problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl13082problendo-13082Research ArticleНарушение углеводного обменаCarbohidrates metabolism disturbanciesДиабетическая гастроэнтеропатия: современные методы диагностики и леченияDiabetic gastroenteropathy: modern methods of diagnosis and treatmenthttps://orcid.org/0000-0002-2405-1801КузнецовК. О.KuznetsovK. O.

Кузнецов Кирилл Олегович.

119021, Москва, переулок Хользунова, д. 7.

SPIN-код: 3053-3773

Kirill O. Kuznetsov.

119021, Moscow, Holzunov lane 7.

SPIN-код: 3053-3773

kirillkuznetsov@aol.comhttps://orcid.org/0000-0003-0809-0728МихееваА. Ю.MikheevaA. J.

Михеева Анастасия Юрьевна.

Санкт-Петербург.

SPIN-код: 3482–0195

Anastasiia Ju. Mikheeva.

Saint Petersburg.

SPIN-код: 3482–0195

nastya.mixeeva.2018@inbox.ruhttps://orcid.org/0000-0002-0281-3211ИшмухаметоваА. А.IshmukhametovaA. A.

Ишмухаметова Аделия Айратовна.

Москва.

SPIN-код: 4202–5632

Adeliya A. Ishmukhametova.

Moscow.

SPIN-код: 4202–5632

adeliya_2704@mail.ruhttps://orcid.org/0000-0001-8687-9623ТолстыхТ. А.TolstykhT. A.

Толстых Татьяна Александровна.

Москва.

SPIN-код: 4807-5541

Tatiana A. Tolstykh.

Moscow.

SPIN-код: 4807-5541

taniaevdt@gmail.comhttps://orcid.org/0000-0002-9977-0819ГалляметдиноваА. Р.GallyametdinovaA. R.

Галляметдинова Алина Рустамовна.

Уфа.

SPIN-код: 4388-6020

Alina R. Gallyametdinova.

Ufa.

SPIN-код: 4388-6020

almaz.makar123@gmail.comhttps://orcid.org/0000-0002-8821-1616БотироваЗ. У.BotirovaZ. U.

Ботирова Зебинисо Улугбек кизи.

Уфа.

SPIN-код: 2228-4660

Zebiniso U. Botirova.

Ufa.

SPIN-код: 2228-4660

z-botirova@mail.ruhttps://orcid.org/0000-0003-2180-3737ЗабироваА. А.ZabirovaA. A.

Забирова Азалия Альбертовна.

Уфа.

SPIN-код: 6195-0410

Azalia A. Zabirova.

Ufa.

SPIN-код: 6195-0410

khamitovaaa2308@gmail.comhttps://orcid.org/0000-0002-5527-352XШариповаА. Ш.SharipovaA. Sh.

Шарипова Алсу Шамилевна.

Уфа.

SPIN-код: 3228-8881

Alsu Sh. Sharipova.

Ufa.

SPIN-код: 3228-8881

alsu.sharipova8a@gmail.comhttps://orcid.org/0000-0002-3838-7875ШайхлисламоваА. Б.ShaikhlislamovaA. B.

Шайхлисламова Альбина Борисовна.

Уфа.

SPIN-код: 3628-7771

Albina B. Shaikhlislamova.

Ufa.

SPIN-код: 3628-7771

white-9797@mail.ruhttps://orcid.org/0000-0001-9217-0223АбрахмановаД. Р.AbdrakhmanovaD. R.

Абдрахманова Дилара Рамилевна.

Уфа.

SPIN-код: 4568-5543

Dilara M. Abdrakhmanova.

Ufa.

