Irritable bowel syndrome (IBS) refers to a group of clinical syndromes including abdominal pain, abdominal distension, change in bowel habits and abnormal stool patterns, mucus stools, etc., which persist or recur, and the organic diseases that can cause these symptoms are excluded by examination. This disease is the most common functional intestinal disorder. In a questionnaire survey conducted in the general population, the number of people with IBS symptoms was reported to be 10%-20% in Europe and the United States, and 8.7% in a group in Beijing, China. Patients are mostly young and middle-aged, and the first onset after the age of 50 is rare. The ratio of male to female is about 1:2. 1.General treatment 2.Medication 3.Psychological and behavioral therapy 4.Chinese medicine treatment Basic overview of irritable bowel syndrome Irritable bowel syndrome, also known as irritable bowel syndrome, is the most common and important functional disorder of the gastrointestinal tract, mostly seen in the prime of life, slightly less in men than in women, and very few people have the first onset after the age of 50. Irritable bowel syndrome Irritable bowel syndrome is an independent disorder of intestinal function with a specific pathophysiological basis. There is no structural defect in the intestine, but there is an excessive or abnormal response to stimuli and physiology. In the past, it was called “colonic dysfunction”, “colonic spasm”, “colonic allergy”, “spastic colitis”. “mucous colitis”, etc. Since intestinal dysfunction is not limited to the colon, it is collectively referred to as irritable bowel syndrome. It is characterized by abdominal pain, bloating, constipation or diarrhea. Irritable bowel syndrome is a global problem, and with the accelerated pace of people’s lives and changes in diet structure in recent years, the incidence of irritable bowel syndrome due to neurological, psychiatric, and infectious factors has been on the rise. It causes some disturbance to the quality of life and work. Generally speaking, young and middle-aged people are the high incidence group, among which women have more incidence than men, and mental workers are higher than manual workers. Symptoms Type of irritable bowel syndrome Constipation: with periodic constipation alternating with more frequent normal stools, frequent white mucus in the stool, cramp-like pain, paroxysmal episodes, or persistent vague pain that can be relieved after defecation. Eating often precipitates the symptoms, which can also include bloating, nausea, indigestion and heartburn. Diarrheal type: sudden onset of diarrhea especially at the beginning, or at the end of a meal. Nocturnal diarrhea is rare and is often associated with pain, bloating and rectal urgency, and can also present with fecal incontinence. The most important clinical manifestations are abdominal pain with changes in bowel habits and stool properties. 1, abdominal pain: almost all patients with IBS have abdominal pain of varying degrees. The location is variable, but it is more common in the lower abdomen and left lower abdomen. Mostly relieved after defecation or exhaustion. 2, diarrhea: generally about 3-5 times a day, a few severe episodes up to a dozen times. The stool is mostly thin paste, but can also be formed soft stool or thin watery. Mostly with mucus, some patients with little stool quality and a lot of mucus, but never pus and blood. Defecation does not disturb sleep. Some patients have alternating diarrhea and constipation. 3, constipation: difficult to defecate, dry stool, small amount, sheep feces or fine rod-shaped, the surface can be attached to mucus. 4, other gastrointestinal symptoms: mostly accompanied by abdominal distension or bloating, may have a sense of incomplete defecation, defecation embarrassment. 5, systemic symptoms: a considerable number of patients may have insomnia, anxiety, depression, dizziness, headache and other mental symptoms. 6, signs: no obvious signs, there may be light pressure pain in the corresponding part, some patients can be palpated salami-like intestinal canal, rectal finger examination can feel anal spasm, high tension, there may be tenderness. 