The Korean Journal of Gastroenterology (대한소화기학회지)

The Korean Society of Gastroenterology (대한소화기학회)
권호 표지
DOI QR코드

DOI QR Code

Irritable Bowel Syndrome

과민성장증후군

  • Kim, Jae Hak (Department of Internal Medicine, Dongguk University College of Medicine) ;
  • Jee, Sam Ryong (Department of Internal Medicine, Inje University College of Medicine)
  • 김재학 (동국대학교 의과대학 내과학교실) ;
  • 지삼룡 (인제대학교 의과대학 내과학교실)
  • Received : 2018.12.28
  • Accepted : 2019.02.01
  • Published : 2019.02.25
⟨ Previous Next ⟩

Abstract

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. Its diagnosis is based on symptoms, and the Rome IV criteria are recognized as the gold diagnostic standard. The Korean Society of Neurogastroenterology and Motility (KSNM) recently updated their clinical practice guidelines for the treatment of IBS, which were last issued in 2011. In this updated edition, the KSNM defines IBS as a chronic, recurrent symptom complex that includes abdominal pain or discomfort, changes in bowel habits, and bloating for at least 6 months, which is somewhat broader than the previous definition. Four major topics have been changed in the up-dated version in-line with the results of recent studies, that is, colonoscopy; a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols; probiotics; and rifaximin. Herein, we review the 2017 revised edition of the KSNM with respect to recommended clinical practice guidelines for IBS and compare these with other guidelines.

