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ГАСТРОЭНТЕРОЛОГИЯ<br />

Литература<br />

Agrawal S., Bhupinderjit A., Bhutani M.S. et al.<br />

Committee of Minority Affairs and Cultural Diversity,<br />

American College of Gastroenterology. Colorectal<br />

cancer in African Americans. Am J Gastroenterol<br />

2005; 100: 515–523.<br />

Bassett J., Cash B.D. A review of irritable bowel<br />

syndrome and an update on therapeutic approaches.<br />

Expert Opin Pharmacother 2008; 9: 1129–<br />

1143.<br />

Bassotti G., de Roberto G., Castellani D. et al.<br />

Normal aspects of colorectal motility and abnormalities<br />

in slow transit constipation. World J<br />

Gastroenterol 2005; 11: 2691–2696.<br />

Bassotti G., Iantorno G., Fiorella S. et al. Colonic<br />

motility in man: features in normal subjects and in<br />

patients with chronic idiopathic constipation. Am J<br />

Gastroenterol 1999; 94: 1760–1770.<br />

Borum M. Constipation: evaluation and management.<br />

Prim Care 2001; 28: 577–590.<br />

Brandt L.J., Prather C.M., Quigley E.M. et al.<br />

Systematic review on the management of chronic<br />

constipation in North America. Am J Gastroenterol<br />

2005; 100 (Suppl 1): 5–21.<br />

Cash B.D. Chronic Constipation: Understanding<br />

Issues in Gut Physiology and Implications for Therapy.<br />

Medscape Gastroenterollgy 2008, Aug. 18.<br />

Cash B.D., Chang E., Talley N.J. et al. Fresh perspectives<br />

in chronic constipation and other functional<br />

bowel disorders. Rev Gastroenterol Disord<br />

2007; 7: 116–133.<br />

Cash B.D., Lacy B.E. FDA-approved prescription<br />

medications for adults with constipation. Gastroenterol<br />

Hepatol 2006; 2: 736–749.<br />

Cheng C., Chan A.O.O., Hui W.M. et al. Coping<br />

strategies, illness perception, anxiety and depression<br />

of patients with idiopathic constipation: a<br />

population-based study. Aliment Pharmacol Ther<br />

2003; 18: 319–326.<br />

Connell A.M., Hilton C., Irvine G. et al. Variation<br />

of bowel habit in two population samples. Br Med<br />

J 1965; 5470: 1095–1099.<br />

Cupoletti J., Malinowska D.H., Tewari K.P. et al.<br />

SPI-0211 activates T84 cell chloride transport and<br />

recombinant human ClC-2 chloride currents. Am J<br />

Physiol Cell Physiol 2004; 287: 1173–1183.<br />

Dennison C., Prasad M., Lloyd A. et al. The<br />

health-related quality of life and economic burden<br />

of constipation. Pharmacoeconomics 2005; 23:<br />

461–476.<br />

Слабительные осмотического<br />

дейст<strong>в</strong>ия<br />

Наиболее обосно<strong>в</strong>анно применяются препараты<br />

четырех агенто<strong>в</strong> – полиэтиленгликоля<br />

(polyethylene glycol – PEG) 3350, лактулозы.<br />

сорбитола и гидрохлорида магния. PEG 3350<br />

и лактулоза досто<strong>в</strong>ерно у<strong>в</strong>еличи<strong>в</strong>ают частоту<br />

стула наряду с улучшением его консистенции<br />

при эпизодической констипации (Brandt<br />

L.J. et al., 2005). При этом эффект лактулозы<br />

реализуется путем ферментации агента кишечными<br />

бактериями, что при<strong>в</strong>одит к у<strong>в</strong>еличению<br />

осмотического да<strong>в</strong>ления <strong>в</strong> полости<br />

кишечника и ретенции интестинальной жидкости.<br />

PEG 3350 не под<strong>в</strong>ергается ферментации,<br />

а проя<strong>в</strong>ляет эффект непосредст<strong>в</strong>енно<br />

путем быстрого создания гиперосмолярного<br />

состояния с последующей ретенцией жидкости.<br />

Последнее я<strong>в</strong>ление <strong>в</strong> обоих случаях<br />

про<strong>в</strong>идит к стимуляции механорцепторо<strong>в</strong> с<br />

результирующим сокращением гладких<br />

мышц стенки кишечника и э<strong>в</strong>акуацией содержимого,<br />

хотя осмотические слабительные<br />

не следует считать прокинетическими<br />

агентами (Cash B.D., Lacy B.E., 2006). Гидрохлорид<br />

магния и сорбитол дейст<strong>в</strong>уют аналогично<br />

и характеризуются таким же побочным<br />

эффектом – диареей (до 40% случае<strong>в</strong>).<br />

Важно подчеркнуть, что ни один из осмотических<br />

слабительных не одобрен для<br />

применения при ХК, а <strong>в</strong> ряде случае<strong>в</strong> FDA<br />

(Упра<strong>в</strong>ление по контролю за продуктами и<br />

лекарст<strong>в</strong>ами США – US Food and Drug<br />

Administration) указы<strong>в</strong>ает на показания к их<br />

кратко<strong>в</strong>ременному использо<strong>в</strong>анию (до 14<br />

суток) у лиц с эпизодической констипацией.<br />

Впрочем, д<strong>в</strong>ойное слепое рандомизиро<strong>в</strong>анное<br />

исследо<strong>в</strong>ание J.A. DiPalma и сотруднико<strong>в</strong><br />

(2007) показало преимущест<strong>в</strong>а<br />

PEG 3350 по сра<strong>в</strong>нению с плацебо <strong>в</strong> терапии<br />

