中医外治法治疗腹泻型肠易激综合征研究进展

腹泻型肠易激综合征(IBS-D)是消化科的常见病,中医病名属于“泄泻”范畴。目前现代医学治疗此病存在疗效不佳,易复发,副作用大等问题,而祖国传统医学中医外治法对此病有独特优势。笔者搜集整理最新文献,欲从针刺、艾灸、穴位贴敷、穴位埋线、中药灌肠、穴位注射、其他外治、联合外治等方面阐述中医外治法近年来在治疗腹泻型肠易激综合征中的研究进展,以期更好的指导临床。

痛泻要方合四逆散治疗腹泻型肠易激综合征41例

目的观察痛泻要方合四逆散治疗腹泻型肠易激综合征的临床疗效。方法对41例腹泻型肠易激综合征患者治疗28d,观察临床疗效。结果痛泻要方合四逆散治疗腹泻型肠易激综合征总有效率为87.80%。结论痛泻要方合四逆散治疗腹泻型肠易激综合征疗效肯定,能明显改善患者临床症状。

疏肝健脾止泻汤治疗肠易激综合征93例

目的:观察疏肝健脾止泻汤治疗肠易激综合征的临床疗效。方法:选符合纳入标准的该病患者153例,随机分为治疗组93例,对照组60例。治疗组给予疏肝健脾止泻汤,对照组予硝苯地平等西药。治疗6周,观察6个月后统计疗效。结果:治疗组痊愈32例,有效54例,无效7例,总有效率为92.47%(95%CI=88.31%～96.63%);对照组痊愈10例,有效33例,无效17例,总有效率为71.67%(95%CI=60.27%～83.07%);两组综合疗效比较,有显著性差异(u=3.1422,P=0.0029);且两组总有效率的95%CI不重叠。结论:疏肝健脾止泻汤治疗肠易激综合征疗效优于硝苯地平等。其收益为OR=0.21(95%CI=0.08～0.53),NNT=5(95%CI=3.1～11.1)。

中医诊治肠易激综合征的现状和展望

肠易激综合征(irritable bowel syndrome ,IBS)是一种比较常见的肠道功能紊乱性疾病.胃肠道动力紊乱、精神因素、肠道感染是诱发 IBS 的主要病因,腹痛、腹胀、排便异常是此病的主要临床表现[1 ].IBS在临床上可分为腹泻型、便秘型、腹泻便秘交替型3种类型,其中腹泻型在临床上最为常见[2 ].大量研究表明[3],IBS 相关性腹痛是由于发生在肠道的末梢神经病变(内脏感觉超敏反应).但是迄今为止,IBS的病因和发病机制尚不完全清楚.中医认为,此病与患者情志失调与外邪内侵密切相关[4 ].张俊龙等[5]认为IBS 的得病之因,在外多为情志刺激,在内则多有脾胃虚弱.肝郁脾虚、肝脾不和是IBS 发病的本质.

Visceral hypersensitivity and altered colonic motility after subsidence of inflammation in a rat model of colitis

AIM:Irritable bowel syndrome(IBS)is a functional bowel disorder characterized by visceral hypersensitivity and altered bowel motility.There is increasing evidence suggesting the role of inflammation in the pathogenesis of IBS,which addresses the possibility that formerly established rat model of colitis could be used as an IBS model after the inflammation subsided. METHODS:Colitis was induced by intracolonic instillation of 4% acetic acid in male Sprague-Dawley rats.The extent of inflammation was assessed by histological examination and myeloperoxidase(MPO)activity assay.After subsidence of colitis,the rats were subjected to rectal distension and restraint stress,then the abdominal withdrawal reflex and the number of stress-induced fecal output were measured, respectively. RESULTS:At 2 days post-induction of colitis,the colon showed characteristic inflammatory changes in histology and 8-fold increase in MPO activity.At 7 days post-induction of colitis,the histological features and MPO activity returned to normal.The rats at 7 days post-induction of colitis showed hypersensitive response to rectal distension without an accompaning change in rectal compliance,and defecated more stools than control animals when under stress.CONCLUSION: These results concur largely with the characteristic features of IBS, visceral hypersensitivity and altered defecation pattern in the absence of detectable disease, suggesting that this animal model is a methodologically convenient and useful model for studying a subset of IBS.

