Vasilenko V.V. Several eponymous symptoms/syndromes associated with pathology of the esophagus and intestines / GastroScan.ru. 2022

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Irritable bowel syndrome is a stable set of functional disorders that are manifested by abdominal pain and/or discomfort that occurs after defecation, which are accompanied by a change in frequency with stool consistency, combined with two or more persistent symptoms characteristic of impaired bowel function, such as:

• changes in the act of defecation itself
• flatulence
• changes in stool frequency
• secretion of mucus in stool
• changes in stool consistency

Symptoms must have been present for at least six months before diagnosis and must have been active for at least three months.

IBS is a functional bowel disorder in which abdominal pain or discomfort is associated with changes in bowel behavior or bowel habits and features of the disorder.

It should be noted that pain can have any localization in the abdomen, but with the exception of the epigastric region. Abdominal discomfort includes symptoms such as rumbling in the abdomen, flatulence, false urge to defecate, a feeling of incomplete bowel movement, and excessive passage of gas.

Irritable bowel syndrome is one of the most common gastrointestinal diseases. According to statistics, about 15-21% of the adult population suffers from it. Moreover, in women it occurs approximately 2.5 times more often than in men.

Types of Irritable Bowel Syndrome

The predominant symptoms are:

• Irritable bowel syndrome with diarrhea : characterized by pasty stools of at least 25% and hard stools of no more than 25% of all bowel movements.
• IBS (irritable bowel syndrome) with constipation : characterized by hard stools of at least 25% and pasty stools of no more than 25% of all bowel movements.
• Unclassified IBS : characterized by unexpressed deviations in stool consistency.
• Mixed IBS : characterized by hard stools of at least 25% and pasty stools of at least 25% of all bowel movements.

Causes of Irritable Bowel Syndrome

The basis of the disease is impaired intestinal motility. This is a functional disease. One of the main factors should be considered disturbances in the nervous and humoral regulation of intestinal motor functions with increased sensitivity of intestinal wall receptors, which are responsible for motor function and pain perception.

Hereditary predisposition is of great importance in the development of this disease. It is also important to:

• severe neuropsychic shocks
• physical overexertion
• unfavorable social environment
• suffered acute intestinal infections
• in the diet – lack of plant fiber
• physical inactivity
• smoking.

Thus, the development of IBS appears as follows: genetic predisposition with a history of acute intestinal infections, and an unfavorable social environment create the preconditions for the disease. Under the influence of various psychosocial factors, for example, prolonged stress, severe neuropsychic shocks, etc., intestinal motility disorders occur with an increase in the sensitivity of intestinal receptors with the formation of IBS.

Newspaper "News of Medicine and Pharmacy" Gastroenterology (264) 2008 (thematic issue)

There is practically no person who is unfamiliar with the feeling of discomfort in the abdomen associated with excess accumulation of gases. This causes not only physical discomfort, but also moral discomfort, when the sonorous rumbling in the stomach, accompanying the release of gases, becomes accessible to the ears of others. Flatulence is bloating as a result of the accumulation of gases in the digestive tract due to their increased formation or insufficient removal from the body. Flatulence is one of the earliest symptoms of dyspepsia, which can occur in the first days after birth.

The problem of excessive gas formation (flatulence) in the gastrointestinal tract dates back to ancient times. Among the gods of Ancient Rome, Crepitus was considered the god of flatulence. From this it follows how much importance the ancient Romans attached to the intestines. Thus, people knew about the benefits of an enema for preventing and treating excess gas formation back in ancient times. The first records of colonic lavage date back to 1500 BC. and are contained in the ancient Egyptian Ebers papyrus. According to ancient Egyptian beliefs, the god Osiris passed on the method of intestinal irrigation to the priests. The highest official of the pharaoh in Ancient Egypt bore, among others, the title “guardian of the pharaoh’s gut.” Hippocrates and Galen recommended the use of washing "to cleanse the body of the winds." Washing was carried out using hollow reeds. The Essenian Gospel of Peace describes the enema technique: “Find a pumpkin whose tendril is as long as the height of a person; take out the pulp and fill the inside with water from the river, heated by the sun. Hang it from a tree, kneel on the ground before the angel of water and insert the end of the tendril into your anus so that the water penetrates your bowels. Then let the water leave your body, taking with it all satanic impurities, and you will see with your eyes and smell with your nose what stinking contents pollute the temple of your body.”

