饮食对肠易激综合征影响的研究进展

肠易激综合征(irritable bowel syndrome,IBS)患者的症状常与饮食有关。目前研究认为正常人群、IBS人群及IBS各亚型在饮食上存在差异,且饮食摄入量与症状的严重程度密切相关。研究结果显示:冷食、辛辣食品、水果和蔬菜、乳制品、茶、碳酸饮料、酒精等诸多食品和饮品均可引起IBS患者的症状,本文即针对饮食与IBS的关系进行分析,以期能够为IBS患者的饮食方案提供指导。     

Effect of dietary fiber on symptoms and rectosigmoid motility in patients with irritable bowel syndrome. A controlled, crossover study

The aims of this study were to determine (a) whether dietary fiber supplements modify symptoms in patients with irritable bowel syndrome, (b) the effect of fiber on rectosigmoid pressures, and (c) the relationship, if any, between rectosigmoid pressure and symptoms. Fourteen patients entered and 9 completed a double-blind, controlled, cross-over study of 7 mo duration. The mean age was 26 yr (range, 18-37). Patients received 4 cookies daily containing 20 mg corn fiber or placebo. Symptoms and compliance were evaluated monthly. Rectosigmoid pressures and dietary intake were evaluated at the outset and completion of each study arm. Symptoms improved during both fiber and placebo treatments. Those symptoms demonstrating significant improvement with time were pain severity, stool frequency, stool consistency (p = 0.001), number of additional gastrointestinal symptoms present (p = 0.02), and total symptom score (p less than 0.001). Rectosigmoid pressures were not significantly altered by fiber or placebo. Fasting pressures at the distal recording site tended to correlate with pain severity (r = 0.6; p = 0.06). It was concluded that (a) corn fiber and placebo were both effective in alleviating symptoms, (b) there was a correlation between symptom severity and fasting rectosigmoid pressure, and (c) there was a trend toward reduction in fasting and postprandial rectosigmoid pressures after fiber therapy.     

肠易激综合征患者胃窦十二指肠移行性复合波的研究

目的　观察肠易激综合征 (IBS)患者的胃窦十二指肠移行性复合波 (MMC)变化 ,并分析其与症状之间的关系。方法　 2 0名健康对照者及 17例IBS患者 (8例腹泻型 ,9例便秘型 )禁食 6h以上 ,用瑞典CTD公司生产的灌注式小肠测压管记录至少 2个完整的MMC周期 ,之后给每位受试者服标准餐 ,用餐时间为 15～ 30min ,继续观察餐后波 1～ 2h。结果　腹泻型IBS患者消化间期MMC周期短、Ⅲ相波幅高、时程长 ,便秘型IBS患者MMC周期长、时程短。IBS患者MMCⅡ相小肠离散丛集簇(DCC)波的时程延长 ,但腹泻组与便秘组之间差异无显著性 (P >0 .0 5 )。IBS腹泻组的Ⅱ、Ⅲ相的运动指数高于便秘组和对照组。进餐后IBS患者小肠运动形式无明显改变。结论　IBS患者消化间期MMC的各相时程及波幅异常与IBS症状密切相关 ,DCC可能与IBS腹泻、便秘症状发生的关系较小 ,IBS患者餐后胃肠运动无明显异常 ,可能与病例数较少有关 ,有待今后增加例数进一步观察     

Sigmoid motility in diverticular disease and the irritable bowel syndrome.

Intraluminal pressures were measured with four open ended, water perfused tubes in the fasting state and after a standard liquid meal (400 KCal, 375 ml, protein 15 g, carbohydrate 55 g, lipid 13.4 g) in six patients with sigmoid diverticular disease, 20 with the irritable bowel syndrome and in 13 controls. The pressure sensors were positioned in the true sigmoid colon at colonoscopy at 25, 35, 45, and 55 cm from the anus. Colonic pressures were significantly higher in diverticular disease than in controls before (p less than 0.02) and after the meal (p less than 0.002), some pressure amplitudes exceeding 300 cm H2O. Patients with the irritable bowel syndrome had lower (p less than 0.05) pressures than controls before the meal. Postprandial sigmoid pressures were within the mean +/- 2 SD of controls in 10, above in two and below in eight patients with the irritable bowel. Hypercontractility of the sigmoid colon in the irritable bowel syndrome was not confirmed under the conditions of this study. The association between sigmoid diverticulosis and high intraluminal pressures is confirmed.     

