Irritable Bowel Syndrome

　　Elderly irritable bowel syndrome (IBS) is one of the most representative and common diseases among functional gastrointestinal disorders. The etiology of this disease is complex and may be the result of the combined action of various factors. The common causes of irritable bowel syndrome include the following points:

　　1, Gastrointestinal motility disorder

　　IBS patients have abnormal migrating motor complex in the small intestine, with a significantly shortened cycle, and more scattered cluster contraction waves appear in the jejunum. These changes are more obvious during stress and sleep. In addition, the transit time of the small intestine and colon in diarrhea-predominant IBS patients is accelerated, while in constipation-predominant patients, it is significantly slowed down. The above changes are not yet clearly related to the symptoms of IBS.

　　2, Abnormal visceral sensation

　　Increased visceral sensitivity is an important pathophysiological mechanism of IBS and one of the biological markers of IBS. Research has found that most IBS patients have clinical characteristics of hypersensitivity to luminal (rectal) distension, with an average decrease in pain threshold, increased discomfort after rectal distension, or abnormal visceral-corporeal radiation pain, indicating abnormal processing of visceral sensory signals at the spinal level.

　　3, Psychological factors

　　Psychological stress has a significant impact on gastrointestinal function and plays an important role in the induction, exacerbation, and persistence of IBS symptoms. The impact of psychological and social factors on IBS can manifest as: the effect on gastrointestinal physiology, the influence on the experience of disease, disease behavior, and disease consequences, and the influence on the indication for behavioral intervention. Severe negative life events have a higher incidence rate in IBS patients. A considerable number of patients in gastrointestinal clinics have psychological disorders, among which anxiety and depression are the main ones.

　　4, Intestinal infection

　　Some IBS patients have a history of intestinal infection before onset, and 20% to 25% of patients with enteritis caused by various pathogens, including bacteria, viruses, and parasites, develop intestinal dysfunction after acute infection, and 10% may develop post-infection IBS. Intestinal infection can affect the intestinal mucosal epithelial barrier and the intestinal mucosal immune system, leading to intestinal dysfunction and triggering IBS. Mast cells are one of the most important immune cells in the intestinal mucosal tissue. During intestinal inflammation, mast cells are stimulated by antigens and degranulate, and their mediators can directly act on smooth muscle cells or secretory cells, or they may first excite the surrounding nerve cells, and then the latter transmit the information to the target cells.

　　5, Other

　　The symptoms of some IBS patients are related to food and can exacerbate their symptoms. The fermentation of fiber in food may be the cause of excessive gas production. In addition, the disorder of the intestinal flora may also be one of the causes of the symptoms.

　　The etiology and pathogenesis of IBS have not been fully elucidated.

　　Elderly patients with irritable bowel syndrome (IBS) often have concurrent psychiatric disorders such as insomnia, anxiety, and autonomic neuropathy, which seriously endanger the physical health of the elderly. Therefore, once the elderly find physical discomfort or signs of illness, they should seek medical attention in a timely manner and not delay the best treatment opportunity.

　　Elderly irritable bowel syndrome has an insidious onset, symptoms are recurrent and prolonged, but the patient's overall condition is basically unaffected. The symptoms are non-specific, and all symptoms can be seen in organic gastrointestinal diseases. Typical symptoms are abdominal pain and distension associated with abnormal defecation (shape/number). According to the main symptoms, they are divided into: diarrhea-dominant type; constipation-dominant type; diarrhea and constipation alternating type. Factors such as spirit, diet, and cold can induce or exacerbate symptoms.
　　1, Abdominal pain:It is the main symptom of IBS, accompanied by abnormal stool frequency or shape, and abdominal pain is more relieved after defecation, some patients are prone to appear after eating. Abdominal pain can occur in any part of the abdomen, localized or diffuse. The nature of pain is diverse and the degree varies, but it will not worsen progressively. It rarely occurs during sleep.
　　2, Diarrhea:① Persistent or intermittent diarrhea, less stool volume, paste-like, containing a large amount of mucus, but no blood, microscopic examination is approximately normal; ② Symptoms disappear after fasting for 72 hours; ③ It does not occur at night, different from organic diseases; ④ About 1/4 patients can be induced by eating; ⑤ Many patients have alternating diarrhea and constipation.
　　3, Constipation:Difficult defecation, dry and hard stools, less in quantity, and more mucus. Constipation can be intermittent or alternating with diarrhea, often accompanied by a feeling of incomplete defecation. Early on, it is mostly intermittent, and later it persists, even long-term dependence on laxatives.
　　4, Abdominal distension:More severe during the day, especially in the afternoon. After sleep at night, it is reduced. The abdominal circumference generally does not increase.
　　5, Non-colonic symptoms and extra-gastrointestinal symptoms:Almost half of the patients have symptoms such as heartburn, early satiety, nausea, vomiting, and upper gastrointestinal symptoms. Non-gastrointestinal symptoms such as fatigue, back pain, headache, palpitations, difficulty breathing, frequent urination, urgency, and sexual dysfunction are more common than organic intestinal diseases. Some patients also have varying degrees of psychological and spiritual abnormalities, such as anxiety, depression, tension, suspicion, and hostility.
　　Signs and symptoms are usually not positive. Some patients have symptoms of autonomic nervous system dysfunction, such as sweating, tachycardia, and hypertension. Sometimes, the sigmoid colon curve or painful intestinal loop can be palpated in the abdomen. It is very easy to feel abdominal pain during sigmoidoscopy, and it is sensitive to injection response. These phenomena are indicative of diagnosis.

