seamedМорская медицинаMarine Medicine2413-57472587-7828Research Institute of Industrial and Maritime Medicine of the Federal Medical and Biological Agency10.22328/2413-5747-2025-11-3-16-27GPCPBBseamed-846Research ArticleОбзорыReviewСиндром раздраженного кишечника на фоне посттравматического стрессового расстройства: современное состояние проблемы и пути решенияIrritable bowel syndrome against background of post-traumatic stress disorder: current status of problem and possible solutionshttps://orcid.org/0009-0000-4526-9802КирееваЕ. Б.KireevaE. B.

Киреева Елена Борисовна – доктор медицинских наук, доцент, заслуженный врач РФ, заведующий кафедрой амбулаторно-поликлинической помощи

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Elena B. Kireeva – Dr. of Sci. (Med.), Associate Professor,  Honored Doctor of the Russian Federation, Head of the Department of Outpatient Care

194044, Saint Petersburg, Academician Lebedev Str., 6

vmeda_85@mil.ruhttps://orcid.org/0000-0001-8134-0485ЕсинаТ. Е.YesinaT. E.

Есина Татьяна Евгеньевна – заведующий терапевтическим отделением, врач-терапевт клиники амбулаторно-поликлинической помощи

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Tatiana E. Yesina – Head of the Therapeutic Department, Physician-Therapist of the Clinic of Outpatient Care

194044, Saint Petersburg, Academician Lebedev Str., 6

vmeda_85@mil.ruhttps://orcid.org/0000-0003-3971-8864СапожниковаТ. В.SapozhnikovaT. V.

Сапожникова Татьяна Владимировна – врач-гастроэнтеролог

198510, Санкт-Петербург, Петергоф, ул. Аврова, д. 33б

Tatyana V. Sapozhnikova – Gastroenterologist

198510, Saint Petersburg, Petergof, Avrova Str., 33B

https://orcid.org/0000-0002-1858-6770СедовА. В.SedovA. V.

Седов Александр Владимирович – научный сотрудник

194044, Санкт-Петербург, Выборгская набережная, д. 29, литер А, пом. 17-н, офис 227

Aleksandr V. Sedov – Research Associate

194044, Saint Petersburg, Vyborgskaya Embankment, 29, liter A, pom. 17-n, office 227

https://orcid.org/0009-0001-8718-0600ГайтиевР. Р.GaitievR. R.

Гайтиев Руслан Рамзанович – начальник медицинской службы

197760, Санкт-Петербург, г. Кронштадт, ул. Макаровская, д. 3

Ruslan R. Gaytiev – Head of the Medical Service

197760, Saint Petersburg, Kronstadt, Makarovskaya Str., 3

https://orcid.org/0000-0001-7596-6772СмирновА. Н.SmirnovA. N.

Смирнов Антон Николаевич – врач-терапевт первой категории, адъюнкт при кафедре военно-полевой терапии

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Anton N. Smirnov – 1st Category General Practitioner, Adjunct at the Department of Military Field Therapy

194044, Saint Petersburg, Academician Lebedev Str., 6

Военно-медицинская академия имени С. М. КироваРоссияMilitary Medical AcademyRussian Federation442-й Военный клинический госпиталь Минобороны РоссииРоссияMilitary Clinical Hospital No. 442Russian FederationМежрегиональное бюро судебных экспертизРоссияInterregional Bureau of Forensic ExaminationsRussian FederationЛенинградская военно-морская база Балтийского флота Минобороны РоссииРоссияLeningrad Naval Base of the Baltic FleetRussian Federation2025031120251131627Copyright © Киреева Е.Б., Есина Т.Е., Сапожникова Т.В., Седов А.В., Гайтиев Р.Р., Смирнов А.Н., 20252025Киреева Е.Б., Есина Т.Е., Сапожникова Т.В., Седов А.В., Гайтиев Р.Р., Смирнов А.Н.Kireeva E.B., Yesina T.E., Sapozhnikova T.V., Sedov A.V., Gaitiev R.R., Smirnov A.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://seamed.elpub.ru/jour/article/view/846ВВЕДЕНИЕ

ВВЕДЕНИЕ. Данная обзорная статья посвящена актуальной теме изучения взаимосвязи синдрома раздраженного кишечника (СРК) и посттравматического стрессового расстройства (ПТСР). За последние десятилетия отмечается рост числа пациентов с сочетанием нарушений адаптационного спектра и функциональных заболеваний желудочно-кишечного тракта (ЖКТ), что требует углубленного анализа как механизмов формирования такой ассоциации, так и оценки ее влияния на качество жизни пациентов и разработки профилактических и коррекционно-восстановительных подходов. Настоящее исследование представляет собой литературный обзор релевантных источников по вопросам эпидемиологии, патогенеза и подходов к лечению данной группы патологий с акцентом на поиск точек приложения антигипоксантов/антиоксидантов и когнитивно-поведенческой терапии (КПТ).

ЦЕЛЬ

ЦЕЛЬ. Анализ патофизиологических механизмов взаимосвязи СРК и ПТСР и оценка перспективных подходов к комплексной терапии.

