中医辨证治疗对腹泻型肠易激综合征患者近期生活质量的影响

[目的]观察中医辨证论治对腹泻型肠易激综合征（IBS-D）患者近期生活质量的影响。[方法]将345例IBS-D患者分为2组,分别采用中药和西药匹维溴胺治疗,疗程4周;采用国际通用的SF-36生存量表对患者治疗前后的生活质量进行评估。[结果]治疗后中药组SF-36量表的8个维度[生理功能（PF）、生理职能（RP）、躯体疼痛（BP）、总体健康（GH）、生命活力（VT）、社会功能（SF）、情感职能（RE）、精神健康（MH）]积分均得到了显著改善;其中治疗后中药组在SF维度改善优于西药组（P〈0．05）;随访后在BP、SF、RP、MH4个维度改善明显优于西药组（P〈0．01,〈0．05）。[结论]中医辨证治疗能够改善IBS-D患者近期的生活质量。     

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。     

高FODMAPs食物摄入与肠易激综合征的相关性研究

目的 了解人群高FODMAPs食物摄入比例及相关饮食和生活习惯与肠易激综合征(IBS)症状的关系,为IBS的预防控制提供参考依据。方法 采用回顾性病例-对照研究方法对2022年8月-2022年10月在福建省立医院就诊的113例IBS患者和同期福建省立医院体检中心的138例健康志愿者进行问卷调查。结果 病例组每日高FODMAPs食物摄入比例38.56%±12.66%,高于对照组(23.55%±8.46%),两者具有显著性差异(P=0.000);病例组IBS-SSS总分(r=0.665,P=0.000)、每10天中腹痛发作天数(r=0.577,P=0.000)、腹痛程度(r=0.471,P=0.000)、腹胀不适程度(r=0.503,P=0.000)与高FODMAPs食物摄入比例存在正相关。多因素logistic回归分析显示高FODMAPs食物摄入比例(OR1.14, 95%CI 1.099～1.182)、睡眠障碍(OR 3.72,95%CI 1.762～7.853)、急性胃肠炎病史(OR 4.45,95%CI 1.808～10.995)、过度进食(OR 2.62,95%CI 1.003～...     

理气安肠汤内服配合结肠宁灌肠治疗肠易激综合征65例

1995年1月～1998年4月,用自拟理气安肠汤内服配合结肠宁灌肠治疗肠易激综合征65例,并设对照组44例对照,疗效满意,现报告如下.     

中西医结合治疗肝郁脾虚型肠易激综合征

肠易激综合征 (IBS)病因和发病机制复杂 ,迄今尚未完全清楚 ,且发病率有上升趋势 ,治疗上尚无肯定的统一方案与药物。现将 2年来我们采用中西医结合方式治疗的属中医辨证分型中的肝郁脾虚型IBS病人 2 4例总结如下。1　临床资料目前对IBS的诊断多采用罗马Ⅱ诊断标准 ,按中医辨证分型可分为肝郁脾虚、脾胃虚弱和脾胃阴虚三型。本文病例皆符合罗马Ⅱ诊断标准 (Gut1999;4 5Suppl2 :Ⅱ 4 3～ 4 7) ,且皆按中医分型中的肝郁脾虚型入选。肝郁脾虚型的标准为 :①常因精神因素如生气、紧张等而发病或加重病情 ;②便前腹痛 ,腹痛即泻 ,泻后痛减 ;…     

改善肠易激综合征患者生活质量方法的研究进展

肠易激综合征(irritable bowel syndrome IBS)是一种多因素引起的功能性胃肠病,其发病率高,严重影响患者的生活质量。目前对IBS的治疗,主要有药物、心理干预、饮食调节、锻炼等干预方式。但很多治疗方式疗效不一,对生活质量的影响不明确。该文对改善IBS患者生活质量的治疗方法作一综述。     

腹针治疗老年便秘型肠易激综合征的疗效及对生活质量的影响

目的探讨腹针对老年性便秘型肠易激综合征(IBS)的临床疗效及对生活质量的影响。方法将120例患者随机分为西药组和腹针组,每组各60例。西药组给予枸橼酸莫沙必利和乳果糖口服液治疗,腹针组给予腹针疗法(引气归元、腹四关、调脾气、天枢)针刺,两组患者连续治疗4 w,并在治疗后1、3个月进行随访。治疗前后采用西医症状积分表、生活质量量表(SF-36)评分,比较两组患者临床疗效和生活质量改善情况。结果两组患者治疗4 w后,临床症状均有明显改善,且腹针组优于西药组(P0.05);生活质量方面,两组患者生理功能(PF)、生理职能(RP)、躯体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)、情感职能(RE)、精神健康(MH)等8个维度均较治疗前明显改善(P0.05),腹针组BP、GH、VT 3个维度改善优于西药组(P0.05)。在随访过程中,两组患者生活质量评分较治疗前有不同程度改善,且腹针组优于西药组(P0.05)。结论腹针疗法能够有效缓解老年性便秘型患者的临床症状,提高患者生活质量,并且具有较好的远期疗效。     