肠易激综合征患者胆囊运动功能的研究

目的 了解肠易激综合征患者的胆囊运动功能情况,协助肠易激综合征的治疗。方法 我们通过对健康志愿者(对照组)和肠易激综合征患者(IBS组)用核素显相测定胆囊排空功能。结果 IBS组23例中有13例(56.5％13／23),对照组16例中有4例(25％4／16),餐后1小时胆囊排空指数(GBEF)降低,两组比较差异有显著性(P<0.01)。餐后30、40、50和60minGBEF IBS组均低于对照组,差异有非常显著性(P<0.01)。结论 IBS组胆囊排空率下降,排空功能不良。在治疗肠易激综合征同时予利胆促动力剂治疗。     

Effect of a tricyclic antidepressant on small intestinal motility in health and diarrhea-predominant irritable bowel syndrome

Antidepressants are used in irritable bowel syndrome (IBS) and may have effects on the gut independent of improving mood. We have investigated the actions of a tricyclic antidepressant on small intestinal motor function in eight healthy volunteers and in six patients with diarrhea-predominant IBS. Fasting ambulatory motility was recorded from six small intestinal sites for 16–18 hr while on no drug (baseline) and while taking imipramine for five days. Orocecal transit time (OCTT) was measured by lactulose hydrogen breath test, during baseline and imipramine administration. Imipramine did not alter migrating motor complex periodicity, but slowed jejunal phase III propagation velocity in controls from 7.5±1.1 to 3.6±0.5 cm/min (P<0.01) and in IBS from 7.8±0.6 to 4.4±0.5 cm/min (P<0.0001). Phase III duration at each site was increased, and total recorded phase III was greater during imipramine than baseline studies. Imipramine increased the amplitude of phase III contractions. There was no effect of imipramine on non-phase-III motility index or discrete clustered contractions. Imipramine prolonged OCTT from 73±6 min to 97±8 min in controls (P<0.05) and from 61±9 min to 89±8 min in IBS (P<0.05). Although OCTT was shorter in this IBS group, no motility differences were seen between controls and IBS. This demonstration that a tricyclic antidepressant can modify small intestinal motor function in health and in IBS supports the view that these drugs may have therapeutic actions in IBS unrelated to mood improvement.This work was supported by the Priory Hospitals Group.     

Effect of hyperventilation on distal colonic motility and rectal sensitivity in irritable bowel syndrome

Hyperventilation is associated with some symptoms suggestive of irritable bowel syndrome and has been implicated in provoking excessive oesophageal contractility. Sixteen patients with irritable bowel syndrome were therefore studied in order to assess the effect of hyperventilation on distal colonic motility and rectal sensitivity. No significant change in either the amplitude or frequency of colonic contractile activity was noted following hyperventilation, nor was any alteration in rectal sensitivity observed. This study shows that acute hyperventilation does not affect colonic motor activity or visceral sensitivity and suggests that hyperventilation and irritable bowel syndrome are not causally related.     

Colon motility and psychological traits in irritable bowel syndrome

Digestive Diseases and Sciences -     

Ambulatory small intestinal motility in 'diarrhoea' predominant irritable bowel syndrome.

Dysmotility of the duodenum and proximal jejunum has been reported in patients with irritable bowel syndrome. This study extended these findings by recording fasting ambulatory motility from electronic strain gauge sensors sited in the jejunum and ileum of eight diarrhoea predominant irritable bowel syndrome patients and 12 healthy controls. During the day, periodicity of migrating motor complexes mean (SEM) did not differ between patients (92 (10) min) and controls (85 (7) min). At night, periodicity was shorter in both patients and controls, and the daytime dominance of phase II was replaced by phase I. In both groups, aboral progression of phase III fronts was associated with a slowing of propagation velocity and maximum contractile rate, but an increase in mean amplitude of contraction. Discrete clustered contractions were seen in seven patients and 10 controls occupying 14 and 16% of daytime phase II activity, respectively. Pain episodes were not associated with any specific motility patterns. Despite the lack of motility differences between the two groups, orocaecal transit time in the irritable bowel syndrome patients was shorter at 57 (9) min than in the controls, 82 (6) min (p < 0.05). This ambulant study has failed to show any abnormalities of fasting small intestinal motility that might distinguish diarrhoea predominant irritable bowel syndrome patients from healthy controls.     

二味中药复方治疗腹泻型肠易激综合征的实验研究

目的观察二味中药煎剂对肝郁脾虚型肠易激综合征大鼠的治疗作用及对胃动素和胆囊收缩素的影响。方法将实验动物随机分为6组：正常组、模型组、阳性对照组及二味中药高、中、低剂量组。运用番泻叶水煎剂灌胃和束缚结合造模,以各剂量的二味中药煎剂治疗,得舒特为阳性对照药物,测定大鼠稀便级及血清和结肠黏膜中胃动素和胆囊收缩素的含量。结果高、中剂量的二味中药可以明显改变大鼠的稀便级;二味中药和得舒特可以明显降低结肠黏膜中胆囊收缩素的含量;胃动素在血浆和结肠黏膜中无显著变化。结论二味中药可以有效治疗肠易激综合征,其作用机制可能与调节胃肠激素有关。     

Reduction of colonic motility by intravenous nicardipine in irritable bowel syndrome.

