЗаборовскийА. В.ZaborovskyA. V.noemail@neicon.ruТрухмановА. С.TrukhmanovA. S.noemail@neicon.ruМаевИ. В.MayevI. V.noemail@neicon.ruИвашкинВ. Т.IvashkinV. T.noemail@neicon.ruФГБОУ ВО «Московский государственный медико-стоматологический университет им. А. И. Евдокимова»РоссияState educational government-financed institution of higher professional education «Yevdokimov Moscow State University of Medicine and Dentistry»Russian FederationФГБОУ ВО «Первый Московский государственный медицинский университет им. И. М. Сеченова»РоссияФГБОУ ВО «Первый Московский государственный медицинский университет им. И. М. Сеченова»Russian Federation201712082018271411Copyright © Андреев Д.Н., Заборовский А.В., Трухманов А.С., Маев И.В., Ивашкин В.Т., 20182018Андреев Д.Н., Заборовский А.В., Трухманов А.С., Маев И.В., Ивашкин В.Т.Andreyev D.N., Zaborovsky A.V., Trukhmanov A.S., Mayev I.V., Ivashkin V.T.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/117

Цель обзора. Отразить современные представления о функциональных заболеваниях желудочнокишечного тракта (ФЗ ЖКТ), а также проанализировать основные клинически релевантные изменения, внесенные в Римские критерии IV пересмотра (2016 г.) по сравнению с предшествующей редакцией. Основные положения. Согласно новой дефиниции, предложенной экспертным советом Римского консенсуса IV пересмотра, ФЗ ЖКТ - это нарушение взаимодействия головного мозга и ЖКТ. Предложено исключить термин «функциональный». В обновленную классификацию ФЗ ЖКТ добавлены новые нозологические единицы с известным кауза тивным фактором (опиоидиндуцированная гастроинтестинальная гипералгезия, опиоидиндуцированный запор, каннабиноидиндуцированный рвотный синдром), гиперсенситивный рефлюксный синдром, синдром тошноты и рвоты (объединяет ранее выделявшиеся нозологии - хроническую идиопатическую тошноту и функциональную рвоту). В новой редакции Римских критериев конкретизирована тактика ведения пациентов с дисфункцией сфинктера Одди, а также уточнены критерии диагностики функциональной диспепсии и синдрома раздраженного кишечника. Заключение. В обновленных Римских критериях произведена ревизия классификации ФЗ ЖКТ и уточнены диагностические критерии ряда нозологий.

Aim of review. To present the modern concept of functional gastrointestinal diseases (FGID) and to analyze the basic clinically relevant changes made in Rome IV criteria (2016) in comparison to the previous edition. Summary. According to the due definition that was proposed by the Rome IV advisory council, FGID are the brain-gut axis interaction disorders. It was proposed to exclude the term «functional» from the definition. The new nosological entities with known causative factor (opioid-induced gastrointestinal hyperalgesia, opioidinduced constipation, cannabinoid induced hyperemesis syndrome), hypersensitive reflux syndrome, nausea and vomiting syndrome (that encompasses previously separate nosological forms: chronic idiopathic nausea and functional vomiting) were added to the new version of the classification. In the new edition of Rome criteria the management approach to patients with sphincter of Oddi dysfunction is specified, along with diagnostic criteria of functional dyspepsia and irritable bowel syndrome. Conclusion. The classification of FGID is revised in updated Rome criteria, diagnostic features of several nosological entities were specified.

