Irritable bowel syndrome (IBS) is a common functional bowel disease characterized by abdominal pain or discomfort that is relieved by defecation, often accompanied by changes in bowel habits and lacking morphological and biochemical abnormalities that could explain the symptoms. Epidemiological studies around the world have reported that IBS is a worldwide multimorbidity. IBS symptoms often overlap with those of other functional gastrointestinal diseases, including functional dyspepsia. IBS symptoms often affect the patient’s school, life and work, causing different degrees of negative impact on the patient’s quality of life. Compared to normal people, IBS patients are more likely to seek medical help and incur high medical costs. Patients who miss work or school due to the disease also suffer from concise financial losses. Therefore, IBS is a clinical and social problem that deserves attention.
Overall, the etiology and pathogenesis of IBS are not well understood. Available findings suggest that the development of IBS is associated with the following factors: (1) abnormal gastrointestinal motility. Some diarrheal IBS exhibit hyperintestinal dynamics such as shortened gastrointestinal transit time and increased colonic contractions, while some constipated IBS may exhibit hyperkinetic bowel movements. (ii) Increased visceral sensitivity. The rectal balloon dilation test shows that IBS patients have a decreased pain threshold and increased sensitivity to mechanical stimuli such as rectal dilation. (iii) Abnormalities in central nervous system perception. Functional magnetic resonance studies have shown that the brain response areas elicited by rectal balloon dilatation stimulation in IBS patients are different from those in normal subjects, and that the brain response areas differ between diarrheal IBS and constipated IBS. ④ Abnormal brain-gut axis regulation. Abnormalities in the central nervous system processing of intestinal afferent signals and regulation of the enteric nervous system may be related to the symptoms of IBS. ⑤ Intestinal infection and inflammatory response. Some studies have shown that some patients develop IBS after acute bacterial infection of the intestine, and the relationship between the mucosal inflammatory response caused by intestinal infection, increased permeability and activation of immune function and the development of IBS deserves further study. 6) Psychosomatic abnormalities. Some patients have psychosomatic abnormalities such as anxiety, stress, depression, insomnia, etc. Psychosomatic stress can also induce or aggravate IBS symptoms, indicating that psychosomatic factors are closely related to IBS.
Diagnosis of irritable bowel syndrome I. Diagnostic criteria and typing (a) Diagnostic criteria: The Rome criteria, which are currently internationally accepted, are recommended. 2006 Rome III diagnostic criteria for diagnosis*: Recurrent episodes of abdominal pain or abdominal discomfort#, with at least 3 days of episodes per month in the last 3 months, accompanied by 2 or more of the following: 1. Improvement of symptoms after defecation; 2. Change in frequency of defecation during episodes; 3. Episodes accompanied by changes in stool properties (appearance).
Note: *Abdominal discomfort is a feeling of discomfort, not pain; # Symptoms have been present for at least 6 months prior to diagnosis, and the following diagnostic criteria have been met in the last 3 months.
The following symptoms are not included in the diagnostic criteria but are supportive of the diagnosis, including abnormal bowel frequency (① less than 3 bowel movements per week, or ② more than 3 bowel movements per day); abnormal stool characteristics (③ dry fecal balls or hard stools, or ④ paste-like stools/dilute watery stools); ⑤ straining to defecate; ⑥ feeling of urgency, incomplete defecation, mucus stools, and abdominal distention.
The frequency thresholds of abdominal pain/abdominal discomfort used in the Rome III criteria are mainly based on relevant research data and are somewhat arbitrary and can be appropriately adjusted according to the purpose of application. It is recommended that the frequency of episodes of abdominal pain or abdominal discomfort be set to at least 2 days per week when screening eligible subjects in pathophysiological studies and clinical trials.
(II) Typology: Type 1-2 for constipation Type 6-7 for diarrhea Type 1 Discrete dry fecal balls, like nuts, difficult to pass Type 2 Salami-like, multiple pieces Type 3 Salami-like, with fissures on the surface Type 4 Salami-like or snake-like, smooth and soft Type 5 Soft masses with clear edges (easy to pass) Type 6 Soft flakes with hairy edges, or paste-like feces Type 7 Watery feces, without solid components Treatment The aim of treatment is to eliminate patient concerns, improve symptoms and improve the quality of life. The principles of treatment are based on a good doctor-patient relationship, symptom treatment according to the main symptom types and graded treatment according to the severity of symptoms. Pay attention to the individualization and comprehensive use of treatment measures.
1.Establishment of good doctor-patient relationship Health education for patients, comfort and establishment of good doctor-patient relationship is an effective and economical treatment method, and the basis for effective implementation of all treatment methods.
2.Dietary treatment Poor eating habits and dietary structure can aggravate the symptoms of IBS. Therefore, a healthy and balanced diet can help reduce the symptoms of gastrointestinal disorders. ②Drinking large amounts of alcohol. ③Caffeine. ④High-fat diet. ⑤ Certain vegetables and beans with “gas-producing” effects. ⑥refined foods and artificial foods (for constipation), sorbitol and fructose (for diarrhea). (7) Intolerant foods (varies from individual to individual). Increasing dietary fiber is mainly used for IBS patients with mainly constipation type, and the method of increasing dietary fiber intake should be individualized.
Although there is no single drug that can completely treat all types of IBS, it has been proven that there are many drugs that can improve the symptoms of IBS in different degrees and with different targets. Commonly used drugs include: ① antispasmodics, ② antidiarrheal drugs, ③ laxative drugs, ④ intestinal power sensory modulation drugs, ⑤ probiotics, ⑥ antidepressants, ⑦ Chinese medicine treatment.
4.Psychological and behavioral treatment Those who have severe and persistent symptoms and those who have failed in general treatment and medication should be considered for psychological and behavioral treatment. This includes psychotherapy, cognitive therapy, hypnotherapy, biofeedback, etc. (Gastrointestinal Dynamics Group of the Chinese Society of Gastroenterology, Changsha, 2007)