Keywords

References

  1. Manning AP, Thompson WG, Heaton KW, Morris AF. Towards positive diagnosis of the irritable bowel. Br Med J 1978;2:653-654. https://doi.org/10.1136/bmj.2.6138.653
  2. Palsson OS, Whitehead WE, van Tilburg MA, et al. Rome IV diagnostic questionnaires and tables for investigators and clinicians. Gastroenterology 2016 Feb 13. [Epub ahead of print]
  3. Stanisic V, Quigley EM. The overlap between IBS and IBD: what is it and what does it mean? Expert Rev Gastroenterol Hepatol 2014;8:139-145. https://doi.org/10.1586/17474124.2014.876361
  4. Ford AC, Bercik P, Morgan DG, Bolino C, Pintos-Sanchez MI, Moayyedi P. Validation of the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care. Gastroenterology 2013;145:1262-1270.e1. https://doi.org/10.1053/j.gastro.2013.08.048
  5. American College of Gastroenterology Task Force on Irritable Bowel Syndrome, Brandt LJ, Chey WD, et al. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 2009;104 Suppl 1:S1-S35.
  6. Gwee KA, Bak YT, Ghoshal UC, et al. Asian consensus on irritable bowel syndrome. J Gastroenterol Hepatol 2010;25:1189-1205. https://doi.org/10.1111/j.1440-1746.2010.06353.x
  7. Hookway C, Buckner S, Crosland P, Longson D. Irritable bowel syndrome in adults in primary care: summary of updated NICE guidance. BMJ 2015;350:h701. https://doi.org/10.1136/bmj.h701
  8. Fukudo S, Kaneko H, Akiho H, et al. Evidence-based clinical practice guidelines for irritable bowel syndrome. J Gastroenterol 2015;50:11-30. https://doi.org/10.1007/s00535-014-1017-0
  9. Chang L, Lembo A, Sultan S. American gastroenterological association institute technical review on the pharmacological management of irritable bowel syndrome. Gastroenterology 2014;147:1149-1172.e2. https://doi.org/10.1053/j.gastro.2014.09.002
  10. Spiller R, Aziz Q, Creed F, et al. Guidelines on the irritable bowel syndrome: mechanisms and practical management. Gut 2007;56:1770-1798. https://doi.org/10.1136/gut.2007.119446
  11. Park JH, Byeon JS, Shin WG, et al. Diagnosis of irritable bowel syndrome: a systematic review. Korean J Gastroenterol 2010;55:308-315. https://doi.org/10.4166/kjg.2010.55.5.308
  12. Kwon JG, Park KS, Park JH, et al. Guidelines for the treatment of irritable bowel syndrome. Korean J Gastroenterol 2011;57:82-99. https://doi.org/10.4166/kjg.2011.57.2.82
  13. Song KH, Jung HK, Kim HJ, et al. Clinical practice guidelines for irritable bowel syndrome in Korea, 2017 revised edition. J Neurogastroenterol Motil 2018;24:197-215. https://doi.org/10.5056/jnm17145
  14. Pimentel M, Talley NJ, Quigley EM, Hani A, Sharara A, Mahachai V. Report from the multinational irritable bowel syndrome initiative 2012. Gastroenterology 2013;144:e1-e5.
  15. Hammer J, Eslick GD, Howell SC, Altiparmak E, Talley NJ. Diagnostic yield of alarm features in irritable bowel syndrome and functional dyspepsia. Gut 2004;53:666-672. https://doi.org/10.1136/gut.2003.021857
  16. Jung HK, Choung RS, Locke GR 3rd, Schleck CD, Zinsmeister AR, Talley NJ. Diarrhea-predominant irritable bowel syndrome is associated with diverticular disease: a population-based study. Am J Gastroenterol 2010;105:652-661. https://doi.org/10.1038/ajg.2009.621
  17. Limsui D, Pardi DS, Camilleri M, et al. Symptomatic overlap between irritable bowel syndrome and microscopic colitis. Inflamm Bowel Dis 2007;13:175-181. https://doi.org/10.1002/ibd.20059
  18. Simren M, Mansson A, Langkilde AM, et al. Food-related gastrointestinal symptoms in the irritable bowel syndrome. Digestion 2001;63:108-115.
  19. Park MI, Camilleri M. Is there a role of food allergy in irritable bowel syndrome and functional dyspepsia? A systematic review. Neurogastroenterol Motil 2006;18:595-607. https://doi.org/10.1111/j.1365-2982.2005.00745.x
  20. Cuomo R, Andreozzi P, Zito FP, Passananti V, De Carlo G, Sarnelli G. Irritable bowel syndrome and food interaction. World J Gastroenterol 2014;20:8837-8845. https://doi.org/10.3748/wjg.v20.i27.8837
  21. Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014;146:67-75.e5. https://doi.org/10.1053/j.gastro.2013.09.046
  22. Nanayakkara WS, Skidmore PM, O'Brien L, Wilkinson TJ, Gearry RB. Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date. Clin Exp Gastroenterol 2016;9:131-142. https://doi.org/10.2147/ceg.s86798
  23. Bohn L, Storsrud S, Liljebo T, et al. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology 2015;149:1399-1407.e2. https://doi.org/10.1053/j.gastro.2015.07.054
  24. Staudacher HM, Lomer MCE, Farquharson FM, et al. A diet low in FODMAPs reduces symptoms in patients with irritable bowel syndrome and a probiotic restores bifidobacterium species: a randomized controlled trial. Gastroenterology 2017;153:936-947. https://doi.org/10.1053/j.gastro.2017.06.010
