Hanning Nikita, Edwinson Adam L, Ceuleers Hannah, Peters Stephanie A, De Man Joris G, Hassett Leslie C, De Winter Benedicte Y, Grover Madhusudan
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Laboratory of Experimental Medicine and Pediatrics (LEMP) and Infla-Med, research consortium of excellence, University of Antwerp, Antwerp, Belgium.
Therap Adv Gastroenterol. 2021 Feb 24;14:1756284821993586. doi: 10.1177/1756284821993586. eCollection 2021.
Irritable bowel syndrome (IBS) is a complex and heterogeneous disorder. Sensory, motor and barrier dysfunctions are the key physiological endophenotypes of IBS. Our aim is to review studies evaluating barrier dysfunction in adults and children with IBS, as well as to link those changes with IBS symptomatology and quality of life.
A comprehensive and systematic review of multiple databases was performed up to March 2020 to identify studies comparing intestinal permeability in IBS patients with healthy controls. Both and studies were considered.
We identified 66 studies, of which 27 used intestinal probes to quantify barrier function. The prevalence of barrier dysfunction differed between PI-IBS (17-50%), IBS-D (37-62%) and IBS-C (4-25%). At a group level, permeability was increased compared with healthy controls in IBS-D (9/13 studies) and PI-IBS (4/4 studies), but only a minority of IBS-C (2/7 studies) and not in the only IBS-M study. All four studies in children with IBS demonstrated loss of barrier function. A heterogeneous set of tight junction genes were found to be altered in small and large intestines of adults with IBS, but these have not been evaluated in children. Positive associations were identified between barrier dysfunction and bowel disturbances (6/9 studies), abdominal pain (9/13 studies), overall symptom severity (1/6 studies), depression and anxiety (1/1 study) and quality of life (1/4 studies). Fecal slurry or supernatants of IBS patients were found to induce barrier disruption in animal models (5/6 studies).
Barrier dysfunction is present in a significant proportion of adult and all pediatric IBS studies, especially in the IBS-D and PI-IBS subtype. The majority of studies indicated a positive association between loss of barrier function and symptoms such as abdominal pain and changes in the bowel function.
肠易激综合征（IBS）是一种复杂的异质性疾病。感觉、运动和屏障功能障碍是IBS的关键生理内表型。我们的目的是综述评估成人和儿童IBS患者屏障功能障碍的研究，并将这些变化与IBS症状及生活质量联系起来。
截至2020年3月，对多个数据库进行了全面系统的综述，以确定比较IBS患者与健康对照者肠道通透性的研究。同时考虑了体内和体外研究。
我们共识别出66项研究，其中27项使用肠道探针来量化屏障功能。PI-IBS（17%-50%）、IBS-D（37%-62%）和IBS-C（4%-25%）中屏障功能障碍的患病率有所不同。在组水平上，IBS-D（9/13项研究）和PI-IBS（4/4项研究）的通透性相较于健康对照有所增加，但只有少数IBS-C（2/7项研究）且唯一的IBS-M研究中未发现增加。所有四项针对儿童IBS的研究均表明存在屏障功能丧失。在患有IBS的成人的小肠和大肠中发现了一组异质性的紧密连接基因发生改变，但这些基因在儿童中尚未得到评估。在屏障功能障碍与肠道紊乱（6/9项研究）、腹痛（9/13项研究）、总体症状严重程度（1/6项研究）、抑郁和焦虑（1/1项研究）以及生活质量（1/4项研究）之间发现了正相关。在动物模型中，发现IBS患者的粪便悬液或上清液可诱导屏障破坏（5/6项研究）。
在大部分成人和所有儿童IBS研究中均存在屏障功能障碍，尤其是在IBS-D和PI-IBS亚型中。大多数研究表明屏障功能丧失与腹痛和肠道功能变化等症状之间存在正相关。
