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[LupusLex]

Ну, пипец, докатились, товарищи.  

Придавая важность вопросам диагностики и лечения СРК, Всемирная организация гастроэнтерологов объявила 2009-й год «годом синдрома раздражённого кишечника».
Теперь мы, типа, под их чутким контролем все дружно выздоровеем, господа…

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World Digestive Health Day 2009 - Irritable Bowel Syndrome
It is now recognized that irritable bowel syndrome (IBS) is a truly global problem reportedly affecting millions of individuals (ca. 1 in 10) worldwide and exerting a significant influence on the quality of life both for the many reported and unreported (ca. 5 in 10) cases. Yet, despite volumes of research highlighting the prevalence and impact of IBS worldwide, IBS remains poorly understood by the medical community and the general public alike.
WGO recognises therefore, that there exists a very significant "knowledge gap" with regard to all aspects of IBS and there is a real unmet need to bring the very latest information on IBS to medical practitioners, other health care workers and the general public. For this reason, WGO, in partnership with industry sponsors, focuses the attention of the global gastroenterology community on May 29, 2009 on IBS.

Monthly Research Review
WGO is pleased to announce a new WDHD tool to support IBS awareness: The Monthly Research Review. Issued once a month until the end of the year, The Monthly Research Review will be featured in the WGO E-Newsletter and website. In each issue a global IBS expert will recommend and highlight a “gold standard” article on IBS with a direct link to the original source. The Monthly Research Review will be archived and accessible on the WGO website.

Professor Shobna Bhatia from India is one of the key authors of the WGO IBS guideline team. This study from Norway aims to characterize persistent abdominal symptoms elicited by Giardia infection according to Rome II criteria and symptoms scores. We are pleased to present this open access article to the global gastroenterology community
“We did not know Giardia lamblia infection was an IBS risk factor. This article shows it is. It infects the small bowel; large bowel symptoms were unexpected."
Institute of Medicine, University of Bergen, Bergen, Norway. mfakh@ikb.uib.no
BACKGROUND: Functional gastrointestinal disorders (FGID) may occur following acute gastroenteritis. This long-term complication has previously not been described after infection with the non-invasive protozoan Giardia lamblia. This study aims to characterize persistent abdominal symptoms elicited by Giardia infection according to Rome II criteria and symptoms scores. METHODS: Structured interview and questionnaires 12-30 months after the onset of Giardia infection, and at least 6 months after Giardia eradication, among 82 patients with persisting abdominal symptoms elicited by the Giardia infection. All had been evaluated to exclude other causes. RESULTS: We found that 66 (80.5%) of the 82 patients had symptoms consistent with irritable bowel syndrome (IBS) and 17 (24.3%) patients had functional dyspepsia (FD) according to Rome II criteria. IBS was sub classified into D-IBS (47.0%), A-IBS (45.5%) and C-IBS (7.6%). Bloating, diarrhoea and abdominal pain were reported to be most severe. Symptoms exacerbation related to specific foods were reported by 45 (57.7%) patients and to physical or mental stress by 34 (44.7%) patients. CONCLUSION: In the presence of an IBS-subtype pattern consistent with post-infectious IBS (PI-IBS), and in the absence of any other plausible causes, we conclude that acute Giardia infection may elicit functional gastrointestinal diseases with food and stress related symptoms similar to FGID patients in general.

Professor Bustos Fernandez, from Argentina, is one of our eminent WGO IBS Guideline review team members. His selected article is very important as the translation of animal model findings to humans is needed to link the various psychological, neurological and immunological changes noted in IBS. This analysis may identify patient sub-groups, which will ultimately be critical for drug testing to be focused accordingly
“This very interesting review explores interactions between different pathophysiological mechanisms in IBS. The definition of the relative importance of all of the various psychological, neurogastroenterological and immunological changes that have been identified in IBS, will be fundamental for the development of new pharmacological targets."
Imperial College, St Mark's Campus, Harrow, London, UK. naila.arebi@imperial.ac.uk
BACKGROUND: The pathogenesis of irritable bowel syndrome (IBS) is founded on interactive mechanisms. Disentangling these processes is a prerequisite for the development of effective drug therapy. AIM: To identify the interaction between the various factors implicated in IBS. METHODS: Articles pertaining to IBS pathogenesis focusing on psychoneuroimmunology were identified using following search terms: IBS, animal models, microbiota, probiotics, immunology, visceral hypersensitivity, imaging, psychology and visceral pain. RESULTS: Cerebral imaging using MRI and proton emission tomography scanning has revealed differential regional cerebral activation, whereas stimuli induced activation has been captured by both MRI and cortical evoked potentials. At the peripheral neurological level, the concept of visceral hypersensitivity has been challenged as perhaps representing psychological traits with symptom over-reporting or hyper-vigilance. Gut mucosal immunology is thought to be relevant with immunological changes reflected as peripheral blood cytokine level changes. Molecular technology advances suggest a role for microbiota by activating the gut immunological system. These interactions have been examined in IBS animal models. CONCLUSIONS: Translation of animal model findings to humans is needed to link the various psychological, neurological and immunological changes noted in IBS. This analysis may identify patient sub-groups, which will ultimately be critical for drug testing to be focused accordingly.

A wonderful and sharp selection by Professor Gwee from Singapore, this prospective multi-centre study by the Indian Society of Gastroenterology's IBS Taskforce with data from 4500 community subjects involving 2785 patients with chronic lower GI symptoms presenting at 30 nation-wide centres in India. Most patients were middle aged men. By contrast, the typical IBS patient in the West is often a young female
“By not being shackled to conventional criteria, this study reaffirms to me that the IBS patient that I see can be different from the image created in Rome."

Убийственное видео – маркетологи фиговы и сюда пробрались
Video: 10 Recommendations for Irritable Bowel Syndrome
Watch a short video about WGO’s ten lifestyle and nutritional recommendations for IBS.
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Украину зацепили, но до России не добрались.
План конференций
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После всего прочтенного вывод только один – гастроэнтерологи нас еще долго не вылечат.

Так и хотелось воскликнуть: «Не умничайте, товарищи ученые! Лучше почитайте форум Srk.su. Больше пользы»  


[вложение удалено Администратором]

[Nicole]

было бы хорошо, если бы кто-то это перевел.... а то переводчик онлайн ерунду какую-то выдает....

[T@bletka]

Да, беден мой словарный запас...  жаль, я когда-то английский забросила 

[LupusLex]

Журнал "World Gastroenterology news". Издание 14. Выпуск 1. Май 2009 г.

Irritable bowel syndrome: a global perspective
Definition: Irritable Bowel Syndrome (IBS) is a functional bowel disorder in which abdominal pain or discomfort is associated with defecation or a change in bowel habit; bloating, distension (in some languages, these words may represented by the same term) and disordered defecation are commonly associated features.

