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1、腸易激綜合征的新概念NewestconceptsinirritablebowelsyndromeIBS舊概念:過(guò)敏性結(jié)腸炎易激結(jié)腸或黏液性結(jié)腸炎新概念:一種以腹痛或腹部不適伴排便習(xí)慣改變?yōu)樘卣鞯墓δ苄阅c病…agroupoffunctionalboweldisordersinwhichdiscomfortorpainisassociatedwithdefecationorachangeinbowelhabit,andwithfeaturesofdisordereddefecation.該病缺乏可解釋癥狀的形態(tài)學(xué)改變和生化異常Psychologicdistu
2、rbancerelatestopatientswhoseephysiciansPsychosocialfactorsinfluencehealthcareseekingIBSNon-patientsnormalIBSpatientsPsychologicdisturbanceIBS-Psychosocial流行病學(xué)研究西方國(guó)家患病率5---24%美國(guó)人群10-20%就診率30%$80億國(guó)內(nèi)北京潘國(guó)宗7.26%廣州陳旻湖5.6%就診率22.4%WhatcausesIBS?DevelopmentofIBSpathophysiology{inflammation
3、5-HTmediatedhypersensitivityandgutmotilityBrain-gutinteractionVisceralhypersensitivityAbnormalmotorfunction195019601970198019902000AbnormalnetworkregulationOfnerve-immune-endocrineIBSmolecularbiology…….IBS發(fā)病機(jī)制的認(rèn)識(shí)臨床癥狀腹痛、不適大便異常,流行病學(xué)等第一階段IBS發(fā)病機(jī)制的認(rèn)識(shí)臨床癥狀運(yùn)動(dòng)異常感覺異常社會(huì)心理致病腹痛、不適壓力、電活動(dòng)大便異常,敏感
4、性、5-HT流行病學(xué)等炎癥、腦腸交流第一階段第二階段VisceralHypersensitivityhyperalgesiaallodyniaEndogenousModulation.cortex.BrainstemEndorgansensitivity.silentnociceptorsSpinalHyperexcitability.NitricoxideActivationLong-termHyperalgesia.toniccorticalregulation.NeuroplasticityIBS發(fā)病機(jī)制的認(rèn)識(shí)臨床癥狀運(yùn)動(dòng)異常感覺異常社會(huì)心理致病腹痛
5、、不適壓力、電活動(dòng)大便異常,敏感性、5-HT流行病學(xué)等炎癥、腦腸交流第一階段第二階段Serotonin(5-HT)inthehumangut5-HT15-HT35-HT4Gastricaccommodation↑↑Transit↓↑↑Colonictone↓↑Sensation↑?Secretion↑IBS發(fā)病機(jī)制的認(rèn)識(shí)臨床癥狀運(yùn)動(dòng)異常感覺異常社會(huì)心理致病腹痛、不適壓力、電活動(dòng)大便異常,敏感性、5-HT流行病學(xué)等炎癥、腦腸交流第一階段第二階段PsychologicdistressYoungerageDurationofabdominalpainDurati
6、onofdiarrheaFemalesFactorsPredictingGISymptomsIBS-PostInfectiousIBS發(fā)病機(jī)制的認(rèn)識(shí)臨床癥狀運(yùn)動(dòng)異常感覺異常社會(huì)心理致病腹痛、不適壓力、電活動(dòng)大便異常,敏感性、5-HT流行病學(xué)等炎癥、腦腸交流第一階段第二階段MechanosensitiveafferentSensitizedspinalcircuitsDorsalrootganglionRepeatedstimulationDescendingVisceralPainPathwayThalamusPAGLocuscoeruleusAmygda
7、laColonSerotonergicNoradrenergicCaudalraphenucleusOpioidergicRostralventralmedullaMotilitySecretionBloodFlowInflammationSightSoundSmellSomatosensoryCognitionAffectViscerosensoryInputIntegrationEffectIBS發(fā)病機(jī)制的認(rèn)識(shí)臨床癥狀運(yùn)動(dòng)異常分子生物學(xué)階段感覺異常網(wǎng)絡(luò)調(diào)控社會(huì)心理致病腹痛、不適壓力、電活動(dòng)大便異常,炎癥、敏感性流行病學(xué)等5-HT、腦腸交流第一階段第二階
8、段第三階段一氧化氮5-HT及受體多巴胺及受體胃腸道激素及受體細(xì)胞因