肠易激综合征：罗马III标准与我国共识意见解读

肠易激综合征在我国的发病率逐年升高,2003年我国制定的IBS的共识意见已不适用,因此2007年我国肠易激综合征共识意见进行了重新修订,称为长沙共识意见。长沙共识意见借鉴了国际公认的罗马III标准,在IBS的诊断所需的时间,IBS的亚型分型等方面做了较大的修订。并强调了随诊在IBS诊断中的重要性。长沙共识意见同时指出罗马III标准是基于西方国家的研究资料制定的,并不完全适用于我国。我国在IBS的诊断中应结合国人的发病特点进行诊断。长沙共识意见在IBS的治疗方面就我国现状提出了治疗流程。     

肠易激综合征：罗马III标准与我国共识意见解读

肠易激综合征在我国的发病率逐年升高，2003年我国制定的IBS的共识意见已不适用，因此2007年我国肠易激综合征共识意见进行了重新修订，称为长沙共识意见。长沙共识意见借鉴了国际公认的罗马III标准，在IBS的诊断所需的时间，IBS的亚型分型等方面做了较大的修订。并强调了随诊在IBS诊断中的重要性。长沙共识意见同时指出罗马III标准是基于西方国家的研究资料制定的，并不完全适用于我国。我国在IBS的诊断中应结合国人的发病特点进行诊断。长沙共识意见在IBS的治疗方面就我国现状提出了治疗流程。     

肠易激综合征相关致病因素及发病机制研究进展

肠易激综合征(IBS)是一种以腹痛或腹部不适伴有大便性状及排便习惯改变为主要症状的肠道功能性疾病。诊断主要依靠罗马Ⅲ诊断标准,且需除外肠道器质性疾病。目前IBS的发病机制尚不明确,相关研究表明其发病可能与遗传、性别、胃肠道运动障碍、内脏高敏感性、脑肠轴调节异常、肠道感染、肠道菌群失调、饮食及社会心理等因素有关。本文就其可能致病因素及发病机制的最新研究进展作一综述。     

生物反馈治疗对肠易激综合征患者情绪及胃肠道症状疗效的Meta分析

目的:应用Meta分析评价生物反馈治疗对肠易激综合征(irritable bowel syndrome,IBS)的疗效。方法:计算机检索中国知网(CNKI)、万方数据库、维普(VIP)、生物医学、Pubmed、Web of Science及Embase数据库,收集2019年5月31日以前国内外关于生物反馈干预肠易激综合...     

肠易激综合征发病机制研究中的几个问题

肠易激综合征是一种肠道功能性疾病,是目前消化病领域的研究热点,近10年来肠易激综合征发病机制的研究没有突破性进展,本文从哲学基本原理的视角对肠易激综合征发病机制研究中的困惑进行思考与分析,希望给今后的肠易激综合征发病机制研究带来一些启示。     

肠易激综合征发病机制研究中的几个问题

肠易激综合征是一种肠道功能性疾病,是目前消化病领域的研究热点,近10年来肠易激综合征发病机制的研究没有突破性进展,本文从哲学基本原理的视角对肠易激综合征发病机制研究中的困惑进行思考与分析,希望给今后的肠易激综合征发病机制研究带来一些启示.     

感染后与非感染后肠易激综合征的多维特点

探讨感染后(PI)与非感染后肠易激综合征(NPI-IBS)的临床,精神心理,组织学特点。取IBS患者和正常人进行问卷调查,了解其多维特点。分别检测肥大细胞的数目。结果显示:(1)PI-IBS与NPI-IBS患者临床、心理特征不同;(2)IBS两组患者肥大细胞的数目无差异,与对照组比较差异明显。因此认为PI-IBS和NPI-IBS有特征差异,对临床治疗有一定指导意义。     

感染后与非感染后肠易激综合征的多维特点

探讨感染后(PI)与非感染后肠易激综合征(NPI-IBS)的临床,精神心理,组织学特点.取IBS患者和正常人进行问卷调查,了解其多维特点.分别检测肥大细胞的数目.结果显示:(1)PI-IBS与NPI-IBS患者临床,心理特征不同;(2)IBS两组患者肥大细胞的数目无差异,与对照组比较差异明显.因此认为PI-IBS和NPI-IBS有特征差异,对临床治疗有一定指导意义.     

