1. No category

(Z"P\) [KDZF KTPF \RGPS\
FRGMR GH FTVG\ .(3) \[MZMC GB \NGINIC QGNC OKIVRP Z[BM OKBKZC
N[ ZGYPF .OKZCDGP OKKGZKDN QFG KNPZGRF IGGJC OKKGZKDN FCGD\C QF
FNGMK \KJZGBK\ .\GRGZIBF OKR[C \GXZPR ZYIR Z\KF=\G[KDZ
,OKRJNGY N[ Z\K=\GVKVX) GPXT KTPC Z\K=\G[KDZP TGCRN FTVG\F
OKCXTF \MZTP \PZC ,(LGPR KGZKD US OT OKRJNGY N[ FNKDZ \GPM
OKHMZPC GB IGPF THD \PZC FTZVFC ,FZE[F JGIC \KHMZPF
NT \GTKCXPF \GEGCTF GCZ ,FRGZIBN .OFKRKC CGNK[ NM GB ,OKRGKNT
OKMGG\PG \KHMZPF OKCXTF \MZTP \B CZTPF KHMZP \GSKG
KTP=IGP ZKXF \GNKTV .(QKRGJGZS EGIKKC) OKKRKZYGERB=GRGPKB=GZKGR
,OKRG[ OKKNBKXGS=GMKSV OKPZGDG IGZ KCXP ,WIN KCXPP OD \TV[GP
ORF KTP=IGP Z[YF KNGNSP .(4) ZCTC \KHKVG \KRKP \GNNT\F \GCZN
([DZ ,FKXKRDGY ,\G[GI\) \GKIGP \GKG[IZ\F Z[BM OKKZJS=GE
,Z\K=\GK\TGR\) KTPF \GKG[IZ\FG ,KTPF \GNKTV NT \GTKV[P
.IGPFG \KHMZPF OKCXTF \MZTP NT \GTKV[P (FPGEMG \G\KGGT
NT FZGVG \KCKSRJRKB ZYIP \EGCT \MZTR \GRGZIBF OKR[C
NTG \KYEKKI SKJKZJRBGZJSD N[ EI TGZKB \GCYTC Z"P\ \TVGF
\GEGCT .(5) Z"P\ N[ \GI\V\FN FZG[YF \K\YNE FCGD\
KZIB EKP\FN OKNGNT Z"P\ KRKPS\[ GPKDEF \GKCKJYVSGZV
QGRDRPF .QMN OEGY Z"P\P GNCS BN[ OKNGIC SKJKZJRBGZJSD
N[ CXP ZXGR OGFKHF \GCYTC KM BGF GNB \GKVX\ ZCSFN TXGPF
"\GKJSNVGZKGR" N[ \GI\V\F OT "FRJY [B" NT \KRGZM \YNE
OT \KRGZM FNIPM Z"P\ \TVGFN OZGD[ L[GPP CBM N[ QGZMKHG
,\GK\ZD[ \GYKECC FND\P FRKB \YNEF .\KNZXSKG Z\K-\G[KDZ
FND\P BKF LB ,\GNKDZ \GTKCX OT KTPF QP \GKSVGKCC \GCZN
Q\KR[ \YNEC FBZRF NMM ZCGEP .\GEIGKP \GKPKMGJSKF \GYKECC
.\K\YNE KTP \NIP QKCN NNM \YNE BNN KTP QKC IGGJC FPYPN
FNCJC OKPG[Z OGKF OKZFC\P OF[ KVM ,GH \YNE N[ OKRGKVBF
: FB C F
ZCZVS KPT 'VGZV
KBGVZF HMZPF ,ECM \GNIPG FKDGNGZJRBGZJSDN QGMPF
,\GBKZCF KTEPN FJNGYVF ,FYGZGS KBJKSZCKRGBF
CDRC QGKZGD=QC \JKSZCKRGB
\GNIPF QKCP FIKM[F FRF (Z"P\) [KDZF KTPF \RGPS\
