肠应激综合征治疗药物的进展与应用评价

目的:评价肠易激综合征药物治疗的疗效、不良反应和药物经济学,以供临床用药参考。方法:通过查阅近期国内、外相关文献总结、分析。结果与结论:目前肠易激综合征尚无确切的治疗方法,主要是对症治疗和综合治疗,包括患者教育、心理疗法、饮食调整等,而药物治疗主要在于改善胃肠道动力,解除肠管痉挛,减轻肠管扩张以及抗菌消炎等,并且尽可能实施个体化治疗方案。     

得舒特治疗肠易激综合征的临床疗效观察

目的:评价得舒特对肠易激综合征的疗效。方法:56例根据罗马标准诊断为肠易激综合征的患者进入本研究。所有患者在服用得舒特治疗前1周服用安慰剂6天,安慰剂治疗无效的患者随后用得舒特治疗,每次50mg,一日3次口服,疗程4周。结果:得舒特对肠易激综合征患者腹痛、腹泻和便秘单项症状的有效率分别为85.1％(40/47)、89.2％(33/37)和93.3％(14/15),对肠易激综合征的总有效率为85.1％(40/47)。治疗期间,除2例诉头晕外,无其它不良反应。结论:得舒特治疗肠易激综合征疗效确切,副反应发生率低,临床上可作为治疗肠易激综合征的首选药物之一。     

肠易激综合征的治疗药物

收集整理药物治疗肠易激综合征的近期文献,总结临床对肠易激综合征的药物治疗经验.     

蒙脱石治疗肠易激综合征的药物联用方案

目的总结和归纳蒙脱石治疗肠易激综合征的药物联用方案,提高临床用药水平。方法根据近15年相关文献资料,就其药物的联用方案、联用原理及联用特点作一详细分析。结果药物联用的方式可大大提高蒙脱石对肠易激综合征的治愈率。结论蒙脱石药物联合方案可有效控制肠易激综合征患者,值得临床推广应用。     

马来酸曲美布汀胶囊治疗96例肠易激综合征的临床观察

目的:探讨马来酸曲美布汀胶囊治疗肠易激综合征的临床疗效。方法:选择符合1992年罗马Ⅱ诊断标准的96例肠易激综合征患者口服马来酸曲美布汀胶囊治疗,观察治疗前后症状变化,并按症状进行分级记分评估。结果:50例肠易激综合症患者经用马来酸曲美布汀胶囊治疗后总体改善率达72.00%,且治疗中未发现不良反应。结论:马来酸曲美布汀胶囊是一种治疗肠易激综合征较理想的药物。     

肠易激综合征的临床治疗分析

目的探索目前临床上对肠易激综合征患者的治疗方法及临床治疗效果。方法通过文献检索总结临床上治疗肠易激综合征的治疗方法,并选择我院治疗的60例肠易激综合征患者,随机分成治疗组和对照组。治疗组30例患者采用药物复方谷氨酰胺颗粒治疗,对照组30例患者采用药物鲁比前列酮治疗。观察临床症状的变换情况,比较两组患者的临床治疗效果。结果对照组治愈率为20.%,总有效率为70%。治疗组治愈率为36.%,总有效率为93.3%。两组各指标对比具有显著差异,P<0.05,具有统计学意义。结论采用使用复方谷氨酰胺颗粒治疗肠易激综合征患者,在临床疗效方面优于使用鲁比前列酮治疗。药物治疗仍是临床上治疗肠易激综合征的有效方法,值得在临床治疗上推广。     

肠易激综合征的药物治疗进展

查阅国内外近期关于肠易激综合征的药物治疗进展的文献,并对其进行综述和分析.文献调研结果表明,不同类型的肠易激综合征其治疗药物是不同的,多种药物对肠易激综合征有疗效,能改善患者的生活质量.     

气滞胃痛颗粒联合匹维溴铵治疗腹泻型肠易激综合征的临床效果分析

目的:研究气滞胃痛颗粒联合匹维溴铵治疗腹泻型肠易激综合征的临床效果.方法:选择医院就诊的110例腹泻型肠易激综合征患者随机分为对照组和观察组.观察组口服气滞胃痛颗粒以及匹维溴铵两种药物,对照组只服用匹维溴铵.治疗后比较两组治疗效率以及腹痛、腹胀、腹泻等指标.结果:观察组治疗有效率明显高于对照组,其他各项指标同样优于对照组.结论:气滞胃痛颗粒联合匹维溴铵治疗腹泻型肠易激综合征效果优于单纯使用气滞胃痛颗粒.     

