Журнал "Медицинский совет. Гастроэнтерология" №14, 2018
M.SH. Ishaque*, S.M. Khosruzzaman, D.S. Ahmed, M.P. Sah, Bangabandhu Sheikh Mujib Medical University, Дакка, Бангладеш
Справочная информация: накопление доказательств подтверждает мнение о том, что дисбаланс кишечных бактерий способствует СРК и что увеличение массы полезных видов может уменьшить количество патогенных бактерий и помочь облегчить симптомы заболевания.
Методы: в данном двойном слепом исследовании 400 взрослых пациентов с клинически выраженным СРК с диареей (СРК-Д) от умеренной до тяжелой степени были рандомизированы для лечения с использованием мультипробиотика Bio-Kult® (14 различных бактериальных штаммов) или плацебо в течение 16 недель. Первичным критерием эффективности было изменение степени тяжести и частоты абдоминальной боли.
Результаты: лечение пробиотиком значительно улучшило степень тяжесть боли в животе у пациентов с СРК-Д. Уменьшение боли на 69% для пробиотика в сравнении с 47% для плацебо (р < 0,001) соответствует 145-кратному снижению по системе оценки тяжести СРК-СОТ (СРК-СОТ). Доля пациентов, которые определили степень своих симптомов от умеренной до тяжелой, была снижена со 100% на исходном уровне до 14% для группы мультипробиотика при последующем наблюдении (5-й месяц) в сравнении с 48% для группы плацебо (р < 0,001). Кроме того, количество дефекаций в день со 2-го месяца было значительно меньше в группе мультибиотика по сравнению с группой плацебо (p < 0,05). Помимо облегчения симптомов, пробиотик заметно улучшил все параметры качества жизни согласно опроснику СРК-качество жизни (СРК-КЖ) из 34 пунктов. О серьезных нежелательных явлениях не сообщалось.
Выводы. Применение мультипробиотика с несколькими штаммами приводит к значительным улучшениям симптомов у пациентов с СРК-Д и хорошо переносится. Эти результаты дают основание полагать, что пробиотики приносят пользу пациентам с СРК-Д и заслуживают дальнейшего изучения. Регистрация исследования: [Clinicaltrials.gov NCT03251625; ретроспективно зарегистрировано 9 августа 2017 г.].
Список литературы
1. Sperber AD, Dumitrascu D, Fukudo S, et al. The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome foundation working team literature review. Gut, 2017, 66: 1075-82.
2. Canavan C, West J, Card T. Review article: the economic impact of the irritable bowel syndrome. Aliment Pharmacol Ther, 2014, 40: 1023-34.
3. Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA, 2015, 313: 949-58.
4. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol, 2012, 10: 712-21.
5. Thompson WG, Heaton KW, Smyth GT, Smyth C. Irritable bowel syndrome in general practice: prevalence, characteristics, and referral. Gut, 2000, 46: 78-82.
6. Masud MA, Hasan M, Azad Khan AK. Irritable bowel syndrome in a rural community in Bangladesh. Prevalence, symptom pattern and health seeking behavior. Am J Gastroenterol, 2001, 96: 1547-52.
7. Perveen I, Hasan M, Masud MA, Bhuiyan MM, Rahman MM. Irritable bowel syndrome in a Bangladeshi urban community: prevalence and health care seeking pattern. Saudi J Gastroenterol, 2009, 15: 239-43.
8. Perveen I, Rahman MM, Saha M, Rahman MM, Hasan MQ. Prevalence of irritable bowel syndrome and functional dyspepsia, overlapping symptoms, and associated factors in a general population of Bangladesh. Indian J Gastroenterol, 2014, 33: 265-73.
9. Jones R, Lydeard S. Irritable bowel syndrome in the general population. BMJ, 1992, 304: 87-90.
10. Chang JY, Talley NJ. An update on irritable bowel syndrome: from diagnosis to emerging therapies. Curr Opin Gastroenterol, 2011, 27: 72-8.
