美沙拉秦与曲美布汀联合对肠易激综合征患者结肠黏膜肥大细胞及其相关炎性介质的影响

背景:肠易激综合征(IBS)患者存在肥大细胞活化现象,对结肠黏膜肥大细胞及其相关炎性介质进行研究有助于疾病的评估和治疗。目的:探讨美沙拉秦联合曲美布汀对IBS患者结肠黏膜肥大细胞数量及其相关炎性介质的影响。方法:选取2014年10月—2016年6月上海市嘉定区中心医院40例腹泻型IBS(IBS-D)和40例便秘型IBS(IBS-C)患者,并以20名健康志愿者作为对照。将40例IBS-D和40例IBS-C患者均随机分为美沙拉秦+曲美布汀组和曲美布汀组,疗程均为4周。以改良甲苯胺蓝染色计数肥大细胞,免疫组化染色评估相关炎性介质的评分,评估患者的临床疗效。结果:与健康对照组相比,基线状态IBS-D患者和IBS-C患者肥大细胞数量均显著升高(P0.05);给予美沙拉秦+曲美布汀治疗后,肥大细胞数量均显著降低(P0.05)。基线状态时,IBS患者5-HT、IL-1、TNF-α、组胺和类胰蛋白酶免疫组化染色评分均显著高于健康对照组(P0.000 1);给予美沙拉秦+曲美布汀治疗后,上述炎性介质的免疫组化染色评分均显著降低(P0.05)。IBS-D患者中,美沙拉秦+曲美布汀组总有效率显著高于曲美布汀组(85.0%对45.0%,P=0.008),而IBS-C患者中两组总有效率无明显差异(55.0%对25.0%,P=0.053)。结论:美沙拉秦联合曲美布汀治疗可降低IBS患者结肠黏膜肥大细胞数量以及相关炎性介质的释放,对IBS-D患者的临床疗效更佳。     

马来酸曲美布汀治疗肠易激综合征的疗效和安全性研究

背景肠易激综合征(IBS)是一种常见的肠道功能性疾病,曲美布汀是一种具有胃肠道运动调节作用的药物,已广泛应用于IBS的治疗。目的评估马来酸曲美布汀治疗IBS的疗效和安全性。方法采用前瞻性、随机、对照、多中心临床研究,将符合罗马Ⅱ标准的79例便秘型IBS(C鄄IBS)患者和81例腹泻型IBS(D鄄IBS)患者分别随机分为马来酸曲美布汀组和匹维溴铵组。研究包括2周基线期、4周治疗期和随后的2周随访期。患者在治疗期内口服马来酸曲美布汀(200mgtid)或匹维溴铵(50mgtid)。主要疗效指标为每周总体症状的评分,次要疗效指标包括每周便秘/腹泻的严重程度评分、腹部胀气和其他IBS症状的严重程度评分。结果马来酸曲美布汀治疗后,C鄄IBS和D鄄IBS患者的总体症状评分均显著下降,分别由基线期的1.9和1.8下降至治疗期结束时的1.1和0.6(P<0.01),次要疗效指标也均显著改善;各症状的改善程度与匹维溴铵组比较均无显著差异。研究期间未发现明显不良反应。结论马来酸曲美布汀是一种安全、有效的缓解IBS症状的药物。     

中西医结合治疗肠易激综合征40例

[目的]观察马来酸曲美布汀(商品名:双迪)联合四逆散加减治疗肠易激综合征(IBS)的疗效.[方法]60例IBS患者随机分为2组,治疗组40例予马来酸曲美布汀联合四逆散加减治疗;对照组20例单用马来酸曲美布汀治疗.[结果]治疗组总有效率92.5%,优于对照组的85.0%(P＜0.05).治疗组缓解腹痛和便秘症状亦优于对照组(均P＜0.05).[结论]马来酸曲美布汀联合四逆散加减治疗IBS疗效较为理想.     