隔物灸脐法治疗脾虚型肠易激综合征

分析了脾虚型肠易激综合征与神阙穴和药物的相关性,探讨了隔物灸脐法干预脾虚型肠易激综合征的途径、作用机制,介绍了本方法的特点及应用,认为隔物灸脐法治疗脾虚型肠易激综合征更具操作性、实用性和有效性。     

肠易激综合征的发病原因与临床治疗体会

目的探讨肠易激综合征发病的原因及临床治疗效果。方法选取我院近年来收治的肠易激综合征患者60例,将患者分为对照组和观察组。观察组患者进行复方谷氨酰胺药物治疗,对照组患者进行鲁比前列酮药物治疗,观察两组患者的治疗效果。结果对照组患者治疗效果明显低于观察组,两组患者比较有差异有统计学意义。结论采用复方谷氨酰胺药物治疗肠易激综合征效果显著,治愈率高,是以一种值得在临床中推广使用的药物。     

Rationale for using serotonergic agents to treat irritable bowel syndrome.

PURPOSE: The role of serotonin in gastrointestinal (GI)-tract functioning, the pharmacologic rationale for using serotonergic agents in the treatment of irritable bowel syndrome (IBS), and clinical experience with novel serotonergic agents are described. SUMMARY: IBS is a common multisymptom disorder that is associated with a high socioeconomic burden. The goal of treatment is to provide rapid and sustained global relief of the multiple symptoms of IBS with a single, effective, well-tolerated agent. Traditional treatment options target single symptoms, and many patients are dissatisfied with the level of relief achieved and adverse effects. Research has revealed that serotonin is involved in three major actions in the gut: (1) mediating intestinal motility, (2) mediating intestinal secretion in the GI tract, and (3) modulating perception in the bowels. Serotonin is also a vital link in the brain-gut axis. Alterations in key elements of serotonin signaling have been demonstrated in patients with IBS. Tegaserod, a selective serotonin type 4 (5-HT(4))-receptor partial agonist, is indicated for use in women with IBS whose primary bowel symptom is constipation. Alosetron, a 5-HT(3)-receptor antagonist, is indicated for use in women with severe diarrhea-predominant IBS in whom traditional therapies have failed. The clinical usefulness of several other serotonergic agents for IBS is being investigated. CONCLUSION: The use of serotonergic agents in patients with IBS is based on the critical role that serotonin plays in the maintenance of normal gut function and brain-gut communication. Pharmacologic therapies targeting specific serotonin receptors represent an important step in the management of IBS.     

Drug discovery approaches to irritable bowel syndrome

Introduction: Irritable bowel syndrome (IBS) is defined by symptoms of abdominal pain and altered bowel habits without detectable organic disease. Antidepressants and serotonin receptor modulators are used to treat IBS, but rare serious adverse events highlight the safety hurdle. Newer drugs with secretory and motility effects via local gut mechanisms have been successfully approved for IBS, often by registering first in a related, non-IBS condition to optimize dosing, formulation and therapeutic window.

Areas covered: This review looks at approaches for novel IBS drug discovery. The underlying pathologies can be tackled locally from the ‘outside-in’ (intestinal lumen, mucosa and neuromuscular) to identify therapeutic targets. The article discusses the mechanisms associated with bile acid malabsorption, microbial dysbiosis, decreased intestinal barrier function, immune dysregulation, motility and visceral hypersensitivity.

Expert opinion: Challenges for new drug discovery are the unknown mechanisms underlying IBS, making it difficult to predict clinically efficacious molecular targets, limited options for translational research and disease progression biomarkers. Drugs acting locally via multiple targets (e.g., eluxadoline [The U.S. Food and Drug Administration approved Viberzi (eluxadoline) for IBS-D on May 27th 2015], crofelemer) to validated mechanisms are proving successful with tolerable safety margins. Novel mechanisms, identified and optimized based on the emerging role of nutrient signaling, probiotics or microbial products, are promising. Therapeutic treatment earlier in disease progression may improve response and have longer term benefits.     

Rifaximin for the treatment of diarrhoea-predominant irritable bowel syndrome

Introduction: Rifaximin is a non-absorbable, semisynthetic antibiotic that acts as an inhibitor of bacterial RNA synthesis, with a broad spectrum of antibacterial activity. Due to its poor absorption, rifaximin has an increased exposure to the intestine, thus it is suitable for the treatment of many gastrointestinal (GI) diseases. In irritable bowel syndrome (IBS) pathogenesis, gut microbiota impairment may play a major role. The possibility of modulating intestinal bacteria using antibiotics, in particular, rifaximin, has been demonstrated to improve IBS symptoms in non-constipation subtypes of IBS.

Areas covered: We reviewed the use of rifaximin in diarrhoea-predominant IBS, focusing on its pharmacokinetic characteristics, its absorption in GI disease, its lack of interaction with other drugs and its new extended release formulation.

Expert opinion: Rifaximin, with its low systemic absorption and no clinically significant interactions with other drugs, may represent a treatment of choice for IBS, mainly due to its ability to act on IBS pathogenesis, through the modulation of gut microbiota. Further studies to analyse the effect of rifaximin treatment on the composition of faecal microbiota are warranted. In particular, they need to evaluate whether resistant bacterial strains are selected and whether they are still present in the faecal sample even a long time after therapy.     

