Variants Of Irritable Bowel Syndrome Research Articles

Effect of Rebamipide on the Intestinal Barrier, Gut Microbiota Structure and Function, and Symptom Severity Associated with Irritable Bowel Syndrome and Functional Dyspepsia Overlap: A Randomized Controlled Trial.

Treatment of functional digestive disorders is not always effective. Therefore, a search for new application points for potential drugs is perspective. Our aim is to evaluate the effect of rebamipide on symptom severity, intestinal barrier status, and intestinal microbiota composition and function in patients with diarrheal variant of irritable bowel syndrome overlapping with functional dyspepsia (D-IBSoFD). Sixty patients were randomized to receive trimebutine (TRI group), trimebutine + rebamipide (T + R group), or rebamipide (REB group) for 2 months. At the beginning and end of the study, patients were assessed for general health (SF-36), severity of digestive symptoms (Gastrointestinal Symptom Rating and 7 × 7 scales), state of the intestinal barrier, and composition (16S rRNA gene sequencing) and function (short-chain fatty acid fecal content) of the gut microbiota. The severity of most digestive symptoms was reduced in the REB and T + R groups to levels similar to that observed in the TRI group. The duodenal and sigmoidal lymphocytic and sigmoidal eosinophilic infiltration was decreased only in the REB and T + R groups, not in the TRI group. Serum zonulin levels were significantly decreased only in the REB group. A decrease in intraepithelial lymphocytic infiltration in the duodenum correlated with a decrease in the severity of rumbling and flatulence, while a decrease in infiltration within the sigmoid colon correlated with improved stool consistency and decreased severity of the sensation of incomplete bowel emptying. In conclusion, rebamipide improves the intestinal barrier condition and symptoms in D-IBSoFD. The rebamipide effects are not inferior to those of trimebutine.

Irritable bowel syndrome: shifts in point of view

The main symptom of irritable bowel syndrome (IBS), a recurrent functional GI disorder, is abdominal pain associated with defecation, a change in the frequency of bowel movements and a change in the consistency of stool. Until recently, it was the only specific disease that was included in the international classification of the 10th revision. Another 53 functional disorders will be included in the classification of the 11th revision and receive the status of ICD diseases. There are four main variants of IBS: IBS with constipation, IBS with diarrhea, IBS with mixed bowel habit and IBS unclassified. The very concept of IBS was fast-changing. The latest Rome IV (2016) guidelines suggested a mechanism of intraepithelial contact disruption as one of the pathogenetic mechanisms, which activates a minor intramucosal inflammation. It could be relevant to the chronicity of the process and require the use of anti-inflammatory drugs and agents in the treatment that restore intraepithelial contacts, which increases the percentage of patients with a positive treatment effect. The report provides data on the pharmacotherapy of drugs that have a combination (concomitant) effect of action, for example, Meteospasmyl®, which is superior to drugs with antispastic action or action that restores impaired motility in terms of the final effect of the action. The author of this report invites to participate in the discussion about the feasibility of introducing a new IBS variant, which may have a chronic course, and the inclusion of anti-inflammatory drugs in the combination treatment (if drugs that affect motor disorders have insufficient effect).

Risk factors for various clinical variants of irritable bowel syndrome

Introduction . Irritable bowel syndrome (IBS) affects a significant portion of the population worldwide. The disease is characterized by a multifactorial pathogenesis and a variable clinical picture, in the center of which is abdominal pain and violations of the act of defecation. Our work shows the relationship between the functional polymorphism of the serotonin reuptake transporter (5-HTTLPR of the SLC6A4 gene) and the features of myoelectric activity (MEA) of the small intestine in various clinical variants of IBS. Purpose — to study clinical, functional and genetic features in patients with IBS and on their basis to determine significant risk factors for the formation of various IBS variants. Materials and methods . 148 patients were examined: 79 patients with IBS (group 1), including 45 patients with IBS with a predominance of diarrhea (group 1a) and 34 patients with IBS with a predominance of diseases (group 1b), 10 healthy volunteers (group 2), 59 patients of therapeutic profile without IBS (group 3). The diagnosis of “IBS” was established according to the Rome criteria III revision. All of them thoroughly studied peripheral electrogastroenterography (PEGEG) and groups of patients 1 and 3 — genetic analysis of the 5-HTTLPR polymorphism of the SLC6A4 gene. Results . In the diarrheal variant of IBS, the 5-HTTLPR promoter more often contains the S allele associated with a decrease in the function of the serotonin reuptake transporter. The risk factors for the formation of clinical variants of IBS include: gender, polymorphic variants of the 5-HTTLPR gene SLC6A4 and the values of the postprandial coefficient of myoelectric activity (MEA) at the frequencies of “ileum” and “jejunum”. Conclusions . The revealed relationships between the motor-evacuation function (MEF) of the gastrointestinal tract and polymorphism of the serotonin transporter gene demonstrate the pathophysiological significance of these associations in the development of IBS and its clinical variability. Features of the functioning and genetic features of the serotonergic system deserve further study, which is promising for improving the diagnostic and therapeutic approach to patients with IBS.

