脾虚证IBS模型WHBE兔血浆环核苷酸水平的变化

目的观察脾虚型肠易激综合征（IBS）模型WHBE兔环核苷酸水平的变化。方法取WHBE兔和日本大耳白兔各18只,分别随机分成两组,即正常对照组6只,模型对照组12只,采用湿热应激加灌服番泻叶煎剂的方法造成脾虚证肠易激综合征（tBs）免模型,其中模型对照组造模后处理6只,剩余兔自然恢复10d,观察实验兔的血浆环核苷酸水平的变化。结果与正常对照组比较,WHBE兔模型对照组血浆cAMP和cGMP水平均显著升高（P〈0．05,P〈0．01）,且自然恢复10d后血浆cAMP和cGMP水平仍高于正常对照组（P〈O．05,P〈O．01）;日本大耳白兔模型对照组造模后及自然恢复10d后血浆cAMP和cGMP水平略有所升高,但差异均不显著（P〉O．05）;且模型对照组和自然恢复组cAMP／cGMP比值均略低于正常对照组,但差异不显著（P〉O．05）。结论本实验脾虚证IBS模型兔的血浆环核苷酸水平随阴阳盛衰而变化,具有双重特点：既有阴虚特点,又有阳虚特点,且WHBE兔更适合于脾虚证IBS模型研究理想的实验动物。     

Effect of wheat bran on weight of stool and gastrointestinal transit time: a meta analysis

Twenty original papers that reported on the effect of wheat bran on large bowel function were analysed. Bran increased the stool weight and decreased the transit time in each study in healthy controls and in patients with the irritable bowel syndrome, with diverticula, and with chronic constipation. Statistical evaluation of the data showed, however, that constipated patients had lower stool output and slower transit whether or not they had taken bran, and they responded less well to bran treatment than controls. From these data it is concluded that bran can be expected to be only partially effective in restoring normal stool weight and transit time in patients who are constipated.     

Irritable Bowel Syndrome Is Positively Related to Metabolic Syndrome: A Population-Based Cross-Sectional Study

Irritable bowel syndrome is a common gastrointestinal disorder that may affect dietary pattern, food digestion, and nutrient absorption. The nutrition-related factors are closely related to metabolic syndrome, implying that irritable bowel syndrome may be a potential risk factor for metabolic syndrome. However, few epidemiological studies are available which are related to this potential link. The purpose of this study is to determine whether irritable bowel syndrome is related to metabolic syndrome among middle-aged people. We designed a cross-sectional study of 1,096 subjects to evaluate the relationship between irritable bowel syndrome and metabolic syndrome and its components. Diagnosis of irritable bowel syndrome was based on the Japanese version of the Rome III Questionnaire. Metabolic syndrome was defined according to the criteria of the American Heart Association scientific statements of 2009. Dietary consumption was assessed via a validated food frequency questionnaire. Principal-components analysis was used to derive 3 major dietary patterns: “Japanese”, “sweets-fruits”, and “Izakaya (Japanese Pub) “from 39 food groups. The prevalence of irritable bowel syndrome and metabolic syndrome were 19.4% and 14.6%, respectively. No significant relationship was found between the dietary pattern factor score tertiles and irritable bowel syndrome. After adjustment for potential confounders (including dietary pattern), the odds ratio (95% confidence interval) of having metabolic syndrome and elevated triglycerides for subjects with irritable bowel syndrome as compared with non-irritable bowel syndrome are 2.01(1.13–3.55) and 1.50(1.03–2.18), respectively. Irritable bowel syndrome is significantly related to metabolic syndrome and it components. This study is the first to show that irritable bowel syndrome was significantly related to a higher prevalence of metabolic syndrome and elevated triglycerides among an adult population. The findings suggest that the treatment of irritable bowel syndrome may be a potentially beneficial factor for the prevention of metabolic syndrome. Further study is needed to clarify this association.     

Hand temperature norms for headache, hypertension, and irritable bowel syndrome

Hand temperature norms are presented for 221 headache patients (migraine, mixed, and tension), 105 hypertensives, 45 irritable bowel syndrome patients, and 56 normal controls under conditions of resting baseline, self-relaxation, volitional handwarming, mental arithmetic, and cold pressor. The two vascular headache groups (migraine and mixed) had significantly lower hand temperatures across conditions.     

