难治性肠易激综合征患者的情绪障碍和治疗

背景:肠易激综合征(IBS)是目前最常见的功能性胃肠道疾病之一,然而其病因和发病机制至今尚不太清楚,临床治疗效果亦不十分理想。目的:探讨心理因素在难治性IBS发病中的作用和抗抑郁药对IBS的疗效。方法:分别对36例经常规治疗无效的腹泻型IBS患者和22名健康成人进行汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)和症状自评量表(SCL)鄄90评分以了解其心理状态,并对IBS患者的主要症状(腹部不适、疼痛和排便异常等)进行分级。在常规治疗的基础上随机予IBS患者选择性5鄄羟色胺再摄取抑制剂(SSRI)类抗抑郁药治疗,20例患者使用盐酸帕罗西汀,16例患者使用盐酸氟西汀,疗程均为12周。疗程结束后1周再进行上述量表评分和主要症状分级。结果:除精神病性因子分外,IBS患者HAMD、HAMA和SCL鄄90的总分和各因子分均显著高于健康对照组(P<0.001);接受抗抑郁药治疗12周后,各量表评分均显著低于治疗前(P<0.001或P<0.01),主要症状分级亦明显降低,按意图治疗(ITT)和方案(PP)分析,治愈率分别为47.2%和51.5%,总有效率分别为91.7%和100%。 结论:心理因素在IBS的发病中起重要作用。难治性IBS患者普遍存在抑郁、焦虑等情绪障碍,应用抗抑郁药治疗能显著改善IBS患者躯体和精神两方面的症状。     

认知治疗和小剂量抗抑郁药治疗难治性肠易激综合征的比较

目的 探讨心理疗法结合小剂量抗抑郁药治疗难治性肠易激综合征（IBS）的可行性。方法 以症状性焦虑、症状严重程度指数、生活质量及精神症状积分为临床疗效评价指标。比较小剂量抗抑郁药和认知方法治疗难治性IBS的反应特征。根据自愿的原则，采用自身对照研究，符合罗马Ⅱ标准的难治性非便秘型IBS患者68例，其中46例选择小剂量抗抑郁药治疗，22例选择认知治疗，疗程均为2－3个月。结果 两组的所有基线参数无显著差异，所有患者均完成疗程。治疗后，两组患者的症状指数和症状相关焦虑显著改善（P＜0.01)；与治疗前比较，第一随访单元患者症状性焦虑各项积分以及症状严重程度指数和频率指数均显著降低（P＝0.000)，两治疗组无明显的差异。但认知治疗组在初步的健康教育和2周认知治疗后，所有的症状性焦虑积分明显降低（P＜0.05)；而抗抑郁药治疗组在开始治疗4周后才出现。两个治疗组均可明显改善患者的生活质量，但抗抑郁药治疗组食物逃避积分改善不明显，并且抗抑郁治疗后所有参数的改善与症状严重性改善相平行。认知治疗可显著改善患者的积极应对积分（P＝0.000)，抗抑郁药治疗则对患者的应对策略无影响。结论 抗抑郁药和认知治疗都是难治性IBS有效的治疗手段，治疗反应各有特征，两者的联合应用将有助于提高治疗的针对性，增加疗效。     

腹泻型肠易激综合征神经调节剂的选择和疗效

目的调查腹泻型肠易激综合征(IBS-D)患者的消化道症状、精神心理状况和使用神经调节剂治疗情况,分析、探讨IBS-D患者神经调节剂选择和疗效。方法连续纳入符合罗马Ⅲ诊断和分型标准的IBS-D患者,以面对面方式问卷调查患者消化道症状和诊疗情况,并进行汉密尔顿焦虑量表(HAMA)和抑郁量表(HAMD)测评,临床医师根据患者病情处方神经调节剂,对患者随诊记录的疗效进行评分。采用t检验、非参数检验、χ~2检验和Spearman秩相关分析进行统计分析。结果共纳入IBS-D患者410例,其中116例(28.3%)处方了神经调节剂(≥2周),19例(16.4%)未随访。神经调节剂治疗组合并中重度焦虑、抑郁比例高于常规治疗组(P=0.001;P=0.000);排便前腹痛/腹部不适频率更高(P=0.005)、排便后腹痛/腹部不适症状更难以改善(P=0.045)。97.9%(95/97)患者服用神经调节剂后情绪、睡眠、腹痛/腹部不适和腹泻4种症状均有不同程度改善。用药后起效时间为(0.8±0.4)个月,最佳疗程为(3.5±2.8)个月。用药后情绪、腹痛/腹部不适、腹泻改善程度与用药疗程均呈正相关(r=0.344;r=0.322;r=0.381)。最常用药为帕罗西汀和米氮平,共占78.4%(76/97);帕罗西汀治疗后情绪显著改善者基线认知障碍因子评分更低(P=0.036),腹泻显著改善者基线精神性焦虑、迟滞因子评分更高(P=0.034;P=0.028);米氮平治疗后腹痛/腹部不适和腹泻显著改善者基线睡眠障碍因子评分更高(P=0.008;P=0.003)。结论神经调节剂适用于合并中重度焦虑和/或抑郁,或肠道症状重的难治性IBS-D患者;个体化选择神经调节剂、足疗程和维持用药可明显提高整体治疗效果。     