　　Elderly people should live a regular life, be open-minded, strengthen physical exercise, do not misuse drugs, and go to the hospital early for diagnosis and treatment if they have a disease. Increase the intake of dietary fiber in food. Whether diarrhea or constipation, supplementing fiber is beneficial. Fiber can accelerate the movement of food, soften the stool, increase fecal volume, and thus facilitate defecation. Foods rich in dietary fiber include fruits, vegetables, grains, corn, etc. There should be enough vegetables in daily diet, such as celery, cabbage, rapeseed, etc. Green vegetables. Eat some fruits like pears, oranges, watermelons, etc. after meals. Grains and corn should be matched with refined rice and fine flour.

　　The laboratory examination mainly excludes common intestinal infectious diseases. Multiple routine fecal culture tests (at least 3 times) were negative, fecal occult blood test was negative, blood and urine routine tests were normal, and erythrocyte sedimentation rate was normal.

　　For newly diagnosed cases in individuals over 40 years old, in addition to the above examinations, it is necessary to assist with colonoscopy and mucosal biopsy to exclude infectious, inflammatory, neoplastic, and some rare diseases.

　　The appropriate diet for elderly patients with irritable bowel syndrome mainly includes the following points:

　　1. Increase the intake of dietary fiber in the diet

　　Fiber can accelerate the movement of food, soften stools, increase stool volume, and thus facilitate defecation. There should be enough vegetables in the daily diet.

　　2. Limit the intake of gas-producing foods

　　The large amount of gas produced by the decomposition of intestinal bacteria in the gas-producing foods entering the intestines can cause intestinal expansion, slow intestinal peristalsis, and lead to intestinal distension, abdominal pain, constipation, or diarrhea. Coffee, carbonated drinks, alcohol, and others can be gas-producing foods, and it is advisable to eat and drink less.

　　3. To maintain regular diet

　　The basic principle is to have light, easily digestible, and low-fat diet. Three meals a day should be regular and in appropriate amounts.

　　The treatment of elderly irritable bowel syndrome (IBS) in traditional Chinese medicine still focuses on differential diagnosis and treatment. The differential diagnosis of IBS varies among different reports, ranging from two types to seven types. In 2003, the Committee on Gastroenterology of the Chinese Society of Integrated Medicine formulated the 'Integrated Treatment Program for Irritable Bowel Syndrome (Draft)' in Chongqing, which divides IBS into five types.

　　1. Liver depression and qi stagnation syndrome
　　Main symptoms: Constipation, difficulty in defecation; Distension and piercing pain in the chest and hypochondrium or lower abdomen; Irritability and easy anger; Wiry pulse. Secondary symptoms: Abdominal rumbling and flatulence; Belching and hiccups, poor appetite and reduced food intake; Feeling of weight and urgency; Insomnia and dreams; Bitter taste and dry throat, or feeling as if there is something obstructing the throat. Diagnosis: With 2 main symptoms plus 2 secondary symptoms, or 1 main symptom plus 3 secondary symptoms.
　　Principle of treatment: Soothing the liver and regulating qi.
　　Therapeutic prescription: Modified Six Grind Decoction: Agarwood (decocted last), Guangmu xiang (decocted last), Areca nut slices, Huoxiang, Aurantium cum pericarpium, Raw rhubarb (decocted last), Yujin, Houpu; Modification: For marked abdominal pain, add Yanhusuo and White peony root; For bitter taste and dry throat due to liver qi stagnation transforming into heat, add Scutellaria baicalensis, Chrysanthemum, and Prunella; For hard stools, add Sesamum indicum,杏仁, and Prunus persica.