11. Bolino CM, Bercik P. Pathogenic factors involved in the development of irritable bowel syndrome: focus on a microbial role. Infect Dis Clin N Am, 2010, 24: 961-75.
12. Imperatore N, Tortora R, Morisco F, Caporaso N. Gut microbiota and functional diseases of the gastrointestinal tract. Minerva Gastroenterol Dietol, 2017, 63: 355-72.
13. Manning AP, Thompson WG, Heaton KW, Morris AF. Towards positive diagnosis of the irritable bowel. Br Med J, 1978, 2: 653-4.
14. Drossman DA, Richter JE, Talley NJ. The functional gastrointestinal bowel disorders, pathophysiology and treatment: a multinational consensus. Boston: Little Brown, 1994.
15. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Mü ller- Lissner SA. Functional bowel disorders and functional abdominal pain. Gut, 1999, 45(Suppl 2): II43-7.
16. Drossman DA, Chang L, Bellamy N, et al. Severity in irritable bowel syndrome: a Rome foundation working team report. Am J Gastroenterol, 2011, 106: 1749-59.
17. Gwee KA, Graham JC, McKendrick MW, et al. Psychometric scores and persistence of irritable bowel after infectious diarrhoea. Lancet, 1996, 347: 150-3.
18. Gwee KA. Irritable bowel syndrome in developing countries-a disorder of civilization or colonization? Neurogastroenterol Motil, 2005, 17: 317-24.
19. Ghoshal UC, Park H, Gwee KA. Bugs and irritable bowel syndrome: the good, the bad and the ugly. J Gastroenterol Hepatol, 2010, 25: 244-51.
20. Gwee KA, Bak YT, Ghoshal UC, Asian Neurogastroenterology and Motility Association, et al. Asian consensus on irritable bowel syndrome. J Gastroenterol Hepatol, 2010, 25: 1189-205.
21. Joint FAO/WHO Working Group. Guidelines for the Evaluation of Probiotics in Food London. Report of a joint FAO/WHO Working Group. Report on Drafting, Ontario, Canada, April 30 and May 1, 2002. Available at: http: // www. http://who.int/foodsafety/fs_management/en/probiotic_guidelines.pdf [last accessed August 2017].
22. Staudacher HM, Whelan K. Altered gastrointestinal microbiota in irritable bowel syndrome and its modification by diet: probiotics, prebiotics and the low FODMAP diet. Proc Nutr Soc, 2016, 75: 306-18.
23. Saulnier DM, Riehle K, Mistretta TA, et al. Gastrointestinal microbiome signatures of pediatric patients with irritable bowel syndrome. Gastroenterology, 2011, 141: 1782-91.
24. Mä ttöJ, Maunuksela L, Kajander K, Palva A, Korpela R, Kassinen A, Saarela M. Composition and temporal stability of gastrointestinal microbiota in irritable bowel syndrome-a longitudinal study in IBS and control subjects. FEMS Immunol Med Microbiol, 2005, 43: 213-22.
25. Ghoshal UC, Shukla R, Ghoshal U, Gwee KA, Ng SC, Quigley EM. The gut microbiota and irritable bowel syndrome: friend or foe? Int J Inflam, 2012, 2012: 151085. https: //doi. org/10.1155/2012/151085.
26. Quigley EM. Probiotics in irritable bowel syndrome: the science and the evidence. J Clin Gastroenterol, 2015, 49(Suppl 1): S60-4.
27. Quigley EM, Shanahan F. The future of probiotics for disorders of the brain- gut axis. Adv Exp Med Biol, 2014, 817: 417-32. 28. Lee HR, Pimentel M. Bacteria and irritable bowel syndrome: the evidence for small intestinal bacterial overgrowth. Curr Gastroenterol Rep, 2006, 8: 305-11.
28. Sisson G, Ayis S, Sherwood RA, Bjarnason I. Randomised clinical trial: a liquid multi-strain probiotic vs. placebo in the irritable bowel syndrome-a 12 week double-blind study. Aliment Pharmacol Ther, 2014, 40: 51-62.