Introduction
IBS subclassification
Based on the patient’s specifics of their bowel habits and stool characteristics according to the Rome III criteria.
IBS with diarrhea (IBS-D)
Loose stools > 25% of the time and hard stools < 25% of the time
Up to one-third of cases
More common in men
IBS with constipation (IBS-C)
Hard stools > 25% of the time and loose stools < 25% of the time
Up to one-third of cases
More common in women
IBS with mixed bowel habits or cyclic pattern (IBS-M)
Both hard and soft stools > 25% of the time
One-third to one-half of cases
It must be remembered, however that:
Patients commonly transition between these subgroupings
The symptoms of diarrhea and constipation are commonly misinterpreted in IBS patients. Thus, many IBS patients who complain of “diarrhea” are referring to the frequent passage of formed stools and, in the same patient population, “constipation” may refer to any one of a variety of complaints associated with the attempted act of defecation and, not simply, to infrequent bowel movements.
On clinical grounds, other subclassifications (for example based on symptoms) may be possible:

BS with predominant bowel dysfunction
IBS with predominant pain
IBS with predominant bloating
Based on precipitating factors:
Post-infectious IBS
Food-induced (meal-induced)
However, the relevance of any of these latter classifications to prognosis or response to therapy remains to be defined.
It must also be remembered that Rome III criteria are not commonly used in clinical practice. Furthermore, cultural issues may inform symptom reporting. For example, in India, a patient who reports straining or passing hard stools is likely to complain of constipation even if he or she passes stools more than once daily.
Global prevalence and incidence
The prevalence of irritable bowel syndrome (IBS) is increasing in countries with developing economies. Estimates of the prevalence of IBS vary widely in the Asia–Pacific region and elsewhere, depending also on which diagnostic criteria are used (Rome I, Rome II, Rome III, Manning, Kruis).
Studies from India for example show that Rome I criteria for IBS identify more patients than Rome II criteria. Reported prevalence includes 0.82% in Beijing, 5.7% in southern China, 6.6% in Hong Kong, 8.6% in Singapore, 14% in Pakistan and 22.1% in Taiwan. A study in China found that the prevalence of IBS defined by Rome III criteria in the outpatient clinic was 15.9%.
Although these values are generally lower than the prevalence of IBS in the USA (10–15%) it is predicted that the continuing economic development of countries will give rise to changes in diet and lifestyle that may increase the incidence and diagnosis of this disorder.


Different presenting features between East and West
As in the case of prevalence data, global information on presenting features also varies and comparisons of studies based on community data, clinical data and hospital statistics are fraught with difficulties.
Typical IBS symptoms are common in healthy population samples but the majority of sufferers with IBS are not actually medically diagnosed—this may explain apparent differences between countries in reported prevalence—most studies only count diagnosed IBS and not community prevalence.
A study in China showed that the prevalence of IBS in South China was higher than that reported in Beijing, but lower than that reported in Western countries.
Some studies in non Western countries indicate a:
Lack of female predominance (possibly due to differences in access and health-care seeking behaviors). In South China, for example, the male to female ratio is only 1 : 1.25 (in comparison to 1:2 in Western Europe).
Close association between marked distress and IBS in men similar to that found in women in Western studies.
Greater frequency of upper abdominal pain.
Lower impact of defecatory symptoms on a patient’s daily life (but no evidence of this was found in China or Mexico).
Several studies suggest that, among Afro-Caribbean Americans, compared with white individuals:
Stool frequency is lower
Prevalence of constipation higher
In Latin America, constipation predominance is more frequent than diarrhea.
Stool frequency appears to be greater in the Indian community as a whole—99% passed stools once or more per day.
In Mexico 70% have anxiety, 46% depression and 40% both.
In Mexico, IBS incurs a high economic impact due to a high use of medical resources.
Clinical overlap of FD and IBS according to Rome III is very common in China.
Psychological distress, life events and negative copying style may play important roles in the pathogenesis of IBS. Furthermore, these factors may also influence the individual’s illness behavior and clinical outcome.
Further studies need to establish:
Importance of dietary differences among countries
Different distribution of subtypes among countries
Differences between urban and rural areas. A study in Israeli Bedouins, for example, suggested significant differences in IBS prevalence between desert Bedouins (5.8%) and town Bedouins (9.4%) using Rome II criteria.
Diagnosis of IBS
Clinical history
Pattern of abdominal pain or discomfort :
Chronic duration
Type of pain: intermittent or continuous
Previous pain episodes
Localization of the pain—well localized pain is atypical
Relief with defecation or passing of flatus
Nocturnal pain is unusual and is considered a warning sign
Other abdominal symptoms:
Bloating
Distension
Borborygmi
Flatulence
Note: Distension can be measured; bloating is a subjective feeling. As defined in English, bloating and distension may not share the same pathophysiology and should not be regarded as equivalent and interchangeable terms (although in some languages the terms may be represented by a single word). Nor does either necessarily imply that intestinal gas production is increased.
Nature of the associated bowel disturbance:
Constipation
Diarrhea
Alternation
Abnormalities of defecation:
Diarrhea for > 2 weeks
Mucus in the feces
Blood in stool
Feeling of incomplete defecation
Diagnostic cascade
Diagnostic cascade
Level 1
History, physical examination, exclusion of alarm symptoms, consideration of psychological factors
Full blood count (FBC), erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), stool studies (white blood cells, ova, parasites, occult blood)
Thyroid function, tissue transglutaminase (TTG) antibody
Colonoscopy and biopsy
Level 2
History, physical examination, exclusion of alarm symptoms, consideration of psychological factors
FBC, ESR or CRP, stool studies, thyroid function
Sigmoidoscopy
Level 3
History, physical examination, exclusion of alarm symptoms, consideration of psychological factors
FBC, ESR and stool examination
Cautionary note: The need for sigmoidoscopy and colonoscopy, should also be dictated by patient characteristics (presenting features, age, etc) and location ( i.e. whether in an area of high prevalence of irritable bowel disease, celiac disease, colon cancer or parasitosis or not). One could argue, for example, that a 21-year-old female with C-IBS-type symptoms and no alarm features merits, at most, celiac serology.
IBS management
Introduction
Note: With patient anxiety playing a key role, reassurance and education are of key importance.
There is no agreement on what is the best treatment for patients with moderate to severe symptoms. Bulking agents, loperamide and antidepressants come first.
The role of probiotics may further come to the fore but larger and high-quality randomized controlled trials are needed before more definite conclusions can be drawn about the benefit of, for example, Lactobacillus and Bifidobacterium.
However, clinical evidence of efficacy is beginning to emerge. The importance of a clear definition of strain selection, dose and viability is vital.
Management cascade
Management cascade
Level 1
Reassurance, dietary and life-style review and counseling
Add quality probiotic with proven efficacy
Symptomatic treatment of:
Pain with locally available antispasmodic, for more severely affected patients add low-dose tricyclic anti-depressant or SSRI
Constipation with dietary measures and fiber supplementation progressing to osmotic laxatives or lactulose
Diarrhea with bulking agents and simple anti-diarrheals
Consider psychological approaches (hypnotherapy, psychotherapy, group therapy) and consultation with a dietitian where indicated
Add specific pharmacological agents where approved:
Lubiprostone for C-IBS
Rifaximin for diarrhea and bloating
Alosetron for D-IBS
Tegaserod for C-IBS
Level 2
Reassurance, dietary and life-style review and counseling
Add quality probiotic with proven efficacy
Symptomatic treatment of:
Pain with locally available antispasmodic, for more severely affected patients add low-dose tricyclic anti-depressant
Constipation with dietary measures and fiber supplementation
Diarrhea with bulking agents and simple antidiarrheals
Level 3
Reassurance, dietary and life-style review and counseling
Symptomatic treatment of:
Pain with locally available antispasmodic
Constipation with dietary measures and fiber supplementation
Diarrhea with bulking agents and simple antidiarrheals