KEK NT \GRKKVGBP GNB \GNIP .NGMKTF \MZTP N[ \GKEGYV\F
GB OKKPGJRB OKKRCP OKKGYKNM OKZCSGP ORKB[ OKKRGZM OKRKPS\
.\GKPKMGKC \GTZVFM
O[F .HKDZF KTPF \RGPS\ \GCZN OKCZ OKKGRKMG \GP[ Z"P\N
\B Z\GK CGJ UY[P BGF[ OG[P FTZVFN Z\GKC OKB\P "[KDZ" KTP
EPP NGJR BGFG ,OGKM \RCGP BKF[ KVM FTZVFF N[ FKDGNGKHKVG\VF
"[KDZ" IRGPF ."KRCXT" GB "HKDZ" D[GPN FGGN\P[ "FP[BF"F N[
.OFKNT NCGYP BGFG GH FTZVFP OKNCGSF \KKGGI \B CJKF UY[P
QM NT .OKKVKXVS OKKDGNGKC GB OKKDGNGKHKV OKRPKS QKB Z"P\N
,FRG\I\ QJC KCBM N[ CGNK[ :FNB OKRPPS NT \SSC\P FRICBF
.L[PFC JZGVPM KNPKRKP ZGZKCG ,\GBKXKF KNDZFC FTZVF
FKDGNGKPEKVB
NT \SSC\P \GZDGC \GKSGNMGBC Z"P\ N[ \GIKM[F \MZTF
\GKDGXKKF \EKPP \GTV[GP FNB OKZYS \GBXG\ .\GKSGNMGB KZYS
FEKPF KRYG ,K\GCZ\/KR\BF TYZF ,\ZYSRF FKKSGNMGBF N[
Z"P\ N[ \IGGEPF \GIKM[F .OKZYGIF \B G[PK[[ OKK\RICBF
OKEPGTF OKZYSRF NM \B \GNNGM GNB \GKGIKM[ .20%=5% QKC FTR
OKRKPS\F QKDC BVGZN OTV KB GMNF OB QKC ,OKK\RICBF FEKPF KRYC
QKC) Z"P\ KRKPS\P OKNCGSF \KCZP[ OGKM TGEK .GBN OB QKCG
.KBGVZ TGKS BNN CJKF OKZE\SPG BVGZN OKRGV ORKB (70%=50%
NKDF[ NMM \IGV BGFG (70% ET) OK[R CZYC Z\GK FGCD Z"P\F ZGTK[
.FNGT
\GNTF .\GBKZCF K\GZK[ NT K\GTP[P SPGT FGGFP Z"P\
EZBKNKPP FNTPNC FMZTGF 2000 \R[C C"FZBC Z"P\ N[ \K\R[F
.(1) ZNGE KXIG
FKDGNGKHKVG\V
NTG OKRKPS\F \KKGGI NT FTV[F [K OKKNBKXGS=GMKSV OKPZGDN
K\GZK[ \GKGNT GC QEKTC .OKNGIF KKI \GMKB KCDN Z"P\ N[ \GMN[FF
KBXG\ NT [DE O[GP ,ZCD\P QRSZN WINFG \GMNGFG \GNED FBGVZF
,OKHGV[B ,OKBVGZ NXB OKZGYKC :QGDM ,(health outcomes) \GBKZC
OKRKKVGBP Z"P\ KNGI .EGTG FEGCTP \GZETKF ,\GVGZ\ NT \GBXGF
KHKVF) KPGK=OGKF EGYV\C FTZVFC \BJC\PF FEGZK OKKI \GMKBC
NXB OKZGYKC \GCZN ,FBGVZF K\GZK[N Z\K=\GYYEHFC ,(K\ZCIFG
.(6) \ZGYKCF \GXGCYN FBGG[FC FEGCTP \GZETKFCG ,OKBVGZ
FGGNPF EGZK KNBKXGS=GMKSV NKVGZV [K OKCZ Z"P\ KNGIN
