Behavioral and complementary approaches for the treatment of irritable bowel syndrome.

Irritable bowel syndrome (IBS) is one of the most common conditions seen in primary care settings. Despite this, there is no consensus as to the pathogenesis of this disorder or a consistently effective therapeutic regimen for many patients. This has encouraged the use of various alternative therapies from behavioral or complementary medicine. This review will address the evidence for alternative therapies, including the following: cognitive behavior therapy, hypnosis, elimination diets based on food antibody testing, nutrition supplements (such as fiber, probiotics, and prebiotics), and, finally, peppermint, l-glutamine, zinc, and cromolyn sodium. The review also explores the evidence for and the therapeutic ramifications of the hypothesis that increased intestinal permeability underlies the symptoms of IBS in many patients, and how a therapeutic plan that addresses nutrition, elimination diets, and nutrition supplements may be useful in restoring the integrity of the gut immune barrier.     

坦度螺酮治疗肠易激综合征疗效观察

目的 观察坦度螺酮治疗肠易激综合征患者的疗效.方法 将肠易激综合征患者分为两组,对照组根据患者不同症状给予对症治疗,治疗组在对照组治疗基础上给予坦度螺酮治疗,疗程均为4周.观察比较治疗前后两组患者主要躯体症状、情绪状态的改变,采用焦虑自评量表（SAS）与抑郁自评量表（SDS）分别对其焦虑、抑郁状况进行评估.结果 治疗组患者躯体症状改善效果优于对照组;治疗组SAS评分明显低于对照组,两组SDS评分差异未见明显统计学意义.结论 肠易激综合征患者,坦度螺酮对于缓解其躯体与情绪症状,改善生存质量具有重要意义.     

Group treatment of patients with irritable bowel syndrome

Irritable bowel syndrome, a chronic illness affecting a large segment of the population, has no known anatomic etiology. Symptoms are precipitated or aggravated by stress or emotional factors as well as diet, drugs and hormones. This article describes the illness and a group treatment approach which takes into account developmental antecedents, communication deficits and existential issues.     

儿童肠易激综合征3种治疗方法比较

目的 探讨儿童肠易激综合征的治疗.方法 对2007年7月-2007年12月在西安市第四医院儿科门诊被诊断为肠易激综合征的75例儿童进行研究,并随机分为金双歧治疗组(30例),四磨汤治疗组(30例)和颠茄片治疗组(15例),观察不同治疗组儿童的腹痛缓解所需时间、停药后疗效持续时间、大便频率改善时间、大便性状改善时间和腹胀改善时间.结果 四磨汤治疗组腹痛缓解所需时间、停药后疗效持续时间、大便频率改善时间、大便性状改善时间和腹胀改善时间依次为4.0±2.0天、2.0±1.0月、4.0±2.0天、5.0±1.0天和4.0±3.0天.金双歧治疗组依次为5.0±2.0天、2.0 4-1.0月、5.0 4-2.0天、5.0±2.0天和4.0 ±1.0天,颠茄片治疗组依次为0.5 ±0.5天、2.0 ±1.0天、7.0±2.0天、8.0 4-4.0天和7.0±4.0天.3种治疗方法进行比较,金双歧治疗组和四磨汤治疗组儿童除腹痛缓减时间长,其余各观察指标均明显优于颠茄片治疗组,比较均有统计学意义(t=2.28～4.74,均P<0.05),而金双歧治疗组和四磨汤治疗组各观察指标比较无显著性差别(t=0～1.936,均P>0.05).结论 微生态和中成药制剂治疗肠易激综合征是可行的临床治疗方法.     

