便秘型和腹泻型肠易激综合征患者肛门直肠运动及直肠感觉功能的检测分析

目的研究便秘型和腹泻型肠易激综合征(IBS)患者肛门直肠运动及直肠感觉改变。方法对2000-01~2004-01广州医学院第二附属医院根据罗马Ⅱ标准入选的便秘型IBS30例,腹泻型IBS20例,正常对照组26例,进行肛门直肠运动功能及直肠感觉测定。结果(1)便秘型和腹泻型IBS肛门括约肌压力、肛门括约肌最大缩窄压和正常对照组相比差异无显著性(P>0.05);增加腹压时,肛门括约肌净增压腹泻型低于正常对照组(P<0.05);模拟大便时直肠和肛门括约肌出现同步收缩发生率便秘型IBS高于正常对照组(P<0.01)。(2)便秘型IBS直肠对容量刺激的最低敏感量、最大耐受性、顺应性明显高于正常对照组(P<0.01)。(3)腹泻型IBS直肠对容量刺激的最低敏感量、最大耐受性、顺应性明显低于正常对照组(P<0.01)。结论(1)IBS存在肛门直肠运动异常。(2)便秘型IBS直肠对容量刺激低敏感、高耐受、高顺应性,可能是引起便秘原因之一。(3)腹泻型IBS直肠对容量刺激存在高敏感、低耐受、低顺应性和肛门自控能力减弱,可能与腹泻有关。     

肠易激综合征患者直肠运动和感觉功能的研究

肠易激综合征 (IBS)是最常见的一种功能性肠病 ,发病率高 ,病因和发病机制复杂且迄今尚不完全清楚 ,治疗困难 ,因而引起广泛重视。为进一步探讨内脏运动和感觉异常在IBS发病机制中的作用 ,本研究用电子恒压器和消化道灌注测压设备 ,研究IBS患者直肠运动和感觉功能改变 ,并分析这些改变与临床症状间的关系。一、对象与方法(一 )研究对象　腹泻型IBS患者 2 5例 ,均为 2 0 0 1年 3月至 2 0 0 2年 3月本院消化内科门诊或住院患者 ,按照罗马Ⅱ诊断标准入选[1] ,经血常规、粪常规、大便细菌学检查、血清生化检查及腹部超声、结肠镜检查排除其…     

肠易激综合征中医证型与肛管直肠动力学的相关性研究

目的：观察肠易激综合征（IBS）不同中医证型肛管直肠动力学变化及临床意义。方法：选择符合罗马Ⅱ标准的IBS患者59例，按中医标准分为肝郁脾虚组25例，脾胃虚弱组20例，脾胃阴虚组14例；另选健康志愿者23例为正常对照组（正常组）。采用水灌注式测压系统，测定其肛管直肠动力学。结果：3型患者直肠静息压、肛管静息压及肛管缩窄压均与正常组差异无显著性意义；但肝郁脾虚组直肠最大耐受量较正常组降低，出现肛管直肠抑制反射（RAIR）所需最小空气量、直肠初始感觉阈值与正常组差异无显著性意义；脾胃虚弱组出现RAIR所需最小空气量、直肠初始感觉阈值、直肠最大耐受量均与正常组差异无显著性意义；脾胃阴虚组上述3项指标均较正常组明显增高。结论：肝郁脾虚组直肠耐受性降低；脾胃阴虚组排便反射不协调、直肠敏感性降低而耐受性增高。     

功能性便秘和便秘型肠易激综合征的结肠运输试验及直肠感觉阈值比较

目的 对功能性便秘和便秘型肠易激综合征（IBS）患者进行肠道转运时间及其肛门直肠运动和直肠容量感觉研究，探讨两类疾病的结肠运动方式有何不同。方法 用不透X线标志物测定全结肠通过时间和结肠分段通过时间并计算转动指数。用电子气压泵研究肛门直肠压力、直肠对容量刺激的感觉和直肠顺应性。结果 便秘型IBS的结肠转动时间延长主要在右半结肠。功能性便秘的各个节段结肠均有延长，结合转动指数研究，发现直肠乙状结肠部位的延长更显著。两种疾病的肛门直肠括约肌静息压、收缩压和松弛压均无明显异常，但两者的顺应性和排便阈值均明显增高，其中功能性便秘的感觉阈值有增加。结论 IBS便秘型结肠运动紊乱主要在右半结肠，功能性便秘的结肠动力改变主要在直肠乙状结肠部为多。说明两者的结肠运动方式改变是不同的，对两者的鉴别诊断有帮助。     