Experience in the Treatment of Irritable Bowel Syndrome Developed after a New Coronavirus Infection (COVID-19)

Aim. To study the effectiveness of Kolofort® (affinally purified antibodies to tumor necrosis factor α, to the brain-specific protein S-100 and to histamine) in patients with various variants of irritable bowel syndrome (IBS) that developed after a new coronavirus infection (COVID-19).Materials and methods. Clinical and laboratory data of 32 patients with IBS who had a history of COVID-19 pneumonia were analyzed. Course therapy with Kolofort® is prescribed according to the standard scheme for 3 months. Before and after treatment, the dynamics of the symptoms of IBS was assessed according to the questionnaire, the dynamics of anxiety was assessed according to the Hamilton scale.Results. There were a statistically significant decrease in the severity of IBS symptoms (normalization of the consistency of the stool, cessation of flatulence, a decrease in abdominal pain; p < 0.05) and a decrease in anxiety after the end of treatment.Conclusions. Kolofort® may be effective in eliminating the symptoms of post-infectious IBS and anxiety that developed after COVID-19.

Correction of vegetative disorders in children with irritable bowel syndrome

Introduction. The article considers the formation of irritable bowel syndrome (IBS) in children. In recent years this pathology occurs more often among the adult and children population in many countries in the world. According to the modern view of the problem, this disease is considered a biopsychological disease, in the development of which an important role is played by the connection of psychological factors, dysfunctions of the autonomic nervous system, motor and secretory disorders of various parts of the intestine, which can cause the discomfort, changes of intestinal habits. All these factors lead to a decrease in the quality of life in children. Purpose of research. The main goal of this research is to study the peculiarities of the status of the autonomic nervous system in children with irritable bowel syndrome and to evaluate the effectiveness of the proposed therapy. Materials and methods One of the main methods for assessing the condition of the autonomic system in patients is cardiointervalography. During this examination, we calculated the index of tension, which is one of the main indicators of assessing the condition of this part of the nervous system. According to this index’s indicators, the vegetative system’s state can be divided into three main variants of functioning – vagotony, eutony, and sympathicotony. All patients were divided into groups according to the main complaints and course of IBS – IBS with constipation (IBS -C), IBS with diarrhea (IBS- D), a mixed form of IBS and an unclassified form of IBS. And also another two large groups were formed – main and control. Results. We analyzed the cardiointervalogram indicators in both groups of patients with different clinical variants of IBS. In the main group, we registered a statistically significant decrease in the index of tension and an improvement in autonomic nervous system dysfunction in patients with IBS with constipation and diarrhea. Indicators in these groups were changed from the state of vagotony and sympathicotonia to eutony. This indicates the restoration of the function of the normal function of the autonomic nervous system. Patients from the control group also showed changes in the index of tension, but the indicators stayed in the borders of vagotony and sympathicotony, and didn’t reach the level of eutony. Conclusions. Аfter the evaluation of the received data, it was proved that the use of hopanthenic acid in the complex therapy of irritable bowel syndrome effectively improve the status of the autonomic nervous system in children.

