肠易激综合征与抑郁症关系研究

近年来,生物-心理-社会医学模式倍受医学界关注,关于肠易激综合征与抑郁的关系研究越来越多,本文阐述伴抑郁障碍肠易激综合征患者特点,抑郁影响肠易激综合征症状的可能机制,对抗抑郁药物治疗肠易激综合征作用可能机理作一综述。     

肠易激综合征患者焦虑调查及人格特征分析

目的探讨肠易激综合征(IBS)患者伴发的焦虑情绪及人格特征,以便对疾病的发生、治疗及预防进行干预。方法对健康人群行IBS筛查,对确诊IBS患者予焦虑自评量表(SAS)和艾森克个性问卷(EPQ)心理评定。结果 IBS发生率12.7%(148/1163),伴有焦虑状态的发生率32.4%(41/127),女性高于男性。EPQ的内外倾向性评分低于中国常模、情绪稳定性评分高于中国常模,两组比较差异有统计学意义(P<0.01)。结论对IBS伴焦虑及人格缺陷,人格塑造及建立稳定的情绪、提高心理柔韧性对其机体健康有积极意义。     

乌灵胶囊治疗伴有抑郁症状的腹泻型肠易激综合征的对照研究

目的探讨乌灵胶囊治疗伴抑郁症状的腹泻型肠易激综合征（D-IBS）患者的临床疗效及安全性。方法按罗马标准Ⅲ选择60例D-IBS患者随机分为2组，研究组30例给予乌灵胶囊和培菲康，对照组30例给予培菲康；疗程8周。应用IBS症状变化及抑郁自评量表（SDS）于治疗前及治疗后进行疗效评定。结果治疗结束时，研究组中显效率、总有效率分别为59．3％和92.6％，对照组分别为30．8％和69.2％，有显著性差异。两组内治疗前与治疗后SDS积分均有显著性差异；治疗后第2、4、8周末研究组SDS积分与对照组相比有显著性差异。结论乌灵胶囊联用培菲康能快速缓解D-IBS的临床症状、改善抑郁症状，安全性好。     

炎症性肠病和肠易激综合征相关性研究进展

炎症性肠病(IBD)是一组病因未明的慢性肠道炎症性疾病,一般指溃疡性结肠炎(UC)和克罗恩病(CD)。肠易激综合征(IBS)是一种临床常见的胃肠功能紊乱性疾病。一般来说两种疾病发病机制、临床表现及预后均不相同。但近年发现,     

炎症性肠病和肠易激综合征相关性研究进展

炎症性肠病(IBD)是一组病因未明的慢性肠道炎症性疾病,一般指溃疡性结肠炎(UC)和克罗恩病(CD).肠易激综合征(IBS)是一种临床常见的胃肠功能紊乱性疾病.一般来说两种疾病发病机制、临床表现及预后均不相同.但近年发现,IBD患者发病早期、缓解期、或仅表现为腹痛及排便习惯的改变时,经常与IBS发生混淆,且两者在发病机制方面具也有一定的相似性.本文就IBD与IBS的相似性表现综述如下.     

肠易激综合征

<正> 肠易激综合征极为常见,可占到消化科门诊的30％～50％,多在20～50岁之间发病。发病后往往迁延数年、甚至数十年不愈,但本病预后良好。一、临床表现由于患者的个体差异,各患者之间的症状与程度可有很大不同。但均以腹部不适和排便异常为主,临床上可按其主要症状的不同分为三型,三型之间并无非常严格的界限,症状可以有所混合,也可互相转变。 1.痉挛性结肠型以腹疼为主,位置不定,左侧为多,有些可表现为右上腹或脐周疼痛,每日     

肠易激综合征

肠易激综合征(IBS)属于胃肠功能紊乱性疾患,是指一组包括腹痛、腹胀、排便习惯和大便性状异常、粘液便持续存在或间歇发作,而又缺乏形态学和生化学异常改变的症候群。其特征是肠道功能的易激性。过去称为粘液性肠炎、结肠痉挛、结肠过敏、过敏性结肠炎、易激结肠等,现均已废弃。1 定 义 1988年罗马国际会议上提出如下定义:肠易激综合征须具备:(1)腹痛,排便后缓解,或伴有大便性状和次数的改变和(或)(2)排便行为异常,表现为以下2项或2项以上:排便次数改变、大便性状改变、大便排出过程异常、排便未尽感、粘液便。     

