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Aspects of the non-pharmacological treatment of irritable bowel syndrome 被引量:6

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摘要 Irritable bowel syndrome(IBS) is one of the most commonly diagnosed gastrointestinal conditions. It represents a significant healthcare burden and remains a clinical challenge. Over the years IBS has been described from a variety of different perspectives; from a strict illness of the gastrointestinal tract(medical model) to a more complex multi-symptomatic disorder of the brain-gut axis(biopsychosocial/psychosomatic model). In this article we present aspects of the pathophysiology and the non-pharmacological treatment of IBS based on current knowledge. Effects of conditioned stress and/or traumatic influences on the emotional system(top-down) as well as effects on the intestine through stressors,infection,inflammation,food and dysbiosis(bottom-up) can affect braingut communication and result in dysregulation of the autonomic nervous system(ANS),playing an important role in the pathophysiology of IBS. Conditioned stress together with dysregulation of the autonomic nervous system and the emotional system may involve reactions in which the distress inside the body is not recognized due to low body awareness. This may explain why patients have difficulty identifying their symptoms despite dysfunction in muscle tension,movement patterns,and posture and biochemical functions in addition to gastrointestinal symptoms. IBS shares many features with other idiopathic conditions,such as fibromyalgia,chronic fatigue syndrome and somatoform disorders. The key to effective treatment is a thorough examination,including a gastroenterological examination to exclude other diseases along with an assessment of body awareness by a body-mind therapist. The literature suggests that early interdisciplinary diagnostic cooperation between gastroenterologists and body-mind therapists is necessary. Re-establishing balance in the ANS is an important component of IBS treatment. This article discusses the current knowledge of body-mind treatment,addressing the topic from a practical point of view. Irritable bowel syndrome(IBS) is one of the most commonly diagnosed gastrointestinal conditions. It represents a significant healthcare burden and remains a clinical challenge. Over the years IBS has been described from a variety of different perspectives; from a strict illness of the gastrointestinal tract(medical model) to a more complex multi-symptomatic disorder of the brain-gut axis(biopsychosocial/psychosomatic model). In this article we present aspects of the pathophysiology and the non-pharmacological treatment of IBS based on current knowledge. Effects of conditioned stress and/or traumatic influences on the emotional system(top-down) as well as effects on the intestine through stressors,infection,inflammation,food and dysbiosis(bottom-up) can affect braingut communication and result in dysregulation of the autonomic nervous system(ANS),playing an important role in the pathophysiology of IBS. Conditioned stress together with dysregulation of the autonomic nervous system and the emotional system may involve reactions in which the distress inside the body is not recognized due to low body awareness. This may explain why patients have difficulty identifying their symptoms despite dysfunction in muscle tension,movement patterns,and posture and biochemical functions in addition to gastrointestinal symptoms. IBS shares many features with other idiopathic conditions,such as fibromyalgia,chronic fatigue syndrome and somatoform disorders. The key to effective treatment is a thorough examination,including a gastroenterological examination to exclude other diseases along with an assessment of body awareness by a body-mind therapist. The literature suggests that early interdisciplinary diagnostic cooperation between gastroenterologists and body-mind therapists is necessary. Re-establishing balance in the ANS is an important component of IBS treatment. This article discusses the current knowledge of body-mind treatment,addressing the topic from a practical point of view.
出处 《World Journal of Gastroenterology》 SCIE CAS 2015年第40期11439-11449,共11页 世界胃肠病学杂志(英文版)
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  • 1Laura-Aline Martínez-Martínez,Tania Mora,Angélica Vargas,Mario Fuentes-Iniestra,Manuel Martínez-Lavín.Sympathetic Nervous System Dysfunction in Fibromyalgia, Chronic Fatigue Syndrome, Irritable Bowel Syndrome, and Interstitial Cystitis: A Review of Case-Control Studies[J]. JCR: Journal of Clinical Rheumatology . 2014 (3)
  • 2Enrique Coss-Adame,Satish S. C. Rao.Brain and Gut Interactions in Irritable Bowel Syndrome: New Paradigms and New Understandings[J]. Current Gastroenterology Reports . 2014 (4)
  • 3Susanna Carolusson.Dynamic Hypnosis, IBS, and the Value of Individualizing Treatment: A Clinical Perspective[J]. International Journal of Clinical and Experimental Hypnosis . 2014 (2)
  • 4Chogle, Ashish,Mintjens, Stijn,Saps, Miguel.Pediatric IBS: An Overview on Pathophysiology, Diagnosis and Treatment[J]. Pediatric Annals . 2014 (4)
  • 5Kristy Phillips,Bradley J. Wright,Stephen Kent.Psychosocial predictors of irritable bowel syndrome diagnosis and symptom severity[J]. Journal of Psychosomatic Research . 2013 (5)
  • 6P. Cheng,W. Shih,M. Alberto,A. P. Presson,A. Licudine,E. A. Mayer,B. D. Naliboff,L. Chang.Autonomic response to a visceral stressor is dysregulated in irritable bowel syndrome and correlates with duration of disease[J]. Neurogastroenterol. Motil. . 2013 (10)
  • 7Guy Boeckxstaens,Enrico S. Corazziari,Fermín Mearin,Jan Tack.IBS and the role of otilonium bromide[J].International Journal of Colorectal Disease.2013(3)
  • 8Michael Camilleri,Carlo Di Lorenzo.Brain-Gut Axis: From Basic Understanding to Treatment of IBS and Related Disorders[J].Journal of Pediatric Gastroenterology and Nutrition.2012(4)
  • 9Nagisa Sugaya,Shuhei Izawa,Kenta Kimura,Namiko Ogawa,Kosuke C. Yamada,Kentaro Shirotsuki,Ikuyo Mikami,Kanako Hirata,Yuichiro Nagano,Shinobu Nomura,Hironori Shimada.Adrenal hormone response and psychophysiological correlates under psychosocial stress in individuals with irritable bowel syndrome[J]. International Journal of Psychophysiology . 2012 (1)
  • 10Perjohan Lindfors,Peter Unge,Henry Nyhlin,Brjánn Ljótsson,Einar S. Bj?rnsson,Hasse Abrahamsson,Magnus Simrén.Long-term effects of hypnotherapy in patients with refractory irritable bowel syndrome[J].Scandinavian Journal of Gastroenterology.2012(4)

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