Constipation-predominant irritable bowel syndrome: A review of current and emerging drug therapies

Irritable bowel syndrome(IBS) is a highly prevalent medical condition that adversely affects patient quality of life and constitutes a significant economic burden on healthcare resources. A large proportion of patients suffer from the constipation subtype of IBS(IBS-C), most commonly afflicting older individuals and those with a lower socioeconomic status. Conventional pharmacologic and nonpharmacologic treatment options have limited efficacies and/or significant adverse events, which lead to increased long-term health care expenditures. Failure to effectively treat IBS-C patients over the past decades has largely been due to a poor understanding of disease pathophysiology, lack of a global view of the patient, and an inappropriate selection of patients and treatment endpoints in clinical trials. In recent years, however, more effective and safer drugs have been developed for the treatment of IBS-C. The advancement in the area of pharmacologic treatment is based on new knowledge of the pathophysiologic basis of IBS-C and the development of drugs with increased selectivity within pharmacologic classes with recognized efficacies. This narrative review covers the spectrum of available drugs and their mechanisms of action, as well as the efficacy and safety profiles of each as determined in relevant clinical trials that have investigated treatment options for IBS-C and chronic constipation. A brief summary of laxative-based treatment options is presented, followed by up-to-date assessments for three classes of drugs: prokinetics, prosecretory agents, and bile acid modulators.

Irritable bowel syndrome: a disease still searching for pathogenesis, diagnosis and therapy

Irritable bowel syndrome (IBS) is the most frequently diagnosed functional gastrointestinal disorder in primary and secondary care. It is characterised by abdominal discomfort, pain and changes in bowel habits that can have a serious impact on the patient’s quality of life. The pathophysiology of IBS is not yet completely clear. Genetic, immune, environmental, inflammatory, neurological and psychological factors, in addition to visceral hypersensitivity, can all play an important role, one that most likely involves the complex interactions between the gut and the brain (gut-brain axis). The diagnosis of IBS can only be made on the basis of the symptoms of the Rome III criteria. Because the probability of organic disease in patients fulfilling the IBS criteria is very low, a careful medical history is critical and should pay particular attention to the possible comorbidities. Nevertheless, the severity of the patient’s symptoms or concerns sometimes compels the physician to perform useless and/or expensive diagnostic tests, transforming IBS into a diagnosis of exclusion. The presence of alarming symptoms (fever, weight loss, rectal bleeding, significant changes in blood chemistry), the presence of palpable abdominal masses, any recent onset of symptoms in patient aged over 50 years, the presence of symptoms at night, and a familial history of celiac disease, colorectal cancer and/or inflammatory bowel diseases all warrant investigation. Treatment strategies are based on the nature and severity of the symptoms, the degree of functional impairment of the bowel habits, and the presence of psychosocial disorders. This review examines and discusses the pathophysiological aspects and the diagnostic and therapeutic approaches available for patients with symptoms possibly related to IBS, pointing out controversial issues and the strengths and weaknesses of the current knowledge.

Effect of cognitive behavior therapy combined with exercise intervention on the cognitive bias and coping styles of diarrhea-predominant irritable bowel syndrome patients

