Functional findings in irritable bowel syndrome

Frequently Asked QuestionsWhat is IBS?IBS is a group of symptoms. It is a long-term disorder of gastrointestinal (GI) functioning. It usually involves the large and small bowel/intestine (also called the gut). Learn MoreWhat are the symptoms of IBS?Common IBS symptoms are abdominal pain or discomfort, altered bowel habits (diarrhea and/or constipation), and bloating or a sense of gaseousness. Abdominal pain or discomfort is the key symptom of IBS. It may feel better with a bowel movement. The pain occurs when stool frequency or consistency changes. Symptoms can come and go, and even change, over time. Learn MoreHow is IBS diagnosed?A doctor will diagnosis IBS by asking about your past history and doing a physical examination. In IBS, certain typical symptoms occur. The diagnosis is based on symptoms and in the absence of signs not typical of IBS.The symptom-based Rome diagnostic criteria for IBS emphasize a “positive diagnosis” rather th an exhaustive tests to exclude other diseases. Learn MoreAre there tests to confirm irritable bowel syndrome?There are no tests that confirm the diagnosis of IBS. Laboratory tests, x-rays, and procedures such as colonoscopy are used to rule out other diseases of the bowel. Research is ongoing to find biological markers for IBS. Learn MoreI have been diagnosed with irritable bowel syndrome (IBS), buttests found nothing wrong. Do I need more tests?In IBS, tests are expected to find nothing. In the absence of physical findings, the symptom-based Rome diagnostic criteria have been shown tobe reliable. In addition, a physical exam and limited diagnostic tests help confirm this diagnosis with a high level of confidence. Extensive testing may be reserved for specific situations.What is the Rome Criteria?The Rome Criteria is a classification system that uses specific symptom patterns to identify functional GI disorders, such as IBS. Learn MoreHow common is IBS?Irritable bowel syndrome (IBS) is the most common functional GIdisorder. Worldwide prevalence rates range from 9–23%.What is a “functional” bowel disorder?A functional bowel disorder occurs when there is a problem with the way the bowels work, not their structure. The body's normal activities are impaired involving:• movement of the intestines,• sensitivity of the nerv es of the intestines, or• the way in which the brain controls some of these functions.What does “irritable” mean?Irritable means that the nerve endings in the bowel wall are unusually sensitive.What causes IBS?The cause of IBS is not yet completely understood. In IBS there is an altered pattern of muscle contraction in the colon. There is increased sensitivity within the GI tract. Normal regulation of the communication between the brain and the gut becomes altered. This leads to changes in normal bowel function.Does lactose intolerance cause IBS?Lactose (milk sugar) intolerance can cause similar symptoms to IBS. Lactose intolerance and IBS can occur at the same time in a person. But they are separate conditions which are treated differently. Learn MoreIs IBS a “serious illness”?For many people, IBS causes symptoms that are mild, which do not interfere with daily activities. For others, IBS may severely compromise their quality of life.Is IBS a risk factor for other serious disease?There are no long-term organic complications associated with IBS. People with IBS have no greater need of preventive checkups than other people. Will my IBS symptoms resolve?Each year, approximately 10% of IBS patients get better. This suggests that most people with IBS will eventually get better. But this is not true for every person.Can the menstrual cycle affect irritable bowel symptoms?Gut function does appear to be influenced by changes in the level of female hormones. Symptoms like looser stools and cramping can become worse at certain times of the cycle, particularly at the time of menses. It is reported as more intense in women with IBS, than in healthy women without IBS. Sometimes it's hard to tell whether it's coming from the pelvic organs or from the GI tract. Learn MoreWhat is the relationship of stress to IBS?Stress does not cause IBS. It can influence symptoms. Stress is the body’s normal response to stimuli, or stressors. It has been shown to increase motility and sensation of the colon to a greater degree in IBS patients compared to healthy individuals without IBS.Stress may modify signals between the brain and the intestinal tract. Factors that might normally affect the bowel might then affect it more. The stress factors could be physical, dietary, psychologic, or environmental. A personwith IBS might eat a regular meal and experience a bowel problem. For them, it's an overreaction of the bowel to the stressors. Learn More Doesn’t everyone experience stress in their life?Yes, and stressful events can cause a brief change in bowel habits and even abdominal pain for most people. However, this response in people with IBS is more pronounced on a recurrent or chronic basis.Does diet cause IBS?Diet does not cause IBS. Nevertheless, dietary factors may worsen symptoms in some persons. In IBS the bowel may over-react to stimuli. Even the act of eating, and not a particular food, may aggravate symptomsat times. Learn MoreDo certain foods affect symptoms?This varies from person to person. Certain foods are known to stimulate the gut in general, and in those with IBS eating too much of these might worsen symptoms. Maintaining a food and symptom diary for a minimum of one to two weeks can help identify triggering foods. Learn MoreMy doctor prescribed an antidepressant to treat my IBS. Does that mean I have a psychological disorder?In IBS low-dose antidepressants are useful, not to treat depression, but to reduce pain and also overall symptoms. Doses are much lower than what is used to treat depression. Learn MoreIs IBS a Disability?Depending on the circumstances it is up to each employer, insurer, or governing authority to determine individual disability.The U.S. Social Security Administration (SSA) defines disability as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. (SSA Pub. No. 64-039, May 2002) However, the SSA does not recognize irritable bowel syndrome on its Listing of Impairments -- Adults, Section 5, Digestive System.On August 15, 2011, the Department of Veterans Affairs (VA) implemented a “presumptive service connection” when assessing disability benefits in soldiers affected by functional GI disorders (such as IBS) who served in Southwest Asia during the Persian Gulf War.The Veterans Affairs Dept first recognized IBS in the Veterans Education and Benefits Expansion Act of 2001, Public Law 107-103 signed by President Bush on December 27, 2001. Section 202 -- Payment of Compensation for Persian Gulf War Veterans with Certain Chronic Disabilities -- includes this provision: (2) For purposes of this subsection, the term "qualifying chronic disability" means a chronic disability resulting from any of the following (or any combination of any of the following): (B) A medically unexplained chronic multi-symptom illness (such as chronic fatigue syndrome,fibromyalgia, and irritable bowel syndrome) that is defined by a cluster ofsigns or symptoms. The law authorizes funding to expand and increase educational, housing, burial and disability benefits for chronic multi-symptom illnesses to the list of service-connected conditions for Gulf War veterans.。

