What is Irritable Bowel Syndrome?

Irritable bowel syndrome (IBS) is a group of persistent or intermittent episodes characterized by abdominal pain, bloating, defecation habits, and / or changes in stool characteristics as clinical manifestations, and the absence of gastrointestinal structure and abnormal biochemical abnormalities Dysfunctional diseases. Rome classifies it as a type of functional bowel disease. The patients are mainly young and middle-aged. The age of onset is more common in 20-50 years. Women are more common than men. They have a tendency to cluster in families. They are often associated with other gastrointestinal disorders. Coexisting diseases such as functional dyspepsia. According to the characteristics of stool, IBS is divided into four clinical types: diarrhea type, constipation type, mixed type and indefinite type. In China, diarrhea is the most common type.

Basic Information

English name: irritable bowel syndrome
Visiting department: Gastroenterology
Multiple groups: 20-50 years old female

Common causes: Mostly related to mental factors, stress states and bowel dysfunction
Common symptoms: Abdominal pain, bloating, diarrhea, constipation, heartburn, nausea, vomiting
Contagious: no

Causes of irritable bowel syndrome

The etiology and pathogenesis of IBS is not very clear. It is considered to be the result of a combination of various factors such as abnormal gastrointestinal motility, visceral paresthesia, abnormal brain and bowel regulation, inflammation, and psychology.

Gastrointestinal dysfunction

Gut dynamics is an important pathophysiological basis for the occurrence of IBS symptoms. IBS patients with predominantly diarrhea showed hyperintestinal motility, the intestinal transit time was significantly shortened, and the mean and maximum values of colonic motility index and high amplitude propulsive contraction were significantly improved. The opposite is true for constipated IBS, which manifests as intestinal motility.

2. Visceral paresthesia

Studies have found that most patients with IBS have clinical characteristics of hypersensitivity to luminal (rectal) dilation. The average pain threshold is reduced, the degree of discomfort after rectal dilatation is enhanced, or there is abnormal visceral-body radiation pain, suggesting that spinal cord levels process visceral sensory signals. The exception.

3. Central paresthesia

Studies have shown that the central pathway of visceral pain in IBS patients is different from that in normal people, and the brain response area between diarrhea-type IBS and constipation-type IBS is also different.

4. Abnormal brain-gut axis regulation

IBS patients have central nervous system processing of intestinal afferent signals and abnormal regulation of the enteric nervous system.

5. Intestinal infection and inflammatory response

Studies have shown that the risk of IBS is significantly increased after acute intestinal infection, so acute intestinal infection is considered as one of the risk factors for inducing IBS. The relationship between mucosal inflammatory response, increased permeability and immune function activation caused by intestinal infection and the pathogenesis of IBS is worth further study.

6. Psychological factors

IBS patients often have psychological abnormalities such as anxiety, tension, and depression. At the same time, psychosocial stress can also induce or aggravate IBS symptoms, indicating that psychosocial factors are closely related to IBS.

Clinical manifestations of irritable bowel syndrome

IBS has no specific symptoms, but has some characteristics compared to organic gastrointestinal diseases: slow onset and intermittent attacks; long duration but unaffected general health; symptoms appear or exacerbate often associated with mental factors or stress Condition-related; obvious during the day and reduced after sleep at night.

Symptoms

(1) Abdominal pain or abdominal discomfort are the main symptoms of IBS, accompanied by abnormal stool frequency or shape. Abdominal pain is relieved after defecation, and some patients are prone to appear after eating. Abdominal pain can occur in any part of the abdomen, localized or diffuse. The nature of pain is diverse. Abdominal pain does not increase progressively, and there are very few people who wake up after sleep at night.

(2) Diarrhea Persistent or intermittent diarrhea, with a small amount of feces, which is pasty and contains a lot of mucus; Symptoms disappear after 72 hours of fasting; Does not appear at night, which is different from organic disorders; Induced by eating; Patients may have alternating diarrhea and constipation.

(3) Constipation Difficulty in defecation, dry stool, small amount, can carry more mucus, constipation can be intermittent or alternate with diarrhea, often accompanied by incontinence of defecation.

(4) Abdominal distension is heavier during the day, especially at noon, and relieved after sleep at night.

(5) Upper gastrointestinal symptoms Nearly half of the patients have upper gastrointestinal symptoms such as burning sensation, nausea, and vomiting.

(6) Parenteral symptoms Parenteral manifestations such as back pain, headache, palpitations, frequent urination, urgency, and sexual dysfunction are more common than organic bowel disease, and some patients have different levels of psychological and psychological abnormalities such as anxiety , Depression, nervousness, etc.

