Psychogenic abdominal pain: causes and symptoms

Abdominal migraine

Pain in the abdomen with abdominal migraine is most common in children and young men, but it is also often found in adult patients. As abdominal equivalent of migraine, abdominal pain can be accompanied by vomiting and diarrhea. Vomiting, as a rule, is persistent, imperative, with bile, not bringing relief; pain expressed, diffuse, can be localized in the navel, accompanied by nausea, vomiting, blanching, cold extremities. Vegetative concomitant clinical manifestations can be of varying degrees, sometimes their vivid manifestation forms a sufficiently distinct picture of one or another variant of the vegetative crisis. The duration of abdominal pain in these situations varies - from half an hour to several hours or even a few days. The duration of vegetative accompanying manifestations can also be different. It is important to emphasize that the presence of hyperventilation components in the structure of vegetative manifestations can lead to the manifestation and intensification of such tetanic symptoms as numbness, stiffness, muscle information and spasms in the distal extremities (carpal, carpopedic spasms).

Analysis of the ratio of abdominal pain with cephalgic manifestations of migraine is of great importance for clinical diagnosis. So, various variants of the indicated ratios are possible: abdominal pains can be detected simultaneously with a seizure of cephalgic migraine; cephalic and abdominal paroxysms may alternate with each other; abdominal pain can be leading in the clinical picture. In the latter case, the diagnosis of the migraine nature of abdominal pain is greatly hampered.

In the diagnosis it is necessary to take into account the following features of abdominal pain of this nature: the presence of a certain connection with a migraine headache (pulsating, provoked by emotions, meteorological factors, accompanied by photophobia, intolerance to noise, etc.), mainly young age, family history of migraines , paroxysmal flow, the relative duration (hours or even days) of paroxysm, the definite effect of antimigraine therapy, the detection in the vessels of bru hydrochloric cavity distsirkulyatsii characteristics (e.g., accelerating the linear flow velocity in the abdominal aorta with Doppler), especially during the paroxysm.

Differential diagnosis is performed with a visceral (abdominal) form of epilepsy.

It should also be pointed out that special studies conducted in such patients reveal signs of disturbance of the vegetative background, reactivity and maintenance, hyperventilation-tetanic manifestations and subclinical disorders of mineral metabolism.

Epilepsy with abdominal seizures

Abdominal pain, which is fundamentally epileptic, despite its long-standing fame, is extremely rarely diagnosed. The pain phenomenon itself, like in most forms of abdominal pain, can not indicate the nature of the pain, so the analysis of the clinical context, the "syndromic environment," is of fundamental importance for diagnosis. The most important in the clinical picture of pain in the abdomen of an epileptic nature is paroxysmal and short-term (seconds, minutes). As a rule, the duration of pain does not exceed several minutes. Before the onset of pain, patients may experience various unpleasant sensations in the epigastric region.

Vegetative and mental disorders with abdominal pain can be of varying intensity. The onset of paroxysm can be manifested by a pronounced panic (horror), which phenomenologically resembles a panic attack, but the suddenness and short duration make it easy to distinguish them from real panic disorders. Vegetative symptoms (pallor, sweating, palpitations, chest compressions, lack of air, etc.) are very bright, but short-lived. The provoking factors of the appearance of this paroxysm can be various stresses, overstrain, overwork, light stimuli (TV, light-music). Sometimes the pain has a distinct crimpial (painful spasms) character. During paroxysms, in some cases, the patient has psychomotor anxiety, a variety of, more often than not clinical, movements of the abdominal muscles and the lower jaw. Sometimes there may be an omission of urine and feces. In some cases, the period after paroxysm is quite typical: a marked asthenic condition, drowsiness, and inhibition.

Diagnostic criteria for abdominal pain epileptic nature: paroxysmal, short-term attack, other manifestations of epilepsy (other types of seizures), expressed affective-vegetative manifestations, the presence of a number of epileptic phenomena in the structure of the attack, stunned after an attack of pain. A great help in clarifying the epileptic genesis of pain can be an electroencephalographic study with various methods of provocation (including deprivation of sleep at night), as well as the achievement of a positive effect in the treatment of anticonvulsant drugs or relief of an attack of pain by intravenous administration of seduxen.

