Chandar Apoorva Krishna
Department of Gastroenterology and Liver Disease, Case Western Reserve University.
Digestive Health Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Int J Gen Med. 2017 Oct 31;10:385-393. doi: 10.2147/IJGM.S126581. eCollection 2017.
Irritable bowel syndrome (IBS) is a complex functional gastrointestinal disorder that is exceedingly common in clinical practice. IBS with predominant constipation (IBS-C) is a subtype of IBS that accounts for more than a third of the IBS diagnosed. Diagnosis of IBS requires a careful personalized approach, a comprehensive clinical history, limited but relevant investigations, and continued follow-up. Major IBS societies and guidelines recommend offering a positive diagnosis of IBS based on presenting symptomatology. Abdominal pain that may or may not be relieved by defecation is the cardinal symptom of IBS; distension and bloating are other common symptoms. Careful attention should be paid to alarm symptoms before a diagnosis of IBS is made. Pharmacotherapy with linaclotide is recommended for moderate-severe IBS-C, based on high-quality evidence from randomized controlled trials. Diarrhea is the major side effect of linaclotide, and limited cost-effectiveness data currently exist.
肠易激综合征（IBS）是一种复杂的功能性胃肠疾病，在临床实践中极为常见。以便秘为主的肠易激综合征（IBS-C）是肠易激综合征的一种亚型，占已诊断肠易激综合征的三分之一以上。肠易激综合征的诊断需要采用谨慎的个性化方法、全面的临床病史、有限但相关的检查以及持续的随访。主要的肠易激综合征学会和指南建议根据呈现的症状做出肠易激综合征的阳性诊断。排便后腹痛可能缓解也可能不缓解是肠易激综合征的主要症状；腹胀和腹部膨隆是其他常见症状。在做出肠易激综合征的诊断之前，应仔细关注警示症状。基于随机对照试验的高质量证据，推荐对中重度IBS-C使用利那洛肽进行药物治疗。腹泻是利那洛肽的主要副作用，目前关于其成本效益的数据有限。
