Review of the treatment options for chronic constipation

Constipation is a common gastrointestinal motility disorder that is often chronic, negatively affects patients' daily lives, and is associated with high healthcare costs. There is a considerable range of treatment modalities available for patients with constipation; however, the clinical evidence supporting their use varies widely. Nonpharmacologic modalities, such as increased exercise or fluid intake and bowel habit training, are generally recommended as first-line approaches, but data on the effectiveness of these measures are limited. The clinical benefits of various traditional pharmacologic agents (many of which are available over the counter, such as laxatives and fiber supplements) remain unclear. Although these modalities may benefit some patients with temporary constipation, their efficacy in patients for whom constipation is chronic is less well defined. Some studies suggest benefit with psyllium, polyethylene glycol, and lactulose; however, the use of other agents, such as calcium polycarbophil, methylcellulose, bran, magnesium hydroxide, and stimulant laxatives, is not supported by strong clinical evidence. More recently, newer agents have been approved for the treatment of patients with chronic constipation on the basis of comprehensive clinical investigation programs. Tegaserod, with its well-established clinical profile, and lubiprostone, the latest addition to the treatment armamentarium, represent the new generation of therapies for chronic constipation. This article reviews the efficacy and safety of traditional therapies used in the management of the multiple symptoms associated with chronic constipation and discusses recently approved and emerging therapies for this disorder.     

Microbial treatment in chronic constipation

Chronic functional constipation is a kind of common intestinal disease that occurs in children, adults and elderly people. This disease not only causes great influence to physiological function, but also results in varying degrees of psychological barriers. At present, constipation treatments continue to rely on traditional methods such as purgative therapy and surgery. However, these approaches can disrupt intestinal function. Recent research between intestinal diseases and gut microbiota has gradually revealed a connection between constipation and intestinal flora disturbance, providing a theoretical basis for microbial treatment in chronic constipation. Microbial treatment mainly includes probiotic preparations such as probiotics, prebiotics, synbiotics and fecal microbiota transplantation (FMT). Due to its safety, convenience and curative effect, probiotic preparations have been widely accepted, especially gradually developed FMT with higher curative effects. Microbial treatment improves clinical symptoms, promotes the recovery of intestinal flora, and has no complications during the treatment process. Compared with traditional treatments, microbial treatment in chronic constipation has advantages, and is worthy of further promotion from clinical research to clinical application.     

Gender differences in self-reported constipation characteristics,symptoms, and bowel and dietary habits among patients attending a specialty clinic for constipation

Objectives: This study assessed gender differences in the frequency of various characteristics of constipation, constipation-specific symptoms, and bowel and dietary habits, as well as the effects of independent but associated risk factors.Methods: A cross-sectional study of patients aged ≥18 years with a primary diagnosis of constipation (ie, constipation, slow-transit constipation, outlet dysfunction constipation) was conducted at a tertiary referral center; patients were excluded if they had a primary diagnosis of fecal incontinence. Patients completed both a clinical questionnaire to obtain information on demographic characteristics and medical history and an unvalidated self-report questionnaire relating to the characteristics and symptoms of constipation as well as various bowel and dietary habits. Likert scales were used to assess 4 characteristics of constipation (frequency of constipation, duration of constipation symptoms of ≥1 month, bowel movement frequency, stool consistency) and the frequency of occurrence of 6 constipation symptoms (abdominal pain, abdominal bloating, incomplete evacuation, unsuccessful attempts at evacuation, pain with evacuation, straining with evacuation). The bowel habits that were evaluated included time spent at each evacuation; frequency of needing to change position to evacuate; use of anal digitation to evacuate; and the use of laxatives, enemas, stool softeners, foods, drinks, or other aids. The dietary habits that were evaluated included use of dietary fiber, use of fiber supplements, and water intake.Results: Of the 518 patients, the majority were female (79.0%), white (76.3%), and employed (62.0%), with a mean (SD) age of 52.4 (16.5) years (range, 18.6–91.5 years). After controlling for a number of related conditions, women were more likely than men to have infrequent bowel movements (adjusted odds ratio [AOR] = 2.97; 95% CI, 1.67–5.28), abnormal stool consistency (ie, hard or pelletlike stools) (AOR = 3.08; 95% CI, 1.80–5.28), and a longer duration of constipation symptoms (AOR = 2.00; 95% CI, 1.05–3.82). In addition, women were more likely to report an increased frequency of occurrence of abdominal pain (AOR = 2.22; 95% CI, 1.22–4.05), bloating (AOR = 2.65; 95% CI, 1.50–4.70), unsuccessful attempts at evacuation (AOR = 1.74; 95% CI, 1.01–3.00), and the use of anal digitation to evacuate stool (AOR = 3.37; 95% CI, 1.15–9.90).Conclusions: The women in this specialty-based clinic study experienced a number of constipation symptoms and abnormal bowel habits more frequently than did men. These findings warrant replication in both population- and specialty clinic-based samples. In addition, the physiologic mechanisms that underlie these gender differences warrant investigation.     

