gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1443Research ArticleОБМЕН ОПЫТОМEXCHANG OF EXPERIENCEДиета при болезнях кишечника: традиционные основы и новые открытияDiet at intestinal diseases: traditional bases and new discoveringsШульпековаЮ. О.ShulpekovaYu. O.Первый Московский государственный медицинский университет им. И.М. СеченоваRussian Federation2011060620112148289Copyright © Шульпекова Ю.О., 20112011Шульпекова Ю.О.Shulpekova Y.O.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/1443

Цель обзора. Осветить основные принципы лечебного питания при заболеваниях кишечника, а также охарактеризовать перспективы его совершенствования за счет включения специальных компонентов, снижающих кишечную проницаемость.Основные положения. В современной медицине лечебное питание не потеряло своего значения. В последние годы существенные прогрессивные изменения претерпела диета при сахарном диабете, язвенной болезни, печеночной недостаточности. Принципы лечебного питания при заболеваниях кишечника в целом остаются прежними и основываются на стремлении к механическому и химическому щажению в период обострения с постепенным переходом к общей диете по мере регрессии симптомов. Спорный характер носят вопросы о необходимости полного исключения употребления лактозы и исключения употребления глютена при «неглютеновых» поражениях кишечника.Показано, что некоторые компоненты пищи, в частности глутамин, омега-3-ненасыщенные жирные кислоты, цинк, селен, куркумин, кверцетин, в существенной степени способствуют восстановлению целостности слизистой оболочки и снижению кишечной проницаемости. В настоящее время эти компоненты обязательно включаются в состав смесей для энтерального питания. Идет разработка пищевых добавок и лекарственных препаратов на их основе. Большой интерес вызывает возможность применения пре и пробиотиков для стимуляции процесса регенерации и создания на их основе продуктов функционального питания.Заключение. Продолжаются исследования способов выявления тех компонентов пищи, которые могут обладать скрытым повреждающим действием либо, наоборот, поддерживать целостность слизистой оболочки, а также лекарственных препаратов, пищевых добавок и препаратов функционального питания, которые могут применяться как дополнение к традиционной диете и способствовать снижению кишечной проницаемости.

The aim of review

The aim of review. To present the basic concept of dietetic therapy at bowel diseases, as well as the prospects of its improvement by addition of the specific components decreasing intestinal permeability.

Original positions

Original positions. In modern medicine dietetic therapy is still of value. In the last years essential progress was achieved for diet at diabetes mellitus, peptic ulcer and liver failure. Principles of dietetic therapy at bowel diseases as a whole remain unchanged and are based on the concept of mechanical and chemical sparing during relapse with gradual transition to general diet along with symptom regression. Issues on necessity of complete avoidance of lactose and gluten at «non-gluten» diseases of intestine are still disputable. It was demonstrated, that some components of food, in particular glutamine, omega-3-non-saturated fatty acids, zinc, selenium, curcumine, meletin, in an essential degree promote restoration of mucosal integrity and decrease intestinal permeability. Now these substances became obligatory components of enteric feeding mixtures. Development of alimentary additives and drugs on their basis is going on. Application of pre- and probiotics for stimulation of regeneration and development of functional nutrition products on their basis invokes major interest.

Conclusion

Conclusion. Investigations of methods to reveal those components of food which can have the concealed damaging effect or, on the contrary, to sustain integrity of a mucosa, is still in the progress as well as development of the drugs, food additives and functional nutrition components, which can be applied as addition to traditional diet and promote decrease of intestinal permeability. 