Let's consider the physiology of gas formation. Normally, 65–70% of intestinal gas is of exogenous origin, and 30–35% is of endogenous origin. Gas is present in the intestines due to:

- swallowing air (aerophagia);

- formation of gas in the intestinal lumen;

- diffusion of gas from the blood.

Normally, aerophagia occurs in small quantities during eating and drinking. With each act of swallowing, air enters the lumen of the stomach in an amount of 2–3 ml. Swallowing large pieces as a result of fast eating leads to an increase in gastric gas bubble. More air enters the stomach when smoking and talking while eating. Unconscious air swallowing occurs in people during anxiety. Some of this air leaves the stomach with belching, and most of it enters the intestinal lumen. Approximately 20–60% of the gas in the intestinal lumen comes from swallowed air. This gas is mainly represented by nitrogen and oxygen.

In the lumen of the intestine itself, carbon dioxide, ammonia, methane, hydrogen sulfide, and hydrogen are formed. Carbon dioxide is formed in the upper parts of the small intestine as a result of the reaction between bicarbonates secreted by the pancreas, intestines, and hydrogen ions released with gastric juice. After each meal, up to four liters of carbon dioxide are released into the duodenum, most of which is quickly reabsorbed in the small intestine. A significant amount of hydrogen is formed in the lumen of the large intestine as a result of the activity of intestinal bacteria. A large amount of hydrogen is released when eating fruits and vegetables. Methane formed in the lumen of the large intestine is a waste product of anaerobic bacteria. Ammonia is formed in the colon due to microbial degradation of urea or amino acids. Up to 30% of urea synthesized in the liver is converted into ammonia. Hydrogen sulfide is formed predominantly during the microbial transformation of sulfur-containing amino acids by anaerobic bacteria. The unpleasant odor is associated with the presence of aromatic compounds: indole, skatole, etc. These substances are formed in the colon as a result of the action of intestinal microflora on undigested organic compounds. In large quantities, they have a toxic effect on the human body. Thus, ammonia is a hepato- and neurotoxic poison. Amines, indole, skatole are carcinogens. Normally, the gastrointestinal tract contains up to 200 ml of gas. When digesting a heavy dinner, about 15 liters of gas is formed, which is predominantly reabsorbed by the intestinal mucosa. About 600 ml of gases are released through the rectum every day, on average up to 15 portions of 40 ml each. When the processes of gas formation in the intestines, their absorption and excretion are disrupted, conditions arise for excessive accumulation of gases in the lumen of the gastrointestinal tract.

Depending on the reasons leading to the development of excess gas formation, the following types of flatulence are distinguished.

Alimentary flatulence occurs when eating carbonated drinks, beer, kvass, and fatty meat. The process of assimilation of these products is accompanied by increased gas formation.

Digestive flatulence occurs due to enzyme deficiency of the pancreas and disruption of absorption processes, resulting in the development of malabsorption syndrome.

Dysbiotic flatulence occurs due to a disturbance in the composition of the microflora in the intestine. Excessive growth of microflora in the small intestine leads to the breakdown of products in the upper digestive tract with a subsequent increase in gas formation. At the same time, in the lower parts of the intestine, the processes of fermentation and putrefaction, and consequently the formation of gas, intensify. The important biological role of the microflora of the gastrointestinal tract can be judged by the total biomass of intestinal bacteria, which in an adult reaches 3 kg. The microflora of the small intestine in the upper sections is represented by streptococci and lactobacilli in the absence of obligate anaerobic bacteria and enterobacteria. In the distal ileum, the intraluminal microflora prevails over the parietal microflora, and the number of aerobic and anaerobic bacteria becomes equal. Anaerobes - bifidobacteria and lactobacilli - are among the main representatives among other types of bacteria in the large intestine. Intestinal dysbiosis causes disruption of the functions of almost all systems in the body and leads to the emergence of a whole range of diseases. Dysbiosis of varying severity was noted in a large proportion of patients with acute intestinal infections, chronic enterocolitis, gastric and duodenal ulcers, chronic pancreatitis, cirrhosis of the liver, etc. It has been proven that intestinal dysbiosis contributes to the development of eczema, diabetes mellitus, allergies, osteochondrosis, etc. d. It is known that lipid metabolism disorders underlie most cardiovascular diseases (coronary heart disease, hypertension, etc.). With bacterial overgrowth syndrome, the metabolism of bile acids and the cycle of their enterohepatic circulation are disrupted, ultimately leading to dyslipoproteinemia. The main organ that is affected is the liver. As a result of numerous studies, it has been established that dyslipidemia is accompanied by pronounced dysbiotic changes in the intestine, and this, in turn, leads to increased gas formation.