Римские критерии IV пересмотрафункциональные заболеванияфункциональная диспепсиясиндром раздраженного кишечникаалгоритмReferencesSleisenger and Fordtran’s Gastrointestinaland Liver Disease: Pathophysiology, Diagnosis, Management / Edited by Mark Feldman, Lawrence S. Friedman, Laurence J. Brandt. 10th ed. 2015.Sleisenger and Fordtran’s Gastrointestinaland Liver Disease: Pathophysiology, Diagnosis, Management / Edited by Mark Feldman, Lawrence S. Friedman, Laurence J. Brandt. 10th ed. 2015.Oshima T., Miwa H. Epidemiology of Functional Gastrointestinal Disorders in Japan and in the World. J Neurogastroenterol Motil 2015;21(3):320-9.Oshima T., Miwa H. Epidemiology of Functional Gastrointestinal Disorders in Japan and in the World. J Neurogastroenterol Motil 2015;21(3):320-9.Lewis M.L., Palsson O.S., Whitehead W.E., van Tilburg M.A. Prevalence of Functional Gastrointestinal Disorders in Children and Adolescents. J Pediatr 2016 May 4. pii: S0022-3476(16)30056-7. [Epub ahead of print].Lewis M.L., Palsson O.S., Whitehead W.E., van Tilburg M.A. Prevalence of Functional Gastrointestinal Disorders in Children and Adolescents. J Pediatr 2016 May 4. pii: S0022-3476(16)30056-7. [Epub ahead of print].Varni J.W., Bendo C.B., Nurko S., Shulman R.J., Self M.M., Franciosi J.P., Saps M., Pohl J.F. Pediatric Quality of Life Inventory (PedsQL) Gastrointestinal Symptoms Module Testing Study Consortium. Healthrelated quality of life in pediatric patients with functional and organic gastrointestinal diseases. J Pediatr 2015;166(1):85-90.Varni J.W., Bendo C.B., Nurko S., Shulman R.J., Self M.M., Franciosi J.P., Saps M., Pohl J.F. Pediatric Quality of Life Inventory (PedsQL) Gastrointestinal Symptoms Module Testing Study Consortium. Healthrelated quality of life in pediatric patients with functional and organic gastrointestinal diseases. J Pediatr 2015;166(1):85-90.Devanarayana N.M., Rajindrajith S., Benninga M.A. Quality of life and health care consultation in 13 to 18 year olds with abdominal pain predominant functional gastrointestinal diseases. BMC Gastroenterol 2014;14:150.Devanarayana N.M., Rajindrajith S., Benninga M.A. Quality of life and health care consultation in 13 to 18 year olds with abdominal pain predominant functional gastrointestinal diseases. BMC Gastroenterol 2014;14:150.Talley N.J. Functional gastrointestinal disorders as a public health problem. Neurogastroenterol Motil 2008 May;20 (Suppl 1):121-9.Talley N.J. Functional gastrointestinal disorders as a public health problem. Neurogastroenterol Motil 2008 May;20 (Suppl 1):121-9.Canavan C., West J., Card T. Review article: the economic impact of the irritable bowel syndrome. Aliment Pharmacol Ther 2014;40(9):1023-34.Canavan C., West J., Card T. Review article: the economic impact of the irritable bowel syndrome. Aliment Pharmacol Ther 2014;40(9):1023-34.Kovacic K. Current concepts in functional gastrointestinal disorders. Curr Opin Pediatr 2015;27(5):619-24.Kovacic K. Current concepts in functional gastrointestinal disorders. Curr Opin Pediatr 2015;27(5):619-24.Drossman D.A., Hasler W.L. Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction. Gastroenterology 2016;150(6):1257-61.Drossman D.A., Hasler W.L. Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction. Gastroenterology 2016;150(6):1257-61.Gaman A., Kuo B. Neuromodulatory processes of thebrain-gut axis. Neuromodulation 2008;11:249-59.Gaman A., Kuo B. Neuromodulatory processes of thebrain-gut axis. Neuromodulation 2008;11:249-59.Pasricha P.J. Neurogastroenterology: a great career choice for aspiring gastroenterologists thinking about thefuture. Gastroenterology 2011;140:1126-8.Pasricha P.J. Neurogastroenterology: a great career choice for aspiring gastroenterologists thinking about thefuture. Gastroenterology 2011;140:1126-8.Drossman D.A. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology 2016;150:1262-79.Drossman D.A. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology 2016;150:1262-79.Engel G. L. The clinical application of the Biopsychosocialmodel. Am J Psychiatr 1980;137:535-44.Engel G. L. The clinical application of the Biopsychosocialmodel. Am J Psychiatr 1980;137:535-44.Levy R.L., Olden K.W., Naliboff B.D., Bradley L.A., Francisconi C., Drossman D.A., Creed F. Psychosocial aspects of the functional gastrointestinal disorders. Gastroenterology 2006;130:1447-58.Levy R.L., Olden K.W., Naliboff B.D., Bradley L.A., Francisconi C., Drossman D.A., Creed F. Psychosocial aspects of the functional gastrointestinal disorders. Gastroenterology 2006;130:1447-58.Saito Y.A., Mitra N., Mayer E.A. Genetic approaches to functional gastrointestinal disorders. Gastroenterology 2010;138:1276-85.Saito Y.A., Mitra N., Mayer E.A. Genetic approaches to functional gastrointestinal disorders. Gastroenterology 2010;138:1276-85.Chen T.S., Lee Y.C., Chang F.Y., Wu H.C., Lee S.D. Psychosocial distress is associated with abnormal gastric myoelectrical activity in patients with functional dyspepsia. Scand J Gastroenterol 2006 Jul;41(7):791-6.Chen T.S., Lee Y.C., Chang F.Y., Wu H.C., Lee S.D. Psychosocial distress is associated with abnormal gastric myoelectrical activity in patients with functional dyspepsia. Scand J Gastroenterol 2006 Jul;41(7):791-6.Дмитриева В.А., Одинцова В.В. Энтеральная нервная система и психосоматические аспекты заболеваний желудочно-кишечного тракта. Мед альманах 2011; 1:166-9.Дмитриева В.А., Одинцова В.В. Энтеральная нервная система и психосоматические аспекты заболеваний желудочно-кишечного тракта. Мед альманах 2011; 1:166-9.Drossman D.A. Presidental address: Gastrointestinal illness and the biopsychosocial model. Psychosomatic Med 1998; 60(3):258-67.Drossman D.A. Presidental address: Gastrointestinal illness and the biopsychosocial model. Psychosomatic Med 1998; 60(3):258-67.Drossman D.A., Creed F.H., Fava G.A. Psychosocial aspects of the functional gastroentestinaldisiders. Gastroenterol Int 1995; 8:47-90.Drossman D.A., Creed F.H., Fava G.A. Psychosocial aspects of the functional gastroentestinaldisiders. Gastroenterol Int 1995; 8:47-90.Schurman J.V., Danda C.E., Friesen C.A., Hyman P.E., Simon S.D., Cocjin J.T. Variations in psychological profile among children with recurrent abdominal pain. J Clin Psychol Med Settings 2008;15:241-51.Schurman J.V., Danda C.E., Friesen C.A., Hyman P.E., Simon S.D., Cocjin J.T. Variations in psychological profile among children with recurrent abdominal pain. J Clin Psychol Med Settings 2008;15:241-51.Rosen J.M., Cocjin J.T., Schurman J.V., Colombo J.M., Friesen C.A. Visceral hypersensitivity and electromechanical dysfunction as therapeutic targets in pediatric functional dyspepsia. World J Gastrointest Pharmacol Ther 2014;5(3):122-38.Rosen J.M., Cocjin J.T., Schurman J.V., Colombo J.M., Friesen C.A. Visceral hypersensitivity and electromechanical dysfunction as therapeutic targets in pediatric functional dyspepsia. World J Gastrointest Pharmacol Ther 2014;5(3):122-38.Fukudo S. Role of corticotropin-releasing hormone in irritable bowel syndrome and intestinal inflammation. J Gastroenterol 2007;42(Suppl. 