应激反应与肠易激综合征

正确认识肠易激综合征 (IBS)发病的神经生理机制 ,有助于深刻认识IBS发病的器质性基础 ,亦有助于指导治疗IBS药物的研制。本文重点概述应激反应与IBS有关的神经生理机制。     

感染后肠易激综合征患者肠黏膜炎性细胞因子的失衡

目的通过检测感染后肠易激综合征(pIBS)患者肠黏膜炎性细胞因子白细胞介素(IL)-6、IL-18和IL-13的表达,探讨Th1及Th2淋巴细胞在感染后肠易激综合征发病中的作用和机制。方法随机抽取肠易激综合征(IBS)患者50例,其中感染后肠易激综合征患者23例,非感染后肠易激综合征(non-pIBS)患者27例,另设结肠息肉电切术后复查者20例为对照组,应用免疫组化方法分别检测肠易激综合征患者和对照组回盲部、直肠黏膜IL-6、IL-18、IL-13的表达。结果感染后IBS患者IL-6、IL-18的黏膜表达阳性率高于对照组(P0.05)及非感染后IBS组(P0.05);非感染后IBS患者IL-6、IL-18的黏膜表达阳性率与对照组比较无显著差异(P0.05);IL-13在感染后IBS及非感染后IBS患者回盲部及直肠的阳性表达率与对照组比较无明显差异(P0.05)。结论感染后肠易激综合征患者以Th1反应为主,促炎细胞因子可能诱发Th1/Th2的平衡失调。     

应激反应与肠易激综合征

正确认识肠易激综合征(IBS)发病的神经生理机制，有助于深刻认识IBS发病的器质性基础，亦有助于指导治疗IBS药物的研制。本文重点概述应激反应与IBS有关的神经生理机制。     

益生菌治疗肠易激综合征的疗效和相关机制

肠易激综合征(IBS)发病与肠道菌群紊乱和结肠发酵异常相关,益生菌能有效改善IBS的临床症状,其作用机制包括调节免疫功能和肠道动力,改善肠内环境.益生菌可作为IBS治疗的有效手段.     

聚克胶囊配合舒丽启能治疗腹泻型肠易激综合征临床疗效分析

肠易激综合征（IBS）是一种常见的慢性非器质性肠功能紊乱疾病,门诊患者中以腹泻型肠易激综合征（D—IBS）较多见。我院门诊应用肠道活菌制剂聚克胶囊配合舒丽启能治疗D—IBS取得较好的临床疗效。现将结果报道如下。     

脑-肠轴在肠易激综合征发病中的作用

肠易激综合征(IBS)的发病可能与肠道动力异常、内脏高敏感、感染、精神心理等有关。脑-肠轴在IBS发病中的作用引起普遍关注,上述的发病因素均可整合到脑-肠互动框架中进行阐述,脑-肠轴成为研究IBS发病机制的切入点。本文从脑-肠轴的概念、作用机制、脑-肠轴功能异常与IBS发病、靶向治疗等方面对脑-肠轴在IBS发病中的作用作一综述。     

肠上皮细胞紧密连接在肠易激综合征发病中的作用

肠易激综合征(IBS)是常见的功能性胃肠病,其病因和发病机制尚未完全明确。近年肠黏膜屏障在IBS发病中的作用备受关注。肠上皮细胞是肠黏膜屏障的重要组成部分,其功能与细胞间紧密连接(TJ)密切相关。研究证实IBS患者肠黏膜TJ结构异常,可能与IBS发病相关。本文就肠上皮细胞TJ在IBS发病中的作用作一综述。     

加强对感染后肠易激综合征的研究

肠易激综合征(IBS)是一组以排便后缓解或减轻的腹痛或腹部不适为主要特征的肠道综合征,根据大便习惯分为腹泻型、便秘型、混合型和不确定型。IBS是一种多因素疾病,其发病与精神心理、感染、食物等多种因素有关。人群发病率在10%~15%。感染后肠易激综合征(PI-IBS)是其中的一种亚     

炎症免疫与肠易激综合征关系的研究进展

肠易激综合征(irritable bowel syndrome,IBS)是一组以腹痛、腹胀以及排便习惯改变为主要症状的慢性功能性肠道疾病.近些年大量研究表明肠黏膜炎症免疫在IBS的发病机制中起了重要的作用,本文综述了肠黏膜炎症免疫与IBS关系的研究进展.     

