益生菌和肠易激综合征的关系

肠易激综合征(IBS)是最常见的功能性胃肠病之一,其发病机制目前还不明确。近年发现肠道微生物群可能参与了IBS的发生发展,细菌感染可以诱发感染后IBS;有一部分IBS患者存在小肠细菌过度生长(SIBO)或是菌群组成改变;口服肠道不吸收的抗生素能够减轻IBS的症状。因此有人提出用益生菌治疗IBS可能是一个合理的方法。此文就益生菌治疗IBS的相关研究作一综述。     

益生菌对肠易激综合征和炎症性肠病的作用

由于胃肠道微生物参与炎症性肠病（inflammatory bowel disease,IBD）的病理过程,而且最近研究表明微生物可能在肠易激综合征（irritable bowel syndrome,IBS）中扮演重要作用.本文重点关注益生菌在这两种疾病中的作用机制和疗效.胃肠道微生物的组成受多种因素调节,包括年龄、饮食和疾病状态.益生菌可能通过影响宿主的微生物菌群和提高黏膜的免疫调节作用发挥疗效.益生菌的口服耐受性较好.许多短期研究表明益生菌在IBS中有效,尽管只是在部分的特殊菌株和某些特定症状中有效.在IBD中,许多临床试验表明大量的益生菌在结肠袋炎和溃疡性结肠炎中有效,而对克罗恩病无明显疗效.显然,益生菌在IBS和IBD的治疗中能起到巨大的作用,但是,这些只是针对特殊的菌株.将来迫切需要进行高质量的临床研究和实验观察益菌对IBD和IBS的疗效.     

Effectiveness of probiotics in irritable bowel syndrome:Updated systematic review with meta-analysis

AIM:To investigate the efficacy of probiotics in irritable bowel syndrome(IBS) patients.METHODS:Pub Med,Cochrane library,Scopus,Google Scholar,and Clinicaltrial.gov databases were searched for literature published between September 2007 and December 2013.The applied Mesh terms were "probiotics," "irritable bowel syndrome," and "irritable bowel syndrome treatment." The collected data contained24 clinical trials,of which 15 were eligible for meta-analysis and nine were reviewed systematically.All studies were randomized placebo-controlled trials in patients with IBS that investigated the efficacy of probiotics in IBS improvement.The Jadad score was used to assess the methodological quality of trials.The quality scale ranges from 0 to 5 points,with a score ≤ 2 indicating a low quality report,and a score of ≥3 indicating a high quality report.Relative risk(RR),standardized effect size,and 95%CI were calculated using the Der Simonian-Laird method.The Cochran Q test was used to test heterogeneity with P 0.05.Funnel plots were constructed and Egger's and BeggMazumdar tests were performed to assess publication bias.RESULTS:A total of 1793 patients were included in the meta-analysis.The RR of responders to therapies based on abdominal pain score in IBS patients for two included trials comparing probiotics to placebo was 1.96(95%CI:1.14-3.36;P = 0.01).RR of responders to therapies based on a global symptom score in IBS patients for two included trials comparing probiotics with placebo was 2.43(95%CI:1.13-5.21;P = 0.02).For adequate improvement of general symptoms in IBS patients,the RR of seven included trials(six studies) comparing probiotics with placebo was 2.14(95%CI:1.08-4.26;P = 0.03).Distension,bloating,and flatulence were evaluated using an IBS severity scoring system in three trials(two studies) to compare the effect of probiotic therapy in IBS patients with placebo,the standardized effect size of mean differences for probiotics therapy was-2.57(95%CI:-13.05--7.92).CONCLUSION:Probiotics reduce pain and symptom severity scores.The results demonstrate the beneficial effects of probiotics in IBS patients in comparison with placebo.     

Gut dysbiosis and irritable bowel syndrome: The potential role of probiotics

Objective

To discuss the role of gut dysbiosis in the development of irritable bowel syndrome (IBS) and the impact of probiotics as a potential therapeutic measure.