Эффективность примененияпрепарата Колонзак у пациентов с различными клиническими вариантами синдрома раздраженного кишечника

Актуальность. На сегодняшний день этиология симптомов синдрома раздраженного кишечника (СРК) полностью не установлена. Отсутствие четкого понимания патогенетических механизмов развития того или иного функционального заболевания кишечника, в том числе СРК, с учетом наличия разнообразных структурно-морфологических нарушений в стенке кишки диктует необходимость поиска новых препаратов, действие которых будет направлено на разные звенья патогенеза кишечных заболеваний. Цель исследования — изучить эффективность и безопасность применения препарата Колонзак у пациентов с различными клиническими вариантами синдрома раздраженного кишечника. Материалы и методы. Обследованы 42 пациента с верифицированным диагнозом СРК (14 — СРК тип 1; 14 — СРК тип 2; 9 — СРК тип 3; 5 — СРК тип 4) в возрасте от 25 до 45 лет (средний возраст 35,0 ± 1,7 года). У всех пациентов с СРК органическая кишечная патология была исключена при проведении колоноскопии. ­Диагноз СРК установлен в соответствии с Римскими критериями IV. Кроме модификации образа жизни и соблюдения правил питания в зависимости от типа СРК, все пациенты (независимо от варианта СРК) получали средство Колонзак по 1 капсуле 2 раза в день, утром и вечером перед едой 30 дней. Все пациенты заполняли опросник по оценке степени тяжести симптомов СРК до и после курса лечения. Полученные результаты были статистически обработаны при помощи программ Excel 2017 (Microsoft) и Statistica 13. Результаты. Проведенное исследование показало, что Колонзак, содержащий пробиотические штаммы бифидобактерий, пребиотик инулин и масляную кислоту, можно рассматривать как безопасное, хорошо переносимое и высокоэффективное средство для пациентов с разными вариантами СРК. У пациентов с СРК применение препарата Колонзак сопровождалось статистически значимым улучшением состояния. Выводы. Наше исследование подтвердило клиническую эффективность средства Колонзак как мультикомпонентного колонопротектора при СРК. Полученные результаты позволяют рекомендовать широкое применение препарата Колонзак у пациентов с разными вариантами СРК.

Functional polymorphism of the serotonin reuptake transporter SLC6A4 gene in various clinical variants of irritable bowel syndrome

Rationale:Irritable bowel syndrome (IBS) is a multifactorial disease, the genetic aspect of which is being actively studied.Aim:To investigate functional polymorphism of the serotonin reuptake transporter (SERT)SLC6A4gene of various clinical variants of IBS.Materials and methods:We performed a cross-sectional single center study in 79 Caucasian patients with IBS (according to the Rome criteria IV). The patients were divided into two groups: group 1, IBS with diarrhea (IBS-D, n = 45) and group 2, IBS with constipation (IBS-C, n = 34). The control group included 59 Caucasian patients with gastrointestinal disorders without IBS. Polymorphism5-HTTLPRof theSLC6A4gene was assessed in all subjects. In group 1 patients, blood serotonin levels were measured and psychological tests were performed, including Spielberger's State / Trait Anxiety Inventory, quality of life by SF36 and GSRS, Asthenia scale, VAS scores for pain intensity.Results:Thirty-five of 45 (77.8%) patients with IBS-D carried the mutantSallele, which was significantly more frequent than in the IBS-C group (p = 0.002) and in the control group (p = 0.005). There were no statistically significant differences (p = 0.54) in the frequency of detection of the homozygousLLgenotype (normal allele) and the heteroand homozygous mutant alleles (SLandSS) genotype between the IBS-C and control patients. In the IBS-D group, a gender difference for the mutantSSallele of5-HTTLPRwas found, with significantly higher frequency in female patients (p = 0.0147). No significant gender differences in the genotype distribution between the patients with IBS-C and the control group were found. There were also no differences in blood serotonin levels in the IBS patients with various5-HTTLPRtypes (p = 0.086); they were all in the reference range. However, there was a trend towards lower serotonin levels in theLLgenotype carriers compared to those with theSS/SLpolymorphisms. The Gastroenterological inventoryGSRSdemonstrated significantly higher total score for the constipation syndrome in the patients with homozygousLL 5-HTTLPRpolymorphism, compared to that in the patients with theSS/SLgenotype (p = 0.013).Conclusion:The results may be related to lower expression of theSLC6A4gene in the carriers of the mutant allele in the5-HTTLPRpromoter and subsequent decreased rate of serotonin uptake, with resulting stimulation of the gastrointestinal tract. TheSERTpolymorphism of theSLC6A4gene is worth further investigation as a potential candidate gene in the IBS pathophysiology.

