To investigate the efficacy of Zhizhu grain combined with Linaclotide in the treatment of irritable bowel syndrome with predominant constipation (IBS-C).

A total of 118 eligible IBS-C patients were retrospectively included in Rugao People's Hospital from August of 2020 to August of 2022 and divided into two groups according to different treatment method, with 59 cases each. The control group was treated with Linaclotide capsule, and the treatment group was orally given with Zhizhu grain on the basis of the control group. The therapeutic effect, IBS symptom severity scale (IBS-SSS) score, abdominal pain degree score, IBS life quality (IBS-QOL) score, and serum levels of vasoactive intestinal peptide (VIP), substance P (SP), nitric oxide (NO), corticotropin releasing hormone (CRH), adrenocorticotropic hormone (ACTH), cortisol and intestinal flora calculation were compared between the two groups.

After 4 weeks of treatment, the total effective rate of IBS-C patients in the treatment group (96.61%) was significantly increased compared with the control group (83.05%, P<0.05). IBS-SSS and abdominal pain severity scores of IBS-C patients in the two groups were significantly decreased, but the decrease was more significant in the treatment group (P<0.01). The IBS-QOL score of IBS-C patients in both groups was significantly increased, but the increase was more significant in the treatment group (P<0.01). The serum VIP and NO levels of IBS-C patients in two groups were significantly decreased, while the SP level was significantly increased, but the above indexes improved better in the treatment group (P<0.01). The count of Escherichia coli in the two groups was significantly reduced, while Lactobacillus and Bifidobacterium were significantly increased, and the above indexes improved better in the treatment group (P<0.01). The serum levels of CRH, ACTH and CORT in the two groups were significantly reduced, but the above indexes in the treatment group were better improved (P<0.01).

Combined with Zhizhu granules can significantly enhance the efficacy of Linaclotide in the treatment of IBS-C, which can evidently improve the symptoms of IBS-C cases, improve the life quality of patients, and regulate the secretion of various brain gut peptide factors, improve levels of intestinal flora and disorder of the hypothalamic-pituitary-adrenal axis.