Yakovenko E P, Strokova T V, Ivanov A N, Iakovenko A V, Gioeva I Z, Aldiyarova M A
Pirogov Russian National Research Medical University.
North Ossetian State Medical Academy.
Ter Arkh. 2022 Feb 15;94(2):180-187. doi: 10.26442/00403660.2022.02.201368.
In the treatment of post-infectious irritable bowel syndrome (PI-IBS), the leading role belongs to the normalization of the composition of the intestinal microbiome, the disturbances of which are associated with previous intestinal infections.
To study the effectiveness of the drug Bifiform in the treatment of PI-IBS.
An open, prospective, comparative, randomized study included 62 patients with PI-IBS. The diagnosis was confirmed by the results of clinical, laboratory and endoscopic examination of the intestine and met the diagnostic criteria for IBS of the Rome Consensus IV. The patients were randomized into 2 groups depending on the therapy. The patients of the main group received an antispasmodic drug (mebeverin 200 mg 2 times a day or trimebutin 200 mg 3 times a day for 4 weeks), an antibiotic (rifaximin 400 mg 3 times a day or nifuroxazide 400 mg 2 once a day for 1 week), a drug that normalizes the consistency of feces (dioctahedral smectite or macrogol 4000) and Bifiform 2 capsules 2 times a day for 2 weeks. For patients of control group similar therapy was performed without the Bifiform. Evaluation of the effectiveness of treatment was carried out at the end of the course of therapy and 6 months after its termination.
All included patients with PI-IBS had abdominal pain, flatulence and tenderness to palpation along the bowel, most of them had diarrhea. Disorders of the intestinal microbiota were detected in 77.4% of patients, while excessive bacterial growth in the small intestine occurred in 72.6%, disorders of the colon microbiocenosis with the presence of opportunistic bacteria in 62.9% of patients. A significant part of the patients had a combination of small and large intestinal dysbiosis. Histological examination of the colon mucosa showed signs of low degree of inflammation activity in all patients. The moderate increase in the level of fecal calprotectin was found in 62.2% of patients with colonic dysbiosis. The majority of patients in the main group showed a pronounced positive dynamics of clinical manifestations of the disease, restoration of the normal composition of the intestinal microbiota and normalization of the content of fecal calprotectin at the end of the course therapy. The good result was observed much more often in the main group at the end of the course of treatment and 6 months after its termination.
The inclusion of Bifiform in the complex therapy of PI-IBS significantly increases its effectiveness both in arresting the clinical manifestations of the disease, and in restoring the normal composition of the intestinal microbiome and reducing the inflammatory process in the intestinal mucosa. In the majority of patients receiving Bifiform, the remission of the disease achieved at the end of the course of treatment and persisted even 6 months after its termination.
在感染后肠易激综合征（PI-IBS）的治疗中，肠道微生物群组成的正常化起着主导作用，其紊乱与先前的肠道感染有关。
研究必奇（Bifiform）药物治疗PI-IBS的有效性。
一项开放、前瞻性、比较、随机研究纳入了62例PI-IBS患者。通过肠道的临床、实验室和内镜检查结果确诊，符合罗马共识IV的IBS诊断标准。根据治疗方法将患者随机分为2组。主要组患者接受抗痉挛药物（美贝维林200mg，每日2次，或曲美布汀200mg，每日3次，共4周）、抗生素（利福昔明400mg，每日3次，或硝呋太尔400mg，每日2次，共1周）、一种使粪便稠度正常化的药物（蒙脱石或聚乙二醇4000）以及必奇2粒胶囊，每日2次，共2周。对照组患者进行类似治疗，但不使用必奇。在治疗疗程结束时和结束后6个月对治疗效果进行评估。
所有纳入的PI-IBS患者均有腹痛、腹胀以及沿肠道触诊压痛，大多数患者有腹泻。77.4%的患者检测到肠道微生物群紊乱，72.6%的患者小肠细菌过度生长，62.9%的患者结肠微生物群落紊乱且存在机会性细菌。相当一部分患者存在小肠和大肠生态失调的组合。结肠黏膜的组织学检查显示所有患者均有低度炎症活动迹象。62.2%的结肠生态失调患者粪便钙卫蛋白水平中度升高。主要组的大多数患者在疗程结束时疾病临床表现有明显的积极变化，肠道微生物群的正常组成得以恢复，粪便钙卫蛋白含量正常化。在治疗疗程结束时和结束后6个月，主要组更常观察到良好结果。
在必奇用于PI-IBS的综合治疗中，无论是在控制疾病临床表现、恢复肠道微生物群的正常组成还是减轻肠道黏膜炎症过程方面，均显著提高了其有效性。在大多数接受必奇治疗的患者中，在治疗疗程结束时实现了疾病缓解，甚至在治疗结束后6个月仍持续缓解。
