Activated coal with irritable intestinal syndrome. An irritable bowel syndrome: double blow. With nervous tension

An irritable bowel syndrome (CRC) refers to functional diseases in which the pathogenesis of the development of symptoms cannot be explained by organic reasons. According to modern ideas, the CPC is a psychosocial disorder with a violation of visceral sensitivity and intestinal motor activity, due to or decreasing the threshold of pain perception, or an increase in the intensity of the feeling of pain impulses with the normal threshold of their perception.

At the same time, almost with all organic diseases of the gastrointestinal tract (gastrointestinal tract): ulcerative disease, gastroesophageal reflux disease, malignant tumors, bile-stone disease, chronic pancreatitis, etc. And somewhat less often of other organs and systems are symptoms characteristic of CRC. This fact allowed a number of authors to express the suggestion of the existence of a PCC crossing syndrome with other diseases or designate them as SRK-like disorders or symptoms. It is important to note that the principles of treatment of the SRC and the SRK-similar disorders of the same type.

CRK is considered the most common disease in the internal organs. Around the world, about 10-20% of the adult population have the corresponding SRC symptoms. According to most studies, women suffer approximately 2 times more often than men. The peak of morbidity falls on the most active worker age: 24-41 years. The symptoms of the CPC continue for a long time, can overlap other functional disorders and sometimes seriously worsen the quality of life.

The following factors are considered in the Pathogenesis of the SRC: a modified Motoric gastrointestinal tract, visceral hypersensitivity, disorder of interaction in the brain-gauge system, vegetative and hormonal shifts, genetic factors and environmental factors, the consequences of transferred intestinal infections and psychosocial disorders.

Diagnostic Criteria SRK

To establish the diagnosis of the SRC, the criteria for the diagnosis of Roman consensus III (2006) are used, which include: the presence of recurrent abdominal pain or discomfort for at least 3 days per month over the past 3 months, with the beginning of symptoms of at least 6 months associated with two or More than the following signs:

1) improvement after defecation;
2) the beginning is associated with a change in the frequency of the chair;
3) The beginning is associated with a change in the shape of the chair.

Symptoms confirming the diagnosis, but not part of the diagnostic criteria of the SRC, include:

1) Chair frequency violation: a chair is less than 3 times a week or more than 3 times a day;
2) Violation of the feces: solid or dumpless, liquefied or watery;
3) strain throughout the act of defecation, or imperative urge, or a sense of incomplete emptying;
4) secretion of mucus;
5) the presence of meteorism.

According to Roman criteria III, relying on the Bristol Cala shape scale (Fig.), It is proposed to classify patients with SRC to the following groups:

1. CPC with a predominance of constipation in the presence of a solid or dietary feces with more than 25% of the total intestinal emptying, however, the presence of a discharge (casczyce) or watery feces for less than 25% of the total emptying.
2. SRK with a dominance of diarrhea for which the presence of a casczyce or watery feces is characterized at more than 25% of the total intestinal emptying, however, the presence of a solid or bean feces for less than 25% of the total intestinal emptying.
3. The mixed type of SRK, in which the alternation of a solid or a bean-shaped feces and a casket-shaped or watery feces occurs at 25% or more of the total intestinal emptying.
4. The non-classified type of CPC is the insufficient severity of the deviations of the Cala's consistency for the above types.

It should be noted that the same patient has various SRC subtypes can vary throughout the disease.

Diagnosis of SRK is a diagnosis of exception, so if it is established, it is necessary to identify the so-called symptoms of anxiety indicating more serious pathology (Table 1).

Lead SPR Symptom - Abdominal pain

With any of the options, the leading symptom of the SRC is abdominal pain. Clinical variants of pain abdominal syndrome at CRC are distinguished by variability and variety. Stomach pain can be: stupid, butt, cutting, uncertain, sharp, cutting, dwarf, grasp-shaped, burning, various location and intensity. The most frequent localization of pain is the lower part of the abdomen, less often the estate. With pronounced intensity of pain, the irradiation of them in the back is possible. Often, pain is intensified in a vertical position or appear in the left hypochondrium or left half of the chest, which is associated with the rise and accumulation of intestinal gases in the highest department of the colon - the spleen corner. The relief or decrease in the intensity of this type of pain is observed when the gases are energized, which is facilitated in the patient's position lying on the stomach with the berries raised upwards, which is indicated by the term "spleen bend syndrome". The presence of the latter makes it possible to exclude cardiac, vascular and pulmonary pathology as the cause of pain syndrome. If there is a connection of pain with food intake, then its appearance or amplification is provoked not so much by its components as the act of food itself.

Treatment of patients with SRK

The CPC treatment program consists of two stages - the primary course and subsequent basic therapy. The purpose of the primary course of treatment is the elimination of symptoms of the disease and verification of EX Juvantibus the correctness of the diagnosis, which eliminates the need to further search for organic pathology and fulfill additional diagnostic procedures. The duration of the primary course of treatment is at least 6-8 weeks, basic therapy - 1-3 months. The choice of the program is determined by the interaction of several factors and depends on the leading symptom (pain, flatulence, diarrhea, constipation), its gravity and influence on the quality of life, as well as on the nature of the patient's behavior and his mental state.

The patient is prescribed an exception diet that does not contain: caffeine, lactose, fructose, sorbitol, vinegar, alcohol, pepper, smoked, as well as products causing excessive gas formation.

Treatment of SRC patients with a predominance of abdominal pain

The main mechanisms for the development of abdominal pain are due to a violation of intestinal motility and visceral hypersensitivity. Depending on the state of the tone and the peristaltic activity of the circular and longitudinal layers of smooth muscles, two types of motor disorders are formed: 1) the accelerated geimus transit in the intestine, due to the increase in the passive activity of the longitudinal muscular muscular layer with the development of diarrhea; 2) Slow transit of intestinal content due to the hypertonus of circular muscles (spastic diskinesia) colon with the formation of constipation. Since smooth muscle spasm is one of the main components of abdominal pain in the SRC, the drugs of choice for removing the spasm of any genesis and relief of pain, especially with the functional disorders of the gastrointestinal tract, are myotropic antispasmodics. They affect the final stage of the formation of hyperkinesia, regardless of its cause and mechanism.

The intestinal motor function is under the control of numerous regulating influences (central, peripheral, enteral nerve systems and gastrointestinal peptides), which determine the normal tone and the contractile activity of the smooth muscles of the intestinal wall. In this regard, it is possible to influence the smooth muscle cell in various ways.

Depending on the main mechanism of impact on the stages of the reduction of muscle fiber, the following groups of muscle relaxants are distinguished (Table 2). Anticholinergic remedies reduce the concentration of intracellular calcium ions, which leads to muscle relaxation. It is important to note that the degree of relaxation is directly dependent on the preceding tone of the parasympathetic nervous system. The latter circumstance determines the significant differences in the individual effectiveness of drugs of this group. Pretty low efficiency, lack of selectivity (action almost all smooth muscles, including the urinary system, vessels, etc., as well as on secretory glands) and in connection with this, a wide range of side effects, as well as the risk of developing muscle fiber hyperelaxation limit the use of anticholinergic drugs For cocutional treatment when the pain of pain in a large part of patients with CPCs.

Phosphodiesterase blockers - Miotropic spasmolitis (papaverine, drootaverine) contribute to the accumulation of CAMF in the CAMF cell and reduce calcium ions concentration, which slows down the Aktin compound with myosin. These effects can be achieved inhibition of phosphodiesterase, or activation of adenylate cyclase, or blockade of adenosine receptors or their combination. When using the above-mentioned group of antispasmodics, it is necessary to take into account the essential individual differences in their effectiveness, the absence of selectivity, the development of the hypomotor dyskinesia and the hypotension of the sphincter apparatus of the digestive tract, especially with long-term use. These drugs are used briefly (from one-time reception to a week) to relieve spasm, but not for course treatment aimed at relieving and preventing recurrence of the disease.

