肠易激综合征的胆囊收缩功能

本文对１５例肠易激综合征（ＩＢＳ）和１０例健康对照的胆囊收缩功能进行了研究。应用超声显像测定了以下参数：（１）空腹胆囊容积（ＦＧＶ），（２）服脂餐后胆囊达最大收缩时残余容积（ＲＧＶ），（３）胆囊最大排空率（ＭＧＥＲ），（４）达最大收缩的经历时间。结果显示，ＩＢＳ患者的ＦＧＶ、达最大收缩时ＲＧＶ及经历时间均显著大于对照组（均为Ｐ＜０．０１），而其ＭＧＥＲ则显著小于对照组（Ｐ＜０．０１）．提示ＩＢＳ患者的胆囊收缩功能显著异常。     

Evolution of Visceral Sensitivity in Patients with Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) has been associated with visceral hypersensitivity. Here we examined the evolution of rectal sensitivity and of gastrointestinal symptomatology in IBS patients over time, to verify if the clinical and biological parameters showed parallel behavior. Patients complaining of IBS, identified by Rome 1 criteria, were included in this study. The severity of the gastrointestinal (Gastrointestinal) symptoms was assessed by a gastrointestinal index. The pain threshold to rectal distension was measured by a barostat programmed for phasic ascending distensions. Both measures were obtained before and after treatment. Thirty-nine patients were followed while on a 10-week group psychotherapy (psy) program. Twelve patients were controlled after pharmacological treatment with amitriptyline (Ami) 10 mg hours for two weeks and then 25 mg hours for the following 4 weeks. Clinical improvement with symptom reduction was achieved in both patients groups. With psy, the Gastrointestinal index declined from an initial value of 78.4 ± 4.8 to 65.5 ± 4.5 at the end of treatment (P < 0.05). With Ami, the gastrointestinal index decreased from 91.6 ± 5.6 to 61.8 ± 9.1 (p < 0.01). The pain threshold to rectal distension increased from 27.7 ± 1.0 to 33.7 ± 1.9 mmHg (P < 0.01) after drug treatment, but remained unchanged (30.6 ± 1.0 vs 30.6 ± 1.1 mm Hg) with psy. Evolution of the gastrointestinal index and rectal sensitivity were directly correlated (r = –0.71; P < 0.01) in Ami patients, but not in those treated with Psy (r = –0.001). In conclusion, visceral hypersensitivity appeared as a stable biological defect over a 10- to 12-week period during clinically-effective treatment with psychotherapy. Rectal pain threshold, however, seemed to be pharmacologically manipulatable in patients treated with Ami.     

The Incidence of Irritable Bowel Syndrome Among Community Subjects With Previous Acute Enteric Infection

The purpose of this study was to determine the incidence of postinfectious irritable bowel syndrome (IBS) among community subjects with positive stool studies. This was a prospective cohort study whereby all individuals with stool-positive acute enteric infection (AEI) were recruited from 3 health regions in Ontario, Canada. Each person completed questionnaires regarding preinfectious bowel habit and their bowel habit 3 months postinfection. Manning and Rome I criteria were used to diagnose irritable bowel syndrome. Two hundred thirty-one patients participated. Forty had preexisting IBS and were excluded. Of the remaining 191 patients, 7 developed irritable bowel syndrome, for an incidence of 3.7% (95% confidence interval: 1.0–6.3%). Fever during AEI was the only identifiable risk factor for developing postinfectious IBS (odds ratio, 11.96; P = .02). The incidence of postinfectious IBS in community subjects is 3.7%. Fever during the AEI may be an important risk factor for this condition.     

Irritable Bowel Syndrome in a Bangladeshi Urban Community: Prevalence and Health Care Seeking Pattern

Background/Aims:

Although irritable bowel syndrome (IBS) is a common gastrointestinal disorder, its prevalence is unknown, especially in the urban population of Bangladesh. This community-based study aimed to find out the prevalence of IBS and healthcare-seeking patterns using the Rome-II definition.

