Pharmacologic and complementary and alternative medicine therapies for irritable bowel syndrome

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by episodic abdominal pain or discomfort in association with altered bowel habits (diarrhea and/or constipation). Other gastrointestinal symptoms, such as bloating and flatulence, are also common. A variety of factors are believed to play a role in the development of IBS symptoms, including altered bowel motility, visceral hypersensitivity, psychosocial stressors, altered brain-gut interactions, immune activation/low grade inflammation, alterations in the gut microbiome, and genetic factors. In the absence of biomarkers that can distinguish between IBS subgroups on the basis of pathophysiology, treatment of this condition is predicated upon a patient's most bothersome symptoms. In clinical trials, effective therapies have only offered a therapeutic gain over placebos of 7-15%. Evidence based therapies for the global symptoms of constipation predominant IBS (IBS-C) include lubiprostone and tegaserod; evidence based therapies for the global symptoms of diarrhea predominant IBS (IBS-D) include the probiotic Bifidobacter infantis, the nonabsorbable antibiotic rifaximin, and alosetron. Additionally, there is persuasive evidence to suggest that selected antispasmodics and antidepressants are of benefit for the treatment of abdominal pain in IBS patients. Finally, several emerging therapies with novel mechanisms of action are in development. Complementary and alternative medicine therapies including probiotics, herbal therapies and acupuncture are gaining popularity among IBS sufferers, although concerns regarding manufacturing standards and the paucity of high quality efficacy and safety data remain.     

The gut microbiome and irritable bowel syndrome: State of art review

Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract, the physiology of which is not very well understood. There are multiple factors and pathways involved in pathogenesis of this entity. Among all, dysmotility, dysregulation of the brain-gut axis, altered intestinal microbiota and visceral hypersensitivity play a major role. Over the last years, research has shown that the type of gut microbiome present in an individual plays a significant role in the pathophysiology of IBS. Multiple studies have consistently shown that subjects diagnosed with IBS have disruption in gut microbiota balance. It has been established that host immune system and its interaction with metabolic products of gut microbiota play an important role in the gastrointestinal tract. Therefore, probiotics, prebiotics and antibiotics have shown some promising results in managing IBS symptoms via modulating the interaction between the above. This paper discusses the various factors involved in pathophysiology of IBS, especially gut microbiota.     

Gut microbiota role in irritable bowel syndrome: New therapeutic strategies

In the last decade the impressive expansion of our knowledge of the vast microbial community that resides in the human intestine, the gut microbiota, has provided support to the concept that a disturbed intestinal ecology might promote development and maintenance of symptoms in irritable bowel syndrome(IBS). As a correlate, manipulation of gut microbiota represents a new strategy for the treatment of this multifactorial disease. A number of attempts have been made to modulate the gut bacterial composition, following the idea that expansion of bacterial species considered as beneficial(Lactobacilli and Bifidobacteria) associated with the reduction of those considered harmful(Clostridium, Escherichia coli, Salmonella, Shigella and Pseudomonas) should attenuate IBS symptoms. In this conceptual framework, probiotics appear an attractive option in terms of both efficacy and safety, while prebiotics, synbiotics and antibiotics still need confirmation. Fecal transplant is an old treatment translated from the cure of intestinal infective pathologies that has recently gained a new life as therapeutic option for those patients with a disturbed gut ecosystem, but data on IBS are scanty and randomized, placebo-controlled studies are required.     

Novel pharmacological therapies for irritable bowel syndrome

Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder, which represents a major cost to healthcare services. Current pharmacological treatment includes fibre supplements, antispasmodics, laxatives, loperamide and antidepressants. This article reviews the novel pharmacological treatments already or recently approved for patients with IBS-C (lubiprostone, linaclotide) and IBS-D (alosetron, ramosetron, rifaximin, eluxadoline). Furthermore, results for drugs in development (plecanatide, ibudutant and ebastine) or used in chronic constipation or for other indications, with potential application in IBS (prucalopride, elobixibat, mesalazine, ondansetron and colesevelam) are also reviewed.     

食物不耐受与肠易激综合征研究进展

肠易激综合征(IBS)是一种最常见的功能性肠病,病因复杂。临床观察提示IBS的症状常由食物因素诱发或加重,IgG介导的食物不耐受可能是IBS的病因之一。食物不耐受在IBS的发生和发展中发挥重要作用,基于食物特异性IgG抗体水平的食物排除疗法对IBS的治疗有重要意义。     