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ. Проведен аналитический обзор литературных источников в базах PubMed, Google Scholar, eLibrary, Scopus, Web of Science, Cochrane Library, КиберЛенинка за последние 10 лет с использованием ключевых слов: СРК, ПТСР, коморбидность, «ось кишечник – мозг». Отобраны 46 статей, которые подошли под искомые требования.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Установлена высокая распространенность коморбидности СРК и ПТСР (ОШ = 4,54; 95 % ДИ: 4,07–5,06) с преобладанием диарейного варианта СРК (71 %) и большей тяжестью симптомов. Выделены ключевые патофизиологические механизмы: дисрегуляция вегетативной нервной системы (симпатикотония), гиперактивация гипоталамо-гипофизарно-надпочечниковой оси и гиперкортизолемия, гипоксические изменения и оксидативный стресс в микробиоте и дисфункция «оси кишечник – мозг» (дисбиоз, системное воспаление).

ОБСУЖДЕНИЕ

ОБСУЖДЕНИЕ. Коморбидность СРК и ПТСР является клинически значимым состоянием с общими патогенетическими механизмами. Наиболее перспективен интегративный подход к лечению, сочетающий применение некоторых основных групп: фармакотерапию (антигипоксанты, Цитофлавин), психотерапию (когнитивно-поведенческую терапию –КПТ).

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Патогенез коморбидности СРК и ПТСР интегрирует нарушения нейровегетативной регуляции, гипоксию и дисфункцию оси «мозг – кишечник». Приоритетным направлением является разработка комбинированных схем лечения (антигипоксанты + КПТ + диета) для воздействия на различные звенья патогенеза.

INTRODUCTION

INTRODUCTION. This review article is devoted to the topical issue of studying the relationship between irritable bowel syndrome (IBS) and post-traumatic stress disorder (PTSD). Over the past decade, there has been an increase in the number of patients with a combination of adaptation disorders and functional gastrointestinal tract (GIT) diseases, which requires an in-depth analysis of both the mechanisms underlying this association and an assessment of its impact on patients’ quality of life, as well as the development of preventive and corrective-rehabilitative approaches. This study is a literature review of relevant sources on the epidemiology, pathogenesis, and treatment approaches for this group of pathologies, with an emphasis on finding points of application for antihypoxants/antioxidants and cognitive-behavioral therapy (CBT).

OBJECTIVE

OBJECTIVE. Analysis of pathophysiological mechanisms linking IBS and PTSD and evaluation of promising approaches to comprehensive therapy.

MATERIALS AND METHODS

MATERIALS AND METHODS. An analytical review of literary sources in PubMed, Google Scholar, eLibrary, Scopus, Web of Science, Cochrane Library, and CyberLeninka databases for the last 10 years was conducted using the keywords: “CBD,” “PTSD,” “comorbidity,” and “brain-gut axis.” Forty-six articles that met the search criteria were selected. RESULTS. A high prevalence of comorbidity between IBS and PTSD (OR = 4.54; 95% CI: 4.07–5.06) was established, with a predominance of the diarrhea variant of IBS (71%) and more severe symptoms. Key pathophysiological mechanisms were identified: dysregulation of the autonomic nervous system (sympathicotonia), hyperactivation of the hypothalamic-pituitary-adrenal axis and hypercortisolemia, hypoxic changes and oxidative stress in the microbiota, and dysfunction of the brain-gut axis (dysbiosis, systemic inflammation).

DISCUSSION

DISCUSSION. The comorbidity of IBS and PTSD is a clinically significant condition with common pathogenetic mechanisms. The most promising approach to treatment is an integrative one, combining the use of several main groups: pharmacotherapy (antihypoxants, cytoflavin), psychotherapy (cognitive-behavioral therapy (CBT)).

CONCLUSION

CONCLUSION. The pathogenesis of comorbidity of IBS and PTSD integrates disturbances in neurovegetative regulation, hypoxia, and dysfunction of the brain-gut axis. The priority direction is the development of combined treatment regimens (antihypoxants + CBT + diet) to influence various links in the pathogenesis.

