Ducrotté P
ADEN EA 4311/IFRMP 23, Département d'Hépato-Gastroentérologie et de Nutrition, CHRU, Hôpital Charles Nicolle, 1, rue de Germont, 76031 Rouen cedex, France.
Gastroenterol Clin Biol. 2009 Feb;33 Suppl 1:S68-78. doi: 10.1016/S0399-8320(09)71527-1.
In irritable bowel syndrome, the main objectives of the treatment are the relief of abdominal pain then the improvement of bowel disturbances. Spasmolytic agents, or clays remain routinely the first line pharmacological options. The efficacy of dietary recommendations is not validated in most of the cases while dietary fibers, mainly insoluble fibers, may even worsen abdominal discomfort. In C-IBS, osmotic laxatives or macrogol are effective to improve colonic transit while loperamide and also colestyramine can be prescribed to reduce the number of stools of D-IBS patients. When the first line treatment fails to improve symptoms, antidepressants (tricyclic rather than SSRs) can be prescribed at lower doses than that recommended for depression. In meta-analysis, the odds ratio for pain relief varies from 2 to 4 and strongly depends on the patient's compliance to the treatment. Probiotics, pregabalin and even antibiotics (i.e neomycin, metronidazole or rifaximin), are possible new therapeutic options. Few clinical trials suggest that ramosetron (a new 5HT3 antagonist), octreotide, melatonin, or lidocain could be also discussed in the future. A non pharmacological therapeutic approach has to be considered, particularly in patients with severe symptoms, in combination with pharmacological treatment.
在肠易激综合征中，治疗的主要目标是缓解腹痛，然后改善肠道功能紊乱。解痉剂或黏土仍然是常规的一线药物选择。在大多数情况下，饮食建议的疗效并未得到证实，而膳食纤维，主要是不溶性纤维，甚至可能会加重腹部不适。在便秘型肠易激综合征中，渗透性泻药或聚乙二醇可有效改善结肠运输功能，而洛哌丁胺以及考来烯胺可用于减少腹泻型肠易激综合征患者的排便次数。当一线治疗无法改善症状时，可使用比治疗抑郁症推荐剂量更低的抗抑郁药（三环类而非选择性5-羟色胺再摄取抑制剂）。在荟萃分析中，疼痛缓解的比值比在2至4之间，并且很大程度上取决于患者对治疗的依从性。益生菌、普瑞巴林甚至抗生素（如新霉素、甲硝唑或利福昔明）都是可能的新治疗选择。很少有临床试验表明，雷莫司琼（一种新型5-羟色胺3拮抗剂）、奥曲肽、褪黑素或利多卡因在未来也值得探讨。必须考虑非药物治疗方法，特别是对于症状严重的患者，可与药物治疗联合使用。
