Grover Madhusudan, Herfarth Hans, Drossman Douglas A
Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7080, USA.
Clin Gastroenterol Hepatol. 2009 Jan;7(1):48-53. doi: 10.1016/j.cgh.2008.08.032. Epub 2008 Sep 3.
Gastroenterologists often encounter situations when the clinical and pathophysiological features that typically distinguish functional from organic disorders overlap. This "blurring of boundaries" can occur with post-infectious irritable bowel syndrome (PI-IBS), a subset of IBS and a newly described entity IBD-IBS. The key associating features include pain and usually diarrheal symptoms that are disproportionate to the observed pathology, microscopic inflammation, and often a co-association with psychological distress. A previous initiating gastrointestinal infection is required for PI-IBS and assumed for IBD-IBS. Using this perspective we discuss the clinical and pathophysiological features of PI-IBS and IBD-IBS and the growing evidence for the overlapping features of these two disorders in terms of alteration of gut flora, immune dysregulation, and role of stress. A unifying model of PI-IBS and IBD-IBS is proposed that may have important clinical and research implications. It obligates us to reframe our understanding of illness and disease from the dualistic biomedical model into a more integrated biopsychosocial (BPS) perspective.
区分功能性疾病和器质性疾病的典型临床及病理生理特征出现重叠。这种“界限模糊”可能出现在感染后肠易激综合征（PI-IBS）中，它是肠易激综合征（IBS）的一个子集，也是一种新描述的疾病——炎症性肠病-肠易激综合征（IBD-IBS）。关键的相关特征包括疼痛，通常还有腹泻症状，这些症状与观察到的病理改变、微观炎症不相称，且常与心理困扰同时出现。PI-IBS需要有先前引发的胃肠道感染，IBD-IBS也假定有此情况。从这个角度出发，我们讨论了PI-IBS和IBD-IBS的临床及病理生理特征，以及在肠道菌群改变、免疫失调和应激作用方面这两种疾病重叠特征的越来越多的证据。我们提出了一个PI-IBS和IBD-IBS的统一模型，这可能具有重要的临床和研究意义。它使我们有必要将对疾病的理解从二元生物医学模式重新构建为更综合的生物心理社会（BPS）视角。