Impact of symptoms by gender and age in Japanese subjects with irritable bowel syndrome with constipation (IBS-C): a large population-based internet survey

Background

Irritable bowel syndrome with constipation (IBS-C) is a representative psychosomatic disorder. Several pathophysiological factors have been linked to IBS symptoms such as the modulation of gastrointestinal motility, visceral hypersensitivity, dysregulation of the gut-brain axis, genetic and environmental factors, sequelae of infection, and psychosocial disorders. It is likely that biopsychosocial aspects of IBS-C underlie its gender and age effects. However, the influence of each symptom of IBS-C by gender and age is not well understood. We hypothesized that the expression rate of each IBS-C symptom in females and in subjects aged 20–49 years was higher than that of subjects who were male and aged 50–79 years.

Methods

We conducted an internet survey of 30,000 adults from the general Japanese population. IBS-C subjects were asked to answer a questionnaire on the degree of anxiety, thoughts about bowel habits, and their dominant gastrointestinal symptoms together with exacerbation factors. The correlation between gender and age and IBS-C symptoms was analyzed.

Results

When analyzed by gender, the expression rate of abdominal discomfort, abdominal distention, and abdominal fullness was significantly higher in female than male IBS-C subjects (66.5% vs. 58.7%, p?<?0.05; 54.7% vs. 43.6%, p?<?0.01; 18.9% vs. 9.6%, p?<?0.01, respectively). When analyzed by age, the expression rate of abdominal distention and abdominal pain was significantly higher among IBS-C subjects aged 20–49 years than those aged 50–79 years (55.7% vs. 46.8%, p?<?0.05; 36.6% vs. 20.6%, p?<?0.001, respectively). In contrast, there was no gender or age differences with regard to the most common and bothersome symptom (abdominal bloating) among IBS-C subjects.

Conclusions

The expression rate of some IBS-C symptoms was higher among females and those aged 20–49 years than males and those aged 50–79 years, respectively. It is important to understand the impact of symptoms by gender and age to evaluate the pathology of IBS-C from a biopsychosocial perspective.

Trial registration

Although this survey was an anonymous internet survey, we obtained informed consent for the study as an online response. The disclosure of this study was approved by the Ethics Committee of Tohoku University Graduate School of Medicine (approval number: 2015–1-405).

     

神阙穴帖敷治疗骨科骨折患者术后便秘的疗效观察

目的探讨大黄水蜜贴敷"神阙"穴对骨折术后便秘的治疗效果。方法选取我院骨科骨折术后发生便秘的患者100例,随机分成治疗组和对照组各50例。对照组采用传统的治疗方法,即在骨科常规护理措施上指导患者多饮水,多进食水果、蔬菜,必要时给予缓泻药或开塞露纳肛。治疗组在对照组的基础上加用大黄水蜜贴敷"神阙"穴治疗,并对两组患者的便秘情况和相关症状进行比较。结果治疗组的治疗有效率为90%,对照组为60%,两组比较差异有统计学意义(P0.05);观察组发生便秘的相关症状少于对照组,差异有统计学意义(P0.05)。结论大黄水蜜贴敷"神阙"穴治疗骨科骨折术后便秘的疗效显著,值得临床推广应用。     

Linaclotide is a potent and selective guanylate cyclase C agonist that elicits pharmacological effects locally in the gastrointestinal tract