For the purposes of clinical diagnosis, it is necessary to differentiate the abdominal pains of epileptic nature from the abdominal form of migraine, tetany, hyperventilation, panic attacks.

Especially difficult is the differential diagnosis of abdominal epilepsy and migraine. However, the shortness of the attack, changes in the EEG, a certain effect of the use of anticonvulsants allow to distinguish these forms of the disease with a certain degree of probability.

The pathogenesis of pain in the abdomen of epileptic nature is associated with various situations. On the one hand, it can be the manifestation of a simple partial seizure with vegetative-visceral disorders within the framework of focal seizures (according to the latest international classification of epileptic seizures - 1981); on the other - the manifestation of the vegetative-visceral aura.

Abdominal form of spasmophilia (tetany) At the heart of visceral, including abdominal, forms of spasmophilia or tetany lies the phenomenon of increased neuromuscular excitability manifested by visceral spasms in organs with smooth muscles. In this regard, an important feature of abdominal pain is most often their periodic, spasmodic and painful (cramp) character. Pain can manifest as paroxysmal (sometimes the intensity of pain is very pronounced), and permanently. In the latter case, patients complain of "colic," a sense of contraction, contraction, and cramping in the abdomen. Painful abdominal paroxysms may be accompanied, in addition to characteristic pains, also by nausea, vomiting. Frequent vomiting can result as a result of loss of fluid and electrolytes to an even greater increase in visceral spasms. Such an analysis of the structure of pain, especially of a paroxysmal nature, can reveal, in addition to specific, a crimp type of pain, also other clinical phenomena that are of great importance in revealing the nature of abdominal pains: these are muscle-tonic phenomena in the extremities (the phenomenon of the obstetrician's hand, pedal convulsions or combined carpopedic spasms), sensations associated with breathing (lump in the throat, difficulty breathing). Characteristic is the presence both during paroxysms and outside them of various types of distal paresthesia (numbness, tingling, crawling sensation). If a doctor thinks about the possible presence of a tetanic manifestation in a patient, symptoms should be established indicating an increase in neuromuscular excitability. To identify the tetanic syndrome, there are certain criteria for diagnosis.

1. Clinical symptoms:
   • sensitive disorders (paresthesia, pain mainly in the distal parts of the limbs);
   • muscular-tonic phenomena (reduction, krampi, carpopedal spasms);
   • "Background" symptoms of increased neuromuscular excitability, symptoms of Khvostek, Trusso, Trusso-Bonsdorf, and others;
   • trophic disorders (tetanic cataract or clouding of the lens, increased fragility of nails, hair, teeth, trophic skin disorders);
2. Electromyographic signs (repeated activity in the form of doublets, triplets, multiplets when carrying out ischemia of the hand in combination with hyperventilation).
3. Biochemical (in particular, electrolyte) disorders (hypocalcemia, hypomagnesemia, hypophosphatemia, imbalance of monovalent and bivalent ions).
4. The effect of ongoing therapy aimed at correcting the mineral imbalance (the introduction of calcium, magnesium).

It should be pointed out that therapy of the tetanic syndrome, a decrease in increased neuromuscular excitability, leading to a significant regression of abdominal pain, are, in our view, a significant evidence of the presence of a pathogenetic connection between tetany and abdominal pain, while not talking about abdominalgia against tetanic manifestations .

The pathogenesis of abdominal pain in tetany is associated with the main phenomenon underlying the clinical manifestations, increased neuromuscular excitability. The connection of increased neuromuscular excitability was established with the appearance of muscle contractions and spasms both in the striated and smooth muscle (visceral form of spasmophilia or tetany), with a violation of (purely subclinical) mineral balance, with autonomic dysfunction. In this case, the "generator" of increased neuromuscular excitability can be different levels of the nervous system (peripheral, spinal, cerebral).