氟哌噻吨美利曲辛联合马来酸曲美布汀治疗肠易激综合征疗效分析

肠易激综合征（IBS）是一种以腹痛或腹部不适伴大便习惯改变和（或）大便性状异常为特征的慢性功能性肠道疾病[1]。目前IBS的发病机制尚不明确,可能与心理、精神、感染等诸多因素有关[2]。有研究表明,IBS患者常伴有焦虑、抑郁等症状,本研究旨在观察促动力药马来酸曲美布汀联合抗抑郁药物氟哌噻吨美利曲辛在IBS中应用效果。     

神经递质调节剂在肠易激综合征治疗中的应用

肠易激综合征(irritable bowel syndrome,IBS)是以反复发作的腹痛、腹部不适伴排便习惯和/或性状改为主要症状的功能性胃肠病,多数患者合并精神心理障碍、焦虑、抑郁和神经过敏等症状.IBS发病机制包括肠动力异常、内脏高敏感、脑-肠轴互动异常、精神心理障碍等.目前常规治疗药物包括解痉药、促动力药、止泻剂、通便药、益生菌和抗生素等.小剂量抗胆碱能和单胺类神经递质及其受体激动剂或拮抗剂能有效治疗IBS,不仅能够调节胃肠道动力,降低内脏高敏感性,还能改善焦虑、抑郁症状,提高生活质量.神经递质调节药物治疗IBS的有效性和安全性仍需要更多随机对照、长期随访的临床研究证据.     

加用氟哌噻吨美利曲辛片治疗肠易激综合征伴抑郁焦虑的疗效

背景:精神心理因素在功能性胃肠病中起重要作用,抑郁焦虑等情感障碍与肠易激综合征(IBS)可能有着共同的发病机制,故抗抑郁焦虑在IBS治疗中越来越被重视。目的:评价加用氟哌噻吨美利曲辛片治疗IBS伴抑郁焦虑的疗效。方法:将60例IBS伴抑郁焦虑患者随机分为对照组和治疗组。对照组予枯草杆菌二联活菌肠溶胶囊和马来酸曲美布汀,治疗组在此基础上加服氟哌噻吨美利曲辛片,疗程均为8周。治疗前后分别行汉密尔顿抑郁、焦虑量表以及症状评分。结果:与对照组相比,治疗组患者抑郁焦虑明显改善(P0.05);腹痛、腹泻的有效率明显升高(P0.05);症状总评分显著降低(P0.05);治疗总有效率显著升高(93.3%对76.7%,P0.05);而不良反应发生率无明显差异。结论:加用氟哌噻吨美利曲辛片可明显提高IBS伴抑郁焦虑的疗效。     

抗抑郁药治疗难治性消化不良的临床研究

目的探讨精神心理因素与难治性功能性消化不良(FD)的关系及抗抑郁药、心理治疗的疗效。方法对常规治疗无效的难治性功能性消化不良患者用Zung氏抑郁量表(SDS)检测，在常规FD治疗基础上，加用抗抑郁药、心理治疗12周，治疗前后用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评分。结果难治性功能性消化不良与精神心理因素有关。36例患者普遍存在程度不同抑郁状态。加用抗抑郁药、心理治疗，能改善躯体与精神症状。     

