A Comprehensive Study On The Relations Between Irritable Bowel Syndrome With Psychological And Social Factors

Objective: Irritable bowel syndrome (IBS) is common psychosomatic disease of digestive system. In recent years, it arouses people pay attention extensively, since its prevalence rate is high and treatment is difficult. The research of clinical relevant IBS grows , but the cause and mechanism of IBS are not completely understanded so far , its treatment is also confined to symptom. Foreign researchs reported the united using antidepressants in IBS and getting better curative effect. The aim of the study is to explore the new channel of treatment and evaluate the effect and safety of clomipramine, a tricyclic antidepressant, in patients suffering from IBS.This study also attempted to discuss the cause and mechanism of IBS.Methods: 135 patients who satisfied the criteria for IBS were randomly assigned to the antidepressant combination group and general treatment group.127 patients received the controlled treatment study for 8 weeks. In the antidepressant combination group, 64 patients received clomipramine 25 mg/d for the first week, 50 mg /d for the second week and 75 mg /d day thereafter until the end of the 8th week. All patients completed the Life Event Scale (LES), Social Support Rating Scale (SSRS), Coping Style Questionnaire (CSQ), Eysenck Personality Questionnaire (EPQ), Zung self-rating depression scale (SDS) and Zung self-rating anxiety scale (SAS). They were compared with normal controls. After they were entered the clinical trial group, visited to judge clinical symptom, record possible side effect and Rate the scores of SDS and SAS at the end of the 2nd, 4th ,6th,8th weeks.Results: The scores of the negative life event were high and the scores of Social Support Rating Scale were low in the patient group. The N factor scores (EPQ) of the patient group were significantly higher than those of normal group.Compared with normal person, patients usually adopt negative coping style and the scors of positive coping style were lower (p < 0.01).The SDS and SAS results scors were significantly higher than those of norm. In the group treated with clomipramine a significantly greater reduction was found for the scores of SDS and SAS at the end of the 6th ,8th weeks.Combined with clomipramine therapy was found to be significantly more effective than general therapy. Improvement and complete remission in bowel symptoms occurred in 85.93% and 62.50% of patients, respectively, treated with clomipramine (P<0.01). No adverse side effect was recorded.Conclusion: There are some connections between IBS and the psychological and social factors. Clomipramine, a tricyclic antidepressant, is helpful in treating IBS, perhaps through antidepressant and antimuscarinic effects and can modify small intestinal motor function and reduce visceral hypersensitivity in IBS. An increased tolerance to aversive visceral sensations may play a role in the therapeutic effect. Clomipramine may be an effective and well-tolerated pharmacologic short-term treatment for IBS in patients with or without clinical mental disorder.