The dissertation is dedicated to improving the effectiveness of treatment for patients with irritable bowel syndrome associated with obesity by developing effective correction methods based on the study of the clinical course, endoscopic lesions of the colon, dysbiotic disorders, ATP-ase activity of the colonic mucosa, and changes in the levels of inorganic phosphorus in the saliva of these patients.
The frequency of irritable bowel syndrome (IBS) was monitored among 120 patients with abdominal obesity from various hospitals in Western Ukraine. Symptoms of IBS were found in 51.7% of patients with obesity, regardless of the region. A significant predominance of comorbidities was established among women, and it was also noted that the diarrhea-predominant subtype of IBS was more common than the constipation-predominant subtype: 34 (54.8 %) cases compared to 28 (45.2 %) cases. A significant prevalence of factors such as alcohol consumption (24.2 %), smoking (38.7 %), irregular and inadequate nutrition (64.5 %), and low physical activity (51.6 %) was identified among individuals with a combination of IBS and abdominal obesity. It was found that signs of depression and anxiety syndrome were observed almost equally in individuals of both sexes. However, in patients with diarrhea-predominant irritable bowel syndrome (IBS), anxiety levels were significantly higher (66.7 %) compared to those with constipation-predominant IBS (33.3 %). Recurrent abdominal pain in various sections of the colon over the past three months was noted in 51.7 % of patients with abdominal obesity. Among 85.5 % of patients with comorbidities, straining and prolonged defecation processes lasting 15-20 minutes were observed, with the frequency of firm stools being 2-3 times per week. Diarrhea syndrome was noted in 54.8 % of patients, while the remaining 45.2 % exhibited a predominance of constipation. Most patients complained of changes in stool consistency. Pain related to defecation was observed equally among individuals of both sexes, although stool disturbances were more frequently diagnosed in females. It was found that the levels of C-reactive protein in all patient groups were significantly higher compared to the control group. Additionally, significantly higher concentrations of fibrinogen were established in all research groups compared to the control. The highest concentrations of both CRP and fibrinogen were recorded among subgroups of patients with diarrhea-predominant irritable bowel syndrome (IBS), regardless of the presence or absence of abdominal obesity. In all patient groups, significantly elevated levels of β-lipoproteins and total cholesterol were observed, with no significant differences among them. A significant decrease in the concentration of inorganic phosphorus in the saliva of patients with IBS compared to practically healthy volunteers was established, and an even greater decrease of this indicator compared to controls in the case of a combination of IBS and abdominal obesity. It is important that no difference was found depending on the type of IBS and the gender composition of the patients. The obtained results became the basis for the registration of a declaratory patent for the useful model "Method of diagnosing irritable bowel syndrome" (patent 142282 U of Ukraine dated May 25th 2020). It was shown that bile acids increase the activity of basal Mg²⁺-ATPase in the post-mitochondrial fraction of the colonic mucosa in overweight patients with IBS, but do not affect the activity of Na⁺/K⁺-ATPase or Ca²⁺-ATPase. A reduction in the number of lactobacilli and bifidobacteria was found, along with a simultaneous increase in opportunistic pathogenic flora in patients with diarrhea-predominant IBS. It was established that the additional administration of a probiotic preparation in combination with a multivitamin complex containing phosphorus and magnesium, along with general recommendations to increase physical activity and follow a low-calorie diet for patients with irritable bowel syndrome (IBS) and abdominal obesity, leads to a reduction in clinical manifestations of IBS and normalization of bowel movements. This comprehensive therapy was well tolerated, with no adverse effects observed. Additionally, after the comprehensive treatment, a significant increase in inorganic phosphorus levels in saliva was noted, approaching the normal values of healthy volunteers.
The above findings suggest the appropriateness of determining the concentration of inorganic phosphorus in the saliva of patients for screening diagnosis of IBS, as well as the additional prescription of comprehensive treatment using a probiotic preparation in combination with a multivitamin complex that includes phosphorus and magnesium to alleviate IBS symptoms