普芦卡必利和伊托必利分别联合生物反馈治疗r老年功能性便秘的疗效比较张莉;顾清;张璐【摘要】目的:比较普芦卡必利和伊托必利分别联合生物反馈治疗老年功能性便秘的疗效和安全性.方法:选择68例功能性便秘患者,随机均分为治疗组和对照组.治疗组34例,予普芦卡必利2mg/次,1次/d;对照组34例,予盐酸伊托必利50mg/次,3次/d.两组均联合生物反馈,2次/周,疗程4周.比较两组治疗前后疗效、便秘症状评分和不良反应.结果:两组患者的治疗有效率比较,差异均有统计学意义(P<0.05).治疗后两组的各项便秘症状均较治疗前明显改善,且治疗组疗效优于对照组,差异均具有统计学意义(P<0.05).结论:普芦卡必利联合生物反馈为治疗功能性便秘安全、有效的药物.【期刊名称】《医学理论与实践》【年(卷),期】2018(031)014【总页数】3页(P2070-2072)【关键词】普芦卡必利;伊托必利;生物反馈;功能性便秘【作者】张莉;顾清;张璐【作者单位】四川省医学科学院·四川省人民医院老年消化科,四川省成都市610072;四川省医学科学院·四川省人民医院老年消化科,四川省成都市 610072;四川省医学科学院·四川省人民医院老年消化科,四川省成都市 610072【正文语种】中文【中图分类】R574.62近年来，由于人们生活方式、饮食习惯及工作压力等多因素的影响慢性便秘的发病率呈逐年上升趋势[1]，相关数据显示，成年人中便秘的患病率为16%，而老年人中患病率竟高达33.5%[2]。

