Spiller R, Aziz Q, Creed F, Emmanuel A, Houghton L, Hungin P, Jones R, Kumar D, Rubin G, Trudgill N, Whorwell P
Wolfson Digestive Diseases Centre, University of Nottingham, Nottingham, UK.
Gut. 2007 Dec;56(12):1770-98. doi: 10.1136/gut.2007.119446. Epub 2007 May 8.
IBS affects 5-11% of the population of most countries. Prevalence peaks in the third and fourth decades, with a female predominance.
To provide a guide for the assessment and management of adult patients with irritable bowel syndrome.
Members of the Clinical Services Committee of The British Society of Gastroenterology were allocated particular areas to produce review documents. Literature searching included systematic searches using electronic databases such as Pubmed, EMBASE, MEDLINE, Web of Science, and Cochrane databases and extensive personal reference databases.
Patients can usefully be classified by predominant bowel habit. Few investigations are needed except when diarrhoea is a prominent feature. Alarm features may warrant further investigation. Adverse psychological features and somatisation are often present. Ascertaining the patients' concerns and explaining symptoms in simple terms improves outcome. IBS is a heterogeneous condition with a range of treatments, each of which benefits a small proportion of patients. Treatment of associated anxiety and depression often improves bowel and other symptoms. Randomised placebo controlled trials show benefit as follows: cognitive behavioural therapy and psychodynamic interpersonal therapy improve coping; hypnotherapy benefits global symptoms in otherwise refractory patients; antispasmodics and tricyclic antidepressants improve pain; ispaghula improves pain and bowel habit; 5-HT(3) antagonists improve global symptoms, diarrhoea, and pain but may rarely cause unexplained colitis; 5-HT(4) agonists improve global symptoms, constipation, and bloating; selective serotonin reuptake inhibitors improve global symptoms.
Better ways of identifying which patients will respond to specific treatments are urgently needed.
在大多数国家，肠易激综合征影响着5% - 11%的人口。患病率在第三和第四个十年达到高峰，女性占主导。
为成年肠易激综合征患者的评估和管理提供指南。
英国胃肠病学会临床服务委员会成员被分配到特定领域以编写综述文件。文献检索包括使用电子数据库进行系统检索，如Pubmed、EMBASE、MEDLINE、科学网和Cochrane数据库以及广泛的个人参考文献数据库。
患者可根据主要排便习惯进行有效分类。除腹泻为突出特征外，几乎无需进行检查。警示特征可能需要进一步检查。常存在不良心理特征和躯体化现象。确定患者的担忧并用简单的语言解释症状可改善治疗效果。肠易激综合征是一种异质性疾病，有多种治疗方法，每种方法仅使一小部分患者受益。治疗相关的焦虑和抑郁通常可改善肠道及其他症状。随机安慰剂对照试验显示的益处如下：认知行为疗法和心理动力人际疗法可改善应对能力；催眠疗法对其他治疗无效的患者的整体症状有益；抗痉挛药和三环类抗抑郁药可改善疼痛；车前草可改善疼痛和排便习惯；5 - HT(3)拮抗剂可改善整体症状、腹泻和疼痛，但可能很少导致不明原因的结肠炎；5 - HT(4)激动剂可改善整体症状、便秘和腹胀；选择性5 - 羟色胺再摄取抑制剂可改善整体症状。
迫切需要更好的方法来确定哪些患者对特定治疗有反应。
