奥替溴铵联合洛哌丁胺治疗改善腹泻型肠易激综合征患者症状及生活质量效果分析

目的探讨奥替溴铵联合洛哌丁胺治疗腹泻型肠易激综合征(IBS-D)改善患者临床症状的效果及对患者生活质量的影响。方法选取2015年5月至2017年8月我院收治的IBS-D患者85例为研究对象,按随机数字表法分为对照组(42例)和观察组(43例)。对照组患者给予奥替溴铵治疗,观察组患者给予奥替溴铵+洛哌丁胺治疗,连续治疗6周。比较两组患者的临床疗效、治疗前后症状(腹痛、腹胀、腹泻)改善状况和生活质量(IBS-QOL评分)的变化。结果治疗6周后,观察组患者的治疗总有效率(97.67%)高于对照组(83.33%),差异有统计学意义(P0.05);观察组患者腹痛、腹泻、腹胀评分显著低于对照组,差异有统计学意义(P0.01);观察组IBS-QOL评分显著高于对照组,差异有统计学意义(P0.05)。结论与单用奥替溴铵治疗比较,奥替溴铵联合洛哌丁胺治疗IBS-D患者,可显著提高疗效,更有效地改善临床症状,提高生活质量。     

奥替溴铵、比特诺尔和地芬诺酯治疗肠易激综合征的双盲随机对照研究

目的 探讨奥替溴铵、比特诺尔和地芬诺酯对IBS的治疗作用及副作用。方法 201例IBS腹泻型和腹痛型患者按照双讯随机对照观察分为A组（奥替溴铵）、B组（比特诺尔）和C组（地芬诺酯）。所有患者均需进行治疗前、后症状评分。疗效判断标准为：显著、中度、轻度缓解和无效。结果 三组治疗后症状平均积分均显著低于治疗前（P≤0.048)。A组和C组中度以上缓解率（69.4%和72.1%)显著高于B组（50.75,p=0.029,0.01)。A组治疗后腹痛、腹胀、排便异常感和腹部触痛积分均性减低（P＝0.000-0.039)，B组和C组治疗后腹痛、排便异常（排便次数增多、大便性状、黏液便）和腹部触痛积分和组内平均积分显著低于治疗前（P≤0.047)。A组副作用发生率（8.1%)显著低于B组（23.9%,P=0.014)和C组（35.3%,P=0.000)，主要由于B组（12.7%)和C组（25.0%)便秘发生增加。结论 上述三种药物对IBS的治疗均有效，其中奥替溴铵选择性作用于腹痛型，比特诺尔和地芬诺酯主要作用于腹泻型。奥替溴铵副作用少，耐比特诺尔和地芬诺酯长期使用易导致便秘。     

奥替溴铵治疗肠易激综合征的疗效观察

目的:探讨奥替溴铵治疗肠易激综合征(IBS)患者的疗效。方法:按罗马Ⅱ标准选择腹泻型IBS患者26例,均予奥替溴铵40 mg口服,每日3次。分别于服药前、服药2周和服     

匹维溴铵治疗腹泻型肠易激综合征的临床观察

目的 观察匹维溴铵对腹泻型肠易综合征(IBS)的治疗效果.方法 95例腹泻型肠易激综合征患者接受匹维溴铵治疗2周,观察患者治疗前后腹痛、腹胀、腹泻、大便形态、生活质量改善以及药物副反应.结果 接受匹维溴铵治疗2周后,腹泻型lBS患者腹痛、腹胀和腹泻症状评分均较治疗前显著降低(P＜0.05),大便性状评分较治疗前下降(P＜0.05),生活质量评分较治疗前提高(P＜0.05).但在停药结束后4周上述指标评分较治疗前无明显差异(P＞0.05).结论 匹维溴铵可有效缓解腹泻型lBS患者的临床症状,但治疗疗程值得进一步研究.     

