gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2022-32-4-95-103gastro-j-755Research ArticleНАЦИОНАЛЬНАЯ ШКОЛА ГАСТРОЭНТЕРОЛОГОВ, ГЕПАТОЛОГОВNATIONAL COLLEGE OF GASTROENTEROLOGISTS, HEPATOLOGISTSСиндром перекреста функциональных гастроинтестинальных расстройств: общие механизмы патогенеза как ключ к рациональной терапииOverlap of Functional Gastrointestinal Disorders: Common Mechanisms of Pathogenesis as a Key to Rational Therapyhttps://orcid.org/0000-0001-7367-9219МехтиевС. Н.MekhdiyevS. N.

Мехтиев Сабир Насрединович — доктор медицинских наук, профессор кафедры госпитальной терапии с курсом аллергологии и иммунологии имени академика М.В. Черноруцкого; главный врач

197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8;197110, Санкт-Петербург, ул. Пионерская, д. 16

Sabir N. Mekhdiyev — Dr. Sci. (Med.), Professor of the Department of Hospital Therapy with the course of Allergology and Immunology named after Academician M.V. Chernorutsky; chief physician

197022, St. Petersburg, Lev Tolstoy str., 6–8;197110, St. Petersburg, Pionerskaya str., 16 

sabirm@mail.ruhttps://orcid.org/0000-0002-0842-855XМехтиеваО. А.MekhdievaO. A.

Мехтиева Ольга Александровна — кандидат медицинских наук, доцент кафедры госпитальной терапии с курсом аллергологии и иммунологии им. акад. М.В. Черноруцкого; врач-гастроэнтеролог

197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8;197110, Санкт-Петербург, ул. Пионерская, д. 16

Olga A. Mekhdieva — Cand. Sci. (Med.), Associate Professor of the Department of Hospital Therapy with a course of allergology and Immunology named after Academician M.V. Chernorutsky; gastroenterologist

197022, St. Petersburg, Lev Tolstoy str., 6–8;197110, St. Petersburg, Pionerskaya str., 16 

olgam-pantera@mail.ruhttps://orcid.org/0000-0001-7379-6896БеркоО. М.BerkoO. M.

Берко Олеся Михайловна — врач-гастроэнтерологСанкт-Петербург, 197110, ул. Пионерская, д. 16

Olesya M. Berko — gastroenterologist

197110, St. Petersburg, Pionerskaya str., 16 

berkoolesya@yandex.ruФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения Российской Федерации; OOO «Гастроэнтерологический центр “Эксперт"»First St. Petersburg State Medical University named after Academician I.P. Pavlov; Gastroenterological Center “Expert” LLCOOO «Гастроэнтерологический центр “Эксперт"»РоссияGastroenterological Center “Expert” LLCRussian Federation20223009202232495103Copyright © Мехтиев С.Н., Мехтиева О.А., Берко О.М., 20222022Мехтиев С.Н., Мехтиева О.А., Берко О.М.Mekhdiyev S.N., Mekhdieva O.A., Berko O.M.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/755

Цель исследования: Рассмотрение общих факторов риска и звеньев патогенеза функциональных гастроинтестинальных расстройств (ФГИР) для оптимизации терапии пациента с сочетанием нескольких ФГИР.Основные положения. ФГИР встречаются более чем у 40 % людей во всем мире, главным образом среди трудоспособного населения – у лиц молодого и среднего возраста. При этом более 30 % пациентов имеют сочетания двух и более функциональных расстройств желудочно-кишечного тракта (ЖКТ) — перекрестный синдром. Среди общих звеньев патогенеза ФГИР выделяют расстройство взаимодействия «головной мозг — кишечник», висцеральную гиперчувствительность, изменение кишечной микробиоты, гиперпродукцию провоспалительных цитокинов, нарушение эпителиальной проницаемости и моторной активности органов ЖКТ. Сочетание у одного пациента ФГИР различных областей ЖКТ связано с более выраженными клиническими симптомами (феномен взаимного отягощения). Наличие общих факторов риска и звеньев патогенеза функциональных расстройств позволяет сократить количество назначаемых лекарств при сочетании у одного пациента нескольких ФГИР, что также увеличивает приверженность терапии. Лечение ФГИР включает коррекцию факторов риска и медикаментозную терапию. В качестве патогенетически обоснованной фармакотерапии перекрестного синдрома интерес представляет препарат Колофорт — технологически очищенные антитела к ФНО-α, гистамину и мозгоспецифическому белку S-100.Заключение. Колофорт продемонстрировал высокую эффективность и безопасность, в том числе среди больных с синдромом перекреста ФГИР, что позволяет рассматривать его как препарат выбора в данной группе пациентов.

Aim: to review the common risk factors and links in the pathogenesis of functional gastrointestinal disorders (FGID) to optimize therapy of patients with a combination of multiple FGID.Key points. FGID occurs in more than 40 % of people globally, mainly affecting the working-age population in young and middle-aged subjects. At the same time, more than 30 % of patients have a combination of 2 or more functional gastrointestinal (GI) disorders i.e. overlap syndrome. Common links in the pathogenesis of FGID include disorders of gut-brain interaction, visceral hypersensitivity, changes in intestinal microbiota, overproduction of proinflammatory cytokines, impaired epithelial permeability and motor activity of the gastrointestinal tract. The combination of FGID in various gastrointestinal segments is associated with more pronounced clinical symptoms (mutual burden syndrome). Common risk factors and pathogenetic links of the functional disorders enables reducing the number of prescribed medications when several FGIDs overlap in one patient, which also increases adherence to therapy. Treatment of FGID includes adjustment of risk factors and drug therapy. As a pathogenetically justified pharmacotherapy of overlap syndrome, Kolofort, highly diluted antibodies to TNF-α, histamine and brain-specific protein S-100, is of interest.Conclusion. Kolofort has demonstrated high efficacy and safety including among patients with overlap FGID enabling to consider it as the treatment of choice in these patients.

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