ХК на протяжении 6 месяце<strong>в</strong>.<br />

Продолжение следует<br />

DiPalma J.A., Cleveland M.V., McGowan J. et al.<br />

A randomized, multicenter, placebo-controlled<br />

trial of polyethylene glycol laxative for chronic<br />

treatment of chronic constipation. Am J<br />

Gastroenterol 2007; 102: 1436–1441.<br />

Feyen B.J., Rao S.S. Functional disorders of defecation:<br />

evaluation and treatment. Curr Treat<br />

Options Gastroenterol 2007; 10: 221–230.<br />

Garrigues V., Galvez C., Ortiz V. et al. Prevalence<br />

of constipation: agreement among several<br />

criteria and evaluation of the diagnostic accuracy<br />

of qualifying symptoms and self-reported definition<br />

in a population-based survey in Spain. Am J<br />

Epidemiol 2004; 159: 520–526.<br />

Glia A., Lindberg G. Quality of life in patients<br />

with different types of functional constipation.<br />

Scand J Gastroenterol 1997; 32: 1083–1089.<br />

Harari D., Gurwitz J.H., Avorn J. et al. How do<br />

older persons define constipation? Implications for<br />

therapeutic management. J Gen Intern Med 1997;<br />

12: 63–66.<br />

Harrell L.E., Chang E.B. Intestinal water and<br />

electrolyte transport. In: Feldman M., Friedman<br />

L.S., Brandt L.J., eds. Sleisenger & Fordtran's Gastrointestinal<br />

and Liver Disease. 8th ed. Philadelphia:<br />

Saunders; 2006: 2127–2146.<br />

Heaton K.W., Ghosh S., Braddon F.E.M. How<br />

bad are the symptoms and bowel dysfunction of<br />

patients with the irritable bowel syndrome? A<br />

prospective, controlled study with emphasis on<br />

stool form. Gut 1991; 32: 73–79.<br />

Heaton K.W., Radavan J., Cripps H. et al. Defecation<br />

frequency and timing, and stool form in the<br />

general population: a prospective study. Gut 1992;<br />

33: 818–824.<br />

Higgins P.D.R., Johanson J.F. Epidemiology of<br />

constipation in North America: a systematic review.<br />

Am J Gastroenterol 2004; 99: 750–759.<br />

Kellow J.E., Azpiroz F., Delvaux M. et al. Applied<br />

principles of neurogastroenterology: physiology/motility<br />

sensation. Gastroenterology 2006;<br />

130: 1412–1420.<br />

Kuo B., McCallum R.W., Koch K.L. et al. Comparison<br />

of gastric emptying of a nondigestible capsule<br />

to a radio-labelled meal in healthy and gastroparetic<br />

subjects. Aliment Pharmacol Ther 2008; 27:<br />

186–196.<br />

Locke G.R. III, Pemberton J.H., Phillips S.F. American<br />

Gastroenterological Association medical position<br />

statement: guidelines on constipation. Gastroenterology<br />

2000; 119: 1761–1778.<br />

Longstreth G.F., Thompson W.G., Chey W.D.<br />

Functional Bowel Disorders. Gastroenterology<br />

2006; 130: 1480–1491.<br />

Muller-Lissner S.A., Kamm M.A., Scarpignato C.<br />

et al. Myths and misconceptions about chronic<br />

constipation. Am J Gastroenterol 2005; 100: 232–<br />

242.<br />

O'Donnell L.J.D., Virjee J., Heaton K.W. Detection<br />

of pseudodiarrhoea by simple clinical assessment<br />

of intestinal transit rate. BMJ 1990; 300:<br />

439–440.<br />

Pare P., Ferrazzi S., Thompson W.G. et al. An<br />

epidemiological survey of constipation in Canada:<br />

definitions, rates, demographics, and predictors<br />

of health care seeking. Am J Gastroenterol 2001;<br />

96: 3130–3137.<br />

Ramkumar D., Rao S.S.C. Efficacy and safety of<br />

traditional medical therapies for chronic constipation:<br />

systematic review. Am J Gastroenterol 2005;<br />

100: 936–971.<br />

Rao S.S.C. Constipation: evaluation and treatment.<br />

Gastroenterol Clin N Am 2003; 32: 659–<br />

683.<br />

Rao S.S.C., Ozturk R., Laine L. Clinical utility of<br />

diagnostic tests for constipation in adults: a systematic<br />

review. Am J Gastroenterol 2005; 100:<br />

1605–1615.<br />

Remes-Troche J.M., Rao S.S.C. Diagnostic testing<br />

in patients with chronic constipation. Curr Gastroenterol<br />

Rep 2006; 8: 416–424.<br />

Stewart W.F., Liberman J.N., Sandler R.S. et al.<br />

Epidemiology of constipation (EPOC) study in the<br />

United States: relation of clinical subtypes to<br />

sociodemographic features. Am J Gastroenterol<br />

1999; 94: 3530–3540.<br />

Thompson W.G., Longstreth G.F., Drossman<br />

D.A. et al. Functional bowel disorders and functional<br />

abdominal pain. Gut 1999; 45 (suppl 2):<br />

II43–II47.<br />

Walter S., Hallbook O., Gotthard R. et al. A<br />

population-based study on bowel habits in a<br />

Swedish community: prevalence of faecal incontinence<br />

and constipation. Scand J Gastroenterol<br />

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Wood J. Neuropathophysiology of functional<br />

gastrointestinal disorders. World J Gastroenterol<br />

2007; 13: 1313–1332.<br />

4/2008 НОВАЯ МЕДИЦИНА ТЫСЯЧЕЛЕТИЯ 17

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