Manifestations Of Irritable Bowel Syndrome Research Articles

Multisample lipidomic profiles of irritable bowel syndrome and irritable bowel syndrome-like symptoms in patients with inflammatory bowel disease: new insight into the recognition of the same symptoms in different diseases.

Overlapping clinical manifestations of irritable bowel syndrome (IBS) and IBS-like symptoms in patients with inflammatory bowel disease (IBD-IBS) present challenges in diagnosis and management. Both conditions are associated with alterations in metabolites, but few studies have described the lipid profiles. Our aim was to pinpoint specific lipids that contribute to the pathogenesis of IBS and IBD-IBS by analyzing multiple biologic samples. Diarrhea-predominant IBS (IBS-D) patients (n = 39), ulcerative colitis in remission with IBS-like symptoms patients (UCR-IBS) (n = 21), and healthy volunteers (n = 35) were recruited. IBS-D patients meet the Rome IV diagnostic criteria, and UCR-IBS patients matched mayo scores ≤ two points and Rome IV diagnostic criteria. Serum, feces, and mucosa were collected for further analysis. Lipid extraction was carried out by ultra-performance liquid chromatography-high resolution mass spectrometry (UPLC-HRMS). Lipidomics of mucosa and serum samples significantly differed among the three groups. Feces showed the most altered lipid species, and the enrichment analysis of 347 differentially abundant metabolites via KEGG pathway analysis revealed that alpha-linolenic acid metabolism was significantly altered in the two groups (P < 0.01). The ratio of omega-6/omega-3 fatty acid were imbalance in serum samples. This study revealed a comprehensive lipid composition pattern between IBS-D patients and UCR-IBS patients. We found several distinctive lipids involved in alpha-linolenic acid metabolism, reflecting an imbalance in the omega-6/omega-3 fatty acid ratio. Compared to mucosa and serum samples, fecal samples might have more advantages in lipidomics studies due to the convenience of sample collection and effectiveness in reflecting metabolic information.

Рrediction of Clinical Manifestations of Irritable Bowel Syndrome when Combined with Type 2 Diabetes Mellitus

The comorbidity of type 2 diabetes mellitus (DM) and irritable bowel syndrome (IBS) remain insufficiently studied. The aim of this study was to compare the clinical, laboratory and instrumental characteristics of patients with combination of IBS and type 2 DM with the clinical data of IBS and to develop criteria for predicting clinical manifestations of IBS in combination with type 2 DM on this basis. 107 patients with type 2 DM which have clinical manifestations of IBS were under observation. All patients were assessed for medical history and underwent a standard examinations. In addition, the levels of glycated hemoglobin, fructosamine, C-peptide, insulin, glucagon-like peptide-1 were assessed, the HOMA-IR and HOMA-B indices were calculated. As a result of the study, a number of statistically significant relationships between some clinical, laboratory and instrumental characteristics of patients and features of the clinical picture of IBS were identified. Based on the analysis of the data obtained, criteria for predicting the development of severe constipation syndrome, severe diarrhea syndrome and severe abdominal pain in patients with IBS and DM type 2 have been developed.

Синдром функциональной абдоминальной боли: обзор литературы

ABSTRACT INTRODUCTION. About 40–60% of adult patients with complaints of abdominal pain suffer from functional gastrointestinal disorders. Currently, functional disorders of the gastrointestinal tract are associated with disturbances in the gut-brain interaction. Abdominal pain syndrome can be one of the leading manifestations of irritable bowel syndrome, functional dyspepsia syndrome and abdominal migraine. The exclusion of organic disorders of the gastrointestinal tract is an essential condition for the diagnosis of functional disorders. The basic principles of the treatment of functional abdominal pain syndrome should be aimed at correcting the psychological disorders involved in the formation of pain sensation. MATERIAL AND METHODS. A review of the literature on this topic was conducted in the following databases: PubMed, Research Gate, Elsevier. The following phrases were used to search for literature: “Functional abdominal pain syndrome”, “Disorders of the gastrointestinal tract”. DISCUSSION. Functional abdominal pain syndrome is a rather complex and ambiguous disease, which is based on complex cerebroabdominal connections (direct and reverse). This diagnosis is an exception, in other words, the diagnosis takes place when there are no obvious organic causes of the disease. The diagnosis of the functional abdominal pain syndrome is long and complex and includes various instrumental and laboratory methods of examination. Various methods are used in the treatment of the functional abdominal pain syndrome, ranging from non-drug methods (cognitive behavioral therapy, hypnotherapy) and ending with the use of medicines (antidepressants). It is important to keep in mind that the diagnosis and treatment of the functional abdominal pain syndrome requires the active participation of doctors of different specialties who are able to build a personalized diagnostic and therapeutic route using a biopsychosociocultural approach. CONCLUSION. Functional abdominal pain syndrome attracts special attention in the diagnostic and therapeutic aspect. Although the exclusion of organic diseases is an essential condition for the diagnosis of the functional abdominal pain syndrome, it is necessary to take into account the connection and involvement of mental factors in the phenomenon of abdominal pain. Taking into account the complexity of the mechanisms involved in the development of functional gastrointestinal diseases, the basic principles of functional abdominal pain syndrome treatment should be aimed at correcting psychological disorders involved in the formation of pain sensation. KEYWORDS: functional abdominal pain syndrome, disturbances in the gut-brain interaction, interaction

