[Guidelines for the treatment of irritable bowel syndrome]

Korean J Gastroenterol. 2011 Feb;57(2):82-99. doi: 10.4166/kjg.2011.57.2.82.
[Article in Ko]

Abstract

Traditional symptom-based therapies of irritable bowel syndrome (IBS) are directed at the relief of individual IBS symptoms, but they are often of limited efficacy in addressing the entire symptom complex. Combinations of drugs to target bothersome symptoms are suggested as the first-line pharmacologic treatment. Increasing knowledge of the pathophysiology and molecular mechanisms of IBS has resulted in the development of several new therapeutic approaches. Thirteen consensus statements for the treatment of IBS were developed using the modified Delphi approach. Exclusion diets have modest efficacy in improving symptoms in some IBS patients. Symptom-based therapies with dietary fiber, bulking agents, laxatives, antispasmodics and laxatives are effective in the improvement of some individual symptoms, e.g. dietary fiber and bulking agents for constipation, laxatives for constipation, antispasmodics for abdominal pain and discomfort, antidiarrheals for diarrhea. 5HT3 receptor antagonists and 5HT((4)) receptor agonists are effective in the relief of global IBS symptoms and individual symptoms such as abdominal pain and abnormal bowel habits. A short term course of nonabsorbable antibiotics may improve global IBS symptoms, particularly in patients with diarrhea- predominant IBS. Some probiotics appear to have the potential benefit in improving global IBS symptoms. Selective C-2 chloride channel activator is more effective than placebo at relieving global IBS symptoms in patients with constipation-predominant IBS. Both tricyclic antidepressants and selective serotonin reuptake inhibitors are equally effective in relieving global IBS symptoms, and have some benefits in treating abdominal pain. Certain types of psychologic therapy may be effective in improving global symptoms in some IBS patients. Further studies are strongly needed to develop better treatment strategies for Korean patients with IBS.

Publication types

  • Practice Guideline

MeSH terms

  • Anti-Infective Agents / therapeutic use
  • Antidepressive Agents / therapeutic use
  • Antidiarrheals / therapeutic use
  • Dietary Fiber / therapeutic use
  • Humans
  • Irritable Bowel Syndrome / therapy*
  • Laxatives / therapeutic use
  • Parasympatholytics / therapeutic use
  • Probiotics / therapeutic use
  • Serotonin 5-HT4 Receptor Agonists / therapeutic use
  • Serotonin Antagonists / therapeutic use

Substances

  • Anti-Infective Agents
  • Antidepressive Agents
  • Antidiarrheals
  • Dietary Fiber
  • Laxatives
  • Parasympatholytics
  • Serotonin 5-HT4 Receptor Agonists
  • Serotonin Antagonists