AimsLinaclotide is an orally administered 14-amino acid peptide being developed for the treatment of constipation-predominant irritable bowel syndrome (IBS-C) and chronic constipation. We determined the stability of linaclotide in the intestine, measured the oral bioavailability, and investigated whether the pharmacodynamic effects elicited in rodent models of gastrointestinal function are mechanistically linked to the activation of intestinal guanylate cyclase C (GC-C).Main methodsLinaclotide binding to intestinal mucosal membranes was assessed in competitive binding assays. Stability and oral bioavailability of linaclotide were measured in small intestinal fluid and serum, respectively, and models of gastrointestinal function were conducted using wild type (wt) and GC-C null mice.Key findingsLinaclotide inhibited in vitro [¹²⁵I]-STa binding to intestinal mucosal membranes from wt mice in a concentration-dependent manner. In contrast, [¹²⁵I]-STa binding to these membranes from GC-C null mice was significantly decreased. After incubation in vitro in jejunal fluid for 30 min, linaclotide was completely degraded. Pharmacokinetic analysis showed very low oral bioavailability (0.10%). In intestinal secretion and transit models, linaclotide exhibited significant pharmacological effects in wt, but not in GC-C null mice: induction of increased fluid secretion into surgically ligated jejunal loops was accompanied by the secretion of elevated levels of cyclic guanosine-3′,5′-monophosphate and accelerated gastrointestinal transit.SignificanceLinaclotide is a potent and selective GC-C agonist that elicits pharmacological effects locally in the gastrointestinal tract. This pharmacological profile suggests that orally administered linaclotide may be capable of improving the abdominal symptoms and bowel habits of patients suffering from IBS-C and chronic constipation.     

Abdominal bloating is the most bothersome symptom in irritable bowel syndrome with constipation (IBS-C): a large population-based Internet survey in Japan

Background

Abdominal bloating is a common symptom in patients with irritable bowel syndrome with constipation (IBS-C). However, it is not included among the required items in the Rome III diagnostic criteria for IBS. Little is known about an impact of abdominal bloating seen in patients with IBS-C. Using a large population-based sample, the aim of the present study was to investigate what is the most bothersome symptom in subjects with IBS-C.

Methods

An Internet survey of 30,000 adults drawn from the general public throughout Japan was conducted to identify subtypes of IBS using the Rome III diagnostic questionnaire. Consecutively, the screened subjects with IBS-C and the same number of age- and sex-matched non-IBS subjects who were randomly selected as controls were asked to answer a questionnaire on the degree of anxiety they experienced in their daily lives, thoughts about bowel habit, and their dominant gastrointestinal symptoms together with exacerbation factors (for IBS-C only).

Results

The screening survey showed that the prevalence of overall IBS was 16.5 % (female 17.4 %, male 15.5 %) and that 2.8 % met the criteria for IBS-C, 4.5 % for IBS with diarrhea (IBS-D) and 8.2 % for mixed IBS (IBS-M). Seven hundred and fifty-nine of 835 (90.9 %) subjects with IBS-C and 746 of 830 (89.9 %) control subjects completed the consecutive questionnaire. IBS-C subjects felt a higher degree of anxiety in their daily lives (p?<?0.01) and considered bowel habit to be an indicator of health (p?<?0.01) to a greater extent than control subjects. In IBS-C, the degree of anxiety was significantly associated with abdominal discomfort (p?<?0.01), pain (p?<?0.01) and bloating (p?=?0.02), but not with the frequency of bowel habit (p?>?0.1). Abdominal bloating was the most bothersome symptom (27.5 %), which was more likely to occur after a meal (52.2 %), at work/school (29.2 %) and during times of stress (26.8 %). Only 4.5 % of IBS-C subjects reported abdominal pain as the ‘most bothersome’ symptom.

Conclusions

A large population-based Internet survey suggests that abdominal bloating has a great impact on the daily lives of subjects diagnosed with IBS-C. Not only bowel movement/abdominal pain but also abdominal bloating should be evaluated in patients with IBS-C.

     

Gastroesophageal reflux: clinical presentations,diagnosis and management.

Symptomatic gastroesophageal reflux occurs daily in an estimated 7% of adults and weekly or monthly in 29%. Untreated it can lead to esophageal erosions, ulceration and stricture formation. The pathogenesis is often multifactorial: defects in the function of the lower esophageal sphincter, esophageal clearance mechanisms and gastric emptying combine to produce frequent lengthy periods during which the lower esophagus is bathed in regurgitated acid. In most patients reflux disease is easily recognized as recurrent heartburn, regurgitation or dysphagia, or a combination. When acute chest pain or respiratory illness is the primary presenting complaint the patient needs particularly careful investigation to determine whether the symptoms are due to a primary cardiac or respiratory condition, are secondary to gastroesophageal reflux alone or represent a combination of disorders. Endoscopy with biopsy and long-term pH monitoring are the most reliable ways of determining whether reflux disease is present. Additional investigations, such as exercise testing, cardiac catheterization or inhalation challenge, may be needed in patients with cardiac or respiratory symptoms. Treatment should follow a stepped-care approach and in most patients should begin with changes in lifestyle, including dietary manipulation, reducing alcohol and cigarette consumption, and raising the head of the bed, together with appropriate use of antacids or alginate-antacid combinations. H2-receptor antagonists and agents to improve both gastric emptying and the tone of the lower esophageal sphincter may be added in sequence. Most patients will respond well to this regimen. Surgery should be considered only for those with intractable symptoms or with complications (e.g., stricture formation, bleeding, development of dysplastic epithelium in those with Barrett''s esophagus, or secondary pulmonary disease that does not respond to medical management). It is successful in 85% of well-selected patients and has few complications.     

