马来酸曲美布汀联合地衣芽孢杆菌治疗腹泻型肠易激综合征疗效分析

目的探讨马来酸曲美布汀联合地衣芽孢杆菌治疗腹泻型肠易激综合征（IBS）的临床疗效。方法将125例腹泻型IBS患者随机分为3组，A组给予曲美布汀及地衣芽孢杆菌，B组单用曲美布汀，C组单用地衣芽孢杆菌，疗程4周，观察各组临床疗效。结果A组临床总有效率为96．2％，B组临床总有效率为60．0％，C组临床总有效率为48．5％，三组疗效比较，P〈0．05，差异有统计学意义。结论马来酸曲美布汀联合地衣芽孢杆菌治疗腹泻型IBS有明显的协同作用，临床疗效确切，可推广应用。     

马来酸曲美布汀治疗肠易激综合征对比研究

目的探讨马来酸曲美布汀对肠易激综合征的治疗效果。方法将诊断为肠易激综合征（IBS）的97例患者随机分成试验组（47例）和对照组（50例），试验组给予马来酸曲美布汀，对照组使用复合维生素B作为安慰剂，两组疗程均为6周，治疗期间均停用其他药物，分别于治疗前及治疗的第2、4、6周及随访8、12周末进行症状评价及评分。结果试验组治疗后积分明显下降，治疗前后比较差异有非常显著性（P〈0．01）；对照组积分下降不明显，治疗前后比较差异无显著性（P〉0．05）；治疗4周后两组间比较，试验组积分下降较对照组明显，差异有非常显著性（P〈0．01）；治疗后两组疗效比较，试验组在2周后有效率达34％，8周和12周时分别达到83％和82％，疗效明显高于对照组，差异有非常显著性（P〈0．01）。结论马来酸曲美布汀对难治性功能性消化不良具有良好的治疗作用和安全性。     

马来酸曲美布汀治疗肠易激综合征疗效和安全性研究

目的评估马来酸曲美布汀治疗肠易激综合征(IBS)的疗效和安全性.方法采用前瞻性临床研究,予符合罗马Ⅲ标准的62例IBS患者口服马来酸曲美布汀4周。研究包括2周基线期,2周治疗期,4周治疗期和随后的2周随访期。治疗前后分别记录症状并检查肝、肾功能。结果62例IBS患者治疗4周后,总改善率为81.2%,IBS的主要症状明显改善。研究期间未发生明显不良反应。结论马来酸曲美布汀治疗IBS安全有效,值得临床推广。     

奥美拉唑联合马来酸曲美布汀治疗反流性食管炎30例

[目的]观察奥美拉唑联合马来酸曲美布汀治疗反流性食管炎（RE）的临床疗效。[方法358例患者随机分为2组,观察组30例,予奥美拉唑20rng,每日2次,马来酸曲美布汀0．1g,每日3次口服;对照组28例：予马来酸曲美布汀0．1g,每日3次口服。疗程均8周,观察烧心、反酸、胸痛等症状,并复查胃镜下愈合率。[结果]观察组临床总有效率100％,内镜下总有效率96．7％;对照组为75．0％及71．4％,2组比较差异有统计学意义（P〈0．05）。[结论]奥美拉唑联合马来酸曲美布汀治疗RE具有较好的疗效。     

