Irritable bowel syndrome K58.9; F45.32

Authors: Prof. Dr. med. Peter Altmeyer, Prof. Dr. med. Guido Gerken

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Last updated on: 21.04.2021

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Synonym(s)

IBS; irritable bowel syndrome; Irritable bowel syndrome; irritable colon (IBS); RDS; spastic colon

Definition
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Irritable bowel syndrome refers to a frequently occurring but not clearly defined clinical picture characterised by various abdominal complaints. It is often associated with psychosomatic diseases.

According to the S3 guideline "Irritable bowel syndrome", 3 criteria must be met:

  • Complaints lasting for >3 months (e.g. abdominal pain, flatulence), which are related to the abdomen by the patient and doctor and are usually accompanied by changes in bowel movements.
  • Relevant limitations of the quality of life
  • There are no changes typical for other clinical pictures which are responsible for these symptoms.

Classification
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Irritable bowel syndrome can be divided into 3 subtypes:

  • diarrhoea (RDS-D)
  • Constipation (RDS-O)
  • Mixing type (RDS-M)

Occurrence/Epidemiology
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Irritable bowel syndrome affects 7-21% of the general population at some point in their lives (Soares RL 2014).

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Etiopathogenesis
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The irritable bowel syndrome is based on constitutional and psychological stress factors. These include above all stress and anger as well as expired intestinal infections. An association between "travellers' diarrhea" and post-infectious irritable bowel syndrome has been demonstrated.

Clinical features
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The clinical picture of irritable bowel syndrome is characterized by cramping, burning or stabbing abdominal pain. In addition, there is a feeling of pressure in the lower abdomen or left colon, a feeling of fullness, audible bowel sounds, constipation, flatulence and diarrhoea. Weight loss is usually not noticeable.

Laboratory
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In the case of irritable bowel syndrome, the following parameters should be within the normal range: BSG, CRP, liver and pancreatic enzymes, blood count, haemoccult test and calprotectin in the stool. Furthermore, the defecation should not contain any worm eggs.

Diagnosis
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For the diagnosis of an irritable bowel syndrome, a medical history including a clinical picture is taken according to ROM III criteria. In addition, a sonography of the abdomen, a digital scan of the colon and, if necessary, further diagnostics of the abdomen are performed.

Differential diagnosis
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If there is existing pain in the left lower abdomen, you should:

  • Diverticulitis
  • Inguinal hernia
  • Adnexal diseases
  • Endometriosis
  • other colonic diseases

should be excluded. If there is pain in the left upper abdomen, diseases of the spleen, pancreas, heart, stomach, and esophagus should be ruled out.
In addition, exclusion of fructose and lactose intolerance, microscopic colitis and sprue should be excluded.

Therapy
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There is no known effective therapy for the treatment of irritable bowel syndrome. Therapeutic measures concentrate on dietary measures and treatment of the stress conditions.

Dietary measures: omitting the food that increases the symptoms, smaller and more frequent meals. In irritable bowel syndrome, a high-fibre diet with sufficient fluid intake.

In various larger studies, probiotics have proven to be a helpful therapeutic option (Didari T et al. 2015).

Symptomatic therapeutic approaches: For cramping pain - spasmolytics. For heartburn, nausea and constipation: prokinetics. For diarrhoea: Antidiarrhoeal drugs.

Naturopathy
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Psyllii semen (flea seed) and Plantaginis ovatae semen (Indian flea seed)

Directions foruse: The daily dose of psyllium or Indian psyllium/flea seed husks is 10 to 30 g, or 12 to 20g. Flea seeds are taken before the meal. To do this, 1 teaspoon of the drug is mixed with about 150 ml of cold water and consumed. Psyllium husks (1-2 teaspoons) are taken with soups or other liquids.

Preparations: Agiocur® granules, Flosine® balance granules, Mucofalk® apple/orange granules, Pascomucil® powder, Schoenenberger NatuPur, Medacalm®, [email protected]

Combined preparations: In the case of irritable bowel syndrome with chronic constipation, a combined preparation with lactulose is recommended; if diarrhoea predominates, a combined preparation with peppermint in capsules resistant to gastric juice is recommended.


Lini semen (linseed)

Directions: Soak two to three tablespoons of the crushed linseed in ¼ to ½ litres of water, then boil briefly, separate the linseed from the mucus and drink the mucus in sips.

Preparations: Linusit® Gold quality linseed, 3 times daily 1 bag before meals and 2 bags before sleeping.

Combination preparations: It is recommended to use in combination with camomile flower extracts, but a ready-to-use combination is not available.

Menthae piperitae aetheroleum (peppermint oil)

Preparations: Chiana® capsules entericcoated, 1 capsule 3 times daily before meals; Medacalm® hard capsules entericcoated, 1 capsule 3 times daily unchewed before meals

Literature
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  1. Chey WD et al (2015) Irritable bowel syndrome: a clinical review. JAMA 313:949-958.
  2. Didari T et al (2015) Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis. World J Gastroenterol 21:3072-3084.
  3. Schwille-Kiuntke J et al (2015) Systematic review with meta-analysis: post-infectious irritable bowel syndrome after travellers' diarrhoea. Aliment Pharmacol Ther 41:1029-1037.
  4. Soares RL (2014) Irritable bowel syndrome: a clinical review. World J Gastroenterol. 20:12144-12160.
  5. Wall GC et al (2014) Irritable bowel syndrome: a concise review of current treatment concepts. World J Gastroenterol 20:8796-8806.

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Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 21.04.2021