BACKGROUND Functional constipation(FC)and constipation-predominant irritable bowel syndrome(IBS-C)represent a spectrum of constipation disorders.However,the majority of previous clinical investigations have focused on...BACKGROUND Functional constipation(FC)and constipation-predominant irritable bowel syndrome(IBS-C)represent a spectrum of constipation disorders.However,the majority of previous clinical investigations have focused on Western populations,with limited data originating from China.AIM To determine and compare the colorectal motility and psychiatric features of FC and IBS-C in an Eastern Chinese population.METHODS Consecutive chronic constipation patients referred to our motility clinic from December 2019 to February 2023 were enrolled.FC and IBS-C diagnoses were established using ROME IV criteria,and patients underwent high-resolution anorectal manometry(ARM)and a colonic transmit test using the Sitz marker study.Constipation-related symptoms were obtained through questionnaires.Anxiety and depression were assessed by the Hamilton anxiety rating scale and the Hamilton Depression Rating Scale-21.The clinical characteristics and colorectal motility patterns of FC and IBS-C patients were compared.RESULTS No significant differences in sex,age or abdominal discomfort symptoms were observed between IBS-C and FC patients(all P>0.05).The proportion of IBS-C patients with delayed colonic transit was higher than that of patients with FC(36.63%vs 15.91%,P<0.05),while rectosigmoid accumulation of radiopaque markers was more common in the FC group than in the IBS-C group(50%vs 26.73%,P<0.05).Diverse proportions of these dyssynergic patterns were noted within both the FC and IBS-C groups by ARM.IBS-C patients were found to have a higher prevalence of depression than FC patients(66.30%vs 42.42%,P<0.05).The scores for feelings of guilt,suicide,psychomotor agitation,diurnal variation,obsessive/compulsive disorder,hopelessness,self-abasedment and gastrointestinal symptoms were significantly higher in IBS-C patients than that in FC patients(P<0.05).For IBS-C(χ^(2)=5.438,P<0.05)but not FC,patients with normal colon transit time were significantly more likely to have anxiety than those with slow colon transit time.For IBS-C patients but not FC patients,the threshold of first constant sensation,desire to defecate and sustained urgency were all weakly correlated with the degree of anxiety(r=0.414,r=0.404,and r=0.418,respectively,P<0.05).The proportion of patients with a low threshold of desire to defecate among IBS-C patients with depression was lower than that in those without depression(69.6%vs 41.9%,χ2=4.054,P<0.05).CONCLUSION Our findings highlight both overlapping and distinctive patterns of colon transit,dyssynergic patterns,anorectal sensation,psychological distress,and associations of psychiatric and colorectal motility characteristics in FC and IBS-C patients in an Eastern Chinese population,providing valuable insights into the pathophysiological underpinnings of these disorders.展开更多
Objective: To explore the mechanism in patients with irritable bowel syndrome (IBS) of the constipation predominant type and observe the therapeutic effects of Sinisan (四逆散, SNS). Methods: Forty -seven IBS patien...Objective: To explore the mechanism in patients with irritable bowel syndrome (IBS) of the constipation predominant type and observe the therapeutic effects of Sinisan (四逆散, SNS). Methods: Forty -seven IBS patients with the constipation predominant type were randomly divided into the treated group ( n =24) and the control group ( n =23). Another group of 22 healthy subjects was set up for healthy control. The treated group was treated with modified SNS, and the control group was treated with Cisapride, the therapeutic course for both groups was 8 weeks. The changes of symptom scoring and anorectal manometry (the anorectal resting pressure, anal tract systolic pressure, anal tract diastolic pressure, rectal threshold feeling, maximal tolerance volume of rectum, and rectum compliance) of these two groups were recorded respectively and compared with each other. Results: Compared with the healthy control group, the rectal threshold feeling, maximal tolerance volume of rectum and rectal compliance of the treated groups got reduced significantly before treatment ( P <0.05). After treatment, the symptom scoring, rectal threshold feeling and maximal tolerance volume of rectum were improved in both groups ( P <0.05), and the improvement of the treated group was more significant than that of the control group( P <0.01). The total effective rate and recurrence rate of the treated group were superior to those of the control group significantly ( P <0.05, P <0.01).Conclusion: SNS has good effect on IBS of the constipation predominant type.展开更多
