Observation on the clinical effect of abdominal massage combined with fomentation in the treatment of constipation-predominant irritable bowel syndrome

Objective:To investigate the clinical effect of abdominal massage combined with fomentation of traditional Chinese medicine in the treatment of constipation-predominantirritable bowel syndrome.Methods:A total of 90 patients with irritable bowel syndrome were selected and randomly divided into a control group and an observation group,with 45 cases in each group.The control group received abdominal massage therapy,and the observation group received abdominal massage combined with traditional Chinese medicine fomentation.The clinical efficacy of the two groups of patients on constipation-predominantirritable bowel syndrome was compared.Results:The total effective rate of the observation group in the treatment of constipation-predominantirritable bowel syndrome was 95.6%(43/45),which was higher than the control group by 80%(36/45),and the difference was statistically significant(P<0.05).Conclusion:Abdominal massage combined with fomentation of traditional Chinese medicine is effective in treating constipation-predominantirritable bowel syndrome.Its environmental protection,green,non-invasive treatment advantages are convenient for clinical promotion and application.

Irritable bowel syndrome:A clinical review

Irritable bowel syndrome (IBS) remains a clinical challenge in the 21st century. It’s the most commonly diagnosed gastrointestinal condition and also the most common reason for referral to gastroenterology clinics. Its can affect up to one in five people at some point in their lives, and has a significantly impact of life quality and health care utilization. The prevalence varies according to country and criteria used to define IBS. Various mechanisms and theories have been proposed about its etiology, but the biopsychosocial model is the most currently accepted for IBS. The complex of symptoms would be the result of the interaction between psychological, behavioral, psychosocial and environmental factors. The diagnosis of IBS is not confirmed by a specific test or structural abnormality. It is made using criteria based on clinical symptoms such as Rome criteria, unless the symptoms are thought to be atypical. Today the Rome Criteria III is the current gold-standard for the diagnoses of IBS. Secure positive evidence of IBS by means of specific disease marker is currently not possible and cannot be currently recommended for routine diagnosis. There is still no clinical evidence to recommend the use of biomarkers in blood to diagnose IBS. However, a number of different changes in IBS patients were demonstrated in recent years, some of which can be used in the future as a diagnostic support. IBS has no definitive treatment but could be controlled by non-pharmacologic management eliminating of some exacerbating factors such certain drugs, stressor conditions and changes in dietary habits.The traditional pharmacologic management of IBS has been symptom based and several drugs have been used. However, the cornerstone of its therapy is a solid patient physician relationship. This review will provide a summary of pathophysiology, diagnostic criteria and current and emerging therapies for IBS.

Systematic review: The placebo effect of psychological interventions in the treatment of irritable bowel syndrome

AIM To determine the placebo response rate associated with different types of placebo interventions used in psychological intervention studies for irritable bowel syndrome. METHODS Randomized controlled trials comparing psychological interventions(stress management/relaxation therapy(cognitive) behavioral therapy, short-term psychodynamic therapy, and hypnotherapy) for the treatment of adult patients with irritable bowel syndrome(IBS) diagnosed with the Manning or Rome criteria with an adequate placebo control treatment and reporting data on IBS symptom severity were identified by searching Pub Med, Embase, the Cochrane Library, CINAHL and Psyc INFO databases. Full-text articles that were written in English and published between 1966 and February 2016 in peer-reviewed journals were selected for the present review. Placebo interventions were considered to be adequate if the number of sessions and the amount of time spent with the therapist were the same as in the active treatment. The placebo response rate(PRR) was computed for IBS symptom severity(primary outcome measure) as well as for anxiety, depression and quality of life(secondary outcome measures). RESULTS Six studies, with a total of 555 patients met the inclusion criteria. Four studies used an educational intervention, whereas two studies used a form of supportive therapy as the placebo intervention. The PRR for IBS symptom severity ranged from 25% to 59%, with a pooled mean of 41.4%. The relative PRR for the secondary outcome measures ranged from 0% to 267% for anxiety, 6% to 52% for depression 20% to 125% for quality of life. The PRR associated with pharmacological treatments, treatment with dietary bran and complementary medicine ranged from 37.5% to 47%. Contrary to our expectations, the PRR in studies on psychological interventions was comparable to that in studies on pharmacological, dietary and alternative medical interventions.CONCLUSION The PRR is probably determined to a larger extent by patient-related factors, such as expectations and desire for the treatment to be effective, than the content of the placebo intervention.

