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肠易激综合征(irritable bowel syndrome,IBS)是一种功能性肠病,表现为与腹痛或腹部不适相关,以排便习惯及粪便性状改变为特征的症状群,没有组织结构的异常.     

肠易激综合征的诊断和治疗

0引言肠易激综合征(Irritable bowel syndrome,IBs) 是一种常见的胃肠功能紊乱性疾病.具有与排便相关或肠道习惯改变相关的腹痛,并伴有不正常排便及腹胀的特征.近年欧美大样本调查显示:肠易激综合征分别占普通人群的22%和 11.6%,我国报道,     

肠易激综合征的诊断与治疗进展

肠易激综合征 (irritablebowelsyndromeIBS)是肠道动力学和内脏感觉异常的胃肠功能性疾病 ,是指一组包括有排便习惯改变 (腹泻 /便秘 )、粪便性状异常 (稀便、黏液便 /硬结便 )、腹痛及腹胀等临床表现的症候群 ,症状持续存在或间歇发作。尽管该病不危及人的生命 ,但却可不同程度的影响工作与生活 ,降低生活质量。IBS的病因与发病机制可能与肠道感染、胃肠动力紊乱、内脏感觉异常及精神心理改变等有关 ,是多种因素综合作用的结果。由于目前对IBS的认识尚不很清楚 ,不同个体的表现也可能不完全一致 ,因而为IBS的诊断与治疗带来了一定的难…     

The gut microbiome and irritable bowel syndrome: State of art review

Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract, the physiology of which is not very well understood. There are multiple factors and pathways involved in pathogenesis of this entity. Among all, dysmotility, dysregulation of the brain-gut axis, altered intestinal microbiota and visceral hypersensitivity play a major role. Over the last years, research has shown that the type of gut microbiome present in an individual plays a significant role in the pathophysiology of IBS. Multiple studies have consistently shown that subjects diagnosed with IBS have disruption in gut microbiota balance. It has been established that host immune system and its interaction with metabolic products of gut microbiota play an important role in the gastrointestinal tract. Therefore, probiotics, prebiotics and antibiotics have shown some promising results in managing IBS symptoms via modulating the interaction between the above. This paper discusses the various factors involved in pathophysiology of IBS, especially gut microbiota.     

Diagnosis of irritable bowel syndrome

Irritable bowel syndrome (IBS) is the most common disorder seen in gastroenterology practice. It is also a large component of primary care practices. Although the classic IBS symptoms of lower abdominal pain, bloating, and alteration of bowel habits is easily recognizable to most physicians, diagnosing IBS remains a challenge. This is in part caused by the absence of anatomic or physiologic markers. For this reason, the diagnosis of IBS currently needs to be made on clinical grounds. A number of symptom-based diagnostic criteria have been proposed over the last 15 years. The most recent of these, the Rome II criteria, seem to show reasonable sensitivity and specificity in diagnosing IBS. However, the role of the Rome II criteria in clinical practice remains ill defined. A review of the literature shows that, in patients with no alarm symptoms, the Rome criteria have a positive predictive value of approximately 98%, and that additional diagnostic tests have a yield of 2% or less. Diagnostic evaluation should also include a psychosocial assessment specifically addressing any history of sexual or physical abuse because these issues significantly influence management strategies and treatment success.     

Diagnosis of irritable bowel syndrome]

According to Rome II criteria, irritable bowel syndrome is defined as a group of functional bowel disorders in which abdominal discomfort or pain is associated with defecation or change in bowel habit and is associated with features of disordered defecation. A diagnosis is based on identifying the consistent symptoms with the exclusion of other organic or functional disorders having similar clinical presentations in a cost-effective manner. A physical examination should be performed on the first visit and on subsequent visits as needed. Two algorithms for the evaluation of patients seen in primary care settings and two other algorithms for patients presenting to gastroenterologists are presented. In general, if Rome II criteria are fulfilled, alarm features are not present, and screening studies from the referring physician are negative, further testing is not needed. Screening studies are recommended when certain historical information is present. In many cases, the therapeutic trial can be undertaken before further diagnostic studies are done and will depend on the symptom subtype and its severity. It needs to be emphasized that patients presenting with typical symptoms and no alarm signs are rarely found to have another diagnosis, supporting the benefit of ongoing care and symptomatic management rather than continued diagnostic evaluation. If initial treatment fails, or certain clinical features emerge requiring further evaluation, studies may be performed by gastroenterologists in specialty centers.     

