益生菌和肠易激综合征

肠易激综合征(IBS)的发病机制主要与内脏敏感性、肠道动力异常等有关,目前证实某些益生菌可以减轻IBS腹痛、腹胀等症状.此文主要对IBS病理生理机制、益生菌对IBS的可能作用以及在IBS治疗中的应用作一综述.     

益生菌和肠易激综合征的关系

肠易激综合征(IBS)是最常见的功能性胃肠病之一,其发病机制目前还不明确。近年发现肠道微生物群可能参与了IBS的发生发展,细菌感染可以诱发感染后IBS;有一部分IBS患者存在小肠细菌过度生长(SIBO)或是菌群组成改变;口服肠道不吸收的抗生素能够减轻IBS的症状。因此有人提出用益生菌治疗IBS可能是一个合理的方法。此文就益生菌治疗IBS的相关研究作一综述。     

益生菌在肠易激综合征治疗中的作用

肠易激综合征(irritable bowel syndrome,IBS)是一组以排便后可缓解或减轻的腹痛或腹部不适为主要症状的功能性肠道疾病.近年来,益生菌用于IBS治疗的疗效引起了人们的兴趣和重视.益生菌是指摄人一定数量,能以活菌状态到达宿主胃肠道,以治疗和预防疾病的微生物.人体内的益生菌包括乳酸杆菌属、双歧杆菌属、芽孢杆菌属等.     

益生菌对肠易激综合征和炎症性肠病的作用

由于胃肠道微生物参与炎症性肠病（inflammatory bowel disease,IBD）的病理过程,而且最近研究表明微生物可能在肠易激综合征（irritable bowel syndrome,IBS）中扮演重要作用.本文重点关注益生菌在这两种疾病中的作用机制和疗效.胃肠道微生物的组成受多种因素调节,包括年龄、饮食和疾病状态.益生菌可能通过影响宿主的微生物菌群和提高黏膜的免疫调节作用发挥疗效.益生菌的口服耐受性较好.许多短期研究表明益生菌在IBS中有效,尽管只是在部分的特殊菌株和某些特定症状中有效.在IBD中,许多临床试验表明大量的益生菌在结肠袋炎和溃疡性结肠炎中有效,而对克罗恩病无明显疗效.显然,益生菌在IBS和IBD的治疗中能起到巨大的作用,但是,这些只是针对特殊的菌株.将来迫切需要进行高质量的临床研究和实验观察益菌对IBD和IBS的疗效.     

益生菌治疗肠易激综合征128例临床观察

目的观察益生菌治疗肠易激综合征的疗效。方法选择医院门诊治疗的肠易激综合征患者128例,随机分为观察组和对照组各64例。对照组给予解痉、通便治疗,观察组采用益生菌联合解痉、通便治疗。比较两组疗效。结果观察组治疗总有效率（93．75％）明显高于对照组（73．44％）,两组比较差异有统计学意义（P〈0．05）。结论益生菌对改善肠易激综合征患者的临床症状有一定效果。     

鼠李糖乳杆菌治疗肠易激综合征机制新进展

肠易激综合征(irritable bowel syndrome,IBS)是临床上常见的功能性胃肠病,其会影响患者的生活质量.因此探寻IBS的有效治疗方法具有重要意义.益生菌可改善IBS患者的症状并提高其生活质量,其中备受关注的是鼠李糖乳杆菌(Lactobacillus rhamnosus GG,LGG).LGG是目前被...     