急性沙门氏菌胃肠炎与肠易激综合征的相关性

目的研究急性沙门氏菌胃肠炎与肠易激综合征（IBS）的相关性。方法回顾42例随访1年后发展为IBS的急性沙门氏菌胃肠炎患者的临床资料，对其进行性别、年龄、急性胃肠炎病程、伴随呕吐症状以及发热症状进行分组，研究各组与IBS发病的相关性。结果42例IBS患者中，以腹泻型（32例）多见；女性（32例）明显多于男性（10例）；20～40岁年龄组（33例）明显多于〉40岁组（9例）；急性胃肠炎病程1—5d组（30例）明显多于〈1d组（12例）；胃肠炎病程中伴呕吐症状组（32例）明显多于无呕吐组（10例）。结论感染后IBS（PI-IBS）以腹泻型多见。女性，20～40岁、急性胃肠炎病程1～5d以及胃肠炎病程中伴呕吐症状均为PI-IBS的易患因素。     

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。     

胃肠激素与肠易激综合征的相关性

目的：研究血管活性肠肽（VIP）,P物质（SP）和酷神经肽（NPY）在肠易激综合征（IBS）患者血浆和乙状结肠粘膜中的变化及临床意义。方法：用放射免疫法分别检测IBS患者（40例）和正常对照组（15例）血浆和乙状结肠粘膜中以上三种激素的含量。结果：IBS患者血浆和乙 状结肠粘膜中NPY含量明显低于对照组（P＜0．05）,而IP和SP在血浆中含量与正常对照组无显著差异（P＞0．015）,在乙状结肠粘膜中含量明显高于对照组（P＜0．01）,结论：P乙状结肠粘膜中三种胃肠激素的变化在IBS的腹痛,腹泻发病中有一定作用。     

肠易激综合征与抑郁症的关系

目的:探讨肠易激综合征(IBS)与抑郁症的关系.方法:运用Zung抑郁自评量表(SDS)和汉密尔顿抑郁量表(HAMD)评分筛选出合并抑郁症的IBS患者48例,随机分为A组和B组,A组予以得舒特、多塞平联合精神心理治疗,B组单用得舒特治疗,治疗8周后再行IBS症状计分、SDS和HAMD表评分.结果:A组患者治疗后IBS症状计分、SDS评分、HAMD评分明显改善,A组总有效率(83.3%),优于B组(25.0%),差异有统计学意义(P<0.01).结论:对IBS患者行抑郁水平评估,联合抗抑郁、精神心理治疗,可以明显改善IBS症状,提高疗效.     

Discrepancy between recalled and recorded bowel habits in irritable bowel syndrome

Aliment Pharmacol Ther 2010; 32: 282ash;288

Summary

Background A discrepancy between recalled and recorded bowel habit subtypes has been reported in irritable bowel syndrome (IBS), but the reasons for it remain unclear. Aim To assess the agreement between recalled and recorded bowel habit subtypes; to determine whether any discrepancy is related to stool form variability or psychological factors; and to test the correlations of recalled and recorded stool form with colonic transit time. Methods Bowel habit subtype was established in 54 IBS patients at the enrolment visit (recalled) and with the aid of diary cards (recorded). Colonic transit time, the variability of stool form and the patients’ psychological profiles were also recorded. Results Recalled and recorded bowel habit subtypes agreed in only 54% of the patients (kappa = 0.28). Stool form variability was greater among the patients whose recalled and recorded bowel habit subtypes were discordant (P = 0.03), whereas the psychological profiles were not different. Colonic transit time significantly correlated with stool form only when it was recorded on diary cards. Conclusion The discrepancy between recalled and recorded bowel habits in IBS patients is related more to stool form variability than an altered psychological profile. Diary cards should be used to ensure that stool form reflects colonic transit time.     

Alosetron and irritable bowel syndrome

Alosetron (Lotronex^®, GlaxoSmithKline) is a potent and selective 5-HT₃-receptor antagonist approved by the FDA for the treatment of women with diarrhoea-predominant irritable bowel syndrome (IBS) in whom conventional therapy has failed. Studies involving healthy volunteers and IBS patients have demonstrated a beneficial effect of treatment with alosetron on global IBS symptoms, abdominal pain and discomfort, altered bowel function as well as improvement of quality of life (QOL). Data from animals studies suggest the involvement of 5-HT₃ receptors on intrinsic primary afferent neurons in the mediation of the effect of alosetron on gastrointestinal motility and secretion. While definitive proof of a visceroanalgesic action is not available, an additional central mechanism of action is suggested by findings obtained in animal models, as well as from human brain imaging studies. Alosetron shows a greater effectiveness in women, and the role of genetic factors underlying inter-individual differences in the response to alosetron is currently under investigation. The most frequent adverse event associated with the use of alosetron is constipation and in some rare cases, the development of colonic mucosal ischaemia. In the following review, the most recent reported effects of alosetron on gastrointestinal motility, visceral sensitivity and anxiety, both in terms of preclinical and clinical data will be discussed. The impact of alosetron on QOL in IBS patients and the safety of treatment with alosetron, will also be covered.     