17):48-51.Fukudo S. Role of corticotropin-releasing hormone in irritable bowel syndrome and intestinal inflammation. J Gastroenterol 2007;42(Suppl. 17):48-51.Camilleri M. Peripheral mechanisms in irritable bowelsyndrome. N Engl J Med 2012;367:1626-35.Camilleri M. Peripheral mechanisms in irritable bowelsyndrome. N Engl J Med 2012;367:1626-35.Mayer E.A., Gebhart G.F. Basic and clinical aspects of visceral hyperalgesia. Gastroenterology 1994;107:271-93.Mayer E.A., Gebhart G.F. Basic and clinical aspects of visceral hyperalgesia. Gastroenterology 1994;107:271-93.Lee Y.J., Park K.S. Irritable bowel syndrome: emerging paradigm in pathophysiology. World J Gastroenterol 2014;20(10):2456-69.Lee Y.J., Park K.S. Irritable bowel syndrome: emerging paradigm in pathophysiology. World J Gastroenterol 2014;20(10):2456-69.Маев И.В., Кучерявый Ю.А., Андреев Д.Н. Функциональная диспепсия: эпидемиология, классификация, этиопатогенез, диагностика и лечение. М.; 2015.Маев И.В., Кучерявый Ю.А., Андреев Д.Н. Функциональная диспепсия: эпидемиология, классификация, этиопатогенез, диагностика и лечение. М.; 2015.Vanheel H., Farré R. Changes in gastrointestinal tract function and structure in functional dyspepsia. Nat Rev Gastroenterol Hepatol 2013;10(3):142-9.Vanheel H., Farré R. Changes in gastrointestinal tract function and structure in functional dyspepsia. Nat Rev Gastroenterol Hepatol 2013;10(3):142-9.Маев И.В., Андреев Д.Н., Кучерявый Ю.А. Современные представления о патофизиологических основах синдрома функциональной диспепсии. Рос журн гастроэнтерол гепатол колопроктол 2015; 4:15-22..Маев И.В., Андреев Д.Н., Кучерявый Ю.А. Современные представления о патофизиологических основах синдрома функциональной диспепсии. Рос журн гастроэнтерол гепатол колопроктол 2015; 4:15-22..Piche T. Tight junctions and IBS-the link between epithelial permeability, low-grade inflammation, and symptom generation? Neurogastroenterol Motil 2014;26:296-302.Piche T. Tight junctions and IBS-the link between epithelial permeability, low-grade inflammation, and symptom generation? Neurogastroenterol Motil 2014;26:296-302.Matricon J., Meleine M., Gelot A., Piche T., Dapoigny M., Muller E., Ardid D. Review article: associations between immune activation, intestinal permeability and the irritable bowel syndrome. Aliment Pharmacol Ther 2012;36:1009-31.Matricon J., Meleine M., Gelot A., Piche T., Dapoigny M., Muller E., Ardid D. Review article: associations between immune activation, intestinal permeability and the irritable bowel syndrome. Aliment Pharmacol Ther 2012;36:1009-31.Ohman L, Simren M. Pathogenesis of IBS: role of inflammation, immunity and neuroimmune interactions. Nat Rev Gastroenterol Hepatol 2010;7:163-73.Ohman L, Simren M. Pathogenesis of IBS: role of inflammation, immunity and neuroimmune interactions. Nat Rev Gastroenterol Hepatol 2010;7:163-73.Самсонов А.А., Андреев Д.Н., Дичева Д.Т. Синдром раздраженного кишечника с позиций современной гастроэнтерологии. Фарматека 2014; 18:7-13.