Ice wrap "Floresan": reviews, instructions and description of the procedure. Use of the probiotic "Florasan" in patients with various clinical variants of IBS What is known about the company

Poluektova E.A.

Oksana Mikhailovna Drapkina, Professor, Doctor of Medical Sciences:

We move on to our final report, a lecture, which will be given by Elena Aleksandrovna Poluektova. This lecture will be devoted to just such a topic, which will probably raise a lot of questions and unresolved discussions. "Probiotics in the practice of a therapist." Whether they are needed or not.

Elena Aleksandrovna Poluektova, Candidate of Medical Sciences:

Dear Oksana Mikhailovna! Dear Colleagues!

The use of probiotics in gastroenterology for many nosologies is justified. Today I will talk about the use of probiotics for irritable bowel syndrome. Marina Fedorovna gave a brilliant lecture, which will serve as the foundation for what I now want to say.

What are probiotics? Probiotics are live microorganisms that can be included in food products, including medications and food additives, that have a positive effect on the functions of microflora.

The most commonly used probiotics are strains of lactobacteria and bifidobacteria, as well as brewer's yeast and some strains of E. coli.

Has the effectiveness of probiotics for irritable bowel syndrome been confirmed to date? In 2009, a meta-analysis of studies that were carried out at the University of Oxford was published. Data for more than 50 years were analyzed. Almost 500 studies were selected that examined the effectiveness of probiotics for irritable bowel syndrome.

The researchers were very strict in selecting these studies. As a result, out of 497 studies, only 14 were selected, which were conducted in accordance with all the requirements of evidence-based medicine.

These studies assessed the following symptoms:

Abdominal pain;

Flatulence;

Feeling of rumbling, transfusion in the abdomen in patients with a confirmed diagnosis of irritable bowel syndrome.

It was concluded that probiotics may play a role in relieving the symptoms of irritable bowel syndrome. However, it is advisable to conduct long-term studies that evaluate the type, optimal dose of probiotic, and the subgroup of patients in whom these drugs will be most effective.

As for the patients with irritable bowel syndrome themselves. For a number of years, until recently, we believed that these patients had visceral hypersensitivity and dysmotility in the gut.

(Slide show).

However, over the past year (maybe even two or three years), scientists around the world have identified changes in the intestinal wall of patients who suffer from IBS. These changes concerned changes in the number of receptors that interact with bacterial cells in such patients. These are the so-called toll-like receptors.

In addition, it turned out that in patients who suffer from irritable bowel syndrome, contacts between epithelial cells are disrupted. This also affects the interaction of macroorganisms and microorganisms that are located in the intestinal lumen.

These patients have an abnormal cytokine profile. There is nonspecific inflammation in the intestinal wall. Presumably, such patients have bacterial overgrowth syndrome (which Marina Fedorovna told us about in great detail).

In recent years, at international congresses (in particular, at the European Gastroenterology Week), a lot of reports are devoted to the study of certain probiotics in patients who suffer from irritable bowel syndrome. We also conduct such research in our clinic.

(Slide show).

On this slide I wanted to show that changes that are localized in the intestinal wall are then converted into an electrical signal and move further through the dorsal ganglia, the dorsal horns of the spinal cord. This pathological arousal affects additional areas of the brain. The response signal that goes to the intestinal wall is excessive, so the intestine begins to contract incorrectly. Thus, a vicious circle of symptoms is formed in patients suffering from IBS.

In our clinic, we currently prescribe the drug "Florasan" to many of our patients who suffer from irritable bowel syndrome. It includes:

Saccharomyces cerevisiae lysate;

Bifidobacterium longum;

Bifidobacterium bifidum;

Lactobacillus rhamnosus.

Each of these microorganisms has individually proven its effectiveness in patients who suffer from irritable bowel syndrome.

I would like to dwell on several clinical examples and show how this drug works.

First, I would like to say that we perform a hydrogen breath test with lactulose on our patients to whom we prescribe Florasan. The sensitivity of this test is 60% - 70%, specificity - 90%.

Lactulose is a synthetic disaccharide that does not occur naturally. It is not cleaved by disaccharidase in humans and is hydrolyzed only by colonic microflora.

What happens normally? When lactulose enters the stomach, then the small intestine, and then the large intestine, it is fermented by bacteria. In exhaled air we can see an increase in the concentration of labeled hydrogen.

What happens in patients with irritable bowel syndrome. When lactulose enters the stomach and then into the small intestine, in the presence of bacterial overgrowth syndrome, we see the first peak of labeled hydrogen exhaled into the air. Then we see the second peak. Thus, we can conclude that there is bacterial overgrowth syndrome.

The first patient, 39 years old. Contacted us with complaints about:

Cramping pain in the abdomen, which was relieved after defecation;

Bloating that gets worse after eating;

Frequency of bowel movements up to five times a day. The patient did not have nocturnal diarrhea;

The stool is mushy, without pathological impurities.

