Irritable bowel syndrome (I13S) is a functional bowel disease characterized by abdominal pain or abdominal discomfort with altered bowel habits, which lacks morphological changes and biochemical abnormalities that could explain the symptoms.The pathophysiological basis of IBS is mainly abnormal gastrointestinal dynamics and visceral perception, and the mechanisms responsible for these changes are not fully elucidated. Psychosocial factors are known to be closely related to the pathogenesis of IBS. In recent years, it has been noted that acute infection of the intestinal tract can cause IBS in susceptible individuals. dysregulation of neuroendocrine regulation of the brain-gut axis and abnormalities of the intestinal immune system that affect this regulation have also received attention in recent years.
I. Diagnostic criteria, typing and diagnostic steps 1. Diagnostic criteria: The internationally accepted IBS Rome II diagnostic criteria proposed in 1999 are recommended.
(1) At least 12 weeks of accumulated abdominal pain or abdominal discomfort in the past 12 months (need not be continuous), accompanied by 2 of the following 3 symptoms (abdominal pain or abdominal discomfort relieved after defecation; accompanied by change in the number of bowel movements; accompanied by change in stool characteristics).
(2) The following symptoms are not necessary for the diagnosis, but they are common symptoms of IBS, and the more these symptoms are present, the more they support the diagnosis of IBS: abnormal bowel frequency (>3 bowel movements per day or <3 bowel movements per week); abnormal stool characteristics (lumpy/hard stool or watery stool); abnormal stool elimination process (effort, urgency, unclean bowel movement); mucus stool; and gastrointestinal distention or abdominal distension. (3) Lack of morphological changes and biochemical abnormalities that could explain the symptoms. 2. Typing: According to clinical symptoms (① defecation <3 times a week; ② defecation >3 times a day; ③ lumpy or hard stool; ④ loose stool or watery stool; ⑤ straining to defecate; ⑥ feeling of urgency in defecation), it can be divided into diarrhea-based type (meeting ②, ④, ⑥ items 1 or more, but no ①, ③, ⑤ items; or having ②, ④, ⑥ items 2 or more, with ①, ⑤ items 1, but no ③ items); constipation-based type ( (one or more of ①, ③, ⑤, but not ②, ④, ⑥; or two or more of ①, ③, ⑤, but one of ②, ④, ⑥) and alternating type of diarrhea and constipation (the above symptoms appear alternately).
3. Diagnostic steps: IBS diagnostic criteria are based on symptomatology. The Rome II diagnostic criteria are a modification of the previously proposed diagnostic criteria based on evidence from recent epidemiological and clinical studies.
The diagnostic criteria reflect the following important principles: the diagnosis should be based on the exclusion of organic diseases; IBS is a functional intestinal disease; the relationship between abdominal pain or abdominal discomfort and defecation is emphasized, reflecting that IBS as a specific syndrome is different from other functional intestinal diseases (such as functional diarrhea, functional constipation, functional abdominal pain, etc.). This diagnostic criterion extends the time period for judgment to 12 months, stipulating that symptoms are present for at least 12 weeks during this period, but can be discontinuous, thus reflecting the chronic and recurrent nature of the disease and reducing the chance of missing organic diseases, especially intestinal tumors. The diagnostic criteria do not stipulate the number of bowel movements and fecal characteristics, but only emphasize the abdominal discomfort or abdominal pain accompanied by changes in the number of bowel movements and fecal characteristics, so that more cases can be diagnosed and the sensitivity of the diagnosis can be improved. The diagnosis of IBS is made on the basis of strict adherence to the above diagnostic criteria and exclusion of organic diseases. The selection of examination methods requires not only not to miss organic diseases, but also to minimize unnecessary tests so as not to increase the economic and mental burden of patients.
(1) Detailed history taking and careful systematic physical examination are essential. When “alarming symptoms and signs” are found, including fever, weight loss, blood in stool or black stool, anemia, abdominal masses and other symptoms and signs that cannot be explained by functional diseases, relevant tests should be performed to thoroughly clarify the etiology; the recent appearance of persistent If there is a recent and persistent change in stool habit (frequency, trait) or a form different from previous episodes or a gradual worsening of symptoms, if there is a family history of colorectal cancer, or if the patient is over 40 years old, colonoscopy or barium enema x-ray should be included as routine. For those who do not have the above conditions, are under 40 years old, are in good general condition, and have typical IBS symptoms, stool routine is a necessary test. Relevant tests can be selected as appropriate, or treatment can be given first, and further tests can be selected depending on the response to treatment.
(2) Based on the clinical manifestations and the organic diseases that need to be identified, relevant laboratory and instrumental tests are selected.
The following items are the basic necessary tests for research cases: routine blood, urine and feces, fecal bacterial culture; blood biochemistry (blood glucose, liver and kidney function tests), blood sedimentation; colonoscopy or barium enema x-ray; abdominal ultrasound examination.
(3) Follow up helps to detect occult organic diseases.
Second, the principles of treatment 1, general treatment: tell the patient the diagnosis of IBS and explain the nature of the disease in detail to relieve the patient’s concerns and improve confidence in treatment. Through detailed medical history, understand patients’ reasons for seeking medical treatment (e.g. cancer-phobia), provide targeted explanations, and try to find out the triggering factors and remove them. Provide advice on dietary and lifestyle adjustments. Provide appropriate sedatives to those with insomnia and anxiety.
2.Pharmacological treatment: For those with obvious symptoms, drugs can be used to control symptoms as appropriate, commonly used drugs include: antispasmodics [anticholinergic drugs such as atropine, bromoproterenol (probenecid) can be used for abdominal pain, but attention should be paid to adverse reactions. Relatively specific calcium channel antagonists for intestinal smooth muscle such as pivetonium bromide may also be used]; antidiarrheal agents (loperamide or compound diphenoxylate may be used for diarrhea, but attention should be paid to adverse reactions such as constipation and abdominal distension. Mild cases can be used adsorbents, such as double octahedral montmorillonite, etc.); laxative (constipation can be used laxative, generally advocate the use of mild action of light laxative to reduce adverse reactions and drug dependence. Commonly used are volume-forming drugs such as oxytocin or methylcellulose, osmotic laxatives such as polyethylene glycol, lactulose or sorbitol); intestinal power sensory modulation drugs (newly reported 5 a hydroxytryptamine receptor partial agonist tegaserod is effective in improving constipation, abdominal pain, abdominal distension, for constipation type IBS); antidepressants (for abdominal pain symptoms and the above treatment is not effective, especially with more obvious psychiatric symptoms can be tried).
3.Psycho-behavioral therapy: Those with severe and stubborn symptoms and ineffective general treatment and medication should be considered for psycho-behavioral therapy. These therapies include psychotherapy, cognitive therapy, hypnotherapy, biofeedback, etc.
4.Other: In recent years, there are reports of using probiotics to treat IBS, but further research on its efficacy and mechanism of action is needed.
5.Chinese herbal medicine treatment