腹泻型肠易激综合征发病相关因素干预试验

目的 针对肠易激综合征(IBS)可能的发病因素实施干预,探讨微生态制剂及抗抑郁药对腹泻型IBS(IBS-D)的交互治疗作用,研究IBS发病的可能机制.方法 选择2005年11月-2006年11月门诊和住院IBS-D患者92例,均符合罗马Ⅱ诊断标准,并经肠镜检查排除肠道器质性疾病,其中63例随访时间按规定要求完成.患者按用药分为以下4组:单用匹维溴铵(商品名:得舒特)组14例,匹维溴铵+微生态制剂(商品名:培菲康)组22例,匹维溴铵+多塞平组12例,匹维溴铵+微生态制剂+多塞平组15例.用药前后4周分别进行肠道菌群检测、SCL-90精神评分、IBS症状评分及SF-36生活质量评分.结果 各组患者IBS肠道症状和生活质量改善十分明显,且对5种肠道益生菌及精神症状均有明显影响.双歧杆菌、多塞平对乳酸杆菌、微生态制剂、肠球菌的调整作用明显(P＜0.05),联合干预作用更显著.多塞平、双歧杆菌对躯体化、抑郁焦虑等症状作用明显(P＜0.05),联合效果更佳;微生态制剂和抗抑郁药在降低肠球菌、肠杆菌及调节精神的交互作用明显(P＜0.05).结论 IBS患者脑-肠之间存在必然的联系,支持脑-肠互动在IBS发病机制中的重要作用.     

肠易激综合征致病的相关危险因素研究进展

肠易激综合征(IBS)是一种常见的胃肠道平滑肌功能紊乱性疾病,目前比较一致的观点认为精神心理、肠道动力、环境及神经内分泌等因素的共同作用可能是IBS症状出现和加重的相关危险因素。本文就近年来有关IBS致病的相关危险因素的研究进展作一综述。     

肠易激综合征症状复发的影响因素

肠易激综合征(IBS)为临床常见的功能性胃肠道疾病,具有慢性、反复发作的特点.IBS虽不至于威胁生命,但其反复发作及其引起的精神心理异常可导致患者生活质量的下降,并造成大量医疗资源的消耗.目前IBS的病因和发病机制尚未完全明确,临床治疗效果不佳,但临床实践中发现其症状反复发作与某些因素相关,去除这些因素后可缓解患者的症状及减少发作次数.此文就影响IBS症状复发的因素作一综述,以期为IBS的合理防治提供参考.     

腹泻型肠易激综合征患者肠黏膜肥大细胞的变化

目的探讨腹泻型肠易激综合征(IBS)与肠黏膜肥大细胞(MC)及脱颗粒之间的关系。方法正常人10例和腹泻型IBS患者11例。每例于结肠镜下取盲肠、横结肠和直肠黏膜组织各2块,用免疫组化方法行MC染色,计算每高倍视野下MC的数量及脱颗粒MC所占MC总数的比例。结果腹泻组IBS患者盲肠、横结肠黏膜MC数量显著高于正常对照组(P<0·01及P<0·05);直肠黏膜MC数量与正常对照组无显著差异(P>0·05)。腹泻型IBS患者盲肠、横结肠、直肠黏膜脱颗粒MC比率显著高于正常对照组(P<0·05或P<0·01)。结论肠黏膜肥大细胞在腹泻型IBS的发病过程中起着重要作用。     

难治性肠易激综合征的认知治疗

目的 探讨肠易激综合征（IBS）认知治疗的程序、实施策略及其对IBS患者症状和生活质量的影响。方法 采用自身对照研究,22例符合罗马Ⅱ标准的难治性IBS患者参与认知治疗,疗程2－3个月。通过比较治疗前后患者症状、生活质量等变化以评价疗效。结果 22例完成第一随访单元的患者中,81．8％的患者症状显著改善（P＜0．01）;随访12个月时,72．7％（8／11）的患者症状完全缓解;第一随访单元结束时与治疗前比较,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）;生活质量明显改善（P＜0．05）;精神症状积分如抑郁和焦虑显著降低（P＜0．001）,积极应对积分明显提高（P＝0．000）。结论 遵循一定治疗程序和个体化原则的认知治疗,对治疗难治性IBS3具有针对性,且疗效显著。     

肠易激综合征的抗抑郁治疗

肠易激综合征(IBS)和精神心理异常(主要是抑郁症)的密切关系已被大量研究证实,但抗抑郁治疗(包括心理和药物治疗)的疗效各学者仍存在分歧,对抗抑郁症应用的适应症,药物的选择。剂量。疗程等问题仍未达成共识,近年多数报道对抗抑郁治疗持肯定态度。早在60年代已有抗抑郁治疗功能性胃肠疾病(FGIDs)包括IBS的报道,但近年本课题才受重视,有不少疗效很好的报道。Guthrie[1]对115例IBS患者用心理治疗(不用药物)与常规药物治疗对照,用精神科量表统计疗效,结果2/3患者有效,显著优于对照组。Clouse[2]回顾5年来抗抑郁药治疗138例IBS患者的疗…     

