调节肠道微生态对胃食管反流病与肠易激综合征重叠症患者临床症状及胃肠道功能的影响

Effects of intestinal microecology regulation on clinical symptoms and gastrointestinal function in patients with gastroesophageal reflux disease and irritable bowel syndrome

目的:观察调节肠道微生态用于胃食管反流病(GERD)与肠易激综合征(IBS)重叠症患者对其临床症状及胃肠道功能的影响。方法:收集2016年7月至2017年12月本院收治的GERD与IBS重叠症患者66例,按照治疗方案不同分为研究组(n=37)与对照组(n=29)。两组均进行饮食及生活习惯指导、心理疏导等基础干预,对照组给予泮托拉唑肠溶胶囊及复方谷氨酰胺肠溶胶囊治疗;观察组在对照组治疗的基础上,给予双歧三联活菌胶囊联合地衣芽孢杆菌胶囊口服,均持续治疗8周。比较治疗前后两组肠道菌群、肠道黏膜屏障功能、临床症状积分及胃肠道功能。结果:治疗后两组患者肠道双歧杆菌、乳酸杆菌、粪肠球菌菌群水平均升高、大肠杆菌菌群水平均降低,且研究组升高或降低幅度大于对照组(均P<0.05)。两组患者血清D-乳酸、二胺氧化酶(DAO)、内毒素(ET)水平均显著低于治疗前,且研究组下降幅度大于对照组(均P<0.05)。两组患者胃灼热、反酸、胸骨后痛、腹痛、腹胀、排便紊乱症状积分均显著低于治疗前,且观察组下降幅度大于对照组(均P<0.05)。治疗后两组患者血清胃动素(MOT)、胃泌素(GAS)水平均显著高于治疗前,而血管活性肠肽(VIP)水平低于治疗前,且观察组上升或下降幅度大于对照组(均P<0.05)。结论:调节GERD与IBS重叠症患者肠道微生态,可以改善患者菌群水平,提高肠道黏膜屏障功能,改善胃肠道功能,减轻临床症状。

Objective:To determine the effects of intestinal microecology regulation on the clinical symptoms and gastrointestinal function in patients with gastroesophageal reflux disease(GERD) and irritable bowel syndrome(IBS).Methods:Sixty-six patients with GERD and IBS adimitted to our hospital between July 2016 and December 2017 were included in the study.According to differenct treatment methods,all patients were divided into the study group(n=37) and control group(n=29).The two groups were given basic interventions of diet and lifestyle guidance and psychological counseling.The control group was given Pantoprazole entericcoated capsules and compound Glutamine entresoluble capsules.In addition,the study group was given oral Bifid triple viable capsules and Bacillus licheniformis capsules for continuous 8 weeks.The intestinal flora changes,intestinal mucosal barrier function,clinical symptoms scores and gastrointestinal function before and after the treatment were compared between the two groups.Results:After the treatment,the flora levels of intestinal bifidobacteria,lactobacillus and enterococcus faecalis increased in the two groups,whereas the flora level of escherichia coli decreased.The increase or decrease in study group was greater than that in the control group(all P<0.05).The levels of serum D-lactic acid,D-lactic acid,diamine oxidase(DAO) and endotoxin(ET) in the two groups after the treatment were significantly lower than those before the treatment,and the decrease in study group was greater than that in the control group(all P<0.05).The symptoms scores of heartburn,acid reflux,substernal pain,abdominal pain,abdominal distension and defecation disorder in the two groups after the treatment were significantly lower than those before the treatment,and the decrease in the study group was greater than that in the control group(all P<0.05).The levels of serum motilin(MOT) and gastrin(GAS) in the two groups after the treatment were significantly higher than those before the treatment,whereas the vasoactive intestinal peptide(VIP) level after the treatment was lower than that before the treatment,and the increase or decrease in the study group was greater than that in the control group(all P<0.05).Conclusion:Intestinal microecology regulation in patients with GERD and IBS may improve flora level,promote intestinal mucosal barrier function,improve gastrointestinal function and alleviate clinical symptoms.