Irritable bowel syndrome
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
Outros fatores diagnósticos
- passage of mucus with stool
- urgency of defecation
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
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- CBC
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
Algoritmo de tratamento
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
Declarações
HW declares that he has no competing interests.
Créditos aos pareceristas
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Declarações
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Referências
Principais artigos
Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterology. 2006 Apr;130(5):1480-91.Texto completo Resumo
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.Texto completo Resumo
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.Texto completo Resumo
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.Texto completo Resumo
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. Resumo
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.Texto completo Resumo
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.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
鉴别诊断
- Crohn disease
- Ulcerative colitis
- Microscopic colitis
更多 鉴别诊断指南
- Probiotics and prebiotics
- AGA clinical practice update on the role of diet in irritable bowel syndrome: expert review
更多 指南患者教育信息
Irritable bowel syndrome: what is it?
Irritable bowel syndrome: what are the treatment options?
更多 患者教育信息
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