美沙拉嗪联合马来酸曲美布汀治疗肠易激综合征患者的临床疗效观察

目的评估美沙拉嗪联合马来酸曲美布汀治疗肠易激综合征(IBS)患者的临床疗效。方法根据罗马Ⅲ诊断标准纳入2014年10月至2016年6月在上海市嘉定区中心医院就诊的腹泻型IBS(IBS-D)和便秘型IBS(IBS-C)患者各40例。40例IBS-D患者随机分为美沙拉嗪+马来酸曲美布汀组和马来酸曲美布汀组,每组各20例;40例IBS-C患者随机分为美沙拉嗪+马来酸曲美布汀组和马来酸曲美布汀组,每组各20例。同期选择20名健康体检者作为正常对照。治疗前后均使用肠易激严重程度评分系统(IBSSS)和医院焦虑抑郁量表(HADS)评估患者的临床疗效和情绪障碍的严重程度。结果研究过程中未观察到严重的药物相关不良反应。在IBS-D患者中,美沙拉嗪+马来酸曲美布汀组经过4周治疗后,IBSSS总分由基线时的(194.5±62.6)分下降至(136.3±47.2)分(P0.000 1),而马来酸曲美布汀单药组则由治疗前的(207.3±49.2)分下降至治疗后的(197.5±47.8)分(P=0.01);在IBS-C患者中,美沙拉嗪+马来酸曲美布汀组经过4周治疗后,IBSSS总分由基线时的(245.8±70.4)分下降至(231.3±65.0)分(P=0.005)。基线状态时,IBS患者组的焦虑和(或)抑郁评分均高于健康对照组(P0.000 1)。在IBS-D患者中,美沙拉嗪+马来酸曲美布汀组经过4周治疗后,焦虑和抑郁评分分别由基线时的(11.9±4.1)分下降至(11.3±4.1)分(P=0.019)、(13.6±4.7)分下降至(12.5±4.5)分(P=0.002 6)。结论美沙拉嗪联合马来酸曲美布汀治疗可改善IBS患者,尤其是IBS-D患者的临床症状和精神心理障碍。     

马来酸曲美布汀联合谷维素治疗肠易激综合征72例疗效观察

目的观察马来酸曲美布汀联合谷维素治疗肠易激综合征（IBS）的I}缶床疗效及安全性。方法将同期收治的146例IBS患者随机分为观察组72例和对照组74例。两组均停用其他治疗IBS的药物,禁用影响胃肠功能药物,均予马来酸曲美布汀口服,200mg／次、3次／d。观察组在此基础上加服谷维素,100ms／次、3次／d,均以4周为1个疗程。观察治疗后IBS症状变化及药物不良反应。结果观察组总有效率显著高于对照组（P〈0．01）;两组不良反应发生率无显著差异。结论马来酸曲美布汀联合谷维素治疗IBS效果显著,安全性高。     

中西医结合治疗肠易激综合征40例

[目的]观察马来酸曲美布汀(商品名:双迪)联合四逆散加减治疗肠易激综合征(IBS)的疗效.[方法]60例IBS患者随机分为2组,治疗组40例予马来酸曲美布汀联合四逆散加减治疗;对照组20例单用马来酸曲美布汀治疗.[结果]治疗组总有效率92.5%,优于对照组的85.0%(P＜0.05).治疗组缓解腹痛和便秘症状亦优于对照组(均P＜0.05).[结论]马来酸曲美布汀联合四逆散加减治疗IBS疗效较为理想.     

马来酸曲美布汀治疗肠易激综合征的疗效和安全性研究

背景肠易激综合征(IBS)是一种常见的肠道功能性疾病,曲美布汀是一种具有胃肠道运动调节作用的药物,已广泛应用于IBS的治疗。目的评估马来酸曲美布汀治疗IBS的疗效和安全性。方法采用前瞻性、随机、对照、多中心临床研究,将符合罗马Ⅱ标准的79例便秘型IBS(C鄄IBS)患者和81例腹泻型IBS(D鄄IBS)患者分别随机分为马来酸曲美布汀组和匹维溴铵组。研究包括2周基线期、4周治疗期和随后的2周随访期。患者在治疗期内口服马来酸曲美布汀(200mgtid)或匹维溴铵(50mgtid)。主要疗效指标为每周总体症状的评分,次要疗效指标包括每周便秘/腹泻的严重程度评分、腹部胀气和其他IBS症状的严重程度评分。结果马来酸曲美布汀治疗后,C鄄IBS和D鄄IBS患者的总体症状评分均显著下降,分别由基线期的1.9和1.8下降至治疗期结束时的1.1和0.6(P<0.01),次要疗效指标也均显著改善;各症状的改善程度与匹维溴铵组比较均无显著差异。研究期间未发现明显不良反应。结论马来酸曲美布汀是一种安全、有效的缓解IBS症状的药物。     