Mechanical flatulence occurs due to a violation of the evacuation function of the intestines. This is facilitated by adhesions and tumors, leading to disruption of passage through the small and large intestines.

Dynamic flatulence occurs due to a violation of the motor function of the gastrointestinal tract. In this case, there may not be increased gas formation, but the passage of gas through the intestines is reduced. Dynamic flatulence occurs with peritonitis, after vagotomy, with intestinal paresis in the postoperative period. Nervous stress can lead to spasm of smooth muscles and slower peristalsis.

Circulatory flatulence develops as a result of circulatory disorders due to abdominal ischemic syndrome. For example, in chronic heart failure, circulatory disorders occur in the intestinal wall. Due to hypoxia of intestinal tissue, there is a decrease in the number of bifidobacteria and lactobacilli in the parietal layer, disruption of the integrity of the epithelial layer of the intestine, disruption of absorption processes, increased putrefactive processes and increased gas formation.

The gases accumulated in the intestines are foam with many small bubbles, each of which is surrounded by a layer of viscous mucus. This mucous foam, covering the surface of the intestinal mucosa with a thin layer, complicates parietal digestion, reduces the activity of enzymes, and disrupts the absorption of nutrients. Due to the fact that gas bubbles are surrounded by thick mucus, the absorption of gases by the intestinal wall is disrupted. In this case, their passage through the intestinal tube is disrupted.

Thus, the factors for excessive gas formation in the intestines are very diverse. The development of flatulence is based on several mechanisms.

The clinical picture of excessive accumulation of gases in the gastrointestinal tract is very diverse. Even in the 6th century Salerno Health Code, the clinical picture of flatulence was described: “Four ailments arise from the accumulation of winds: colic, spasms, dropsy, and dizziness.” Most often, there is a feeling of discomfort, bloating and/or pain in the abdomen, early satiety, a feeling of fullness, and nausea. The severity of pain does not always depend on the volume of gas. In most patients, flatulence is accompanied by minor symptoms, while patients with irritable bowel syndrome often complain of severe pain with much less gas in the intestines. Most likely, this is due to increased sensitivity of the intestines and functional disorders of its motor activity. Therefore, flatulence often occurs against the background of psycho-emotional overload. As a rule, patients with irritable bowel syndrome are passive in their personal characteristics, do not have sufficient persistence in achieving goals and have certain difficulties in containing anger. With excessive accumulation of gases, painful sensations may appear on the part of other organs and systems (digestive asthenia). Often flatulence occurs under the guise of cardiac syndrome: there is a burning sensation in the heart area, interruptions in heart rhythm, palpitations, sleep and mood disturbances, and general weakness. In some cases, severe shortness of breath (dyspeptic asthma) occurs.

There are several variants of the manifestation of flatulence. Patients complain of a feeling of fullness, distension, and enlargement of the abdomen due to intestinal bloating. The passage of gases is slow due to spastic contractions of the colon. Relief occurs after the act of defecation and release of gases. Most often, bloating and pain increase in the afternoon, i.e. during the period of greatest activity of digestive processes.

There are variants of local flatulence: splenic flexure syndrome, hepatic angle syndrome and cecal syndrome. Most often in medical practice, splenic flexure syndrome occurs. Its occurrence is facilitated by anatomical features. The left flexure of the colon is located high under the diaphragm and forms an acute angle, which acts as a trap accumulating gas and chyme. Poor posture and wearing tight clothing also contribute to this. Patients complain of fullness and pressure in the left upper quadrant of the abdomen. Often this symptomatology is accompanied by irradiation to the left side of the chest.

Hepatic angle syndrome is characterized by the accumulation of gases in the hepatic flexure of the colon, causing the colon to become pinched between the diaphragm and the liver. Clinically manifested by pain in the epigastric region with irradiation to the right hypochondrium and shoulder.

Cecal syndrome is accompanied by pain in the right iliac region. Its pathogenesis involves insufficiency of the ileocecal sphincter due to its distension by gases. Massage in the area of ​​the projection of the cecum promotes the evacuation of gas and causes relief.

