A Comprehensive Study On The Relation Between Irritable Bowel Syndrome And Psychological Factors

Objective; Irritable bowel syndrome (IBS) is common psychosomatic disease of digestive system. In recent years, because of its high prevalence and its difficulty in treatment, more and more scholars pay attention extensively to this area. The cause and the mechanism of IBS do not completely understand so far, and its treatment is also confined to symptom itself. Foreign researches reported the united using antidepressants in IBS and getting better effect, but there are a few domestic studies on it. The aim of the study is to explore the new channel of treatment and evaluate the effect of the treatment with antidepressant in patients suffering from IBS.Methods: The study used a random, single-blinded and follow-up research. Of 192 IBS patients who satisfied the Rome Ⅱ criteria, 138 followed by depression or/and anxiety. The 138 were randomly assigned to the antidepressant combination group and general treatment group. 119 cases completed therapy and follow-up unit. The treatments in two groups were of similar, but in the antidepressant combination one, 62 patients received antidepressant treatment (fluoxetine 20mg/d or Deanxit 2#/d) . All patients completed the Hamilton depression scale(HAMD, 17terms), Hamilton anxiety scale(HAMA), severity and frequency index of symptom and quality of life specific of IBS before therapy and follow-up unit.Results: Used the HAMD scale≥17 and HAMA≥14 to judge how many IBS patients accompany with depression or anxiety, up to 72% IBS patients exhibit psychiatric disturbances. Comparing two groups, In the group treated with antidepressant/anti-anxiety a significantly greater reduction was found for the scores of severity and frequency index of symptom, as well as the scores of HAMD and HAMA at the end of the 4th, 6th, 8th and 12th weeks(P<0.05-0.01 =. Improvement and complete remission in bowel symptoms are great, and no serious adverse side effect was recorded. In the meantime, IBS-QOL improved(P<0.05-0.01). Combined with antidepressant/anti-anxiety therapy was found to be significantly more effective than general therapy.Conclusion: There are some connections between IBS and the psychological and social factors. Antidepressant is helpful in treating IBS, perhaps through antidepressant and antimuscarinic effects and can modify small intestinal motor function and reduce visceral hypersensitivity in IBS. An increased tolerance to aversive visceral sensations may play a role in the therapeutic effect. However fluoxetine neither can improve the symptom of IBS-C greatly nor cause thesymptom of IBS-D more severity. A futher study on its mechanisms is suggested.