肠易激综合征的治疗新进展

肠易激综合征（irritable bowel syndrome，IBS）是一种功能性的肠综合征，其特征表现为腹部不适和排便习惯的改变。早前认为其发病主要是由于心理精神因素和压力所导致的结果，近来的研究又表明其发病与胃肠道运动功能障碍和内脏感觉过敏有关。IBS主要见于女性，大多数去主动求医的患者年龄在20—50岁之间。尽管只有大约10％-30％的IBS患者会去主动求医但每年仍然有大约3500万的患者并消耗大量的医药资源，而目前尚无有效的治疗措施，给患者的身心健康带来了不可估量的损失，成为亟待解决的问题。     

替加色罗治疗肠易激综合征

目的观察替加色罗在治疗肠易激综合征(IBS)的疗效。方法96例患者随机分为两组,治疗组51例,替加色罗6mg口服2次/d;对照组45例,西沙比利5mg口服3次/d;均为6周;治疗前后分别记录症状,同时检查血、尿、粪常规及培养,肝、肾功能。结果治疗组51例患者应用替加色罗6mg治疗后总改善率为80.4%,IBS的主要症状腹痛、腹胀、便秘都明显改善,有效率分别为87.8%,96.4%,86.7%。替加色罗治疗期间发生腹痛3例,发生腹泻5例。结论替加色罗是目前治疗IBS较为有效的药物,不良反应少。     

飞行员肠易激综合征误诊1例

1 临床资料 患者男,29岁,直-9飞行教员,飞行时间520h。2001年9月开始出现下腹部疼痛、腹胀、腹泻,腹泻多在清晨起床和早餐后,大便稀软或呈水样,每日3～4次,腹痛在排便、排气后缓解。多次查血、尿、粪常规正常,行腹部X线、B超检查也未见异常,诊断为“慢性肠炎”。曾先后服用泻立停、黄连     

肠易激综合征的药物治疗进展

肠易激综合征(IBS)发病率很高,药物治疗是目前治疗IBS的主要手段。本文重点按IBS腹泻型与便秘型两个方面介绍了IBS的药物应用现状。其中对用于腹泻型的阿洛司琼、雷莫司琼、索菲那新等5-羟色胺受体拮抗剂与抗生素制剂利福昔明,对用于便秘型的纤维补充剂、聚乙二醇等泻剂;促动力药替加色罗、鲁比前列酮、利那洛肽等促分泌药及胆汁酸调节剂进行了系统综述。同时对用于IBS的其他辅助用药也作了简要讨论。     

肠易激综合征及其亚型与胆囊结石的相关性分析

目的 分析肠易激综合征(IBS)及其亚型与胆囊结石的相关性。方法 选取2019年1月-2023年3月于解放军总医院第六医学中心消化内科就诊的患者556例,其中IBS组161例,非IBS组395例。对研究对象进行问卷调查、体格检查及血液检查,比较两组性别、年龄、身高、体重、血压、血生化指标等资料。采用logistic回归分析IBS与胆囊结石的关系。结果 556例患者中胆囊结石90例(16.2%),其中IBS组胆囊结石37例(23.0%),非IBS组胆囊结石53例(13.4%),IBS组胆囊结石患病率高于非IBS组(P<0.05)。IBS组胆囊泥沙样结石6例(3.7%),非IBS组胆囊泥沙样结石3例(0.8%),IBS组患者胆囊泥沙样结石患病率高于非IBS组(P<0.05)。Logistic回归分析发现,年龄、BMI、总胆汁酸(TBA)、总胆固醇(TC)及合并IBS是胆囊结石的独立影响因素(P<0.05)。161例IBS患者中,腹泻型IBS 114例,其中胆囊结石26例(22.8%);便秘型IBS47例,其中胆囊结石11例(23.4%);395例非IBS患者中胆囊结石53...     

硝苯地平加多塞平治疗肠易激综合征30例

笔者于1989年4月～1995年1月随机应用硝苯地平（心痛定）加多塞平治疗肠易激综合征（IBS）30例，并与单用硝苯地平治疗的ZO例进行对照，现将结果报告如下。1对象和方法1．且对象50例系我院内科门诊患者，均符合1986年“全国慢性腹泻学术讨论会”成都会议制定的“IBS临床诊断参考标准”。将其随机分为硝苯地平加多塞平组（A组）30例和单用硝苯地平组（B组）20例。A组男12例，女18例，年龄17～62岁，平均38．6土IO．3岁，病程6个月～12年，平均4．2土3．8年。临床表现为腹痛伴腹泻者18例，腹痛伴腹泻与便秘交替者11例，腹痛伴便秘1例。B…     

