Lucak Susan, Chang Lin, Halpert Albena, Harris Lucinda A
Division of Digestive and Liver Diseases, Department of Medicine, Weill Cornell Medicine, 903 Park Avenue, First Floor, New York, NY 10075, USA.
Division of Digestive Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Therap Adv Gastroenterol. 2017 Feb;10(2):253-275. doi: 10.1177/1756283X16663396. Epub 2016 Sep 16.
Irritable bowel syndrome with diarrhea (IBS-D) is a common, chronic functional gastrointestinal disorder with symptoms that can be distressing for patients and often result in substantially impaired quality of life. This review focuses on providing clinicians with information on practical, evidence-based treatment for IBS-D. Current therapies commonly used for the treatment of IBS-D, including pharmacologic and nonpharmacologic interventions, are briefly reviewed, followed by discussion of the emergent pharmacologic treatments (rifaximin and eluxadoline) and medical foods (IBgard and EnteraGam). Given the lack of a standard treatment algorithm for IBS-D and the emergence of new pharmacologic therapies, treatment needs to be tailored to the individual patient and take into account the severity of disease. In this context, the latter part of this manuscript examines how treatments for IBS-D can be used in clinical practice by presenting three patient case scenarios with varying degrees of IBS-D severity. For each case, the patient's medical history and clinical presentation are related to the Rome Foundation multidimensional clinical profile (MDCP) and potential treatment options with current and emergent therapies are reviewed. The interplay of gastrointestinal symptoms and their psychosocial impact, as well as the importance of a patient-centered approach to therapy, are discussed. Consideration is given to the potential need for combination therapies and how emergent treatments could fit into the treatment pathway for mild, moderate, and severe cases of IBS-D in clinical practice.
腹泻型肠易激综合征（IBS-D）是一种常见的慢性功能性胃肠疾病，其症状会给患者带来痛苦，常常导致生活质量严重受损。本综述旨在为临床医生提供关于IBS-D实用、循证治疗的信息。简要回顾了目前常用于治疗IBS-D的疗法，包括药物和非药物干预措施，随后讨论了新出现的药物治疗（利福昔明和埃卢多啉）和医用食品（IBgard和EnteraGam）。鉴于IBS-D缺乏标准的治疗方案且新的药物疗法不断涌现，治疗需要根据个体患者进行调整，并考虑疾病的严重程度。在此背景下，本手稿的后半部分通过呈现三个不同严重程度的IBS-D患者病例场景，探讨了IBS-D的治疗方法在临床实践中的应用。对于每个病例，将患者的病史和临床表现与罗马基金会多维临床概况（MDCP）相关联，并回顾当前和新出现疗法的潜在治疗选择。讨论了胃肠道症状及其心理社会影响之间的相互作用，以及以患者为中心的治疗方法的重要性。考虑了联合治疗的潜在需求以及新出现的治疗方法如何适用于临床实践中轻度、中度和重度IBS-D病例的治疗路径。
