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.