肠易激综合征的中医虚实证型与血浆脑肠肽水平变化的相关性研究

[目的]观察肝郁气滞型、脾胃虚弱型、肝郁脾虚型肠易激综合征（IBS）患者脑肠肽的变化,探讨IBS的中医虚实证型与血浆脑肠肽水平变化的相关性。[方法]90例IBS患者分为肝气郁滞证组、肝郁脾虚证组、脾胃虚弱证组各30例,正常对照（正常）组10例,应用放射免疫法同批测定血浆血管活性肠肽（VIP）、神经肽Y（NPY）和神经降压素（NT）水平。[结果]3个证型组患者血浆VIP水平显著高于正常组（P〈0.05,〈0.01）;脾胃虚弱、肝郁脾虚证组患者VIP水平显著高于肝气郁滞证组（P〈0.05）,但脾胃虚弱证组和肝郁脾虚证组之间比较差异无统计学意义。3个证型组患者血浆NPY水平显著低于正常组（P〈0.05,〈0.01）,肝郁脾虚证组和肝气郁滞证组NPY水平明显低于脾胃虚弱证组（P〈0.01,〈0.05）,肝郁脾虚证组NPY水平低于肝气郁滞证组,但2组比较差异无统计学意义。3个证型组患者血浆NT水平显著高于正常组（P〈0.01）。3证型间比较差异无统计学意义。[结论]不同中医证型IBS脑肠肽存在不同的变化。IBS的中医病机观与现代医学所倡导的脑-肠轴学说具有相关性。     

老年肠易激综合征患者肠黏膜肥大细胞与血管活性肠肽的表达及意义

目的探讨肠易激综合征(IBS)患者肠黏膜肥大细胞(MC)及血管活性肠肽(VIP)的表达及其可能作用。方法 33例腹泻型IBS患者(D-IBS组)、27例便秘型IBS患者(C-IBS组)及18例健康体检者(对照组)纳入研究。分别取回盲部、乙状结肠黏膜行VIP免疫组织化学染色和甲苯胺蓝染色MC计数,检测肛管直肠压力。结果 1D-IBS组和C-IBS组乙状结肠部MC计数均较回盲部显著降低(P<0.05),两组间各部MC计数比较无统计学差异(P>0.05),但各部位均较对照组显著增高(P<0.05)。2D-IBS组和C-IBS组回盲部和乙状结肠黏膜VIP表达无统计学差异(P>0.05),但各部位均较对照组显著增高(P<0.05)。3三组间静息压、最大收缩压及松弛压均无统计学差异(P>0.05)。D-IBS组和C-IBS组患者感觉阈值、最大容量阈值及疼痛阈值均无统计学差异(P>0.05),但与对照组比较均显著降低(P<0.05)。结论 IBS患者结肠黏膜MC和VIP表达增加,可能对IBS患者内脏高敏感性的形成有一定影响。     

肠易激综合征血浆及乙状结肠粘膜中VIP及SS的含量

目的 :探讨肠易激综合征 (IBS)患者血浆及乙状结肠粘膜中血管活性肠肽 (VIP)、生长抑素 (SS)有无变化 ,以及它们在IBS发病过程中的可能作用和临床意义。方法 :应用放射免疫分析法 (RIA)测定IBS患者血浆及乙状结肠粘膜内VIP、SS的含量 ,并与正常组比较。结果 :便秘型IBS血浆及乙状结肠粘膜中VIP含量显著高于正常组 (P <0 .0 1 ) ,腹泻型显著低于正常组 (P <0 .0 5) ;SS在IBS各组均显著高于正常组 (P <0 .0 5) ,而便秘型又显著高于腹泻型 (P <0 .0 5)。结论 :IBS患者存在VIP、SS含量异常 ,且这些异常可能在IBS发病中起一定的作用 ;不同类型IBS患者VIP及SS含量有显著差异 ,说明不同类型IBS在发病机制上有其不同的病理生理学基础     