认知行为治疗联合马来酸曲美布汀对肠易激综合征患者的疗效观察

[目的]探讨认知行为治疗联合马来酸曲美布汀胶囊对肠易激综合征(IBS)患者治疗中的可行性及效果.[方法]纳入符合罗马Ⅳ诊断标准的IBS患者54例,对照组24例口服马来酸曲美布汀,观察组30例在此基础上联合认知行为治疗.以IBS患者焦虑自评量表(SAS)、抑郁自评量表(SDS)、IBS症状严重程度量表(IBS-SSS)、...     

马来酸曲美布汀治疗肠易激综合征疗效和安全性研究

目的评估马来酸曲美布汀治疗肠易激综合征(IBS)的疗效和安全性.方法采用前瞻性临床研究,予符合罗马Ⅲ标准的62例IBS患者口服马来酸曲美布汀4周。研究包括2周基线期,2周治疗期,4周治疗期和随后的2周随访期。治疗前后分别记录症状并检查肝、肾功能。结果62例IBS患者治疗4周后,总改善率为81.2%,IBS的主要症状明显改善。研究期间未发生明显不良反应。结论马来酸曲美布汀治疗IBS安全有效,值得临床推广。     

马来酸曲美布汀联合复方阿嗪米特治疗功能性消化不良疗效观察

目的观察马来酸曲美布汀联合复方阿嗪米特肠溶片治疗功能性消化不良的疗效。方法将确诊为功能性消化不良的患者120例分成3组,观察组（A 组）40例,给予马来酸曲美布汀、复方阿嗪米特肠溶片口服;对照组（B 组）40例,单用马来酸曲美布汀口服;对照组（C 组）40例,单用复方阿嗪米特肠溶片口服,疗程均为4周。观察患者治疗前后腹胀及上腹部不适症状的改善情况。结果3组患者治疗后腹胀及上腹部不适症状改善均有统计学意义（P ＜0．05）,观察组较对照组症状改善明显。结论马来酸曲美布汀和复方阿嗪米特肠溶片联合治疗消化不良,疗效优于单用马来酸曲美布汀和复方阿嗪米特肠溶片。     

马来酸曲美布汀联合西兰司琼治疗腹泻型肠易激综合征的疗效

目的探讨马来酸曲美布汀联合西兰司琼治疗腹泻型肠易激综合征的疗效。方法选择2015年5月至2017年5月在武警四川总队医院就诊的100例肠易激综合征(IBS)患者作为研究对象,以随机数表法分为观察组(n=55)和对照组(n=45)。对照组使用马来酸曲美布汀治疗,观察组采用马来酸曲美布汀联合西兰司琼进行治疗。比较两组治疗后的有效率、胃肠道症状及血清P物质(SP)、生长抑素(SS)、神经肽Y(NPY)、5-羟色胺(5-HT)、降钙素基因相关肽(CGRP)表达水平的变化。结果治疗后,观察组的临床总有效率(94.55%)高于对照组(73.33%),差异有统计学意义(P0.05);治疗后,两组患者血清SP、SS表达水平均明显下降,且观察组血清SP、SS表达水平显著低于对照组,差异具有统计学意义(P0.05);治疗后,两组患者血清5-HT、CGRP表达水平均明显下降,NPY表达水平明显上升,且观察组血清5-HT、CGRP表达水平显著低于对照组,NPY水平明显高于对照组,差异均有统计学意义(P均0.05);治疗后,两组腹泻、腹痛、恶心呕吐评分及总积分均明显下降,且观察组各项评分及总积分均显著低于对照组,差异均具有统计学意义(P均0.05)。结论对IBS患者应用马来酸曲美布汀联合西兰司琼的疗效显著,可有效改善患者血清5-HT、CGRP及NPY表达水平,改善胃肠道症状,值得临床推广和应用。     