In the regulation of motorcycles, Serotonin plays a significant role. Several subtypes of serotonin receptors (5-nt 1-4) are isolated, but the 5-nt 3 and 5-nt 4 are most studied. Summage of serotonin C 5-NT 3 contributes to relaxation, and with 5-NT 4 - reduction in muscle fiber. At the same time, the accurate mechanisms of serotonin action on muscle fibers are not installed. Currently, antagonist 5-NT 3 is known from the drugs of this group, the total agonist 5-nt 4 - Prukalopride and a partial agonist of the 5th NT 4 - TigCorerD (in Russia, drugs are not used).

A certain value in the regulation of the motor function of the gastrointestinal organs is given to endogenous opiates. When they bind them to μ- (MJ) and Δ- (Delta), the opiate receptors of myocytes occurs, and from κ- (kappa) - slow motion. Currently, the treatment of opiate receptors is used in the treatment of patients with SRC - trimethetin (trime) - Motoric regulator GCC.

However, in the treatment of patients with CPC, preference is given to myotropic antispasmodics with a selective effect on smooth muscular cells of the gastrointestinal tract (furniture, bromide poverery). The group of fastest sodium channels of the cell membrane of myocyte refers to the preparation of furniture (Duspatolyalin), the mechanism of action of which is reduced to the blockade of the fast sodium channels of the cell membrane of the myocyte, which disrupts the flow of sodium into the cell, slows down the depolarization processes and blocks the calcium input to the cell through slow channels. As a result, the phosphorylation of myozin is disturbed and the reduction of muscle fiber is stopped. In addition, the drug blocks the replenishment of intracellular depot calcium ions, which, ultimately, leads only to the short-term output of potassium ions from the cell and its hypopolarization, which prevents the development of long-term relaxation of myocyte. The drug is prescribed 1 capsule 2 times a day 20 minutes before meals.

At the end stage, the balanced operation of the smooth muscle apparatus depends on the concentration of calcium ions in the cytoplasm of myocytes. Calcium ions come to myocytes through specialized membrane channels. The discovery of calcium channels leads to an increase in calcium concentration, the formation of the Aktin-myosin complex and the reduction of smooth muscles, and the blocking of the channels is accompanied, respectively, by a decrease in calcium concentration in the myocyte and relaxation. Previously, attention was drawn to the fact that calcium antagonists used to treat cardiovascular diseases (nifedipine and verapamil) have related effect on the sleek gastrointestinal sheds. This served as a reason to create a group of modern efficient myotropic spasmolitics - selective calcium channels of calcium channels of smooth muscles of the gastrointestinal tract. The classic representative of this group is Panoveria Bromide. Panoveria Bromide was first registered in 1975 and since then all over the world the drug is appointed annually about three million patients. It is currently being implemented in more than 60 countries. In Russia, the drug is registered entitled Dietetel.

Dicetel is calcium antagonist with a highly selective antispasmodic effect on the smooth muscles of the intestine. This determines its therapeutic use in abdominal pain, intestinal dysfunction and intestinal discomfort due to CPC. Currently, due to the results of electrophysiological and pharmacological studies, at least four types of calcium channels are identified: L, T, P, N. L-type channels are located on the surface of the cytoplasmic membrane of smooth muscle cells and consist of several subunits from which the most important is alpha1- Subunit. Alpha1-subunit of the L-type channel can be opened due to the potential difference on the surface of the cell membrane (neuronal control) or indirectly in the presence of digestive hormones and mediators. Studies using DNA cloning techniques and polymerase chain reaction It was demonstrated that the structure of the alpha1-subunit of the calcium channel of the intestinal cells differs from such an alpha1 subunit of calcium channels in the cells of other tissues. Dicetetel has a high affinity for the isoform of alpha1-subunit calcium channel, mainly localized in intestinal cells, which emphasizes the high selectivity of the drug in relation to this target organ. Thus, dicetetel has a unique double therapeutic effect: not only with antispasmodic effect, but also ability to reduce visceral sensitivity. These effects are implemented both due to the blockade of potential-dependent and receptor-controlled calcium channels of smooth muscle cells of the colon and by reducing the sensitivity of intestinal muscles receptors to gastrointestinal hormones and mediators, such as cholecystokinin and substance p.

Pharmacodynamics of Bromide Panoveria, Therapeutic effects:

• panovereiya Bromide has a maximal affinity for smooth muscle colon cells;
• significantly shortening the transit time in the colon, mainly due to an increase in the speed of the passage through a downward and rectosigmoidal zone of the colon;
• in diarrhea, the drug does not increase the mobility of the colon;
• inhibition does not enhance when re-stimulating and differs in that it does not depend on the voltage;
• the drug can be applied for a long time without fear of intestinal hypotension.

Over the past 20 years, the effectiveness of dicetela for the relief of SRC symptoms with all subtypes is estimated in numerous multicenter, open, comparative and placebo-controlled studies both in Russia and abroad. Evaluation of the effectiveness of Dicetela both by the researchers and patients showed a high frequency of good and very good results for the relief of the main symptoms of the SRC: Abdominal pain, constipation, diarrhea, abdominal bloating. The drug effectively and quickly stops pain caused by spastic abbreviations of the intestinal wall, and restores intestinal transit.

It has been a good tolerability of the drug, with a minimum number of side effects. Metaanalysis 26/23 studies grouped various antispasmodics for the presence of adverse reactions in comparison with placebo. Dicetetel was recognized as a means of best tolerant than hyoscium, trimeturin, cimetropy bromide, oxychonium bromide, peppermint essential oil, dicyclic bromide. Dicetell does not interact with the vegetative nervous system and therefore does not have anticholinergic side effects, especially when using therapeutic doses. In this regard, the drug can be used in patients with SRCs having concomitant prostate gland hypertrophy, urine delay or glaucoma. Unlike standard calcium antagonists, dicetela in therapeutic doses does not have cardiovascular effects. This is due to a very low level of its systemic absorption, mainly hepatobiliary excretion and high specificity in relation to both the smooth muscle tissue of the intestine and the subtypes of calcium channels. Dicetetel is prescribed 100 mg × 3 times a day while eating. Dicetetels can be combined with volumetric laxatives (lactulose, polyethylene glycol, psylium) in the treatment of patients with PCC with constipation. When diarrhea, the effectiveness of the diolete can be increased by a combination with enveloping drugs and adsorbents.

In the presence of meteorism, the drugs of simethicon - dimethics can be added to the dicetetel, which will increase the effectiveness of the treatment of patients with SRC.

Treatment of patients with CRC with predominance of constipation

Under the CRC with constipation, if there is no effect of the diet (increase in the consumption of dietary fibers up to 25 g / day) and myotropic spasmolitics, the treatment regimen includes osmotic laxatives, among which lactulose, magnesian milk, ppi ppi-ppi, macrogol and 4000 and Dr. Irritating laxatives for the treatment of CPCs with constipation are contraindicated, because they can provoke spastic cuts in the intestine and enhance painful syndrome.

Treatment of patients with CRC with the predominance of diarrhea

If the patient has a slight increase in the frequency of the chair, it is possible to use adsorbents - calcium carbonate, activated carbon, dysmectitis of 3 g per day in the form of a suspension. However, it is necessary to take into account that the antidiare effect of these drugs occurs no earlier than 3-5 days. With the ineffectiveness of the combined assistance of antispasmodics and adsorbents and a significant increase in the frequency of the chair can be assigned Loperamide. Loperamide refers to the agonists of M-opiate receptors, which determines its ability to suppress the rapid passive intestinal abbreviations and leads to a slowdown in the transit of the carts. This is accompanied by a decrease in the passage of the liquid part of the chimus, as a result of which the reabsorption of fluid and electrolytes in the intestine increases. The initial dose of loperamide for adults is 4 mg (2 capsules). The supporting dose should not exceed the maximum permissible daily dose for adults - 16 mg (8 capsules).