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.

Meta-analysis of probiotics for the treatment of irritable bowel syndrome

Irritable bowel syndrome （IBS） is a chronic condition affecting 3%-25% of the general population. As no curative treatment is available, therapy is aimed at reducing symptoms, often with little success. Because alteration of the normal intestinal microflora has been observed in IBS, probiotics （beneficial microbes taken to improve health） may be useful in reducing symptoms. This paper systematically reviews randomized, controlled, blinded bials of probiotics for the treatment of IBS and synthesizes data on efficacy across trials of adequate quality. Pubr4ed, Medline, Google Scholar, NIH registry of clinical trials, metaRegister, and the Cochrane Central Register of Controlled Trials were searched from 1982-2007. We also conducted secondary searches of reference lists, reviews, commentaries, relevant articles on associated diseases, books and meeting abstracts. Twenty trials with 23 probiotic treatment arms and a total of 1404 subjects met inclusion criteria. Probiotic use was associated with improvement in global IBS symptoms compared to placebo [pooled relative risk （RRpooled） 0.77, 95% confidence interval （95% CI） 0.62-0.94]. Probiotics were also associated with less abdominal pain compared to placebo [RRpooled = 0.78 （0.69-0.88）]. Too few studies reported data on other IBS symptoms or on specific probiotic strains to allow estimation of a pooled RR. While our analyses suggest that probiotic use may be associated with improvement in IBS symptoms compared to placebo, these results should be interpreted with caution, given the methodological limitations of contributing studies. Probiotics warrant further study as a potential therapy for IBS.

Chronic gastrointestinal symptoms and quality of life in the Korean population

AIM： To evaluate the prevalence of chronic gastroin- testinal symptoms and their impact on health-related quality of life （HRQOL） in the Korean population. METHODS： A cross-sectional survey, using a reliable and valid Rome I] based questionnaire, was per- formed on randomly selected residents, between 18 and 69 years in age. All respondents were interviewed at their homes or offices by a team of interviewers. The impact of chronic gastrointestinal symptoms on HRQOL was assessed using the Korean version of the 36-item Short-Form general health survey （SF-36）. RESULTS： Of the 1807 eligible subjects, 1417 （78.4%： male 762; female 655） were surveyed. Out of the respondents, 18.6% exhibited at least one chronic gastrointestinal symptom. The prevalence of gastro- esophageal reflux disease （GERD）, defined as heart- burn and/or acid regurgitation experienced at least weekly, was 3.5% （95% CI, 2.6-4.5）. The prevalence of uninvestigated dyspepsia, irritable bowel syndrome （IBS） and chronic constipation based on Rome Ⅱ criteria were 11.7% （95% CI, 10.1-13.5）, 2.2% （95% CI, 1.5-3.1）, and 2.6% （95% CI, 1.8-3.5） respectively. Compared with subjects without chronic gastrointesti- nal symptoms （n = 1153）, those with GERD （n = 50）, uninvestigated dyspepsia （n = 166） and IBS （n = 31） had significantly worse scores on most domains of the SF-36 scales. CONCLUSION： The prevalence of GERD, uninvesti- gated dyspepsia and IBS were 3.5%, 11.7% and 2.2% respectively, in the Korean population. The health- related quality of life was significantly impaired in subjects with GERD, uninvestigated dyspepsia and IBS in this community.