肠易激综合征患者结肠黏膜P物质、血管活性肠肽和肥大细胞的变化

背景：肠易激综合征（IBS）的发病机制尚不明确。目的：探讨IBS患者结肠黏膜P物质（SP）、血管活性肠肽（VIP）、肥大细胞（MC）的变化及其在IBS中的可能作用。方法：20例腹泻型IBS患者、22例便秘型IBS患者和18名正常对照者纳入本研究．取回盲部、乙状结肠黏膜行SP、VIP免疫组化染色和MC计数。结果：IBS患者回盲部、乙状结肠黏膜SP、VIP免疫阳性神经纤维较正常对照组增多、增粗，阳性增强（P〈0．05）。IBS患者乙状结肠黏膜SP、VIP免疫阳性神经纤维与回盲部相比无显著差异。IBS患者回盲部黏膜MC计数较正常对照组显著增高（P〈0．01），乙状结肠黏膜MC计数与正常对照组相比无显著差异。IBS患者乙状结肠黏膜MC计数与正常对照组相比，显著低于回盲部（P〈0．01）。结论：SP、VIP和MC在IBS的发病中起有一定作用。     

肠易激综合征患者内脏高敏感性的机制研究

目的检测肠易激综合征(IBS)患者的内脏感觉及其结肠黏膜肥大细胞(MC)、P物质(SP)和血管活性肠肽(VIP)的改变,探讨MC、SP、VIP对IBS患者内脏高敏感性的作用及其机制.方法黏膜标本取自19例正常人和22例腹泻型IBS(D-IBS)、20例便秘型IBS(C-IBS)患者回肠末端、回盲部、升结肠、乙状结肠,应用特殊组织化学染色法、免疫组织化学染色法分别对MC、SP和VIP免疫反应阳性神经纤维进行染色,应用彩色病理图像分析软件进行分析,电镜观察MC及其毗邻结构;应用电子气压泵及灌注导管测压仪检测上述患者肛门直肠压力、直肠对容量刺激的感觉及直肠顺应性.结果IBS组回肠末端、回盲部、升结肠MC明显增多,MC显著变异(P＜0.01);IBS组结肠黏膜SP、VIP免疫反应阳性神经纤维较正常对照组增多、增粗、阳性强度增强(P＜0.01);IBS组SP、VIP免疫反应阳性纤维的阳性强度均值、面积与MC的密度、面积密切相关(r=0.3860～0.6632,P＜0.01、P＜0.05),并可观察到MC与无髓神经末梢及浆细胞等内分泌细胞毗邻或密切接触;IBS组肛门直肠括约肌的静息压、收缩压、松弛压与正常对照组相似(P＞0.05),感觉阈值、排便阈值、疼痛阈值明显低于正常对照组(P＜0.01),直肠顺应性降低(P＜0.01),向直肠内注气20或40 ml后均可引起直肠肛门抑制性反射.结论MC、SP、VIP在IBS的病理生理机制中可能起关键性作用,MC活性、SP、VIP免疫反应阳性神经纤维可能与IBS以内脏感觉及动力变化为特征的内脏高敏感性相关联.     

眼针疗法对D-IBS模型大鼠结肠VIPR1表达的影响

目的 观测眼针对腹泻型肠易激综合征(D-IBS)模型大鼠血清、结肠组织中血管活性肠肽(VIP)含量及结肠组织VIP受体1(VIP-Rl)表达的变化,探讨眼针治疗D-IBS的作用机制.方法 30只雄性SPF级大鼠,分为对照组、IBS模型组和眼针组,采用慢性应激与束缚相结合的方法复制D-IBS模型后,进行眼针治疗7d.应用ELISA方法检测VIP含量；采用免疫组化、RT-PCR方法检测VIP-R1表达.结果 与对照组比较,模型组血清、结肠组织中VIP含量及VIP-R1表达明显增高和上调(P ＜0.01,P＜0.05)；与模型组比较,眼针组血清、结肠组织中VIP含量及VIP-R1表达明显下降和下调.结论 眼针治疗D-IBS的机制之一可能与抑制血清、结肠组织VIP释放、下调VIP-R1表达有关.     