Alosetron and irritable bowel syndrome

Alosetron (Lotronex, GlaxoSmithKline) is a potent and selective 5-HT(3)-receptor antagonist approved by the FDA for the treatment of women with diarrhoea-predominant irritable bowel syndrome (IBS) in whom conventional therapy has failed. Studies involving healthy volunteers and IBS patients have demonstrated a beneficial effect of treatment with alosetron on global IBS symptoms, abdominal pain and discomfort, altered bowel function as well as improvement of quality of life (QOL). Data from animals studies suggest the involvement of 5-HT(3) receptors on intrinsic primary afferent neurons in the mediation of the effect of alosetron on gastrointestinal motility and secretion. While definitive proof of a visceroanalgesic action is not available, an additional central mechanism of action is suggested by findings obtained in animal models, as well as from human brain imaging studies. Alosetron shows a greater effectiveness in women, and the role of genetic factors underlying inter-individual differences in the response to alosetron is currently under investigation. The most frequent adverse event associated with the use of alosetron is constipation and in some rare cases, the development of colonic mucosal ischaemia. In the following review, the most recent reported effects of alosetron on gastrointestinal motility, visceral sensitivity and anxiety, both in terms of preclinical and clinical data will be discussed. The impact of alosetron on QOL in IBS patients and the safety of treatment with alosetron, will also be covered.     

Serotonergic modulation and irritable bowel syndrome

Irritable bowel syndrome (IBS) is a debilitating disease, which is characterised by recurrent abdominal cramping and pain, and is associated with either constipation and/or diarrhoea. It is approximately twice as prevalent in women as it is in men and is among the most common gastrointestinal (GI) disorders encountered in primary care. The aetiology of the disease is poorly understood but may include motility dysregulation, visceral sensitivity, inflammation, bacterial infection, dietary antigens, psychological stress, GI surgery or a gut-brain phenomenon. At present, there is no acceptable treatment for IBS, although recent advances indicate that some relief may be achieved by the administration of compounds that act on 5-HT (serotonin) receptors. This suggestion is the result of numerous studies which have shown that 5-HT may exert a number of diverse effects on human GI tissues. In addition, it has emerged that the levels of the 5-HT metabolite (5-HIAA) are raised in the plasma of IBS patients and that administration of 5-HT-like compounds may mimic the symptoms of IBS. It has therefore been proposed that therapy with compounds that act at 5-HT receptors will return the intestine to normal activity and alleviate the pain experienced by these patients. One compound (alosetron, a 5-HT3 receptor antagonist) has already been released onto the market but showed benefit in female patients only and only in those whose primary symptom was diarrhoea. In addition, the compound was recently withdrawn following concerns over its safety. The reasons why alosetron only appears to show efficacy in females, why these treatments are only effective in a subset of the population of IBS patients and why alosetron elicits its particular side effect profile have not been elucidated. One further serotonergic compound, tegaserod (Zelmac, a 5-HT4 receptor agonist), has shown promise for the treatment of patients with constipation-predominant IBS and is currently in pre-registration for this indication. It is clear, however, that further research will have to take place before the utility of serotonergic modulation in the treatment of IBS can be fully validated.     

Food hypersensitivity and irritable bowel syndrome

Irritable bowel syndrome is a common condition but its pathophysiology remains poorly understood. Many irritable bowel syndrome patients give a history of food intolerance, but data from dietary elimination and re-challenge studies are inconclusive. Multiple aetio-pathological mechanisms have been postulated. The gut has an extensive immune system but current understanding of processing of food antigens in health and disease is limited. There is no clinically useful marker available to test for food hypersensitivity in irritable bowel syndrome. Researchers have employed both skin tests and serum immunoglobulins (IgG and IgE) as markers of food hypersensitivity in various disorders including irritable bowel syndrome, but published data are equivocal. In this article, the evidence for the role of food hypersensitivity in irritable bowel syndrome is reviewed and, based on the available data, a possible pathophysiological hypothesis has been formulated.