Features of management of patients with combined gastroesophageal reflux disease and irritable bowel syndrome

The course of Gastroesophageal reflux disease (GERD), which is a widespread disease, is aggravated by a combination with other diseases, including functional pathology of the gastrointestinal tract, for example, functional dyspepsia or irritable bowel syndrome (IBS). This combination affects not only the clinical features of the disease, but also the effectiveness of GERD therapy, when there are cases of incomplete response to proton pump inhibitors (PPIs). And the doctor is faced with the choice of drugs for the complex treatment of GERD. For example, in the case of a combination of GERD and IBS in complex therapy, it is necessary to consider the use of antispasmodics or normokinetics. On the other hand, when prescribing this or that PPI, it is important to remember that these drugs themselves can affect the treatment response in patients with a combination of GERD and IBS, especially with diarrheal or mixed variants, since some patients may have a reaction to additional PPI components that are necessary for improvement bioavailability of the drug. Thus, the presence of sorbitol, mannitol, and lactose can aggravate the course of IBS, increasing the manifestations of diarrhea. The absence of these additives in the pantoprazole drug allows it to be prescribed for the correction of GERD in combination with IBS, regardless of the variant of the latter. This article will present a clinical example of a patient with a combined course of GERD and IBS, the mutually aggravating influence of both diseases not only from the point of view of patho genetic mechanisms, but also the influence of PPI pharmacotherapy, which is especially important in IBS with diarrhea. Approaches to therapy are considered, primarily the prescription of antisecretory therapy using pantoprazole as an example.