RU2668496C2 - Method of diagnosing the severity of irritable bowel syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to methods for diagnosing the severity of irritable bowel syndrome. Technical result is achieved by recording the enzyme deficiency and with lactase insufficiency, a slight degree of severity of irritable bowel syndrome is noted, in case of carbohydrase insufficiency, the average severity of irritable bowel syndrome and when peptidase deficiency is noted, severe and extremely severe severity of irritable bowel syndrome.

EFFECT: object of the present invention is to improve the accuracy of the diagnosis of the severity of irritable bowel syndrome.

1 cl

Description

The invention relates to medicine, namely to methods for diagnosing the severity of irritable bowel syndrome.

A known method for the diagnosis of irritable bowel syndrome by bacterioscopic examination, including when staining according to Tsil-Nielsen, adopted as an analogue (1 - ND Mikhailova. A manual for coprological research. M., 1962: Reference to clinical laboratory research methods. Under Edited by E.A. Kost, p. 270).

There is a known method for the diagnosis of irritable bowel syndrome, adopted as a prototype (2 - ND Mikhailova. A manual for coprological research. M., 1962: a Handbook of clinical laboratory research methods. Edited by E.A. Kost, p. 271), including the preparation of smears followed by microscopy, including fixation with a Schaudinn solution and staining with Heidengain iron hematoxylin.

However, the prototype method has limited accuracy and does not allow an assessment of the severity of irritable bowel syndrome.

The aim of the present invention is to improve the accuracy of diagnosis of the severity of irritable bowel syndrome.

The technical result is achieved by the fact that enzyme insufficiency is recorded and mild severity of irritable bowel syndrome is noted in case of lactase deficiency, moderate severity of irritable bowel syndrome is noted in carbohydrase deficiency, and severe and extremely severe severity of irritable bowel syndrome is noted in peptidase deficiency.

The method is implemented as follows.

The patient, upon admission, complains of general weakness, periodic aching pains in the abdomen, decreasing after bowel movements, moderate intensity, bloating, on a mushy stool 3-4 p / day, intolerance to carbohydrates and proteins, weight loss.

From the anamnesis it is known that the appearance of frequent loose stools is noted after visiting a food service center, after which there are abdominal pains, stools up to 8 or more times a day, nausea, vomiting. Over the next six months, the patient has intolerance to milk and dairy products, intolerance to products containing various sugars (maltose, sucrose), in severe cases - intolerance to protein food.

Upon admission: satisfactory or moderate condition. Heart sounds are clear or muffled, the rhythm is correct or single extrasystoles, blood pressure and heart rate are normal or reduced. In the lungs, vesicular or muffled breathing. The tongue is overlaid at the root. The abdomen is soft, moderately painful on palpation.

With an objective study:

Endoscopy: The mucous membrane of the esophagus is pink, the cardia does not close. Gastroesophageal prolapse. The gastric mucosa is moderately hyperemic. In the cavity of the stomach a moderate amount of mucous contents. Peristalsis can be traced in all departments. The angle of the stomach is not changed. The gatekeeper will close, we pass. Bulb 12 p. Intestines of medium size, not deformed. The mucosa of the bulb 12 p. Of the intestine is pale pink, isolated erosion. Conclusion: gastroduodenitis, cardia failure.

With sigmoidoscopy, the rectal mucosa is pink, smooth, shiny. The vascular pattern is distinct. No bleeding. In the visible areas of organic pathology from the rectum was not detected.

Ultrasound of the abdomen. The liver is not enlarged. The structure of the parenchyma is homogeneous. General echogenicity is not changed. The diameter of the portal vein is normal. Vascular pattern saved. The gall bladder is not deformed. In the cavity of the bladder, homogeneous contents are determined. The pancreas is visualized satisfactorily, the contours are clear, even. The structure of the parenchyma is homogeneous. General echogenicity is not changed. Pancreatic duct is not expanded. The spleen is adequately visualized, the contour is clear, the surface is even, the capsule is sealed. The structure is homogeneous, the overall echogenicity is average. The splenic vein is not dilated, the lumen is uniform. Conclusion: echoes of pathology of the examined organs were not detected.