马来酸曲美布汀联合复方阿嗪米特治疗功能性消化不良疗效观察

目的观察马来酸曲美布汀联合复方阿嗪米特肠溶片治疗功能性消化不良的疗效。方法将确诊为功能性消化不良的患者120例分成3组,观察组（A 组）40例,给予马来酸曲美布汀、复方阿嗪米特肠溶片口服;对照组（B 组）40例,单用马来酸曲美布汀口服;对照组（C 组）40例,单用复方阿嗪米特肠溶片口服,疗程均为4周。观察患者治疗前后腹胀及上腹部不适症状的改善情况。结果3组患者治疗后腹胀及上腹部不适症状改善均有统计学意义（P ＜0．05）,观察组较对照组症状改善明显。结论马来酸曲美布汀和复方阿嗪米特肠溶片联合治疗消化不良,疗效优于单用马来酸曲美布汀和复方阿嗪米特肠溶片。     

马来酸曲美布汀治疗肠易激综合征的临床疗效

目的：临床验证马来酸曲美布汀(诺为)治疗肠易激综合征(IBS)的疗效及安全性。方法：单一中心开放基础上对照研究。选择IBS患者54例，空白对照治疗2周，15例临床症状缓解，39侧进入诺为治疗组，口服200mg，tid，疗程2周，观察腹痛、腹泻、排便困难等症状变化。结果：诺为对腹痛治疗有效率为89．7％，腹泻有效率为90．0％，排便困难有效率为81.8％。总体评估总有效率为84．6％。临床未发现不良反应。结论：诺为治疗IBS是安全有效的。     

Efficacy of trimebutine therapy in patients with gastroesophageal reflux disease and irritable bowel syndrome

BACKGROUND/AIMS: GERD (gastroesophageal reflux disease) occurs in 25-51% of IBS (irritable bowel syndrome) patients. Trimebutine has been effective in some IBS patients by modulating colonic motility. Furthermore, it increases gastric emptying rates, and controls esophageal motility. The aim of this study was to investigate the efficacy of trimebutine therapy in GERD patients with IBS. METHODOLOGY: Sixty-nine patients with GERD and IBS underwent upper gastrointestinal endoscopic, histologic and clinical evaluation prior to and 3 months post-treatment. H. pylori presence was determined by histology and CLOtest. Forty patients (Group A) were treated with omeprazole plus trimebutine for 3 months: in 32 H. pylori-positive patients (subgroup A1), a standard triple eradication regimen was introduced. Twenty-nine patients (Group B) were treated with omeprazole for 3 months: in 24 H. pylori-positive patients (subgroup B1), the same eradication therapy was employed. RESULTS: Specialized intestinal metaplasia of the gastroesophageal junction was observed in 20% and in 17.2% of the patients in Groups A and B, respectively. Eradication rates were similar in subgroups A1 (84%) and B1 (83%). In Group A there was a significant improvement in GERD (P = 0.003) and IBS symptoms (P < 0.0001) as well as esophagitis (P = 0.029), when compared with Group B. CONCLUSIONS: Trimebutine appears to be effective in patients with GERD and IBS.     

