Irritable Bowel Syndrome

　　Irritable Bowel Syndrome (IBS) is a functional bowel disease characterized by abdominal pain or discomfort accompanied by changes in defecation habits, which requires examination and exclusion of organic diseases that can cause these symptoms. This disease is the most common type of functional bowel disease, also known as intestinal dysfunction, allergic colitis, spastic colitis, mucous colitis, and so on. It is estimated that IBS accounts for 50% to 70% of patients with digestive system symptoms, with a male-to-female incidence ratio of 1:2, and is more common in middle-aged and young adults, and is widely recognized as a psychosomatic disease with a special pathophysiological basis. Currently, the pathophysiological basis of IBS is mainly gastrointestinal motility disorders and visceral sensory disorders, while the mechanisms causing these changes have not been elucidated. It is known that psychiatric and psychological disorders are important factors in the pathogenesis of IBS.

　　1. Gastrointestinal dynamics abnormalities Abnormal dynamics are not limited to the colon and can often involve the entire gastrointestinal tract. They have an exaggerated dynamic response to various physiological and non-physiological stimuli and present as a recurrent process.

　　2. Abdominal perception abnormalities Rectal balloon inflation test shows that the pain threshold of IBS patients is significantly lower than that of the control group.

　　3. Mental factors Psychological stress has a significant impact on gastrointestinal motility. A large number of surveys have shown that IBS patients have personality abnormalities, with significantly higher anxiety and depression scores than normal people, and a higher frequency of stress events than normal people.

　　4. Others Approximately 1/3 of patients may have symptoms exacerbated by intolerance to certain foods. Some patients may develop IBS symptoms after the cure of intestinal infection. Recent research has shown that the disease may be related to low-grade inflammation of the intestinal mucosa, such as degranulation of mast cells and high expression of inflammatory mediators.

　　The onset or exacerbation of symptoms is often related to mental factors or some stress states. Some patients may have symptoms of multiple functional disorders of the upper gastrointestinal tract and extra-intestinal organs. They may also have abnormal psychological and mental manifestations, such as depression, suspicion, tension, anxiety, and hostility.

　　1. Symptoms

　　1. Abdominal pain can occur at any part of the colon, but it is more common in the left iliac fossa and left lower abdomen, often accompanied by abdominal distension, and pain may subside after passing gas or defecating.

　　2. Diarrhea and constipation are often characterized by loose stools containing mucus, and sometimes there may be a large amount of mucoid secretion. In some cases, constipation may occur with feces resembling sheep dung or chestnuts, and diarrhea may alternate with constipation.

　　3. Neurofunctional symptoms commonly accompanied by anxiety, tension, insomnia, fatigue, shortness of breath, palpitations, excessive sweating of hands and feet, low blood pressure, frontal paroxysmal fever, and symptoms such as dizziness, headache, chest pain, back pain, difficulty breathing, frequent urination, and urgency.

　　4. Dyspeptic symptoms such as decreased appetite, abdominal distension, discomfort, nausea, and vomiting.

　　2. Signs

　　1. Sometimes, spastic sigmoid colon or fecal mass, and mild tenderness in the colon area can be palpated.

　　2. Digital rectal examination suggests increased anal sphincter tone and pain sensation in the patient.

　　3. Clinical Classification

　　The Rome III Expert Committee selected the faecal characteristics as an index with a relatively clear pathological and physiological basis, simplifying the classification of IBS subtypes to only rely on faecal characteristics for typing. According to this, IBS is divided into diarrhea-predominant (IBS-D), constipation-predominant (IBS-C), mixed-type (IBS-M, also known as alternating type), and unclassified (IBS-U).

　　1. Constipation-type IBS (IBS-C): At least 25% of defecation is hard stool or dry ball stool, and loose (paste-like) stool or watery stool is less than 25%.

　　2. Diarrhea-type IBS (IBS-D): At least 25% of defecation is loose (paste-like) stool or watery stool, and hard stool or dry ball stool is less than 25%.

　　3. Mixed-type IBS (IBS-M): At least 25% of defecation is hard stool or dry ball stool, and at least 25% of defecation is loose (paste-like) stool or watery stool. That is, diarrhea and constipation appear intermittently, sometimes diarrhea is the main symptom, and sometimes constipation is the main symptom.