米氮平联合奥替溴铵治疗腹泻型肠易激综合征21例疗效观察

肠易激综合征(IBS )指一种以腹痛或腹部不适伴排便习惯改变为特征的功能性肠病,诊断时需排除相关器质性病变.近年来,由于生活节奏加快、精神压力增大以及医疗模式对心理与社会因素的重视等原因,IBS发病率明显上升,但尚无特效治疗药物.2007年1月～2008年12月,我们采用米氮平联合奥替溴铵治疗腹泻型IBS患者21例,效果较满意.现报告如下.     

舒眠胶囊联合匹维溴铵治疗老年肠易激综合征

[目的]观察舒眠胶囊联合匹维溴铵治疗老年肠易激综合征(irritable bowel syndrome,IBS)的临床效果。[方法]76例老年IBS患者采用随机化方法分为观察组和对照组各38例。观察组在服用匹维溴铵片的基础上联合服用舒眠胶囊,对照组仅服用匹维溴铵片,疗程均为6周。观察2组治疗前后各项IBS症状评分、IBS生活质量评价量表(IBS-quality of life,IBS-QOL)、抑郁自评量表(self-rating depression scale,SDS)和焦虑自评量表(self-rating anxiety scale,SAS)的变化。[结果]观察组腹痛、腹胀、大便次数、大便性状的改善率显著高于对照组(P0.05);观察组IBS-QOL烦躁不安、行为冲突、身体意象、健康忧虑4个维度的改善率显著高于对照组(P0.05);观察组SDS和SAS的改善率均显著高于对照组(P0.05)。[结论]在口服匹维溴铵治疗老年IBS的基础上,舒眠胶囊可以进一步提高疗效。     

盐酸屈他维林治疗肠易激综合征的多中心临床试验

背景:肠易激综合征(IBS)是一种常见的慢性功能性肠病,严重影响患者的生活质量,现有治疗药物多数疗效欠佳。目的:观察盐酸屈他维林对IBS的疗效和安全性。方法:采用前瞻性、自身对照、多中心试验设计。217例IBS患者接受盐酸屈他维林片80 mg tid口服治疗,疗程2周。每天记录腹痛以及排便不尽感、排便费力、排便急迫感等伴随症状及其严重程度,同时记录排便次数和粪便性状。结果:经盐酸屈他维林治疗2周,IBS患者的周平均腹痛评分较治疗前显著减低(0.66±0.59对1.42±0.42,P=0.0000),总有效率达77.9%;便秘型IBS(IBS-C)患者的一周日平均排便次数较治疗前显著增加(0.8+0.3对0.6±0.4,P=0.0004),腹泻型IBS(IBS-D)患者则较治疗前显著减低(1.6+0.8对2.8±1.2,P=0.0000),两组患者的粪便性状以及排便不尽感、排便费力、排便急迫感等亦分别有不同程度的改善。试验中未发生严重不良事件。结论:盐酸屈他维林能有效且安全地治疗各亚型IBS。     

肠康方联合奥替溴铵治疗对肠易激综合征患者IL-8和TNF-α水平的影响

目的探究肠康方联合奥替溴铵治疗对肠易激综合征患者IL-8和TNF-α水平的影响。方法选取2014年6月至2015年10月我院收治的肠易激综合征患者90例,采用随机数字表法随机分为对照组和观察组,每组45例。对照组患者口服奥替溴铵片治疗,观察组患者在同对照组治疗基础上加用肠康方治疗。检测比较两组患者治疗前后血清IL-8和TNF-α水平,治疗总有效率、临床症状改善情况以及不良反应发生情况。结果治疗后观察组患者血清IL-8和TNF-α水平显著降低(P0.05),对照组患者TNF-α显著降低(P0.05),观察组患者血清IL-8和TNF-α水平显著低于对照组患者(P0.01)。治疗后两组患者中医症状积分均显著降低(P0.05);观察组患者中医症状积分显著低于对照组(P0.05)。观察组患者治疗总有效率为86.7%,对照组为64.4%,两组比较差异有统计学意义(P0.05);观察组患者临床治疗效果优于对照组(P0.01)。结论肠康方联合奥替溴铵治疗能显著降低肠易激综合征患者血清中IL-8和TNF-α水平,改善患者症状,提高临床治疗效果,值得推广使用。     