肠易激综合征患者直肠肛门动力学研究

为了研究肠易激综合征患者肛门运动功能，我们测定了５０例ＩＢＳ患者在１１例正常人直肠肛门压力衣排便功能；发现：（１）直肠静息压，肛门括约肌静息压及其最大缩窄压在ＩＢＳ腹泻组，便秘组及正常对照组组均无显著差异。（２）肛管高压带长度在ＩＢＳ腹泻组及便秘组均显著高于正常对照组。（３）直肠壶腹部的感觉阈值，最大耐受量等，在ＩＢＳ腹泻组均显著低于正常对照组。（４）ＩＢＳ便秘组感觉阈值与正常对照组差异，但其最大     

便秘型肠易激综合征患者结、直肠肛门动力学的临床研究

目的研究便秘型肠易激综合征患者结肠、直肠动力,直肠感觉功能.方法用结肠传输试验检测结肠传输时间,并用结肠传输指数分型,用肛门直肠测压方法测定便秘型IBS直肠静息压,肛管静息压,肛门括约肌最大缩榨压,模拟排便时,直肠收缩压,肛门括约肌剩余压,直肠对容量扩张刺激的初始感觉阈值,最大耐受容量,直肠顺应性.结果便秘型IBS患者全结肠及各节段结肠传输时间均高于对照组,便秘型IBS患者肛管静息压,直肠静息压与对照组无差异(P＞0.05),肛门括约肌最大缩榨压低于正常对照组,最大耐受容量及直肠顺应性均明显高于对照组(P＜0.01),且发现不同传输类型的便秘型IBS肛门直肠测压表现不同.结论便秘型IBS患者存在结肠、肛门直肠动力及直肠感觉功能异常,结肠传输试验与肛门直肠测压相结合,可体现不同传输类型便秘型IBS肛门直肠动力学病因机制.     

功能性便秘和便秘型肠易激综合征患者的直肠顺应性

背景:直肠顺应性是直肠运动的重要特征,其改变可能是便秘的重要病理生理机制之一。目的:研究不同类型便秘患者直肠感觉和顺应性的差异,了解直肠顺应性的临床意义。方法:应用恒压器(barostat),以500ml聚乙烯球囊对直肠进行快速位相性扩张,检测功能性便秘(FC)和便秘型肠易激综合征(C-IBS)患者的直肠感觉和顺应性,并与正常对照者进行比较。结果:FC和C-IBS组的直肠顺应性较正常对照组显著降低(6.34ml/mmHg±2.26ml/mmHg和6.50ml/mmHg±2.48ml/mmHg对9.57ml/mmHg±2.77ml/mmHg,P<0.05),但两组间差异无显著性。直肠感觉过敏便秘患者的顺应性明显增高,但FC和C-IBS组感觉与顺应性的关系并不完全相同。结论:一些便秘患者对直肠扩张感觉异常可能部分系由直肠顺应性改变所致,根据直肠顺应性结合感觉变化可以更好地区分不同类型的便秘。     

肠易激综合征患者直肠肛门压力变化及临床意义

为了研究肠易激综合征（ＩＢＳ）患者直肠肛门运动功能，测定了８０例ＩＢＳ患者和２０例正常人直肠肛门压力及排便功能。发现：①直肠静息压、肛门括约肌静息压及其最大缩窄压在ＩＢＳ腹泻组、便秘组及正常对照组均无显著差异。②肛管高压带长度在ＩＢＳ腹泻组及便秘组均显著高于正常对照组。③直肠壶腹部的感觉阈值、最大耐受量、直肠顺应性及直肠－肛门抑制反应的直肠扩张容量在ＩＢＳ腹泻组均显著低于正常对照组，肛门括约肌松弛率ＩＢＳ腹泻组与正常对照组无显著差异。④ＩＢＳ便秘组感觉阈值与正常对照组无差异，但其最大耐受量及引起直肠－肛门抑制反射的直肠扩张容量均显著高于正常对照组，其直肠顺应性和肛门括约肌松弛率显著低于正常对照组。     

直肠内温度变化影响肠易激综合征患者内脏感觉阈值

目的 探讨直肠内温度及压力变化对肠易激综合征(IBS)患者内脏感觉阈值的影响，进一步研究IBS的发病机制。方法 通过直肠球囊内注入空气(压力刺激)、38℃温水、4℃冰水(温度刺激)及脐部放置冰袋加直肠球囊内充气，研究直肠温度和压力变化刺激对初始感觉阈值和排便阈值的影响。结果 (1)直肠球囊内注气后，IBS组患者的初始感觉阈值明显低于对照组，排便阈值差异不明显。IBS组中腹泻型与交替型患者的初始感觉阈值及排便阈值均明显降低；便秘型患者的初始感觉阈值稍低于对照组，排便阈值明显增高。(2)直肠球囊内注入4℃冰水后，除便秘型IBS的排便阈值稍有所增加外，其余患者初始感觉阈值及排便阈值均显著降低，以腹泻型变化最明显。(3)脐部放置冰袋可诱发部分患者产生症状，但对初始感觉阈值和排便阈值无明显影响。结论 直肠温度和压力刺激可明显降低IBS患者的初始感觉阈值和排便阈值，以腹泻型患者最显著。内脏对压力和温度的敏感性增高可能是IBS发病的重要机制之一。     