Clinical trial:Lactobacillus plantarum 299v(DSM 9843)improves symptoms of irritable bowel syndrome

AIM:To assess the symptomatic efficacy of Lactobacillus plantarum 299v(L.plantarum 299v)(DSM 9843) for the relief of abdominal symptoms in a large subset of irritable bowel syndrome(IBS) patients fulfilling the Rome Ⅲ criteria.METHODS:In this double blind,placebo-controlled,parallel-designed study,subjects were randomized to daily receive either one capsule of L.plantarum 299v(DSM 9843) or placebo for 4 wk.Frequency and intensity of abdominal pain,bloating and feeling of incomplete rectal emptying were assessed weekly on a visual analogue scale while stool frequency was calculated.RESULTS:Two hundred and fourteen IBS patients were recruited.After 4 wk,both pain severity(0.68 + 0.53 vs 0.92 + 0.57,P < 0.05) and daily frequency(1.01 + 0.77 vs 1.71 + 0.93,P < 0.05) were lower with L.plantarum 299v(DSM 9843) than with placebo.Similar results were obtained for bloating.At week 4,78.1 % of the patients scored the L.plantarum 299v(DSM 9843) symptomatic effect as excellent or good vs only 8.1 % for placebo(P < 0.01).CONCLUSION:A 4-wk treatment with L.plantarum 299v(DSM 9843) provided effective symptom relief,particularly of abdominal pain and bloating,in IBS patients fulfilling the Rome Ⅲ criteria.

Xi-Feng-Hua-Shi granules for diarrhea-predominant irritable bowel syndrome:protocol for a randomized,double-blind,placebo-controlled multi-center clinical trial

Background:Irritable bowel syndrome(IBS)is a common functional bowel disorder that can severely affect the quality of life of patients.Limited drugs have been reported for modern medical IBS treatment.The advantages of traditional Chinese medicine(TCM)treatment are gradually becoming prominent.Xi-Feng-Hua-Shi granules have been clinically used for diarrhea-predominant IBS(IBS-D)treatment for many years in TCM practice.Thus,this study aimed to further verify the effectiveness and safety of Xi-Feng-Hua-Shi(XFHS)granules in IBS-D treatment through a randomized,double-blind,placebo-controlled multi-center clinical trial and provide high-quality evidence for its effectiveness and safety in treatment,as well as provide a basis for clinical rational drug use and explore new clinical IBS-D treatment plans.Methods:A randomized,double-blind,placebo-controlled multi-center clinical trial will be performed in 23 hospitals.A total of 300 participants will be randomly divided into the experimental group(prescribed with XFHS granules)and the control group(prescribed with the placebo granules),with 150 participants in each group.The appearance,shape,color,and taste of the placebo granules are the same as those of XFHS granules.All participants will receive a 4-week treatment and a 6-month follow-up.The primary outcome is the overall clinical efficacy;the secondary outcomes are the IBS-Symptom Severity Score(IBS-SSS),TCM Syndrome Evaluation,and the IBS-Quality of Life(IBS-QoL)score,mental state assessment,and recurrence rate.Outcome measures(including primary and secondary outcome measures)are collected at baseline,as well as 2,4,16,and 28 weeks post-intervention.Discussion:This randomized,placebo-controlled,multi-center trial may provide high-quality evidence for the clinical XFHS granule efficacy in IBS-D treatment.Additionally,this study will conduct safety evaluations to provide a basis for clinical rational drug use.