заболевания кишечникалечебное питаниеаглютеновая диетаглутаминbowel diseasesdietetic therapygluten-free dietglutamineReferencesБеюл Е.А., Будаговская В.Н., Высоцкий В.Г. и др. Справочник по диетологии / Под ред. М.А. Самсонова, А.А. Покровского. – М.: Медицина, 1992.Беюл Е.А., Будаговская В.Н., Высоцкий В.Г. и др. Справочник по диетологии / Под ред. М.А. Самсонова, А.А. Покровского. – М.: Медицина, 1992.Гастроэнтерология: Национальное руководство / Под ред. В.Т. Ивашкина, Т.Л. Лапиной. – М.: ГэотарМедиа, 2008.Гастроэнтерология: Национальное руководство / Под ред. В.Т. Ивашкина, Т.Л. Лапиной. – М.: ГэотарМедиа, 2008.Рациональная фармакотерапия заболеваний органов пищеварения: Практическое руководство (Рациональная фармакотерапия) / Под ред. В.Т. Ивашкина, Т.Л. Лапиной. – Т. 4. – М.: Литтерра, 2003.Рациональная фармакотерапия заболеваний органов пищеварения: Практическое руководство (Рациональная фармакотерапия) / Под ред. В.Т. Ивашкина, Т.Л. Лапиной. – Т. 4. – М.: Литтерра, 2003.Синдром раздраженного кишечника / Под ред. И.В. Маева. – М.: ГОУ ВУНМЦ МЗ и СР РФ, 2004.Синдром раздраженного кишечника / Под ред. И.В. Маева. – М.: ГОУ ВУНМЦ МЗ и СР РФ, 2004.URL: http://www.bankreceptov.ru/diet/diet-0023. shtml (2 мая 2011 г.).URL: http://www.bankreceptov.ru/diet/diet-0023. shtml (2 мая 2011 г.).URL: http://www.mayoclinic.org (2 мая 2011 г.).URL: http://www.mayoclinic.org (2 мая 2011 г.).URL: http://www.medkrug.ru (2 мая 2011 г.).URL: http://www.medkrug.ru (2 мая 2011 г.).URL: http://www.professional.diabetes.org (2 мая 2011 г.).URL: http://www.professional.diabetes.org (2 мая 2011 г.).Шифрин О.С. Лактулоза в лечении функциональных запоров // Рус. мед. журнал. – 2010. – № 13. – С. 834–837.Шифрин О.С. Лактулоза в лечении функциональных запоров // Рус. мед. журнал. – 2010. – № 13. – С. 834–837.Aggarwal B.B., Sung B. Pharmacological basis for the role of curcumin in chronic diseases: an age-old spice with modern targets // Trends Pharmacol. Sci. – 2009. – Vol. 30. – P. 85–94.Aggarwal B.B., Sung B. Pharmacological basis for the role of curcumin in chronic diseases: an age-old spice with modern targets // Trends Pharmacol. Sci. – 2009. – Vol. 30. – P. 85–94.Agrawal A., Houghton L.A., Morris J. 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. – Vol. 29, N 1. – P. 104–114.Agrawal A., Houghton L.A., Morris J. 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. – Vol. 29, N 1. – P. 104–114.Ak T., Gulcin I. Antioxidant and radical scavenging properties of curcumin // Chem. Biol. Interact. – 2008. – Vol. 174. – P. 27–37.Ak T., Gulcin I. Antioxidant and radical scavenging properties of curcumin // Chem. Biol. Interact. – 2008. – Vol. 174. – P. 27–37.Al-Toma A., Verbeek W.H., Mulder C.J. Update on the management of refractory coeliac disease // J. Gastrointestin. Liver Dis. – 2007. – Vol. 16, N 1. – P. 57–63.Al-Toma A., Verbeek W.H., Mulder C.J. Update on the management of refractory coeliac disease // J. Gastrointestin. Liver Dis. – 2007. – Vol. 16, N 1. – P. 57–63.Berrada N. et al. Bifidobacterium from fermented milks: Survival during gastric transit // J. Dairy Sci. – 1991. – Vol. 74. – P. 409–413.Berrada N. et al. Bifidobacterium from fermented milks: Survival during gastric transit // J. Dairy Sci. – 1991. – Vol. 74. – P. 