gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2017-27-5-105-112gastro-j-186Research ArticleНАЦИОНАЛЬНАЯ ШКОЛА ГАСТРОЭНТЕРОЛОГОВ, ГЕПАТОЛОГОВNATIONAL COLLEGE OF GASTROENTEROLOGISTS, HEPATOLOGISTSЗапор функционального происхожденияFunctional constipationШульпековаЮ. О.ShulpekovaYu. O.jshulpekova@gmail.comКурбатоваА. А.KurbatovaA. A.noemail@neicon.ruСедоваА. В.SedovaA. V.noemail@neicon.ruФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова»РоссияFederal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical UniversityRussian Federation201712082018275105112Copyright © Шульпекова Ю.О., Курбатова А.А., Седова А.В., 20182018Шульпекова Ю.О., Курбатова А.А., Седова А.В.Shulpekova Y.O., Kurbatova A.A., 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/186

Цель обзора. Рассмотреть последние изменения в классификации запора функционального происхождения (как самостоятельного заболевания, так и в рамках синдрома раздраженного кишечника), представления о его происхождении, а также рекомендуемые подходы к ведению пациентов с этой патологией. Основные положения. В 2016 г. представлены материалы последнего Консенсуса по диагностике и лечению функциональных заболеваний желудочно-кишечного тракта (так называемые Римские критерии IV). В разделе, касающемся заболеваний кишечника, выделена новая форма - опиоидиндуцированный запор; также претерпели некоторые изменения диагностические (в основном временные) критерии синдрома раздраженного кишечника и функционального запора. В новом Римском консенсусе различные виды функциональной патологии кишечника оценивают как проявления своеобразного континуума. Происхождение функциональных заболеваний кишечника продолжают рассматривать в контексте биопсихосоциальной модели; в их происхождении играют роль как конститутивные факторы, в частности особенности серотонинергической и адренергической регуляции, так и особенности питания, обмена желчных кислот и пр. В последние годы углубленно изучается роль изменений кишечной микробиоты. Принципы лечения запора функционального происхождения в общих чертах остаются прежними. В первую очередь следует предпринимать усилия по модификации питания и образа жизни, включая потребление кисломолочных продуктов; на втором этапе назначают пищевые волокна, при неэффективности этих мер - относительно безопасные слабительные средства, при необходимости - препараты для лечения боли. Применение пробиотиков и пребиотиков - перспективное направление лечения функциональных заболеваний кишечника, такой подход наиболее патогенетически обоснован и безопасен. Многообещающие результаты получены при применении определенных штаммов бифидобактерий и лактобацилл, в частности комбинированного препарата «Флорасан Д», в состав которого входят Bifidobacterium bifidum, B. longum, B. infantis, Lactobacillus rhamnosus. Получен большой объем данных, доказывающих эффективность при запоре и вздутии живота штамма B. lactis DN-173010 (коммерческое наименование «ActiRegularis»), который включают в состав продуктов функционального питания для ежедневного приема.

Aim of review. To discuss the recent updates in classification of constipation of functional origin (both as separate entity, and within the pattern of constipationpredominant irritable bowel syndrome), the concepts on pathogenesis and recommended treatment approaches. Key points. In 2016 multinational consensus statement on functional gastrointestinal disorders (so-called Rome IV criteria) was presented. In the section devoted to the bowel diseases the new entity - opioid-induced constipation was defined; besides that diagnostic (mostly - the time-based criteria) of irritable bowel syndrome and functional constipation were modified. In new Rome consensus different types of functional bowel diseases were considered as specific forms of certain continuum. The origin of functional bowel diseases is still presented in the context of biopsychosocial model; that develop due to impact of constitutive factors, in particular features of serotoninergic and adrenergic regulation, dietary habit, bile acid metabolism etc. In the recent years the role of intestinal microbiota changes was studied intensively. The treatment approach for functional constipation underwent no significant changes. First of all it is required to attempt to modify dietary habits and lifestyle, including consumption of fermented milk products; at the second stage food fibers are prescribed, at inefficiency of these measures - relatively safe laxatives, and if necessary - drugs to relieve pain. Administration of probiotics and prebiotics is the promising trend in the functional bowel disease treatment, being pathogenically justified and. Promising results are received at administration of specific strains of bifidobacteria and lactobacilli, in particular the combined probiotic «Florasan D» that includes Bifidobacterium bifidum, B.longum, B. infantis, Lactobacillus rhamnosus. Largescale studies proving efficacy of B. lactis DN-173 010 strain (the commercial name «ActiRegularis») at constipation and functional flatulence are received, the drug is included to the spectrum of functional nutritional products for daily intake.

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