肠易激综合征患者肠黏膜中褪黑素受体的表达及其临床意义

目的探讨肠易激综合征（irritable bowel syndrome，IBS）患者结肠黏膜中褪黑素受体（melatonin receptor，MR）的表达情况及其与肠易激综合征临床症状的相关性。方法用免疫组化法，检测正常对照20例、腹泻型肠易激综合征（diarrhea-predominant IBS，D-IBS）23例、便秘型肠易激综合征（constipation-predominant IBS，C-IBS）20例结肠黏膜中MR的表达情况。使用JEDA801D形态学图像分析系统，测量阳性表达面积及光密度（opacity density，OD）。结果MR在黏膜层含量较多，黏膜下层含量较少。回盲部和乙状结肠MR阳性面积及OD值表现为：D-IBS明显高于正常对照组（P〈0．05），正常对照组明显高于C-IBS（P〈0．05）。与同组IBS乙状结肠相比，回盲部阳性面积增高（P〈0．05）；OD值无明显差异。结论MR在D-IBS中高表达，在C-IBS中低表达，说明MR对IBS患者胃肠道运动有一定影响。     

肠易激综合征模型大鼠血清胰高糖素样肽-1及结肠组织中其受体的变化

目的 观察肠易激综合征( IBS)不同亚型模型大鼠血清胰高糖素样肽(GLP)-1及结肠组织中GLP-1受体的变化,初步探讨GLP-1及其受体在IBS发病中的作用.方法 40只雄性SD大鼠均分为腹泻型IBS(D-IBS)模型组、灌肠对照组、便秘型IBS(C-IBS)模型组、灌胃对照组及空白对照组.乙酸加束缚应激法制备D-IBS模型,冰水灌胃法制备C-IBS模型.观察大鼠粪便变化,检测粪便重量、粪便含水量及大鼠小肠推进率,给予结直肠扩张(CRD)刺激,记录腹外斜肌放电活动(EMG),评价模型大鼠的内脏敏感性.酶联免疫法测定各组大鼠血清中活性GLP-1的含量.免疫组织化学法、实时定量PCR法及Western印迹法检测各组大鼠近端结肠及远端结肠组织中GLP-1 受体的分布和表达.结果 与各自的对照组及空白对照组相比,D-IBS模型组大鼠粪便湿重、粪便含水量及小肠推进率均上升(P＜0.05);C-IBS模型组粪便湿重、粪便含水量及小肠推进率均降低(P＜0.05).在压力为20、40及60 mm Hg(1 mm Hg=0.133 kPa)的结直肠扩张刺激下各模型组大鼠腹外斜肌放电幅值均较各对照组明显增加,且D-IBS模型组高于C-IBS模型组(P＜0.05).C-IBS模型组血清中活性GLP-1的水平高于D-IBS模型组(P＜0.05),IBS模型组和对照组之间差异无统计学意义.GLP-1受体主要分布在结肠黏膜组织、环肌层及肌间神经丛中.C-IBS模型组结肠组织中GLP-1受体mRNA及蛋白表达量显著高于灌胃对照组,D-IBS模型组结肠组织中表达量低于灌肠对照组(P＜0.05).结论 不同亚型IBS结肠组织中GLP-1受体的表达水平不同,血清GLP-1水平也不同,提示GLP-1及其受体的改变可能与IBS不同亚型的发生有关.     

肠易激综合征患者近端胃舒张和排空功能的研究

背景：实时B超检查测量近端胃舒张和排空功能在胃肠动力障碍性疾病中的应用已越来越受到临床工作者的关注。目的：探讨腹泻型肠易激综合征（D-IBS）和便秘型肠易激综合征（C-IBS）患者近端胃舒张和排空功能的改变。方法：D-IBS患者、C-IBS患者和健康志愿者各20例，以实时B超检查测定饮用标准营养液（500ml）后不同时间点近端胃容积的变化。结果：D-IBS组、C-IBS组和对照组之间胃底气体评分无显著差异。D-IBS组除试餐后5、60min以及C-IBS组除试餐后60min外。其余时间点两组近端胃容积均显著低于对照组。D-IBS组与C-IBS组0min时近端胃容积和最大近端胃容积均显著低于对照组。D-IBS组所有时间点的近端胃容积与C-IBS组无显著差异。D-IBS组、C-IBS组的胃延迟排空相与对照组无显著差异。D-IBS组近端胃液体半排空时间（T1/2）较对照组显著提前，C-IBS组T1/2与对照组无显著差异。结论：IBS患者近端胃舒张功能受损，但D-IBS与C-IBS间无差异，IBS患者的近端胃排空加快。     

