irritable bowel syndrome
Introduction
Introduction to irritable bowel syndrome Irritable Bowel Syndrome (IBS) refers to a group of clinical syndromes including abdominal pain, bloating, changes in bowel habits, abnormal stool characteristics, mucus stools, etc., persistent or recurrent, which can be caused by examination. Organic disease. This disease is the most common type of functional bowel disease. basic knowledge The proportion of illness: 0.015% Susceptible people: no specific population Mode of infection: non-infectious Complications: gastrointestinal dysfunction
Cause
Causes of irritable bowel syndrome
(1) Causes of the disease
The cause of IBS is not yet clear and is currently considered to be related to the following factors.
1. Mental and neurological factors: The incidence of mental and psychological abnormalities in patients with IBS is significantly higher than that of ordinary people. Studies have shown that mental stress can change the mmc of the intestines. Mental stimulation is more likely to cause intestinal dysfunction in IBS patients than normal people. Modern nerves Physiology suggests that the intestinal tract of IBS patients is more sensitive to tension and multiple stimuli, but this is due to abnormalities in the intestinal plexus and its receptor or afferent nerve pathway, or abnormal regulation of the intestinal tract by the central nervous system. It is still unclear. Other studies have found that stress can cause functional colonic motility disorder in rats, and it is found that the release of some gastrointestinal hormones increases after stress, indicating that the regulation of neuroendocrine is involved in the process of intestinal dysfunction caused by stress. The above spirit, the relationship between neurological factors and IBS, supports the current view that IBS is a gastrointestinal disease of physical and mental diseases.
2. Intestinal stimulating factors: Certain factors in the intestine may change intestinal function and aggravate the original irritable bowel syndrome. These stimulating factors include external food, drugs, microorganisms, etc., and may also include some Some internal substances, experiments have found that the intestinal mucosa of the sensitized antigen in the cavity can significantly induce intestinal contractile activity and diarrhea in the mouse. Some analysts believe that when some stimulants act on the intestinal tract multiple times, the intestinal tract may be changed. Sensation of motor function and sensitivity to stimuli, resulting in "susceptibility" of the intestine, it has been reported that IBS patients with ileum are very sensitive to the secretion of bile acid, but may not be diagnosed as bile acid malabsorption, short-chain or Medium-chain fatty acids may reach the right colon in patients with limited absorption capacity or rapid operation in the small intestine, causing rapid pressure waves in the right colon, which are highly effective in advancing colonic contents and may cause pain and Diarrhea, whether these intestinal stimuli are an inducement or cause in IBS is currently undecided.
(two) pathogenesis
1. Intestinal movement abnormality: The main pathogenesis of IBS is abnormal intestinal motility. Some studies have found that patients with IBS have increased stenotic clustered constrictions (DCCs) and prolonged proliferative constrictions (PPCs). Consistent with spastic pain, diarrhea-type IBS patients have increased migrating motor complex (MMc) times and shortened cycles; more jejunum contractions in stage II and after meals; colons show a lot of rapid Contraction and propellant contraction; the proximal colon rapidly passes and is positively correlated with the weight of the stool; cholinergic stimulation reduces the sigmoid colon multiple motility index. On the contrary, the proximal colonic transit time of constipation type IBS patients is prolonged, and the emptying is significantly reduced. Slow; high propensity to reduce contraction; lowering, sigmoid colon shrinkage frequency and contraction time under basal state, decreased reactivity to cholinergic stimulation, while the percentage of proximal colonic contraction time increased significantly, as Inconsistent, the pressure in the anal canal is increased, and the anal sphincter is slow to respond to rectal dilation. Then when abnormal external sphincter contraction and bowel problems related to IBS patients.
The abnormality of IBS is not limited to the motility disorder of the intestine, esophagus, stomach and biliary tract, so it is called asthma of gut. At present, the results of IBS kinetics are not completely consistent, and some even get The opposite result shows that the dynamic disturbance of IBS is very complicated. It is not only an abnormality of the power of a certain intestine, but there is a problem of coordination with each other.
2. Paresthesia: IBS patients have lower abdominal pain threshold than normal people, so they have excessive sensation of standard colonic expansion. The synergistic effect of this paresthesia and cluster motor abnormality is the main factor of spastic pain in IBS patients. Anxiety aggravates the painful feeling of colon expansion in patients. On the contrary, the perception of intestinal dilatation is reduced in the relaxed state. The abnormal rectal anal sensation causes the feeling of defecation, and even the abdominal pain before defecation, and the excessive feeling of the rectum and the rectum is excessive. The reflex movement is accompanied by an increase in the motor response, which results in an increase in the frequency of defecation, but not an increase in the weight of the defecation.
3. Abnormal secretion: In the small intestine mucosa of IBS patients, the secretion of stimulating substances is enhanced, and mucus secretion is increased in the colon mucosa.
Prevention
Irritable bowel syndrome prevention
First, often relax, take more deep breaths, go out and walk.
Second, pay attention to life and diet, eat less gastrointestinal irritating things.
