| 特集名 | 機能性消化管疾患―病態の解明と新たな治療 | |
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| 題名 | 機能性消化管疾患診療ガイドライン―Rome基準との比較から (2) 過敏性腸症候群 | |
| 発刊年月 | 2015年 02月 | |
| 著者 | 千葉俊美 | 岩手医科大学医学部内科学講座消化器内科消化管分野 |
| 著者 | 松本主之 | 岩手医科大学医学部内科学講座消化器内科消化管分野 |
| 【 要旨 】 | 過敏性腸症候群（irritable bowel syndrome；IBS）は機能性腸疾患の代表疾患であり，慢性・再発性の腹痛あるいは腹部不快感とそれに関連した 便通異常を特徴とする．IBSの有病率は性，年齢，居住地，職業により異なるが，女性で高く加齢とともに低下する傾向にある．病態として，ストレス，腸内細菌・粘膜炎症，神経伝達物質・内分泌 物質，心理的異常，遺伝的要因などが関与し，脳と消化管の機能的な関連である脳腸相関（brain‒gut interactions）がIBS患者の病態生理の重要部分を占めている．一方，感染性腸炎後にも発症率が増加し，post‒infectious IBSと呼ばれる病態がIBS全体に占める割合は5～25％程度とされる．Rome III基準はIBSの診断に有用であるが，アラームサインに注意した器質的疾患の鑑別，および機能性ディスペプシアや胃食道逆流症などの機能性消化管疾患とのオーバーラップに注意する．治療目標は患者の自覚症状の改善であり，そのためには良好な患者‒医師関係の構築が重要である．治療は消化管主体の治療を行う第1段階，中枢機能の調節を含む第2段階，心理療法を行う第3段階に大別される．寛解期炎症性腸疾患の50％弱がIBSの診断基準を満たし，IBSから炎症性腸疾患への移行も少なくない．さらに，IBSでは消化管外の身体疾患がQOLをより低下させる要因となる． | |
| Theme | Unraveling of the Pathophysiology of Functional Gastrointestinal Disorders and Updated Treatments | |
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| Title | The Guideline of Irritable Bowel Syndrome from the View Point of the Differences from the Rome III Definition | |
| Author | Toshimi Chiba | Division of Gastroenterology, Department of Internal Medi- cine, School of Medicine, Iwate Medical University |
| Author | Takayuki Matsumoto | Division of Gastroenterology, Department of Internal Medi- cine, School of Medicine, Iwate Medical University |
| [ Summary ] | Definition and Epidemiology : Irritable bowel syndrome (IBS) comprises a group of functional bowel disorders, in which abdominal pain and discomfort are associated with defecation disorders and bowel habbits. The prevalence of IBS is higher for women than men. It decreases with age and there are variables associated with geographic areas and socio‒economic status. Pathophysiology : Stress, microbiota, mucosal inflammation, neurotransmitters, endocrine substances, psychological disturbances and genetics are closely related to the pathophysiology of IBS. Diagnosis : The Rome III criteria are useful for the diagnosis of IBS. Functional examinations of gastrointestinal motility reveal obvious differences in the test results between IBS patients and healthy control groups. Treatment : The primary aim of therapy for IBS is to achieve improvements in symptoms. These improvements should be assessed by patients' reported outcomes. Patients with moderately severe symptoms, who do not respond to gut targeted pharmacotherapy, are candidates for second stage treatment. Patients with severe symptoms, who do not respond to traditional pharmacotherapy, should be referred to third stage psychosomatic intervention. Prognosis and complications : IBS is frequently associated with functional dyspepsia (FD) and gastroesophageal reflux disease (GERD). Patients with IBS exhibit extra‒intestinal disorders. Furthermore, patients with inflammatory bowel disease are at higher risk of developing IBS, while the risk of IBD is also high in patients with IBS. Accompanying disorders are closely associated with quality of life for IBS patients. |
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