2. Signs

Usually there are no positive findings or only mild tenderness in the abdomen. Some patients have symptoms of autonomic nervous disorders such as sweating, fast pulses, and high blood pressure. Sometimes they can touch the sigmoid flexure or painful bowel in the abdomen. Digital rectal examination can feel anal spasm, high tension, and tenderness.

Irritable bowel syndrome examination

The aim is to rule out organic lesions. Negative routine stool cultures have been negative for multiple (at least 3) times. The fecal occult blood test has been negative, hematuria is normal, erythrocyte sedimentation is normal, and thyroid, liver, gall, pancreas, and kidney functions are normal. For patients over 40 years of age, in addition to the above examinations, colonoscopy and mucosal biopsy are required to exclude intestinal infectious and tumorous diseases. Barium enema X-rays and abdominal ultrasound are also commonly used for exclusion diagnosis.

Irritable bowel syndrome diagnosis

The IBS diagnostic criteria are based on symptomology. The diagnosis is based on the exclusion of organic diseases. It is recommended to use the currently internationally recognized IBS Rome III diagnostic criteria:

Recurring abdominal pain or discomfort (discomfort means feeling uncomfortable rather than pain). At least 3 days in each month within the past 3 months, symptoms appear, combined with 2 or more of the following: symptoms relieve after defecation; at the time of onset Accompanied by changes in defecation frequency; accompanied by changes in stool characteristics (appearance).

The symptoms appear for at least 6 months before diagnosis, and the above criteria are met in the last 3 months.

The following symptoms are supportive for diagnosis, including abnormal defecation frequency (less than 3 defecations per week, or more than 3 defecations per day); abnormal fecal characteristics (dry or hard feces, or mushy / dilute feces) Dung); laborious defecation; urgency of defecation, endless defecation, mucus and abdominal distension.

Irritable bowel syndrome treatment

The current treatment of IBS is limited to symptomatic treatment. The gastrointestinal dynamics group of the Chinese Medical Association Gastroenterology Branch stated in the "Consensus on the diagnosis and treatment of irritable bowel syndrome": "The purpose of treatment is to eliminate patient concerns, improve symptoms and improve quality of life. The principle of treatment is to build on good medicine Based on the relationship between patients and patients, symptomatic treatment according to the main symptom types and hierarchical treatment according to the severity of the symptoms. Pay attention to the individualization and comprehensive application of treatment measures. "

1. adjust your diet

Learn more about the patient's eating habits and their relationship with symptoms, avoid sensitive foods, avoid excessive fats and irritating foods such as coffee, strong tea, alcohol, etc., and reduce the intake of gas-producing foods (dairy products, soybeans, lentils, etc.) . High-fiber foods (such as bran) can stimulate colon movement and have a significant effect on improving constipation.

2. Psychological and behavioral therapy

Patients are explained patiently, including psychotherapy, biofeedback therapy, etc. For those who have insomnia, anxiety and other symptoms, sedative drugs can be given appropriately.

3. Drug treatment

(1) Antispasmodics At present, the more commonly used are selective intestinal smooth muscle calcium channel antagonists, or ion channel modulators. Anticholinergic drugs such as atropine, belladonna, and scopolamine can also improve the symptoms of abdominal pain, but attention should be paid to adverse reactions.

(2) Laxatives Laxatives can be used for constipation. Volumetric laxatives such as methylcellulose and osmotic laxatives such as polyethylene glycol and lactulose can be tried. Irritant laxatives should be used with caution.

(3) Antidiarrheal agents, such as loperamide or compound benzidine, can improve diarrhea. Pay attention to adverse reactions such as constipation and bloating. Mild patients can use octahedral montmorillonite and other adsorbents.

(4) Prokinetic agent Suitable for patients with abdominal distension and constipation. Commonly used are cisapride or mosapride.

(5) Visceral analgesics Somatostatin and its analogs, such as octreotide, have the effect of alleviating physical and visceral pain. 5-HT ₃ receptor blockers such as alosetron can improve abdominal pain and stool frequency in patients with diarrhea, and can cause adverse reactions such as ischemic colitis. It should be used with caution. Some 5-HT ₄ receptor agonists have been discontinued because of their increased risk of cardiovascular ischemic events.

(6) Antipsychotics Symptoms, antidepressants, and anxiolytics can be helpful to patients with severe abdominal pain and the above treatments are ineffective, especially those with obvious mental symptoms.

(7) Probiotics can adjust the ecological balance of the intestinal microflora of the host, and is suitable for IBS patients with intestinal flora imbalance.

4. Chinese medicine treatment

Traditional Chinese medicine classifies IBS into syndromes such as large intestine dryness and heat syndrome, cold and heat mixed syndrome, spleen and stomach weakness syndrome, liver qi multiplication of spleen syndrome, liver depression and qi stagnation syndrome, and other methods have achieved certain effects on the treatment of IBS through syndrome differentiation and acupuncture. Further research in the future.