7.Typing: According to the clinical characteristics, it can be divided into diarrhea type, constipation type, alternating diarrhea and constipation type, and flatulence type. IBS mostly starts at the age of 20~30 years old, causing symptomatic attacks, and recurring irregularly. The first attacks are rare in middle and late life. Symptoms are common when awake and rarely occur in sleeping patients. Symptoms can be triggered by stress or food intake. IBS features: pain may be relieved by bowel movements, alternating bowel habits, bloating, mucus in stool and a feeling of incomplete stool, the more symptoms present, the greater the likelihood of having IBS. Usually, the characteristics and location of abdominal pain, precipitating factors and type of bowel movements vary among patients. Changes in common symptoms or deviations from common symptoms suggest a concurrent organic condition and should be thoroughly investigated. Patients with IBS may also have extra-intestinal symptoms (e.g., fibromyalgia, headache, dyspareunia, temporomandibular syndrome). There are two main clinical types of IBS 1. Constipated IBS, with frequent constipation but different stool habits. Most patients have colonic pain in at least one or more areas, with periodic constipation alternating with more frequent normal stools. The stools often contain clean or white mucus, and the pain is strangulated, with paroxysmal episodes, or persistent vague pain that is relieved by defecation. Eating often precipitates symptoms, but also bloating, flatulence, nausea, indigestion and heartburn. 2. Diarrheal IBS, especially sudden onset of diarrhea at the beginning, during or just after eating. Nocturnal diarrhea is rare. There is often pain, bloating and rectal urgency, and fecal incontinence may also occur. Painless diarrhea is atypical and the internist should consider the possibility of other diagnoses (e.g. dyspepsia, osmotic diarrhea). Pathology The etiology of irritable bowel syndrome (IBS) is unclear, and no anatomical cause can be found. Emotional factors, diet, medications, or hormones can precipitate or exacerbate this hypertonic gastrointestinal motility. Some patients have anxiety disorders; especially phobias, adult depression and somatic symptomatization disorder. However, stress and emotional distress are not always accompanied by episodes and recurrence of symptoms. Some patients with IBS exhibit an acquired abnormal pathological behavior, for example, they tend to express their mental distress as complaints of the GI tract, usually abdominal pain. The internist should be aware of any unresolved psychological problems, including sexual abuse and somatic vices, when evaluating patients with IBS, especially those with intractable symptoms. Irritable bowel syndrome – pathogenesis 1, abnormal gastrointestinal dynamics Under physiological conditions, the basal electrical rhythm of the colon is a slow wave frequency of 6 beats/min. IBS with constipation and abdominal pain predominantly has a significantly increased slow wave frequency of 3 beats/min. 2, abnormal visceral perception Rectal balloon inflation test showed that the inflation pain threshold of IBS patients was significantly lower than that of the control group. 3, mental factors Psychological stress has a significant effect on gastrointestinal motility. A large number of surveys have shown that IBS patients have personality abnormalities, with significantly higher anxiety and depression scores than normal, and higher frequency of stressful events than normal. 4.Other About 1/3 of patients have intolerance to certain foods that induce aggravation of symptoms. In some patients, the symptoms of IBS occur after the intestinal infection is cured. Recent studies have shown that the disease may be associated with low-grade inflammation of the intestinal mucosa, such as mast cell degranulation, high expression of inflammatory mediators, etc. Pathophysiology In patients with IBS, the circular and longitudinal muscles of the small intestine and sigmoid colon are particularly sensitive to kinetic abnormalities. The proximal small intestine appears to be highly responsive to food and parasympathomimetic drugs. Small bowel transit is variable in patients with IBS, and changes in intestinal transit time are usually not associated with symptoms. Intraluminal pressure measurements in the sigmoid colon show that functional constipation can occur when colonic pouch segmentation motility is highly responsive (e.g., increased frequency and amplitude of contractions), and conversely, diarrhea is associated with reduced motility. Location of irritable bowel syndrome Patients with IBS often experience mucus hypersecretion, which is not related to mucosal injury, the cause of which is unknown, but is associated with cholinergic neural hyperactivity. In the same way that patients are prone to pain in the presence of normal amounts and qualities of gas in the intestinal lumen, pain in IBS appears to be caused by an abnormal intensity of contraction of the smooth muscle of the small intestine or by hypersensitivity to the dilatation of the small intestinal lumen. Hypersensitivity to gastrin and cholecystokinin may also be present. However, fluctuations in hormones are not consistent with clinical symptoms. Increased caloric intake of food may increase the amplitude and frequency of electromyographic activity and