Effectiveness and safety of herbal medicines in the treatment of irritable bowel syndrome:A systematic review

AIM： To explore the efficacy and safety of herba medicines （HM） in the treatment of irritable bowe syndrome （IBS）. METHODS： A computer-based as well as manual literature search was performed. We reviewed randomized controlled trials on the treatment of IBS with and without HM. RESULTS： A total of 22 studies with 25 HMs met the inclusion criteria. Four of these studies were of good quality, while the remaining 18 studies involving 17 Chinese herbal medicine （CHM） formulas were of poor quality. Eight of these reports using 9 HMs showed global improvement of IBS symptoms, 4 studies with 3 HMs were efficacious in diarrhea-predominant IBS, and 2 studies with 2 HMs showed improvement in constipation- predominant IBS. Out of a total of 1279 patients, 15 adverse events in 47 subjects were reported with HM. No serious adverse events or abnormal laboratory tests were observed. The incidence of the adverse events was low （2.97%; 95% CI： 2.04%-3.90%）. CONCLUSION： Herbal medicines have therapeutic benefit in IBS, and adverse events are seldom reported in literature. Nevertheless, herbal medicines should be used with caution. It is necessary to conduct rigorous, well-designed clinical trials to evaluate their effectiveness and safety in the treatment of IBS.

Updates on treatment of irritable bowel syndrome

Irritable bowel syndrome （IBS） is a highly prevalent gastrointestinal disorder characterized by abdominal pain and discomfort in association with altered bowel habits. It is estimated tD affect 10%-15% of the Western population, and has a large impact on quality of life and （in）direct healthcare costs. IBS is a multifactorial disorder involving dysregulation within the brain-gut axis, and it is frequently associated with gastrointestinal motor and sensory dysfunction, enteric and central nervous system irregularities, neuroimmune dysregulation, and postinfectious inflammation. As with other functional medical disorders, the treatment for IBS can be challenging. Conventional therapy for those with moderate to severe symptoms is largely unsatisfactory, and the development of new and effective drugs is made difficult by the complex pathogenesis, variety of symptoms, and lack of objective clinical findings that are the hallmark of this disorder. Fortunately, research advances over the past several decades have provided insight into potential mechanisms responsible for the pathogenesis of IBS, and have led to the development of several promising pharmaceutical agents. In recent years there has been much publicity over several of these new IBS medications （alosetron and tegaserod） because of their reported association with ischemic colitis and cardiovascular disease. While these agents remain available for use under restricted prescribing programs, this highlights the need for continued development of safe and effective medication for IBS. This article provides a physiologicallybased overview of recently developed and frequently employed pharmaceutical agents used to treat IBS, and discusses some non-pharmaceutical options that may be beneficial in this disorder.

Infectious causation of chronic disease:Examining the relationship between Giardia lamblia infection and irritable bowel syndrome

AIM: To evaluate whether a higher prevalence of Giardia lamblia infection is associated with an increase in irritable bowel syndrome (IBS) prescriptions at the county level in Michigan. METHODS: The Michigan Disease Surveillance System (MDSS) was used to ascertain both the numbers of Giardia lamblia infections as well as the total number of foodborne illnesses per population by county in Michigan during 2005. This was compared with Blue Cross Blue Shield (BCBS) of Michigan numbers of drug prescriptions for IBS per one thousand members per county in 2005. These data were also analyzed for associations with per capita income by county and the number of refugees entering each county in 2005. RESULTS: There were a total of 786 confirmed cases of Giardia lamblia reported to MDSS in 2005. During the same time period, the number of prescriptions for IBS varied from 0.5 per 1000 members up to 6.0 per 1000 members per month. There was no trend towards higher numbers of IBS prescriptions in the counties with more Giardia lamblia infections. Per capita income was not associated with either IBS prescriptions or Giardiasis. There was a significant linear association between the number of refugees entering each county, and the number of Giardia lamblia cases per 100 000 population. CONCLUSION: In this ecological study, there was no association found between BCBS prescriptions for IBS and Giardia lamblia infections in Michigan counties. Our findings may have been influenced by the disparate number of refugees admitted per county.

