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。     

中西药结合治疗58例便秘型肠易激综合征临床体会

目的：比较中药六味安消胶囊和西药莫沙比利治疗便秘型肠易激综合征（IBS）的效果。方法：将58例便秘型IBS的患者随机分为2组,治疗组31例,给予莫沙比利5mg／次,3次/天;六味安消胶囊3粒,次,3次,天,均口服,4周为一疗程。对照组27例,给予莫沙比利5ms／次,3次／天口服,服用4周为一疗程。两组患者均给予高纤维食物,避免产气的食物如乳制品、大豆等。结果：治疗组显效8例（26％）,有效19例（61％）,无效4例（13％）。对照组显效3例（11％）,有效13例（48％）,无效11例（41％）。两组比较P〈0．01。结论：中西药结合治疗便秘型IBS是临床可行的治疗方案。     

肠易激综合征发病机制与诊治

<正> 肠易激综合征(irritable bowel syndrome,IBS)是与肠道动力学异常及内脏感觉异常有关的功能性胃肠疾病,是指一组包括排便习惯改变(腹泻或便秘)、粪便性状异常(稀便、黏液便或硬结便)、腹痛及腹胀等临床表现的症候群,持续存在或间歇发作,并无器质性疾病(形态学、细菌学及生化代谢等异常)的证据。目前IBS仍被认为是功能性疾病,许多研究已显示IBS患者具有胃肠动力学异常和内脏感觉异常的病理现象。尽管IBS不危及人的生命,却对工作、生活产生不同程度的影响,使人     

Current developments for the diagnosis and treatment of irritable bowel syndrome

Current treatment options for the chronic gastrointestinal disorder irritable bowel syndrome (IBS) have long been limited to symptomatic treatments due to lack of pathophysiologic understanding of the syndrome. Within the past 10 years, however, a number of new pharmacological targets have been identified that may aid in the treatment of irritable bowel syndrome. Although only a limited number of new drug entities have entered the market in the past years, many new potential pharmacophores are evolving. Among them, several drugs are in the pipeline that target cholecystokinin or corticotropin-releasing factor receptors, serve as inhibitors for specific tryptophan hydroxylase iso-enzymes, modulate chloride secretion, influence immune responses via monoclonal antibodies or ATP-mediated pathways, and even normalize the gastrointestinal microflora via supplementation with probiotics. While new treatments that act via chloride secretion and immune modulation present with favorable outcomes in clinical trials, other novel therapies require further evaluation. This review is intended to provide a synopsis of current and emerging pharmacotherapies for IBS.     

应用 CONSORT标准评价中医药治疗肠易激综合征随机对照试验报告的质量

目的:应用CONSORT 2010标准评价5种核心期刊近5年发表的中医药治疗肠易激综合征随机对照试验的报告质量。方法:电子检索中国知网(CNKI)、中文科技期刊数据库(VIP)、万方数据库2009年至2013年发表在5种核心期刊中医药治疗肠易激综合征的RCT。由2名研究者按照CONSORT 2010标准对照检查清单制定统一的评价表对纳入的每篇文献进行分配,每一条目根据作者是否报告,给出"是"或"否"判断并进行分析。结果:共纳入18篇文献,在报告质量上均存在不同程度的问题,主要在文题、样本量、分配隐藏、实施、盲法、基线资料、辅助分析、危害、局限性、试验注册、试验方案及资助等方面。结论:能够达到CONSORT 2010标准的高质量的中医药治疗肠易激综合征的随机对照试验很少,在接纳和运用其结果时应谨慎。     

