Long-term treatment of irritable bowel syndrome: results of a randomized controlled trial

To examine the long-term management of irritable bowel syndrome we conducted a two-part controlled therapeutic trial on 28 patients who had recovered completely after four to six weeks of treatment with ispaghula husk and propantheline. In part I patients were randomly divided into two groups. Group A received a placebo capsule while Group B continued with treatment as before. After six months the response to treatment was assessed according to a scoring system. The overall relapse rate in Group B was 46 per cent compared to 82 per cent in group A. With continued treatment patients in Group B became asymptomatic from the fourth month while patients in Group A continued to deteriorate. In part II, patients who had relapsed whilst on placebo received active treatment. Six of the seven who agreed to continue with the study became asymptomatic within four weeks. However, all the patients who were asymptomatic while on active treatment relapsed on discontinuation and again recovered on reinstitution of active treatment. We conclude that irritable bowel syndrome is a chronic relapsing disorder and that treatment with a combination of ispaghula husk and propantheline is effective, both in relieving symptoms and in the maintenance of remission.     

匹维溴铵对肠易激综合征280例的临床疗效

目的 :探讨肠道平滑肌钙拮抗剂匹维溴铵对肠易激综合征 (IBS)的临床疗效。方法 :对2 80例确诊 IBS病人进行多中心、开放性研究 ,病人口服匹维溴铵 5 0 mg,每天 3次 ,疗程 4周。结果 :匹维溴铵对腹痛、腹泻、便秘症状缓解率分别是 72 %、 66%和 68% ,有效率分别是 92 %、 92 %和 85 % ,其他症状缓解率在 76%～ 96%之间 ,轻度不良反应仅 3.2 %。结论 :匹维溴铵是治疗 IBS安全有效的药物。     

Efficacy and safety of Ayurvedic herbs in diarrhoea-predominant irritable bowel syndrome: A randomised controlled crossover trial

ObjectiveHerbal medicines have been used widely for the treatment of irritable bowel syndrome (IBS) patients. The aim of this study is to investigate efficacy and safety of an Ayurvedic herbal compound preparation made from: Murraya koenigii (curry), Punica granatum (pomegranate) and Curcuma longa (turmeric), compared to a placebo in patients with diarrhoea predominant IBS.Material and methodsThis trial was conducted as a randomised placebo-controlled crossover trial with randomised sequence of verum and placebo for each patient. Verum and placebo were provided as ground powders and delivered in sealed containers. Patients and outcome assessors were blinded. Patients were advised to ingest the decoction twice daily for 4 weeks. The primary outcome measure was IBS symptom intensity; secondary outcomes included: quality of life, anxiety and depression, compliance and safety.Results32 IBS patients were included in the trial (19 females, mean age 50.3 ± 11.9 years). Eleven people dropped out during the trial resulting in 37 complete verum and 35 complete placebo phases. No group differences were found between verum and placebo for IBS symptom intensity (difference 24.10; 95% CI: −17.12; 65.32, p = 0.26). The same was true for secondary outcomes. Compliance was satisfactory to good and the preparation appeared to be safe, but one third of the patients registered at least one minor adverse event that might be related to the study interventions.ConclusionAn Ayurvedic herbal preparation made from Murraya koenigii, Punica granatum and Curcuma longa appeared to be no more effective in improving diarrhoea predominant irritable bowel symptoms than placebo.     