加强益生菌对肠易激综合征治疗的研究

在消化科门诊中,肠易激综合征（IBS）是常见疾病之一.由于病因和发病机制复杂,临床上缺乏十分有效的治疗药物.近年来随着研究的深入,不少学者开始注意到肠腔内菌群失调在IBS发病机制中的重要地位,因此,根据微生态理论采用益生菌及其产物治疗IBS具有可行性。     

肠易激综合征中医药治疗机制研究现状

肠易激综合征(irritable bowel syndrome,IBS)是一种肠道功能性疾病,为常见病、多发病.西医对IBS的发病机制目前尚未完全清楚,一般认为与胃肠动力、内脏敏感性、脑-肠轴、神经-内分泌-免疫网络等功能异常及肠道菌群失调、肠道感染等多种因素有关.目前对IBS的治疗,现代医学方面尚缺特效药物,而中医药却有独到之处.应用现代医学的方法研究中医药治疗IBS的作用机制日受重视,许多中医学者从多角度探索IBS不同中医证候物质基础的差异及中药干预的可能作用途径.本文将10年来IBS的中医证候物质基础、中医药治疗IBS作用机制的临床及实验研究文献综述如下.     

肠易激综合征的发病机制及治疗研究进展

<正>肠易激综合征(irritable bowel syndrome,IBS)是一种常见的功能性胃肠病,以腹痛、腹部不适、腹胀和排便习惯改变为特征。据报道,人群患病率高达5%～15%,且有逐年增高的趋势[1]。目前该病的发病机制仍不明确,治疗也不统一,本文主要针对IBS的发病机制及相关治疗的研究进展作一综述。     

中西医结合治疗肠易激综合征疗效观察

肠易激综合征（IBS）主要临床表现是慢性腹泻，或腹泻与便秘交替，伴腹胀腹痛。现代医学对IBS的治疗方法主要是止泻与对症治疗为主，但疗效欠满意，而单用中药治疗，疗程较长，又易复发。笔者自1994年至今．用中医辨证用药加服洛赛克治疗40例IBS患者，疗效满意，现总结报道如下。1临床资料1．1一股资料：40例IBS患者来自我科门诊和住院病例，均符合1986年11月全国慢性腹泻学术会制定《肠易激综合征》临床诊断标准、并全部经X光或结肠镜检排除肠道内器质性病变。其中男28例，女12例，年龄19～68岁，病程6个月～4年，发病1年以上者36例…     

Nuances in treating irritable bowel syndrome

Irritable bowel syndrome (IBS) is a difficult disease to treat because of its ill-defined triggers, variable clinical course, and unpredictable myriad of symptoms of varying severity. Both doctors and patients are frustrated by the insidious nature of IBS--a nonlethal disorder that destroys lives, relationships, and careers. Traditional therapies are sometimes effective in mild disease but are often self-limiting because they focus primarily on individual symptoms. A combination of lifestyle and diet modifications, pharmacologic agents, and therapeutic interventions is usually necessary to address the multiple symptoms characteristic of IBS. One of the major advancements in the treatment of patients with IBS has been the development of US Food and Drug Administration--approved serotonergic therapeutics that specifically target the underlying causes of IBS and provide multisymptom relief by improving gastrointestinal function. Although they are controversial, alternative treatment approaches that target normalization of intestinal bacterial microflora may be helpful for some patients in whom intestinal bacterial overgrowth is present. Patients who have co-existing pelvic floor dysfunction may benefit from physical therapy. Overall, treatment approaches for IBS should address multisymptom relief and improvement of overall patient well-being.     

Legal risks in treating irritable bowel syndrome

Physicians who treat irritable bowel syndrome (IBS) reasonably seek strategies to reduce the risk of malpractice. They are concerned that, in the absence of laboratory or radiographic markers specific for the disorder, what appears to be a reasonable diagnosis of IBS could lead to a malpractice claim if an alternate diagnosis is later discovered. Physicians need to understand the sources of malpractice risk, and risk management strategies related to these sources, to reduce their exposure to liability suits in this area. This article outlines these sources of risk, or conditions under which physicians may be sued, known as torts. The tort of negligence is covered, including its 4 elements: the duty to provide care to a patient, medical practice below the standard of care, the resultant harm, and the establishment of compensable damages. The concepts of informed consent and vicarious liability are also presented. This discussion is developed within the context of a risk management approach, to assist physicians in developing a preventative approach to malpractice liability when considering the diagnosis of IBS.     

