Corney R H, Stanton R, Newell R, Clare A, Fairclough P
Department of Psychological Medicine, St Bartholomews Hospital, London, U.K.
J Psychosom Res. 1991;35(4-5):461-9. doi: 10.1016/0022-3999(91)90041-l.
The irritable bowel syndrome is a highly prevalent condition whose underlying aetiology is not understood. While many patients respond to a combination of gastrointestinal antispasmodics, bulking agents and dietary manipulation, controlled clinical trials have suggested that the benefit is only marginal and is due mainly to the large placebo effect found in this condition, which has been calculated to range between 54 and 81%. Associations between the syndrome and psychological and social stresses suggest, however, that treatment involving a systematic approach to the management of symptoms may hold out real therapeutic possibilities. In the current study, 42 IBS patients were randomly allocated to either medical treatment or to behavioural psychotherapy with a nurse therapist. They were assessed initially and at 4 and 9 months. There was a general improvement over the 9 months on a number of physical and psychological symptoms measured. However, no differences were found between treatment groups except for changes in two avoidance scores. A significant correlation was found, however, between improvement in the bowel symptoms of IBS (stomach pain and diarrhoea) and improvement in the psychological symptoms measured by the Clinical Interview Schedule, suggesting a close interrelationship between the two.
肠易激综合征是一种高度常见的病症，其潜在病因尚不清楚。虽然许多患者对胃肠解痉药、容积性泻药和饮食调整的联合治疗有反应，但对照临床试验表明，这种治疗的益处甚微，主要是因为该病症存在较大的安慰剂效应，据计算，安慰剂效应在54%至81%之间。然而，该综合征与心理和社会压力之间的关联表明，采用系统方法管理症状的治疗可能具有真正的治疗潜力。在当前的研究中，42名肠易激综合征患者被随机分配接受药物治疗或由护士治疗师进行行为心理治疗。在研究开始时以及4个月和9个月时对他们进行了评估。在所测量的一些身体和心理症状方面，9个月内总体有所改善。然而，除了两个回避分数的变化外，各治疗组之间未发现差异。不过，发现肠易激综合征的肠道症状（胃痛和腹泻）的改善与临床访谈量表所测量的心理症状的改善之间存在显著相关性，这表明两者之间存在密切的相互关系。