马来酸曲美布丁联合匹维溴胺治疗肠易激综合征的疗效观察

目的观察马来酸曲美布丁联合匹维溴胺治疗肠易激综合征的疗效。方法将100例肠易激综合征患者随机分为2组：实验组（57例）应用马来酸曲美布丁0.1g tid、匹维溴胺50 mg tid治疗;对照组（43例）应用匹维溴胺50 mg tid治疗,疗程均为4周。结果实验组总有效率88%,对照组总有效率74%,存在显著性差异。结论马来酸曲美布丁联合匹维溴胺治疗肠易激综合征的疗效更好。     

不同药物治疗肠易激综合征的临床疗效

背景:肠易激综合征(IBS)是消化内科常见疾病之一,但目前所用药物尚不能对所有IBS症状有疗效。目的:分析不同药物对不同类型IBS的临床疗效。方法:136例便秘型IBS患者随机分为西沙必利或莫沙必利治疗组(A组)和西沙必利或莫沙必利+乳果糖治疗组(B组);72例腹泻型IBS患者随机分为匹维溴铵治疗组(C组)和马来酸曲美布汀治疗组(D组),分别观察治疗1周、1个月和3个月时的疗效。结果:A组1周、1个月和3个月时的总有效率分别为29.8％、25.3％和19.0％,而B组分别为69.2％、51.9％和41.2％,均显著高于A组(P<0.005、P<0.005和P<0.01)。C组1周、1个月和3个月时的总有效率分别为90.9％、67.7％和61.3％,而D组分别为79.5％、51.4％和31.4％,C组3个月时的总有效率显著高于D组(P<0.05)。各组的疗效在3个月时均有所降低,但B组和C组的总有效率仍较高。结论:单用西沙必利或莫沙必利治疗便秘型IBS疗效有限,加用乳果糖可提高疗效。匹维溴铵和马来酸曲美布汀对腹泻型IBS的近期疗效较好。     

An Asia-Pacific,double blind,placebo controlled,randomised study to evaluate the efficacy,safety, and tolerability of tegaserod in patients with irritable bowel syndrome

BACKGROUND: Tegaserod has been shown to be an effective therapy for the multiple symptoms of irritable bowel syndrome (IBS) in Western populations. However, little information is available regarding the use of tegaserod in the Asia-Pacific population. AIMS: To evaluate the efficacy, safety, and tolerability of tegaserod versus placebo in patients with IBS from the Asia-Pacific region. PATIENTS: A total of 520 patients from the Asia-Pacific region with IBS, excluding those with diarrhoea predominant IBS. METHODS: Patients were randomised to receive either tegaserod 6 mg twice daily (n=259) or placebo (n=261) for a 12 week treatment period. The primary efficacy variable (over weeks 1-4) was the response to the question: "Over the past week do you consider that you have had satisfactory relief from your IBS symptoms?" Secondary efficacy variables assessed overall satisfactory relief over 12 weeks and individual symptoms of IBS. RESULTS: The mean proportion of patients with overall satisfactory relief was greater in the tegaserod group than in the placebo group over weeks 1-4 (56% v 35%, respectively; p<0.0001) and weeks 1-12 (62% v 44%, respectively; p<0.0001). A clinically relevant effect was observed as early as week 1 and was maintained throughout the treatment period. Reductions in the number of days with at least moderate abdominal pain/discomfort, bloating, no bowel movements, and hard/lumpy stools were greater in the tegaserod group compared with the placebo group. Headache was the most commonly reported adverse event (12.0% tegaserod v 11.1% placebo). Diarrhoea led to discontinuation in 2.3% of tegaserod patients. Serious adverse events were infrequent (1.5% tegaserod v 3.4% placebo). CONCLUSIONS: Tegaserod 6 mg twice daily is an effective, safe, and well tolerated treatment for patients in the Asia-Pacific region suffering from IBS and whose main bowel symptom is not diarrhoea.     