Abdominal pain syndrome in patients with irritable bowel syndrome: features of selection of therapy

Irritable bowel syndrome (IBS) is an important social problem, since it is often diagnosed in people of young working age, significantly affects the quality of life of patients and causes economic damage to society. IBS is a chronic functional bowel disease, the main manifestation of which is pain combined with changes in bowel movements, frequency and character of stool. The mechanism of formation of abdominal pain syndrome is due to a disruption in the interaction along the brain-gut axis, which leads to changes in the regulation of intestinal motor function and the development of visceral hypersensitivity (VH). Abdominal pain as a manifestation of IBS is primarily associated with spasm of intestinal smooth muscles. The first-line drugs for pain relief are antispasmodics, which reduce the tone and contractility of intestinal smooth muscles, effectively coping with abdominal pain. The domestic pharmaceutical market is represented by different groups of muscle relaxants, among which calcium channel blockers are of particular relevance for patients with IBS. Representative of the latter is the drug Otilonium bromide, which is widely used throughout the world, is effective and safe, well tolerated and superior to placebo in reducing symptoms and preventing relapse of pain in patients with IBS. The effectiveness of otilonium bromide is due to a triple mechanism of action: blockade of calcium channels (relief of spasm), antagonism of tachykinone NK2 receptors (effect on HHV) and inhibition of acetylcholine muscarinic receptors (M3-ChR) (reduction of intestinal secretion). This article presents a short review of the literature on the causes and mechanism of development of pain in IBS, as well as the possibilities of its relief, primarily with the use of smooth muscle relaxants, namely otilonium bromide.

Irritable Bowel Syndrome: Frequency and Epidemiological Profile through 4530 Ileo-Colonoscopies

Introduction: The clinical manifestations of irritable bowel syndrome are not specific. Irritable bowel syndrome (IBS) is a common condition that affects the digestive system. It is usually a lifelong problem. The diagnosis is retained after elimination of an organic cause at colonoscopy. The main objective of this study is to determine the frequency of these disorders and to study the epidemiological characteristics of these patients. Patients and Methods: From January 2016 to January 2022, were included all patients with symptoms of IBS (abdominal pain, transit disorder, abdominal bloating) referred to our department for ileocolonoscopy. Patients with warning signs (rectal bleeding, melena, anemia, altered deteroriation of the general condition) or with incomplete colonoscopy were excluded. The diagnosis of IBS was retained in patients with a normal total ileo-colonoscopy All colonoscopies were done under propofol sedation and all patients were prepared with Polyethylene Glycol (PEG). Results: Of 4530 ileo-colonoscopies performed, 1132 (25%) were indicated for symptoms of IBS without warning signs. The average age of the patients was 47 years (16-89 years), the age group of 40-65 years predominated in 41%. 66.7% were female. The frequency of symptoms was as follows: abdominal pain in 64.3% of cases, chronic diarrhea: 33%, and constipation: 30.7%, alternating diarrhea-constipation: 18.1% and abdominal bloating in 10.75%. 569 patients (50.2%) had a normal ileo-colonoscopy. Ileo-colonoscopy was abnormal in 49.8% of cases: polyps: 47%, diverticula: 19%, congestive or ulcerative colonic and/or ileal mucosa: 18.8%, tumour: 7%, lipoma: 4.7% and colonic melanosis: 3.5%. Tumors were primarily in patients &gt; 40 years old (9%), and IBD lesions in patients &lt; 40 years old (11%). Conclusion: Ileo-colonoscopy remains essential to eliminate an organic cause even in the presence of typical symptoms of IBS. Indeed, half of our patients with symptoms of IBS without warning signs have an organic lesion dominated by tumors primarily in those &gt; 40 years old and IBD lesions in those &lt; 40 years old.

