Review Article: Current and future treatment approaches for IBS with diarrhoea (IBS‐D) and IBS mixed pattern (IBS‐M)

医学 肠易激综合征 利福昔明 便秘 腹痛 内科学 中西医结合 肠道通透性 显微镜下结肠炎 乳果糖 小肠细菌生长过度 功能性胃肠病 膨胀 胃肠病学 重症监护医学 替代医学 疾病 炎症性肠病 抗生素 病理 微生物学 生物
作者
Judy Nee,Anthony Lembo
出处
期刊:Alimentary Pharmacology & Therapeutics [Wiley]
卷期号:54 (S1) 被引量:19
标识
DOI:10.1111/apt.16625
摘要

Irritable bowel syndrome-diarrhoea (IBS-D) and IBS-mixed stool pattern (IBS-M) are disorders of gut-brain interaction characterised by abdominal pain associated with diarrhoea or both diarrhoea and constipation respectively. The pathophysiology of IBS-D/M is multifactorial and not completely understood; thus, treatment is aimed at multiple mechanisms such as altering gut microbiota, visceral hypersensitivity, intestinal permeability, gut-brain interaction and psychological strategies.The goal of this article was to provide an up-to-date review of the current evidence for both non-pharmacological and pharmacological treatment options in IBS-D and IBS-M. Future treatments for IBS-D and IBS-M will also be discussed.Medline and Embase database searches (through April 30 2021) to identify clinical studies in subjects with IBS-D in which dietary modification, alternative treatments (probiotics, acupuncture, exercise) as well as FDA-approved medications were used.Dietary modification is often the first line of therapy. Furthermore, lifestyle treatments include complementary alternative medications (CAM), probiotics and peppermint oil are useful adjuncts but have not specifically been described in IBS-D/M. Evidence strongly supports psychotherapy in the treatment of IBS. Beyond over-the counter anti-diarrhoeals, anti-spasmodics and anti-depressants, pharmacological treatment now includes treating for bile acid malabsorption and the FDA-approved medications rifaximin, eluxadoline and alosetron.The treatment of IBS-D/M ideally involves a multidisciplinary approach of primary care, gastroenterologist and psychologist. Treatment often involves both non-pharmacological and pharmacological therapies. Future therapies may include faecal microbial transplant, Crofelemer and serotonin antagonists, but further studies are needed.
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