морская медицинасиндром раздраженного кишечникапосттравматическое стрессовое расстройствогипоксияантигипоксантыантиоксидантыпсихотерапиякогнитивно-поведенческая терапияmarine medicineirritable bowel syndromepost-traumatic stress disorderhypoxiaantihypoxantsantioxidantspsychotherapycognitive behavioral therapyReferencesKarchoud J. F., Haagsma J., Karaban, I., Hoeboer, C., van de Schoot, R., Olff, M., & van Zuiden, M. (2024). Long-term PTSD prevalence and associated adverse psychological, functional, and economic outcomes: a 12–15 year follow-up of adults with suspected serious injury. European Journal of Psychotraumatology, 15(1). https://doi.org/10.1080/20008066.2024.2401285Karchoud J. F., Haagsma J., Karaban, I., Hoeboer, C., van de Schoot, R., Olff, M., & van Zuiden, M. (2024). Long-term PTSD prevalence and associated adverse psychological, functional, and economic outcomes: a 12–15 year follow-up of adults with suspected serious injury. European Journal of Psychotraumatology, 15(1). https://doi.org/10.1080/20008066.2024.2401285Торопова К. А., Ивашкина О. И., Анохин К. В. Посттравматическое стрессовое расстройство: теоретические подходы и пути моделирования на животных // Журнал высшей нервной деятельности им. И.П. Павлова. 2021. Т. 71, № 6. С. 735-759.Toropova, K. A., Ivashkina O. I., Anokhin K. V. Post-traumatic stress disorder: theoretical approaches and ways of modeling on animals // Pavlov Journal of Higher Nervous Activity. 2021. Vol. 71, No. 6. pp. 735-759. (In Russ.) https://doi.org/10.31857/S0044467721060113. EDN BQFNRL.Кекелидзе З. И., Портнова А. А. Критерии диагностики посттравматического стрессового расстройства // Журнал неврологии и психиатрии им. C.C. Корсакова. 2009. Т. 109, № 12. С. 4-7.Kekelidze, Z. I., Portnova A. A. Diagnostic criteria for post-traumatic stress disorder // Journal of Neurology and Psychiatry named after C.C. Korsakov. 2009. Vol. 109, No. 12. pp. 4-7. (In Russ.) EDN LBEVIT.Buono JL, Mathur K, Averitt AJ, Andrae DA. Economic Burden of Irritable Bowel Syndrome with Diarrhea: Retrospective Analysis of a U.S. Commercially Insured Population. J Manag Care Spec Pharm. 2017 Apr;23(4):453-460. doi: 10.18553/jmcp.2016.16138. Epub 2016 Nov 21. PMID: 28345443; PMCID: PMC10398241.Buono JL, Mathur K, Averitt AJ, Andrae DA. Economic Burden of Irritable Bowel Syndrome with Diarrhea: Retrospective Analysis of a U.S. Commercially Insured Population. J Manag Care Spec Pharm. 2017 Apr;23(4):453-460. doi: 10.18553/jmcp.2016.16138. Epub 2016 Nov 21. PMID: 28345443; PMCID: PMC10398241.Iorio N, Makipour K, Palit A, Friedenberg FK. Post-traumatic Stress Disorder Is Associated With Irritable Bowel Syndrome in African Americans. J Neurogastroenterol Motil. 2014 Oct 30;20(4):523-30. https://doi.org/10.5056/jnm14040. PMID: 25273122; PMCID: PMC4204408.Iorio N, Makipour K, Palit A, Friedenberg FK. Post-traumatic Stress Disorder Is Associated With Irritable Bowel Syndrome in African Americans. J Neurogastroenterol Motil. 2014 Oct 30;20(4):523-30. https://doi.org/10.5056/jnm14040. PMID: 25273122; PMCID: PMC4204408.Goldstein RB, Smith SM, Chou SP, et al: The epidemiology of DSM-5 posttraumatic stress disorder in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Soc Psychiatry Psychiatr Epidemiol 51(8):1137-1148, 2016. https://doi.org/10.1007/s00127-016-1208-5Goldstein RB, Smith SM, Chou SP, et al: The epidemiology of DSM-5 posttraumatic stress disorder in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Soc Psychiatry Psychiatr Epidemiol 51(8):1137-1148, 2016. https://doi.org/10.1007/s00127-016-1208-5Kent KG. The relationship between post-traumatic stress disorder and gastrointestinal disease in United States Military Veterans. SAGE Open Med. 2024 Jun 22;12:20503121241260000. https://doi.org/10.1177/20503121241260000. PMID: 38911441; PMCID: PMC11193927.Kent KG. The relationship between post-traumatic stress disorder and gastrointestinal disease in United States Military Veterans. SAGE Open Med. 2024 Jun 22;12:20503121241260000. https://doi.org/10.1177/20503121241260000. PMID: 38911441; PMCID: PMC11193927.Орлова А. Д. Уровень стрессоустойчивости и склонности к тревожности у пациентов с синдромом раздраженного кишечника // Международный студенческий научный вестник. 2018. № 5. С. 47.Orlova A.D. The level of stress tolerance and tendency to anxiety in patients with irritable bowel syndrome // International Student Scientific Bulletin. 