Antinociceptive and antidiarrheal effects of pioglitazone in a rat model of diarrhoea‐predominant irritable bowel syndrome: Role of nitric oxide

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曲美布汀治疗肠易激综合征的临床疗效

目的 :观察曲美布汀治疗肠易激综合征(IBS)的临床疗效。方法 :参照罗马Ⅱ标准 ,选择 60例IBS病人 ,随机分成治疗组和对照组 ,每组 30例。对照组男性 12例 ,女性 18例 ,年龄 (33±s 16)a。治疗组男性 13例 ,女性 17例 ,年龄 (31± 12 )a。 2组均给予谷维素 (2 0mg ,po ,tid)、维生素B1(2 0mg ,po ,tid)、维生素C (0 .2 g ,po ,tid)。治疗组加用曲美布汀 2 0 0mg ,po ,tid ,疗程 2wk。观察治疗前后IBS腹痛、腹泻、便秘、腹胀的情况。结果 :治疗组wk 1总有效率 67% ,wk 2总有效率 83%。wk 2腹痛缓解率 90 % ,腹泻缓解率 89% ,便秘缓解率77% ,腹胀缓解率 81%。无明显不良反应。结论 :曲美布汀是治疗IBS安全有效的药物     

Tenapanor hydrochloride for the treatment of constipation-predominant irritable bowel syndrome

Introduction: Constipation-predominant irritable bowel syndrome (IBS-C) is a common functional gastrointestinal (GI) disorder characterized by recurrent abdominal pain and prolonged GI transit. The pathogenesis of IBS-C has still not been established; therefore, drugs currently in use in IBS-C act mainly symptomatically, whereas novel pharmacological targets are urgently needed. Tenapanor is a potent inhibitor of Na⁺/H⁺ exchanger 3 [NHE3], localized in the apical membrane of intestinal epithelial cells. NHE3 participates in the uptake of sodium ions and water from the intestinal lumen.

Areas covered: In this review, the authors discuss pharmacodynamics and pharmacokinetics of tenapanor, focusing on animal models and in vitro studies. They also summarize clinical trials on tenapanor’s safety and efficacy in view of its potential role in IBS-C therapy.

Expert opinion: Tenapanor possesses an excellent preclinical safety profile and, as of now, there are no serious concerns about its side effects. The non-systemic action of tenapanor constitutes a significant advantage, as it minimizes possible adverse effects or drug–drug interactions. However, Phase III clinical trials are still needed to confirm results obtained in earlier phases and optimize the dose–response for tenapanor, whereas limiting diarrhea, its major adverse effect.     

益生菌治疗肠易激综合征疗效的Meta分析

目的探讨益生菌治疗肠易激综合征(IBS)的临床疗效及安全性。方法计算机检索PubMed、国际Cochrane中心、Embase、中国生物医学文献数据库、中国期刊全文数据库、万方数据库、维普数据库,收集益生菌治疗IBS的随机对照试验(RCT),并手工检索已获文献的参考文献,由两位评价者按照纳入和排除标准筛选、提取资料并行方法学质量评价,采用RevMan 5.0软件对数据行Meta分析。结果共纳入19个RCT,2172例患者。Meta分析结果显示,益生菌较安慰剂在改善患者总体症状积分[SMD=-0.18,95%CI(-0.28,-0.08),P=0.000 6]、腹痛[SMD=-0.13,95%CI(-0.21,-0.04),P=0.0031、腹胀[SMD=-0.15,95%CI(-0.25,-0.05),P=0.004]、排便不适感[SMD=-0.15,95%CI(-0.27,-0.02),P=0.02】方面均有显著意义,在总体生活质量[SMD:0.09,95%CI(-0.08,0.25),P=0.301、不良反应发生率[RR=0.91,95%CI(0.71,1.16),P=0.45]方面无显著意义。结论目前证据显示益生菌制剂能有效改善IBS患者的临床症状,且安全性好,但现有RCT在方法质量学以及研究设计上存在一定不足,今后的研究应在菌株、剂量、疗程、IBS亚组患者方面进行严谨、高质量、大样本长期随访的临床研究予以证实。     

Is there an appropriate strategy for treating co-morbid irritable bowel syndrome and bladder pain syndrome?

Introduction: Two of the most frequent components of chronic pelvic pain syndrome (CPPS) are irritable bowel syndrome (IBS) and bladder pain syndrome (BPS), characterized by considerable overlapping symptoms and pathophysiology. Currently, its management is challenging meaning there is high the demand for novel efficient therapeutics to aid patient care and to tackle the socioeconomic burden of IBS and BPS. As there are presently no sufficient treatment strategies, identifying the mechanisms that result in their main symptoms is the opportunity for developing appropriate therapies.

Areas covered: Herein, the authors explore the potential common treatment strategies for co-morbid IBS and BPS and highlight the absolute need for further research of these deliberating clinical entities.

Expert opinion: In the future, the authors summise that the discovery of predictive molecular biomarkers combined with clinical phenotypic categorization will likely allow for more definitive differentiation of patients and thus for better treatment options. Furthermore, it has been suggested that effective IBS treatment strategies would be of great value to co-morbid IBS and BPS therapy.     