The effect of nicardipine, a new dihydropyridine calcium antagonist, on postprandial colonic motility was assessed in 10 patients with irritable bowel syndrome. Each patient was studied twice receiving intravenously either N saline or nicardipine after a 1000 calorie meal. In the control study there was a significant (p less than 0.01) postprandial increase in the contractile activity of the colon, reaching a peak at approximately 20 minutes. Intravenous nicardipine completely abolished the colonic response, with a significant reduction in the number (p less than 0.005) and amplitude (p less than 0.005) of contractions and of the motility index (p less than 0.025). These results support the need for further studies to evaluate the therapeutic role of nicardipine in the irritable bowel syndrome.     

Altered small bowel motility in irritable bowel syndrome is correlated with symptoms

The pathogenesis of irritable bowel syndrome (IBS) has been related more to dysmotility of the colon than to abnormalities of the small intestine. To look for small bowel abnormalities, we recorded ultraluminal pressures in 16 patients with IBS. All patients complained of abdominal pain, and diarrhea (n = 8) or constipation (n = 8) were also prominent symptoms. Comparable studies were performed on 16 age-matched controls. The observations include diurnal and nocturnal fasting recordings and the response to a fatty meal. Periodicities of the interdigestive migrating myoelectric complexes were shorter in IBS (p less than 0.05); this was due to much shorter diurnal cycles in patients with diarrhea (77 +/- 10 min) than those with constipation (118 +/- 15 min) or controls (113 +/- 10 min, both p less than 0.05). All groups exhibited circadian changes, with nocturnal cycles being more frequent. Two specific patterns of small bowel motor activity were more common in IBS--ileal propulsive waves and clusters of jejunal pressure activity (both p less than 0.05 compared to controls). Moreover, cramping abdominal pain was usually noted in IBS when ileal motility was propulsive; jejunal bursts were also sometimes associated with abdominal symptoms. We conclude that motility of the small intestine is modified in some patients with IBS and that certain motor patterns are related to their symptoms.     

Myoelectric and manometric patterns of human rectosigmoid colon in irritable bowel syndrome and diverticulosis

Rectosigmoid electric control activity and intraluminal pressure were measured in the fasting state and after a standard 3040-kJ meal in irritable bowel syndrome (IBS) patients (n = 41), diverticulosis patients (n = 15), and healthy controls (n = 13). Analysis of myoelectric and motor patterns was performed computer-based with home-made software. Spectral analysis (fast Fourier transform) and computer recognition of slow waves emulating visual scoring showed very similar slow-wave frequency patterns in all three groups. Calculation of contractile indices displayed a widely scattered variable of motility in all three groups without significant differences. IBS subgroups with different bowel patterns showed very similar frequencies of basic myoelectric rhythm and a considerable overlap of contractile activity without significant differences among the subgroups and compared with controls. Slow-wave rhythm seems unlikely to be the basis of disturbed motility in IBS and diverticular disease. A specific pattern of contractile activity was not detectable in either condition.     

Alterations in rectal sensitivity and motility in childhood irritable bowel syndrome

BACKGROUND & AIMS: Children with chronic abdominal pain have a heterogeneous clinical presentation, but no organic cause can be identified in most of them. Some children present with symptoms of irritable bowel syndrome (IBS). We hypothesized that visceral hypersensitivity and motor abnormalities may be underlying mechanisms in these children. METHODS: Rectal sensation and rectal contractile response to a meal were studied in 8 children with IBS and 8 children with functional abdominal pain (FAP) and were compared with those of 9 healthy volunteers (HVs). RESULTS: The threshold for pain, but not that for first sensation and urge to defecate, was significantly decreased in IBS patients (6 +/- 1 mm Hg) compared with FAP patients and HVs (17 +/- 1 and 22 +/- 2 mm Hg, respectively). In HVs and patients with FAP, ingestion of a meal induced a decrease in rectal volume with an early and late component. This motor pattern was absent in children with IBS. In IBS patients, no rapid volume waves were observed during fasting in contrast to FAP patients (2.7 +/- 0.3/10 min) and HVs (1.8 +/- 0.5/10 min). CONCLUSIONS: Children fulfilling the Rome II criteria for IBS have a significantly lowered threshold for pain and a disturbed contractile response to a meal. Comparable to results reported in adults, sensory and motor abnormalities might play a pathophysiologic role in childhood IBS.     

Stress and oesophageal motility in normal subjects and patients with irritable bowel syndrome.