2018. No. 5. p. 47. (In Russ.) EDN UZQKYE.Cohen H., Benjamin J., Kaplan Z., Kotler M. Administration of high-dose ketoconazole, an inhibitor of steroid synthesis, prevents posttraumatic anxiety in an animal model. Eur. Neuropsychopharmacol. 2000. 10: 429–435.Cohen H., Benjamin J., Kaplan Z., Kotler M. Administration of high-dose ketoconazole, an inhibitor of steroid synthesis, prevents posttraumatic anxiety in an animal model. Eur. Neuropsychopharmacol. 2000. 10: 429–435.Cohen H., Kaplan Z., Kotler M. CCK-antagonists in a rat exposed to acute stress: implication for anxiety associated with post-traumatic stress disorder. Depress. Anxiety. 1999. 10(1): 8–17.Cohen H., Kaplan Z., Kotler M. CCK-antagonists in a rat exposed to acute stress: implication for anxiety associated with post-traumatic stress disorder. Depress. Anxiety. 1999. 10(1): 8–17.Cohen H., Kaplan Z., Matar M.A., Loewenthal U., Kozlovsky N., Zohar J. Anisomycin, a protein synthesis inhibitor, disrupts traumatic memory consolidation and attenuates posttraumatic stress response in rats. Biol. Psychiatry. 2006. 60: 767–776.Cohen H., Kaplan Z., Matar M.A., Loewenthal U., Kozlovsky N., Zohar J. Anisomycin, a protein synthesis inhibitor, disrupts traumatic memory consolidation and attenuates posttraumatic stress response in rats. Biol. Psychiatry. 2006. 60: 767–776.Cohen H., Kozlovsky N., Alona C., Matar M.A., Joseph Z. Animal model for PTSD: from clinical concept to translational research. Neuropharmacology. 2012. 62: 715–724.Cohen H., Kozlovsky N., Alona C., Matar M.A., Joseph Z. Animal model for PTSD: from clinical concept to translational research. Neuropharmacology. 2012. 62: 715–724.Cohen H, Kozlovsky N, Matar MA, Kaplan Z, Zohar J. Mapping the brain pathways of traumatic memory: inactivation of protein kinase M zeta in different brain regions disrupts traumatic memory processes and attenuates traumatic stress responses in rats. Eur Neuropsychopharmacol. 2010 Apr;20(4):253-71. https://doi.org/10.1016/j.euroneuro.2009.12.006. Epub 2010 Feb 2. PMID: 20129764.Cohen H, Kozlovsky N, Matar MA, Kaplan Z, Zohar J. Mapping the brain pathways of traumatic memory: inactivation of protein kinase M zeta in different brain regions disrupts traumatic memory processes and attenuates traumatic stress responses in rats. Eur Neuropsychopharmacol. 2010 Apr;20(4):253-71. https://doi.org/10.1016/j.euroneuro.2009.12.006. Epub 2010 Feb 2. PMID: 20129764.Cohen H., Zohar J. An animal model of posttraumatic stress disorder: the use of cut-off behavioral criteria. Ann. N. Y. Acad. Sci. 2004. 1032: 167–178.Cohen H., Zohar J. An animal model of posttraumatic stress disorder: the use of cut-off behavioral criteria. Ann. N. Y. Acad. Sci. 2004. 1032: 167–178.Cohen H., Zohar J., Matar M. A., Zeev K., Loewenthal U., Richter-Levin G. Setting apart the affected: the use of behavioral criteria in animal models of post traumatic stress disorder. Neuropsychopharmacology. 2004. 29: 1962–1970.Cohen H., Zohar J., Matar M. A., Zeev K., Loewenthal U., Richter-Levin G. Setting apart the affected: the use of behavioral criteria in animal models of post traumatic stress disorder. Neuropsychopharmacology. 2004. 29: 1962–1970.Cohen H., Zohar J., Matar M. The relevance of differential response to trauma in an animal model of posttraumatic stress disorder. Biol. Psychiatry. 2003. 53: 463–473.Cohen H., Zohar J., Matar M. The relevance of differential response to trauma in an animal model of posttraumatic stress disorder. Biol. Psychiatry. 2003. 53: 463–473.Cohen H, Jotkowitz A, Buskila D, Pelles-Avraham S, Kaplan Z, Neumann L, Sperber AD. Post-traumatic stress disorder and other co-morbidities in a sample population of patients with irritable bowel syndrome. Eur J Intern Med. 2006 Dec; 17(8):567-71. https://doi.org/10.1016/j.ejim.2006.07.011. PMID: 17142176.Cohen H, Jotkowitz A, Buskila D, Pelles-Avraham S, Kaplan Z, Neumann L, Sperber AD. Post-traumatic stress disorder and other co-morbidities in a sample population of patients with irritable bowel syndrome. Eur J Intern Med. 2006 Dec; 17(8):567-71. https://doi.org/10.1016/j.ejim.2006.07.011. PMID: 17142176.Wernersson R., Carlsson J Posttraumatic stress disorder is correlated to irritable bowel syndrome. Ugeskrift for laeger. 2015. 177. 1248-1252.Wernersson R., Carlsson J Posttraumatic stress disorder is correlated to irritable bowel syndrome. Ugeskrift for laeger. 2015. 177. 1248-1252.Храмов Е.В., Деулин Д.В., Котенев И.О., Пахалкова А.