Treatment of patients with CRK with a predominance of meteorism

Inalienable and patient for the patient, SRC symptoms are bloating or a sense of abdominal stretching, as well as belching and excess gas separation through the rectum. These symptoms have minimal intensity in the morning hours and enhanced in the evening. The basis of their formation is not so much an increase in the volume of intricated gas, how much decrease in tolerance to the stretching of the intestinal wall. The main causes of excess gas in the intestine is an increase in its intestinal microflora products, slowing transit as a result of spastic dyskinesia, as well as impaired absorption in the intestinal wall in blood, in particular, with a quick transit during diarrhea.

If the SRC clinic prevails complaints and meteorism, with an adequate assessment of the role of gas formation in each particular case, the prescription of drugs is shown, the mechanism of action of which is based on the weakening of the surface tension of gas bubbles in the digestive tract, which ensures resorption and free gas selection. One of these symptomatic drugs to reduce gases in the intestine is Simetikon. The meteorism is prescribed 2 simethicone capsules 3-5 times a day. The simultaneous purpose of antispasmodics improves gas transit in the intestine. It should be borne in mind that in the pathogenesis of excess gas formation, the violation of the intestine microflora is played.

Correction of intestinal microflora

Recently, a large amount of data has been accumulated on the role of the violation of intestinal microflora in the formation of the SRC and SRK-like violations. This is especially true for patients with post-infectious CRCs, whose symptoms have evolved after transferred acute intestinal infections.

The results of experimental and clinical studies have shown that the change in the composition and habitats of the intestinal microflora is accompanied by impairment of motor activity and sensory sensitivity of the intestine, which underlies the formation of symptoms of intestinal dyspepsia, including abdominal pain, stool disorders, meteorism, etc.. When diarrhea, the accelerated transit of chimus in the intestine, due to the increase in the passive activity of the longitudinal muscular layer, is accompanied by a violation of hydrolysis and suction processes due to short-term contact of food ingredients with enzymes. This creates conditions for the development of excess bacterial growth, improving products and reduce the absorption of intestinal gas into the blood. Slowing transit of intestinal content due to the hypertonus of circular muscles (spastic dyskinesia) colon with the development of constipation is accompanied by an increase in intricate pressure not only in thick, but also in the small intestine and duodenum, as well as in the stomach. Long-term stasis of intestinal content leads to a violation of the quantitative and high-quality composition of intestinal microflora.

In the presence of excess bacterial growth in the intestine, a pronounced meteorism, when identifying a conditionally pathogenic microflora in the sowing of intestinal content of drug therapy, regardless of the type of CPC, it is recommended to add one or two seven-day courses of intestinal antiseptics of a wide range of action (Alpha Normix (Rifaximin), Furazolidon, Nifuroksazid, Sulgin (Sulfaguanidine) and others in generally accepted doses), with a change in the drug in the next course treatment and subsequent use of probiotics (bifiform, lines, etc.).

Psychological treatment

Psychological treatment should be used when the symptoms of the CPC refractory to drug treatment or there are evidence that stressful and psychological factors contribute to the exacerbation of gastrointestinal symptoms. Understanding the sick need of such treatment is an important factor in the success of therapy. Treatment is selected with the participation of the psychotherapist. In CRC, tricyclic antidepressants or selective serotonin capture inhibitors are usually prescribed. The purpose of the appointment of such drugs is: 1) treatment of mental comorbidity; 2) a change in the physiology of the gastrointestinal tract (visceral sensitivity, motility and secretion); 3) Reducing the central perception of pain. It is important to understand that antidepressants are prescribed under CPCs as drugs directly reduced visceral hypersensitivity, and only in the second phase to relocate depressive symptoms caused by pain. Such therapy should continue 6-12 months before the moment of reducing and determining the maintenance dose.

With CRC, various additional healing procedures are also used - therapeutic physical culture, physiotherapy, hypnotherapy, methods based on the principle of biological feedback, and group interpersonal treatment.

Literature

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N. A. Agafonova,
E. P. Yakovenko, doctor of Medical Sciences, Professor
A. S. Skinichnikova,candidate of Medical Sciences, Associate Professor
A. V. Yakovenko, candidate of Medical Sciences, Associate Professor
A. N. Ivanov, candidate of Medical Sciences, Associate Professor

RGMU, Moscow

According to the working group of the World Health Organization (WHO), irritable bowel syndrome (CPC) is a functional intestinal disorder, in which abdominal pain is combined with disorders of the intestinal function and defecation. The prevalence of SRC among the population is 14-48%.

In women, this pathology is 2-4 times more often than in men. Although the disease often begins in the youth, the peak of turning to the doctor about the specified illness refers to age of 35-50 years. Every year in the United States, the costs of diagnosis and visits to the doctor about CRC are $ 3 billion, and the costs of treatment - $ 2 billion in patients with CPCs significantly decreases working capacity, sleep, sexual activity is disturbed, other disorders that interfere with normal life are observed.

SRK - mystery?

Until now, the true causes of CRC, unfortunately, are not installed. It is believed that the SRC occurs due to motor and sensitive intestinal disorders. An important role is played by the disorders of the normal function of the central nervous system (CNS).

In patients, abnormal intestinal motility are noted, violations of secretion processes in the intestine, changes in visceral sensitivity. With CRC, both thin and the thick intestine show increased reactivity in the form of intestinal spasm, slowing down or accelerating motor skills on the impact of various stimuli, including drugs and even food.

E.P. Yakovenko et al. (1998) believes that in addition to the above factors, a significant role is played by the disturbed microbial composition in the lumen of fine and colon.

The products of the life of microorganisms support the irritable state of the intestine, contribute to the impaired hydrolysis of sugars, fats, proteins. An intraquish pH may decrease, which causes the inactivation of digestive enzymes and leads to relative enzymatic failure.

At the same time changes in sensitivity and intestines can occur under the influence of the CNS, including the highest departments. Patients are prone to depression, anxiety, carchatercophobia, they often react more actively by stress.

Border neuropsychiatric disorders are found in 75% of patients with SRC. It is possible, however, assume the feedback: such changes in personality are not the cause, but by the consequence of long-term disorders from the gastrointestinal tract (gastrointestinal tract).

Endogenous opioids (enkephalins, endorphins) and catecholamines are highlighted in the gastrointestinal tract, and in the brain. They can influence the change in the exchange of mediators (acetylcholine, serotonin, gastrin, etc.) on the motorcy and secretion of the intestine.

The CRK is often considered as a psychosomatic disease in which stressful situations act as trigger factors, followed by the inclusion of nervous, neuromuscular and hormonal chain reactions that determine the individual type of human motor skills.

Thus, in the PAT pathogenesis, the leading importance is attached to the following factors: psychological, violation of motility and visceral sensitivity, changing the chemical composition of intestinal content.

How to recognize the CPC

For the diagnosis, this largely mysterious disease is used by the so-called Roman criteria.

The following symptoms are preserved or recurred for at least 3 months.

Pain and / or discomfort in the stomach, which is easier after defecation, depend on changes in frequency or consistency of the chair.
The combination of two or more of the following symptoms that are worried for at least 25% of the total time when the patient is experiencing any complaints:

• changing the frequency of the chair (more than 3 times a day or less than 3 times a week);
• changing the consistency of the chair (fragmented, dense, liquid, watery);
• changing the act of defecation (the need for long-term outrelary, urgent urge, a sense of incomplete intestinal emptying);
• secretion of mucus during defecation;
• cutting in the intestine of gases and the feeling of overflow of the abdomen.