肠易激综合征患者5-羟色胺转运体的基因多态性

目的 探讨5-羟色胺转运体(SERT)基因多态性在肠易激综合征(IBS)中的意义。方法 用PCR方法对48例健康对照和30例便秘型IBS(C-IBS)、32例腹泻型IBS(D-IBS)和19例交替型IBS(A-IBS)患者SERT基因的VNTRs和5-HTTLPR区多态性进行研究。结果 VNTRs区：IBS患者STin2．12／10基因型频率明显高于对照组,各亚型间基因型频率差异无显著性。5-HTTLPR区：C-IBS组L／L频率显著高于D-IBS、A-IBS和对照组;D-IBS、A-IBS组IMS频率显著高于C-IBS组。C-IBS组12／12-L／L基因型联合的频率显著高于A-IBS和D-IBS组。结论 SERT基因VNTRs区STin2．12／10基因型可能与IBS相关,具有L／L基因型以及12／12-L／L基因型联合的人群可能更易患C-IBS,IMS基因型的人群易患D-IBS和A-IBS。     

肠易激综合征乙状结肠移行性运动与胃肠肽胆囊收缩素、胃动素的相关性研究

目的研究肠易激综合征(IBS)患者乙状结肠移行性运动与胃肠肽胆囊收缩素(CCK)、胃动素(MTL)的关系,探讨CCK、MTL对IBS患者乙状结肠动力的调节作用。方法对2004年3月至2005年2月,在广西壮族自治区人民医院消化内科住院,符合罗马Ⅱ诊断标准的腹泻型(D-IBS)和便秘型(C-IBS)IBS患者各20例及年龄、性别匹配的健康志愿者组15名(男7名、女8名),分别采用毛细管液体灌注测压法记录空腹状态下乙状结肠移行性高幅突发波的波幅及占记录时间百分比;同时采用放射免疫法测定所有研究对象血浆和乙状结肠黏膜CCK、MTL的含量。结果D-IBS组乙状结肠移行性高幅突发波的波幅和持续时间显著高于C-IBS组和健康组(P<0.05),D-IBS组血浆MTL、CCK浓度显著高于C-IBS组和健康组(P<0.01),黏膜MTL显著高于C-IBS组和健康组(P<0.01)。IBS患者乙状结肠移行高幅突发波的波幅和持续时间与血浆或黏膜CCK、MTL分别呈正相关(P<0.05)。结论IBS患者乙状结肠移行性运动可能受血浆CCK、黏膜和血浆MTL浓度相关的正性调节作用。     

5-羟色胺转运体基因多态性与肠易激综合征的相关性

目的:探讨SERT基因启动子区5-HTTLPR和内含子2 VNTRs多态性在肠易激综合征(IBS) 中的意义．方法:采用PCR方法对51例腹泻型IBS(D- IBS)、58例便秘型IBS(C-IBS)、38例便秘腹泻交替型IBS(A-IBS)患者与48例健康对照者SERT基因启动子区5-HTTLPR和内含子2 VNTRs多态性进行比较分析．结果:C-IBS组L／L基因型及L等位基因频率显著高于对照组(31．0％vs 8．3％,X2=8．229, P<0．05;47．4％vs29．2％,X2=7．342,P<0．05), D-IBS组S／S基因型频率和S等位基因频率显著高于A-IBS和C-IBS组(S／S:56．9％vs 36．8％, 36．2％,P<0．05;S:71．6％vs 56．6％,52．6％, P<0．05),L／L基因频率显著低于A-IBS和C-IBS 组(9．8％vs 28．1％,P<0．05)．IBS各组与对照组之间内含子2 VNTRs多态性分布无显著性差异(P>0．05)．结论:具有L／L基因型和L等位基因的人更易患C-IBS,具有S／S基因型和S等位基因的人更易患D-IBS,L／L基因型可能是D-IBS的保护因素之一．     