Colonoscopy: the apparatus was performed in the ileum. The ileal mucosa is pink, its peristalsis is active. Bauginieva damper closed, oriented to the dome. The sigmoid colon is elongated and forms loops. The mucous membrane of the colon in the examined areas is pink, smooth, shiny. The vascular pattern is distinct, correct. Folds of the mucous membrane of medium size, elastic. Gut lumen is not deformed. Intestine tone saved.

X-ray examination of the small intestine. After taking barium suspension, filling the loops of the small intestine is uniform, timely. In the jejunum, the normal lumen and relief of the mucosa. In the visible loops of the ileum, areas of spastic contractions are noted, which indicates the presence of spastic dyskinesia of the small intestine.

Clinical and laboratory analysis is within normal limits.

Final diagnosis: Irritable bowel syndrome with a predominance of diarrhea. Secondary lactase deficiency (mild), disaccharidase deficiency (moderate to severe IBS), peptidase deficiency (severe and extremely severe).

The prognosis of the disease (gastroenterological) is favorable.

Example 1

Patient J., 29 years old, was admitted with a diagnosis of irritable bowel syndrome with a predominance of diarrhea. Gastroesophageal reflux disease in the stage of erosive esophagitis. Complaints at admission: for periodic aching pains in the lower abdomen and the right half of the abdomen, aggravating before defecation, decreasing after defecation, of moderate intensity, without irradiation; for an increase in body temperature in the evening to 37.1 ° C, for a mushy stool 3-4 p / day, with an admixture of mucus, for general weakness, for a decrease in body weight of 10 kg over the past 1 year. Intolerance to milk and dairy products.

An anamnesis of this disease: considers himself sick a year and a half, when after drinking beer he noted the appearance of frequent loose stools up to 10 times a day, abdominal pain, nausea, vomiting. Deterioration over the past six months, when he began to notice a periodic increase in body temperature in the evening to 37.1 ° C, increased abdominal pain, stool was unstable, and began to lose weight. Ambulatory ultrasound of the abdominal cavity - diffuse changes in the liver, pancreas, ultrasound - signs of chronic cholecystitis.

Objectively upon admission: satisfactory condition, HELL = 120/80 mm Hg, heart rate = 76 per min. BH = 16 per min. There are no wheezing in the lungs. Heart sounds are clear, the rhythm is correct. The tongue is moist, slightly coated at the root with a white-yellow coating. The abdomen is soft, moderately painful during palpation along the colon and the right ileal region. The stool was 3 times a day, mushy, with an admixture of mucus.

Survey Results:

ECG: semi-vertical position of the EOS. Sinus rhythm, correct, heart rate 76.

EGDS: We pass the esophagus. The mucous membrane of the esophagus is pink, in the dietary department there are two linear erosions up to 0.4 cm, the cardia does not close. Gastroesophageal prolapse and reflux. Stomach: a moderate amount of mucous contents in the stomach cavity. The gastric mucosa is moderately hyperemic on the tops of the folds. Folds of medium height, elastic. Peristalsis can be traced in all departments. The angle of the stomach is not changed. The gatekeeper will close, we pass. Onion 12p. the intestines are medium in size, not deformed, the exit from the bulb is free. Mucous bulbs 12p. the intestines are pale pink. The folds are medium sized, elastic. The jejunum is without features.

Conclusion: superficial gastritis, erosive reflux esophagitis, cardia failure.

Biopsy: mucosal fragments from the distal duodenum. Intestinal villi and crypts are high. The number of MEL is within normal limits. In their own plate there is a small lymphoplasmocytic infiltration. Conclusion: the mucous membrane of the duodenum of the normal structure.

Sigmoidoscopy: a rectoscope inserted 11 cm from the anus. In the lumen of the intestine a large amount of contents, which greatly complicated the examination. The rectal mucosa in the examined areas is pink, smooth, shiny. The vascular pattern is distinct. No bleeding. No ulcers, polyps, tumors were detected. When the apparatus is removed, internal hemorrhoidal nodes are visualized, without signs of inflammation. Conclusion - internal hemorrhoids, remission. In the visible areas of organic pathology from the rectum was not detected.