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。     

Subtypes of irritable bowel syndrome on Rome III criteria: a multicenter study

Background and Aim: The aim of this study was to explore the distribution and clinical characteristics of four subtypes of irritable bowel syndrome (IBS) based on Rome III criteria in Chinese. Methods: A total of 754 consecutive IBS outpatients from three tertiary hospitals in China were included. Diagnostic criteria were based on Rome II or Rome III. Results: Among 754 outpatients, 510 (67.6%) patients met the Rome II criteria, 735 (97.5%) patients met the Rome III criteria and 492 (65.3%) patients met both sets of criteria. Among 735 patients who met the Rome III criteria, 66.3% had IBS with diarrhea (IBS‐D), 14.7% had IBS with constipation (IBS‐C), 4.2% had mixed IBS (IBS‐M) and 14.8% had unsubtyped IBS (IBS‐U). Most of the IBS‐D, IBS‐C and IBS‐M patients based on the Rome III criteria matched the diarrhea‐predominant IBS, constipation‐predominant IBS and alternating IBS based on the Rome II criteria, respectively. Among IBS‐U patients, 57.0%, 33.3% and 9.7% had constipation‐predominant IBS, diarrhea‐predominant IBS and alternating IBS, respectively. For IBS‐M, the frequencies of bowel movements were stable in 48.4% patients and variable in 51.6% patients. Defecation urgency and straining were most frequent in IBS‐M and least frequent in IBS‐U patients than other subtypes. About 77.2% of IBS‐U patients had abnormal stool frequency (< 3 times/week or > 3 times/day). Conclusion: The Rome III criteria are more sensitive and practical in diagnosing IBS. IBS‐D is the most frequent subtype, which is followed by IBS‐U, IBS‐C and IBS‐M. IBS‐U is a new subtype, which warrants further studies.     

Relationship between severity of symptoms and quality of life in 858 patients with irritable bowel syndrome

AIMS: Heath-related quality of life (QoL) is decreased in patients with irritable bowel syndrome (IBS) but the relationship between symptom intensity of IBS and QoL remains largely unknown. The aim of this prospective survey was to investigate the relationship between intensity of IBS and changes in QoL. METHODS: Eight hundred and fifty-eight patients with IBS, according to Rome II criteria, completed a symptom questionnaire to measure intensity of IBS, and the gastrointestinal quality of life (GIQLI) questionnaire, which is a general QoL measure in patients with gastrointestinal disorders. RESULTS: 37.2% of the patients had constipation-predominant type IBS, 37.3% had diarrhea-predominant IBS and 25.4% had alternating diarrhea and constipation type symptoms. IBS was considered to be in remission or mild in 8.3% of patients; 41.3% had moderate IBS and 50.4% had severe IBS. The mean GIQLI score was 88 +/- 20. There was a significant correlation between symptom intensity and changes in QoL. Other significantly related factors were the type of bowel abnormality and gender. CONCLUSION: In IBS patients, symptom intensity and type of IBS have a negative impact on health-related QoL.     

Relationship between subtypes of irritable bowel syndrome and severity of symptoms associated with panic disorder

Objective. To investigate the relationship between subtypes of irritable bowel syndrome (IBS) and severity of symptoms associated with panic disorder (PD). Material and methods. The study comprised 178 consecutive new PD outpatients. Sixty-four patients met the Rome-II criteria for IBS (IBS[+]; 29 diarrhea-predominant IBS (IBSD), 14 constipation-predominant IBS (IBSC), 21 other types of IBS). Results. IBSD patients with agoraphobia avoided a greater number of scenes owing to fear of panic attack than did PD patients without IBS (IBS[?]) and with agoraphobia. IBS[+] patients with avoidant behavior due to fear of IBS symptoms had significantly higher Beck Depression Inventory (BDI) scores and avoided a larger number of scenes owing to fear of panic attack than IBS[+] patients with agoraphobia and without avoidant behavior due to fear of IBS symptoms or IBS[?] patients with agoraphobia. Conclusions. The results suggest that the presence of IBSD or avoidant behavior because of fear of IBS symptoms may be associated with a more severe form of agoraphobia, and the latter may also be associated with depression.     

