George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah, USA.
Divisions of Gastroenterology, University of Utah, Salt Lake City, Utah, USA.
Neurogastroenterol Motil. 2024 Oct;36(10):e14889. doi: 10.1111/nmo.14889. Epub 2024 Aug 5.
A subset of patients with irritable bowel syndrome (IBS) develop their symptoms after gastroenteritis, referred to as postinfectious IBS (PI-IBS). PI-IBS is associated with low-grade intestinal inflammation. Previous studies have evaluated mesalamine, an anti-inflammatory drug, in patients with IBS. We evaluated the efficacy of long-acting mesalamine in patients with PI-IBS.
Sixty-one patients who developed diarrhea-predominant IBS (IBS-D) after gastroenteritis were randomized to receive either 2.4 g of long-acting mesalamine or placebo daily for 8-weeks. The symptoms assessed were abdominal pain, bloating, stool frequency, stool consistency, severity of diarrhea and constipation, satisfaction with bowel habits, and IBS affecting or interfering with life. Quality-of-life (QOL) was assessed using the IBS-QOL questionnaire. The prespecified primary outcome variable was the overall bowel symptom score (BSS) after 8-weeks of treatment. Effect sizes were expressed as standardized mean differences (Cohen's d).
Fifty-four patients completed the 8-week treatment (n = 28 mesalamine, n = 26 placebo), 49 (91%) were male, and age range 23-71 years (mean ± SD 43 ± 13). Mesalamine demonstrated superior efficacy compared to placebo on the primary outcome variable, overall BSS (Cohen's d = 0.57, p = 0.042). Mesalamine was also superior for the secondary outcome of how much IBS affects your life in general (d = 0.72, p = 0.01). For the secondary outcomes of IBS symptoms, 7 of the 7 symptoms had trends of mesalamine superiority. For the secondary outcomes of IBS-QOL subscales, 8 of 9 had trends of mesalamine superiority.
In patients with PI-IBS, long-acting mesalamine demonstrated to be effective in reducing IBS symptoms and improving QOL.
一部分肠易激综合征（IBS）患者在肠胃炎后出现症状，称为感染后肠易激综合征（PI-IBS）。PI-IBS 与低度肠道炎症有关。先前的研究评估了用于 IBS 患者的抗炎药美沙拉嗪。我们评估了长效美沙拉嗪在 PI-IBS 患者中的疗效。
61 名在肠胃炎后出现腹泻型 IBS（IBS-D）的患者被随机分配每日接受 2.4g 长效美沙拉嗪或安慰剂治疗 8 周。评估的症状包括腹痛、腹胀、排便频率、粪便稠度、腹泻和便秘严重程度、对排便习惯的满意度以及 IBS 对生活的影响或干扰。使用 IBS-QOL 问卷评估生活质量（QOL）。主要预设结局变量是治疗 8 周后的整体肠症状评分（BSS）。效应大小用标准化均数差（Cohen's d）表示。
54 名患者完成了 8 周的治疗（n=28 名美沙拉嗪，n=26 名安慰剂），49 名（91%）为男性，年龄 23-71 岁（平均±SD 43±13）。与安慰剂相比，美沙拉嗪在主要结局变量，即整体 BSS（Cohen's d=0.57，p=0.042）上显示出更好的疗效。美沙拉嗪在一般而言 IBS 对生活的影响（d=0.72，p=0.01）这一次要结局上也更优。在次要结局 IBS 症状方面，7 种症状有美沙拉嗪优势的趋势。在次要结局 IBS-QOL 亚量表方面，8 种中有美沙拉嗪优势的趋势。
在 PI-IBS 患者中，长效美沙拉嗪在减轻 IBS 症状和改善 QOL 方面表现出疗效。
