Irritable bowel syndrome

Visão geral 
Teoria 
Diagnóstico 
Tratamento 
ACOMPANHAMENTO 
Recursos 

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Última revisão: 23 Sep 2025

Última atualização: 01 Nov 2023

Irritable bowel syndrome symptoms include recurrent abdominal pain or discomfort that is associated with a change in stool frequency or form. The pain or discomfort may be relieved by defecation.

It is important to determine whether there are any potential precipitating dietary associations such as caffeine, lactose-containing foods, or fructose-containing foods.

Examination of the abdomen is usually unremarkable. There may be mild and poorly localized tenderness in the right lower quadrant and/or left lower quadrant.

The diagnosis is based on the patient's history; there are no specific diagnostic tests. If the patient has worrying symptoms or findings such as anemia, weight loss, or fever, then these require thorough investigation.

Treatment should be individualized and is dependent on the patient's predominant symptoms.

Definição

Irritable bowel syndrome (IBS) is a chronic condition characterized by abdominal pain associated with bowel dysfunction. The pain is often relieved by defecation and is sometimes accompanied by abdominal bloating. There are no structural abnormalities to explain the pain. IBS occurs in about 15% of the adult population. The etiology is probably multifactorial, and evidence suggests motility, inflammatory, genetic, immune, psychological, and dietary components.[1]

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

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

Adjunct Professor of Medicine

University of Texas Medical Branch

Galveston

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

Declarações

DD declares that he has no competing interests.

Simon McLaughlin, MBBS

Research Fellow

Department of Gastroenterology

St Mark's Hospital

Northwick Park

Harrow

Declarações

SM declares that he has no competing interests.

Horace Williams, MBBS

Clinical Research Fellow

Division of Medicine

Imperial College

London

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия
- Crohn disease
- Ulcerative colitis
- Microscopic colitis
Больше Отличия
Рекомендации
- Probiotics and prebiotics
- AGA clinical practice update on the role of diet in irritable bowel syndrome: expert review
Больше Рекомендации
Лифлеты для пациента
Irritable bowel syndrome: what is it?
Irritable bowel syndrome: what are the treatment options?
Больше Лифлеты для пациента
Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Использование этого контента попадает под действие нашего заявления об отказе от ответственности

Irritable bowel syndrome

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

constipation-predominant

diarrhea-predominant

alternating constipation and diarrhea

Colaboradores

Autores

Ned Snyder, MD, MACP, AGAF

Declarações

Revisores

Douglas Drossman, MD

Declarações

Simon McLaughlin, MBBS

Declarações

Horace Williams, MBBS

Раскрытие информации

Peer reviewer acknowledgements

Disclosures

Список литературы

Основные статьи

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия

Рекомендации

Лифлеты для пациента

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись, чтобы получить полноценный доступ к BMJ Best Practice