\GEEGP\F KZG[KM ,OKKNKN[ OKKI KTGZKB KGCKZ ,\KDGNGMKSV FYGXPC
GB/G \GKHKV \GNNT\F N[ TYZ OK\TNG FKGYN \K\ZCI FMKP\ ,OKNE
51
ZYIP \GEGCT \GZPN ,FKKE \RCGP FRKB Z"P\ N[ FKDGNGKHKVG\VF
OKKZYKTF OKRGRDRPF OGKM TGEKF NMM .FH B[GRN \G[EYGPF \GCZ
\G[KDZF \ZCDFC ZYKTCG KTPF \GK\TGR\C OKKGRK[C OKZG[Y
US Z"P\ KNGIN .KTPF N[ (visceral hypersensitivity) \KNZXSKGGF
F\TDFG CBMF \[GI\ .CBM N[ KGZKDN OKZIBP Z\GK LGPR \G[KDZ
GRF[ (brain-gut axis) KTP=IGP ZKXC \GSKGG KRGRDRPN FZG[Y FTEG\N
.(2) Z"P\ N[ FKDGNGKHKVG\VF \ZKYIC KHMZP EYGP
KTPC \GK\TGR\ KSGVE QKC Z[YF \B ZZCN GSKR OKCZ OKZYIP
N[ \KRC\N \GET QKB LB ,Z"P\ KRKPS\ QKCN SDF KTPCG YEF
QKC K\GTP[P OB\P QKBG Z"P\N \KRKKVGB GB \KVKXVS \GK\TGR\
.OKYECRF \GRGN\ QKCN \GK\TGR\C OKKGRK[
Z\K=\G[KDZ NT \GCZ\PG \GMNGF \GKGET \GPKKY ,\BH \PGTN
\GIKVR \[GI\ NT OKIGGEP FNB OKNGI .Z"P\ KNGI CZYC \KNZXSKG
OKYECRN FBGG[FC \K\GTP[P OKRJY IGVKR KXING KIVRC CBMG
ECM \GNIPG FKDGNGZJRBGZJSD
UKSGFN Z[VB \GCKSRF KVN .\GKPKMGKC \GYKECG FPN[ OE \RGP\
NCGYP .EGTG ,SKZ\F \JGNC N[ OKRGPZGFN OE \YKEC ,OE \TKY[
OKNCGS[ 50=45 NKDN \I\P OKNGIN FKVGYSGEKBGPDKS \G[TN
.50 NKD NTP OKNGIN FKVGYSGRGNGYG ,KZYKT QKPS\M NG[N[P
\G[TN OD NCGYP (QKDGZKSN NG[N[G \GZKXT GB) NG[N[ OT OKNGIN
KRKIC\G QDJRZ KPGNKX :QGDM \GVSGR \GYKECG ,\GPKB\P FBGX \GYKEC
N[ QGZYKTF NT FZKP[ LG\ ,\KVKXVSF FYKRKNYN OB\FC FVK[R
.WGIR KNPKRKP ZGZKC
NGVKJF
NGVKJ BGXPN OKSRPF OKKRKNYF OKKGSKRF OKCZ \GRGZIBF OKR[C
N[ \ZCGDG \MNGFF FRCFC ZG[Y \GEGCTF KGCKZ .Z"P\N NKTK
N[ EKYV\F EGIKKCG ,Z"P\ N[ OKKDGNGKHKVG\VF OKMKNF\F
FNIPF KVGB ,\BH OT .G\G[KDZ USCG KTPF \GK\TGR\C QKRGJGZSF
\K\GTP[PF GCRKBF \TV[F ZGBN OKZYGCP OKKGSKR TGXKC NT F[YP
.(9) [EI NGVKJ NM \NKI\C Z"P\F KNGI CGZ NXB \KVXR[
,Z"P\C OKKNBKXGS=GMKSVG OKKDGNGKHKV OKPZGD N[ CGNK[F ZGBN
