一例腸易激綜合征患者的循證治療_《中國循證醫學雜志》

作者：

晏霞 ,  丁一娟

武漢大學人民醫院消化內科（武漢 430060）;

關鍵詞：

腸易激綜合征循證治療隨機對照試驗系統評價

DOI：

10.7507/1672-2531.20090179

視頻：

導出 下載 收藏 掃碼 引用

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目的　為1 例成年女性腸易激綜合征患者確定治療目標及治療方案。
方法　在充分評估病人的情況后，提出臨床問題，從Cochrane 圖書館（2008 第3 期）、PubMed（1990 ～ 2008 年）和SCIE（http://apps.isiknowledge.com）檢索治療腸易激綜合征的系統評價和隨機對照試驗。根據證據結果及病人意愿為患者制定治療方案。
結果　共檢出與不同問題相關的隨機對照試驗114 篇，系統評價/Meta 分析21 篇。通過對檢索結果進行分析并結合患者意愿，為患者制定了合理的治療方案和預期目標：控制癥狀，提高患者的生活質量。經16 個月的隨訪證實，該方案適合患者。
結論　采用循證治療的方法，為初診成年女性腸易激綜合征患者確定合理的治療目標和治療方案，控制了患者的癥狀，提高了其生活質量。

引用本文： 晏霞,丁一娟. 一例腸易激綜合征患者的循證治療. 中國循證醫學雜志, 2009, 09(9): 1018-1021. doi: 10.7507/1672-2531.20090179 復制

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2.	Whitehead WE. Hypnosis for irritable bowel syndrome: the empirical evidence of therapeutic effects. Int J Clin Exp Hypn, 2006, 54(1): 7-20.
3.	Klooker TK, Kuiken SD, Lei A. Effect of long-term treatment with octreotide on rectal sensitivity in patients with non-constipated irritable bowel syndrome. Aliment Pharmacol Ther, 2007, 26(4): 605-615.
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6.	Kajander K, Myllyluoma E. Clinical trial: multispecies probiotic supplementation alleviates the symptoms of irritable bowel syndrome and stabilizes intestinal microbiota. Aliment Pharmacol Ther, 2008, 27(1): 48-57.
7.	Jones BW, Moore DJ, Robinson SM, et al. A systematic review of tegaserod for the treatment of irritable bowel syndrome. J Clin Pharm Ther, 2002, 27(5): 343-352.
8.	Drouault-Holowacz S, Bieuvelet S. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol Clin Biol, 2008, 32(2): 147-152.
9.	Moayyedi P, Ford AC, Talley NJ. The efficacy of probiotics in the therapy of irritable bowel syndrome: a systematic review. Gut, 2008, 30(5): 123-126.
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12.	van Kerkhoven LA, Laheij RJ, Aparicio N. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepato, 2008, 6(7): 746-752.
13.	Lee V, Guthrie E, Robinson A. Functional bowel disorders in primary care: factors associated with health-related quality of life and doctor consultation. J Psychosom Res, 2008, 64(2): 129-138.
14.	Bijkerk CJ, Muris JW, Knottnerus JA, et al. Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther, 2004, 19(3): 245-251.
15.	Huertas-Ceballos A, Logan S, Bennett C. Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database Syst Rev, 2009, (1): CD003019.
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17.	Rask CU, Thomsen PH. Cognitive behavioural therapy of functional recurrent abdominal pain in children. Ugeskr Laeger, 2007, 169(45): 3839-3845.
18.	Kennedy TM, Chalder T, McCrone P, et al. Cognitive behavioural therapy in addition to antispasmodic therapy for irritable bowel syndrome in primary care: randomised controlled trial. Health Technol Assess, 2006, 10(19): 1-67.
19.	Lackner JM, Jaccard J, Krasner SS. How does cognitive behavior therapy for irritable bowel syndrome work? A mediational analysis of a randomized clinical trial. Gastroenterology, 2007, 133(2): 433-444.
20.	Kennedy TM, Chalder T, McCrone P. Hypnosis for irritable bowel syndrome: the empirical evidence of therapeutic effects. Health Technol Assess, 2006, 10(19): 1-67.
21.	Talley NJ, Kellow JE, Boyce P. Antidepressant therapy (imipramine and citalopram) for irritable bowel syndrome: a double-blind, randomized, placebo-controlled trial. Dig Dis Sci, 2008, 53(1): 108-115.
22.	van Kerkhoven LA, Laheij RJ, Aparicio N, et al. Effect of the antidepressant venlafaxine in functional dyspepsia: a randomized, double-blind, placebo-controlled trial. Clin Gastroenterol Hepato, 2008, 6(7): 746-752.
23.	Bahar RJ, Collins BS, Steinmetz B. Double-blind placebo-controlled trial of amitriptyline for the treatment of irritable bowel syndrome in adolescents. J Pediatr, 2008, 152(5): 685-689.
24.	Creed F, Tomenson B, Guthrie E. The relationship between somatisation and outcome in patients with severe irritable bowel syndrome. J Psychosom Res, 2008, 64(6): 613-620.
25.	Pimentel M, Chat ter jee S, Chow EJ . Neomycin improves constipation-predominant irritable bowel syndrome in a fashion that is dependent on the presence of methane gas: subanalysis of a double-blind randomized controlled study. Dig Dis Sci, 2006, 51(8): 1297-1301.
26.	Drouault-Holowacz S, Bieuvelet S, Burckel A, et al. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol Clin Biol, 2008, 32(2): 147-152.
27.	Fennerty MB. Traditional therapies for irritable bowel syndrome: an evidence-based appraisal. Rev Gastroenterol Disord, 2003, 3(Suppl 2): S18-24.
28.	Chang FY, Lu CL. Treatment of irritable bowel syndrome using complementary and alternative medicine. J Chin Med Assoc, 2009, 72(6): 294-300.
29.	Spanier JA, Howden CW, Jones MP. A systematic review of alternative therapies in the irritable bowel syndrome. Arch Intern Med, 2003, 163(3): 265-274.

