Most studies provide strong support for an etiologic role of stressful life events in irritable bowel syndrome (IBS). Consistent with the observations in both patients and doctors that psychosocial disturbances seem to precede the onset or exacerbation of gut symptoms, researches have consistently found high levels of emotional distress in a proportion of patients with IBS and other functional gastrointestinal disorders. Moreover, a variety of other potentially psychiatric diseases such as anxiety, depression, and sleep disorder also coexist frequently with IBS. In recent literatures, some studies have shown altered mechanoelastic properties such as colonic tone, compliance, and accommodation. The demonstrated differences in colonic compliance and accommodation suggest peripheral neuromuscular substrate contributing to the pathogenesis of IBS. However, until now, attention has focused on the disturbances of visceral hypersensitivity rather than on gastrointestinal motor function as a hallmark of IBS pathophysiology. But not all IBS patients show decreased rectosigmoid pain thresholds. Recent advances in brain imaging have allowed investigators to measure changes in regional cerebral blood flow during stimulation. Those methods have extended our understanding of brain function and brain-gut interaction. IBS is characterized by hypersensitivity to visceral sensation and augmented response to stress. Studies on the disorders of sensori-motor function have also contributed to understand the knowledge of neurotransmitters involved in the function of the enteric nervous system and to identify targets for the development of new treatments for IBS.
Brain/physiology ; Humans ; Intestines/innervation/physiopathology ; Irritable Bowel Syndrome/physiopathology/*psychology ; Stress, Psychological/complications/physiopathology

OBJECTIVETo compare the effects of electroacupuncture (EA) and moxibustion therapies on patients with diarrhea-predominant irritable bowel syndrome (D-IBS).

METHODSA total of 60 D-IBS patients were randomly allocated to the EA group (30 cases) and moxibustion group (30 cases). Before and after treatment, the gastrointestinal symptoms and psychological symptoms were scored by Visual Analogue Scale, Bristol Stool Form Scale, Hamilton Anxiety Rating Scale (HAMA), and Hamilton Depression Rating Scale (HAMD); the expressions of 5-hydroxytryptamine (5-HT), 5-HT3 receptor (5-HT3R), and 5-HT4 receptor (5-HT4R) in the sigmoid mucosal tissue were measured by immunohistochemical staining. Additionally, the effects on the functional brain areas of the anterior cingulate cortex (ACC), insular cortex (IC) and prefrontal cortex (PFC) were observed by functional magnetic resonance imaging.

RESULTSCompared with before treatment, both EA and moxibustion groups reported significant improvements in abdominal pain and abdominal bloating after treatment (P<0.01 or P<0.05). The moxibustion group reported greater improvements in defecation emergency, defecation frequency, and stool feature than the EA group (P<0.01). Both HAMA and HAMD scores were significantly decreased in the moxibustion group than in the EA group (P<0.01). Both groups demonstrated significantly reduced expressions of 5-HT, 5-HT3R and 5-HT4R in the colonic mucosa after treatment (P<0.01), with a greater reduction of 5-HT in the moxibustion group (P<0.05). Finally, decreased activated voxel values were observed in the left IC, right IC and PFC brain regions of patients in the moxibustion group under stimulation with 150 mL colorectal distension after treatment (P<0.05 or P<0.01), while in the EA group only PFC area demonstrated a reduction (P<0.05).

CONCLUSIONMoxibustion can significantly improve the symptoms of D-IBS, suggesting that moxibustion may be a more effective therapy than EA for D-IBS patients.

Adult ; Anxiety ; Brain ; physiology ; Cerebral Cortex ; physiopathology ; Colon, Sigmoid ; chemistry ; Depression ; Diarrhea ; physiopathology ; Electroacupuncture ; Gastrointestinal Tract ; physiology ; Gyrus Cinguli ; physiopathology ; Humans ; Immunohistochemistry ; Intestinal Mucosa ; chemistry ; Irritable Bowel Syndrome ; physiopathology ; psychology ; therapy ; Magnetic Resonance Imaging ; Moxibustion ; Pain Measurement ; Prefrontal Cortex ; physiopathology ; Receptors, Serotonin, 5-HT3 ; analysis ; Serotonin ; analysis

OBJECTIVETo observe the TCM therapy for invigorating Pi, soothing Gan, eliminating dampness and resolving blood stasis (TCM-T) on the short-term quality of life (stQOL) in patients with diarrhea type irritable bowel syndrome (IBS-D).

METHODSOne hundred and twenty-five patients with IBS-D were assigned to 3 groups, Group A was treated with TCM-T; Group B treated with some selected Chinese patent drugs according to patients' syndrome types, such as Changweikang granule, Guben Yichang tablet, Bupi Yichang pill and Shenling Baizhu pill, Group C treated with Western medicines as Dicetel 50 mg, Oryzanol 10 mg, and Bifid triple viable 420 mg, 3 times daily by oral administration. The therapeutic course was 4 weeks for all. The stQOL was evaluated and compared by SF-36 scale before and after treatment.

RESULTSComparison between groups on the scores for the 8 dimensions of SF-36 scale, i.e., physiological function (PF), role physical (RP), body pain (BP), global health (GH), vitality (VT), society function (SF), emotional effect (RE), and mental health (MH), showed no significant difference before treatment, but scores of all the 8 dimensions were improved significantly in Group A after treatment (P < 0.05), with scores of SF, BP, GH and MH superior to those in Group B (P < 0.05, P < 0.01), and scores of RP, GH, SF, RE, PF and MH superior to those in Group C (P < 0.05, P < 0.01).

CONCLUSIONTCM-T has favorable effect in treating IBS-D, it could improve the stQOL of patients.

Adolescent ; Adult ; Aged ; Drug Administration Schedule ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Irritable Bowel Syndrome ; drug therapy ; physiopathology ; psychology ; Liver ; drug effects ; physiopathology ; Male ; Medicine, Chinese Traditional ; Mental Health ; Middle Aged ; Quality of Life ; Spleen ; drug effects ; physiopathology ; Treatment Outcome ; Young Adult