得舒特加中药理气安肠汤治疗腹泻型肠易激综合征的疗效观察

目的 观察得舒特加中药理气安肠汤治疗腹泻型肠易激综合征(IBS)的疗效及对胃动素、胃泌素的影响。方法 将110例患者随机分为中药治疗组、西药治疗组和中西医结合治疗组3组，疗程8周，观察治疗前后症状，并测定血浆胃动素及胃泌素的含量变化。结果 中西医结合组的治愈率和有效率明显高于单用中药组或单用西药组；IBS患者的血浆胃动素与胃泌素水平明显高于正常对照组，三种疗法都能不同程度地降低血浆胃动素与胃泌素水平，而以中西医结合组的作用最明显，优于单用中药组或单用西药组。结论 得舒特和中药理气安肠汤是治疗腹泻型IBS的有效药物，中西药联合应用可进一步提高疗效。     

黛力新治疗对肠易激综合征患者生活质量的影响

目的 探讨肠易激综合征(IBS)患者在黛力新治疗前后的生活质量变化.方法 观察我院2008年12月至2009年12月给予黛力新治疗的110例IBS患者的疗效,治疗前后采用SF-36健康量表调查问卷方式了解患者的生活质量.结果 治疗后患者在SF-36健康量表中活力、躯体疼痛、情感职能、精神健康、总体健康和社会职能6个维度...     

Impact of irritable bowel syndrome on quality of life

The aims of this study were to determine the impact of irritable bowel syndrome on quality of life using a well-standardized measure, the SF-36, and to determine whether apparent impairments may be due to neuroticism. Undergraduate students with irritable bowel syndrome who had consulted a physician (41 females, 42 males), students with irritable bowel who had not consulted a physician (91 females, 74 males), and asymptomatic controls (52 females, 70 males) completed questionnaires on quality of life, neuroticism, and psychological distress. Patients showed greater impairment in quality of life than nonconsulters, who in turn showed greater impairment than controls. Neuroticism and psychological distress were correlated with all quality-of-life measures. However, when neuroticism and psychological distress were statistically partialed out, irritable bowel syndrome still had a significant negative impact. The SF-36 may be a useful outcome measure in treatment studies, but investigators will need to correct for confounding influences of neuroticism.Supported by a grant from Glaxo Welcome Inc., and by NIMH Research Scientist Award KO5 MH00133.     

二味中药复方治疗腹泻型肠易激综合征的实验研究

目的观察二味中药煎剂对肝郁脾虚型肠易激综合征大鼠的治疗作用及对胃动素和胆囊收缩素的影响。方法将实验动物随机分为6组：正常组、模型组、阳性对照组及二味中药高、中、低剂量组。运用番泻叶水煎剂灌胃和束缚结合造模,以各剂量的二味中药煎剂治疗,得舒特为阳性对照药物,测定大鼠稀便级及血清和结肠黏膜中胃动素和胆囊收缩素的含量。结果高、中剂量的二味中药可以明显改变大鼠的稀便级;二味中药和得舒特可以明显降低结肠黏膜中胆囊收缩素的含量;胃动素在血浆和结肠黏膜中无显著变化。结论二味中药可以有效治疗肠易激综合征,其作用机制可能与调节胃肠激素有关。     

腹泻型与便秘型肠易激综合征直肠肛管动力和感觉功能的不同特点

目的 研究腹泻型与便秘型肠易激综合征（IBS）病人直肠肛管动力和直肠感觉功能的不同特点。方法 选择IBS病人85例，分成两组。其中腹泻组52例，便秘组33例，20例健康志愿者为对照组，采用PC Polygraf ID高分辨率多道胃肠功能测定仪，分别测定直肠肛管压力、直肠感知阈值、排便阈值、最大耐受量和直肠肛门抑制反射最低充气量。结果IBS病人的直肠静息压、肛管静息压和直肠肛门抑制反射最低充气量与健康对照组比较无显著性差异。腹泻组的最大缩窄压和排便阈值显著低于健康对照组。便秘组的松弛压、直肠感知阈值、排便阈值和最大耐受量显著高于健康对照组。结论腹泻型IBS病人的症状与最大缩窄压和排便闽值降低有关；而便秘型则与松弛压、直肠感知阈值、排便阈值和最大耐受量显著增高有关。     

