There is little data on the long term evolution of patients with irritable bowel syndrome (IBS) and of associated conditions. We therefore studied the evolution of IBS patients in a single tertiary center during a long interval of time.
Methods. We carried out a retrospective study based on the survey of patients records. We analyzed the records of symptoms, therapy, associated diseases, as consigned at follow-up visits for an interval of 4 years in average (2008-2011).
Results. A cohort of 114 patients with IBS diagnosed based on Rome III criteria were included (29 men and 85 women), age 19-85 years (mean age: 43.45 years). Urban patients were predominant. The main three symptoms were: abdominal pain, bowel disorders (constipation, diarrhea) and bloating. IBS - constipation (IBS - C) is associated with a favorable course of symptoms (increasing the number of stools, decrease intensity of abdominal pain and bloating) after treatment and IBS - diarrhea (IBS - D) is associated with variable symptoms after treatment (p = 0.031). Using trimebutin or mebeverin in association with other drugs for one month correlates with a favorable evolution of symptoms after treatment and monotherapy is associated with fluctuating symptoms ( p< 0.001). Favorable symptoms are associated with the use of probiotics in combination, but not in monotherapy (p< 0.001). Favorable evolution of symptoms is also associated with the use of anxiolytics in combination. Persistence of symptoms after treatment was correlated with the presence or absence of depression. The absence of depression was correlated with a favorable evolution of symptoms (p = 0.005). IBS-C is associated at limit (marginal significance) with hemorrhoidal disease (p = 0.56). 33 patients (29%) - received monotherapy (trimebutin or mebeverin or probiotics); 81 patients (71%) - received combined therapy: (trimebutin or mebeverin or probiotics) + anxiolytics or proton pump inhibitors (PPI) or nonsteroidal anti-inflammatory (NSAI) or spasmolitics. The most common associated diseases observed in patients with IBS were: depression (27.19%), dyslipidemia (25.43%), hemorrhoidal disease (22.80%) and fibromyalgia (21%).
Conclusions. The highest response rate was obtained with trimebutin or mebeverin + anxiolitics + probiotics. The most frequent disease associated with IBS was depression. Other diseases with a high incidence: dyslipidemia, hemorrhoidal disease and fibromyalgia. Further studies are needed to analyze the link between IBS and some associated diseases.
Scopul studiului. Există puţine date în literatură privind evoluţia pacienţilor cu Sindrom de intestin iritabil (SII) şi alte boli asociate. Prin urmare, noi am studiat evoluţia pacienţilor cu SII într-un singur centru terţiar, într-un interval mai mare de timp.
Metode. A fost realizat un studiu retrospectiv bazat pe studierea arhivei pacienţilor cu SII din clinica noastră. Am analizat datele privind simptomele, terapia administrată pacienţilor şi bolile asociate, toate acestea fiind consemnate la vizitele de urmărire pe o perioadă de patru ani (2008-2011).
Rezultate. Au fost incluşi în studiu 114 pacienţi cu SII diagnosticaţi pe baza criteriilor Roma III (29 de bărbaţi şi 85 de femei), cu vârste între 19-85 ani (vârsta medie: 43,45 ani). Au predominat pacienţii din mediul urban. Principalele trei simptome înregistrate au fost: durerea abdominală, tulburările tranzitului intestinal (constipaţie, diaree) şi balonarea. SII cu predominanţa constipaţiei (SII - C) este asociat cu o evoluţie favorabilă a simptomelor după tratament (creşterea numărului de scaune, scăderea intensitaţii durerii abdominale şi a balonării) iar SII - cu predominanţa diareei (SII - D) este asociat cu simptome de intensitate variabilă după tratament ( p = 0,031). Utilizarea trimebutinei sau mebeverinei în asociere cu alte medicamente timp de o lună se corelează cu o evoluţie favorabilă a simptomelor după tratament, iar monoterapia este asociată cu fluctuanţa simptomelor (p < 0,001). Evoluţia favorabilă a simptomelor este asociată cu utilizarea de probiotice în combinaţie, dar nu şi în monoterapie (p < 0,001). Evoluţia favorabilă a simptomelor este de asemenea asociată cu utilizarea anxioliticelor în combinaţie cu alte medicamente. Persistenţa simptomelor după tratament a fost corelată cu prezenţa sau absenţa depresiei. Absenţa depresiei a fost corelată cu o evoluţie favorabilă a simptomelor (p = 0,005). SII-C este asociat la limită (semnificaţie marginală), cu boala hemoroidală (p = 0,56). 33 de pacienţi (29%) - au primit monoterapie (trimebutină sau mebeverină sau probiotice; 81 de pacienţi (71%) - au primit terapie combinată: (trimebutină sau mebeverină sau probiotice + anxiolitice sau inhibitori ai pompei de protoni (IPP), antiinflamatoare nesteroidiene (AINS) sau spasmolitice. Cele mai frecvente boli asociate observate la pacienţii cu SII au fost: depresia (27,19%), dislipidemia (25,43%), boala hemoroidală (22,80%) şi fibromialgia (21%).
Concluzii. Cea mai mare rată de răspuns a fost obţinută după administrarea tratamentului cu trimebutină sau mebeverină + anxiolitice + probiotice. Cea mai frecventă boală asociată cu SII a fost depresia. Alte boli cu o incidenţă ridicată: dislipidemia, boala hemoroidală şi fibromialgia. Sunt necesare studii suplimentare pentru a analiza legătura dintre SII şi unele boli asociate.
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