coloproctology

, Volume 36, Issue 3, pp 190–195 | Cite as

Reizdarmsyndrom – Diagnostik und Therapie

Übersichten
  • 221 Downloads

Zusammenfassung

Bis zu 25 % aller gastroenterologischen Patienten leiden unter einem Reizdarmsyndrom (RDS). Bei Neudiagnose eines RDS sind eine fundierte und zielgerichtete Diagnostik entscheidend für den weiteren klinischen Verlauf. Nach Diagnosestellung erbringen erneute Abklärungen, insbesondere repetitive endoskopische Untersuchungen, jedoch praktisch nie zusätzliche Erkenntnisse. Die medikamentöse Therapie ist individuell an den Symptomen des Patienten auszurichten. Nichtmedikamentöse und alternative Therapieverfahren können dabei eine wirksame Ergänzung darstellen.

Schlüsselwörter

RDS/IBS Obstipation Diarrhö Lebensstilveränderungen FODMAPs 

Irritable bowel syndrome—diagnostics and therapy

Abstract

Up to 25 % of gastroenterology outpatients complain of symptoms attributable to irritable bowel syndrome (IBS). A well founded diagnosis of IBS is the key to subsequent successful treatment. To safely establish a diagnosis of IBS a panel of basic investigations to carefully exclude alternative diagnoses is warranted. Once the diagnosis of IBS is established repetition of examinations, especially repeat endoscopy should be avoided in the absence of new clinical information. Medical treatment should be tailored to individual symptoms. Non-medical forms of treatment including dietary changes, exercise and alternative forms of treatment, such as hypnotherapy can be effective supportive measures in IBS.

Keywords

Colonic diseases, functional Constipation Diarrhea Lifestyle modifications FODMAPs 

Notes

Einhaltung der ethischen Richtlinien

Interessenkonflikt. Dr. Pohl ist als Berater für die Firma Almirall tätig. Er erhält Referentenhonorar von der Firma MSD und Kongressunterstützung von der Firma Roche Pharma (Schweiz). Dr. Heinrich gibt an, dass kein Interessenkonflikt besteht. Dr. Misselwitz erhält Referentenhonorar von der Firma MSD.