KSIKNG OKPZGDF KR[N SIKK\FN \CKKI \KNGVKJ \KRMG\ NM[ KZF
\EKP ,OKRKPS\F \ZPGI NT SSC\K NGVKJF .OFKRKC[ QKNPGDF
OGKYCG ,FNGIF KKI \GMKBC FTKDVF \EKP ,\KDGNGKHKVF FTZVFF
.(10) \GK[VRG \GKNBKXGS=GMKSV \GKTC
\GKFN OKNGMK FNB OKNGI .OKNY OKRKPS\ [K Z"P\ KNGI \KCZPN
NNM TKDP GRKB UB OYNIG \KRG[BZF FBGVZF \GZDSPC OKNVGJP
CGZG ,\GZVSC OKZGBK\F CGZ ,\BH \PGTN .DGNGZJRBGZJSDN
OKRKPS\ OT OKNGIF CZYP OKBC ,OKKRKNYF OKKGSKRC OKV\\[PF
\SKV\ NT QF FTKV[P GH FECGT .F[Y ET \KRGRKC FZPGI \DZEC
\GBXG\ NT QFG OKZIB OKNVJPG OKDGNGZJRBGZJSD KRKTC FNIPF
.OKKRKNYF OKKGSKRF
FCZ FEKPC OKKGN\ ,Z"P\ KNGIC NGVKJF N[ FINXFF KKGMKS
KTP=IGP Z[Y OT FNIPC ZCGEP[ \GKF .KCGKI FNGI-BVGZ Z[YC
FK\VPBG QM QKKRT OT ,NVJPF EXP \KJSKNGF F[KD F[GZE ,YFCGP
OD K\KPB FNGIF N[ GNCKS[ QKCFN BVGZF NT .GNCKSG FNGIF KVNM
\TDGV "OGNM LN QKB"[ DGSFP FZKPB NMG ,\GRKY\ \GYKECF OB
QKCFN LKZX BVGZF .FNGIF OT KNGVKJ Z[Y \ZKXKN KGMKSC \G[Y
OK[Y\P OKBVGZ .GKKI \GMKBC \TDGVF \KRGZM FNIPP NCGS FNGIF[
OKNCGS BVGZF \RKICP[ FNBM "OKKREZJ" OKNGI OT EEGP\FN
.\RKKRTP BNG FPGEP FKTC GHKBP
FP KR[F GB QG[BZF [DVPC ZZCN KGXZ \K\ZD[F FHRPRBN USGRC
,(FKCGVZXRY N[PN) [[GI BGF FPP ,(FRCG\) G\NIP NT FNGIF QKCP
SIKK\FN [K .(BNPG ZKFP KGVKZ N[PN) NGVKJF QP GK\GKVKX OF FPG
,\K\GBKXP \KNGVKJ \KRMG\ \KKGG\F LG\ \GKVKXNG \G[[IN ,FRCG\N
,N[PN) OKK\GBKXP OKKNGVKJ OKETK ,FNGTV UG\K[ NT \SSGCPF
UXZ \IJCFG ,(FPGEMG OKRKPS\ NT FNYF ,OKKIF \GMKBC ZGVK[
.\KRGZM FNIP NMC DGFR[ KVM KNGVKJ
FRCG\ \GCGZY OK\TN [K ,F[Y OKRKPS\ \ZPGI OT Z"P\ KNGIN
\B NCYN OKRMGP ORKB OF \GCGZY OK\TNG OCXP KCDN F\GIV
KGVKZN BKF O\[KZE .O\NIP N[ OKKNBKXGS=GMKSVF OKZ[YFF
\B BGXPN QGKSKRC OKNVJP UKNIFN OKJGR OFG \KHKVF O\NIP
,\GCGZY OK\TN ,[K FNB OKNGIN .OZGCT BNVF \VGZ\ OT TK[GPF
K\GZK[C HZVGP [GPK[N FKKJRG \KZJBKMKSV=\KDGNGMKSV FBGNI\