心内科门诊患者躯体症状与焦虑、抑郁的相关分析

目的对在广州地区综合医院心内科门诊就诊的患者进行焦虑、抑郁症状和躯体症状的现状调查,并探讨躯体症状与焦虑、抑郁的相互关系。方法通过随机抽样从广州市卫生局抽取广州6家大型综合医院,采用医院焦虑抑郁量表(hospital anxiety and depression scale,HADS)和患者健康问卷(patient health questionnaire-15,PHQ-15)对906例在综合医院心内科门诊就诊的患者进行量表评定,统计患者焦虑、抑郁检出率及不同程度躯体症状患者焦虑、抑郁患病相对危险度。结果906例门诊患者中,焦虑、抑郁及焦虑、抑郁合并现患病率分别为12.6%、9.7%、16.6%。躯体症状与焦虑、抑郁的相关分析显示,PHQ-15总分、PHQ-15阳性症状数目与HADS总分(r=0.512,P<0.01;r=0.475,P<0.01)、HAD-A因子分(r=0.504,P<0.01;r=0.469,P<0.01)及HAD-D因子分(r=0.431,P<0.01;r=0.399,P<0.01)呈正相关。躯体症状轻度(PHQ-15,5～9分)、中度(PHQ-15,10～14分)、重度(PHQ-15,15～30分)患者焦虑患病的相对危险度(relative risk,RR)及95%可信区间(confidence interval,CI)分别为4.41(1.98～9.86)、13.95(6.38～30.51)、47.73(18.74～121.53);抑郁患病的相对危险度[RR(95%CI)]分别为2.14(0.95～4.83)、6.96(3.12～15.51)、15.70(6.26～39.36);焦虑、抑郁合并患病的相对危险度[RR(95%CI)]分别为3.56(1.59～7.95)、10.70(4.91～23.32)、32.66(13.68～78.02)。结论综合医院心内科门诊就诊患者焦虑、抑郁常见;躯体症状与焦虑、抑郁密切相关,躯体症状程度越重,躯体症状数目越多,患焦虑、抑郁相对危险度越高。     

焦虑及其结构因子与腹泻型肠易激综合征患者症状的相关性

背景:肠易激综合征(IBS)患者常合并焦虑,焦虑可影响IBS症状的严重程度和治疗效果。目的:了解腹泻型IBS(IBS-D)患者的临床总体症状、精神心理状况,并探讨焦虑及其结构因子与患者症状的关系。方法:连续纳入符合罗马Ⅲ标准的IBS-D患者,以面对面问卷调查的方式评估患者症状,并进行汉密尔顿焦虑量表(HAMA)测评。分析HAMA及其结构因子与IBS-D患者肠道主要症状、排便症状、重叠上消化道症状、胃肠道外症状的相关性。结果:共纳入410例IBS-D患者,264例(64. 4%)患者合并焦虑。与无焦虑患者比,合并焦虑的患者肠道主要症状评分、排便后腹痛/腹部不适评分明显升高,腹胀、排便费力、排黏液便、重叠胃食管反流病和胃肠道外症状的比例均显著升高(P 0. 05)。精神性焦虑与肠道症状评分、排便后腹痛/腹部不适改善程度存在相关性(P 0. 05);躯体性焦虑与排便前腹痛/腹部不适程度相关性较强(P 0. 05); HAMA各结构因子与患者平时(非发作期)和IBS发作时排便次数和粪便性状变化无明显相关性。腹胀、排黏液便、重叠胃食管反流病、重叠胃肠道外症状者的HAMA总分、精神性焦虑和躯体性焦虑因子评分显著高于无相应症状者(P 0. 05)。结论:焦虑及其结构因子主要与IBSD患者腹痛/腹部不适严重程度有关,与排便次数和粪便性状无关。     

抗抑郁药物治疗肠易激综合征的研究进展

肠易激综合征(IBS)是常见的功能性胃肠病之一,严重影响患者生活质量。目前IBS的发病机制尚未明确,内脏敏感性增高、中枢痛觉异常可能参与发病过程。抗抑郁药物可改善IBS患者腹痛、腹部不适、精神障碍、排便异常,提高患者生活质量。本文就抗抑郁药物治疗IBS的研究进展作一综述。     

替加色罗治疗肠易激综合征的系统评价

目的 评价替加色罗治疗肠易激综合征(irritable bowel syndrome,IBS)的有效性和安全性.方法 对替加色罗治疗便秘型或非腹泻型IBS的随机对照试验(RCTs)进行系统评价.结果 共纳入13项RCTs,7 189例患者.替加色罗12 mg/d和4 mg/d对总体IBS症状的改善均优于安慰剂;对腹痛/腹部不适症状的缓解与安慰剂比无显著差异;对腹胀的疗效,各研究结果不一致;腹泻发生率显著高于安慰剂,替加色罗组报道了2例缺血性心脏病,严重不良事件的发生率与安慰剂比无显著差异.结论 替加色罗能改善便秘型或非腹泻型IBS患者的总体症状;缓解腹痛/腹部不适和腹胀等症状的证据不足;腹泻是替加色罗的主要不良反应.     