А. Соматические проявления при посттравматическом стрессовом расстройстве. // Современная зарубежная психология, 2023. Том 12. № 3. С. 64–73Khramov E.V., Deulin D.V., Kotenev I.O., Pakhalkova A.A. Somatic manifestations in post-traumatic stress disorder. // Modern Foreign Psychology, 2023. Volume 12. No. 3. pp. 64-73. (In Russ.) https://doi.org/10.17759/jmfp.2023120306Smoller, J. The Genetics of Stress-Related Disorders: PTSD, Depression, and Anxiety Disorders. Neuropsychopharmacol 41, 297–319 (2016). https://doi.org/10.1038/npp.2015.266Smoller, J. The Genetics of Stress-Related Disorders: PTSD, Depression, and Anxiety Disorders. Neuropsychopharmacol 41, 297–319 (2016). https://doi.org/10.1038/npp.2015.266Michopoulos V, Rothbaum AO, Jovanovic T, Almli LM, Bradley B, Rothbaum BO, Gillespie CF, Ressler KJ. Association of CRP genetic variation and CRP level with elevated PTSD symptoms and physiological responses in a civilian population with high levels of trauma. Am J Psychiatry. 2015 Apr;172(4):353-62. https://doi.org/10.1176/appi.ajp.2014.14020263. Epub 2014 Dec 12. PMID: 25827033; PMCID: PMC4440454.Michopoulos V, Rothbaum AO, Jovanovic T, Almli LM, Bradley B, Rothbaum BO, Gillespie CF, Ressler KJ. Association of CRP genetic variation and CRP level with elevated PTSD symptoms and physiological responses in a civilian population with high levels of trauma. Am J Psychiatry. 2015 Apr;172(4):353-62. https://doi.org/10.1176/appi.ajp.2014.14020263. Epub 2014 Dec 12. PMID: 25827033; PMCID: PMC4440454.Swathi M., Manjusha S., Isatrin J. Vadakkiniath, Gururaj A. Prevalence and correlates of stress, anxiety, and depression in patients with chronic diseases: a cross-sectional study. Middle East Curr Psychiatry 30, 66 (2023). https://doi.org/10.1186/s43045-023-00340-2Swathi M., Manjusha S., Isatrin J. Vadakkiniath, Gururaj A. Prevalence and correlates of stress, anxiety, and depression in patients with chronic diseases: a cross-sectional study. Middle East Curr Psychiatry 30, 66 (2023). https://doi.org/10.1186/s43045-023-00340-2Gradus JL, Farkas DK, Svensson E, Ehrenstein V, Lash TL, Toft Sørensen H. Posttraumatic Stress Disorder and Gastrointestinal Disorders in the Danish Population. Epidemiology. 2017 May;28(3):354-360. https://doi.org/10.1097/EDE.0000000000000622. PMID: 28099266; PMCID: PMC5523445.Gradus JL, Farkas DK, Svensson E, Ehrenstein V, Lash TL, Toft Sørensen H. Posttraumatic Stress Disorder and Gastrointestinal Disorders in the Danish Population. Epidemiology. 2017 May;28(3):354-360. https://doi.org/10.1097/EDE.0000000000000622. PMID: 28099266; PMCID: PMC5523445.Ng QX, Soh AYS, Loke W, Venkatanarayanan N, Lim DY, Yeo WS. Systematic review with meta-analysis: The association between post-traumatic stress disorder and irritable bowel syndrome. J Gastroenterol Hepatol. 2019 Jan;34(1):68-73. https://doi.org/10.1111/jgh.14446. Epub 2018 Sep 10. PMID: 30144372.Ng QX, Soh AYS, Loke W, Venkatanarayanan N, Lim DY, Yeo WS. Systematic review with meta-analysis: The association between post-traumatic stress disorder and irritable bowel syndrome. J Gastroenterol Hepatol. 2019 Jan;34(1):68-73. https://doi.org/10.1111/jgh.14446. Epub 2018 Sep 10. PMID: 30144372.Воловик М. Г., Белова А. Н., Кузнецов А. Н., Полевая А. В., Воробьева О. В., Халак М. Е. Технологии виртуальной реальности в реабилитации участников боевых действий с посттравматическим стрессовым расстройством (обзор) // Современные технологии в медицине. 2023. Т. 15, № 1. С. 74-86.Volovik M. G., Belova A. N., Kuznetsov A. N., Polevaya A.V., Vorobyeva O. V., Khalak M. E. Virtual reality technologies in the rehabilitation of combat participants with posttraumatic stress disorder (review) // Modern technologies in medicine. 2023. Vol. 15, No. 1. pp. 74-86 (In Russ.) https://doi.org/10.17691/stm2023.15.1.08. – EDN NTPCZA.Smith JP, Bulejko T, Frey LC. The association between posttraumatic stress disorder and irritable bowel syndrome: a systematic review of the literature. J Clin Psychiatry. 2018;79(3):e24.Smith JP, Bulejko T, Frey LC. The association between posttraumatic stress disorder and irritable bowel syndrome: a systematic review of the literature. J Clin Psychiatry. 