ASSOCIATION BETWEEN PSYCHOLOGICAL UPSET AND IRRITABLE BOWEL SYNDROME AMONG NURSING STUDENTS AT KSA

Irritable bowel syndrome (IBS) is a fairly common disorder that occurs in the general population. IBS is a functional bowel disorder associated with decreased work productivity. The aim of this study is to investigate the relationship between psychological upset and irritable bowel syndrome among nursing students at the Hafr Albatin University king Saudi Arabia. A descriptive cross-sectional research design on 223 student nurses from Hafr Al Batin university. One tool is divided into three main parts; demographic data, student's psychological upset, and irritable bowel syndrome manifestations sheet. According to the results of the study there is a statistically significant correlation between students' psychological stiffness and manifestations of irritable bowel syndrome (p

Is Personalized Dietary Therapy Effective for Individuals With Irritable Bowel Syndrome?

Introduction: Adverse reactions to foods and food additives have a critical role in clinical manifestations of irritable bowel syndrome (IBS). Personalized dietary modifications conducted under the supervision of a qualified health practitioner could considerably impact the clinical care and course of the condition. Objective: To investigate the clinical effectiveness of the Lifestyle Eating and Performance (LEAP) program based on the Leukocyte Activation Assay-MRT (LAA-MRT®) results in improving IBS symptoms and quality of life. Methods: The retrospective study included de-identified client records (n = 146) from private group practices seen by registered dietitians. The eligibility criteria were adults aged > 18years old with an established diagnosis of IBS. Results: Participants were 46.7 ± 12.6years old and had a BMI of 26.7 ± 6.1 kg/m2; the majority were female (87.0%) and followed-up by a registered dietitian for 10.1 ± 6.4weeks. There was a significant reduction post-dietary intervention in overall Global Gastrointestinal Symptom Survey Scores (P < 0.001) and improvement in quality of life (P < 0.001). Conclusion: This study generates real-world evidence of an alternative treatment option for IBS using a personalized dietary approach. A more precise understanding of the effect of food intake reactions is vital for clinical improvements and enhancing health outcomes in IBS.

Colorectal Cancer in Patient with Functional Gastrointestinal Symptoms

Aim. A clinical observation to highlight the importance of detailed examination in patients with functional gastrointestinal symptoms.Key points. A 28-yo female patient was admitted with complains of left ileal pain, abdominal distention and up to 4-day stool delay. The complaints had long been interpreted as clinical manifestations of irritable bowel syndrome. No significant abnormalities were revealed in outpatient check-up (general and biochemical blood panels, stool test, abdominal ultrasound, oesophagogastroduodenoscopy). Colonoscopy was performed on admission, with diagnosis of rectal adenocarcinoma. The patient had a prompt surgical intervention, repeated courses of polychemotherapy and is currently followed by an oncologist and coloproctologist. No relapse signs have been reported.Conclusion. Patients with the complaints satisfying the Rome Criteria Revision IV for functional gastrointestinal diseases should have a thorough examination as per recommendations of the Russian Gastroenterological Association and Russian Association of Coloproctologists.

Dynamics of clinical manifestations of irritable bowel syndrome against the background of cytoprotector rebamipide intake: intermediate results of the SOKRAT program

