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It is only for medical professionals to read for reference to explore better treatments and improve the quality of life of patients with constipation-type irritable bowel syndrome
.
Irritable bowel syndrome (IBS) is a common clinical functional gastrointestinal disease, and its prevalence is increasing year by year [1]
.
IBS can be divided into many subtypes according to symptoms.
Among them, constipation-type irritable bowel syndrome (IBS-C) has abdominal pain, bloating or abdominal discomfort as the main symptoms, which greatly affects the quality of life of patients.
There are very urgent clinical treatments.
Demand
.
In order to allow IBS-C patients to get a more accurate diagnosis and more reasonable treatment, "Medical Circle" specially invited Professor Xiong Lishou from the First Affiliated Hospital of Sun Yat-sen University to give us a detailed interpretation of related issues
.
Expert profile Professor Xiong Lishou Doctor of Gastroenterology, the First Affiliated Hospital of Sun Yat-Sen University, Chief Physician; Postdoctoral and Doctoral Supervisor of Hopkins University School of Medicine, USA; Deputy Group Leader of Gastrointestinal Functional Diseases Collaboration Group of Digestive Branch of Chinese Medical Association; Physician of Guangdong Province Deputy leader of the Gastrointestinal Mucosal Disease Professional Group of the Association’s Digestive Branch; presided over the National Natural Science Foundation, Guangdong Science and Technology Project and Guangdong Natural Science Foundation; published more than 100 papers, including 35 SCI papers, first or corresponding author Identity "Aliment Pharmacol Ther", "J Biol Chem" and "Developmental Cell" and other magazines published 23 articles; participated in the compilation of more than 10 monographs; fight against SARS third-class merit and Guangzhou fight against SARS advanced individuals; won the Guangzhou Science and Technology Award for scientific and technological progress First prize in the category
.
The clinical symptoms of IBS-C are complex, causing a "multi-dimensional" blow to patients.
According to statistics, the prevalence of IBS in China is about 6.
5% [2].
Calculations based on this prevalence data mean that 14-18 million people in China are affected.
In the face of such a large group, it is very important to correctly understand the clinical characteristics of IBS-C and its impact on patients
.
Professor Xiong mentioned that as one of the four subtypes of IBS, IBS-C mainly presents these characteristics in clinical practice: IBS-C meets the diagnosis of chronic constipation and has changes in bowel habits
.
The patient has visceral hypersensitivity, so it is accompanied by abdominal pain, as well as abdominal discomfort and abdominal distension
.
Some patients have extracolonic symptoms, such as insomnia, irregular menstruation, dysmenorrhea, anxiety, depression and so on
.
The impact of IBS-C on patients is also more complicated, which is mainly reflected in four aspects: 1.
Impact on quality of life: Compared with healthy people, IBS-C patients have a lower quality of life.
Studies have even shown that the life of IBS-C patients The quality is lower than that of patients with gastroesophageal reflux disease and diabetes
.
2.
Absenteeism from work and school: Abdominal pain, abdominal discomfort, constipation and other symptoms of IBS-C patients may affect work and school, causing their absenteeism from work and school more frequently than healthy people
.
3.
Causes anxiety and depression: Many patients with IBS-C have repeated symptoms and cannot be cured, which may lead to anxiety and depression
.
4.
Repeated medical treatment: IBS-C patients often fail to get a clear diagnosis, and the treatment effect is not ideal.
The patient’s repeated medical treatment will result in a waste of medical resources, and will also lead to excessive financial pressure on patients and excessive time spent on medical treatment
.
The diagnosis rate of IBS-C in China is low, and accurate diagnosis is a prerequisite for reasonable treatment.
IBS-C seriously affects the quality of life of patients, and it is very important to strengthen the diagnosis and treatment of patients
.
Speaking of the current status of IBS-C diagnosis in China, Professor Xiong emphasized that the current number of IBS patients in China is seriously underestimated and the diagnosis rate is low
.
In previous surveys, there is one out of nine people in Guangdong Province with IBS, and IBS-C accounts for about one-seventh of IBS
.
However, in clinical practice, many doctors believe that there are fewer patients with IBS.
This is mainly due to two reasons: First, many patients with IBS did not go to the hospital for treatment, and may handle it on their own or even not treat it; Intestinal diseases (including IBS-C) are not well understood and dare not to be diagnosed easily.
The diagnosis may only include some symptoms, such as abdominal pain, constipation, etc.
, or no corresponding diagnosis has been made.
This has resulted in the low diagnosis rate of IBS-C in China
.
