The irritable bowel syndrome.

The irritable bowel syndrome (IBS) is an extremely common disorder. It is believed to occur usually after emotional stress and perhaps because of behavioural and dietary factors. There is definite evidence of disturbed gastrointestinal function associated with IBS; however, a diagnostic marker remains elusive. The current trend is to diagnose IBS on the basis of the patient's history and the findings at physical examination and after minimal investigation. The physician-patient relationship remains the most important factor in the management of IBS. Long-term benefit may be achieved with the use of dietary fibre supplements or stool-bulking agents. The evaluation of currently available drugs is difficult because of the placebo effect. Drug therapy should be aimed at specific symptoms and used mainly during the initial phase of treatment.     

Prevalence,Behaviours and Burden of Irritable Bowel Syndrome in Medical Students and Junior Doctors

BackgroundIrritable bowel syndrome (IBS) is a common functional gastrointestinal disorder which can have a strong impact on patients'' quality of life including influence on various social aspects and psychological ramifications. The aim of the study was to assess the prevalence and consequences of IBS in medical students and junior doctors in Malta.MethodAn online survey was sent out to all medical students enrolled at University of Malta and all doctors training with the Malta Foundation Programme.Key ResultsThe prevalence of IBS was 17.7% (total number =192), with 6.2% being previously diagnosed with IBS and the rest (11.5%) having symptoms consistent with IBS according to the Rome IV criteria. There was no statistically significant difference in BMI and in activity level as determined by the Godin Leisure-Time Exercise Questionnaire between IBS and non-IBS group.Absenteeism was significantly commoner in students/ doctors with IBS (47.1%) than in those without IBS (9.5%; p=0.0001). Of those previously diagnosed with IBS, 66.7% self-medicated compared to 45.4% of those diagnosed through the questionnaire. 71.6% of those in the IBS group tried dietary modification as to control their symptoms.On the Kessler 6 Distress scale, 91.2% of the IBS group had a score >6, with 44.1% having a score >13. The mean Visceral Sensitivity Index Score was 40.1 (95% CI 33.6 - 46.6).ConclusionIBS is prevalent, yet under-recognized, in medical students and junior doctors. Measures should be instituted for timely, confidential detection and management of IBS and its related psychological consequences.     

Recommendations for the management of irritable bowel syndrome in family practice

To help family physicians manage patients with irritable bowel syndrome (IBS), a consensus conference was convened in June 1997 at which 5 internationally recognized experts in IBS presented position papers on selected topics previously circulated to the conference participants. Five working groups comprising family physicians, gastroenterologists and allied health care professionals from across Canada were then charged with developing recommendations for the diagnosis, patient education, psychosocial management, dietary advice and pharmacotherapy, respectively. An evidence-based approach was used where possible; otherwise, recommendations were made by consensus. The participants concluded that family physicians can make a positive diagnosis of IBS using symptom criteria. The pathophysiology is poorly understood, but motility and sensory disturbances appear to play a role. Neither psychological nor specific dietary factors cause IBS, but both can trigger symptoms. Drug therapy is not recommended for the routine treatment of IBS, but short-term trials of drug therapy may be targeted to predominant symptoms in selected patients. A step-wise, patient-centred approach to management is outlined.     

心胃相关理论在肠易激综合征中的应用

目的：探讨心胃相关理论在肠易激综合征中的应用。方法：从中医基础理论、现代医学研究、临床实践三个方面对情志因素在肠易激综合征中的发病机制和其治疗方法进行初步探讨。结论：心胃相关理论符合中医基本理论及现代医学理论,深入研究必然对我们对＂肠易激综合征＂的认识产生质的飞跃,对该病诊治模式产生深远影响。     

肠易激综合征发病机制的研究进展

肠易激综合征(IBS)是一种与生物生理心理等有关的综合征,多见于女性,是消化系统常见的功能性胃肠疾病,因其在现代社会中发病率高,症状顽固,治疗花费巨大,住院病例逐年增加,已引起广泛重视,IBS病因及发病机制尚不十分明确,大多数学者认为与肠道的传输改变、内脏敏感性增加、神经免疫机制、精神心理因素及遗传因素有关。随着人们对心身疾病的认识,精神心理因素在IBS中的作用越来越受到重视。该文通过查阅国内外文献,阐述IBS的概念、诊断及发病机制,为IBS的诊断治疗提供依据。     