The role of probiotics in management of irritable bowel syndrome

Inflammatory bowel syndrome (IBS) affects a significant proportion of the North American population; however, the etiology and pathophysiology of this disease remain poorly understood, and treatment is focused on symptom management. Over the years, research has revealed that the bacterial flora in the human gut interact with the bowel in a complex and dynamic relationship and may be responsible for the induction and progression of some of the pathophysiologic aspects of IBS. Probiotics are nonpathogenic bacteria that benefit the host, and the roles they can play in the bacterio-gut relationship provide hope of a safe treatment that would allow for modulation of IBS disease states. Probiotic treatment for IBS has undergone significant exploration, yet the exact therapeutic effects and doses of these beneficial bacteria remain unclear due to the conflicting nature of available evidence. This review discusses the evidence from randomized controlled trials on probiotic treatment of IBS and presents the current understanding of the mechanisms of action of probiotics as they apply to IBS and provides a plausible explanation for the variability in evidence documented by the various trials under review.     

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.     

The effects of probiotics on symptoms of irritable bowel syndrome]

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) tract disorder that has heterogeneous clinical presentations such as abdominal pain, diarrhea, constipation, and abdominal distension. It is known that several mechanisms are involved in the pathogenesis of IBS. Probiotics may target one or more pathophysiologic pathways in IBS and may improve the symptoms of IBS. However, the results of studies about probiotics on IBS are controversial. Therefore, the aim of this study was to evaluate the effect of probiotics on GI symptoms and intestinal gas volume changes in patients with IBS. METHODS: Forty patients were randomly allocated to be treated with Medilac DS (Bacillus subtilis, Streptococcus faecium) (n=20) or placebo (n=20) in a double-blind, prospective manner. The change in intestinal gas volume and symptom scores after 4-week treatment were evaluated for the efficacy. RESULTS: There was no significant difference in bloating, frequency of gas expulsion, frequency of defecation, and hardness of stool before and after the treatment. However, the severity of abdominal pain and the frequency of abdominal pain decreased significantly in Medilac DS group (2.4+/-1.3 cm/day --> 1.6+/-1.6 cm/day, 1.7+/-1.3/day --> 1.0+/-1.0/day) (p=0.044, p=0.038), but not in placebo group (2.1+/-2.0 cm/day --> 1.8+/-2.1 cm/day, 1.3+/-1.2/day --> 1.4+/-1.9/day). In both groups, intestinal gas volume at baseline, after 2-week treatment, and after 4-week treatment did not show significant change. Medilac DS was well tolerated without adverse events. CONCLUSIONS: Medilac DS is a safe and useful probiotic agent for the treatment of abdominal pain in patients with IBS.     

乳果糖联合微生态制剂对便秘型肠易激综合征的疗效观察

[目的]探讨乳果糖口服液联合微生态制剂(美常安)治疗便秘型肠易激综合征(IBS-C)的临床疗效。[方法]IBS-C患者231例,随机分为联合治疗组(71例)、乳果糖组(84例)和莫沙必利组(76例),疗程均为8周。记录及评价3组患者治疗前后的排便次数、大便性状及便秘程度。[结果]治疗后,排便次数及大便Bristol评分:3组均较治疗前明显提高,且治疗前后3组之间两两相比较差异无统计学意义。便秘程度的AGACHAN得分:治疗前3组之间比较差异无统计学意义;治疗后,3组均较治疗前明显降低,且联合治疗组明显低于乳果糖组、莫沙必利组,差异有统计学意义(P0.05),而乳果糖组与莫沙必利组治疗后评分差异无统计学意义(P0.05)。[结论]乳果糖联合益生菌可明显改善IBS-C患者便秘程度,但在改善大便性状及大便次数方面与单用乳果糖、莫沙必利的疗效无差别。     

Gut dysbiosis and irritable bowel syndrome: The potential role of probiotics

Objective

To discuss the role of gut dysbiosis in the development of irritable bowel syndrome (IBS) and the impact of probiotics as a potential therapeutic measure.