The diagnosis of the SRC is set by the exclusion method. Complete blood test, urine, feces analysis on hidden blood, a coprological study is determined by the daily loss of feed fat, the microbiological composition of the feces is determined, the ultrasound of the abdominal organs, colonoscopy, gynecological examination, with the accompanying gastrointestinal dyspepsia - FGS.

It is advisable to advise the patient with a psychiatrist. In accordance with the recommendations of the International Expert Meeting (Rome, 1998), the CRC with pain syndrome and meteorism, CRC with diarrhea, CRC with constipation.

Principles of treatment of SRK

The main condition for successful therapy is to establish trust relationships with patients. He must clarify the functional nature of the disease, and also to warn that the manifestations of the syndrome can be maintained for many months and even years without progression; Under the influence of treatment, symptoms can be weakened.

The patient's attention should be emphasized that the disease does not go into cancer and which is related to the intestinal hypersensitivity to the usual factors of the external environment. The duration of such a discussion with the patient should be at least 15 minutes.

Together with the patient, an individual plan of the activities needed to achieve remission of the disease, and possibly full cure.

It was not possible to prove the role of dietary nutrition in controlled tests, nevertheless the influence of dietary factors on the character of the chair (diarrhea, constipation) seems to be sufficiently significant. It should be limited to the reception of oily and gas-forming food, alcohol, caffeine, sometimes - excess fiber.

During constipation, it should be attempting to increase the number of ballast substances - dietary fiber (PV) in the diet.

Sources PV: cereals, roots (beets, carrots, pumpkin), fruit, cereals (buckwheat, oatmeal). The most pronounced opportunity effect is rendered black bread, dried fruits, especially prunes, dried apricots. Traditionally, during constipation, the number of vegetables and fruits in the diet should be at least 500-700 g daily.

When swolling and pain first, they should be taken in boiled, stew and baked. As pain, the combination of raw and boiled, stew, baked vegetables and fruits is individually selected. At the same time, it should be said that the opinion on the therapeutic effect of dietary fibers during CPC is ambiguous.

With constipation, the defecation may violate not only due to a change in the consistency of the feces and slowing motility of the entire colon, but also due to coordination disorders of the pelvic bottom muscles.

For diarrhea, milk, raw vegetables and fruits are excluded, it is possible to use a small amount (100-200 g) boiled or stewed carrots, zucchini, baked apples. It is allowed to eat beef, chicken meat, rabbit, fish, eggs, dairy products, including cottage cheese, cheese, white bread, porridge.

With pronounced diarrhea, food is wiping. As well-being improved, the amount and composition of vegetables and fruits is determined by the patient individually.

Pharmacotherapy SRK

Drug treatment of the SRC is carried out according to the recommendations on the diagnostic and treatment of the CRC approved on the V Russian Gastroenterological Week (Moscow, 1999).

Constipation and bad tolerance of products containing ballast substances (PV). Using swelling laxatives: Mukofalc - a drug from the shells of plantain seeds. It is able to hold water, thereby increasing the volume of the chair and it becomes soft.

Unlike other laxatives, these drugs are not annoyed by the intestines. Mukofalc is taken before breakfast (1-2 packages), drinking a significant amount of water, if necessary, the drug is accepted in the evening. In constipation resistant to the mucofalk, it is combined with lactulose or cisapride.

Osmotic laxatives: lactulose, sulfurium magnesia, citrate and magnesium hydroxide, Forlax, etc.

Forlax forms hydrogen bonds with water molecules in the intestinal lumen, increases the amount of fluid in the chimus, stimulates the mechanorersceptors, improves intestinal peristaltics.

Reflex evacuation is restored and the defecation act is optimized (due to the normal volume and consistency of Hamus). The drug is not absorbed and is not metabolized, it takes 1-2 packages 1-2 times a day. The laxative effect develops 24-48 hours after taking.

Lacktulose takes 30 ml 1-2 times a day, sulfate magnesia - 10-30 g in 1/2 cup of water, citrate and magnesium hydroxide - 3-5 g per reception.

It is possible to use laxatives, softening powerful masses: vaseline, almond oil, liquid paraffin, although their relaxing effect is somewhat less expressed.

Laxatives are stimuli (with an anti-relaxing-secretory mechanism of action): Guttalaks, bisakodil, anthranoida. These drugs inhibit the absorption of water and electrolytes in a thin and colon, thereby increasing the flow of water into the intestinal lumen.

This increases the volume of intestinal content and the time of passing it in the colon is reduced. They also stimulate the contractile activity of the colon.

Guttalaks prescribe 5-15 cap., Bisakodil - 2-3 dragey per day or 1 candle rectally. These two drugs are one of the most appointed, probably due to the predictability of their actions.

Anthranoids: Drugs of Senna, Aloe, Cruise Cort, Rhubarb root. Currently, they are appointed less often due to the fact that their use is accompanied by pain syndrome, especially the first time. However, it is characteristic of all "stimuli" in the first 3-6 receptions. With prolonged use of SENNA preparations, the formation of melanose the mucous membrane of the colon and the damage to intermushny nerve plexuses is possible.

Means activating motorcycle gasts: These drugs are isolated to an independent group of prokinetics. They have a relaxing effect and significantly reduce the bloating. These include cisaprid (coordinix, peristyle), which is prescribed 3 times a day 15 minutes before meals and at night, or 20 mg 2 times a day.

Ponom. Preparations are prescribed, slowing down the promotion of the intestinal content. First of all, it is Loperamide (Imodium, Vero-Loperamide). Dosing scheme: 2-4 mg 1-2 times a day.

Binding: Calcium carbonate (1.5-3 g 1-3 times a day), aluminum hydroxide (1 g 1-2 times a day), smacks (1-2 package 3-4 times a day).

SRK with pain syndrome

Safety:

1. calcium channel blockers: Austzomen (40 mg 3 times a day) or dicetela (50 mg 3 times a day;
2. cholinolitics: Buckopan (10 mg 3 times a day);
3. motoric regulators: Debidat (1-2 Table. 3 times a day).

The drug acts on an encofalinergic intestinal system, as a result of which decreases with pain syndrome. With affinity for suppression and excitation receptors, it has a stimulating effect in the hypomotoric and antispasmodic effect during hyperkinesia.

Often, pain syndrome is not connected so much with a spasm (and antispasmodics in this case will be ineffective), but with a gas of the intestine of the gas, in connection with which a number of patients pain disappears after the appointment of funds that reduce the bloating of the abdomen.

Meteorism, Flatnament often bother patients with SRK and as independent symptoms. The reasons for excess accumulation of gases in the intestines are complex. An important role is played excessive ingestion of air. It occurs with a hurry food, insufficient firewalk and conversations during meals. A significant amount of gas is produced in a thin and colon.

In the colonum, the gas is formed as a result of the enzymatic effect of intestinal bacteria on organic matter, non-pecked in the small intestine. It is more often carbohydrates, non-treated with amylases, in this case CO2 is formed.

Hydrogen sulfide is a product of amino acid transformation anaerobes. For days, 20 liters of gas is formed in the intestines. It is mostly reabsorbated through the intestinal wall. Nitrogen and hydrogen sulfide are not absorbed and stand out through the rectum. During the day, 600 ml of gases is distinguished through the rectum, individual differences are possible in the range of 200-2000 ml.

An unpleasant smell of gases is associated with the presence of trace amounts of scatol, hydrogen sulfide, mercaptan. They are formed in the colon as a result of the effects of microflora on non-fulfilled protein substrates in the small intestine. The accumulating substances are formed in the intestine of the foam: a dispersion system consisting of gas bubbles and liquids. This system is subject to the laws of surface tension.

The stronger the processes of normal digestion and suction of food ingredients are broken, the more gases are formed and the conditions for the formation of a stable foam are facilitated. Foam, covered with a thin layer of the surface of the intestinal mucosa, makes it difficult for the tribe digestion, reduces the activity of enzymes, reduces the reabsorption of gases.

In patients with CPCs, there is most often an alimentary, dysbiotic, dynamic and psychogenic meteorism. Treatment is aimed at eliminating the causes of meteorism.

Effective adsorbents and defoamers. It can be activated carbon, white clay, aluminum hydroxide, bismuth preparations. The best defoamer is Siemeticone (Espumizan). This is a high molecular weight polymer based on silicon. It is scheduled for 40 mg 3 times a day.

SRC with excess bacterial growth in the small intestine and dysbiosis of the colon. First, antibacterial drugs are prescribed: Intetrix (1-2 caps. 3 times a day), or Frazolidon (0.1 g 3 times a day), or Erspuril (1 caps. 3-4 times a day), or Metronidazole (0, 25 g 3 times a day), Sulgin (0.5 g 4 times a day), enterol 1-2Pack 2 times a day. One of these funds is appointed, as a rule, for 5-7 days, there are two consecutive courses in various drugs.

It is possible to prescribe probiotic - bacterial drug: bifiform (1-2 caps. 2 times a day), or colibacterin, bifidum bacterine, lactobacterin (5 bioodosis 1-3 times a day immediately after eating for 2-6 weeks). At the same time, it is possible to prescribe and prebiotic: Hilak-forte (the product of the metabolism of normal microorganisms of intestinal flora of 50-60 cap. 3 times a day).

Against the background of the intestinal dysbiosis, the relative deficit of digestive enzymes may be observed. In this regard, enzyme preparations can be appointed. Under the CRC with constipation, it is more expedient to prescribe enzyme preparations containing bile and / or hemicelylase: panzinors, festal, digestal, enzystal, etc. They are prescribed 1 table. In the morning, 2 tab. At lunch and 3 tab. in the evening.

When IPCs with diarrhea use enzymes containing pancreatin (polecut, caon, limitarasis, mesim-forte). In general, with a SRC with excess bacterial growth syndrome in the intestine, the following approximate treatment regimens are recommended:

• 1st week: Ersafuril and / or metronidazole + enzyme preparation + drugs, normalizing motor disorders;
• 2nd week: Hilak-Forte + BIFI Forms + enzyme preparation + drugs, normalizing motor disorders;
• 3rd week: Hilak-Forte + Biofi-forms.

When depressed, increased alarm, asthenia, carcercofobia can be assigned anxiolitics and antidepressants. As a rule, they are appointed after consulting a psychiatrist. The most effective tricyclic antidepressants: amitriptyline (1-2 table.), Lerivon 1-2 Table., Or inhibitors of serotonin reverse seizure: fluoxetine (Framex) - 40 mg / day.

In addition to the relief of the actual symptoms of depression, they have a neuromooling and analgesic effect. Eglonyl (25-50 mg 2 times a day) contributes to the relief of pronounced vegetative disorders.

Despite the sufficient set of drugs used for the treatment of SRC, often the effectiveness of treatment is estimated as insufficient. There is a search for new tools for the treatment of this disease.

A great achievement is new enzyme preparations. One of them is pepfis. The effectiveness of the drug pepfis (Ranbaxix Laboratories Ltd.) was investigated) in patients with SRK.

Pepfis contains in 1 tablet: papain 84 mg, fungal diastasse 30 mg, Siemeticone 27.5 mg and auxiliary substances - sodium bicarbonate, potassium bicarbonate, citric acid, fumaric acid, saccharin sodium, sodium carbonate, sodium lauryl sulfate, dye Sansset yellow and orange flavoring.

Pharmacological properties: Papain digestive enzymes and fungal diastasses facilitate digestion and assimilation in the body of proteins and carbohydrates. Siemeticone is a "defoamer", which reduces the amount of gas in the intestine.

Pepfisis is shown in any violations of the outer-generating function of the pancreas (chronic pancreatitis), proximal departments of the small intestine and during liver diseases, in the syndrome of ugly dyspepsia, with meteorism, enhanced gas formation in the postoperative period, a sense of stomach overflow or meteorism due to unusual food, overfers alcohol, coffee, nicotine.

Dosing mode: 1 Table. 2-3 times a day after meals. Content 1 tab. Before use is dissolved in 1/2 art. water. Sidey of action in the drug is not detected. In 1 peplis tablet contains 419 mg sodium, and therefore it is necessary to prescribe with caution in hypertension, kidney and liver diseases. The drug is contraindicated in individual intolerance.

CONSIDERATION OF THE ARTICLE: ClassList.Toggle () "\u003e Expand

An irritable intestine syndrome (CRC) is a comprehensive impairment of the digestive tract, is a functional disorder (there are no irreversible changes in the body). Women suffer 2 times more often than men, the disease amazing people aged 20-45 years.

The reasons

SRK may occur for the following reasons:

According to the characteristic of the chair, the following types of SRK are distinguished:

• CRC with a predominance of constipation: solid carriages make up 25%, diarrhea less than 25% of the total number of feces;
• SRK with a predominance of a liquid chair: diarrhea is greater than 25%, solid feces less than 25%;
• Mixed SRK: solid and liquid chair make up more than 25%;
• Unclassified SRK: data is not suitable for the above options.

Symptoms

The main symptoms of the SRC include:

In addition to the "intestinal" symptoms, in physical and emotional overvoltage, the person may have the following signs:

• Insomnia;
• Sensation of a lump in the throat;
• Lack of air;
• Headache;
• Noise in ears;
• Lethargy, drought;
• Polyuria (stripped urination).

Diagnosis of the disease

The diagnosis of "irritable intestinal syndrome" is placed on the basis of the complaints of the patient, collecting anamnesis (heredity, nature of nutrition, lifestyle), when inspecting (bloating, spasm of smooth musculature), according to the results of laboratory research.

Diagnostic studies:

• Clinical blood test for leukocytosis, accelerated ESP, anemia (reduced amount of erythrocytes);
• Cal on hidden blood;
• Coprogram - Cala's study on color, the presence of blood impurities in it, mucus, untapped food fragments;
• - endoscopic rectum research: assess the state of the mucous membrane;
• Irrigoscopy - X-ray study with a contrasting substance. The patient drinks the barium suspension, then produce a series of pictures on which the intestinal performance is evaluated, congestive phenomena of the roaming masses.

Methods of treating SRK

Medical treatment:

• Analgesics - for the removal of pain syndrome: Analgin, Ketanol, Salpadeev Fast. Ketanol, 1-2 capsules 2-3 times a day;
• Safasmolitis - to remove spasm smooth muscles: spasmolgon, dicyclomine, spask. Sparec 200 mg, 1 tablet 2 times a day;
• Anti-diaper - with a liquid chair: Diar, Lopedium, Imodium. Diara, the initial dose of 2 tablets, then 1 tablet after each fence, the maximum daily dosage of 16 mg (8 tablets);
• Laxatives during constipation: citrut, gutasyl, metamocil. Citrofole, 1 capsule twice a day;
• Antidepressants - to remove depression: imipramine, fluoxetine, amitriptyline. Amitriptyline, 1 tablet 3 times a day;
• Probiotics - to restore the natural intestinal microflora: acipol, bifidumbacterin, lactobacterin. Lactobacterin, 5 doses per day;
• Enterosorbents - remove toxic substances from the body: polyfepan, activated carbon, smect. Activated carbon, 1─2 tablets 4 times a day;
• Enzymatic means - to improve digestion: Creon, Mezim, Penzal. Mesim, 1-2 tablets 2-3 times a day;
• Intestinal antiseptics: Intetrix, Furazolidon. Intotrix, 2 capsules in the morning and 2 capsules before bedtime.

Physiotherapeutic procedures:

Psychological methods:

• Spoken treatment: identifying problems, their elimination, suppression of anxiety; relaxation (relaxation) of the body;
• Hypnotherapy (hypnosis treatment): Hypnosis helps to reduce pain syndrome on the subconscious level, a sense of discomfort.

Patient with irritable intestinal syndrome It is necessary to perform regular dosage physical exertion, to make hiking outdoors.

Physical exertion have a positive impact on the activity of the nervous system, increases the stress resistance to stressful situations.

Diet

Diet with CPC depends on the predominance of symptoms (diarrhea or constipation). Power must be fractional, minimal portions, at least 6 times a day at one set time. Preferences need to be given to products that contain coarse fiber (fiber) - whole cereals, bran.

When the SRC with constipation should include the following products:

• Raw vegetables and fruits;
• Sweets (honey, jam);
• Lactic acid products (kefir, sour cream, cottage cheese);
• Creamy, vegetable oil;
• Rye bread, with bran;
• Meat fish;
• Cold soups;
• Cereals, cereals;
• Robber decoction, green tea, vegetable and fruit juices.

Prohibited products:

ethnoscience

The following recipes of traditional medicine are used in the treatment of SRCs:

Complications

CRK is not able to cause serious complications and diseases, but may cause psycho-emotional disorder (Depression, quick temper, anxiety).

It can have a negative impact on some aspects of a person's life: public (visiting work, public events), private (relationship with family, sexual partner).

In most cases, drugs for the treatment of irritable intestine syndrome are selected on the basis of its clinical picture. The main condition for the successful treatment of CRC is the effective cooperation of the patient and the doctor, modifying the lifestyle and diet. Only in the absence of the effect of these events, the patient needs to begin taking medicines from irritable intestinal syndrome.

Groups of drugs

Preparations used in the SRC can be divided into the following groups:

• anticholinergic agents;
• antipipped drugs;
• antidepressants;
• laxatives increasing the volume of carts;
• serotonin receptor antagonists;
• activators of chloride channels;
• guanillaziclase agonists;
• probiotics.

The medicine in the irritable intestine syndrome is selected based on the clinical picture existing in the patient, that is, is symptomatic.

The most common means

Consider the testimony to drugs from the groups listed above.

Anticholinergic agents

Medicines from this group have spasmolytic properties, that is, suppress the reduction in the smooth muscles of the intestine. These drugs help alleviate the symptoms of spasms in the abdomen during irritable intestinal syndrome.

Dicyclomin (Bentil)

This drug directly relaxes the smooth muscles of the intestine, without affecting the production of gastric acid. Its action begins 1-2 hours after reception and lasts up to 4 hours. Dicyclomin take orally, as a rule - 4 times a day before meals and at night.

To prevent the development of side effects, the doctor may first assign this tool in small quantities, and then gradually increase the dose. Antacts reduce the absorption of Dicyclic, so it is impossible to be taken at the same time.

If you take this medicine for the treatment of irritable bowel syndrome, quite regularly and long, with a sudden cessation of its reception, the abolition syndrome may occur, which is manifested by dizziness, sweating and vomiting.

Other side effects that may appear when using Dicyclic:

• dizziness (40%);
• dry mouth (33%);
• visual clouding (27%);
• drowsiness (9%);
• nervousness (6%);
• general weakness (7%).

The bloating, the confusion of consciousness, accommodation paralysis, delirium, dermatitis, erythema, fatigue, hallucinations, insomnia, malaise, palpitations, rash, syncopal states are less likely.

This preparation for treatment cannot be used simultaneously with alcohol.

Dicyclomin is contraindicated with:

• allergies on it or other anticholinergic agents;
• clotted glaucoma;
• miasthenia;
• massive bleeding;
• intestinal atonia;
• toxic megacolon;
• severe;
• Ezophagitis.

It is also not used in women, nursing breasts, and in children under 6 months.

With caution, dicyclomin is prescribed:

• patients with hepatic or renal failure;
• patients with benign prostatic hyperplasia;
• people with stagnant heart failure;
• with tachycardia due to heart failure or thyrotoxicosis, arterial hypertension, ischemic heart disease, chronic obstructive disease of the lung, mitral stenosis, brain damage;
• with tachyarhythmias.

Hyoscyamine

This agent is used to treat problems with the digestive tract, including irritable intestinal syndrome, as well as various urinary bubble diseases. Hyoscyamine reduces the production of gastric acid, slows down, relaxes smooth muscles in many organs.

Take this drug needed strictly to appoint a doctor. Quick-action tablets take 30-60 minutes before meals orally or under the tongue at a dose of 125-250 μg every 4 hours or as needed. It is impossible to exceed a dose of 1.5 mg per day (12 tablets).

When tablets of prolonged action, it is necessary to take 375-750 μg of the Hyoscyamine twice a day. It is also impossible to exceed a dose of 1.5 mg in 24 hours (4 tablets of prolonged action).

Side effects include:

• dry mouth;
• urine delay;
• blurred vision;
• tachycardia;
• midship;
• an increase in intraocular pressure;
• loss of perception of taste;
• headaches;
• nervousness;
• drowsiness;
• weakness;
• nausea;
• vomiting;
• constipation;
• bloating and abdominal pain;
• diarrhea;
• allergic reactions, etc.

Hyoscyiamine intake for the treatment of irritable intestinal syndrome is contraindicated with patients with allergies to it, closed-coronal glaucoma, miastenia, overlapping of urinary tract, obstruction of the digestive tract (for example, pylorus stenosis), intestinal atonia, unstable hemodynamics during bleeding, severe ulcerative colitis.

The drug can not be applied to women who feed the baby's breast.

With care, hyoscyamine is used if:

• stagnant heart failure;
• ischemic heart disease;
• chronic obstructive pulmonary disease;
• diaphragmal hernia;
• reflux-esophagitis;
• mitral stenosis;
• down syndrome;
• autonomous neuropathy;
• hyperthyroidism;
• tahiaritimia.

Contrast drugs

Contrast drugs in the treatment of irritable intestinal syndrome slow down the passage of food and reduce the production of digestive juices.

Lobyl (DiPhenoxylate hydrochloride + atropine)

This combined drug helps reduce the incidence of defecation during diarrhea, slowing the intestinal peristalsis. Diphenoxylate is similar to narcotic anesthetics, but mainly acts on the intestines. Atropine belongs to the class of anticholinergic agents, which also slow down the intestinal peristalsis and reduce the secretion of digestive juices.

Adults with an irritable bowel syndrome and the diarrhea first are prescribed to take cloth 2 tablets 4 times a day, and then gradually reduce the dose individually. Children aged 2 to 13 years old are prescribed in the form of a syrup in a dose designed for their weight. Most often, the relief of diarrhea occurs in the first 48 hours.

The side effects of this drug include:

• blurred vision;
• sedation;
• nausea and vomiting;
• discomfort and abdominal pain;
• dry mouth;
• aggravation;
• bloating;
• constipation;
• deterioration of appetite;
• drowsiness;
• heart palpitations;
• shortness of breath;
• nervousness and irritability.

Lobtil can not be prescribed to people with allergies to diphenoxylate or atropine, intestinal obstruction, closed-coronal glaucoma, miastenia, weakness of muscle intestinal machine, diarrhea associated with pseudommbranous colitis or bacterial infection.

With caution, it is used in the presence of renal and liver failure, ulcerative colitis.

This is one of the most frequently used counter-line drugs for the treatment of irritable intestinal syndrome. It slows down the peristaltics and reduces the watery of the chair, facilitating the diarrhea.

In diarrhea in adults, first, Loperamide is given in the starting dose of 4 mg (2 tablets), and then 2 mg (1 tablet) after each liquid stool. It is impossible to exceed a dose of 16 mg (8 tablets) per day. In children aged 2 to 6 years old, the use of a loperamide in the form of a syrup is recommended, the doctor picks up the doctor on the basis of the severity of the child's disease and weight.

The drug is contraindicated in the presence:

• allergies for Loperamide;
• bloody diarrhea;
• very high body temperature;
• infectious diarrhea;
• pseudomambranous colitis;
• constipation.

You can not heal children under 2 years old.

Side reactions to Loperamide include:

• bloating;
• constipation;
• deterioration of appetite;
• nausea;
• dizziness;
• abdominal pain and nausea and vomiting;
• skin rash;
• drowsiness;
• dry mouth.

Antidepressants

Tricyclic antidepressants have a contracted and anesthetic effect during irritable intestinal syndrome, so effectively eliminate the symptoms of this disease.

This tool provides an anesthetic effect in the bowel in doses, which are below those that are needed for antidepressive action. Amitriptin also lengthens the intestinal food time, reduces the pain in the stomach and the frequency of the chair, improves the overall well-being. The amitriptyline is taken from the irritable intestine syndrome in the tablets at a dose of 10-50 mg once a day before bedtime.

This drug is contraindicated in the presence of allergies to it, in the acute period of myocardial infarction, in the treatment of monoaminoxidase inhibitors during the previous 2 weeks, with glaucoma, under the age of 12 years.

With caution should be used amitriptyline if:

• cardiovascular diseases;
• diabetes;
• renal and liver failure;
• thyroid dysfunction;
• convulsive seizures;
• a benign prostate hyperplasia;
• urine delays;
• weakening peristaltics.

The drug in the treatment of irritable intestinal syndrome penetrates the maternal milk, so at the time of its reception from breastfeeding it is necessary to refuse.

Amitriptyline side effects may include:

• constipation or diarrhea;
• nausea and vomiting;
• changes in appetite and weight;
• more frequent urination;
• rash, itching;
• the edema of the mammary glands;
• reduction of sexual entry and impotence;
• dizziness;
• weakness;
• temperature increase.

In no case cannot simultaneously take amitriptyline and alcohol.

Antibiotics

Antibacterial agents can be used in the treatment of irritable intestinal syndrome to prevent excessive reproduction of intestinal bacteria.

Rifaximin

This is a semi-synthetic antibiotic, the overwhelming protein synthesis in bacteria and their growth. Most often, when Rifaximin is prescribed in the presence of diarrhea. As a rule, it is applied at a dose of 550 mg every 8 hours within 14 days.

Rifaximin is contraindicated in the presence of allergies to it. Side effects include meteorism, headaches, tenesmas, pain in the abdomen, nausea, constipation, temperature rise, vomiting, allergic reactions, itching, rash.

Laxative means increasing the volume of carte

These drugs consist of hydrophilic polysaccharides and hiking cellulose, which swell in intestinal fluid, forming a gel that facilitates the passage of intestinal content and stimulating peristaltic. They can facilitate the symptoms of constipation and diarrhea.

Methylcellulose

This synthetic preparation is prescribed with irritable bowel syndrome to provide a soft laxative action. Take it 2 capsules to 6 times a day, be sure to drink every dose of glass of water.

Methylcellulose can not be applied at:

• allergies for her;
• intestinal obstruction;
• symptoms of appendicitis or acute abdomen;
• availability of ulcers in the digestive tract;
• calovable dawn;
• dysphagia;
• bleeding from the rectum.

The side effects of this drug include meteorism, excessive intestinal activity.

Seeds of plantain

Preparations of plantain seeds stimulate a chair, forming a gel fluid and contributing to the peristaltics. They are produced in the form of powder or granules that are in bags. These drugs are adopted at a dose of 2.5-7.5 grams, spreading in a glass of water, until 30 grams per day reaching.

Contraindications include allergies, intestinal obstruction, appendicitis symptoms or acute abdomen, the presence of an ulcers in the digestive tract, a wheelchair, dysfagia and bleeding from the rectum.

Side effects include spasms in the abdomen, flatulence, constipation.

Serotonin receptor antagonists

From this group of medicines from the irritable intestinal syndrome is used by Alosault. The drug applies only in women with CRC, manifested by severe diarrhea and not responding to standard treatment.

At first, it is prescribed 0.5 mg orally every 12 hours for 4 weeks, then, subject to good tolerability, the dose is raised to 1 mg every 12 hours.

Drug is contraindicated in the presence of:

• allergies;
• reliced \u200b\u200bbleeding;
• constipation;
• ischemic colitis;
• intestinal obstruction;
• intestine perforations;
• crohn's diseases;
• ulcerative colitis;
• severe liver failure.

Side effects include:

• constipation;
• abdominal pain;
• nausea;
• headaches;
• fatigue;
• stretching bowel;
• flatulence;
• hemorrhoids;
• urinary tract infections;
• ischemic colitis;
• anxiety;
• bone pain.

Activators chloride channels

Preparations increase the amount of fluid in the intestine, which stimulates its emptying. They are prescribed when CPCs with constipation.

Lubiprostton

The drug is used in irritable intestinal syndrome with constipation only in women over 18 years old. Lubiproston is prescribed at a dose of 8 μg orally every 8 hours.

It is contraindicated in allergies and mechanical intestinal obstruction. Side effects include nausea, vomiting, diarrhea, edema, discomfort in chest, fatigue, dizziness, flatulence, dyspepsia, dry mouth, abdominal pain.

Agonists guanillates

Preparations increase the secretion of fluid into the intestinal lumen and speed up the passage of food.

LinacloTide

It is used to treat irritable bowel syndrome with constipation in adults, it helps to increase the volume of intestinal content by enhancing the secretion of the liquid. This facilitates the passage of the intestinal content, and also weakens pain and discomfort in the abdomen.

Linaclotid is taken at a dose of 290 μg 1 time per day on an empty stomach 30 minutes before the first meal.

The drug is contraindicated in the presence of allergies to it, in children under 6 years old, mechanical intestinal obstruction. More adult children (from 6 to 17 years old) from the use of linaklotide should also be refrained, since there is enough information about its safety.

Side effects include diarrhea, pain in the abdomen, meteorism, headaches, sinusitis, incontinence, fatigue, vomiting.

Probiotics

These are funds that contain so-called friendly bacteria, restoring the natural balance of intestinal microflora. Some patients note that regular reception of probiotics helps to facilitate SRC symptoms, but these statements do not have scientifically based evidence.

If a person with irritable intestinal syndrome decided to take probiotics, he needs to be treated with them at least for 4 weeks.

Enterozermina

This drug consists of a Bacillus Clausii microorganism dispute, which is part of the normal intestinal microflora, due to which it can be useful in its recovery. As a rule, enterozermina is taken orally 1 bottle 2-3 times a day.

Contraindications include allergies for the drug, children's age up to 1 month. In the treatment of enteroezermy, side effects rarely develop, the occurrence of allergic reactions - urticaria and skin rash.

Treatment with folk remedies and diet

The treatment of irritable intestinal syndrome by drugs is recommended to combine with therapy with folk remedies and a diet.

The diet is selected on the basis of dominant symptoms. The patient needs to start a diary and celebrate consumed products in it, write down the symptoms of the disease. This will help calculate that food that provokes the exacerbation of the SRC to avoid it.

If the CRC is combined with constipation, an increase in the diet of the soluble fiber can be helped, which is contained in fruits, root crops (carrots, potatoes), oats, barley, rye. On the contrary, with diarrhea, it is better to eat with a high content of insoluble fiber - wholegrain products, bran, nuts and seeds.

If the patient is concerned about the constant bloating, he can help restriction of the use of products containing oligosaccharides, disaccharides, monosaccharides and polishes. These substances are quickly learned in the intestines, which is accompanied by the release of a large number of gases. Such products include ordinary, sheet, Chinese, color and Brussels cabbage, broccoli, peas, nuts, lentils, beans.

Often, patients give advantage of folk remedies with irritable intestinal syndrome. It is possible to do this, but first you need to consult with your doctor, since some ingredients used in such treatment can enter into interaction with drug received medicines.

As well as drug treatment, the use of methods of traditional medicine in the SRC depends on the symptoms of the disease:

• With frequent spasms in the stomach helps the infusion of peppermint. For its preparation 2 tablespoons of dry leaves poured with a glass of boiling water and insist for 20 minutes. Infusion can be used instead of tea.
• When scaring the abdomen can help infusion from dill. For its preparation, a tablespoon of grass or dill seed should be pouring 500 ml of boiling water and insist 2 hours. Use 100-150 ml three times a day before meals.
• At diarrhea, it is sometimes used in the grenade crust. Tablespoon of dry crust pour 250 ml of boiling water and insist to pink. It should be used at a time.
• When constipation, the seeds of the plantain can help. For this, 2 dessert seed spoons need to soak in 100 ml of water for 30 minutes, after which they need to eat.

In addition, physical exercises are useful to patients with CPCs - they help facilitate depression and stress, stimulate the normal functioning of the digestive tract.

An irritable bowel syndrome is a common disease. Such a diagnosis is subject to other reasons for existing symptoms of digestive disorders. Before starting to treat the irritable intestines with medicines, you should try to eliminate his signs with the help of diet and exercise.

Useful video about the treatment of irritable intestinal syndrome

Thank you

The site provides reference information solely to familiarize yourself. Diagnosis and treatment of diseases must be under the supervision of a specialist. All drugs have contraindications. Consultation of a specialist is obligatory!

General

In total, almost twenty-two million inhabitants of the planet suffers from this disease, which is 20% of the population of mature age. More susceptible to a disease of a weak floor representative aged from thirty to forty years. Unfortunately, the overwhelming majority of patients do not even resort to the services of doctors, despite the fact that the disease not only worsens the digestion of food, but also significantly reduces the quality of life of the patient. Patients decreases sexual attraction, performance falls, people cease to rejoice in life.

The reasons

• Eating in stress state
• Illiterate diet drawing up, too high caffeine, alcohol, fatty meal ( fat food very strongly stimulates intestinal motor activity), soda,
• Lack of plant fiber in the diet,
• Gluttony.

Psyche and Development of SRK

In some persons, the motor function is somewhat changed, which is an impetus for the development of the syndrome.
According to doctors, with this syndrome, pain is localized in the wall of the large intestine. In the tissues of this organ there are many nerve endings sensitive to "stress hormones", including adrenaline. The pain leads to the fact that the intestinal peristalsis increases, with increased gas formation, even a small stretch of the intestine causes pain, since the receptors are already "excited". The reaction to pain can be directly opposite - that is, the patient has constipation. They are spashed as a small intestine and fat.

Signs of the disease

• The main symptom is diarrhea,
• The main symptom - constipation,
• The main symptom is increased gas formation and epigastric pain.

Symptoms with a predominance of diarrhea

• Pain immediately after waking up in the morning. The intensity of pain can be different, but the time of appearance is permanent.
• The pain appears during the meal, more often before lunch.
• Nearby diarrhea, feeling not the final exemption of the intestine.
• Increased gas formation in the morning.
• Panic attacks and urges for defecation during complex situations.
• Predisposition to dysbacteriosis.
• Discomfort when lying on the left side.
• Violation of urinary.
• Migreen pain.
• The feeling of lack of oxygen.
• Sensation of the foreign sore throat during swallowing.
• Sometimes the predisposition to candidiasis.

Symptoms with predominance of constipation

• Difficulties with a detergent in 25% of cases and more
• Solid or rolling ( ovechy) Cal in 25% of cases and more often
• Sensation of the congestion in 25% and more cases,
• Help with hands in a sparking of 25% and more often or three times a week.

Diagnostics

Treatment of patients with predominance of constipation

As a supplement to drug treatment, therapeutic physical culture, hypnotherapy, physiotherapy is shown. During the border, even schools and group classes for patients with SRC are practiced.

Irritable bowel syndrome in children

Symptoms that should alert parents:

• Child Caprisen, often crying,
• For a long time sits on the pot,
• He has an unstable defecation: then constipation, then diarrhea.

In the absence of signs of other diseases, the child is prescribed by treatment that takes into account the specifics of its illness. At the end of the first course of treatment, its effectiveness is determined.

Treatment of SRK in children is based on the same principles as in adult patients. This is primarily the correction of nutrition and the use of medicines.
With the exacerbation of pain and bloody, it is impossible to give a child raw products ( only boiled or stew).
With diarrhea, food should be in a piercing semi-liquid form. It should be abandoned with raw fruits and vegetables, milk.

Medicines for SRK in children

• Medicines that increase the number of feces and improving their intestinal movement: plantain seeds, lactulose,
• Prokinetics, for example, domperidon,
• Gemicellulose and bile preparations,
• Probiotics, prebiotics,
• If necessary, after consulting a psychotherapist, special drugs for the correction of the mental state.

With diarrhea:

• Binding preparations, sorption and enveloping: for example, a smect. If their use does not give action - loperamide. Its children are not prescribed for a long time, only until the state is facilitated,
• Probiotics, prebiotics,
• Enzyme preparations: mezim, festal, pancreatin,
• If necessary, preparations for the correction of psycho-emotional state.

• Safety spasmodics of selective action, for example, duspatalin,
• Preparations for reducing gas formation, for example, siemetikon,
• Probiotics and prebiotics,
• Enzyme preparations
• After appointing a doctor, psychotherapeutic drugs.

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Diet with pain and constipation

• Bread grain or cut, rye bread,
• Fresh milk products, cottage cheese and sour cream,
• Oils vegetable and creamy,
• Fish and meat prepared in different ways,
• Boiled screwed chicken eggs,
• Listed above the cereals,
• Raw fruits and vegetables,
• Jam, honey, compote,
• Sauces and seasonings.

• Chocolate, cocoa, coffee, strong tea,
• Mozmond porridge,
• Sofob
• Cream soups
• Kissel.

Diet with diarrhea

• Three-day fermented milk products, fresh cottage cheese,
• Creamy oil limit
• Eggs limit
• Decoction of oats and rice,
• Meat in small quantities
• Salt, sugar and sweets in small quantities.

• Spices, pickles, seasonings, sharp dishes,
• Fruits vegetables,
• Rye bread,
• Fresh milk products, milk,
• Fatty meat and fish,
• Cold drinks,
• Sdob.

A lot of disputes in the scientific world comes on how to use vegetable fibers in medicinal nutrition. Those studies that were conducted while they give fairly controversial results. But in one doctors one: in the diet of patients with CRCs with constipation there should be an abundance of coarse fiber, which enhances the peristaltics. And in the diet of persons suffering from diarrhea, on the contrary, there must be a lot of water-soluble fiber ( pectinov).

Thus, when constipation is recommended to enter into diet, bran, pumpkin, beets, cabbage, carrots, sea cappist, mushrooms, apples, oatmeal and buckwheat croup. Food fibers create in the intestine favorable conditions for the reproduction of the useful microflora and the production of microbes of oil and propionic acids, favorable for the intestinal mucosa.

How else to facilitate the state at SRK?

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