Cashman Michael D, Martin Daniel K, Dhillon Sonu, Puli Srinivas R
Clinical Professor of Internal Medicine, University of Illinois College of Medicine at Peoria, 5105 Glen Park Place, Peoria, IL 61614, USA.
Curr Rheumatol Rev. 2016;12(1):13-26. doi: 10.2174/1573397112666151231110521.
Symptoms of irritable bowel syndrome (IBS) are common in population studies including chronic abdominal pain associated with altered bowel habits. Patients often have associated gastrointestinal and somatic symptoms suggesting a possible common contributing mechanism, but the heterogeneous symptom patterns of individual patients make generalizations difficult. The pathophysiology of IBS is incompletely understood but includes disturbances of the brain-gut axis. Central mechanisms are: the psychosocial history and environment, dysfunctional brain processing of peripheral signals attributed to the intestine including the enteric nervous system, the microbiome and the innate and adaptive immune system. As a result there is visceral hypersensitivity and disturbed intestinal secretory and motor activity. Some mechanisms of visceral pain hypersensitivity may overlap with other pain syndromes including fibromyalgia (FMS). Central Sensitization (CS) would offer a way to conceptualize an integration of life experience and psychologic response into a biopsychosocial framework of pathophysiology, diagnosis and treatment of IBS. Corticotropin-releasing factor, a principle regulator in the stress and pain response may contribute to a neuroendocrine mechanism for the brain-gut interaction. The positive diagnostic approach to IBS symptoms to avoid excess testing and enhance the patient-provider therapeutic relationship requires the recognition of the "cluster" of IBS symptoms while identifying "alarm" symptoms requiring specific attention. The severity of the symptoms and other individual psychosocial factors characterize patients who seek medical care. The presence of significant psychosocial comorbidities adds to the complexity of management which often requires a multidisciplinary approach. Several treatment options exist but no single method is effective for all the symptoms of IBS. The therapeutic benefit of the well-executed physician-patient relationship is considered essential to success in managing IBS symptoms over the long term.
肠易激综合征（IBS）的症状在人群研究中很常见，包括与排便习惯改变相关的慢性腹痛。患者通常伴有胃肠道和躯体症状，提示可能存在共同的致病机制，但个体患者的症状模式各异，难以一概而论。IBS的病理生理学尚未完全明确，但包括脑-肠轴功能紊乱。中枢机制有：社会心理病史和环境、大脑对归因于肠道（包括肠神经系统、微生物群以及先天和适应性免疫系统）的外周信号处理功能失调。结果导致内脏超敏反应以及肠道分泌和运动活动紊乱。内脏疼痛超敏反应的一些机制可能与包括纤维肌痛（FMS）在内的其他疼痛综合征重叠。中枢敏化（CS）将为把生活经历和心理反应整合到IBS病理生理学、诊断和治疗的生物心理社会框架中提供一种概念化方法。促肾上腺皮质激素释放因子是应激和疼痛反应的主要调节因子，可能有助于脑-肠相互作用的神经内分泌机制。对IBS症状采取积极的诊断方法以避免过度检查并加强医患治疗关系，这需要识别IBS症状“集群”，同时识别需要特别关注的“警示”症状。症状的严重程度和其他个体社会心理因素是寻求医疗护理患者的特征。显著的社会心理合并症的存在增加了管理的复杂性，这通常需要多学科方法。有几种治疗选择，但没有一种方法对IBS的所有症状都有效。良好的医患关系所带来的治疗益处被认为是长期成功管理IBS症状的关键。