Relationship between food allergies and composition of intestinal microbiota at irritable bowel syndrome

Currently, there is an increase in the number of patients with irritable bowel syndrome (IBS). However, to date, there is no single concept of the etiopathogenesis of functional disorders of the digestive tract. Initially, great attention was paid to disorders of motility and impaired regulatory interactions of the brain‑intestine as causes of irritable bowel syndrome, but in recent years the focus has shifted to subclinical inflammation in the colon mucosa and the development of visceral hypersensitivity. The reasons contributing to the formation of immune inflammation in the intestinal wall, include a violation of the composition of the intestinal microbiota, as well as food allergies and food intolerance. This article discusses the qualitative and quantitative changes in the intestinal microbiota in patients with irritable bowel syndrome if they have food allergies, as well as the effect of the composition of the intestinal microbiota on the clinical variant of irritable bowel syndrome. The study included 257 patients with IBS. At the first stage, an assessment was made of the history of food allergies, such as IBS, in accordance with the Bristol scale, as well as a microbiological study of feces. At the second stage, the evaluation of intestinal microbiota correction schemes was carried out in patients who had food allergies. The patients were divided into two equal groups, the first group received intestinal antiseptic in combination with multi‑component probiotic, the second — intestinal antiseptic in combination with Saccharomyces boulardii. When analyzing the obtained results, it was noted that approximately half of patients with IBS in the anamnesis had manifestations of food allergy. In most cases, food allergy was associated with the development of patients with IBS variant with diarrhea and excessive growth of conditionally pathogenic microflora with a decrease in the number of lactic and bifidobacteria. When comparing schemes for the correction of disorders of the intestinal microbiota, the greatest efficacy was observed with the combination of intestinal antiseptic and Saccharomyces boulardii.

Генетические и психологические предпосылки к возникновению рефрактерного варианта синдрома раздраженного кишечника

Purpose of the study. Тo determine predictors of refractory course of irritable bowel syndrome with consideration for genetic markers and psychological peculiarities of patients. Materials and methods. 101 patients with irritable bowel syndrome (73 with refractory form of irritable bowel syndrome, 28 with non-refractory form of the same) have been examined. We analyzed the triggers of the disease, assessed the levels of distress, depression, anxiety, somatization, and aggression, and we have determined polymorphic variants of genes COMT Val158Met, TLR9 G2848A, TLR9 T-1237C. Results. Refractory variant of irritable bowel syndrome is associated with the onset at an earlier age, social and psychological triggers, extraintestinal manifestations and non-gastroenterological symptoms, high levels of distress, depression, anxiety, somatization, and aggression. We have revealed that refractoriness and some clinical forms of irritable bowel syndrome are associated with polymorphic variants of certain genes. Conclusion. Refractory variant of irritable bowel syndrome is associated with certain genetic and psychological factors.

Отдаленные результаты лечения пациентов с синдромом раздраженного кишечника

Aim of investigation. To estimate duration of remission of irritable bowel syndrome after treatment by multistrain probiotic drug, motility regulator or antispasmodic medication. Material and methods. Original study included overall 87 patients with irritable bowel syndrome (IBS) or IBS in combination with functional dyspepsia (FD) in whom the diagnosis was confirmed according to compliance of symptoms to the Rome-III criteria and absence of organic diseases according to laboratory and instrumental investigation. In 42 patients diarrheapredominant variant of IBS was diagnosed (IBS-D), in 45 patients - constipation-predominant (IBS-C). All patients enrolled in original study underwent monotherapy by probiotic agent, motility regulator trimebutine or spasmolytic drug. The probiotic agent (Bifidobacterium bifidum, B. longum, B. infantis, Lactobacillus rhamnosus) was prescribed to 15 patients with IBS-D and 15 patients with IBS-C, motility regulator (trimebutine) - respectively to 12 and 15 patients, antispasmodic was used in 15 patients with IBS-D and 15 - with IBS-C. All patients at the end of 28thday of treatment achieved clinical remission of the disease (decrease of the total score of «7×7» Questionnaire for 50% and more). At the 30, 45 and 60 days after treatment secession in patients had telephone interview with health-related questions. Patients’ responses of those who received no maintenance therapy were statistically analyzed. Results. In 30 days secession of pharmaceutical therapy 73.3% of patients with IBS-D who received probiotic therapy during relapse maintained clinical remission, 75% of patients often motility regulator treatment and 60% of those who received antispasmodic medications. Of patients with IBS-C in 30 days after treatment termination remission was maintained in 60% of those after probiotic treatment, in 80% of the motility regulator treatment and in 60% antispasmodic therapy. In 45 days 47% of IBS-D patients treated by probiotics had sense of well-being, 58% of those who received motility regulators and 47% of patients who received antispasmodics previously. Of IBS-C patients in 1.5 months 33.3% of those, who received probiotic were symptomless, 46,3% of patients after trimebutine therapy and 33,3% of patients who achieved remission after antispasmodic therapy. In 60 days of IBS-D 20% in the group of patients remained in remission after probiotic treatment, 20% after trimebutine therapy and 33% after antispasmodic. Of IBS-C patients 20, 33 and 20% of patients respectively maintained clinical remission. No statistically significant differences between groups of patients with IBS-D and IBS-C were revealed (р>0.05). Conclusion. According to the obtained data, pharmacologically induced remission in the most of IBS cases is short-term. Remission duration depend neither on clinical variant of disease, nor on the group of drugs applied for remission induction.