Добавлено: 31 Май 2009, 15:09:20Дальше интересней, но форум ругается  :D :D :D

[T@bletka]

Люпус, давай переводи нам! Интересная статья, но со словарем тяжело читать 

[LupusLex]

Я еще побольше данных соберу. Потом все переведу. И надо будет у Anti попросить, чтоб он это на сайт выложил...

Пользуясь сучаем пишу продолжение

Gastroenterology on the Internet: IBS and PubMed
Drs. Justus Krabshuis
Highland Data, Tourtoirac, France

Introduction
Nobody knows what causes irritable bowel syndrome (IBS)—it is functional, and its etiology is unknown. It cannot be explained, but that does not stop us … we can describe it and then we can treat the symptoms. Recent research shows that fiber, antispasmodics, and peppermint oil are more effective than placebo in the treatment of irritable bowel syndrome (PMID 19008265). Antidepressants are also effective in the treatment of IBS. There is less high-quality evidence on the routine use of psychological therapies in IBS, but available data suggest these may be of comparable efficacy (PMID 19001059). And probiotics? Well, the future of probiotics may be bright, as the most recent systematic review in the journal Gut suggests (PMID 19091823).
IBS is to be the subject of the 2009 World Digestive Health Day (WDHD). As its contribution to WDHD, the World Gastroenterology Organisation (WGO) has just completed a guideline on IBS—an IBS review team has looked at the latest in IBS management, and in line with WGO publishing policy there are cascades for colleagues in resource constrained areas. WGO guidelines are not “resource-blind”—see the latest version when it becomes available at зарегистрируйтесь или войдите чтобы посмотреть ссылку.
So let’s look at the online landscape—reminding ourselves of some useful PubMed features and as usual reflecting on a few controversial questions, this time about if and how different cultures can affect the presence and reporting of IBS symptoms. Finally, I want to share with you a fine PubMed-based initiative from Latin America—a virtual gastroenterology library with IBS as its first example.
Looking for IBS in PubMed
As a librarian, it took me a while to understand the difference between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). So, not surprisingly, I turned to PubMed. Let’s look under “PubMed services” in the left-hand navigation bar and click on “MeSH database.” You can always get a definition of any MeSH term by going to the PubMed thesaurus, Medical Subject Headings (MeSH) at: зарегистрируйтесь или войдите чтобы посмотреть ссылку. Type in the word which you think best describes what you are looking for, choosing a unique word rather than a common word, for example “irritable.”
There are two MeSH terms that include the word ‘irritable’: irritable mood and irritable bowel syndrome: The latter is defined as “A disorder with chronic or recurrent colonic symptoms without a clearcut etiology. This condition is characterized by chronic or recurrent abdominal pain, bloating, mucus in feces, and an erratic disturbance of defection. Year introduced: 2004.”
Now click on “irritable bowel syndrome,” and you find several interesting items. MeSH recognizes the following synonyms (called “entry terms”):
Irritable bowel syndromes
Syndrome, irritable bowel
Syndromes, irritable bowel
Colon, irritable
Colitis, mucous
Colitides, mucous
Mucous colitides
Mucous colitis
I also note that the term was introduced in 2004. How, one wonders, was the concept indexed before 2004? A quick check of the indexing history shows:
Colonic diseases (1967–1970)
Colonic diseases, functional (1970–2003)
What does this mean? Well, anything resembling what today we call IBS would have been indexed under “colonic diseases” in the period 1967–1970 and under “colonic diseases, functional” in the period 1970–2003.
This is a nuisance for searchers. If you are in an evidence-based frame of mind and looking for IBS trials going back further than 2003, for example for the last 10 years, you will now have to stop and think a little. After all, you now need two strategies—one for randomized controlled trials (RCTs) published between 1999 and 2003 and another for RCTs published from 2004 to today.
Apart from building the right strategy, there is an additional problem. “Colonic diseases, functional” is a very broad concept, and in the period 1970–2003 it would have been used for a number of varying conditions, not just IBS. So when searching for IBS over the last 10years by combining the two indexing terms used for IBS over the last 10years you will find that many of the “hits” are not relevant. The precision of the search goes down. There is no way around this other than “re-indexing,” and that is impossible.
Now you can search for IBS in PubMed – let’s have some fun and move on to more controversial issues.
Is there an “East–West” issue? Shall we “sack Rome”?
The prevalence of irritable bowel syndrome in any defined population depends on which criteria (for prevalence) are applied: the Kruis scoring system, the Manning criteria, or the ROME-I, ROME-II, or ROME-III criteria (from the Rome Foundation at: зарегистрируйтесь или войдите чтобы посмотреть ссылку). Not all criteria are validated for all countries. Some countries are “still” using ROME-I, while others are already (!) using ROME-III. Does this sound a little like academic one-upmanship to you?
These are “process-centered” criteria. A recent study from India (PMID 18541934) argues that we should be mindful of “patient-centered” criteria. Key symptoms such as diarrhea, constipation, bloating, and pain are subjective, and in India these are not captured adequately by the Rome criteria. The study suggests that the local culture in different countries may inform which symptoms are reported, and how.
So is IBS a Western disease? No; probably not. Is IBS studied from a predominantly Western point of view—that is to say, described with Western- developed criteria? Yes, definitely!
Is this a good thing? “For whom?” I hear you ask. And, speaking as a true librarian, I would answer: “It depends on who you read.”
With IBS research driven by available resources, there is (understandably, I think), a natural tendency for the West to “self-cite.” This world—for example, the world of the Rome Foundation, set up in the 1980s to develop the study of functional gastrointestinal disorders, represents the elite of the IBS research community. A glance at the Rome Foundation committees provides a “Who’s Who” in IBS—it consists almost entirely of physicians from the Western world.
Do we not need more representation from non-Western experts here? Medical science, especially, does not play out in a sociocultural vacuum, whether East or West. Key symptoms such as diarrhea, constipation, bloating, and pain may be experienced differently. The typical western IBS patient is often a young woman, but this gender characteristic has not been reproduced in recent studies in Asia. Most patients with IBS in India were middle-aged men in the Indian study mentioned above, and abdominal pain or discomfort (an essential ROME-III criterion), though frequent, were not universal.
Besides, what about the influence of diet? If we assume that different dietary patterns have varying effects on colonic motility and other physiological phenomena relevant to IBS, is it possible that the Rome-III criteria may only “work” in populations in which dietary patterns are more or less similar? Is this not what the old ceteris paribus (other things being equal) criterion is all about? Let me leave you with a stirring quote about Rome and functional gastrointestinal disorders (FGIDs) that I found in Neurogastroenterology and Motility (2007;19:793–7; PMID 17883430): “It is, therefore, time to marvel and be thankful for what Rome has left us (the Coliseum, its culture, the precision of Latin, and an appreciation of the prevalence of FGIDs and their impact), and move on! It is time to sack Rome and follow the Hun.”
Does culture matter?
Could the Rome Foundation not start an “IBS and Culture” committee? At the same time, could scientific and medical publishers not start a journal on comparative gastroenterology? A journal focusing on “nature–nurture” issues in key gastroenterology topics? Alternatively, it could be called the “Journal of Cultural Gastroenterology.” Comparison is one of the oldest methods in science and is truly heuristic.
Let’s look again at the recent large IBS enquiry conducted by the Indian Society of Gastroenterology Task Force (ISG), published in the Indian Journal of Gastroenterology in 2008 (PMID 18541934; for the full text, click here). A commentary is published in the same issue under the title “Defining IBS in India: a brave new world” (PMID 18541928; for the full text, click here).
And while we are talking “culture”—what exactly does this mean? If the Rome-III criteria suggest that a certain percentage of Indian men have diarrhea-predominant IBS, but the self-reporting does not back this up … what then? And anyway (I am taking this from the commentary mentioned earlier; click here), “to base outcomes on a questionable recall of a subjective rating of discomfort makes the Rome criteria highly unreliable.” The comment compliments the ISG study for its courage in “not allowing itself to be straight-jacketed by Western-directed criteria’ (i.e., Kruis, Manning, and Rome).
I know we should always try to stand on each others’ shoulders when exploring a topic (meaning we should take account of the existing evidence), but there is an issue of “false avenues” and paradigms that have come to an end, and there are questions of ethnicity and culture and geography as discussed in the literature (e.g. PMID 15771752 and PMID 15916618). Try a search in PubMed for “irritable bowel syndrome” and “ethnic groups.” The hyperlink below has stored the strategy:
Irritable Bowel Syndrome[mh] AND Ethnic groups[mh]
Now come the important questions: Do you, the reader, feel that IBS presents differently in different parts of the world? Does culture have an effect on symptom reporting? Does culture matter? How?
The Spinelli–Henderson
IBS Library
So, what can PubMed do for our IBS information needs? There are several ways we can stay informed about IBS research, and the Spinelli–Henderson Virtual Library for IBS is the most creative one I have seen to date (click on the hyperlinked title above to access the library at зарегистрируйтесь или войдите чтобы посмотреть ссылку). Its functionality is based on PubMed’s feature of allowing a search strategy to be captured as a web address, and in this way—hyperlinking from our self-designed icons—we can build a virtual library with automatic searches based on embedded search strategies. Clicking on the red icon (for “practice guideline”), for example, searches PubMed for publications indexed with both “irritable bowel disease” and “practice guideline.” Clicking on the green icon (for IBS and diagnosis) links to full-text articles dealing with IBS and diagnosis. The site is, of course, experimental and entirely thanks to the voluntary efforts of two Latin American professors of medicine. Their initiative deserves wide recognition for creativity in using advanced PubMed features. Needless to say, this approach can also be easily applied in other areas of medicine.
Have a look and let me know what you think. Or e-mail your suggestions and ideas to Prof. Osvaldo Spinelli in Argentina (ospineli@gmail.com) or Prof. Eduardo Henderson in Uruguay (eduardo.henderson@gmail.com). Happy searching—and remember, IBS is the topic for World Digestive Health Day 2009.

