Sach Joel A., Chang Lin
UCLA/CURE Neuroenteric Disease Program, 11301 Wilshire Blvd Bldg 115, Room 213, Los Angeles, CA 90073, USA. E-mail:
Curr Treat Options Gastroenterol. 2002 Aug;5(4):267-278. doi: 10.1007/s11938-002-0049-3.
Because treatment of irritable bowel syndrome (IBS) patients can be frustrating to the clinician and patient as well, the physician should strive to gain the patient's confidence with a concise, appropriate work-up and by offering reassurance and education that IBS is a functional disorder without significant long-term health risks. First-line treatment should be aimed at treating the most bothersome symptom. Tricyclic antidepressants are superior to placebo in reducing abdominal pain scores, as well as improving global symptom severity. Loperamide is superior to placebo in managing IBS-associated diarrhea. Whereas fiber has a role in treating constipation, its value for IBS or, specifically, in the relief of abdominal pain or diarrhea associated with IBS is controversial. Although certain antispasmodics have demonstrated superiority over placebo in managing abdominal pain, none of these agents are available in the United States. Probiotic therapy using Lactobacillus plantarum has demonstrated superiority to placebo in improving pain, regulating bowel habits, and decreasing flatulence. As studied in a recent placebo-controlled prospective study, Chinese herbal medicines significantly improved bowel symptom scores and global symptom profile, and reduced IBS-related quality of life impairment. Some of the most promising emerging therapies in IBS revolve around targeted pharmacotherapeutic modulation of serotonin receptors (ie, 5-HT3 and 5-HT4 subtypes), which are involved in sensory and motor functions of the gut. Other investigational agents that are also being explored include cholecystokinin antagonists, alpha2-adrenergic agonists (eg, clonidine), serotonin reuptake inhibitors (eg, citalopram), and neurokinin antagonists. IBS is best understood through the biopsychosocial paradigm, and therefore, its effective management requires a comprehensive multidisciplinary approach based on patient education and reassurance, enhanced by diet recommendations and lifestyle modifications, and complemented by pharmacotherapy and psychosocial intervention in more severe cases.
由于肠易激综合征（IBS）患者的治疗对临床医生和患者来说都可能令人沮丧，医生应努力通过简洁、恰当的检查以及给予保证和教育，让患者相信IBS是一种功能性疾病，没有重大的长期健康风险，从而赢得患者的信任。一线治疗应旨在治疗最困扰人的症状。三环类抗抑郁药在降低腹痛评分以及改善整体症状严重程度方面优于安慰剂。洛哌丁胺在治疗IBS相关腹泻方面优于安慰剂。虽然纤维在治疗便秘方面有作用，但其对IBS的价值，或者具体来说，对缓解与IBS相关的腹痛或腹泻的价值存在争议。尽管某些解痉药在治疗腹痛方面已证明优于安慰剂，但这些药物在美国均未上市。使用植物乳杆菌的益生菌疗法在改善疼痛、调节排便习惯和减少肠胃胀气方面已证明优于安慰剂。在最近一项安慰剂对照的前瞻性研究中，中药显著改善了肠道症状评分和整体症状概况，并减轻了与IBS相关的生活质量损害。IBS中一些最有前景的新兴疗法围绕着对5-羟色胺受体（即5-HT3和5-HT4亚型）的靶向药物调节，这些受体参与肠道的感觉和运动功能。其他正在探索的研究药物包括胆囊收缩素拮抗剂、α2-肾上腺素能激动剂（如可乐定）、5-羟色胺再摄取抑制剂（如西酞普兰）和神经激肽拮抗剂。通过生物心理社会范式能最好地理解IBS，因此，其有效管理需要基于患者教育和保证的全面多学科方法，通过饮食建议和生活方式改变加以强化，并在更严重的情况下辅以药物治疗和心理社会干预。