Genetic determination of irritable bowel syndrome

Irritable bowel syndrome （IBS） is a common functional gastrointestinal disorder. According to the Rome m criteria, IBS is defined as recurrent abdominal pain or discomfort for at least 3 d per month during the previous 3 mo associated with two or more of the following symptoms： improvement with defecation, onset associated with a change in the frequency of stool and/or onset associated with a change in form or appearance of stool. There is growing evidence regarding the genetic contribution in IBS, however the precise etiology of IBS is still unknown. The evaluation of the genetic influence is based on twin studies, familial aggregation and genetic epidemiological investigations. Most studies showed a concordance for IBS significantly greater in monozygotic than in dizygotic twins. The majority of the studies have shown that familial aggregation may represent exposures to a similar environment, as well as the influence of genetic factors. Whereas no specific gene has been identified in association with IBS, recent studies have noticed the importance of polymorphisms in the promoter region of the serotonin reuptake transporter gene, G-protein beta 3 subunit gene （C825T）, cholecystokinin receptor （CCKAR gene 779T〉C）, and high-producer tumor necrosis factor genotype. Further studies are necessary to determine how genetic factors influence the clinical manifestations and therapeutical response in IBS patients.

State-of-the-art of irritable bowel syndrome and inflammatory bowel disease research in 2008

Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are two of the leading causes of chronic intestinal conditions in the world. This issue of World Journal of Gastroenterology (WJG ) presents a series of papers from world experts who discuss the current knowledge and opinions on these important conditions. Although great strides have been made in the diagnosis, treatment and pathology of IBS and IBD; much has yet to be explained. The etiologies and risk factors of these multifactorial conditions remain elusive. Specific diagnostic biomarkers need to be developed and safer treatments developed. The burden of IBS and IBD on the healthcare system is felt with repeated medical care visits and high costs. IBS and IBD patients can account for 30%-50% of office visits at gastroenterology services/clinics. Over one million people have IBD in the United States, with 30 000 new cases being diagnosed every year. One-quarter million people in the UK are afflicted with IBD. The cost of medical care in the United States for IBD is estimated to be $1.8 billion/year.

CLINICAL STUDY ON SPLEEN-STOMACH-REINFORCING MOXIBUSTION TREATMENT OF DIARRHEA-TYPE IRRITABLE BOWEL SYNDROME

In the present paper, the therapeutic effect of spleen- stomach- reinforcing moxibustion for treatment of irritable bowel syndrome (IBS) is observed and its underlying mechanisms on immunity are analyzed. A total of 72 IBS patients are randomly divided into moxibustion group (n= 46) and acupuncture group (control group, n = 26). Acu-points used are Zhongwan (CV 12), Qihai (CV 6) and Zusanli (ST 36), etc. Serum IgG, IgA and IgM contents, blood T-lympocytes (T3+, T4+, T8+) counts, T4+ /T8+, cancer embryonic antigen (CEA) content, serum IL-2 and slL-2R contents are assayed for evaluating changes of the immunocompetence. After two courses of treatment (24 sessions), results show that in moxibustion group, 25 cases (54.35%) are cured, 17 experience improvement in clinical symptoms and 4 have no apparent changes, with an effective rate of 91.30% ; in control group, 8 cases (30. 78%) are cured, 12 experience improvement and 6 have no marked improvement, with an effective rate of 76.92% . The therapeutic effect of moxibustion is significantly superior to that of acupuncture (P<0.01). In addition, moxibustion can effectively rectify abnormal immune function and stabilize human's immunity. This research provides a reliable experimental basis for clinical application of 'principal prescription of moxibustion for reinforcing the spleen and stomach'.