Pain in the abdomen in patients with hyperventilation syndrome is noted by many researchers. As a separate clinical manifestation in the framework of hyperventilation disorders, abdominal pain syndrome has been recently identified. Pain in the abdomen is more often localized in the epigastric region, has the character of "gastric cramp", in many ways resembles the pain sensations described in tetany. It is important to emphasize that the abdominal syndrome is inscribed in a specific clinical context, accounting for which helps in many ways to identify the pathophysiological basis of suffering. Two variants of this clinical context are most often found in patients. The first is other disorders of the digestive tract (nausea, vomiting, rumbling in the stomach, constipation, diarrhea, lump in the throat). A special place among them is the manifestation associated with the "invasion" of air into the gastrointestinal tract as a result of increased respiration and frequent swallowing, characteristic of patients with hyperventilation syndrome. It is a sensation of bloating, flatulence, belching with air or food, aerophagia, a feeling of raspiraniya in the stomach, in the stomach, heaviness, pressure in the epigastric region. The second variant of clinical phenomena is the breakdown of other systems: emotional disorders, respiratory (lack of air, dissatisfaction with inspiration, etc.), unpleasant sensations from the heart (pain in the heart, palpitations, extrasystoles) and other disorders.

In the structure of numerous manifestations of hyperventilation syndrome, there are often signs of increased neuromuscular excitability (tetany). This seems to be related to the identity of a number of features of the abdominal syndrome, namely, the crimpedial character of the pain. Of great importance is the analysis of the syndromic "environment" of painful manifestations, the hyperventilation test, which reproduces a number of complaints available to patients who are absent at the time of the examination, a positive test of "breathing into a cellophane bag," the presence of symptoms of increased neuromuscular excitability, alveolar air.

The pathogenesis of abdominal pain in the context of hyperventilation disorders is associated with several mechanisms. Vegetative expressed dysfunction is naturally accompanied by a violation of the motility of the stomach and intestines, which leads to a sharp decrease in the threshold of vegetative perception. This factor, together with an increase in neuromuscular excitability and changes in humoral character as a result of hyperventilation (hypocapnia, alkalosis, mineral imbalance, etc.) determines the formation of powerful intra -ceptive impulses in conditions of reduced thresholds (vegetative perception, sensory, pain). These mechanisms, predominantly of the biological order, in combination with a number of psychological characteristics of the affective and cognitive plan seem to be leading in the formation of abdominal pain in patients with hyperventilation disorders.

Periodic illness

In 1948 EMReimanl described six cases of the disease, which he called "periodic disease". The disease was characterized by recurrent attacks of acute pain in the abdomen and joints, accompanied by a rise in temperature to high figures. Such conditions lasted for several days, after which they disappeared without a trace, but after a while they reappeared.

Periodic disease affects patients of almost all nationalities, but most often it occurs in representatives of certain ethnic groups, mainly among the inhabitants of the Mediterranean region (Armenians, Jews, Arabs). The abdominal variant of the periodic illness is the main and the brightest.

Paroxysms of abdominal pain in this disease, in addition to periodicity, have a well-known stereotype. The characteristic clinical picture is manifested by peculiar paroxysms of pain in the abdomen, the intensity of which resembles that of an acute abdomen. In this case, the picture of diffuse serositis (peritonitis) develops. The localization of pain may be different (epigastric region, lower abdomen, right hypochondrium, around the navel or the entire abdomen) and vary from attack to attack. A frequent concomitant symptom of abdominal pain is a rise in temperature, sometimes to high figures (42 ° C).

Abdominal seizure may be accompanied by emotional and vegetative manifestations at the very beginning or even in the form of precursors in 85-90% of patients. This - a feeling of anxiety, fear, general malaise, throbbing headache, pallor or flushing of the face, cold extremities, yawning, polyuria, fluctuations in blood pressure, pain in the heart, palpitation, sweating. During the height of paroxysm because of severe pain, patients are bedridden, the slightest movements increase pain. Palpation reveals a sharp tension in the muscles of the anterior wall of the abdomen; there is a sharply positive symptom of Shchetkin-Blumberg.

Given that abdominal pain, in addition to fever, may also be accompanied by an increase in ESR and leukocytosis, then often (47.8%) patients with intermittent disease undergo surgery, some of them (32.2%) - repeated. In such patients, the abdomen is covered with numerous surgical scars ("geographical stomach"), which has a certain diagnostic value. On the part of the gastrointestinal tract of patients, most often nausea, vomiting, profuse defecation and other manifestations are disturbed. An important aspect of abdominal pain with periodic illness is the duration of the attack - 2-3 days. Most patients note a number of factors that can provoke an attack: negative emotions, fatigue, the transfer of a disease or operation, menstruation, the intake of certain foods (meat, fish, alcohol), etc.