A systematic review of effi cacy and tolerability of mebeverine in irritable bowel syndrome

We evaluated the eff icacy and tolerability of mebeverine, a musculotropic antispasmodic agent, in irritable bowel syndrome (IBS) and compared its usual dosages by meta-analysis. Medical databases and all relevant literature were searched from 1965 to June 2009 for any placebo-controlled clinical trials of mebeverine, using search terms such as mebeverine, clinical trials, and IBS. Eight randomized trials met our criteria, including six trials that compared mebeverine with placebo and two that compared mebeverine tablets with capsules. These eight trials included 555 patients randomized to receive either mebeverine or placebo with 352 (63%)women and 203 (37%) men in all subtypes of IBS. The pooled relative risk (RR) for clinical improvement of mebeverine was 1.13 (95% CI: 0.59-2.16, P = 0.7056) and 1.33 (95% CI: 0.92-1.93, P = 0.129) for relief of abdominal pain. The efficacy of mebeverine 200 mg compared to mebeverine 135 mg indicated RRs of 1.12 (95% CI: 0.96-1.3, P = 0.168) for clinical or global improvement and 1.08 (95% CI: 0.87-1.34, P = 0.463) for relief of abdominal pain. Thus, mebeverine is mostly well tolerated with no signif icant adverse effects; however, its eff icacy in global improvement of IBS is not statistically signif icant.

Effi cacy of tricyclic antidepressants in irritable bowel syndrome:A meta-analysis

We aimed to evaluate the efficacy of tricyclic antidepressants(TCAs) as a therapeutic option for irritable bowel syndrome(IBS) through meta-analysis of randomized controlled trials.For the years 1966 until September 2008,PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials were searched for double-blind,placebo-controlled trials investigating the effi cacy of TCAs in the management of IBS.Seven randomized,placebo-controlled clinical trials met our criteria and were included in the metaanalysis.TCAs used in the treatment arm of these trials included amitriptyline,imipramine,desipramine,doxepin and trimipramine.The pooled relative risk for clinical improvement with TCA therapy was 1.93(95% CI:1.44 to 2.6,P<0.0001).Effect size of TCAs versus placebo for mean change in abdominal pain score among the two studies was -44.15(95% CI:-53.27 to -35.04,P<0.0001).It is concluded that low dose TCAs exhibit clinically and statistically signifi cant control of IBS symptoms.

Factorial study of moxibustion in treatment of diarrhea-predominant irritable bowel syndrome

AIM: To identify an appropriate therapeutic regimen for using aconite cake-separated moxibustion to treat diarrhea-predominant irritable bowel syndrome (D-IBS).

Influence of irritable bowel syndrome on treatment outcome in gastroesophageal reflux disease

AIM: To investigate the influence of irritable bowel syndrome (IBS)-like symptoms on treatment outcomes with pantoprazole in gastroesophageal reflux disease (GERD) in a real life setting. METHODS: For this prospective, open-label, multinational, multicentre study, 1888 patients assessed by the investigators as suffering from GERD were recruited. The patients were additionally classified as with or without IBS-like symptoms at baseline. They were treated with pantoprazole 40 mg once daily and completed the Reflux Questionnaire (ReQuest) short version daily. Response rates and symptom scores were compared after 4 and 8 wk of treatment for subgroups defined by the subclasses of GERD [erosive(ERD) and non-erosive reflux disease (NERD)] and the presence of IBS-like symptoms. RESULTS: IBS-like symptoms were more prevalent in NERD than in ERD (18.3% vs 12.7%, P = 0.0015). Response rates after 4 and/or 8 wk of treatment were lower in patients with IBS-like symptoms than in patients without IBS-like symptoms in both ERD (Week 4: P < 0.0001, Week 8: P < 0.0339) and NERD (Week 8: P = 0.0088). At baseline, ReQuest "lower abdominal com- plaints" symptom scores were highest in NERD patients with IBS-like symptoms. Additionally, these patients had the strongest symptom improvement after treatment compared with all other subgroups. CONCLUSION: IBS-like symptoms influence treatment outcome and symptom burden in GERD and should be considered in management. Proton pump inhibitors can improve IBS-like symptoms, particularly in NERD.