研究还发现[3]，年龄与功能性便秘的发病率呈正相关。

长期便秘由于其迁延反复难治的特点，不仅增加肛门直肠疾病、结肠肿瘤及心脑血管疾病的患病风险，还常伴随情绪失常及加重患者的经济负担，严重影响患者的身心健康[4]。

而对于功能性便秘，其病因复杂、常规治疗效果差、易依赖泻药且缺乏满意的治疗方案。

生物反馈疗法(Biofeedback therapy)为一种新兴生物行为疗法，目前已广泛应用于功能性便秘的临床治疗，具有无创、无痛、操作简单等优点[5]。

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小肠平滑肌功能紊乱机制研究进展陈杰【摘要】The research of pediatric gastrointestinal motility disorders is still in the early stage. It is found that the altered homeostasis of muscarinic receptors, the activity changes of l-type Ca2+ channels, and the network and quantity of interstitial cells of Cajal in intestinal smooth muscle played important roles on pathogenesis of intestinal smooth muscle dysfunction. This review focuses on the effects of muscarinic receptor, L-type Ca2+ channels and interstitial cells of Cajal on intestinal smooth muscle dysfunction.%胃肠动力紊乱性疾病的观察和研究在儿科仍属初级阶段,小肠平滑肌毒蕈碱样胆碱能受体平衡的变化、L型钙离子通道活力改变及Cajal间质细胞网络和数量的改变在小肠平滑肌功能紊乱发病机制中有着重要的意义.该文重点阐述毒蕈碱样胆碱能受体、L型钙离子通道及Cajal间质细胞三大因素在导致小肠动力紊乱中的作用机制.【期刊名称】《临床儿科杂志》【年(卷),期】2012(030)002【总页数】3页(P195-197)【关键词】毒蕈碱样胆碱能受体;L型钙离子通道;Cajal间质细胞【作者】陈杰【作者单位】南通大学附属医院小儿外科,江苏南通,226001;上海交通大学医学院附属新华医院小儿外科,上海,200092【正文语种】中文【中图分类】R725胃肠动力紊乱性疾病（disorders of gastrointestinal motility，DGIM）的诊断以运动检测指标为基础，其运动障碍可以是胃肠本身的功能异常，也可能是其他系统疾病的结果。

治疗腹泻型肠易激综合征新药——艾沙度林夏玲红;孙黎;金冠钦【摘要】肠易激综合征(IBS)是一种常见的胃肠疾病,艾沙度林是一种混合的μ受体激动药、δ受体拮抗药、κ受体激动药,用于腹泻型肠易激综合征(IBS-D)的缓解治疗.研究显示艾沙度林能明显改善IBS-D患者的临床症状,耐受性良好,不良反应较少.该文对艾沙度林作用机制、药动学、临床研究以及安全性等进行综述.【期刊名称】《医药导报》【年(卷),期】2017(036)0z1【总页数】2页(P66-67)【关键词】艾沙度林;肠易激综合征,腹泻型;阿片受体【作者】夏玲红;孙黎;金冠钦【作者单位】上海交通大学医学院附属仁济医院药剂科,上海 200001;上海交通大学医学院附属仁济医院药剂科,上海 200001;上海交通大学医学院附属仁济医院药剂科,上海 200001【正文语种】中文【中图分类】R975;R574DOI 10.3870/j.issn.1004-0781.2017.z1.032肠易激综合征(irritable bowel syndrome，IBS)是一种常见的功能性胃肠疾病，全球发病率>10%[1]。

其主要表现为腹部疼痛或不适，伴有多次排便或粪便异样，排便后症状好转，而无形态学和生态异常变化。

使用布里斯托尔粪便量表(BristolStool Form Scale，BSFS)，IBS患者可分为腹泻型、便秘型、腹泻便秘交替型和不确定型[2]。

其中以腹泻型IBS(IBS-D)最为常见，约占40%。

美国食品药品管理局(FDA)于2015年5月批准艾沙度林(eluxadoline)用于腹泻型IBS的缓解治疗，推荐剂量为100 mg，每天2次，与食物同服。

艾沙度林具有混合的阿片受体活性——μ受体激动药、δ受体拮抗药及κ受体激动药[3]。

阿片受体在体内广泛分布，一般可分为4种亚型，包括μ受体κ受体、δ受体及阿片样受体-1[4]。

艾沙度林具有混合的阿片受体活性，激动μ受体，可以缓解腹泻型IBS患者肠道疼痛症状，同时减慢胃肠蠕动，从而改善腹泻。

肠易激综合征与功能性消化不良患者症状重叠分析作者：陈仙梅于晓兵董琳高瑞萍曹贞子来源：《医学信息》2018年第17期摘要：目的分析回族与汉族、银川市区与海原农村地区的肠易激综合征与功能性消化不良症状重叠情况。