　　4. Atypical IBS (IBS-U): The characteristics of feces do not meet the above IBS-C, IBS-D, or IBS-M standards.

　　In 2007, a study conducted by the Department of Gastroenterology of Addenbrooke's Hospital in Cambridge on 500 patients with irritable bowel syndrome showed that 75% of the patients are suitable for dietary therapy. And a reasonable diet can effectively prevent the recurrence of the patient's condition, so patients should follow the following 7 points in their diet.

　　1. Regular diet: Regular diet can help the digestive system establish order.

　　2. Eat less and more often: Eating too much at one time can lead to stomach bloating and diarrhea.

　　3. Eating slowly: Patients should eat slowly, as wolfing down food will swallow more air, leading to intestinal and stomach bloating.

　　4. Chewing thoroughly: Thorough chewing allows the enzymes in saliva more time to digest food and stimulate the secretion of gastric juice.

　　5. Large amount of water: Patients should pay attention to drinking plenty of water in their daily life, as water combines with intestinal fiber to increase the volume of feces, making it easier to excrete; it can also play a role in replenishing body fluids during diarrhea.

　　6. Refuse high-fat foods: Simple and plain food is more conducive to achieving a balanced diet, and foods with low fat and sugar content and strong taste may be beneficial to intestinal health.

　　7. Increase beneficial bacteria: Among them, the effects of probiotics such as lactic acid bacteria and bifidobacteria families and thermophilic streptococci are most obvious.

　　In addition, patients should eat more fish, green vegetables, fruits, rice, yogurt, bananas, and other foods in dietary adjustment, and try to avoid eating cheese, chocolate, nuts, beef, white bread, and other foods.

　　1. Colonoscopy: It can be seen that the colon is spasmodic and mucus increases, especially in the sigmoid colon and rectum.

　　2. Barium enema has the following characteristics:

　　(1) When the barium is filled, the colon becomes thinner, the colon pouches increase, and after certain strong contractions, it can present in an expanded state.

　　(2) When the barium is emptying, the colon becomes thinner, the colon mucosal stripes are significantly reduced, and barium retention is present in the colon pouches after certain strong contractions.

　　3. Auxiliary examination: Stool examination shows only mucus without a large number of red blood cells and white blood cells, stool occult blood test is negative, and erythrocyte sedimentation rate is normal.

　　Traditional Chinese medicine's dietary therapy can adjust the peristalsis, secretion, and absorption of the intestines, as well as adjust the imbalance of intestinal flora. More importantly, it can adjust a person's mental and emotional state, which will be of great help to patients with irritable bowel syndrome (IBS).

　　(1) Cassia Honey Drink: 30g of cassia seeds, 30g of pure honey. Preparation: First, select the cassia seeds, remove impurities, then put them into a pot and gently stir-fry, crush them, then put them into a pot, add an appropriate amount of clean water, and simmer over low heat. After boiling, take the medicine juice, mix it with honey, and take it twice a day in the morning and evening. This food therapy is suitable for yin fluid deficiency and intestinal dryness and constipation.

　　(2) Lian Shan Flour: 500g of lotus seed meat, 500g of Chinese yam, 500g of Job's tears, 500g of Euryale ferox. Preparation: First, put the lotus seed meat, Chinese yam, Job's tears, and Euryale ferox into a pot, stir-fry them over low heat until slightly brown, then put each of the drugs into a mill and grind them into powder, mix the four kinds of powder together, and store them in a dry glass bottle. Take 30g each time, mix with warm water to make a thin paste, and take it several times a day. This food therapy is suitable for spleen deficiency diarrhea.

　　(3) Charcoal Rice Porridge: 100g of glutinous rice. Preparation: First, wash the glutinous rice clean with water, then put the glutinous rice into a pot, stir-fry it over low heat until it turns slightly yellow, then add an appropriate amount of clean water, cook it into a thin porridge over low heat, and serve it when warm. It can be taken 2-3 times a day. This food therapy is suitable for spleen deficiency diarrhea and poor digestion.