[Banditka]

Смущает, что при поддержке Данон:) Точно изобретут потом "чудо йогурт" для сркашников. Сама с фарм-компаниями работала и изнутри все это выглядит отвратно... Но надеюсь, что исследования подгонять ни подо что не будут далее.

[LupusLex]

Так они и так уже лет пять в рекламе спорят у кого бактерии полезней.
Мне особенно последнее понравилось, что-то вроде "бактерии должны попасть в кишечник, но их не пускает АГРЕССИВНАЯ среда желудка"   :D :D :D
Добавлено: 31 Май 2009, 19:28:04Current challenges in diagnosing and treating IBS:
The importance of a positive diagnosis and a graded general treatment approach
Per Olav Vandvik, MD
Consultant Physician, Department of Gastroenterology, Innlandet Hospital Health Authority, Gjøvik, Norway/Associate Professor, Faculty of Medicine, University of Oslo


Although there is more that we need to learn more about the etiology of IBS, this should not keep us from providing nearly half of our patients with optimal care. Clinical guidelines set high standards for the diagnosis and treatment of IBS. This review aims to provide gastroenterologists with an update on some key elements and challenges.
Optimal management of IBS—why bother?
IBS is the most common gastrointestinal disorder in the population, both in primary care and in specialist health care. Although not all patients will consult for IBS and most consulters are handled by family practitioners, patients with IBS constitute 30–50% of the workload at gastroenterology outpatient clinics [1]. The subset who are referred to gastroenterologists represents only the “tip of the iceberg” of IBS, characterized by more pronounced symptom intensity and higher levels of psychosocial problems than patients in primary care [2]. IBS is also associated with a markedly reduced quality of life and high utilization of health-care resources [1,3].
Irritable bowel syndrome (IBS) is an enigma. The Rome III Committee defines IBS as a functional gastrointestinal disorder: symptoms of IBS represent the clinical product of altered gut physiology and psychosocial factors interacting via the brain–gut axis. Research on IBS is flourishing, with the annual number of publications in PubMed exceeding 500 in 2005. In particular, research on the basic pathophysiological mechanisms involved and on drugs targeted towards the gastrointestinal tract is receiving significant attention. Some experts believe IBS will turn out to represent a series of poorly understood organic diseases [4]. Others caution against this “organification” of IBS and find it unlikely that an altered gene or set of specific biological etiologies will explain a complex brain–gut disorder such as IBS [5]. One phenomenon to support this cautious approach is the “comorbidity” aspect of IBS: patients with IBS report other gastrointestinal symptoms (such as heartburn and dyspepsia), somatic symptoms (such as musculoskeletal pain and headache), and psychiatric symptoms (anxiety and depression) more often than those without IBS [6,7]. Referred patients have the highest levels of comorbid symptoms and disorders. In contrast to the Rome III report, recent evidence shows that somatic and psychiatric comorbidity is a feature of IBS and not only of those with the condition who consult physicians [7]. The etiological implications of the observed comorbidity need further elucidation. The comorbidity of IBS also explains a large part of the reduced quality of life and increased use of health resources hitherto attributed to IBS [1,7]. Optimal care for patients with IBS will therefore often require physicians to look beyond the gastrointestinal tract. The comorbidity of IBS underlines the need for continuous and optimal care to be delivered to these patients by family practitioners. This report will focus on what gastroenterologists can do in clinical encounters with referred patients.
Making a positive diagnosis
In the absence of a biological marker, diagnosing IBS continues to be a challenge. Nevertheless, all guidelines recommend that IBS can and should be made as a positive, symptom-based diagnosis [8,9]. This approach requires a careful interpretation of the temporal relationship between abdominal pain/discomfort, bowel habit, and stool characteristics. Diagnostic criteria have been established to facilitate a symptom-based diagnosis, with the Rome III criteria for IBS representing the latest revision (Table1). The new criteria only feature minor changes from the Rome II list, including a simplified time frame and a subtype classification based on stool consistency. These criteria and a novel diagnostic questionnaire developed by a validation process can easily be downloaded from зарегистрируйтесь или войдите чтобы посмотреть ссылку. As acknowledged by the authors, the criteria are imperfect and there is a great need to generate data that will sharpen the criteria and validate their use in clinical practice. Interestingly, few if any studies have looked at how such criteria should be used in busy clinical practices [10,11]. However, the success of a positive diagnosis probably relies more on gastroenterologists’ attitudes and knowledge than on the strict use of criteria.
The positive symptom-based approach is preferred because it allows explanation, reassurance and education of the patient and reduces the need for costly and potentially harmful diagnostic evaluations [9,12]. Indeed, a confident diagnosis may be the physician’s most important therapeutic tool and is considered a cornerstone in the general treatment approach (see below). Importantly, although this approach differs from a traditional “diagnosis of exclusion” approach, it does not rule out the need for additional investigations before a diagnosis of IBS is reached in every patient.
Providing a graded general treatment approach
In a harmless disorder such as IBS, symptoms may range from negligible to incapacitating. In the absence of curative treatment, symptomatic and supportive treatment is the goal. The guidelines recommend a graded general treatment approach, key elements of which are a strong physician–patient relationship, assessment of psychosocial factors, and targeted treatment in selected patients [8,9].
The establishment of a strong and therapeutic patient–physician relationship hinges on thorough evaluation and on reassurance and education of the patient. The patient-physician encounter in IBS is challenging and can be frustrating to both parties. As the guidelines in Table 2 show, a structured approach is therefore recommended for establishing a therapeutic relationship.
