Schoenfeld Philip S
Professor of Medicine Director of the GI Epidemiology Training Program University of Michigan School of Medicine Ann Arbor, Michigan.
Gastroenterol Hepatol (N Y). 2016 Aug;12(8 Suppl 3):1-11.
Irritable bowel syndrome (IBS) is characterized by chronic intermittent abdominal pain and associated diarrhea (IBS-D), constipation (IBS-C), or both. IBS can significantly impact patient function and quality of life. The diagnosis of IBS is based on the presence of characteristic symptoms, the exclusion of concerning features, and selected tests to exclude organic diseases that can mimic IBS. The pathophysiology of IBS remains incompletely understood, and new contributing factors have been identified over the past decade. Altered gut immune activation, intestinal permeability, and the intestinal and colonic microbiome may be important factors. Poorly absorbed carbohydrates have been implicated in triggering IBS symptoms. Increasing evidence supports the benefit of a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). Although there are several randomized controlled trials of probiotics in IBS, they are typically poorly designed and have not consistently demonstrated efficacy. Until recently, there were few effective treatments for IBS-D. Data from recent clinical trials support the use of rifaximin, eluxadoline, and peppermint oil. Options for the treatment of IBS-C include lubiprostone and linaclotide.
肠易激综合征（IBS）的特征为慢性间歇性腹痛，并伴有腹泻（腹泻型IBS，IBS-D）、便秘（便秘型IBS，IBS-C）或两者兼具。IBS会对患者的功能和生活质量产生重大影响。IBS的诊断基于特征性症状的存在、排除相关特征，并通过特定检查以排除可模仿IBS的器质性疾病。IBS的病理生理学仍未完全明了，在过去十年中已发现了一些新的促成因素。肠道免疫激活改变、肠道通透性以及肠道和结肠微生物群可能是重要因素。吸收不良的碳水化合物被认为与引发IBS症状有关。越来越多的证据支持低发酵性寡糖、双糖、单糖和多元醇（FODMAPs）饮食的益处。尽管有多项关于益生菌治疗IBS的随机对照试验，但这些试验通常设计不佳，且未始终证明其疗效。直到最近，腹泻型IBS的有效治疗方法还很少。近期临床试验的数据支持使用利福昔明、埃卢多啉和薄荷油。便秘型IBS的治疗选择包括鲁比前列酮和利那洛肽。
