不同类型肠易激综合征患者肠道菌群与血清微小RNA的关系

研究不同类型肠易激综合征（IBS）患者肠道菌群与血清微小RNA（miRNA）的关系。

选择2019年1月至2022年1月于我院接受治疗的93例IBS患者为研究对象,根据其IBS类型,分为腹泻型IBS组（44例）与便秘型IBS组（49例）,同时将我院30例行胃镜检查未患IBS者作为对照组。采集研究对象十二指肠液行肠道菌群计数与培养,分析不同类型IBS患者肠道菌群差异。采集研究对象外周血,检测血清miR-29a、miR-143-5p水平。分析肠道菌群与血清miRNAs之间的关系。

便秘型IBS患者回肠末端肠液中拟杆菌数量高于对照组,B/E比值低于对照组（均P＜0.05）;腹泻型IBS患者肠道双歧杆菌、乳杆菌数量及B/E比值均低于对照组,肠杆菌数量高于对照组（均P＜0.05）。便秘型IBS组和腹泻型IBS组患者血清miR-29a及miR-143-5p水平均高于对照组（均P＜0.05）。相关性分析显示,便秘型IBS患者回肠内拟杆菌数量与其血清miR-29a和miR-143-5p水平均呈正相关（r = 0.326,P = 0.046;r = 0.343,P = 0.041）;腹泻型IBS患者回肠内双歧杆菌数量与其血清miR-143-5p水平呈负相关（r = －0.431,P = 0.013）,乳杆菌数量与血清miR-29a和miR-143-5p水平均呈负相关（r = －0.411,P = 0.017;r = －0.377,P = 0.029）,肠杆菌数量与miR-143-5p水平呈正相关（r = 0.339,P = 0.047）。

便秘型IBS及腹泻型IBS患者均存在肠道菌群失衡的情况,不同类型IBS患者血清miR-29a和miR-143-5p水平均异常升高,且血清miR-29a和miR-143-5p可能与肠道菌群相互作用,共同参与IBS的发生。

     

Globus and headache: common symptoms of the irritable bowel syndrome.

Persons with the irritable bowel syndrome (IBS) have a significantly higher prevalence of globus and migraine-like headache than age-matched control subjects. On the other hand, persons with organic disease of the esophagus or colon may have a reduced prevalence of functional symptoms involving the opposite end of the gastrointestinal tract. The dispersed pattern of symptoms in IBS suggests that some agent, such as a hormone, may be acting systemically.     

Proteomics and irritable bowel syndrome

Introduction: Irritable bowel syndrome (IBS) is a gastrointestinal disease that according to Rome IV criteria is subdivided into four subtypes. The pathophysiology of this disease is not well understood due to numerous factors playing multiple roles in disease development, such as diet, stress and hormones. IBS has a variety of symptoms and overlaps with many other gastrointestinal and non-gastrointestinal diseases.

Area covered: This review aims to present an overview of implementation of proteomics in experimental studies in the field of IBS.

Expert commentary: Proteomics is commonly used for biomarker discovery in and has also been extensively used in IBS research. The necessity of a sensitive and specific biomarker for IBS is apparent, but despite the intensive research performed in this field, an appropriate biomarker is not yet available.     

V. Stress and irritable bowel syndrome

Different types of stress play important roles in the onset and modulation of irritable bowel syndrome (IBS) symptoms. The physiological effects of psychological and physical stressors on gut function and brain-gut interactions are mediated by outputs of the emotional motor system in terms of autonomic, neuroendocrine, attentional, and pain modulatory responses. IBS patients show an enhanced responsiveness of this system manifesting in altered modulation of gastrointestinal motility and secretion and in alterations in the perception of visceral events. Functional brain imaging techniques are beginning to identify brain circuits involved in the perceptual alterations. Animal models have recently been proposed that mimic key features of the human syndrome.     

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.     

经肠镜导入益生菌对肠易激综合征治疗的可行性研究

目的 观察经肠镜导入益生菌对肠易激综合征（IBS）患者症状的影响及可能的不良反应。方法 选择福建医科大学附属第一医院就诊的IBS患者,入选患者均符合IBS罗马IV诊断标准并同意进入本研究。患者肠镜检查完成时于右半结肠单次喷洒33.6 mg/mL的双歧杆菌三联活菌‒生理盐水混悬液100 mL,第0、2和4周进行粪便Bristol分型、腹痛视觉评分（VAS）、结肠症状评分和IBS严重程度调查表评分（IBS-SSS）;第0、4周进行医院焦虑抑郁量表（HADS）测定。结果 入选患者中共有5例IBS便秘型（IBS-C）、13例IBS腹泻型（IBS-D）患者完成研究,年龄分别为（49.4±10.0）岁和（36.1±8.9）岁,男女比例分别为1∶0.66和3.3∶1,均无严重不良反应发生。IBS-C组患者症状指标均无显著改善（P>0.05）,该组患者提前终止。IBS-D组患者综合疗效指数0.692,与第0周相比,第2和4周患者的粪便Bristol分型、腹痛VAS评分、症状总积分和IBS-SSS评分均显著下降（P0.05）。结论 经肠镜单次双歧杆菌三联活菌混悬液喷洒可安全有效地改善IBS-D患者的肠道症状,但对IBS-C患者无效。     

