_ofirritable bowel syndrome概述ofirritable肠易激综合征课件

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1、OverviewofIrritableBowelSyndromeArnoldWald,MDProfessorofMedicineDepartmentofGastroenterology,Hepatology,andNutritionUniversityofPittsburghMedicalCenterPittsburgh,PennsylvaniaIrritableBowelSyndromeChronicorrecurrentGIsymptomsLowerabdominalpain/discomfortAlteredbowelhabitsBloatingNotexplain

2、edbystructuralorbiochemicalabnormalities2IBSClinicalSubgroupsConstipationpredominantDiarrheapredominantAlternatingconstipation/diarrhea3IBSClinicalSubgroupsConstipationpredominantDiarrheapredominantAlternatingconstipation/diarrhea4RomeIICriteriaforIBSAtleast12weeksormore,whichneednotbeconsec

3、utive,inthepreceding12months,ofabdominaldiscomfortorpainthathas2outof3features:RelievedbydefecationOnsetassociatedwithachangeinfrequencyofstoolOnsetassociatedwithachangeinform(appearance)ofstoolGut.1999.5EpidemiologyofIBSinUS(15%to20%ofPopulation)Specialists5%25%to50%ofreferralstoGIsareIB

4、SNonconsulters80%Primarycare15%6PrevalenceofDisordersinUSIBS:15%-20%Dyspepsia:8%GEreflux:7%Asthma:4%Diabetes:3%7IBSSymptomsReducePatientWellBeingReducedsenseofwellbeingAbdominalpainAlteredbowelhabitsCrampsBloatingConstipationDiarrheaUrgency8MedicalCostsAssociatedWithIBSEstimated$8billionan

5、nuallyindirectcostsIncreasedphysicianvisitsforbothGIandnon-GIcomplaintsIBSpatientsincur74%morehealthcarecoststhandonon-IBSsufferersDrossman,etal.DigDisSci.1993;38(9):1569-1580.Talley,etal.Gastroenterology.1995;109(6):1736-1741.9ImpactofIBSonWorkMissedwork:30%(1.7days)Reduceddays:46%(3days)Tu

6、rneddownpromotion:16%Changedjob,healthreasons:9%Changedworkschedule:8%HahnBA,etal.Digestion.1999;60(1):77-81.10PathophysiologyofIBS:ABiopsychosocialDisorderBiologicalAlteredGImotoractivityAlteredvisceralsensationPsychosocialBehavioralCognitiveEmotional11MultipleMedicationsAreUsedtoTreatIBS

7、AnticholinergicsTricyclicantidepressantsSSRIsAntidiarrhealsBulkingagentsLaxativesAlosetron**Datasupportefficacyfordiarrhea-predominantIBS.12IO135-HT4agonistsAlteredmotilityAlteredsensationNewTreatmentParadigmforC-IBS13