The second variant of clinical manifestations of flatulence is characterized by constant, abundant release of gases from the intestines. In this case, the pain syndrome is slightly expressed. The patient complains of rumbling and transfusion in the abdomen, which is audible not only to the patient, but also to the people around him. The pathogenesis is based on the movement of gases and liquids through a relatively narrow space. In some cases, healthy people, especially young people, develop psychoneurosis against this background. It is known that for one of the French artists who performed on the stage of the Moulin Rouge, this variant of flatulence turned out to be an advantage and made it popular. He played melodies with emitted gases.

General flatulence occurs when gases accumulate in the small intestine. Lateral flatulence - with the accumulation of gases in the colon. During examination: percussion - increased tympanic sound; Auscultation - splashing noise. Since flatulence syndrome is nonspecific and can occur both with functional disorders and with organic diseases of the gastrointestinal tract (chronic pancreatitis, colitis, cholecystitis, cholelithiasis, intestinal cancer, etc.), a detailed study of the medical history and diet nutrition helps to develop management tactics for a particular patient.

The treatment of flatulence is based on several principles. The main one is to eliminate, if possible, the causes of increased gas formation: diet correction, restoration of intestinal microbiocenosis, treatment of diseases of the gastrointestinal tract. Another principle is the removal of accumulated gases from the intestinal lumen.

It is necessary to begin treatment of a patient with flatulence with the organization of a balanced diet. Therapeutic nutrition is based on the underlying disease. It is recommended to avoid foods containing non-absorbable carbohydrates and refractory fats. If you are lactose intolerant, foods containing milk should be excluded from your diet. In addition to treating the underlying disease, in some cases it is necessary to prescribe special medications that reduce flatulence. These include adsorbents (activated carbon, smecta), carminatives (fennel fruits and oil, caraway fruits, chamomile flowers), defoamers (organosilicon compounds dimethicone and simethicone).

A drug that reduces foaming in the intestinal lumen by 84–87% is Espumisan (simethicone), which is a high-molecular silicon-based polymer - dimethylsiloxane with the addition of silicon dioxide. Simethicone (activated dimethicone), according to its mechanism of action, belongs to the so-called defoamers - surfactants that reduce the surface tension of gas bubbles in chyme and mucus in the intestinal lumen, leading to their rupture. In this case, a process of coalescence occurs - the merging of gas bubbles and the destruction of foam, as a result of which free gas is able to be absorbed through the intestinal mucosa or evacuated along with the intestinal contents. Espumisan does not absorb food components or medications. The drug is inert, is not absorbed in the gastrointestinal tract, is not fermented by microorganisms, is excreted unchanged and does not affect the processes of digestion and absorption. At the same time, due to the defoaming effect and reducing the gas content in the intestines, simethicone indirectly affects the normalization of digestive functions. Due to its properties, Espumisan can be used to treat any pathology associated with excessive gas formation; flatulence caused by disturbances in the processes of cavity and membrane digestion and absorption or reduced peristalsis; postoperative abdominal bloating, as well as for preparation for X-ray contrast and ultrasound examinations, gastroduodenoscopy.

Symptoms of Irritable Bowel Syndrome

Complaints : abdominal pain, abdominal discomfort with stool disorders.

Abdominal pain is of a very diverse nature: from unpleasant sensations, aching pain to cramping, intense pain. The pain most often occurs in the morning and during the day, and subsides during sleep and rest. There are several pain syndromes:

• Splenic flexure syndrome : characterized by discomfort, pain, and a feeling of pressure in the left hypochondrium. They can even be in the chest (left half), upper left shoulder. The pain may resemble angina pectoris. Palpitations and shortness of breath may occur. Pain is often associated with eating, physical activity, defecation, and psycho-emotional stress. Poor posture and wearing tight clothing contribute to the development of this syndrome. During the examination, pain in the left hypochondrium and percussion - pronounced tympanitis are noted.
• Hepatic flexure syndrome : occurs less frequently; a feeling of pressure and fullness in the right hypochondrium is bothersome. The pain radiates to the middle part of the chest, epigastric region, rarely to the right shoulder, and back. These symptoms resemble symptoms of diseases of the liver and biliary tract.
• Cecal syndrome: pain in the right iliac region is bothersome and is common. During the examination, pain in this area is noted. Massaging the area of ​​the cecum often brings some relief.

Stool disorders are characteristic: diarrhea (diarrhea), constipation or alternation of constipation and diarrhea.