Materials and Methods:

A population-based cross-sectional survey of 1503 persons aged 15 years and above was carried out in an urban community of Bangladesh. The subjects were interviewed using a valid questionnaire based on Rome-II criteria in a home setting. Statistical analysis was performed with Statistical Package for Social Science (SPSS) Programmers and the level of significance was set at P ≤ 0.05.

Results:

A response rate of 97.2% yielded 1503 questionnaires for analysis. The prevalence of IBS was found to be 7.7% (n = 116) with a male to female ratio of 1:1.36 (49 vs. 67). “Diarrhoea-predominant IBS” (50%, n = 58) was the predominant IBS subgroup. Symptoms of abdominal pain associated with a change in stool frequency (100%) and consistency (88.8%) were quite common. All IBS symptoms were more prevalent among women (P < 0.000). In the past one year, 65.5% (n = 76) IBS subjects had consulted a physician with a slightly higher rate of women consulters (68.6 vs. 61.2%). The main predictor for healthcare-seeking was the presence of multiple dyspeptic symptoms.

Conclusions:

The prevalence of IBS in the urban community was found to be similar to that in rural communities. A higher rate of consultation was found among urban IBS subjects than in the rural subjects, with sex not seen to be a discriminator to seek consultation.     

Distal Colonic Motor Activity in Four Subgroups of Patients with Irritable Bowel Syndrome

With the aim of improving end organ treatment, we describe a new system of classifying irritable bowel syndrome (IBS) according to clinical features into four groups, spastic colon syndrome (SCS), functional diarrhea (FD), diarrhea-predominant spastic colon syndrome (DPSCS), and midgut dysmotility (MGD). The aim of the study was to investigate fasting and postprandial distal colonic motility in the four groups of patients and to compare the results with normal controls. Distal colonic motility studies were performed in the unprepared colon. 2.5-hr recordings were made from four channels with a standard meal administered at 0.5 hr. The intubated colon was treated as a study segment and data analyzed for study segment activity index (SSAI) and number and mean amplitude of pressure peaks over 30-min epochs. Patients with SCS had significantly higher (P < 0.05) mean amplitude of pressure peaks (60 min, 120 min) and SSAI (120 min) than controls and patients with FD, DPSCS, and MGD. In contrast, patients with FD and DPSCS had significantly (P < 0.05) lower postprandial SSAI than controls and patients with SCS (60 min, 120 min). With the exception of raised postprandial mean amplitude of pressure peaks (120 min), MGD patients had normal distal colonic motility. Division of IBS patients into subgroups has highlighted significant differences in distal colonic motility that provide insights into etiopathogenesis and should assist targeting of current and newly developed therapies, particularly receptor active agents.     

美常安联合得舒特治疗腹泻型肠易激综合征的疗效观察

目的 探讨美肠安治疗腹泻型肠易激综合征的疗效.方法 将60例患者随机分为2组,A组30例,口服得舒特50 mg,每天3次.B组30例,口服美常安500 mg,每天3次,得舒特50 mg,每天3次,疗程4周.观察大便性状评分,腹部综合症状等级评分和疗效评价.结果 治疗4周后,两组Bristol评分均较治疗前明显提高,腹部症状评分较治疗前都有明显下降,B组改善更明显.两组之间的治疗效果比较有明显差异,B组疗效更好.结论 美肠安治疗腹泻型肠易激综合征安全有效.     

Rectal Hypersensitivity Reduced by Acupoint TENS in Patients with Diarrhea-Predominant Irritable Bowel Syndrome: A Pilot Study

