過敏性腸症候群の臨床 : その診断基準・病態・治療(過敏性腸症候群の臨床-その診断基準・病態・治療)(第33回日本心身医学会総会)

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The irritable bowel syndrome (IBS) is a typical functional disorder in the gastrointestinal tract, which is characterized by alteration of bowel habits, abdominal pain, or both. Although IBS is the most common problem encountered by gastroenterologists, its positive diagnosis remains un-established. The present study aimed at providing latest progress in its pathogenesis, diagnostic criteria and treatment of IBS from a view point of psychosomatic medicine. We studied 78 consecutive patients with IBS who visited our outpatient clinic in 1990-1991 ; 55 were classified as unstable type of IBS (28 of spastic constipation and 27 of alternative stool ab-normality), 22 as the continuous diarrhea type and only one case as the secretory type. There was considerable evidence that psychological factors were deeply involved in the onset of IBS symptoms (85.9%). Moreover, we found that IBS patients had poor tolerance against stressors, which was assessed by the novel stress marker that we had originally developed. The stress marker level of urinary 17-ketosteroid sulfate (17-KS-S) , was significantly lower in IBS patients than that in age- and sex-matched controls. In an attempt to clarify motility disorders in IBS, we also performed manometric studies on IBS patients. We observed that IBS patients demonstrated not only hypertonicity of the colonic wall but also abnormality in the stomach during the digestive state or increased simultaneous contrac-tions of the esophagus. Of great interest was that certain IBS patients showed markedly abnor-mal contractile patterns of the gallbladder in response to a cholecystkinin stimulation. These re-sults suggest that IBS is not a disease in the colon only, but represents a physiological expres-sion (gastrointestinal symptom) of an affective disorder. On the basis of these findings, we em-phasize here that psychosomatic approach is extremely crucial in the management of IBS patients.
日本心身医学会の論文
1993-02-01

過敏性腸症候群の臨床 : その診断基準・病態・治療(過敏性腸症候群の臨床-その診断基準・病態・治療)(第33回日本心身医学会総会)

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