AIM:To assess the esophageal motility in patients with irritable bowel syndrome(IBS)and to compare those with patients with autoimmune disorders.METHODS:15 patients with IBS,22 with systemic lupus erythematosus(SLE)an...AIM:To assess the esophageal motility in patients with irritable bowel syndrome(IBS)and to compare those with patients with autoimmune disorders.METHODS:15 patients with IBS,22 with systemic lupus erythematosus(SLE)and 19 with systemic sclerosis(SSc)were prospectively selected from a total of 115patients at a single university centre and esophageal motility was analysed using standard manometry(Mui Scientific PIP-4-8SS).All patients underwent esophagogastro-duodenoscopy before entering the study so that only patients with normal endoscopic findings were included in the current study.All patients underwent a complete physical,blood biochemistry and urinary examination.The grade of dysphagia was determined for each patient in accordance to the intensity and frequency of the presented esophageal symptoms.Furthermore,disease activity scores(SLEDAI and modified Rodnan score)were obtained for patients with autoimmune diseases.Outcome parameter:A correlation coefficient was calculated between amplitudes,velocity and duration of the peristaltic waves throughout esophagus and patients’dysphagia for all three groups.RESULTS:There was no statistical difference in the standard blood biochemistry and urinary analysis in all three groups.Patients with IBS showed similar pathologic dysphagia scores compared to patients with SLE and SSc.The mean value of dysphagia score was in IBS group 7.3,in SLE group 6.73 and in SSc group7.56 with a P-value>0.05.However,the manometric patterns were different.IBS patients showed during esophageal manometry peristaltic amplitudes at the proximal part of esophagus greater than 60 mmHg in46%of the patients,which was significant higher in comparison to the SLE(11.8%)and SSc-Group(0%,P=0.003).Furthermore,IBS patients showed lower mean resting pressure of the distal esophagus sphincter(Lower esophageal sphincter,22 mmHg)when compared with SLE(28 mmHg,P=0.037)and SSc(26 mmHg,P=0.052).23.5%of patients with SLE showed amplitudes greater as 160 mmHg in the distal esophagus(IBS and SSc:0%)whereas 29.4%amplitudes greater as 100 mmHg in the middle one(IBS:16.7%,SSc:5.9%respectively,P=0.006).Patients with SSc demonstrated,as expected,in almost half of the cases reduced peristalsis or even aperistalsis in the lower two thirds of the esophagus.SSc patients demonstrated a negative correlation coefficient between dysphagia score,amplitude and velocity of peristaltic activity at middle and lower esophagus[r=-0.6,P<CONCLUSION:IBS patients have comparable dysphagia-scores as patients with autoimmune disorders.The different manometric patterns might allow differentiating esophageal symptoms based on IBS from other organic diseases.展开更多
基金the External Science and Technology Cooperation Planning Projects of Anhui Province of China,No.1604b060202.
文摘BACKGROUND Functional constipation(FC)and constipation-predominant irritable bowel syndrome(IBS-C)represent a spectrum of constipation disorders.However,the majority of previous clinical investigations have focused on Western populations,with limited data originating from China.AIM To determine and compare the colorectal motility and psychiatric features of FC and IBS-C in an Eastern Chinese population.METHODS Consecutive chronic constipation patients referred to our motility clinic from December 2019 to February 2023 were enrolled.FC and IBS-C diagnoses were established using ROME IV criteria,and patients underwent high-resolution anorectal manometry(ARM)and a colonic transmit test using the Sitz marker study.Constipation-related symptoms were obtained through questionnaires.Anxiety and depression were assessed by the Hamilton anxiety rating scale and the Hamilton Depression Rating Scale-21.The clinical characteristics and colorectal motility patterns of FC and IBS-C patients were compared.RESULTS No significant differences in sex,age or abdominal discomfort symptoms were observed between IBS-C and FC patients(all P>0.05).The proportion of IBS-C patients with delayed colonic transit was higher than that of patients with FC(36.63%vs 15.91%,P<0.05),while rectosigmoid accumulation of radiopaque markers was more common in the FC group than in the IBS-C group(50%vs 26.73%,P<0.05).Diverse proportions of these dyssynergic patterns were noted within both the FC and IBS-C groups by ARM.IBS-C patients were found to have a higher prevalence of depression than FC patients(66.30%vs 42.42%,P<0.05).The scores for feelings of guilt,suicide,psychomotor agitation,diurnal variation,obsessive/compulsive disorder,hopelessness,self-abasedment and gastrointestinal symptoms were significantly higher in IBS-C patients than that in FC patients(P<0.05).For IBS-C(χ^(2)=5.438,P<0.05)but not FC,patients with normal colon transit time were significantly more likely to have anxiety than those with slow colon transit time.For IBS-C patients but not FC patients,the threshold of first constant sensation,desire to defecate and sustained urgency were all weakly correlated with the degree of anxiety(r=0.414,r=0.404,and r=0.418,respectively,P<0.05).The proportion of patients with a low threshold of desire to defecate among IBS-C patients with depression was lower than that in those without depression(69.6%vs 41.9%,χ2=4.054,P<0.05).CONCLUSION Our findings highlight both overlapping and distinctive patterns of colon transit,dyssynergic patterns,anorectal sensation,psychological distress,and associations of psychiatric and colorectal motility characteristics in FC and IBS-C patients in an Eastern Chinese population,providing valuable insights into the pathophysiological underpinnings of these disorders.
