Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction which can have a considerable impact on quality of life. Following diagnosis, timely and evidence-based management is vital to the care of patients with IBS, aiming to improve outcomes, and enhance patient satisfaction. Good communication is paramount, and clinicians should provide a clear explanation about the disorder, with a focus on exploring the patient’s own beliefs about IBS, and a discussion of any concerns they may have. It should be emphasised that symptoms are often chronic, and that treatment, while aiming to improve symptoms, may not relieve them completely. Initial management should include simple lifestyle and dietary advice, discussion of the possible benefit of some probiotics, and, if this is unsuccessful, patients can be referred to a dietician for consideration of a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet. Antispasmodics and peppermint oil can be used first-line for the treatment of abdominal pain. If patients fail to respond, central neuromodulators can be used second-line; tricyclic antidepressants should be preferred. Loperamide and laxatives can be used first-line for treating diarrhoea and constipation, respectively. Patients with constipation who fail to respond to laxatives should be offered a trial of linaclotide. For patients with diarrhoea, the 5-hydroxytryptamine-3 receptor agonists alosetron and ramosetron appear to be the most effective second-line drugs. Where these are unavailable, ondansetron is a reasonable alternative. If medical treatment is unsuccessful, patients should be referred for psychological therapy, where available, if they are amenable to this. Cognitive behavioural therapy and gut-directed hypnotherapy are the psychological therapies with the largest evidence base.

中文翻译：

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肠易激综合症的最佳治疗


肠易激综合症（IBS）是一种常见的肠-脑相互作用疾病，对生活质量产生相当大的影响。诊断后，及时和基于证据的管理对于 IBS 患者的护理至关重要，旨在改善结果并提高患者满意度。良好的沟通至关重要，临床医生应提供有关该疾病的清晰解释，重点是探索患者自己对 IBS 的看法，并讨论他们可能有的任何担忧。应该强调的是，症状通常是慢性的，治疗虽然旨在改善症状，但可能无法完全缓解症状。初始管理应包括简单的生活方式和饮食建议，讨论某些益生菌的可能益处，如果不成功，可以将患者转介给营养师，考虑低 FODMAP（可发酵寡糖、二糖、单糖和多元醇）饮食。解痉药和薄荷油可作为治疗腹痛的一线药物。如果患者没有反应，可以使用中枢神经调节剂作为二线药物；应首选三环类抗抑郁药。洛哌丁胺和泻药可分别作为治疗腹泻和便秘的一线药物。对泻药无效的便秘患者应试用利那洛肽。对于腹泻患者，5-羟色胺-3受体激动剂阿洛司琼和雷莫司琼似乎是最有效的二线药物。如果无法获得这些药物，昂丹司琼是一个合理的替代方案。如果药物治疗不成功，如果患者愿意的话，应将其转介接受心理治疗。 认知行为疗法和肠道导向催眠疗法是拥有最大证据基础的心理疗法。