帕罗西汀治疗肠易激综合征抑郁症的疗效评价

目的评价帕罗西汀对肠易激综合征(Irritable bowel syndrome,IBS)的症状疗效及抑郁量表评分影响。方法选择2003年1月至2004年6月在全科门诊诊断的伴有抑郁症状的IBS患者60例,随机分成两组,治疗组32例,抑郁评分为58.50±4.24,采用对症治疗,同时,用帕罗西汀治疗,帕罗西汀20mg每日一次,共8w,疗程结束后随访4~6个月;对照组28例,抑郁评分56.48±4.35,只采用对症治疗。观察两组的临床疗效和抑郁评分的影响。结果治疗组的疗效评价32例中有效28例,有效率为87.50%。对照组有效17例,有效率为60.72%。两组患者疗效间比较,差别有显著性意义(P<0.05)。治疗组抑郁评分下降明显,与对照组比较,差异有显著性意义。结论帕罗西汀治疗伴有抑郁症状的IBS疗效显著。     

综合康复干预对肠易激综合征患者心理状况的影响

目的 探讨肠易激综合征(IBS)患者焦虑、抑郁的发生率及综合康复干顶对IBS患者心理状况的影响.方法 采用Zung焦虑自评量表(SAS)及抑郁自评量表(SDS)对100例门诊及20例住院的肠易激综合征患者进行问卷调查,了解其焦虑、抑郁的发生率;并对存在焦虑、抑郁的患者进行综合康复护理干预3个月,并对干预前后焦虑、抑郁情况进行评价.结果 120例肠易激综合征患者焦虑发生率为26.7%、抑郁的发生率为25.0%;对存在焦虑、抑郁的患者,干预后与干预前比较,SAS及SDS评分明显降低(P＜0.05).结论 肠易激综合征患者焦虑、抑郁的发生率高,给予综合康复干预,可明显降低患者焦虑、抑郁症状,有利于肠易激综合征患者康复,提高其生活质量.

Abstract：

Objective To study the incidence rate of anxiety and depression about the IBS, and the psychological effect of comprehensive rehabilitation intervention for IBS. Methods A questionnaire survey was conducted among 100 outpatients and 20 inpatients with IBS by using SAS and SDS. The incidence rate of anxiety and depression was studied, then the patients suffering from anxiety and depression were treated with comprehensive rehabilitation intervention for three months. The scores of SAS and SDS were recorded before and after treatment Results Of all the 120 IBS, the incidence rate of anxiety was 26.7%, and the incidence rate of depression was 25.0%. To the anxiety and depression ones, the SAS and SDS scores were reduced obviously (P＜0.05) . Conclusions Comprehensive rehabilitation intervention can enhance the quality of life by reducing the incidence rate of anxiety and depression of IBS.     

小剂量氟哌噻吨美利曲辛辅助治疗腹泻型肠易激综合征临床疗效观察

目的 应用抗抑郁药氟哌噻吨/美利曲辛(黛力新)辅助治疗腹泻型肠易激综合征患者,观察其对患者的肠道功能紊乱改善的疗效.方法 136例临床诊断为腹泻型肠易激综合征患者,随机分为两组(各68例),治疗组(匹维溴胺、双歧三联活菌、黛力新口服),对照组(匹维溴胺、双歧三联活菌口服),疗程均为12周.治疗前行腹泻、腹胀和腹痛等肠道功能紊乱症状评估,治疗12周后按疗效观察标准分析,分别观察两组症状持续改善、临床疗效及不良反应发生情况.结果 12周末治疗组腹痛减轻、腹泻症状改善均高于对照组,分别为98.2%vs 80.8%、94.1%vs 82.4%(P＜0.05或＜0.01).治疗组有效率高于对照组,92.6%vs 76.5%(P＜0.01).两组不良反应总发生率11.8%vs7.4%(P＞0.05).结论 抗抑郁药黛力新联用匹维溴胺、双歧三联活菌能明显改善腹泻型肠易激综合征肠道功能紊乱症状,是肠易激综合征辅助治疗的一种有效安全方法.     