慢性失眠与躯体疾病的相关临床研究进展

睡眠是机体恢复和调整的重要生理过程,对学习记忆的巩固、保持免疫活性、促进疾病康复发挥重要作用。随着社会节奏的加快和社会压力的增大,睡眠时间减少和睡眠质量降低成为现代社会威胁公众健康的突出问题。国内外研究业已证明慢性睡眠障碍在多种躯体疾病的发生发展过程中起重要作用,涉及到心血管、神经、内分泌、消化、呼吸、皮肤等多个系统疾病,如原发性高血压、脑血管病、糖尿病、肠易激综合征、哮喘等;同时很多躯体疾病伴发失眠障碍。所以,睡眠障碍尤其是失眠理应受到临床医师的重视与干预,促进全民身心健康。     

骨科疾病诊治中的临床思维

医学哲学是对医学科学成就总的概括,并以此为基础探讨生命活动和病程的一般规律,研究医学科学的思维方式,直至疾病预防、诊断治疗。同时研究辩证规律和范畴在医学科学中的表现,从而指导骨科医师解决在骨科疾病诊治中遇到的诸多问题,并有助于形成正确的临床思维。结合临床工作体会,探讨医学哲学在骨科疾病诊治临床思维中的应用。     

Pain Catastrophizing and Clinical Outcomes Among Patients Receiving a Novel Cognitive-Behavioral Therapy for Irritable Bowel Syndrome: An Experimental Therapeutics Approach

Irritable bowel syndrome (IBS) is the most common gastrointestinal (GI) condition treated by GI and primary care physicians. Although IBS symptoms (abdominal pain, bowel problems) are generally refractory to medical therapies, consistent research has shown that they improve following cognitive-behavioral therapy (CBT). Notwithstanding empirical support for CBT, there is less research explicating the reasons for why or how it works. Like other pain disorders, the focus on change mechanisms for behavioral pain treatments has focused on pain-specific cognitive-affective processes that modulate pain experience, few of which are more important than pain catastrophizing (PC). The fact that PC changes are seen across treatments of differing theoretical and technical orientation, including CBT, yoga, and physical therapy, suggests that it may be a nonspecific (vs. theory-based) change mechanism akin to therapeutic alliance and treatment expectancy. Therefore, the current study examined change in PC as a concurrent mediator of IBS symptoms severity, global GI symptom improvement, and quality of life among 436 Rome III-diagnosed IBS patients enrolled in a clinical trial undergoing two dosages of CBT versus a nonspecific comparator emphasizing education and support. Results from structural equation modeling parallel process mediation analyses suggest that reduction in PC during treatment are significantly associated with improvement in IBS clinical outcomes through 3-month follow-up. Results from the current study provide evidence that PC may be an important, albeit nonspecific change mechanism, during CBT for IBS. Overall, reducing the emotional unpleasantness of pain through cognitive processes is associated with improved outcomes for IBS.     

Das Reizdarmsyndrom

Irritable bowel syndrome is a common disorder that can be associated with significant disability and health care costs. Beyond it is the most common disease diagnosed by gastroenterologists. Diagnosis is based on typical complaints including abdominal pain, bloating, irregularities of bowel movements and defecation. The discussion of different etiopathogenetic models showed that irritable bowel syndrome is a biopsychosocial disorder in which psychosocial factors, altered motility and visceral hypersensitivity interact. When symptoms are moderate to severe and are associated with psychological distress and impaired quality of life, psychological treatments can be considered. Apart from symptomatic treatment with loperamide for diarrhoea and antidepressants for abdominal pain and comorbid psychological symptoms for example cognitive behavioral treatment, hypnotherapy, psychodynamic short-term psychotherapy and functional relaxation are being evaluated.     

A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations

BackgroundIrritable bowel syndrome (IBS) is a chronic and debilitating medical condition with few efficacious pharmacological or psychosocial treatment options available. Evidence suggests that visceral anxiety may be implicated in IBS onset and severity. Thus, cognitive-behavioral treatment (CBT) that targets visceral anxiety may alleviate IBS symptoms.MethodsThe current study examined the efficacy of a CBT protocol for the treatment of IBS which directly targeted visceral sensations. Participants (N = 110) were randomized to receive 10 sessions of either: (a) CBT with interoceptive exposure (IE) to visceral sensations; (b) stress management (SM); or (c) an attention control (AC), and were assessed at baseline, mid-treatment, post-treatment, and follow-up sessions.ResultsConsistent with hypotheses, the IE group outperformed AC on several indices of outcome, and outperformed SM in some domains. No differences were observed between SM and AC. The results suggest that IE may be a particularly efficacious treatment for IBS.ConclusionsImplications for research and clinical practice are discussed.     