Effectiveness of probiotics in irritable bowel syndrome:Updated systematic review with meta-analysis

AIM:To investigate the efficacy of probiotics in irritable bowel syndrome(IBS) patients.METHODS:Pub Med,Cochrane library,Scopus,Google Scholar,and Clinicaltrial.gov databases were searched for literature published between September 2007 and December 2013.The applied Mesh terms were "probiotics," "irritable bowel syndrome," and "irritable bowel syndrome treatment." The collected data contained24 clinical trials,of which 15 were eligible for meta-analysis and nine were reviewed systematically.All studies were randomized placebo-controlled trials in patients with IBS that investigated the efficacy of probiotics in IBS improvement.The Jadad score was used to assess the methodological quality of trials.The quality scale ranges from 0 to 5 points,with a score ≤ 2 indicating a low quality report,and a score of ≥3 indicating a high quality report.Relative risk(RR),standardized effect size,and 95%CI were calculated using the Der Simonian-Laird method.The Cochran Q test was used to test heterogeneity with P 0.05.Funnel plots were constructed and Egger's and BeggMazumdar tests were performed to assess publication bias.RESULTS:A total of 1793 patients were included in the meta-analysis.The RR of responders to therapies based on abdominal pain score in IBS patients for two included trials comparing probiotics to placebo was 1.96(95%CI:1.14-3.36;P = 0.01).RR of responders to therapies based on a global symptom score in IBS patients for two included trials comparing probiotics with placebo was 2.43(95%CI:1.13-5.21;P = 0.02).For adequate improvement of general symptoms in IBS patients,the RR of seven included trials(six studies) comparing probiotics with placebo was 2.14(95%CI:1.08-4.26;P = 0.03).Distension,bloating,and flatulence were evaluated using an IBS severity scoring system in three trials(two studies) to compare the effect of probiotic therapy in IBS patients with placebo,the standardized effect size of mean differences for probiotics therapy was-2.57(95%CI:-13.05--7.92).CONCLUSION:Probiotics reduce pain and symptom severity scores.The results demonstrate the beneficial effects of probiotics in IBS patients in comparison with placebo.     

Antidepressant Therapy (Imipramine and Citalopram) for Irritable Bowel Syndrome: A Double-Blind,Randomized, Placebo-Controlled Trial

Background The efficacy of antidepressants in irritable bowel syndrome (IBS) is controversial. No trials have directly compared a tricyclic with a selective serotonin reuptake inhibitor. Our aim was to determine whether imipramine and citalopram are efficacious in IBS. Methods This was a randomized, double-blind, placebo-controlled, parallel group pilot trial with imipramine (50 mg) and citalopram (40 mg). Results Of 51 IBS patients randomized, baseline characteristics were comparable among the treatment arms; the majority was diarrhea-predominant. Adequate relief of IBS symptoms (primary endpoint) was similar for each treatment arm. Improvements in bowel symptom severity rating for interference (P = 0.05) and distress (P = 0.02) were greater with imipramine versus placebo, but improvements in abdominal pain were not. There was a greater improvement in depression score (P = 0.08) and in the SF-36 Mental Component Score (P = 0.07), with imipramine. Citalopram was not superior to placebo. Approximately 20% of the variance in scores was explained by treatment differences for abdominal pain, bowel symptom severity disability, depression and the mental component of the SF-36. Conclusion Neither imipramine nor citalopram significantly improved global IBS endpoints over placebo.     