Our aim was to compare rectal perception of patients with diarrhea-predominant irritable bowel syndrome (IBS-D), constipation-predominant irritable bowel syndrome (IBS-C), functional constipation (FC), and healthy controls and to evaluate the therapeutic effect of acupoint transcutaneous electric nerve stimulation (TENS). Age- and sex-matched patients (24 IBS-D, 20 IBS-C, and 30 FC) were selected, and 30 volunteers served as healthy controls. Rectal sensory thresholds were evaluated by rectal balloon distension. Short- and long-term acupoint TENS was given respectively. IBS-D patients had significantly lower rectal sensory thresholds of the first sensation of stool, urgency of defecation, and pain than IBS-C or FC patients or healthy controls (P < 0.05), but there were no differences in rectal sensory thresholds among IBS-C and FC patients and healthy controls. In each group, females had significantly lower rectal sensory thresholds than males (P < 0.05), but there was no difference between younger (< or = 50 years old) and older (> 50 years old) patients. Short-term acupoint TENS increased rectal sensory thresholds of IBS-D patients. After 2-month acupoint TENS treatment in IBS-D patients, rectal sensory thresholds were significantly increased, stool times and the intensity of abdominal pain were decreased, and psychological scores were relieved to normal. Lowered rectal perception threshold is a hallmark of IBS-D patients. Females have significantly lower rectal sensory thresholds than males. Acupoint TENS is effective to treat IBS-D.     

Rectosigmoid Motility Response to Beta-Adrenoceptor Stimulation in Patients with the Irritable Bowel Syndrome

Patients with the irritable bowel syndrome were studied with regard to the effects of beta-adrenoceptor agonists on rectosigmoid motility. Pressure was recorded with a continuously inflated balloon in the upper rectum and recorded from a pressure catheter in the sigmoid colon. On different days the beta-2 agonist terbutaline, the beta-1 agonist prenalterol, and placebo, respectively, were administered intravenously after a control period. During each examination contractile activity was quantified for three consecutive periods of 25 min. Terbutaline in a total dose of 0.50 mg decreased sigmoid motility index significantly from 3.0 ± 0.6 (SEM) to 1.1 ± 0.3 kPa times; min (p < 0.01). After ?5 mg prenalterol no significant changes of motility index were observed. After placebo an increase, although not significant, in contractile activity was seen compared with the initial control period. Rectal motility indices were low and not changed by the beta agonists. The serum concentrations of the drugs were within the therapeutic limits used in clinical practice and caused a dose-dependent increase of both systolic blood pressure and heart rate. It is concluded that beta-2 adrenoceptor stimulation significantly decreases sigmoid motility whereas the motility index seems to be unaffected by beta-1 adrenergic stimulation.     

A Double-Blind Study of the Effect of Trimipramine in Patients with the Irritable Bowel Syndrome

The study was performed in 428 patients, of whom 216 were women. The median age was 36.5 (16–75) years and the median weight 67 (42–118) kg. The complaints were registered on a 10-cm-long linear analogue scale by the patients and the physicians. The patients were given coded identical-appearing tablets of placebo and different doses of trimipramine (Surmontil®, Rhône-Poulenc) and randomized into groups A-E. During the 6 weeks of treatment the grades of complaints were reduced to about the half of pretreatment levels. The groups treated with trimipramine (groups A-D) felt significantly more improved than the group receiving placebo (group E). The side effect of tiredness was somewhat more pronounced 1–2 weeks after start with 50 mg trimipramine in the evening than in the groups receiving placebo and lower dose schedules of trimipramine.     

Irritable Bowel Syndrome on Inflammatory Bowel Disease in Deep Remission: No Relation with Remission Deepening and Inflammation

Background: The aim of the study was to establish the frequency of irritable bowel syndrome (IBS) in patients with inflammatory bowel disease (IBD) in clinical, endoscopic, and histologic remission and in relation to both the depth of remission and inflammation markers. Methods: Patients with ulcerative colitis (UC) and with Crohn’s disease (CD) in clinical remission for at least 6 months were enrolled in the study. All of the patients underwent colonoscopy, and biopsy specimens were taken to evaluate endoscopic and histopathologic remission. Patients were evaluated according to Rome III criteria for IBS. Fecal calprotectin level and blood samples for C-reactive protein (CRP), sedimentation rate, and fibrinogen levels were studied.Results: IBS frequency was 20.9% in UC cases and 28.9% in CD cases in clinical remission. Rates with and without endoscopic remission in UC (20.5% vs. 22.2%, P = .727) and CD (25% vs. 33.3%, P = .837, respectively) were not different. Similarly, rates with and without histopathologic remission in UC (15.7% vs. 26.6%, P = .723), and CD (21.4% vs. 33.3%, P = .999) were not statistically different. Also, it was not related to inflammation markers.Conclusion: IBS frequency among IBD patients with remission was in a substantial rate; these rates kept up with the process of deep remission and even complete mucosal healing and were irrelevant to inflammation.     