Concomitant functional dyspepsia and irritable bowel syndrome decrease health-related quality of life in gastroesophageal reflux disease

Objective. Previous studies have reported an overlap between gastroesophageal reflux symptoms, functional dyspepsia (FD) and irritable bowel syndrome (IBS). The aim of this study was to investigate the prevalence of FD and IBS in gastroesophageal reflux disease (GERD) and the effect on health-related quality of life (HRQoL). Material and methods. FD and IBS prevalence and HRQoL were assessed by means of questionnaires in 215 referred and 48 non-referred (non-care-seeking) GERD patients, proven with 24-h pH-metry. HRQoL in 131 matched controls was used for comparison. Results. In this group of GERD patients 25% had FD (Dutch general population 13–14%), 35% had IBS (Dutch general population 0.6–6%) and 5% had both FD and IBS. Only 35% had neither FD nor IBS. Among referred GERD patients, the prevalence of FD and IBS was higher (p=0.002 versus non-referred). Compared with controls, GERD patients without FD/IBS had lower HRQoL scores on only one of the nine SF-36 subscales (p≤0.001); GERD+FD patients had lower scores on six subscales (p≤0.0005); GERD+IBS patients had lower scores on eight subscales (p <0.0005) and GERD+FD+IBS patients had lower scores on seven subscales (p≤0.001). Compared with patients with GERD only, GERD+FD patients had lower scores on five subscales (p≤0.001); GERD+IBS patients had lower scores on eight subscales (p <0.0005) and GERD+FD+IBS patients had lower scores on six subscales (p≤0.001). Conclusions. In patients with proven GERD, FD and IBS are more prevalent than in the general population. This prevalence is higher among care-seeking GERD patients. Only those GERD patients with concomitant FD/IBS have a much lower HRQoL. This suggests that in GERD, when properly treated, HRQoL is affected mainly by concomitant functional disorders and not by GERD itself.     

Food-specific IgG4 antibody-guided exclusion diet improves symptoms and rectal compliance in irritable bowel syndrome

Objective

Dietary modification improves symptoms in irritable bowel syndrome (IBS). Identification of offending foods by dietary elimination/re-challenge is cumbersome. IgG4 antibodies to common food antigens are elevated in IBS. The aim of this article was to evaluate the effect of exclusion diet based on IgG4 titres on IBS symptoms and rectal sensitivity and compliance.

Material and methods

The study comprised 25 patients with IBS (3 M, 22 F, mean age 43 years, Rome II criteria). IgG4 titres to 16 foods (milk, eggs, cheese, wheat, rice, potatoes, chicken, beef, pork, lamb, soya bean, fish, shrimps, yeast, tomatoes and peanuts) were measured. Foods with titres >250?µg/l were excluded for 6 months. Symptom severity was assessed with a previously validated questionnaire at baseline, at 3 months and at 6 months. Rectal compliance and sensitivity were measured in 12 patients at baseline and at 6 months.

Results

IgG4 antibodies to milk, eggs, wheat, beef, pork and lamb were commonly elevated. Significant improvement was reported in pain severity (p<0.001), pain frequency (p=0.034), bloating severity (p=0.001), satisfaction with bowel habits (p=0.004) and effect of IBS on life in general (p=0.008) at 3 months. Symptom improvement was maintained at 6 months. Rectal compliance was significantly increased (p=0.011) at 6 months but the thresholds for urge to defecate/discomfort were unchanged.

Conclusions

Food-specific IgG4 antibody-guided exclusion diet improves symptoms in IBS and is associated with an improvement in rectal compliance.     

抑肝扶脾清热利湿法对广东地区腹泻型肠易激综合征患者血浆胃肠激素含量的影响

[目的]观察抑肝扶脾清热利湿法对广东地区腹泻型肠易激综合征（diarrheatypeirritablebowelsyn—drome,IBS-D）患者血浆胃动素（MTL）、血管活性肠肽（VIP）、生长抑素（SS）、胆囊收缩素（CCK）的影响,并探讨其作用机制。[方法3160例IBS-D患者随机分为2组,中药组采用易激灵2号方,煎取200ml,早晚分服;西药组口服马来酸曲美布丁片（商品名：舒丽启能）0．1g／次、枯草杆菌二联活菌肠溶胶囊（商品名：美常安）0．5g／次,3次／d;2组疗程均为4周。另选20例健康体检者为正常对照组。[结果]IB孓D患者血浆CCK、MTL水平较正常对照组明显增高（P〈O．01）;中药组和西药组自身疗后比较,血浆CCK、MTL水平明显降低（P〈O．01,P％0．05）;中药组治疗后血浆MTL水平较西药组明显降低（P〈O．05）。[结论]抑肝扶脾清热利湿法很可能是通过影响患者胃肠激素水平,达到治疗目的。     

肠易激综合征生活质量评价的研究现状及展望

肠易激综合征是临床上最为常见的功能性胃肠道疾病之一,生活质量量表提供了一个判断其病情严重性及治疗效果的测量工具.本文综述了国内外常用的普适量表和专用量表在评价肠易激综合征生活质量的研究现状,并对量表的优缺点及其合理选择、量表研制和引进的知识产权问题、扩大人群研究层次、发挥中医药改善生活质量的优势等方面进行展望.     