Efficacy and safety of non-pharmacological interventions for irritable bowel syndrome in adults

BACKGROUND Although nonpharmacological interventions(NPI) for irritable bowel syndrome(IBS) have been applied clinically, their relative efficacy and safety are poorly understood.AIM To compare and rank different NPI in the treatment of IBS.METHODS Five electronic databases were searched from their inception to January 12, 2020. Data of included publications were analyzed using network meta-analysis(NMA). Quality of endpoints were assessed by tools of the Cochrane Handbook and the GRADEpro software. Pooled relative risk or standardized mean difference with their corresponding 95% confidence intervals were used for statistical analysis. Surface under the cumulative ranking curve(SUCRA) probability value was conducted to rank the examined interventions. Sensitivity analysis was performed to verify the robustness of results and test the source of heterogeneity.RESULTS Forty randomized controlled trials with 4196 participants were included in this NMA. Compared with routine pharmacotherapies and placebo, acupuncture and cognitive behavioral therapy(CBT) had better efficacy in relieving IBS symptoms. Based on the SUCRA values, acupuncture ranked first in improving overall clinical efficacy and avoiding adverse effects. CBT ranked first in lowering the scores of IBS symptom severity scale, self-rating anxiety scale and self-rating depression scale.CONCLUSION This study confirmed the efficacy and safety of NPI for improving IBS symptoms, which to some extent recommended several interventions for clinical practice.

Efficacy and dose response of Lactiplantibacillus plantarum in diarrhea-predominant irritable bowel syndrome

BACKGROUND Probiotics have shown promise in alleviating symptoms of diarrhea-predominant irritable bowel syndrome(IBS-D);however,the certainty of evidence is low.Wellpowered randomized controlled dose-ranging trials are warranted on promising single-strain candidates.AIM To investigate the clinical efficacy of Lactiplantibacillus plantarum(L.plantarum)Lpla33(DSM34428)in adults with IBS-D.METHODS This is a randomized,double-blind,placebo-controlled,multi-center,and doseranging study.Three hundred and seven adults,18-70 years of age,with IBS-D,according to Rome IV criteria,were allocated(1:1:1)to receive placebo or L.plantarum Lpla33 at 1×10^(9)(1B)or 1×10^(10)(10B)colony-forming units/d over an 8-wk intervention period.The primary outcome was the change in IBS severity scoring system(IBS-SSS)total score after 8 wk,while secondary and exploratory outcomes included abdominal pain severity,IBS related quality of life,stool and microbial profile,and perceived stress.RESULTS IBS-SSS was significantly reduced,after 8 wk,in participants receiving L.plantarum 1B(-128.45±83.30;P<0.001)and L.plantarum 10B(-156.77±99.06;P<0.001),compared to placebo(-58.82±74.75).Further,a dose-ranging effect was observed,with a greater absolute reduction in the L.plantarum 10B group(P<0.05).A reduction in sub-scores related to abdominal pain,abdominal distension,bowel habits,and quality of life was observed in both L.plantarum groups compared to placebo(P<0.001).Further,62.5%and 88.4%of participants administered L.plantarum 1B and 10B,respectively,were classified as stool consistency responders based on a reduction in diarrheal stool form,as compared to 26.3%in the placebo group(P<0.001).In contrast,no significant shifts were observed in microbial diversity.CONCLUSION L.plantarum Lpla33(DSM34428)is well tolerated and improves IBS symptom severity with a dose-ranging effect and a corresponding normalization of bowel habits in adults with IBS-D.

Evaluating the efficacy of endoscopic sphincterotomy on biliary-type sphincter of Oddi dysfunction: A retrospective clinical trial

