抗生素治疗的争议（英文PPT）Probiotics and IBSppt课件.pptVIP

Pathogenesis of IBS: Infections Chaudary Truelove – 1962 – described onset of IBS after dysentery McKendall Read – 1994 – Bowel dysfunction developed in 12/38 patients after salmonella infection Neal et al (1997) – at 6 month follow-up, 7% of patients developed IBS symptoms after bacterial gastroenteritis Garcia-Rodriguez (1999) – RR for developing IBS symptoms after bacterial gastroenteritis = 10 Pathogenesis of IBS: Infections Gwee (1999) 94 patients with acute gastroenteritis compared to controls 23% had IBS symptoms at 3 months 64% were women Stress, hypochondriasis associated with increased likelihood Rectal biopsies at 3 months revealed an increased number of mucosal inflammatory cells Pathogenesis of IBS: Inflammation Gwee et al (Gut 1999) – rectal biopsies revealed an increase in mucosal inflammatory cells in patients with post-infectious IBS Spiller et al (Gut 2000) – After Campylobacter enteritis patients (n=21) were found to have increased: mucosal permeability number of lymphocytes in the lamina propria number of intra-epithelial lymphocytes at 1 year FU Pathogenesis of IBS: Inflammation Tornblom et al (Gastro. 2002) – Full thickness jejunal biopsies of IBS patients (n=10) revealed low-grade infiltration of lymphocytes in the myenteric plexus in 9 patients, and neuronal degeneration in the myenteric plexus in 6/9 patients Experimental colitis alters myenteric nerve function and previous inflammation changes/sensitizes rats to stress (Jacobson et al, Gastro 1995; Collins et al, Gastro 1996) Pathogenesis of IBS: Altered Gut Flora IBS patients may have different ratios of normal gut flora Reduced levels of Lactobacilli and Bifidobacterium Increased levels of Clostridium Balsari et al, Microbiologica 1982 Malinen et al, Am J Gastro 2005 Lin, JAMA 2004 Risk Factors for SIBO Ileocecal resection Small intestinal stasis Diverticulosis, strictures Abnormal motility (scleroderma, CIP) Hypochlorhydria Immunodeficiency Gastroparesis Chronic diseases