FKRVFN OKEDR\P CGZN LB KZJBKMKSV WGTKKN OKYGYH OF .\GBKZCF
[K .KRGZM CBMC OKIP\PF OKHMZPC NGVKJC OKZHTR OYNI .GH QKTP
KVNM QF ,KRGZM KNGI CXPP KR[P IGGZ N[ \GZ[VB ZZCN OGYP
ECM \GNIPG FKDGNGZJRBGZJSD
,FBXG\F .OKRKPS\F \KKGGI NT FTZN TKV[FN OKNGNT FNB NM .\KRKP
.OKKNKN[ \GBKZC KBXG\G \GBKZCF OGI\C \KDGNG\V \GDFR\F BKF
:QGICB
OKRKPS\ N[ \CGN[\ NT SSGCP Z"P\ N[ QGICBF :FHRPRB
OKRGKZJKZY GKV\G[G DRKRP GPSZV 1978=C ZCM .KNPKRKP ZGZKCG
\GKRDZGB \GKTC QKCN Z"P\ QKC FCGJ FRICF GZ[VB[ ,Z"P\ QGICBN
OKIPGP N[ OK\GGX G[CKD QGZIBF ZG[TC .(7) NGMKTF \MZTPC
OKRGKZJKZY .OKRKPS\ NT OKSSGCPF Z"P\ QGICBN OKRGKZJKZY
\GEGCTN QFG \K\ZD[ \KRKNY FEGCTN QF OK[P[P FNB OKEKIB
.OKKRKNY OKKGSKRG OKKDGNGKPEKVB OKZYIP \GCZN ,ZYIP
,(8) ``II BPGZ N[ OKRGKZJKZY'' OKRGMPF ,Z"P\N OKRGKZJKZYF
\NGTVP OKTV[GPF OKZHGI GB OKVGXZ QJC KCBM N[ CGNK[ OKNNGM
OKKVKXVSF OKRGKZJKZYF .\GBKXKF KNDZFC FTZVF OT EIK OKKTPF
.2 'SP FNCJC OKDXGP
NT BNG ,OKRKPS\ LPS NT "KCGKI" QGICB NT \SSC\PF ,GH F[KD
,QM NT .FRICBF YGKE \PZ \B FZKCDP ,ECNC \GZIB \GNIP \NKN[
\NKN[N \G[GZEF \GYKECF ZVSP \B K\GTP[P QVGBC OXPXN Q\KR
QGICB \GJK[ N[ NKTK [GPK[ \Z[VBP F[KDF .\GZIB \GNIP
KNGI QFC[ \GPEGYF \G[KDN FBGG[FC CGJ \NTG\-\GNT SIK FDK[PG
GPKDEF OKZYIP .FRICBF \TKCYN ET \GYKEC \NNGS GZCT Z"P\
.EGBP QJY Z"P\M GRICGB[ OKNGI NXB \GKGTJF ZGTK[[
QKBG FHRPRB NT ZYKTC \SSGCP FRICBF KM OB :\KRVGD FYKEC
FYKECN FCZ \GCK[I [K ,GH FNIPN OKKVKXVS OKKNYKHKV OKBXPP
LMG ,\GZIB \GNIP N[ OKEK[IP OKBXPP ZZCN Q\KR[ QGGKM \KRVGDF
.GN[ "[BZC" NMF[ C[GI BVGZF[ [KDZK BN FNGIF
NT OD SSC\P Z"P\ QGICB[ \GKF :FKPEFG FECTP \GYKEC
BGXPN \GCGZY OK\TN OKTCG\ OKNGI[ QGGKMPG ,\GZIB \GNIP \NKN[
EGBP UKYP ZGZKC TXCN OKBVGZ NXB FKKJR [K ,ONXB "ZESC BN FP"
OKZYPC \TZGD UBG FNKTGP FRRKB GH F[KD .\GCIZR \GYKEC NNGMF
\GYKECN U[IR FNGIFG ,\NTG\-\GNT KRICPC \EPGT FRRKB BKF .OKCZ
