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FEATURES OF THE VEGETATIVE TONE OF PATIENTS WITH IRRITABLE BOWEL SYNDROME
Kireeva T.
Candidate of Medical Sciences, Associate Professor of the Department of Samara State Medical University, Samara
Deyneka N.
Candidate of Medical Sciences, Associate Professor of the Department of Samara State Medical University, Samara
Abstract
The global prevalence of irritable bowel syndrome ranges from 9% to 48%. This disease is difficult to treat due to the variety of etiological factors and associated emotional disorders. The relevance of the study of predictors of the development of this disease is caused by the need to develop psycho corrective events.
Keywords: irritable bowel syndrome, functional bowel diseases, organic bowel diseases, vegetative tone, sympathetic nervous system, parasympathetic nervous system.
Irritable bowel syndrome (IBS) is the most striking and common functional disorder in which abdominal pain is accompanied by diarrhea or constipation, flatulence. The basis for classifying IBS as a functional disorder is the lack of diagnostic confirmation of clinical symptoms [3].
This disease has been known for decades. During this time, it was described under various names: «chronic spastic colitis», «functional colopathy», «intestinal colic», «dyskinesia of the large intestine», «intestinal neurosis», etc. These names reflected various symptoms of the disease, but did not reflect a common understanding of the problem [2].
According to modern concepts, irritable bowel syndrome is a biopsychosocial disease. Its development involves psychological, social and biological factors, the complex effect of which leads to the development of visceral hypersensitivity, impaired intestinal motility and slow passage of gases, which is manifested by such symptoms of the disease as abdominalgia, flatulence, and stool disorders [1].
Treatment of patients with functional disorders of the gastrointestinal tract is a difficult task, which is associated with a variety of factors leading to the development of the disease, often emerging disorders of the psychoemotional sphere. The relevance of the study of individual psychological predictors of the development of functional disorders of the gastrointestinal tract is due to the need to develop psychocorrectional measures
that would improve the quality of life of this contingent of patients by reducing their psychological discomfort.
The study was conducted on the basis of the Department of Gastroenterology of the Clinics of the Samara State Medical University. The study involved 45 patients. The clinical group consisted of 30 patients admitted with complaints of abdominal pain of various nature and intensity, as well as dyspeptic disorders. The clinical group was divided into two subgroups: patients with functional disorders (15 people) and patients with organic disorders (Crohn's disease, ulcerative colitis) -15 people. The control group consisted of 15 people without gastrointestinal diseases. The age of the subjects was 18 - 41 years old.
The study was carried out using the Psychovege-tative Questionnaire designed to diagnose functional disorders of the nervous system. The technique was developed by M.E. Sandomirsky (2005). Assessment of autonomic tone is carried out on a number of functional systems with separate counting of parasympathetic (PST) and sympathetic tone (ST). The dominant division of the autonomic nervous system is determined by comparing the total values of parasympathetic and sympathetic tone, expressed as a percentage of their maximum sums (PST% and ST%). Mathematical analysis of the data was carried out using the Mann-Whitney U-criteria.
The results of the study of the characteristics of the vegetative tone are presented in the table.
Study results of the predominant type of the vegetative system (%)
groups PST % ST % PST % - ST %
Functional disorders of the gastrointestinal tract 46,68 46,82 -0,13
Organic disorders of the gastrointestinal tract 36,98 42,28 -5,30
U-criteria 52,5 90,5 90,0
P 0,011* 0,370 0,370
Functional disorders of the gastrointestinal tract 46,68 46,82 -0,13
The control group 33,6 43,31 -9,71
U-criteria 38,0 91,0 75,0
P 0,001* 0,389 0,126
* - statistically significant differences
Analysis of the autonomic nervous system showed that in the group of patients with functional diseases of the gastrointestinal tract, the parasympathetic and sympathetic nervous systems are balanced, i.e. should harmoniously regulate the work of internal organs without noticeable shifts in one direction or the other.
In the group of patients with organic diseases of the gastrointestinal tract, the predominance of the sympathetic nervous system over the parasympathetic one is noted, but the magnitude of the difference between them (5,3) is estimated as relative equilibrium.
In the group of healthy subjects, the predominance of the sympathetic system over the parasympathetic
The significance of the differences is related to the severity of the parasympathetic type of the autonomic nervous system in the subjects with functional disorders of the gastrointestinal tract compared with patients with organic disorders and with healthy people (U = 52,5, at p <0,011 and U = 38, at p <0,001). Accordingly, in subjects with IBS, the action of the parasympathetic system (vagotonia) is more pronounced. It is expressed in sweating, moisture of the skin, bradycardia, and a tendency to faint. At the behavioral level, persons with a predominance of the parasympathetic system are characterized by sluggishness, indecision, phlegmatism, low ability to work and resistance to stress, and a tendency to depression. Problems with the digestive system are as following: diarrhea or constipation, flatulence, abdominal pain.
The main directions in the correction of vagotonic disorders are:
1. Normalization of the regime, nutrition, physical activity.
2. Psychotherapy and psychocorrection.
3. Medication support.
An extremely important measure in the correction of autonomic dysfunction is psychotherapy, moreover, individual work with patients with functional disorders
system is also noted, but the difference between them is higher than in the first control group (9,7), and its value corresponds to the tendency towards predominance. Accordingly, in the group of healthy people, there is a tendency towards a predominance of the sympathetic nervous system (sympathicotonia), which is manifested by dilated eyes and pupils, dry mouth, tachycardia, and increased blood pressure, constipation. In their activity, they are characterized by increased motor activity, high efficiency, initiative, brightness, and instability of emotional reactions, anxiety, restless sleep.
is more effective than group sessions, because of the personality characteristics and emotional response of vagotonics.
REFERENCES:
l.Ivashkin V.T. Methodological recommendations for the treatment of irritable bowel syndrome (IBS) [Metodicheskie rekomendacii po lecheniyu sindroma razdrazhennogo kishechnika (SRK)] // Internist, 2013. URL: https://internist.ru/publications/de-tail/metodicheskie-rekomendacii-po-lecheniyu-sin-droma-razdrazhennogo-kishechnika-(srk) (Date of access : 09.10.2017)
2.Makhov V.M., Romasenko L.V., Turko T.V., Mamontova V.V. An interdisciplinary approach to irritable bowel syndrome [Mezhdisciplinarnyj podhod k sindromu razdrazhennogo kishechnika] // Russian Medical Journal. - 2013. - № 13. - P. 702-704.
3.Parfenov A.I. Irritable Bowel Syndrome: 20 Years of Following Roman Criteria [Sindrom razdrazhennogo kishechnika: 20 let sledovaniya rimskim kriteriyam] // Russian Medical Journal. - 2011. - № 17. - P. 1107-1110.