肥大细胞在肠易激综合征中的作用研究进展

肠易激综合征(irritable bowel syndrome,IBS)是一种多因素相互作用的胃肠道功能紊乱性疾病,全球范围内发病率较高。其发病机制复杂,如内脏高敏感、胃肠道动力异常、肠道屏障损坏、肠道免疫紊乱、神经免疫失调等。研究表明,肥大细胞(mast cells,MCs)在IBS的发生与发展中起到重要作用,在IBS治疗中也有初步尝试。该文就MCs在IBS发病机制中的作用及针对MCs的IBS治疗方案进行综述。     

Review of rifaximin as treatment for SIBO and IBS

Background: Rifaximin is a broad-range, gastrointestinal-specific antibiotic that demonstrates no clinically relevant bacterial resistance. Therefore, rifaximin may be useful in the treatment of gastrointestinal disorders associated with altered bacterial flora, including irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO). Objective: To review rifaximin for treatment of IBS and SIBO. Methods: Review of rifaximin clinical trials. Results/conclusion: Rifaximin improved global symptoms in 33 – 92% of patients and eradicated SIBO in up to 84% of patients with IBS, with results sustained up to 10 weeks post-treatment. Rifaximin caused a lower number of adverse events compared with metronidazole or levofloxacin and may have a more favorable adverse event profile than systemic antibiotics, without clinically relevant antibiotic resistance.     

中医药对炎症性肠病免疫调节的研究

炎症性肠病包括溃疡性结肠炎（UC）和克罗恩病,目前认为其是一种主要累及直结肠黏膜的自身免疫性疾病,以腹痛、腹泻、黏液脓血便、里急后重为主要临床表现,其病因和发病机制尚不明确,目前认为可能是遗传、肠道菌群、环境和免疫功能异常等多重因素共同作用所致。目前免疫应答成为研究的焦点和热点。目前炎症性肠病的西医治疗药物主要包括氨基水杨酸类、皮质激素类、免疫抑制剂和生物制剂等,这些药物或因疗效、或因副作用而使药效受限,且价格昂贵,中医药治疗凸显出较好的发展优势。本文旨在对近年来中医药治疗UC免疫调节方面发挥的作用进行综述,为以后临床上应用中医药提供一定的参考依据。     

Drug treatment options for irritable bowel syndrome: managing for success

Irritable bowel syndrome (IBS) is a functional gut disorder the diagnosis of which is based on clinical symptoms as set forth by the Rome criteria. As the population ages, especially with the population of patients >75 years of age expanding greatly over the next 10 years, IBS is becoming one of the most common diseases of the elderly. Thus far, developing treatment strategies for patients with IBS has been difficult because of the lack of pharmacological targets and the wide range of symptomatology. Additionally, demonstration of a therapeutic benefit is difficult in the presence of a high placebo response observed regardless of the therapy employed. Fibre, antidiarrhoeals and antispasmodics all play some role in the symptomatic treatment of IBS. With the evolution of IBS as a disorder of visceral hypersensitivity, new drugs have been developed that target the enteric nervous system. Tricyclic antidepressants (TCAs) have been found to target the enteric neurons and play a role in pain modulation. Currently, the TCAs are recommended only for severe cases of IBS pain. The newest class of drugs to be approved for use in IBS are the serotonin (5-hydroxytryptamine; 5-HT) antagonists. Specifically, the 5-HT3 receptor antagonists have been shown to decrease symptoms in female patients with IBS. A related class of drugs, the 5-HT4 receptor agonists, is being developed for the treatment of constipation-predominant IBS. Further investigation into the role of spinal afferent neurons in visceral hypersensitivity is at the forefront of IBS research. Several experimental drug therapies for IBS are also discussed in this review including N-methyl-D-aspartate receptor antagonists, neurokinin-1 receptor antagonists, octreotide, clonidine and the selective M3 receptor antagonist, zamifenacin.     

金双歧对肠易激幼鼠肠道菌群影响的研究

目的通过金双歧治疗肠易激幼鼠模型观察金双歧对幼鼠肠道菌群的影响。方法建立幼鼠肠易激模型,共20只,随机选同期正常生长幼鼠10只为正常组A,另取肠易激模型幼鼠10只为模型组B,取10只用金双歧治疗为实验组C。然后对三组幼鼠分别作粪便含水量检测及肠道菌群检测。结果小鼠建立肠易激模型后肠杆菌、肠球菌数量明显增多（P〈0.05）,双歧杆菌、乳酸杆菌数量大量减少（P〈0.05）：用金双歧治疗10d后,肠杆菌、肠球菌数量减少（P〈0.05）,双歧杆菌、乳酸杆菌大量增多（P〈0.05）,3组鼠粪便干湿重及粪便含水量比较,B组与A、C组间有显著差异（P〈0.05）。结论金双歧治疗肠易激综合症对幼鼠粪便性状症状及肠道菌群有明显改善,为应用益生菌治疗肠易激综合症提供理论依据。