2018;79(3):e24.Puhl RM, Telke S, Larson N, Eisenberg ME, Neumark-Stzainer D. Experiences of weight stigma and links with self-compassion among a population-based sample of young adults from diverse ethnic/racial and socio-economic backgrounds. J Psychosom Res. 2020 Jul;134:110134. https://doi.org/10.1016/j.jpsychores.2020.110134. Epub 2020 May 7. PMID: 32413612; PMCID: PMC7384387.Puhl RM, Telke S, Larson N, Eisenberg ME, Neumark-Stzainer D. Experiences of weight stigma and links with self-compassion among a population-based sample of young adults from diverse ethnic/racial and socio-economic backgrounds. J Psychosom Res. 2020 Jul;134:110134. https://doi.org/10.1016/j.jpsychores.2020.110134. Epub 2020 May 7. PMID: 32413612; PMCID: PMC7384387.Murphy R, Harris B. Can current post-traumatic growth models capture the lived experience of life with a fluctuating chronic illness? Towards a new model. Br J Health Psychol. 2025 Sep;30(3):e70003. https://doi.org/10.1111/bjhp.70003. PMID: 40589134; PMCID: PMC12209698.Murphy R, Harris B. Can current post-traumatic growth models capture the lived experience of life with a fluctuating chronic illness? Towards a new model. Br J Health Psychol. 2025 Sep;30(3):e70003. https://doi.org/10.1111/bjhp.70003. PMID: 40589134; PMCID: PMC12209698.Wirkner J, Ventura-Bort C, Schwabe L, Hamm AO, Weymar M. Chronic stress and emotion: Differential effects on attentional processing and recognition memory. Psychoneuroendocrinology. 2019 Sep;107:93-97. https://doi.org/10.1016/j.psyneuen.2019.05.008. Epub 2019 May 10. PMID: 31121343.Wirkner J, Ventura-Bort C, Schwabe L, Hamm AO, Weymar M. Chronic stress and emotion: Differential effects on attentional processing and recognition memory. Psychoneuroendocrinology. 2019 Sep;107:93-97. https://doi.org/10.1016/j.psyneuen.2019.05.008. Epub 2019 May 10. PMID: 31121343.Taché Y, Bonaz B. Corticotropin-releasing factor receptors and stress-related alterations of gut motor function. J Clin Invest. 2007 Jan;117(1):33-40. doi: 10.1172/JCI30085. PMID: 17200704; PMCID: PMC1716215.Taché Y, Bonaz B. Corticotropin-releasing factor receptors and stress-related alterations of gut motor function. J Clin Invest. 2007 Jan;117(1):33-40. doi: 10.1172/JCI30085. PMID: 17200704; PMCID: PMC1716215.Brandt L.J., Chey W.D., Foxx-Orenstein A.E., et al. An Evidence-Based Systematic Review of the Management of Irritable Bowel Syndrome American College of Gastroenterology Task Force on IBS). Am J Gastroenterol 2009; 104(Suppl. 1):1-35.Brandt L.J., Chey W.D., Foxx-Orenstein A.E., et al. An Evidence-Based Systematic Review of the Management of Irritable Bowel Syndrome American College of Gastroenterology Task Force on IBS). Am J Gastroenterol 2009; 104(Suppl. 1):1-35.Ford A.C., Moayyedy P., Lacy B.E., et al. American College of Gastroenterology Monograph on the Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation. Am J Gastroenterol 2014; 109(Suppl. 1):2-26.Ford A.C., Moayyedy P., Lacy B.E., et al. American College of Gastroenterology Monograph on the Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation. Am J Gastroenterol 2014; 109(Suppl. 1):2-26.Layer P., Andresen V., Pehl C., et al. Guideline Irritable Bowel Syndrome: Definition, Pathophysiology, Diagnosis and Therapy. Joint Guideline of the German Society for Digestive and Metabolic Diseases (DGVS) and the German Society for Neurogastroenterology and Motility (DGNM). Z Gastroenterol 2011; 49:237-93.Layer P., Andresen V., Pehl C., et al. Guideline Irritable Bowel Syndrome: Definition, Pathophysiology, Diagnosis and Therapy. Joint Guideline of the German Society for Digestive and Metabolic Diseases (DGVS) and the German Society for Neurogastroenterology and Motility (DGNM). Z Gastroenterol 2011; 49:237-93.Sabaté J.-M., Jouet P. Prise en charge du Syndrome de I’Intestin Irritable (SIL). Conseil de practique. Societé Nationale Française de Gastro-Entérologie, 2013:1-5.Sabaté J.-M., Jouet P. Prise en charge du Syndrome de I’Intestin Irritable (SIL). Conseil de practique. Societé Nationale Française de Gastro-Entérologie, 2013:1-5.Schwartz ES et al. Increased serum interleukin-6 levels are associated with symptom severity in patients with posttraumatic stress disorder comorbid with irritable bowel syndrome // Psychosom Med. 2011;73(5):411–417.Schwartz ES et al. Increased serum interleukin-6 levels are associated with symptom severity in patients with posttraumatic stress disorder comorbid with irritable bowel syndrome // Psychosom Med. 2011;73(5):411–417.Kim YH, Park JM, Kang MJ. Stress-induced alterations in gut microbiota composition and immune function are associated with irritable bowel syndrome symptoms in patients with post-traumatic stress disorder. Brain Behav Immun. 