BACKGROUND Although endoscopic sphincterotomy(EST)has a positive therapeutic effect on biliary-type sphincter of Oddi dysfunction(SOD),some patients still have little relief after EST,which implies that other functional abdominal pain may also be present with biliary-type SOD and interfere with the diagnosis and treatment of it.AIM To retrospectively assess EST as a treatment for biliary-type SOD and analyze the importance of functional gastrointestinal disorder(FGID)in guiding endoscopic treatment of SOD.METHODS Clinical data of 79 patients with biliary-type SOD(type I and type II)treated with EST at Affiliated Hospital of Guizhou Medical University from January 2014 to January 2019 were retrospectively collected to evaluate the clinical therapeutic effect of EST.The significance of relationship between FGID and biliary-type SOD was analyzed.RESULTS Seventy-nine patients with biliary-type SOD received EST,including 29 type 1 patients and 50 type 2 patients.The verbal rating scale-5(VRS-5)scores before EST were all 3 or 4 points,and the scores decreased after EST;the difference was statistically significant(P<0.05).After EST,the serum indexes of alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase and total bilirubin in biliary-type SOD were significantly lower than before(P<0.05).After EST,67(84.8%)and 8(10.1%)of the 79 patients with biliary-type SOD had obviously effective(VRS-5=0 points)and effective treatment(VRS-5=1-2 points),with an overall effectiveness rate of 94.9%(75/79).There was no difference in VRS-5 scores between biliary-type SOD patients with or without FGID before EST(P>0.05).Of 12 biliary-type SOD(with FGID)patients,11 had abdominal pain after EST;of 67 biliary-type SOD(without FGID)patients,0 had abdominal pain after EST.The difference was statistically significant(P<0.05).The 11 biliary-type SOD(with FGID)patients with recurrence of symptoms,the recurrence time was about half a year after the EST,and the symptoms were significantly relieved after regular medical treatment.There were 4 cases of postendoscopic retrograde cholangiopancreatography pancreatitis(5.1%),and no cholangitis,bleeding or perforation occurred.Patients were followed up for 1 year to 5 years after EST,with an average follow-up time of 2.34 years,and there were no long-term adverse events such as sphincter of Oddi restenosis or cholangitis caused by intestinal bile reflux during the follow-up.CONCLUSION EST is a safe and effective treatment for SOD.For patients with type I and II SOD combined with FGID,single EST or medical treatment has limited efficacy.It is recommended that EST and medicine be combined to improve the cure rate of such patients.

Efficacy of acupuncture in refractory irritable bowel syndrome patients:a randomized controlled trial

Previous studies have confirmed that acupuncture for irritable bowel syndrome(IBS)provided an additional benefit over usual care alone.Therefore,we performed a multicenter,randomized,sham-controlled trial to assess the efficacy and safety of acupuncture versus sham acupuncture for refractory IBS in patients in the context of conventional treatments.Patients in the acupuncture and sham acupuncture groups received real or sham acupuncture treatment in 3 sessions per week for a total of 12 sessions.The primary outcome was a change in the IBS–Symptom Severity Scale(IBS-SSS)score from baseline to week 4.A total of 521 participants were screened,and 170 patients(85 patients per group)were enrolled and included in the intention-to-treat analysis.Baseline characteristics were comparable across the two groups.From baseline to 4 weeks,the IBS-SSS total score decreased by 140.0(95%CI:126.0 to 153.9)in the acupuncture group and 64.4(95%CI:50.4 to 78.3)in the sham acupuncture group.The between-group difference was 75.6(95%CI:55.8 to 95.4).Acupuncture efficacy was maintained during the 4-week follow-up period.There were no serious adverse events.In conclusion,acupuncture provided benefits when combined with treatment as usual,providing more options for the treatment of refractory IBS.

Effect of Tongxie Yaofang(痛泻要方) Granule in Treating Diarrhea-Predominate Irritable Bowel Syndrome

Objective:To study the clinical effect of Tongxie Yaofang(痛泻要方,TXYF) Granule in treating diarrhea-predominate irritable bowel syndrome(D-IBS) and its possible mechanism.Methods:A total of 120 patients were assigned to two groups using stratified block randomization,80 in the intervention group and 40 in the control group.To the intervention group the TXYF granule was given at one package each time,twice a day; the control group was treated with Miyarisan three times a day,two tablets each time.The course of...

The antibacterial activity of Berberis heteropoda Schrenk and its effect on irritable bowel syndrome in rats

The dried roots of Berberis heteropoda Schrenk have traditionally been used to treat acute gastroenteritis and dysentery. The aim of this study was to confirm the antibacterial activity of an extract of Berberis heteropoda Schrenk root in vitro and its therapeutic effects on rats with diarrhea-predominant irritable bowel syndrome(D-IBS) in vivo, as well as to identify the related signaling pathways. A water extract of Berberis heteropoda Schrenk root(BHS) inhibited the growth of S. aureus, E. coli, P. aeruginosa and S. faecalis. BHS potentially damaged the structure of the bacterial cell membrane and decreased the activity of some membranous enzymes, eventually killing the S. aureus, E. coli, P. aeruginosa and S. faecalis bacteria. Oral administration of BHS(low, middle and high dose group, L, M and H) significantly alleviated the abdominal pain, diarrhea, and depression-like symptoms of D-IBS rats, and the efficacy index ranged from 30% to 60%, indicating that the BHS treatment was effective. BHS(L, M and H) alleviated the abnormal pathological changes in the brain, as evidenced by HE staining. The expression of CHAT, 5-HT, C-FOS and CGRP was reduced by the BHS treatment(L, M and H). Our findings provide novel insights into the use of the natural product BHS to inhibit pathogenic bacteria by destroying the bacterial structure, indicating that BHS possesses certain biological activities. Furthermore, BHS has the potential to alleviate diarrhea, abdominal pain and depression-like behaviors in D-IBS rats by regulating the brain-gut peptide levels.