肠易激综合征患者脑部痛觉功能区域的变化

目的应用血氧水平依赖性功能性磁共振(BOLD fMRI)技术研究肠易激综合征(irritablebowelsyndrome ,IBS)患者颅内痛觉功能区的变化及临床意义并比较与正常人的差异。方法2 0 0 2年1月～2 0 0 4年2月期间,参照罗马II诊断标准纳入67例肠易激综合征患者和10例正常志愿者,其中腹泻型肠易激综合征44例,男19例,女2 5例。年龄3 4～73岁,平均年龄5 3 0 7±8 44岁。便秘型肠易激综合征2 3例,其中男12例,女11例,年龄2 1～74岁,平均年龄46 2 2±14 64岁。直肠注气试验记录感觉阈值和感觉评分;功能性磁共振(fMRI)分析直肠扩张3 0ml、60ml、90ml和12 0ml时颅内痛觉功能区扣带前皮质(ACC)、脑岛皮质(IC)、额前皮质(PFC)及丘脑(THAL)的激活面积和强度。结果腹泻型IBS患者排便急迫和疼痛阈值显著低于便秘型患者和正常志愿者(P <0 0 5 ) ;腹泻型IBS患者在直肠注气90ml和12 0ml时视觉模拟评分(VAS)显著高于正常志愿者(P <0 0 5 ) ;便秘型IBS患者直肠扩张12 0ml时额前皮质、右侧丘脑兴奋面积较正常对照组显著增高(P <0 0 5 ) ,腹泻型IBS患者直肠扩张12 0ml时右侧脑岛皮质、额前皮质和右侧丘脑的兴奋面积较正常对照组显著增高(P <0 0 5 ) ;所有IBS患者直肠扩张90ml时脑岛皮质、直肠扩张12 0ml时脑岛皮质、额前皮质和丘脑     

不同亚型肠易激综合征患者大肠黏膜组织蛋白质组双向凝胶电泳分析

目的 分析不同亚型肠易激综合征（IBS）患者与正常人大肠黏膜组织蛋白质组表达的差异。方法 采用双向凝胶电泳（2-DE）技术和计算机辅助的图像分析方法，对腹泻型IBS（D-IBS）和便秘型IBS（C-IBS）患者与正常人大肠黏膜组织蛋白质进行分离和比较分析。结果 D-IBS组与正常人大肠黏膜组织比较有11个蛋白点表达明显增强，未发现明显低表达的蛋白质点。C-IBS组与正常人大肠黏膜组织比较有18个蛋白质点的表达存在明显差异，其中有3个蛋白点表达发生明显上调，有15个蛋白点表达发生明显下调。有1个蛋白点表达在D-IBS和C-IBS组均增强；有3个蛋白点在C-IBS组表达减弱，在D-IBS组表达增强。结论 D-IBS、C-IBS患者与正常人大肠黏膜组织蛋白质表达存在明显差异，可能与IBS的发病机制有关；不同亚型IBS的发病机制可能存在不同的分子基础。     

肠易激综合征患者消化不良症状与胃排空之间的关系

目的　探讨肠易激综合征(IBS)患者消化不良症状与固体胃排空之间的关系。方法　采用不透X线标志物测定54例IBS患者餐后6小时残留胃内的钡条数,确定6种消化不良症状并对每种症状计分。结果　IBS患者中有消化不良症状者占54%,便秘型IBS患者与腹泻型IBS患者的消化不良症状总积分无明显差异(P>0. 05)。便秘型IBS患者中有消化不良症状者的固体胃排空延迟发生率较无消化不良症状者明显高(P<0. 05 ),腹泻型IBS患者中有消化不良症状者和无消化不良症状者的固体胃排空延迟发生率比较,无明显差异(P>0. 05);便秘型IBS患者的固体胃排空延迟发生率较腹泻型IBS高(P<0. 01)。结论　便秘型IBS患者消化不良症状与固体胃排空延迟可能相关,腹泻型IBS患者消化不良症状与固体胃排空延迟无关。     