马来酸曲美布汀分散片联合聚乙二醇4000散治疗便秘型肠易激综合征的临床效果

目的探究马来酸曲美布汀分散片联合聚乙二醇4000散治疗便秘型肠易激综合征(irritable bowel syndrome-constipation,IBS-C)临床疗效.方法选取2015-09/2016-09浙江中医药大学附属第三医院收治的96例IBS-C患者,采取随机数表法将患者分成对照组和实验组;对照组患者采用马来酸曲美布汀分散片进行治疗,实验组患者采用马来酸曲美布汀分散片联合聚乙二醇4000散进行治疗;治疗4 wk后,比较两组患者的疗效、不良反应以及复发率.结果实验组患者的总有效率高于对照组(93.75%vs 79.17%,P0.05);实验组和对照组不良反应的总发生率比较,差异不具有统计学意义(8.33%vs 10.42%,P0.05);实验组复发2例,对照组复发8例,实验组复发率低于对照组(4.17%vs 16.7%,P=0.032,χ~2=5.457).结论马来酸曲美布汀分散片联合聚乙二醇4000散治疗IBS-C能够显著改善患者单项临床症状,临床疗效显著,安全性较高,复发率较低,值得临床推广.     

马来酸曲美布汀、谷维素联合山莨菪碱治疗IBS 78例效果观察

目的探讨马来酸曲美布汀、谷维素联合山莨菪碱治疗肠易激综合征(IBS)的临床效果。方法将132例IBS患者随机分为观察组78例及对照组54例,观察组予马来酸曲美布汀口服,0.1～0.2 g/次,3次/d,根据症状适当调整;谷维素10～20 mg/次,3次/d;山莨菪碱5～10 mg/次,3次/d。持续用药4周。对照组仅予马来酸曲美布汀,用法及用量均同观察组。比较两组症状评分、症状频率评分、临床效果及不良反应发生情况。结果观察组症状程度评分及症状频率评分均明显低于对照组,总有效率显著高于对照组,P均<0.05;不良反应发生率与对照组比较无统计学差异。结论马来酸曲美布汀、谷维素及山莨菪碱联合应用能显著提高IBS的治疗效果,且较为安全。     

马来酸曲美布汀联合谷维素治疗肠易激综合征72例疗效观察

目的观察马来酸曲美布汀联合谷维素治疗肠易激综合征（IBS）的I}缶床疗效及安全性。方法将同期收治的146例IBS患者随机分为观察组72例和对照组74例。两组均停用其他治疗IBS的药物,禁用影响胃肠功能药物,均予马来酸曲美布汀口服,200mg／次、3次／d。观察组在此基础上加服谷维素,100ms／次、3次／d,均以4周为1个疗程。观察治疗后IBS症状变化及药物不良反应。结果观察组总有效率显著高于对照组（P〈0．01）;两组不良反应发生率无显著差异。结论马来酸曲美布汀联合谷维素治疗IBS效果显著,安全性高。     

Decreased expression of serotonin in the jejunum and increased numbers of mast cells in the terminal ileum in patients with irritable bowel syndrome