Ultrasound of the abdominal cavity: Acoustic access is satisfactory. The liver is not enlarged (CWR of the right lobe is 151 mm, the thickness of the left lobe is 59 mm). The structure of the parenchyma is homogeneous. General echogenicity is not changed. The diameter of the portal vein is 10 mm. Vascular pattern saved. The gallbladder is not deformed, the dimensions are not enlarged: 7.6 × 2.4 cm. The walls of the bladder are not thickened, 2.5 mm (normal to 3 mm), the echogenicity is average, of a homogeneous structure. In the cavity of the bladder, homogeneous contents are determined. There are no calculi. The bile ducts are not dilated, the walls are even, the lumen is uniform. The common bile duct is not dilated (2 mm), the walls are even, the lumen is uniform, there are no stones. The pancreas is visualized satisfactorily, the contours are clear, even, the size of the head is 24 mm, the body is 12 mm, the tail is 14 mm. The structure of the parenchyma is homogeneous. General echogenicity is not changed. Pancreatic duct is not expanded. The spleen is adequately visualized, the contour is clear, the surface is even, the capsule is sealed. Dimensions not enlarged: 119 × 51 mm (normal 120 × 60 mm). The structure is homogeneous, the overall echogenicity is average. The splenic vein is not dilated, the lumen is uniform. Conclusion: echoes of pathology of the examined organs were not detected.

Colonoscopy: the apparatus was carried out into the ileum by 10 cm. The mucous membrane of the ileum is pink, velvety, its active motility. The Bauginieva damper is polypous in shape, closed, oriented to the dome. The sigmoid colon is elongated and forms loops. The mucous membrane of the colon in the examined areas is pink, smooth, shiny. The vascular pattern is distinct, correct. Folds of the mucous membrane of medium size, elastic. Gut lumen is not deformed. Intestine tone saved. No ulcers, polyps, tumors were detected. A biopsy was taken from the ileal and distal sigmoid colon to clarify the diagnosis. Conclusion - convincing endoscopic data for IBD have not been obtained.

X-ray examination of the small intestine: the act of swallowing is not broken. After taking 400 ml of barium suspension, filling the loops of the small intestine is uniform, timely. In the jejunum, the normal lumen and relief of the mucosa are represented by curcring folds. The ileum in the form of a "ball" is located above the entrance to the pelvis. In the visible loops of the ileum, frequent and prolonged spastic bridges, the width of the lumen and the relief of the mucosa are not changed. After 4.5 hours from the start of the study, the contrast fills the right colon. Terminal ileum with clear contours, the walls are not thickened, active peristalsis, edge effects of filling up to 4 mm are determined (lymphoid hyperplasia). Conclusion: the x-ray picture corresponds to spastic dyskinesia of the small intestine.

Laboratory data

Antibodies to Shigella, Salmonella, Yersinia were not identified.

HBs-Ag and anti-HCV are not detected. Blood group AB (IV) Rh-positive, Kell antigen negative.

Clinical urine analysis - transparent, protein 0.1 traces, beats / weight 1015, white blood cells neg. erythrocytes neg, urobilinogen neg., ketones neg, glucose - no.

Fecal analysis reaction to occult blood is negative.

Electromyography. An electromyogram of the small intestine is recorded, an increase in the frequency of slow waves to 28 min and an amplitude of 0.29 mV, an electromyogram of the ascending colon and an increase in the frequency of slow waves to 26 min and an amplitude of 0.27 mV, and an increase in the frequency of slow sigmoid waves intestines up to 14.3 per min and increase in amplitude to 0.21 mV.

Treatment: table 4-b, without lactose, mezim forte, niaspam, omez, gastal.

Against the background of the therapy, the patient’s discomfort in the lower abdomen decreased, there is a decrease in the frequency of stools, stool during treatment 1-2 times a day, designed without impurities.