The treatment of irritable bowel syndrome

The efforts of clinical researchers, lay organizations and pharmaceutical companies have increased the public profile of irritable bowel syndrome and made it a respectable diagnosis. Diagnostic symptom criteria encourage a firm clinical diagnosis, which is the foundation of a logical management strategy. This begins with education. Reassurance that no structural disease threatens should be tempered with the reality that symptoms are likely to recur over many years. Patients expect diet and lifestyle advice, even if this is not specific to irritable bowel syndrome. Only a few of those with irritable bowel syndrome see doctors, and even fewer see specialists. Therefore, the treating physician should ascertain the reason for the visit, the patient's fears and the presence of any comorbid illness, such as depression, that might require treatment in its own right. No drug treatment is useful for all of the symptoms of irritable bowel syndrome, and many patients require no drug at all. If used, drugs should target the predominant symptom. Alosetron, a 5-HT3 antagonist, is effective in treating women with irritable bowel syndrome who also have diarrhoea. Tegaserod, a 5-HT4 agonist, is useful for women with irritable bowel syndrome who are constipated. Most patients with irritable bowel syndrome need psychological support. Reassurance, discussion and relaxation techniques can be provided by the family doctor. Difficult psychopathology may require referral to a mental health professional, and the gastroenterologist can settle diagnostic uncertainties. In all cases, successful treatment depends on a confident diagnosis and the strength of the doctor-patient relationship.     

Diagnosis and treatment of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common medical disorder characterized by symptoms of abdominal pain and bowel dysfunction. It is associated with significant disability and health care costs. A practical approach to diagnosis is the symptom-based Rome criteria. Management of patients has been helped by recent findings relating to the epidemiology, pathophysiology and psychosocial contributions of the disorder. Dysregulation of intestinal motor, sensory and central nervous system function is currently believed to be the basis for IBS symptoms. Symptoms are due to both abnormal intestinal motility and enhanced visceral sensitivity. Psychosocial factors are not a cause but can affect the illness experience and clinical outcome. Finally, treatment involves an effective physician-patient relationship and an integrated pharmacologic and behavioral approach that is determined by the needs of the patient, the type and severity of the symptoms and the degree of disability.     

氟西汀治疗肠激惹综合征

目的：观察氟西汀治疗肠激惹综合征的疗效。方法：治疗组５６例（男性１９例，女性３７例，年龄４３±ｓ１２ａ），给氟西汀２０ｍｇ，ｐｏ，ｔｉｄ；对照组５２例（男性１７例、女性２５例，年龄４２±１１ａ），给维生素Ｂ１２０ｍｇ、谷维素２０ｍｇ，ｐｏ，ｔｉｄ，对腹痛、腹泻较重者另加山莨菪碱１０ｍｇ，ｐｏ，ｔｉｄ。２组疗程均为４ｗｋ。观察治疗前后症状、大便次数及性状等。结果：治疗组总有效率９５％，比对照组总有效率５６％显著提高（Ｐ＜０．０１）。结论：氟西汀治疗肠激惹综合征有显著疗效。     

Diltiazem in the treatment of the irritable bowel syndrome

A short-term double-blind study has been conducted to evaluate the clinical efficacy of diltiazem in 18 patients with irritable bowel syndrome, divided into two groups: group A, on the sequence placebo-diltiazem-placebo for three weeks. Group B, diltiazem-placebo-diltiazem for an identical period. The substance was administered in three daily doses of 60 mg prior to meals. Clinical manifestations and the general condition were evaluated after each period of three weeks following a pre-established score. Globally, it has been impossible to demonstrate the superiority of diltiazem over the placebo, but there seems to exist a trend to the improvement of diarrhoea and abdominal pain. It will be necessary to make an additional study to delineate the efficacy of this drug in the irritable bowel syndrome.     

肠易激综合征的药物治疗

肠易激综合征(IBS)是临床常见的功能性肠道疾病,其基本病因尚未完全阐明,因而目前尚缺乏特异性药物治疗手段.目前临床IBS治疗仍是以对症治疗为主的综合性治疗,包括饮食治疗、药物治疗和心理治疗等,解痉剂、止泻剂、缓泻剂、抗菌药物及微生态制剂等均能用于IBS的治疗.     

Rifaximin for the treatment of irritable bowel syndrome

Introduction: Few therapeutic options are available for irritable bowel syndrome (IBS). Lubiprostone is approved by the FDA for IBS with constipation, and alosetron in IBS with diarrhea (IBS-D). It has been proposed that alterations in the bowel microflora may play a role in the pathophysiology of IBS, and that modulation of the microflora holds therapeutic potential. Rifaximin is a nonsystemic antibiotic that has shown efficacy in IBS.

Areas covered: This narrative review covers the treatment options available for IBS-D and focuses on rifaximin. Rifaximin pharmacodynamics, clinical pharmacology and results of clinical studies from proof of concept to the latest Phase III and retreatment studies in IBS are summarized. Challenges to rifaximin use, safety issues and regulatory data are also discussed.

