肠易激综合征的药物治疗

肠易激综合征(IBS)是常见功能性肠病，其药物治疗效果未尽人意，控制症状是治疗的目标。对腹痛症状，解痛药有一定疗效，三环类抗抑郁药对症状顽固者有帮助，但需注意副作用，选择性5-羟色胺重摄取抑制剂(SSRI)副反应少，但作用未完全确定。对腹泻症状，阿片类似药洛哌丁胺有效，胆盐结合剂可对某些病例奏效，5羟色胺3(5-HT3)拮抗剂阿洛斯琼疗效好，但担心副作用，应限用于严重病例。对便秘症状，膳食纤维和膨胀剂可能有效，泻药在治疗中的地位未确定，但患者常服用。5-HT4部分类似剂替加色罗是有效和安全的新药。益生菌和抗生素作用未确定，可对某些病例有效。研制中的新药包括降低内脏感知性止痛药和多种激素的类似剂和拮抗剂，为提高疗效提供了新的希望。

Pharmacological Therapy for the Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common functional intestinal disorder. The management ofIBS remains unsatisfactory. Control of the symptoms is the main target. For abdominal pain, antispasmodics areof modest efficacy. Tricyclic antidepressants with some side effects are useful. Selective serotonin reuptakeinhibitors have uncertain efficacy. For diarrhea, opioid agonists, especially loperamine are useful. Bile saltsequestering agents seem to be of value in some patients. Alostron, a 5-HT3 antagonist, should be reserved forsevere patients who have failed to respond to conventional therapy. For constipation, fiber and bulking agentsmay help. Laxatives are not of established value but often taken by patients. Tegaserod, a partial 5-HT4 agonist,is of efficacy and safety. Probiotics and antibiotics are of uncertain efficacy but may be helpful in some cases.Other new drugs in development include novel visceral analgesics and hormone agonists/antagonists.