BACKGROUND: Irritable bowel syndrome (IBS) is one of the most common diseases of the gastrointestinal tract, the detection rate of which in the general population is 9-23%, in the Russian Federation 8.3-19%. IBS is the cause of chronic pain which accompanies patients throughout their life, significantly reducing its quality and disrupting social adaptation. Insufficient effectiveness of modern methods of treating IBS dictates the need to search for new drugs, the pharmacological action of which is aimed at the pathogenetic mechanisms of IBS formation. Currently, more and more attention in the development of IBS is paid to the syndrome of increased epithelial permeability, in connection with which it is promising to include the universal cytoprotector rebamipide in the complex therapy of patients with IBS.&#x0D; AIM: To evaluate the effect of rebamipide on the course of irritable bowel syndrome.&#x0D; MATERIALS AND METHODS: This article presents the intermediate results of the SOCRAT study, which has assessed the effect of rebamipide on the course of IBS. For this purpose, 40 patients with IBS have been examined and subsequently randomized into two groups comparable in gender, age and type of IBS. The patients of the main group (n = 21) received cytoprotector rebamipide in addition to standard antispasmodic therapy, and the patients of the comparison group (n = 19) received cytoprotector bismuth tripotassium dicitrate. Patients gastroenterological complaints have been assessed before and after treatment using GSRS, 7x7, IBS-QOL questionnaires and a visual analogue scale.&#x0D; RESULTS: According to the study findings, the well-being of the patients has improved in the both study groups. However, more significant positive dynamics has been observed in the main group, as evidenced by a significant decrease in the frequency and severity of abdominal pain and symptoms caused by constipation, which, in turn, led to an increase in the quality of life of the studied patients.&#x0D; CONCLUSIONS: Thus, protective therapy of epithelium with rebamipide has not only a symptom-reducing effect, but also a positive effect on the course of IBS.

How can probiotic improve irritable bowel syndrome symptoms?

The onset and manifestations of irritable bowel syndrome (IBS) is associated with several factors, and the pathophysiology involves various central and peripheral mechanisms. Most studies indicate that the management of gut microbiota could significantly affect the improvement of subjective disorders in patients with IBS. Numerous clinical trials have assessed the efficacy of probiotics for IBS with controversial conclusions. Several clinical trials have suggested that probiotics can improve global IBS symptoms, while others only improve individual IBS symptoms, such as bloating scores and abdominal pain scores. Only a few clinical trials have found no apparent effect of probiotics on IBS symptoms. Generally, probiotics appear to be safe for patients with IBS. However, the question of which probiotics should be used for certain IBS subtypes remains unresolved. In everyday practice, the dose of the recommended probiotic remains questionable, as well as how long the probiotic should be used in therapy. The use of probiotics in the M subtype and non-classified IBS is particularly problematic, in which combination therapy should be recommended due to the change in symptoms. Therefore, new approaches are needed in the design of clinical studies that should address certain subtypes of IBS.

The new guideline on irritable bowel syndrome: what is new?

WHAT IS NEW?: The following refers only to irritable bowel syndrome (IBS) in adults. The new guideline includes a separate section on IBS for paediatric patients. Irritable bowel syndrome (IBS) presents as a heterogeneous picture with chronic abdominal complaints related to the bowel. These are usually accompanied by changes in bowel movements and lead to impaired quality of life. The genesis is multifactorial and there are complex underlying pathophysiological mechanisms associated with IBS. Thus, disturbances in various components of the gut-brain axis and the increasing importance of the microbiome can be identified. Various psychological comorbidities also play a role. The diagnosis is made by a thorough anamnesis and symptom-oriented exclusion of important differential diagnoses. A subdivision into different subtypes depending on the main symptoms is beneficial for the further management of IBS patients. The diagnosis of IBS should be made as early as possible after reliable exclusion of the important differential diagnoses. If diarrhoea dominates as a symptom, a detailed differential diagnosis and functional diagnosis should be carried out. There is no proven causal and no established standard therapy. Due to the variable genesis and symptom manifestation of IBS, a broad spectrum of therapy options results, whereby there is no individual prediction regarding effectiveness and therefore every therapy is initially probationary. Symptom-independent general therapies that can be used for all subtypes include dietary methods (e. g. the low-FODMAP diet), probiotics, psychotherapy methods and complementary medicine. The choice of symptom-dependent drug treatments is made according to the subtype/main symptom. In the case of diarrhoea, bile acid binders, the non-absorbable antibiotic rifaximin or, in individual cases, 5-HT3-antagonists can be used in addition to loperamide. In constipation, prucalopride and linaclotide have value in addition to the use of soluble fibre and macrogol/other laxatives. For abdominal pain/cramps, studies show good results for spasmolytics, especially peppermint oil, and for tricyclic-type antidepressants. For the main symptom of flatulence, probiotics, rifaximin and especially the low-FODMAP diet can show positive results in studies.