409–413.Camacho-Barquero L., Villegas I., Sanchez-Calvo J.M. et al. Curcumin, a Curcuma longa constituent, acts on MAPK p38 pathway modulating COX-2 and iNOS expression in chronic experimental colitis // Int. Immunopharmacol. – 2007. – Vol. 7. – P. 333–342.Camacho-Barquero L., Villegas I., Sanchez-Calvo J.M. et al. Curcumin, a Curcuma longa constituent, acts on MAPK p38 pathway modulating COX-2 and iNOS expression in chronic experimental colitis // Int. Immunopharmacol. – 2007. – Vol. 7. – P. 333–342.Cani P.D., Delzenne N.M. Interplay between obesity and associated metabolic disorders: new insights into the gut microbiota // Curr Opin Pharmacol. – 2009. – Vol. 9. – P. 737–743.Cani P.D., Delzenne N.M. Interplay between obesity and associated metabolic disorders: new insights into the gut microbiota // Curr Opin Pharmacol. – 2009. – Vol. 9. – P. 737–743.Coëffier M., Marion-Letellier R., Déchelotte P. Potential for amino acids supplementation during inflammatory bowel diseases // Inflamm. Bowel Dis. – 2010. – Vol. 16. – P. 518–524.Coëffier M., Marion-Letellier R., Déchelotte P. Potential for amino acids supplementation during inflammatory bowel diseases // Inflamm. Bowel Dis. – 2010. – Vol. 16. – P. 518–524.DeMeo M.T., Mutlu E.A., Keshavarzian A., Tobin M.C. Intestinal permeation and gastrointestinal disease // J. Clin. Gastroenterol. – 2002. – Vol. 34, N 4. – P. 385–396.DeMeo M.T., Mutlu E.A., Keshavarzian A., Tobin M.C. Intestinal permeation and gastrointestinal disease // J. Clin. Gastroenterol. – 2002. – Vol. 34, N 4. – P. 385–396.De-Souza D.A., Greene L.J. Intestinal permeability and systemic infections in critically ill patients: effect of glutamine // Crit. Care Med. – 2005. – Vol. 33. – P. 1125–1135.De-Souza D.A., Greene L.J. Intestinal permeability and systemic infections in critically ill patients: effect of glutamine // Crit. Care Med. – 2005. – Vol. 33. – P. 1125–1135.Drago S., El Asmar R., Di Pierro M. et al. Gliadin, zonulin and gut permeability: Effects on celiac and nonceliac intestinal mucosa and intestinal cell lines // Scand. J. Gastroenterol. – 2006. – Vol. 41, N 4. – P. 408–419.Drago S., El Asmar R., Di Pierro M. et al. Gliadin, zonulin and gut permeability: Effects on celiac and nonceliac intestinal mucosa and intestinal cell lines // Scand. J. Gastroenterol. – 2006. – Vol. 41, N 4. – P. 408–419.Duez H. et al. A colony – Immunobloting method for quantitative detection of a Bifidobacterium animalis probiotic strain in human faeces // J. Appl. Microbiol. – 2000. – Vol. 88. – P. 1019–1027.Duez H. et al. A colony – Immunobloting method for quantitative detection of a Bifidobacterium animalis probiotic strain in human faeces // J. Appl. Microbiol. – 2000. – Vol. 88. – P. 1019–1027.Fink M.P. Leaky gut hypothesis: a historical perspective // Crit. Care Med. – 1990. – Vol. 18, N 5. – P. 579–580.Fink M.P. Leaky gut hypothesis: a historical perspective // Crit. Care Med. – 1990. – Vol. 18, N 5. – P. 579–580.Guyonnet D., Chassany O., Ducrotte P. et al. Effect of a fermented milk containing Bifidobacterium animalis DN173 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. – Vol. 26, N 3. – P. 475–486.Guyonnet D., Chassany O., Ducrotte P. et al. Effect of a fermented milk containing Bifidobacterium animalis DN173 