Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, O&N1, Box 701, Herestraat 49, 3000, Louvain, Belgium.
J Gastroenterol. 2014 Aug;49(8):1193-205. doi: 10.1007/s00535-014-0966-7. Epub 2014 May 21.
Functional abdominal pain in the context of irritable bowel syndrome (IBS) is a challenging problem for primary care physicians, gastroenterologists and pain specialists. We review the evidence for the current and future non-pharmacological and pharmacological treatment options targeting the central nervous system and the gastrointestinal tract. Cognitive interventions such as cognitive behavioral therapy and hypnotherapy have demonstrated excellent results in IBS patients, but the limited availability and labor-intensive nature limit their routine use in daily practice. In patients who are refractory to first-line therapy, tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors are both effective to obtain symptomatic relief, but only TCAs have been shown to improve abdominal pain in meta-analyses. A diet low in fermentable carbohydrates and polyols (FODMAP) seems effective in subgroups of patients to reduce abdominal pain, bloating, and to improve the stool pattern. The evidence for fiber is limited and only isphagula may be somewhat beneficial. The efficacy of probiotics is difficult to interpret since several strains in different quantities have been used across studies. Antispasmodics, including peppermint oil, are still considered the first-line treatment for abdominal pain in IBS. Second-line therapies for diarrhea-predominant IBS include the non-absorbable antibiotic rifaximin and the 5HT3 antagonists alosetron and ramosetron, although the use of the former is restricted because of the rare risk of ischemic colitis. In laxative-resistant, constipation-predominant IBS, the chloride-secretion stimulating drugs lubiprostone and linaclotide, a guanylate cyclase C agonist that also has direct analgesic effects, reduce abdominal pain and improve the stool pattern.
功能性腹痛在肠易激综合征（IBS）的背景下是一个令初级保健医生、胃肠病学家和疼痛专家都感到棘手的问题。我们回顾了针对中枢神经系统和胃肠道的当前和未来非药物和药物治疗选择的证据。认知干预，如认知行为疗法和催眠疗法，在 IBS 患者中已经显示出了极好的效果，但由于可用性有限和劳动强度大，限制了它们在日常实践中的常规应用。对于一线治疗无效的患者，三环类抗抑郁药（TCA）和选择性 5-羟色胺再摄取抑制剂（SSRIs）都能有效地缓解症状，但只有 TCA 在荟萃分析中显示能改善腹痛。低发酵碳水化合物和多元醇（FODMAP）饮食在某些患者亚组中似乎能有效减轻腹痛、腹胀，并改善排便习惯。纤维的证据有限，只有伊车前草可能有点益处。益生菌的疗效难以解释，因为不同研究中使用了不同数量的多种菌株。抗痉挛药，包括薄荷油，仍被认为是 IBS 腹痛的一线治疗药物。腹泻型 IBS 的二线治疗包括非吸收性抗生素利福昔明和 5-HT3 拮抗剂阿洛司琼和雷莫司琼，尽管前者的使用受到限制，因为其罕见的缺血性结肠炎风险。对于通便剂抵抗、便秘为主的 IBS，氯分泌刺激药物鲁比前列酮和鸟苷酸环化酶 C 激动剂利那洛肽，也有直接的镇痛作用，可减轻腹痛并改善排便习惯。