Irritable bowel syndrome in China: a review on the epidemiology,diagnosis, and management

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disease worldwide. Current guidelines of IBS are mostly based on the western populations and expected to vary in different communities. China has a large population and a vast literature is available on IBS. Due to linguistic variations in the literature, the studies are not widely known and their conclusions thus remain largely obscured to the western medical literature. In this article, we reviewed the published literatures on the investigations of IBS epidemiology, diagnosis, and management in the Chinese population and emphasized the different findings gleaned from the western publications. The detailed literature review will benefit understanding of and promote future study on IBS.     

Bugs on the brain; brain in the gut—seeking explanations for common gastrointestinal symptoms

Introduction

Gastrointestinal symptoms such as heartburn, indigestion (or dyspepsia), bloating, distension, constipation, abdominal pain, abdominal discomfort and diarrhoea are extremely common worldwide. For some, such symptoms can prove to be chronic and disabling.

Methods

The recent literature on irritable bowel syndrome and, in particular, work emanating form this authors research group, was reviewed.

Results

These functional symptoms commonly occur in aggregations, referred to as functional gastrointestinal disorders (FGIDs). Some of the FGIDs and, most notably irritable bowel syndrome (IBS), have achieved a degree of scientific and clinical credibility as coherent entities. Several lines of evidence ranging from gut motility to the microbiota are under investigation in attempts to explain IBS or its symptomatology.

Conclusion

Though biomarkers for IBS and other FGIDs have proven elusive, considerable progress has been made in understanding possible aetiological factors in IBS; progress which may well lead to better therapeutic strategies.     

小肠细菌过度生长在肠易激综合征发病机制中的作用

小肠细菌过度生长(SIB0)是指远端肠道内菌群因各种原因移位进入小肠,引起小肠内厌氧菌过度孳生而表现为营养吸收不良、腹泻、腹胀及小肠动力异常等症状的临床综合征.SIB0与肠易激综合征(IBS)的症状重叠.相关研究表明SIB0与IBS具有相关性;推测SIB0可能是IBS发生的一种潜在的病原性因素.该文就近年来SIB0在IBS发病机制中作用的研究进展作一综述.     

小肠细菌过度生长在肠易激综合征发病机制中的作用

小肠细菌过度生长（SIB0）是指远端肠道内菌群因各种原因移位进入小肠,引起小肠内厌氧菌过度孳生而表现为营养吸收不良、腹泻、腹胀及小肠动力异常等症状的临床综合征.SIB0与肠易激综合征（IBS）的症状重叠.相关研究表明SIB0与IBS具有相关性;推测SIB0可能是IBS发生的一种潜在的病原性因素.该文就近年来SIB0在IBS发病机制中作用的研究进展作一综述.     

肠易激综合征治疗与预防的研究进展

肠易激综合征（IBS）是一种胃肠道功能紊乱的慢性疾病,临床症状主要有腹痛和排便异常,临床上将IBS分为4种类型,环境因素和宿主差异是导致IBS的原因,但确切发病机制尚不清楚。IBS的诊断、治疗和预防在临床上均较棘手,需要针对患者的生理和心理采用个性化的治疗方法,具体包括专业指导、饮食干预和心理疏导等。IBS不同于功能性腹泻和功能性便秘的最主要诊断要点为腹痛,治疗方法包括非药物疗法和/或药物疗法,总体来说,IBS的药物治疗主要根据患者的具体情况而定。新进研究表明,肠道菌群也参与了IBS的发生发展,通过使用益生菌以及肠道微生物群移植可能成为治疗IBS的有效措施。本文综述了IBS发生发展的最新机制、目前的治疗方法、预防策略以及未来可能的研究方向。     