gastric activity. Fat intake may cause a delay in the onset of peak power, a phenomenon that is more pronounced in patients with IBS. The first days of menstruation may cause transient prostaglandin E2 elevation, leading to increased pain and diarrhea. This is not due to estrogen or progesterone, but to prostaglandin release. Clinical diagnosis Diagnostic criteria: The clinical diagnostic reference criteria for IBS established in 1986 in China are: 1. Abdominal pain, bloating, diarrhea or constipation as the main complaint, accompanied by generalized neurological symptoms (symptoms persist or recur for more than 3 months) 2. Good general condition, no wasting or fever, only findings on systemic physical examination 3. Multiple negative fecal routine and culture (at least 3 times), negative fecal occult blood test 4. No positive findings in enema examination, or signs of irritation in the colon 5, colonoscopy shows hypermotility in some patients, no obvious mucosal abnormalities, histological examination is basically normal 6, normal blood and urine routine, normal blood sedimentation 7, no history of dysentery, schistosomiasis and other parasitic diseases, experimental treatment is ineffective (Note: refers to metronidazole test treatment and discontinuation of dairy products) If the above criteria are met, the clinical diagnosis can generally be made. However, attention should be paid to differentiate from some other diseases with insidious manifestations or atypical symptoms, and those who have doubts about the diagnosis can choose relevant further tests. Differential diagnosis: abdominal pain should be differentiated from the disease causing abdominal pain. Diarrhea should be differentiated from diseases causing diarrhea, among which lactose intolerance is common and difficult to differentiate. Constipation should be distinguished from diseases causing constipation, among which habitual constipation and constipation caused by adverse drug reactions are common. Currently, the Rome criteria are mostly used internationally, and the latest Rome 3 criteria were released in 2006. The diagnosis of IBS is based on the characteristics of the stool, the duration and features of the pain, and the exclusion of other diseases by physical examination and routine diagnostic tests. Standardized criteria for the diagnosis of IBS have been established, including abdominal pain relieved by defecation, change in frequency or nature of stool, bloating or mucus. The patient’s explanation of personal problems and the patient’s general emotional state are equally important. A good doctor-patient relationship is critical to the diagnosis and outcome of treatment. On physical examination, patients with IBS generally present in a healthy state and may have abdominal tenderness on palpation, especially in the left lower abdomen, and sometimes may have a sigmoid colon that is painful on pressure. Anal finger examination is required in all patients, and pelvic examination should be performed in women. A fecal occult blood test should be performed (preferably for a period of three consecutive days). Routine examination for eggs or parasites or stool culture is rarely needed if not supported by associated travel or symptoms (e.g., fever, bloody diarrhea, acute episodes of severe diarrhea). Fibrorectosigmoidoscopy should be performed; sigmoidoscopic insertion and injection of air often induces intestinal spasm and pain. mucosa and blood vessels are often normal in patients with IBS. In patients with chronic diarrhea, especially in older women, mucosal biopsy can rule out microscopic colitis of two types: collagenous colitis, in which trichrome staining shows submucosal collagen deposits; and lymphocytic colitis, in which the mucosal lymphocyte count is increased. The average age of these patients is 60-65 years, with a female predominance. As with IBS, the presentation is nonhemorrhagic watery diarrhea, which can be diagnosed by rectal mucosal biopsy. Laboratory tests, should include a complete blood count; sedimentation; 6 or 12 biochemical profiles, which include serum amylase, urinalysis and thyroid stimulating hormone assay. Abdominal sonography, barium enema, esophagogastroduodenoscopy, or colonoscopy should be selected based on the patient’s basic history, physical examination, age, and follow-up evaluation. However, these examinations should be performed only if less invasive and less costly tests reveal abnormalities. The diagnosis of IBS should not exclude the suspicion of concomitant disease. Changes in symptoms may suggest the presence of another disease, such as changes in the localization, form and intensity of pain, changes in stool habits, constipation or diarrhea, or vice versa, and new symptoms or complaints (e.g., nocturnal diarrhea) may