From the anamnesis it is known that he has been ill since the spring of 2010. He cannot connect the presence of his complaints with any external reasons. He went to the clinic at his place of residence. He was prescribed proton pump inhibitors and enzyme preparations. However, he continued to experience abdominal pain, bloating, and frequent bowel movements. He contacted our clinic so that we could examine him and prescribe treatment.

From the patient's life history it is known:

Born in Moscow.

He developed according to his age.

Denies bad habits.

There is no allergic history.

Works as a programmer.

Divorced.

The father died at a young age.

According to our patient, his mother is very sick - she suffers from coronary heart disease, hypertension, diabetes, and rheumatoid arthritis. Needs outside care.

Lives with his mother.

What we noticed when examining our patient. Everything was fine, except that his face was amicable and did not express any emotions, no matter what topics we touched on in conversation with him. His speech was monotonous. This is the general impression we have from our patient.

We gave him a preliminary diagnosis - irritable bowel syndrome with a predominance of diarrhea.

We performed a complete examination of our patient (including a lactulose breath test) and identified bacterial overgrowth. We also performed an ultrasound examination of the abdominal organs, gastroscopy, and colonoscopy. But no organic pathology was detected.

We consulted our patient with a psychiatrist. His mental status was determined by deep emotional impoverishment, coldness, weak interest in praise, joint activities, and a certain strangeness in judgments.

The patient did not complain spontaneously about emotional or mental problems. Current delusional disorders, perception disorders, and hallucinations were also not detected.

Thus, our patient's diagnosis from the point of view of our psychiatrist sounded like schizoid personality disorder.

Full clinical diagnosis: irritable bowel syndrome with predominance of diarrhea, schizoid personality disorder.

How we treated our patient. We prescribed him the drug "Florasan", one capsule twice a day for a month. The patient categorically refused to take any psychotropic medications.

Taking into account the Law of the Russian Federation of 1992 “On the provision of psychiatric care and guarantees of the rights of citizens during its provision”, guided by this law, we do not have the right to treat a person with psychotropic drugs if he does not pose a danger to himself and others. We provided our patient with only symptomatic treatment.

(Slide show).

A miracle happened. Despite the fact that the lactulose breath test was positive even after treatment, the patient’s well-being improved significantly. As you can see, by the fourth week of treatment the pain decreased significantly - from 4 points on the visual analogue scale to 1 point. Flatulence decreased significantly - from 7 points to 2. The number of bowel movements decreased from 20 per week to 7 per week. The patient began to have bowel movements every day.

The patient was very satisfied with our treatment. When he was discharged, he said that he was very glad that this was the first medical institution where they helped him.

Here is another clinical example. The patient, a 30-year-old girl, came to us with the following complaints:

Constipation up to 7 days;

Almost constant bloating;

Pain in the lower abdomen of a bursting nature, which decreased after defecation.

The above complaints have been bothering our patient since 2006, that is, for six years now. Moreover, during all this time she did not consult a doctor, she was treated on her own. She tried to eat vegetables and fruits and include a sufficient amount of liquid in her diet. We can say that the pain in the abdomen, bloating and decreased bowel movements did not bother her very much.

Why did she come to our clinic? There is probably a social problem here. She got ready to get married at the age of 30 and went to the clinic at the insistence of her future husband. The young man agreed to marry her only if the bride turned out to be completely healthy. The patient herself reacted extremely negatively to the upcoming examination and treatment. It was just a step before entering into an official marriage.

What attracted attention during an objective examination of this patient. The condition is satisfactory. However, she is not interested in talking to the doctor. Answers questions reluctantly and briefly. Expresses wishes to be examined and receive a document as soon as possible. According to her organ systems, everything was more or less in order.

Our patient's preliminary diagnosis was irritable bowel syndrome with constipation.

We examined our patient as it should be, customary for this disease, to confirm or make some other diagnosis. We did not identify any deviations from the norm. We were unable to detect bacterial overgrowth using the lactulose breath test.

Thus, our patient's clinical diagnosis was irritable bowel syndrome with constipation.

After treatment with Florasan, which we carried out, excessive bacterial growth was also not detected. However, unfortunately, the level of pain, flatulence, and the number of bowel movements, both before and after treatment, all remained at the same level. The patient said: “I told you, I just need paper. I want to get married." I want to say that she got married. Everything ended well for her.

Third, last, short example. A 49-year-old patient came to us with complaints of:

Belching with air after eating;

Aching pain in the right iliac region, which was clearly not associated with food intake;

Bloating;

Pasty stools up to 4 - 5 times a day;

An admixture of mucus in the stool.