Самсонов А.А., Андреев Д.Н., Дичева Д.Т. Синдром раздраженного кишечника с позиций современной гастроэнтерологии. Фарматека 2014; 18:7-13.Sarnelli G., D’Alessandro A., Pesce M., Palumbo I., Cuomo R. Genetic contribution to motility disorders of the upper gastrointestinal tract. World J Gastrointest Pathophysiol 2013; 4(4):65-73.Sarnelli G., D’Alessandro A., Pesce M., Palumbo I., Cuomo R. Genetic contribution to motility disorders of the upper gastrointestinal tract. World J Gastrointest Pathophysiol 2013; 4(4):65-73.Tahara T., Shibata T., Nakamura M. et al. Homozygous TRPV1 315C influences the susceptibility to functional dyspepsia. J Clin Gastroenterol 2010; 44(1):e1-7.Tahara T., Shibata T., Nakamura M. et al. Homozygous TRPV1 315C influences the susceptibility to functional dyspepsia. J Clin Gastroenterol 2010; 44(1):e1-7.Arisawa T., Tahara T., Shiroeda H., Minato T., Matsue Y., Saito T., Fukuyama T., Otsuka T., Fukumura A., Nakamura M. et al. Genetic polymorphisms of SCN10A are associated with functional dyspepsia in Japanese subjects. J Gastroenterol 2013;48:73-80.Arisawa T., Tahara T., Shiroeda H., Minato T., Matsue Y., Saito T., Fukuyama T., Otsuka T., Fukumura A., Nakamura M. et al. Genetic polymorphisms of SCN10A are associated with functional dyspepsia in Japanese subjects. J Gastroenterol 2013;48:73-80.De Palma G., Collins S.M., Bercik P. The microbiotagut-brain axis in functional gastrointestinal disorders. Gut Microbes 2014;5(3):419-29.De Palma G., Collins S.M., Bercik P. The microbiotagut-brain axis in functional gastrointestinal disorders. Gut Microbes 2014;5(3):419-29.Krogius-Kurikka L., Lyra A., Malinen E., Aarnikunnas J., Tuimala J., Paulin L., Mäkivuokko H., Kajander K., Palva A. Microbial community analysis reveals high level phylogenetic alterations in the overall gastrointestinal microbiota of diarrhoea-predominant irritable bowel syndrome sufferers. BMC Gastroenterol 2009;9:95.Krogius-Kurikka L., Lyra A., Malinen E., Aarnikunnas J., Tuimala J., Paulin L., Mäkivuokko H., Kajander K., Palva A. Microbial community analysis reveals high level phylogenetic alterations in the overall gastrointestinal microbiota of diarrhoea-predominant irritable bowel syndrome sufferers. BMC Gastroenterol 2009;9:95.Carroll I.M., Ringel-Kulka T., Keku T.O., Chang Y.H., Packey C.D., Sartor R.B., Ringel Y. Molecular analysis of the luminaland mucosal-associated intestinal microbiota in diarrhea-predominant irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol 2011;301: G799-G807.Carroll I.M., Ringel-Kulka T., Keku T.O., Chang Y.H., Packey C.D., Sartor R.B., Ringel Y. Molecular analysis of the luminaland mucosal-associated intestinal microbiota in diarrhea-predominant irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol 2011;301: G799-G807.Dear K.L., Elia M., Hunter J.O. Do interventions which reduce colonic bacterial fermentation improve symptoms of irritable bowel syndrome? Dig Dis Sci 2005;50:758-66.Dear K.L., Elia M., Hunter J.O. Do interventions which reduce colonic bacterial fermentation improve symptoms of irritable bowel syndrome? Dig Dis Sci 2005;50:758-66.Simren M., Barbara G., Flint H., Spiegel B.M., Spiller R.C., Vanner S., Verdu E.F., Whorwell P.J., Zoetendal E.G. Intestinal microbiota in functional bowel disorders: a Rome Foundation