Traditional Chinese Medicine Clinical Experience of the Treatment for Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a functional bowel disorder that includes abdominal pain or discomfort associated with defecation or a change in bowel habits with features of disordered defecation.This disease lacks morphological changes and biochemical abnormalities to explain the symptoms.

加味交泰丸联合地衣芽孢杆菌活菌治疗腹泻型肠易激综合征临床疗效及对血清IL-6、IL-8、TNF-α水平影响

目的探讨加味交泰丸联合地衣芽孢杆菌活菌治疗腹泻型肠易激综合征肝郁脾虚证的疗效及对血清IL-6、IL-8、TNF-α水平影响。方法选取医院门诊收治的腹泻型肠易激综合征患者60例,随机分为两组各30例。对照组患者给予地衣芽孢杆菌活菌,实验组在对照组基础上给予加味交泰丸,两组患者均持续治疗28 d。对比两组患者的临床疗效、腹痛消失时间、大便性状、大便次数恢复正常时间及中医证候积分、IBS-SSS评分、IBS-QOL评分、血清IL-6、IL-8、TNF-α水平及不良反应情况。结果治疗后,实验组总有效率较高(P<0.05);实验组腹痛消失时间、大便性状、大便次数恢复正常时间明显低于对照组(P<0.05);两组患者治疗后腹痛、大便性状、大便次数等证候评分显著降低(P<0.05);实验组降低较明显(P<0.05);两组治疗前血清IL-6、IL-8、TNF-α水平差异无统计学意义(P>0.05);两组治疗后血清IL-6、IL-8、TNF-α水平显著降低(P<0.05);实验组降低较明显(P<0.05);两组治疗前IBS-SSS评分差异无统计学意义(P>0.05);两组治疗后IBS-SSS评分显著降低(P<0.05);并且实验组降低较明显(P<0.05);两组患者治疗前IBS-QOL评分无差异(P>0.05);两组患者治疗后IBS-QOL量表各条目评分显著降低(P<0.05);并且实验组降低较多(P<0.05)。结论采用加味交泰丸联合地衣芽孢杆菌活菌治疗腹泻型肠易激综合征肝郁脾虚证具有较好的治疗效果,能够降低血清IL-6、IL-8、TNF-α水平,安全性较高,值得在临床上推广应用。

巨细胞病毒阳性的青光眼睫状体炎综合征临床特点及20g/L更昔洛韦滴眼液干预效果

目的:比较巨细胞病毒(CMV)阳性和阴性的青光眼睫状体炎综合征(PSS)患者的临床特征,评价20g/L更昔洛韦滴眼液局部治疗CMV阳性PSS患者的临床疗效及短期复发情况。方法:比较CMV阳性(86例86眼)和CMV阴性(60例60眼)PSS患者的差异,比较CMV阳性患者中常规组(30例30眼,仅给予抗炎降压治疗)和试验组(56例56眼,在常规组治疗基础上,给予配制的20g/L更昔洛韦滴眼液点眼)的一般资料、眼部参数和分布、房水中IFN-γ和IL-4水平、临床疗效以及1a内复发情况。结果:纳入的146例PSS患者中,CMV阳性率为58.9%。CMV阳性患者的平均眼压、发作眼与对侧眼的角膜内皮细胞数差显著升高,发作眼角膜内皮细胞数显著减少(P<0.05)。治疗后,试验组各眼部参数及分布均显著优于常规组(P<0.05),试验组IFN-γ水平显著低于常规组,IL-4水平显著高于常规组(P<0.05)。与常规组相比,试验组总有效率高,所需治愈时间短,1a内复发率低、复发间隔时间长(P<0.05)。结论:CMV阳性的PSS患者比阴性患者眼压更高,角膜内皮细胞损伤更大。20g/L更昔洛韦滴眼液局部点眼通过抵抗CMV感染可有效控制眼压及炎症发展,临床疗效显著,短期不易复发。