　　2. Liver qi overpowering the spleen syndrome
　　Main symptoms: Abdominal pain followed by diarrhea, pain alleviating after diarrhea (often exacerbated by anger or nervousness); Lower abdominal spasm; Distension and piercing pain in the chest and hypochondrium; Wiry or wiry-thin pulse. Secondary symptoms: Abdominal rumbling and flatulence; Mucous in stools; Depressed mood, fond of sighing; Irritability and easy anger; Poor appetite and abdominal distension. Diagnosis: With 2 main symptoms plus 2 secondary symptoms, or 1 main symptom plus 3 secondary symptoms.
　　Principle of treatment: Suppressing the liver and reinforcing the spleen.
　　Therapeutic prescription: Modified Pain Relieving Decoction: Fried Atractylodes macrocephala, White peony root, Forsythia, Fried tangerine peel, Bupleurum, Braised Costus root, Fried Quercus acutissima, Processed Cyperus rotundus, Prepared rhizoma Corydalis, Licorice root; Modification: For severe abdominal pain, add Yanhusuo and Sichuan mulberry; For frequent belching, add Agarwood and Amomum villosum; For diarrhea, add Codonopsis pilosula, Prunus mume, and Chinese papaya; For marked abdominal distension, add areca nut slices, Aurantium cum pericarpium, and large belly skin; For irritability and easy anger, add Moutan bark and Gardenia; For poor sleep at night, add fried Semen Ziziphi Spinosae and Cuscuta chinensis.

　　3. Spleen and Stomach Weakness Syndrome
　　Main symptoms: diarrhea after meals, stools are sometimes loose and sometimes liquid, with mucus; poor appetite; abdominal distension and discomfort after eating; pale tongue with puffy body and teeth marks, white fur; thin and weak pulse. Secondary symptoms: hidden pain in the abdomen, desirable to be pressed; abdominal distension and intestinal rumbling; fatigue and lack of energy, limbs weak and weary; yellowish face. Syndrome determination: main symptoms 2 items plus secondary symptoms 2 items, or main symptom 1 item plus secondary symptoms 3 items.
　　Treatment principle: Strengthen the spleen and invigorate the qi.
　　Treatment and medicine: Modified Shenling Baizhu Powder: Codonopsis pilosula, stir-fried white atractylodes, Poria cocos, white peony root,山药, stir-fried mung bean, lotus seed, Coix seed, Amomum villosum, stir-fried tangerine peel, costus, licorice; modifications: for prolonged diarrhea and insufficient middle qi, add Cimicifuga foetida, Bupleurum chinense, Astragalus membranaceus; for spleen deficiency and kidney deficiency, diarrhea in the morning, add Fructus psoraleae, Myristica fragrans; for abdominal pain that is desirable to be pressed and aversion to cold, loose stools, add dried ginger and cinnamon; for spleen deficiency and dampness, add Atractylodes macrocephala, Magnolia officinalis, Polemonium reptans, Alisma orientale.

　　4. Mixed Cold and Heat Syndrome
　　Main symptoms: alternating attacks of diarrhea and constipation; sticky and gelatinous stool or mixed with foam; abdominal pain before defecation, pain eases and stops after defecation; dark red tongue with white greasy fur; wiry and thin pulse or wiry and slippery pulse. Secondary symptoms: abdominal distension and intestinal rumbling; bitter taste in the mouth; rectal prolapse; uncomfortable defecation. Syndrome determination: main symptoms 2 items plus secondary symptoms 2 items, or main symptoms 3 items.
　　Treatment principle: Balance cold and heat, invigorate the spleen and warm the middle.
　　Treatment and medicine: Modified Wu梅pill: Wu梅, Coptis, Phellodendron, Sichuan pepper, prepared aconite, dried ginger, Codonopsis pilosula, white atractylodes, Poria cocos, Angelica sinensis, white peony root, licorice; modifications: for cold pain in the lower abdomen, remove Coptis, add fennel and lychee kernel; for burning sensation in the epigastrium and bitter taste in the mouth, remove Sichuan pepper, dried ginger, and aconite, add gardenia and Evodia; for sticky and uncomfortable stool, with urgent need to defecate, add areca nut slices, magnolia bark, hawthorn charcoal.

　　5. Large Intestine Dried Heat Syndrome
　　Main symptoms: constipation, once every few days; feces like sheep dung, wrapped with mucus; lower abdominal mass, tender and painful when pressed; red tongue with thin yellow fur, thin and rapid pulse. Secondary symptoms: dizziness and headache; emaciation; dry mouth or halitosis; insomnia and anxiety. Syndrome determination: main symptoms 2 items plus secondary symptoms 2 items.
　　Treatment principle: Clear heat and clear intestines, moisten intestines and promote defecation.
　　Treatment and medicine: Modified Maxima seeds pill: raw rhubarb (added later), hemp seeds, almonds, white peony root,枳实, white honey (to be taken with water), North American Platycodon root, Ophiopogon japonicus, Angelica sinensis; modifications: for severe constipation, add Scrophularia ningpoensis, raw Rehmannia, raw Hedysarum polybotrys; for obvious abdominal pain, add Corydalis yanhusuo, use the original formula with more white peony root.