Irritable bowel syndrome subtypes differ in body awareness, psychological symptoms and biochemical stress markers

AIM： To elucidate the differences in somatic, psychological and biochemical pattern between the subtypes of irritable bowel syndrome （IBS）. METHODS： Eighty IBS patients, 30 diarrhoea predominant （D-IBS）, 16 constipation predominant （C- IBS） and 34 alternating IBS （A-IBS） underwent physiotherapeutic examinations for dysfunctions in body movements and awareness and were compared to an apparently healthy control group （AHC）. All groups answered questionnaires for gastrointestinal and psychological symptoms. Biochemical variables were analysed in blood. RESULTS： The D-IBS group showed less body awareness, less psychological symptoms, a more normal sense of coherence and psychosocial rating as well as higher C-peptide values. C-IBS had a higher degree of body dysfunction and psychological symptoms, as well as the lowest sense of coherence compared to controls and D-IBS. They also demonstrated the most elevated prolactin levels. A-IBS had the lowest degree of body disturbance, deteriorated quality of life and affected biochemical pattern. All subtypes had higher pain scores compared to controls. In addition they all had significantly increased triglycerides and elevated morning cortisol levels, however, without statistical significance compared with the controls.CONCLUSION： IBS subtypes showed different profiles in body awareness, somatic and psychological symptoms and in biochemical variables. D-IBS differed compared to the other groups by lowered body awareness, less psychological symptoms and a higher sense of coherence and elevated C-peptide values. C-IBS and A-IBS subtypes suffered more from depression and anxiety, associated with a lower quality of life. These differences may be important and will be taken into account in our treatment of these patients.     

Rectal afferent hypersensitivity and compliance in irritable bowel syndrome: differences between diarrhoea-predominant and constipation-predominant subgroups

OBJECTIVES: To evaluate the differences in rectal compliance and sensory thresholds for the urge to defecate and discomfort between irritable bowel syndrome (IBS) subgroups and controls, and to correlate these parameters with rectal symptoms. METHODS: A total of 38 IBS patients [Rome II criteria; 19 diarrhoea-predominant IBS (D-IBS), 16 constipation-predominant IBS (C-IBS), three with alternating diarrhoea and constipation IBS (Alt-IBS)] and 10 controls were studied. A barostat was used to measure rectal compliance and sensory thresholds, in the 'unprepared' rectum. The thresholds for the urge to defecate and discomfort were determined using phasic rectal balloon distension in a double random staircase sequence. RESULTS: D-IBS had significantly lower rectal compliance and threshold for the urge to defecate compared with controls [4 ml/mmHg interquartile range (IQR) 3.99 versus 8.4 ml/mmHg IQR 5.69; P=0.001; 8 mmHg IQR 6 versus 20 mmHg IQR 4; P=0.003]. D-IBS also had significantly lower rectal compliance and threshold for the urge to defecate compared with the C-IBS group (5.8 ml/mmHg IQR 4.61; P=0.027; 16 mmHg IQR 12; P=0.003). The volume at the threshold for discomfort was significantly lower in D-IBS compared with controls (163 ml IQR 99.5 versus 212 ml IQR 147.25; P=0.016). The severity of abdominal pain and rectal symptoms showed a significantly negative correlation with rectal sensory thresholds. CONCLUSION: This study shows that the sensory threshold for the urge to defecate and rectal compliance is significantly lower in D-IBS compared with C-IBS and controls. The consequent inability to tolerate rectal faecal loading may account for the symptoms of the passage of frequent, small-volume stools in D-IBS patients.     

