| Research background and purposeIrritable bowel syndrome(IBS)is a common clinical gastrointestinal functional gastrointestinal disorders(FGIDs),which is mainly manifested as continuous or intermittent attacks,accompanied by abdominal pain,abdominal discomfort and frequency of defecation and/or changes in traits,but no abnormal intestinal structure abnormalities.The specific pathogenesis of IBS has not been clarified.At present,changes in visceral sensitivity,gastrointestinal motility disorders,intestinal-brain axis dysfunction,gastrointestinal immune activation,neuroimmune interactions,intestinal flora imbalance,and subsequent stomach intestinal infections are considered to be mechanisms related to IBS in several studies.In addition,related risk factors related to IBS include environment,eating habits,lifestyle and socio-psychological factors.Existing treatments can improve the symptoms and quality of life of patients,but there is no way to completely control IBS.The prolonged and repeated illness of IBS can seriously affect the quality of life and work efficiency of patients,also consume a large amount of medical resources,and cause a heavy economic burden.In the early stage,we established a prospective single disease FGIDs clinical database,which can use the Internet to achieve multi-regional,multi-person,log-in at any time,and can perform retrieval statistics and classification management.We have used the database to study diseases such as gastroesophageal reflux disease,functional abdominal pain,and functional bloating.Based on previous research,we developed a Case report form(CRF)to collect information on patients and healthy controls to further explore the pathogenesis and efficacy analysis of IBS,with a view to provide recommendations for the clinical treatment of IBS.The research objectsFrom October 2015 to October 2019,the clinical information of 298 IBS-D patients diagnosed in the outpatient or inpatient department of the Gastroenterology Department of hospital and diagnosed according to Rome III or Rome IV standards was collected by CRFs.All patients need to complete the colonoscopy,and some patients have completed gastroscopy or gastrointestinal angiography,abdominal ultrasound,capsule endoscopy,and abdominal CT.In the control group,126 patients with no gastrointestinal symptoms were selected from family members,escorts or health checkups.All IBS-D cases and controls need to complete the Zung self-rating anxiety and depression scale.The research methodCollect the clinical information of 298 IBS-D patients and 126 healthy controls through CRFs,All information,including patient information,condition,course,life habits,psychological pressure,etc.collected at the initial diagnosis,as well as various information such as treatment plan,treatment course,curative effect,and follow-up for each follow-up visit,are recorded in the functional gastrointestinal disease single disease database.Simultaneously,At the same time,according to the IBS-SSS scale score,the severity of symptoms of IBS-D patients is divided into mild,moderate and severe grades[1].Among them,32 patients were mild,and the number of patients was not divided into groups.They were treated with Pinaverium bromide tablets(Des chute)+Bifidobacterium triple live bacteria capsules(pefican),and those with anxiety and/or depression were added Haloperidol melitroxine tablets(Delixin,0.5 mg bid).And they were followed up at 4th and 8th week.204 patients were moderately divided into three groups randomly,with 63 patients in the first group,67 cases in the second group and 74 cases in the third group.There is no significant difference in age and gender among the three groups,and they are comparable(P>0.05).The first group was given Desut+Peficon capsules,the second group was given Desult+Peficon capsules+Delixin(0.5mg bid),the third group was given Desuter+Peficon capsules+FengLiaoChangweikang tablets,and they were followed up at 4th,8th and 12th weeks respectively.62 severe patients were randomly divided into two groups,30 cases in the first group,32 cases in the second group,and there is no significant difference in age and gender between the two groups which is comparable(P>0.05).The first group was given Dexter+Peifeikang capsule+Trimebutine maleate tablets(Yuanshengliwei);the second group was given Dexute+Peifeikang capsule+Yuanshengliwei+Delixin(0.5mg bid)treatment,follow-up at 4th,8th,12th and 16th weeks respectively.Efficacy evaluation according to literature[1]:IBS-SSS score drop<75 points is invalid,drop 75-100 points For remission,a decrease of>100 is divided into marked effect,the number of effective cases=remission cases+markedly effective cases,the total effective rate=(remission+markedly effective cases)/total number of cases × 100%.The clinical