Irritable bowel syndrome

Introduction 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, and can be caused by examination and exclusion. Organic symptoms of these symptoms. This disease is the most common type of functional intestinal disease. In the general population, a questionnaire survey was conducted. The symptoms of IBS were reported in Europe and America as 10%-20%, and in Beijing, China, a report was 8.7%. The majority of patients are young and middle-aged, and the first incidence after 50 years of age is rare. The ratio of male to female is about 1:2. 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.

Cause

Gastrointestinal motility disorder

IBS patients with small intestinal digestive transitional motor abnormalities, the cycle is significantly shortened, the jejunum appears more discrete cluster contraction waves, and most of the authors of abdominal pain are related to these changes, these changes are more obvious in stress and sleep.

2. Visceral paresthesia

The study found that most patients with IBS have clinical features of hypersensitivity to luminal (rectal) dilation, with a decrease in mean pain threshold, increased discomfort after rectal dilation, or abnormal visceral-somatic radiation pain, suggesting that spinal cord levels are visceral sensory signal processing. Anomaly.

3. Mental factors

Psychological stress has a significant effect on gastrointestinal function. It plays an important role in the induction, aggravation and persistence of IBS symptoms. A considerable number of patients are associated with psychological disorders, including anxiety and depression.

4. Intestinal infection

Some patients with IBS have a history of intestinal infection before the onset of the disease. Some patients with gastroenteritis caused by various pathogens (including bacteria, viruses, parasites) have intestinal dysfunction, and 10% can develop IBS after infection. .

5. Other

The symptoms of some patients with IBS are related to food, which can aggravate their symptoms. The fiber fermentation in food may be the cause of excessive gas production. In addition, the disorder of intestinal flora may be one of the causes of symptoms.

an examination

Related inspection

Gastrointestinal CT examination of rectal-anal motor function

Repeated (at least 3 times) routine stool culture were negative, the occult blood test was negative, normal hematuria was normal, and erythrocyte sedimentation rate was normal. For patients over 40 years old, in addition to the above examination, colonoscopy and mucosal biopsy were performed to exclude the intestine. Infectious, neoplastic diseases, etc.

Differential diagnosis

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 being revised. Currently adopted in the international community is 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.

Differential diagnosis of irritable bowel syndrome:

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 can cause diarrhea and partial intestinal obstruction with intermittent attacks. Colon tumors can also have symptoms similar to intestinal functional diseases. Especially for the elderly should pay attention. X-ray barium angiography or colonoscopy can be performed to confirm the diagnosis.

6. Ulcerative colitis: abnormal manifestations such as fever, pus and bloody stools. It can be identified by X-ray barium angiography or colonoscopy.

7. Crohn's disease: often have systemic symptoms such as fever, anemia, and weakness. X-ray barium angiography or colonoscopy can be identified.

8. Lactase deficiency: The lactose tolerance test can be identified. Lactase deficiency is inherited and acquired. The clinical manifestation is severe diarrhea after eating dairy products. The stool contains a lot of foam and lactose, lactic acid. If the milk or dairy product is removed from the food, the symptoms can be improved. The yogurt is decomposed by lactic acid bacteria and can be consumed by such patients.

9. Gastrointestinal endocrine tumors: Gastrinoma can cause severe diarrhea and stubborn ulcer disease. Serum gastrin levels are extremely high, and general treatment is ineffective. Vasoactive intestinal peptide tumor (Vipoma) also causes severe diarrhea; serum VIP levels are elevated.

10. Thyroid disease: Hyperthyroidism can cause diarrhea. Constipation can occur with hyperparathyroidism. It can be used for thyroid and parathyroid function tests for identification.

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