2019;76:185-193.Kim YH, Park JM, Kang MJ. Stress-induced alterations in gut microbiota composition and immune function are associated with irritable bowel syndrome symptoms in patients with post-traumatic stress disorder. Brain Behav Immun. 2019;76:185-193.Zhang L, Wang Z, Ma X. The effect of cognitive behavioral therapy combined with anti-hypoxic agents on treatment outcomes in patients with comorbid PTSD and IBS. Clin Psychopharmacol Neurosci. 2022;20(1):34-42.Zhang L, Wang Z, Ma X. The effect of cognitive behavioral therapy combined with anti-hypoxic agents on treatment outcomes in patients with comorbid PTSD and IBS. Clin Psychopharmacol Neurosci. 2022;20(1):34-42.Ивашкин В.Т., Маев И.В., Шелыгин Ю.А., и др. Диагностика и лечение синдрома раздраженного кишечника Клинические рекомендации Российской гастроэнтерологической ассоциации и Ассоциации колопроктологов России. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2021. 31(5). C. 74-95Ivashkin V.T., Maev I.V., Shelygin Yu.A., and others Diagnosis and treatment of irritable bowel syndrome Clinical recommendations of the Russian Gastroenterological Association and the Association of Coloproctologists of Russia. Russian Journal of Gastroenterology, Hepatology, and Coloproctology. 2021. 31(5). C. 74-95. (In Russ.). https://doi.org/10.22416/1382-4376-2021-31-5-74-95Mawdsley JE, Rampton DS. Psychological stress in IBD: new insights into pathogenic and therapeutic implications. Gut. 2005 Oct;54(10):1481-91. https://doi.org/10.1136/gut.2005.064261. PMID: 16162953; PMCID: PMC1774724.Mawdsley JE, Rampton DS. Psychological stress in IBD: new insights into pathogenic and therapeutic implications. Gut. 2005 Oct;54(10):1481-91. https://doi.org/10.1136/gut.2005.064261. PMID: 16162953; PMCID: PMC1774724.Chang L. The role of stress on physiologic responses and clinical symptoms in irritable bowel syndrome. Gastroenterology. 2011 Mar;140(3):761-5. https://doi.org/10.1053/j.gastro.2011.01.032. Epub 2011 Jan 19. PMID: 21256129; PMCID: PMC3039211.Chang L. The role of stress on physiologic responses and clinical symptoms in irritable bowel syndrome. Gastroenterology. 2011 Mar;140(3):761-5. https://doi.org/10.1053/j.gastro.2011.01.032. Epub 2011 Jan 19. PMID: 21256129; PMCID: PMC3039211.Cryan, J., Dinan, T. Microbiota and neuroimmune signalling—Metchnikoff to microglia. Nat Rev Gastroenterol Hepatol 12, 494–496 (2015). https://doi.org/10.1038/nrgastro.2015.127Cryan, J., Dinan, T. Microbiota and neuroimmune signalling—Metchnikoff to microglia. Nat Rev Gastroenterol Hepatol 12, 494–496 (2015). https://doi.org/10.1038/nrgastro.2015.127Sansone RA, Sansone LA. IRRITABLE BOWEL SYNDROME: Relationships with Abuse in Childhood. Innov Clin Neurosci. 2015 May-Jun;12(5-6):34-7. PMID: 26155376; PMCID: PMC4479362.Sansone RA, Sansone LA. IRRITABLE BOWEL SYNDROME: Relationships with Abuse in Childhood. Innov Clin Neurosci. 2015 May-Jun;12(5-6):34-7. PMID: 26155376; PMCID: PMC4479362.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5®). Arlington, VA: American Psychiatric Publishing; 2013.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5®). Arlington, VA: American Psychiatric Publishing; 2013.Захаров К. И., Белов В. Г., Парфёнов Ю. А. Бихевиоральная терапия и цитофлавин в лечении деформирующего коксартроза у пациентов пожилого и старческого возраста // Успехи геронтологии. 2016. Т. 29. № 5. C. 816– 822Zakharov K. I., Belov V. G., Parfenov Yu. A. Behavioral therapy and cytoflavin in the treatment of deforming coxarthrosis in elderly and senile patients // Successes of gerontology. 2016. Vol. 29. No. 5. pp. 816-822 (In Russ.).Парфенов Ю. А., Василевская М. А., Парфенов С. А. Обоснование показаний к применению БОС терапии и Цитофлавина в лечении неврологических осложнений остеохондроза у пожилых пациентов. // Медицинские новости Грузии. 2018. № 10 (283). С. 89–96Parfenov Yu. A., Vasilevskaya M. A., Parfenov S. A. Substantiation of indications for the use of BOS therapy and Cytoflavin in the treatment of neurological complications of osteochondrosis in elderly patients. // Medical news of Georgia. 2018. No. 10 (283). pp. 89-96 (In Russ.).Захаров К. И., Белов В. Г., Парфёнов Ю. А. Обоснование применения препарата цитофлавин и когнитивно-поведенческой терапии в комплексном лечении пациентов старшей группы с деформирующим коксартрозом. // Успехи геронтологии. 2019. Т. 32, № 3. С. 439–444Zakharov K. I., Belov V. G., Parfenov Yu. A. Justification of the use of cytoflavin and cognitive behavioral therapy in the complex treatment of patients in the senior group with deforming coxarthrosis. // The successes of gerontology. 