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Irritable bowel syndrome

Última revisão: 23 Sep 2025
Última atualização: 01 Nov 2023

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • abdominal pain
  • alteration of bowel habits associated with pain
  • abdominal bloating or distension
  • normal exam of abdomen
Detalhes completos

Outros fatores diagnósticos

  • passage of mucus with stool
  • urgency of defecation
Detalhes completos

Fatores de risco

  • physical and sexual abuse
  • posttraumatic stress disorder (PTSD)
  • age <50 years
  • female sex
  • previous enteric infection
  • family history
  • family and job stress
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • CBC
Detalhes completos

Investigações a serem consideradas

  • fecal occult blood test
  • quantitative fecal immunochemical test (FIT)
  • serologic tests for celiac disease
  • fecal calprotectin
  • fecal lactoferrin
  • serum C-reactive protein (CRP)
  • erythrocyte sedimentation rate (ESR)
  • serum fibroblast growth factor 19
  • 23‐seleno‐25‐homotaurocholic acid (SeHCAT) test
  • 48-hour stool collection for total bile acids
  • empiric trial of bile acid binder
  • hydrogen/methane breath test
  • stool tests for Giardia lamblia
  • plain abdominal radiograph
  • colonoscopy
  • flexible sigmoidoscopy
Detalhes completos

Algoritmo de tratamento

CONTÍNUA

constipation-predominant

diarrhea-predominant

alternating constipation and diarrhea

Colaboradores

Autores

Ned Snyder, MD, MACP, AGAF

Professor of Medicine

Baylor College of Medicine and Marion DeBakey VA Hospital

Houston

TX

Adjunct Professor of Medicine

University of Texas Medical Branch

Galveston

TX

Declarações

NS declares that he is a member on the board of the Kelsey Research Foundation, a non-profit organization. Kelsey Research Foundation has received and awarded private grants for the study of the microbiome in several diseases, including irritable bowel syndrome.

Revisores

Douglas Drossman, MD

Professor of Medicine and Psychiatry

School of Medicine

Co-Director

UNC Center for Functional GI and Motility Disorders

Chapel Hill

NC

Declarações

DD declares that he has no competing interests.

Simon McLaughlin, MBBS

Research Fellow

Department of Gastroenterology

St Mark's Hospital

Northwick Park

Harrow

UK

Declarações

SM declares that he has no competing interests.

Horace Williams, MBBS

Clinical Research Fellow

Division of Medicine

Imperial College

London

UK

Раскрытие информации

HW declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

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Основные статьи

Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterology. 2006 Apr;130(5):1480-91.Полный текст  Аннотация

Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: management of irritable bowel syndrome. Am J Gastroenterol. 2021 Jan 1;116(1):17-44.Полный текст  Аннотация

Smalley W, Falck-Ytter C, Carrasco-Labra A, et al. AGA clinical practice guidelines on the laboratory evaluation of functional diarrhea and diarrhea-predominant irritable bowel syndrome in adults (IBS-D). Gastroenterology. 2019 Sep;157(3):851-4.Полный текст  Аннотация

Chey WD, Hashash JG, Manning L, et al. AGA clinical practice update on the role of diet in irritable bowel syndrome: expert review. Gastroenterology. 2022 May;162(6):1737-45.e5.Полный текст  Аннотация

Dionne J, Ford AC, Yuan Y, et al. A systematic review and meta-analysis evaluating the efficacy of a gluten-free diet and a low FODMAPs diet in treating symptoms of irritable bowel syndrome. Am J Gastroenterol. 2018 Sep;113(9):1290-300. Аннотация

Chang L, Sultan S, Lembo A, et al. AGA clinical practice guideline on the pharmacological management of irritable bowel syndrome with constipation. Gastroenterology. 2022 Jul;163(1):118-36.Полный текст  Аннотация

Lembo A, Sultan S, Chang L, et al. AGA clinical practice guideline on the pharmacological management of irritable bowel syndrome with diarrhea. Gastroenterology. 2022 Jul;163(1):137-51.Полный текст  Аннотация

Статьи, указанные как источники

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