Regarding how to effectively diagnose IBS-C clinically, Professor Xiong also put forward his own suggestions: “The diagnosis of IBS-C must first meet the symptoms of abdominal pain, abdominal discomfort, and bloating.
In addition, these discomforts are related to defecation (most patients are Discomfort in the process of defecation, a small part of the symptoms aggravate after defecation); there are also changes in bowel habits, which include changes in bowel frequency (the frequency of bowel movements is less than three times a week), and changes in stool characteristics, according to Bristol Stool The classification method is mainly manifested as sheep feces and hard ball-like stools.
If the frequency of these two types of stool is greater than 25%, then it can be considered as IBS-C
.
"Professor Xiong reminded: "Generally, it will be clinically.
Ask the patient about other symptoms in detail, because many patients may overlap the symptoms of the upper gastrointestinal tract
.
For
example, ask the patient whether they have acid reflux, belching, whether they overlap symptoms such as gastroesophageal reflux disease and functional dyspepsia
.
And many patients are accompanied by anxiety and depression At the same time, a mental diagnosis is required
.
"The demand for IBS-C treatment has not been met.
The multiple advantages of new secretagogues demonstrate that accurate diagnosis of IBS-C is very important, and reasonable treatment after diagnosis is also very important.
Professor Xiong mentioned that functional gastrointestinal diseases (including IBS- C) The goal of treatment is to control the symptoms and improve the quality of life of the patient.
Sometimes individualized treatment is needed
.
Specific treatment methods mainly include 3 aspects: 1.
Change life>
.
2.
Medication: If the symptoms cannot be improved by adjusting the life>
.
3.
Psychotherapy: The incidence of anxiety and depression in IBS-C patients is normal.
3 times the rate, mental and psychological interventions can be carried out when necessary, including drug intervention, cognitive behavioral therapy and other means
.
Talking about the current unsatisfied status of IBS-C treatment, Professor Xiong said that the current IBS-C There are some clinical problems in the treatment of diarrhea
.
For
example, antispasmodics can relieve the patient’s abdominal pain, but cannot relieve the patient’s constipation symptoms
.
Some laxatives, such as polyethylene glycol and lactulose, can relieve bowel movements and increase the patient’s completeness.
The effect of spontaneous defecation, although it can increase the frequency of the patient’s bowel movement, it cannot relieve the patient’s abdominal pain and abdominal discomfort; even some volumetric laxatives may also aggravate the patient’s abdominal distension
.
These previous treatments can only be aimed at patients A certain symptom progresses, and it may also bring adverse reactions
.
However, recently there are new clinical treatment options, such as the use of secretagogues, including the guanylate cyclase-C agonist linaclotide
.
Professor Xiong summarized the four major advantages of linaclotide in the treatment of IBS-C: Advantage 1: Linaclotide can increase the concentration of cyclic guanosine phosphate (cGMP) in the intestinal cells, thereby promoting the secretion of intestinal juice and improving the symptoms of constipation in patients On the other hand, Linaclotide can penetrate into the submucosa, reduce visceral hypersensitivity, relieve the patient's abdominal pain symptoms, and achieve the purpose of one drug and two effects
.
It has been observed clinically that Linaclotide can also relieve patients' abdominal distension and abdominal discomfort symptoms, and even achieve multiple effects of one drug
.
Advantage 2: There are many types of secretagogues.
Linaclotide is a new type of secretagogue.
The meta-analysis with other secretagogues shows that Linaclotide has a relatively better effect
.
Advantage 3: Linaclotide is not absorbed in the gastrointestinal tract, does not produce systemic side effects, does not interfere with the absorption of other drugs, and does not interact with other drugs
.
Advantage 4: Just because linaclotide has one drug and two effects, and has fewer systemic side effects, from the published data of randomized controlled trials, the longest safe use time can be as long as two years
.
Summary: The diagnosis rate of IBS-C in China is low, and the demand for treatment is not met, which seriously affects the quality of life of patients
.
The new secretagogue linaclotide has one drug and two effects, and has fewer systemic side effects.
It brings more hope to IBS-C patients and will help more IBS-C patients return to normal life
.
References: [1] Cheng Nengneng.
A novel, oral intestinal epithelial cell guanylate cyclase C agonist—linaclotide[J].
Chinese Journal of Clinical Pharmacy,2019,28(04):291-295 .
[2] Gastrointestinal Functional Diseases Collaboration Group, Chinese Medical Association Gastroenterology Branch.