Electromyography. An electromyogram of the small intestine is recorded and a decrease in the frequency of slow waves to 19.5 per minute and amplitude to 0.21 mV, an electromyogram of the ascending part of the colon and a decrease in the frequency of slow waves to 8.8 per minute and amplitude to 0.15 mV, and note a decrease in the frequency of slow waves of the sigmoid colon to 6.2 per minute and a decrease in amplitude to 0.13 mV, which makes it possible to evaluate the treatment as effective.

The prognosis of the disease (gastroenterological) is favorable.

Example 2

Patient K., 29 years old, was admitted with complaints of loose and gruel-like stools 1-2 times a day, without pathological impurities, bloating, increased gas formation, decreasing after defecation, weight loss by 6 kg. Sick for about 8 years. The appearance of these symptoms is associated with stress and the use of milk, vegetables or fruits. Upon examination of the correct addition, satisfactory nutrition, BMI of 20.5 kg / m ² . On examination, a moderately coated tongue and “splashing noise” were noted during palpation of the cecum. Laboratory blood tests, ultrasound of the abdominal cavity, colonoscopy and endoscopy are within normal limits. During histological examination, the mucous membrane of the bulbous section of the duodenum of normal structure, but the activity of carbohydrases was significantly lower than normal values. The activity of glucoamylase was 139 ng of maltase - 96, sucrose - 16, lactase - 4 ng of glucose / mg of tissue x min.

Thus, in a patient with functional diarrhea, a deficiency of the membrane enzymes responsible for the digestion of lactose, maltose, starch and sugar was found. This served as the basis for establishing the diagnosis of IBS, a moderate to severe course of disaccharidase deficiency. The patient is recommended a diet with a low content of milk and dairy products, sugar and starch and a high protein content. Gradually a remission began: bloating and diarrhea stopped.

SURVEY RESULTS:

ECG: semi-horizontal position of the EOS. Sinus rhythm, correct, heart rate 68. Ultrasound of the abdominal cavity: the liver is enlarged - CWR of the right lobe 149 (normal to 150 mm), the thickness of the left lobe 58 mm (normal to 60 mm). The echo structure is homogeneous. Echogenicity is increased. The vascular pattern is depleted. The portal vein is 12 mm (normal up to 14 mm), the lumen is free. Volumetric formations are not identified. The bile ducts are not dilated. Choledoch 4-5 mm in diameter, free. The gallbladder with an S-shaped inflection in the neck, dimensions not increased - 7.22 × 4.8 mm. Wall 2.7 mm. Homogeneous bile. The paravesical region is not changed. The pancreas is usually located, the contours are uneven, fuzzy. Dimensions: head 29 mm (norm up to 30 mm), body 15 mm (norm up to 20 mm), tail - 22 mm. The echostructure is diffusely heterogeneous, echogenicity is increased. Wirsung duct is not expanded, 1.5 mm. The spleen is usually located, the contours are even, clear, the capsule is not changed. Dimensions not increased - 105 × 50 mm (normal 120 × 60 mm). The parenchyma is homogeneous. Echogenicity is average. The splenic vein is not dilated, 1.5 mm.

CONCLUSION: diffuse changes in the liver (steatosis), diffuse changes in the pancreas.

Endoscopy in dynamics: The esophagus is passing. The mucous membrane of the esophagus is pink, the cardia does not close, the vascular pattern is preserved, peristalsis is satisfactory. Stomach: a moderate amount of clear fluid and mucus in the stomach cavity. The gastric mucosa is hyperemic in places, swollen. Folds of medium height, elastic. Peristalsis is satisfactory. The angle of the stomach is not changed. The gatekeeper is round in shape. Onion 12p. intestines of medium size, not deformed, bile reflux. Mucous bulbs 12p. the intestines are pink. Postbulbar departments are not visualized.

Conclusion: superficial gastritis, DGR, cardia failure, urease test is negative.

Colonoscopy: an endoscope was placed in the ileum by 10 cm. The mucosa of the small intestine is pink, velvety, its active motility. The Bauginieva damper is polypous in shape, closed, oriented to the dome. The sigmoid colon forms a loop. The mucous membrane of the colon is pink, smooth, shiny throughout. The vascular pattern is distinct. Folds of normal height, the lumen of the intestine is not deformed. Intestine tone saved.

