| Part 1 Evaluation of the psychological status, Quality of Life and Symptom Severity of IBS patientsAim Irritable bowel syndrome (IBS) is most common among digestive diseases, the etiology and pathogenesis of IBS still not clear. Now days more and more attention have been attracted by social and psychological factors among the clinicists. But the effects of psychological abnormalities on life quality and symptom severity of IBS patients have not been fully clarified. In order to find the effects of psychological problem on quality of life, symptom severity score and quality of sleep of IBS patients, we use different scalrs to evaluate these aspects and then analysis the correlation between them.Method A total of 101 IBS patients from Nov.2014 to May 2015 who have visited the Anhui Provincial Hospital gastroenterology clinic were enrolled in our study. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate the mental state of patients, irritable bowel syndrome-quality of life (IBS-QOL) was used to evaluate the life quality of patients, Pittsburgh sleep quality index (PSQI) was used to evaluate the sleep quality of patients, and IBS symptom severity score (IBS-SSS) was used to evaluate the symptom severity of patients.Result ①58 (58.4%) of IBS Patients were accompanied by varying degrees of anxiety and (or) depression. SAS score was49.84±8.29 and the SDS was 45.83±9.61.34 of the them were mild anxiety,15 of them were moderate anxiety and 0 of them was severe anxiety.②The IBS-QOL score of 101 patients was 73.28 ± 12.79, dysphoria, food avoidance and health worry were the most severely affected aspects.③ 74(73.3%) of patients were accompanied by varying degrees of sleep disorders, in which daytime dysfunction(1.82±0.93), sleep quality(1.49±0.81)and sleep efficiency(1.49±1.16)were the most severely affected.④Among the 101 IBS patients,13 patients’ symptom severity were mild,63 patients were moderate,25 patient were severe, IBS-SSS score was 253.00±72.58. ⑤Correlation analysis showed that anxiety, depression were negatively correlated with life quality (r=-0.426, P<0.001; r=-0.501, P<0.001) and positively correlated with sleep quality (r=0.556, P<0.000; r=0.513, P<0.000) and symptom severity (r=0.231, P=0.020; r=0.357, P<0.001). Symptom severity was negatively correlated with life quality (r=-0.417, P<0.001).Conclusions ①IBS patients had psychological abnormalities;②Among the IBS patients,who have more serious of psychological abnormalities, who has worse life quality and sleep qualities, the IBS symptoms were more severer.Part2 Therapeutic efficacy of alverine citrate combined with low dose of anti-depression drug in patients with refractory IBSAim The morbidity of IBS had increasing year by year recently. Because its etiology and pathogenesis still not clear, so there are no effective drugs clinically. Some of the IBS patients who seeking medical repeatedly were called refractory. These patients often accompanied with psychological problem, such as anxiety and depression. Some study achieved satisfactory therapeutic effects by using psychotherapy both in China and abroad.In order to investigate the clinical effects of the alverine citrate and it combined with low dose antidepressant drug on the refractory IBS patients, we gave 45 refractory IBS patients alverine citrate(Group A) or alverine citrate with flupentixol and melitracen (Group B) two different treatments. All 45 patients were evaluated before and after 4 weeks therapy in order to find whether there is any improvement on quality of life, IBS symptom severity, anxiety-depression and sleep quality by the end of the treatments.Method 45 refractory patients who meet the Rome Ⅲ criteria, and randomly assigned in Group A and Group B. Gave them alverine citrate(Group A, ac.po.tid.) or alverine citrate(ac.po.tid) with flupentixol and melitracen (Group B, mild and moderate anxiety or depression pc.po.qd, severe anxiety or depression pc.po.bid) two different treatments Using self-control study to compare IBS-QOL,IBS-SSS, anxiety, depression and quality of sleep before and after 4 weeks treatment,and observe the drug adverse reactions at the same time.Results All patients from group A and group B had finish the treatments and follow up, no adverse effects were observed. Group A patients’ IBS-QOL score was (59.38± 12.99vs68.49±14.87,P=0.015), and group B patients’ IBS-QOL score was (56.75± 11.26vs73.21±10.39,P<0.001),all have statistical differences when compare with baseline levels. Group A patients’ IBS-SSS score was (267.92±67.89vs214.83± 75.32,P=0.003), and group B patients’IBS-SSS score was (271.84±64.95vs162.64± 88.60,P<0.001),all have statistical differences when compare with baseline levels. Group A patients’sleep quality score was (7.42±3.45vs6.17±2.66,P=0.017), and group B patients’sleep quality score was (8.68±4.43vs5.60±3.44, P<0.001),all have statistical differences when compare with baseline levels.Group A patients’anxiety score was (44.83± 9.62vs43.92± 10.43,P=0.415), depression score was (39.08±9.34vs38.75±9.35, P=0.674), have no statistical differences when compare with baseline levels.But group B patients’anxiety score was (52.12±8.19vs39.28±9.88), depression score was (47.64±9.53vs38.24±9.41), all have statistical significant difference after 4 weeks therapy(P<0.001).Conclusion ①Refractory IBS patients often with more psychological abnormalities, severer symptoms severity and worse life quality.②Alverine citrate shows slight effects on IBS-QOL, sleep quality and IBS-SSS, but there is no any improvement in mental illness. ③The effects on IBS-QOL, sleep quality and IBS-SSS were more significant when alverine citrate combined with antidepressant, and the psychological status of these patients have improved at the same time. |
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