Drossman D A
UNC Functional GI Disorders Center, University of North Carolina at Chapel Hill 27599-7080, USA.
Aliment Pharmacol Ther. 1999 May;13 Suppl 2:3-14. doi: 10.1046/j.1365-2036.1999.0130s2003.x.
Our understanding of the pathophysiology of irritable bowel syndrome (IBS) has evolved from a disorder of motility to a more integrated understanding of enhanced motility and visceral hypersensitivity associated with brain-gut dysfunction. Psychosocial factors contribute to the predisposition, precipitation and perpetuation of IBS symptoms, and affect the clinical outcome. Newer brain imaging techniques (e.g. PET, fMRI) may help us understand the relationship between altered emotional states with pain enhancement and other gastrointestinal symptoms. Diagnosis using symptom-based (e.g. Rome) criteria and a conservative diagnostic approach is recommended. Treatment is based on an effective physician-patient relationship and a combined pharmacological and behavioural approach. Newer medications acting at the 5-HT receptor may help in reducing pain and bowel dysfunction. For more severe pain, antidepressants may be considered.
我们对肠易激综合征（IBS）病理生理学的理解已从一种动力障碍性疾病，发展为对与脑-肠功能障碍相关的动力增强和内脏超敏反应的更全面理解。心理社会因素促成了IBS症状的易感性、发作和持续存在，并影响临床结果。更新的脑成像技术（如正电子发射断层扫描、功能磁共振成像）可能有助于我们理解情绪状态改变与疼痛加剧及其他胃肠道症状之间的关系。建议采用基于症状的（如罗马）标准和保守的诊断方法进行诊断。治疗基于有效的医患关系以及药物和行为相结合的方法。作用于5-羟色胺（5-HT）受体的新型药物可能有助于减轻疼痛和肠道功能障碍。对于更严重的疼痛，可考虑使用抗抑郁药。