29. Zhang Y, Li L, Guo C, Mu D, Feng B, Zuo X, Li Y. Effects of probiotic type, dose and treatment duration on irritable bowel syndrome diagnosed by Rome III criteria: a meta-analysis. BMC Gastroenterol, 2016, 16: 62. https: //doi. org/10.1186/s12876-016-0470-z.
30. Zeng J, Li YQ, Zuo XL, Zhen YB, Yang J, Liu CH. Clinical trial: effect of active lactic acid bacteria on mucosal barrier function in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther, 2008, 28: 994-1002.
31. Kabir MA, Ishaque SM, Ali MS, Mahmuduzzaman M, Hasan M. Role of Saccharomyces Boulardii in diarrhea predominant irritable bowel syndrome. Mymensingh Med J, 2011, 20: 397-401.
32. Rahman MZ, Chowdhury MS, Rahman MA. Efficacy of probiotics in irritable bowel syndrome-a randomized, double blind placebo controlled study. BSMMU J, 2013, 6: 21-8.
33. Roberts LM, McCahon D, Holder R, Wilson S, Hobbs FDR. A randomised controlled trial of a probiotic ‘functional food’ in the management of irritable bowel syndrome. BMC Gastroenterol, 2013, 13: 45. https: doi.org/10. 1186/1471-230X-13-45.
34. Francis CY, Morris J, Whorwell PJ. The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther, 1997, 11: 395-402.
35. Drossman DA, Patrick DL, Whitehead WE, Toner BB, Diamant NE, Hu Y, Jia H, Bangdiwala SI. Further validation of the IBS-QOL: a diseasespecific quality- of-life questionnaire. Am J Gastroenterol, 2000, 95: 999-1007.
36. Spiegel B, Bolus R, Harris LA, Lucak S, Naliboff B, Esrailian E, Chey WD, Lembo A, Karsan H, Tillisch K, Talley J, Mayer E, Chang L. Measuring irritable bowel syndrome patient-reported outcomes with an abdominal pain numeric rating scale. Aliment Pharmacol Ther, 2009, 30: 1159-70.
37. Lyra A, HilliläM, Huttunen T, et al. Irritable bowel syndrome symptom severity improves equally with probiotic and placebo. World J Gastroenterol, 2016, 22: 10631-42.
38. European Medicines Agency. Guidance on the evaluation of medicinal products for the treatment of IBS. Available at: http: www.ema. http://europa.eu docs/en_GB/document_library/ Scientific_guideline/2014/09/WC500173457. pdf [last accessed June, 2017].
39. Bixquet Jimenez M. Treatment of irritable bowel syndrome with probiotics. An etiopathogenetic approach at last? Rev Esp Dig, 2009, 101: 553-64.
40. McKenzie YA, Thompson J, Gulia P, Lomer MC, (IBS Dietetic Guideline Review Group on behalf of Gastroenterology Specialist Group of the British Dietetic Association). British dietetic association systematic review of systematic reviews and evidence-based practice guidelines for the use of probiotics in the management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet, 2016, 29: 576-92.
41. Kennedy PJ, Cryan JF, Dinan TG, Clarke G. Irritable bowel syndrome: a microbiome-gutbrain axis disorder? World J Gastroenterol, 2014, 20: 14105-25.
42. Staudacher HM, Irving PM, Lomer MC, Whelan K. Mechanisms and efficacy of dietary FODMAP restriction in IBS. Nat Rev Gastroenterol Hepatol, 2014, 11: 256-66.
43. Thaiss CA, Zmora N, Levy M, Elinav E. The micro biome and innate immunity. Nature, 2016, 535: 65-74.
44. Honda K, Littman DR. The microbiota in adaptive immune homeostasis and disease. Nature, 2016, 535: 75-84.
45. Gwee KA. Post-infectious irritable bowel syndrome, an inflammation-immunological model with relevance for other IBS and functional dyspepsia. J Neurogastroenterol Motil, 2010, 16: 30-4.