be clinically significant. Other symptoms that should be examined include fresh blood in the stool, weight loss, very severe abdominal pain or abnormal abdominal distention, steatorrhea or apparently foul white stool, fever or chills, persistent vomiting, vomiting of blood, symptoms that prompt the patient to awaken from sleep (e.g., pain or urgency to defecate), or persistent worsening of symptoms. Common conditions that may be confused with IBS are: lactose intolerance, diverticulosis, “drug diarrhea”, biliary tract disease, light laxative abuse, parasitic disease, bacterial enteritis, eosinophilic gastritis or enteritis, microscopic (collagenous) colitis, and early inflammatory bowel disease. The age distribution of patients with inflammatory bowel disease is bimodal, so the evaluation of both young and old patients must take these conditions into account. In patients older than 40 years, especially those without a previous history of IBS symptoms, colon polyps and tumors must be excluded by colonoscopy if there are changes in stool habits, and ischemic bowel disease should be considered in patients older than 60 years. A pelvic examination in women can help rule out ovarian tumors and cysts or uterine fibroids, as the symptoms of these diseases can be similar to IBS. In patients with diarrhea, hyperthyroidism, carcinoid syndrome, medullary thyroid carcinoma, VIP tumor, and Zollinger-Ellison syndrome should all be considered. Patients with constipation and no anatomic lesions should be considered for hypothyroidism or hyperparathyroidism. If the patient’s history and laboratory tests suggest impaired absorption, absorption assays should be performed to rule out tropical stomatitis diarrhea, celiac disease, and Whipple’s disease, and finally, for all patients with constipation that requires excessive straining during non-defecation, other diseases of the queue should be considered (e.g., pelvic floor muscle incoordination). Treatment 1. General treatment Establish good lifestyle habits. Avoid foods that induce symptoms in the diet, which varies from person to person. High-fiber foods can help improve constipation. For insomnia, anxiety can be given appropriate sedative drugs. 2, drug treatment (1) gastrointestinal antispasmodics, anticholinergic drugs can be used as short-term symptomatic treatment of abdominal pain with heavy symptoms. Calcium channel blockers such as nifedipine have certain effect on abdominal pain and diarrhea, and piviram is a calcium channel blocker that selectively acts on smooth muscle of gastrointestinal tract, so it has few side effects. (2) Antidiarrheal drugs, loperamide or compound diphenoxylate have good antidiarrheal effect and are suitable for those with heavy diarrhea symptoms, but should not be used for a long time. For general diarrhea, it is advisable to use adsorbent antidiarrheal drugs such as Simethicone and medicinal charcoal. (3) laxatives, use laxatives as appropriate for patients with constipation type, but should not be used for a long time. Hemicellulose or hydrocolloid, which is not digested and absorbed in the intestine, but has a strong hydrophilic, absorbing water and swelling in the intestinal lumen to increase the water and volume of intestinal contents, to promote intestinal peristalsis, softening the stool, is considered to be a more desirable drug for the treatment of IBS constipation. Such as psyllium preparations and natural polymeric polysaccharides. (4) antidepressants, for abdominal pain, diarrhea symptoms and the above treatment is ineffective and no significant psychiatric symptoms can be tried. (5) Combination therapy with omeprazole enteric-coated tablets, glutamate tablets and trimebutine maleate tablets. (6) Intestinal flora regulating drugs such as bifidobacterium, lactobacillus and other preparations can correct intestinal flora imbalance, effective for abdominal distension, diarrhea. Gastrointestinal motility drugs such as cisapride can help improve constipation. (7) gastrointestinal dynamics of two-way regulators: trimebutine maleate tablets, it acts on the peripheral ENS opioid receptors, direct action on the smooth muscle of the gastrointestinal tract, affect the release of gastrointestinal peptides three ways to regulate gastrointestinal dynamics disorders. 