某部新兵肠易激综合征的流行病学调研

目的调研某部新兵肠易激综合征的患病率及危险因素。方法按罗马Ⅲ标准制订表格,用多级分层随机整群抽样方法,对某部新兵17～19岁2188人进行问卷调查,对有症状者进行结肠镜或结肠气钡造影排除结肠器质性疾病,得出患病率。对患病有关的危险因素作单因素和多因素分析。结果某部新兵符合罗马Ⅲ标准的患病率为15．27％,分层研究表明患病率在城市（18．32％）和农村（13．78％）差异显著（P〈0．05）;患病与文化程度存在一定关系,高中学历（X^2=8．67）和中专、初中学历（X^2=4．67）差异显著（P〈0．05）。经多因素回归分析,家族史、紧张疲劳、痢疾肠炎史、饮酒、抑郁为最可能性的危险因素。结论肠易激综合征是某部新兵的常见病,病因较明确,部队人员应提高对该病的认识,加强防治工作。     

肠易激综合征肠粘膜肥大细胞的实验研究

探讨肠易激综合征（irritable bowel syndrome,IBS)患者粘膜肥大细胞（mast cell,MC)计数有无变化，以及它在IBS中的可能作用和临床意义。粘膜标本取自15名正常人和28例IBS患者回肠末端、回盲部（ileocecal junction,ICJ)、升结肠、乙状结肠，应用特殊组化染色法对MC进行染色，并应用彩色病理图像分析软件进行分析；电镜观察MC的结构及其毗邻结构。结果显示，IBS患者回肠末端、回盲部MC明显增多（P＜0.01)，MC显著变异；并可观察到MC与无髓神经末梢及浆细胞等内分泌细胞毗邻或密切接触。研究表明，MC在IBS的病理生理机制中可能起关键性的作用，MC活性与IBS内脏感觉及动力变化相关联，MC稳定剂或MC产物拮抗剂对IBS可能具有治疗作用。     

心理因素对肠易激综合征影响62例分析

1998年1月～2004年1月,我们对门诊由于心理因素引起肠易激综合征(IBS)62例进行了调查和心理治疗,现分析如下。     

盐酸帕罗西汀对难治性肠易激综合征疗效的影响

目的 探讨盐酸帕罗西汀对难治性肠易激综合征(irritable bowel syndrome,IBS)疗效的影响.方法 124例IBS患者,随机分为常规组和盐酸帕罗西汀组,各62例.常规组口服马来酸曲美布汀0.1 g,3次/d,双歧杆菌活菌胶囊(商品名:培菲康)420 mg,3次/d.盐酸帕罗西汀组在常规组治疗的基础上给予盐酸帕罗西汀20 mg,1次/d,口服.两组疗程均为4周.在治疗前和治疗结束后分别予以焦虑自评量表(SAS)和抑郁自评量表(SDS)测评.观察两组治疗后症状改善情况及有效率.结果 盐酸帕罗西汀组总有效率为96.77%,常规组总有效率为77.42%,两组比较有统计学差异(P<0.01).IBS患者的SAS和SDS治疗前评分与正常人组之间存在显著性差异(P<0.01).盐酸帕罗西汀组患者的SAS和SDS治疗后较治疗前评分有统计学差异(P<0.01),常规组治疗前后SAS和SDS评分无统计学差异(P>0.05).结论 盐酸帕罗西汀对IBS疗效影响较大且能改善患者的情绪状态.     

Altered gastric emptying in patients with irritable bowel syndrome

Irritable bowel syndrome is the most frequent functional disorder of the digestive system. Patients with irritable bowel syndrome have motor disorders not only in the colon, but also in other parts of the digestive tract such as the oesophagus and small intestine; however, it is not known whether the stomach is also involved. We used a radiolabelled mixed solid-liquid meal (technetium-99m for the solid component, indium-111 for the liquid component) to study gastric emptying of solids (GES), liquids (GEL) and indigestible solids (GER) in 50 patients diagnosed as having irritable bowel syndrome (30 with predominant constipation and 20 with predominant diarrhoea). GER was measured by counting the number of indigestible solids remaining in the stomach 4 h after they were swallowed. In patients with irritable bowel syndrome, GES and GEL were slower than in control subjects (P<0.05). GER was normal in all patients except for two women. Thirty-two patients (64%) showed delayed GES, 29 (58%) delayed GEL, and 2 (4%) delayed GER. Among patients with irritable bowel syndrome, GES was slower in those with predominant constipation than in those with predominant diarrhoea (P<0.05); GEL and GER were similar in both groups. Gastroparesis was found in a large proportion of patients with irritable bowel syndrome, suggesting the presence of a more generalised motor disorder of the gut. Received 29 July and in revised form 29 December 1998     

Altered gastric emptying in patients with irritable bowel syndrome

Irritable bowel syndrome is the most frequent functional disorder of the digestive system. Patients with irritable bowel syndrome have motor disorders not only in the colon, but also in other parts of the digestive tract such as the oesophagus and small intestine; however, it is not known whether the stomach is also involved. We used a radiolabelled mixed solid-liquid meal (technetium-99m for the solid component, indium-111 for the liquid component) to study gastric emptying of solids (GES), liquids (GEL) and indigestible solids (GER) in 50 patients diagnosed as having irritable bowel syndrome (30 with predominant constipation and 20 with predominant diarrhoea). GER was measured by counting the number of indigestible solids remaining in the stomach 4 h after they were swallowed. In patients with irritable bowel syndrome, GES and GEL were slower than in control subjects (P<0.05). GER was normal in all patients except for two women. Thirty-two patients (64%) showed delayed GES, 29 (58%) delayed GEL, and 2 (4%) delayed GER. Among patients with irritable bowel syndrome, GES was slower in those with predominant constipation than in those with predominant diarrhoea (P<0.05); GEL and GER were similar in both groups. Gastroparesis was found in a large proportion of patients with irritable bowel syndrome, suggesting the presence of a more generalised motor disorder of the gut.     