Postinfectious irritable bowel syndrome

Postinfectious irritable bowel syndrome (IBS) is a subgroup of IBS. Patients with an episode of bacterial gastroenteritis may have a 12-fold increased risk of developing IBS symptoms within the same year. The IBS can be manifested in each of its clinical types, but the diarrhea-predominant form occurs most commonly. The primary pathophysiologic factor in developing IBS after enteral infection may be defects in enteric nervous system which can produce abnormality in visceral hypersensitivity and intestinal motility. These patients also display exaggerated increases in mucosal immunocompetent T lymphocytes and an abnormally high pro- versus anti-inflammatory cytokine ratio, providing evidence to the contribution of the immune system in the development of postinfectious IBS. Via bi-directional brain-gut interactions both peripheral and central events can play a role in the development of clinical symptoms. Stress is associated with significant worsening of the complaints in IBS and may also result in a shift in the host-gut microbial relationship. IBS itself may predispose patients to acute bacterial gastroenteritis because of the altered intestinal motility. It needs further clarifying the relationship between IBS and small intestinal bacterial overgrowth syndrome. Upon the data so far the altered intestinal flora in IBS would merely reflect developments due to altered motility and not a causal relationship. The treatment of postinfectious IBS does not differ principally from that of the idiopathic IBS. Antibiotics or probiotics may lead to temporary symptomatic improvement, but, given the lack of evidence based data, they cannot be advised for routine use so far.     

匹维溴铵联合酪酸梭菌活菌治疗肠易激综合征的疗效观察

目的探讨匹维溴胺联合酪酸梭菌活菌（米桑）治疗肠易激综合征（IBS）的临床疗效。方法选择54例IBS患者,随机分为对照组和治疗组各27例。对照组口服匹维溴胺50mg,3次／d;治疗组在此基础上加服酪酸梭菌活菌400mg,32．／d;疗程均为4周;观察两组治疗后腹痛、腹泻、便秘等症状变化及临床疗效。结果治疗组总有效率为92．6％,对照组总有效率为66．7％,治疗组优于对照组,差异有统计学意义（P〈0．05）。结论匹维溴胺联合酪酸梭菌活菌可有效改善IBS患者的临床症状,提高疗效。     

肠易激综合征的发病机制

肠易激综合征 (irritablebowelsyndrome,IBS)是最常见的消化疾病之一。西方国家约 1 5 %～2 0 %的人患有IBS ,我国IBS的发病率具体不详。目前 ,一般认为IBS是一种功能性肠病 ,尚缺乏公认的形态学、生化指标或基因异常的改变 ,但近年的研究逐渐提示IBS的发病机制可能具有其组织或分子生物学的基础。本文就其发病机制进行总结 ,结合我们的研究阐述对本病发病机制的理解。1　肠道运动异常机制IBS病人表现有腹泻、便秘等。近半个世纪以来多数学者认为IBS病人肠道运动具有异常 ,70～90年代许多研究发现IBS结肠或小肠的通过时间与正常人…     

Nutritional intakes in irritable bowel syndrome

Background: Irritable bowel syndrome (IBS) is a chronic and relapsing bowel disorder that affects 12% of the UK population. Two‐thirds of patients perceive their symptoms to be diet related (Simren, 2001) and restrict their food intake hoping to improve symptoms. This may put them at risk of low nutrient intakes. This study aimed to assess the dietary intake of IBS patients and compare nutrient intake to control subjects. Methods: Patients with IBS and controls were recruited from gastroenterology clinics from local hospitals. Controls were patients who were attending for colonoscopy surveillance for colon cancer or polyps and had a normal bowel habit with no history of IBS symptoms. Each consenting subject completed a validated food frequency questionnaire (FFQ; Bingham, 1997). Energy and nutrient intakes (excluding supplements) were calculated and comparisons were made between groups and with the UK DRVs. Data were compared between the IBS and control groups using unpaired t‐tests or Mann–Whitney U‐tests and a P < 0.05 was considered statistically significant. For nutrients with a significant difference, one‐sample t‐tests were used to determine the significance of any differences between the IBS group and DRVs. Results: Food frequency questionnaires were completed on 34 patients with IBS (35.3 ± 10.3 years; six male) and 17 controls (46.5 ± 9.8 years; 12 male). Energy and macronutrient intakes were similar between groups ( Table 1 ). Intakes of calcium and iron were significantly lower in the IBS group than in controls. Nine women had a calcium intake and nine women had an iron intake below the reference nutrient intake. Twenty‐five (74%) patients with IBS and eight (47%) controls (chi‐squared test, P = 0.1) were taking supplements compared with 35% of respondents in the 2003 National Diet & Nutrition Survey. Nine (26%) patients with IBS and six (35%) controls (chi‐squared test, P = 0.7) were taking either multivitamins or multivitamins & minerals.