The main criteria for the diagnosis of abdominal pain in a periodic illness are based on the analysis of the attack itself: it is rhythmically repeated pain attacks, their duration (2-3 days), the presence of diffuse serous peritonitis, pleurisy, complete disappearance of pain in the interictal period. As additional criteria of the disease are: the onset of the disease in early childhood or in the period of puberty, ethnic predisposition and hereditary burden, complications of amyloid nephrosis, frequent arthropathies, changes in the course of the disease during pregnancy and lactation, increased ESR, leukocytosis, eosinophilia, autonomic disorders and other

Periodic disease is differentiated from appendicitis, pancreatitis, cholecystitis, porphyria, etc.

The etiology and pathogenesis of the periodic illness are not known to date. Numerous theories (infectious, genetic, immunological, endocrine, hypothalamic, etc.) reflect, apparently, various aspects of the pathogenesis of this suffering. At the heart of the mechanisms of symptom formation is a periodic violation of the permeability of the vascular wall and the formation of serous effusions, serosites (peritonitis, pleurisy, rarely pericarditis). A special study of the neurological aspects of the periodic disease revealed signs of vegetative dysfunction in the interparacterial period, organic microsymptomatics, which indicated the involvement of deep brain structures, the involvement of hypothalamic mechanisms in the pathogenesis of the disease.

Abdominal pain associated with peripheral (segmental) autonomic disorders

The defeat of the solar plexus (solyaritis) with the appearance of well-known clinical manifestations, described in detail by native vegetologists, is now extremely rare, practically being casuistry. Similar descriptions (with the exception of traumatic and oncological situations) in the world literature practically do not occur. The long-term clinical experience of the All-Russia Center of Pathology of the Autonomic Nervous System testifies that in the majority of patients diagnosed with "solarium", "solararhia", "solyaropathy", etc. With careful analysis, there are no evident signs of the defeat of the solar plexus, as well as lesions of other vegetative plexuses. The vast majority of such patients have abdominal pains of a psychogenic nature, suffer from abdominal migraine or myofascial pain, or have abdominal manifestations of hyperventilation and tetany. The listed causes of pain may be independent clinical syndromes, but more often they are components in the structure of psycho-vegetative syndrome of permanent or (more often) paroxysmal nature.

A special study of prolonged and persistent pain in the abdomen without signs of organic damage to the peripheral autonomic nervous system and without somatic organic disorders made it possible to establish a greater role of the psychic factor in the genesis of these pains. An in-depth analysis of the psychic sphere, the autonomic nervous system, and a careful dynamic measurement of the sensory and pain thresholds in this group of patients, as well as in patients with organic diseases of the gastrointestinal tract and in the control group, revealed a number of characteristic patterns of the pathogenesis of abdominal pains that prove an unquestionable psycho-vegetative genesis called solarites. To this we should add that an adequate study of the lesion of the peripheral autonomic nervous system should be modern special tests, described in detail in the section on methods of investigating peripheral vegetative insufficiency. Symptoms such as pain in the epigastric region (permanent or paroxysmal), painful "vegetative" points, past "neuroinfections", etc., can not serve as a serious criterion for diagnosing "solaris" or "solararhia", since they are regular situations in patients with psycho-vegetative syndrome of psychogenic nature.

In most cases, the damage to the solar plexus is essentially a syndrome of solar irrigations as a result of various diseases of the abdominal cavity organs, as well as other systems. The signs of the defeat of the solar plexus often hide the cancer of the pancreas and other organs of the abdominal cavity. Another cause may be trauma to this area. Tuberculosis and syphilis can also affect the solar plexus both locally and through general toxic effects.

"Gastric" tabetic crises. Despite the fact that the late stage of syphilis - the dry tissue of the spinal cord (tabes darsalis) - is rare enough, the neurologist should keep this pathology in mind. "Gastric crisis" usually imitates pain in the stomach ulcer, cholelithiasis and nephrolithiasis, or even intestinal obstruction. Pain in the abdomen, as a rule, begins without a prodromal period, suddenly and quickly reaches maximum severity. The pain is very pronounced, painful, pulling, "tearing", cramping character. Most often, the pain is localized in the epigastric region, but can irradiate to the left hypochondrium or lumbar region, it can be diffuse. Periodically increasing, the pain can last several days and suddenly stop. There is no connection between pain and food intake, usual pain killers do not give the effect.