BACKGROUND Irritable bowel syndrome(IBS)is a common digestive system disease with a high incidence rate and is common in women.The cause of IBS remains unclear.Some studies have shown that mental and psychological diseases are independent risk factors for IBS.At present,the treatment of IBS is mainly symptomatic treatment.Clinically,doctors also use cognitive behavioral therapy to improve patients'cognitive ability to diseases and clinical symptoms.In recent years,exercise therapy has attracted more and more attention from scholars.Improving the symptoms of IBS patients through psychosomatic treatment strategy may be a good treatment method.AIM To explore the effects of an intervention of cognitive behavioral therapy combined with exercise(CBT+E)on the cognitive bias and coping styles of patients with diarrhea-predominant irritable bowel syndrome(IBS-D);and to provide a theoretical reference for the management of IBS.METHODS Sixty IBS-D patients and thirty healthy subjects were selected.The 60 IBS-D patients were randomly divided into experimental and control groups.The experimental group was treated with the CBT+E intervention,while the control group was treated with conventional drugs without any additional intervention.The cognitive bias and coping styles of the participants were evaluated at baseline and after 6 wk,12 wk and 24 wk using the Automatic Thoughts Questionnaire(ATQ),Dysfunctional Attitudes Scale(DAS)and Pain Coping Style Questionnaire(CSQ)instruments,and the intervention effect was analyzed using SPSS 17.0 statistical software.RESULTS At baseline,the scores on the various scales showed that all subjects had cognitive bias and adverse coping styles.The IBS Symptom Severity Scale(IBSSSS)scores,ATQ total scores,DAS scores and CSQ scores of the two groups were not significantly different(P>0.05).Compared with baseline,after 6 wk of the CBT+E intervention,there were significant differences in the ATQ scores,the dependence and total scores on the DAS,and the catastrophization,distraction and prayer scores on the CSQ(P<0.05).After 12 wk,there were significant differences in the scores for perfectionism on the DAS and in the scores for reinterpretation,neglect and pain behavior on the CSQ in the experimental group(P<0.05).After 24 wk,there were significant differences in the vulnerability,dependence,perfectionism,and total scores on the DAS and in the catastrophization,distraction and prayer scores on the CSQ in the experimental group(P<0.01).The IBS-SSS scores were negatively correlated with the ATQ and DAS total scores(P<0.05)but were positively correlated with the CSQ total score(P<0.05).CONCLUSION Intervention consisting of CBT+E can correct the cognitive bias of IBS-D patients and eliminate their adverse coping conditions.CBT+E should be promoted for IBS and psychosomatic diseases.

Body awareness therapy: A new strategy for relief of symptoms in irritable bowel syndrome patients

AIM: To compare irritable bowel syndrome (IBS) pa- tients with apparently healthy persons and to evaluate body awareness therapy, which is a physiotherapeutic remedy focusing on normalising tensions in the body, for the treatment of IBS with the hypothesis that altered body tension is associated with the syndrome. METHODS: Twenty-one IBS patients received body awareness therapy two hours weekly for 24 wk. At base- line as well as after 12 and 24 wk, they underwent ex- aminations including resource oriented body examination in combination with body awareness scale evaluation and f illed in gastrointestinal and psychological symptom questionnaires. Saliva cortisol was analysed. A group of 21 apparently healthy persons underwent the same ex- aminations once. RESULTS: Compared to the apparently healthy group, IBS patients scored higher at baseline for gastrointestinal and psychological symptoms. They showed more often alterations in normal body tension patterns, as well as deviating cortisol slopes in saliva. After 24 wk of body awareness therapy, their gastrointestinal and psychologi- cal symptoms were reduced overall. Somatic symptoms decreased in parallel with depressive symptoms. Whole body pain score decreased, coping ability as well as bio- chemical stress markers improved. CONCLUSION: IBS patients scored higher for gastroin- testinal and psychological symptoms, and presented with altered biochemical stress markers. Their body tension deviated compared to healthy controls. Furthermore,body awareness therapy gave relief of both somatic com- plaints, psychological symptoms and normalised body tension. These findings indicate that distorted tension constitutes an important part of the symptoms in IBS.

Cognitive-behavioral therapy for the management of irritable bowel syndrome

Irritable bowel syndrome(IBS)is a common disorder,reported to be found in 5%-20%of the general population.Its management accounts for up to 25%of a gastroenterologist’s workload in the outpatient department,and the main symptoms are abdominal pain,bloating,and altered bowel habits.Despite a great amount of available pharmacological treatments aimed at a wide variety of gastrointestinal and brain targets,many patients have not shown adequate symptom relief.In recent years,there has been increasing evidence to suggest that psychological treatments,in particular cognitive-behavioral therapy(CBT),are effective for the management of IBS.This review discusses CBT for the management of IBS.CBT has proved to be effective in alleviating the physical and psychological symptoms of IBS and has thus been recommended as a treatment option for the syndrome.

