Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology "S. de Bellis" Research Hospital, Via Turi 27, 70013, Castellana Grotte, BA, Italy.
Scientific Direction, National Institute of Gastroenterology "S. de Bellis" Research Hospital, 70013, Castellana Grotte, BA, Italy.
BMC Gastroenterol. 2021 May 22;21(1):235. doi: 10.1186/s12876-021-01820-7.
Irritable bowel syndrome (IBS) is characterised by gastrointestinal (GI) and psychological symptoms (e.g., depression, anxiety, and somatization). Depression and anxiety, but not somatization, have already been associated with altered intestinal barrier function, increased LPS, and dysbiosis. The study aimed to investigate the possible link between somatization and intestinal barrier in IBS with diarrhoea (IBS-D) patients.
Forty-seven IBS-D patients were classified as having low somatization (LS = 19) or high somatization (HS = 28) according to the Symptom Checklist-90-Revised (SCL-90-R), (cut-off score = 63). The IBS Severity Scoring System (IBS-SSS) and the Gastrointestinal Symptom Rating Scale (GSRS) questionnaires were administered to evaluate GI symptoms. The intestinal barrier function was studied by the lactulose/mannitol absorption test, faecal and serum zonulin, serum intestinal fatty-acid binding protein, and diamine oxidase. Inflammation was assessed by assaying serum Interleukins (IL-6, IL-8, IL-10), and tumour necrosis factor-α. Dysbiosis was assessed by the urinary concentrations of indole and skatole and serum lipopolysaccharide (LPS). All data were analysed using a non-parametric test.
The GI symptoms profiles were significantly more severe, both as a single symptom and as clusters of IBS-SSS and GSRS, in HS than LS patients. This finding was associated with impaired small intestinal permeability and increased faecal zonulin levels. Besides, HS patients showed significantly higher IL-8 and lowered IL-10 concentrations than LS patients. Lastly, circulating LPS levels and the urinary concentrations of indole were higher in HS than LS ones, suggesting a more pronounced imbalance of the small intestine in the former patients.
IBS is a multifactorial disorder needing complete clinical, psychological, and biochemical evaluations.
肠易激综合征（IBS）的特征是胃肠道（GI）和心理症状（例如，抑郁、焦虑和躯体化）。抑郁和焦虑，但不是躯体化，已经与改变的肠道屏障功能、增加的 LPS 和菌群失调有关。本研究旨在调查腹泻型肠易激综合征（IBS-D）患者中躯体化与肠道屏障之间的可能联系。
根据症状清单-90-修订版（SCL-90-R），将 47 名 IBS-D 患者分为低躯体化（LS=19）或高躯体化（HS=28）（临界值分数=63）。使用肠易激严重程度评分系统（IBS-SSS）和胃肠道症状评分量表（GSRS）评估 GI 症状。通过乳果糖/甘露醇吸收试验、粪便和血清肠通透素、血清肠脂肪酸结合蛋白和二胺氧化酶研究肠道屏障功能。通过检测血清白细胞介素（IL-6、IL-8、IL-10）和肿瘤坏死因子-α来评估炎症。通过尿液吲哚和粪臭素浓度和血清脂多糖（LPS）评估菌群失调。所有数据均采用非参数检验进行分析。
HS 患者的 GI 症状谱比 LS 患者更为严重，无论是单个症状还是 IBS-SSS 和 GSRS 的症状群。这一发现与小肠通透性受损和粪便肠通透素水平升高有关。此外，HS 患者的血清 IL-8 浓度显著升高，IL-10 浓度显著降低。最后，HS 患者的循环 LPS 水平和尿液吲哚浓度高于 LS 患者，表明前者患者的小肠更为明显失衡。
IBS 是一种需要进行全面临床、心理和生化评估的多因素疾病。