沙美特罗替卡松及噻托溴铵联合对COPD患者肺功能的的作用探究

目的探究沙美特罗替卡松及噻托溴铵联合治疗对COPD患者肺功能的的作用。方法将我院收治的COPD患者118例随机分为两组,实验组患者59例,联用噻托溴铵吸入剂18μg,1次/d,沙美特罗替卡松(50/250μg)吸入,2次/d。对照组患者59例,吸入沙美特罗替卡松(50/250μg),2次/d。疗程为6个月。观察比较两组患者治疗前后的疗效,FEV1、FEV1占预计值测量及进行呼吸困难分级。结果实验组患者总有效率89.8%(53/59),显著高于对照组患者总有效率76.3%(45/59),差异有统计学意义(P<0.05);治疗后实验组患者肺功能改善结果显著优于对照组患者,差异有统计学意义(P<0.05)。结论沙美特罗替卡松及噻托溴铵联合治疗COPD患者具有良好的临床疗效,可以显著改善患者的肺功能,提高患者的生活质量,值得临床应用。     

奥替溴铵联合益生菌治疗腹泻型肠易激综合征的临床疗效观察

目的研究分析奥替铵溴联合腹泻型肠易激综合征临床疗效。方法选取本院2014年6月至2015年6月收治腹泻型肠易激综合征患者90例,分为对照组与研究组,其中对照组给予奥替溴铵进行治疗,研究组在对照组基础上给予益生菌进行治疗,比较两组临床疗效。结果治疗后对照组总有效率为71.11%,明显低于研究组的88.89%(P0.05),研究组腹部不适改善时间与腹泻改善时间明显低于对照组(P0.05)。结论奥替溴铵联合益生菌治疗腹泻型肠易激综合征临床疗效显著,患者症状改善时间短,恢复快,值得临床广泛推广应用。     

IBS and the role of otilonium bromide

Introduction

Awareness of the seriousness of irritable bowel disorder (IBS) remains low among clinicians. In this review, we summarize the current knowledge of IBS and highlight the major personal, economic, and social burden of the disease, and the importance of adequate treatment of what is still often viewed as a trivial disorder. In fact, IBS is a major reason for referral.

Pathophysiology

It is crucial that the varied pathophysiologies of this complex heterogeneous disease are understood in order to be able to treat both the presenting symptoms (pain, bloating, flatulence, abnormal defecation, diarrhea, constipation) and the underlying disorder effectively. Low-grade inflammatory and immune activation has been observed, but the precise triggers and mechanisms, and the relevance to symptom generation, remain to be established.

Treatment

IBS patients require different treatment strategies according to the pattern, severity, frequency, and symptoms. While initial therapy traditionally targets the most bothersome symptom, long-term therapy aims at maintaining symptom control and preventing recurrence. In addition to dietary/lifestyle interventions and psychosocial strategies, a wide range of pharmacologic therapies are approved for use in IBS depending on the symptoms reported. Musculotropic spasmolytics, which act directly on intestinal smooth muscle contractility, such as otilonium bromide, are effective, particularly in the relief of abdominal pain and bloating, and are well tolerated in IBS.

The OBIS trial

The recent large placebo-controlled Otilonium Bromide in Irritable Bowel Syndrome study demonstrated the superiority of otilonium bromide versus placebo not only in the reduction of pain and bloating, but also in protection from relapse due to the long-lasting effect.     