Colonic Response to Pentazocine

The effects of pentazocine on colonic motor activity were studied in five normal subjects, five patients with irritable bowel syndrome, and five patients with diverticular disease. The drug decreased intraluminal colonic pressures in all patients but one. Since morphine, which increases intraluminal colonic pressures, is contraindicated in patients with abdominal pain of colonic origin (diverticular disease, irritable bowel syndrome), we suggest that pentazocine may be a useful drug in such cases.     

阿洛司琼联合微生态制剂治疗腹泻型肠易激综合征的临床研究

目的:探究阿洛司琼联合微生态制剂治疗腹泻型肠易激综合征的临床效果。方法:选择2016年1月-2018年1月于我院进行治疗的96例腹泻型肠易激综合征患者为研究对象,按照随机数字表法将其均分为实验组与对照组,每组各48例。对照组患者单纯使用阿洛司琼治疗,实验组患者在对照组患者基础上加用微生态制剂,两组患者治疗时间均为4周,分别于干预前及干预后对两组患者症状进行评分,使用IBS病情严重程度调查表(IBS-SSS)对两组患者干预前后治疗效果进行评估,并比较两组患者干预前后肠道乳酸杆菌、肠球菌及酵母样真菌菌群数及生活质量(SF-36)评分。结果:干预后,实验组患者症状评分及IBS-SSS量表评分均显著低于对照组(P0.05),SF-36生理功能、心理功能及生活功能得分、乳酸菌及肠球菌菌群数均显著高于对照组,而酵母样真菌菌群数低于对照组(P0.05)。结论:阿洛司琼联合微生态制剂治疗腹泻型肠易激综合征能够有效改善患者的肠道菌群、有效缓解临床症状,并可显著提高患者的生活质量。     

Irritable bowel syndrome in the general population.

OBJECTIVE--To determine the prevalence of symptoms compatible with a clinical diagnosis of irritable bowel syndrome in the general population. DESIGN--Validated postal questionnaire sent to 2280 subjects randomly selected in 10 year age bands from the lists of eight general practitioners. The Manning criteria were used to define irritable bowel syndrome. SETTING--Urban population in Southampton and mixed urban-rural population in Andover, Hampshire. RESULTS--A response of 71% yielded 1620 questionnaires for analysis, of which 412 (25%) reported more than six episodes of abdominal pain in the preceding year, with 350 (22%) reporting symptoms consistent with the diagnosis of irritable bowel syndrome. The male: female ratio was 1:1.38. More subjects with irritable bowel syndrome had constipation and diarrhoea and 35% with the syndrome reported rectal bleeding compared with an overall prevalence of 20%. Other symptoms and conditions including heartburn, dyspepsia, flushing, palpitations, migraine, and urinary symptoms were significantly more common in the group with irritable bowel syndrome. Abdominal pain in childhood was more common in the subjects with irritable bowel syndrome (12%) than without (3%). One third of the group with irritable bowel syndrome had sought medical advice during the study period (male:female ratio 1:1.21); consultation behaviour was influenced by age and the presence of associated symptoms, varied considerably among patients registered with different general practitioners, and was poorly correlated with symptom severity. CONCLUSION--Symptoms consistent with a diagnosis of irritable bowel syndrome are present in almost one quarter of the general population and tend to be associated with a number of other complaints and conditions, some of which may reflect smooth muscle dysfunction.     

WHBE兔脾虚型肠易激综合征模型舌象病理组织形态学观察

目的观察脾虚型肠易激综合征模型WHBE兔活体舌象和舌组织病理形态学的变化。方法采用湿热应激复合番泻叶致脾虚型肠易激综合征兔模型,观察造模及自然恢复后WHBE兔和日本大耳白兔活体舌象和舌组织病理形态学的变化。结果与正常对照组比较,脾虚型肠易激综合征模型兔舌色淡红,舌质嫩;背隆起前后固有层乳头密度明显降低（P〈0．01）,基底层核分裂相频数减少（P〈0．01）,舌下角质层和上皮层厚度均明显增厚（P〈0．01）,且角质层／上皮层比值明显增加（P〈0．01）,且WHBE兔菌状乳头密度显著降低（P〈0．05）;自然恢复10d后,自然恢复组实验兔背隆起前后固有层乳头密度仍显著低于正常对照组（P〈0．01）,舌下角质层厚度明显大于正常对照组（P〈0．05）,且WHBE兔的上皮层厚度显著高于正常对照组（P〈O．05）,日本大耳白兔角质层,上皮层比值显著高于正常对照组（P〈0．05）。结论脾虚型肠易激综合征可能与机体营养、代谢相关。     