肠易激综合征与精神心理因素

肠易激综合征(IBS)是消化道常见的功能性疾病，因其病因及发病机制仍不完全清楚，目前的治疗仅为对症治疗，患者症状常呈持续存在或反复发作．近年随着生物-心理-社会疾病模式的建立，精神心理因素在IBS发病中的作用日益受到重视，本文就精神心理因素在IBS发病中的作用做一综述。旨在能更好的了解IBS．     

小肠细菌过度生长与肠易激综合征的关系

近年来,国内外研究发现小肠细菌过度生长(SIBO)与肠易激综合征(IBS)之间存在相关性:多项随机双盲对照研究提示IBS患者中SIBO的发生率较高,并且抗生素治疗在根除过度生长的小肠细菌后亦可使得部分患者不再满足IBS诊断。一些学者因此认为SIBO参与了IBS的发病机制,甚至可能作为病因,但临床实验设计及检测方法上仍存在争议,故目前尚无定论,本文就此予以综述。     

MicroRNA与肠易激综合征的相关性研究进展

肠易激综合征(IBS)是一种常见的病因不明的紊乱性疾病。在IBS患者的血液微泡和结肠组织中存在一些失调的microRNA(miRNA)。对于miRNA的研究,最初阶段可能作为一种新的途径用来进一步了解IBS的病理生理学特征,而最终将使用miRNA作为新的策略思考IBS的诊断和治疗方法。目前,miRNA在IBS发病机制中的作用的研究报道甚少。本文主要对miRNA在IBS方面的研究进行综述。     

抗生素对肠易激综合征的影响及机制探讨

作为20世纪伟大的医学发现之一,抗生素被广泛用于各种病原微生物的感染治疗,其中包括了肠易激综合征（IBS）。尽管临床实践以及多项临床研究均表明抗生素对IBS临床症状的改善有一定的作用,相关的指南、共识也推荐非吸收性抗生素利福昔明用于治疗非腹泻型IBS,但抗生素能否用于IBS的治疗指征尚未明确,长期运用抗生素引发的不良反应也令人担忧,不良反应与临床效益之间的平衡更难把握。然而,还有多项研究发现抗生素的使用对于IBS的发生起着促进作用。本文综述了近年来关于抗生素对IBS影响的研究,发现抗生素可能从降低肠道微生物多样性、损害上皮屏障功能、影响细胞因子产生等多个方面引发IBS,同时也从两个方面指出抗生素应用于IBS指征的不确定性,认为临床医生应当重视抗生素对IBS发病的影响,评估抗生素治疗IBS的利弊,合理、谨慎地使用抗生素,从而为抗生素在IBS的发生、发展以及临床应用方面提供一定的参考和借鉴。     

Effectiveness of Menthacarin on symptoms of irritable bowel syndrome

Wiener Medizinische Wochenschrift - Irritable bowel syndrome (IBS) and functional dyspepsia (FD) are common functional gastrointestinal disorders with overlapping symptoms. Effectiveness and safety...     

功能性消化不良和肠易激综合征症状重叠与焦虑的关系

目的探讨功能性消化不良与肠易激综合征症状重叠的发生率及焦虑、抑郁障碍的关系。方法对60例FGIDs患者进行性别、年龄、FD症状、IBS症状、汉密尔顿焦虑量表、汉密尔顿抑郁量表问卷调查。结果①在性别上,女性多于男性;②在年龄段中,发病高峰以青年组、中年组常见;③重叠症状：FD组与IBS组中FD症状发生率差异有统计意义（P〈0.05）,IBS组与重叠组中FD症状发生率差异有统计意义（P〈0.05）,FD组与重叠组中FD症状发生率差异无统计意义（P〉0.05）,FD组与IBS组中IBS症状发生率差异有统计意义（P〈0.05）,IBS组与重叠组中IBS症状发生率差异无统计意义（P〉0.05）,FD组与重叠组中IBS症状发生率差异有统计意义（P〈0.05）;④焦虑、抑郁状态评分：FD组与IBS组中焦虑状态评分差异无统计意义（P〉0.05）,IBS组与重叠组中焦虑状态评分差异无统计意义（P〉0.05）,FD组与重叠组中焦虑状态评分差异有统计意义（P〈0.01）,FD组与IBS组中抑郁状态评分差异无统计意义（P〉0.05）,IBS组与重叠组中抑郁状态评分差异有统计意义（P〈0.05）,FD组与重叠组中抑郁状态评分差异有统计意义（P〈0.01）。结论FD、IBS患者容易发生症状重叠,重叠症状越多,焦虑、抑郁状态越明显。     