Biochemical markers of ongoing joint damage in rheumatoid arthritis - current and future applications, limitations and opportunities

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease associated with potentially debilitating joint inflammation, as well as altered skeletal bone metabolism and co-morbid conditions. Early diagnosis and aggressive treatment to control disease activity offers the highest likelihood of preserving function and preventing disability. Joint inflammation is characterized by synovitis, osteitis, and/or peri-articular osteopenia, often accompanied by development of subchondral bone erosions, as well as progressive joint space narrowing. Biochemical markers of joint cartilage and bone degradation may enable timely detection and assessment of ongoing joint damage, and their use in facilitating treatment strategies is under investigation. Early detection of joint damage may be assisted by the characterization of biochemical markers that identify patients whose joint damage is progressing rapidly and who are thus most in need of aggressive treatment, and that, alone or in combination, identify those individuals who are likely to respond best to a potential treatment, both in terms of limiting joint damage and relieving symptoms. The aims of this review are to describe currently available biochemical markers of joint metabolism in relation to the pathobiology of joint damage and systemic bone loss in RA; to assess the limitations of, and need for additional, novel biochemical markers in RA and other rheumatic diseases, and the strategies used for assay development; and to examine the feasibility of advancement of personalized health care using biochemical markers to select therapeutic agents to which a patient is most likely to respond.     

Effect of a glucagon-like peptide 1 analog, ROSE-010, on GI motor functions in female patients with constipation-predominant irritable bowel syndrome

The glucagon-like peptide 1 (GLP-1) analog ROSE-010 reduced pain during acute exacerbations of irritable bowel syndrome (IBS). Our objective was to assess effects of ROSE-010 on several gastrointestinal (GI) motor and bowel functions in constipation-predominant IBS (IBS-C). In a single-center, randomized, parallel-group, double-blind, placebo-controlled, dose-response study, we evaluated safety, pharmacodynamics, and pharmacokinetics in female patients with IBS-C. ROSE-010 (30, 100, or 300 μg sc) or matching placebo was administered once daily for 3 consecutive days and on 1 day 2-10 days later. We measured GI and colonic transit by validated scintigraphy and gastric volumes by single-photon emission computed tomography. The primary end points were half time of gastric emptying of solids, colonic transit geometric center at 24 h, and gastric accommodation volume. Analysis included intent-to-treat principle, analysis of covariance (with body mass index as covariate), and Dunnett-Hsu test for multiple comparisons. Exposure to ROSE-010 was approximately dose-proportional across the dose range tested. Demographic data in four treatment groups of female IBS-C patients (total 46) were not different. Gastric emptying was significantly retarded by 100 and 300 μg of ROSE-010. There were no significant effects of ROSE-010 on gastric volumes, small bowel or colonic transit at 24 h, or bowel functions. The 30- and 100-μg doses accelerated colonic transit at 48 h. Adverse effects were nausea (P < 0.001 vs. placebo) and vomiting (P = 0.008 vs. placebo). Laboratory safety results were not clinically significant. In IBS-C, ROSE-010 delayed gastric emptying of solids but did not retard colonic transit or alter gastric accommodation; the accelerated colonic transit at 48 h with 30 and 100 μg of ROSE-010 suggests potential for relief of constipation in IBS-C.     

Endocannabinoid and Cannabinoid-Like Fatty Acid Amide Levels Correlate with Pain-Related Symptoms in Patients with IBS-D and IBS-C: A Pilot Study

Aims

Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder, associated with alterations of bowel function, abdominal pain and other symptoms related to the GI tract. Recently the endogenous cannabinoid system (ECS) was shown to be involved in the physiological and pathophysiological control of the GI function. The aim of this pilot study was to investigate whether IBS defining symptoms correlate with changes in endocannabinoids or cannabinoid like fatty acid levels in IBS patients.