文摘Objective: To explore the mechanism in patients with irritable bowel syndrome (IBS) of the constipation predominant type and observe the therapeutic effects of Sinisan (四逆散, SNS). Methods: Forty -seven IBS patients with the constipation predominant type were randomly divided into the treated group ( n =24) and the control group ( n =23). Another group of 22 healthy subjects was set up for healthy control. The treated group was treated with modified SNS, and the control group was treated with Cisapride, the therapeutic course for both groups was 8 weeks. The changes of symptom scoring and anorectal manometry (the anorectal resting pressure, anal tract systolic pressure, anal tract diastolic pressure, rectal threshold feeling, maximal tolerance volume of rectum, and rectum compliance) of these two groups were recorded respectively and compared with each other. Results: Compared with the healthy control group, the rectal threshold feeling, maximal tolerance volume of rectum and rectal compliance of the treated groups got reduced significantly before treatment ( P <0.05). After treatment, the symptom scoring, rectal threshold feeling and maximal tolerance volume of rectum were improved in both groups ( P <0.05), and the improvement of the treated group was more significant than that of the control group( P <0.01). The total effective rate and recurrence rate of the treated group were superior to those of the control group significantly ( P <0.05, P <0.01).Conclusion: SNS has good effect on IBS of the constipation predominant type.
文摘AIM:To assess the esophageal motility in patients with irritable bowel syndrome(IBS)and to compare those with patients with autoimmune disorders.METHODS:15 patients with IBS,22 with systemic lupus erythematosus(SLE)and 19 with systemic sclerosis(SSc)were prospectively selected from a total of 115patients at a single university centre and esophageal motility was analysed using standard manometry(Mui Scientific PIP-4-8SS).All patients underwent esophagogastro-duodenoscopy before entering the study so that only patients with normal endoscopic findings were included in the current study.All patients underwent a complete physical,blood biochemistry and urinary examination.The grade of dysphagia was determined for each patient in accordance to the intensity and frequency of the presented esophageal symptoms.Furthermore,disease activity scores(SLEDAI and modified Rodnan score)were obtained for patients with autoimmune diseases.Outcome parameter:A correlation coefficient was calculated between amplitudes,velocity and duration of the peristaltic waves throughout esophagus and patients’dysphagia for all three groups.RESULTS:There was no statistical difference in the standard blood biochemistry and urinary analysis in all three groups.Patients with IBS showed similar pathologic dysphagia scores compared to patients with SLE and SSc.The mean value of dysphagia score was in IBS group 7.3,in SLE group 6.73 and in SSc group7.56 with a P-value>0.05.However,the manometric patterns were different.IBS patients showed during esophageal manometry peristaltic amplitudes at the proximal part of esophagus greater than 60 mmHg in46%of the patients,which was significant higher in comparison to the SLE(11.8%)and SSc-Group(0%,P=0.003).Furthermore,IBS patients showed lower mean resting pressure of the distal esophagus sphincter(Lower esophageal sphincter,22 mmHg)when compared with SLE(28 mmHg,P=0.037)and SSc(26 mmHg,P=0.052).23.5%of patients with SLE showed amplitudes greater as 160 mmHg in the distal esophagus(IBS and SSc:0%)whereas 29.4%amplitudes greater as 100 mmHg in the middle one(IBS:16.7%,SSc:5.9%respectively,P=0.006).Patients with SSc demonstrated,as expected,in almost half of the cases reduced peristalsis or even aperistalsis in the lower two thirds of the esophagus.SSc patients demonstrated a negative correlation coefficient between dysphagia score,amplitude and velocity of peristaltic activity at middle and lower esophagus[r=-0.6,P<CONCLUSION:IBS patients have comparable dysphagia-scores as patients with autoimmune disorders.The different manometric patterns might allow differentiating esophageal symptoms based on IBS from other organic diseases.