A quick look at these guidelines shows that gastroenterologists need to invest both time and interest. A therapeutic relationship will facilitate the assessment of psychosocial factors, which should include symptoms of depression and anxiety, somatic comorbid symptoms, health beliefs, coping, illness impact, and health-related quality of life. Another important dimension is the exploration of chronological “coincidences” between psychosocial factors and periods of worsening or improving symptoms. In patients with severe symptomatology, referral to a skilled psychiatrist or psychologist can be useful. Rome III suggests “red flags” for consideration of early referral to a mental health care provider. In addition to severe depression, some other red-flag items include chronic refractory pain, severe disability, and difficulties in physician–patient interaction.
Patient education is facilitated by written materials, which can be effective interventions in themselves. In patients with IBS in the United Kingdom, a self-help handbook reduced the use of health care and of perceived symptom severity [13]. We should make such handbooks available to our patients. In my experience, patients warmly welcome detailed information, and such books reduce my workload. Some of these books can also be recommended for physicians. I have learnt a lot from reading Nicholas Talley’s Conquering Irritable Bowel Syndrome [14].
Whereas patients with mild symptoms are likely to benefit from the above general treatment approach, patients with more severe symptoms will often need targeted treatment for their most troublesome symptoms. A detailed review of such treatment is beyond the scope of this report. In general, drugs help only some symptoms in selected patients, and there is a notable placebo effect. Novel drug treatments such as serotonin-receptor agonists and antagonists display have been disappointing, and they are unavailable in most European countries. While we are waiting for more effective drugs for IBS, gastroenterologists need to provide patients with proven effective drug treatment. Such treatment includes tricyclic antidepressants in low doses for abdominal pain, loperamide for diarrhea/urgency, and soluble fiber for constipation [15–18].
Mind–body treatment (psychological intervention) is also effective in IBS, although there is a shortage of high-quality evidence [16]. Treatment modalities include gut-focused hypnotherapy, cognitive behavioral therapy (CBT), stress relaxation therapy, and interpersonal therapy. In particular, hypnotherapy and CBT have demonstrated beneficial effects in severely affected patients in clinical trials [19]. The advantages of mind–body treatment include efficacy in relation to comorbid conditions in IBS, its absence of adverse effects, and the shift of the locus of control so that patients themselves may feel more able to cope with the symptoms. If the goal is global improvement of patients’ lives and reduction of health-resource use, then mind–body treatment should more often be the treatment of choice. A major challenge is that such treatment is resource-demanding and that it requires highly skilled therapists interested in IBS. In my experience, these therapists are not easy to find.
How are we performing today? Is it time to change our practices?
The recommendations for the diagnosis and treatment of patients with IBS made by Rome III are by no means revolutionary [20,21]. One would therefore expect these recommendations to be widely implemented in clinical practice. Unfortunately, evidence suggests that this is not the case and that we have a long way to go.
We need to improve physicians’ knowledge and attitudes towards functional gastrointestinal disorders.
Many gastroenterologists still view functional gastrointestinal disorders as psychological disorders, or merely as an absence of organic disease, while others deny the existence of functional gastrointestinal disorders. Gastroenterologists often ascribe pejorative characteristics to the patient or show negative attitudes during patient encounters [8]. Rome III strongly advocates proper education of physicians, stating that functional gastrointestinal disorders should be prominent parts of undergraduate and postgraduate medical curricula, clinical training programs, and international symposia. There is probably a significant gap between these recommendations and current educational efforts in gastroenterology worldwide. As a hospital physician, I knew next to nothing about IBS before I became involved in IBS research.
We need to organize our clinical practice to set the scene for optimal diagnosis and treatment. Gastroenterology outpatient practice probably varies across countries all over the world. In Norway, gastroenterologists most often choose to perform a colonoscopy in these patients, based on a short referral note from the family practitioner. Accordingly, patients’ first (and perhaps only) clinical encounter with a gastroenterologist is when they are lying on the endoscopy table with their bowels emptied and anus facing the gastroenterologist. This is not the optimal setting for making a positive diagnosis and providing a general treatment approach! In addition, drugs administered before the endoscopic examination may affect patients’ memory and further diminish the value of a clinical consultation, which sometimes follows after the colonoscopy. Many gastroenterologists are strong believers in the therapeutic value of a colonoscopy with negative findings, but this belief is not supported
by research evidence. In other words, it seems obvious that we need to reorganize practice if we are aiming to provide patients with the optimal care outlined above. Perhaps we should start with a well-conducted clinical consultation in patients with symptoms suggestive of IBS. In harmony with the principles of evidence-based health care, this approach would allow clinical expertise to be combined with patients’ preferences in the diagnostic evaluation. In a young patient with typical symptoms of IBS, a fecal calprotectin test might be sufficient to rule out inflammatory bowel disease [22]. Although some patients would need to come back for a colonoscopy, it is likely that a significant proportion of colonoscopies would be avoided. Gastroenterologists will, quite understandably, fear missed organic disease and an increased workload with this approach. We therefore need high-quality research evidence that this approach is reliable in terms of diagnostic validity and cost-effective in terms of relevant patient outcomes and health-resource usage. Although all existing evidence supports an approach based on a positive diagnosis and general treatment, there is urgent need for clinical research to improve the evidence base.
In conclusion, gastroenterologists face significant challenges in the clinical management of patients with IBS. The road from best evidence to best practice is seldom straightforward and involves many factors other than drawing up guidelines. For gastroenterologists, the first and crucial step on this road is to recognize that a confident diagnosis and a graded general treatment approach could be the best treatment we currently have to offer for many of our patients with IBS.

