Kwon Joong Goo, Park Kyung Sik, Park Jung Ho, Park Jae Myung, Park Cheol Hee, Lee Kwang Jae, Park Hyo Jin, Rhee Jong Chul
Department of Internal Medicine, Catholic University of Daegu School of Medicine, Korea.
Korean J Gastroenterol. 2011 Feb;57(2):82-99. doi: 10.4166/kjg.2011.57.2.82.
Traditional symptom-based therapies of irritable bowel syndrome (IBS) are directed at the relief of individual IBS symptoms, but they are often of limited efficacy in addressing the entire symptom complex. Combinations of drugs to target bothersome symptoms are suggested as the first-line pharmacologic treatment. Increasing knowledge of the pathophysiology and molecular mechanisms of IBS has resulted in the development of several new therapeutic approaches. Thirteen consensus statements for the treatment of IBS were developed using the modified Delphi approach. Exclusion diets have modest efficacy in improving symptoms in some IBS patients. Symptom-based therapies with dietary fiber, bulking agents, laxatives, antispasmodics and laxatives are effective in the improvement of some individual symptoms, e.g. dietary fiber and bulking agents for constipation, laxatives for constipation, antispasmodics for abdominal pain and discomfort, antidiarrheals for diarrhea. 5HT3 receptor antagonists and 5HT((4)) receptor agonists are effective in the relief of global IBS symptoms and individual symptoms such as abdominal pain and abnormal bowel habits. A short term course of nonabsorbable antibiotics may improve global IBS symptoms, particularly in patients with diarrhea- predominant IBS. Some probiotics appear to have the potential benefit in improving global IBS symptoms. Selective C-2 chloride channel activator is more effective than placebo at relieving global IBS symptoms in patients with constipation-predominant IBS. Both tricyclic antidepressants and selective serotonin reuptake inhibitors are equally effective in relieving global IBS symptoms, and have some benefits in treating abdominal pain. Certain types of psychologic therapy may be effective in improving global symptoms in some IBS patients. Further studies are strongly needed to develop better treatment strategies for Korean patients with IBS.
肠易激综合征（IBS）基于传统症状的疗法旨在缓解IBS的个体症状，但在解决整个症状复合体方面往往疗效有限。建议联合使用针对令人烦恼症状的药物作为一线药物治疗。对IBS病理生理学和分子机制的了解不断增加，已促成了几种新治疗方法的开发。采用改良德尔菲法制定了13条IBS治疗的共识声明。排除饮食在改善部分IBS患者症状方面有一定疗效。基于症状使用膳食纤维、容积性泻药、缓泻药、解痉药和止泻药进行治疗，对改善某些个体症状有效，例如膳食纤维和容积性泻药治疗便秘、缓泻药治疗便秘、解痉药治疗腹痛和不适、止泻药治疗腹泻。5HT3受体拮抗剂和5HT（（4））受体激动剂可有效缓解IBS整体症状以及腹痛和排便习惯异常等个体症状。短期使用不可吸收抗生素可能改善IBS整体症状，尤其是腹泻型IBS患者。一些益生菌似乎对改善IBS整体症状有潜在益处。选择性C - 2氯离子通道激活剂在缓解便秘型IBS患者的IBS整体症状方面比安慰剂更有效。三环类抗抑郁药和选择性5 - 羟色胺再摄取抑制剂在缓解IBS整体症状方面同样有效，且在治疗腹痛方面有一定益处。某些类型的心理治疗可能对改善部分IBS患者的整体症状有效。迫切需要进一步开展研究，为韩国IBS患者制定更好的治疗策略。
