Intestines dyskinesia – the functional disorder of intestines which is shown a pain syndrome, discomfort in an abdominal cavity, change of frequency and a consistence of a chair. All symptoms of a disease divide on intestinal (pains, an abdominal distension, diarrhea or a lock), others gastroenterologichesky and negastroenterologichesky. Criterion of dyskinesia of intestines is preservation of symptomatology within 3 days a month for 3 calendar months in a year. In diagnostics correctly collected anamnesis, identification of a syndrome of uneasiness is of great importance; tool techniques are necessary only for the differential diagnosis. Treatment is conservative: diet, work with the psychologist, symptomatic therapy.
Dyskinesia of intestines is quite widespread pathological state – from this syndrome near the fifth part of the population of the planet suffers. However sensitivity of this problem leads to the fact that the vast majority of patients with a syndrome of the angry intestines do not ask for medical care. The greatest incidence is noted at people of working-age (30-40 years), at the same time at younger age among patients women prevail, and after 50 years sexual distinctions become insignificant. The risk of developing of dyskinesia of intestines decreases with age. The first symptoms of a disease can appear already at children's age though most often they arise after fifteen years.
Intestines dyskinesia reasons
One of the main reasons of development of dyskinesia of intestines – acute or chronic stress. Symptoms of a disease can appear in several weeks after the postponed tragic event (the death of the loved one, sexual violence, etc.) or against the background of a chronic stressful situation (a serious illness of the relative, a problem at work, difficult vital circumstances). There are special questionnaires and scales allowing to reveal the hidden uneasiness at the patient, to determine the level of disturbing frustration, to find a somatization (the multiple polymorphic symptoms caused by depressive frustration, but not organic pathology).
Refer some features of the personality to provocative factors: weak ability to distinguish emotional and physical pain, a somatization (manifestation of emotional instability somatic symptoms), the increased uneasiness, inability to an emotional discharge, etc. The researches conducted on a joint of gastroenterology and psychology showed genetic conditionality of these personal features, and, therefore, and intestines dyskinesia. There are instructions and on rather high frequency of development of dyskinesia of intestines after the sharp intestinal infections which are especially caused by shigellas and a kampilobakter.
The listed above factors, in total influencing a human body, development of visceral hypersensitivity, disorder of physical activity of intestines, delay of evacuation of gases and a calla cause. Gradually it leads to emergence of a meteorizm, instability of a chair (locks and diarrhea).
Classification of dyskinesia of intestines
Allocate four main clinical forms of dyskinesia of intestines (depending on change of a consistence of kalovy masses):
- with locks (more than a quarter of all acts of defecation passes with allocation of the dense, fragmented chair; less than a quarter – with diarrhea);
- with diarrhea (more than a quarter of cases of defecation – with a liquid chair, less than a quarter – with dense);
- the mixed form (both a dense, and liquid chair meet more than in 25% of cases);
- not classified form (change of a consistence of a chair is not enough for verification of any of the listed above disease forms).
There is also a division of dyskinesia of intestines according to symptomatology: with prevalence of intestinal symptoms, a pain syndrome, meteorizm. On an etiology allocate the post-infectious dyskinesia of intestines connected with the use of certain products or a stress.
The Bristol scale of a chair indicating the fact that the longer time occupies passing a calla on intestines is the basis for classification the kalovy masses becomes more dense. Nevertheless, the gastroenterologist should draw close attention to complaints of the patient: diarrhea and a lock often is meant as change not of a consistence of a chair, and frequency of defekation.
Intestines dyskinesia symptoms
All symptoms at this disease divide on belonging to intestines, to other digestive organs and negastroenterologichesky. Also absence of organic pathology is important for diagnosis. Rank belly-ache, a meteorizm, diarrhea and a lock as intestinal symptoms.
Belly-ache at intestines dyskinesia never arises at night. Pain can be uncertain, aching, stupid, or dagger, the constant unscrewing. Most often pain is localized in podvzdoshny area, it is more at the left. Strengthening of pains is connected with meal, easing – with defecation and an otkhozhdeniye of gases. Meteorizm usually accrues by the evening or after meal.
Absence at night and emergence in the morning after a breakfast is also characteristic of diarrhea. The first portions the calla usually more dense, then during a short period arises several desires on defecation by a watery chair. The feeling of incomplete depletion of intestines is characteristic. Total daily amount calla very small, no more than two hundred grams. At locks the chair dense, in a form can be as sheep a calla, in the form of a pencil. Often behind dense kalovy masses there is a semi-fluid chair. Impurity of blood and pus are uncharacteristic for intestines dyskinesia, and here slime meets rather often.