The using of low-FODMAP diet is an important step in the treatment of children with irritable bowel syndrome

Diet therapy, in most cases, is the first stage of treatment of diseases of the gastrointestinal tract. Especially, this question remains relevant in patients suffering from functional gastrointestinal disorders. The irritable bowel syndrome is one of the most common of functional gastrointestinal tract disorders in the population. The Rome criteria IV are basic recommendations for the diagnosis and treatment of functional gastrointestinal disorders in patients of different ages. The diet with a reduced content of fermentable oligosaccharides (fructans and galactans), di- (lactose), monosaccharides (fructose) and polyols (FODMAP) is recommended by current international consensus for patients of different ages with irritable bowel syndrome. The article presents current findings on the low-FODMAP diet effect on the clinical manifestations of irritable bowel syndrome. The elimination of various foods in the diet of patients with different clinical variants of irritable bowel syndrome according to the low-FODMAP diet scheme leads to a decrease in gassing and normalization of contractile activity of the intestine. It significantly reduces the frequency of exacerbations of the disease and improves the quality of life of such patients. A number of clinical studies using the low-FODMAP diet in adult patients and children with irritable bowel syndrome are presented. It is concluded that further clinical studies to study the effectiveness of the low-FODMAP diet in patients with irritable bowel syndrome are needed. Especially this issue remains relevant in pediatric practice.

Emotional and personality features of patients with irritable bowel syndrome and bowel inflammatory diseases

To conduct a comparative analysis of the emotional and personality characteristics of patients with irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) in remission with IBS-like symptoms. This study carried out based at a specialized gastroenterology clinic in the period from 2010 to 2015 included 125 patients with IBS (IBS-D - 46, IBS-C - 20, IBS-M - 59) and 37 patients with IBD in remission: Crohn's disease (CD) - 11 and ulcerative colitis (UC) -26 patients. The levels of depression (Beck questionnaire), urgent and personal anxiety (Spielberger questionnaire), the degree of alexithymia (Toronto scale) as well as the severity of psychopathology and behavioral symptoms (PBS) were estimated. Patients with IBS were not significantly different from those with IBD in remission with IBS-like symptoms in terms of depression, actual anxiety, alexithymia and PBS. Only the index of personal anxiety was significantly higher in the group of patients with IBS compared with IBD in remission with IBS-like symptoms (p = 0.0376). Men with IBS exhibited significantly higher actual anxiety than men with IBD (p = 0.04). Maximum severity of depression, anxiety and alexithymia was documented in the locking version of IBS (IBS-C) in comparison with other variants of IBS (p <0.05). Patients with CD in remission are characterized by higher rates of depression and alexithymia compared to UC (p <0.05). Behavioural disorders are most pronounced in the diarrheal variant of IBS and CD. A higher personal anxiety was observed in patients with IBS compared to those in remission of IBD with IBS-like symptoms although other parameters were not significantly different. Patients with IBS-C were characterized by more pronounced manifestations of emotional and personality disorders. More severe emotional and behavioral disorders distinguish CD from UC.

Виды нарушений двигательной функции толстой кишки и висцеральной гиперчувствительности при различных клинических вариантах синдрома раздраженного кишечника

Виды нарушений двигательной функции толстой кишки и висцеральной гиперчувствительности при различных клинических вариантах синдрома раздраженного кишечника

Morphological changes of intestinal mucosa in patients with different clinical variants of irritable bowel syndrome using tetracyclic antidepressants and selective serotonin reuptake inhibitor.