Table 1. Diagnostic criteria* for irritable bowel syndrome.
Recurrent abdominal pain or discomfort† at least 3  days per month the last 3  months associated with two or more of the following:
1. Improvement with defecation
2. Onset associated with a change in frequency of stool
3. Onset associated with a change in form (appearance) of stool
* Criteria must have been fulfilled for the previous 3 months, with symptom onset at least 6 months before diagnosis.
† Discomfort means an uncomfortable sensation not described as pain. In pathophysiology research and clinical trials, a pain/discomfort frequency of at least 2 days a week is required during screening evaluation for patients to be eligible for inclusion.



Table 2. Guidelines for establishing a therapeutic physician–patient relationship.
Obtain the history through a nondirective, nonjudgmental, patient-centered interview
Conduct a careful examination and cost-efficient investigation
Determine how much the patient understands about the illness and what his or her concerns are (“What do you think is causing your symptoms?”)
Provide a thorough explanation of the disorder that takes into consideration the patient’s beliefs
Identify and respond realistically to the patient’s expectations for improvement (“How do you feel I can be helpful to you?”)
When possible. provide a link between stressors and symptoms that are consistent with the patient’s beliefs—(“I understand you don’t think stress is causing your pain, but the pain itself is so severe and disabling that it’s causing you a great deal of distress”)
Set consistent limits (“I appreciate how bad the pain must be, but narcotic medication is not indicated”)
Involve the patient in the treatment (“Let me suggest some treatments for you to consider”)
Make recommendations consistent with the patient’s interests (“Antidepressants can be used for depression, but they are also used to ‘turn down’ the pain and in doses lower than those used for depression”)
Establish a long-term relationship with a primary care provider

[gaga]

Всемирный день здоровья пищеварительной 2009 - Синдром раздраженного кишечника
В настоящее время признано, что синдром раздраженного кишечника (СРК) является поистине глобальной проблемой сообщений, затрагивающих миллионы людей (около 1 на 10) по всему миру и оказывают значительное влияние на качество жизни как для многочисленных сообщений и несообщаемым (около 5 в 10) случаях. Однако, несмотря на объемы исследований, подчеркнув важность распространения и влияния по всему миру IBS, IBS по-прежнему плохо понимают по медицинским сообществом и широкой общественности.
WGO признает поэтому, что существует весьма значительный "разрыв в знаниях" с учетом всех аспектов IBS и есть реальная неудовлетворенная потребность привести самую последнюю информацию о IBS для практикующих врачей, других работников здравоохранения и широкой общественности. По этой причине, WGO, в партнерстве с промышленными спонсорами, в центре внимания мирового сообщества гастроэнтерологии 29 мая 2009 года IBS.

 Ежемесячный обзор исследования
WGO рада объявить новый инструмент WDHD для поддержки IBS осведомленность: ежемесячные Research Review. Выходит раз в месяц до конца года, ежемесячный обзор исследования будут фигурировать в WGO электронного бюллетеня и веб-сайт. В каждом выпуске глобальных эксперт IBS будет рекомендовать и выделить "золотой стандарт" статью о СРК с прямой ссылкой на первоисточник. Ежемесячный обзор исследования будут архивироваться и доступны на веб-сайте WGO.

 Профессор Shobna Бхатия из Индии является одним из основных авторов руководящей команды WGO IBS. Это исследование из Норвегии цели охарактеризовать стойким брюшные симптомы вызваны инфекцией Giardia согласно Рим II критерии и оценки симптомов. Мы рады представить эту статью открытым доступом для мирового сообщества, гастроэнтерология
"Мы не знаем Giardia лямблий инфекция была IBS фактор риска. Эта статья показывает, что оно есть. Он поражает тонкий кишечник; большой симптомы кишечника было неожиданным ".
Институт медицины, Университет Бергена, Берген, Норвегия. mfakh@ikb.uib.
КОММЕНТАРИИ: функциональные расстройства желудочно-кишечного тракта (FGID) может возникнуть после острого гастроэнтерита. Эта долгосрочная осложнение ранее не были описаны после инфицирования неинвазивного простейших лямблий Giardia. Это исследование призвано охарактеризовать стойким брюшные симптомы вызваны инфекцией Giardia согласно Рим II критерии и оценки симптомов. МЕТОДЫ: структурированные интервью и анкет 12-30 месяцев после начала инфекции Giardia, и по меньшей мере 6 месяцев после искоренение Giardia, среди 82 пациентов с сохраняющимися симптомами брюшного вызванного инфекцией Giardia. Все они были оценены, чтобы исключить другие причины. Результаты: установлено, что 66 (80.5%) Из 82 больных были симптомы, совпадающие с синдромом раздраженного кишечника (СРК) и 17 (24,3%) больных были функциональной диспепсии (FD) в соответствии с критериями Рим II. IBS была югу подразделяются на D-IBS (47,0%), A-IBS (45,5%) и С-IBS (7,6%). Метеоризм, диарея и боли в животе, как сообщается, наиболее остро. Симптомы обострения, связанные с конкретными Foods сообщили 45 (57,7%) пациентов и физического или психического напряжения на 34 (44,7%) больных. ВЫВОД: В присутствии IBS-подтип модель в соответствии с пост-инфекционные IBS (PI-IBS), и в отсутствии какой-либо другой правдоподобной причины, мы заключаем, что острая инфекция Giardia может вызвать функциональных заболеваний желудочно-кишечного с продуктами питания и связанных со стрессом симптомы аналогичные FGID пациентов в целом.