2019. Vol. 32, No. 3. pp. 439-444 (In Russ.).Елькин А. А., Сапожников К. В., Парфенов С. А. Эффективность психофармакологической коррекции функционального состояния пожилых хоккеистов // Профилактическая медицина. 2020. Т. 23, № 6, с. 86–90Elkin A. A., Sapozhnikov K. V., Parfenov S. A. The effectiveness of psychopharmacological correction of the functional state of elderly hockey players // Preventive medicine. 2020. Vol. 23, No. 6, pp. 86-90 (In Russ.). https://doi.org/10.17116/profmed20202306286.Чутко Л. С., Сурушкина С. Ю., Яковенко Е. А., Анисимова Т. И., Прокопенко С. М. Исследование эффективности цитофлавина в лечении соматоформных расстройств // Журнал неврологии и психиатрии им. C. C. Корсакова. 2017. Т. 117. № 1. С. 21–24Chutko L. S., Surushkina S. Yu. It’s Yakovenko. A., Anisimova T. And., Prokopenko S. M. Investigation of the effectiveness of cytoflavin in the treatment of somatoform disorders / et al. // Journal of Neurology and Psychiatry named after C. C. Korsakov. 2017. Vol. 117. No. 1. pp. 21-24 (In Russ.). https://doi.org/10.17116/jnevro20171171121–24Чутко Л. С. Соматоформные расстройства // Медицинский совет. 2011. № 1–2. С. 84–90Chutko L. S. Somatoform disorders // Medical Council, 2011, No. 1-2, pp. 84-90 (In Russ.).Чутко Л. С. Функциональные неврологические расстройства / Л. С. Чутко, С. Ю. Сурушкина // Журнал неврологии и психиатрии им. C. C. Корсакова. 2021. Т. 121. № 1. С. 98–103Chutko L. S. Functional neurological disorders / L. S. Chutko, S. Y. Surushkina // Journal of Neurology and Psychiatry named after C. C. Korsakov. 2021. Vol. 121. No. 1. pp. 98-103 (In Russ.). https://doi.org/10.17116/jnevro202112101198Чутко Л. С., Сурушкина С. Ю., Яковенко Е. А., Рожкова А. В., Анисимова Т. И., Бондарчук Ю. Л. Эффективность цитофлавина при лечении синдрома эмоционального выгорания // Журнал неврологии и психиатрии им. C. C. Корсакова. 2015. Т. 115. № 10. С. 66–70Chutko L. S., Surushkina S. Yu., Yakovenko E. A., Rozhkova A.V., Anisimova T. I., Bondarchuk Yu. L. The effectiveness of cytoflavin in the treatment of burnout syndrome // Journal of Neurology and Psychiatry named after C. C. Korsakov. 2015. Vol. 115. No. 10. pp. 66-70 (In Russ.). https://doi.org/10.17116/jnevro201511510166–70Сапожникова Т. В., Парфенов С. А., Елькин А. А., Ризаханов Д. М., Ризаханова О. А. Влияние цитофлавина на качество жизни пациентов с функциональной диспепсией // Экспериментальная и клиническая гастроэнтерология. 2022. № 8(204). С. 133-140Sapozhnikova T. V., Parfenov S. A., Yelkin A. A., Rizakhanov D. M., Rizakhanova O. A. The effect of cytoflavin on the quality of life of patients with functional dyspepsia // Experimental and clinical gastroenterology. 2022. No. 8(204). pp. 133-140 (In Russ.). https://doi.org/10.31146/1682-8658-ecg-204-8-133-140. – EDN UAYRDL.Сапожникова Т. В., Сапожников К. В., Парфенов С. А., Седов А. В. Пути совершенствования терапии функциональных заболеваний желудочно-кишечного тракта // University Therapeutic Journal. 2023. Т. 5, № S. С. 154-155Sapozhnikova T. V., Sapozhnikov K. V., Parfenov S. A., Sedov A.V. Ways to improve the treatment of functional diseases of the gastrointestinal tract // University Therapeutic Journal. 2023. Vol. 5, no. S. pp. 154-155 (In Russ.). – EDN JKKDJU.Сапожникова Т. В., Парфенов С. А., Есина Т. Е., Сапожников К. В., Смирнов А. Н., Паулов А. А., Ризаханов Д. М., Ризаханова О. А. Применение антиоксидантов и когнитивно-бихевиоральной терапии у пациентов с функциональной диспепсией // Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2023. Т. 33, № 3. С. 34-42Sapozhnikova T. V., Parfenov S. A., Esina T. E., Sapozhnikov K. V., Smirnov A. N., Paulov A. A., Rizakhanov D. M., Rizakhanova O. A. The use of antioxidants and cognitive behavioral therapy in patients with functional dyspepsia // Russian Journal of Gastroenterology, Hepatology, and Coloproctology. 2023. Vol. 33, No. 3. pp. 34-42 (In Russ.). https://doi.org/10.22416/1382-4376-2023-33-3-34-42. – EDN MGLXIK.Sperber AD, Mearin F, Shamir R. Rome IV criteria for functional gastrointestinal disorders: new advances and challenges. Nat Rev Gastroenterol Hepatol. 2017;14(1):49-64.Sperber AD, Mearin F, Shamir R. Rome IV criteria for functional gastrointestinal disorders: new advances and challenges. Nat Rev Gastroenterol Hepatol. 2017;14(1):49-64.

The authors declare that there are no conflicts of interest present.