AIM： To investigate if there are changes in serotonin （5-HT） levels, enterochromaffin （EC） cells and mast cells in small intestinal mucosa of patients with irritable bowel syndrome （IBS）. METHODS： Diarrhea-predominant （IBS-D, n = 20）, or constipation-predominant （IBS-C, n = 18） IBS patients and healthy controls （n = 20） underwent colonoscopy and peroral small intestinal endoscopy, and mucosal samples were obtained at the descending part of the duodenum, proximal end of jejunum and terminal ileum. High-performance liquid chromatographyelectrochemistry and immunohistochemical methods were used to detect 5-HT content, EC cells and mast cells. RESULTS： （1） There were no differences in the number and distribution of EC cells between IBS patients and the normal group. （2） The mucosal 5-HT contents at the duodenum, jejunum and ileum in IBS-C patients were 182 ± 90, 122 ± 54, 61 ± 35 ng/mg protein, respectively, which were all lower than those in the normal group （256 ± 84, 188 ± 91, and 93 ± 45 ng/ mg protein, respectively）, with a significant difference at the jejunum （P 〈 0.05）. There were no differences in the small intestinal mucosal 5-HT contents between IBS-D patients and the normal group. The mucosal 5-HT contents at the duodenum were significantly higher than those at the ileum in the three groups （P 〈 0.001）. （3） The numbers of mast cells in patients with IBS-C and IBS-D at the ileum were 38.7 ± 9.4 and 35.8 ± 5.5/highpower field （hpf）, respectively, which were significantly more than that in the normal group （29.8 ± 4.4/hpf） （P 〈 0.001）. There was no significant difference in the numbers of mast cells at the other two parts between IBS patients and the normal group. The numbers of mast cells in IBS-C, IBS-D, and normal groups were all significantly higher at the ileum （38.7 ± 9.4, 35.8 ± 5.5, 29.8 ±4.4/hpf, respectively） than at the duodenum （19.6± 4.7, 18.5 ± 6.3, 19.2 ±3.3/hpf, respectively, P 〈 0.001）. CONCLUSIO     

Diarrhoea-predominant irritable bowel syndrome distinguishable by 16S rRNA gene phylotype quantification

AIM: To study whether selected bacterial 16S ribosomal RNA (rRNA) gene phylotypes are capable of distinguishing irritable bowel syndrome (IBS).METHODS: The faecal microbiota of twenty volunteers with IBS, subdivided into eight diarrhoea-predominant (IBS-D), eight constipation-predominant (IBS-C) and four mixed symptom-subtype (IBS-M) IBS patients, and fifteen control subjects, were analysed at three timepoints with a set of fourteen quantitative real-time polymerase chain reaction assays. All assays targeted 16S rRNA gene phylotypes putatively associated with IBS, based on 16S rRNA gene library sequence analysis. The target phylotypes were affiliated with Actinobacteria, Bacteroidetes and Firmicutes. Eight of the target phylotypes had less than 95% similarity to cultured bacterial species according to their 16S rRNA gene sequence. The data analyses were made with repeatedmeasures ANCOVA-type modelling of the data and principle omponent analysis (PCA) with linear mixed-effects models applied to the principal component scores. RESULTS: Bacterial phylotypes Clostridium cocleatum 88%, Clostridium thermosuccinogenes 85%, Coprobacillus catenaformis 91%, Ruminococcus bromii-like, Ruminococcus torques 91%, and R. torques 93% were detected from all samples analysed. A multivariate analysis of the relative quantities of all 14 bacterial 16S rRNA gene phylotypes suggested that the intestinal microbiota of the IBS-D patients differed from other sample groups. The PCA on the first principal component (PC1), explaining 30.36% of the observed variation in the IBS-D patient group, was significantly altered from all other sample groups (IBS-D vs control, P = 0.01; IBS-D vs IBS-M, P = 0.00; IBS-D vs IBS-C, P = 0.05). Significant differences were also observed in the levels of distinct phylotypes using relative values in proportion to the total amount of bacteria. A phylotype with 85% similarity to C. thermosuccinogenes was quantified in significantly different quantities among the IBS-D and control subjects (-4.08 ± 0.90 vs -3.33 ± 1.16, P = 0.04) and IBS-D and IBS-M subjects (-4.08 ± 0.90 vs -3.08 ± 1.38, P = 0.05). Furthermore, a phylotype with 94% similarity to R. torques was more prevalent in IBS-D patients' intestinal microbiota than in that of control subjects (-2.43 ± 1.49 vs -4.02 ± 1.63, P = 0.01). A phylotype with 93% similarity to R. torques was associated with control samples when compared with IBS-M (-2.41 ± 0.53 vs -2.92 ± 0.56, P = 0.00). Additionally, a R. bromii-like phylotype was associated with IBS-C patients in comparison to control subjects (-1.61 ± 1.83 vs -3.69 ± 2.42, P = 0.01). All of the above mentioned phylotype specific alterations were independent of the effect of time.CONCLUSION: Significant phylotype level alterations in the intestinal microbiotas of IBS patients were observed, further emphasizing the possible contribution of the gastrointestinal microbiota in IBS.     