Patterns of oesophageal motility were recorded in 17 healthy volunteers and 12 patients with the irritable bowel syndrome. Recordings were taken at rest and under stress by hyperventilation, a dichotic hearing challenge and a cold pressor test. In healthy volunteers the dichotic hearing challenge was associated with a significant increase in the mean amplitude of oesophageal peristalsis from 69.9 mmHg to 82.4 mmHg (p less than 0.01) and in the percentage of simultaneous waves from 9.7% to 24.5% (p less than 0.01). The cold pressor test increased the peristaltic amplitude from 69.9 mmHg to 87.1 mmHg (p less than 0.001) and the percentage of simultaneous waves from 9.7% to 34.4% (p less than 0.01). Both manoeuvres were associated with increases in pulse and blood pressure. In patients with irritable bowel syndrome, the resting mean oesophageal peristaltic amplitude was higher than that seen in normal volunteers (95.9 mmHg v 69.9 mmHg p less than 0.05). Changes in oesophageal motility during stress were similar in these patients to those seen in normal subjects although the changes were not significant. This study refutes the hypothesis that symptoms of irritable bowel syndrome and their association with stress are attributable to increased sensitivity of oesophageal motility to disruption by stressful stimuli.     

Enhanced perception of physiological intestinal motility in the irritable bowel syndrome

An increased awareness of intestinal distention or contraction is implicated in the pathogenesis of the irritable bowel syndrome. This study aimed to test this hypothesis in 20 patients with the irritable bowel syndrome and 10 controls by relating the reporting of abdominal sensations to the occurrence of the duodenal phase 3 activity front of the migrating motor complex. During prolonged recordings of interdigestive small bowel motility, subjects were asked to report any episodes of abdominal sensation they experienced. Diurnally, the rate of occurrence of abdominal sensation was significantly greater in patients with the irritable bowel syndrome than in controls (P less than 0.001); such episodes were coincident with a duodenal activity front in 9 patients with the irritable bowel syndrome and in 1 control (P less than .05). Moreover, the rate of occurrence of episodes of sensation was greater (P less than 0.01) during diurnal phase 3 activity than during diurnal phase 2 activity. When episodes were coincident with duodenal phase 3 activity, these activity fronts were of significantly greater amplitude (irritable bowel syndrome: median, 23 mm Hg) than "noncoincident" activity fronts (median, 17 mm Hg; P less than 0.05) in both patients and controls. These data strongly suggest that certain physiological small bowel motor events, if of sufficient contraction amplitude, are able to be perceived by a greater proportion of irritable bowel syndrome patients and with greater frequency than by healthy subjects. The authors conclude that the threshold for perception of intestinal contraction is lower than normal in at least some patients with the irritable bowel syndrome.     

Effect of renzapride on transit in constipation-predominant irritable bowel syndrome.

BACKGROUND & AIMS: The aim of this study was to evaluate the dose-ranging pharmacodynamic effects of renzapride, a 5-hydroxytryptamine 4 (5-HT4) receptor full agonist/5-HT3 receptor antagonist, on gastrointestinal transit and symptoms in patients with constipation-predominant irritable bowel syndrome (C-IBS). METHODS: Forty-eight patients (46 women) with C-IBS underwent recording of baseline symptoms for 1 week. Twelve patients per group were randomized (double-blind, parallel design) to 11-14 days of renzapride (1, 2, or 4 mg) or placebo, once daily. Daily bowel habits and weekly satisfactory relief of IBS symptoms were recorded. At the end of treatment, gastric emptying (GE), small bowel transit (SBT), and colon transit (CT) were measured by scintigraphy. The relationship between CT and bowel function was evaluated. RESULTS: A statistically significant linear dose response to renzapride was detected for CT (GC8 h, P = 0.004; GC24 h, P = 0.056), and ascending colon (AC) emptying t1/2 (P = 0.019), but not for GE (t1/2, P = 0.088; or SBT, P = 0.41). AC half-time transit (t1/2) for placebo and 4 mg of renzapride were (median) 17.5 vs. 5.0 hours, respectively. Improved bowel function scores (stool form and ease of passage, but not frequency) were significantly (P < 0.05) associated with accelerated CT. Pharmacokinetic analysis showed linear kinetics of renzapride with a mean t1/2 in plasma of 10 hours. Bowel function and satisfactory relief were not significantly altered by renzapride, although a type II error cannot be excluded. No significant adverse clinical, laboratory, or electrocardiogram (ECG) effects were observed. CONCLUSIONS: Renzapride causes clinically significant dose-related acceleration of CT, particularly ascending colonic emptying; this acceleration of transit is associated with improvement of bowel function in female C-IBS patients.