Role of antispasmodics in the treatment of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a long-lasting, relapsing disorder characterized by abdominal pain/discomfort and altered bowel habits. Intestinal motility impairment and visceral hypersensitivity are the key factors among its multifactorial pathogenesis, both of which require effective treatment. Voltage-gated calcium channels mediate smooth muscle contraction and endocrine secretion and play important roles in neuronal transmission. Antispasmodics are a group of drugs that have been used in the treatment of IBS for decades. Alverine citrate, a spasmolytic, decreases the sensitivity of smooth muscle contractile proteins to calcium, and it is a selective 5-HT_1A receptor antagonist. Alverine, in combination with simethicone, has been demonstrated to effectively reduce abdominal pain and discomfort in a large placebo-controlled trial. Mebeverine is a musculotropic agent that potently blocks intestinal peristalsis. Non-placebo-controlled trials have shown positive effects of mebeverine in IBS regarding symptom control; nevertheless, in recent placebo-controlled studies, mebeverine did not exhibit superiority over placebo. Otilonium bromide is poorly absorbed from the GI tract, where it acts locally as an L-type calcium channel blocker, an antimuscarinic and a tachykinin NK2 receptor antagonist. Otilonium has effectively reduced pain and improved defecation alterations in placebo-controlled trials in IBS patients. Pinaverium bromide is also an L-type calcium channel blocker that acts locally in the GI tract. Pinaverium improves motility disorders and consequently reduces stool problems in IBS patients. Phloroglucinol and trimethylphloroglucinol are non-specific antispasmodics that reduced pain in IBS patients in a placebo-controlled trial. Antispasmodics have excellent safety profiles. T-type calcium channel blockers can abolish visceral hypersensitivity in animal models, which makes them potential candidates for the development of novel therapeutic agents in the treatment of IBS.     

Effect of antispasmodic agents, alone or in combination, in the treatment of Irritable Bowel Syndrome: Systematic review and meta-analysis

IntroductionIrritable bowel syndrome (IBS) is characterized by recurrent abdominal pain, bloating, and changes in bowel habit.AimsTo determine the clinical effectiveness of the antispasmodic agents available in Mexico for the treatment of IBS.MethodsWe carried out a systematic review and meta-analysis of randomized controlled clinical trials on antispasmodic agents for IBS treatment. Clinical trials identified from January 1960 to May 2011 were searched for in MEDLINE, the Cochrane Library, and in the ClinicalTrials.gov registry. Treatment response was evaluated by global improvement of symptoms or abdominal pain, abdominal distention/bloating, and frequency of adverse events. The effect of antispasmodics vs placebo was expressed in OR and 95% CI.ResultsTwenty-seven studies were identified, 23 of which fulfilled inclusion criteria. The studied agents were pinaverium bromide, mebeverine, otilonium, trimebutine, alverine, hyoscine, alverine/simethicone, pinaverium/simethicone, fenoverine, and dicyclomine. A total of 2585 patients were included in the meta-analysis. Global improvement was 1.55 (CI 95%: 1.33 to 1.83). Otilonium and the alverine/simethicone combination produced significant values in global improvement while the pinaverium/simethicone combination showed improvement in bloating. As for pain, 2394 patients were included with an OR of 1.52 (IC 95%: 1.28 a 1.80), favoring antispasmodics.ConclusionsAntispasmodics were more effective than placebo in IBS, without any significant adverse events. The addition of simethicone improved the properties of the antispasmodic agents, as seen with the alverine/simethicone and pinaverium/simethicone combinations.     

Extended analysis of a double-blind,placebo-controlled, 15-week study with otilonium bromide in irritable bowel syndrome