A controlled crossover study of the selective serotonin reuptake inhibitor citalopram in irritable bowel syndrome

INTRODUCTION: Selective serotonin reuptake inhibitors (SSRIs) are frequently used in the treatment of irritable bowel syndrome (IBS) although evidence of their efficacy is scarce. AIM: Twenty three non-depressed IBS patients were recruited from a tertiary care centre and included in a crossover trial comparing six weeks of treatment with the SSRI citalopram (20 mg for three weeks, 40 mg for three weeks) with placebo. IBS symptom severity was the primary outcome measure, and depression and anxiety scores were also measured. The effect of acute administration of citalopram on colonic sensitivity and on colonic response to feeding was investigated as a putative predictor of symptomatic response to the drug. RESULTS: After three and six weeks of treatment, citalopram significantly improved abdominal pain, bloating, impact of symptoms on daily life, and overall well being compared with placebo. There was only a modest effect on stool pattern. Changes in depression or anxiety scores were not related to symptom improvement. The effect of acute administration of citalopram during a colonic barostat study did not predict clinical outcome. Analysis of the first treatment period as a double blind parallel arm study confirmed the benefit of citalopram over placebo. CONCLUSIONS: The SSRI citalopram significantly improves IBS symptoms, including abdominal pain, compared with placebo. The therapeutic effect is independent of effects on anxiety, depression, and colonic sensorimotor function.     

Meta-analysis of probiotics for the treatment of irritable bowel syndrome

Irritable bowel syndrome （IBS） is a chronic condition affecting 3%-25% of the general population. As no curative treatment is available, therapy is aimed at reducing symptoms, often with little success. Because alteration of the normal intestinal microflora has been observed in IBS, probiotics （beneficial microbes taken to improve health） may be useful in reducing symptoms. This paper systematically reviews randomized, controlled, blinded bials of probiotics for the treatment of IBS and synthesizes data on efficacy across trials of adequate quality. Pubr4ed, Medline, Google Scholar, NIH registry of clinical trials, metaRegister, and the Cochrane Central Register of Controlled Trials were searched from 1982-2007. We also conducted secondary searches of reference lists, reviews, commentaries, relevant articles on associated diseases, books and meeting abstracts. Twenty trials with 23 probiotic treatment arms and a total of 1404 subjects met inclusion criteria. Probiotic use was associated with improvement in global IBS symptoms compared to placebo [pooled relative risk （RRpooled） 0.77, 95% confidence interval （95% CI） 0.62-0.94]. Probiotics were also associated with less abdominal pain compared to placebo [RRpooled = 0.78 （0.69-0.88）]. Too few studies reported data on other IBS symptoms or on specific probiotic strains to allow estimation of a pooled RR. While our analyses suggest that probiotic use may be associated with improvement in IBS symptoms compared to placebo, these results should be interpreted with caution, given the methodological limitations of contributing studies. Probiotics warrant further study as a potential therapy for IBS.     

A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome

OBJECTIVES: The purpose of this study was to evaluate the effects of a probiotic combination on symptoms in patients with irritable bowel syndrome (IBS). METHODS: We investigated the efficiency of a probiotic dietary supplement, containing four strains of lactic acid bacteria, on symptoms of IBS. One hundred and sixteen patients with IBS fulfilling the Rome II criteria were randomized in a parallel group, double-blind study to receive a placebo or a probiotic combination (1 x 10(10) cfu once daily) for four weeks. The symptoms that were monitored weekly included discomfort, abdominal pain, and stool frequency and quality. Quality of life was assessed before and at the end of the treatment using the SF36 and FDD-quality-of-life questionnaires. RESULTS: One hundred subjects completed the study (48 probiotic combination, 52 placebo). The probiotic combination was not superior to the placebo in relieving symptoms of IBS (42.6 versus 42.3% improvement). However, the decrease of abdominal pain between the first and the fourth week of treatment was significantly higher in probiotic treated patients (-41.9 versus -24.2%, P=0.048). Interesting findings from the IBS sub-groups were also observed such as a lower pain score at end point in patients with alternating bowel habits (P=0.023) and an increase of stool frequency in the constipated sub-group from the first week of probiotic treatment (P=0.043). CONCLUSIONS: The probiotic combination was not significantly superior to the placebo in relieving symptoms of IBS. Despite the apparent high placebo response, interesting findings from IBS sub-groups were observed in the field of abdominal pain and stool frequency.     