The Incidence of Abdominal and Pelvic Surgery Among Patients with Irritable Bowel Syndrome

Rates of abdominopelvic surgery, with a particular focus on gallbladder procedures, were measured in patients with irritable bowel syndrome (IBS) (n = 108,936) and compared with those in a general population sample (n = 223,082). The patient sample was selected from persons who were members of a managed care organization during the years 1995-2000. Medical records from a randomly selected subset of IBS patients were reviewed to confirm the diagnosis. Crude and standardized rates and adjusted rate ratios for surgery were calculated. The incidence of abdominopelvic surgery, excluding gallbladder procedures, was 87% higher in patients with IBS than that for the general population. The incidence of gallbladder surgery was threefold higher in IBS patients than the general population. Patients with IBS have an increased risk for abdominopelvic and gallbladder surgery and, thus, an associated risk for experiencing morbidity and mortality associated with these surgical procedures.     

Sleep Disturbance Influences Gastrointestinal Symptoms in Women with Irritable Bowel Syndrome

This analysis evaluated the association between sleep disturbance and gastrointestinal symptoms in women with and without irritable bowel syndrome (IBS), and examined the role of psychological distress in this relationship. Women with IBS (N = 82) reported considerably higher levels of sleep disturbance compared to controls (N = 35), using both retrospective seven-day recall and daily diary recall for two menstrual cycles (P < 0.05 on 8 of 10 measures). We used daily diary data to estimate the association between sleep disturbance and gastrointestinal symptoms, both across women (ie, whether women with high average sleep disturbance have higher average gastrointestinal symptoms) and within woman (ie, whether poorer than average sleep on one night is associated with higher than average gastrointestinal symptoms the following day). The regression coefficients for the across-women effect are large and highly significant in both groups (IBS, ± se = 0.46 ± 0.08, P < 0.001; controls, 0.57 ± 0.13, P < 0.001). The regression coefficients for the within-woman effect are considerably smaller and statistically significant only in the IBS group (IBS, 0.06 ± 0.02, P = 0.006; control, 0.01 ± 0.03, P = 0.691). These regression coefficients showed little change when daily psychological distress or stress was controlled for, the one exception being the coefficient for the across-women effect in the IBS group, which decreased substantially but still remained highly significant. Because it is possible that gastrointestinal symptoms could, in fact, cause poor sleep, we also fitted the temporally reversed model to evaluate the association between gastrointestinal symptoms on one day and sleep disturbance that night. The within-woman regression coefficients were nonsignificant in both the IBS and control groups. In conclusion, these results are consistent with the hypothesis that poor sleep leads to higher gastrointestinal symptoms on the following day among women with IBS.     

Relationship Between Asthma and Irritable Bowel Syndrome: Role of Food Allergy

The increasing prevalence of both asthma and irritable bowel syndrome (IBS) are major health problems. One hundred twenty-five patients with asthma and 95 healthy subjects were included in this study. The rate of IBS was 29.6% and 12.7% (p < 0.005), and the incidence of food allergy was 7.2% and 2.1% (p > 0.05) respectively for asthma and control group. There was no significant association between asthma related parameters, IBS, and food allergy. There is not a single clear reason as to what causes IBS, so further studies are needed to clarify the potential pathogenic mechanisms underlying the association between IBS and asthma.     

