Post-Infectious Irritable Bowel Syndrome.
Post-Infectious Irritable Bowel Syndrome.
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DOI：
10.1007/s11894-017-0595-4
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发表时间：
2017-09-25
影响因子：
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通讯作者：
Rao, Satish S C
中科院分区：
文献类型：
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作者：
Lee, Yeong Yeh;Annamalai, Chandramouli;Rao, Satish S C
回顾目的：感染性肠易激综合征（PI-IBS）以持续腹痛和腹泻为特征，通常在感染性肠胃炎发作后发生。IBS-D的机制仍然难以捉摸，但PI-IBS提供了这种疾病的机制模型。本文综述了PI-IBS的最新病理生理学、临床特征和治疗方法。最近发现：免疫反应紊乱和细胞因子释放导致肠道炎症和功能障碍似乎是PI-IBS的关键特征。脑-肠-微生物群相互作用紊乱、感染因子类型和宿主遗传易感性是危险因素，但也是临床严重程度不同的原因。虽然预后一般良好，但症状和炎症可能持续很长时间。止泻药、抗痉挛药、5HT3拮抗剂、美沙胺、益生菌和低剂量抗抑郁药仍然是缓解症状的主要方法，但在一些困难的病例中，针对病理生理的药物组合可能会有所帮助。PI-IBS与IBS-D具有许多重叠的特征，并且具有相似的病理生理学和治疗方法。
PURPOSE OF REVIEW: Post-infectious irritable bowel syndrome (PI-IBS) is characterized by persistent abdominal pain and diarrhea, typically following an episode of infectious gastroenteritis. The mechanisms that underlie IBS-D remain elusive, but PI-IBS provides a mechanistic model of this disorder. This review provides an up-to-date appraisal of the pathophysiology, clinical features, and management approaches for PI-IBS.RECENT FINDINGS: Disordered immune reactions and release of cytokines with resultant gut inflammation and dysfunction appear to be key features of PI-IBS. Disordered brain-gut-microbiota interactions, type of infecting agent, and host-genetic susceptibility are risk factors but also are reasons for the varying spectrum of clinical severity. Although prognosis is generally good, symptoms and inflammation may persist for a long time. Symptomatic relief with antidiarrheals, antispasmodics, 5HT3 antagonists, mesalamine, probiotics, and low-dose antidepressants remain the primary approaches, but in some difficult cases, a combination of drugs that target the pathophysiology may be helpful. PI-IBS has many overlapping features with IBS-D and shares similar pathophysiology and management approaches.