Incidence of IBS in a Cohort of People with Asthma

We conducted a study to examine the relation of asthma and its treatment to irritable bowel syndrome (IBS). We identified cohorts of members with and without asthma from January 1996 though June 2002 and calculated rates of IBS in both cohorts. In a nested case-control study, we calculated odds ratios for oral steroid dispensing before IBS onset. To address differential IBS detection, we conducted a quantitative sensitivity analysis. We identified 91,237 people with asthma and sample of 24,518 people without asthma. There was a 20% increase in the incidence of IBS among people with asthma (standardized morbidity ratio = 1.2; 95% CI, 1.0-1.5), and no association between oral steroids and IBS among people with asthma (OR = 1.0; 95% CI, 0.9-1.1.) Misclassification of IBS would have biased the rate ratio toward the null. We observed a small increase in IBS among people with asthma, and no association between oral steroids and IBS onset among asthma patients.     

Epidemiology of IBS

Irritable bowel syndrome (IBS) is a common functional gastrointestinal (GI) disorder. Because not everyone needs to seek care, population-based studies are needed to truly understand the epidemiology of IBS. About 10% of the population has IBS at any one time and about 200 people per 100,000 will receive an initial diagnosis of IBS over the course of a year. IBS patients are more frequently younger in age, and a female predominance has been observed in Western countries and tertiary care settings. IBS patients commonly report overlapping upper GI, as well as a variety of non-GI, complaints.     

Prevalence of rectal hypersensitivity in patients with irritable bowel syndrome and its clinical subgroups.

AIM: To evaluate the prevalence of rectal hypersensitivity in our irritable bowel syndrome (IBS) patients, the relationship of hypersensitivity to rectal distensibility and the differences in sensitivity among clinical subgroups of IBS. MATERIAL AND METHODS: 18 healthy subjects and 56 IBS patients (Rome-II criteria; 22 diarrhea-predominant, 15 constipation-predominant and 19 alternating). Rectal sensitivity and distensibility were studied by isobaric phasic distension of a poliethilene bag with a barostat. RESULTS: IBS patients showed a lower threshold for discomfort, pain and maximum tolerate distension, without any differences in rectal distensibility. 64% of IBS patients were hypersensitive. 89% of patients with alternating IBS were hypersensitive while only 68% and 26% of patients with diarrhea-predominant IBS and constipation-predominant IBS, respectively, were. There were no differences in rectal distensibility between hypersensitive and normosensitive patients. CONCLUSION: 64% of our IBS patients show rectal hypersensitivity, apparently not related to rectal distensibility. Hypersensitivity is mostly found in alternating IBS patients, and rare in constipation-predominant IBS.     

Regulation of the serotonin transporter in the pathogenesis of irritable bowel syndrome

Serotonin(5-HT) and the serotonin transporter(SERT) have earned a tremendous amount of attention regarding the pathogenesis of irritable bowel syndrome(IBS). Considering that enteric 5-HT is responsible for the secretion, motility and perception of the bowel, the involvement of altered enteric 5-HT metabolism in the pathogenesis of IBS has been elucidated. Higher 5-HT availability is commonly associated with depressed SERT mR NA in patients with IBS compared with healthy controls. The expression difference of SERT between IBS patients and healthy controls might suggest that SERT plays an essential role in IBS pathogenesis, and SERT was expected to be a novel therapeutic target for IBS. Progress in this area has begun to illuminate the complex regulatory mechanisms of SERT in the etiology of IBS. In this article, current insights regarding the regulation of SERT in IBS are provided, including aspects of SERT gene polymorphisms, microR NAs, immunity and inflammation, gut microbiota, growth factors, among others. Potential SERT-directed therapies for IBS are also described. The potential regulators of SERT are of clinical importance and are important for better understanding IBS pathophysiology and therapeutic strategies.     