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. – Vol. 26, N 3. – P. 475–486.Hulsewe K.W., van Acker B.A., Hameeteman W. et al. Does glutamine-enriched parenteral nutrition really affect intestinal morphology and gut permeability? // Clin. Nutr. – 2004. – Vol. 23. – P. 1217–1225.Hulsewe K.W., van Acker B.A., Hameeteman W. et al. Does glutamine-enriched parenteral nutrition really affect intestinal morphology and gut permeability? // Clin. Nutr. – 2004. – Vol. 23. – P. 1217–1225.Jacob R.A., Burri B.J. Oxidative damage and defense // Am. J. Clin. Nutr. – 1996. – Vol. 63, N 6. – P. 985–990.Jacob R.A., Burri B.J. Oxidative damage and defense // Am. J. Clin. Nutr. – 1996. – Vol. 63, N 6. – P. 985–990.Klapproth M.A., Katz J. Celiac Sprue. URL: http://emedicine.medscape.com/article/171805-overview (2 мая 2011 г.).Klapproth M.A., Katz J. Celiac Sprue. URL: http://emedicine.medscape.com/article/171805-overview (2 мая 2011 г.).Lammers K.M., Lu R., Brownley J. et al. Gliadin induces an increase in intestinal permeability and zonulin release by binding to the chemokine receptor CXCR3 // Gastroenterology. – 2008. – Vol. 135, N 1. – P. 194–204.Lammers K.M., Lu R., Brownley J. et al. Gliadin induces an increase in intestinal permeability and zonulin release by binding to the chemokine receptor CXCR3 // Gastroenterology. – 2008. – Vol. 135, N 1. – P. 194–204.Lochs H., Pichard C., Allison S.P. Evidence supports nutritional support // Clin. Nutr. – 2006. – Vol. 25.– P. 177–179.Lochs H., Pichard C., Allison S.P. Evidence supports nutritional support // Clin. Nutr. – 2006. – Vol. 25.– P. 177–179.Meance S. et al. Recent advance in the use of functional foods: Effect of the commercial fermented milk with Bifidobacterium animalis strain DN-173 010 and yogurt strains on gut transit time in the elderly // Microb. Ecology Health Dis. – 2003. – Vol. 15. – P. 15–22.Meance S. et al. Recent advance in the use of functional foods: Effect of the commercial fermented milk with Bifidobacterium animalis strain DN-173 010 and yogurt strains on gut transit time in the elderly // Microb. Ecology Health Dis. – 2003. – Vol. 15. – P. 15–22.Mennigen R., Bruewer M. Effect of probiotics on intestinal barrier function // Ann. N. Y. Acad. Sci. – 2009. – Vol. 1165. – P. 183–189.Mennigen R., Bruewer M. Effect of probiotics on intestinal barrier function // Ann. N. Y. Acad. Sci. – 2009. – Vol. 1165. – P. 183–189.Montalto M., Gallo A. Sufficient evidence that 12 g of lactose is tolerated by most adults with lactose malabsorption and intolerance but insufficient evidence on the effectiveness of therapeutical strategies tested so far // Evid. Based Med. – 2010. – Vol. 15, N 6. – P. 172–173.Montalto M., Gallo A. Sufficient evidence that 12 g of lactose is tolerated by most adults with lactose malabsorption and intolerance but insufficient evidence on the effectiveness of therapeutical strategies tested so far // Evid. Based Med. – 2010. – Vol. 15, N 6. – P. 172–173.Nones K., Dommels Y.E., Martell S. et al. The effects of dietary curcumin and rutin on colonic inflammation and gene expression in multidrug resistance gene-deficient (mdr1a-/-) mice, a model of inflammatory bowel diseases // Br. J. Nutr. – 2009. – Vol. 101. – P. 169–181.Nones K., Dommels Y.E., Martell S. et al. The effects of