Chey William D
Timothy T. Nostrant Collegiate Professor of Gastroenterology.
Gastroenterol Hepatol (N Y). 2017 Feb;13(2 Suppl 1):1-16.
Many nonpharmacologic and pharmacologic therapies are available to manage irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC). The American College of Gastroenterology (ACG) regularly publishes reviews on IBS and CIC therapies. The most recent of these reviews was published by the ACG Task Force on the Management of Functional Bowel Disorders in 2014. The key objective of this review was to evaluate the efficacy of therapies for IBS or CIC compared with placebo or no treatment in randomized controlled trials. Evidence-based approaches to managing diarrhea-predominant IBS include dietary measures, such as a diet low in gluten and fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs); loperamide; antispasmodics; peppermint oil; probiotics; tricyclic antidepressants; alosetron; eluxadoline, and rifaximin. Evidence-based approaches to managing constipation-predominant IBS and CIC include fiber, stimulant laxatives, polyethylene glycol, selective serotonin reuptake inhibitors, lubiprostone, and guanylate cyclase agonists. With the growing evidence base for IBS and CIC therapies, it has become increasingly important for clinicians to assess the quality of evidence and understand how to apply it to the care of individual patients.
有许多非药物和药物疗法可用于管理肠易激综合征(IBS)和慢性特发性便秘(CIC)。美国胃肠病学会(ACG)定期发表关于IBS和CIC疗法的综述。这些综述中最新的一篇由ACG功能性肠病管理特别工作组于2014年发表。该综述的主要目的是在随机对照试验中评估IBS或CIC疗法与安慰剂或不治疗相比的疗效。以证据为基础的治疗以腹泻为主的IBS的方法包括饮食措施,如低麸质和低可发酵寡糖、双糖、单糖和多元醇(FODMAPs)饮食;洛哌丁胺;抗痉挛药;薄荷油;益生菌;三环类抗抑郁药;阿洛司琼;埃卢多啉和利福昔明。以证据为基础的治疗以便秘为主的IBS和CIC的方法包括纤维、刺激性泻药、聚乙二醇、选择性5-羟色胺再摄取抑制剂、鲁比前列酮和鸟苷酸环化酶激动剂。随着IBS和CIC疗法证据基础的不断扩大,临床医生评估证据质量并了解如何将其应用于个体患者的护理变得越来越重要。