working team report. Gut 2013;62:159-76.Simren M., Barbara G., Flint H., Spiegel B.M., Spiller R.C., Vanner S., Verdu E.F., Whorwell P.J., Zoetendal E.G. Intestinal microbiota in functional bowel disorders: a Rome Foundation working team report. Gut 2013;62:159-76.Patel A., Sayuk G.S., Gyawali C.P. Prevalence, characteristics, and treatment outcomes of reflux hypersensitivity detected on pH-impedance monitoring. Neurogastroenterol Motil 2016;28(9):1382-90.Patel A., Sayuk G.S., Gyawali C.P. Prevalence, characteristics, and treatment outcomes of reflux hypersensitivity detected on pH-impedance monitoring. Neurogastroenterol Motil 2016;28(9):1382-90.Patel A., Sayuk G.S., Kushnir V.M., Chan W.W., Gyawali C.P. GERD phenotypes from pH-impedance monitoring predict symptomatic outcomes on prospective evaluation. Neurogastroenterol Motil 2016;28(4):513-21.Patel A., Sayuk G.S., Kushnir V.M., Chan W.W., Gyawali C.P. GERD phenotypes from pH-impedance monitoring predict symptomatic outcomes on prospective evaluation. Neurogastroenterol Motil 2016;28(4):513-21.Aziz Q., Fass R., Gyawali C.P., Miwa H., Pandolfino J.E., Zerbib F. Functional Esophageal Disorders.Gastroenterology2016;150:1368-79.Aziz Q., Fass R., Gyawali C.P., Miwa H., Pandolfino J.E., Zerbib F. Functional Esophageal Disorders.Gastroenterology2016;150:1368-79.Евсютина Ю.В., Трухманов А.С. Ведение пациентов с рефрактерной ГЭРБ. Русс мед журн 2015; 28:1684-8.Евсютина Ю.В., Трухманов А.С. Ведение пациентов с рефрактерной ГЭРБ. Русс мед журн 2015; 28:1684-8.Stanghellini V., Chan F. K., Hasler W. L., Malagelada J.R., Suzuki H., Tack J., Talley N.J. Gastroduodenal Disorders. Gastroenterology 2016; 150(6):1380-92.Stanghellini V., Chan F. K., Hasler W. L., Malagelada J.R., Suzuki H., Tack J., Talley N.J. Gastroduodenal Disorders. Gastroenterology 2016; 150(6):1380-92.Шептулин А.А., Курбатова А.А. Новые Римские критерии функциональной диспепсии IV пересмотра. Рос журн гастроэнтерол гепатол колопроктол 2016; 26(4):124-8.Шептулин А.А., Курбатова А.А. Новые Римские критерии функциональной диспепсии IV пересмотра. Рос журн гастроэнтерол гепатол колопроктол 2016; 26(4):124-8.Cotton P.B., Elta G.H., Carter C.R., Pasricha P.J., Corazziari E.S. Gallbladder and Sphincter of Oddi Disorders. Gastroenterology 2016;150(6):1420-9.Cotton P.B., Elta G.H., Carter C.R., Pasricha P.J., Corazziari E.S. Gallbladder and Sphincter of Oddi Disorders. Gastroenterology 2016;150(6):1420-9.Lacy B.E., Mearin F., Chang L., Chey W.D., Lembo A.J., Simren M., Spiller R. Bowel Disorders. Gastroenterology 2016;150(6):1393-407.Lacy B.E., Mearin F., Chang L., Chey W.D., Lembo A.J., Simren M., Spiller R. Bowel Disorders. Gastroenterology 2016;150(6):1393-407.Spiegel B.M., Bolus R., Agarwal N., Sayuk G., Harris L.A., Lucak S., Esrailian E., Chey W.D., Lembo A., Karsan H., Tillisch K., Talley J., Chang L. Measuring symptoms in the irritable bowel syndrome: development of a framework for clinical trials. Aliment Pharmacol Ther 2010;32(10):1275-91.Spiegel B.M., Bolus R., Agarwal N., Sayuk G., Harris L.A., Lucak S., Esrailian E., Chey W.D., Lembo A., Karsan H., Tillisch K., Talley J., Chang L. Measuring symptoms in the irritable bowel syndrome: development of a framework for clinical trials. Aliment Pharmacol Ther 2010;32(10):1275-91.

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