Irritable bowel syndrome evaluation using computed tomography colonography

AIM To evaluate the morphology of the colon in patients with irritable bowel syndrome(IBS) by using computed tomography colonography(CTC).METHODS Twelve patients with diarrhea type IBS(IBS-D), 13 patients with constipation type IBS(IBS-C), 12 patients with functional constipation(FC) and 14 control patients underwent colonoscopy following CTC. The lengths of the rectosigmoid colon, transverse colon and the total colon were measured. The diameters of the rectum, sigmoid colon, descending colon, transverse colon, and ascending colon were measured.RESULTS The mean length of the total colon was 156.5 cm in group C, 158.9 cm in group IBS-D, 172.0 cm in group IBS-C, and 188.8 cm in group FC. The total colon in group FC was significantly longer than that in group C(P 0.05). The mean length of the rectosigmoid colon was 56.2 cm, 55.9 cm, 63.6cm, and 77.4 cm(NS). The mean length of the transverse colon was 49.9 cm, 43.1 cm, 57.0 cm, and 55.0 cm. The transverse colonin group IBS-D was significantly shorter than that in group IBS-C(P 0.01) and that in group FC(P = 0.02). The mean diameter of the sigmoid colon was 4.0 cm, 3.3 cm, 4.2 cm, and 4.3 cm(NS). The mean diameter of the descending colon was 3.6 cm, 3.1 cm, 3.8 cm, and 4.3 cm. The descending colon diameter in group IBS-D was significantly less than that in group IBS-C(P = 0.03) and that in group FC(P 0.001). The descending colon diameter in group FC was significantly greater than that in group C(P = 0.04). The mean diameter of the transverse colon was 4.4 cm, 3.3 cm, 4.2 cm, and 5.0 cm(NS).CONCLUSION CT colonography might contribute the clarification of subtypes of IBS.     

Patients with irritable bowel syndrome-diarrhea have lower disease-specific quality of life than irritable bowel syndrome-constipation

AIM: To determine effect of irritable bowel syndrome(IBS) subtype on IBS-specific quality of life(QOL) questionnaire and its subscales.METHODS: We studied IBS patients visiting our functional gastroenterology disorder clinic at a tertiary care center of Unites States.IBS and IBS subtype were diagnosed using Rome-Ⅲ questionnaire.QOL was assessed using IBS-QOL questionnaire.IBSQOL assesses quality of life along eight subscales: dysphoria,interference with activities,body image,health worry,food avoidance,social reactions,sexual health,and effect on relationships.IBS-QOL and its subscales were both scored on a range of 0-100 with higher scores suggestive of better QOL.Results of overall IBS-QOL scores and subscale scores are expressed as means with 95%CI.We compared mean IBS-QOL score and its subscales among various IBSsubtypes.Analysis of variance(ANOVA) was used to compare the mean difference between more than two groups after controlling for age and gender.A posthoc analysis using Bonferroni correction was used only when P value for ANOVA was less than 0.05.RESULTS: Of 542 patients screened,243 had IBS as per Rome-Ⅲ criteria.IBS-mixed(IBS-M) was the most common IBS subtype(121 patients,49.8%) followed by IBS- diarrhea(IBS-D)(56 patients,23.1%),IBSconstipation(IBS-C)(54 patients,22.2%) and IBSunspecified(IBS-U)(12 patients,4.9%).Overall IBSQOL scores were significantly different among various IBS-subtypes(P = 0.01).IBS-QOL of patients with IBS-D(61.6,95%CI: 54.0-69.1) and IBS-M(63.0,95%CI: 58.1-68.0) was significantly lower than patients with IBS-C(74.5,95%CI: 66.9-82.1)(P = 0.03 and 0.02 respectively).IBS-D patients scored significantly lower than IBS-C on food avoidance(45.0,95%CI: 34.8-55.2 vs 61.1,95%CI: 50.8-71.3,P = 0.04) and interference with activity(59.6,95%CI: 51.4-67.7 vs 82.3,95%CI: 74.1-90.6,P 0.001).IBS-M patients had more interference in their activities(61.6,95%CI: 56.3-66.9 vs 82.3,95%CI: 74.1-90.6,P = 0.001) and greater impact on their relationships(73.3,95%CI: 68.4-78.2 vs 84.7,95%CI: 77.2-92.2,P = 0.02) than IBS-C patients.Patients with IBS-M also scored significantly lower than IBS-C on food avoidance(47.2,95%CI: 40.7-53.7 vs 61.1,95%CI: 50.8-71.3,P = 0.04) and social reaction(66.1,95%CI: 61.1-71.1 vs 80.0,95%CI: 72.1-87.7,P = 0.005).CONCLUSION: IBS-D and IBS-M patients have lower IBS-QOL than IBS-C patients.Clinicians should recognize food avoidance,effects on daily activities and relationship problems in these patients.     