Discrepancies between the responses to skin prick test to food and respiratory antigens in two subtypes of patients with irritable bowel syndrome

AIM:To compare the response to skin prick tests (SPTs) to food antigens (FAs) and inhalant allergens (IAs) in patients with two subtypes of irritable bowel syndrome (IBS) and healthy controls. METHODS:We compared the results of SPTs for IAs and FAs in 87 volunteers divided into three groups:diarrhea predominant IBS (D-IBS) GroupⅠ(n = 19), constipation predominant IBS (C-IBS) Group Ⅱ (n = 17), and normal controls Group Ⅲ (n = 51). RESULTS:Of the 285 tests (171 for FAs and 114 for IAs) performed in GroupⅠwe obtained 45 (26.3%) positive responses for FA and 23 (20.1%) for IA. Of the 153 tests for FA in Group Ⅱ, we obtained 66 (20.1%) positive responses, and of the 102 tests for IA, we obtained 20 (19.6%) positive responses. Of the 459 tests for FA performed in Group Ⅲ, we obtained 39 (84%) positive responses, and of the 306 for IA, we obtained 52 (16.9%) positive responses. The numbers of positive responses were not significantly different between the three groups, but in the D-IBS group, the number of SPTFA responses differed significantly from those for the other two groups (P < 0.01). CONCLUSION:Despite the small number of cases studied, the higher reactivity to FAs in GroupⅠcompared to Groups Ⅱ and Ⅲ adds new information, and suggests the presence of a possible alteration in intestinal epithelial function.

YINDARA-4 relieves visceral hypersensitivity in irritable bowel syndrome rats via regulation of gut microbiota and serotonin levels

Objective:The present study aims to evaluate the in vivo efficacy of YINDARA-4 in improving the symptoms of irritable bowel syndrome(IBS)in a rat model and investigate the impact of YINDARA-4 on potential targets of IBS management,such as the serotonin level in intestinal tissues and the structure and composition of the gut microbiota.Methods:We developed an IBS rat model by combining stress from maternal separation,acetic acid administration,and restraint.We administered YINDARA-4 water extract to the IBS rat model for 10 consecutive days.The fecal water content,visceral sensitivity,gut microbiota,and serotonin levels in the colonic tissue were then analyzed and compared between the control group,IBS model group,and YINDARA-4–treated groups.Results:Treatment with YINDARA-4 reversed visceral hypersensitivity in a dose-dependent manner in the experimental rat model of IBS.The relief of visceral hypersensitivity upon treatment with YINDARA-4 involved regulation of the gut microbiota structure and composition,and normalization of elevated serotonin levels in the colon.The decrease in colonic serotonin levels with YINDARA-4 treatment might be associated with a reduction in the abundance of Helicobacter and enrichment of Butyricimonas.Conclusions:Treatment with YINDARA-4 was beneficial against visceral hypersensitivity in a rat model of IBS.The improved symptoms exhibited in IBS rats were associated with favorably altered gut microbiota and normalization of serotonin levels in the colon.

The Chinese herbal Formula Tongxieyaofang for irritable bowel syndrome:a protocol for meta-analysis of randomized controlled trials

Background:Irritable bowel syndrome(IBS)is a chronic functional bowel disorder characterized by abdominal pain and altered bowel function.The TongXieYaoFang(TXYF)is a Chinese herbal formula with a long history for the management of chronic diarrhea accompanied by abdominal pain,and it is always used to relieve symptoms of IBS.Although there are some studies were published,there is no consensus on its effects.Moreover,new relevant study was published recently.Therefore,a systematic review and meta-analysis is needed to assess the safety and eff ectiveness of the Chinese herbal medicine TongXieYaoFang for IBS.Methods and analysis:PubMed,EMBASE,the Cochrane library,CNKI,WanFang,VIP and CBM databases will be searched without search date and language restrictions.We will include randomized controlled trial(RCT)comparing TXYF with another therapy method for IBS.The quality of included studies will be independently assessed using Risk of bias tool in the Cochrane Handbook 5.1.0,and be categorized as being at low,unclear or high risk of bias.The primary outcome is the disappearance and significant improvement in global symptoms,and the secondary outcomes including visual analog scale(VAS)score,adverse event,rehospitalization rate and the quality of life.The Meta-analysis will be performed using the Cochrane Collection’s tool RevMan 5.3 software.Results:This study is ongoing and will be submitted to a peerreviewed journal for publication.Conclusion:This study will provide a confirmed evidence on the safety and eff ectiveness of TXYF for IBS.Ethics and dissemination:Ethical approval and patient consent are not required because of the study is a systematic review and meta-analysis based on literatures.The results of this study will be submitted to a peer-reviewed journal for publication.