1. Ford AC, Talley NJ, Spiegel BM. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ, 2009, 14(3):84.
2. Whitehead WE. Hypnosis for irritable bowel syndrome: the empirical evidence of therapeutic effects. Int J Clin Exp Hypn, 2006, 54(1): 7-20.
3. Klooker TK, Kuiken SD, Lei A. Effect of long-term treatment with octreotide on rectal sensitivity in patients with non-constipated irritable bowel syndrome. Aliment Pharmacol Ther, 2007, 26(4): 605-615.
4. Vahedi H, Merat S, Rashidioon A. The effect of fluoxetine in patients with pain and consti 2007 M pation-predominant irritable bowel syndrome: a double-blind randomized-controlled study. Aliment Pharmacol Ther, 2005, 22(5): 381-385.
5. Vahedi H, Merat S, Momtahen S. Clinical trial: the effect of amitriptyline in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther, 2008, 27(8): 678-684.
6. Kajander K, Myllyluoma E. Clinical trial: multispecies probiotic supplementation alleviates the symptoms of irritable bowel syndrome and stabilizes intestinal microbiota. Aliment Pharmacol Ther, 2008, 27(1): 48-57.
7. Jones BW, Moore DJ, Robinson SM, et al. A systematic review of tegaserod for the treatment of irritable bowel syndrome. J Clin Pharm Ther, 2002, 27(5): 343-352.
8. Drouault-Holowacz S, Bieuvelet S. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol Clin Biol, 2008, 32(2): 147-152.
9. Moayyedi P, Ford AC, Talley NJ. The efficacy of probiotics in the therapy of irritable bowel syndrome: a systematic review. Gut, 2008, 30(5): 123-126.
10. McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol, 2008, 14(17): 2650-2661.
11. Pimentel M, Chatterjee S, Chow EJ, et al. Neomycin improves constipation-predominant irritable bowel syndrome in a fashion that is dependent on the presence of methane gas: subanalysis of a double-blind randomized controlled study. Dig Dis Sci, 2006, 51(8): 1297-1301.
12. van Kerkhoven LA, Laheij RJ, Aparicio N. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepato, 2008, 6(7): 746-752.
13. Lee V, Guthrie E, Robinson A. Functional bowel disorders in primary care: factors associated with health-related quality of life and doctor consultation. J Psychosom Res, 2008, 64(2): 129-138.
14. Bijkerk CJ, Muris JW, Knottnerus JA, et al. Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther, 2004, 19(3): 245-251.
15. Huertas-Ceballos A, Logan S, Bennett C. Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database Syst Rev, 2009, (1): CD003019.
16. Huertas-Ceballos A, Logan S, Bennett C. Psychosocial interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database Syst Rev, 2008, (1): CD003014.
17. Rask CU, Thomsen PH. Cognitive behavioural therapy of functional recurrent abdominal pain in children. Ugeskr Laeger, 2007, 169(45): 3839-3845.
18. Kennedy TM, Chalder T, McCrone P, et al. Cognitive behavioural therapy in addition to antispasmodic therapy for irritable bowel syndrome in primary care: randomised controlled trial. Health Technol Assess, 2006, 10(19): 1-67.
19. Lackner JM, Jaccard J, Krasner SS. How does cognitive behavior therapy for irritable bowel syndrome work? A mediational analysis of a randomized clinical trial. Gastroenterology, 2007, 133(2): 433-444.
20. Kennedy TM, Chalder T, McCrone P. Hypnosis for irritable bowel syndrome: the empirical evidence of therapeutic effects. Health Technol Assess, 2006, 10(19): 1-67.
21. Talley NJ, Kellow JE, Boyce P. Antidepressant therapy (imipramine and citalopram) for irritable bowel syndrome: a double-blind, randomized, placebo-controlled trial. Dig Dis Sci, 2008, 53(1): 108-115.
22. van Kerkhoven LA, Laheij RJ, Aparicio N, et al. Effect of the antidepressant venlafaxine in functional dyspepsia: a randomized, double-blind, placebo-controlled trial. Clin Gastroenterol Hepato, 2008, 6(7): 746-752.
23. Bahar RJ, Collins BS, Steinmetz B. Double-blind placebo-controlled trial of amitriptyline for the treatment of irritable bowel syndrome in adolescents. J Pediatr, 2008, 152(5): 685-689.
24. Creed F, Tomenson B, Guthrie E. The relationship between somatisation and outcome in patients with severe irritable bowel syndrome. J Psychosom Res, 2008, 64(6): 613-620.
25. Pimentel M, Chat ter jee S, Chow EJ . Neomycin improves constipation-predominant irritable bowel syndrome in a fashion that is dependent on the presence of methane gas: subanalysis of a double-blind randomized controlled study. Dig Dis Sci, 2006, 51(8): 1297-1301.
26. Drouault-Holowacz S, Bieuvelet S, Burckel A, et al. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol Clin Biol, 2008, 32(2): 147-152.
27. Fennerty MB. Traditional therapies for irritable bowel syndrome: an evidence-based appraisal. Rev Gastroenterol Disord, 2003, 3(Suppl 2): S18-24.
28. Chang FY, Lu CL. Treatment of irritable bowel syndrome using complementary and alternative medicine. J Chin Med Assoc, 2009, 72(6): 294-300.
29. Spanier JA, Howden CW, Jones MP. A systematic review of alternative therapies in the irritable bowel syndrome. Arch Intern Med, 2003, 163(3): 265-274.

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