Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder with a global prevalence of 10%-20% and a prevalence of 2%-12% in my country. Its main symptoms are abdominal pain and changes in bowel habits, without obvious organic lesions, but it severely impacts patients’ quality of life and even increases the risk of mental illnesses such as depression. Current drug treatment primarily focuses on symptom relief, but patient heterogeneity is high, with approximately 60% dissatisfied with existing treatments. Some patients experience symptoms persisting for more than 12 months and do not respond to psychotherapy, developing into treatment-resistant IBS. Traditional medicine acupuncture is considered a potential adjunctive therapy, but current research suffers from methodological limitations and insufficient evidence from pseudo-controlled trials; its efficacy in treating treatment-resistant IBS remains unclear.
The study was conducted at six centers in my country from October 2020 to May 2022, recruiting patients through outpatient clinics, social media, and community channels. Inclusion criteria included age 18–70 years, irritable bowel syndrome duration ≥12 months, unresponsiveness to at least 6 weeks of dietary intervention and one standard medication, and normal colonoscopy results within the past year for patients over 50 years of age. Patients with severe organic disease, alarm symptoms (such as unexplained rectal bleeding, anemia), and those who had received acupuncture within the past 3 months were excluded. Ultimately, 170 patients were randomly assigned in a 1:1 ratio to either the real acupuncture group (n=85) or the sham acupuncture group (n=85) using dynamic block randomization.
Symptoms:-
Abdominal pain or discomfort : The pain is mostly located in the lower abdomen and can be relieved after defecation. The degree of pain is related to the frequency or characteristics of defecation.1.
Abnormal bowel movements : divided into three types:
Diarrhea type (IBS-D) : Frequent loose or watery stools, with obvious urgency to defecate.
Constipation type (IBS-C) : Difficulty in defecation, reduced frequency of bowel movements, and hard, dry stools.
Mixed type (IBS-M) : Diarrhea and constipation alternate.
Abdominal distension and bloating : often worsen after meals, and some patients experience increased anal gas.3.
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Etiology and Precipitating Factors
The exact cause is not yet fully understood, but the following factors may be involved in its development:
Visceral hypersensitivity : The intestines have an enhanced pain response to normal stimuli.
Brain-gut axis dysfunction : Emotional stress affects gut function through nerve signals.
Gut microbiota imbalance : In some patients, the number of beneficial bacteria in the gut decreases while the number of pathogenic bacteria increases.
Food intolerance : Foods high in FODMAP (short-chain carbohydrates that are easily fermented) may trigger symptoms.
Psychological factors : Anxiety, depression , or chronic stress may worsen the condition.
How to diagnose:-
The diagnosis must meet the following conditions:
Rome IV criteria : recurrent abdominal pain (at least 1 day per week) lasting for more than 3 months, accompanied by at least 2 of the following:1.
Abdominal pain is relieved after defecation;
Abdominal pain accompanied by changes in bowel movement frequency;
Abdominal pain accompanied by changes in stool consistency.
Exclude organic diseases : Inflammatory bowel disease , lactose intolerance , intestinal infection, etc. , through stool tests, blood tests, colonoscopy , etc.2.
- Management and Treatment
- Dietary adjustments
01. Low FODMAP diet
Short-term reduction in the intake of easily fermentable foods (such as onions, beans, and dairy products).
Regular eating habits : Avoid overeating and reduce spicy and greasy foods.
Personalized adjustments : Keep a food diary and identify foods you are allergic to.
02. Improvement of lifestyle habits
Maintain a regular sleep schedule : Ensure sufficient sleep and avoid staying up late.
Moderate exercise , such as walking or yoga, can relieve intestinal tension.
03. Symptomatic drug treatment
Antispasmodics (such as pinaverium bromide ): relieve abdominal pain and intestinal spasms.
Medications to regulate bowel movements : For diarrhea, use antidiarrheal drugs (such as loperamide); for constipation, use osmotic laxatives (such as polyethylene glycol).
Probiotics : Some strains (such as Bifidobacterium ) may improve bloating.
04. Psychological intervention
Cognitive behavioral therapy and mindfulness-based stress reduction can alleviate anxiety-related symptoms, and antidepressants may be necessary in combination when needed.
Precautions:-
Avoid over-reliance on medication : Medication should be used under the guidance of a doctor, and laxatives or antidiarrheal drugs should not be taken for a long period of time on one’s own.
Be alert to warning symptoms : such as weight loss, rectal bleeding, and abdominal pain at night. Seek medical attention promptly to rule out serious diseases such as tumors .
Long-term management : IBS is mostly a chronic disease, and symptoms need to be controlled through lifestyle modifications and regular follow-up.