Methods

AEA, 2-AG, OEA and PEA plasma levels were determined in diarrhoea-predominant (IBS-D) and constipation-predominant (IBS-C) patients and were compared to healthy subjects, following the establishment of correlations between biolipid contents and disease symptoms. FAAH mRNA levels were evaluated in colonic biopsies from IBS-D and IBS-C patients and matched controls.

Results

Patients with IBS-D had higher levels of 2AG and lower levels of OEA and PEA. In contrast, patients with IBS-C had higher levels of OEA. Multivariate analysis found that lower PEA levels are associated with cramping abdominal pain. FAAH mRNA levels were lower in patients with IBS-C.

Conclusion

IBS subtypes and their symptoms show distinct alterations of endocannabinoid and endocannabinoid-like fatty acid levels. These changes may partially result from reduced FAAH expression. The here reported changes support the notion that the ECS is involved in the pathophysiology of IBS and the development of IBS symptoms.     

Biofeedback treatment of gastrointestinal disorders.

Biofeedback has had a greater impact on gastroenterology than on any other medical subspecialty. Biofeedback is the treatment of choice for many of the most common types of fecal incontinence, and preliminary studies suggest that it is likely to become a preferred method for treating patients with constipation related to inability to relax the striated pelvic floor muscles during defecation. This dysfunction may account for up to 50% of patients with chronic constipation. Thermal biofeedback forms part of a multicomponent behavioral treatment for irritable bowel syndrome that is reported to be effective, and other promising applications of biofeedback for gastrointestinal disorders are under investigation.     

凝结芽孢杆菌活菌片治疗妊娠期便秘的临床观察

目的 观察和评价凝结芽孢杆菌活菌片(商品名:爽舒宝)治疗妊娠期便秘的临床疗效.方法 将80例妊娠期便秘患者随机分为治疗组和对照组,治疗组和对照组均为40例,两组均给予基础治疗.其中治疗组在基础治疗的同时加用凝结芽孢杆菌活菌片,首次2.1g,以后1.05g/次,3次/d,温水送服.观察治疗前后大便次数、粪便性状,有无排便不尽及排便费力感、腹部不适、腹胀、腹痛.结果 治疗组总有效率、大便频率明显高于对照组,差异有统计学意义(P＜0.05),同时治疗组患者治疗后无腹部不适、腹胀、排便费力、排便不尽感等新症状出现,明显优于对照组.结论 凝结芽孢杆菌活菌片辅助治疗妊娠期便秘疗效显著,值得临床推广.     

Hyperthyroidism in the elderly: aspecific signs may cause a delay in diagnosis

The clinical manifestations of thyroid diseases in the elderly are often atypical and can easily be attributed to other medical conditions or 'normal aging'. Two nursing home patients with hyperthyroidism are described. Due to the atypical presentation of the thyroid disease their complaints were attributed to other conditions. In both patients there was a significant delay in diagnosis and treatment of hyperthyroidism. In elder patients signs and symptoms of thyreotoxicosis are frequently related to cardiovascular, gastrointestinal and neuropsychiatric disorders. Most often occur atrial fibrillation, worsening of cardiac failure and angina pectoris, weight loss, anorexia, constipation, cognitive impairment and delirium. Delay of diagnosis and treatment of hyperthyroidism may be potentially harmful to the patient. Untreated thyreotoxicosis may lead to serious cardiovasculair complications (particularly cardiac failure and cerebrovascular accidents), mental deterioration and osteoporosis. In elder people with unexplained and vague signs and symptoms thyroid function should always be checked. The TSH assay is a very accurate diagnostic test for screening thyroid function. A normal TSH indicates euthyroidism with an accuracy of almost 100%. The medical treatment for hyperthyreoidism in the elderly are antithyroid drugs. When an euthyroid state is rendered, suppletion with L-thyroxine may be nessecary. Radioactive iodine treatment is preferred in some cases though there may be practical difficulties with the application of this treatment in nursing home patients because temporary isolation is necessary.     

