I. Diagnosis Based on the latest Rome III diagnostic criteria.
(1) Symptoms have been present for at least 6 months prior to diagnosis, and the following diagnostic criteria have been met in the last 3 months.
Recurrent episodes of abdominal pain or discomfort, at least 3 days per month for the last 3 months, accompanied by 2 or more of the following: (1) improvement of symptoms after defecation; (2) change in frequency of defecation at the time of occurrence; (3) change in stool properties (appearance) at the time of occurrence.
(2) The following symptoms are not necessary for diagnosis, but are supportive of the diagnosis: abnormal frequency of defecation (①defecation >3 times a day or ②<3 times a week); abnormal stool characteristics (③dry bulbous stool/hard stool or ④paste-like stool/dilute watery stool); straining to defecate; feeling of urgency to defecate, incomplete defecation, mucus defecation, and abdominal distension. Liu Xiaofeng, Department of Gastroenterology, General Hospital of Jinan Military Region
(2) Typing IBS diarrhea type (IBS-D), IBS constipation type (IBS-C), and IBS mixed type (IBS-M).
II. Treatment
The aim of treatment is to eliminate patients’ concerns, improve symptoms and enhance quality of life. The principle of treatment is based on establishing a good doctor-patient relationship, symptomatic treatment according to the main symptom types and graded treatment according to the severity of symptoms. Pay attention to the individualization and comprehensive use of treatment measures.
1. General treatment
(1) Establishing a good doctor-patient relationship Health education, comforting and establishing a good doctor-patient relationship are effective and economical treatment methods.
(2) Dietary treatment A healthy, balanced diet can help reduce the symptoms of gastrointestinal disorders. Over-eating; heavy alcohol consumption; caffeine; high-fat diet; certain vegetables and legumes with gas-producing effect; refined food and artificial food (for constipation), sorbitol and fructose (for diarrhea); individual intolerant food should be avoided. Increasing dietary fiber is mainly used in patients with constipation as the main cause.
2. Drug therapy There is no one drug that can effectively treat all kinds of IBS. Certain drugs can improve symptoms to varying degrees.
(1) Antispasmodics Anticholinergic drugs such as atropine, probenecid, and scopolamine should be noted for adverse effects and can be used as short-term symptomatic treatment to relieve abdominal pain. Selective calcium channel antagonists of the smooth muscle of the gastrointestinal tract such as pivibromine (usage is 50mg/dose, 3 times/day), otibuterol (usage is 40mg/dose, 3 times/day), or ion channel modulators trimebutine maleate (usage is 100-200mg/dose, 3 times/day) have good effects and safety.
(2) Antidiarrheal drugs Loperamide or diphenoxylate have good antidiarrheal effect and are suitable for those with severe diarrhea symptoms, but should not be used for a long time. In mild cases, it is advisable to use adsorbent antidiarrheal drugs such as montelukast.
(3) laxative drugs Constipated patients use laxative drugs as appropriate, it is advisable to use mild laxatives to reduce adverse reactions and drug dependence. Commonly used are volumetric drugs such as oxytocin and methylcellulose, osmotic laxatives such as polyethylene glycol, lactulose or sorbitol, etc.
(4) intestinal power sensory modulation 5-HT3 receptor antagonist alosetron can improve abdominal pain and reduce the number of stools in severe patients, but can start ischemic colitis and other serious adverse effects. 5-HT4 receptor partial agonist tegaserod has been discontinued due to cardiovascular adverse effects.
(5) Probiotics such as bifidobacterium, lactobacillus, casein, and other preparations are effective in improving symptoms.
(6) Depressants can be tried for those who have heavy abdominal pain symptoms and the above treatments are ineffective, especially when accompanied by more obvious psychiatric symptoms.
(7) Chinese medicine treatment Chinese medicine and acupuncture may have certain effect. 3. Psychological and behavioral therapy Those with severe and persistent symptoms and ineffective general treatment and drug therapy should consider psychological and behavioral therapy, including psychotherapy, cognitive therapy, hypnotherapy and biofeedback therapy.