Dietary treatment of the irritable bowel syndrome

Opinion statement Most patients with functional gastrointestinal disorders report that food ingestion appears to exacerbate their symptoms and consequently conclude that they have some form of gastrointestinal food allergy or intolerance. Dietary management of functional gastrointestinal conditions is an attractive therapeutic option for the patient and physician alike because it is safe and economical and empowers the patient to help themselves. However, in practice, dietary manipulation frequently yields rather disappointing results. Exclusion diets can be helpful, but are labor intensive and occasionally can be very restrictive. Laboratory testing for immunoglobulin E food antibodies usually is not helpful, except in a small subgroup of patients with diarrhea, predominant irritable bowel syndrome (IBS), and atopy. There is some preliminary evidence to suggest that elimination diets based on immunoglobulin G food antibody testing may possibly have therapeutic potential in IBS, but this requires confirmation.     

饮食调整在肠易激综合征治疗中的进展

肠易激综合征(irritablebowelsyndrome，IBS)是常见的慢性胃肠道功能紊乱疾病，以腹痛、腹部不适伴有排便习惯改变为特征，缺乏形态学和生化学异常。目前，IBS的发病机制仍不清楚，其治疗尚无特效药物。多年的研究发现，不良的饮食习惯和不合理的膳食结构可以加剧IBS患者的症状，因此，医学专家和营养学专家认为，健康、平衡的饮食可有助于减轻IBS患者的胃肠功能紊乱症状。近年来，探寻引起IBS症状的饮     

Domperidone treatment in the irritable bowel syndrome

Domperidone treatment did not differ significantly from placebo treatment in irritable bowel syndrome patients concurrently put on high fibre diet. No side effects attributable to the drug were encountered. This study further reinforces the necessity to have patients concurrently on a high fibre diet when testing for drug efficiency in the irritable bowel syndrome. Double-blind drug versus placebo studies should be undertaken in the irritable bowel syndrome patients who fail to respond to a high fibre diet. Dopamine receptor sites are unlikely to be primarily involved in the irritable bowel syndrome.     

Timolol treatment in the irritable bowel syndrome

The overall effect of the beta-blocker timolol maleate was not significantly different from placebo in patients with the irritable bowel syndrome on a high fibre diet. However, all 3 symptom-free patients were on timolol maleate. If beta-blockers have a major role to play in the treatment of the irritable bowel syndrome it must be through a central rather than a peripheral effect.     

Acupuncture treatment in irritable bowel syndrome

BACKGROUND AND AIMS: Despite occasional positive reports on the efficacy of acupuncture (AC) on functions of the gastrointestinal tract, there is no conclusive evidence that AC is effective in the treatment of irritable bowel syndrome (IBS). PATIENTS AND METHODS: Forty three patients with IBS according to the Rome II criteria were randomly assigned to receive either AC (n = 22) or sham acupuncture (SAC) (n = 21) using the so-called "Streitberger needle". Treatment duration was 10 sessions with an average of two AC sessions per week. The primary end point was improvement in quality of life (QOL) using the functional digestive diseases quality of life questionnaire (FDDQL) and a general quality of life questionnaire (SF-36), compared with baseline assessments. QOL measurements were repeated three months after treatment. RESULTS: Both the AC and SAC groups improved significantly in global QOL, as assessed by the FDDQL, at the end of treatment (p = 0.022), with no differences between the groups. SF-36 was insensitive to these changes (except for pain). This effect was partially reversed three months later. Post hoc comparison of responders and non-responders in both groups combined revealed a significant prediction of the placebo response by two subscales of the FDDQL (sleep, coping) (F = 6.746, p = 0.003) in a stepwise regression model. CONCLUSIONS: Acupuncture in IBS is primarily a placebo response. Based on the small differences found between the AC and SAC groups, a study including 566 patients would be necessary to prove the efficacy of AC over SAC. The placebo response may be predicted by high coping capacity and low sleep quality in individual patients.     