Autonomic Nervous System Function in Women with Irritable Bowel Syndrome

Autonomic nervous system (ANS) balance was assessed in women with and without irritable bowel syndrome (IBS) using laboratory tests of function (ie, expiratory/inspiratory ratio, Valsalva, posture changes, and cold pressor) and spectral and nonspectral measures of heart rate variability (HRV). Women with (N = 103) and without IBS (N = 49) were recruited, interviewed, then completed a laboratory assessment and wore a 24-hr Holter monitor Analysis using the entire sample showed little difference between IBS and control women and between subgroups with IBS on either laboratory measures or 24-hr HRV measures. However, analysis restricted to those women with severe IBS symptoms showed quite pronounced differences between two IBS subgroups on 24-hr HRV measures. Parasympathetic tone was significantly lower and ANS balance was significantly higher in the constipation-predominant compared to the diarrhea-predominant group. Subgroups of women with IBS do differ in ANS function as measured by 24-hr HRV; however, these differences are only apparent among women with severe symptoms. These findings point out the importance of considering symptom severity when interpreting studies of IBS.     

Role of Anger in Antral Motor Activity in Irritable Bowel Syndrome

There is considerable evidence indicating that patients with irritable bowel syndrome respond to emotional and environmental stimulation with increased colon motor activity. It has been suggested also that increased colon motor activity is not confined to the colon and may be representative of a broader disorder affecting the rest of the gastrointestinal tract in this population. The results of our current study suggest that anger may have a significant, although differential effect on antral motor activity in IBS patients compared to normal controls. We found that while antral motor activity did not differ significantly in our groups during rest, anger decreased antral motor activity in IBS patients and increased antral motor activity in normal controls. The difference was not attributable to a difference in anger levels since the groups did not differ in their response to the standardized anger stressor. Rather, the difference in the antral motor response appears to be qualitative and a possible marker for irritable bowel syndrome. Our data further suggest that increased colon motor activity in IBS patients during emotional stress is not a result of a rise in motor activity throughout the gastrointestinal tract, but a phenomenon that may be unique to the colon in this patient population.     

Relationship of Bloating to Other GI and Menstrual Symptoms in Women with Irritable Bowel Syndrome

This report examines the relationships between bloating and other symptoms in young women with irritable bowel syndrome (IBS), using both retrospective and daily diary measures of symptoms. Of the 195 IBS women, 147 (75%) reported retrospectively that they often feel bloated and distended. Across-women analyses of both retrospective and daily diary data show that bloating is most strongly associated with constipation, abdominal pain, and intestinal gas. Within-woman analyses of daily symptoms also show a strong association of bloating with abdominal pain and intestinal gas (i.e., abdominal pain and intestinal gas are higher on days when bloating is higher) but only a weak association with constipation. Bloating is strongly associated with uterine cramping and breast tenderness, but only when perimenses days are included in the analysis. In conclusion, bloating is a very common symptom in women with IBS that is most strongly related to abdominal pain and intestinal gas but may be confounded with menses-associated symptoms.     

Relationship Between Systemic Immune-Inflammation Index and Irritable Bowel Syndrome

BackgroundIrritable bowel syndrome is accepted as a functional disorder; however, there is growing evidence in favor of the inflammatory process contributing to its pathogenesis. We aimed to evaluate the role of the systemic immune-inflammation index as a marker of inflammation in patients with irritable bowel syndrome.MethodsThe study was conducted in the outpatient clinic of the Gastroenterology Department with patients having constipation-predominant irritable bowel syndrome diagnosis according to Rome IV criteria between March 1, 2019 and December 31, 2020. The systemic immune-inflammation index was calculated and compared with age- and sex-matched healthy controls.ResultsThe study was performed with 214 participants, 107 patients and 107 control groups. Platelet and neutrophil counts (P < .001, for both) were higher, and lymphocyte count (P = .003) was lower in the irritable bowel syndrome group. The systemic immune-­inflammation index was higher in irritable bowel syndrome patients (P < .001). Multivariate logistic regression analyses showed the role of the systemic immune-inflammation index as an independent predictor of the presence of IBS (odds ratio: 1.100, P < .001).ConclusionSystemic immune-inflammation index may be a cheap, universal, and reliable indicator of the inflammatory process in irritable bowel syndrome patients.