Repetitive rectal painful distention induces rectal hypersensitivity in patients with irritable bowel syndrome

Background A reduced rectal perceptual threshold has been reported in patients with irritable bowel syndrome (IBS), but this phenomenon may be induced by a comorbid psychological state. We evaluated the rectal pain threshold at baseline and after conditioning (repetitive rectal painful distention: RRD) in patients with IBS or functional abdominal pain syndrome (FAPS), which is an abdominal pain disorder, and in healthy controls, and determined whether rectal hypersensitivity is a reliable marker for IBS. Methods The rectal sensory threshold was assessed by a barostat. First, a ramp distention of 40 ml/min was induced, and the threshold of pain and the maximum tolerable pressure (mmHg) were measured. Next, RRD (phasic distentions of 60-s duration separated by 30-s intervals) was given with a tracking method until the subjects had complained of pain six times. Finally, ramp distention was induced again, and the same parameters were measured. The normal value was defined by calculating the 95% confidence intervals of controls. Results Five or six of the seven IBS patients showed a reduced rectal pain threshold or maximum tolerable pressure, respectively, at baseline. In all patients with IBS, both thresholds were reduced after RRD load, but they were reduced in none of the patients with FAPS. RRD significantly reduced both thresholds in the IBS group (P < 0.05), but it had no effect in the control or FAPS groups. Conclusions Rectal hypersensitivity induced by RRD may be a reliable marker for IBS. Conditioning-induced visceral hypersensitivity may play a pathophysiologic role in IBS.     

便秘型肠易激综合征患者肛门直肠运动感觉功能及自主神经活性的变化

目的 研究便秘型肠易激综合征(C-IBS)患者肛门直肠感觉运动功能及自主神经活性变化,以探讨C-IBS的发病机制.方法 用电子气压泵及液流灌注压力监测系统对28例C-IBS患者和15名对照组进行肛门直肠测压检查.对其中12例C-IBS患者和8例健康志愿者,通过HRV频域分析比较两组交感神经张力的变化.结果 C-IBS患者的肛门内括约肌最大收缩压、最小抑制容量、直肠顺应性、初始感觉阈值、初次排便阈值、排便窘迫阈值、最大容量感觉阈值均明显低于对照组(P＜0.05).在C-IBS患者组及对照组中,P1/(P1 P2)在产生便意、排便窘迫、最大耐受时均显著高于基础静息状态(P＜0.05);C-IBS患者组P1/(P1 P2)在基础静息、产生初始感觉、产生便意、排便窘迫时显著高于对照组(P＜0.05).结论 C-IBS患者存在直肠感觉过敏和自主神经功能异常,直肠顺应性也显著低于对照组,可能是C-IBS的发病机制之一.     

Effect of oral nicardipine on anorectal function in normal human volunteers and patients with irritable bowel syndrome

Paired controlled studies were performed in 10 normal volunteers and 32 patients with irritable bowel syndrome to investigate the effect of the calcium channel blocker nicardipine, on the responses of the anorectum to rectal distension and a meal. Nicardipine was administered orally in standard (20 mg) and sustained-release (30 mg twice a day) formulations. In normal volunteers standard nicardipine had no significant effect on the rectal responses to distension but did significantly reduce the postprandial motility index (P <0.05). In the patients with irritable bowel syndrome, standard nicardipine caused a significant reduction in distension-induced rectal motor activity (P <0.05) and increased the rectal sensory thresholds for desire to defecate and discomfort (P <0.02). Slow-release nicardipine caused a significant reduction in distension-induced activity (P <0.05) but did not alter rectal sensory thresholds. Both formulations of nicardipine significantly reduced the postprandial motility index (P <0.05) and symptoms (P <0.05). In conclusion, this study confirms that calcium channel blockers may be useful in the management of irritable bowel syndrome.     