 Профессор Бустос Фернандес из Аргентины, является одним из наших видных WGO IBS членами группы по рассмотрению принципа. Его выбрали стать очень важным, как перевод животного выводов модели для людей необходимо для увязки различных психологических, неврологических и иммунологических изменений отмечено в IBS. Этот анализ может выявить пациентов подгрупп, которые будут в конечном итоге решающее значение для наркологической экспертизы должно быть сосредоточено соответственно
"Это очень интересный обзор исследует взаимодействие между различными патофизиологических механизмов в IBS. Определение относительной важности всех различных психологических, neurogastroenterological и иммунологические изменения, которые были выявлены в IBS, будет иметь решающее значение для развития новых фармакологических мишеней ".
Имперский колледж, Городок Сан-Марко, Harrow, Лондон, Великобритания. naila.arebi @ imperial.ac.uk
КОММЕНТАРИИ: патогенез синдром раздраженной кишки (СРК) основана на интерактивных механизмов. Выяснение этих процессов является необходимым условием для разработки эффективной терапии. Цель: идентификация взаимодействия различных факторов, обуславливающих IBS. МЕТОДЫ: статьи, касающиеся патогенеза IBS упором на психонейроиммунологии были определены с использованием следующие условия поиска: IBS, животных моделях, микробиоты, пробиотики, иммунология, висцеральной гиперчувствительности, изображениями, психологией и висцеральной болью. РЕЗУЛЬТАТЫ: церебральный изображениями помощью МРТ и протон-эмиссионная томография сканирование выявило региональные дифференциальные церебральной активации, в то время как стимулы активация была захвачена и МРТ и корковых вызванных потенциалов. В периферийной нервной уровня, концепция висцеральной гиперчувствительности были оспорены, поскольку, возможно, представляющих психологических черт с симптомом более докладов или гипер-бдительность. Кишечного эпителия иммунологии считается с соответствующими иммунологические изменения отражены в качестве периферийного изменения уровня цитокинов крови. Молекулярная достижениями технологий предлагают роли микробиоты путем активизации иммунной системы кишки. Эти взаимодействия были рассмотрены в моделях IBS животного. ВЫВОДЫ: Перевод животного выводов модель на людей необходимо увязать различные психологические, неврологические и иммунологические изменения, отмечается в IBS. Этот анализ может выявить пациентов подгрупп, которые будут в конечном итоге решающее значение для наркологической экспертизы должно быть сосредоточено соответственно.

 Прекрасное и резкое отбор профессор Gwee из Сингапура, это перспективный многоцентрового исследования Индийского общества гастроэнтерологов IBS целевой группы с данными 4500 сообществом субъектов с участием 2785 пациентов с симптомами хронического нижней И. присутствуют на 30 общенациональных центров в Индии. Большинство пациентов были мужчины среднего возраста. В отличие от типичных пациентов IBS на Западе часто молодые женщины
"Не будучи привязанными к обычным критериям, это исследование подтверждает мне, что пациент IBS, что я вижу может отличаться от образа, созданного в Риме".
Добавлено: 15 Сентябрь 2009, 15:49:20Синдром раздраженного кишечника: глобальные перспективы
Определение: Синдром раздраженного кишечника (СРК) является функциональным расстройством кишечника, в котором абдоминальная боль или дискомфорт связан с дефекации или изменения в кишечнике привычки; вздутие живота, вздутия (в некоторых Языки, эти слова могут представлена на тот же срок) и неупорядоченной дефекации обычно связаны особенности.

 Введение
IBS подклассификацией
На основании особенностей пациента о своих кишечника и стула характеристик в соответствии с Римским критериям III.
СРК с диареей (СРК-Д)
Жидкий стул> 25% времени и жестких стульях <25% времени
До одной трети случаев
Чаще встречается у мужчин
СРК с запорами (СРК-С)
Жесткий стул> 25% времени и жидкий стул <25% времени
До одной трети случаев
Чаще встречается у женщин
IBS со смешанным кишечника или циклическая модель (IBS-M)
Оба жестких и мягких стула> 25% времени
Одной трети до половины случаев
Следует помнить, однако, что:
Пациенты обычно перехода между этими подгруппами
Симптомами диареи и запоров обычно неправильно истолкованы у больных IBS. Таким образом, многие пациенты IBS, которые жалуются на "диарея" имеют в виду частое прохождение формируется стул, и в то же самое население пациенту "запор" может относиться к любому из целого ряда жалоб связано с попыткой акта дефекации и, Не просто, редкие движения кишечника.
По клиническим признакам, другие subclassifications (например, на основе симптомов), может быть возможным:

 Б. с преобладающим дисфункция кишечника
СРК с преобладанием болей
СРК с преобладанием вздутие живота
На основании выпадающих факторы:
После инфекционные IBS
Food-индуцированной (еда-индуцированной)
Однако, значимость любого из этих классификаций в последнем прогнозе или ответа на терапию еще предстоит определить.
Следует также помнить, что Рим III критерии обычно не используются в клинической практике. Кроме того, культурные вопросы могут сообщить симптом отчетности. Например, в Индии, пациент, который отчитывается напрягаясь или ближнего жестких стульях, скорее всего жалуются на запоры, даже если он или она проходит стул несколько раз в день.
Глобальный показатель распространенности и заболеваемости
Распространенность синдрома раздраженной кишки (СРК) растет в странах с развивающейся экономикой. Оценки распространенности СРК значительно различаются в Азиатско-Тихоокеанском регионе и в других местах, в зависимости от того, какие диагностические критерии используются (Рим I, Рим II, III Рим, Мэннинг, Kruis).
Исследования, проведенные в Индии на примере показать, что Рим I критериев IBS определить больше пациентов, чем Рим критериям II. Отмеченные факты распространения включает в себя 0,82% в Пекине, на 5,7% в южном Китае, 6,6% в Гонконге, 8,6% в Сингапуре, 14% в Пакистане и 22,1% в Тайване. Исследование, проведенное в Китае обнаружено, что распространенность ИБС определены критерии Риме III в амбулаторной клинике составила 15,9%.
Хотя эти величины, как правило, ниже, чем распространенность ИБС в США (10-15%) он предсказал, что продолжающееся экономическое развитие стран, приведет к изменениям в диете и образе жизни, которые могут увеличить частоту и диагностики этого расстройства.