3, psychological and behavioral therapy including psychotherapy, hypnosis, biofeedback therapy, foreign reports have some efficacy. Treatment is supportive and symptomatic. Compassionate understanding and guidance by the physician is important. The physician must explain the nature of the underlying disease and convincingly confirm to the patient that no organic disease is present. This requires time to listen to the patient and explain to them the normal intestinal physiology and the hypersensitivity of the gut to stressful foods or medications. These explanations give us the basis to try to re-establish the normal pattern of bowel movements and to choose the specific therapy appropriate for the patient. The prevalence, long-term nature and need for continued treatment of IBS should be emphasized. Psychological stress, anxiety and emotional abnormalities should be sought, assessed and treated. Regular physical activity can help relieve stress and promote bowel function, especially in patients with constipation. In general, a normal diet should be resumed. Patients with bloating and gas should eat little or no beans, cabbage and other foods containing fermentable carbohydrates, and eat less apples, grape juice, bananas, various nuts and raisins to reduce the occurrence of gas. Patients who are lactose intolerant should reduce the intake of milk or dairy products. Intake of sorbitol, mannitol, fructose, or a combination of sorbitol and fructose can also cause intestinal dysfunction. Sorbitol and mannitol are artificial sweeteners used as nutritional food or as drug carriers, while fructose is an essential component of fruits, berries, and plants. A low-fat, high-protein diet can be tried in patients with postprandial abdominal pain. Increasing dietary fiber is beneficial in many patients with IBS, especially in the constipated form. Less stimulating foods such as bran can be given, starting at 15 ml (1 tablespoon) per meal and increasing as fluid intake increases. Alternatively, take a hydrophilic slurry of Plantago Ovata with two glasses of water at a time, which often stabilizes intestinal water and has a volume-increasing effect. These preparations help retain water in the intestine and prevent constipation. They also reduce colonic transit time and act as shock absorbers to prevent spasm between the intestinal walls. The addition of small amounts of fiber may also help reduce diarrhea in IBS by absorbing water and hardening the stool. However, excessive fiber application can lead to bloating and diarrhea, so fiber application should be individualized. Anticholinergic drugs (e.g., scopolamine 0.125 mg, 30-60 minutes before meals) can be used in conjunction with fiber. Narcotics, sedatives, hypnotics and other drugs that can produce dependence are not recommended. For patients with diarrhea, phenelzine 2.5-5mg (1~2 tablets) or loperamide 2-4mg (1~2 capsules) can be given before meals. Because tolerance to the antidiarrheal effect can occur, long-term application of antidiarrheal drugs is not recommended. Antidepressants (e.g., desipramine, promethazine, and amitriptyline, 50-100 mg daily) can be helpful in patients with both types of IBS. In addition to constipation and diarrhea, antidepressants may also relieve abdominal pain and bloating. These drugs can reduce pain by downregulating the activity of spinal and cortical afferent nerves from the intestine. Finally, certain aromatic oils (analgesics) may relieve spastic pain in some patients by relaxing smooth muscle. Piperine oil is the most commonly used preparation in such patients. According to the clinical manifestations of this disease, it belongs to the categories of “abdominal pain”, “constipation” and “depression” in Chinese medicine. From the point of view of the lesion, although the disease is in the large intestine, it is related to the dysfunction of the liver, spleen and stomach and other internal organs. The etiology of the disease can be summarized as follows: emotional and mental disorders lead to liver qi stagnation, liver and spleen disharmony, causing intestinal qi disorder and intestinal conduction disorder; or due to cold in the day, spleen yang weakness and loss of kidney yang, yang deficiency can not warm the middle jiao, transportation and transformation malfunction, resulting in diarrhea. In addition, diet, fatigue and cold temperature disorders can affect the dysfunction of the internal organs and cause this disease. The clinical application of Chinese medicine can receive better results, and can be divided into the following three types of treatment. Liver depression and spleen deficiency type: the symptoms are diarrhea, pain after diarrhea, belching and less food, easily irritable and good at breathing, light red tongue with thin white coating and thin string pulse. The treatment is to dredge the liver and transport the spleen and regulate the qi. The formula is selected from the formula for painful diarrhea plus or minus, with 20-30g of fried peony, 10g of fried Atractylodes macrocephala, Fructus, Chen Pi, Citrus aurantium, Gynostemma, Magnolia, 15g of Radix et Rhizoma przewalskii, 6g of Radix et Rhizoma cicada, Glycyrrhiza glabra. Spleen and kidney Yang deficiency type: the symptoms include cold form and limbs, cold pain in the