Bowel urgency in patients with irritable bowel syndrome

BACKGROUND & AIMS: Bowel urgency is the most bothersome symptom in irritable bowel syndrome patients with diarrhea, but its pathophysiology is poorly understood. Our aim was to assess the relationships among reporting the symptom, the reservoir functions of the colon and rectum, and the patients' psychologic profile. METHODS: The study involved 28 consecutive patients with irritable bowel syndrome and 17 healthy subjects. The presence or absence of bowel urgency was verified by means of a questionnaire during the 3 days required for the ingestion of radio-opaque markers. On the fourth day, an abdominal x-ray was taken to assess colonic transit time, and rectal sensory and motor responses were measured during rectal distention. The subjects' psychologic profiles were assessed using a psychologic symptoms checklist. RESULTS: Forty-six percent of the patients reported urgency associated with at least 1 defecation. The multivariate logistic regression analysis showed that colonic transit was the only variable independently associated with reported bowel urgency, but the threshold for the sensation of urgency was not removed from the model since its borderline significance level. Rectal compliance was closely associated with the threshold for the sensation of urgency during rectal distention but was not an independent factor for reporting the sensation. The patients with and without urgency showed altered psychologic profiles. CONCLUSIONS: The symptom of urgency is associated with objective alterations in the colonic and rectal reservoir of patients with irritable bowel syndrome.     

Complementary and alternative medicines in irritable bowel syndrome: An integrative view

Irritable bowel syndrome(IBS)is a common gastrointestinal disorder with a high incidence in the general population.The diagnosis of IBS is mainly based on exclusion of other intestinal conditions through the absence of inflammatory markers and specific antigens.The current pharmacological treatment approaches available focus on reducing symptom severity while often limiting quality of life because of significant side effects.This has led to an effectiveness gap for IBS patients that seek further relief to increase their quality of life.Complementary and alternative medicines(CAM)have been associated with a higher degree of symptom management and quality of life in IBS patients.Over the past decade,a number of important clinical trials have shown that specific herbal therapies(peppermint oil and Iberogast?),hypnotherapy,cognitive behavior therapy,acupuncture,and yoga present with improved treatment outcomes in IBS patients.We propose an integrative approach to treating the diverse symptoms of IBS by combining the benefits of and need for pharmacotherapy with known CAM therapies to provide IBS patients with the best treatment outcome achievable.Initial steps in this direction are already being considered with an increasing number of practitioners recommending CAM therapies to their patients if pharmacotherapy alone does not alleviate symptoms sufficiently.     

Probiotics and irritable bowel syndrome

Irritable bowel syndrome(IBS)is common gastrointestinal problems.It is characterized by abdominal pain or discomfort,and is associated with changes in stool frequency and/or consistency.The etiopathogenesis of IBS may be multifactorial,as is the pathophysiology,which is attributed to alterations in gastrointestinal motility,visceral hypersensitivity,intestinal microbiota,gut epithelium and immune function,dysfunction of the brain-gut axis or certain psychosocial factors.Current therapeutic strategies are often unsatisfactory.There is now increasing evidence linking alterations in the gastrointestinal microbiota and IBS.Probiotics are living organisms which,when ingested in certain numbers,exert health benefits beyond inherent basic nutrition.Probiotics have numerous positive effects in the gastrointestinal tract.Recently,many studies have suggested that probiotics are effective in the treatment of IBS.The mechanisms of probiotics in IBS are very complex.The purpose of this review is to summarize the evidence and mechanisms for the use of probiotics in the treatment of IBS.     

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。     

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.     

认知治疗联合益生菌、匹维溴胺治疗腹泻型肠易激综合征的临床研究

目的本研究试图评价应用认知治疗联合益生菌、匹维溴胺治疗腹泻型肠易激综合征(diarrhea-preclomnant irritable bowelsyndrons,D-IBS)的有效性和安全性。方法符合罗马Ⅲ标准的90例D-IBS患者接受认知治疗、匹维溴胺(50 mg/次,3次/d)、双岐三联活菌制剂(粪链球菌、嗜酸乳杆菌、双歧杆菌3种肠道固有菌的活菌制剂)(420 mg/次,3次/d)共8周,分别记录治疗前后患者SF-36生活质量评分和症状积分以评价疗效;治疗前后对粪便菌丛进行记数,对粪便中5种细菌进行培养并对集落形成单位进行记数;治疗前后用不透X线标志物测定全结肠通过时间来评价结肠运输时间的变化;应用SPSS软件对试验数据进行统计学分析。结果有81例患者完成了本研究;试验过程中未发现不良反应;对于D-IBS患者的治疗,认知治疗联合匹维溴胺、益生菌的总有效率达88.9%,症状改善明显尤其是对于腹痛、大便性状的改善;患者生活质量明显改善,躯体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)、情感职能(RE)和精神健康(MH)维度的积分有显著提高(P<0.05);益生菌能够明显增加肠道双歧杆菌(P<0.01)和乳酸杆菌(P<0.05),明显减少肠球菌(P<0.01)和类杆菌(P<0.05),而肠杆菌无显著变化(P>0.05);结肠运输时间延迟显著(P<0.05)。结论认知治疗联合匹维溴胺和益生菌治疗D-IBS是安全、有效的。     