.OKMGCKSC OK\TNG ,QPH NGJKC ,\GIGR KBC \GMGZMF \GZ\GKP
FRF K\KKPEFG K\ECTP ZGZKCN OGKM \NCGYPF F[KDF ZGPBM
:QGDM \GK\ZD[ OE \GYKEC ZCGT FNGI NM .KNPKRKP ZGZKC TGXKCN
52
ZGBNG ,Z"P\N KVKXVS K\VGZ\ NGVKJ ZETKFC .K\VGZ\ BN NGVKJ
,KNGIF \KKGGI NT \GKNBKXGS=GMKSVF \GTV[FFG \RGPS\F \GCMZGP
OKNGVKJF .\GVGZ\ BNN NGVKJN OKCZ OKKNGVKJ \GRGKSKR OKPKKY
,(12) FKVZ\GRVKF ,(11) K\GDFR\F=KCKJKRDGY NGVKJ ,Z\KF QKC ,OKNNGM
KPRKE=GMKSV NGVKJG SZJS \\IVFG FKVZF ,YCEKVGKC ,FIRGP QGKPE
,GNB \GJK[C OKZYGCP OKZYIP N[ \GBXG\F IG\KR .(13) K[KB=QKC
NGVKJFG ,K\GDFR\FF=KCKJKRDGYF NGVKJF ,FHGRVKFF N[ EGIKKCG
OKRKPS\F \\IVFC \GNKTKF NT TKCXP ,K[KB=QKC KDGNGMKSVF
EGYV\) K[KBF ZG[KPC QF (FPGEMG OKKGXKV ,\GMR) OKKP[Z \GESGP
.(EGTG FEGCTC ,FIV[PC
QKC ONGFF CGNK[F \B NGNMN LKZXG KEPP=CZ GRF Z"P\C NGVKJF
BN GB/G K\VGZ\ NGVKJ ,(FRGH\ N[PN) OKKI IZGBC KGRK[ ,LGRKI
.KRGZM CBMC NGVKJG ,K\VGZ\
OK\TN .KNGVKJF Z[YC KHMZP YNI GRF FNGIF LGRKI .LGRKI
KVGB NT ZCSFNG \K\VPBF \GSIKK\FN Z\GK CZ LZT [K \GCGZY
.ZIB NGVKJ N[ DGS NMP FNIPF
OKRGRDRPC EYP\FN OKNGMK OKZCSFF
FBZP QGKSKRF .Z"P\ N[ OKKZ[VBF
CJKF OKPKRVPG OKRKCP OKNGI[
\GK\TGR\C FTZVF KCDN OKZSP
.KTPF N[ Z\KF=\G[KDZ KCDN EGIKKCG
FTZVFF ZGYP[ ZCSFN OKIG\V OF
\GMGG\P \GTV[FC FGGNPF ,KTPC WGTR
\KHMZPF OKCXTF \MZTPC QZGYP[
,\GKRKZYGERB=GRGPKB=GZKGR \GMZTPCG
O\PZN OB\GP ZCSFF[ KBR\C
=K\GCZ\F TYZNG \KNBGJYNJRKBF
.OFN[ KR\BF
\GRMSF \IB .KJJBKE NGVKJ
"\GZKHD"F FRF Z"P\ KNGIN \GCZGBF
GB ,OPXT NT OKZHGD OF[ \GK\RGH\F
GPM CGJ QGXZ KNTC OFKRVC OKXKNPP[
OKCZ OKNGI .OKRM[G OKZCI ,OKCGZY
QGHP DGSN OK[KDZ OF[ OK[KDZP
OK\TN ,G\GB NGMBN OKYKSVPG OKGSP
\TV[F) FCKJKP \KRG[BZ FTV[F OT
G\GPEYN ZHGI CXPF L[PFC .(GCRKB
QGHPF \B ZKHIFN HTP GRKB FNGIF LB
ZIB [GVKIC LK[PP BGFG JKZV\N
,LKNF\ N[ GVGS ."OKP[B" OKNMBP