肠易激综合征的分类治疗

肠易激综合征(irritable bowel syndrome,IBS)是一种常见的慢性功能性肠道疾病,其特征是大便习惯和性状的改变、腹痛、腹胀而无器质性病理改变。在肠易激综合征的流行程度上女性与男性相比有明显的不同,在美国家庭调查中,肠易激综合征存在于14.5％的女性,而在男性仅为7.7％。相似的流行病学上的差别在其他西方国家的研究中也     

肠易激综合征的治疗进展

肠易激综合征（irritable bowel syndrome,IBS）作为消化系统疾病中较为常见的功能性胃肠病,由于发病机制未 明,临床上缺乏行之有效的治疗手段,其临床诊治一直以来是研究的热点和难点。而近年来,相关药物的研发及诊疗 策略的更新,使得IBS的诊疗得到了进一步发展。文章就目前IBS的治疗进展做一论述,以期为IBS的临床诊治提供 指导,使更多的IBS患者从中获益。     

Melatonin for the treatment of irritable bowel syndrome

Irritable bowel syndrome(IBS)is a common disorder characterized by recurrent abdominal pain or discomfort,in combination with disturbed bowel habits in the absence of identifiable organic cause.Melatonin(Nacetyl-5-methoxytryptamine)is a hormone produced by the pineal gland and also large number by enterochromaffin cells of the digestive mucosa.Melatonin plays an important part in gastrointestinal physiology which includes regulation of gastrointestinal motility,local anti-inflammatory reaction as well as moderation of visceral sensation.Melatonin is commonly given orally.It is categorized by the United States Food and Drug Administration as a dietary supplement.Melatonin treatment has an extremely wide margin of safety though it may cause minor adverse effects,such as headache,rash and nightmares.Melatonin was touted as a potential effective candidate for IBS treatment.Putative role of melatonin in IBS treatment include analgesic effects,regulator of gastrointestinal motility and sensation to sleep promoter.Placebo-controlled studies in melatonin suffered from heterogeneity in methodology.Most studies utilized 3 mg at bedtime as the standard dose of trial.However,all studies had consistently showed improvement in abdominal pain,some showed improvement in quality of life of IBS patients.Melatonin is a relatively safe drug that possesses potential in treating IBS.Future studies should focus on melatonin effect on gut mobility as well as its central nervous system effect to elucidate its role in IBS patients.     

Hypnotherapy in the treatment of irritable bowel syndrome

There is accumulating and compelling evidence that hypnotherapy is an effective treatment for irritable bowel syndrome. Recently, studies have shown that hypnotherapy has beneficial effects that are long lasting, with most patients maintaining improvement, and with decreased consultation and medication needs in the long term. The particular gut directed approach used, which is aimed at normalizing and controlling gut function, is also described. While the mechanisms of how hypnotherapy brings about its therapeutic effect are not fully known, changes in colonic motility and rectal sensitivity have been demonstrated, although changes in central processing and psychological effects may also play a role.     

Updates on treatment of irritable bowel syndrome

Irritable bowel syndrome （IBS） is a highly prevalent gastrointestinal disorder characterized by abdominal pain and discomfort in association with altered bowel habits. It is estimated tD affect 10%-15% of the Western population, and has a large impact on quality of life and （in）direct healthcare costs. IBS is a multifactorial disorder involving dysregulation within the brain-gut axis, and it is frequently associated with gastrointestinal motor and sensory dysfunction, enteric and central nervous system irregularities, neuroimmune dysregulation, and postinfectious inflammation. As with other functional medical disorders, the treatment for IBS can be challenging. Conventional therapy for those with moderate to severe symptoms is largely unsatisfactory, and the development of new and effective drugs is made difficult by the complex pathogenesis, variety of symptoms, and lack of objective clinical findings that are the hallmark of this disorder. Fortunately, research advances over the past several decades have provided insight into potential mechanisms responsible for the pathogenesis of IBS, and have led to the development of several promising pharmaceutical agents. In recent years there has been much publicity over several of these new IBS medications （alosetron and tegaserod） because of their reported association with ischemic colitis and cardiovascular disease. While these agents remain available for use under restricted prescribing programs, this highlights the need for continued development of safe and effective medication for IBS. This article provides a physiologicallybased overview of recently developed and frequently employed pharmaceutical agents used to treat IBS, and discusses some non-pharmaceutical options that may be beneficial in this disorder.