gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2019-29-4-7-14gastro-j-392Research ArticleОБЗОРЫREVIEWSПатогенетическое обоснование лечебного воздействия на микробиоту при синдроме раздраженного кишечникаPathogenetic Substantiation of the Therapeutic Impact on Microbiota in Irritable Bowel SyndromeШульпековаЮ. О.ShulpekovaYu. O.

кандидат медицинских наук, доцент кафедры пропедевтики внутренних болезней 119991, г. Москва, ул. Погодинская, д. 1, стр. 1

Cand. Sci. (Med), Assoc. Prof., Department of Propaedeutics of Internal Diseases, Faculty of Medicine

119991, Moscow, Pogodinskaya str., 1, building 1

jshulpekova@gmail.comБабаеваГ. Г.BabaevaG. H.

доктор философии по медицине, доцент кафедры терапии (с курсом физиотерапии)

AZ1012, г. Баку, просп. Тбилиси, д. 3165

PhD in Medicine, Assoc. Prof., Department of Therapy (with Physiotherapy course)

AZ1012, Baku, Tbilisi ave., 3165

doctorabu@mail.ruРусяевВ. Ю.RusyaevV. Yu.

студент  

Student

slava.rusyaev@yandex.ruФГАОУ ВО «Первый Московский государственный университет им. И.М. Сеченова» (Сеченовский университет) Министерства здравоохранения Российской ФедерацииРоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationАзербайджанский государственный институт усовершенствования врачей им. А. АлиеваАзербайджанAzerbaijan State Advanced Training Institute for Doctors named after A. AliyevAzerbaijan201921092019294714Copyright © Шульпекова Ю.О., Бабаева Г.Г., Русяев В.Ю., 20192019Шульпекова Ю.О., Бабаева Г.Г., Русяев В.Ю.Shulpekova Y.O., Babaeva G.H., Rusyaev V.Y.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/392

Цель обзора: осветить характер изменений кишечной микробиоты при синдроме раздраженного кишечника (СРК) и представить патогенетическое обоснование лечебного воздействия на микробиоту.Основные положения. Важным аспектом взаимодействия кишечных бактерий с клетками «хозяина» выступает контакт с паттерн-распознающими рецепторами энтероцитов, рецепторами дендритных клеток, трансцеллюлярный транспорт антигенов в области пейеровых бляшек. Область взаимодействия кишечных бактерий и организма человека не ограничивается кишечником. Кишечные бактерии оказывают значительное гуморальное влияние за счет сигнальных молекул, часть которых проявляет свойства нейромедиаторов. Значительный интерес представляет изучение проблемы «перекрестного питания» бактерий различных видов, под которым подразумевают взаимное использование питательных субстратов, вырабатывающихся бактериями различных видов. Развитие воспаления низкой степени активности при СРК отчасти может объясняться усилением взаимодействия флагеллина с соответствующим рецептором, а также поступлением избыточного количества бактерий из тонкой кишки. В большинстве работ при СРК продемонстрировано преобладание кишечных бактерий с провоспалительным потенциалом (Enterobacteriaceae) и недостаток бактерий с выраженной противовоспалительной, антимикробной и ферментативной активностью (Lactobacillus и Bifidobacterium), а также повышенное содержание видов, вызывающих деградацию слизи. Сходные изменения наблюдаются при воспалительных заболеваниях кишечника. Снижение микробного разнообразия повышает восприимчивость к кишечным инфекциям и паразитозам, в том числе вызванным условно-патогенными для взрослого человека простейшими, такими как Blastocystis hominis hominis, Dientamoeba fragilis, Giardia lamblia. С помощью коррекции питания, применения пробиотиков и функциональных продуктов питания, содержащих определенные пробиотические штаммы, растительных волокон (прежде всего псиллиума) и в ряде случаев — невсасывающихся антибиотиков удается достичь положительного эффекта у значительной части пациентов с СРК. Работы последних лет указывают, что клиническое улучшение сопровождается изменением в составе кишечной микробиоты.Заключение. Для патогенетического лечения синдрома раздраженного кишечника обосновано применение средств немедикаментозного лечения: оптимальной диеты, растительных волокон и пробиотических штаммов бактерий, положительное действие которых в значительной степени обосновывается модификацией состава кишечной микробиоты. Это открывает перспективы дальнейшего более направленного влияния на кишечный микробиом.

Aim

Aim. This review aims to describe the nature of changes in the intestinal microbiota in irritable bowel syndrome (IBS) and provide a pathogenetic justification of the feasibility of a therapeutic impact on microbiota. 

General findings

General findings. An important aspect of the interaction of intestinal bacteria with the “host” cells is their contact with pattern recognition receptors of enterocytes, dendritic cell receptors, as well as a transcellular transport of antigens in the region of Peyer’s patches. The area of interaction of intestinal bacteria and the human body is not limited to the intestines. Intestinal bacteria demonstrate a significant humoral effect due to signalling molecules, some of which exhibit neurotransmitter properties. The study of the bacterial cross-feeding for various species, i.e. mutual use of nutrient substrates produced by bacteria of various species, is of a great interest. The development of a lowactivity inflammation in IBS can partly be explained by the increased interaction of flagellin with the corresponding receptor, as well as the influx of excess bacteria from the small intestine. The majority of studies on IBS have demonstrated the predominance of intestinal bacteria with pro-inflammatory potential (Enterobacteriaceae) and the lack of bacteria with a pronounced anti-inflammatory, antimicrobial and enzymatic action (Lactobacillus and Bifidobacterium), as well as increased mucus degradation. Similar changes are observed in inflammatory bowel diseases. Reduced microbial diversity increases susceptibility to intestinal infections and parasitoses, including those caused by protozoa conditionally pathogenic for adults, such as Blastocystis hominis hominis, Dientamoeba fragilis, Giardia lamblia. With the help of nutrition correction, the use of probiotics and functional foods containing certain probiotic strains, plant fibres (primarily psyllium) and, in some cases, nonabsorbable antibiotics, a positive effect can be achieved in a significant number of IBS patients. Recent works have shown that clinical improvement is accompanied by a change in the composition of the intestinal microbiota.

Conclusion

Conclusion. For the pathogenetic treatment of irritable bowel syndrome, the use of non-drug treatment is justified, such as diet optimization and prescription of plant fibres and probiotic bacterial strains. The positive effect of such an approach is largely determined by modification of the intestinal microbiota composition. This opens up prospects for a further, more targeted impact on the intestinal microbiome.

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