肠易激综合征患者结肠黏膜辣椒素受体、P物质和肥大细胞变化的研究

背景:腹痛是一般人群中最常见的肠道症状,肠易激综合征(IBS)患者的腹痛症状更为严重、频繁,然而其发生机制尚不明确。目的:分析IBS患者结肠黏膜中与痛觉和内脏高敏感相关的辣椒素受体VR1、P物质(SP)和肥大细胞(MC)的变化,探讨IBS患者内脏高敏感和腹痛的发生机制。方法:39例IBS患者[腹泻型IBS(IBS-D)21例,便秘型IBS(IBS-C)18例]和18名健康人纳入研究。受检者于结肠镜检查时在回盲部和乙状结肠取活检,行VR1、SP免疫组化染色和MC改良甲苯胺蓝染色。结肠镜检查前采用视觉模拟评分法行疼痛评分。结果:IBS患者乙状结肠VR1、回盲部和乙状结肠SP免疫反应阳性细胞以及回盲部MC数量显著多于正常对照组(P0.01),IBS-D与IBS-C组间则无明显差异。IBS-D和IBS-C患者的腹痛评分均与VR1呈正相关(r=0.553,P=0.009;r=0.592,P=0.010)。结论:IBS患者结肠黏膜中VR1、SP免疫反应阳性细胞和MC数量显著增多,VR1与腹痛评分呈正相关,三者可能参与了IBS患者内脏高敏感和腹痛的发生机制。     

肠易激综合征患者小肠移行性复合运动的研究

目的 了解肠易激综合征(IBS)患者移行性复合运动(MMC)与健康人相比是否有差异及IBS患者离散性丛集波(DCC)与腹痛是否有关.同时改进目前胃肠运动的监测方法 .方法 采用16导水灌注测压导管对16例便秘型IBS(IBS-C)患者、18例腹泻型IBS(IBS-D)患者、18例健康对照者进行MMC的监测.结果 IBS-C[(127.5±25.5)min]及IBS-D患者[(74.5±18.7)min]MMC周期持续时间与健康对照组[(87.5±24.2)min]相比存在显著不同(P值均<0.001).与健康对照者相比,IBS-C患者MMC Ⅲ相波幅及传播速度显著降低[(39.8±11.7)mm Hg比(61.1±14.1)mm Hg,P<0.001,1 mm Hg=0.133 kPa;(1.8±0.9)cm/min比(2.6±0.8)cm/min,P<0.01];而IBS-D患者MMC Ⅲ相波幅[(69.7±20.5)mm Hg]升高,MMC Ⅲ相传播速度[(4.1±2.5)cm/min]显著加快.IBS-C、IBS-D患者及健康对照组MMC Ⅱ相DCC发生率分别为87.5%,88.8%,83.3%,各组之间差别无统计学意义(P>0.05).IBS-C及IBS-D患者MMC Ⅲ相波中断、传导障碍等异常现象发生率分别为68.8%、66.7%,且只在空肠部位观察到,而健康人中未见到该异常.结论 (1)IBS-C、IBS-D患者的MMC与健康人相比有明显差异,提示MMC运动异常是IBS重要发病机制之一,而且IBS患者空肠部位MMCⅢ相波的变化可能是IBS重要的胃肠道运动异常.(2)DCC与IBS患者腹痛无明显相关性.     