Irritable bowel syndrome and abdominoplasty

Irritable bowel syndrome is a chronic disease involving pain or discomfort relieved by defecation and associated with a change in frequency or consistency of the stools. The effect of abdominoplasty on patients with irritable bowel syndrome has not been elucidated, so advising patients with irritable bowel syndrome about the effects of surgery on their disease was difficult. One hundred female patients from a pool of 120 patients responded to a questionnaire relating to abdominoplasty surgery. Follow-up ranged from 6 months to 2 years. Patients completed questionnaires formulated on the basis of Rome II Diagnostic Criteria. Of the 100 patients, nine had true irritable bowel syndrome, nine had moderate symptoms and were receiving medication (not true irritable bowel syndrome), 16 had mild symptoms on occasional medication, and 66 had no symptoms of irritable bowel syndrome before surgery. Of the true irritable bowel syndrome patients, all had symptomatic improvement with decreased medication, eight of the nine patients with moderate symptoms improved markedly, and five of the 16 patients with mild symptoms improved significantly. No patient had any initiation or deterioration of symptoms. It is thus concluded that the symptoms of irritable bowel syndrome are certainly not worsened, in the short term, by surgery, and may be alleviated or improved in most significant cases.     

Hand temperature norms for headache,hypertension, and irritable bowel syndrome

Hand temperature norms are presented for 221 headache patients (migraine, mixed, and tension), 105 hypertensives, 45 irritable bowel syndrome patients, and 56 normal controls under conditions of resting baseline, self-relaxation, volitional handwarming, mental arithmetic, and cold pressor. The two vascular headache groups (migraine and mixed) had significantly lower hand temperatures across conditions.This research was supported in part by grants from NINCDS (NS-15235 and NS-23440), from NHLBI (HL-27622 and HL-31189), and from NIDDK (DK-38614).     

Pre-referral rectal artesunate in severe malaria: flawed trial

Introduction

Irritable bowel syndrome affects as many as 14% of high school-aged students. Symptoms include discomfort in the abdomen, along with diarrhea and/or constipation and other gastroenterological symptoms that can significantly impact quality of life and daily functioning. Emotional stress appears to exacerbate irritable bowel syndrome symptoms suggesting that mind-body interventions reducing arousal may prove beneficial. For many sufferers, symptoms can be traced to childhood and adolescence, making the early manifestation of irritable bowel syndrome important to understand. The current study will focus on young people aged 14-26 years with irritable bowel syndrome. The study will test the potential benefits of Iyengar yoga on clinical symptoms, psychospiritual functioning and visceral sensitivity. Yoga is thought to bring physical, psychological and spiritual benefits to practitioners and has been associated with reduced stress and pain. Through its focus on restoration and use of props, Iyengar yoga is especially designed to decrease arousal and promote psychospiritual resources in physically compromised individuals. An extensive and standardized teacher-training program support Iyengar yoga's reliability and safety. It is hypothesized that yoga will be feasible with less than 20% attrition; and the yoga group will demonstrate significantly improved outcomes compared to controls, with physiological and psychospiritual mechanisms contributing to improvements.

Methods/Design

Sixty irritable bowel syndrome patients aged 14-26 will be randomly assigned to a standardized 6-week twice weekly Iyengar yoga group-based program or a wait-list usual care control group. The groups will be compared on the primary clinical outcomes of irritable bowel syndrome symptoms, quality of life and global improvement at post-treatment and 2-month follow-up. Secondary outcomes will include visceral pain sensitivity assessed with a standardized laboratory task (water load task), functional disability and psychospiritual variables including catastrophizing, self-efficacy, mood, acceptance and mindfulness. Mechanisms of action involved in the proposed beneficial effects of yoga upon clinical outcomes will be explored, and include the mediating effects of visceral sensitivity, increased psychospiritual resources, regulated autonomic nervous system responses and regulated hormonal stress response assessed via salivary cortisol.