With marked paroxysms of abdominal pain, other disorders of the gastrointestinal tract are possible: nausea, vomiting, which does not facilitate the patient's condition. Palpation of the abdomen is painless, the abdomen is soft, but with palpation there may be reflexes, more precisely - a mental (anxious) plan, contractions of the abdominal muscles. In addition to abdominal pain, fly-like pains in the extremities can be detected.

Multidimensional general and vegetative disorders such as asthenia, hyperthermia, tachycardia, hypotension, sometimes fainting, oliguria, etc. Are also possible. To recognize the nature of the pain described, serological studies and the analysis of neurological symptoms are of importance, which may indicate the presence of latent or obvious signs of a lyuetic defeat of the nervous system.

The pathogenesis of paroxysms of pain in dorsal dryness is not yet fully understood. Selective damage to the posterior columns, posterior roots and spinal cord envelopes is most common in the lower thoracic, lumbar and sacral (lower tabes). The mechanism of involvement of the posterior columns of the spinal cord remains unclear. Among the existing hypotheses, the most widespread is the idea that explains the mechanism of hitting the posterior columns by their compression at the sites of passage through the pia mater of the proliferative processes of the affected posterior roots and membranes. It is possible that these organic processes disrupt the processes of the nociceptive-antinociceptive system (according to the theory of gate control), forming a number of conditions for the occurrence of paroxysmal pain manifestations.

Porphyria is a large group of diseases of various etiologies, which are based on a disruption of porphyrin metabolism. One of the most common variants of porphyria is acute intermittent porphyria. The leading sign of this form of the disease is abdominal syndrome: a periodically occurring colicky abdominal pain lasting from several hours to several days. To pain, vomiting, constipation, and diarrhea may soon join.

Pathognomonic for porphyria is the allocation of urine of red color, the intensity of which depends on the severity of the disease. A special analysis reveals a positive reaction to porphobilinogen in the feces and uroporphyrin in the urine. Later, there are various signs of involvement of the nervous system.

The diagnosis of abdominal pain associated with porphyria is based on a combination of severe pain with mental and neurological manifestations, a change in the color of urine (red color in the absence of hematuria, a positive qualitative reaction to porphobilinogen), the presence of skin changes, accounting factors (taking a number of medications) provoking seizures, family history.

Differential diagnosis is performed with abdominal pain in case of lead poisoning (lead colic), predkomatoznym state with diabetes mellitus, late periarteritis. In the clinical picture of all these conditions - a combination of abdominal pain and damage to the nervous system (especially its peripheral department). However, the correct diagnosis is possible only with account of clinical features and paraclinical data.

The etiology and pathogenesis of porphyria have not been adequately studied. Genetically determined porphyria is most common. There are also more diffuse lesions of the nervous system - in the form of polyradiculoneuropathy or even encephalomyelopolyradiculoneuropathy. A feature of neuropathies is their predominantly motor deficit. Upper limbs can be affected more heavily than the lower extremities, and the proximal muscles are larger than the distal ones. Paresis of facial and ocular muscles is possible. In some cases, seizures develop. A number of patients may have a muscular system (myopathic porphyria).

Pain in abdomen of vertebrogenic nature

Pain in the abdomen can be associated with the defeat of nerve formations (posterior roots) of a spondylogenic nature. Most often, these are degenerative changes in the spine, but there may be other various diseases (spondylosis, tuberculosis, tumors, traumatic spine changes, etc.).

Pain in the abdomen is not diffuse, but localized in the zone of innervation of a segment of the spinal cord. Most often, the pain is felt on the surface of the body, in the muscles of the abdomen, but can also be deep, visceral. An important characteristic of pain syndrome is its connection with the movement of the trunk. Getting up from bed, flexing, unbending of the trunk, turns can cause or exacerbate the pain. Closely associated with pain and with changes in intra-abdominal pressure, which is manifested when coughing, defecation, straining. Often the pain can be one-sided, can be combined with pain in the lower back or back. As a rule, the pain is permanent, it is dull and becomes sharp when provoked, but the course of pain can be paroxysmal.