直肠刺激的脑功能磁共振成像研究

目的：运用功能磁共振成像(fMRI)研究正常人和肠易激综合征(IBS)患者直肠刺激时脑内局部活动。方法：11名正常人和26例IBS患者为对象。以不同气体容量扩张直肠获得fMRI图像，并和T1W解剖图像融合，进行脑内活动区的面积和信号强度分析。结果：大多数正常人和IBS患者的直肠刺激明显激活扣带回前皮层(ACC)、脑岛皮层(IC)、前额叶皮层(PFC)和丘脑(THAL)。在正常人中，注气量达90ml和120ml时，均以ACC中的活动Ⅸ面积最大；在不同的注气量时，绝大多是以PFC和ACC中的活动区MR信号强度变化幅度最大。在相同容积直肠刺激时，IBS患者脑内活动区比正常人组活跃；IBS患者组在疼痛性直肠扩张时脑内活动区以PFC最为明显。结论：正常人直肠刺激时，中枢兴奋区主要位于ACC和PFC；而IBS患者在疼痛性直肠扩张时以PFC为主。     

Treatment of irritable bowel syndrome

What is known and Objective: The complexity and diversity of irritable bowel syndrome’s (IBS) presentation make treatment difficult. Although there are reviews and guidelines for treating IBS, they focus on the efficacy of medications for IBS symptoms using high‐priority endpoints, leaving those of lower priority largely unreported. Therefore, the aim of this review is to provide a comprehensive evidence‐based review of the efficacy of medications to treat IBS symptoms, reported by IBS subtype, including secondary symptom endpoints that are often underreported. Methods: A review of PubMed for articles published through December 2009 using the keywords: ‘irritable bowel syndrome’, ‘therapeutics’, ‘antidiarrhoeals’, ‘laxatives’, ‘loperamide’, ‘dietary fibre’, ‘psyllium’, ‘calcium polycarbophil’, ‘bulking agents’, ‘lubiprostone’, ‘antidepressant agents, tricyclics’ and its representative entities, ‘serotonin reuptake inhibitors’ and its representative entities, ‘dicyclomine’, hyoscyamine’, ‘peppermint oil’, ‘parasympatholytics’ and its representative entities, ‘rifaximin’, ‘pregabalin’, ‘gabapentin’, ‘clonidine’, ‘octreotide’, ‘atropine’ and ‘probiotics’ is provided. Placebo‐controlled trials were evaluated for the strength of evidence supporting the efficacy of each medication for explicit IBS symptoms. The efficacy of each medication for the symptoms of abdominal pain, bloating, stool form, mucus, urgency, feeling of incomplete evacuation, flatulence, frequency, or borborgymi and overall symptoms are reported by IBS subtype. Results and Discussion: The literature search identified 58 placebo‐controlled trials of the efficacy of medications for treating IBS symptoms, which were critically evaluated and reported. The available studies suggest improvement in various IBS symptoms with loperamide, fibre supplements, lubiprostone, tricyclic antidepressants (TCAs), selective serotonin receptor inhibitors (SSRIs), antispasmotics, rifaximin, pregabalin, gabapentin, clonidine, octreotide and probiotic treatments. What is new and Conclusion: This review is the first to compile the available evidence on the efficacy of the various pharmacological treatments for IBS on the basis of IBS subtype and specific symptoms. This evidence is limited and more well‐designed studies are required to better inform therapeutic decision‐making in the management of this difficult syndrome.     

A systematic review of Tuina for irritable bowel syndrome: Recommendations for future trials

ObjectivesThis systematic review assessed whether Tuina (therapeutic massage) is more effective and safer than no treatment or routine medical treatment for irritable bowel syndrome (IBS).MethodsEleven databases were searched for randomized controlled trials of IBS diagnosed based on Manning or Rome criteria. Tuina with or without routine treatments (RTs) was tested against RTs. The Cochrane risk of bias was evaluated for each trial. RevMan 5.3 was used to conduct a meta-analysis.ResultsA total of 8 trials (5 IBS-diarrhea and 3 IBS-constipation) with 545 participants using 8 different manipulations were included. All trials were published in Chinese. For overall symptom improving rate (> 30 % improvement in overall symptom scores), it had not been shown that Tuina was significantly better than RTs (RR 1.23, 95 % CI 0.94–1.60, 197 participants, 3 studies, I² = 65 %) for IBS-diarrhea, and Tuina combined with RTs showed more benefit than RTs alone (RR 1.29, 95 % CI 1.08–1.54, 115 participants, 3 studies) for IBS-diarrhea. All trials did not report adverse effect in relation to Tuina. Risk of bias was generally unclear across all domains.ConclusionsTuina combined with RTs may be superior to RTs for improving overall symptom of IBS-diarrhea. Due to the existing methodological issues and the heterogeneity of Tuina manipulation, current findings need to be confirmed in large scale, multicenter, and robust randomized trials (especially on outcome assessing blinding and allocation concealment).     

