小结
定义
病史和体格检查
关键诊断因素
- abdominal pain
- alteration of bowel habits associated with pain
- abdominal bloating or distension
- normal exam of abdomen
其他诊断因素
- passage of mucus with stool
- urgency of defecation
危险因素
- physical and sexual abuse
- posttraumatic stress disorder (PTSD)
- age <50 years
- female sex
- previous enteric infection
- family history
- family and job stress
诊断性检查
首要检查
- CBC
需考虑的检查
- 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
治疗流程
constipation-predominant
diarrhea-predominant
alternating constipation and diarrhea
撰稿人
作者
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
利益声明
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.
同行评议者
Douglas Drossman, MD
Professor of Medicine and Psychiatry
School of Medicine
Co-Director
UNC Center for Functional GI and Motility Disorders
Chapel Hill
NC
利益声明
DD declares that he has no competing interests.
Simon McLaughlin, MBBS
Research Fellow
Department of Gastroenterology
St Mark's Hospital
Northwick Park
Harrow
UK
利益声明
SM declares that he has no competing interests.
Horace Williams, MBBS
Clinical Research Fellow
Division of Medicine
Imperial College
London
UK
利益声明
HW declares that he has no competing interests.
参考文献
关键文献
Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterology. 2006 Apr;130(5):1480-91.全文 摘要
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.全文 摘要
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.全文 摘要
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.全文 摘要
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. 摘要
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.全文 摘要
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.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of 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 treatments work?
更多 患者教育信息
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明