Especially isolated vertebrogenic abdominal syndrome as one of the most common syndromes of lesions of the thoracic and lumbar spine. Its frequency varies from 10 to 20% in patients with osteochondrosis of the spine. The main clinical manifestations are the same as those described above. At the same time pay attention to the fact that the pain is lomiashchy, aching, raspiruyuschy or boring character. In addition to abdominal pain, patients usually complain of restriction of movements in the affected spine, a feeling of stiffness in it, stiffness.

There are three variants of vertebrogenic abdominal syndrome: thoracic, lumbar and lumbosacral. With an objective examination of patients, certain changes in the muscles of the abdominal wall can be detected: a change in tone (hypotension, hypertension), a zone of neuro-osteofibrosis. As a rule, the movements of the spine are limited in the frontal and sagittal planes, there may be vertebral deformations. The tension of the paravertebral muscles is revealed, the soreness of the affected vertebral-motor segments. On radiographs, changes in degenerative character are revealed. The diagnosis of pain in the abdomen of vertebrogenic nature is based on the clinical characteristics of pain: limitedness, corresponding to certain segments, one-sidedness, close connection with the movement and fluctuations of intra-abdominal pressure; presence of signs of vertebrogenic disease - a change in the tone, the configuration of the muscles of the abdominal wall and the paravertebral area, the restriction of movements. Important are the results of X-ray studies.

The occurrence of pain in the abdomen with osteochondrosis of the spine is realized through vegetative-irrational mechanisms, visceromotor reactions, which largely determine the appearance of neurodystrophic changes in the abdominal muscles.

An important issue is the pathogenetic mechanisms of paroxysmal pain manifestations. In addition to local and reflex reactions, cerebral, in particular deep, brain structures that integrate the mental, vegetative and endocrine-humoral functions involved in the phenomenon of chronic pain in these situations are of great importance. Pain in the abdomen with organic diseases of the brain and spinal cord. Pain in the abdomen at some stage of the development of a neurological disease can occupy an important place in the clinical manifestations of the disease. Most often, abdominal pain can occur with multiple sclerosis, syringomyelia, and brain tumors. Acute abdominal pain is described and is also found in acute encephalitis, vascular lesions of the nervous system, encephalopathies and other diseases. With the defeat of the spinal cord of any etiology (tumor, myelitis, meningomyelitis, etc.), the involvement of roots can lead to the appearance of abdominal pains, a characteristic of which was given in the corresponding section. Pain in the abdomen with tumors of the IV ventricle is very intense, accompanied by spontaneous vomiting without previous nausea (cerebral vomiting). Tumors of the temporal (especially in the region of the insula) and upper-localization can cause bright visceral, most often epigastric pain of abdominal localization. Pain in the abdomen with multiple sclerosis and syringomyelia rarely act as a leading syndrome in clinical manifestations; most often this is part of a fairly pronounced neurological disorder. The diagnosis is made on the basis of the exclusion of a physical illness and the detection of a disease of the nervous system. Treatment of abdominal pain is closely related to the treatment of the underlying disease.

Abdominal pain in diseases of the gastrointestinal tract of unknown etiology In recent years, it has become increasingly obvious that psychic factors, vegetative dysfunction play a major role in the pathogenesis of so-called inorganic (functional) diseases of the gastrointestinal tract. Analysis of contemporary literature on this issue allows us to identify two situations in which abdominalgic syndrome may be the main or one of the main manifestations of the disease. This is irritable bowel syndrome and gastric dyspepsia syndrome. In many respects identical, these two pathological states still differ from each other. They are united by an etiology unknown up to now and an unclear pathogenesis. Given the unquestionable role of psycho-vegetative mechanisms in the pathogenesis of both states, the presence in their clinical manifestations of abdominal pains suggests that modern vegetology should be included in the clinical and scientific analysis of these conditions.

