Irritable bowel syndrome: modern ideas about pathology and the possibility of its correction

Abstract

Among the  defecating disorders  with  constipation or diarrhea,  there  is a  group  of major  intestinal disorders  defined  by the  Rome IV Diagnostic  Criteria (2016): irritable  bowel  syndrome, functional  constipation, functional  diarrhea. The presence of several updates of the Rome criteria is due to the current  lack of objective signs of the listed disorders while many options for describing  subjective  sensation by patients from different  countries. It calls for their terminological multilingual  standardization. Both constipation and diarrhea  can be caused  by a variety of exogenous and endogenous factors and have different pathogenetic mechanisms,  but they cannot  be identified  properly using modern  clinical and laboratory  methods for functional intestinal disorders. However, the  high prevalence of these  syndromes, characterized by the  presence of complaints  that reduce  patients’ quality of life, necessitates their  correction. The drug choice for defecation disorders  and abdominal  pain is often limited by contradictions from international clinical guidelines and national  regulations.Therefore, the Recommendations of the  Russian Gastroenterological Association for the  treatment of functional  intestinal diseases  contain  many instructions on general  therapeutic and dietary measures. The pain syndrome treatment is based on the spasmolytics. Among the laxatives that  have long been  used in the treatment of chronic constipation, sodium picosulfate has long been  successfully used. This drug has high efficacy and safety profiles; the instructions for its medical  use allow to prescribe  it in patients suffered  from irritable  bowel syndrome with constipation. The use of sodium picosulfate for IBS is regulated by many clinical recommendations. However, this  drug  may be ineffective  against  abdominal  pain. It is incorrect  to assign  the  mission  of pain  relief  to a laxative  because of multifactorial pathogenesis of IBS pain with constipation or diarrhea  and uncertainty of methods for its pharmacological control.