Study on functional constipation and constipation‐predominant irritable bowel syndrome by using the colonic transit test and anorectal manometry

OBJECTIVE: To investigate the visceral perception, anorectal pressure and colonic transit time (CTT) in patients with functional constipation and constipation‐predominant irritable bowel syndrome (C‐IBS), and to study the manometric abnormalities of these two conditions. METHODS: The CTT in patients with functional constipation and C‐IBS was studied by using radiopaque markers. Rectal visceral perception thresholds, rectal compliance and anorectal pressure were examined by electric barostat. RESULTS: The CTT in both groups of constipated patients was abnormal. A lot of radiopaque markers remained in the right colon in C‐IBS patients, whereas in patients with functional constipation, the radiopaque markers remained in each segment of the colon. The anorectal resting pressure, squeezing pressure and relaxation pressure were normal in both groups. Rectal compliance and defecation thresholds were much higher compared with controls, and the rectal visceral perception of functional constipation was also abnormal. CONCLUSIONS: The motility abnormalities of functional constipation and C‐IBS occurred in different colonic segments. Results suggest that CTT measure­ment and anorectal manometry could be helpful in the differential diagnosis of these two conditions.     

Visceral perception thresholds after rectal thermal and pressure stimuli in irritable bowel syndrome patients

BACKGROUND AND AIM: Visceral hypersensitivity has been shown to be present in irritable bowel syndrome (IBS). The current study sought to compare the characteristics of visceral perception thresholds after rectal thermal and pressure stimuli between IBS patients and healthy subjects. METHODS: A total of 46 patients with IBS were diagnosed using Rome II criteria. Thirteen healthy individuals participated in the study. Rectal visceral perception thresholds were examined in patients with IBS and in normal controls after thermal and pressure stimuli. Subjects were asked to report the sensation type, location, and spread. RESULTS: Compared with healthy subjects, IBS patients demonstrated significantly initially lower perception thresholds and defecation thresholds to rectal thermal and pressure stimuli, particularly in patients with diarrhea-predominant IBS. Ice stimuli on the abdominal wall had varied effects on symptoms in patients with IBS and did not affect perception thresholds. CONCLUSIONS: Visceral perception thresholds were decreased significantly after rectal thermal and pressure stimuli in patients with IBS. Visceral hypersensitivity may be one of the important pathogenic mechanisms in IBS.     

Post-infectious irritable bowel syndrome in patients with Shigella infection

BACKGROUND AND AIMS: Bacterial gastroenteritis has been known as a risk factor of irritable bowel syndrome (IBS). Several risk factors of post-infectious IBS (PI-IBS) have been documented. The aims of this study were to verify the role of bacterial gastroenteritis in the development of IBS and the risk factors for the development of PI-IBS. The clinical course of PI-IBS was also investigated. METHODS: We recruited 143 patients with shigellosis during its outbreak and 113 controls. Both groups were followed up for 12 months. Bowel symptoms were evaluated by use of questionnaires at 3, 6 and 12 months after the initial recruitment. RESULTS: Complete data were obtained from 101 patients (70.6%) and 102 healthy controls (90.3%). At 12 months, 15 patients and six controls had IBS (adjusted OR; 2.9, 95% CI; 1.1-7.9). Of the 15 patients, five had IBS symptoms consistently for 12 months, three did not have IBS symptoms initially and seven had fluctuating bowel symptoms. The duration of diarrhea was an independent risk factor of PI-IBS. CONCLUSIONS: Bacterial gastroenteritis is a risk factor of IBS and the duration of diarrhea as the index of severity of initial illness is an independent risk factor of PI-IBS. The clinical course of PI-IBS is variable over the 1 year of follow-up.     

Visceral perception in irritable bowel syndrome

We wished to determine if visceral perception in the rectum and stomach is altered in patients with irritable bowel syndrome and to evaluate the effects on visceral sensation of 5-HT₃ receptor blockade. Twelve community patients with diarrhea-predominant irritable bowel syndrome and 10 healthy controls were studied in a double-blind, randomized, placebo-controlled study. Using two barostats, the stomach and rectum were distended, with pressure increments of 4 mm Hg, from 10 to 26 mm Hg; visceral perception was measured on an ordinal scale of 0–10. Personality traits were measured using standard psychological methods, and somatic pain was evaluated by immersion of the nondominant hand in cold water. The effect of 5-HT₃ antagonism was tested with a single intravenous dose of ondansetron at 0.15 mg/kg. Gastric perception was higher in irritable bowel syndrome, but rectal distension was perceived similarly in irritable bowel syndrome and controls. Pain tolerance to cold water was also similar in irritable bowel syndrome and controls. Ondansetron induced rectal relaxation and increased rectal compliance but did not significantly alter gastric compliance or visceral perception. Psychological test scores were similar in patients and controls. We conclude that in this group of psychologically normal patients with irritable bowel syndrome, who were not chronic health-care seekers, visceral perception was normal. Ondansetron did not alter gut perception in health or in irritable bowel syndrome.This work was supported in part by grants AG09440, DK32121, and RR585 from the National Institutes of Health.     