Acupuncture for diarrhea-predominant irritable bowel syndrome:A randomized control study

Objective:To verify the effectiveness of acupuncture for diarrhea-predominant irritable bowel syndrome(IBS-D).Methods:Sixty-five patients with IBS-D were randomized into an acupuncture group(33 cases)and a sham-acupuncture group(32 cases).In the acupuncture group,Tiānshū(天枢ST25),Zhōngwǎn(中脘CV12),Zúsānlǐ(足三里ST36),Shàngjùxū(上巨虚ST37),Gōngsūn(公孙SP4),Fēnglóng(丰隆ST40),Zhāngmén(章门LR13)and Yīnlíngquán(阴陵泉SP9)were selected and stimulated with routine acupuncture technique,once every two days,3 times weekly,for 8 weeks consecutively,24 times in total.In the shamacupuncture group,the sham-acupoints were selected,0.5 cun or 1 cun superior,inferior,lateral or medial to the corresponding points separately.The blunt-tip needles were used to stimulate only the skin surface of each point.The treatment frequency and courses were the same as the acupuncture group.Before treatment,in 4 weeks of treatment,after treatment and in follow-up,the changes in the score of IBS symptom severity scale(IBS-SSS),Bristol stool form scale and defecation satisfaction were observed in the patients of two groups.After treatment,the effectiveness was assessed in the two groups.Results:In 4 weeks of treatment,after treatment and in follow-up,IBS-SSS score,Bristol stool form scale and defecation satisfaction were all lower than those before treatment in either group(all P<0.01).Bristol stool form scale in the acupuncture group was lower than that in the sham-acupuncture group in4 weeks of treatment,after treatment and in follow-up,while,IBS-SSS score and defecation satisfaction were lower than the sham-acupuncture group in follow-up(all P<0.05).Conclusion:Acupuncture can effectively relieve diarrhea and improves defecation satisfaction in the patients with IBS-D.

腹泻型肠易激综合征患者的血清IL-10、CCL16水平及其临床意义

目的探究腹泻型肠易激综合征(IBS-D)患者的血清IL-10、CC趋化因子配体16(CCL16)水平及其临床意义。方法选择2019年1月至2022年12月在来安家宁医院就诊的65例IBS-D患者设为IBS-D组,另选择67名同期健康体检者设为对照组。收集受试者的一般资料;采用ELISA法检测血清IL-10、CCL16水平;采用细菌三级鉴定法鉴别受试者粪便菌群(双歧杆菌、乳杆菌、拟杆菌和肠杆菌),并计算每克粪便中的菌群数量。对IBS-D患者进行IBS-D症状严重程度的评估,并根据严重程度总评分将IBS-D患者分为轻中度组和重度组,采用Pearson或Spearman相关分析法探究IBS-D患者的血清IL-10、CCL16水平与粪便菌群、IBS-D症状严重程度评分的相关性。结果与对照组相比,IBS-D组的血清IL-10、CCL16水平均显著升高(P均<0.05),粪便中肠杆菌数量显著增多(P<0.05),双歧杆菌、乳杆菌数量均显著减少(P均<0.05)。IBS-D患者的IBS-D症状严重程度总评分为(262.00±41.25)分,与轻中度组相比,重度组的血清IL-10、CCL16水平均显著升高(P均<0.05),粪便中肠杆菌数量显著增多(P<0.05),双歧杆菌、乳杆菌数量均显著减少(P均<0.05)。IBS-D患者的血清IL-10水平与血清CCL16水平呈正相关(r=0.390,P<0.05);血清IL-10、CCL16水平与粪便中双歧杆菌、乳杆菌数量均呈负相关(P均<0.05),与肠杆菌数量、IBS-D症状各项评分及严重程度总评分均呈正相关(P<0.05)。结论IBS-D患者的血清IL-10、CCL16水平升高,且与粪便中双歧杆菌、乳杆菌、肠杆菌及患者的IBS-D症状严重程度均显著相关。检测血清IL-10、CCL16水平可能有助于诊断IBS-D及评估病情严重程度,进而指导临床治疗。