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第二階段 第三階段一氧化氮一氧化氮5-- HT及受體及受體多巴胺及受體多巴胺及受體胃腸道激素胃腸道激素 (jī s249。)及受體及受體細胞因子及受體細胞因子及受體細胞信號轉導蛋白細胞信號轉導蛋白離子及離子通道離子及離子通道 ● ● ●第二十一 頁 ,共五十三 頁 。Extracellular work regulation Nerve cellsImmune cells Endocrine cellsCytokine, receptor, peptide, 5HT第二十二 頁 ,共五十三 頁 。How to develop in a person?第二十三 頁 ,共五十三 頁 。Predisposing factorsPsychoPhysiologicaltriggersConcurrentmodifiersBraingutdysregulationEarlylifeGeic vulnerability,Enviromnent eg illnessBehavior reinforcement,abuse第二十四 頁 ,共五十三 頁 。Predisposing factorsPsychoPhysiologicaltriggersConcurrentmodifiersBraingutdysregulationEarlylifeGeic EnvironmentChronic threat prolonged effortful copingEntericInfection/Inflammation/toxins↑↓第二十五 頁 ,共五十三 頁 。Predisposing factorsPsychoPhysiologicaltriggersConcurrentmodifiersBraingutdysregulationEarlylifeGeic EnvironmentChronic threat prolonged effortful copingEntericInfection/Inflammation/toxins↓StressresponseneuromodulationPostinfectiveneuromodulationPersonality, emotionalSupport, age, gender,Sleep dysfunctionLife event stress,Food allergens,Altered bowel flora↑第二十六 頁 ,共五十三 頁 。Predisposing factorsPsychoPhysiologicaltriggersConcurrentmodifiersBraingutdysregulationEarly lifeEnteric infectionInflammation,trauma↓StressresponseneuromodulationPostinfectiveneuromodulationPersonality, emotionalSupport, age, gender,Sleep dysfunctionLife event stress,Food allergens,Altered bowel flora↑Prolonged threateffortful coping CNSENSCorticalArousal(anxiety))VisceralhypersensitivityGI symptomsEI symptomsIBSDysmotilityAlteredEpithelialpermeability第二十七 頁 ,共五十三 頁 。How to diagnose ?第二十八 頁 ,共五十三 頁 。診斷 (zhěndu224。n)l 以癥狀 (zh232。ngzhu224。ng)為基礎第二十九 頁 ,共五十三 頁 。診斷 (zhěndu224。n)標準l Manning標準 1978年l Rome I 1992年 l Rome II 1999年l Rome III 2024年 ?l 2024年三月 廣州首屆全國 IBS會議 決定采用國際 (gu243。j236。)認同的 Rome II 診斷標準第三十 頁 ,共五十三 頁 。Rome I Criteria Rome II Criteria● at least 12 weeks, which need not be consecutive, in the past 12 months, of abdominal disfort or pain that has two of three features relieved by defecation。 and/or onset associated with a change in frequency of stool。 and/or onset associated with a change in form(appearance) of stool● At least 3 months continuous / recurrent symptoms of the following