Visceral sensitivity in diagnostics and treatment of severe irritated bowel syndrome
- 作者: Makarova A.1, Diukova G.1, Ruchkina I.1, Romashkina N.1, Indejkina L.1,2, Degterev D.1, Dbar S.1, Parfenov A.1
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隶属关系:
- Loginov Moscow Clinical Research and Practical Center
- Research Institute of Health Organization and Medical Management
- 期: 卷 94, 编号 2S (2022)
- 页面: 356-361
- 栏目: Conference proceedings
- URL: https://journals.rcsi.science/0040-3660/article/view/110786
- DOI: https://doi.org/10.26442/00403660.2022.02.201394
- ID: 110786
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Background. Irritable bowel syndrome (IBS) is a biopsychosocial model based on the malfunction of "brain-intestinal linking".
Aim. To improve diagnostics of the severe IBS accompanied with somatoform disorders by using balloon dilatation test (BDT) and optimize the therapy by using antidepressants from the serotonin and noradrenaline reuptake inhibitor type.
Materials and methods. 61 patients with severe IBS and diarrhea were examined, among them 29 female with a median age of 31 years old (24; 36), and 31 male with a median age of 31 (24; 36) years old. All patients were randomized into two groups, group 1 consisted of 30 patients (15 female, 15 male), group 2 consisted of 31 patients (15 female, 16 male).
The symptoms of all patients were assessed using the Visual Analogue Pain Scale (VAS Pain), visceral sensitivity index (VIS) was assessed according to the J. Labus questionnaire (2007) and visceral sensitivity threshold was assessed according to the BDT, the psycho-emotional state was assessed using the Beck scale of anxiety and depression and the Spielberger-Khanin scale. Both group patients underwent a comparative effectiveness evaluation between the therapy based on the use of Trimebutine at a dose of 600 mg per day and the SNRI-Duloxetine therapy at a dose of 60 mg per day for 8 weeks.
Results. Patients from group with severe IBS and diarrhea who had undergone the antidepressant therapy showed the decrease of pain syndrome from 7 (5; 7) to 2.5 (2; 3) points according to VAS Pain; normalization of stool frequency from 7 (6; 9) to 2 (1; 2) times a day; normalization of stool consistency from 6 (6; 7) to 3 (3; 4) type; and decrease of VIS: first urge from 56 (34; 74) to 95 (80; 98) ml.; as well as the decrease of the depression level (Beck scale) from 26 (23; 32) to 11.5 (10; 13) points and anxiety according to Beck scale from 38 (31; 45) to 11 (10; 12), the decrease of personal anxiety level (Spielberger-Khanin scale) from 42.5 (35; 53) to 22 (20; 24) points, and the decrease of situational anxiety from 40 (37; 49) to 22 (21; 36) points. During the trimebutine therapy in group 1, the clinical symptoms of IBS have persisted. According to the BDT, the visceral sensitivity (HF) threshold remained at a low level. And the indicators of anxiety and depression remained at a high level according to the psychometric scales.
Conclusion. The insufficient effect of the trimebutine therapy can be explained by the somatoform disorders persistence in patients from group 1. Meanwhile SNRI-duloxetine therapy in group 2 showed a clinical remission of IBS: such as a reliable relief from pain and diarrheal syndrome, as well as an increase in the HF threshold.
Thus, Duloxetine is a promising treatment for severe IBS with somatoform disorders. BDT can be used as an objective criterion to diagnose and evaluate the effectiveness of therapy in patients with IBS.
作者简介
Alina Makarova
Loginov Moscow Clinical Research and Practical Center
编辑信件的主要联系方式.
Email: 207lec@mail.ru
ORCID iD: 0000-0003-1050-2437
мл. науч. сотр. лаб. функциональной диагностики заболеваний кишечника
俄罗斯联邦, MoscowGalina Diukova
Loginov Moscow Clinical Research and Practical Center
Email: 207lec@mail.ru
ORCID iD: 0000-0001-9805-1022
д-р мед. наук, проф., отд-ние неврологии
俄罗斯联邦, MoscowIrina Ruchkina
Loginov Moscow Clinical Research and Practical Center
Email: 207lec@mail.ru
ORCID iD: 0000-0002-4571-2883
д-р мед. наук, вед. науч. сотр. отд-ния невоспалительной патологии кишечника
俄罗斯联邦, MoscowNataliya Romashkina
Loginov Moscow Clinical Research and Practical Center
Email: 207lec@mail.ru
ORCID iD: 0000-0002-4501-8031
врач-психиатр Центра персонализированной медицины
俄罗斯联邦, MoscowLilia Indejkina
Loginov Moscow Clinical Research and Practical Center; Research Institute of Health Organization and Medical Management
Email: 207lec@mail.ru
ORCID iD: 0000-0002-3829-3211
зав. лаб. функциональной диагностики заболеваний кишечника
俄罗斯联邦, Moscow; MoscowDaniil Degterev
Loginov Moscow Clinical Research and Practical Center
Email: 207lec@mail.ru
ORCID iD: 0000-0002-4550-1509
канд. мед. наук, зав. неврологическим отд-нием
俄罗斯联邦, MoscowSaria Dbar
Loginov Moscow Clinical Research and Practical Center
Email: 207lec@mail.ru
ORCID iD: 0000-0001-6516-7782
мл. науч. сотр., врач-гастроэнтеролог отд-ния невоспалительной патологии кишечника
俄罗斯联邦, MoscowAsfold Parfenov
Loginov Moscow Clinical Research and Practical Center
Email: 207lec@mail.ru
ORCID iD: 0000-0002-9782-4860
д-р мед. наук, проф., зав. отд. патологии кишечника
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