Irritable bowel syndrome (IBS) is a group of intestinal dysfunctional diseases with persistent or intermittent episodes of abdominal pain, abdominal distension, change in bowel habit and/or stool characteristics, and lack of structural and biochemical abnormalities in the gastrointestinal tract. Typical symptoms are abdominal pain and bloating associated with abnormal defecation, and are classified according to the main symptoms as: diarrhea-dominant; constipation-dominant; alternating diarrhea and constipation. Mental, dietary, and cold factors can induce the recurrence or aggravation of symptoms.
Etiology
1, gastrointestinal tract power disorder
2, abnormal visceral sensation
3, mental factors
4.Intestinal tract infection
5.Other
Clinical manifestations
1.Symptoms
According to the main symptoms are divided into: diarrhea-dominant; constipation-dominant; alternating diarrhea and constipation. Mental, dietary, cold and other factors can induce the recurrence or aggravation of symptoms.
(1) Abdominal pain
It is the main symptom of IBS, accompanied by abnormal stool frequency or shape, abdominal pain is mostly relieved after defecation, some patients tend to appear after eating, abdominal pain can occur in any part of the abdomen, limited or diffuse, the nature of pain is varied.
(2)Diarrhea
(1) Persistent or intermittent diarrhea, with small amount of feces, paste-like, containing a lot of mucus;
(2) Symptoms disappear after 72 hours of fasting;
③Not appearing at night, different from organic disorders;
④Some patients may be triggered by eating;
⑤ Patients may have alternating diarrhea and constipation.
(3) Constipation
Constipation can be intermittent or alternate with diarrhea, often accompanied by a sense of incomplete defecation.
(4) Abdominal distension
It is heavier during the day, especially in the afternoon, and relieved at night after sleep.
Nearly half of the patients have upper gastrointestinal symptoms such as heartburn, nausea, vomiting, etc. Extra-gastrointestinal manifestations such as back pain, headache, palpitations, urinary frequency, urinary urgency, sexual dysfunction, etc. are significantly more common than organic bowel disease, and some patients also have different degrees of psycho-psychiatric abnormalities, such as anxiety, depression, tension, etc.
2, physical signs
There are usually no positive findings, some patients have excessive sweating, rapid pulse, high blood pressure and other autonomic disorders, and sometimes sigmoid curvature or painful intestinal loops can be palpated in the abdomen.
For patients over 40 years of age, in addition to the above tests, colonoscopy and mucosal biopsy should be performed to exclude infectious and neoplastic diseases of the intestine.
The diagnosis of IBS is based on symptomatology, and the diagnosis is based on the exclusion of organic diseases, and the internationally accepted IBS Rome III diagnostic criteria are recommended.
Recurrent episodes of abdominal pain or discomfort (discomfort implies feeling uncomfortable rather than painful), with symptoms on at least 3 days per month in the last 3 months, combining 2 or more of the following.
① Relief of symptoms after defecation ;
(ii) The attack is accompanied by a change in the frequency of defecation;
(iii) change in stool characteristics (appearance) during the episode.
The symptoms have been present for at least 6 months prior to diagnosis, and the above criteria have been met in the last 3 months.
Treatment should be individualized according to the patient’s specific situation, and should actively seek and eliminate the cause to reduce symptoms:
1.Adjustment of diet
Detailed understanding of the patient’s dietary habits and their relationship to symptoms, avoiding sensitive foods, reducing gas-producing foods (dairy products, soy, lentils, etc.), high-fat foods that inhibit gastric emptying, increasing gastroesophageal reflux, and strengthening postprandial colonic motility. High-fiber foods (such as bran) can stimulate colonic motility, which has a significant effect on improving constipation.
2.Psychological and behavioral treatment
Patiently explain to the patient, including psychotherapy, biofeedback therapy, etc. For those who have insomnia, anxiety and other symptoms, appropriate sedative drugs can be given.
3.Medication
(1) Gastrointestinal antispasmodics anticholinergic drugs are most commonly used, and can also partially antagonize the gastrocolonic reflex and reduce intestinal gas production, reduce postprandial abdominal pain, calcium channel blocking drugs such as: nifedipine (nifedipine), pivetonium bromide.
(2) Gastrointestinal power-related drugs Loperamide, domperidone (morpholine), cisapride, etc.
(3) Laxatives Usually avoided, but for severe constipation can be used for a short time, preferably hemicellulose or osmotic laxatives, lactulose 15-30ml at bedtime, the effect is also better, especially for the elderly.
(4) Psychotropic drugs For patients with obvious psychiatric symptoms, appropriate sedatives, antidepressants, anxiolytics can help.
(5) Eliminate gastrointestinal flatulence Dimethicone oil, medicinal charcoal (activated carbon) has the effect of eliminating gas and removing foam, and is commonly used clinically.
(6) Intestinal probiotics Some diarrhea-type patients may have intestinal flora disorders, the application of intestinal probiotic preparations are helpful.
(7) Other 5-HT4 receptor partial agonist tegaserod is effective for constipated IBS and can significantly improve the abdominal pain symptoms of patients, and 5-HT3 receptor antagonist alosetron is effective for diarrhea-oriented IBS.