Chinese Journal of Digestion, 2016,36(5):299-312.
Statement:
.
Irritable bowel syndrome (IBS) is a common clinical functional gastrointestinal disease, and its prevalence is increasing year by year [1]
.
IBS can be divided into many subtypes according to symptoms.
Among them, constipation-type irritable bowel syndrome (IBS-C) has abdominal pain, bloating or abdominal discomfort as the main symptoms, which greatly affects the quality of life of patients.
There are very urgent clinical treatments.
Demand
.
In order to allow IBS-C patients to get a more accurate diagnosis and more reasonable treatment, "Medical Circle" specially invited Professor Xiong Lishou from the First Affiliated Hospital of Sun Yat-sen University to give us a detailed interpretation of related issues
.
Expert profile Professor Xiong Lishou Doctor of Gastroenterology, the First Affiliated Hospital of Sun Yat-Sen University, Chief Physician; Postdoctoral and Doctoral Supervisor of Hopkins University School of Medicine, USA; Deputy Group Leader of Gastrointestinal Functional Diseases Collaboration Group of Digestive Branch of Chinese Medical Association; Physician of Guangdong Province Deputy leader of the Gastrointestinal Mucosal Disease Professional Group of the Association’s Digestive Branch; presided over the National Natural Science Foundation, Guangdong Science and Technology Project and Guangdong Natural Science Foundation; published more than 100 papers, including 35 SCI papers, first or corresponding author Identity "Aliment Pharmacol Ther", "J Biol Chem" and "Developmental Cell" and other magazines published 23 articles; participated in the compilation of more than 10 monographs; fight against SARS third-class merit and Guangzhou fight against SARS advanced individuals; won the Guangzhou Science and Technology Award for scientific and technological progress First prize in the category
.
The clinical symptoms of IBS-C are complex, causing a "multi-dimensional" blow to patients.
According to statistics, the prevalence of IBS in China is about 6.
5% [2].
Calculations based on this prevalence data mean that 14-18 million people in China are affected.
In the face of such a large group, it is very important to correctly understand the clinical characteristics of IBS-C and its impact on patients
.
Professor Xiong mentioned that as one of the four subtypes of IBS, IBS-C mainly presents these characteristics in clinical practice: IBS-C meets the diagnosis of chronic constipation and has changes in bowel habits
.
The patient has visceral hypersensitivity, so it is accompanied by abdominal pain, as well as abdominal discomfort and abdominal distension
.
Some patients have extracolonic symptoms, such as insomnia, irregular menstruation, dysmenorrhea, anxiety, depression and so on
.
The impact of IBS-C on patients is also more complicated, which is mainly reflected in four aspects: 1.
Impact on quality of life: Compared with healthy people, IBS-C patients have a lower quality of life.
Studies have even shown that the life of IBS-C patients The quality is lower than that of patients with gastroesophageal reflux disease and diabetes
.
2.
Absenteeism from work and school: Abdominal pain, abdominal discomfort, constipation and other symptoms of IBS-C patients may affect work and school, causing their absenteeism from work and school more frequently than healthy people
.
3.
Causes anxiety and depression: Many patients with IBS-C have repeated symptoms and cannot be cured, which may lead to anxiety and depression
.
4.
Repeated medical treatment: IBS-C patients often fail to get a clear diagnosis, and the treatment effect is not ideal.
The patient’s repeated medical treatment will result in a waste of medical resources, and will also lead to excessive financial pressure on patients and excessive time spent on medical treatment
.
The diagnosis rate of IBS-C in China is low, and accurate diagnosis is a prerequisite for reasonable treatment.
IBS-C seriously affects the quality of life of patients, and it is very important to strengthen the diagnosis and treatment of patients
.
Speaking of the current status of IBS-C diagnosis in China, Professor Xiong emphasized that the current number of IBS patients in China is seriously underestimated and the diagnosis rate is low
.
In previous surveys, there is one out of nine people in Guangdong Province with IBS, and IBS-C accounts for about one-seventh of IBS
.
However, in clinical practice, many doctors believe that there are fewer patients with IBS.
This is mainly due to two reasons: First, many patients with IBS did not go to the hospital for treatment, and may handle it on their own or even not treat it; Intestinal diseases (including IBS-C) are not well understood and dare not to be diagnosed easily.
The diagnosis may only include some symptoms, such as abdominal pain, constipation, etc.
, or no corresponding diagnosis has been made.
This has resulted in the low diagnosis rate of IBS-C in China
.