方法选取我院2016年1月～12月按照罗马Ⅲ的标准诊断肠易激综合征和功能性消化不良的患者175例，其中海原县农村地区患者76例，银川市区患者99例，统计并比较城乡、回汉族、男女IBS-FD重叠情况。

结果农村地区IBS-FD占总FD 8.51%，占IBS 12.12%，市区IBS-FD占总FD 37.04%，占总IBS 30.77%，农村地区IBS-FD重叠率低于市区（P0.05）。

结论农村与市区环境因素可能影响IBS-FD重叠率，且女性患者可能更易发生症状重叠。

关键词：肠易激综合征；功能性消化不良；IBS-FD；症状重叠中图分类号：R57；R574 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.17.022文章编号：1006-1959（2018）17-0075-03Abstract：Objective To analyze the symptoms of irritable bowel syndrome and functional dyspepsia in Hui and Han，Yinchuan and Haiyuan rural areas.Methods From January to December 2016，our hospital diagnosed 175 patients with irritable bowel syndrome and functional dyspepsia according to the criteria of Rome III，including 76 patients in rural areas of Haiyuan County and 99 patients in Yinchuan urban pare the overlap of IBS-FD between urban and rural areas，Hui Han people and men and women.Results In rural areas，IBS-FD accounted for 8.51% of total FD，accounting for 12.12% of IBS，urban IBS-FD accounted for 37.04% of total FD， accounting for 30.77% of total IBS，and the overlap rate of IBS-FD in rural areas was lower than that of urban areas （P0.05）.Conclusion Rural and urban environmental factors may affect the IBS-FD overlap rate，and female patients may be more susceptible to symptom overlap.Key words：Irritable bowel syndrome；Functional dyspepsia；IBS-FD；Overlapping symptoms功能性胃肠病（functional gastrointestinal disorders，FGIDs）是一组表现为慢性、反复发作的，而无器质性病变或生化指标无异常的胃肠道综合征。

·论著·利那洛肽联合普芦卡必利对便秘型肠易激综合征大鼠脑肠肽和胃肠激素分泌的影响王影刘畅张婉谷云孙丹崔文丽任晓华【摘要】目的研究利那洛肽（linaclotide）联合普芦卡必利（prucalopride）对便秘型肠易激综合征（IBS-C）大鼠脑肠肽和胃肠激素分泌的影响。

方法选取50只 SPF级SD大鼠，随机选取其中10只大鼠设为正常对照组（Con组）；其余40只大鼠采用冰水灌胃法建立IBS-C模型后，将其随机分为IBS-C组、利那洛肽组（Lina组）、普芦卡必利组（Pruca组）和利那洛肽联合普芦卡必利组（Lina＋Pruca组），每组10只大鼠；各组给药干预。

记录各组的24 h粪便粒数并测定24 h粪便含水量，采用腹部回缩反射（AWR）评分测定各组的内脏敏感度，活性炭混悬液灌胃法测定各组的小肠推进率，H-E染色法观察各组肠黏膜组织病理形态学变化，蛋白质印迹法检测各组结肠组织中相关蛋白的表达水平。

结果与Con组比较，IBS-C组的24 h粪便粒数及含水量均显著减少，20、40、60、80 mmHg压力下的AWR评分均显著增高，小肠推进率显著降低（P均＜0.05）；IBS-C组的结肠黏膜腺体排列较整齐，肌层有断裂，黏膜层可见少量炎症细胞浸润；IBS-C组的结肠组织中5-羟色胺（5-HT）、血管活性肠肽（VIP）、生长抑素（SS）蛋白的表达水平均显著升高，P物质（SP）、胃动素（MOT）蛋白的表达水平均显著降低（P均＜0.05）。