Thermal hypersensitivity in a subset of irritable bowel syndrome patients

AIM： To characterize thermal hypersensitivity in patients with constipation- and diarrhea-predominant irritable bowel syndrome （IBS）.
METHODS： Thermal pain sensitivity was tested among patients with diarrhea-predominant IBS （D-IBS） and constipation-predominant IBS （C-IBS） compared to healthy subjects. A total of 42 patients （29 female and 13 male; mean age 27.0 ＋ 6.4 years） with D-IBS; 24 patients （16 female and eight male; mean age 32.5 ：1：8.8 years） with C-IBS; and 52 control subjects （34 female and 18 male; mean age 27.3 ± 8.0 years） participated in the study. Thermal stimuli were delivered using a Medoc Thermal Sensory Analyzer with a 3 cm × 3 cm surface area. Heat pain threshold （HPTh） and heat pain tolerance （HPTo） were assessed on the left ventral forearm and left calf using an ascending method of limits. The Functional Bowel Disease Severity Index （FBDSI） was also obtained for all subjects.
RESULTS： Controls were less sensitive than C-IBS and D-IBS （both at P 〈 0.001） with no differences between C-IBS and D-IBS for HPTh and HPTo. Thermal hyperalgesia was present in both groups of IBS patients relative to controls, with IBS patients reporting significantly lower pain threshold and pain tolerance at both test sites. Cluster analysis revealed the presence of subgroups of IBS patients based on thermal hyperalgesia. One cluster （17% of the sample） showed a profile of heat pain sensitivity very similar to that of healthy controls; a second cluster （47% of the sample） showed moderate heat pain sensitivity; and a third cluster （36% of the sample） showed a very high degree of thermal hyperalgesia.
CONCLUSION： A subset of IBS patients had thermal hypersensitivity compared to controls, who reported significantly lower HPTh and HPTo. All IBS patients had a higher score on the FBDSI than controls. Interestingly, the subset of IBS patients with high thermal sensitivity （36%） had the highest FBDSI score compared to the other two groups of IBS patients.     

Irritable bowel syndrome subtypes according to bowel habit: revisiting the alternating subtype

BACKGROUND: Disturbed bowel habit, diarrhoea or constipation is a key manifestation of irritable bowel syndrome (IBS). In some patients, diarrhoea and constipation alternate, giving rise to the so-called alternating subtype. AIMS: To assess IBS subtype breakdown (constipation (C-IBS), diarrhoea (D-IBS) or alternating (A-IBS)) according to the Rome II criteria and patients' self-assessment, the predominance in the alternating subtype (i.e. constipation, diarrhoea or neither), and the medical and personal impact, including health-related quality of life (HRQoL), of the different IBS subtypes. SUBJECTS AND METHODS: Two thousand individuals selected randomly to represent the general population were classified as potential IBS subjects (n = 281) or as non-potential IBS subjects (n = 1719) according to a validated questionnaire. Bowel habit classification was determined using the Rome II IBS supportive symptoms. RESULTS: Among 201 subjects meeting the Rome I criteria, 15% presented with D-IBS, 44% presented with C-IBS, 19% presented with A-IBS, and 22% presented with normal bowel habit. Among the 63 subjects meeting the Rome II criteria, 23% presented with A-IBS. According to the subjects' self-assessment, of those meeting the Rome I criteria, 16% considered themselves to have D-IBS, 66% to have C-IBS and 18% to have A-IBS. In subjects meeting the Rome II criteria, 24% considered themselves to have A-IBS. Among those classified with A-IBS by the Rome II criteria, most considered themselves to be constipated. Regardless of the subtype self-classification, most subjects reported a normal frequency of bowel movements. Clinical manifestations in A-IBS were very similar to those of C-IBS but with the added presence of defecatory urgency. Abdominal discomfort/pain and frequency of visits to physicians were greater in the A-IBS subtype than in the other two IBS subtypes. HRQoL was affected similarly in all IBS subtypes. CONCLUSIONS: Approximately one-quarter of subjects with IBS belong to the A-IBS subtype by the Rome II criteria, although the majority consider themselves to be constipated; indeed, clinical manifestations are more akin to the C-IBS subtype than to the D-IBS subtype. Abdominal discomfort/pain and frequency of visits to physicians are greater in the A-IBS subtype than in the other two IBS subtypes, while HRQoL is impaired similarly.