One drug and two effects, patients with constipation-type irritable bowel syndrome usher in a new treatment option!

Only for medical professionals to read for reference.
Patients with constipation-type irritable bowel syndrome need more accurate diagnosis and more reasonable treatment
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 Irritable bowel syndrome (IBS) is a common clinical functional bowel disease, manifested as recurrent abdominal pain, which is related to defecation or accompanied by changes in defecation habits [1-2]
.

IBS can be divided into constipation type, diarrhea type, mixed type and indeterminate type according to symptoms.
Constipation type irritable bowel syndrome (IBS-C) is characterized by difficulty in defecation and uncomfortable defecation
.

In China, IBS-C accounts for about 15.
1% of the total number of IBS patients [3], and there is a very urgent clinical need for treatment
.

 In order to enable more IBS-C patients to receive timely and reasonable treatment, the "medical community" specially invited Professor Yuan Yaozong from Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine to give a detailed interpretation of the progress in the diagnosis and treatment of IBS-C
.

 Current status of IBS-C patients in China-poor quality of life and low diagnosis rate.
Intestinal health is closely related to our physical health.
Many people in our country suffer from functional bowel disease.
Among them, the number of IBS patients is very large.
There are investigations in China.
, The prevalence of IBS in the Chinese population is about 6.
5% [4], and some scholars initially estimated that the number of IBS patients in China is about 15 million
.

Although there are a large number of IBS patients, relatively few patients go to the hospital for treatment, which means that most IBS patients are not properly diagnosed and treated
.

 IBS has a serious impact on the quality of life of patients.
Professor Yuan mentioned: “For those patients with severe IBS, their outings and daily activities will be affected.
A series of symptoms of IBS will seriously affect the work efficiency and quality of life of the patients.
Therefore, we should also attach great importance to patients with IBS.
We hope that through our efforts, the quality of life of patients with IBS can be improved and the impact of the disease on patients can be minimized
.

" Talking about the subtype of IBS-C, Professor Yuan Said that IBS is a common disease in the gastroenterology department.
It has a variety of clinical manifestations.
According to different manifestations, it can be divided into diarrhea and constipation (ie IBS-C).
Among them, IBS-C patients show reduced bowel frequency and stool characteristics.
Compared with other subtypes, IBS-C has a more serious impact on the quality of life of patients
.

 Regarding the current diagnosis of IBS, Professor Yuan said that IBS patients generally present with abdominal pain and bloating, accompanied by changes in the frequency of bowel movements and changes in stool characteristics
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In the case of IBS-C, the change in bowel frequency is often manifested as a decrease in the frequency of bowel movements
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Different types of IBS patients have different changes in stool characteristics.
The stool characteristics of patients with diarrhea-type IBS show loose stools and watery stools, and the stools of IBS-C patients show sheep feces or dry stools
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For some atypical IBS, doctors should judge according to their own clinical experience, and take different treatment measures for different subtypes
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 Compared with the Rome IV standard, the typical symptoms of IBS-C are more in line with the actual diagnostic standards.
Only suitable diagnostic methods can maximize the diagnosis rate of IBS-C patients.
For the diagnosis of IBS-C, there are currently many doctors in the clinic refer to the Rome IV standard.
Professor Yuan said that the Rome IV criterion is the gold standard for diagnosing functional gastrointestinal diseases, but the diagnostic criterion is more rigorous and often has a very important position in clinical research
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In the actual diagnosis, the diagnosis is based on the relevant clinical symptoms of IBS-C patients
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The Rome IV standard also has certain limitations.
Professor Yuan pointed out: "It is mentioned in the Rome IV standard that the onset of related symptoms must be at least 6 months before the diagnosis, and the symptoms must meet the diagnostic criteria in the past 3 months, but in fact the patient May not remember the symptoms of such a long period of time in the past 6 months or the past 3 months
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In clinical practice, some patients cannot meet the diagnostic criteria of Rome IV and Rome III, but there are some typical clinical symptoms, such as typical Abdominal pain, bloating, and constipation can also be diagnosed as IBS-C
.