Common traditional Chinese medicine therapies for diarrhea-predominant irritable bowel syndrome: An overview of systematic reviews

Objective: To critically evaluate and summarize the methodological quality of systematic reviews(SRs)and present objective and important outcomes on the effectiveness of traditional Chinese medicine(TCM) therapies, including Chinese herbal medicine(CHM), acupuncture, and moxibustion, for diarrheapredominant irritable bowel syndrome(IBS-D).Methods: We conducted a comprehensive literature search for SRs in 7 databases until April 16, 2022.Two reviewers independently extracted data and assessed the methodological quality of the reviews according to the Assessing the Methodological Quality of Systematic Reviews 2(AMSTAR-2), the Risk of Bias in Systematic reviews(ROBIS) tool, and the Preferred Reporting Item for Systematic Review and Meta-analysis(PRISMA) statement. The Grading of Recommendations, Assessment, Development, and Evaluation(GRADE) was used to rate the quality of evidence.Results: IBS-D patients included in 12 reviews were diagnosed in accordance with the Rome criteria, 9 reviews focused on CHM, 2 articles observed moxibustion and heat-sensitive moxibustion, 1 article studied acupuncture and CHM. The outcomes of the SRs were the effectiveness rate, the total effectiveness rate,global symptom improvement, and adverse effects. Based on AMSTAR-2, which measures the quality of methodology, all of the included studies were of low or critically low quality. According to the ROBIS tool, 10 SRs(83.33%) had a high risk of bias. With the PRISMA checklist, only 3 SRs reached over 90% compliance.Based on GRADE, most evidence was of low quality, and there was a moderate quality of evidence that the effectiveness rate of modified-Tongxie Yaofang was superior to Western medicine in the treatment of IBS-D.Conclusion: Given the suboptimal reporting and methodological quality of existing SRs, more studies are needed to clarify whether TCM therapies are more effective or safe than pharmacological medicine.Future studies should combine evidence-based medicine with TCM research according to the characteristics of TCM.

New therapeutic perspectives in irritable bowel syndrome: Targeting low-grade inflammation, immuno-neuroendocrine axis, motility, secretion and beyond

Irritable bowel syndrome(IBS)is a chronic,recurring,and remitting functional disorder of the gastrointestinal tract characterized by abdominal pain,distention,and changes in bowel habits.Although there are several drugs for IBS,effective and approved treatments for one or more of the symptoms for various IBS subtypes are needed.Improved understanding of pathophysiological mechanisms such as the role of impaired bile acid metabolism,neurohormonal regulation,immune dysfunction,the epithelial barrier and the secretory properties of the gut has led to advancements in the treatment of IBS.With regards to therapies for restoring intestinal permeability,multiple studies with prebiotics and probiotics are ongoing,even if to date their efficacy has been limited.In parallel,much progress has been made in targeting low-grade inflammation,especially through the introduction of drugs such as mesalazine and rifaximin,even if a better knowledge of the mechanisms underlying the low-grade inflammation in IBS may allow the design of clinical trials that test the efficacy and safety of such drugs.This literature review aims to summarize the findings related to new and investigational therapeutic agents for IBS,most recently developed in preclinical as well as Phase 1 and Phase 2clinical studies.

Regulation of the serotonin transporter in the pathogenesis of irritable bowel syndrome

Serotonin(5-HT) and the serotonin transporter(SERT) have earned a tremendous amount of attention regarding the pathogenesis of irritable bowel syndrome(IBS). Considering that enteric 5-HT is responsible for the secretion, motility and perception of the bowel, the involvement of altered enteric 5-HT metabolism in the pathogenesis of IBS has been elucidated. Higher 5-HT availability is commonly associated with depressed SERT mR NA in patients with IBS compared with healthy controls. The expression difference of SERT between IBS patients and healthy controls might suggest that SERT plays an essential role in IBS pathogenesis, and SERT was expected to be a novel therapeutic target for IBS. Progress in this area has begun to illuminate the complex regulatory mechanisms of SERT in the etiology of IBS. In this article, current insights regarding the regulation of SERT in IBS are provided, including aspects of SERT gene polymorphisms, microR NAs, immunity and inflammation, gut microbiota, growth factors, among others. Potential SERT-directed therapies for IBS are also described. The potential regulators of SERT are of clinical importance and are important for better understanding IBS pathophysiology and therapeutic strategies.

