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Síndrome del intestino irritable

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
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Last reviewed: 16 Aug 2025
Last updated: 20 May 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presencia de factores de riesgo
  • dolor abdominal
  • alteración del ritmo intestinal con dolor
  • distensión abdominal o distensión
  • exploración abdominal normal
Full details

Other diagnostic factors

  • defecación con moco
  • urgencia defecatoria
Full details

Risk factors

  • abuso físico y sexual
  • trastorno por estrés postraumático (TEPT)
  • edad <50 años
  • sexo femenino
  • infecciones intestinales previas
  • antecedentes familiares
  • estrés personal y laboral
Full details

Diagnostic investigations

1st investigations to order

  • hemograma completo (HC)
Full details

Investigations to consider

  • sangre oculta en heces
  • prueba inmunoquímica fecal cuantitativa (FIT)
  • pruebas serológicas para la enfermedad celíaca
  • calprotectina fecal
  • lactoferrina en heces
  • proteína C-reactiva (PCR) sérica
  • velocidad de sedimentación globular (VSG)
  • factor de crecimiento de los fibroblastos séricos 19
  • prueba de ácido homotaurocólico taura-23-selena-25 (SeHCAT)
  • Recogida de heces durante 48 horas para los ácidos biliares totales
  • ensayo empírico del aglutinante de ácidos biliares
  • prueba de hidrógeno/metano en el aliento
  • pruebas de heces para Giardia lamblia
  • radiografía simple de abdomen
  • colonoscopia
  • sigmoidoscopia flexible
Full details

Treatment algorithm

ONGOING

predominio de estreñimiento

predominio de diarrea

estreñimiento y diarrea alternantes

Contributors

Authors

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

Disclosures

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.

Peer reviewers

Douglas Drossman, MD

Professor of Medicine and Psychiatry

School of Medicine

Co-Director

UNC Center for Functional GI and Motility Disorders

Chapel Hill

NC

Disclosures

DD declares that he has no competing interests.

Simon McLaughlin, MBBS

Research Fellow

Department of Gastroenterology

St Mark's Hospital

Northwick Park

Harrow

UK

Disclosures

SM declares that he has no competing interests.

Horace Williams, MBBS

Clinical Research Fellow

Division of Medicine

Imperial College

London

UK

Disclosures

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.

References

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.

Key articles

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

Lacy BE, Mearin F, Chang L, et al. Bowel disorders. Gastroenterology. 2016 May;150(6):1393-407. Abstract

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.Full text  Abstract

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.Full text  Abstract

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.Full text  Abstract

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. Abstract

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.Full text  Abstract

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.Full text  Abstract

Reference articles

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

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