脑-肠互动在肠易激综合征发病中的作用

Efficacy and safety of low-dose tricyclic antidepressants in patients with irritable bowel syndrome: a meta-analysis

AIM: To systematically assess the efficacy and safety of low-dose tricyclic antidepressants (TCAs) for irritable bowel syndrome (IBS).

METHODS: PubMed, The Cochrane Central Register of Controlled Trials and Chinese Biomedical Literature Database, and CNKI were searched for double-blind, placebo-controlled trials investigating the efficacy of TCAs in the management of IBS. The Revman4.2 software provided by the Cochrane Collaboration was used for assessment.

RESULTS: Eight placebo-controlled, double-blind, randomized trials including 334 patients were involved in this analysis. TCAs used in these studies included amitriptyline, imipramine, desipramine, doxepin and trimipramine. Compared to placebo (40.76%), TCAs (72.43%) were associated with a higher rate of global symptom relief [40.76% vs 72.43%; RR = 1.79, 95%CI = (1.48, 2.17), P < 0.05]. There was a greater improvement in abdominal pain score [SMD = -1.68, 95%CI = (-3.13, -0.23), P < 0.05)] with TCAs than placebo. There was no significant difference in the incidence of serious adverse events between the TCA and placebo groups [RR = 1.34, 95%CI = (0.91, 1.96), P > 0.05].

CONCLUSION: Low-dose TCAs may be effective and safe in relief of the symptoms of IBS patients, especially in the improvement of abdominal pain score.

A butyrate-induced model of non-inflammatory colonic hypersensitivity in rats

AIM: To investigate Butyrate-enema's efficacy on visceral hypersensitivity in rats and to explore a new method of establishing a model of non-inflammatory colonic hypersensitivity in rats.

METHODS: Rats of the model group received enemas of 1 mL of butyrate solution (300 mmol/L) twice a day for 6 d. After 3 d or 6 d when the model of visceral hypersensitivity was built, scores of abdominal withdrawal reflex (AWR) in colorectal distention (CRD) were recorded. Hypersensitivity parameters were determined. Meanwhile, the pressure thresholds of initial sensation and most endurance thresholds were recorded. Macroscopic and histologic activities of MPO and counting of mast leukocyte and eosinophile granulocyte were performed on colonic mucosa tissue at the end of the experiment.

RESULTS: Macroscopic and histologic activities of MPO analyses, counting of mast leukocyte and eosinophile granulocyte were not significantly different between control group and experimental group. At day 6, there was a significant increase in scores of CRD in experimental group against control group for the most pressure (t = 9.25, P < 0.01). There were a significant increase in average and highest pressure of colorectal motion in experimental group against control group (t = 36.71, 15.02, both P < 0.01).

CONCLUSION: Butyrate-enema may lead to colonic hypersensitivity while not bring damages to colonic mucosal structure. Colonic hypersensitivity has no correlation with mast cells.