1. Introduction

Irritable bowel syndrome (IBS) is a biopsychosocial disease consisting of a set of functional disorders not explained by organic changes in the intestines [1,4,5].

The analysis of modern data on the etiology and pathogenesis of the functional pathology of the digestive tract allows us to comment on the concept of the formation of the disease, which, of course, is not one, but several etiological factors, and these factors, in turn, are not the same. Rather, it is related to several pathophysiological mechanisms. And the complexity of controlling such patients is that the combination of etiopathogenetic mechanisms in each individual case is individual. Among them, the following are relevant today: socio-economic status, genetic predisposition, the probability of the disease in children of parents with IBS, psychological aspects, hypersensitivity of internal organs, disorders of the gastrointestinal tract, neuroendocrine system changes (brain-intestinal axis), low-grade inflammation, the concept of IBS after an infectious disease, microflora imbalance and finally, nutritional factors [2,3,6,7].

The purpose of the study consists in evaluating the clinical-laboratory severity levels of the disease in the types of irritable bowel syndrome with the predominance of diarrhea and constipation.

2. Material and Methods

The study was conducted in the polyclinic and gastroenterology department of the Bukhara regional multidisciplinary medical center (BRMDMC), and 98 patients who were examined with IBS in outpatient conditions were selected. The diagnosis of IBS was made based on IV Rome criteria (2016). The average age of patients is 34.6±0.9 years.

Patients with IBS were divided into two groups: IBS type with diarrhea predominance (IBS-D – 47 patients) and constipation type with predominance (IBS-C – 51 patients).

All patients underwent general blood, general fecal analysis, fecal occult blood test, blood biochemical analysis, intestinal microbiota analysis, cytokine analysis - IL-1 b, IL-4, IL-6, IL-10, α-TNF (Vekor-Best reagents), fecal calprotectin (De medi tec reagents) and cortisol analysis in blood, from instrumental examinations - esophagofibromastroduodenoscopy (FUGINON. FUGI FILM EPX-2500, 2014, Japan; FUGI FILM-EG-530PF, 2014, Japan), colonoscopy (FUGI FILM-EG -530FL, 2014, Japan), ultrasound examination of internal organs (Vivid S-60, 2014, Norway) was performed.

3. Results and Analyses

After patients with an IBS-like syndrome were excluded from the study, 98 patients diagnosed with IBS were included in the follow-up program.

30 healthy subjects were included in the control group to obtain normative data. The average age of the control group was 29.3±1.02 years. The study was carried out simultaneously. The type of clinical course of IBS was determined clinically, as well as retrospectively, taking into account the anamnesis data and the results of the study of medical records.

In order to facilitate the examination and data analysis, a program was developed for the assessment of symptoms: absence of symptoms 0 points, mild to moderate symptoms - 1 point, severe symptoms - 2 was evaluated with points. The points collected by each patient are based on clinical-laboratory symptoms (abdominal pain, diarrhea, constipation, feeling of abdominal rest, feeling of incomplete bowel emptying, false stools, mucus discharge, defecation additional increases in time, IL-1β, IL-6, IL-10, αTNF, cecal calprotectin and blood cortisol) were summarized. Patients with a score of 21-28 were considered to have a severe disease, patients with a score of 10-20 were considered to have a moderate disease, and patients with a score of 1-9 were considered to have a mild disease (Table 1).

Table 1. Algorithm for determining the severity of irritable bowel syndrome

The course of the disease according to the severity of IBS clinical symptoms and summarizing the results of the scoring system is described in Table 2.

Table 2. Clinical signs of the disease during the induction of irritable bowel syndrome

"Intestinal" symptoms were more pronounced in the diarrhea-predominant type of IBS compared to the constipation-predominant type: in patients with IBS-D, the number of bowel movements was 1-4 times a day (p=0.0011), mainly observed in the morning with mucus mixture, it was found that there were frequent false alarms (p=0.0341) and the feeling of incomplete emptying of the bowel (p=0.0314).

The majority of patients suffering from IBS-C complained of having a bowel movement once every 3-4 days (p=0.0001), mucus discharge with feces (p=0.0087). False alarms (p=0.0007) were observed more frequently in diarrhea-predominant type, bowel fullness (p=0.0263) in constipation-predominant type of IBS.

In terms of the severity of the clinical course of the disease, when comparing the types with a predominance of diarrhea and constipation, 14.9% of patients with IBS-D and 27.4% of patients with IBS-C had a severe course. condition was recorded (p<0.05).

In addition, the amount of fecal calprotectin was studied in 98 patients and 30 healthy controls (Table 3).

Table 3. Fecal calprotectin values corresponding to types of irritable bowel syndrome

The faecal calprotectin index prevailed in the diarrhea-predominant type of IBS compared to the constipation-predominant type (77.6±2.15 and 44.9±2.54, respectively). These indicators are not typical for inflammatory diseases of the intestine and correspond to the data in the literature.

A comparative analysis of inflammatory and anti-inflammatory cytokines in patients with IBS revealed increased levels of pro-inflammatory cytokines - IL-1β, IL-6, α-TNF and anti-inflammatory cytokines - IL-4 and IL-10 levels were found to be decreased (Table 4).

Table 4. Cytokine analysis in patients with irritable bowel syndrome

Cytokine status in patients with IBS was analyzed by species for comprehensive information (Table 5).

Table 5. Quantitative indicators of cytokines depending on the types of irritable bowel syndrome, M±m, pg/ml

Non-significant deviations were found when comparing the types of diarrhea and constipation predominance. The amount of pro-inflammatory cytokines differed between the groups. A significant decrease in IL-10 level was found in the constipation-predominant type of IBS (p<0.05), and this indicator also showed the same result in the diarrhea-predominant type of IBS (p<0.05).

In order to determine mental-emotional disorders in patients, the amount of cortisol in the blood was checked. The results of the analysis are presented in Table 6.

Table 6. Cortisol analysis results in blood, nmol/l, in types of irritable bowel syndrome

When the test results were analyzed, a reliable difference was found between the IBS patients and the control group in both daytime and evening blood cortisol levels (p<0.05). This, in turn, indicates the presence of psycho-emotional disorders in patients with IBS. In addition, comparing the results of the analysis among the IBS groups, it was observed that the amount of cortisol in the blood was significantly different in patients with constipation predominance (p<0.05).

4. Conclusions

Thus, when analyzing the types of bowel syndrome with the predominance of diarrhea and constipation according to clinical and laboratory parameters, the main part of the patients was mild. At the same time, an increase in the amount of inflammatory cytokines and cortisol in the blood also requires an individual approach to the selection of treatment methods.