Recent advances in pharmacological treatment of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a highly prevalent functional disorder that reduces patients’ quality of life. It is a chronic disorder characterized by abdominal pain or discomfort associated with disordered defecation in the absence of identifiable structural or biochemical abnormalities. IBS imposes a significant economic burden to the healthcare system. Alteration in neurohumoral mechanisms and psychological factors, bacterial overgrowth, genetic factors, gut motility, visceral hypersensitivity, and immune system factors are currently believed to influence the pathogenesis of IBS. It is possible that there is an interaction of one or more of these etiologic factors leading to heterogeneous symptoms of IBS. IBS treatment is predicated upon the patient’s most bothersome symptoms. Despite the wide range of medications and the high prevalence of the disease, to date no completely effective remedy is available. This article reviews the literature from January 2008 to July 2013 on the subject of IBS peripherally acting pharmacological treatment. Drugs are categorized according to their administration for IBS-C, IBS-D or abdominal pain predominant IBS.     

替加色罗治疗肠易激综合征的系统评价

目的 评价替加色罗治疗肠易激综合征(irritable bowel syndrome,IBS)的有效性和安全性.方法 对替加色罗治疗便秘型或非腹泻型IBS的随机对照试验(RCTs)进行系统评价.结果 共纳入13项RCTs,7 189例患者.替加色罗12 mg/d和4 mg/d对总体IBS症状的改善均优于安慰剂;对腹痛/腹部不适症状的缓解与安慰剂比无显著差异;对腹胀的疗效,各研究结果不一致;腹泻发生率显著高于安慰剂,替加色罗组报道了2例缺血性心脏病,严重不良事件的发生率与安慰剂比无显著差异.结论 替加色罗能改善便秘型或非腹泻型IBS患者的总体症状;缓解腹痛/腹部不适和腹胀等症状的证据不足;腹泻是替加色罗的主要不良反应.     

中药痛泻要方治疗肠易激综合征疗效的荟萃分析

目的:评价以痛泻要方(TXYF)为基础方的中药方剂(TXYFa)治疗肠易激综合征(IBS)的疗效.方法:通过对网上电子数据库、临床试验注册数据库、参考文献以及手工对相关会议检索的TXYF和TXYFa治疗IBS随机或半随机对照试验,对照组用西药、安慰剂或不治疗者的对象和数据进行荟萃分析.结果:31个临床试验涉及32个TXYFa符合入选条件而纳入研究.对所有纳入试验的数据分析显示TXFYa具有显著疗效(RR:1.30,95%CI:1.22-1.38,P<0.01).其中23个TXYFa(72%)分别与西药或安慰剂比较有显著疗效(P<0.05);11个和20个试验数据分别显示TXYFa显著改善IBS总体症状(RR:1.31,95%CI:1.23-1.40,P<0.01)和腹泻型IBS的相关症状(RR:1.33,95%CI:1.21-1.45,P<0.01).纳入试验的方法质量学评估均为低质量试验,倒漏斗图形显示不对称,提示存在发表偏畸.结论:痛泻要方的潜在疗效和安全性有待严格设计的随机、双盲、安慰剂对照试验加以证实.     

鼠李糖乳杆菌治疗肠易激综合征机制新进展

肠易激综合征(irritable bowel syndrome,IBS)是临床上常见的功能性胃肠病,其会影响患者的生活质量.因此探寻IBS的有效治疗方法具有重要意义.益生菌可改善IBS患者的症状并提高其生活质量,其中备受关注的是鼠李糖乳杆菌(Lactobacillus rhamnosus GG,LGG).LGG是目前被...     

肠易激综合征与肠道微生态的研究现状分析

肠易激综合征(IBS)发病机制复杂,目前没有统一的理论能解释IBS的发病,也没有单一的药物能缓解IBS的所有症状。此文就肠易激综合征与肠道微生态研究现状作一综述。     

