ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2021-1-20-29ophthalmology-1431Research ArticleОБЗОРЫREVIEWSКоморбидные воспалительные заболевания пищеварительной системы и органа зренияComorbid Inflammatory Diseases of Digestive System and Eyehttps://orcid.org/0000-0002-8793-752XБулгаковС. А.BulgakovS. A.

Булгаков Сергей Александрович – доктор медицинских наук, профессор

ул. Островитянова, 1, Москва, 117997

Sergey A. Bulgakov – MD, Professor

Ostrovityanova str., 1, Moscow, 117997

https://orcid.org/0000-0002-9630-6076ЧернаковаГ. М.ChernakovaG. M.

Чернакова Галина Мэлсовна – кандидат медицинских наук, доцент, врач-офтальмолог

Мичуринский проспект, д. 21-б, Москва, 119192

Galina M. Chernakova – PhD, docent, ophthalmologist

Michurinsky ave., 21B, Moscow, 119192

https://orcid.org/0000-0002-1392-3432КлещеваЕ. А.KleshchevaE. A.

Елена Александровна Клещева – кандидат медицинских наук, доцент

ул. Баррикадная, 2/1, Москва, 123995,

Мичуринский проспект, 21-б, Москва, 119192

Elena A. Kleshcheva – PhD, docent

Barrikadnaya str., 2/1, Moscow, 125993,

Michurinsky ave., 21B, Moscow, 119192

klelen@mail.ruhttps://orcid.org/0000-0002-1271-1630СимоноваС. В.SimonovaS. V.

Симонова Симона Валентиновна – заведующая организационно-методическим отделом по офтальмологии

ул. Шарикоподшипниковская, 9, Москва, 115088

Simona V. Simonova – head of the organizational and methodological department of ophthalmology

Sharikopodshipnikovskaya str., 9, Moscow, 115088

ФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Министерства здравоохранения Российской Федерации ул. ОстровитяноваРоссияThe Russian National Research Medical University named after N.I. PirogovRussian FederationООО «Герпетический центр» Российской академии медико-технических наук Мичуринский проспектРоссияHerpetic Center of the Russian Academy of Medical and Technical SciencesRussian FederationООО «Герпетический центр» Российской академии медико-технических наук Мичуринский проспект; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской ФедерацииРоссияHerpetic Center of the Russian Academy of Medical and Technical Sciences; Russian Medical Academy of Continuous Professional EducationRussian FederationГБУ «Научно-исследовательский институт организации здравоохранения и медицинского менеджмента Департамента здравоохранения города Москвы»РоссияScientific Research Institute of Healthcare Organization and Medical Management of Moscow Department of HealthcareRussian Federation2021030420211812029Copyright © Булгаков С.А., Чернакова Г.М., Клещева Е.А., Симонова С.В., 20212021Булгаков С.А., Чернакова Г.М., Клещева Е.А., Симонова С.В.Bulgakov S.A., Chernakova G.M., Kleshcheva E.A., Simonova S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ophthalmojournal.com/opht/article/view/1431

Болезнь Крона и неспецифический язвенный колит являются хроническими воспалительными заболеваниями кишечника, которые нередко сопровождаются воспалением других органов. В данной статье приведены современные данные об этиологии, патогенезе и клиническом течении воспалительных заболеваний кишечника, а также представлена информация о внекишечных глазных проявлениях неспецифического язвенного колита и болезни Крона. Рассмотрена роль состава микрофлоры кишечника, генетических факторов, дефектов иммунной системы в патогенезе кишечного воспаления и внекишечных глазных проявлений. Отмечена возможность развития офтальмопатологии не только на фоне кишечного воспаления, но и как следствие терапевтических и хирургических методов лечения неспецифического язвенного колита и болезни Крона. Выделены особенности течения эписклерита/склерита, кератита, увеита, хориоретинита, оптического неврита у пациентов с воспалительными заболеваниями кишечника. Наличие данных осложнений может отражать активность основного заболевания, что в некоторых случаях требует коррекции терапии. Передний увеит и эписклерит/склерит являются наиболее распространенными внекишечными глазными проявлениями воспалительных заболеваний кишечника. Воспаление тканей заднего сегмента глаза и зрительного нерва на фоне неспецифического язвенного колита и болезни Крона встречается реже, но имеет клиническое значение, так как способно привести к катастрофическому повреждению структур глазного яблока и, как следствие, снижению или полной потере зрительных функций. Учитывая возможность слабовыраженной клинической симптоматики и бессимптомного течения воспаления в оболочках глаза, подчеркнута важность офтальмологического обследования всех пациентов с неспецифическим язвенным колитом и болезнью Крона. Освещены аспекты современной терапии офтальмопатологии и фонового кишечного воспаления. В качестве наиболее перспективных в лечении воспалительных заболеваний кишечника и внекишечных проявлений выделены биологические препараты — антагонисты провоспалительных цитокинов. Отмечена важная роль правильного питания и биологически активных добавок, содержащих омега-3 жирные кислоты, витамин D, микроэлементы, в качестве вспомогательной терапии как кишечного, так и внекишечного воспаления.

Crohn’s disease and ulcerative colitis are chronic inflammatory bowel diseases, which are often accompanied by inflammation of other organs. This article presents modern data on etiology, pathogenesis and clinical course of inflammatory bowel diseases, as well as information on extraintestinal eye manifestations of nonspecific ulcerative colitis and Crohn’s disease. The role of microbiota, genetic factors, immune system defects in pathogenesis of intestinal inflammation and extraintestinal eye manifestations is considered. The possibility the development of ophthalmopathology not only against the background of intestinal inflammation, but also as a consequence of therapeutic and surgical methods of treatment of ulcerative colitis and Crohn’s disease is noted. The peculiarities of the course of episcleritis/scleritis, keratitis, uveitis, chorioretinitis, optical neuritis for patients with inflammatory bowel diseases are considered. The presence of these complications may reflect the activity of the underlying disease, which in some cases requires correction of therapy. Anterior uveitis and episcleritis/scleritis are the most common extraintestinal manifestations of inflammatory bowel disease. Inflammation of tissues of the posterior segment of the eye and optic nerve against the background of ulcerative colitis and Crohn’s disease are less common, but are of clinical importance, as they can catastrophically damage the structures of the eye and, as a consequence, lead to complete blindness. Considering the possibility of mild clinical symptoms and asymptomatic course of inflammation in the eye envelopes, the importance of ophthalmological examination of all patients with ulcerative colitis and Crohn’s disease is emphasized. Aspects of modern therapy of ophthalmopathology and background intestinal inflammation are highlighted. Biological preparations — antagonists of pro-inflammatory cytokines — have been identified as the most promising in the treatment of inflammatory intestinal diseases and extraintestinal manifestations. The important role of proper nutrition and biologically active supplements containing omega-3 fatty acids, vitamin D, microelements, was noted as auxiliary therapy of both intestinal and extraintestinal inflammation.

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