Burgell R E, Asthana A K, Gibson P R
Department of Gastroenterology, Alfred Health and Monash University, Melbourne, Australia -
Minerva Gastroenterol Dietol. 2015 Dec;61(4):201-13. Epub 2015 Sep 30.
Ongoing troublesome bowel symptoms despite quiescent inflammatory disease are a frequent management challenge when caring for patients with inflammatory bowel disease (IBD). Even when active disease has been excluded the prevalence of residual gastrointestinal symptoms is surprisingly high and the cause often obscure. The presence of a concurrent functional disorder such as irritable bowel syndrome (IBS) is associated with worse quality of life, worse physical functioning, higher prevalence of anxiety and greater health care utilization. Potential etiological mechanisms leading to the development of IBS like symptoms include the development of visceral hypersensitivity following the original inflammatory insult, alteration in cortical processing, dysbiosis and residual subacute inflammation. Therapeutic options for managing IBS in patients with IBD include dietary modification, interventions targeted at correction of visceral sensory dysfunction or cortical processing and modulation of the gut microbiota. As there are few studies specifically examining the treatment of IBS in patients with IBD, the majority of therapeutic interventions are extrapolated from the IBS literature. Given the frequency of residual functional symptoms in IBS, significantly more research is warranted in this field.
对于炎症性肠病（IBD）患者的护理而言，尽管炎症性疾病已静止，但持续存在的肠道症状仍是常见的管理挑战。即使排除了活动性疾病，残余胃肠道症状的患病率仍高得出奇，且病因往往不明。同时存在诸如肠易激综合征（IBS）等功能性疾病，与生活质量较差、身体功能较差、焦虑患病率较高以及医疗保健利用率较高有关。导致IBS样症状出现的潜在病因机制包括最初的炎症损伤后内脏超敏反应的发展、皮质处理改变、肠道菌群失调和残余亚急性炎症。IBD患者IBS的治疗选择包括饮食调整、针对纠正内脏感觉功能障碍或皮质处理以及调节肠道微生物群的干预措施。由于专门研究IBD患者IBS治疗的研究较少，大多数治疗干预措施是从IBS文献中推断出来的。鉴于IBS中残余功能性症状的频率，该领域需要更多的研究。