　　(4) Ginger and Mugwort Syrup: 12g of ginger, 9g of mugwort, 6 dates, 15g of brown sugar, 15g of white sugar. Preparation: Wash the ginger clean of mud, remove the ginger peel, and cut into thin slices for use. Wash the dust of mugwort clean for use. Soak the dates in clean water for a while, wash and remove the kernel for use. After all the ingredients are ready, put them into a pot, add an appropriate amount of clean water, and cook over medium heat until warm. This recipe is suitable for abdominal pain due to internal coldness.

　　(5) Sesame Seed and Perilla Seed Rice Porridge: 15g of sesame seed, 15g of perilla seed, 50g of glutinous rice. First, grind the sesame seed and perilla seed into paste, then add water to grind and filter the juice, remove the residue, and use the juice to cook the porridge. This recipe has the effect of moistening the intestines and promoting defecation, and is suitable for irritable bowel syndrome patients with constipation.

　　(6) Chestnut Rice Porridge: 15g of chestnuts, 50g of glutinous rice. Cook the chestnuts and glutinous rice into porridge and eat it. This recipe has the effect of invigorating the spleen and stomach, and is effective for spleen deficiency diarrhea.

　　(7) Cardamom Rice Porridge: 3g of cardamom, 50g of glutinous rice, 2 slices of ginger. First, cook the glutinous rice with clean water, and after boiling for 10 minutes, add the cardamom and ginger, and continue until the porridge is done. Take 1-2 times a day on an empty stomach. It has the effects of promoting Qi and reducing bloating, warming and harmonizing the middle burner, and astringing intestines to stop diarrhea. It is suitable for abdominal pain and diarrhea, and it is more comfortable when the stools are loose and warm.

　　There is still no medication that can completely effectively treat irritable bowel syndrome, and an effective and ideal treatment plan for irritable bowel syndrome has not yet been formed. The Chinese Medical Association's Gastroenterology Branch pointed out in the 2003 consensus on the diagnosis and treatment of irritable bowel syndrome: 'The purpose of treating irritable bowel syndrome is to eliminate patients' concerns, improve symptoms, and improve the quality of life. The treatment principle is to carry out graded treatment based on the severity of symptoms and symptomatic treatment based on the type of symptoms, while paying attention to the individualization and comprehensive application of treatment measures.' Therefore, it is recommended to adopt comprehensive treatment, which should include psychological and behavioral intervention, dietary adjustment, and medication.

　　1. Establishing a good doctor-patient relationship:Establishing a good doctor-patient relationship is the most effective and economical treatment for irritable bowel syndrome, and it is also the foundation for the effective implementation of all treatment methods. In this relationship, doctors need to pay attention to listening, analyzing and explaining, clarifying problems and expectations, giving answers, and involving patients in the treatment process, so that patients can establish confidence, increase trust, thereby reducing the number of visits to the hospital by patients and improving patient satisfaction.

　　2. Diet Treatment:Clinical experience and research have found that poor dietary habits and unreasonable dietary structures can exacerbate the symptoms of irritable bowel syndrome, therefore, a healthy and balanced diet can help alleviate the gastrointestinal dysfunction symptoms of patients with irritable bowel syndrome. ① Principle: Patients with irritable bowel syndrome should avoid the following factors: overeating, excessive alcohol consumption, caffeine, high-fat diet, certain vegetables and beans with gas-producing effects, refined flour and artificial foods, sorbitol and fructose. ② Adjust dietary fiber and fiber preparations: such as grains, fruits, vegetables, seeds, nuts, and beans, which are the main dietary fiber. Mainly used for patients with constipation as the main symptom, generally starting from a low dose and gradually increasing the dose and should be individualized.

　　3. Medication Treatment:Although there is no medication that can completely and effectively treat all types of irritable bowel syndrome at present, there are many medications that can control various symptoms of irritable bowel syndrome to varying degrees. Commonly used drugs can be divided into the following types: ① Antispasmodics. Such as atropine, belladonna, bromopropylamine, pinaverium bromide, trimebutine, etc. ② Antidiarrheals. Such as loperamide, compound difenoxin. ③ Laxatives. Such as magnesium oxide milk, lactulose, sorbitol, etc. ④ Probiotics. ⑤ Antipsychotics. Such as diazepam, amitriptyline, paroxetine.

　　4. Psychological and Behavioral Treatment:Many studies believe that cognitive-behavioral therapy, standard psychology, and hypnotherapy have certain therapeutic effects on some patients with irritable bowel syndrome.