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Diagnostic and therapeutic strategies in the irritable bowel syndrome.
Minerva Med 2004; 95(5):427-41MM

Abstract

The management of patients with irritable bowel syndrome (IBS) is a frequent, yet challenging task in both primary care and gastroenterology practice. A diagnostic strategy guided by keen clinical judgment should focus on positive symptom criteria and on the absence of alarm symptoms. In younger patients lacking alarm features, invasive testing has a low-yield. The presence of food intolerance and underlying celiac disease should be excluded. The usefulness of fecal tests such as calprotectin and lactoferrin to exclude organic bowel disease is not adequately established. In patients with moderate to severe symptoms who fail initial therapeutic trials, further tests can be performed in tertiary care settings, such as transit measurement and tests for diagnosing pelvic floor dysfunction. Treatment strategies for IBS are currently directed at the predominant symptoms. In diarrhea-predominant IBS, opioids (e.g. loperamide) and the 5-HT(3) receptor antagonist alosetron are efficacious. In constipation-predominant IBS, fiber and bulk laxatives are traditionally used, but their efficacy is variable and may worsen symptoms. The 5-HT(4) receptor agonist tegaserod is efficacious in female patients with IBS and constipation. In patients with IBS and abdominal pain, antispasmodics and antidepressants can be used, with the best evidence supporting the prescription of tricyclic antidepressants. The efficacy of psychological treatments in terms of relieving the symptoms of IBS is still uncertain. Limited evidence suggests that anti-enkephalinase agents, somatostatin analogues, alpha(2)-receptor agonists, opioid antagonists, selective serotonin reuptake inhibitors, probiotics and herbal treatments may be useful in IBS patients.

Authors+Show Affiliations

Clinical Enteric Neuroscience Translational and Epidemiological Research, (CENTER) Program, Mayo Clinic, Rochester, MN, USA.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Review

Language

eng

PubMed ID

15467518

Citation

Cremonini, F, and N J. Talley. "Diagnostic and Therapeutic Strategies in the Irritable Bowel Syndrome." Minerva Medica, vol. 95, no. 5, 2004, pp. 427-41.
Cremonini F, Talley NJ. Diagnostic and therapeutic strategies in the irritable bowel syndrome. Minerva Med. 2004;95(5):427-41.
Cremonini, F., & Talley, N. J. (2004). Diagnostic and therapeutic strategies in the irritable bowel syndrome. Minerva Medica, 95(5), pp. 427-41.
Cremonini F, Talley NJ. Diagnostic and Therapeutic Strategies in the Irritable Bowel Syndrome. Minerva Med. 2004;95(5):427-41. PubMed PMID: 15467518.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic and therapeutic strategies in the irritable bowel syndrome. AU - Cremonini,F, AU - Talley,N J, PY - 2004/10/7/pubmed PY - 2004/12/16/medline PY - 2004/10/7/entrez SP - 427 EP - 41 JF - Minerva medica JO - Minerva Med. VL - 95 IS - 5 N2 - The management of patients with irritable bowel syndrome (IBS) is a frequent, yet challenging task in both primary care and gastroenterology practice. A diagnostic strategy guided by keen clinical judgment should focus on positive symptom criteria and on the absence of alarm symptoms. In younger patients lacking alarm features, invasive testing has a low-yield. The presence of food intolerance and underlying celiac disease should be excluded. The usefulness of fecal tests such as calprotectin and lactoferrin to exclude organic bowel disease is not adequately established. In patients with moderate to severe symptoms who fail initial therapeutic trials, further tests can be performed in tertiary care settings, such as transit measurement and tests for diagnosing pelvic floor dysfunction. Treatment strategies for IBS are currently directed at the predominant symptoms. In diarrhea-predominant IBS, opioids (e.g. loperamide) and the 5-HT(3) receptor antagonist alosetron are efficacious. In constipation-predominant IBS, fiber and bulk laxatives are traditionally used, but their efficacy is variable and may worsen symptoms. The 5-HT(4) receptor agonist tegaserod is efficacious in female patients with IBS and constipation. In patients with IBS and abdominal pain, antispasmodics and antidepressants can be used, with the best evidence supporting the prescription of tricyclic antidepressants. The efficacy of psychological treatments in terms of relieving the symptoms of IBS is still uncertain. Limited evidence suggests that anti-enkephalinase agents, somatostatin analogues, alpha(2)-receptor agonists, opioid antagonists, selective serotonin reuptake inhibitors, probiotics and herbal treatments may be useful in IBS patients. SN - 0026-4806 UR - https://www.unboundmedicine.com/medline/citation/15467518/Diagnostic_and_therapeutic_strategies_in_the_irritable_bowel_syndrome_ L2 - http://www.diseaseinfosearch.org/result/3876 DB - PRIME DP - Unbound Medicine ER -