Гастроэнтерология» в формате .pdf - Новая Медицина ...
Гастроэнтерология» в формате .pdf - Новая Медицина ...
Гастроэнтерология» в формате .pdf - Новая Медицина ...
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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 />
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Glia A., Lindberg G. Quality of life in patients<br />
with different types of functional constipation.<br />
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Harari D., Gurwitz J.H., Avorn J. et al. How do<br />
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Harrell L.E., Chang E.B. Intestinal water and<br />
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Heaton K.W., Ghosh S., Braddon F.E.M. How<br />
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Higgins P.D.R., Johanson J.F. Epidemiology of<br />
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130: 1412–1420.<br />
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