Laboratory test results:

General blood analysis

Biochemical analysis

Blood type O (I) Rh-positive, kell antigen - negative.

Markers of viral hepatitis B and C were not found.

Clinical urine analysis - transparent, protein OD, beats / weight 1034, white blood cells, red blood cells, ketones, glucose - neg. Fecal analysis reaction to occult blood is negative.

Final diagnosis: Irritable bowel syndrome of moderate severity.

Disaccharidase deficiency. Liver steatosis.

Electromyography. An electromyogram of the small intestine is recorded and an increase in the frequency of slow waves to 22 per minute and amplitudes to 0.25 mV are detected, an electromyogram of the ascending colon is an increase in the frequency of slow waves to 16 per minute and an amplitude to 0.24 mV, and an electromyogram of the sigmoid colon - increasing the frequency of slow waves of the sigmoid colon to 11 per minute and amplitude to 0.15 mV.

Treatment: table 4-b, a diet devoid of disaccharides, mezim forte, metronidazole, bactisubtil, sparex.

Against the background of the therapy, the patient has stool 1-2 times a day, half-formed consistency, without impurities.

Electromyography after treatment. An electromyogram of the small intestine is recorded and a decrease in the frequency of slow waves to 18 per minute and amplitude to 0.16 mV, an electromyogram of the ascending part of the colon - a decrease in the frequency of slow waves to 8.4 per minute and amplitude to 0.11 mV, and reducing the frequency of slow waves of the sigmoid colon to 5.9 per min and lowering the amplitude to 0.11 mV evaluate treatment as effective.

Discharged in satisfactory condition.

Example 3

Patient N., 32 years old, was admitted with a diagnosis of irritable bowel syndrome with a predominance of diarrhea. Complaints upon admission: intense pain in the epigastric region, aggravating before bowel movements, decreasing after bowel movements, pronounced intensity, an increase in body temperature in the evening to 37.8 ° C, on pulp-like stools 5-7 r / day, with an admixture of mucus, on general weakness, a decrease in body weight of 12 kg over the past year. Intolerance to milk and dairy products, products containing disaccharides and proteins is noted.

An anamnesis of this disease: considers himself sick for more than 10 years, when after eating salad in a catering he noted the appearance of frequent loose stools up to 12 times a day, abdominal pain, nausea, and vomiting. The deterioration of the state over the past six months, when he began to notice a periodic increase in body temperature in the evening to 37.8 ° C, increased abdominal pain, stool was unstable, and began to lose weight. Outpatient ultrasound of the abdomen - diffuse changes in the pancreas, ultrasound - signs of chronic pancreatitis.

Objectively upon admission: satisfactory condition, HELL = 140/90 mm Hg, heart rate = 89 per minute. BH-20 in minutes Heart sounds are muffled, the rhythm is correct. The tongue is coated at the root with a yellowish coating. The abdomen is soft, moderately painful on palpation in the epigastric region, along the colon and the right ileal region. The stool was 10 times a day, mushy, with an admixture of mucus.

Survey Results:

ECG: semi-vertical position of the EOS. Sinus rhythm, correct, heart rate 89.

EGDS: We pass the esophagus. The mucous membrane of the esophagus is pink, in the distal section there are two linear erosions of up to 0.5 cm, the cardia closes. The gastric mucosa is moderately hyperemic on the tops of the folds. Folds of medium height, elastic. Peristalsis can be traced in all departments. The gatekeeper will close, we pass. Onion 12p. the intestines are medium in size, not deformed, the exit from the bulb is free. Mucous bulbs 12p. the intestines are pale pink. The folds are medium sized, elastic. The jejunum is without features.

Conclusion: superficial gastritis, cardia failure.

Biopsy: mucosal fragments from the distal duodenum. Intestinal villi and crypts are high. The number of MEL is within normal limits. In their own plate there is a small lymphoplasmocytic infiltration. Conclusion: the mucous membrane of the duodenum of the normal structure.