dietary curcumin and rutin on colonic inflammation and gene expression in multidrug resistance gene-deficient (mdr1a-/-) mice, a model of inflammatory bowel diseases // Br. J. Nutr. – 2009. – Vol. 101. – P. 169–181.Peuhkuri K., Vapaatalo H., Korpela R. Even lowgrade inflammation impacts on small intestinal function // World J. Gastroenterol. – 2010. – Vol. 16, N 9.Peuhkuri K., Vapaatalo H., Korpela R. Even lowgrade inflammation impacts on small intestinal function // World J. Gastroenterol. – 2010. – Vol. 16, N 9.– P. 1057–1062.– P. 1057–1062.Plauth M., Merli M., Kondrup J. et al. ESPEN guidelines for nutrition in liver disease and transplantation // Clin. Nutr. – 1997. – Vol. 16. – P. 43.Plauth M., Merli M., Kondrup J. et al. ESPEN guidelines for nutrition in liver disease and transplantation // Clin. Nutr. – 1997. – Vol. 16. – P. 43.Pochart P. et al. Isoelement des bifidobacteries dans les selles apres ingestion prolongee de lait bifidus // Med. Mal. Infect. – 1990. – Vol. 20. – P. 75–78.Pochart P. et al. Isoelement des bifidobacteries dans les selles apres ingestion prolongee de lait bifidus // Med. Mal. Infect. – 1990. – Vol. 20. – P. 75–78.Pochart P. et al. Survival of Bifidobacteria ingested via fermented milk during their passage through the human small intestine: an in vivo study using intestinal perfusion // Am. J. Clin. Nutr. – 1992. – Vol. 55. – P. 78–80.Pochart P. et al. Survival of Bifidobacteria ingested via fermented milk during their passage through the human small intestine: an in vivo study using intestinal perfusion // Am. J. Clin. Nutr. – 1992. – Vol. 55. – P. 78–80.Quan Z.F., Yang C., Li N., Li J.S. Effect of glutamine on change in early postoperative intestinal permeability and its relation to systemic inflammatory response // World J. Gastroenterol. – 2004. – Vol. 10. – P. 1992–1994.Quan Z.F., Yang C., Li N., Li J.S. Effect of glutamine on change in early postoperative intestinal permeability and its relation to systemic inflammatory response // World J. Gastroenterol. – 2004. – Vol. 10. – P. 1992–1994.Rapin J.R., Wiernsperger N. Possible links between intestinal permeability and food processing: A potential therapeutic niche for glutamine // Clinics (Sao Paulo). – 2010. – Vol. 65, N 6. – P. 635–643.Rapin J.R., Wiernsperger N. Possible links between intestinal permeability and food processing: A potential therapeutic niche for glutamine // Clinics (Sao Paulo). – 2010. – Vol. 65, N 6. – P. 635–643.Resta-Lenert S.C., Barrett K.E. Modulation of intestinal barrier properties by probiotics: role in reversing colitis // Ann. N. Y. Acad. Sci. – 2009. – Vol. 1165. – P. 175–182.Resta-Lenert S.C., Barrett K.E. Modulation of intestinal barrier properties by probiotics: role in reversing colitis // Ann. N. Y. Acad. Sci. – 2009. – Vol. 1165. – P. 175–182.Rochet V., Rigottier-Gois L., Ledaire A. et al. Survival of Bifidobacterium animalis DN-173 010 in the faucal microbiota after administration in lyophilised form or in fermented product – A randomised study in healthy adults // J. Mol. Microbiol. Biotechnol. – 2008. – Vol. 14, N 1–3. – P. 128–136.Rochet V., Rigottier-Gois L., Ledaire A. et al. Survival of Bifidobacterium animalis DN-173 010 in the faucal microbiota after administration in lyophilised form or in fermented