肠道菌群失衡与肠易激综合征

肠易激综合征（irritable bowel syndrome, IBS）是一种常见的功能性胃肠道疾病,其发病机制目前尚不完全清楚,但有越来越多的证据表明IBS可能与肠道菌群谱的改变有关。本文就IBS患者存在的结肠菌群失衡、小肠细菌过度生长及它们可能的致病机制,以及干预肠道菌群失衡等的治疗手段作一综述。     

肠易激综合征的药物治疗进展

查阅国内外近期关于肠易激综合征的药物治疗进展的文献,并对其进行综述和分析.文献调研结果表明,不同类型的肠易激综合征其治疗药物是不同的,多种药物对肠易激综合征有疗效,能改善患者的生活质量.     

Atypical antipsychotics as a possible treatment option for irritable bowel syndrome

Introduction: Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder (FGID) that is characterised by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits. Although the pathophysiology of IBS is not fully understood, it is believed that psychiatric comorbidities are highly common in such patients. A variety of psychotropic medications are widely used in the treatment of IBS, particularly older antidepressants such as tricyclic antidepressants (TCAs).

Areas covered: With the advent of newer antidepressant classes with better safety and tolerability compared with TCAs, such as serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), clinicians now have more advanced treatment options for treating IBS. Additionally, some atypical antipsychotics (AAs) have recently received approval for treatment of major depressive disorder (MDD). Some AAs may have potentials based on their pharmacodynamic profile and proven benefit for mood symptoms, pain, anxiety and sleep disturbances. This article describes the potential rationale, clinical data and practical aspects involved in the use of AAs for patients with IBS.

Expert opinion: Atypical antipsychotics (AAs) may have a role in the treatment of irritable bowel syndrome (IBS) based on the currently available findings, although there is no clear evidence, and a number of clinical issues to be addressed in the use of AAs for the treatment of IBS.     

氟西汀治疗伴有情绪障碍表现的肠易激综合征患者的近期疗效观察

目的:探讨氟西汀治疗伴有情绪障碍表现的肠易激综合征(IBS)患者的近期疗效,观察此类患者腹部症状与精神症状的相互关系.方法:40例伴有情绪障碍表现的肠易激综合征患者口服氟西汀8周,治疗前后分别对患者进行汉密尔顿抑郁量表(HAMD)和胃肠道症状计分标准(GSRS)的评估,观察疗效以及2种评分之间的相互关系.结果:有2例患者因出现不良反应退出研究,其余38例患者用药后的精神抑郁症状与腹部症状均有明显改善,治疗前后的HAMD和GSRS之间均存在显著差异(P＜0.05).而且HAMD与GSRS之间存在相关性(相关系数=0.65),表明肠易激综合征患者的腹部症状与情绪障碍之间存在一定相关性.结论:氟西汀对改善伴有情绪障碍的肠易激综合征患者的腹部症状及抑郁症状均有效果,提示抗抑郁治疗对此类患者有效.     

肥大细胞在肠易激综合征中的作用研究进展

肠易激综合征(irritable bowel syndrome,IBS)是一种多因素相互作用的胃肠道功能紊乱性疾病,全球范围内发病率较高。其发病机制复杂,如内脏高敏感、胃肠道动力异常、肠道屏障损坏、肠道免疫紊乱、神经免疫失调等。研究表明,肥大细胞(mast cells,MCs)在IBS的发生与发展中起到重要作用,在IBS治疗中也有初步尝试。该文就MCs在IBS发病机制中的作用及针对MCs的IBS治疗方案进行综述。     

消化门诊肠易激综合征患者肠外症状分析

目的了解肠易激综合征(IBS)患者临床症状表现,尤其是肠外症状,提高IBS诊断率。方法对2010年12月至2011年7月郑州大学第一附属医院消化内科门诊就诊并按照罗马Ⅲ标准诊断为IBS的患者进行问卷调查。共调查866例,收回问卷847份作为统计病例。结果 IBS是一种复杂的身心疾病,除表现在胃肠功能紊乱,腹痛、腹部不适,排便性状、频率改变外,还表现有咽部不适及异物感,口干、口苦、口臭、无味觉,功能性消化不良,无饥饿感,腰背及肌肉酸、痛、纤维肌痛综合征等全身不明原因的疼痛,手心、脚心灼热等功能性低热,肢体凉、畏寒,失眠、头痛,心烦,慢性疲劳综合征,体重减轻,尿道不适,性交困难等肠外表现等。结论 IBS患者多反复就诊于综合医院的各个科室,部分临床医生对IBS复杂的临床症状尤其是肠道外症状认识少,鉴别困难,使IBS诊断率低,治疗效果差。     

多塞平联合双歧三联活菌治疗腹泻型肠易激综合征疗效观察

目的:观察多塞平、双歧三联活菌联合治疗腹泻型肠易激综合征(D-IBS)的疗效和不良反应.方法:85例D-IBS患者随机分为2组,治疗组43例用多塞平联合双歧三联活菌,对照组42例单用双歧三联活菌.用药前后4周分别作IBS症状评分及SCL-90精神评分.结果:治疗组总有效率88.37%,明显高于对照组的69.05%(P＜...     