肠道菌群与腹泻型肠易激综合征相关性的研究进展

肠易激综合征（IBS）是一种常见的功能性胃肠道疾病,其特征是反复发作的腹痛,伴随排便频率与大便性状的改变。腹泻为主的肠易激综合征（IBS-D）是其主要亚型,主要表现是腹痛和腹泻。目前IBS-D的发病机制尚不完全明确,但大量的研究提示可能与胃肠道动力紊乱、黏膜通透性和肠上皮屏障功能改变、内脏高敏感性增加、“脑‒肠‒菌”轴失调、肠道感染与炎症反应激活、精神心理因素异常等有关。随着研究的不断深入,发现肠道菌群与IBS-D的关系密切,调节肠道菌群的益生菌干预成为缓解IBS-D相关症状的手段之一。本研究就近十余年来肠道菌群情况与IBS-D关系的研究现状作一综述。     

Relaxation training as a treatment for irritable bowel syndrome

Although there have been many successful, controlled demonstrations of the clinical efficacy of multicomponent treatments for irritable bowel syndrome (IBS), in the present study we sought to evaluate a single component of many of these regimens, relaxation training. Eight IBS patients received a 10-session (over 8 weeks) regimen of abbreviated progressive muscle relaxation with regular home practice while 8 comparable patients merely monitored GI symptoms. Based on daily GI symptom diaries collected for 4 weeks before and 4 weeks after treatment (or continued symptom monitoring), the Relaxation condition showed significantly (p=.05) more improvement on a composite measure of primary GI symptom reduction than the Symptom Monitoring condition. Fifty percent of the Relaxation group were clinically improved at the end of treatment.     

Neuropharmacology of stress-induced mucosal inflammation: implications for inflammatory bowel disease and irritable bowel syndrome

Inflammatory bowel disease (IBD) and the irritable bowel syndrome (IBS) are common causes of medical consultation and the most frequent diagnosis raised by gastroenterologists. Recent years have witnessed considerable advances in the understanding of the mechanisms involved in the initiation and perpetuation of these chronic and recurrent disorders. However, particularly in IBS, the success of the "bench-to the-bedside medicine" has been rather poor since many affected individuals still experience significant bother and negative impact in their quality of life despite growing investigative and sanitary costs. Besides IBD, several subgroups of IBS patients have been lately identified as carriers of mucosal inflammation throughout the gut. Although multifactorial, life stress has emerged as a critical factor for mucosal inflammation in these conditions. Due to the clinical and biological heterogeneity of IBD and IBS patients, the simplistic hypothesis of a stress-related stepwise progression of gut inflammation may be useful to gain operative knowledge and render better and specific diagnostic markers and improved therapeutic options. Therefore, in this review, we have consciously admitted the possibility of linear evolution of gut inflammation, from the mucosa to the serosa, and assumed a bidirectional progression, from physiological to pathological inflammation. Thus, we have outlined the stress neurocircuitry implicated in the regulation of gut inflammation and the participating pathways (mechanisms, receptors and molecules) and provided with both, evidence and a theoretical-based approach to present and potential drugs that, alone or in combination, might help to prevent, control or regress the stress-induced inflammatory process at different stages.     

Bowel sound biofeedback as a treatment for irritable bowel syndrome

Using an electronic stethoscope placed on subjects' abdomens, bowel sound biofeedback was administered to five subjects suffering from irritable bowel syndrome (functional diarrhea). They were instructed to alternately increase and decrease colonic sounds in an attempt to gain control over bowel activity. Using daily ratings of diarrhea as the primary dependent measure, three of five subjects reduced mean ratings enough at posttreatment to meet our 50% criterion for success (100%, 94%, and 54%). At 1-year follow-up, two of the three short-term successes had maintained their level of improvement — each had ratings 75% below those of pretreatment.     

Recommendations for the management of irritable bowel syndrome in family practice

To help family physicians manage patients with irritable bowel syndrome (IBS), a consensus conference was convened in June 1997 at which 5 internationally recognized experts in IBS presented position papers on selected topics previously circulated to the conference participants. Five working groups comprising family physicians, gastroenterologists and allied health care professionals from across Canada were then charged with developing recommendations for the diagnosis, patient education, psychosocial management, dietary advice and pharmacotherapy, respectively. An evidence-based approach was used where possible; otherwise, recommendations were made by consensus. The participants concluded that family physicians can make a positive diagnosis of IBS using symptom criteria. The pathophysiology is poorly understood, but motility and sensory disturbances appear to play a role. Neither psychological nor specific dietary factors cause IBS, but both can trigger symptoms. Drug therapy is not recommended for the routine treatment of IBS, but short-term trials of drug therapy may be targeted to predominant symptoms in selected patients. A step-wise, patient-centred approach to management is outlined.     

Anthropological, demographic and socioeconomic characteristics of irritable bowel syndrome

Irritable bowel syndrome (IBS) in one of the most frequent functional gastrointestinal disorders (FGIDs) with a prevalence in 10 to 20%, of cases in some developed countries. The Rome Foundation has drawn up Rome III criteria, diagnostic questionnaires and scoring algorithm for FGIDs, applicable in clinical practice and population studies. The aim of this research is to determine the presence of IBS in Osjecko-baranjska County and the effect of anthropometric, demographic and socioeconomic factors. 703 subjects selected in the systematic sample filled in the Rome III diagnostic questionnaire for IBS. Prevalence of IBS was recorded in 29.16%, in men in 21.39%, and in women in 36.69% of cases, anxiety and depression in 26.34% and 25.85%. Persons suffering from IBS were on average shorter, weighed less and had a lower BMI than persons not showing signs of IBS. Women have 2.101 times greater chance of risk of IBS, and with an increase in the number of members in the household the risk of IBS increases 1.139 times. Rome III survey questionnaire is an acceptable method for diagnosing IBS and identifying persons showing signs of structural changes in order to provide further treatment.     

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).