联合抗抑郁药治疗腹泻型肠易激综合征的临床研究

目的探讨联合抗抑郁药氟哌噻吨美利曲辛、匹维溴胺及培菲康治疗腹泻型肠易激综合征的临床疗效。方法将82例患者随机分为两组。对照组40例,口服匹维溴胺及培菲康;治疗组42例,加服氟哌噻吨美利曲辛。疗程均为4周,观察治疗前后Zung焦虑自评量表（SAS）、Zung抑郁自评量表（SDS）及IBS病情变化积分（BSS）。结果治疗后治疗组患者SAS、SDS评分及BSS评分均较治疗前降低,且较对照组降低,两者比较差异均具有统计学意义（P〈0.05）。结论联合抗抑郁药氟哌噻吨美利曲辛能明显改善肠易激综合征的症状,并能改善患者的精神状态,临床效果显著,值得临床进一步研究应用。     

Current and emerging drug options in the treatment of diarrhea predominant irritable bowel syndrome

Introduction: Irritable bowel syndrome diarrhea predominant (IBS-D) is a highly prevalent GI disease, affecting nearly a third of all patients diagnosed with irritable bowel syndrome. Current treatment options are limited.

Areas covered: This review discusses the pharmacotherapeutic options for IBS-D including currently used medications, the two newly FDA approved medications, as well as emerging therapies with potential benefit in IBS-D. Particular emphasis is placed on rifaximin and eluxadoline and their possible use in IBS-D.

Expert Opinion: Current pharmacological treatment of IBS-D includes loperamide, bile acid sequestrants, antispasmodics, tricyclic antidepressants, alosetron, eluxadoline and rifaximin. The latter two treatments have significantly added to the pharmacotherapeutic options for patients suffering from IBS-D.     

Epidemiology,pathogenesis and treatment of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a very common functional disorder of the gastrointestinal (GI) tract that is associated with significant healthcare costs and disability. Despite this, our understanding of this syndrome is yet limited and our treatment methods only modestly effective. The aim of this article is to review the epidemiology and pathophysiology of IBS and subsequently discuss the various treatment methods available, including current, novel and potential future therapies.     

Emerging drugs for irritable bowel syndrome

Irritable bowel syndrome (IBS) is one of the most common chronic gastrointestinal disorders, yet its pathophysiology is incompletely understood and pharmacological treatments remain unsatisfactory. Current therapeutic choices include a range of drugs aimed at normalising bowel habits, reducing pain or treating comorbid psychological symptoms. However, this individual symptom-targeted approach remains unsatisfactory in terms of global symptom relief and patient satisfaction. In the last decade, further characterisation of IBS pathophysiology has provided new and exciting targets at different levels of the brain–gut axis for the development of several candidate drugs. Advances in clinical trial design will help to evaluate these compounds in different IBS patient populations.     

936例临床疑诊肠易激综合征病人的结肠镜结果分析

目的探讨结肠镜检查在诊断肠易激综合征（IBS）中的意义。方法回顾分析2000年～2006年到我院就诊且疑诊肠易激综合征的936例病人．这些病人在肠镜检查前根据临床有关资料均提示为肠易激综合征．对这些病人的结肠镜检查结果进行了分析．以便评价肠镜检查在诊断IBS中的意义。结果936例疑诊肠易激综合征病人结肠镜结果正常的674例（72％）。息肉76例（8．11％）．溃疡性结肠炎34例（3．63％）,血管畸形3例（0.32％）,憩室2例（0．21％）,黑变病1例（0．1％）,寄生虫4例（0.43％）,癌16例（1．7％）,克罗恩病1例（0．1％）。不进行结肠镜检查仅根据临床上的其他资料诊断IBS的准确率为72％．而28％的病人存在结肠器质性病变。其中肿瘤性病变占9．81％。结论结肠镜检查是诊断IBS时排他性的必备检查。     

肠易激综合征的药物治疗进展

查阅国内外近期关于肠易激综合征的药物治疗进展的文献,并对其进行综述和分析.文献调研结果表明,不同类型的肠易激综合征其治疗药物是不同的,多种药物对肠易激综合征有疗效,能改善患者的生活质量.     

门诊护理干预对肠易激综合征的作用

目的探讨门诊护理干预对肠易激综合征的治疗效果的影响。方法应用随机、单盲的方法,将山东中医药大学第二附属医院2008年4月至2009年8月门诊就诊的112例肠易激综合征患者随机分为对照组与实验组,实验组给予一般治疗及门诊护理干预,对照组仅给予一般治疗,门诊随访4周,观察患者症状改善情况及肛门测压。结果临床总疗效比较中观察组总有效率为91．1％;对照组总有效为38例,总有效率为67．9％。χ2=9．247,P〈0．01。两组比较差异有统计学意义。两组直肠压力变化中观察组总有效率为83．9％;对照组总有效为31例,总有效率为44．6％。χ2=10．811,P〈0．01。两组比较差异有统计学意义。结论门诊护理干预明显改善肠易激综合征的预后,是一种良好的辅助治疗手段。     

Efficacy and safety of plecanatide in treating constipation predominant irritable bowel syndrome

Introduction: Uroguanylin interacting with intestinal Guanylate Cyclase C (GC-C) receptors plays an important role in gastrointestinal fluid and electrolyte homeostasis. Plecanatide is the first uroguanylin analog that stimulates GC-C receptors on gastrointestinal mucosa with pH-sensitive receptor binding. Binding to the GC-C receptor activates intracellular conversion of GTP to cGMP resulting in the stimulation of intestinal fluid secretion.

