刺激性肠综合征中的中央神经调节剂:为什么,如何和何时
Ignacio Hanna-Jairala1, Douglas A Drossman2
1Division of Gastroenterology, Department of Internal Medicine, Hospital Alcivar, Guayaquil, Ecuador.
The American journal of gastroenterology
|April 10, 2024
概括
中央神经调节器通过向大脑-肠轴,有效地治疗刺激性肠综合征 (IBS). 治疗选择和持续时间是控制IBS症状和预防复发的关键.
科学领域:
- 神经胃肠病学 神经胃肠病学
- 药理学 药理学 是一个学科.
- 精神病学是一个精神病学.
背景情况:
- 刺激性肠综合征 (IBS) 是一种功能性胃肠疾病,通常使用中央神经调节器进行管理.
- 中央神经调节器影响神经递质系统 (血清激素,上腺素,多巴胺) 在大脑-肠轴.
- 这些药物会影响肠道运动,内脏敏感性和与IBS相关的精神病并发症.
研究的目的:
- 审查中央神经调节器在刺激性肠综合征 (IBS) 管理中的作用.
- 根据主要的IBS症状和药理性质指导选择合适的神经调节剂.
- 概述IBS中中央神经调节器治疗的治疗持续时间,增强策略和逐渐缩小的协议.
主要方法:
- 在IBS中使用的中枢神经调节剂的药理性质的审查.
- 对抗抑郁药物 (TCAs,SNRIs,SSRIs) 基于症状的选择标准的分析.
- 讨论治疗反应时间表,复发预防,增强和停止治疗的策略.
主要成果:
- 三环抗抑郁药 (TCA) 是第一线治疗IBS疼痛的药物; 血清激素和诺亚上腺素再吸收抑制剂 (SNRIs) 是替代药物.
- 选择性血清素再吸收抑制剂 (SSRI) 帮助焦虑和便秘,但不会疼痛;TCA帮助腹,但可能导致便秘.
- 临床反应需要6-8周,治疗6-12个月以预防复发;建议增加和缓慢逐渐减少.
结论:
- 中枢神经调节器对IBS有效,根据症状 (疼痛,焦虑,肠道习惯) 进行量身定制的选择,这对最佳结果至关重要.
- 长期治疗和不典型的抗精神病药物或行为疗法的潜在增强对于持续的IBS症状控制很重要.
- 需要小心缓慢地逐渐减少中央神经调节剂,以避免停药效应.
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