As the listed intestinal symptoms are not specific and can meet at other diseases, it is necessary to direct the attention to identification of symptoms of dysfunction of other digestive organs (gullet dyskinesia; the dyspepsia which is not connected with stomach ulcer of a stomach; anorektalny dysfunction, etc.), and also negastroenterologichesky complaints (headaches, backbone pains, feeling of shortage of air and incomplete breath, internal shiver).
Diagnosis of dyskinesia of intestines
For diagnosis of dyskinesia of intestines the greatest value has correctly collected anamnesis. Consultation of the gastroenterologist will help to reveal etiologichesky and provocative factors of a disease, to determine intestines dyskinesia duration until the request for medical care, to find out efficiency of the previous treatment. At the first stage the preliminary diagnosis is established, the main simptomokompleks and a stage of a disease is defined, researches for an exception of organic pathology and differential diagnostics are appointed.
To exclude the diseases having symptomatology, similar to intestines dyskinesia, to the patient the ezofagogastroduodenoskopiya, ultrasonography of abdominal organs, a survey X-ray analysis of OBP, an irrigoskopiya, an endoscopic research of a large intestine (a kolonoskopiya, a sigmoskopiya) is carried out. From laboratory researches appoint the analysis a calla to the hidden blood, scrape on , the analysis a calla on eggs of helminths, biochemical blood test, determination of level of S-jet protein. Identification of any aberrations (a gepatomegaliya, a splenomegaliya, fistulas of hollow bodies, etc.), organic pathology of a GIT excludes the diagnosis of dyskinesia of intestines.
Testify in favor of serious pathology and the following signs exclude the functional nature of a disease: unmotivated weight loss, blood to Calais, existence in the anamnesis of tumoral and inflammatory diseases of intestines, inflammatory changes in blood test, belly-ache in combination with temperature increase, connection of the beginning of a disease with reception of certain medicines or periods, emergence of the first symptoms after 50 years.
It is necessary to differentiate intestines dyskinesia with infectious pathology; reaction to change of habits of food and some foodstuff, drugs; inflammatory diseases and tumors of intestines; endocrine frustration; a syndrome of the broken absorption; gynecologic diseases at women; psychiatric pathology.
Treatment of dyskinesia of intestines
Hospitalization in office of gastroenterology is required only at primary address (for full inspection and installation of the diagnosis) and difficulties in selection of therapeutic actions. In most cases treatment of dyskinesia of intestines is carried out on an outpatient basis. A main objective of therapy – elimination of symptoms of a disease and restoration of social activity.
Non-drug treatment can demand participation of the psychologist for removal of alarm, the report to the patient of an essence of his disease. It is necessary to explain in an available form to the patient that this disease does not pose threat for his life, has the functional nature. It is necessary to focus attention on normal results of inspections, absence of serious organic pathology. Together with the nutritionist products which use leads to an aggravation of symptoms come to light, the individual diet is developed.
Medicinal therapy depends on an intestines dyskinesia form. At prevalence in a clinical picture of locks various depletive (the increasing volume of kalovy masses stimulating motility of intestines, osmotic laxatives) are used. The osmotic laxatives and medicines increasing the volume of kalovy masses do not exert impact on an intestinal wall and motility of a gut, can be applied a long time. Stimulators of motility are usually used in cases when the first two groups were inefficient; no more than 10 days are appointed a course. It is preferable to use at the same time medicines of two different mechanisms of action.
If in clinic diarrhea prevails, are appointed loperamide and smektit dioctahedral - their efficiency is proved clinically. Many authors discuss expediency of purpose of probiotics at intestines dyskinesia. Now it is considered that the greatest efficiency a probiotics with bifidobacteria has. The mechanism of action of probiotics consists in normalization of a ratio of pro-inflammatory and anti-inflammatory mechanisms in an intestines wall, as leads to mitigation and even disappearance of symptoms of a disease. Antibacterial therapy at dyskinesia of intestines is carried out according to strict indications.
At the mixed disease form locks alternate with diarrhea, patients most often show complaints to belly-aches and the increased gas generation. In this case antikholinergichesky medicines and spazmolitik have the greatest clinical effect. If necessary consultation of the patient with the psychiatrist is held, antidepressants or neuroleptics for removal of a syndrome of uneasiness, reduction of intensity of a pain syndrome are appointed.
Forecast and prevention of dyskinesia of intestines
The forecast for life at intestines dyskinesia favorable – the frequency of inflammatory diseases of intestines, tumoral transformation corresponds to the general in population. For recovery the forecast adverse as it is possible to reach long remission only at every tenth patient, and more than at a half of patients symptoms do not regress, despite the carried-out therapy. The forecast at patients with the accompanying psychiatric pathology, the long anamnesis of a disease prior to treatment, unwillingness to be treated, in the presence of a chronic stress is most adverse. Specific prevention of dyskinesia of intestines does not exist.