从罗马iv标准角度分析肠易激综合征.pptx

从罗马IV标准角度析肠易激综合征的药物治疗现状汇报人：xxx 讨论的问题罗马IV对IBS诊断标准的修订及其意义根据IBS主要症状及其潜在机制的治疗策略 功能性肠病（FBD）Irritable bowel syndrome (IBS)Functional constipation (FC)Functional diarrhea (FDr)Functional abdominal bloating/distention (FAB/D)Unspecified functional bowel disorder (U-FBD)]Opioid induced constipation (OIC) 肠易激综合征(IBS) 是临床常见的功能性肠道疾病患病率全球总患病率在5%～25% 之间，大部分亚洲国家患病率在5%～10%之间性别患病女性高于男性，男女性别比在1:1～1:2 之间年龄多见于30 ～ 40岁的中青年症状反复发作，严重影响患者的生活质量 腹痛与腹部不适疼 痛不 痛不适？ 腹部不适的含义是什么?腹部不适 = 腹痛?只是性质与程度的差异? Rome III 及 Rome IV标准诊断IBS的差异IBS prevalence (%)02468101214Rome IVRome III11.15.8(N= 3600 – UK, US and Canada)?FCFDrFAB/DUFBD IBS Rome IV分型% BM hard or lumpy% BM loose or watery02550751000255075100IBS-UIBS-CIBS-MIBS-DBristol types 1 or 21 and 2Bristol types 6 or 7Type 1Type 2Type 3Type 4Type 5Type 6Type 7plus6 and 7IBS with constipation (IBS-C)IBS with diarrhea (IBS-D)IBS with constipation/diarrhea (IBS-M)IBS unclassifiable (IBS-U)Based only on days with abnormal bowel habitsAt least 4 days of abnormal bowel habits/monthOff medications used to treat bowel habit abnormalitiesFor clinical trials, subtyping based on ≥ 2 weeks daily diary data is recommended 罗马IV对罗马 III IBS分型的影响 Rome IIIRome IV100906050403020108070017%21%60%2%28%34%33%5%IBS-CIBS-DIBS-MIBS-U 罗马III对IBS诊断“Few tests are required for patients who have typical IBS symptoms and no alarm features”.“IBS is often properly diagnosed without testing”. 罗马IV对IBS诊断“Fulfilling diagnostic criteria is mandatory to make the diagnosis of IBS but it is not enough. Some organic diseases may also meet these criteria.” IBS常与FC 及FD重叠功能性便秘N=513IBS-CN1%6811.7%40870.2%功能性腹泻N=615IBS-DN6%16521.1%40051.3% FBDs为一组疾病相互重叠腹胀便秘腹泻腹痛腹部膨胀IBSMCDFCFDr FBD相互转换随自然病程、治疗反应或两者共同作用转换IBSFDrFCFAB/DC?D FC与IBS-C随病程转换12 months folow-upIBS-C(n=142)FC: 39%IBS-C: 13%IBS-M: 5%Normal: 41%FC: 26%IBS-C: 36%IBS-M: 16%Normal: 21%FC(n=195) IBS的病理生理饮食习惯－FODMAP－乳糖不耐受食物消化吸收 肠道细菌肠道微生物－肠道感染－过度增殖(SIBO)－菌群构成改变/紊乱肠道炎症/免疫激活－炎性细胞/介质－通透性增高－肠道高敏感性肠道动力/痉挛－胃肠蠕动波－食物传输 - 平滑肌痉挛精神因素－紧张、焦虑、