Literatur

  1. 1.
    Akehurst R, Kaltenthaler E (2001) Treatment of irritable bowel syndrome: a review of randomised controlled trials. Gut 48: 272–282PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Bijkerk CJ, Wit NJ de, Muris JW et al (2009) Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ 339: b3154PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Black TP, Manolakis CS, Di Palma JA (2012) „Red flag“ evaluation yield in irritable bowel syndrome. J Gastrointestin Liver Dis 21: 153–156PubMedGoogle Scholar
  4. 4.
    Brandt LJ, Chey WD, Foxx-Orenstein AE et al (2009) An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 104(Suppl 1): S1–S35PubMedCrossRefGoogle Scholar
  5. 5.
    Brinkhaus B, Hentschel C, Von Keudell C et al (2005) Herbal medicine with curcuma and fumitory in the treatment of irritable bowel syndrome: a randomized, placebo-controlled, double-blind clinical trial. Scand J Gastroenterol 40: 936–943PubMedCrossRefGoogle Scholar
  6. 6.
    Chey WD, Drossman DA, Johanson JF et al (2012) Safety and patient outcomes with lubiprostone for up to 52 weeks in patients with irritable bowel syndrome with constipation. Aliment Pharmacol Ther 35: 587–599PubMedCrossRefGoogle Scholar
  7. 7.
    Chey WD, Lembo AJ, Lavins BJ et al (2012) Linaclotide for irritable bowel syndrome with constipation: a 26-week, randomized, double-blind, placebo-controlled trial to evaluate efficacy and safety. Am J Gastroenterol 107: 1702–1712PubMedCrossRefGoogle Scholar
  8. 8.
    Dang J, Ardila-Hani A, Amichai MM et al (2012) Systematic review of diagnostic criteria for IBS demonstrates poor validity and utilization of Rome III. Neurogastroenterol Motil 24: 853–e397PubMedCrossRefGoogle Scholar
  9. 9.
    Di Palma JA, Herrera JL (2012) The role of effective clinician-patient communication in the management of irritable bowel syndrome and chronic constipation. J Clin Gastroenterol 46: 748–751CrossRefGoogle Scholar
  10. 10.
    Drossman DA, Toner BB, Whitehead WE et al (2003) Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology 125: 19–31PubMedCrossRefGoogle Scholar
  11. 11.
    Engsbro AL, Begtrup LM, Kjeldsen J et al (2013) Patients suspected of irritable bowel syndrome-cross-sectional study exploring the sensitivity of Rome III criteria in primary care. Am J Gastroenterol 108: 972–980PubMedCrossRefGoogle Scholar
  12. 12.
    Ford AC, Chey WD, Talley NJ et al (2009) Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. Arch Intern Med 169: 651–658PubMedCrossRefGoogle Scholar
  13. 13.
    Ford AC, Talley NJ, Spiegel BM et al (2008) Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ 337: a2313PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Ford AC, Vandvik PO (2012) Irritable bowel syndrome. Clin Evid (Online)Google Scholar
  15. 15.
    Gibson PR, Shepherd SJ (2010) Evidence-based dietary management of functional gastrointestinal symptoms: the FODMAP approach. J Gastroenterol Hepatol 25: 252–258PubMedCrossRefGoogle Scholar
  16. 16.
    Halpert A, Dalton CB, Diamant NE et al (2005) Clinical response to tricyclic antidepressants in functional bowel disorders is not related to dosage. Am J Gastroenterol 100: 664–671PubMedCrossRefGoogle Scholar
  17. 17.
    Halpert A, Dalton CB, Palsson O et al (2007) What patients know about irritable bowel syndrome (IBS) and what they would like to know. National Survey on Patient Educational Needs in IBS and development and validation of the Patient Educational Needs Questionnaire (PEQ). Am J Gastroenterol 102: 1972–1982PubMedCrossRefGoogle Scholar
  18. 18.
    Halpin SJ, Ford AC (2012) Prevalence of symptoms meeting criteria for irritable bowel syndrome in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol 107: 1474–1482PubMedCrossRefGoogle Scholar
  19. 19.
    Harvey RF, Salih SY, Read AE (1983) Organic and functional disorders in 2000 gastroenterology outpatients. Lancet 1: 632–634PubMedCrossRefGoogle Scholar
  20. 20.
    Johannesson E, Simren M, Strid H et al (2011) Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol 106: 915–922PubMedCrossRefGoogle Scholar
  21. 21.
    Khan S, Chang L (2010) Diagnosis and management of IBS. Nat Rev Gastroenterol Hepatol 7: 565–581PubMedCrossRefGoogle Scholar
  22. 22.
    Layer P, Andresen V, Pehl C et al (2011) Irritable bowel syndrome: German consensus guidelines on definition, pathophysiology and management. Z Gastroenterol 49: 237–293PubMedCrossRefGoogle Scholar
  23. 23.
    Leeds JS, Hopper AD, Sidhu R et al (2010) Some patients with irritable bowel syndrome may have exocrine pancreatic insufficiency. Clin Gastroenterol Hepatol 8: 433–438PubMedCrossRefGoogle Scholar
  24. 24.
    Leung WK, Wu JC, Liang SM et al (2006) Treatment of diarrhea-predominant irritable bowel syndrome with traditional Chinese herbal medicine: a randomized placebo-controlled trial. Am J Gastroenterol 101: 1574–1580PubMedCrossRefGoogle Scholar
  25. 25.
    Madisch A, Holtmann G, Plein K et al (2004) Treatment of irritable bowel syndrome with herbal preparations: results of a double-blind, randomized, placebo-controlled, multi-centre trial. Aliment Pharmacol Ther 19: 271–279PubMedCrossRefGoogle Scholar
  26. 26.
    Manheimer E, Wieland LS, Cheng K et al (2012) Acupuncture for irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol 107: 835–847 (quiz 848)PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Moser G, Tragner S, Gajowniczek EE et al (2013) Long-term success of GUT-directed group hypnosis for patients with refractory irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol 108: 602–609PubMedCrossRefGoogle Scholar
  28. 28.
    Offner FA, Jao RV, Lewin KJ et al (1999) Collagenous colitis: a study of the distribution of morphological abnormalities and their histological detection. Hum Pathol 30: 451–457PubMedCrossRefGoogle Scholar
  29. 29.
    Pan F, Zhang T, Zhang YH et al (2009) Effect of Tongxie Yaofang Granule in treating diarrhea-predominate irritable bowel syndrome. Chin J Integr Med 15: 216–219PubMedCrossRefGoogle Scholar
  30. 30.
    Park MI, Camilleri M (2006) Is there a role of food allergy in irritable bowel syndrome and functional dyspepsia? A systematic review. Neurogastroenterol Motil 18: 595–607PubMedCrossRefGoogle Scholar
  31. 31.
    Pimentel M, Lembo A, Chey WD et al (2011) Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med 364: 22–32PubMedCrossRefGoogle Scholar
  32. 32.
    Poynard T, Regimbeau C, Benhamou Y (2001) Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther 15: 355–361PubMedCrossRefGoogle Scholar
  33. 33.
    Ruepert L, Quartero AO, Wit NJ de et al (2011) Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. Cochrane Database Syst Rev: CD003460Google Scholar
  34. 34.
    Saito YA, Rey E, Almazar-Elder AE et al (2010) A randomized, double-blind, placebo-controlled trial of St John’s wort for treating irritable bowel syndrome. Am J Gastroenterol 105: 170–177PubMedCrossRefGoogle Scholar
  35. 35.
    Shinozaki M, Kanazawa M, Kano M et al (2010) Effect of autogenic training on general improvement in patients with irritable bowel syndrome: a randomized controlled trial. Appl Psychophysiol Biofeedback 35: 189–198PubMedCrossRefGoogle Scholar
  36. 36.
    Vahedi H, Merat S, Momtahen S et al (2008) Clinical trial: the effect of amitriptyline in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 27: 678–684PubMedCrossRefGoogle Scholar
  37. 37.
    Wang G, Li TQ, Wang L et al (2006) Tong-xie-ning, a Chinese herbal formula, in treatment of diarrhea-predominant irritable bowel syndrome: a prospective, randomized, double-blind, placebo-controlled trial. Chin Med J (Engl) 119: 2114–2119Google Scholar
  38. 38.
    Wedlake L, A’Hern R, Russell D et al (2009) Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 30: 707–717PubMedCrossRefGoogle Scholar
  39. 39.
    Whorwell PJ, Prior A, Faragher EB (1984) Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Lancet 2: 1232–1234PubMedCrossRefGoogle Scholar
  40. 40.
    Yang J, Lee HR, Low K et al (2008) Rifaximin versus other antibiotics in the primary treatment and retreatment of bacterial overgrowth in IBS. Dig Dis Sci 53: 169–174PubMedCrossRefGoogle Scholar
  41. 41.
    Yoon SL, Grundmann O, Koepp L et al (2011) Management of irritable bowel syndrome (IBS) in adults: conventional and complementary/alternative approaches. Altern Med Rev 16: 134–151PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Gastroenterologie und HepatologieUniversitätsSpital ZürichZürichSchweiz

Personalised recommendations