Regarding how to effectively diagnose IBS-C clinically, Professor Xiong also put forward his own suggestions: “The diagnosis of IBS-C must first meet the symptoms of abdominal pain, abdominal discomfort, and bloating.
In addition, these discomforts are related to defecation (most patients are Discomfort in the process of defecation, a small part of the symptoms aggravate after defecation); there are also changes in bowel habits, which include changes in bowel frequency (the frequency of bowel movements is less than three times a week), and changes in stool characteristics, according to Bristol Stool The classification method is mainly manifested as sheep feces and hard ball-like stools.
If the frequency of these two types of stool is greater than 25%, then it can be considered as IBS-C
.
"Professor Xiong reminded: "Generally, it will be clinically.
Ask the patient about other symptoms in detail, because many patients may overlap the symptoms of the upper gastrointestinal tract
.
For
example, ask the patient whether they have acid reflux, belching, whether they overlap symptoms such as gastroesophageal reflux disease and functional dyspepsia
.
And many patients are accompanied by anxiety and depression At the same time, a mental diagnosis is required
.
"The demand for IBS-C treatment has not been met.
The multiple advantages of new secretagogues demonstrate that accurate diagnosis of IBS-C is very important, and reasonable treatment after diagnosis is also very important.
Professor Xiong mentioned that functional gastrointestinal diseases (including IBS- C) The goal of treatment is to control the symptoms and improve the quality of life of the patient.
Sometimes individualized treatment is needed
.
Specific treatment methods mainly include 3 aspects: 1.
Change life>
.
2.
Medication: If the symptoms cannot be improved by adjusting the life>
.
3.
Psychotherapy: The incidence of anxiety and depression in IBS-C patients is normal.
3 times the rate, mental and psychological interventions can be carried out when necessary, including drug intervention, cognitive behavioral therapy and other means
.
Talking about the current unsatisfied status of IBS-C treatment, Professor Xiong said that the current IBS-C There are some clinical problems in the treatment of diarrhea
.
For
example, antispasmodics can relieve the patient’s abdominal pain, but cannot relieve the patient’s constipation symptoms
.
Some laxatives, such as polyethylene glycol and lactulose, can relieve bowel movements and increase the patient’s completeness.
The effect of spontaneous defecation, although it can increase the frequency of the patient’s bowel movement, it cannot relieve the patient’s abdominal pain and abdominal discomfort; even some volumetric laxatives may also aggravate the patient’s abdominal distension
.
These previous treatments can only be aimed at patients A certain symptom progresses, and it may also bring adverse reactions
.
However, recently there are new clinical treatment options, such as the use of secretagogues, including the guanylate cyclase-C agonist linaclotide
.
Professor Xiong summarized the four major advantages of linaclotide in the treatment of IBS-C: Advantage 1: Linaclotide can increase the concentration of cyclic guanosine phosphate (cGMP) in the intestinal cells, thereby promoting the secretion of intestinal juice and improving the symptoms of constipation in patients On the other hand, Linaclotide can penetrate into the submucosa, reduce visceral hypersensitivity, relieve the patient's abdominal pain symptoms, and achieve the purpose of one drug and two effects
.
It has been observed clinically that Linaclotide can also relieve patients' abdominal distension and abdominal discomfort symptoms, and even achieve multiple effects of one drug
.
Advantage 2: There are many types of secretagogues.
Linaclotide is a new type of secretagogue.
The meta-analysis with other secretagogues shows that Linaclotide has a relatively better effect
.
Advantage 3: Linaclotide is not absorbed in the gastrointestinal tract, does not produce systemic side effects, does not interfere with the absorption of other drugs, and does not interact with other drugs
.
Advantage 4: Just because linaclotide has one drug and two effects, and has fewer systemic side effects, from the published data of randomized controlled trials, the longest safe use time can be as long as two years
.
Summary: The diagnosis rate of IBS-C in China is low, and the demand for treatment is not met, which seriously affects the quality of life of patients
.
The new secretagogue linaclotide has one drug and two effects, and has fewer systemic side effects.
It brings more hope to IBS-C patients and will help more IBS-C patients return to normal life
.
References: [1] Cheng Nengneng.
A novel, oral intestinal epithelial cell guanylate cyclase C agonist—linaclotide[J].
Chinese Journal of Clinical Pharmacy,2019,28(04):291-295 .
[2] Gastrointestinal Functional Diseases Collaboration Group, Chinese Medical Association Gastroenterology Branch.
Chinese Journal of Digestion, 2016,36(5):299-312.
Statement:
