Ефективність застосування пробіотиків у дітей з синдромом подразненого кишечника: питання оптимальної тривалості лікування

Abstract

Following the biopsychosocial model of medicine, irritable bowel syndrome (IBS) is a heterogeneous disorder, which is caused by multiple factors in different combinations. However, in most clinical cases probiotics are included in the treatment of IBS due to their influence on intestinal bacterial colonization, and immune, metabolic and motoric activity of the gut. The purpose - to evaluate the efficiency of probiotics (Lactobacillus reuteri DSM 17938) in children with IBS and to determine the optimal duration of the treatment. Materials and methods. We examined 108 children aged 6-12 years with a verified diagnosis of IBS, according to Rome criteria IV. Assessment of the main clinical symptoms was obtained by 4-point Likert scale. Enzyme immunoassay RIDASCREEN Calprotectin (R-Biopharm AG, Germany) was used for the quantitative determination of calprotectin in stool samples. Data were processed using Microsoft Excel 2016 and analysed with GraphPad (Prism 5.0). Results. Our study revealed the heterogenety of IBS in children not only according to clinical subtype, but also due to the trigger factor of the disorder. Patients with stress-related IBS were characterized by the higher level of asthenic syndrome and autonomic dysfunction (р=0.0003). In contrast, children with post-infectious IBS had higher concentration of fecal calprotectin, which is a result of low-grade intestinal inflammation (р=0.0003). After 10 days and 1 month since the beginning of treatment, we have observed a significant decrease in the severity of clinical syndromes, but the level of fecal calprotectin remained elevated. Conclusions. The efficiency of probiotics was confirmed by positive dynamics of clinical signs and the level of fecal calprotectin in children with various clinical subtypes of IBS. Even in the absence of any symptoms, the optimal duration of the use of Lactobacillus reuteri DSM 17938 in children with IBS should be 1-3 months. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.