Trial registration

ClinicalTrials.gov NCT01107977.     

Comparison of various treatments for irritable bowel syndrome.

A previous therapeutic trial of factorial design showed that a combination of a psychotropic drug, a smooth-muscle relaxant, and a bulk former (lorazepam, hyoscine hydrobromide, and ispaghula husk) relieved symptoms of the irritable bowel syndrome more effectively than the same agents given singly. Another trial of similar design was undertaken to compare each of these three agents with another having the equivalent clinical actions--namely, Motival (fluphenazine/nortriptylene mixture), mebeverine, and bran. Ninety-six patients took part; all received three agents, one from each of the three pairs being compared, and no placebos were used. Fifty-six patients reported a sustained symptomatic improvement, which was a significantly higher incidence than in the previous trial, when placebos were used. Ispaghula was significantly more effective than bran. The combination of ispaghula, Motival, and mebeverine improved 11 out of 12 patients--significantly more than bran, Motival, and hyoscine (five improved), or bran, lorazepam, and mebeverine (four improved). Mebeverine was significantly more effective when combined with Motival (18 out of 24 improved) than with lorazepam (10 improved). These results confirm the value of a combined therapeutic approach to the relief of the irritable bowel syndrome and suggest the possibility of synergism between agents.     

益生菌对肠易激综合征患者肠道微环境及免疫功能的影响

目的:探讨益生菌对肠易激综合征患者肠道微环境及免疫功能的影响,为临床相关研究提供参考。方法:选择2013年6月-2015年6月在我院接受治疗的肠易激综合征患者79例作为研究对象,根据治疗方案不同分为研究组(47例)和对照组(42例)。研究组患者采用双歧三联活菌联合美沙拉嗪治疗,对照组患者给予美沙拉嗪治疗。观察并比较两组患者治疗前后肠道内肠杆菌、双歧杆菌、乳酸杆菌、粪肠球菌及类杆菌的变化情况,以及血清CD4~+,CD8~+及CD4~+/CD8~+水平,并评价两组的临床疗效。结果:治疗前,两组患者肠道菌群数量比较,差异无统计学意义(P0.05);治疗后,两组患者肠道内大肠杆菌及粪肠球菌数量均减少,且研究组少于对照组,差异具有统计学意义(P0.05);治疗后,两组患者肠道内乳酸杆菌、双歧杆菌和类杆菌数量均增加,且研究组高于对照组,差异具有统计学意义(P0.05)。治疗前,两组患者免疫功能指标比较,差异无统计学意义(P0.05);治疗后,两组患者CD4~+T细胞以及CD4~+/CD8~+均显著高于治疗前,而CD8~+T细胞显著降低,差异具有统计学意义(P0.05);治疗后,研究组患者CD4~+T细胞及CD4~+/CD8~+均高于对照组,而CD8+T细胞低于对照组,差异具有统计学意义(P0.05)。研究组患者的临床疗效(91.67%)高于对照组(76.67%),但两组比较,差异无统计学意义(P0.05)。结论:益生菌制剂治疗不仅能够调节肠易激综合征患者肠道内的菌群平衡,而且能够改善患者的免疫功能,值得临床推广应用。     

Metabolomics of fecal extracts detects altered metabolic activity of gut microbiota in ulcerative colitis and irritable bowel syndrome

(1)H NMR spectroscopy of aqueous fecal extracts has been used to investigate differences in metabolic activity of gut microbiota in patients with ulcerative colitis (UC) (n = 13), irritable bowel syndrome (IBS) (n = 10), and healthy controls (C) (n = 22). Up to four samples per individual were collected over 2 years giving a total of 124 samples. Multivariate discriminant analysis, based on NMR data from all three groups, was able to predict UC and C group membership with good sensitivity and specificity; classification of IBS samples was less successful and could not be used for diagnosis. Trends were detected toward increased taurine and cadaverine levels in UC with increased bile acid and decreased branched chain fatty acids in IBS relative to controls; changes in short chain fatty acids and amino acids were not significant. Previous PCR-denaturing gradient gel electrophoresis (PCR-DGGE) analysis of the same fecal material had shown alterations of the gut microbiota when comparing UC and IBS groups with controls. Hierarchical cluster analysis showed that DGGE profiles from the same individual were stable over time, but NMR spectra were more variable; canonical correlation analysis of NMR and DGGE data partly separated the three groups and revealed a correlation between the gut microbiota profile and metabolite composition.     