Objective. To assess histological changes of colonic mucosa in patients with clinically different types of irritable bowel syndrome (IBS) before and after the treatment with tetracyclic antidepressant and selective serotonin reuptake inhibitor. Methods. Adult patients (over 18 years) with confirmed diagnosis of IBS were examined. Biopsy specimens were taken from colon during colonoscopy for the next histological examination. One expert gastrointestinal pathologist assessed all tissue samples. We patent semi quantitative assessment of the severity of cell infiltration of colonic mucosa, which could be assessed as inflammatory (neutrophils), immune (lymphocytes, plasma cells, macrophages), or allergic (eosinophils) response (0 to 3 degrees). All patients received treatment due to the clinical variant of IBS: 1) IBS-constipation – mirtazapinum 15 mg/night+lactulose 30ml/morning (+30ml/night if needed); 2) IBS-diarrhea – escitalopram 5mg/night+rifaximine 600mg/twice a day; 3) IBS-unspecified – mirtazapinum 15 mg/escitalopram 5mg/ night; 4) IBS-mixed – mirtazapinum 15 mg, lactulose 30ml/morning (+30ml/night if needed) / escitalopram 5mg/night+rifaximine 600mg/twice a day. Results. 107 patients were examined, 36 of them had constipation (I group), 35 – diarrhea (II group), 22- unspecified variant (III group) and 12 patients had mixed variant of IBS (IV group) due to Rome III criteria (2006). 1 st degree of lymphocyte infiltration was detected in 100% IBS-constipation patients and in 58,3% IBS-mixed variant (p 0.05). No cases of 2 nd or 3 rd degree of colonic mucosa infiltration were found. Conclusion. After the treatment with tetracyclic antidepressant and selective serotonin reuptake inhibitor we found that the degree of inflammation of colonic mucosa was reduced or disappeared, due to the zero degree of infiltration according to our patented classification.

Personality factors and profile in variants of irritable bowel syndrome

Personality factors and profile in variants of irritable bowel syndrome

Personality factors and profiles in variants of irritable bowel syndrome

瞄准：学习在急躁的肠症候群(IBS ) 之间的协会变体(便秘，腹泻，或) 并且在非精神病学的病人的个性特点。方法：IBS 在器官的肠病理的排除以后用罗马 II 诊断标准被诊断。每个病人的入口被证实跟随精神病学的会见。个性特点和每个因素的分数用 NEO 被评估五因素库存。结果：150 个病人被学习。吝啬的年龄(+/- SD ) 是 33.4 (+/- 11.0 ) 年(62% 女性) 。题目在神经病的主义更高得分了( 26.25 +/- 7.80 对 22.92 +/- 9.54 ， P < 0.0005 )，坦诚( 26.25 +/- 5.22 对 27.94 +/- 4.87 ， P < 0.0005 )并且良心( 32.90 +/- 7.80 对 31.62 +/- 5.64 ， P < 0.01 )与我们的将军相比，人口源于伊朗的大学。我们的学习人口与腹泻 dominant-IBS 由 71 个病人组成了， 33 与便秘 dominant-IBS 并且 46 与改变 type-IBS。良心和神经病的主义的分数在 C-IBS 与相比是显著地更高的把钓饵轻轻放进水里并且 A-IBS (35.79 +/- 5.65 对 31.95 +/- 6.80， P = 0.035 和 31.97 +/- 9.87， P = 0.043，分别地) 。良心是在每变体的个性的最高的尺寸。有 C-IBS 的病人有几乎类似的个性侧面，为神经病的主义和良心的更高的分数镇静与适合的底层，一般人口接近了那些的坦诚和外向性。结论：差别在 IBS 病人和一般人口之间，以及在 IBS 子类型之间被观察，以个性因素。有便秘占优势的 IBS 的病人显示出类似的个性侧面。有 IBS 的每种子类型的病人可以得益于心理干预，它能就每种子类型的特征而言被集中。

Paraduodenal hernia presenting as unexplained recurrent abdominal pain

We present a case of a 29-yr-old female nurse who presented with an 8-h history of abdominal pain. She had had similar episodes (twice/yr) over the last 5 yr, and the pain had usually resolved spontaneously. Prior investigations including laboratory studies, plain films of the abdomen, an abdominal and pelvic ultrasound, and a CT scan yielded no diagnosis. Her pain was previously considered to be either psychosomatic or a variant of irritable bowel syndrome. On this admission, an evaluation and subsequent enteroclysis revealed a left paraduodenal hernia. The importance of considering paraduodenal hernias in the differential diagnosis of unexplained intermittent abdominal pain is discussed here.