Constipation – low frequency of bowel movements (less than 3 times a week), low productivity of bowel movements, the presence of non-plastic compacted stools, the need for additional efforts to empty the bowels. For mild cases, frequency up to 1 time per week. In moderate cases , the frequency is up to 1 time in 10 days. In severe cases, the frequency is less than 1 time in 10 days.

It should be noted that the disease lasts for a long time, without noticeable progression with a favorable prognosis, there is a deterioration in the well-being of patients due to psychosocial factors and the disappearance of pain with abdominal discomfort at night.

The main clinical signs are nonspecific and can be observed in various organic intestinal diseases, for example, ulcerative colitis (UC), intestinal tumors, intestinal diverticulosis, Crohn's disease, etc.

Payr's syndrome (Splenic angle syndrome)

The choice of therapeutic tactics is carried out taking into account the stage of the disease. Patients in the compensation and subcompensation phase are recommended to have a high-calorie diet with food containing a small amount of fiber and stimulating acid fermentation. Products that slow down intestinal peristalsis are limited: strong tea, cocoa, chocolate, coffee. Exercise therapy with exercises for abdominal muscles and increased peristaltic activity is useful. The conservative treatment regimen for Payr's syndrome includes:

• Herbal laxatives
  . They are used when it is impossible to normalize stool using diet therapy. Liquefaction of feces and stimulation of peristalsis facilitate bowel movements, reduce the severity of pain, and prevent autointoxication.
• B vitamins
  . Parenteral administration of water-soluble vitamin preparations compensates for their deficiency associated with impaired absorption in the colon. Vitamin therapy is also aimed at restoring liver functions that are impaired during intestinal endotoxicosis.
• M-anticholinergics
  . In Payra's disorder with a pronounced spastic component, they have an analgesic effect by reducing the tone of smooth muscle fibers. Due to the possible inhibition of motor skills, they are used with caution, mainly in the painful form of the disease.
• Physiotherapeutic techniques
  . To reduce the intensity and relieve pain, electrophoresis with novocaine is indicated on the anterior wall of the abdomen. In cases of severe intestinal atony, a course of iontophoresis with proserin is recommended. Paraffin baths, diathermy, UHF therapy, and abdominal massage are effective.

According to indications, complex conservative therapy is supplemented with anti-inflammatory drugs, myotropic antispasmodics, enzyme preparations, prebiotics, spa treatment with the use of mineral waters and their use in the form of therapeutic microenemas. In the decompensated course of Payr's disease with progression of pain, motor-evacuation disorders, persistent intestinal intoxication, and ineffectiveness of conservative therapy, surgical correction is indicated. The operations of choice are resection of the transverse colon with end-to-end colo-coloanastomosis and fixation of the intestine in an anatomically correct position, laparoscopic excision of the colosplenic and colophrenic ligaments to reduce the splenic flexure. When the syndrome is combined with dolichosigma, a left-sided hemicolectomy or a combined intervention with resection of the sigmoid colon is performed.

Diagnosis of irritable bowel syndrome in Israel

The diagnosis of IBS can be made only after complete exclusion of organic intestinal pathology.

• Not typical: blood in the stool, weight loss, fever, accelerated ESR, anemia, leukocytosis.

Laboratory and instrumental studies:

• There are no changes in the general blood test .
• No changes in biochemical blood test
• X-ray examination (irrigography): signs of intestinal dyskinesia, such as uneven filling, bowel emptying, alternation of dilated and spastically contracted areas.
• Colonoscopy is the main mandatory examination, supplemented by a biopsy to exclude inflammatory and tumor lesions of the intestine. There are no morphological changes in IBS.
• Balloon dilatation test to assess intestinal transit time.

Treatment of irritable bowel syndrome in Israel

• Consultation with a psychotherapist
• For abdominal pain - drugs that weaken the motor activity of the intestine (papaverine, mebeverine)
• For diarrhea - antidiarrheal drugs (loperamide, imodium)
• For constipation - laxatives (Forlax, Duphalac)
• For bloating , medications that reduce gas formation (espumisan).