Ill since 2000. When he developed bloating and unstable stools, he went to the clinic at his place of residence. He underwent an ultrasound examination and found stones in the gall bladder.

The doctor told him: “You need to perform a cholecystectomy, and then everything will be fine.” Our patient decided that he was not mentally ready for surgery, and over the next nine years he did not consult a doctor, although he continued to be bothered by bloating and unstable stools.

We asked him the question: “Why didn’t you go to the doctor for nine years?” He said: “But they told me that I needed to have surgery - I didn’t. Why am I going to walk if I haven’t done what was prescribed to me?”

During these nine years, the patient's wife fed him fermented milk products all the time. I made homemade kefir and yogurt. The patient said that as soon as he went on such a diet, he immediately felt better.

In 2009, all his problems in the form of bloating and unstable stools were supplemented by abdominal pain. Then he decided that he was mentally ready to perform a cholecystectomy. He went to a treatment facility. But before he had a cholecystectomy, he was given a routine examination and a gastroscopy was performed.

Gastroscopy revealed erosions in the esophagus. Proton pump inhibitors were prescribed. His erosions have healed. He underwent cholecystectomy. But, unfortunately, after performing it, he still had bloating, unstable stools, abdominal pain. He came to our clinic with these complaints.

Upon inspection:

The condition is satisfactory.

The skin and visible mucous membranes are of normal color.

The musculoskeletal system is without features.

Over the lungs, breathing is vesicular, there are no wheezes.

Heart rate - 74 per minute. The pulse is rhythmic. Blood pressure 110 and 70.

The tongue is moist, not coated.

The abdomen is symmetrical, and upon palpation it is sensitive in the epigastric region, right hypochondrium, right and left iliac regions.

Our patient's preliminary diagnosis was as follows. Gastroesophageal reflux disease: reflux esophagitis. Irritable bowel syndrome with diarrhea. Gallstone disease: cholecystectomy in 2009.

We examined the patient. The examination plan included a lactulose breath test, which did not reveal bacterial overgrowth. In addition, we included 24-hour pH monitoring in our patient's examination plan. Indeed, in those moments when he experienced belching and heartburn, you can see from the graph above that his pH dropped significantly.

Thus, the clinical diagnosis of our patient was as follows: gastroesophageal reflux disease: catarrhal reflux esophagitis. Irritable bowel syndrome with diarrhea. Gallstone disease: cholecystectomy in 2009.

The patient was prescribed Gaviscon, one tablespoon 3 times a day after meals, and Florasan, one capsule 2 times a day for a month.

(Slide show).

After treatment, a breath test with lactulose was again negative. But the treatment turned out to be very effective. You see that by the fourth, even third week of treatment, our patient had completely stopped being bothered by abdominal pain. Abdominal bloating decreased significantly - from 4 points on the visual analogue scale to 1 point. The number of bowel movements per week has decreased significantly.

Thus, the first impression of prescribing Florasan is very positive. Unfortunately, I did not have the opportunity to talk about all the patients we treated with this drug. But at the same time, it’s probably too early to talk about any possibilities for statistical processing. Today we have only six such patients. These are patients with both diarrhea and constipation. The drug has an effect both in patients with diarrhea and in patients with constipation.

It is planned to continue a thorough analysis of the clinical picture of the disease and medical history of patients suffering from IBS who are prescribed Florasan, to determine the subgroup of patients in whom the effectiveness of the drug will be maximum.

It seems to us that a more sensitive test is needed to assess the qualitative and quantitative composition of the microflora in such patients.

Thank you for your attention.

Compound

Aqua, Glycerin, Isopropyl Palmitate, Cocos Nucifera Oil, Dimethicone, Cetearyl Alcohol, Glyceryl Stearate, PEG – 100 Stearate, Calendula Officinalis Extract, Hydroxypropyl Starch phosphate, PEG-4 Rapseedamide, Oenothera Biennis Oil, Lanoleic Acid, Carbomer, PVP, PEG- 75 Lanolin, Cyclomethicone, Panthenol, Menthol, Triethanolamine, Phenoxyethanol, Methylparaben, Ethylparaben, Propylparaben, Parfum, Benzyl Salicylate, Benzyl Benzoate.

Description

Formula 109

A highly effective product for caring for face and body skin after prolonged exposure to the sun. The vitamin F contained in the product moisturizes, soothes and refreshes sun-irritated skin. D-panthenol relieves redness after sun exposure, preventing the appearance of burns. Coconut oil and calendula extract nourish and moisturize the skin. The result is a beautiful, long-lasting tan without dry skin!

Cream-gel spray of light texture, easy to apply, quickly absorbed, leaves no stickiness or greasy marks, pleasant smell,

Selling Features

Without a license

Indications

has a regenerating effect

Long lasting and safe tan

Contraindications

Individual intolerance to product components