Rectal potential differences in irritable bowel syndrome and in inflammatory bowel diseases in man

We have studied rectal potential difference (pd) in 200 subjects: 30 healthy volunteers or control patients, 46 patients with irritable bowel syndrome (IBS) and painless diarrhoea (group I), 60 IBS patients without diarrhoea (group II) and 64 patients with inflammatory bowel disease (IBD) with (group III, n = 41) or without (group IV, n = 23) rectal involvement. Pd measurement used a rectal perfused probe and a subcutaneous needle both connected, via agar-KCl bridges, to calomel electrodes and a millivoltmeter. Statistical analysis used Student's t-test for paired and unpaired data and Mann-Whitney U-test as appropriate. Mean rectal pd values were, respectively -43.5 +/- 8.7 mV in control group, -32.9 +/- 10.2 mV in IBS-group I patients (P less than 0.001), -41.3 +/- 12 mV in IBS-group II patients (NS), -21.4 +/- 14.1 mV in IBD patients with rectal involvement (P less than 0.001), and -45.1 +/- 14.3 mV in IBD-group IV patients (NS). A histological examination was performed in 36 IBS patients; mean rectal pd was significantly decreased in patients showing abnormal patterns (n = 27, pd = -31.8 +/- 9 mV) compared to patients with normal mucosa (n = 9, pd = -41.1 +/- 6.5 mV; P less than 0.01). These results show that: (1) potential difference is significantly decreased in patients with ulcerative and rectal involvement; (2) in patients with Crohn's disease, normal rectal pd values do not assess the appearance of colonic mucosa above; (3) patients with IBS and diarrhoea also present a significant diminution in mean rectal pd. Although the mechanisms involved remain unclear, rectal pd measurement appears to be an objective test for intestinal mucosae weakness in functional or inflammatory diseases of the large intestine and rectum.     

Alterations in cerebral potentials evoked by rectal distention and drinking ice water in patients with irritable bowel syndrome

AIM: Visceral hypersensitivity has been found to be present in irritable bowel syndrome (IBS). The current study sought to study visceral afferent hypersensitivity in IBS patients and obtain further objective evidence of alterations in intestinal afferent pathways in IBS patients by cerebral evoked potentials (CEP). METHOD: We studied 30 female IBS patients and 12 female healthy subjects. Rectal perception thresholds to balloon distention were measured and CEP was recorded in response to rhythmic rectal distention (two distention series, each of 100 repetitions at a frequency of 1 Hz) at the volume of perception thresholds. All subjects were then asked to drink 220 mL 4 degrees C ice water and the above steps were repeated 20 min later. RESULTS: Rectal distention led to recognizable and reproducible CEP. Compared to healthy subjects, IBS patients demonstrated significantly shorter N1, P1 and N2 latencies (P < 0.05). After drinking ice water, IBS patients exhibited further shortened N1, P1 and N2 latencies (P < 0.05), but drinking did not alter the latencies of healthy controls and the amplitudes of both IBS patients and healthy controls. CONCLUSION: The shorter latency of cerebral potentials evoked by rectal distention and ice water stimulation in IBS patients provided further objective evidence for defective visceral afferent transmission in IBS patients.     

便秘型肠易激综合征患者直肠肛管压力的改变与焦虑/抑郁情绪测定评分的临床意义

[目的]探讨便秘型肠易激综合征(IBS-C)患者直肠肛管压力的变化及其与焦虑/抑郁情绪测定评分的关系与意义。[方法]选择确诊为IBS-C的患者70例为试验组、健康志愿者24例作为对照组,采用肛管直肠测定仪进行动力学检查,并采用综合医院焦虑/抑郁情绪测定表进行心理状况评估,比较2组直肠肛管的压力和情绪测定评分的差异。[结果]试验组患者直肠初始感觉阈值、初始排便感觉阈值、直肠最大容量感觉阈值均高于对照组(P0.05);试验组直肠肛门抑制反射阈值和肛管静息压高于对照组,但2组比较差异无统计学意义(P0.05);试验组肛管最大自主收缩压低于对照组、焦虑评分与抑郁评分显著高于对照组(均P0.05)。[结论]IBS-C患者存在明显的直肠感觉功能的障碍和盆底肌协调运动障碍,且存在焦虑抑郁症状,为临床诊治提供了依据。