认知治疗联合匹维溴胺、益生菌治疗腹泻型肠易激综合征

目的探讨认知治疗结合匹维溴铵、益生菌治疗腹泻型肠易激综合征（D-IBS）的可行性。方法符合罗马Ⅲ标准的62例D-IBS患者随机分为2组,A组：匹维溴胺（50 mg/次,3次/d）＋双歧三联活菌制剂（粪链球菌、嗜酸乳杆菌、双歧杆菌3种肠道固有菌的活菌制剂）（420 mg/次,3次/d）;B组：认知治疗＋匹维溴胺（50 mg/次,3次/d）＋双歧三联活菌制剂（420 mg/次,3次/d）,疗程为8周。分别记录治疗前后患者SF-36生活质量评分和症状积分。结果 A组症状显效率和总有效率分别为35.5%和77.4%;B组分别为54.8%和90.3%;B组治疗后,患者生活质量明显改善,躯体疼痛（BP）、总体健康（GH）、活力（VT）、社会功能（SF）、情感职能（RE）和精神健康（MH）维度的积分有显著提高（P〈0.05）,优于A组。结论认知治疗联合匹维溴胺和益生菌对改善患者的生活质量和IBS症状疗效优越。     

认知治疗联合益生菌、匹维溴胺治疗腹泻型肠易激综合征的临床研究

目的本研究试图评价应用认知治疗联合益生菌、匹维溴胺治疗腹泻型肠易激综合征(diarrhea-preclomnant irritable bowelsyndrons,D-IBS)的有效性和安全性。方法符合罗马Ⅲ标准的90例D-IBS患者接受认知治疗、匹维溴胺(50 mg/次,3次/d)、双岐三联活菌制剂(粪链球菌、嗜酸乳杆菌、双歧杆菌3种肠道固有菌的活菌制剂)(420 mg/次,3次/d)共8周,分别记录治疗前后患者SF-36生活质量评分和症状积分以评价疗效;治疗前后对粪便菌丛进行记数,对粪便中5种细菌进行培养并对集落形成单位进行记数;治疗前后用不透X线标志物测定全结肠通过时间来评价结肠运输时间的变化;应用SPSS软件对试验数据进行统计学分析。结果有81例患者完成了本研究;试验过程中未发现不良反应;对于D-IBS患者的治疗,认知治疗联合匹维溴胺、益生菌的总有效率达88.9%,症状改善明显尤其是对于腹痛、大便性状的改善;患者生活质量明显改善,躯体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)、情感职能(RE)和精神健康(MH)维度的积分有显著提高(P<0.05);益生菌能够明显增加肠道双歧杆菌(P<0.01)和乳酸杆菌(P<0.05),明显减少肠球菌(P<0.01)和类杆菌(P<0.05),而肠杆菌无显著变化(P>0.05);结肠运输时间延迟显著(P<0.05)。结论认知治疗联合匹维溴胺和益生菌治疗D-IBS是安全、有效的。     

Probiotics and irritable bowel syndrome

Irritable bowel syndrome(IBS)is common gastrointestinal problems.It is characterized by abdominal pain or discomfort,and is associated with changes in stool frequency and/or consistency.The etiopathogenesis of IBS may be multifactorial,as is the pathophysiology,which is attributed to alterations in gastrointestinal motility,visceral hypersensitivity,intestinal microbiota,gut epithelium and immune function,dysfunction of the brain-gut axis or certain psychosocial factors.Current therapeutic strategies are often unsatisfactory.There is now increasing evidence linking alterations in the gastrointestinal microbiota and IBS.Probiotics are living organisms which,when ingested in certain numbers,exert health benefits beyond inherent basic nutrition.Probiotics have numerous positive effects in the gastrointestinal tract.Recently,many studies have suggested that probiotics are effective in the treatment of IBS.The mechanisms of probiotics in IBS are very complex.The purpose of this review is to summarize the evidence and mechanisms for the use of probiotics in the treatment of IBS.     

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.     

益生菌联合奥替溴铵治疗腹泻型肠易激综合征有效性与安全性的meta分析

目的 系统评价益生菌联合奥替溴铵治疗腹泻型肠易激综合征有效性与安全性,为临床治疗提供循证参考.方法 本研究通过计算机检索EMBASE、Pubmed、Cochrane Library、万方、中国生物医学文献数据库、维普及中国知网,收集益生菌联合奥替溴铵治疗腹泻型肠易激综合征的随机对照试验,检索时间均为数据库建库时间至20...     