Areas covered: Herein, all published research regarding the development of and clinical experience with plecanatide is reviewed. Clinical study results in patients with Chronic Idiopathic Constipation (CIC) and Irritable Bowel Syndrome with Constipation (IBS-C) are also reviewed. Success in the treatment of CIC and IBS-C is supported by beneficial effects on stool viscosity, Complete Spontaneous Bowel Movements and visceral sensation. Finally, the discussion within focuses on the importance of plecanatide in understanding the physiology of uroguanylin, the pathophysiology of IBS-C and the potential for development of uroguanylin and guanylin analogs.

Expert opinion: Given this broad spectrum of potential activity for GC-C agonists, it would not be surprising to see that the use of agents such as plecanatide in new areas grow to a level even greater than the use for the present CIC and IBS-C indications.     

痛泻宁颗粒联合氟西汀、培菲康治疗腹泻型肠易激综合征的效果观察

目的观察痛泻宁颗粒联合氟西汀、培菲康治疗腹泻型肠易激综合征的效果。方法将符合诊断标准的74例腹泻型肠易激综合征患者随机分为对照组和治疗组各37例,对照组给予痛泻宁颗粒治疗,观察组在对照组基础上加用氟西汀、培菲康治疗。结果两组治疗后总有效率分别为70.27%和91.89%,治疗组疗效显著优于对照组（P〈0.05）;治疗组SAS、SDS评分下降均显著高于对照组（P〈0.05）。结论痛泻宁颗粒联合氟西汀、培菲康可有效改善腹泻型肠易激综合征的症状及患者的不良情绪,且不良反应少,值得推广应用。     

菝葜治疗便秘型肠易激综合征作用机制的实验研究

目的研究菝葜治疗便秘型肠易激综合征的疗效及作用机制。方法用冰水灌胃法复制大鼠便秘型肠易激综合征模型,将造模成功大鼠分为模型组、菝葜提取物高、中、低剂量组(浓度依次为8、4、2 g.ml-1,按生药量计)、阳性对照组,另设空白对照组。灌胃给药3周后,酶免法测定大鼠血清5-HT和血浆SS、SP含量的变化,观察菝葜提取物对大鼠结肠5-HT、SP、SS和脊髓SP免疫组化染色的影响,以及对大鼠结肠MC甲苯胺蓝法染色的影响。结果与模型组相比,菝葜提取物低剂量组能够降低模型大鼠血清5-HT和血浆SS含量(P<0.05);能够升高模型大鼠血浆SP的含量(P<0.05);能够升高模型大鼠结肠SS、SP和脊髓SP免疫组化染色的平均灰度值(P<0.05);能够升高模型大鼠结肠5-HT免疫组化染色平均灰度值(P<0.01);并且能够减少模型大鼠结肠MC计数(P<0.05)。结论菝葜对便秘型肠易激综合征模型大鼠有明显的治疗作用,其作用机制可能是通过调整模型大鼠血清5-HT,血浆SS、SP,结肠5-HT、SP、SS、MC,脊髓SP等来实现的。     

Dexloxiglumide for the treatment of constipation predominant irritable bowel syndrome

Introduction: Irritable bowel syndrome (IBS) is a multifactorial functional gut disorder, where sensory/motor disturbances seem to play a major role, with no satisfactory treatment for a majority of patients. Cholecystokinin (CCK) is a hormone with several effects on gastrointestinal function, and IBS patients have been shown to produce altered sensory/motor responses to CCK.

Areas covered: Dexloxiglumide is a selective antagonist of the type 1 receptor of CCK, which has demonstrated to revert the CCK mediated effects on gastrointestinal motility and sensitivity. In humans, Dexloxiglumide has been shown to accelerate gastric emptying, slow down transit in the proximal colon, and increase the tolerance to intestinal gas. In phase 2 clinical trials Dexloxiglumide 200 mg tid has demonstrated to be superior to placebo in symptom relief in constipation predominant IBS (IBS-C). In a phase 3 withdrawal study Dexloxiglumide obtained a more sustained effect than placebo. However, these promising effects in IBS-C have not been confirmed in large phase 3 studies so far.

Expert opinion: Dexloxiglumide has demonstrated positive effects on important aspects of gastrointestinal function, like gastric emptying and gas tolerance, that deserves consideration in future studies. However, the available data is insufficient to recommend dexloxiglumide for treatment of IBS-C today.