A prospective assessment of bowel habit in irritable bowel syndrome in women: defining an alternator

BACKGROUND & AIMS: Irritable bowel syndrome (IBS) is subtyped as IBS with diarrhea (IBS-D) or IBS with constipation (IBS-C) based on Rome II guidelines. The remaining group is considered as having mixed IBS (IBS-M). There is no standard definition of an alternator (IBS-A), in which bowel habit changes over time. Our aim was to use Rome II criteria to prospectively assess change in bowel habit for more than 1 year to understand IBS-A. METHODS: Female patients (n=317) with IBS entering a National Institutes of Health treatment trial were studied at baseline with questionnaires and 2-week daily diary cards of pain and stool frequency and consistency. Studies were repeated at the end of treatment (3 months) and at four 3-month intervals for one more year. Algorithms to classify subjects into IBS-D, IBS-C, and IBS-M groups used diary card information and modified Rome II definitions. Changes in bowel habit at 3-month intervals were then assessed using these surrogate diary card measures. RESULTS: At baseline, 36% had IBS-D, 31% IBS-M, and 34% IBS-C. Except for stool frequency, there were no differences between groups. While the proportion of subjects in each subgroup remained the same over the year, most individuals (more than 75%) changed to either of the other 2 subtypes at least once. IBS-M was the least stable (50% changed out by 12 weeks). Patients were more likely to transition between IBS-M and IBS-C than between IBS-D and IBS-M. Notably, only 29% switched between the IBS-D and IBS-C subtypes over the year. CONCLUSIONS: While the proportion of subjects in each of the IBS subtypes stays the same, individuals commonly transition between subtypes, particularly between IBS-M and IBS-C. We recommend that IBS-A be defined as at least one change between IBS-D and IBS-C by Rome II criteria over a 1-year period.     

Reduction in duodenal endocrine cells in irritable bowel syndrome is associated with stem cell abnormalities

AIM: To determine whether the decreased density of duodenal endocrine cells in irritable bowel syndrome (IBS) is associated with abnormalities in stem cell differentiation.METHODS: The study sample comprised 203 patients with IBS (180 females and 23 males with a mean age of 36 years) and a control group of 86 healthy subjects without gastrointestinal complaints (77 females and 9 males with a mean age of 38 years). The patients included 80 with mostly diarrhoea (IBS-D), 47 with both diarrhoea and constipation (IBS-M), and 76 with mostly constipation (IBS-C). Both the patients and controls underwent gastroscopy and four biopsy samples were taken from the descending part of the duodenum, proximal to the papilla of Vater. The biopsy samples were sectioned and immunostained for Musashi 1 (Msi-1), neurogenin 3 (NEUROG3), secretin, cholecystokinin (CCK), gastric inhibitory peptide (GIP), somatostatin and serotonin. Immunostaining was performed with an ultraView Universal DAB Detection Kit (v1.02.0018, Venata Medical Systems, Basal, Switzerland) using the BenchMark Ultra immunohistochemistry/in situ hybridization staining module (Venata Medical Systems). Endocrine cell densities were quantified by computerized image analysis using the Olympus cellSens imaging program.RESULTS: The densities of Msi-1 and NEUROG3 cells were significantly lower in IBS patients, regardless of the subtype, than in the controls (77 ± 17 vs 8 ± 2; P = 0.0001, and 351 ± 33 vs 103 ± 22; P = 0.00002, respectively). Furthermore, the densities of secretin, and CCK cells were significantly lower in patients with diarrhoea as the predominant IBS symptom (IBS-D) than in the controls (161 ± 11 vs 88 ± 8; P = 0.00007, and 325 ± 41 vs 118 ± 10; P = 0.00006, respectively), but not in patients with constipation as the predominant IBS symptom (IBS-C) or those with both diarrhoea and constipation (IBS-M). The GIP cell density was significantly reduced in both IBS-D (152 ± 12 vs 82 ± 7; P = 0.00003), and IBS-C (152 ± 12 vs 107 ± 8; P = 0.01), but not in IBS-M. The densities of somatostatin cells in the controls and the IBS-total, IBS-D, IBS-M and IBS-C patients were 81 ± 8, 28 ± 3, 20 ± 4, 37 ± 5 and 28 ± 4 cells/mm² epithelium, respectively. The density of somatostatin cells was lower in IBS-total, IBS-D, IBS-M and IBS-C patients than in the controls (P = 0.00009, 0.00006, 0.009 and 0.00008, respectively). The density of serotonin cells did not differ between IBS patients and controls.CONCLUSION: The reduction in duodenal endocrine cells in IBS patients found in this study is probably attributable to the reduction in cells expressing Msi-1 and NEUROG3.     

