肠易激综合征的新概念.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,肠易激综合征的新概念Newest concepts in irritable bowel syndromeIBS,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,a group of functional bowel disorders in which discomfort or pain is associated with defecation or a change in bowel habit,and with features of disordered defecation.,该病缺乏可解释症状的形态学改变和生化异常,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,What causes IBS?,Development of IBS pathophysiology,inflammation,5-HT mediated hypersensitivity,and gut motility,Brain-gut interaction,Visceral hypersensitivity,Abnormal motor function,1950 1960 1970 1980 1990 2000,Abnormal network regulation,Of nerve-immune-endocrine,IBS molecular biology,.,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,、,脑肠交流,第一阶段 第二阶段,Visceral Hypersensitivity,hyperalgesia,allodynia,Endogenous,Modulation,.cortex,.Brainstem,End,organ sensitivity,.silentnociceptors,Spinal,Hyperexcitability,.Nitric oxide,Activation,Long-term,Hyperalgesia,.,tonic cortical regulation,.Neuroplasticity,Serotonin(5-HT)in the human gut,5-HT,1,5-HT,3,5-HT,4,Gastric accommodation ,Transit ,Colonic tone ,Sensation?,Secretion ,Psychologic,distress,Younger age,Duration of abdominal pain,Duration of diarrhea,Females,Factors Predicting,GI Symptoms,IBS-Post Infectious,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,、,脑肠交流,第一阶段 第二阶段,Descending Visceral Pain Pathway,Thalamus,PAG,Locus coeruleus,Amygdala,Colon,Serotonergic,Noradrenergic,Caudal raphe nucleus,Opioidergic,Rostral ventral,medulla,Motility,Secretion,Blood Flow,Inflammation,Sight,Sound,Smell,Somatosensory,Cognition,Affect,Viscerosensory,Input,Integration,Effect,IBS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,5HT及受体,多巴胺及受体,胃肠道激素及受体,细胞因子及受体,细胞信号转导蛋白,离子及离子通道,Extracellular network regulation,Nerve cells,Immune cells,Endocrine cells,Cytokine,receptor,peptide,5-HT,Predisposing,factors,Psycho-,Physiological,triggers,Concurrent,modifiers,Brain-gut,dysregulation,Early,life,Genetic vulnerability,Enviromnent eg illness,Behavior reinforcement,abuse,Predisposing,factors,Psycho-,Physiological,triggers,Concurrent,modifiers,Brain-gut,dysregulation,Early,life,Genetic,Environment,Chronic,threat&,prolonged,effortful,coping,Enteric,Infection/,Inflammation/,toxins,Predisposing,factors,Psycho-,Physiological,triggers,Concurrent,modifiers,Brain-gut,dysregulation,Early,life,Genetic,Environment,Chronic,threat&,prolonged,effortful,coping,Enteric,Infection/,Inflammation/,toxins,Stress-response,neuromodulation,Post-infective,neuromodulation,Personality,emotional,Support,age,gender,Sleep dysfunction,Life event stress,Food allergens,Altered bowel flora,How to diagnose？,诊断,以症状为基础,Rome I Criteria Rome II Criteria,at least 12 weeks,which need not be consecutive,in the past 12 months,of abdominal discomfort or pain that has two of three features,-relieved by defecation;and/or,-onset associated with a change in frequency of stool;and/or,-onset associated with a change in form(appearance)of stool,At least 3 months continuous/recurrent symptoms of the following,-Abdominal pain or discomfort that is,-associated with a change in frequency of stool and/or,-associated with a change in consistency of stool;and,Two or more of the following at least 25%of the time,altered stool frequency(3/day or 40岁,诊断流程,问诊查体,有 无,发热、消瘦、便血、腹部包块,彻底检查,近期排便习惯改变、肿瘤家族史、40岁,肠镜或钡灌肠,大便常规OB,是,否,What is the best management approach?,治疗,个体化、综合治疗,治疗原则,A comprehensive multicomponent approach,Treatment program is based on,dominant symptom,and their,severity,and on,psychosocial factors,and etiological factors,Drugs for dominant in IBS,Abdominal,pain,Antispasmodics,Tricyclic,Antidepressants,SSRI,Diarrhea,Constipation,Fiber,Osmotic laxatives,Tegaserod,PEG solution,Loperamide,Cholestyramine,Diphenoxylate,治疗原则,A comprehensive multicomponent approach,Treatment program is based on,dominant symptom,and their,severity,and on,psychosocial factors,and etiological factors,Mild Lifestyle and dietary modification,Severe Realistic goals,Antidepressants,Referral for pain management,Moderate Gut acting agents Psychologic,(motility/sensation)treatments,All,Therapeutic relationship/continuity of care education/reassurance,治疗原则,A comprehensive multicomponent approach,Treatment program is based on,dominant symptom,and their,severity,and on,psychosocial factors,and etiological factors,心理治疗,What can we do?,How to do?,心理治疗,第一层次,：一般性心理治疗或支持性心理治疗（supportive psychotherapy）,第二层次,：心理治疗干预(psychotherapeutic intervention),DefinitionPathogenesisDiagnosisTreatment,谢谢,