BACKGROUND/OBJECTIVE: In order to follow the most recent developments and recommendations in trial methodology for drug evaluation in patients with irritable bowel syndrome, we performed an extended analysis of a large clinical trial from a previously published study of otilonium bromide, using an assessment that integrates the key symptoms of irritable bowel syndrome. MATERIALS AND METHODS: A large-scale clinical trial with a double-blind, placebo-controlled, parallel-group study design was conducted in 378 patients, treated for 15 weeks with the recommended standard dose of 40 mg otilonium bromide or placebo three times daily. The study was based on the collection of 12 single efficacy endpoints. The new efficacy assessment was based on the data reported by the patients. Rather than demonstrating score differences between the treatment groups of the study, we carried out an assessment that integrates the most frequent symptoms reported (pain frequency and intensity, presence of meteorism and distension) by the patient. RESULTS: The rate of response to treatment within 2-4 months (the primary efficacy outcome measure) was significantly higher in the otilonium bromide group (36.9%) than in the placebo group (22.5%; P = 0.007). In each month of treatment, the rate of monthly response was higher in the otilonium bromide group as compared to the placebo group (P < 0.05). The total monthly and weekly responses to the single endpoints (intensity and frequency of pain and discomfort, meteorism/abdominal distension, severity of diarrhoea or constipation and mucus in the stool) were significantly more frequent in the group treated with otilonium bromide than in the placebo-treated group, with differences ranging from 10% to 20%. The subgroup analysis of the intestinal habits endpoint indicates that patients with diarrhoea have an additional benefit. CONCLUSION: The present re-evaluation of a previously published study confirms that otilonium bromide is more effective than placebo for the treatment of irritable bowel syndrome, being very efficient in relieving pain and discomfort.     

A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome

OBJECTIVES: The purpose of this study was to evaluate the effects of a probiotic combination on symptoms in patients with irritable bowel syndrome (IBS). METHODS: We investigated the efficiency of a probiotic dietary supplement, containing four strains of lactic acid bacteria, on symptoms of IBS. One hundred and sixteen patients with IBS fulfilling the Rome II criteria were randomized in a parallel group, double-blind study to receive a placebo or a probiotic combination (1 x 10(10) cfu once daily) for four weeks. The symptoms that were monitored weekly included discomfort, abdominal pain, and stool frequency and quality. Quality of life was assessed before and at the end of the treatment using the SF36 and FDD-quality-of-life questionnaires. RESULTS: One hundred subjects completed the study (48 probiotic combination, 52 placebo). The probiotic combination was not superior to the placebo in relieving symptoms of IBS (42.6 versus 42.3% improvement). However, the decrease of abdominal pain between the first and the fourth week of treatment was significantly higher in probiotic treated patients (-41.9 versus -24.2%, P=0.048). Interesting findings from the IBS sub-groups were also observed such as a lower pain score at end point in patients with alternating bowel habits (P=0.023) and an increase of stool frequency in the constipated sub-group from the first week of probiotic treatment (P=0.043). CONCLUSIONS: The probiotic combination was not significantly superior to the placebo in relieving symptoms of IBS. Despite the apparent high placebo response, interesting findings from IBS sub-groups were observed in the field of abdominal pain and stool frequency.     

Colonic transit, bowel movements, stool form, and abdominal pain in irritable bowel syndrome by treatments with calcium polycarbophil

BACKGROUND/AIMS: Calcium polycarbophil improves abdominal symptoms in patients with irritable bowel syndrome (IBS). We examined colonic transit times in IBS patients both before and after administration of calcium polycarbophil, and clarified the correlations among colonic transit, bowel movements, stool form and abdominal pain. METHODOLOGY: A total of 26 IBS patients (14 diarrhea-predominant type, 12 constipation-predominant type) with a median age of 51 yr were enrolled. Before administration of calcium polycarbophil, mean colonic transit times were calculated from the number of radiopaque markers in the colon. Bowel movements, the stool form scale score and abdominal pain were also measured. After oral administration of calcium polycarbophil for 8 weeks, the transit times were again measured. RESULTS: In diarrhea type, the mean colonic transit time increased, bowel movements decreased in frequency, the stool form scale score decreased, and the abdominal pain appeared to be diminished after treatment (p<0.05). In constipation type, mean colonic transit time decreased, bowel movements increased in frequency, the stool form scale score increased, the abdominal pain appeared to be diminished after treatment (p<0.05). Colonic transit times were highly correlated with stool form or bowel movements. Stool form was also highly correlated with bowel movements before and after treatment. Abdominal pain was significantly correlated with colonic transit before treatment. CONCLUSIONS: Calcium polycarbophil is useful in improving colonic transit, bowel movements, stool form and abdominal pain in both types of IBS. Improvement in colonic transit might relieve abdominal pain in IBS patients.     

