[综述] 肠易激综合征及相关的肠-脑相互作用障碍
完整摘要 · 中文译文
肠易激综合征、慢性便秘和功能性腹泻是肠-脑相互作用障碍，其症状包括排便性状或频率异常，并伴有不同程度的腹痛、腹部不适、腹胀或腹部膨隆。这些疾病影响全球20%的人口，病程呈复发缓解。危险因素包括女性、较年轻年龄、常见精神障碍病史以及急性肠道感染。肠易激综合征、慢性便秘和功能性腹泻的病理生理学仍未完全明确，但被认为继发于整个肠-脑轴的异常相互作用，导致肠道动力紊乱和内脏高敏感。这些疾病的诊断结合临床病史、无警报症状（如体重减轻或直肠出血）以及针对性检查。富有同理心的管理方式可改善生活质量和症状、减少医疗资源使用并提高治疗依从性。治疗的主要手段包括教育、饮食和生活方式建议、调整纤维摄入以及针对主要症状的药物。对于严重症状，其他治疗包括特定医疗设备、生物反馈或心理治疗。然而，大多数治疗的效果有限，仍持续需要扩展肠道疾病的可及治疗手段，目前有数种新药正在研发中。
完整摘要 · 英文原文
Irritable bowel syndrome, chronic constipation, and functional diarrhoea are disorders of gut-brain interaction, the symptoms of which include abnormal stool consistency or frequency accompanied by varying degrees of abdominal pain, discomfort, bloating, or distension. These conditions affect 20% of the global population with a relapsing and remitting course. Risk factors include female sex, younger age, a history of common mental disorders, and acute enteric infection. The pathophysiology of irritable bowel syndrome, chronic constipation, and functional diarrhoea remain incompletely understood, but are thought to be secondary to aberrant interactions throughout the gut-brain axis, resulting in disordered gut motility and visceral hypersensitivity. These conditions are diagnosed with a combination of clinical history, absence of alarm symptoms-such as weight loss or rectal bleeding-and targeted investigations. An empathetic management approach improves quality of life and symptoms, reduces health-care use, and enhances treatment adherence. Mainstays of treatment include education, dietary and lifestyle advice, modifying fibre intake, and drugs directed towards predominant symptoms. For severe symptoms, other treatments include specific medical devices, biofeedback, or psychological therapies. However, the effectiveness of most treatments is modest and there is an ongoing need to expand available treatments for bowel disorders, with several novel drugs currently in development.