” Compared with the Rome III standard, the Rome IV standard deletes the symptom of "abdominal discomfort" and emphasizes that "abdominal pain" is a necessary condition for the diagnosis of IBS
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In response to this change, Professor Yuan pointed out: "Chinese experts and scholars believe that this change is not suitable for patients in our country, because the country has different cultural backgrounds and different expressions.
Some patients have mild abdominal pain, which can also be expressed as abdominal distension
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So our country When clinicians are diagnosing IBS, they need to take into account the differences in expression of Chinese culture.
Some patients can also diagnose IBS-C when they have typical abdominal distension and constipation
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" Linaclotide has "one drug and double effect", breaking the deadlock of traditional medication.
The treatment of IBS-C has always been a difficult problem.
Professor Yuan pointed out: “IBS-C is a functional disease.
Some patients with IBS-C will experience overlap and alternation of symptoms, which may overlap the acid reflux of gastroesophageal reflux disease.
Heartburn, abdominal distension, epigastric pain, and belching that overlap with functional dyspepsia
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Some patients may show IBS-C for a period of time, and may show mixed IBS after a while.
Therefore, clinicians should deal with the entire functional gastrointestinal disease.
There is a more comprehensive understanding of treatment
.

"For a typical IBS-C patient, medication is mainly used for symptoms
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Traditional medical treatment mainly uses antispasmodics to relieve pain symptoms and polyethylene glycol to improve constipation symptoms
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But so far, these drugs can only solve some of the symptoms of patients
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With the prolongation of medication time, it is impossible to solve all the symptoms of patients.
Therefore, the demand for new drugs with comprehensive curative effects is imminent
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 Regarding the latest developments in the treatment of IBS-C, Professor Yuan mentioned linaclotide: “Linaclotide is a guanylate cyclase-C agonist.
It has one-drug and dual-effects, which can improve constipation while improving constipation.
It can relieve abdominal pain.
In the "American Gastroenterology Association IBS Treatment Guidelines", linaclotide is strongly recommended for the treatment of IBS-C
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In the "2020 China IBS Expert Consensus", linaclotide has also been awarded Recommendation
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In terms of the treatment of IBS-C, Linaclotide is currently a new drug recognized by experts at home and abroad
.

" Finally, Professor Yuan also pointed out that for more severe IBS-C patients, it may be necessary to combine other drugs for comprehensive treatment
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For example, patients with IBS-C may cause anxiety and depression due to symptoms such as pain.
At this time, some anti-anxiety and depression drugs can be used, which is also of great help to the improvement of patients' symptoms
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 Summary: Compared with the stricter Rome IV standard, clinically early diagnosis and treatment based on IBS-C-related symptoms can bring greater benefits to patients
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Linaclotide has one drug and two effects, which can significantly improve the symptoms of IBS-C patients such as abdominal pain, bloating, abdominal discomfort and constipation.
It also breaks the deadlock that traditional drugs can only improve a single symptom, and has been unanimously recommended by domestic and foreign guidelines
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Expert profile Professor Yuan Yaozong, Department of Gastroenterology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Chief Physician, Doctoral Supervisor Honorary Chief Editor of Chinese Journal of Digestion, Member of Gastroenterology Branch of Chinese Medical Association, Honorary Chairman of Digestive Disease Professional Committee of Chinese Association of Non-Public Medical Institutions References ：[1] Quigley EMM, Fried M, Gwee KA, et al.
World Gastroenterology Organisation global guidelines irritable bowel syndrome: A global perspectⅣe update September 2015[J].
Journal of clinical gastroenterology, 2016, 50(9): 704-713 .
[2] Lacy BE, Mearin F, Chang L, et al.
Bowel disorders[J].
Gastroenterology, 2016, 150(6): 1393-1407.
e5.
[3] Xiong Lishou, Chen Minhu, Chen Huixin, et al.
Epidemiological study of irritable bowel syndrome in community population in Guangdong Province［J］.
Chinese Medical Journal, 2004, 84(4): 278.
[4] Gastrointestinal Functional Diseases Collaboration Group, Chinese Medical Association Gastroenterology Branch.
Chinese Journal of Digestion, 2016, 36(5):299-312.
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