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UDC 611.345

N.I. BEILINA, A.O. PODNYAK, E.V. MALYSHEV

KSMA - branch of RMANPO of the Ministry of Health of Russia, 420012, Kazan, st. Butlerova, 36

Beilina Natalya Ilyinichna - Candidate of Medical Sciences, Associate Professor of the Department of Therapy, Geriatrics and Family Medicine, e-mail: , ORCID ID 0000-0001-9755-8681

Pozdnyak Alexander Olegovich - Doctor of Medical Sciences, Head of the Department of Therapy, Geriatrics and Family Medicine, e-mail: , ORCID ID 0000-0002-9950-3630

Malysheva Elena Vladimirovna - therapist at the KSMA polyclinic - a branch of the Federal State Budgetary Educational Institution of Further Professional Education RMANPO of the Ministry of Health of Russia, e-mail: , ORCID ID 0000-0002-2371-1521

Purpose of the study. Analysis of the medical history of a woman with constipation syndrome.

Materials and methods. Medical history of patient F., born in 1966, who applied for a consultation; collection, assessment of complaints and anamnesis, examination, interpretation of research data /

Results . An analysis of the patient's complaints, clinical, functional, and laboratory tests was carried out, as well as a diagnosis of combined pathology of the gastrointestinal tract - Payr's syndrome and other abnormalities of many organs.

Conclusions. A feature of the case is the combination of Payr's syndrome with other pathology (rectocele, colon diverticulosis, dolichosigma, hemorrhoids, biliary dysfunction, adhesive disease of the pelvic organs with additional fixation of the sigmoid, hypothyroidism), leading to aggravation of constipation syndrome and requiring diagnosis and correction.

Key words: Payra syndrome (disease), constipation, abdominal pain.

( For citation: Beilina N.I., Pozdnyak A.O., Malysheva E.V. Payra syndrome (disease). Practical medicine. 2018)

NI BEYLINA, JSC POZDNYAK, EV MALYSHEVA

KSMA – Branch Campus of the FSBEI FPE RMACPE MOH Russia, 36 Butlerov Str., Kazan, Russian Federation, 420012

Payer syndrome (disease)

Beylina NI - Ph. D. (medicine), Associate Professor of the Department of Therapy, Geriatrics and Family Medicine, e-mail: , ORCID ID 0000-0001-9755-8681

Pozdnyak AO - D. Sc. (medicine), Head of the Department of Therapy, Geriatrics and Family Medicine, e-mail: , ORCID ID 0000-0002-9950-3630

Malysheva EV – General Physician of the polyclinic, e-mail: , ORCID ID 0000-0002-2371-1521

Analysis of the medical history in women with constipation syndrome.

Materials and methods. The case history of the patient F., born in 1966, who applied for advisory reception; collection, evaluation of complaints and anamnesis, examination, interpretation of research data.

Results. The complaints, clinical, functional, laboratory studies of the patient, diagnosis of combined pathology of the gastrointestinal tract, Payer syndrome, and other abnormalities of many organs were analyzed.

The conclusions. The case feature is the combination of Payer syndrome with another pathology (rectocele, colon diverticulosis, dolichosigma, hemorrhoids, biliary dysfunction, pelvic adhesive disease with additional fixation of sigma, hypothyroidism), leading to aggravation of the locking syndrome and requiring diagnosis, and correction .

Key words: Payer syndrome (disease), constipation, abdominal pain.

( For citation : Beylina NI, Pozdnyak AO, Malysheva EV Payr syndrome (disease). Practical Medicine. 2018)

In European countries, constipation affects 25–50% of the population [1]. Doctors often have to deal with this problem in their daily activities. The causes of constipation syndrome are varied. Organic causes of stool retention may include Payr's syndrome (disease), caused by obstruction of the colon in the area of ​​the splenic angle due to kinking, spasm of the excessively long intestine and its high fixation. It was first described in 1905 by the German surgeon Irwin Payer.

Common symptoms of Payr's syndrome are abdominal pain and constipation. Abdominal pain increases with physical exertion and after eating a large amount of food. Reducing pain intensity is achieved in a horizontal position. With age, pain tends to increase. Among other complaints, patients may experience a feeling of pressure, fullness in the upper left quadrant of the abdomen, decreased appetite, vomiting, nausea, dizziness, irritability, various types of pain in the left half of the chest, palpitations, shortness of breath, a feeling of fear, bilateral or unilateral pain in upper limbs, pain in the interscapular region.

The “golden” diagnostic standard is considered to be irrigography/irrigoscopy with a barium suspension, which reveals the abnormal structure of the large intestine with sagging of the transverse colon, sometimes even into the pelvis [1, 2, 3].

