臨牀消化器内科 Vol.15 No.13(2)


特集名 過敏性腸症候群
題名 過敏性腸症候群の病態生理
発刊年月 2000年 12月
著者 樋田 信幸 兵庫医科大学第四内科
著者 里見 匡迪 兵庫医科大学第四内科
著者 下山 孝 兵庫医科大学第四内科
【 要旨 】 過敏性腸症候群(irritable bowel syndrome;IBS)の病態生理に関する最近の知見について概説する.IBS患者にみられる腹痛,下痢,便秘などの主症状は,消化管の運動異常がIBSの主要因であることを示唆している.実際,大腸や小腸におけるさまざまな運動異常が指摘されているが,これらを病的とするかどうかは未だ確定していない.消化管とくに直腸で認められる知覚過敏がIBSの病態において重要であると推定されており,痛覚閾値の低下により症状を呈している可能性がある.ストレスなどの心理的因子によりIBSの病態が増悪することから,最近とくにIBSの病因として脳腸相関が注目されている.また,腸管の炎症がIBS発症の要因となる可能性についても述べる.
Theme Irritable Bowel Syndrome
Title Pathophysiology of Irritable Bowel Syndrome
Author Nobuyuki Hida Department of Internal Medicine, Hyogo College of Medicine
Author Masamichi Satomi Department of Internal Medicine, Hyogo College of Medicine
Author Takashi Shimoyama Department of Internal Medicine, Hyogo College of Medicine
[ Summary ] Recent advances in the pathophysiology of irritable bowel syndrome(IBS) were reviewed. Common symptoms in patients with IBS, such as abdominal pain relieved by defecation, diarrhea, constipation, and postprandial bloating, indicate that disorders of motility are the most prominent features of IBS. Although a number of disturbances in large and small bowel motility have been defined in some studies, the significance of these findings remains unclear. Sensory dysfunction of the gut, most commonly the rectum, is now generally believed to play a critical role in the pathophysiology of IBS. Patients with IBS who are shown to have visceral hypersensitivity may sense normal contractions of the gut abnormally and may therefore cause abdominal symptoms. There is a close association with psychological factors, such as stress, along with the development and persistence of symptoms in IBS patients. Recently, brain-gut interactions have been suggested to be relevant in the pathophysiology of IBS and research in this area is drawing attention to this connection. The possibility of gut inflammation as a factor which can precipitate IBS is also described in this review.
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