  25. Mansueto P, Seidita A, D'Alcamo A, Carroccio A. Role of FODMAPs in patients with irritable bowel syndrome. Nutr Clin Pract 2015; 30:665-682. https://doi.org/10.1177/0884533615569886
  26. Varju P, Farkas N, Hegyi P, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: a meta-analysis of clinical studies. PLoS One 2017;12:e0182942. https://doi.org/10.1371/journal.pone.0182942
  27. Johannesson E, Simren M, Strid H, Bajor A, Sadik R. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol 2011;106:915-922. https://doi.org/10.1038/ajg.2010.480
  28. Johannesson E, Ringstrom G, Abrahamsson H, Sadik R. Intervention to increase physical activity in irritable bowel syndrome shows long-term positive effects. World J Gastroenterol 2015;21:600-608. https://doi.org/10.3748/wjg.v21.i2.600
  29. Moayyedi P, Quigley EM, Lacy BE, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol 2014;109:1367-1374. https://doi.org/10.1038/ajg.2014.195
  30. Ford AC, Talley NJ, Spiegel BM, et al. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ 2008;337:a2313. https://doi.org/10.1136/bmj.a2313
  31. Snook J, Shepherd HA. Bran supplementation in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther 1994;8:511-514. https://doi.org/10.1111/j.1365-2036.1994.tb00323.x
  32. Chapman RW, Stanghellini V, Geraint M, Halphen M. Randomized clinical trial: macrogol/PEG 3350 plus electrolytes for treatment of patients with constipation associated with irritable bowel syndrome. Am J Gastroenterol 2013;108:1508-1515. https://doi.org/10.1038/ajg.2013.197
  33. Khoshoo V, Armstead C, Landry L. Effect of a laxative with and without tegaserod in adolescents with constipation predominant irritable bowel syndrome. Aliment Pharmacol Ther 2006;23:191-196. https://doi.org/10.1111/j.1365-2036.2006.02705.x
  34. Chey WY, Jin HO, Lee MH, Sun SW, Lee KY. Colonic motility abnormality in patients with irritable bowel syndrome exhibiting abdominal pain and diarrhea. Am J Gastroenterol 2001;96:1499-1506. https://doi.org/10.1111/j.1572-0241.2001.03804.x
  35. Ruepert L, Quartero AO, de Wit NJ, van der Heijden GJ, Rubin G, Muris JW. Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. Cochrane Database Syst Rev 2011;(8):CD003460.
  36. Clave P, Acalovschi M, Triantafillidis JK, et al. Randomised clinical trial: otilonium bromide improves frequency of abdominal pain, severity of distention and time to relapse in patients with irritable bowel syndrome. Aliment Pharmacol Ther 2011;34:432-442. https://doi.org/10.1111/j.1365-2036.2011.04730.x
  37. Jayanthi V, Malathi S, Ramathilakam B, Dinakaran N, Balasubramanian V, Mathew S. Role of pinaverium bromide in south Indian patients with irritable bowel syndrome. J Assoc Physicians India 1998;46:369-371.
  38. Defrance P, Casini A. A comparison of the action of otilonium bromide and pinaverium bromide: study conducted under clinical control. Ital J Gastroenterol 1991;23(8 Suppl 1):64-66.
  39. Cann PA, Read NW, Holdsworth CD, Barends D. Role of loperamide and placebo in management of irritable bowel syndrome (IBS). Dig Dis Sci 1984;29:239-247. https://doi.org/10.1007/BF01296258
  40. Hovdenak N. Loperamide treatment of the irritable bowel syndrome. Scand J Gastroenterol Suppl 1987;130:81-84. https://doi.org/10.3109/00365528709091004
  41. Lavo B, Stenstam M, Nielsen AL. Loperamide in treatment of irritable bowel syndrome--a double-blind placebo controlled study. Scand J Gastroenterol Suppl 1987;130:77-80.
  42. Efskind PS, Bernklev T, Vatn MH. A double-blind placebo-controlled trial with loperamide in irritable bowel syndrome. Scand J Gastroenterol 1996;31:463-468. https://doi.org/10.3109/00365529609006766
  43. Goldberg PA, Kamm MA, Setti-Carraro P, van der Sijp JR, Roth C. Modification of visceral sensitivity and pain in irritable bowel syndrome by 5-HT3 antagonism (ondansetron). Digestion 1996;57:478-483. https://doi.org/10.1159/000201377
  44. Matsueda K, Harasawa S, Hongo M, Hiwatashi N, Sasaki D. A phase II trial of the novel serotonin type 3 receptor antagonist ramosetron in Japanese male and female patients with diarrhea-predominant irritable bowel syndrome. Digestion 2008;77:225-235. https://doi.org/10.1159/000150632
  45. Fukudo S, Ida M, Akiho H, Nakashima Y, Matsueda K. Effect of ramosetron on stool consistency in male patients with irritable bowel syndrome with diarrhea. Clin Gastroenterol Hepatol 2014;12:953-959.e4. https://doi.org/10.1016/j.cgh.2013.11.024
  46. Fukudo S, Matsueda K, Haruma K, et al. Optimal dose of ramosetron in female patients with irritable bowel syndrome with diarrhea: a randomized, placebo-controlled phase II study. Neurogastroenterol Motil 2017;29:e13023. https://doi.org/10.1111/nmo.13023