Sigmoidoscopy: a rectoscope inserted 11 cm from the anus. In the lumen of the intestine a large amount of content. The rectal mucosa in the examined areas is pink, smooth, shiny. The vascular pattern is distinct. No ulcers, polyps, tumors were detected. When the apparatus is removed, internal hemorrhoidal nodes are visualized, without signs of inflammation. Conclusion - internal hemorrhoids, remission. In the visible areas of organic pathology from the rectum was not detected.

Ultrasound of the abdominal cavity: Acoustic access is satisfactory. The liver is not enlarged (CWR of the right lobe is 153 mm, the thickness of the left lobe is 61 mm). The structure of the parenchyma is homogeneous. General echogenicity is not changed. The diameter of the portal vein is 10 mm. Vascular pattern saved. The gallbladder is not deformed, the dimensions are not enlarged: 7.8 × 2.5 cm. The walls of the bladder are not thickened, 2.8 mm (normal to 3 mm), the echogenicity is average, of a homogeneous structure. In the cavity of the bladder, homogeneous contents are determined. The bile ducts are not dilated, the walls are even, the lumen is uniform. The common bile duct is not expanded (2.5 mm), the walls are even, the lumen is uniform, there are no calculi. The pancreas is visualized satisfactorily, the contours are clear, even, the size of the head is 26 mm, the body is 14 mm, the tail is 15 mm. The structure of the parenchyma is homogeneous. General echogenicity is not changed. Pancreatic duct is not expanded. The spleen is adequately visualized, the contour is clear, the surface is even, the capsule is sealed. Dimensions not enlarged: 118 × 54 mm (normal 120 × 60 mm). The structure is homogeneous, the overall echogenicity is average. The splenic vein is not dilated, the lumen is uniform. Conclusion: echoes of pathology of the examined organs were not detected.

Colonoscopy: the apparatus was performed in the ileum by 10 cm. The mucous membrane of the ileum is pink, velvety, its active motility. The Bauginieva damper is polypous in shape, closed, oriented to the dome. The sigmoid colon is elongated and forms loops. The mucous membrane of the colon in the examined areas is pink, smooth, shiny. The vascular pattern is distinct, correct. Folds of the mucous membrane of medium size, elastic. Gut lumen is not deformed. Intestine tone saved. No ulcers, polyps, tumors were detected. A biopsy was taken from the ileal and distal sigmoid colon to clarify the diagnosis.

X-ray examination of the small intestine: the act of swallowing is not broken. After taking 400 ml of barium suspension, filling the loops of the small intestine is uniform, timely. In the jejunum, the normal lumen and relief of the mucosa are represented by curcring folds. The ileum is located above the entrance to the pelvis. In the visible loops of the ileum, frequent and long spastically jumpers, the width of the lumen and the relief of the mucosa are not changed. After 4.5 hours from the start of the study, the contrast fills the right colon. Terminal ileum with clear contours, the walls are not thickened, active peristalsis, edge effects of filling up to 4 mm are determined (lymphoid hyperplasia). Conclusion: the x-ray picture corresponds to spastic dyskinesia of the small intestine.

Laboratory data

Antibodies to Shigella, Salmonella, Yersinia were not identified.

HBs-Ag and anti-HCV- not detected. Blood group VO (III) Rh is positive, kell antigen is negative.

Clinical urine analysis - transparent, protein 0.12 traces, beats / weight 1025, white blood cells neg. erythrocytes neg, urobilinogen neg., ketones neg, glucose - no.

Fecal analysis: reaction to occult blood is negative.

Electromyography. An electromyogram of the small intestine is recorded, an increase in the frequency of slow waves to 31 per minute and amplitudes to 0.33 mV, an electromyogram of the ascending colon and an increase in the frequency of slow waves to 30 per minute and amplitudes to 0.29 mV, and an increase in the frequency of slow sigmoid waves intestines up to 15.4 per min and increase in amplitude to 0.25 mV.

Treatment: table 4-b, without lactose, with a limited amount of protein, mezim forte, niaspam, omez, gastal.