肠易激综合征患者生存质量的评价

目的　探讨与评价社区人群中肠易激综合征 (IBS)患者的健康相关生存质量 (HRQOL)情况。方法　在广东省采用分层、整群、随机抽样的调查中收集到的符合RomeⅡ诊断标准的 2 31例IBS患者 ,并随机选取 6 36例非IBS(NIBS)者为对照组 ;生存质量的调查采用世界卫生组织推荐的SF 36量表。结果　 (1)两组对象在年龄、性别、学历及城乡分布方面 ,经检验差异无显著性 (P >0 0 5 ) ;(2 )IBS组比NIBS组在生理机能、生理职能、情感职能、社会功能、躯体疼痛、精力、一般状况、精神健康、健康变化等各个维度分值均有明显降低 (P <0 0 5 ) ;IBS就诊者SF 36各个维度的分值比非就诊者有所降低 ,但差异无显著性 (P >0 0 5 ) ;(3)SF 36各维度分值与IBS患者每月犯腹痛的次数相关 (P <0 0 5 ) ;并与患者自诉腹痛对生活和工作的影响程度相关 (P <0 0 5 ) ;也与IBS患者是否出现乏力的症状相关 (P <0 0 5 ) ;(4)应对方式与HRQOL明显相关 ;控制应对方式对HRQOL的影响后 ,IBS组仍比NIBS组的HRQOL有明显下降。结论　与NIBS者相比 ,IBS患者生存质量明显下降 ;SF 36量表适用于IBS的HRQOL评估 ;但有必要进行有关IBS特异的生存质量量表的研究分析。     

抗抑郁剂在难治性肠易激综合征中的应用

对难治性肠易激综合征（IBS）患者在常规治疗基础上分别采用帕罗西汀和多塞平治疗,治疗8个月后,帕罗西汀组临床疗效及精神心理量表评分均优于多塞平组,且副作用少.提示帕罗西汀可作为治疗IBS的主要药物之一.     

阿奇霉素治疗腹泻型肠易激综合征的疗效

[目的]探讨阿奇霉素治疗肠易激综合征的临床疗效。[方法]本研究选取110例腹泻型肠易激综合征患者进行随机、对照试验,观察单用阿奇霉素(A组38例)、单用马来酸曲美布汀(B组33例)及阿奇霉素+马来酸曲美布汀(C组39例)治疗前后腹泻及腹部不适的发病情况。[结果]各组大便异常及腹部不适均有改善,C组疗效优于A组及B组(均P0.05)。[结论]阿奇霉素可有效缓解IBS的症状,与马来酸曲美布汀联用时效果更好。     

Patients with irritable bowel syndrome-diarrhea have lower disease-specific quality of life than irritable bowel syndrome-constipation

AIM: To determine effect of irritable bowel syndrome(IBS) subtype on IBS-specific quality of life(QOL) questionnaire and its subscales.METHODS: We studied IBS patients visiting our functional gastroenterology disorder clinic at a tertiary care center of Unites States.IBS and IBS subtype were diagnosed using Rome-Ⅲ questionnaire.QOL was assessed using IBS-QOL questionnaire.IBSQOL assesses quality of life along eight subscales: dysphoria,interference with activities,body image,health worry,food avoidance,social reactions,sexual health,and effect on relationships.IBS-QOL and its subscales were both scored on a range of 0-100 with higher scores suggestive of better QOL.Results of overall IBS-QOL scores and subscale scores are expressed as means with 95%CI.We compared mean IBS-QOL score and its subscales among various IBSsubtypes.Analysis of variance(ANOVA) was used to compare the mean difference between more than two groups after controlling for age and gender.A posthoc analysis using Bonferroni correction was used only when P value for ANOVA was less than 0.05.RESULTS: Of 542 patients screened,243 had IBS as per Rome-Ⅲ criteria.IBS-mixed(IBS-M) was the most common IBS subtype(121 patients,49.8%) followed by IBS- diarrhea(IBS-D)(56 patients,23.1%),IBSconstipation(IBS-C)(54 patients,22.2%) and IBSunspecified(IBS-U)(12 patients,4.9%).Overall IBSQOL scores were significantly different among various IBS-subtypes(P = 0.01).IBS-QOL of patients with IBS-D(61.6,95%CI: 54.0-69.1) and IBS-M(63.0,95%CI: 58.1-68.0) was significantly lower than patients with IBS-C(74.5,95%CI: 66.9-82.1)(P = 0.03 and 0.02 respectively).IBS-D patients scored significantly lower than IBS-C on food avoidance(45.0,95%CI: 34.8-55.2 vs 61.1,95%CI: 50.8-71.3,P = 0.04) and interference with activity(59.6,95%CI: 51.4-67.7 vs 82.3,95%CI: 74.1-90.6,P 0.001).IBS-M patients had more interference in their activities(61.6,95%CI: 56.3-66.9 vs 82.3,95%CI: 74.1-90.6,P = 0.001) and greater impact on their relationships(73.3,95%CI: 68.4-78.2 vs 84.7,95%CI: 77.2-92.2,P = 0.02) than IBS-C patients.Patients with IBS-M also scored significantly lower than IBS-C on food avoidance(47.2,95%CI: 40.7-53.7 vs 61.1,95%CI: 50.8-71.3,P = 0.04) and social reaction(66.1,95%CI: 61.1-71.1 vs 80.0,95%CI: 72.1-87.7,P = 0.005).CONCLUSION: IBS-D and IBS-M patients have lower IBS-QOL than IBS-C patients.Clinicians should recognize food avoidance,effects on daily activities and relationship problems in these patients.     

