Kindt S, Louis H, De Schepper H, Arts J, Caenepeel P, De Looze D, Gerkens A, Holvoet T, Latour P, Mahler T, Mokaddem F, Nullens S, Piessevaux H, Poortmans P, Rasschaert G, Surmont M, Vafa H, Van Malderen K, Vanuytsel T, Wuestenberghs F, Tack J
Department of gastroenterology and Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussel, Belgium.
Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium.
Acta Gastroenterol Belg. 2022 Apr-Jun;85(2):360-382. doi: 10.51821/85.2.10100.
Irritable bowel syndrome (IBS) is characterised by recurrent abdominal pain related to defaecation or associated with altered stool frequency or consistency. Despite its prevalence, major uncertainties in the diagnostic and therapeutic management persist in clinical practice.
A Delphi consensus was conducted by 20 experts from Belgium, and consisted of literature review and voting process on 78 statements. Grading of recommendations, assessment, development and evaluation criteria were applied to evaluate the quality of evidence. Consensus was defined as > 80 % agreement.
Consensus was reached for 50 statements. The Belgian consensus agreed as to the multifactorial aetiology of IBS. According to the consensus abdominal discomfort also represents a cardinal symptom, while bloating and abdominal distension often coexist. IBS needs subtyping based on stool pattern. The importance of a positive diagnosis, relying on history and clinical examination is underlined, while additional testing should remain limited, except when alarm features are present. Explanation of IBS represents a crucial part of patient management. Lifestyle modification, spasmolytics and water-solube fibres are considered first-line agents. The low FODMAP diet, selected probiotics, cognitive behavioural therapy and specific treatments targeting diarrhoea and constipation are considered appropriate. There is a consensus to restrict faecal microbiota transplantation and gluten-free diet, while other treatments are strongly discouraged.
A panel of Belgian gastroenterologists summarised the current evidence on the aetiology, symptoms, diagnosis and treatment of IBS with attention for the specificities of the Belgian healthcare system.
肠易激综合征（IBS）的特征是反复出现与排便相关的腹痛，或伴有大便频率或性状改变。尽管其发病率较高，但在临床实践中，诊断和治疗管理仍存在重大不确定性。
由来自比利时的20位专家进行了德尔菲共识会议，包括对78条陈述进行文献综述和投票过程。应用推荐分级、评估、制定和评价标准来评估证据质量。共识定义为达成超过80%的一致意见。
就50条陈述达成了共识。比利时的共识会议认同IBS的多因素病因。根据共识，腹部不适也是一个主要症状，而腹胀和腹部膨隆常常并存。IBS需要根据大便模式进行分型。强调了基于病史和临床检查进行阳性诊断的重要性，而除了出现警示特征外，额外的检查应保持有限。对IBS的解释是患者管理的关键部分。生活方式改变、解痉药和水溶性纤维被视为一线治疗药物。低发酵性寡糖、双糖、单糖和多元醇（FODMAP）饮食、选定的益生菌、认知行为疗法以及针对腹泻和便秘的特定治疗被认为是合适的。对于限制粪便微生物群移植和无麸质饮食达成了共识，同时强烈不鼓励其他治疗。
一组比利时胃肠病学家总结了关于IBS病因、症状、诊断和治疗的当前证据，并关注了比利时医疗保健系统的特殊性。