Morphological manifestations of irritable bowel syndrome

The article presents modern data on morphological changes in the intestinal mucosa in patients with irritable bowel syndrome. There were analyzed the studies of different years on the morphological manifestations of irritable bowel syndrome. It has been shown that this pathology has an unusual low-grade inflammation. Mast cells play an important role in these inflammatory disorders, they have an effect on motility disorders, visceral hypersensitivity and other pathogenetic factors of irritable bowel syndrome. Disorders of intercellular tight junctions in this category of patients were also analyzed. The role of proteins involved in intercellular contacts (occludin, claudin, ZO) has been characterized. An analysis of the studies investigating these disorders has been carried out. The article provides examples of the analysis of biopsies in patients with irritable bowel syndrome using various methods of their assessment.

BNSTAV GABA-PVNCRF Circuit Regulates Visceral Hypersensitivity Induced by Maternal Separation in Vgat-Cre Mice.

Visceral hypersensitivity as a common clinical manifestation of irritable bowel syndrome (IBS) may contribute to the development of chronic visceral pain. Our prior studies authenticated that the activation of the corticotropin-releasing factor (CRF) neurons in paraventricular nucleus (PVN) contributed to visceral hypersensitivity in mice, but puzzles still remain with respect to the underlying hyperactivation of corticotropin-releasing factor neurons. Herein, we employed maternal separation (MS) to establish mouse model of visceral hypersensitivity. The neuronal circuits associated with nociceptive hypersensitivity involved paraventricular nucleus CRF neurons by means of techniques such as behavioral test, pharmacology, molecular biology, retrograde neuronal circuit tracers, electrophysiology, chemogenetics and optogenetics. MS could predispose the elevated firing frequency of CRF neurons in PVN in murine adulthood, which could be annulled via the injection of exogenous GABA (0.3mM, 0.2µl) into PVN. The PVN-projecting GABAergic neurons were mainly distributed in the anterior ventral (AV) region in the bed nucleus of stria terminalis (BNST), wherein the excitability of these GABAergic neurons was reduced. Casp3 virus was utilized to induce apoptosis of GABA neurons in BNST-AV region, resulting in the activation of CRF neurons in PVN and visceral hyperalgesia. In parallel, chemogenetic and optogenetic approaches to activate GABAergic BNSTAV-PVN circuit in MS mice abated the spontaneous firing frequency of PVN CRF neurons and prevented the development of visceral hypersensitivity. A priori, PVNCRF-projecting GABAergic neurons in BNST-AV region participated in the occurrence of visceral hypersensitivity induced by MS. Our research may provide a new insight into the neural circuit mechanism of chronic visceral pain.

Circulating neurotransmitter levels in irritable bowel syndrome: correlation of laboratory tests and clinical findings

Objective: to estimate blood levels of serotonin and melatonin neurotransmitters in patients with irritable bowel syndrome and to evaluate the role of neurohumoral imbalance in the development and clinical manifestations of irritable bowel syndrome phenotypes.Materials and methods: the study included 60 patients (range, 18 – 45 years) diagnosed with irritable bowel syndrome according to the Roman IV criteria for irritable bowel syndrome (2016). 20 patients with a confirmed diagnosis of ulcerative colitis (UC) were assigned to a comparison group. The control group was composed of 45 apparently healthy subjects. All subjects were assigned to subgroups based on the prominent clinical presentation: irritable bowel syndrome with constipation (IBS-C), irritable bowel syndrome with diarrhea (IBS-D) and mixed irritable bowel syndrome (IBS-M). In addition to all the necessary procedures (clinical, laboratory and instrumental), blood concentrations of endogenous serotonin and melatonin were measured using enzyme-linked immunosorbent assay (ELISA).Results: the concentrations of endogenous serotonin and melatonin were significantly lower in patients with irritable bowel syndrome as compared with those having ulcerative colitis or healthy individuals. The detection rates of lowering serotonin levels were 53.3 % and 65 % — for melatonin. Low levels of melatonin were detected both in IBS-D and IBS-C patients. 69.57 % of IBS-D patients had elevated levels of serotonin as compared with the reference values for healthy subjects. We found a strong correlation between the severity of bloating and abdominal pain on the one hand, and low levels of endogenous serotonin and melatonin, on the other hand.Conclusion: our findings suggest that serotonin and melatonin neurotransmitters play a significant role in the pathophysiology and clinical manifestations of estimate blood levels of serotonin and melatonin neurotransmitters in patients with irritable bowel syndrome.