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。     

Irritable bowel syndrome: the burden and unmet needs in Europe.

Irritable bowel syndrome affects approximately 10-15% of the European population, although prevalence rates vary depending on the classification used and the country surveyed. This may be due to differences in patterns of medical care and diagnosis of the condition. Up to 70% of individuals with irritable bowel syndrome may not have been formally diagnosed. The disorder affects 1.5-3 times as many women as men and poses a significant economic burden in Europe, estimated at euro 700-euro 1600 per person per year. It also reduces quality of life and is associated with psychological distress, disturbed work and sleep, and sexual dysfunction. It is a chronic disorder, which affects many individuals for more than 10 years. Most patients are managed in primary care, although some are referred to gastroenterologists and other specialists. Patients with irritable bowel syndrome undergo more abdomino-pelvic surgery than the general population. We propose that a positive diagnosis of the condition may avoid the delay in diagnosis many patients experience. We conclude that, in Europe, there are significant unmet needs including lack of familiarity with irritable bowel syndrome, difficulties in diagnosis and lack of effective treatments for the multiple symptoms of the disorder. The development of pan-European guidelines for irritable bowel syndrome will benefit patients with this condition in Europe.     

Cross-Cultural Validation of Irritable Bowel Syndrome Quality of Life in Korea

Patients’ responses to quality-of-life questionnaires are dependent on the cultural milieu. The aims of this study were to translate the Irritable Bowel Syndrome Quality of Life questionnaire, which was developed in the West, into Korean and to validate the translated questionnaire in patients with irritable bowel syndrome. Translation of the original questionnaire was performed according to accepted linguistic validation guidelines. Korean patients had no difficulty understanding the questions. Data from the translated questionnaire were well correlated with results from the SF-36 questionnaire and reflected the stress status of the patients as measured on the Perceived Stress Scale. Some questionnaire items seemed, on first analysis, to be problematic in this subset of patients, but these results may relate, in part, to cultural differences between Korea and the West. We conclude that the translated questionnaire is reliable and offers an accurate measure of quality of life for Korean patients with irritable bowel syndrome.     

肠易激综合征与炎症性肠病

近年发现,炎症性肠病(IBD)患者发病早期或缓解期时常表现为肠易激综合征(IBs)症状,且IBD与IBS的临床表现具有一定的相似性。因而IBS与IBD的相关性受到广泛的重视。此文就IBS与IBD的发病机制及临床相关性予以阐述,以期为临床个体化治疗提供借鉴。     

肠易激综合征与肠黏膜异常

肠易激综合征（irritable bowel syndrome，IBS）是以腹痛或腹部不适，伴有大便性状改变和排便习惯改变为特征的功能性肠道疾病，是消化科常见的疾病之一。目前，IBS的发病机制尚不明确。肠道黏膜是机体接触外环境最大的部位，拥有丰富的神经、免疫、内分泌等感觉细胞，IBS患者肠道黏膜的变化对研究IBS的发病机制具有独特的意义。本文对近年IBS与肠黏膜异常的研究进展做一综述。     

Efficacy of tandospirone in patients with irritable bowel syndrome-diarrhea and anxiety

