Increased bladder permeability in interstitial cystitis/painful bladder syndrome

The definition of interstitial cystitis (IC) has evolved over the years from being a well-defined entity characterized by diagnostic lesion (Hunner’s ulcer) in the urothelium to a clinical diagnosis by exclusion [painful bladder syndrome (PBS)]. Although the etiology is unknown, a central theme has been an association with increased permeability of the bladder. This article reviews the evidence for increased permeability being important to the symptoms of interstitial cystitis/painful bladder syndrome (IC/PBS) and in treating the disorder. Recent work showing cross-communication among visceral organs is also reviewed to provide a basis for understanding IC/PBS as a systemic disorder of a complex, interconnected system consisting of the bladder, bowel and other organs, nerves, cytokine-responding cells and the nervous system.     

肠易激综合征母婴分离模型应用进展

作为一种重要的生命早期刺激方式, 出生后至断乳前的母婴分离刺激已被证实在成年后能够模拟肠易激综合征胃肠道症状及精神症状。利用母婴分离建立的肠易激动物模型, 因其同时模拟了肠易激综合征中枢精神症状及外周胃肠道症状成为当前研究肠易激综合征生物学机制的一个常用模型。文章综合整理母婴分离对啮齿类动物神经发育及胃肠道发育的影响,对该模型运用于研究肠易激综合征机制的进展稍作总结,以表明母婴分离可以模拟大部分肠易激综合征的外周及中枢表现,证实了该模型模拟脑肠轴异常造成的肠易激综合征的可行性,为采用该模型进行肠易激综合征相关研究提供一定的理论支持。     

痛泻要方治疗腹泻型肠易激综合征的作用机制研究现状与思考

肝脾同治是中医药治疗肠易激综合征治疗的重要特点,以调肝理脾为法的痛泻要方是治疗腹痛泄泻的代表方剂,其类方在肠易激综合征治疗中显示了独特的优势。文章综合近5年来痛泻药方及其类方治疗肠易激综合征的研究,从调节脑肠轴、改善内脏感觉高敏感、调节免疫功能等方面探讨痛泻要方干预肠易激综合征起效的药理学机制。研究表明,与IBS 复杂的发病机制相对应,痛泻要方的起效机制可能涉及多个层面且相互联系。     

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).     

The microbiota-gut-brain axis in functional gastrointestinal disorders

Functional gastrointestinal disorders (FGIDs) are highly prevalent and pose a significant burden on health care and society, and impact patients’ quality of life. FGIDs comprise a heterogeneous group of disorders, with unclear underlying pathophysiology. They are considered to result from the interaction of altered gut physiology and psychological factors via the gut-brain axis, where brain and gut symptoms are reciprocally influencing each other’s expression. Intestinal microbiota, as a part of the gut-brain axis, plays a central role in FGIDs. Patients with Irritable Bowel Syndrome, a prototype of FGIDs, display altered composition of the gut microbiota compared with healthy controls and benefit, at the gastrointestinal and psychological levels, from the use of probiotics and antibiotics. This review aims to recapitulate the available literature on FGIDs and microbiota-gut-brain axis.     

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。     

Visceral hyperalgesia and intestinal dysmotility in a mouse model of postinfective gut dysfunction

BACKGROUND & AIMS: We established the concept that transient enteric infection may lead to persistent gut dysfunction, evident in vitro, in nematode-infected mice. The present study determined whether gut dysfunction in this model involves motor and sensory changes reminiscent of changes found in patients with postinfective irritable bowel syndrome (PI-IBS) and investigated underlying mechanisms. METHODS: Mice infected up to 70 days previously with Trichinella spiralis (Tsp) underwent videofluoroscopy with image analysis to assess upper gastrointestinal motility. Pseudoaffective responses to colorectal distention (CRD) were assessed using a barostat and validated by single fiber recordings from spinal nerves during CRD. Tissues were examined at different time points for histology, immunohistochemistry, and cytokine analysis. Some mice received dexamethasone intraperitoneally on days 23-25 PI or Tsp antigen orally on days 29, 43, and 57 PI. RESULTS: From day 28 PI, no discernible inflammation was present in the gut. Frequency and propagation velocity of intestinal contractions decreased, and retroperistalsis increased at days 28 to 42 PI. CRD induced an allodynic and hyperalgesic response in PI mice, which was accompanied by increased single unit discharge. Gavage of Tsp antigen induced T-cell responses and sustained gut dysfunction for 70 days PI. Administration of dexamethasone postinfection normalized dysmotility and visceral hyperalgesia. CONCLUSIONS: Long-lasting gut dysmotility and hyperalgesia develop in mice after transient intestinal inflammation. These changes are maintained by luminal exposure to antigen and reversed by corticosteroid treatment. The findings prompt consideration of this as a model of PI-IBS.