Acupuncture for irritable bowel syndrome: A blinded placebo-controlled trial

AIM:Irritable bowel syndrome (IBS) is a common disorder and many patients fail to find adequate relief from conventional therapies for their symptoms. This study tests the claim that acupuncture is effective for a majority of these patients. METHODS: A prospective, blinded, sham acupuncture-controlled trial of traditional Chinese acupuncture was performed at a single postgraduate teaching hospital in Europe. Sixty patients with well-established IBS were recruited. The blinded comparator was sham acupuncture administered by the second of two acupuncturists who alone was aware of the randomization, and who otherwise followed the prescription of the first. The primary end-point was a defined fall in the symptom score at 13 wk (by intention to treat). The prior expectation was a 30% placebo response, and a response rate of 70% from acupuncture, for which the study was adequately powered. RESULTS: Patients in treated and sham groups improved significantly during the study-mean improvement in scores being equal (minus 1.9) and significant for both (P<0.05; one-tailed t test). There was a small numeric but nonsignificant difference between the response rate in patients receiving acupuncture (40.7%) and sham treatment (31.2%). Several secondary end-points marginally favored active treatment, but an improved symptom score of any degree of magnitude occurred more often with sham therapy (65.6% vs 59.2%). For no criterion was statistical significance approached. CONCLUSION: Traditional Chinese acupuncture is relatively ineffective in IBS in the European hospital setting, and the magnitude of any effect appears insufficient to warrant investment in acupuncture services.

Complementary and alternative medicines in irritable bowel syndrome: An integrative view

Irritable bowel syndrome(IBS)is a common gastrointestinal disorder with a high incidence in the general population.The diagnosis of IBS is mainly based on exclusion of other intestinal conditions through the absence of inflammatory markers and specific antigens.The current pharmacological treatment approaches available focus on reducing symptom severity while often limiting quality of life because of significant side effects.This has led to an effectiveness gap for IBS patients that seek further relief to increase their quality of life.Complementary and alternative medicines(CAM)have been associated with a higher degree of symptom management and quality of life in IBS patients.Over the past decade,a number of important clinical trials have shown that specific herbal therapies(peppermint oil and Iberogast?),hypnotherapy,cognitive behavior therapy,acupuncture,and yoga present with improved treatment outcomes in IBS patients.We propose an integrative approach to treating the diverse symptoms of IBS by combining the benefits of and need for pharmacotherapy with known CAM therapies to provide IBS patients with the best treatment outcome achievable.Initial steps in this direction are already being considered with an increasing number of practitioners recommending CAM therapies to their patients if pharmacotherapy alone does not alleviate symptoms sufficiently.

Irritable bowel syndrome in children: Pathogenesis, diagnosis and evidence-based treatment

Irritable bowel syndrome (IBS) is the commonest cause of recurrent abdominal pain (RAP) in children in both more developed and developing parts of the world. It is defined by the Rome III criteria for functional gastrointestinal disorders. It is characterized by abdominal pain that is improved by defecation and whose onset is associated with a change in stool form and or frequency and is not explained by structural or biochemical abnormalities. It is estimated that 10%-15% of older children and adolescents suffer from IBS. IBS can be considered to be a brain-gut disorder possibly due to complex interaction between environmental and hereditary factors. The diagnosis of IBS is made based on the Rome III criteria together with ruling out organic causes of RAP in children such as inflammatory bowel disease and celiac disease. Once the diagnosis of IBS is made, it is important to explain to the parents (and children) that there is no serious underlying disease. This reassurance may be effective treatment in a large number of cases. Lifestyle modifications, stress management, dietary interventions and probiotics may be beneficial in some cases. Although there is limited evidence for efficacy of pharmacological therapies such as antispasmodics and antidiarrheals; these have a role in severe cases. Biopsychosocial therapies have shown encouraging results in initial trials but are beset by limited availability. Further research is necessary to understand the pathophysiology and provide specific focused therapies.

Aspects of the non-pharmacological treatment of irritable bowel syndrome

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.