AIM: To investigate the efficacy of tandospirone in patients with irritable bowel syndrome-diarrhea (IBS-D) and anxiety in a prospective, randomized, controlled study.METHODS: Two hundred patients with IBS-D and moderate anxiety were randomized to receive pinaverium and tandospirone (arm A) or pinaverium and placebo (arm B). Tandospirone or placebo was given thrice daily at a fixed dose of 10 mg and pinaverium was given thrice daily at a fixed dose of 50 mg. The duration of treatment was 8 wk. Patients were assessed for abdominal pain and diarrhea. Anxiety was evaluated using the Hamilton Rating Scale for Anxiety (HAM-A). The primary study endpoints were response rates for abdominal pain and diarrhea. The secondary study endpoints were response rates for anxiety. Adverse events were also evaluated.RESULTS: One hundred and seventy of 200 patients (82 patients in arm A and 88 patients in arm B) completed the study. Demographic and baseline characteristics of the 200 participants were comparable in the two arms. At week 8, the overall response rate for abdominal pain and diarrhea was 52.0% for arm A and 37.0% for arm B (P < 0.05). The HAM-A score showed that the response rate was 61.0% for arm A and 21.0% for arm B (P < 0.01). The treatments were well tolerated and no significant adverse events were reported.CONCLUSION: Tandospirone is effective and can be combined with pinaverium in IBS-D patients with anxiety.     

肠易激综合征与饮食因素

肠易激综合征（irritable bowel syndrome,IBS）症状与饮食关系密切,饮食疗法是IBS的重要的治疗手段之一。饮 食疗法主要包括传统的饮食建议,低可发酵的低聚糖、二糖、单糖和多元醇（fermentable oligosaccharides, disaccharides,monosaccharides and polyols,FODMAPs）饮食,无麸质饮食(gluten-free diet,GFD）以及益生菌。文章重点 阐述了饮食因素与IBS发病的关系以及饮食管理在IBS治疗中的作用。     

肠易激综合征患者的生存质量评价及其影响因素分析

目的评价肠易激综合征 irritable bowel syndrome, IBS） 病人的生存质量并分析其影响因素。方法对在消化专科门诊就诊、符合罗马Ⅲ诊断标准的73例IBS病人和78例其他功能性肠病（functional bowel diseases, FBD）患者采用肠易激综合征生存质量量表汉化版（ Chinese Irritable Bowel Syndrome-Quality Of Life Questinnaires, ChlBS-QOL）,以及焦虑自评量表（Self-RatingDepressionScale,SAS）、抑郁自评量表（ Self-Rating Depression Scale, SAS）进行问卷调查,并建立病人的资料档案。结果ChIBS-QOL的总条目及各维度得分,尤其是饮食限制方面,均明显低于对照组（P均〈0．05）。将病人的性别、年龄、婚姻状态、职业、精神心理因素、文化程度、经济收入、病程、罗马Ⅲ分型,以及是否伴随功能性消化不良（FD）作为白变量,ChIBS-QOL作为因变量,进行多元逐步回归分析,筛选出精神心理因素（β=-17．729,t=-4．506,P〈0．001）和文化程度（β=3．897,t=2．688,P〈0．01）是影响ChIBS—QOL总分的主要因素。结论IBS患者的生存质量明显降低,精神心理因素和文化程度是影响其生存质量的重要因素。     

Irritable bowel syndrome symptom severity improves equally with probiotic and placebo

AIM To determine the effects of Lactobacillus acidophilus NCFM on irritable bowel syndrome(IBS) symptoms and quality of life(Qo L).METHODS In this randomized triple-blind trial, adult IBS volunteerswho were recruited according to Rome Ⅲ criteria received 109 or 1010 colony-forming units of NCFM or placebo daily for 12 wk. IBS Symptom Severity Score(IBS-SSS), which constituted the primary outcome, and secondary outcomes, including individual IBS symptoms, IBS-related QoL questionnaire, anxiety and depression, defecation frequency, and stool consistency, were assessed at baseline at the end of the 8-wk runin period, after 4 and 12 wk of intervention, and after a 4-wk washout.RESULTS A total of 340 of 391 randomized volunteers completed the trial. IBS-SSS improved over 12 wk of treatment in all treatment groups, decreasing by a mean ± SD of 44.0 ± 80.2, 50.8 ± 82.4, and 48.3 ± 72.2 in the placebo, active low-dose, and active high-dose groups, respectively. Similarly, secondary outcomes did not differ between treatment groups. However, in a post hoc analysis of volunteers with moderate to severe abdominal pain at baseline(VAS 35/100), the treatment significantly reduced the sensation of abdominal pain. Pain scores fell by 20.8 ± 22.8, 29.4 ± 17.9, and 31.2 ± 21.9 in the placebo, active low-dose, and active high-dose groups, respectively(P value for placebo vs combined active doses = 0.0460).CONCLUSION NCFM alleviates moderate to severe abdominal pain, consistent with earlier observations of this strain mitigating visceral pain through increased analgesic receptor expression.