UCF College of Medicine, HCA Consortium Family Medicine Residency, Gainesville, FL, USA.
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Curr Med Res Opin. 2021 Apr;37(4):567-578. doi: 10.1080/03007995.2021.1888705. Epub 2021 Mar 3.
We sought to summarize current recommendations for the diagnosis of diarrhea-predominant irritable bowel syndrome (IBS-D) and describe available management options, highlighting a newer US Food and Drug Administration (FDA)-approved agent, eluxadoline.
Literature on IBS-D was assessed up to January 2020 using PubMed, with key search terms including "IBS-D diagnosis", "IBS-D management", and "eluxadoline".
IBS is a common gastrointestinal disorder affecting up to 14% of US adults and is particularly prevalent in women and those aged under 50. Symptoms include abdominal pain associated with altered bowel habits (i.e. diarrhea and/or constipation subtyped based on the predominant stool pattern). As IBS-D is challenging to manage with varying symptom severity, effective treatment requires a personalized management approach. Evidence-based therapeutic options endorsed by the American Gastroenterological Association and the American College of Gastroenterology can be used to effectively guide treatment. Dietary and lifestyle modifications, including adequate hydration, reducing caffeine and alcohol intake, and increasing soluble fiber intake may lead to symptom improvement. Over-the-counter medications such as loperamide are frequently recommended and may improve stool frequency and rectal urgency; however, for the outcome of abdominal pain, mixed results have been observed. Several off-label prescription medications are useful in IBS-D management, including tricyclic antidepressants, bile acid sequestrants, and antispasmodics. Three prescription medications have been approved by the FDA for IBS-D: alosetron, eluxadoline, and rifaximin.
IBS-D can be effectively managed in the primary care setting in the absence of alarm features. Benefits and risks of pharmacologic interventions should be weighed during treatment selection.
总结目前腹泻型肠易激综合征（IBS-D）的诊断建议，并描述可用的治疗方法，重点介绍一种新的获得美国食品和药物管理局（FDA）批准的药物，即鲁比前列酮。
使用 PubMed 评估截至 2020 年 1 月的 IBS-D 相关文献，主要检索词包括“IBS-D 诊断”、“IBS-D 治疗”和“鲁比前列酮”。
IBS 是一种常见的胃肠道疾病，影响多达 14%的美国成年人，尤其常见于女性和 50 岁以下人群。其症状包括与排便习惯改变相关的腹痛（即根据主要粪便模式分为腹泻型和/或便秘型）。由于 IBS-D 的症状严重程度不同，因此难以管理，有效的治疗需要个性化的治疗方法。美国胃肠病协会和美国胃肠病学院认可的循证治疗选择可用于有效指导治疗。饮食和生活方式的改变，包括充足的水分摄入、减少咖啡因和酒精的摄入以及增加可溶性纤维的摄入，可能会导致症状改善。洛哌丁胺等非处方药物常被推荐使用，可改善粪便频率和直肠紧迫感；然而，对于腹痛的结局，观察到的结果喜忧参半。几种非标签处方药物对 IBS-D 的管理很有用，包括三环类抗抑郁药、胆汁酸螯合剂和抗痉挛药。FDA 已批准三种药物用于 IBS-D：阿洛司琼、鲁比前列酮和利福昔明。
在没有警报特征的情况下，IBS-D 可以在初级保健环境中得到有效管理。在选择治疗方法时，应权衡药物干预的益处和风险。
