INFLUENCE OF LACTULOSIS ON THE GUT MI- CROBIOTA AND LIPID BLOOD SPECTRUM IN PATIENTS WITH IRRITABLE BOWEL SYN- DROME COMBINING WITH OBESITY

The prevalence of irritable bowel syndrome is between 12% and 35%, and its presence significantly reduces the quality of life and requires significant cost of diagnosis. Excessive risk factors for the development of irritable bowel syndrome, in addition to lack of fiber in the diet, stress, inflammation, genetic predisposition are obesity and a high body mass index. Along with the known mechanisms of developing a variant of the syndrome with constipation, an important role belongs to the violation of the microbiota of the colon. The purpose of the study is to investigate the effect of lactulose on the state of the colon microflora and lipid profile of blood in patients with irritable bowel syndrome with constipation in combination with obesity. Materials and methods. We examined 42 patients with irritable bowel syndrome with constipation on the back- ground of obesity, divided into two groups depending on treatment. Patients in the first group (22 patients) re- ceived prebiotic lactulose ("Dufalak") in addition to anti- hypertensive, anti-lipidemic therapy and prokinetics. The second group (20 patients) was treated with similar thera- py without prebiotics. Diagnosis of irritable bowel syn- drome was established according to Roman criteria - IV. The diagnosis of arterial hypertension was confirmed by data from anamnesis, complaints, blood pressure meas- urements and daily monitoring of blood pressure data. All patients had a bacteriological examination of the contents of the colon obtained using a thick probe before and after treatment. Indicators of the lipid spectrum of blood (total cholesterol, cholesterol of low and high density lipopro- tein, triacylglycerides were determined by the enzyme- colorimetric method for all patients. Results. Under the influence of basic therapy, the pa- rameters of intestinal microbiota did not significantly change. Under the influence of complex treatment with the addition of lactulose to the base therapy, there was an increase in the amount of lactobacilli in 1,5 times . Inte- grated therapy with the inclusion of lactulose contributed to a decrease in the intestinal microbiota of clostridium and St. aureus in 1,3 times, E. coli in 1,2 times. Course of lactulose application also contributed to the reduction of Candida and St.Epidermidis in 1.2 times. Since microbial colon contamination is an important etiological factor affecting intestinal peristalsis, causing structural and functional reactions of enteral neurons, its improvement can be considered as one of the effects of lactulose. The increase in the number of bifidobacteria and lactoba- cilli decreases the possibility of obesity and promotes lipid metabolism. Under the influence of the course of lactulose application, a significant decrease (p <0.05) in the level of total cholesterol and cholesterol of low densi- ty lipoprotein and some increase in the level of cholester- ol of high density lipoprotein in the absence of the dy- namics of triacylglycerides was established. Conclusions. It was established that the course of lactu- lose application slightly reduces the level of Firmicutes, without affecting the number of bifidobacteria, increases the number of lactobacilli and through them improves some indicators of lipidogram.