Fibromyalgia: clinical presentation and variants of the disease

Fibromyalgia (FM) is a condition characterized by generalized pain syndrome and by the presence of fatigue, cognitive impairment, affective and multiple somatic symptoms. Pain syndrome can have national, ethnic, gender, and age characteristics.Objective: to evaluate the features of the course of FM in a large industrial center of the Russian Federation and to present its phenotypic options.Patients and methods. The investigation enrolled 92 FM patients (8 men, 84 women) aged 18 to 86 years (mean age, 50.5 years). The diagnosis was established according to the 2016 ACR criteria. Account was taken of data on disease duration, occupation, sport training loads, previous therapy, pain intensity, and somatic symptoms according to the 2010 ACR diagnostic criteria and on general health assessment in the patients. All the patients completed the hospital anxiety and depression scale (HADS).Results and discussion. The most significant somatic symptoms in the clinical picture of FM were shown to be muscle pain and muscle weakness, the manifestations of irritable bowel syndrome and fatigue; moreover, the prevalence of many symptoms in people over 60 years of age was lower than that in younger patients. Female gender was an additional risk factor for increases in pain and cognitive impairment. The presence of concomitant depression verified by HADS was associated with a substantial deterioration of the clinical manifestations of FM. At the same time, professional activities and sports were found to be protective factors against a number of symptoms of FM. It was hypothesized that there were several FM phenotypes (anxious, anxiety-depressive, egocentric, and vascular ones).Conclusion. The authors have demonstrated the features of the course of FM in a large industrial center of the Russian Federation and identified various disease phenotypes, which can be useful for determining the treatment policy for patients.

Sex as a biological variable in irritable bowel syndrome.

The pathophysiology and mechanisms of irritable bowel syndrome (IBS) involve both central and peripheral mechanisms that result in altered perception, as well as changes in bowel functions. These dysfunctions are associated with motor, sensory, immune, barrier, and intraluminal perturbations, including the microbiota, and their products and endogenous molecules with bioactive properties. There is evidence that these mechanisms are altered in both females and males. However, there is also increasing evidence that sex is a biological variable that impacts a number of aspects of the mechanisms, epidemiology, and manifestations of IBS. The objective of this article is to review the evidence of the differences among genders of the following factors in IBS: the brain-gut axis and sex hormones, epidemiology, diagnostic criteria and prognosis, pain perception, colonic transit, abdominal distension, overlap with urogynecological conditions, psychologic issues, anorexia, fibromyalgia, serotonin, and responsiveness to treatment of IBS. It is important to consider the variations attributable to sex in order to enhance the management of patients with IBS and the research of mechanisms involved in IBS.

Predictors of irritable bowel syndrome formation among students

Objective — to establish the role of the nervous system disorders in the formation of irritable bowel syndrome (IBS) among students. Materials and methods. Examination involved 32 students with IBS, aged 19 to 26 years. The Gastrointestinal Quality of Life Index (GIQLI) questionnaire was used, in which 36 questions were presented. Results. The changes in the psycho-emotional sphere in students with IBS occurred in all patients. Upper and lower dyspeptic syndromes with different frequency were inherent in all patients and depended on the nature of the stool. A short-term deterioration of the condition showed after passing tests or exam, which was manifested by increased and upset stools, increased abdominal pain. The skin redness or pallor of the face, excessive sweating, palpitations and fluctuations in blood pressure also were marked. The involvement of the autonomic nervous system with the predominance of the tone of its parasympathetic division has been established. Along with this, the IBS clinical symptoms significantly decreased until the complete disappearance at the peak of the examination period. This phenomenon reflected the formation of a stable psycho-emotional dominant «successful completion of the session». Conclusions. The development of irritable bowel syndrome in a student environment occurs against the background of changes in the autonomic nervous system, which had a significant effect on specific clinical symptoms. Clinical manifestations of IBS in students are reduced in the «peak period» of emotional stress, but are greatly enhanced after «training stresses». In this case, the development of vegetative disorders with acceleration of the heart rate and the lability of blood pressure are traced. The imbalance of the autonomic nervous system not only exacerbates the clinical symptoms of IBS, but also affects the patient quality of life.

