Objective: To assess the efficacy of cognitive behaviour therapy delivered in primary care for treating irritable bowel syndrome. Design: Randomised controlled trial. Setting: 10 general practices in London. Participa...Objective: To assess the efficacy of cognitive behaviour therapy delivered in primary care for treating irritable bowel syndrome. Design: Randomised controlled trial. Setting: 10 general practices in London. Participants: 149 patients with moderate or severe irritable bowel syndrome resistant to the antispasmodic mebeverine. Interventions: Cognitive behaviour therapy delivered by trained primary care nurses plus 270 mg mebeverine taken thrice daily compared with mebeverine treatment alone. Main outcome measures: Primary measures were patients’ scores on the irritable bowel syndrome symptom severity scale. Secondary measures were scores on the work and social adjustment scale and the hospital anxiety and depression scale. Results: Of 334 referred patients, 72 were randomised to mebeverine plus cognitive behaviour therapy and 77 to mebeverine alone. Cognitive behaviour therapy had considerable initial benefit on symptom severity compared with mebeverine alone, with a mean reduction in score of 68 points (95% confidence interval 103 to 33), with the benefit persisting at three months and six months after therapy (mean reductions 71 points (109 to 32) and 11 points (20 to 3)) but not later. Cognitive behaviour therapy also showed significant benefit on the work and social adjustment scale that was still present 12 months after therapy (mean reduction 2.8 points (5.2 to 0.4)), but had an inconsistent effect on the hospital anxiety and depression scale. Conclusion: Cognitive behaviour therapy delivered by primary care nurses offered additional benefit over mebeverine alone up to six months, although the effect had waned by 12 months. Such therapy may be useful for certain patients with irritable bowel syndrome in primary care.展开更多
目的:探讨肠易激综合征(IBS)患儿实施集束化护理基础上配合应用艾箱灸的效果。方法:入选2019年7月—2020年9月佛山市高明区人民医院84例肠易激综合征患儿为研究对象,用随机数字表法分为对照组(予集束化护理)和试验组(予集束化护理配合...目的:探讨肠易激综合征(IBS)患儿实施集束化护理基础上配合应用艾箱灸的效果。方法:入选2019年7月—2020年9月佛山市高明区人民医院84例肠易激综合征患儿为研究对象,用随机数字表法分为对照组(予集束化护理)和试验组(予集束化护理配合应用艾箱灸),每组42例,比较两组患儿干预前和干预后30 d IBS症状尺度表(IBS-BSS)和专用生活质量量表(IBS-QOL)评分,比较两组患儿干预前后血清D-乳酸(D-LA)和乳脂球表皮生长因子-8(MFG-E8)含量,比较两组患儿干预效果及家属满意度。结果:干预后,对照组和试验组IBS-SSS评分、D-LA含量均较干预前下降,IBS-QOL评分升高、MFG-E8含量增加,差异均有统计学意义(P<0.01)。干预后,试验组IBS-SSS评分为(236.60±47.82)分,低于对照组的(304.08±51.36)分;IBS-QOL评分为(83.40±7.35)分,高于对照组的(75.12±6.11)分;试验组D-LA含量为(6.56±1.04)mg/L,低于对照组的(9.75±1.11)mg/L,MFG-E8含量高于对照组,组间比较差异均有统计学意义(P<0.01)。试验组干预有效率(97.62%)高于对照组(90.48%,P<0.01)。结论:对肠易激综合征患儿在集束化护理基础上联合应用艾箱灸治疗,能改善临床效果和生活质量、缓解症状,并促进患儿肠道屏障功能的逐步恢复。展开更多
Background: Patients with irritable bowel syndrome (IBS) often feel they have some form of dietary intolerance and frequently try exclusion diets. Tests attempting to predict food sensitivity in IBS have been disappoi...Background: Patients with irritable bowel syndrome (IBS) often feel they have some form of dietary intolerance and frequently try exclusion diets. Tests attempting to predict food sensitivity in IBS have been disappointing but none has utilised IgG antibodies. Aims: To assess the therapeutic potential of dietary elimination based on the presence of IgG antibodies to food. Patients: A total of 150 outpatients with IBS were randomised to receive, for three months, either a diet excluding all foods to which they had raised IgG antibodies (enzyme linked immunosorbant assay test) or a sham diet excluding the same number of foods but not those to which they had antibodies. Methods: Primary outcome measures were change in IBS symptom severity and global rating scores. Noncolonic symptomatology, quality of life, and anxiety/depression were secondary outcomes. Intention to treat analysis was undertaken using a generalised linear model. Results: After 12 weeks, the true diet resulted in a 10%greater reduction in symptom score than the sham diet (mean difference 39 (95%confidence intervals (CI) 5-72); p = 0.024) with this value increasing to 26%in fully compliant patients (difference 98 (95%CI 52-144); p<0.001). Global rating also significantly improved in the true diet group as a whole (p = 0.048, NNT = 9) and even more in compliant patients (p = 0.006, NNT = 2.5). All other outcomes showed trends favouring the true diet. Relaxing the diet led to a 24%greater deterioration in symptoms in those on the true diet (difference 52 (95%CI 18-88); p = 0.003). Conclusion: Food elimination based on IgG antibodies may be effective in reducing IBS symptoms and is worthy of further biomedical research.展开更多