与IBS-C组比较，Lina组、Pruca组和Lina＋Pruca组的24 h粪便粒数及含水量均显著增多（P均＜0.05）；Lina组、Pruca组和Lina＋Pruca组的20、40、60、80 mmHg压力下的AWR评分均显著降低，小肠推进率均显著升高（P均＜0.05）；Lina组、Pruca组和Lina＋Pruca组的肠黏膜组织形态学均有缓解；Lina组、Pruca组和Lina＋Pruca组的结肠组织中5-HT、VIP、SS蛋白的表达水平均显著降低，SP、MOT蛋白的表达水平均显著升高（P均＜0.05）；Lina＋Pruca组的上述指标改善均较Lina组和Pruca组显著（P均＜0.05）。

International Foundation for Functional Gastrointestinal DisordersIFFGD700 W. Virginia St., #201 Milwaukee, WI 53204Phone: 414-964-1799Toll-Free (In the U.S.): 888-964-2001Fax: 414-964-7176 Internet: IBS (195)© Copyright 2005-2012 by the International Foundation for Functional Gastrointestinal DisordersReviewed and Updated by Author, 2009Is it IBS or Something Else?By: George F. Longstreth, M.D., Chief of Gastroenterology, Kaiser Permanente Medical Care Plan, San Diego, C.A.Physicians can usually identify irritable bowel syndrome (IBS) from patients’ symptoms. Many patients additionally require only routine blood tests and a colon evaluation, and some require no tests at all to secure the diagnosis. However, some patients worry that they could have another cause for their symptoms, especially when symptoms are severe and chronic, or they know other people who they think had similar symptoms but a different disorder. Occasionally, another medical problem mimics IBS symptoms. This discussion focuses on how IBS is diagnosed and distinguished from other disorders.Typical patterns of abdominal discomfort or pain, bowel habit disturbance, and bloating point strongly to IBS. Physicians often rely on the “Manning” or “Rome” symptoms (Table 1), which include abdominal pain or discomfort that is associated with abnormal frequency or appearance of stools and is relieved by evacuation. A patient’s age, past history, family history, and particular symptoms help physicians individualize testing.“Alarm signs” are symptoms or laboratory findings that are not explainable by IBS (examples include unexplained weight loss, rectal bleeding, fever, and anemia). However, the presence of these signs often does not indicate an alarming problem. For example, rectal bleeding is much more often a sign ofhemorrhoids than cancer. These “alarm signs” and atypical symptoms guide physicians to search for certain diseases.Colorectal cancer – With so much public attention to the worthwhile goal of detecting colorectal cancer early, it is understandable that some patients worry about it. This cancer rarely causes IBS-like symptoms, but most people should begin periodic screening when they are about 50; a family history of colorectal polyps or cancer might lead to earlier screening. Conventional procedures include testing stool specimens for blood, barium enema x-ray examination, and endoscopy(flexible sigmoidoscopy or colonoscopy). Computerized colon tomography (virtual colonoscopy) and stool DNA testing are new and undergoing evaluation. The selected test depends on whether the patient has an average or higher risk for getting cancer (usually assessed from the family history) and the availability, risk, benefits, and cost of the tests.Gallstones – Gallbladder stones increase with age and develop in up to 30% of women and 15% of men. When gallstone pain occurs, it is usually severe, located in the upper abdomen, lasts one to several hours, and occurs every few weeks to months. Serious complications can occur, including inflammation of the gallbladder (cholecystitis) or pancreas (pancreatitis), orobstruction of bile flow from the liver. However, most people with gallstones never have symptoms from them. Daily pain is unusual, and it is unrelated in time to abnormal bowel habit and unrelieved by evacuation, as characterize IBS. If the pain of IBS is mistakenly attributed to gallstones, gallbladder removal (cholecystectomy) does not relieve the pain. Gastroenterology consultation can help determine the source of pain when patients have both gallstones and IBS.Inflammatory bowel disease – Chronic inflammation (swelling, increased white blood cells, and ulcers) of the small or large bowel can cause diarrhea (often with bleeding), pain, weight loss, anemia, and other problems. The two main types of inflammatory bowel disease – chronic ulcerative colitis and Crohn’s disease – are usually diagnosed with barium x-ray exams, computerized tomography (CT), and endoscopy with biopsy. These procedures reveal no abnormality responsible for IBS symptoms.Celiac disease – In the past, this disease (also called celiacsprue) was regarded as an uncommon small bowel disorder, and it was mainly suspected in patients of Northern European ancestry with chronic diarrhea, weight loss, and nutritional deficiency. According to recent studies, celiac disease is more common than previously thought. It can have variousmanifestations, such as iron deficiency anemia or bone thinning (osteoporosis) with little or no diarrhea, and it responds to restricting the protein gluten from the diet. Patients with dermatitis herpetiformis (an unusual skin disorder), type I diabetes, and thyroid disease have it more often than people without these problems. Some studies identify celiac disease in occasional referral patients with IBS. A special blood test has high diagnostic accuracy, and physicians sometimes obtain it, especially if patients have weight loss, anemia, or other “alarm signs.” However, the proportion of patients with IBS who have celiac disease and would be helped by gluten restriction is uncertain.Gynecological disorders – Women are especially likely to seek care for IBS. Their pain is usually in the lower abdomen and sometimes increased during menstrual periods, so a gynecological origin of the pain is sometimes suspected.Gynecologists often refer to this pain as “chronic pelvic pain” and perform ultrasound exams or diagnostic laparoscopy (endoscopy through a small abdominal incision) to check for disease of the uterus or ovaries. For example, endometriosis can cause chronic pain in the same body area as IBS pain. As applies to gallstone pain, however, this pain usually does not have the typical IBS-type association with evacuation. Women with IBS have more menstrual symptoms than other women and are more likely to undergo hysterectomy, which eliminates abnormal bleeding and can help gynecological pain. However, this operation does not alleviate IBS pain. Ovarian cancer can。

