The Clinical Research Of Treating IBS-D With Food Rejectingtrend

PURPOSE:Observing the incidence of food intolerance in patients with diarrhea-predominant irritable bowel syndrome(IBS-D)and healthy physical examinees,at the same time,using food scalping method to treat IBS-D according to detection results of food intolerance and evaluate the efficacy,the aim is to find a simple,effective,economical and safe method for the treatment of IBS-D.METHODS: 1、Select sixty-eight patients with IBS-D who were coincident with Rome Ⅲ diagnostic criteria and enrolled in the Department of Gastroenterology and Digestive Medical Ward Shanghai Eighth People’s Hospital affiliated to Jiangsu University which meets the Rome Ⅲ diagnostic criteria and 40 healthy controls.2、Determine fourteen food-specific IgG antibodies by enzyme-linked immunosorbent assay(ELISA)and compare the positive rate of food intolerance between the two groups.3、For IBS-D patients with food intolerance,treat with food scalping method for 12 weeks,investigate the quality of life scale(IBS-QOL)and the severity of the symptoms before and after treatment and compare the scores before and after treatment,so as to evaluate the therapeutic effect of the food scalping method and to analyze the correlation between the quality of life and the severity of the symptoms.RESULTS: 1、There was no significant difference between the IBS-D group(30 males,38 females)and control group(18 males,22 females)(χ2 = 0.008,P> 0.05);The age of IBS-D group was(54.82 ± 17.75)years old and the age of control group was(53.23 ± 16.56)years old.There was also no significant difference between the two groups(t = 0.46,P> 0.05).2、There were 55 cases who had at least one food intolerance among the 68 patients with IBS-D and the positive rate was 80.88%.In the control group,13 patients had food intolerance and the positive rate was 32.50%.There was a significant statistical difference between the two groups(χ2 = 25.28,P <0.01).There was no significant statistical difference in the positive rate of food intolerance between males and females of two groups(in IBS-D group χ2 =1.98,P=0.16,P> 0.05;in control groupχ2 = 0.33,P= 0.56,P> 0.05).3、The first four food which had the highest positive rate of the two groups were both wheat,egg white / egg yolk,milk and soybeans;the positive rates of tomato,pork and chicken were both 0.4、After 12 weeks of diet treatment,the total score of IBS-D patients(3.13 ± 3.52)was significantly lower than before(8.25 ± 2.97)(t = 11.107,P<0.01),which has an apparent statistical difference.The self-ratings(t=12.429,11.016,5.685,5.558,7.681,11.065,P<0.01)of abdominal pain,the frequency of abdominal pain,the frequency of diarrhea,the degree of bloating,the shape of stool improved a lot too.There w as no significant difference between the scores of male and female patients before trea tment(t =0.942,0.462,-0.093,1.774,1.969,1.813,1.424,P>0.05).5、IBS-D patients’ scores of IBS-QOL(71.22 ± 9.27)were significantly higher than t hat before treatment(57.95 ± 11.34),(t =-18.595,P <0.01),the difference has an o bvious statistical meaning.The scores of anxiety,behavioral disorders,physical thought s,health worries,picky eaters,social functions and interpersonal relationships significa ntly improved(t=-13.159,-13.325,-9.796,-16.148,-15.701,-13.121,-11.268,-18.595,P <0.01).There were no significant statistical differences between the scores of male a nd female patients before treatment(t = 1.008,0.995,1.214,0.700,0.220,1.276,1.806,1.1767,P>0.05).6、Among the 54 IBS-D patients(1 patient lost to follow-up),61.11%(33/54)significantly improved,24.07%(13/54)improved,14.81%(8/54)was ineffective,the total effective rate was 86.36%(46/54).The effective rate was 86.36%(19/22)in male patients.The effective rate was 84.38%(27/32)in female patients,and there was no significant difference between the effective probability of male and female patients(χ2= 0.04,P = 0.84,P> 0.05).7、There was a significant negative correlation between symptom score and patients’ quality of life with IBS-D(r =-0.963,P <0.001).CONCLUSION: 1、IBS-D patients’ the rate of suffering from food-specific IgG antibody positive was significantly higher than the normal population,suggesting that food intolerance may be one of the pathogenesis of IBS-D and both are related.2、According to the results of food-specific IgG antibody test,with the food removal method,the severity of symptoms decreased,the quality of life score increased,indicating that the method of treatment of IBS-D is effective,which deserves promotion.3、Food-specific IgG antibodies not only exist in IBS-D patients,but also in the normal population,suggesting that food-specific IgG antibodies may not only have a correlation with IBS-D,may also be related to the occurrence of other diseases;Or the presence of food-specific IgG antibodies positive not necessarily causes discomfort and the occurrence of disease,which is worthy of our further study.