文摘Objective: To assess the efficacy of cognitive behaviour therapy delivered in primary care for treating irritable bowel syndrome. Design: Randomised controlled trial. Setting: 10 general practices in London. Participants: 149 patients with moderate or severe irritable bowel syndrome resistant to the antispasmodic mebeverine. Interventions: Cognitive behaviour therapy delivered by trained primary care nurses plus 270 mg mebeverine taken thrice daily compared with mebeverine treatment alone. Main outcome measures: Primary measures were patients’ scores on the irritable bowel syndrome symptom severity scale. Secondary measures were scores on the work and social adjustment scale and the hospital anxiety and depression scale. Results: Of 334 referred patients, 72 were randomised to mebeverine plus cognitive behaviour therapy and 77 to mebeverine alone. Cognitive behaviour therapy had considerable initial benefit on symptom severity compared with mebeverine alone, with a mean reduction in score of 68 points (95% confidence interval 103 to 33), with the benefit persisting at three months and six months after therapy (mean reductions 71 points (109 to 32) and 11 points (20 to 3)) but not later. Cognitive behaviour therapy also showed significant benefit on the work and social adjustment scale that was still present 12 months after therapy (mean reduction 2.8 points (5.2 to 0.4)), but had an inconsistent effect on the hospital anxiety and depression scale. Conclusion: Cognitive behaviour therapy delivered by primary care nurses offered additional benefit over mebeverine alone up to six months, although the effect had waned by 12 months. Such therapy may be useful for certain patients with irritable bowel syndrome in primary care.
文摘目的:探讨肠易激综合征(IBS)患儿实施集束化护理基础上配合应用艾箱灸的效果。方法:入选2019年7月—2020年9月佛山市高明区人民医院84例肠易激综合征患儿为研究对象,用随机数字表法分为对照组(予集束化护理)和试验组(予集束化护理配合应用艾箱灸),每组42例,比较两组患儿干预前和干预后30 d IBS症状尺度表(IBS-BSS)和专用生活质量量表(IBS-QOL)评分,比较两组患儿干预前后血清D-乳酸(D-LA)和乳脂球表皮生长因子-8(MFG-E8)含量,比较两组患儿干预效果及家属满意度。结果:干预后,对照组和试验组IBS-SSS评分、D-LA含量均较干预前下降,IBS-QOL评分升高、MFG-E8含量增加,差异均有统计学意义(P<0.01)。干预后,试验组IBS-SSS评分为(236.60±47.82)分,低于对照组的(304.08±51.36)分;IBS-QOL评分为(83.40±7.35)分,高于对照组的(75.12±6.11)分;试验组D-LA含量为(6.56±1.04)mg/L,低于对照组的(9.75±1.11)mg/L,MFG-E8含量高于对照组,组间比较差异均有统计学意义(P<0.01)。试验组干预有效率(97.62%)高于对照组(90.48%,P<0.01)。结论:对肠易激综合征患儿在集束化护理基础上联合应用艾箱灸治疗,能改善临床效果和生活质量、缓解症状,并促进患儿肠道屏障功能的逐步恢复。
文摘Background: Patients with irritable bowel syndrome (IBS) often feel they have some form of dietary intolerance and frequently try exclusion diets. Tests attempting to predict food sensitivity in IBS have been disappointing but none has utilised IgG antibodies. Aims: To assess the therapeutic potential of dietary elimination based on the presence of IgG antibodies to food. Patients: A total of 150 outpatients with IBS were randomised to receive, for three months, either a diet excluding all foods to which they had raised IgG antibodies (enzyme linked immunosorbant assay test) or a sham diet excluding the same number of foods but not those to which they had antibodies. Methods: Primary outcome measures were change in IBS symptom severity and global rating scores. Noncolonic symptomatology, quality of life, and anxiety/depression were secondary outcomes. Intention to treat analysis was undertaken using a generalised linear model. Results: After 12 weeks, the true diet resulted in a 10%greater reduction in symptom score than the sham diet (mean difference 39 (95%confidence intervals (CI) 5-72); p = 0.024) with this value increasing to 26%in fully compliant patients (difference 98 (95%CI 52-144); p<0.001). Global rating also significantly improved in the true diet group as a whole (p = 0.048, NNT = 9) and even more in compliant patients (p = 0.006, NNT = 2.5). All other outcomes showed trends favouring the true diet. Relaxing the diet led to a 24%greater deterioration in symptoms in those on the true diet (difference 52 (95%CI 18-88); p = 0.003). Conclusion: Food elimination based on IgG antibodies may be effective in reducing IBS symptoms and is worthy of further biomedical research.