Expert opinion: The evidence supports rifaximin as an emerging treatment for IBS. Strategies for appropriate patient selection need to be further developed, and continued efficacy of rifaximin over repeated treatment courses needs to be better characterized.     

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.     

Drug treatment of the irritable bowel syndrome.

Irritable bowel syndrome (IBS) is defined as a functional bowel disorder in which abdominal pain is associated with defecation or a change in bowel habit, and with features of disordered defecation and distension. The irritable bowel syndrome occurs in 10 to 20% of people worldwide and is very commonly encountered in clinical practice. This has encouraged the pharmaceutical industry to search for effective drug therapy. So far, a universally effective agent has not been found, and since this is a chronic, benign disorder, beginning in youth, long term drug use should be avoided. Nevertheless, if a specific IBS symptom, such as constipation or abdominal pain dominates, a specific drug may be helpful. However, tests and treatment should be minimised or even avoided in order to do no harm. A largely nonpharmaceutical approach to IBS should be taken. This approach employs drugs sparingly and then only targeted at specific and resistant symptoms.     

Rifaximin for the treatment of irritable bowel syndrome

INTRODUCTION: Few therapeutic options are available for irritable bowel syndrome (IBS). Lubiprostone is approved by the FDA for IBS with constipation, and alosetron in IBS with diarrhea (IBS-D). It has been proposed that alterations in the bowel microflora may play a role in the pathophysiology of IBS, and that modulation of the microflora holds therapeutic potential. Rifaximin is a nonsystemic antibiotic that has shown efficacy in IBS. AREAS COVERED: This narrative review covers the treatment options available for IBS-D and focuses on rifaximin. Rifaximin pharmacodynamics, clinical pharmacology and results of clinical studies from proof of concept to the latest Phase III and retreatment studies in IBS are summarized. Challenges to rifaximin use, safety issues and regulatory data are also discussed. EXPERT OPINION: The evidence supports rifaximin as an emerging treatment for IBS. Strategies for appropriate patient selection need to be further developed, and continued efficacy of rifaximin over repeated treatment courses needs to be better characterized.     

New horizons in the treatment of irritable bowel syndrome

Irritable bowel syndrome is one of the most common diseases in gastroenterology clinics. Bowel movement is controlled by many factors such as gastrointestinal hormones and gut brain system, which are too complicated to evaluate by clinical investigation. Therefore, IBS is diagnosed on the basis of the Rome diagnostic criteria, after excluding organic gastrointestinal diseases. The basic principle in the therapy of IBS is to centrally stabilize the mental state and locally normalize intestinal function, in addition to regular daily life and dietary guidance.     

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.     

Evaluation of drug treatment in irritable bowel syndrome

The irritable bowel syndrome (IBS) remains a therapeutic challenge in part because of the limited understanding of the pathophysiology. The placebo response rate varies in randomized controlled trials from 20 to 70%, and can persist for up to at least 1 year. It is contentious whether dietary fibre and bulking agents relieve the symptoms of IBS; constipation probably improves. Anticholinergic and antispasmodic agents are of questionable benefit in IBS despite positive meta-analyses of poor quality trials. A meta-analysis concluded that the tricyclic antidepressants were superior to placebo in IBS, although the individual trial results were variable. Selective serotonin reuptake inhibitors are of uncertain benefit. Laxatives are used for constipation but probably poorly control the IBS symptom complex. Loperamide is superior to placebo in improvement of diarrhoea but not abdominal pain in IBS. Tegaserod is a well- tolerated aminoguanidine indole derivative of serotonin that is a partial 5HT4-receptor agonist with prokinetic properties; a therapeutic gain over placebo of 5% to 15% has been observed in constipation-predominant IBS in females. Alosetron is a 5HT3-receptor antagonist that is efficacious in females with diarrhoea-predominant IBS, with a 12% to 17% therapeutic gain; the risk of ischaemic colitis is 1 in 350, with very severe constipation occurring in about 1 in 1000. Optimizing study design remains a challenge in IBS. New visceral analgesic and motility modifying agents, as well as anti-inflammatory agents are in trials, and hopefully additional efficacious therapeutic options for patients with IBS will soon emerge.