Table 1. Energy and nutrient intakes of controls and IBS patients

复方谷氨酰胺治疗腹泻型肠易激综合征的疗效观察

目的 观察复方谷氨酰胺治疗腹泻型肠易激综合征的疗效和安全性.方法 采用随机对照临床研究,将符合诊断标准的150例腹泻型肠易激综合征患者随机分为复方谷氨酰胺组和奥替溴胺组,复方谷氨酰胺组给予复方谷氨酰胺3粒,每日3次,餐前口服,疗程4周;奥替溴胺组给予奥替溴胺40 mg,每日3次口服,疗程4周.观察用药前后腹痛或腹部不适及腹泻评分的变化.结果 复方谷氨酰胺可使腹泻型肠易激综合征患者症状评分明显下降,无不良反应.结论 复方谷氨酰胺可明显缓解腹泻型肠易激综合征患者的腹痛和腹部不适及腹泻症状,安全性好.     

Brain-gut interaction in irritable bowel syndrome

Abdominal pain occurs commonly in irritable bowel syndrome. The mechanism of pain is likely to be either peripheral or central sensitization of gut nerves or aberrant brain processing. Functional brain techniques are now allowing the study of brain-gut interactions.     

Role of partially hydrolyzed guar gum in the treatment of irritable bowel syndrome

Irritable bowel syndrome (IBS) is the world's most common gastrointestinal functional disorder and is associated with several social and economic costs. Health-related quality of life is often impaired in patients with IBS. The pathophysiologic mechanisms underlying IBS remain poorly defined. The therapeutic approach to patients with IBS is based on symptoms, and fibers may play an important role in treatment. Among the various types of fiber, water-soluble, non-gelling fibers seem to be a promising option for treatment of IBS. Partially hydrolyzed guar gum (PHGG) is a water-soluble, non-gelling fiber that has provided therapeutic benefits. In clinical trials, PHGG decreased symptoms in constipation-predominant and diarrhea-predominant forms of IBS and decreased abdominal pain. Further, an improvement in quality of life was observed in patients with IBS during and after treatment with PHGG. Moreover, PHGG seems to have prebiotic properties because it increases the colonic contents of short-chain fatty acids, Lactobacilli, and Bifidobacteria.     

Genetic background of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a functional disorder which affects the 20% of the population. The exact origin is unknown. IBS is the result of interaction of genes and environmental factors. Familial aggregation and higher concordance rate of monozygotic twins compared to dizygotic twins provide evidence for the importance of genetic factors in the pathogenesis of IBS. Interest has focused on genetic variants of serotonin transporter and receptors, because of their role in gut motility, visceral sensitivity, immune processes and mood. Firm conclusions about the role of serotonin system, as well as other neuroreceptors, G-proteins, cytokine polymorphisms in the pathogenesis of IBS cannot be made.     

The pathophysiology of irritable bowel syndrome

The irritable bowel syndrome (IBS) is a frequent gastrointestinal disorder (10 -15% of the population).It is characterized by chronic abdominal pain with modification in the bowel habits. The diagnosis is based of ROME II criteria. The pathophysiology of the SII remains unknown . It result from visceral hypersensitivity with anomalies of the digestive motility. These anomalies are secondary of dysfunction of the brain - gut axis modulated by environmental and the psychosocial factors. The understanding of the pathophysiological mechanisms of the SII and in particular the function of the brain-gut axis will permit a better handling of the patients. Indeed, the present knowledge of the neurotransmitter implied in the communication between the central nervous system and the digestive tract are currently the basis of the new therapies aimed to modulate the mechanisms implicated in the causation of the several symptoms of IBS. These novel pharmacotherapy should reduce the indirect societal and costs of IBS.