abdomen, loose stools, 3-4 times a day, or diarrhea, abdominal peace after diarrhea, abdominal distension and dullness, warmth and weakness, light tongue and body fat, thin white fur, sunken and thin pulse. The tongue is pale, the fur is thin and white, and the pulse is sunken and thin. Treatment is to warm the spleen and kidney, thicken the intestines and stop diarrhea. The formula is Sishen Wan plus or minus, with 12-15g of Radix Codonopsis Pilosulae (or 15-20g of Radix Codonopsis Pilosulae), 10g each of simmered nutmeg, bone marrow, fried Atractylodes Macrocephala, Chebulus Macrocephala, Bacopa monniera, 15-30g each of fried white herbs and coix seeds, 6-10g of dried ginger, 6g each of roasted licorice, mullein and sand. Yangming heat knot type: symptoms include constipation with little stool volume, abdominal distension and pain, accompanied by dry mouth and irritability, red tongue with little moss or yellow moss and little fluid, and a string or The pulse is stringy or slightly stringy. The treatment is to nourish Yin and remove heat, moisten the intestines and clear the bowels. The formula is Zengyi Chengqi Tang with addition and subtraction, using 15-30g each of Shengdihuang and XuanShen, 6-10g each of Citrus aurantium, HouPu, DaHuang and Gardenia, 10g each of betel nut and almond, 10-20g of fire hemp, and 6g of raw licorice. Prevention The prevention of irritable bowel syndrome is also divided into pre-illness and post-illness. Prevention of irritable bowel syndrome before the disease (1) Appropriate participation in cultural and physical activities, active exercise to enhance physical fitness and prevent the disease1. (2) Try not to eat foods suspected of intolerance, such as shrimp, crab, milk, peanuts, etc. Spicy, frozen, greasy and cold foods as well as tobacco and alcohol should be avoided. At the same time, avoid laxatives and physical and chemical factors to stimulate the intestinal tract. Eat a rationed diet, do not be hungry or full, and develop good living habits. (3) The disease mostly develops when there is a heavy burden of thought, emotional tension, anxiety, anger, depression and other factors. Therefore, avoiding mental stimulation, relieving tension and maintaining an optimistic attitude are the keys to preventing this disease. Prevention of irritable bowel syndrome after the disease (1) eat less and more meals. Patients with diarrhea should eat less residue, easy to digest, low fat, high protein food; constipated people should eat multi-fiber vegetables, coarse grains, etc., to establish the habit of regular bowel movements. Avoid eating cold and stimulating foods. (2) The disease generally does not require bed rest, encourage patients to combine work and rest, and participate in appropriate work and establish good living habits. (3) The mental care of this disease is very important, the medical staff must cooperate with the family to relieve the patient’s mind, according to the examination results, let the patient understand the cause of the disease, the nature and good prognosis, in order to release the tension, establish confidence to overcome the disease. (4) This disease is generally not life-threatening. However, it is important that the symptoms of chronic disease in these patients can easily conceal new malignant lesions of the intestine. For this reason, medical practitioners should always be vigilant and pay attention to the early detection of concurrent organic lesions. In the treatment and prevention of irritable bowel syndrome, it should be noted that: patients with diarrhea should be fed with less residue and easily digestible food; while patients with constipation should develop regular bowel habits and increase foods containing more fiber, in addition to drinking more water. The irritable bowel syndrome diet care 1, avoid excessive diet. The three meals a day should be regular and quantitative, so as not to cause hunger and satiety. Experts point out that a regular and controlled diet is good for the balance of intestinal digestive and absorption functions, while uncontrolled overeating, especially overeating, can cause serious disorders of intestinal function and induce recurrence or aggravation of irritable bowel syndrome patients. Therefore, patients should pay special attention to diet moderation and reasonable arrangement of three meals a day to prevent the harm of excessive diet. 2.Prevent drinking a lot of alcohol. Alcohol can cause intestinal movement and digestion and absorption dysfunction, aggravate the symptoms of abdominal distension and abdominal pain, and large amounts of alcohol can also stimulate the intestinal mucosa, reduce local resistance and cause intestinal mucosal damage, aggravate indigestion and diarrhea. Therefore, medical experts cautioned patients with irritable bowel syndrome, must completely abstain from alcohol, be sure to do not touch the drop of alcohol. 