\NCDGP FRGH\ BGF ,GH "FKXRKPKNB"
.\RHGBP K\NCG
Z\GK Z"P\ KNGIN QKB NNMM
FKKSGNMGBN Z[BP QGHPN \GKDZNB
OKRKPS\ SIKKN FKKJR BNB ,\KNNMF
KDGS OR[K .OKRG[ \GRGHPN \G[KDZN
NT FTZN TKV[FN OKNGNT[ \GRGHP
,KRPG[ NMGB :QGDM ,\KNNMF O\[DZF
\GKRJY) OKHD OKZXGK[ OKNMBP
ZSIP OKNCGS[ OKNGIC CNI \ZXG\G
N[ \GHZVGP \GKGPM \KK\[ .(HGJYNC
ZKPIFN FNGNT OD QKBVY OT \GBY[P
\GKZ[VB \GKG[KDZ ZZCN KEM .OKRKPS\
'OKRKPS\G NMGB QPGK' NGFKRC \NTG\ [K
FIMGF QKB .\GTGC[ 2=1 L[PC
OKZV[P QKCGSG \KB\ N[ \VSG\[
OGZDN OKNGNT OFG ,Z"P\ KRKPS\
OKHDFG \GIVR\FF \[GI\C FZPIFN
.OKNGIF QP YNI NXB
53
ECM \GNIPG FKDGNGZJRBGZJSD
\GKDZRKNGM=KJRB \GVGZ\ I\VN \GRGKSKR
\ZPGI \B \KIVFN KEM Z\GK \GKVKXVS
\GTZVFG FVC [CGK) KBGGNF \GTVG\
.(\KHMZPF OKCXTF \MZTPC
\GEDGR \GVGZ\ .QGBMKE \GEDGR \GVGZ\
\G[P[P ,\KSIK OKMGPR OKRGRKPC ,QGBMKE
\GNIP \GCZN \GRG[ \GNIPC CBM KMM[PM
OD .FKKDNBKPGZCKV :QGDM \GZIB \GKEGYV\
GNB \GVGZ\ KEK NT OKNYGP Z"P\ KRKPS\
.(18) KRGBMKE CXP N[ \GIMGRN Z[Y BNN
\IYN Z"P\ KNGI TGRM[C K[GY OKKY
\GVGZ\P O[[I ZGBN GNB \GVGZ\
EEGP\FN BVGZF NT .("KMKSV KRB[ C[GI BVGZF") \GKZJBKMKSV
FVGZ\F N[ FNGTVF QGRDRP NT OKZCSF \GTXPBC GNB \G[[I OT
.KHMZPF QGRDRPC CBM LGMK[C FBZRF NMM ZG[Y[ Z"P\N SIKC
,(Amitryptillin) NGZJNB GPM \GYK\G \GVGZ\C [GPK[N NKCYPC
\GVGZ\C [GPK[F ,(Desipramine) QSYZVEG (Nortryptillin) QKNKJZGR
NGVKJC O\GNKTK KCDN \GKTP[P=EI QRKB[ \GKGET OT ZCGD SSRI DGSP
,FN FXGIPG NGMKTF \MZTPC \GKZ[VBF KBGGNF \GTVG\ ZGBN .Z"P\C
.ZGJKRG CYTP LG\ FNGIN \KVKXVSF FVGZ\F \B OKB\FN [K
I\GV Z"P\ N[ FKDGNGKHKVG\VF KCDN ZCGDG LNGFF TEKF ,OGMKSN
FTZVFC NGVKJN \GKVKXVS \GVGZ\ N[ QIG\KVN FGGY\ N[ I\V
BVGZF QKC KNGVKJF Z[YF ,\BH OT .FC OKYGNN ZGHP OT GH \KEGYV\
,FNB OKNGIC INXGP NGVKJN KIZMFF SKSCF \GKFN LK[PK FNGIFG
.NVGJPN OKKIF \GMKBC ZGVK[G BVGZN KTGXYP YGVKS YKRTFN KG[T[
\GZGYP
1.
