背景:肠易激综合征(IBS)是一种常见的功能性肠病,关于幽门螺杆菌(Hp)感染与IBS之间的关系,目前尚未明确.目的:探讨根除Hp在腹泻型IBS(IBS-D)中的作用以及Hp感染与IBS-D的关系.方法:收集2009年1月—2015年12月在云南省交通中心医院和西双版纳傣族自治州人民医院住院、符合罗马Ⅲ标准的IBS-D患者335例,同期健康体检者335例作为对照组,以快速尿素酶试验和14 C-尿素呼气试验检测Hp感染状态.对2015年入组的Hp感染患者行根除治疗,并予匹维溴铵、蒙脱石散治疗IBS症状;根据Hp根除情况分组,观察、随访两组临床疗效.结果:IBS-D患者的Hp感染率显著高于健康体检者(53.7%对41.8%,P<0.05).行Hp根除治疗的IBS-D患者中,51例归入根除组,26例归入未根除组,两组间各IBS单项症状(腹痛/不适、腹胀、排便频率)和总体疗效(68.6%对65.4%)差异均无统计学意义(P>0.05).经6个月的随访,两组间各项疗效指标仍无明显差异(P>0.05).结论:IBS-D患者的Hp感染率高于一般人群,但根除Hp对IBS症状的改善作用不明显.Hp感染与IBS-D的关系仍有待进一步研究.%Background:Irritable bowel syndrome (IBS)is a commonly seen functional intestinal disorder. The association between Helicobacter pylori (Hp)infection and IBS is not clarified yet. Aims:To investigate the role of Hp eradication in diarrhea-predominant IBS (IBS-D)and the relationship between Hp infection and IBS-D. Methods:A total of 335 IBS-D patients and 335 health examination subjects were recruited from Jan. 2009 to Dec. 2015 at Transportation Center Hospital of Yunnan Province and People's Hospital of Xishuangbanna Dai Autonomous Prefecture. All IBS-D patients were hospitalized patients and fulfilled the Rome Ⅲ criteria. Positive for both rapid urease test and 14 C-urea breath test was defined as Hp infection. Hp-positive IBS-D patients recruited in 2005 received Hp eradication therapy and were allocated into two groups according to the results of eradication therapy. Pinaverium bromide and montmorillonite powder were given in both groups and the clinical efficacy for IBS symptoms was assessed after treatment and followed up for 6 months. Results:The Hp infection rate of IBS-D patients was significantly higher than that in healthy controls (53. 7% vs. 41. 8%,P < 0. 05). In IBS-D patients received Hp eradication therapy,51 were allocated into eradicated group and 26 into non-eradicated group. No significant differences were observed in individual symptoms including abdominal pain/discomfort,bloating and stool frequency and the overall efficacy for global symptoms (68. 6% vs. 65. 4%)between the two groups (P > 0. 05). After a 6-month follow up,the differences were still insignificant (P > 0. 05). Conclusions:Hp infection is more prevalent in IBS-D patients than in general population,however,eradication of Hp has no impact on IBS symptoms. The association between Hp infection and IBS-D needs further study.
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