Intestinal microbiota in pathophysiology and management of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a functional bowel disorder without any structural or metabolic abnormalities that sufficiently explain the symptoms, which include abdominal pain and discomfort, and bowel habit changes such as diarrhea and constipation. Its pathogenesis is multifactorial: visceral hypersensitivity, dysmotility, psychosocial factors, genetic or environmental factors, dysregulation of the brain-gut axis, and altered intestinal microbiota have all been proposed as possible causes. The human intestinal microbiota are composed of more than 1000 different bacterial species and 10¹⁴ cells, and are essential for the development, function, and homeostasis of the intestine, and for individual health. The putative mechanisms that explain the role of microbiota in the development of IBS include altered composition or metabolic activity of the microbiota, mucosal immune activation and inflammation, increased intestinal permeability and impaired mucosal barrier function, sensory-motor disturbances provoked by the microbiota, and a disturbed gut-microbiota-brain axis. Therefore, modulation of the intestinal microbiota through dietary changes, and use of antibiotics, probiotics, and anti-inflammatory agents has been suggested as strategies for managing IBS symptoms. This review summarizes and discusses the accumulating evidence that intestinal microbiota play a role in the pathophysiology and management of IBS.     

褪黑激素与肠易激综合征

肠易激综合征是一种原因不明的慢性肠功能紊乱性疾病，其发病机制尚不清楚。其治疗方法也在不断改进中，褪黑激素对肠易激综合征的治疗有着积极的作用。     

饮食在肠易激综合征症状发作和治疗中的作用

流行病学研究资料提示,肠易激综合征(irritable bowel syndrome,IBS)患者的症状发作与饮食有关.饮食影响IBS症状的机制仍未完全阐明,可能与食物的促动力和促胃肠激素分泌作用、食物不耐受、食物过敏和不良进食习惯等有关.有证据表明采用食物剔除和添加膳食纤维、益生菌和益生元等特殊食物成分的饮食调整治疗能缓解IBS的症状.本文从IBS与食物有关的表现、饮食影响IBS症状的原因和机制、饮食对IBS治疗的作用3个方面总结了相关研究的进展.     

Unraveling the ties between irritable bowel syndrome and intestinal microbiota

Irritable bowel syndrome(IBS)is the most prevalent functional gastrointestinal disorder.It is a multifactoria disorder.Intestinal microbiota may cause the pathogenesis of IBS by contributing to abnormal gastrointestina motility,low-grade inflammation,visceral hypersensitivity,communication in the gut-brain axis,and so on.Previous attempts to identify the intestinal microbiota composition in IBS patients have yielded inconsistent and occasionally contradictory results.This inconsistency may be due to the differences in the molecular techniques employed,the sample collection and handling methods,use of single samples that are not linked to fluctuating symptoms,or other factors such as patients diets and phenotypic characterizations.Despite these difficulties,previous studies found that the intestina microbiota in some IBS patients was completely different from that in healthy controls,and there does appear to be a consistent theme of Firmicutes enrichment and reduced abundance of Bacteroides.Based on the differences in intestinal microbiota composition,many studies have addressed the roles of microbiotatargeted treatments,such as antibiotics and probiotics,in alleviating certain symptoms of IBS.This review summarizes the current knowledge of the associations between intestinal microbiota and IBS as well as the possible modes of action of intestinal microbiota in the pathogenesis of IBS.Improving the current level of understanding of host-microbiota interactions in IBS is important not only for determining the role of intestinal microbiota in IBS pathogenesis but also for therapeutic modulation of the microbiota.     

Peripherally acting therapies for the treatment of irritable bowel syndrome

Gut-acting therapies are common therapies for irritable bowel syndrome (IBS). Most of these peripheral acting agents are primarily targeted at individual symptoms. The evidence supporting the use of these agents in IBS is largely anecdotal. Serotonergic agents and the chloride channel activator lubiprostone have shown efficacy in treating symptoms of IBS. The clinical evidence supporting the use of these agents is based on data from high-quality clinical trials. The use of serotonergic agents for IBS in the United States is limited to the 5-hydroxytryptamine-3 antagonist alosetron in the treatment of women with severe IBS with diarrhea refractory to traditional therapy.