Irritable bowel syndrome is a group of clinical syndromes including abdominal pain, abdominal distension, change in bowel habits and abnormal stool characteristics, mucus stools, and other manifestations that persist or recur, and on examination, the organic disease causing these symptoms can be excluded. This disease is the most common and typical kind of functional intestinal disorder.
I. Etiology
1, abnormal gastrointestinal dynamics in normal conditions, the basic electrical rhythm of the colon for the slow wave frequency 6 times / min, and 3 times / min slow wave frequency is related to the segmental contraction, of which 3 times / min slow wave in normal people accounted for only 10%, IBS to constipation, abdominal pain mainly 3 times / min slow wave frequency increased significantly up to 40%. The high amplitude contraction waves of the colon in normal people are mainly before and after eating and defecating, which are related to the long-distance propulsive movement of intestinal contents, and the high amplitude contraction waves of diarrheal IBS are significantly increased.
2, abnormal visceral perception
3, mental factors psychological stress has a significant effect on gastrointestinal motility.
4, other intolerance to certain foods and induced aggravation of symptoms. In some patients, IBS symptoms occur after the intestinal infection is cured. Certain gastrointestinal hormones may be related to the symptoms.
II. Clinical manifestations
There are three main types of IBS
1.Motility disorders as the main manifestation, such as constipation.
2, with secretion disorders as the main manifestation, such as diarrhea.
3. mixed manifestations.
The symptoms are recurrent or chronically prolonged, but the general health status is not affected. The most important clinical manifestations are abdominal pain with changes in bowel habits and stool properties. (What is spleen area syndrome)
1. Abdominal pain is more common in the lower abdomen and left lower abdomen. It is mostly relieved after defecation or exhaustion.
2, diarrhea stools are mostly in the form of thin paste, but can also be formed soft stools or thin watery. Mostly with mucus, never pus and blood. Some patients have alternating diarrhea and constipation. With the urgency of defecation, straining to defecate and not clean feeling.
3, constipation stool dry, small amount, sheep feces or fine rod-shaped, the surface can be attached mucus.
4, other gastrointestinal symptoms are mostly accompanied by abdominal distension or bloating, there may be a sense of incomplete defecation, defecation embarrassment. Some patients also have indigestion symptoms.
5, systemic symptoms quite some patients may have insomnia, anxiety, dizziness, headache and other mental symptoms. Women often have dysmenorrhea.
6.Signs are not obvious, there may be light pressure pain in a considerable part of patients, some patients can be palpated salami-like intestinal canal, rectal finger examination can feel anal spasm, high tension, there may be tenderness.
Clinical diagnosis reference standard
1, abdominal pain, diarrhea or constipation as the main complaint, accompanied by systemic neurological symptoms (symptoms persist or recur for more than 3 months).
2, good general condition, no wasting and fever, only abdominal pressure pain found on systematic physical examination.
3, repeatedly negative fecal routine and culture (at least 3 times) and negative fecal occult blood test.
4, no positive findings on X-ray barium enema, or signs of irritation in the colon.
5. colonoscopy showing hypermobility in some patients, no obvious mucus abnormalities, and basically normal histological examination.
6, normal blood and urine routine, normal blood sedimentation.
7, no history of dysentery, schistosomiasis and other parasitic diseases, and experimental treatment is ineffective.
Differential diagnosis.
1, abdominal pain should be differentiated from the diseases causing abdominal pain.
2, diarrhea should be differentiated from diseases causing diarrhea, of which lactose intolerance is common and difficult to differentiate.
3, constipation should be distinguished from diseases causing constipation, among which habitual constipation and constipation caused by adverse drug reactions are common.
Fourth, treatment
Mainly to actively search for and remove the contributing factors and symptomatic treatment, emphasizing comprehensive treatment and individualized treatment.
1.General treatment
2.Drug treatment
1, gastrointestinal antispasmodics anticholinergic drugs such as atropine, probenecid, etc. can be used as short-term symptomatic treatment for abdominal pain with heavy symptoms. Calcium channel blockers such as pivetonium bromide are effective for abdominal pain and diarrhea. The new prokinetic drug cisapride has a prokinetic effect on the colon and is effective for patients with mainly constipation.
2, antidiarrheal drugs loperamide or compound difenoxanthine, for those with heavy diarrhea symptoms, but should not be used for a long time.
3, laxatives should not be used for a long time. Hemicellulose or hydrocolloid, is the treatment of constipation more ideal drugs, such as psyllium preparations and natural polymer polysaccharides.
4, antidepressants, such as amitriptyline or promethazine, etc.
5, other intestinal flora regulation drugs, can correct intestinal flora imbalance, pro-gastrointestinal dynamics drugs, help constipation improvement.
3, psychological and behavioral therapy including psychotherapy, hypnosis, physiological feedback therapy.