Voß Ulrike, Lewerenz Anne, Nieber Karen
University of Leipzig, Leipzig, Germany.
Handb Exp Pharmacol. 2012(214):473-97. doi: 10.1007/978-3-642-30726-3_21.
Patients with functional gastrointestinal disorders constitute the majority of patients seeking healthcare for gastrointestinal symptoms in primary and secondary care. Of these disorders irritable bowel syndrome (IBS) is one of the most common and affects 10-20% in the Western world. IBS is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. Sex and gender aspects are important in understanding differences between men and women in their risk and experience of IBS. Relative to men, women are diagnosed more frequently with IBS. Female patients are more likely to be constipated, complain of abdominal distension and of certain extracolonic symptoms. Given the variability of IBS, the most successful treatment will be comprehensive, involving multiple strategies. Efficacy, safety and tolerability are important in the evaluation of IBS therapies, as patients are likely to require long-term treatment. Laxatives, antidiarrheals or antispasmodics are common in the treatment of IBS but the majority of patients receive antispasmodics followed by prokinetic agents. In treatment of IBS there appears to be a greater clinical response to serotonergic agents developed for IBS in women compared to men. There is an absence of drugs licensed specifically for the treatment of IBS. Further studies with novel agents are needed, to evaluate new approaches to IBS management including gender specific behavioral therapies and better characterization of patient subgroups with regard to drug therapy so that personalized therapy can be tested.
在初级和二级医疗保健中，因胃肠道症状寻求医疗服务的患者中，功能性胃肠疾病患者占大多数。在这些疾病中，肠易激综合征（IBS）是最常见的疾病之一，在西方世界，其发病率为10%-20%。IBS是一种功能性肠道疾病，其特征为慢性腹痛、不适、腹胀以及在无任何可检测到的器质性病因情况下的排便习惯改变。性别因素在理解男性和女性患IBS的风险及患病体验差异方面很重要。相对于男性，女性被诊断为IBS的频率更高。女性患者更易出现便秘，主诉腹胀及某些结肠外症状。鉴于IBS的变异性，最成功的治疗方法将是综合性的，涉及多种策略。疗效、安全性和耐受性在IBS治疗评估中很重要，因为患者可能需要长期治疗。泻药、止泻药或解痉药在IBS治疗中很常见，但大多数患者接受的是解痉药，其次是促动力药。在IBS治疗中，与男性相比，女性对专门为IBS研发的5-羟色胺能药物似乎有更大的临床反应。目前尚无专门用于治疗IBS的获批药物。需要对新型药物进行进一步研究，以评估IBS管理的新方法，包括针对性别差异的行为疗法，以及在药物治疗方面更好地对患者亚组进行特征描述，以便能够测试个性化治疗方案。