  47. Fukudo S, Kinoshita Y, Okumura T, et al. Ramosetron reduces symptoms of irritable bowel syndrome with diarrhea and improves quality of life in women. Gastroenterology 2016;150:358-366.e8. https://doi.org/10.1053/j.gastro.2015.10.047
  48. Fukudo S, Kinoshita Y, Okumura T, et al. Effect of ramosetron in female patients with irritable bowel syndrome with diarrhea: a phase III long-term study. J Gastroenterol 2016;51:874-882. https://doi.org/10.1007/s00535-016-1165-5
  49. Grider JR, Foxx-Orenstein AE, Jin JG. 5-hydroxytryptamine4 receptor agonists initiate the peristaltic reflex in human, rat, and guinea pig intestine. Gastroenterology 1998;115:370-380. https://doi.org/10.1016/S0016-5085(98)70203-3
  50. Prather CM, Camilleri M, Zinsmeister AR, McKinzie S, Thomforde G. Tegaserod accelerates orocecal transit in patients with constipation-predominant irritable bowel syndrome. Gastroenterology 2000;118:463-468. https://doi.org/10.1016/S0016-5085(00)70251-4
  51. Bouras EP, Camilleri M, Burton DD, Thomforde G, McKinzie S, Zinsmeister AR. Prucalopride accelerates gastrointestinal and colonic transit in patients with constipation without a rectal evacuation disorder. Gastroenterology 2001;120:354-360. https://doi.org/10.1053/gast.2001.21166
  52. Ke M, Zou D, Yuan Y, et al. Prucalopride in the treatment of chronic constipation in patients from the Asia-Pacific region: a randomized, double-blind, placebo-controlled study. Neurogastroenterol Motil 2012;24:999-e541. https://doi.org/10.1111/j.1365-2982.2012.01983.x
  53. Ke M, Tack J, Quigley EM, et al. Effect of prucalopride in the treatment of chronic constipation in Asian and non-Asian women: a pooled analysis of 4 randomized, placebo-controlled studies. J Neurogastroenterol Motil 2014;20:458-468. https://doi.org/10.5056/jnm14029
  54. Bures J, Cyrany J, Kohoutova D, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol 2010;16:2978-2990. https://doi.org/10.3748/wjg.v16.i24.2978
  55. Carroll IM, Chang YH, Park J, Sartor RB, Ringel Y. Luminal and mucosal-associated intestinal microbiota in patients with diarrhea-predominant irritable bowel syndrome. Gut Pathog 2010;2:19. https://doi.org/10.1186/1757-4749-2-19
  56. Sharara AI, Aoun E, Abdul-Baki H, Mounzer R, Sidani S, Elhajj I. A randomized double-blind placebo-controlled trial of rifaximin in patients with abdominal bloating and flatulence. Am J Gastroenterol 2006;101:326-333. https://doi.org/10.1111/j.1572-0241.2006.00458.x
  57. Pimentel M, Park S, Mirocha J, Kane SV, Kong Y. The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial. Ann Intern Med 2006;145:557-563. https://doi.org/10.7326/0003-4819-145-8-200610170-00004
  58. Pimentel M, Lembo A, Chey WD, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med 2011;364:22-32. https://doi.org/10.1056/NEJMoa1004409
  59. Lembo A, Pimentel M, Rao SS, et al. Repeat treatment with rifaximin is safe and effective in patients with diarrhea-predominant irritable bowel syndrome. Gastroenterology 2016;151:1113-1121. https://doi.org/10.1053/j.gastro.2016.08.003
  60. Brenner DM, Moeller MJ, Chey WD, Schoenfeld PS. The utility of probiotics in the treatment of irritable bowel syndrome: a systematic review. Am J Gastroenterol 2009;104:1033-1049; quiz 1050. https://doi.org/10.1038/ajg.2009.25
  61. Didari T, Mozaffari S, Nikfar S, Abdollahi M. Effectiveness of probiotics in irritable bowel syndrome: updated systematic review with meta-analysis. World J Gastroenterol 2015;21:3072-3084. https://doi.org/10.3748/wjg.v21.i10.3072
  62. Ford AC, Talley NJ, Schoenfeld PS, Quigley EM, Moayyedi P. Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. Gut 2009;58:367-378. https://doi.org/10.1136/gut.2008.163162
  63. Ford AC, Quigley EM, Lacy BE, et al. Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol 2014;109:1350-1365; quiz 1366. https://doi.org/10.1038/ajg.2014.148
  64. Xie C, Tang Y, Wang Y, et al. Efficacy and safety of antidepressants for the treatment of irritable bowel syndrome: a meta-analysis. PLoS One 2015;10:e0127815. https://doi.org/10.1371/journal.pone.0127815

Cited by

  1. Study of hepatic histomorphology in HBeAg+ and HBeAg- patients with CHB: Experience from Bangladesh vol.2, pp.3, 2019, https://doi.org/10.1016/s2221-6189(13)60133-x
  2. The Effect of Complex Korean Medical Treatment with Acupotomy on Irritable Bowel Syndrome: A Case Report vol.37, pp.1, 2019, https://doi.org/10.13045/jar.2019.00311
  3. 기능성 위장관 질환의 한의학적 치료 연구전략 수립을 위한 연구 동향 분석 vol.29, pp.1, 2021, https://doi.org/10.14374/hfs.2021.29.1.57