Медицинский совет (May 2020)
Combination of functional disorders of the digestive organs
Abstract
Many publications and major population studies have been devoted to the problem of combination of two or more functional disorders (FD) of digestive organs. The Rome Consensus IV applies the term “overlapping of FD” to cases of combinations within a single organ and stresses that the irritable bowel syndrome in any form should rather be regarded as a “continuum of different clinical variants” according to modern ideas. As a possible explanation for the existence of the overlap of FD the increase of visceral hypersensitivity, the expansion of the hypersensitivity zone, the progression of motor disorders are considered. With a combination of FD the number and intensity of complaints increases, the quality of life indicators decrease, the average number of concomitant somatic symptoms and drugs taken increases. Functional dyspepsia is more common in combinations of FD. At the same time, postprandial distress syndrome is more often combined with irritable bowel syndrome with constipation, epigastric pain syndrome with irritable bowel syndrome with diarrhea, and endoscopic-negative gastro-esopha-geal reflux disease. In addition to food components, a special role in the development of visceral sensitization is given to the persistence of inflammation after infection, gluten exposure, disorders of the intestinal microbiome, conditions of depression and anxiety. When two or more digestive organ FDs combine, it is advisable to choose the methods of treatment aimed at eliminating the action of intraluminal stimuli and the formation of “pain memory”. Drugs that normalize intestinal peristalsis and secretion are used, the choice of which is determined by the clinical version of the course, probiotics, as well as the means that affect the state of the central nervous system. When two or more digestive organ FDs combine, it is advisable to choose medications that affect their general pathogenetic mechanisms.
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