Third, take some skin care products and foods that are more effective in adjusting the intestinal flora.
Complication
Irritable bowel syndrome complications Complications gastrointestinal dysfunction
Symptoms appearing or aggravating are often associated with mental factors or some stress states. Some patients are accompanied by symptoms of multiple dysfunctions of the upper gastrointestinal tract and the intestines, and may also be associated with mental and mental abnormalities such as depression, suspiciousness, nervousness, and anxiety. , hostility, etc.
Symptom
Symptoms of irritable bowel syndrome Common symptoms Fecal excretion abnormal constipation constipation with severe abdominal pain Diarrhea Abdominal discomfort Mucus Intestine flatulence Abdominal pain Abdominal expansion
Symptom
(1) Abdominal pain, abdominal discomfort: often have discomfort or abdominal pain along the intestines, can develop colic, lasts for several minutes to several hours, relieves after defecation, some foods such as crude fiber vegetables, coarse fruits, strong seasoning Products, wine, cold drinks, etc., can induce abdominal pain, but abdominal pain does not progressively worsen, does not occur during sleep.
(2) Diarrhea or non-formation: often after meals, especially after breakfast, can occur in the rest of the time, but not at night, occasionally stool can be up to 10 times or more, but each time the amount of stool is small The total amount rarely exceeds the normal range, and sometimes the stool is only 1 or 2 times, but it is not formed, and diarrhea or non-formation sometimes alternates with normal stool or constipation.
(3) Constipation: 1 or 2 bowel movements per week, occasionally more than 10 days, early multi-interruption, and later need to take laxatives.
(4) Abnormal defecation process: patients often have difficulty in defecation, and the symptoms of defecation are not satisfactory or they are urgent.
(5) Mucus: The stool often has a small amount of mucus, but occasionally a large amount of mucus or mucus type is discharged.
(6) bloating: obvious during the day, after nighttime sleep, the general abdominal circumference does not increase.
2. Signs: The cecum and sigmoid colon are often accessible, and the cecum is often inflated with a bowel-like sensation; the sigmoid colon often has a cord-like bowel or a fecal mass, and the intestine can have mild tenderness, but the tenderness is not fixed, and the pain is continued. Disappeared, some patients have anal pain in the anus and have a feeling of increased sphincter tension.
Examine
Examination of irritable bowel syndrome
1. X-ray barium enema examination: often no abnormal findings, a small number of cases due to intestinal line sputum "line sign", other non-specific performance may have deepened or increased colonic bag.
2. Sigmoidoscopy or fiberoptic colonoscopy: no abnormalities in the mucosa observed by the naked eye, no abnormalities in biopsy, but can cause paralysis, pain, or pain during inflation, such as suspected spleen syndrome, can be examined Slowly inject 100 ~ 200ml of gas, and then quickly pull out the mirror, the patient sitting up, after 5 ~ 10min can appear left upper abdominal pain, radiation to the left shoulder, which can be an objective indication of spleen syndrome.
Some doctors put airbags in the rectum, and the patient has pain after pumping. When abdominal pain occurs in allergic colon patients, the pressure of the airbag is significantly lower than that of normal people.
3. The stool is watery, soft or hard, with mucus and no other abnormalities.
4. Intestinal motility examination: not identical to the esophagus and stomach and imperfect.
(1) Intestinal transit time check:
1 Hydrogen breath test method: The principle is that sugars that can not be absorbed in the small intestine, such as lactulose, are explained by bacterial fermentation in the colon, and hydrogen is excreted through the lungs. Therefore, after oral lactulose, the expiratory hydrogen is collected at a certain time (10-15 minutes). Using a gas-sensitive chromatograph to measure the concentration of expiratory hydrogen, and measuring the mouth-blind passage time according to the change of the hydrogen concentration of the exhaled gas, when the concentration of the respiratory hydrogen is higher than 50% of the base value or higher than the level of 4 to 10 ppm, it is the peak value. The time from oral lactulose to the peak is the oral-blind passage time. Some factors affect the test results, such as lactulose on an empty stomach. For different patients, the digestive phase is different at the time, resulting in mouth-blindness. Through the time result heterogeneity, the lactulose should be taken at the same time as the test meal, because the digestive period is stopped immediately after the meal, and replaced by the digestive period activities, so that the subject conditions are the same, if given with the liquid test meal It represents the passage time of the liquid. If it is the same as the solid, it means the passage time of the solid. The composition of the test meal needs to be similar to the composition of the ordinary meal. The amount of exercise affects the power. The amount of exercise; drugs will affect the breath test, requiring anti-cholinergic drugs, calcium channel blockers, nitroglycerin, sedatives and psychotropic drugs stopped 48 hours before the test, no antibiotics used within 1 month; in addition, gastric emptying function should also be considered And the effects of bacteria in the digestive tract.
2 radionuclide scanning method:
A. Small intestine transit time measurement: usually test the test with 99mTC, after the meal, count under the gamma camera (nuclear scan of the front and back position to correct the error), if two radionuclide labels are used, one of them is used Gastric emptying, one for measuring the mouth-blind passage time, thereby deducing the small intestine transit time.