product – A randomised study in healthy adults // J. Mol. Microbiol. Biotechnol. – 2008. – Vol. 14, N 1–3. – P. 128–136.Roth E. Nonnutritive effects of glutamine // J. Nutr. – 2008. – Vol. 138. – P. 2025–2031.Roth E. Nonnutritive effects of glutamine // J. Nutr. – 2008. – Vol. 138. – P. 2025–2031.Strowski M.Z., Wiedenmann B. Probiotic carbohydrates reduce intestinal permeability and inflammation in metabolic diseases // Gut. – 2009. – Vol. 58. – P. 1044–1045.Strowski M.Z., Wiedenmann B. Probiotic carbohydrates reduce intestinal permeability and inflammation in metabolic diseases // Gut. – 2009. – Vol. 58. – P. 1044–1045.Szilagyi A., Shrier I., Heilpern D. et al. Differential impact of lactose/lactase phenotype on colonic microflora // Can. J. Gastroenterol. – 2010. – Vol. 24, N 6. – P. 373–379.Szilagyi A., Shrier I., Heilpern D. et al. Differential impact of lactose/lactase phenotype on colonic microflora // Can. J. Gastroenterol. – 2010. – Vol. 24, N 6. – P. 373–379.Tabbers M.M., Chmielewska A., Roseboom M.G. et al. Effect of the consumption of a fermented dairy product containing Bifidobacterium lactis DN-173 010 on constipation in childhood: a multicentre randomised controlled trial (NTRTC: 1571) // BMC Pediatr. – 2009. – Vol. 18, N 9. – P. 22.Tabbers M.M., Chmielewska A., Roseboom M.G. et al. Effect of the consumption of a fermented dairy product containing Bifidobacterium lactis DN-173 010 on constipation in childhood: a multicentre randomised controlled trial (NTRTC: 1571) // BMC Pediatr. – 2009. – Vol. 18, N 9. – P. 22.Ukena S.N., Singh A., Dringenberg U. et al. Probiotic Escherichia coli Nissle 1917 inhibits leaky gut by enhancing mucosal integrity. PLoS One. – 2007;2:e1308.Ukena S.N., Singh A., Dringenberg U. et al. Probiotic Escherichia coli Nissle 1917 inhibits leaky gut by enhancing mucosal integrity. PLoS One. – 2007;2:e1308.Vanderhoof J.A. Probiotics in allergy management // J. Pediatr. Gastroenterol. Nutr. – 2008. – Vol. 47 (suppl. 2). – P. 38–40.Vanderhoof J.A. Probiotics in allergy management // J. Pediatr. Gastroenterol. Nutr. – 2008. – Vol. 47 (suppl. 2). – P. 38–40.Weber C.R., Turner J.R. Inflammatory bowel disease: Is it really just another break in the wall? // Gut. – 2007. – Vol. 56, N 1. – P. 6–8.Weber C.R., Turner J.R. Inflammatory bowel disease: Is it really just another break in the wall? // Gut. – 2007. – Vol. 56, N 1. – P. 6–8.Zeissig S. et al. Changes in expression and distribution of claudin 2,5, and 8 lead to discontinuous tight junctions and barrier dysfunction in active Crohn’s disease // Gut. – 2007. – Vol. 56, N 1. – P. 61–72.Zeissig S. et al. Changes in expression and distribution of claudin 2,5, and 8 lead to discontinuous tight junctions and barrier dysfunction in active Crohn’s disease // Gut. – 2007. – Vol. 56, N 1. – P. 61–72.Zurier R.B., Campbell R.G., Hashim S.A. et al. Use of medium-chain triglyceride in management of patients with massive resection of the small intestine // N. Engl. J. Med. – 1966. – Vol. 274. – P. 490–493.Zurier R.B., Campbell R.G., Hashim S.A. et al. Use of medium-chain triglyceride in management of patients with massive resection of the small intestine // N. Engl. J. Med. – 1966. – Vol. 274. – P. 490–493.

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