Whole-bowel transit in patients with the irritable bowel syndrome

The transit of radiolabelled preparations through the stomach, small intestine and colon was monitored in ten patients with the irritable bowel syndrome. Five patients complained of diarrhoea, and five complained of constipation. The preparations comprised a non-disintegrating capsule and a multiparticulate system. Both preparations emptied from the stomach together and at the same rates in both groups of patients. In the patients complaining of constipation, the transit times through the small intestine were the same for both preparations. In the patients complaining of diarrhoea, the capsule passed through the small intestine slightly faster than the particles, but there were no significant differences in the small-intestinal transit rates of the two patient groups. Within the colon, the transit of the capsule was faster than that of the small particles. Although movement through the colon was, on average, faster in the group of patients complaining of diarrhoea, there was considerable intersubject variability, and the differences in transit rates between the two patient groups were not statistically significant.     

自拟中药方灌肠治疗腹泻型肠易激综合征58例

目的探讨自拟中药方灌肠治疗腹泻型肠易激综合征的疗效。方法将58例腹泻型肠易激综合征病人随机分成治疗组（30例）和对照组（28例）。对照组行药物治疗（给予胃肠解痉药、止泻药、抗焦虑药、肠道菌群调节药）;治疗组在对照组的基础上加用中药灌肠,疗程为1个月。结果治疗组和对照组的总有效率分别为93.33%和64.29%,两组比较,差异有统计学意义（P〈0.05）。结论自拟中药方灌肠治疗腹泻型肠易激综合征有显著疗效。     

Review of the role of abdominal imaging in irritable bowel syndrome

The role of radiologic imaging in the investigation of irritable bowel syndrome (IBS) remains a subject of debate and there is some evidence, from recent studies of utilization of imaging in IBS, which focused on associated costs and radiation exposure, that imaging is being used relatively widely in these patients. This review aims to assess current best evidence to accurately define the role of radiologic imaging in IBS patients. Primary and secondary literature searches were performed. Evidence suggests that the lack of “red flag” or alarm features in IBS patients should reassure the clinician that the diagnosis of IBS is correct and United States and United Kingdom guidelines recommend no radiologic imaging for IBS patients if alarm features are not present. In patients presenting with IBS symptoms and alarm features, radiologic testing may be used to exclude an alternative diagnosis and the imaging modality should be chosen based on the most likely alternative diagnosis.     

放射学成像在肠易激综合征的作用:循证评价

目的慎重地评价当代文献,从而确定现今放射学成像方法(CT、MRI、超声、透视、常规照片)对肠易激综合征(IBS)的作用。材料与方法使用"肠易激综合征"一词用于网上检索临床证据、最新发现、循证医学图书馆、TRIP、国立健     

地衣芽孢杆菌联合肠宁舒颗粒治疗肠易激综合征临床疗效分析

目的探讨地衣芽孢杆菌联合肠宁舒颗粒治疗肠易激综合征的临床疗效。方法选择2015年1月至2016年1月收治的腹泻型肠易激综合征患者160例,采用数字表法随机分为联合治疗组(A组)与地衣芽孢杆菌治疗组(B组)。B组口服地衣芽孢杆菌治疗,0.5 g/次,3次/d;A组在地衣芽孢杆菌治疗同时,联合肠宁舒颗粒治疗,5 g/次,3次/d。两组患者疗程均为4周,评价其临床疗效。结果 A组与B组总有效率分别为77.5%、47.5%,A组临床疗效显著优于B组,差异有统计学意义(P<0.05);A组患者腹痛时间、腹痛频率、排便性状异常、腹胀症状缓解的疗效均明显优于B组,差异有统计学意义(P<0.05)。结论地衣芽孢杆菌联合肠宁舒颗粒治疗肠易激综合征的临床疗效显著,值得临床上应用与推广。     

肠易激综合征患者生活质量、胃肠道症状及精神心理状况分析

目的 调查肠易激综合征(IBS)患者的生活质量、胃肠道症状及精神心理状况,分析影响其生活质量的主要因素.方法 应用IBS特异生活质量调查表、HAD焦虑抑郁量表和胃肠道症状调查表对IBS患者(n=55)及健康人(对照组,n=40)进行问卷调查,了解其生活质量、胃肠道症状及精神心理状况,并对结果进行统计分析.结果 IBS患者生活质量各方面积分均低于对照组(P＜0.05).相关分析显示,生活质量积分与症状严重程度无关,而与焦虑、抑郁积分呈负相关(P＜0.05).结论 IBS患者生活质量明显降低,不良精神心理状况是其主要影响因素.