Effect of antispasmodic agents, alone or in combination, in the treatment of Irritable Bowel Syndrome: Systematic review and meta-analysis

IntroductionIrritable bowel syndrome (IBS) is characterized by recurrent abdominal pain, bloating, and changes in bowel habit.AimsTo determine the clinical effectiveness of the antispasmodic agents available in Mexico for the treatment of IBS.MethodsWe carried out a systematic review and meta-analysis of randomized controlled clinical trials on antispasmodic agents for IBS treatment. Clinical trials identified from January 1960 to May 2011 were searched for in MEDLINE, the Cochrane Library, and in the ClinicalTrials.gov registry. Treatment response was evaluated by global improvement of symptoms or abdominal pain, abdominal distention/bloating, and frequency of adverse events. The effect of antispasmodics vs placebo was expressed in OR and 95% CI.ResultsTwenty-seven studies were identified, 23 of which fulfilled inclusion criteria. The studied agents were pinaverium bromide, mebeverine, otilonium, trimebutine, alverine, hyoscine, alverine/simethicone, pinaverium/simethicone, fenoverine, and dicyclomine. A total of 2585 patients were included in the meta-analysis. Global improvement was 1.55 (CI 95%: 1.33 to 1.83). Otilonium and the alverine/simethicone combination produced significant values in global improvement while the pinaverium/simethicone combination showed improvement in bloating. As for pain, 2394 patients were included with an OR of 1.52 (IC 95%: 1.28 a 1.80), favoring antispasmodics.ConclusionsAntispasmodics were more effective than placebo in IBS, without any significant adverse events. The addition of simethicone improved the properties of the antispasmodic agents, as seen with the alverine/simethicone and pinaverium/simethicone combinations.     

Rectal instillation of butyrate provides a novel clinically relevant model of noninflammatory colonic hypersensitivity in rats

BACKGROUND & AIMS: The treatment of irritable bowel syndrome (IBS), characterized by abdominal pain and bloating, is empirical and often poorly efficient. Research lacks suitable models for studying the pathophysiologic mechanisms of the colonic hypersensitivity and new pharmacologic targets. The present study aimed to develop a novel model of colonic hypersensitivity possessing several of the characteristics encountered in patients with IBS. METHODS: Rats received enemas of a butyrate solution (8-1000 mmol/L) twice daily for 3 days. A time course was determined for colonic hypersensitivity (colorectal distention test) and referred cutaneous lumbar hyperalgesia (von Frey hairs). Macroscopic and histologic analyses were performed on colonic mucosa. The efficacy of morphine, U50488H (a kappa opioid agonist), and trimebutine on the 2 pain parameters was determined. Finally, the involvement of peptidergic C-fibers was evaluated using capsaicin-pretreated animals and treatments with calcitonin gene-related peptide (CGRP) and neurokinin 1 receptor antagonists. RESULTS: Butyrate enemas induced a sustained, concentration-dependent colonic hypersensitivity and, to a lesser extent, a referred cutaneous mechanical hyperalgesia, particularly in female rats, but no macroscopic and histologic modifications of the colonic mucosa, as observed in patients with IBS. Both pain parameters were sensitive to morphine, U50488H, trimebutine, neonatal capsaicin treatment, and the CGRP receptor antagonist but not to the neurokinin 1 receptor antagonist. CONCLUSIONS: These results present our noninflammatory model of chronic colonic hypersensitivity as a useful novel tool for studying IBS. The CGRP receptor antagonist-induced reduction of colonic hypersensitivity suggests that CGRP receptors may provide a promising target for treatment of IBS.     

Extra Digestive Manifestations of Irritable Bowel Syndrome: Intolerance to Drugs?

