Intervention Treatment Of The Etiological Factors In Diarrhea Predominant Irritable Bowel Syndrome And Search For The Etiopathogenisis

BACKGROUNDIrritable bowel syndrome(IBS)is the most commonly functional disorder of the gastrointestinal tract characterized by alterations in bowel function and accompanied by abdominal pain or discomfort.IBS had a high prevalence.The prevalence of IBS is tendency to increasing with years and more and more studies have paid attention to it. However it remains an incompletely understood with unmet medical needs.Many studies demonstrate abnormal motility of gastrointestinal tract and visceral hypersensitivity are the main mechanisms.Recent research found psychological abnormality and intestinal dysbacteriosis are related to IBS.All above-mentioned reflect the diversity aspects of the etiology of IBS.With the growing of neuro-gastroenterology,more and more evidences support the brain-gut axis dysfunction in the etiopathogenisis of IBS.Trying to integration erery aspect of etiology from the point of brain-gut interactions.All these factors in combination can exert an effect on the "brain-gut axis".The "brain-gut axis" is a theoretical model describing the bidirectional neural pathways linking cognitive and emotional centres in the brain to neuroendocrine centres,the enteric nervous system,and the immune system,and plays a major role in the concept of IBS.Simultaneous measurement of brain and gut function contribute to the elucidation of the complex pathophysiology of IBS.AIMIntervention treatments to the possible etiology of IBS,Investigate the therapeutic results and the treatment interaction between probiotics and tricyclic antidepressant.To elucidate the possible interaction between the brain and gut from therapeutics.MATERIAL AND METHODSMATERIALFrom November 2005 to November 2006,ninety-two romaⅡcriteria-positive diarrhea-predominant Irritable Bowel Syndrome(D-IBS)patients were recruited. Ninety-two patients,male 38,female 54;age 18-72(41.70±12.88)years.All were excluded organic disease by enteroscope;had used Spasmolytics,Probiotics, antidepressant or antibiotics before 2 weeks;couldn't follow the doctor's orders; couldn't tolerate the adverse effects during study.METHODSNinety-two D-IBS patients were randomly divided into four groups,every group has 23 patients.Dicetel use as a foundation medicine,add Bifco or doxepin or both.Group one:male 10,female 13,Dicetel(100 mg three times daily),Group two: male 10,female 13,Dicetel(100 mg three times daily)plus Bifco(420 mg three times daily),Group three:male 9,female 14,Dicetel(100 mg three times daily)plus doxepin(50 mg once daily),Group four:male 9,female 14,Dicetel(100 mg three times daily)plus Bifco(420 mg three times daily)plus doxepin(50 mg once daily).Before and after 4wk of treatment,patients were assessed using IBS symptoms, Bacteriogical analysis of intestinal flora,Symptom Checklist-90(SCL-90),quality of life(SF-36)and the interaction between probiotics and antidepressant.Data were analyzed using the SPSS 11.5 statistical package.Mean±SD were used to describe proportions data.To use matched-pairs t-test and 2×2 factor analysis within-and between-group comparisions.Significance was set at 0.05.RESULTS (1)Sixty-three patients completed the trial.male 24,female 39;age 18-67(43.75±13.52) years.Group one:14 patients,male 5,female 9,age25-67(43.71±10.50)years;Group two:22 patients,male 11,female 11,age18-67(40.73±15.29)years;Group three:12 patients,male 4,female 8,age25-61(44.92±9.98)years;Group four:15 patients,male 4,female 11,age20-67(47.27±16.39)years.(2)IBS symptoms:After treatment every group had an obvious improvement in IBS symptoms.So each interventions had a significant effect.(3)Intestinal flora:After treatment every group had two kinds of bacteria obviously changed at least.These changes were had little to do with probiotics.in the groups using probiotics had three to four bacteria changes.(4)SCL-90 psychological symptoms:After treatment every group had an obvious difference in somatization symptoms,multi-interventions had a better effect than minority interventions in psychological symptoms.(5)SF-36 life quality:After treatment every group had four life quality index obvious improvement at least,multi- interventions had an obviously better effect than minority interventions in improving life quality.(6)The interaction between probiotics and antidepressant:probiotics and antidepressant had an obvious additive effect on IBS symptoms,intestinal flora, psychological symptoms,and quality of life.CONCLUSION(1)To aim at the etiological factors in irritable bowel syndrome,different Intervention treatment could treat effectively,multi-interventions had an obviously better effect than minority interventions in improving life quality.Supporting the possible etiology oflBS maybe effect each other.(2)Probiotics and antidepressant had an obvious additive effect on IBS symptoms, intestinal flora,psychological symptoms,and quality of life.The brain-gut axis has necessarily association,supporting the mechanism of brain-gut interaction in the pathogenesis of IBS.