SPIN-код: 4568-5543

dilara-2000@yandex.ruРоссийский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияN.I. Pirogov Russian national research medical universityRussian FederationНациональный медицинский исследовательский центр им. В.А. АлмазоваРоссияAlmazov national medical research centreRussian FederationПервый Московский государственный медицинский университет им. И.М. СеченоваРоссияI.M. Sechenov First Moscow State Medical UniversityRussian FederationБашкирский государственный медицинский университетРоссияBashkir state medical universityRussian Federation2022130720226856778Copyright © Кузнецов К.О., Михеева А.Ю., Ишмухаметова А.А., Толстых Т.А., Галляметдинова А.Р., Ботирова З.У., Забирова А.А., Шарипова А.Ш., Шайхлисламова А.Б., Абрахманова Д.Р., 20222022Кузнецов К.О., Михеева А.Ю., Ишмухаметова А.А., Толстых Т.А., Галляметдинова А.Р., Ботирова З.У., Забирова А.А., Шарипова А.Ш., Шайхлисламова А.Б., Абрахманова Д.Р.Kuznetsov K.O., Mikheeva A.J., Ishmukhametova A.A., Tolstykh T.A., Gallyametdinova A.R., Botirova Z.U., Zabirova A.A., Sharipova A.S., Shaikhlislamova A.B., Abdrakhmanova D.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.probl-endojournals.ru/jour/article/view/13082

Сахарный диабет является хроническим заболеванием с растущей распространенностью во всем мире, вместе с тем увеличивается и распространенность его осложнений, включая гастроэнтеропатию. Патофизиология диабетической гастроэнтеропатии (ДГ) объединяет гипергликемию, дисфункцию блуждающего нерва, снижение экспрессии синтазы оксида азота в миентеральном сплетении, изменения в интерстициальной клеточной сети Кахаля, а также окислительный стресс. Клиническими признаками ДГ являются гастроэзофагеальный рефлюкс, гастропарез, запор, боль в животе и диарея. Среди методов диагностики выделяют манометрию с измерением pH (оценка моторики пищевода), сцинтиграфию опорожнения желудка, дыхательный тест (с целью оценки гастропареза), аспирацию и культивирование содержимого тощей кишки (с целью диагностики синдрома избыточного бактериального роста). На сегодняшний день не существует окончательного лечения ДГ — междисциплинарный подход направлен на замедление прогрессирования заболевания, облегчение симптомов и восстановление функции желудочно-кишечного тракта. Пациентам рекомендуются диета с низким содержанием простых сахаров и высоким содержанием клетчатки, оптимизация гликемического контроля при целевой гликемии менее 180 мг/дл. Что касается медикаментозной терапии, оправдано использование прокинетиков и противорвотных средств, а при возникновении синдрома избыточного бактериального роста — проведение антибактериальной терапии (рифаксимин). Также накапливаются современные подходы к лечению ДГ, включая использование ботулинического токсина, пилоропластику и электрическую стимуляцию желудка у отдельных пациентов. Несмотря на постоянную разработку новых методов лечения, они пока не способны полностью излечить ДГ в ближайшем будущем, что делает необходимым проведение дальнейших исследований в данной области.

Diabetes mellitus is a chronic disease with a growing prevalence worldwide, however, the prevalence of its complications, including gastroenteropathy, is also increasing. The pathophysiology of diabetic gastroenteropathy (DH) combines hyperglycemia, vagus nerve dysfunction, decreased expression of nitric oxide synthase in the myenteric plexus, changes in the interstitial Cajal cell network, as well as oxidative stress. Clinical signs of DH are gastroesophageal reflux, gastroparesis, constipation, abdominal pain and diarrhea. Among the diagnostic methods are manometry with pH measurement (assessment of esophageal motility), gastric emptying scintigraphy, respiratory test (to assess gastroparesis), aspiration and cultivation of the contents of the jejunum (to diagnose bacterial overgrowth syndrome). To date, there is no definitive treatment for DH — an interdisciplinary approach is aimed at slowing the progression of the disease, relieving symptoms and restoring gastrointestinal function. Patients are recommended a diet low in simple sugars and high in fiber; optimization of glycemic control with a target glycemia of less than 180 mg/dl. As for drug therapy, the use of prokinetics and antiemetics is justified, and in case of excessive bacterial growth syndrome, antibacterial therapy (rifaximin) is carried out. Modern approaches to the treatment of DH are also accumulating, including the use of botulinum toxin, pyloroplasty and electrical stimulation of the stomach in individual patients. Despite the constant development of new treatments, they are not yet able to completely cure DH in the near future, which makes it necessary to conduct further research in this area.

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The authors declare that there are no conflicts of interest present.