Conservative treatment is aimed at relieving pain, improving stool passage (diet, antispasmodics, prokinetics, laxatives); Surgical treatment is indicated in case of ineffectiveness of conservative therapy, complicated course (intestinal obstruction, intoxication syndrome) [1, 2, 3, 4, 5, 6].

We present an observation of patient F., born in 1966, who applied for a consultation.

Complaints: constipation, increased gas formation, discomfort in the right flank of the abdomen, headaches.

History of the disease. According to the patient, “problems with the gastrointestinal tract since birth.” She noted the absence of stool for up to a week, without significant discomfort. I had headaches every month. Since 2014, the deterioration of health has been associated with the appearance of pain in the back and left leg, constant headaches, laxatives previously used with effect have ceased to work, discomfort in the abdominal area has appeared due to stool retention - distension on the right, especially in a sitting position and lying on the left side; constant increased gas formation, notes a connection with stress. Since the end of 2015, depression, panic attacks, and fears have increased (including fear of malignant processes). At the same time, the character of the stool changed (unstable, fragmented, foamy, sometimes greasy and sticky); there were unpleasant sensations in the rectum. Pain relief with Duspatalin and Trimedat is complete. The patient uses table No. 3 and does physical therapy. Conducts course treatment with Zakofalk, Ursosan, Odeston, Holenzym, Mezim, Linex, Bifidum bacterin, Maxilak. Stool with cleansing enemas, laxatives (Fitolax, Fortrans, Fitomucil, Mucofalk, Resolor, Slabilen, Bisacodyl suppositories) with the effect of incomplete bowel emptying, often uses a finger aid to empty the rectum.

Anamnesis of life. Diseases suffered: disc herniation C2-C3, L4-L5, L5-S1, coccyx injury with cauda equina syndrome, endometriosis, autoimmune thyroiditis with hypothyroidism (has been taking L-thyroxine since 2016), chronic cholecystitis, hemorrhoids; 20 years ago I had a laparoscopy for a cyst of the right fallopian tube. There is no heredity for diseases of the digestive system.

Objectively. Height 179 cm, weight 66 kg. The skin is of physiological color, without rash. The tongue is wet, there is a coating at the root of the tongue. The abdomen is symmetrical, not swollen, participates in the act of breathing, is soft on palpation, painless in all parts. Percussion dimensions of the liver and spleen were not changed. There is no visible swelling.

Examination per rectum: protrusion of the anterior wall of the rectum in the form of a pocket reaching the border of the vestibule of the vagina (rectocele II degree).

Data from laboratory clinical studies of blood, urine and feces do not differ from the age norm.

Ultrasound of the hepatobiliary system: in the 3rd segment there is an anechoic formation - a cyst 14x10 mm. The gallbladder is 79x24 mm with a bend in the body area.

Ultrasound of the intestines: moderate flatulence. Peristalsis of the small intestine is active, sometimes erratic. The Bauginian valve is in a semi-closed position, partial reflux is observed. There is active peristalsis in the ascending colon. Gaustrae are pronounced. Wall thickness up to 2 mm. A loop is formed in the hepatic angle. The peristalsis of the transverse colon is not rhythmic, the haustra are smoothed. Wall thickness up to 1.5 mm. A complex loop forms in the splenic angle. Diverticula up to 2.5 mm are visualized. In the descending section of the colon, peristalsis is active, the wall thickness is up to 1.5 mm. Diverticula up to 2.5–2.8 mm are visualized. The sigmoid colon is dilated, elongated, forms a loop, and there are diverticula measuring up to 2.8 mm. The upper third of the rectum is dilated. Conclusion: signs of chronic colitis, diverticulosis of the colon, elongation and looping of the colon, dolichosigma.

Endoscopy: duodenogastric bile reflux, gastroduodenitis

Irrigoscopy: gas in the intestinal loops. The contrast mass filled all parts of the large intestine up to the dome of the cecum. The ampulla of the rectum is up to 11.8 cm. The sigma is elongated, fixed, probably due to the adhesive process, and forms additional bends. The descending colon is elongated and forms a number of additional bends and loops. The transverse colon is moderately elongated, its proximal parts sag down to the pectineal line. Throughout the entire length of the sigmoid colon and descending colon, diverticula up to 1.5 cm are identified. The contours of the large intestine are smooth, clear, and can be traced throughout. The walls are elastic, the displacement of the loops with the exception of the sigma is not limited. Haustration is expressed in all departments. Emptying is uneven and incomplete. In barium-free areas, the mucosal relief is preserved. After emptying, increased sagging of the loops of the transverse colon and ascending colon is determined - the loops are located below the pectineal line, above the entrance to the small pelvis. Conclusion: Megarektym. Dolichocolon. Colotransversoptosis. Diverticular disease of the colon with signs of diverticulitis. Signs of adhesions in the pelvis.