Sandler RS, Everhart JE, Donowitz M, et al. The burden of
selected digestive diseases in the United States. Gastroenter-
FPGE FEKPC OKKIF \GMKBC ZGVK[G
K\VGZ\F NGVKJF KEK NT \D[GPF FTV[FN
.OGKM OKKYF
:K\VGZ\F NGVKJF
FRF Z\GKC FIKM[F FVGZ\F .NG[N[
ZYKTC \[P[P[ (OGKEGPKB) EKPZVGN
FNGIF OFC OKCXPC NG[N[ \TKRPN
OKTGZKBC ,\GTKSRC) EIGKPC [[GI
\[GI\ \B \KIVP EKPZVGN .(FPGEMG
OKPKGSP OKZYPC TRGPG FBKXKN \GVKIEF
\GRGZIBF OKR[C .\KRGXZ K\NC FP\MF
\GVGZ\ OT OKKRKNY OKKGSKR OKMZTR
.(15,14) 5HT3 DGSP QKRGJGZS KRJNGYN OKJSKRGDJRBM \GNTGVF
\Z[GBP ,(Alosetron) QGZJSGNB =F :FH DGSP FRG[BZF FVGZ\F
\GKGG\FF .NG[N[G Z"P\ OT OK[R N[ C"FZBC NCDGP [GPK[N
OZJ FVGZ\F .FVGZ\C [GPK[N GZ[YR[ KBGGN \GTVG\ N[C \GZKPIP
QGZJSRNKSF BKF GH FIV[PP \VSGR FVGZ\ .WZBC [GPK[N FZ[GB
KMKNFN CGZYC [DG\G OKRGZIB KGSKR KCN[C \BXPRF ,(Silansetron)
.C"FZBC ZG[KB
N[ F\GNKTKN \YFCGP \GET F\KKF BN FRGZIBN ET .\GZKXT
[GPK[ GNNM[ OKCZ \GRGKSKR .\GZKXT OT Z"P\ KNGIC KF[NM FVGZ\
FCKJP FTV[F [K FBZRF NMM .\GZ\GS \GBXG\ GCKRF QKCGSG \KB\C
OZGD FHM QGRKP LB ,(FPPKN OZD 30=20 QKC) FGCD QGRKPC \KB\ N[
Z"P\ KNGI NXB ZCGD QJC CBMC OKGGNPF OKHD KGCKZG \GIKVR \[GI\N
.OKCZ
(Tegaserod) EGZSDJ :F[EI FVGZ\ FZ[GB FRGZIBF FR[C
K\GTP[P QVGBC GCRKBFP Z\GK FNKTKM OKKRKNY OKKGSKRC FIMGF[
FVGZ\ .5HT4 DGSP QKRGJGZS KRJNGY N[ JSKRGDJRB FRF EGZSDJ .(16)
.F[Y \GZKXTG Z"P\ OT OK[RN WZBC FRGZIBN FZ[GB GH
ology 2002;122:1500-11.
2.
Ringel Y, Sperber AD, Drossman AD. Irritable bowel
3.
Mertz H. Review article: Visceral hypersensitivity. Aliment
syndrome. Annu Rev Med 2001;52:319-38.
Pharmacol Ther 2003;17:623-33.
(\MZTPC OKZGP[ \GZGYPF ZB[)
ECM \GNIPG FKDGNGZJRBGZJSD
QF FNB OKRKPS\N \GKZYKTF \GVGZ\F .\GIVR\FG QJC KCBM
GNB \GVGZ\N .(16) (YNI ZKZ[ \GVZPF) \GKEGPHVS=KJRB \GVGZ\
OKTKCXP OKZYGCP OKZYIP \GBXG\ LB ,\NJGCP BN GCRKB \TV[F
OK[TR FRGZIBN .(17) GCRKBF \TV[FN ZCTP FNY FCKJP FTV[F NT
54