Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan.
Mount Sinai Medical Center, New York, New York.
Gastroenterology. 2021 Jan;160(1):47-62. doi: 10.1053/j.gastro.2020.06.099. Epub 2020 Oct 19.
Irritable bowel syndrome (IBS) is a common, symptom-based condition that has negative effects on quality of life and costs health care systems billions of dollars each year. Until recently, management of IBS has focused on over-the-counter and prescription medications that reduce symptoms in fewer than one-half of patients. Patients have increasingly sought natural solutions for their IBS symptoms. However, behavioral techniques and dietary modifications can be effective in treatment of IBS. Behavioral interventions include gastrointestinal-focused cognitive behavioral therapy and gut-directed hypnotherapy to modify interactions between the gut and the brain. In this pathway, benign sensations from the gut induce maladaptive cognitive or affective processes that amplify symptom perception. Symptoms occur in response to cognitive and affective factors that trigger fear of symptoms or lack of acceptance of disease, or from stressors in the external environment. Among the many dietary interventions used to treat patients with IBS, a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols is the most commonly recommended by health care providers and has the most evidence for efficacy. Patient with IBS who choose to follow a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols should be aware of its 3 phases: restriction, reintroduction, and personalization. Management of IBS should include an integrated care model in which behavioral interventions, dietary modification, and medications are considered as equal partners. This approach offers the greatest likelihood for success in management of patients with IBS.
肠易激综合征(IBS)是一种常见的以症状为基础的疾病,它会对生活质量产生负面影响,并使医疗保健系统每年花费数十亿美元。直到最近,IBS 的管理一直侧重于非处方和处方药物,这些药物只能减轻不到一半患者的症状。患者越来越多地寻求针对 IBS 症状的自然解决方案。然而,行为技术和饮食改变可以有效地治疗 IBS。行为干预包括以胃肠道为重点的认知行为疗法和肠道导向催眠疗法,以改变胃肠道和大脑之间的相互作用。在这个途径中,来自胃肠道的良性感觉会引起适应性认知或情感过程,从而放大症状感知。症状是对触发对症状的恐惧或对疾病缺乏接受的认知和情感因素,或对外部环境中的应激源的反应。在用于治疗 IBS 患者的许多饮食干预中,低可发酵寡糖、双糖、单糖和多元醇饮食是医疗保健提供者最常推荐的,并且具有最有效的证据。选择遵循低可发酵寡糖、双糖、单糖和多元醇饮食的 IBS 患者应该了解其 3 个阶段:限制、重新引入和个性化。IBS 的管理应包括一个综合护理模式,其中行为干预、饮食改变和药物被视为平等的合作伙伴。这种方法最有可能成功管理 IBS 患者。
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