Intestinal membrane permeability and hypersensitivity in the irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder in which the underlying pathophysiology is poorly understood; however, increased intestinal permeability in diarrhea-predominant IBS patients has been reported. Here we demonstrate that diarrhea-predominant IBS (D-IBS) patients display increased intestinal permeability. We have also found that increased intestinal membrane permeability is associated with visceral and thermal hypersensitivity in this subset of D-IBS patients. We evaluated 54 D-IBS patients and 22 controls for intestinal membrane permeability using the lactulose/mannitol method. All subjects ingested 5 g of lactulose and 2 g of mannitol in 100 ml of water after which their urine was collected. We also evaluated the mean mechanical visual analogue scale (M-VAS) pain rating to nociceptive thermal and visceral stimulation in all subjects. All study participants also completed the FBDSI scale. Approximately 39% of diarrhea-predominant IBS patients had increased intestinal membrane permeability as measured by the lactulose/mannitol ratio. These IBS patients also demonstrated higher M-VAS pain intensity reading scale. Interestingly, the IBS patients with hypersensitivity and increased intestinal permeability had a higher FBDSI score (100.8 ± 5.4) than IBS patients with normal membrane permeability and sensitivity (51.6 ± 12.7) and controls (6.1 ± 5.6) (p < 0.001). A subset of D-IBS patients had increased intestinal membrane permeability that was associated with an increased FBDSI score and increased hypersensitivity to visceral and thermal nociceptive pain stimuli. Thus, increased intestinal membrane permeability in D-IBS patients may lead to more severe IBS symptoms and hypersensitivity to somatic and visceral stimuli.     

A symptom-based approach to making a positive diagnosis of irritable bowel syndrome with constipation

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder. Characterised by abdominal pain or discomfort, bloating and altered bowel habit, IBS is a chronic recurring condition, typically affecting up to 15% of the Western population, IBS can be subclassified into IBS with constipation (IBS-C), IBS with diarrhoea (IBS-D), or IBS with alternating constipation or diarrhoea symptoms (IBS-A). Conventional clinical diagnosis focuses on excluding all potential organic causes of patient symptoms. However, a positive diagnosis of IBS may be established using published criteria such as the Manning and/or Rome criteria. While these methods are useful to identify patients with IBS who are suitable for enrollment into clinical trials, the criteria are relatively complex and not readily applicable to general practice. In this review we present an 'identify, eliminate, probe' algorithm that may be appropriate to establish a positive diagnosis of patients with IBS-C, as symptoms characteristic of patients in this IBS subgroup are least likely to be confused with symptoms reflecting serious organic disease.     

Psychodynamic interpersonal therapy and improvement in interpersonal difficulties in people with severe irritable bowel syndrome

The aim of the present study was to assess the relationship between change in interpersonal difficulties with change in chronic pain, health status and psychological state in 257 irritable bowel syndrome (IBS) patients in a randomized control trial comparing psychotherapy, antidepressant and usual care. We assessed at three time points interpersonal problems (IIP-32), abdominal pain and bowel symptoms, psychological distress (SCL-90), and health status (SF-36). Analysis included repeated measures (ANOVA) to assess change over time and multiple regressions to identify whether change in IIP was associated with outcome after controlling for psychological status. The main findings were: (1) difficulties with social inhibition and dependency were associated with longer disease duration; (2) change in mean IIP-32 over 15 months was significantly correlated with changes in pain, but these relationships were mediated by change in psychological distress; (3) change in IIP-32 was an independent predictor of improved health status at 15 months only in the psychotherapy group. These results indicate that improvement in interpersonal problems in IBS patients appear to be primarily associated with reduced psychological distress but, in addition, the association with improved health status following psychotherapy suggests that specific help with interpersonal problems may play a role in improving health status of patients with chronic painful IBS.     

