Section of Gastroenterology, Mayo Clinic, Jacksonville, Florida.
Aliment Pharmacol Ther. 2018 Oct;48(8):817-830. doi: 10.1111/apt.14948. Epub 2018 Sep 7.
Irritable bowel syndrome (IBS) is multifactorial in nature, and a wide range of therapies is available to manage symptoms of this common disorder.
To provide an overview of the safety of interventions that may be used to manage patients with diarrhoea-predominant IBS (IBS-D).
Medline and Embase database searches (through 02 May 2018) to identify clinical studies that evaluated treatment safety and/or efficacy in adults with IBS-D.
IBS-D treatments include dietary modification, probiotics, serotonin receptor antagonists, opioid receptor agonists and antagonists, nonsystemic antibiotics, bile acid sequestrants, antidepressants, and complementary and alternative therapies. These treatments vary in administration frequency (eg, daily; short-course therapy) and target various pathophysiologic factors. Safety profiles vary considerably by treatment among IBS-D therapies. The number needed to harm (defined as the number of patients treated to encounter an adverse event) was lowest (worse) for antidepressants (8.5) and highest (best) for probiotics (35), and the number needed to harm (defined as the number of patients who discontinued due to an adverse event) was lowest for tricyclic antidepressants (9) and highest for rifaximin (8971). Notable safety concerns with IBS-D treatments include pancreatitis with eluxadoline, ischaemic colitis and serious complications of constipation with alosetron, and cardiac adverse events with loperamide and tricyclic antidepressants. Treatment decisions need to account for medication risks and adverse events for each patient.
Multiple treatment options are now available for patients with IBS-D. However, the safety profiles of these agents vary widely by number needed to harm value. Providers should consider both safety and efficacy of a specific intervention when determining how best to manage patients' IBS-D symptoms.
肠易激综合征（IBS）本质上是多因素的，有多种治疗方法可用于缓解这种常见疾病的症状。
综述可能用于治疗腹泻型肠易激综合征（IBS-D）患者的干预措施的安全性。
通过 Medline 和 Embase 数据库检索（截至 2018 年 5 月 2 日），以确定评估 IBS-D 成人治疗安全性和/或疗效的临床研究。
IBS-D 的治疗方法包括饮食调整、益生菌、5-羟色胺受体拮抗剂、阿片受体激动剂和拮抗剂、非系统性抗生素、胆酸螯合剂、抗抑郁药和补充及替代疗法。这些治疗方法在给药频率（例如，每日；短期治疗）和作用的病理生理因素上存在差异。IBS-D 治疗方法的安全性因治疗而异。需要治疗的患者数（定义为出现不良反应的患者数）最低（最差）的是抗抑郁药（8.5），最高（最好）的是益生菌（35），因不良反应而停药的患者数最低的是三环类抗抑郁药（9），最高的是利福昔明（8971）。IBS-D 治疗的安全性问题包括：依鲁替尼引起的胰腺炎、阿洛司琼引起的缺血性结肠炎和严重便秘并发症、洛哌丁胺和三环类抗抑郁药引起的心脏不良事件。治疗决策需要考虑每位患者的药物风险和不良反应。
目前有多种治疗选择可用于治疗 IBS-D 患者。然而，这些药物的安全性因需要治疗的患者数而异。在确定如何最好地治疗患者的 IBS-D 症状时，医生应考虑特定干预措施的安全性和疗效。