P2Y1R is involved in visceral hypersensitivity in rats with experimental irritable bowel syndrome

AIM To evaluate the role of P2Y1 R in visceral hypersensitivity in rats with experimental irritable bowel syndrome.METHODS A rat model of irritable bowel syndrome was generated by intra-colonic administration of acetic acid(AA) and assessed by histology and myeloperoxidase(m PO) activity assay. Then P2Y1 R expression in the colonic tissue was detected by Western blot. In order to explore the regulatory role of P2Y1 R in visceral hypersensitivity, an agonist(m RS2365) and an antagonist(m RS2179) of P2Y1 R were intra-colonically administered and effects were tested through a colorectal distension test. The abdominal withdrawal reflex and abdominal electromyography were tested during the course. RESULTS model assessment tests showed an obvious inflammatoryreaction that appeared on the 2^(nd) d after the AA injection, and the inflammatory reaction gradually recovered and almost disappeared on the 7^(th) d. The model finished on day 8 and showed a clear feature of IBS that had no organic lesion. The average expression of P2Y1 R was significantly higher in the AA group than in the na?ve group(0.319 ± 0.02 vs 0.094 ± 0.016, P < 0.001). m RS2365 could effectively raise the colonic hypersensitivity status at intervention doses of 10(AUC value from 0.30 ± 0.089 to 1.973 ± 0.127 mv?s, P < 0.01) and 100 μmol/L(AUC value from 0.290 ± 0.079 to 1.983 ± 0.195 mv?s, P < 0.01); m RS2179 could effectively reduce the hypersensitivity status at intervention dose of 100 μmol/L(from a mean baseline AUC value of 1.587 ± 0.099 mv?s to 0.140 ± 0.089 mv?s, P < 0.0001). Differences between the m RS2179 group(1.88 ± 1.45) and either the m RS2365 group(3.96 ± 0.19) or the combined treatment(m RS2179 and m RS2365) group(3.28 ± 0.11) were significant(P < 0.01).CONCLUSION P2Y1 R plays a regulatory role in visceral hypersensitivity in rats with experimental IBS. Specific antagonists of P2Y1 R may have potential therapeutic value in treating abdominal pain in IBS.

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'.

ACUPUNCTURE TREATMENT OF 36 CASES OF IRRITABLE BOWEL SYNDROME

In the present study, 36 cases of irritable bowel syndrome were treated by acupuncturing some acupoints selected according to differentiation of syndromes of traditional Chinese medicine.After 10 - 30 sessions of treatment, 35 cases were cured and the rest one case had improvement, with the effective rate being 100 %.

Research Progress of Traditional Chinese Medicine in Treating Irritable Bowel Syndrome Based on Network Pharmacology and Molecular Docking Technology

In recent years,using network pharmacology and molecular docking technology to reveal the therapeutic targets of irritable bowel syndrome(IBS)has become a research hotspot.This paper summarizes 31 studies of traditional Chinese medicine for IBS by domestic and foreign scholars,and expounds the action mechanism of single drug,drug pair and compound prescription in the treatment of IBS from the aspects of drug activity,action target,biological process and pathway analysis.It also discusses the shortcomings and prospects of network pharmacology and molecular docking technology in the field of traditional Chinese medicine research,and provides reference for expanding the research ideas of traditional Chinese medicine in treating IBS.

A Meta-analysis of Acupuncture Treatment for Irritable Bowel Syndrome

To assess the efficacy of acupuncture for treatment of irritable bowel syndrome through meta-analysis of randomized controlled trials in recent 20 years.Online databases,including CNKI,VIP,WANFANG,PubMed,Cochrane Library,Web of Science and Embase were searched for randomized controlled trials(RCTs)of acupuncture for IBS.Retrieval time was from January 1,2000 to January 31,2021.According to Jadad scoring criteria,the bias risk and quality assessment of each RCT included were evaluated by two researchers.RevMan 5.3 software was used for the metaanalysis.Eight RCTs were selected which include a total of 1181 patients.The control group has 425 patients and the experimental group has 756 patients.The result of meta-analysis indicates that the total effective rate for the experimental group was superior to that of the control group[OR=3.29,95%CI[2.16~5.03](P<0.01)],and the funnel plot was basically symmetric.Acupuncture therapy is shown to have a good safety and compliance record.However,the number of high-quality trials is small,and there are some deficiencies in the methodology of clinical research.Acupuncture,as a supplementary therapy for irritable bowel syndrome,has positive clinical significance and prospects for application.The methodology of clinical research needs to be further improved.