Controlled observation on the efficacy of acupuncture and western medicine on diarrhea-type irritable bowel syndrome

Objective To compare the difference in the therapeutic effects on diarrhea- type irritable bowel syndrome （D-IBS） between acupuncture based on soothing the liver and strengthening the spleen and western medicine. Methods Seventy cases were randomized into an acupuncture group and a western medicine group, 35 cases in each one. In the acupuncture group, the conventional acupuncture was applied at Tianshu {天枢 ST 25）, Zusanli （足三里 ST 36）, Shangjuxu {上巨虚 ST 37）, Sanyinjiao （三阴交 SP 6）, Taichong （太冲 LR 3） and so on. Electric stimulation was supplemented at bilateral ST 25. The treatment was given once a day, 3-4 treatments in a week. In the western medicine group, pinaverium bromide （dicetel） was prescribed for oral administration, 50 mg each time, three times a day. Four weeks made one session in the two groups. Separately, before treatment and after 1 session treatment, the integral of clinical symptom and the score in the scale of the quality of life measure for irritable bowel syndrome （IBS-Q OL） were observed for the patients in the two groups. The efficacy and recurrence rate were assessed in the two groups. Results The symptom integral and IBS-QOL score in the two groups were improved significantly after treatment Call P〈0.01）, and the improvements in the acupuncture group were superior to that in the western medicine group （P〈0.01）. The effective rate was 94.3% {33/35） in the acupuncture group, which was superior to 77.1% （27/35） in the western medicine group （P〈0.01）. In 3 months, the recurrence rate was 36.4% （12/33） in the acupuncture group, which was lower apparently than 72.0% （18/25） in the western medicine group （P〈O.01）. Conclusion Acupuncture therapy based on soothing the liver and strengthening the spleen achieves the superior efficacy on D-IBS as compared with western medication, pinaverium bromide. This therapy improves apparently the quality of life of the patients and is lower in recurrence rate.

Efficacy observation on warm needling for 60 cases of diarrhea irritable bowel syndrome

Objective To observe the clinical effect of warm needling in the treatment of diarrhea irritable bowel syndrome. Methods One hundred and twenty patients with diarrhea irritable bowel syndrome were randomly divided into a warm needling group and a western medicine group by random digit table method, 60 patients were included in each group. Tiānshū （天枢 ST 25）, Zúsānl （足三里 ST 36） and Sānyīnjiāo （三阴交 SP 6） were selected as the main acupoints for the warm needling group, the needles were retained for 30 min, once a day, an interval of 1 day was set up after treatment for six days, and the treatment were carried out for continuous four weeks. The patients in the western medicine group were orally administered with 2 mg loperamide hydrochloride capsules, 3 times a day, and the treatment were carried out for continuous four weeks. The treatment effects were compared between the two groups, and the recurrence rates were counted after for six-month followup. Results The total effective rate in the warm needling group was 86.7% （52/60） and the total effective rate in the western medicine group was 71.7% （43/60）, and the difference between the two groups was statistically significant （P0.05）; after six-month follow-up, the recurrence rate in the warm needling group was 21.4% （6/28）, while the recurrence rate in the western medicine group was 54.5% （12/22）, and the difference between the two groups was statistically significant （P0.05）. Conclusion The warm needling therapy shows relatively satisfactory treatment effects in the treatment of diarrhea irritable bowel syndrome and the recurrence rate is relatively low.