桂利嗪治疗肠易激综合征临床观察

目的 :观察桂利嗪在临床中治疗肠易激综合征 (IBS)的疗效。方法 :采用随机对照开放实验方法 ,选用复方地芬诺酯作为对照药。结果 :桂利嗪治疗IBS有效率为 86 8% ,复方地芬诺酯治疗IBS有效率为 72 7% ,两组有明显差异 (P <0 0 1)。结论 :桂利嗪治疗IBS是一种可供选择、有效的、可靠的方法。     

多塞平联合匹维溴铵及培菲康治疗腹泻型肠易激综合征的临床研究

目的 选用胃肠动力调节剂、肠道微生态制剂以及三环类抗抑郁药,针对IBS发病可能的病因干预治疗,观察单药、双药及三药治疗对腹泻型肠易激综合征(D-IBS)的临床疗效及交互治疗作用.方法 选择D-IBS患者128例,均符合罗马Ⅱ标准,并经肠镜排除肠道器质性疾病,其中103例按规定要求完成.患者按用药分为以下4组:单用匹维溴...     

Alosetron for severe diarrhea-predominant irritable bowel syndrome: improving patient outcomes

Abstract

Background:

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder often diagnosed and managed by primary care physicians (PCPs). Despite the high prevalence of IBS, symptom severity is often underappreciated and inadequately managed. The goal of this review is to discern IBS treatment gaps and identify opportunities for improving its management in the primary care setting, as well as describe the most current clinical experience with alosetron, a targeted treatment for severe diarrhea-predominant IBS (IBS-D) in women.     

Is there an appropriate strategy for treating co-morbid irritable bowel syndrome and bladder pain syndrome?

Introduction: Two of the most frequent components of chronic pelvic pain syndrome (CPPS) are irritable bowel syndrome (IBS) and bladder pain syndrome (BPS), characterized by considerable overlapping symptoms and pathophysiology. Currently, its management is challenging meaning there is high the demand for novel efficient therapeutics to aid patient care and to tackle the socioeconomic burden of IBS and BPS. As there are presently no sufficient treatment strategies, identifying the mechanisms that result in their main symptoms is the opportunity for developing appropriate therapies.

Areas covered: Herein, the authors explore the potential common treatment strategies for co-morbid IBS and BPS and highlight the absolute need for further research of these deliberating clinical entities.

Expert opinion: In the future, the authors summise that the discovery of predictive molecular biomarkers combined with clinical phenotypic categorization will likely allow for more definitive differentiation of patients and thus for better treatment options. Furthermore, it has been suggested that effective IBS treatment strategies would be of great value to co-morbid IBS and BPS therapy.     

肠易激综合征的主要致病因素及中医药治疗

肠易激综合征 (Irritable bowel syndrome,IBS) 是一种慢性复发性功能性胃肠道疾病。IBS 的病理生理学尚未完全了解,并且它的致病是多因素的。IBS有许多致病因素,这些因素不一定全部存在于每个患者中,但都对IBS的发病发挥着重要作用。IBS 的典型临床表现是因排便形式的改变而产生的不适或腹痛。IBS 的及时诊断很重要,因此可以引入可缓解症状（腹泻、便秘、疼痛）的治疗方法。本文整理了 IBS 在现有研究中可能致病的发病因素,为研究者在研究治疗 IBS 药物的新靶标上提供更多的思路,同时总结了 IBS 在中医诊断下的证候,对中医药治疗 IBS 进行综述。     

思密达与美常安对腹泻型肠易激综合征的治疗效果

目的：观察思密达与美常安联合应用对腹泻型肠易激综合征（IBS）的治疗效果。方法：60例腹泻型1BS患者随机分为三组：联合用药组21例同时服思密达3g，tid及美常安胶囊500mg，tid，另两组分别服思密达（18例）或美常安（21例），剂量同前。记录治疗前后患者的症状、大便次数、大便性状。结果：联合用药组在服药d7时症状总评分已比治疗前下降78．1％，每日大便次数、大便性状评分已接近正常，与思密达组或美常安组比较，差异有统计学意义（P〈0．05），未观察到联合用药有明显的不良反应。结论：联合应用作用机制不同的思密达与美常安能迅速、安全地缓解腹泻型IBS的病情。     

曲美布汀联合丽珠肠乐治疗肠易激综合征的疗效分析

目的:观察曲美布汀联合丽珠肠乐治疗肠易激综合征(irritable bowel syndrome,IBS)的临床疗效.方法:将135例IBS患者随机分成两组,治疗组采用曲美布汀联合丽珠肠乐;对照组单用曲美布汀,疗程均为4周.结果:治疗组和对照组总有效率分别为88.57％与73.58％,治疗组明显优于对照组(P＜0.05),治疗组6个月复发率与对照组比较差异有显著性(P＜0.05).结论:曲美布汀联合丽珠肠乐治疗IBS疗效满意,复发率低,优于单用曲美布汀,值得临床推广和应用.     