research takes the curative effect greater than 80%as the observation node.The data analysis function and SPSS 20.0 software were used for statistical analysis to study the relevant pathogenesis factors,clinical characteristics and therapeutic effects of different regimens of IBS.The research resultsAmong the 298 IBS-D patients,there were 111 male patients and 187 female patients,with a male to female ratio of 1:1.68.The age range was 16-79 years,with an average age of 35.67±15.49 years,and the age of onset was mainly distributed between 20-49 years.The median duration of cases in this study was around 25 months.There is no difference between urban and rural areas.Not directly related to drinking.Compared with the control group,patients with IBS-D preferred smoking,carbonated drinks and greasy or spicy diet,and were easily associated with stress,anxiety,and depression.Most male patients have a history of smoking.The IBS-SSS scores of patients with mild IBS-D after 4 weeks and 8 weeks of treatment were gradually lower than those at the first diagnosis,8 weeks of treatment were more significant than 4 weeks of IBS-SSS points,and the total effective rate of 8 weeks of treatment was higher than 4 weeks(93.8%vs 65.6%),the differences are statistically significant(P<0.05);the IBS-SSS scores of moderate patients after 4 weeks,8 weeks and 12 weeks of treatment are progressively lower than the previous follow-up time point,the second group and the third group decreased more than the first group.After 4 weeks,8 weeks,and 12 weeks of treatment,the effective rates of the second and third groups were higher than the first group(58.2%,56.8%vs 39.7%;74.6%,71.6%vs 52.4%;86.6%,85.1%vs 66.7%),the differences are statistically significant(P<0.05),but there is no significant difference between the second group and the third group(P>0.05).In severe patients,after 4 weeks,8 weeks,12 weeks,and 16 weeks of treatment,the IBS-SSS scores decreased from the previous follow-up time point,and the scores of the second group at 8th,12th week,and 16th week were more obvious than the first group,the total effective rate of treatment in the second group was higher than that in the first group(59.4%vs33.3%;71.9%vs46.7%;81.2%vs53.3%),the differences are statistically significant(P<0.05).Conclusions1.The prevalence of women with IBS is higher than that of men,and the age of onset is mainly distributed between 20 and 49 years old;compared with the control group,IBS patients have significant stress,anxiety or depression,or experience adverse events;In terms of diet,it is related to the preference for carbonated drinks,greasy and/or spicy diets,most male patients have a history of smoking;the incidence is not significantly related to urban and rural areas,occupation,and drinking.Remind patients to pay attention to the diet structure is conducive to relieve the disease.It is of great significance to ease the psychological pressure of patients and to communicate well with doctors and patients.2.Patients with IBS-D need to be evaluated the severity of the disease in clinical treatment,the clinical condition of most clinical cases is moderate,and different treatment options should be selected individually.3.The treatment effect of 8-week course of pinaverium bromide tablets(Desuter)+Bifidobacterium triple live bacteria capsules(peficon)in mild IBS-D patients is 93.8%,which can improve patients’ symptoms than 4-week treatment.This suggests that:(1)Piveronium Bromide Tablets+Bifidobacterium triple viable bacteria capsule can be used as the basic drug of IBS-D;(2)Clinically,8 weeks or more is the best course of treatment for mild patients.4.For patients with moderate IBS-D,the observation group of Piveronium Bromide tablets(Desuter)+Bifidobacterium Triple Live capsules(Peficomb)+Delixin or+FengLiaoChangWeiKang tablets has better efficacy than the basic medicine group of bromide tablets+Bifidobacterium triple live bacteria capsules,the 12-week course of treatment reached 85.1%and 86.6%,respectively.This suggests that:(1)Clinical addition of anxiolytic drugs or Chinese patent medicines at the same time as the basic drugs can improve the efficacy;(2)12 weeks or more is the best course of treatment for moderate patients.5.For severe IBS-D patients,on the basis of pinaverium bromide tablets(Desuter)+Bifidobacterium triple viable bacteria capsules(pefican),adding trimebutine maleate tablets(bioliferic)can improve Efficacy,but the effect is better when additional anti-anxiety drugs are added.The 16-week course can reach 81.2%.This suggests that:(1)Severe patients should add trimebutine maleate tablets and anti-anxiety drugs to basic drugs;(2)Clinically,16 weeks or more is the best course of treatment for severe patients. |
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