Irritable Bowel Syndrome: A Misunderstood Psychophysiological Affliction

Irritable bowel syndrome is a benign, chronic, gastrointestinal disorder that affects much of the general population. Misunderstanding and lack of patient education often result in increased anxiety and physical distress. Counselors can be instrumental in recognizing the condition in afflicted clients and providing emotional support and stress management training.     

Pain perception in irritable bowel syndrome

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by chronic abdominal discomfort or pain in the absence of detectable organic disease. IBS is common and is associated with a significant impairment in health-related quality of life. Enhanced perception of visceral stimuli ("visceral hypersensitivity") appears to be an important pathophysiological mechanism. Early IBS studies using functional brain imaging techniques suggest an alteration in central pain modulation circuits, rather than an increased sensitivity of peripheral visceral pain pathways. The frequent comorbidity with psychiatric disorders suggests the possibility of shared pathophysiological mechanisms and etiologic factors.     

当代中国医生角色道德病症及其原因探析

医生在进行职业角色扮演的时候容易出现角色的紧张与冲突,其实质是医生所承担的角色内部及其之间利益的紧张与冲突。角色道德问题是当代中国医德发展所面临的一大难题。分析了当代中国医生角色道德病症及其原因,为当代中国医德研究开辟了一条新的路径。     

Cognitive and Behavioral Differences Between Subtypes in Refractory Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a functional gastrointestinal syndrome consisting of different bowel pattern subtypes: diarrhea predominant (IBS-D), constipation predominant (IBS-C), and alternating (IBS-A). This paper aimed to identify whether (a) psychological factors implicated in the cognitive behavioral model of IBS were differentially associated with bowel pattern subtypes, (b) whether there were differences in symptom severity and work and social adjustment across the IBS-subtypes. Analysis was conducted on baseline data of 557 individuals with refractory IBS recruited into the Assessing Cognitive Therapy in Irritable Bowel (ACTIB) randomized controlled trial. Correlations assessed the associations between psychological factors, stool patterns, symptom severity, and work and social adjustment. Hierarchical regressions identified whether cognitive and behavioral factors were significantly associated with frequency of loose/watery stools, hard/lumpy stools and symptom severity while controlling for affective (anxiety and depression) and demographic factors (age, gender, symptom duration). One-way ANOVAs were conducted to assess differences across Rome III classified subtypes (IBS-A, D and C) in cognitive, behavioral, affective, symptom severity, and adjustment measures. Psychological factors were significantly associated with symptom severity and work and social adjustment. Increased avoidance behavior and unhelpful gastrointestinal (GI) cognitions were significantly associated with higher frequency of loose/watery stools. Increased control behaviors were associated with higher frequency of hard/lumpy stools. Cognitive and behavioral differences were significant across the Rome III classified IBS subtypes. There were no differences in anxiety, depression, overall symptom severity, or work and social adjustment. The results are discussed in terms of their utility in tailoring cognitive behavioral treatments to IBS subtypes.     

Participation and Attrition in a Coping Skills Intervention for Adolescent Girls with Inflammatory Bowel Disease

The current study examined factors associated with adolescent and parent participation in a coping skills intervention for adolescent girls with inflammatory bowel disease (IBD) and examined factors associated with attrition related to intermittent missing data. Thirty-one adolescent girls with IBD and their parents enrolled in the intervention. Psychosocial and disease factors related to participation in the 6-week web component of the coping skills intervention were examined as were baseline group differences between those who provided post-treatment data and those who did not. Adolescents experiencing more difficulties related to their disease and psychosocial functioning participated less in the web component of the treatment intervention. Families who attrited had higher baseline levels of parental catastrophic thoughts, parenting stress, and adolescent depression. Families experiencing greater levels of psychological and disease-related difficulties may be at risk for low participation and eventual dropout from pediatric IBD psychological treatment interventions.