Colonoscopy: the loops of the colon are significantly mobile, tortuous, and form a large number of difficult bends. The sigmoid colon is moderately elongated. The bauhinium valve is fish-shaped and closed. The distal 15.0 cm of the terminal ileum was examined. Mucous pink, velvety. In the sigmoid colon, the mouths of diverticula are up to 0.8 cm with a frequency of up to 1–3 diverticula per haustra. Conclusion: signs of chronic colitis in remission, diverticulosis.

Features of this case, the presence of concomitant conditions in the patient that aggravate constipation syndrome:

Rectocele is a diverticulum-like protrusion of the rectal wall towards the vagina. When examining the patient per rectum, signs characteristic of grade II rectocele are determined, which is confirmed by instrumental research methods (ultrasound of the intestine, irrigoscopy).

Diverticulosis of the colon - the formation of pouch-like protrusions in the intestinal wall - in a particular case is widespread from the transverse colon to the sigmoid colon.

Dolichosigma - an abnormal increase in the length of the sigmoid colon and its mesentery - is a common finding in Payr's syndrome.

With hemorrhoids - thrombosis, inflammation of pathologically dilated and tortuous hemorrhoidal veins, forming nodes around the rectum, about a circle, when constipation leads to the development of hemorrhoids, and the presence of the latter leads to an anatomical obstruction to the movement of feces.

Violation of the outflow of bile (in the patient it is justified by ultrasound data of the hepatobiliary system - an inflection of the gallbladder and the presence of duodenogastric reflux on endoscopy) can lead to a weakening of intestinal motor activity.

Adhesive disease of the pelvic organs with additional fixation of the sigmoid (according to irrigoscopy) worsens the passage of feces through the intestines.

Hypothyroidism – decreased function of the thyroid gland causes swelling of the intestinal mucosa and inhibition of intestinal motor activity.

Thus, in real clinical practice, in an adult patient, Payr's syndrome can be combined with another pathology, leading to aggravation of symptoms and requiring diagnosis and treatment.

Literature

1. Glazunova L.V., Artamonov R.G., Bektashyants E.G. and others. Payra's disease // General Medicine. — — No. 4. — P. 85–87.
2. Minushkin O.N., Javadov E.A., Kurbanov F.S. and others. Surgical treatment of chronic intestinal stasis in patients with dolichocolon // Surgery. - 2010. - No. 9. — pp. 53–56.
3. Parfenov A.I. Modern ideas about constipation. From symptom to disease // Consilium Medicum. — — No. 1. — P. 40–44.
4. Samsonov A.A. Chronic constipation syndrome // Breast cancer. — — T. 17, No. 4. — P. 233.
5. Belousova E.A., Nikulina I.V. Principles of choosing laxatives in different categories of patients with constipation // Farmateka. — — No. 2. — P. 48–53.
6. Shulpekova Yu.O. Algorithm for the treatment of constipation of various origins // RMZh. Gastroenterology. — — T. 15, No. 15. — P. 1–7.

REFERENCES

1. Glazunova LV, Artamonov RG, Bektashyants EG et al. Disease Payer. Lechebnoe delo, 2008, no. 4, pp. 85–87 (in Russ.).
2. Minushkin ON, Dzhavadov EA, Kurbanov FS et al. Surgical treatment of chronic intestinal stasis in patients with dolichocolon. Khirurgiya, 2010, no. 9, pp. 53–56 (in Russ.).
3. Parfenov AI Modern concepts of constipation. From the symptom to the disease. Consilium Medicum, 2007, no. 1, pp. 40–44 (in Russ.).
4. Samsonov AA Syndrome of chronic constipation. RMZH, 2009, vol. 17, no. 4, p. 233 (in Russ.).
5. Belousova EA, Nikulina IV Principles of choice of laxatives in different categories of patients with constipation. Farmateka, 2009, no. 2, pp. 48–53 (in Russ.).
6. Shulʹpekova Yu.O. Algorithm of treating constipation of various origins. RMZH. Gastroehnterologiya, 2007, vol. 15, no. 15, pp. 1–7 (in Russ.).