The using of low-FODMAP diet is an important step in the treatment of children with irritable bowel syndrome

Diet therapy, in most cases, is the first stage of treatment of diseases of the gastrointestinal tract. Especially, this question remains relevant in patients suffering from functional gastrointestinal disorders. The irritable bowel syndrome is one of the most common of functional gastrointestinal tract disorders in the population. The Rome criteria IV are basic recommendations for the diagnosis and treatment of functional gastrointestinal disorders in patients of different ages. The diet with a reduced content of fermentable oligosaccharides (fructans and galactans), di- (lactose), monosaccharides (fructose) and polyols (FODMAP) is recommended by current international consensus for patients of different ages with irritable bowel syndrome. The article presents current findings on the low-FODMAP diet effect on the clinical manifestations of irritable bowel syndrome. The elimination of various foods in the diet of patients with different clinical variants of irritable bowel syndrome according to the low-FODMAP diet scheme leads to a decrease in gassing and normalization of contractile activity of the intestine. It significantly reduces the frequency of exacerbations of the disease and improves the quality of life of such patients. A number of clinical studies using the low-FODMAP diet in adult patients and children with irritable bowel syndrome are presented. It is concluded that further clinical studies to study the effectiveness of the low-FODMAP diet in patients with irritable bowel syndrome are needed. Especially this issue remains relevant in pediatric practice.

Bloating and Abdominal Distension: Old Misconceptions and Current Knowledge

Bloating, as a symptom and abdominal distension, as a sign, are both common functional-type complaints and challenging to manage effectively. Individual patients may weight differently the impact of bloating and distension on their well-being. Complaints may range from chronic highly distressing pain to simply annoying and unfashionable protrusion of the abdomen. To avoid mishaps, organic bloating, and distension should always be considered first and appropriated assessed. Functional bloating and distension often present in association with other manifestations of irritable bowel syndrome or functional dyspepsia and in that context patients tend to regard them as most troublesome. A mechanism-based management bloating and distension should be ideal but elucidating key operational mechanisms in individual patients is not always feasible. Some clues may be gathered through a detailed dietary history, by assessing bowel movement frequency and stool consistency and special imaging technique to measure abdominal shape during episodes of distension. In severe, protracted cases it may be appropriate to refer the patient to a specialized center where motility, visceral sensitivity, and abdominal muscle activity in response to intraluminal stimuli may be measured. Therapeutic resources focussed upon presumed or demonstrated pathogenetic mechanism include dietary modification, microbiome modulation, promoting gas evacuation, attenuating visceral perception, and controlling abdominal wall muscle activity via biofeedback.

Clinical peculiarities of antibiotic associated bowels impairment and its significance in irritable bowel syndrome appearance

Aim: the main objective of this study was to investigate bowels impairment due to treatment with antibiotics, its incidence and clinical peculiarities; to evaluate its role in appearance of in irritable bowel syndrome. Material and Methods. We studied 110 patients (33 males and 77 females), age range 16-83 years, who received treatment with antibiotic. We evaluated the function of the intestine before treatment with antibiotic, then in 1 week, 3 months after treatment finish (1, 2, 3, 4 visits respectively). Control group included 20 healthy persons, who haven't had antibiotics administered during recent two years. Results. We revealed that the signs of bowel function impairment took place at the first visit in 18.2% of patients, at the second visit – in 60.0% of patients, at the third visit – in 45.5% of patients and at the fourth visit – in 41.1% of patients. At the second, third and fourth visits the signs of bowels function impairment were observed reliably more often then at the first visit (before antibiotic administration), p<0.001). At the second visit the signs bowels function disorders were the most prominent: abdominal pain – in 44.5%, distention – in 46.4%, diarrhea – in 29.1%, constipation – in 18.2%, presence of both (diarrhea and periodically constipation) manifestations – in 2.7%; and extraintestinal manifestations (depression. depressed mood, sorrow, apathy, decreased stamina, sleep disturbances – in 29.1% of patients. Clinical manifestations of irritable bowel syndrome occured in 6 months of observation in 32.2% of patients. Conclusions. The signs of bowel function impairment were observed in 60.0% of patients after finishing treatment with antibiotic. This incidence is much higher than in control group (р<0.001). Bowel disorders mostly manifested as the changes in quantity and consistency of feaces, pain, abdominal distention and extraintestinal manifestations. In 32.2% of patients clinical manifestations of irritable bowel syndrome developed in 6 months of observation. This incidence is reliably higher than before treatment (10.9% of patients) and compared with control group (5.0% of patients), of observation р<0.01.