Sleep-Related Autonomic Disturbances in Symptom Subgroups of Women with Irritable Bowel Syndrome

The objective was to investigate whether predominant symptom patterns in women with irritable bowel syndrome (IBS) affect autonomic activity during sleep. Seventy-five women with IBS underwent a polysomnographic sleep study. Twenty-two of the IBS patients were diarrhea-predominant (IBS-D), 33 were constipation-predominant (IBS-C), and 20 patients had alternating symptoms (IBS-A). Autonomic activity was measured by heart rate variability. The IBS-D group had significant vagal withdrawal compared to the IBS-A group during REM and non-REM sleep (P < 0.05). The IBS-D symptom subgroup had significantly (P < 0.05) greater sympathetic dominance during non-REM than IBS-A patients. Lower abdominal pain correlated with sympathetic dominance during sleep in the IBS-D group (r=0.54, P < 0.01). The IBS-D patients were physiologically distinct with regard to autonomic functioning during sleep compared to the alternating patients, but not the constipated patients. Sleep appears to unmask differences in autonomic activity that may distinguish IBS patients.     

肠易激综合征模型大鼠5-羟色胺7受体的表达及作用

目的 观察5-羟色胺7受体在肠易激综合征(IBS)不同亚型模型大鼠大脑和消化道组织中表达和分布的差异,探讨其在IBS发病中的作用.方法 45只成年SD大鼠分均为对照组、腹泻型IBS(IBS-D)组和便秘型IBS(IB-C)组.乙酸加束缚应激法制备IBS-D模型,冰水灌胃法制备IBS-C模型.免疫组化法和实时定量PCR法检测各组大鼠大脑、空肠、回肠、近端结肠、远端结肠中5-HT7受体的分布及表达差异.放射免疫法测定以上各组织中环磷酸腺苷(cAMP)含量.结果 免疫组化结果 显示,IBS-C组和IBS-D组海马及下丘脑、IBS-C组回肠、近端结肠、远端结肠5-HT7受体表达强于对照组(P＜0.05).实时定量PCR结果 显示,IBS-C和IBS-D组海马和下丘脑、IBS-C组回肠、近端结肠及远端结肠5-HT7受体mRNA明显高于对照组(P＜0.05).IBS-C和IBS-D组海马和下丘脑、IBS-C组近端结肠和远端结肠cAMP含量显著高于对照组(P＜0.05).结论 两组大鼠脑组织及IBS-C大鼠结肠5-HT7受体表达及cAMP水平明显增高,可能与IBS-C胃肠动力障碍和内脏感觉异常有关.