Palmer Bernard V, Lockley W John, Palmer Robert B, Kulinskaya Elena
Lister Hospital, Corey's Mill Lane, Stevenage, SG1 4AB, UK.
Int J Colorectal Dis. 2002 Nov;17(6):402-11. doi: 10.1007/s00384-001-0389-9. Epub 2002 Mar 7.
To assess the effect on irritable bowel syndrome (IBS) of treating ano-rectal problems by applying multiple Barron's bands to prolapsing mucosa and excising haemorrhoids, with or without a low lateral sphincterotomy.
144 patients with IBS whose ano-rectal abnormalities were treated by a single consultant surgeon. A prospective "within person" study of consecutive patients referred with ano-rectal problems who also had IBS symptoms according to the Rome criteria. All patients completed structured questionnaires about anal and IBS symptoms before operation and 6-60 months later. The findings were compared with those from patients who had no abdominal pains.
The principal IBS symptoms of abdominal pain, abdominal distension, and altered bowel habit all improved significantly after operation. Those with persistent anal problems had more problems with persistent IBS symptoms, but when the anal problems were corrected, the IBS tended to settle. Posterior anal tenderness is present in 80% of IBS patients and is a useful diagnostic sign.
This work suggests that in many patients with IBS there is a physical ano-rectal disorder amenable to physical treatment. Patients with IBS should all be proctoscoped carefully, with and without the patient straining, looking for abnormalities. Correcting mucosal prolapse and other anal problems produced an improvement in IBS symptoms in 86% of patients. This suggests that ano-enteric reflexes are a significant factor in irritable bowel syndrome, if not the major cause.
评估通过对脱垂黏膜应用多条巴伦氏带并切除痔疮（无论是否进行低位侧方括约肌切开术）来治疗肛肠问题对肠易激综合征（IBS）的影响。
144例患有IBS的患者，其肛肠异常由同一位顾问外科医生进行治疗。对根据罗马标准转诊来的同时患有肛肠问题及IBS症状的连续患者进行一项前瞻性“自身对照”研究。所有患者在手术前以及术后6至60个月完成了关于肛门和IBS症状的结构化问卷。将结果与无腹痛患者的结果进行比较。
术后，IBS的主要症状腹痛、腹胀及排便习惯改变均有显著改善。存在持续性肛门问题的患者，其IBS持续性症状更多，但当肛门问题得到纠正后，IBS往往会缓解。80%的IBS患者存在肛门后部压痛，这是一个有用的诊断体征。
这项研究表明，在许多IBS患者中存在一种适合物理治疗的肛肠器质性疾病。所有IBS患者都应仔细进行直肠镜检查，无论患者是否用力，以寻找异常情况。纠正黏膜脱垂和其他肛门问题后，86%的患者IBS症状得到改善。这表明肛肠反射在肠易激综合征中是一个重要因素，即便不是主要病因。