Effect of oral nicardipine on anorectal function in normal human volunteers and patients with irritable bowel syndrome

Paired controlled studies were performed in 10 normal volunteers and 32 patients with irritable bowel syndrome to investigate the effect of the calcium channel blocker nicardipine, on the responses of the anorectum to rectal distension and a meal. Nicardipine was administered orally in standard (20 mg) and sustained-release (30 mg twice a day) formulations. In normal volunteers standard nicardipine had no significant effect on the rectal responses to distension but did significantly reduce the postprandial motility index (P <0.05). In the patients with irritable bowel syndrome, standard nicardipine caused a significant reduction in distension-induced rectal motor activity (P <0.05) and increased the rectal sensory thresholds for desire to defecate and discomfort (P <0.02). Slow-release nicardipine caused a significant reduction in distension-induced activity (P <0.05) but did not alter rectal sensory thresholds. Both formulations of nicardipine significantly reduced the postprandial motility index (P <0.05) and symptoms (P <0.05). In conclusion, this study confirms that calcium channel blockers may be useful in the management of irritable bowel syndrome.     

肠吉安口服液对肝脾不和腹泻型肠易激综合征患者大脑功能区激活面积的影响

[目的]研究中药复方制剂肠吉安治疗前后肝脾不和腹泻型肠易激综合征(IBS)患者大脑痛觉功能区激活面积的变化.[方法]24例肝脾不和腹泻型IBS患者随机分为两组,分别给予肠吉安口服液(14例)和安慰剂(10例).通过直肠注气试验记录两组患者的感觉阈值和感觉评分,并应用功能性磁共振(fMRI)分析直肠扩张30、60、90和120ml时大脑痛觉功能区的激活面积.[结果]肠吉安组治疗后症状评分明显下降(P＜0.05),两组治疗前后比较差异有统计学意义(P＜0.05).直肠注气试验中两组治疗前后组间比较急迫排便阈值、疼痛阈值差异有统计学意义(P＜0.05);视觉模拟评分治疗前后组间比较,直肠注气＞30 ml时差异有统计学意义(P＜0.05);直肠注气120 ml时,肠吉安组治疗后大脑痛觉功能区右侧脑岛皮质和额前皮质的激活面积显著减少(P＜0.05),而安慰剂组治疗前后未见显著改变(P＞0.05).[结论]肠吉安通过调节大脑痛觉功能区的激活面积发挥对肝脾不和型IBS患者的显著疗效.     

Effect of Lactobacillus plantarum 299v on colonic fermentation and symptoms of irritable bowel syndrome

A number of recent clinical trials have promoted the use of probiotic bacteria as a treatment for irritable bowel syndrome (IBS). The recent demonstration of abnormal colonic fermentation in some patients with this condition provides an opportunity for the objective assessment of the therapeutic value of these bacteria. This study was designed to investigate the effects of Lactobacillus plantarum 299V on colonic fermentation. We conducted a double-blind, placebo-controlled, cross-over, four-week trial of Lactobacillus plantarum 299V in 12 previously untreated patients with IBS. Symptoms were assessed daily by a validated composite score and fermentation by 24-hr indirect calorimetry in a 1.4-m³ canopy followed by breath hydrogen determination for 3 hr after 20 ml of lactulose. On placebo, the median symptom score was 8.5 [6.25–11.25 interquartile range (IQR)], the median maximum rate of gas production was 0.55 ml/min (0.4–1.1 IQR), and the median hydrogen production was 189.7 ml/24 hr (118.3–291.1 IQR). On Lactobacillus plantarum 299V the median symptom score was 8 (6.75–13.5 IQR), the median maximum rate of gas production 0.92 ml/min (0.45–1.5 IQR), and the median hydrogen production 208.2 ml/24 hr (146–350.9 IQR). There was no significant difference. Breath hydrogen excretion after lactulose was reduced by the probiotic (median at 120 min, 6 ppm; placebo, 17 ppm; P = 0.019). In conclusion, Lactobacillus plantarum 299V in this study did not appear to alter colonic fermentation or improve symptoms in patients with the irritable bowel syndrome.