Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA.
Sleep Med. 2011 Jun;12(6):610-3. doi: 10.1016/j.sleep.2011.03.007. Epub 2011 May 13.
Restless legs syndrome (RLS) is linked to gastrointestinal disorders. The prevalence of irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) in RLS patients was determined.
RLS subjects were recruited from unbiased ads that did not mention gastrointestinal symptoms. RLS diagnosis was confirmed by a neurologist and utilized the International RLS Study Group criteria. General population controls (GPC) were spouses of gastrointestinal clinic patients and were excluded for RLS. Completely healthy controls (CHC) were excluded for RLS and gastrointestinal symptoms. IBS was diagnosed by Rome II criteria. SIBO was diagnosed by the lactulose breath test (LBT).
There were 32 RLS subjects (23F/9M; 57 yo), 25 GPC (13F/12M; 58 yo) and 30 CHC (19F/11M; 44 yo). Twenty-nine had RLS unassociated with other GI diseases, one had celiac disease, and two had gastric resections. IBS was diagnosed in 28% of RLS subjects compared to 4% GPC (p=0.0317). SIBO was diagnosed in 69% of RLS subjects compared to 28% of GPC (p=0.0033) and 10% of CHC. Using a false positive rate of 10%, 59% of positive LBT results are associated with RLS.
IBS and SIBO are common in RLS. Three hypotheses developed are (a) RLS patients are selectively immunocompromised or genetically predisposed and thus more subject to SIBO; (b) SIBO leads to autoimmune changes, and subsequent auto-antibodies attack brain and/or peripheral nerves and (c) SIBO inflammation leads to increased hepcidin and CNS iron deficiency which, in turn, leads to RLS. These hypotheses bear further investigation.
不宁腿综合征（RLS）与胃肠道疾病有关。本研究旨在确定 RLS 患者中肠易激综合征（IBS）和小肠细菌过度生长（SIBO）的患病率。
通过不提及胃肠道症状的无偏广告招募 RLS 受试者。RLS 诊断由神经病学家确认，并采用国际 RLS 研究组标准。一般人群对照（GPC）为胃肠诊所患者的配偶，排除 RLS 患者。完全健康对照（CHC）排除 RLS 和胃肠道症状。IBS 采用罗马 II 标准诊断。SIBO 采用乳果糖呼气试验（LBT）诊断。
共有 32 名 RLS 患者（23 名女性/9 名男性；57 岁）、25 名 GPC（13 名女性/12 名男性；58 岁）和 30 名 CHC（19 名女性/11 名男性；44 岁）。29 名 RLS 患者与其他胃肠道疾病无关，1 名患有乳糜泻，2 名接受过胃切除术。与 4%的 GPC 相比，28%的 RLS 患者被诊断为 IBS（p=0.0317）。与 28%的 GPC 和 10%的 CHC 相比，69%的 RLS 患者被诊断为 SIBO。使用假阳性率为 10%，59%的阳性 LBT 结果与 RLS 相关。
IBS 和 SIBO 在 RLS 中很常见。提出了三个假设：（a）RLS 患者选择性免疫功能低下或遗传易感性，因此更容易发生 SIBO；（b）SIBO 导致自身免疫变化，随后自身抗体攻击大脑和/或外周神经；（c）SIBO 炎症导致铁调素增加和中枢神经系统铁缺乏，进而导致 RLS。这些假设需要进一步研究。