Efficacy and Safety of Antidepressants for the Treatment of Irritable Bowel Syndrome: A Meta-Analysis

Aim

The aim of this meta-analysis was to analyze the efficacy and safety of antidepressants for the treatment of irritable bowel syndrome.

Methods

We searched MEDLINE, EMBASE, Scopus and The Cochrane Library for randomized controlled trials investigating the efficacy and safety of antidepressants in the treatment of irritable bowel syndrome. Article quality was evaluated by Jadad score. RevMan 5.0 and Stata 12.0 were used for the meta-analysis.

Results

Twelve randomized controlled trials were included in this study and most of these trials were of high quality (Jadad score ≥4). Five articles focused on tricyclic antidepressants, six articles involved selective serotonin reuptake inhibitors, and one article investigated both types of treatment. The pooled risk ratio showed antidepressant treatment can improve global symptoms (RR = 1.38, 95% CI 1.08, 1.77). In the subgroup analysis, treatment with tricyclic antidepressants showed an improvement in global symptoms (RR = 1.36, 95% CI 1.07, 1.71), while treatment with selective serotonin reuptake inhibitors showed no statistically significant difference in global symptoms compared with the control groups (RR = 1.38, 95% CI 0.83, 2.28). The pooled risk ratio of dropout due to side effects following antidepressant treatment was 1.71 with 95% CI (0.98, 2.99). The subgroup analysis showed the pooled risk ratio of dropout in the tricyclic antidepressants group was 1.92 with 95% CI (0.89, 4.17). In the selective serotonin reuptake inhibitors group, the pooled risk ratio of dropout was 1.5 with 95% CI (0.67, 3.37). Selective serotonin reuptake inhibitors showed no benefit in alleviating abdominal pain and improving quality of life. There was no difference in the incidence of common adverse events between treatment and control groups.

Conclusions

TCAs can improve global symptoms of irritable bowel syndrome, while there was no strong evidence to confirm the effectiveness of SSRIs for the treatment of IBS.     

微生态制剂干预肠易激综合征患者疗效meta分析

目的对微生态制剂干预肠易激综合征患者的疗效进行系统性分析,指导临床用药。方法联机检索Medline、维普、万方数据库、CNKI、CBMdisc中微生态制剂治疗肠易激综合征疗效的随机对照临床试验,对文献质量进行严格评价和资料提取,对符合质量标准的RCT进行Meta分析。结果共有7项研究符合入选标准,其中5项研究提示微生态制剂干预肠易激综合征患者疗效不优于安慰剂,2项研究认为微生态制剂有效改善患者的临床症状,荟萃结果表明微生态制剂可以有效缓解肠易激综合征临床症状[OR(95%CI):1.66(1.27,2.18)]。结论微生态制剂可以有效缓解肠易激综合征临床症状。     

肠易激综合征模型WHBE兔神经-体液-内分泌系统调节的变化

目的观察肠易激综合征（IBS）模型WHBE兔神经内分泌激素和电解质水平的变化,探讨神经-体液-内分泌系统在IBS中的作用。方法以湿热环境应激加小剂量致泻剂诱导WHBE兔建立IBS模型,在造模9d和14d时取血分离血清,检测血清中5-羟色胺（5-HT）、多巴胺（DA）、促肾上腺皮质激素（ACTH）、皮质醇（COR）、β-内啡肽（β-EP）激素和K^＋、Na^＋、cl^-含量的变化,并以JW兔作对照。结果与正常对照组比,造模9d时WHBE兔的5-HT、DA、ACTH、β-EP、COR均显著升高（P〈0．05,P〈0．01）,Na^＋、K^＋含量均显著降低（P〈0．01）,而JW兔ACTH、β-EP、COR均显著升高（P〈0．05,P〈0．01）,K^＋含量显著降低（P〈0．05）;造模14d时WHBE兔5-HT、ACTH、β-EP均显著升高（P〈0．05,P〈0．01）,JW兔ACTH显著升高（P〈0．05）;相关分析显示,IBS模型中血清中5-HT、COR与Na^＋、K^＋浓度呈显著负相关（P〈0．05,P〈0．01）,血清中DA、β-EP水平与Na^＋、K^＋、Cl^-浓度呈显著负相关（P〈0．05,P〈0．01）,ACTH水平则与K^＋浓度呈显著负相关（P〈0．01）。结论IBS的发生不仅与HPA轴兴奋性升高有关,亦与体液因素有关,故神经-体液-内分泌系统参与了WHBE兔IBS的发生过程。     