小肠细菌过度生长和肠易激综合征关系的探讨

目的　探讨小肠细菌过度生长与肠易激综合征发病中的关系。方法　用乳果糖氢呼气试验测定 49例腹泻及便秘型肠易激综合征病人口 -回盲瓣通过时间 ,并了解其阳性发生率 ;对其中 10例阳性者给普瑞博思治疗1周 ,进行治疗前后比较。结果　在肠易激综合征病人中腹泻及便秘型口 -回盲瓣通过时间较对照组延长 (P <0 0 5 ) ,阳性发生率无差别 (P >0 0 5 ) ,治疗后口 -回盲瓣通过时间改善明显 (P <0 0 5 ) ,症状改善。结论　小肠功能紊乱可导致小肠细菌过度生长 ,并可能是肠易激综合征发病因素之一。     

百忧解治疗肠易激综合征的临床研究

目的　评价百忧解对肠易激综合征 (ISB)的疗效 ,以供临床用药参考。方法　随机选取 65例伴有明显抑郁症状的IBS患者 ,3 4例治疗组对症治疗的同时给予百忧解 2 0mg ,每日清晨 1次顿服 ,共 8周 ,疗程结束后随诊 4～ 6个月。 3 1例对照组只采用对症治疗。结果　治疗组 3 4例中有效者 2 9例 ,有效率为 83 5 %。对照组有效者 19例 ,有效率为 61 3 %。两组之间差别极显著 (P<0 0 1)。结论　百忧解治疗伴有抑郁症状的IBS疗效显著 ,值得推广应用     

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.     

思密达R治疗肠易激综合征的临床研究

目的 观察思密达治疗肠易激综合征（IBS）的疗效和安全性。方法 采用双盲对照实验，68例患者随机分为2组。疗程60天，治疗组口服思密达3袋／天，对照组口服安慰剂，使用方法相同。前30天治疗有效者进行下一阶段治疗（30天）。疗效评价标准如下：大便次数；患者主观症状，包括腹痛、腹胀，其严重程度以计分评估。结果 同安慰剂相比，思密达治疗IBS的疗效明显优于安慰剂（P＜0.01)；其在缓解患者腹痛、腹胀症状方面也显示出很好的疗效（P＜0.01)。结论 思密达是一有效，安全的治疗IBS药物。     

肠易激综合征与功能性消化不良重叠的治疗进展

肠易激综合征(irritable bowel syndrome,IBS)与功能性消化不良(functional dyspepsia,FD)重叠的治疗,以益生菌和胃肠动力剂为主;精神心理和行为疗法具有协同作用,能增加胃肠动力,改善患者症状;中药治疗强调整体观念和辩证论治;针刺和物理疗法是有效的非药物疗法,综合治疗能提高临床疗效。     

The microbiota link to irritable bowel syndrome

Irritable Bowel Syndrome (IBS) is a clinically heterogeneous disorder which is likely to involve a number of causative factors. The contribution of altered intestinal microbiota composition or function to this disorder is controversial, and is the subject of much current research. Until recently, the technical limitations of the methodologies available have not permitted an adequate survey of low-abundance microbial species. Recent technological developments have enabled the analysis of the global population of the microbiome using high through-put, culture independent, 16S rRNA amplicon pyrosequencing. Using these new methodologies, we are able to gain important biological insights into the link between functional bowel disorders and the microbiome. This addendum contextualizes and summarizes the results of these studies, and defines the future challenges and opportunities in the field.     

肠易激综合征的研究进展及未来突破方向

通过对国内外相关文献进行梳理,对肠易激综合征(IBS)的诊断标准、致病机制、流行病学研究、治疗方法等进行回顾性总结和综述,IBS未来将在以下研究领域进行突破:主要包括研究方法的改进与真实数据的获取,对特殊群体比如军人IBS的治疗探索,对执行特殊任务群体人员的研究,以及益生菌、维生素、心理治疗和免疫治疗等新的治疗方法的探索。     

肠易激综合征与肠道微生态的研究现状分析

肠易激综合征(IBS)发病机制复杂,目前没有统一的理论能解释IBS的发病,也没有单一的药物能缓解IBS的所有症状。此文就肠易激综合征与肠道微生态研究现状作一综述。     

肠易激综合征动物模型研制现状和进展

肠易激综合征(IBS)是一种常见的肠功能紊乱性疾病,特点是慢性反复发作的腹痛、腹部不适及排便习惯的改变。发病机制目前尚未阐明。研究显示IBS可能与肠道动力、内脏感觉过敏和肠道感染等因素有关。此文对IBS动物模型研制现状及展望作一综述。