Detection of Colorectal Tumor and Inflammatory Bowel Disease during Follow-up of Patients with Initial Diagnosis of Irritable Bowel Syndrome

Background: We wanted to estimate the incidence of irritable bowel syndrome (IBS) and functional dyspepsia (FD) in the general population, and the detection of colorectal tumor (CRT) and inflammatory bowel disease (IBD) after the diagnosis of IBS and FD. Methods: Patients aged 20-79 years newly diagnosed with IBS (N = 2956) or FD (N = 9900), together with a comparison cohort randomly sampled from the general source population, were followed-up during a mean time of 3 years. Results: We found an overall incidence of 10.3 per 1000 person-years for FD and 2.6 per 1000 person-years for IBS. There was a greater prevalence of depression, stress, fatigue, and pain disorders among IBS and FD patients than in the general population. During the 1st year after a diagnosis of IBS the cumulative risk of detecting CRT was close to 1% in IBS patients. After the 1st year the risk of CRT in IBS patients was close to that in the general population. We found a significantly increased risk of detecting IBD among patients initially diagnosed as having IBS (relative risk (RR), 16.3; 95% confidence interval (CI), 6.6-40.7), which was constant during all the follow-up period. No association was found between dyspepsia and CRT, or IBD. Conclusion: IBS and FD shared some comorbidity features, yet demographics and incidence rates were different. Unlike the detection of colorectal tumor, the excess risk of IBD after an initial diagnosis of IBS was cumulatively increased during all the follow-up period. The continuously increased risk of IBD detection in IBS patients favors a true association between IBS and IBD.     

Racial differences in the impact of irritable bowel syndrome on health-related quality of life

GOALS: To compare the impact of irritable bowel syndrome (IBS) on health related quality of life (HRQOI) for non-white and white IBS patients. BACKGROUND: There are no reported data evaluating the HRQOL of non-white persons with IBS. STUDY: SF-36 scores are compared between non-white IBS patients (n = 166), white IBS patients (n = 707), the general US population, and patients with selected chronic diseases. RESULTS: Of the n = 166 non-white IBS patients included for analysis, 66 (40%) described themselves as African-American, 56 (34%) as Hispanic, 25 (15%) as Asian-American, 2 (1%) as Native American and the remaining 17 (10%) as "other." Compared with white IBS patients, non-white IBS patients reported similar decrements in their HRQOL after controlling for age, gender, income and education level. On all 8 SF-36 scales, non-white IBS patients had significantly worse HRQOL compared with the general US population, (P < 0.001). Compared with GERD patients, non-white IBS patients scored significantly lower on all SF-36 scales (P < 0.001) except physical functioning. Similarly, non-white IBS patients had significantly worse HRQOL on selected SF-36 scales compared with diabetes mellitus and ESRD patients. Non-white IBS patients had significantly better emotional well-being than depressed patients, (P < 0.001). CONCLUSIONS: Non-white IBS patients experience impairment in vitality, role limitations-physical, and bodily pain. Yet overall, non-white IBS patients report similar HRQOL to white IBS patients. These data provide the first detailed evaluation of the impact of IBS on HRQOL in non-white IBS patients.     

肠易激综合征血浆及乙状结肠粘膜中VIP及SS的含量

目的 :探讨肠易激综合征 (IBS)患者血浆及乙状结肠粘膜中血管活性肠肽 (VIP)、生长抑素 (SS)有无变化 ,以及它们在IBS发病过程中的可能作用和临床意义。方法 :应用放射免疫分析法 (RIA)测定IBS患者血浆及乙状结肠粘膜内VIP、SS的含量 ,并与正常组比较。结果 :便秘型IBS血浆及乙状结肠粘膜中VIP含量显著高于正常组 (P <0 .0 1 ) ,腹泻型显著低于正常组 (P <0 .0 5) ;SS在IBS各组均显著高于正常组 (P <0 .0 5) ,而便秘型又显著高于腹泻型 (P <0 .0 5)。结论 :IBS患者存在VIP、SS含量异常 ,且这些异常可能在IBS发病中起一定的作用 ;不同类型IBS患者VIP及SS含量有显著差异 ,说明不同类型IBS在发病机制上有其不同的病理生理学基础