Diagnosis and Treatment of Irritable Bowel Syndrome
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1 Special Issue Diagnosis and Treatment of Irritable Bowel Syndrome Myung Gyu Choi, M.D. Department of Internal Medicine The Catholic University of Korea, College of Medicine Kangnam St. Mary's Hospital E mail : choim@catholic.ac.kr Abstract Irritable bowel syndrome (IBS) is a common chronic, relapsing functional bowel disorder. IBS can be diagnosed according to the established series of criteria excluding organic diseases, and by institution of a therapeutic trial. Treatment should be tailored to individual patients needs and fears. Education and reassuring the patients is a simple and effective form of therapy. Correction of precipitating factors can also be therapeutic. Some patients may be helped by changing the diet, avoiding certain drugs, and reducing life stressors. Symptomatic treatment includes fiber for constipation, loperamide for diarrhea, and low dose antidepressants or antispasmodics for pain; therapeutic efficacy of novel modalities including drugs acting on serotonin receptors are under investigation. Keywords : Irritable bowel syndrome 61
2 : 1 1,
3 Special Issue 614
4 615
5 Special Issue 1. Pain and bloating. Constipation 3. Diarrhea Anticholinergics(cimetropium) Calcium antagonist(alverine, pinavarium, octilonium, mebeverine) Opiate agonist(trimebutine, fedotozine) Tricyclic or SSRI 5HT 3 antagonists(alosetron, cilansetron) 5HT agonist(cisapride, tegaserod) COX inhibitor? Antibiotics or probiotics? Dietary fiber(0 g/day) Psyllium 5HT4 agonist(cisapride, tegaserod) Loperamide, Diphenoxylate Cholestyramine(bile related; cholecystectomy) Antibiotics? psychotherapy stress management program 4. Major depression or Psychological treatment a history of abuse cognitive behavioral treatment Psychotropic medication tricyclic antidepressants(amitriptyline, imipramine) serotonin reuptake inhibitor(fluoxetine, paroxetine) 616
6 (meta analysis) N Duration Abd. pain (Weeks) Drug Placebo P Overall Assessment Drug Placebo P Mebeverine Peppermint oil Octylonium Prifinium Trimebutine Cibetropium Dicyclomine Buscopan % 83% 71% 73% 60% 75% 80% 87% 56% 8% 33% % % 0% 66% 8% 16% 41% NS NS 83% 71% 81% 83% 39% 50% 71% 78% 6% 89% 87% 84% 76% 33% 5% 55% 17% 5% 13% 5% 33% 68% 69% % 53% 64% NS NS 617
7 Special Issue 618
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