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.
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.
Literatur
Akehurst R, Kaltenthaler E (2001) Treatment of irritable bowel syndrome: a review of randomised controlled trials. Gut 48: 272–282
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: b3154
Black TP, Manolakis CS, Di Palma JA (2012) „Red flag“ evaluation yield in irritable bowel syndrome. J Gastrointestin Liver Dis 21: 153–156
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–S35
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: 936–943
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: 587–599
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: 1702–1712
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–e397
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: 748–751
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: 19–31
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: 972–980
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: 651–658
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: a2313
Ford AC, Vandvik PO (2012) Irritable bowel syndrome. Clin Evid (Online)
Gibson PR, Shepherd SJ (2010) Evidence-based dietary management of functional gastrointestinal symptoms: the FODMAP approach. J Gastroenterol Hepatol 25: 252–258
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: 664–671
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: 1972–1982
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: 1474–1482
Harvey RF, Salih SY, Read AE (1983) Organic and functional disorders in 2000 gastroenterology outpatients. Lancet 1: 632–634
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: 915–922
Khan S, Chang L (2010) Diagnosis and management of IBS. Nat Rev Gastroenterol Hepatol 7: 565–581
Layer P, Andresen V, Pehl C et al (2011) Irritable bowel syndrome: German consensus guidelines on definition, pathophysiology and management. Z Gastroenterol 49: 237–293
Leeds JS, Hopper AD, Sidhu R et al (2010) Some patients with irritable bowel syndrome may have exocrine pancreatic insufficiency. Clin Gastroenterol Hepatol 8: 433–438
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: 1574–1580
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: 271–279
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)
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: 602–609
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: 451–457
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: 216–219
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: 595–607
Pimentel M, Lembo A, Chey WD et al (2011) Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med 364: 22–32
Poynard T, Regimbeau C, Benhamou Y (2001) Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther 15: 355–361
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: CD003460
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: 170–177
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: 189–198
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: 678–684
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: 2114–2119
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: 707–717
Whorwell PJ, Prior A, Faragher EB (1984) Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Lancet 2: 1232–1234
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: 169–174
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: 134–151
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.
Author information
Authors and Affiliations
Corresponding author
Additional information
Dieser Beitrag wurde erstpubliziert in Der Gastroenterologe 8:417–424.
Rights and permissions
About this article
Cite this article
Pohl, D., Heinrich, H. & Misselwitz, B. Reizdarmsyndrom – Diagnostik und Therapie. coloproctology 36, 190–195 (2014). https://doi.org/10.1007/s00053-014-0438-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00053-014-0438-9