Patients with IBS frequently complain of medication side effects. The goals of this study were to assess the prevalence of drug intolerance as an extra GI manifestation in patients with IBS and to verify the association between drug intolerance and psychological comorbidity. Female patients followed in a tertiary care center completed questionnaires assessing the presence of drug intolerance as well as somatic and psychological extra GI conditions. IBS patients (Rome II criteria; n = 71) were compared to inflammatory bowel disease patients (IBD; n = 96) or to healthy controls (HC; n = 67). The relationship to psychological comorbidity was verified in two different paradigms: (1) by looking at the statistical correlation between drug intolerance and the psychological extra GI symptoms in our IBS patients, and (2) by comparing in a meta-analysis the side effects to placebo (the nocebo effect is presumably increased due to hypervigilance or amplification in psychological disorders) in IBS patients or in patients with comparable medical conditions included in various drug trials approved by Health Canada. Our results show that prevalence of drug intolerance was significantly more elevated in IBS (41% patients) than in HC (7%) or in IBD (27%); somatic and psychological extra GI symptoms were also markedly increased in IBS. In addition, drug intolerance in our IBS patients was significantly associated with somatic comorbidities such as fatigue or multiple symptoms (P < 0.001), but not with psychological factors such as depression, anxiety, mood instability, or sleep disorder. A meta-analysis revealed that the nocebo effect was not different in patients with IBS than in control patients. In conclusion, drug intolerance is a frequent extra GI manifestation of IBS that is not associated with psychological comorbidity; thus, a somatic origin must be explored.     

Improvement in irritable bowel syndrome following ano-rectal surgery

BACKGROUND AND AIMS: To assess the effect on irritable bowel syndrome (IBS) of treating ano-rectal problems by applying multiple Barron's bands to prolapsing mucosa and excising haemorrhoids, with or without a low lateral sphincterotomy. PATIENTS AND METHODS: 144 patients with IBS whose ano-rectal abnormalities were treated by a single consultant surgeon. A prospective "within person" study of consecutive patients referred with ano-rectal problems who also had IBS symptoms according to the Rome criteria. All patients completed structured questionnaires about anal and IBS symptoms before operation and 6-60 months later. The findings were compared with those from patients who had no abdominal pains. RESULTS: The principal IBS symptoms of abdominal pain, abdominal distension, and altered bowel habit all improved significantly after operation. Those with persistent anal problems had more problems with persistent IBS symptoms, but when the anal problems were corrected, the IBS tended to settle. Posterior anal tenderness is present in 80% of IBS patients and is a useful diagnostic sign. CONCLUSIONS: This work suggests that in many patients with IBS there is a physical ano-rectal disorder amenable to physical treatment. Patients with IBS should all be proctoscoped carefully, with and without the patient straining, looking for abnormalities. Correcting mucosal prolapse and other anal problems produced an improvement in IBS symptoms in 86% of patients. This suggests that ano-enteric reflexes are a significant factor in irritable bowel syndrome, if not the major cause.     

Alosetron controls bowel urgency and provides global symptom improvement in women with diarrhea-predominant irritable bowel syndrome

OBJECTIVES: Bowel urgency is one of the most bothersome symptoms for nonconstipated IBS patients. The efficacy of alosetron in control of bowel urgency and Global Improvement of IBS symptoms were evaluated in a multicenter double-blind, randomized, placebo-controlled study. METHODS: Female IBS patients with lack of satisfactory control of bowel urgency were randomized 2:1 to alosetron 1 mg twice daily or placebo treatment groups. The primary endpoint was the proportion of days with satisfactory control of bowel urgency during the 12-wk treatment period and 2-wk follow-up period. Secondary endpoints included IBS Global Improvement (responder defined as patient-reported moderate or substantial improvement in IBS symptoms) and improvements in bowel function (stool frequency, consistency, and sensation of incomplete evacuation). RESULTS: A total of 801 women were randomized to the alosetron (n = 532) or placebo groups (n = 269). Physicians classified 98% of patients with diarrhea-predominant IBS. Patients treated with alosetron had a significantly greater proportion of days with satisfactory control of urgency compared to placebo for the treatment period (73% vs 57%, p < 0.001). A significantly greater number of patients treated with alosetron were IBS Global Improvement responders compared to placebo at week 12 (76% vs 44%, p < 0.001). IBS Global Improvement responders had more days with satisfactory control of urgency at week 12 (88% vs 48%) as well as firmer stools, fewer stools/day, and fewer days with incomplete evacuation compared with nonresponders. Alosetron-treated patients showed improvements in bowel functions compared to placebo-treated patients. Constipation was the most commonly reported adverse event.