Influence of the requirement for abdominal pain in the diagnosis of irritable bowel syndrome with constipation (IBS-C) under the Rome IV criteria using data from a large Japanese population-based internet survey

Background

Rome III was revised to Rome IV in May 2016. One important change in the Rome IV criteria is that abdominal pain must be present for a diagnosis of irritable bowel syndrome (IBS). Under Rome III, in contrast, patients with abdominal discomfort only could be diagnosed with IBS, but these cases under Rome IV are now classified as unspecified functional bowel disorder (FBD). In a simple comparison of Rome III and Rome IV, it is unclear whether this difference reflects the influence of symptomatic frequency or the presence of abdominal pain. In particular, the influence of abdominal pain restriction on the diagnosis of IBS with predominant constipation (IBS-C) in the Rome IV criteria is largely unknown.

Methods

We reclassified subjects from a Japanese internet survey experiencing abdominal pain or discomfort at least one day each week as surrogate Rome III IBS-C subjects. Among them, we then reclassified subjects experiencing abdominal pain as surrogate Rome IV IBS-C subjects and subjects not experiencing abdominal pain as surrogate Rome IV FBD subjects. Symptoms were quantified and compared between the two groups.

Results

The surrogate Rome IV IBS-C subjects felt a significantly higher degree of anxiety in their daily lives (p?<?0.001) compared with the surrogate Rome IV FBD subjects. The combined female and 20–49?years surrogate Rome IV IBS-C subjects felt a higher degree of anxiety in their daily lives (p?<?0.05) than the respective Rome IV FBD subjects.

Conclusions

These results suggest that female IBS-C patients aged 20–49?years with abdominal pain in Rome IV have more anxiety than those without abdominal pain in Rome III. Changes in the diagnostic criteria from Rome III to Rome IV will better identify candidates for the biopsychosocial approach.

Trial registration

Although this survey was an anonymous internet survey, we obtained informed consent for the study as an online response. The disclosure of this study was approved by the Ethics Committee of Tohoku University Graduate School of Medicine (approval number: 2015–1-405).

     

Biofeedback treatment of gastrointestinal disorders

Biofeedback has had a greater impact on gastroenterology than on any other medical subspeciality. Biofeedback is the treatment of choice for many of the most common types of fecal incontinence, and preliminary studies suggest that it is likely to become a preferred method for treating patients with constipation related to inability to relax the striated pelvic floor muscles during defecation. This dysfunction may account for up to 50% of patients with chronic constipation. Thermal biofeedback forms part of a multicomponent behavioral treatment for irritable bowel syndrome that is reported to be effective, and other promising applications of biofeedback for gastrointestinal disorders are under investigation.Supported by NIMH Research Scientist Award No. KO5 MH00133.     

乳果糖联合美常安治疗成人功能性便秘的临床疗效观察

目的 观察乳果糖联合美常安(枯草杆菌肠球菌二联活菌)治疗成人功能性便秘的疗效及安全性.方法 采用随机分组、平行对照试验.按入选标准选择成人便秘患者64例,随机进入试验组和对照组,每组均为32例.试验组服用乳果糖15 mL bid和美常安500 mg tid;对照组服用乳果糖15 mL bid,疗程2周.观察排便次数、大便性状及便秘伴随症状的变化.结果 试验组48 h首次排便率(78.12％)明显高于对照组(53.33％)(P＜0.05);试验组平均每周排便次数明显高于对照组(P＜0.01);治疗后试验组和对照组大便恢复正常率分别为87.50％和60.00％(P＜0.05),试验组腹胀缓解率(84.00％)及排便困难缓解率(92.59％)均明显高于对照组(56.52％和65.38％)(均为P ＜0.05);试验组总有效率(93.75％)明显高于对照组(73.33％)(P＜0.05);两组均无严重不良反应发生.结论 乳果糖联合美常安治疗成人功能性便秘比单纯应用乳果糖治疗症状改善快、效果好、安全.     

阿泰宁治疗肠易激综合征50例的疗效观察

目的 观察和评价阿泰宁（含酪酸梭菌CGMCC NO.0313-1株）治疗肠易激综合征（IBS）的临床疗效.方法 对符合罗马Ⅱ诊断标准的IBS患者,用阿泰宁胶囊口服,1次3粒,1天2次,疗程14～21 d.治疗期间观察患者的症状变化、服药情况,治疗结束后评价药物的疗效.结果 50例IBS患者治疗后的腹泻或便秘等症状有显著的改善（P＜0.05）.治愈率为62%（31/50）,总有效率为94%（47/50）,治疗中未见不良反应或副作用.结论 阿泰宁是治疗IBS的一种安全有效的微生态药品,不但短期应用效果好,而且慢性腹泻或便秘患者可长期服用.