Effects of intradermal needle therapy plus pinaverium bromide on gastrointestinal hormone levels in irritable bowel syndrome-diarrhea patients

Objective:To observe the clinical efficacy difference in treating irritable bowel syndrome-diarrhea(IBS-D)of liver-qi stagnation and spleen-deficiency pattern with different treatment protocols,and the effects on serum levels of 5-hydroxytryptamine(5-HT),substance P(SP)and vasoactive intestinal peptide(VIP),for unveiling the mechanism of intradermal needle therapy plus pinaverium bromide in treating IBS-D.Methods:A total of 123 IBS-D patients were divided into an observation group,a Western medication group and an integrated Western and Chinese medication group using the random number table method,with 41 cases in each group.The Western medication group was given oral pinaverium bromide,50 mg each time and 3 times a day.The integrated Western and Chinese medication group was given additional Chinese herbal medicine Tong Xie Yao Fang,one dose each day.The observation group was given additional intradermal needle therapy on the basis of the Western medication group.The whole intervention lasted for 6 weeks.Before and after treatment,the scores of gastrointestinal symptoms,traditional Chinese medicine(TCM)symptoms,irritable bowel syndrome(IBS)symptom severity scale(IBS-SSS)and IBS quality of life(IBS-QOL)questionnaire,as well as the serum levels of 5-HT,SP and VIP were observed.The clinical efficacy was estimated.Results:The total effective rate was 92.7%in the observation group,68.3%in the Western medication group and 78.1%in the integrated Western and Chinese medication group.The total effective rate was higher in the observation group than in the other two groups,and higher in the integrated Western and Chinese medication group than in the Western medication group,showing statistical significance(all P<0.05).After treatment,the scores of gastrointestinal symptoms,TCM symptoms and IBS-SSS showed significant decreases in the three groups,presenting statistical significance compared with the baseline(all P<0.05);the scores of gastrointestinal symptoms,TCM symptoms and IBS-SSS were notably lower in the observation group than in the other two groups(all P<0.05),and lower in the integrated Western and Chinese medication group than in the Western medication group(all P<0.05).After treatment,the eight component scores of IBS-QOL showed significant increases in the three groups compared with the baseline(all P<0.05);the eight component scores in IBS-QOL were significantly higher in the observation group than in the other two groups(all P<0.05),and higher in the integrated Western and Chinese medication group than in the Western medication group(all P<0.05).After treatment,the serum levels of 5-HT,SP and VIP decreased markedly in the three groups compared with the baseline(all P<0.05);the serum levels of 5-HT,SP and VIP were significantly lower in the observation group than in the other two groups(all P<0.05),and lower in the integrated Western and Chinese medication group than in the Western medication group(P<0.05).Conclusion:Treatment with intradermal needle therapy plus pinaverium bromide results in significant improvements in the gastrointestinal symptoms and quality of life in patients with IBS-D of liver-qi stagnation and spleen deficiency pattern,and effectively regulates the gastrointestinal hormone production.

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.

Irritable bowel syndrome with diarrhea (IBS-D) treated with moxibustion on heat-sensitive acupoints: a randomized controlled trial

Objective To compare the effects between acupuncture combined with moxibustion on heat-sensitive acupoints and acupuncture on irritable bowel syndrome with diarrhea （IBS-D）. Methods Sixty-four cases were randomly divided into an acupuncture and moxibustion group （n=32） and an acupuncture group （n=32）. Conventional acupuncture at Tiānshū （天枢 ST 14）, Zúsānlǐ （足三里 ST 36）, Gōngsūn （公孙 SP 4） and other acupoints was used in the two groups, and moxibustion on heat-sensitive acupoints was added in the acupuncture and moxibustion group. The treatment frequency was 5 times a week, and 4 weeks were a course. After 2 courses, the therapeutic effect was evaluated. Results The clinical symptom scores after treatment in two groups decreased obviously than those before treatment （both P〈0.01）. The cured and markedly effective rate in the acupuncture and moxibustion group was 87.5% （28/32）, and that in the acupuncture group was 37.5% （12/32）, so the effect in the acupuncture and moxibustion group was better than that in the acupuncture group （P〈0.01）. The improvement of all kinds of symptom scores in the acupuncture and moxibustion group was all better than that in the acupuncture group （all P〈0.05）. Conclusion The clinical effect of acupuncture combined with moxibustion on heat-sensitive acupoints on IBS-D is better than that of acupuncture.