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Síndrome do intestino irritável

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  • Descripción general
  • Teoría
  • Diagnóstico
  • Manejo
  • Seguimiento
  • Recursos
Última revisión: 21 Dec 2025
Última actualización: 20 May 2025

Resumen

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • dor abdominal
  • alteração dos hábitos intestinais associados à dor
  • inchaço ou distensão abdominal
  • exame do abdome normal
Full details

Other diagnostic factors

  • passagem de muco nas fezes
  • urgência de defecção
Full details

Risk factors

  • abuso físico e sexual
  • transtorno do estresse pós-traumático (TEPT)
  • idade <50 anos
  • sexo feminino
  • infecção entérica prévia
  • história familiar
  • estresse familiar e no trabalho
Full details

Diagnostic investigations

1st investigations to order

  • Hemograma completo
Full details

Investigations to consider

  • exame de sangue oculto nas fezes
  • teste imunoquímico fecal (FIT) quantitativo
  • testes sorológicos para doença celíaca
  • calprotectina fecal
  • lactoferrina fecal
  • proteína C-reativa sérica
  • velocidade de hemossedimentação (VHS)
  • fator de crescimento de fibroblastos 19 sérico
  • Teste de taurina-ácido homocólico marcado com selênio (SeHCAT)
  • Coleta de fezes de 48 horas para ácidos biliares totais
  • ensaio empírico do ligante de ácidos biliares
  • teste do hidrogênio/metano no ar expirado
  • exames de fezes para Giardia lamblia
  • radiografia abdominal simples
  • colonoscopia
  • sigmoidoscopia flexível
Full details

Treatment algorithm

ONGOING

com constipação predominante

predominância de diarreia

alternação entre constipação e diarreia

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

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.

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.

参考文献

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.

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

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