Moayyedi Paul, Andrews Christopher N, MacQueen Glenda, Korownyk Christina, Marsiglio Megan, Graff Lesley, Kvern Brent, Lazarescu Adriana, Liu Louis, Paterson William G, Sidani Sacha, Vanner Stephen
Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada.
Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada.
J Can Assoc Gastroenterol. 2019 Apr;2(1):6-29. doi: 10.1093/jcag/gwy071. Epub 2019 Jan 17.
BACKGROUND & AIMS: Irritable bowel syndrome (IBS) is one of the most common gastrointestinal (GI) disorders, affecting about 10% of the general population globally. The aim of this consensus was to develop guidelines for the management of IBS.
A systematic literature search identified studies on the management of IBS. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Statements were developed through an iterative online platform and then finalized and voted on by a multidisciplinary group of clinicians and a patient.
Consensus was reached on 28 of 31 statements. Irritable bowel syndrome is diagnosed based on symptoms; serological testing is suggested to exclude celiac disease, but routine testing for C-reactive protein (CRP), fecal calprotectin or food allergies is not recommended. A trial of a low fermentable oligosaccharides, disaccharides, monosaccharides, polyols (FODMAP) diet is suggested, while a gluten-free diet is not. Psyllium, but not wheat bran, supplementation may help reduce symptoms. Alternative therapies such as peppermint oil and probiotics are suggested, while herbal therapies and acupuncture are not. Cognitive behavioural therapy and hypnotherapy are suggested psychological therapies. Among the suggested or recommended pharmacological therapies are antispasmodics, certain antidepressants, eluxadoline, lubiprostone, and linaclotide. Loperamide, cholestyramine and osmotic laxatives are not recommended for overall IBS symptoms. The nature of the IBS symptoms (diarrhea-predominant or constipation-predominant) should be considered in the choice of pharmacological treatments.
Patients with IBS may benefit from a multipronged, individualized approach to treatment, including dietary modifications, psychological and pharmacological therapies.
肠易激综合征（IBS）是最常见的胃肠道疾病之一，全球约10%的普通人群受其影响。本共识的目的是制定IBS的管理指南。
通过系统的文献检索确定IBS管理的相关研究。根据推荐评估、制定和评价分级（GRADE）方法对证据质量和推荐强度进行评级。通过迭代在线平台制定声明，然后由多学科临床医生和患者小组最终确定并投票。
31条声明中有28条达成了共识。IBS根据症状进行诊断；建议进行血清学检测以排除乳糜泻，但不建议常规检测C反应蛋白（CRP）、粪便钙卫蛋白或食物过敏。建议尝试低发酵性寡糖、双糖、单糖、多元醇（FODMAP）饮食，而不建议采用无麸质饮食。补充车前草而不是麦麸可能有助于减轻症状。建议使用薄荷油和益生菌等替代疗法，而不建议使用草药疗法和针灸。认知行为疗法和催眠疗法是建议采用的心理疗法。建议或推荐的药物疗法包括抗痉挛药、某些抗抑郁药、埃索美拉嗪、鲁比前列酮和利那洛肽。不建议使用洛哌丁胺、考来烯胺和渗透性泻药来治疗IBS的整体症状。在选择药物治疗时应考虑IBS症状的性质（腹泻型或便秘型）。
IBS患者可能从多方面、个体化的治疗方法中获益，包括饮食调整、心理和药物治疗。