Hypnosis for irritable bowel syndrome: the empirical evidence of therapeutic effects

Irritable bowel syndrome (IBS) is a complex and prevalent functional gastrointestinal disorder that is treated with limited effectiveness by standard medical care. Hypnosis treatment is, along with cognitive-behavioral therapy, the psychological therapy best researched as an intervention for IBS. Eleven studies, including 5 controlled studies, have assessed the therapeutic effects of hypnosis for IBS. Although this literature has significant limitations, such as small sample sizes and lack of parallel comparisons with other treatments, this body of research consistently shows hypnosis to have a substantial therapeutic impact on IBS, even for patients unresponsive to standard medical interventions. The median response rate to hypnosis treatment is 87%, bowel symptoms can generally be expected to improve by about half, psychological symptoms and life functioning improve after treatment, and therapeutic gains are well maintained for most patients for years after the end of treatment.     

度洛西汀与阿米替林治疗伴焦虑症状肠易激综合征对照研究

目的探讨度洛西汀与阿米替林治疗伴焦虑症状肠易激综合征的临床疗效和安全性。方法将36例伴焦虑症状的肠易激综合征患者随机分为两组,每组18例,两组在消化内科常规治疗的基础上,研究组口服度洛西汀治疗,对照组口服阿米替林治疗,观察6周。于治疗前及治疗2周、4周、6周末采用汉密顿焦虑量表和生存质量量表评定临床疗效,副反应量表评定不良反应。结果两组治疗4周末起汉密顿焦虑量表总分均较治疗前显著下降（P〈0．01）;治疗6周末,研究组有效率为83．3％,对照组为77．8％,两组差异无显著性（P〉0．05）。研究组不良反应较轻微,发生率显著低于对照组（P〈0．05）。研究组生存质量量表的躯体不适感、自尊、人际交往功能、婚姻与家庭因子分均显著高于对照组（P〈0．01）。结论度洛西汀与阿米替林治疗伴焦虑症状肠易激综合征的疗效相当,但度洛西汀能显著改善肠易激综合征患者的躯体性不适症状,且起效更快、安全性高、依从性好。     

Central and peripheral hypersensitivity in the irritable bowel syndrome

Previous investigations of somatic hypersensitivity in IBS patients have typically involved only a single stimulus modality, and little information exists regarding whether patterns of somatic pain perception vary across stimulus modalities within a group of patients with IBS. Therefore, the current study was designed to characterize differences in perceptual responses to a battery of noxious somatic stimuli in IBS patients compared to controls. A total of 78 diarrhea-predominant and 57 controls participated in the study. We evaluated pain threshold and tolerance and sensory and affective ratings of contact thermal, mechanical pressure, ischemic stimuli, and cold pressor stimuli. In addition to assessing perceptual responses, we also evaluated differences in neuroendocrine and cardiovascular responses to these experimental somatic pain stimuli. A subset of IBS patients demonstrated the presence of somatic hypersensitivity to thermal, ischemic, and cold pressor nociceptive stimuli. The somatic hypersensitivity in IBS patients was somatotopically organized in that the lower extremities that share viscerosomatic convergence with the colon demonstrate the greatest hypersensitivity. There were also changes in ACTH, cortisol, and systolic blood pressure in response to the ischemic pain testing in IBS patients when compared to controls. The results of this study suggest that a more widespread alteration in central pain processing in a subset of IBS patients may be present as they display hypersensitivity to heat, ischemic, and cold pressor stimuli.