Levchenko A. Optimization of the diagnosis and treatment of irritable bowel syndrome in patients with concomitant allergic diseases

Thesis is devoted to optimizing the diagnosis and treatment of patients with irritable bowel syndrome (IBS) and concomitant allergic diseases (AD) by studying the frequency, role, characteristics of the course of combined pathology, impaired histamine tolerance, developing an algorithm for managing the corresponding category of patients .The results of the examination of 150 people with IBS have shown that AD frequency in IBS patients is 56 %, and allergic rhinitis (51.2 %), drug allergies (42.9 %) and pollinosis (40.5 %) are dominated among AD. Moreover, a subtype of IBS with diarrhea is more often (57.1 % of cases) in patients with IBS and AD and a mixed subtype of IBS (16.6 % of cases) is much less often. Сhanges in the nature of the immune response in the form of a decrease in the absolute number of T-lymphocytes, elevated levels of IgM, IgE and IgG4, circulating immune complexes (CIC) and tumor necrosis factor (TNF) –α are observed in patients with IBS and concomitant allergies, compared with healthy individuals. A sensitization to mites D. pteronyssinus and D. farinae is significantly more often occur in patients with IBS and AD, than among healthy individuals, which allows us to consider them as a possible trigger factor for the development of IBS in patients sensibilized to mite allergens. It was found that 51.4 % of patients with IBS and AD have a low level of diamine oxidase and a high level of histamine, which, combined with an increase in the total IgE level, the presence of allergen-specific IgE, increases the likelihood of developing both allergopathology and low histamine tolerance syndrome. It is proved that the inclusion of a hypogistamine diet, antihistamines, antileukotriene drugs as anti-mediator therapy in the basic therapy of patients with IBS and AD increases the efficacy of treatment of the corresponding categories of patients, especially with the subtype of IBS with diarrhea. The developed algorithm for diagnosing and treating IBS in patients with concomitant allergic pathology allows optimizing the management of this category of patients and increasing the efficacy of their treatment.