肠易激综合征的新概念

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1、肠易激综合征的新概念NewestconceptsinirritablebowelsyndromeIBS张虎华西医院消化科旧概念：过敏性结肠炎易激结肠或黏液性结肠炎新概念：一种以腹痛或腹部不适伴排便习惯改变为特征的功能性肠病…agroupoffunctionalboweldisordersinwhichdiscomfortorpainisassociatedwithdefecationorachangeinbowelhabit,andwithfeaturesofdisordereddefecation.该病缺乏可解释症状的形态学改变

2、和生化异常PsychologicdisturbancerelatestopatientswhoseephysiciansPsychosocialfactorsinfluencehealthcareseekingIBSNon-patientsnormalIBSpatientsPsychologicdisturbanceIBS-Psychosocial流行病学研究西方国家患病率5---24%美国人群10-20%就诊率30％$80亿国内北京潘国宗7.26％广州陈旻湖5.6％就诊率22.4％WhatcausesIBS?Development

3、ofIBSpathophysiology｛inflammation5-HTmediatedhypersensitivityandgutmotilityBrain-gutinteractionVisceralhypersensitivityAbnormalmotorfunction195019601970198019902000AbnormalnetworkregulationOfnerve-immune-endocrineIBSmolecularbiology…….IBS发病机制的认识临床症状腹痛、不适大便异常，流行病学等第一阶段I

4、BS发病机制的认识临床症状运动异常感觉异常社会心理致病腹痛、不适压力、电活动大便异常，敏感性、5-HT流行病学等炎症、脑肠交流第一阶段第二阶段VisceralHypersensitivityhyperalgesiaallodyniaEndogenousModulation.cortex.BrainstemEndorgansensitivity.silentnociceptorsSpinalHyperexcitability.NitricoxideActivationLong-termHyperalgesia.toniccortica

5、lregulation.NeuroplasticityIBS发病机制的认识临床症状运动异常感觉异常社会心理致病腹痛、不适压力、电活动大便异常，敏感性、5-HT流行病学等炎症、脑肠交流第一阶段第二阶段Serotonin(5-HT)inthehumangut5-HT15-HT35-HT4Gastricaccommodation↑↑Transit↓↑↑Colonictone↓↑Sensation↑?Secretion↑IBS发病机制的认识临床症状运动异常感觉异常社会心理致病腹痛、不适压力、电活动大便异常，敏感性、5-HT流行病学等炎症、脑

6、肠交流第一阶段第二阶段PsychologicdistressYoungerageDurationofabdominalpainDurationofdiarrheaFemalesFactorsPredictingGISymptomsIBS-PostInfectiousIBS发病机制的认识临床症状运动异常感觉异常社会心理致病腹痛、不适压力、电活动大便异常，敏感性、5-HT流行病学等炎症、脑肠交流第一阶段第二阶段MechanosensitiveafferentSensitizedspinalcircuitsDorsalrootgangli

7、onRepeatedstimulationDescendingVisceralPainPathwayThalamusPAGLocuscoeruleusAmygdalaColonSerotonergicNoradrenergicCaudalraphenucleusOpioidergicRostralventralmedullaMotilitySecretionBloodFlowInflammationSightSoundSmellSomatosensoryCognitionAffectViscerosensoryInputIntegr

8、ationEffectIBS发病机制的认识临床症状运动异常分子生物学阶段感觉异常网络调控社会心理致病腹痛、不适压力、电活动大便异常，炎症、敏感性流行病学等5-HT、脑肠交流第一阶段第二阶段第三阶段一氧化氮5－HT及受体多巴胺及受体胃肠