匹维溴胺单用及联用黛力新治疗肠易激综合征的疗效观察

目的 观察匹维溴胺及匹维溴胺联用黛力新对肠易激综合征患者治疗的效果。方法 按罗马Ⅱ标准选择126例IBS随机分为两组,每组63例。仅予匹维溴胺治疗者为单剂组,同时予匹维溴胺和黛力新治疗者为联用组。单剂组口服匹维溴胺50mg,tid;联用组患者在单剂组的用药基础上加用黛力新,每日2片。结果 治疗2周后,单剂组和联用组的症状学评分均显著降低(P<0.05),联用组在便秘、腹痛、腹胀三项症状的改善上显著优于单用组(各为:0.52±0.20比1.63±0.16;0.74±0.20比1.42±0.20;0.69±0.11比1.37±0.44;P<0.05)。结论 匹维溴胺能够有效缓解IBS患者的症状;对于以便秘、腹痛、腹胀为主的IBS患者,加用黛力新可以得到更好的疗效。     

Management of irritable bowel syndrome

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders. The prevalence rate is 10-20% and women have a higher prevalence. IBS adversely affects quality of life and is associated with health care use and costs. IBS comprises a group of functional bowel disorders in which abdominal discomfort or pain is associated with defecation or a change in bowel habit, and with features of disordered defecation. The consensus definition and criteria for IBS have been formalized in the "Rome II criteria". Food, psychiatric disorders, and gastroenteritis are risk factors for developing IBS. The mechanism in IBS involves biopsychosocial disorders; psychosocial factors, altered motility, and heightened sensory function. Brain-gut interaction is the most important in understanding the pathophysiology of IBS. Effective management requires an effective physician-patient relationship. Dietary treatment, lifestyle therapy, behavioral therapy, and pharmacologic therapy play a major role in treating IBS. Calcium polycarbophil can benefit IBS patients with constipation or alternating diarrhea and constipation.     

Otilonium bromide in irritable bowel syndrome: A dose-ranging randomized double-blind placebo-controlled trial

AIM: To examine the efficacy and safety of otilonium bromide (OB) in treatment-sensitive functional irritable bowel syndrome (IBS) clinical parameters.METHODS: Ninety-three patients (44.8 ± 12.6 years, 69% female) with IBS symptoms complying with Rome II criteria participated in this double-blind, placebo-controlled, randomised, dose-ranging phase I/II study. Patients were administered OB 20 mg (n = 24), 40mg (n = 23) and 80 mg (n = 23) tid or placebo (n = 23) in 4 parallel groups for 4 wk. Primary efficacy variables included abdominal discomfort, intestinal habits, number of daily evacuations and stool consistency. Secondary efficacy measures included return to regular intestinal habits and global discomfort. Safety was also assessed.RESULTS: Baseline clinical characteristics were similar among the 4 groups. Although individual parameters such as intensity and frequency of abdominal discomfort, bloating or pain were reduced by OB over the 4 wk, no significant differences were observed between groups. Similarly, no difference was observed between OB treatment or placebo for mucus in stool and incomplete or difficulty of evacuation. However, evacuation frequency was significantly reduced after 4 wk by 80 mg OB compared to placebo (-8.36% for placebo vs -41.9% for 80 mg OB, P < 0.01). While 21.7% of patients in the placebo group experienced regular intestinal habits after 4 wk, this improvement was greater for patients treated with 40 mg OB (P < 0.01 vs placebo). Furthermore, a dose-dependent reduction in frequency of diarrhoea (χ²-test for trend = 11.5, P < 0.001) and an increase in normal stool frequency was observed. Combining individual variables into a global discomfort index revealed significant improvement among increasing OB doses, favouring 40 mg (P = 0.013) and 80mg OB (P = 0.001) over placebo. No difference was observed between frequency of adverse events for placebo vs OB.CONCLUSION: This dose-ranging study demonstrates that OB at 40 and 80 mg can improve individual and global clinical symptoms of IBS compared to placebo over a 4-wk period.