 Различные представления функций между Востоком и Западом
Как и в случае распространения данных, глобальной информации о представлении функций также меняется и сопоставление исследований, основанных на данных Сообщества, клинические данные и статистика больницы сопряжены с трудностями.
Типичными симптомами IBS являются общими в образцах здорового населения, но большинство страдающих от IBS фактически не медицинский диагноз как это может объяснить очевидные различия между странами в сообщениях распространенность-большинства исследований рассчитывать только диагноз СРК, а не сообщество распространенности.
Исследование, проведенное в Китае показало, что распространенность ИБС в Южном Китае, была выше, чем сообщалось в Пекине, но ниже, чем сообщалось в западных странах.
Некоторые исследования в не западных странах указывают:
Отсутствие преобладание женщин (возможно, из-за различий в доступе к медицинским ищет поведение). В Южном Китае, например, мужчин и женщин отношение только 1: 1,25 (по сравнению с 1:2 в Западной Европе).
Тесная связь между отмеченными при бедствии и для IBS у мужчин аналогичные тем, которые имеются у женщин в западных исследованиях.
Большая частота верхней боли в животе.
Нижняя последствия дефекации симптомов на повседневную жизнь пациента (но никаких доказательств этого было найдено в Китае и Мексике).
Некоторые исследования предполагают, что среди афро-карибского американцы, по сравнению с белыми лицами:
Стул нижних частот
Распространенность запоров выше
В Латинской Америке, запоры преобладание более часты, чем понос.
Частота стула, как представляется, больше в индийской общине в целом-99% прошли стулья один или несколько раз в день.
В Мексике 70% имеют тревоги, депрессии, 46% и 40% другого.
В Мексике, IBS несет высокие экономические последствия из-за высокой использования медицинских ресурсов.
Клинические перекрытия FD и IBS в соответствии с Римской III весьма распространена в Китае.
Психологического стресса, жизненные события и негативные стиль копирование может сыграть важную роль в патогенезе IBS. Кроме того, эти факторы также могут повлиять на болезнь поведения человека и клинических результатов.
Дальнейшие исследования должны установить:
Важность диетических различия между странами
Различные подтипы распределение между странами
Различия между городскими и сельскими районами. Исследование, проведенное в израильских бедуинов, например, предложили значительные различия в распространенности IBS между пустыне бедуинов (5,8%) и город бедуинов (9,4%), используя Рим II критериям.
Диагностика IBS
История болезни
План абдоминальная боль или дискомфорт:
Хронические продолжительности
Тип боли: периодической или непрерывной
Предыдущие эпизоды более
Локализация болей хорошо локализован более атипичный
Помощи при дефекации или кончины вздутие
Nocturnal более необычным, и считается предупреждающий знак
Другие симптомы брюшного:
Bloating
Растяжению
Borborygmi
Метеоризм
Примечание: растяжения могут быть измерены, вздутие живота это субъективное чувство. Как определено в английском языке, вздутие живота и растяжению, не могут одни и те же патофизиологии и не должна рассматриваться как эквивалент и взаимозаменяемых терминов (хотя в некоторых Языки условий может быть представлена одним словом). Увеличивается также не обязательно означает либо, что кишечные производства газа.
Характер нарушений связано кишечника:
Запоры
Диарея
Чередование
Аномалии дефекации:
Диарея для> 2 недель
Слизь в кале
Кровь в стуле
Чувство неполной дефекации
Диагностический каскад
Диагностический каскад
Уровень 1
История, физическое обследование, исключение симптомы тревоги, учет психологических факторов
Полный анализ крови (СКС), скорость оседания эритроцитов (СОЭ) или С-реактивного белка (СРБ), стул исследований (белые кровяные клетки, яйцеклетки, паразиты, скрытую кровь)
Функции щитовидной железы, ткань трансглутаминазе (ТТГ) антитело
Колоноскопия и биопсия
Уровень 2
История, физическое обследование, исключение симптомы тревоги, учет психологических факторов
СКС, СОЭ или СРБ, стул исследования функции щитовидной железы
Ректороманоскопия
Уровень 3
История, физическое обследование, исключение симптомы тревоги, учет психологических факторов
СКС, ЭПР и табуретки экспертиза
Примечание по: необходимость ректороманоскопия и колоноскопия, также должна быть продиктована характеристик пациента (представление особенностей, возраста и т.д.) и место (т.е. будь то в районе с высокой распространенностью заболевания кишечника раздражительными, целиакия, рак толстой или паразитарное заболевание или нет ). Можно утверждать, например, что 21-летняя женщина с С-IBS типа симптомы и никакой тревоги особенностей существу, самое большее, целиакией Серология.
IBS управления
Введение
Примечание: с пациентом тревога играет ключевую роль, гарантии и образование, имеют ключевое значение.
Существует нет согласия относительно того, что лучшее лечение для пациентов с умеренными и тяжелыми симптомами. Увеличивающие объем каловых масс, лоперамид и антидепрессантов в первую очередь.
Роль пробиотиков может еще больше выходят на передний план, но более крупные и высококачественные рандомизированного контролируемого испытания, прежде чем более определенно можно сделать выводы о пользе, например, Lactobacillus и Bifidobacterium.
Однако, клинические доказательства эффективности начинают появляться. Важность четкого определения отборе штаммов, доза и жизнеспособности является жизненно важным.
Управление каскадом
Управление каскадом
Уровень 1
Заверений, диетического и обзор жизни и стиль консультирования
Добавить качеству пробиотических с доказанной эффективностью
Симптоматическое лечение:
Боли с локально доступных спазмолитическое, для более серьезно пострадавшим пациентам добавить низких доз трициклических антидепрессантов или СИОЗС
Запоры с мерами и диетических добавок волокно прогрессирующих к осмотических слабительных или лактулоза
Диарея с увеличивающие объем каловых масс и простой анти-diarrheals
Рассмотрим психологические подходы (гипнотерапия, психотерапия, групповая терапия) и консультации с диетологом, где указано
Добавить конкретные фармакологических препаратов при условии получения одобрения:
Lubiprostone для С-IBS
Rifaximin для понос и вздутие живота
Alosetron для D-IBS
Tegaserod для С-IBS
Уровень 2
Заверений, диетического и обзор жизни и стиль консультирования
Добавить качеству пробиотических с доказанной эффективностью
Симптоматическое лечение:
Боли с локально доступных спазмолитическое, для более серьезно пострадавшим пациентам добавить низких доз трициклические антидепрессанты
Запоры с мерами и диетических добавок волокно
Диарея с увеличивающие объем каловых масс и простым antidiarrheals
Уровень 3
Заверений, диетического и обзор жизни и стиль консультирования
Симптоматическое лечение:
Боли с локально доступных спазмолитическое
Запоры с мерами и диетических добавок волокно
Диарея с увеличивающие объем каловых масс и простым antidiarrheals

[Banditka]

gaga, а можно ссылочку на первоисточник?

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ее выше написал LupusLex.