Regional Neuroplastic Brain Changes in Patients with Chronic Inflammatory and Non-Inflammatory Visceral Pain

Regional cortical thickness alterations have been reported in many chronic inflammatory and painful conditions, including inflammatory bowel diseases (IBD) and irritable bowel syndrome (IBS), even though the mechanisms underlying such neuroplastic changes remain poorly understood. In order to better understand the mechanisms contributing to grey matter changes, the current study sought to identify the differences in regional alterations in cortical thickness between healthy controls and two chronic visceral pain syndromes, with and without chronic gut inflammation. 41 healthy controls, 11 IBS subjects with diarrhea, and 16 subjects with ulcerative colitis (UC) underwent high-resolution T1-weighted magnetization-prepared rapid acquisition gradient echo scans. Structural image preprocessing and cortical thickness analysis within the region of interests were performed by using the Laboratory of Neuroimaging Pipeline. Group differences were determined using the general linear model and linear contrast analysis. The two disease groups differed significantly in several cortical regions. UC subjects showed greater cortical thickness in anterior cingulate cortical subregions, and in primary somatosensory cortex compared with both IBS and healthy subjects. Compared with healthy subjects, UC subjects showed lower cortical thickness in orbitofrontal cortex and in mid and posterior insula, while IBS subjects showed lower cortical thickness in the anterior insula. Large effects of correlations between symptom duration and thickness in the orbitofrontal cortex and postcentral gyrus were only observed in UC subjects. The findings suggest that the mechanisms underlying the observed gray matter changes in UC subjects represent a consequence of peripheral inflammation, while in IBS subjects central mechanisms may play a primary role.     

Viscerosensory-cardiovascular reflexes: altered baroreflex sensitivity in irritable bowel syndrome

Animal studies have demonstrated that visceral afferent stimulation alters autonomic cardiovascular reflexes. This mechanism might play an important role in the pathophysiology of conditions associated with visceral hypersensitivity, such as irritable bowel syndrome (IBS). As such, studies in humans are lacking, we measured viscerosensory-cardiovascular reflex interactions in IBS patients and healthy controls. Systolic blood pressure (SBP), heart rate (HR), and arterial baroreflex sensitivity (BRS) were studied in 87 IBS patients and 36 healthy controls under baseline conditions and during mild (15 mmHg) and intense (35 mmHg) visceral stimulation by rectal balloon distension. BRS was computed from continuous ECG and arterial blood pressure signals (Finapres-method) during 5-min periods of 15-min metronome respiration. Baseline SBP and HR were not different between patients and controls. In both groups, SBP increased similarly during rectal stimulation, whereas HR decreased during mild and increased intense stimulation. BRS was significantly higher in patients compared with controls at baseline (7.9 +/- 5.4 vs. 5.7 +/- 3.7 ms/mmHg, P = 0.03) and increased significantly in both groups during mild stimulation. This increase persisted in controls during intense stimulation, but BRS returned to baseline in patients. BRS was not significantly different between groups during rectal distension. This study demonstrates the presence of a viscerosensory-cardiovascular reflex in healthy individuals and in IBS patients. The increased BRS in IBS patients at baseline may either be a training-effect (frequent challenging of the reflex) or reflects altered viscerosensory processing at the nucleus tractus solitarii.     

微生态制剂(贝飞达)治疗非便秘型肠易激综合征

目的探讨微生态制剂贝飞达对肠易激综合征（IBS）的疗效。方法采用中国预防医学科学院流行病学研究所海斯药业有限公司生产的双歧三联活菌胶囊贝飞达（长双歧杆菌、嗜酸乳酸杆菌、粪肠球菌）治疗25例IBS患者,与服用安慰剂组25例进行疗效对比分析。结果IBS特征性症状评分治疗前后的差值,治疗组明显高于安慰剂组,各种症状的改善率明显优于对照组。结论贝飞达的短期疗法有望成为IBS治疗中的一个颇有前途的手段。