益生菌治疗肠易激综合征的相关机制

肠易激综合征(IBS)是最常见的功能性胃肠病之一,其病因及发病机制尚未完全明确。肠道菌群失调及小肠细菌过度生长与其发病关系密切,目前研究表明益生菌治疗可能为IBS的一种有效方法,现拟从益生菌调整肠道菌群失调、抑制小肠细菌过度生长、增强肠黏膜屏障、增强肠黏膜免疫、降低内脏高敏感性等几个方面对益生菌治疗肠易激综合征的相关机制及安全性等予以综述。     

高中生肠易激综合征现状调查及影响因素研究

背景 近年来,随着学业压力的增加,高中生熬夜、饮食及作息不规律等状况屡见不鲜,导致高中生肠易激综合征（IBS）的发病率呈逐年上升趋势。该疾病病程长,症状长期反复发作,治疗效果不理想,严重影响患者的生活质量,并造成相应的经济负担和社会负担。 目的 调研高中生IBS的发病现状和流行病学信息,分析其危险因素,并为制定切实可行的治疗方案提供科学依据。 方法 采用整群随机抽样方法,于2020年7—8月对上海市、青海省、河南省、澳门特别行政区的高中生进行流行病学问卷调查,收集人口统计学信息、IBS患病情况、精神因素、睡眠习惯、生活习惯等相关信息。采用罗马Ⅳ诊断标准判断IBS发生情况,采用症状自评量表（SCL-90）量表调查精神因素,采用匹兹堡睡眠质量指数（PSQI）调查睡眠习惯。采用SPSS 21.0软件分析高中生IBS发病的危险因素。 结果 共发放问卷5 046份,回收有效问卷4 793份,回收有效率为95.00%。4 793例高中生中217例（4.50%）发生IBS。高年级、抑郁、焦虑、人际关系敏感、食用辛辣食物、跳餐、饮酒、睡眠环境过亮和有噪声、主观睡眠质量较差和很差、入睡时间≥15 min、睡眠时间<7 h、服用催眠药物、有日间障碍、PSQI总分≥7分是高中生发生IBS的危险因素（P<0.05）。 结论 IBS是高中生的常见病和多发病。高中生应注意规律饮食、学会疏导焦虑情绪、保证良好的睡眠质量,以便有效地减少IBS的发生。     

痛泻要方加味治疗腹泻型肠易激综合征45例

目的观察痛泻要方加味治疗肠易激综合征（腹泻型）患者的临床疗效。方法将90例肠易激综合征（腹泻型）患者随机分为治疗组45例,对照组45例,其中治疗组口服痛泻要方加味并随症加减。对照组给予口服思密达,观察两组患者的临床常见症状改善情况。结果两组患者治疗前常见症状积分比较差异无统计学意义（P〉0.05）。治疗4周后治疗组在腹痛、泄泻、郁怒或紧张、胸胁胀闷、嗳气、纳差、肠鸣矢气等常见症状改善方面,均优于对照组,差异有统计学意义（P〈0.05）;治疗组在治疗4周后总有效率明显优于对照组,两组比较,差异有统计学意义（P〈0.05）。结论痛泻要方对腹泻型肠易激综合征有较好的疗效,能明显缓解临床症状,缩短治疗时间,且无不良反应,值得临床推广。     

Globus and headache: common symptoms of the irritable bowel syndrome.

Persons with the irritable bowel syndrome (IBS) have a significantly higher prevalence of globus and migraine-like headache than age-matched control subjects. On the other hand, persons with organic disease of the esophagus or colon may have a reduced prevalence of functional symptoms involving the opposite end of the gastrointestinal tract. The dispersed pattern of symptoms in IBS suggests that some agent, such as a hormone, may be acting systemically.