Irritable bowel syndrome is a chronic pathological condition characterized by the presence of abdominal pain, combined with intestinal dysfunction (diarrhea, constipation) without compromising appetite and weight loss, the duration of the disorders is at least 3 months. In the absence of organic changes in the gastrointestinal tract, which could explain the existing disorders. In the American population, irritable bowel syndrome occurs in 8-17% of the examined patients, and among the patients of the gastroenterological contingent this percentage is much higher - 50-70. The ratio of women and men is 1.5: 1. The most common syndrome occurs in the third decade of life, although cases of illness in childhood and senile age are not uncommon. Pain syndrome is characterized by a variety of manifestations: from diffuse blunt pain to acute, spasmodic; from permanent to paroxysms of pain in the abdomen. In adults, pain is most often localized in the left lower quadrant of the abdomen, but often in the left and right hypochondria, around the navel (periumbilic pains are especially characteristic of children), the pain of the brain also has a diffuse character. The duration of pain episodes - from several minutes to several hours. Pain in the abdomen can disturb the patient all day, but falling asleep, sleep is not disturbed. Paroxysmal pain is irregular both in duration and in duration. In 90% of cases, pain is accompanied by bowel dysfunction (diarrhea or constipation). Diarrhea is possible with increased pain and is not associated with pain.

A number of authors distinguish even two versions of irritable bowel syndrome: with predominance of pain and predominance of diarrhea. In the morning, patients several times (3-4 times) empty the intestine. In the presence of constipation, the stool can resemble "sheep feces", have a small volume, the act of defecation is painful. Appetite, as a rule, does not suffer, the body weight does not change. Some patients have intolerance to a number of food products.

There are asthenic, mild depressive and anxiety disorders, signs of autonomic dysfunction. In endoscopic studies, hyperalgesia of the mucous membranes of the sigmoid colon is determined. X-rays reveal the spasmodic state of various parts of the intestine.

The diagnosis of irritable bowel syndrome is based on clinical and paraclinical studies. In modern publications devoted to this problem, among the clinicians with a certain orientation on the search for psychosomatic bases of suffering, the following diagnostic criteria are most popular:

1. The presence of abdominal pain without organic changes in the gastrointestinal tract.
2. Stool disorders (diarrhea with an unformed stool or constipation with a stool of small volume, ball-shaped, pills, like "sheep stool").
3. Clinical manifestations are constant or periodic and last more than 3 months.
4. The absence of other diseases in the patient, which could explain the genesis of the existing disorders.

Etiology and pathogenesis are not clear. Change in the mental sphere in the form of anxious and depressive disorders occurs in 70-90% of patients with irritable bowel syndrome. Symptoms of panic disorders in these patients disappear in the treatment of antidepressants at the same time as normalization of the function of the gastrointestinal tract, which indicates the existence of a connection between these two states. There is also a series of evidence on the role of hyperventilation mechanisms in the pathogenesis of irritable bowel syndrome.

Dyspepsia is defined as abdominal pain, discomfort or nausea that occurs intermittently, lasts at least a month, is not associated with exercise, and does not disappear within 5 minutes of rest [Talley N., Piper D., 1987].

Non-ulcer dyspepsia is dyspepsia in which a detailed clinical study does not reveal organic changes, and when performing panendoscopy, acute or chronic peptic ulcer, esophagitis and malignant tumors are excluded.

Essential dyspepsia was defined as non-ulcer dyspepsia, in which biliary tract diseases were excluded by radiological studies, and irritable bowel and gastroesophageal reflux syndrome were excluded from clinical criteria, with no other gastrointestinal diseases or disorders that could explain these clinical manifestations .

There are other definitions of dyspepsia, such as examining it in the syndrome of digestive failure - a violation of the processes of cavitary digestion in the stomach, small or large intestine.

Pain syndrome with dyspepsia is largely identical to pain in irritable bowel syndrome. They are usually combined with a feeling of heaviness, pressure and overflow after eating in the epigastric region, belching with air or food, an unpleasant metallic taste in the mouth, and sometimes a decrease in appetite. Patients are also concerned about the rumbling, transfusion, intensification of peristalsis. More often diarrhea develops, flight constipation. Such disorders, despite the fact that they disturb the patients, causing them numerous suffering, causing asthenic and vegetative disorders, do not significantly affect the overall social activity of patients.

In addition to discussing the factors that cause the disturbance of enzymatic activity as a result of the transferred diseases (gastritis, duodenitis, enteritis, colitis), great importance is attached to psychogenic influences. It is shown that psychosomatic mechanisms can affect the tone and motor functions of the gastrointestinal tract, causing disorders of a different nature.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]