3, do not drink coffee. For the gastrointestinal tract, coffee is a stimulating beverage, and alcohol can cause intestinal motility and digestive dysfunction, aggravating the symptoms of bloating and abdominal pain, so patients with irritable bowel syndrome better avoid drinking coffee. 4, do not eat a high-fat diet. The diet of irritable bowel syndrome patients should be light, easy to digest, less greasy as the basic principle. In any case, a high-fat diet can cause reduced digestive function, aggravate the symptoms of intestinal flatulence, and easily induce constipation, therefore, patients should limit the intake of fat, especially to strictly limit the intake of animal fat. 5, eat less gas-producing food. Gas-producing food into the intestinal tract, the decomposition of intestinal bacteria can produce a large amount of gas, causing intestinal dilation and slow intestinal peristalsis, which can lead to intestinal flatulence, abdominal pain, constipation or diarrhea and other symptoms. Studies have shown that carbonated beverages, beans, potatoes, kale, apples and grapes are all gas-producing foods, and patients must be strictly limited to consuming these foods. Identification of irritable bowel syndrome IBS should be distinguished from the following diseases: 1. malabsorption syndrome: this syndrome often has diarrhea, but fat and undigested food can be seen in the stool routine. 2. 2, chronic colitis: also often have abdominal pain and diarrhea, but mainly mucus and blood stools, colonoscopy seen in the colon mucosa congestion edema, erosion or ulceration. 3, chronic dysentery: diarrhea to pus and blood stools, fecal routine can be seen in a large number of pus and blood cells, or see dysentery bacilli, fecal culture can be seen in the growth of dysentery bacilli. 4, Cronh’s disease: often have anemia, fever, weakness and other systemic symptoms, enteroscopy can be seen “linear ulcer” or intestinal mucosa is “pavement-like” changes. Irritable bowel syndrome (IBS) is a gastrointestinal disorder that refers to a group of syndromes that include abdominal pain, bloating, abnormal bowel habits and stool patterns, mucus stools, persistent or intermittent episodes, and lack of morphological and biochemical abnormalities that can be explained. It is characterized by irritability of the bowel function. Chronic colitis is a chronic, recurrent, and multiple disease with the colon, sigmoid colon, and rectum as the site of origin. It refers to inflammatory edema, ulceration, and bleeding lesions of the intestine in the rectum and colon due to various pathogenic causes. So what is the difference between the two? Both have recurrent episodes of abdominal pain, diarrhea, and mucus stools. Although irritable bowel syndrome episodes are recurrent, they usually do not affect the general condition; while chronic colitis is often accompanied by systemic symptoms such as wasting and anemia of different procedures. The colon endoscopy, chronic colitis microscopically visible colonic mucosa rough, contact easy bleeding, with mucus bloody secretions attached, multiple erosions, ulcers, or diffuse mucosal congestion, edema, and even the formation of polyposis. x-ray barium enema shows changes such as narrowing and shortening of the intestinal canal, coarse disorganization of the mucosa, disappearance of intestinal pockets and pseudopolyposis. In the case of irritable bowel syndrome, the mucosa was only mildly edematous on microscopy, but there were no changes such as bleeding erosions and ulcers. The mucosal biopsy is normal. there are no positive findings on X-ray barium enema, or irritable colon. Hazards The appearance or exacerbation of symptoms is often associated with psychological factors or some stressful states. Some patients have symptoms of upper gastrointestinal and extraintestinal multiple dysfunction. It may also be accompanied by abnormal psycho-psychiatric manifestations such as depression, paranoia, nervousness, anxiety, hostility, etc. Other: functional constipation and constipation-type irritable bowel syndrome Functional constipation and constipation-type irritable bowel syndrome are both functional bowel disease, barium enema or colonoscopy do not show any lesions, and there is no evidence of systemic disease. The difference is that patients with IBS have abdominal pain and/or bloating and are associated with abnormal bowel movements (constipation or diarrhea). subtypes of IBS are constipation (C-IBS), diarrhea (D-IBS), and alternating (A-IBS). Among these, the Rome II diagnostic criteria for C-IBS emphasize the presence of decreased stool frequency, hardened stools, and difficulty in defecation in patients.