腹泻型肠易激综合征相关的菌-肠-脑轴机制研究进展摘要：腹泻型肠易激综合征(IBS-D) 是临床上常见的功能性肠病之一，病因和发病机制多样，目前尚未有明确的定论。

有相关研究证明肠道菌群失调是IBS-D 的重要发病原因之一，最新罗马Ⅳ标准指出脑-肠互动障碍可能贯穿肠易激综合征( IBS) 发病的始终。

肠道微生态失衡被认为是导致脑-肠互动障碍的重要始动因素，参与构成菌群-肠-脑轴，成为新兴研究热点。

本文以菌-脑-肠轴机制为出发点，探讨总结其与 IBS-D 的联系及研究进展，为进一步探究 IBS-D 的发病机制提供更有价值的参考依据。

关键词：腹泻型肠易激综合征；肠道菌群；菌-肠-脑轴；研究进展中图分类号：R 文献标识码：AProgress In the Research of the Microbiota-Gut-Brain Axis About Diarrhea TypeIrritable Bowel SyndromeDeng Tianlin1, Yang Linlin1,Feng Peimin2△(1. Chengdu University of Traditional Chinese Medicine, Chengdu Sichuan, 610075, China)(2. Department of gastroenterology, Affiliated Hospital of ChengduUniversity of Traditional Chinese Medicine, Chengdu Sichuan, 610072, China) Abstract: Diarrhea-predominant irritable bowel syndrome（IBS-D）is one of the common functional gastrointestinal diseases in clinical practice. Its aetiology and pathogenesis is perse. There is no clear conclusion. Studies have shown that intestinal dysbacteriosis is an important cause of IBS-D. The latest Rome IV criteria states that abnormal brain-gut interaction may persist throughout the onset of irritable bowel syndrome (IBS)．Intestinal dysbiosis is considered to be an important initiating factor leading to disorder of brain-gut interaction, constituting the microbiota-gut-brain axis, which has become a new research hotspot. This paper takes the mechanism of microbiota-gut-brain axis as the starting point, discusses its relationship with IBS-D and its research progress, and provides a more valuable reference for further exploring thepathogenesis of IBS-D.Keywords: Diarrhea Type Irritable Bowel Syndrome；Intestinal Microbiota；Microbiota-Gut-Brain Axis；Research Progress前言肠易激综合征（irritable bowel syndrome,IBS）是一组表现为反复发作的腹痛症状并伴有排便习惯和粪便性状改变的功能性肠道疾病，然而临床上尚无可观察的形态学及生化学的改变。