混合型5-HT_4受体激动剂/5-HT_3受体拮抗剂治疗肠易激综合征的系统评价

目的:系统评价混合型5-HT4受体激动剂/5-HT3受体拮抗剂(西沙必利、莫沙必利、伦扎必利)治疗肠易激综合征(IBS)的有效性和安全性.方法:采用Cochrane协作网推荐的方法,对纳入的全世界范围内有关西沙必利、莫沙必利、伦扎必利治疗肠易激综合征的8个随机对照试验(n=2841)进行系统评价.结果:Meta分析结果显示,西沙必利对IBS总体症状[RR=0.91,95%CI(0.58,1.43)]、腹痛症状[RR=0.90,95%CI(0.72,1.11)]及便秘症状(RR=0.91,95%CI(0.74,1.12)的疗效均不优于安慰剂.伦扎必利1mg/d组和2mg/d组对IBS总体症状的疗效不优于安慰剂[RR=0.95,95%CI(0.67,1.35);RR=0.79,95%CI(0.67,1.17)],伦扎必利4mg/d组对IBS总体症状的疗效优于安慰剂[67.8%vs73.9%,RR=0.91,95%CI(0.86,0.96)].西沙必利[RR=1.52,95%CI(0.58,3.99)]和伦扎必利[RR=1.11,95%CI(0.98,1.24)]的药物不良事件发生率与安慰剂无显著性差异.结论:伦扎...     

Relationship of functional gastrointestinal disorders and psychiatric disorders： Implications for treatment

This article revisits the links between psychopathology and functional gastrointestinal disorders such as irritable bowel syndrome （IBS）, discusses the rational use of antidepressants as well as non-pharmacological approaches to the management of IBS, and suggests guidelines for the treatment of IBS based on an interdisciplinary perspective from the present state of knowledge. Relevant published literature on psychiatric disorders, especially somatization disorder, in the context of [BS, and literature providing direction for management is reviewed, and new directions are provided from findings in the literature. IBS is a heterogeneous syndrome with various potential mechanisms responsible for its clinical presentations. IBS is typically complicated with psychiatric issues, unexplained symptoms, and functional syndromes in other organ systems. Most IBS patients have multiple complaints without demonstrated cause, and that these symptoms can involve systems other than the intestine, e.g. bones and joints （fibromyalgia, temporomandibular joint syndrome）, heart （non-cardiac chest pain）, vascular （post-menopausal syndrome）, and brain （anxiety, depression）. Host IBS patients do not have psychiatric illness per se, but a range of psychoform （psychological complaints in the absence of psychiatric disorder） symptoms that accompany their somatoform （physical symptoms in the absence of medical disorder） complaints. It is not correct to label IBS patients as psychiatric patients （except those more difficult patients with true somatization disorder）. One mode of treatment is unlikely to be universally effective or to resolve most symptoms. The techniques of psychotherapy or cognitive-behavioral therapy can allow IBS patients to cope more readily with their illness. Specific episodes of depressive or anxiety disorders can be managed as appropriate for those conditions. Medications designed to improve anxiety or depression are not uniformly useful for psychiatric complaints in IBS, because the p     

Oral cimetropium bromide, a new antimuscarinic drug, for long-term treatment of irritable bowel syndrome

Most drugs are ineffective for the long-term treatment of irritable bowel syndrome (IBS). The beneficial effects of medical treatment of IBS are poor and last for only a relative short time. Over a period of 6 months, we investigated the effectiveness of cimetropium bromide, a new antimuscarinic compound, in patients with IBS. Forty-eight patients were treated at random and in double-blind fashion with cimetropium bromide (50 mg, tid) or placebo for 6 months. Personal diary cards and monthly check-ups guaranteed the monitoring of symptoms (mainly pain). In addition, personality patterns (MHQ-CBA tests) were obtained for the patients before and after therapy, both to detect possible psychoneurotic traits and to observe the changes in these traits in relation to the changes in pain symptoms. Three patients on placebo and one on cimetropium dropped out. At the end of therapy, pain scores had decreased an average of 16% in the placebo group and 87% in the cimetropium group (p less than 0.01). Twenty patients (87%) on cimetropium versus five patients (24%) on placebo considered themselves to be globally improved (p less than 0.01). The MHQ test showed significant improvement in the anxiety score in the cimetropium group only. The CBA test confirmed a significant decrease in anxiety state (STAI-X-1) after cimetropium treatment. Eleven patients (48%) on cimetropium reported side effects (mainly dry mouth and sleepiness), but none withdrew from the study. The results of this trial indicate that long-term treatment of IBS with cimetropium bromide significantly improves symptoms and associated psychological disorders.