B. Determination of colon transit time: radioactive labeling of liquids into the cecum or oral radionuclide capsules that are disintegrated in the cecum, thereby measuring the filling of the colon and the passage time of each segment. The disadvantage is that non-physiological markers In contrast, the oral capsule method is closer to the physiological condition.
3 X-ray marker method: Oral one or more (with a certain time interval) after X-ray markers are not taken regularly, according to the distribution of markers on the abdominal plain film, using the colon gas, while using the abdomen The bony mark on the flat sheet, and the direction of the marker moving in the continuous film, the position of the marker on the flat sheet is judged, the total gastrointestinal transit time, the mouth-blind passage time, the whole colon and the colonic passage time of each segment are measured. .
(2) Pressure measurement:
1 Intestinal pressure measurement: a pressure collection tube or a catheter with a miniature pressure sensor is inserted into the duodenum through the stomach until the upper part of the jejunum (guided by a guide wire under the X-ray, which can be inserted through the endoscope), and the small intestine digestive compartment can be measured. During the period and digestive period (the number of contractions, contraction amplitude and dynamic index), there are many influencing factors, the intracatheter bubble affects the accuracy of pressure measurement; the intestinal lumen does not disappear when the intestinal contraction will affect the accuracy of the record; Influencing accuracy, intubation and measurement process, technology and coordination are also important influencing factors, standardization instrument is very important, otherwise it will cause measurement error.
2 Colon pressure measurement: the guide wire is fed through the colonoscopy biopsy hole, and then the pressure catheter is placed in the guide wire, and under the guidance of X-ray, it is sent to the colon to record the fasting and post-meal or post-administration dynamic activities. The influencing factors are as follows: fasting and eating activities are inconsistent; drug effects are obvious; different results vary widely; insertion techniques are light and fast, otherwise the results are affected.
Diagnosis
Diagnosis and differentiation of irritable bowel syndrome
diagnosis
Diagnosis of symptoms of intestinal functional diseases, after the exclusion of various possible organic diseases, can be diagnosed as intestinal functional diseases, the diagnostic criteria for irritable bowel syndrome are not uniform, and are constantly revised, currently widely used internationally. For the 1992 Rome standard:
1. Symptoms persist or occur more than 3 months.
2. Must have the following symptoms
(1) abdominal pain or abdominal discomfort, and has the following characteristics: relief after defecation; and/or accompanied by changes in stool characteristics.
(2) Abnormal bowel movements occur at least 25% of the time, at least two of the following: stool frequency changes (>3 times / d or <3 times / week); stool characteristics change (hard: mass (or) thin: water ()); the process of defecation changes (defecation or emergency or defecation); discharge mucus, accompanied by flatulence or bloating.
According to its main manifestations, irritable bowel syndrome can be divided into different types, generally divided into two categories: diarrhea-predominant (IBS-D) and constipation-predominant (IBS-C). Mixed type.
Differential diagnosis
1. Chronic bacterial infection: multiple stools and cultures have positive findings, as well as adequate and effective antibiotic systemic treatment, the symptoms are improved significantly, and the diagnosis can be confirmed.
2. Chronic amoebic dysentery: multiple stools to find amoeba and metronidazole test treatment can be a clear diagnosis.
3. Schistosomiasis infection: Patients in schistosomiasis areas can be examined by sigmoidoscopy, and the rectal mucosa can be taken to find schistosomiasis eggs, or by fecal hatching and other methods.
4. Malabsorption syndrome: There is diarrhea, but there are often fat and undigested food in the stool.
5. Intestinal tumors: benign small tumors of the small intestine may have partial intestinal obstruction of diarrhea and intermittent seizures. Colon tumors may also have symptoms similar to intestinal functional diseases, especially for the elderly, X-ray tinctures may be administered. An angiographic examination or a colonoscopy to confirm the diagnosis.
6. Ulcerative colitis: abnormalities such as fever, pus and bloody stools can be identified by X-ray barium angiography or colonoscopy.
7. Crohn's disease: often have fever, anemia, weakness and other systemic symptoms, X-ray barium angiography or colonoscopy can be identified.
8. Lactase deficiency: lactose tolerance test can be identified, lactase deficiency has congenital and acquired points, clinical manifestations of severe diarrhea after eating dairy products, stool contains a lot of foam and lactose, lactic acid, food to remove milk or dairy products The symptoms can be improved, and the yogurt is decomposed by lactic acid bacteria for consumption by such patients.
9. Gastrointestinal endocrine tumors: gastrinoma can cause severe diarrhea and stubborn ulcer disease, serum gastrin level is extremely high, general treatment is ineffective, vasoactive intestinal peptide tumor (Vipoma) also causes severe diarrhea; serum VIP The level is increased.
10. Thyroid disease: thyroid dysfunction can occur diarrhea, hyperparathyroidism can cause constipation, can be used for thyroid, parathyroid function test for identification.