Against the background of the therapy, the patient’s discomfort in the lower abdomen decreased, there is a decrease in the frequency of stools, stool during treatment 1-2 times a day, designed without impurities.

Electromyography. An electromyogram of the small intestine is recorded and a decrease in the frequency of slow waves to 22 per min and amplitudes to 0.24 mV is noted, an electromyogram of the ascending part of the colon and a decrease in the frequency of slow waves to 11.8 per min and amplitudes to 0.17 mV are noted and a decrease the frequency of slow waves of the sigmoid colon to 7.3 per minute and a decrease in amplitude to 0.1 mV, which allows us to evaluate the treatment as effective.

Peptidases In the comparison group, the activity of glycyl valindipeptidase (Gli-Val) was distributed in the range from 324 to 376 μmol⋅min / g and averaged 350 ± 26 μmol⋅min / g. For glycyl-leucindipeptidase (Gli-Lei), these values were respectively 304, 352 and 328 ± 24 μmol-min / g, and for phenyl-alanine dipeptidase (Phen-Ala) -372, 448 and 410 ± 38 μmol-min / g Alanine aminopeptidase (AAP) activity ranged from 27.5 to 34.5 and averaged 30.0 ± 4.5 μmol min – g / g. Indicators of peptidase activity in patients with UC, depending on the severity and duration of the disease are presented in table. 2. In patients of the first group with a mild UC, an increase in the level of enzyme activity by 65% was determined (Gli-Val - 580.0 ± 35.0 μmol⋅min / g, Gli-Lei - 450.0 ± 16.0 μmol⋅min / g, Fen-Ala - 410.0 ± 38.0 μmol⋅min / g). AARP activity did not change. In the moderate course of UC, peptidase deficiency was observed, reaching 55-60% compared with the corresponding indices in patients with IBS (Gli-Val activity - 160.0 ± 20.0 μmol⋅min / g, Gli-Lei - 120.0 ± 35, 0 μmol⋅min / g, Fen-Ala - 110.0 ± 20.0 μmol⋅min / g, ААП - 17.5 ± 4.6 μmol⋅min / g). The severe course of UC was characterized by a sharp (up to 80%) inhibition of the activity of intestinal peptidases: Gli-Val - 70.0 ± 25.0 μmol⋅min / g, Gli-Lei - 68.0 ± 17.0 μmol⋅min / g, Fen Ala - 60.0 ± 15.0 μmol⋅min / g, AAP - 12.7 ± 7.0 μmol⋅min / g. Patients of the second group with mild UC did not show an increase in the activity of Gli-Val, Gli-Lei and Fen-Al. At the same time, the activity of small intestine peptidases in moderate to severe cases did not significantly differ from the indicators in the first group. Thus, the peptidase activity of the small intestine with UC changes significantly: with a mild course of the disease lasting up to 5 years, it increases by 65%. With a longer course of increased activity of the small intestine peptidases is not observed. Moreover, with the progression of severity and a longer course, peptidase activity is inhibited. In patients with moderate UC, it decreases by 55-60%, and in severe cases - up to 80%

Diagnosis. IBS, severe course, peptidase deficiency

The severity of irritable bowel syndrome was assessed: 12 patients with lactase deficiency (mild), 16 patients with disaccharidase deficiency (moderate to severe), 18 patients with peptidase deficiency (severe and extremely severe) according to the proposed method. Subsequent treatment and follow-up for 12 months did not reveal relapse of irritable bowel syndrome with diarrhea.

Information sources

1. N.D. Mikhailova. Handbook of coprological research. M., 1962: Handbook of clinical laboratory research methods. Ed. E.A. Coast, p. 270.

2. There.

Claims (1)

A method for diagnosing the severity of irritable bowel syndrome through a clinical trial, characterized in that with lactase deficiency a mild severity of irritable bowel syndrome is noted, with disaccharidase deficiency, a moderate severity of irritable bowel syndrome is noted, and with peptidase deficiency, a severe and extremely severe severity of irritable bowel syndrome is noted .