Postinfectious irritable bowel syndrome
Postinfectious irritable bowel syndrome
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DOI：
10.1016/s0016-5085(03)00324-x
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发表时间：
2003-05-01
期刊：
影响因子：
29.4
通讯作者：
Spiller, RC
中科院分区：
文献类型：
--
作者：
Spiller, RC
一小群但重要的肠易激综合征（IBS）患者报告在肠胃炎发作后突然发作IBS症状。基于人群的调查显示，尽管神经症和心理障碍史、疼痛相关疾病和肠胃炎都是发生IBS的危险因素，但肠胃炎是最有效的。产生毒素的生物体越多，患病风险增加11倍，初次发病持续3周以上也是如此。疑病症和不良生活事件使感染后肠易激综合征（PI -IBS）的风险增加一倍，这可能是妇女患这种综合征比例增加的原因。PI-IBS与黏膜T淋巴细胞和含血清素的肠内分泌细胞的适度增加有关。动物模型和一些初步的人体数据表明，这会导致黏膜释放过多的血清素。人类的组织学改变和症状可能持续多年，只有40%的人在6年的随访中恢复。乳糜泻、显微镜下结肠炎、乳糖不耐症、早期克罗恩病和胆盐吸收不良应排除在外，年龄超过45岁或有阳性家族史的人也应排除结肠癌。洛哌丁胺、低纤维饮食和胆盐结合疗法可能对一些患者有帮助。血清素拮抗剂是合乎逻辑的治疗方法，但尚未得到评估。
A small but significant subgroup of patients with irritable bowel syndrome (IBS) report a sudden onset of their IBS symptoms after a bout of gastroenteritis. Population-based surveys show that although a history of neurotic and psychologic disorders, pain-related diseases, and gastroenteritis are all risk factors for developing IBS, gastroenteritis is the most potent. More toxigenic organisms increase the risk 11-fold, as does an initial illness lasting more than 3 weeks. Hypochondriasis and adverse life events double the risk for postinfective (PI)-IBS and may account for the increased proportion of women who develop this syndrome. PI-IBS is associated with modest increases in mucosal T lymphocytes and serotonin-containing enteroendocrine cells. Animal models and some preliminary human data suggest this leads to excessive serotonin release from the mucosa. Both the histologic changes and symptoms in humans may last for many years with only 40% recovering over a 6-year follow-up. Celiac disease, microscopic colitis, lactose intolerance, early stage Crohn's disease, and bile salt malabsorption should be excluded, as should colon cancer in those over the age of 45 years or in those with a positive family history. Treatment with Loperamide, low-fiber diets, and bile salt-binding therapy may help some patients. Serotonin antagonists are logical treatments but have yet to be evaluated.