Fukudo Shin, Kaneko Hiroshi, Akiho Hirotada, Inamori Masahiko, Endo Yuka, Okumura Toshikatsu, Kanazawa Motoyori, Kamiya Takeshi, Sato Ken, Chiba Toshimi, Furuta Kenji, Yamato Shigeru, Arakawa Tetsuo, Fujiyama Yoshihide, Azuma Takeshi, Fujimoto Kazuma, Mine Tetsuya, Miura Soichiro, Kinoshita Yoshikazu, Sugano Kentaro, Shimosegawa Tooru
Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for irritable bowel syndrome", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13 Ginza, Chuo, Tokyo, 104-0061, Japan,
J Gastroenterol. 2015 Jan;50(1):11-30. doi: 10.1007/s00535-014-1017-0. Epub 2014 Dec 12.
New strategies for the care of irritable bowel syndrome (IBS) are developing and several novel treatments have been globally produced. New methods of care should be customized geographically because each country has a specific medical system, life style, eating habit, gut microbiota, genes and so on. Several clinical guidelines for IBS have been proposed and the Japanese Society of Gastroenterology (JSGE) subsequently developed evidence-based clinical practice guidelines for IBS. Sixty-two clinical questions (CQs) comprising 1 definition, 6 epidemiology, 6 pathophysiology, 10 diagnosis, 30 treatment, 4 prognosis, and 5 complications were proposed and statements were made to answer to CQs. A diagnosis algorithm and a three-step treatment was provided for patients with chronic abdominal pain or abdominal discomfort and/or abnormal bowel movement. If more than one alarm symptom/sign, risk factor and/or routine examination is positive, colonoscopy is indicated. If all of them, or the subsequent colonoscopy, are/is negative, Rome III or compatible criteria is applied. After IBS diagnosis, step 1 therapy consisting of diet therapy, behavioral modification and gut-targeted pharmacotherapy is indicated for four weeks. Non-responders to step 1 therapy proceed to the second step that includes psychopharmacological agents and simple psychotherapy for four weeks. In the third step, for patients non-responsive to step 2 therapy, a combination of gut-targeted pharmacotherapy, psychopharmacological treatments and/or specific psychotherapy is/are indicated. Clinical guidelines and consensus for IBS treatment in Japan are well suited for Japanese IBS patients; as such, they may provide useful insight for IBS treatment in other countries around the world.
肠易激综合征（IBS）的护理新策略正在不断发展，全球已研发出多种新型治疗方法。由于每个国家都有特定的医疗体系、生活方式、饮食习惯、肠道微生物群、基因等，新的护理方法应因地制宜。目前已提出了多项IBS临床指南，日本胃肠病学会（JSGE）随后制定了基于证据的IBS临床实践指南。提出了62个临床问题（CQs），包括1个定义、6个流行病学问题、6个病理生理学问题、10个诊断问题、30个治疗问题、4个预后问题和5个并发症问题，并针对这些CQs给出了相应陈述。为慢性腹痛或腹部不适和/或排便异常的患者提供了诊断算法和三步治疗方案。如果出现一种以上的报警症状/体征、危险因素和/或常规检查呈阳性，则建议进行结肠镜检查。如果所有这些情况或随后的结肠镜检查结果均为阴性，则应用罗马III标准或兼容标准。IBS诊断后，第一步治疗包括饮食疗法、行为矫正和肠道靶向药物治疗，为期四周。第一步治疗无反应者进入第二步，包括使用精神药物和简单心理治疗，为期四周。在第三步中，对于第二步治疗无反应的患者，建议采用肠道靶向药物治疗、精神药物治疗和/或特定心理治疗相结合的方法。日本IBS治疗的临床指南和共识非常适合日本IBS患者；因此，它们可能为世界其他国家的IBS治疗提供有益的见解。