援生力维和小剂量抗抑郁药治疗难治性肠易激综合征的临床疗效

目的 观察援生力维和小剂量抗抑郁药治疗难治性肠易激综合征（IBS）的临床疗效。方法64例IBS患者，在谷雏素、维生素B1、维生素C等治疗基础上，治疗组加用援生力维200mg，3次／d，疗程4周。观察治疗前后患者腹痛、腹泻、便秘、腹胀的情况。结果治疗组4周末总有效率71．9％，8周末总有效率84、4％，均显著高于对照组（P＜0、01）；8周末腹痛缓解率86．7％，腹泻缓解率81．0％，便秘缓解率78、6％，腹胀缓解率81．3％，均明显高于对照组（P＜．05或0．01）。均无明显不良反应发生。结论援生力维和小剂量抗抑郁药治疗难治性IBS安全有效。     

氟西汀合用奥替溴铵治疗肠易激综合征43例

目的:比较氟西汀合用奥替溴铵与单用奥替溴铵治疗肠易激综合征的临床疗效.方法:将86例肠易激综合征患者随机分为两组,每组43例,治疗组用氟西汀20 mg,po,qd,加奥替溴铵40 mg,po,tid,对照组用奥替溴铵40 mg,po,tid.疗程均为4周. 结果:治疗组总有效率95.3%,对照组72.1%,两组比较差异有极显著性(P＜0.01).治疗组对缓解腹痛、腹胀、便秘、腹泻及黏液便明显优于对照组.结论:氟西汀合并奥替溴铵是治疗肠易激综合征较有效的方法.     

肠易激综合征治疗前后氢呼气试验参数及胃肠激素分泌水平的变化研究

目的 探究肠易激综合征(IBS)患者治疗前后氢呼气试验参数及胃肠激素分泌水平的变化情况.方法 采用氢呼气试验测定正常对照组及IBS患者口盲传输时间(OTCC)及产生H2浓度,同时利用放射免疫法检测正常对照组及IBS患者血浆中胃动素(MTL)、血管活性肠肽(VIP)、胆囊收缩素(CCK)和生长抑素(SS)的含量.结果 治疗前腹泻组患者OCTT显著低于对照组和便秘组,且便秘组OCTT显著高于对照组(P＜0.05),治疗前IBS患者H2浓度和SIBO阳性率均显著高于对照组(P＜0.05),治疗后H2浓度和SIBO阳性率显著降低,差异有统计学意义(P＜ 0.05).治疗前腹泻组患者血浆中MTL和CCK明显高于对照组和便秘组,治疗后腹泻组患者MTL和CCK水平较治疗前显著降低,而便秘组较治疗前显著升高(P＜0.05);而治疗前IBS患者血浆中VIP和SS明显高于对照组,治疗后IBS患者VIP和SS水平较治疗前显著降低,差异有统计学意义(P＜0.05).结论 氢呼气试验参数和胃肠激素分泌水平改变与IBS发病过程密切相关.     

匹维溴胺联合氟哌噻吨美利曲辛治疗肠易激综合征伴抑郁状态疗效观察

目的观察匹维溴胺联合氟哌噻吨美利曲辛对伴有抑郁状态的肠易激综合征患者的治疗效果。方法选择伴抑郁状态的肠易激综合征患者120例,完全随机分为2组,单用匹维溴胺治疗者62例为对照组,联合应用匹维溴胺及氟哌噻吨美利曲辛者58例为治疗组。对照组口服匹维溴胺50mg,3次／d;治疗组在匹维溴胺基础上加用氟哌噻吨美利曲辛片（黛力新）,25mg／次,2次／d,早晨及中午服用。对患者腹痛、腹胀、腹泻、便秘、黏液便、里急后重、排便不尽感及抑郁状态进行评分,比较治疗前后评分结果。结果治疗2周及4周后,治疗组和对照组的症状学评分及抑郁自评量表（SDS）评分均有所降低,治疗组各症状评分及SDS评分较对照组差异有统计学意义（P〈0．05）。结论匹维溴胺联合氟哌噻吨美利曲辛能有效治疗肠易激综合征伴抑郁状态。     

Novel therapies in the treatment of irritable bowel syndrome

Irritable bowel syndrome (IBS) is characterised by abnormalities in motility, sensation and perception. It is one of the most common conditions encountered in clinical practice, especially by gastroenterologists. Pharmacological treatment of IBS is aimed at the predominant symptom and recent advances in pathophysiology has opened the door to the development of new compounds that target specific receptors. During this review, the most promising investigational and recently approved drugs will be discussed.