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Diagnosis and treatment of Irritable Bowel Syndrome

已有 2388 次阅读 2017-6-22 15:13 |个人分类:临床指南和病例解析|系统分类:观点评述| style, color

Diagnosis and treatment of Irritable Bowel Syndrome

Diagnosis and treatment of Irritable Bowel Syndrome

HOW TO DIAGNOSE IBS?
IBS can be a positive diagnosis in patients fulfilling the Rome III criteria for IBS with no alarm signals, a normal physical examination and a normal CRP and hemoglobin 2b
Patients with IBS and diarrhea should be tested for celiac disease 3a
Patients with IBS and diarrhea should not routinely be tested for intestinal parasites 3b
Patients with IBS and diarrhea should not routinely have a breath test for bacterial overgrowth 4
In patients <40 years with IBS symptoms and diarrhea, a normal fecal calprotectin excludes IBD with a high probability 2b
Genetic testing for lactose intolerance may be performed based on clinical suspicion. 1c
Screening for bile acid malabsorption can be attempted with a treatment test of cholestyramine in IBS-D 1c
Lower endoscopy is not routinely recommended in the evaluation of IBS symptoms 4

HOW TO TREAT IBS?
Exercise 3 times weekly of moderate intensity can reduce symptoms and increase quality of life (QOL) in motivated patients 1b
Low FODMAP diet can be tried in motivated patients supervised by a dietician. In short term studies in selected patients the diet may reduce bloating and pain and increase QOL. 1b
Traditional dietary advice can reduce symptoms to the same extent as the low FODMAP diet 1c
Gluten free diet. There is no clinical relevant effect of a gluten free diet on IBS symptoms 1b
Probiotics do not have a significant effect on symptoms of IBS 1a
Psyllium may reduce symptoms of IBS (global effect) 1a
Acupuncture is not better in reducing symptoms in IBS patients compared to placebo-acupuncture 1b
Loperamide can reduce stool frequency in patients with IBS-D 1c
Ondansetron can reduce urgency, bloating and stool frequency in patients with IBS-D (limited data) 1b
Cholestyramine is not efficacious in IBS-D patients without bile acid malabsorption 4
Osmotic laxatives (but not lactulose) and stimulant laxatives can be used for IBS-C 5
Linaclotide has a positive effect on constipation and pain in IBS-C 1b
Prucalopride can be used for IBS-C 5
Peppermint oil may reduce abdominal pain in IBS 1b
Antispasmodics (hyoscine) may have a slight effect on abdominal pain 1a
Low-dose TCA may reduce abdominal pain in IBS 1a
SSRI drugs may reduce IBS symptoms (global effect) 1a
Rifaximin is not recommended for bloating in patients with IBS due to a limited and short lasting effect 1b
Simethicone/dimethicone is not recommended (never tested in IBS patients) 5