BACKGROUND: Irritable bowel syndrome is characterized by chronic abdominal symptoms and irregular bowel movements without any cause than can be revealed by routine diagnostic assessment. In recent years, its pathophysiology has come to be much better understood, and new therapeutic approaches have been developed. These advances were taken into consideration and assessed for their relevance to clinical practice in the framework of a new interdisciplinary S3 guideline. METHODS: A systematic search of the literature retrieved a total 5573 articles, from which 243 were selected on the basis of criteria relating to their form and content, individually assessed, and summarized in evidence tables. The recommendations formulated in this way were discussed in a Delphi procedure and a consensus conference, then accordingly modified and finalized. RESULTS: Variable symptom constellations are caused by disturbances of gastrointestinal regulation at multiple levels. The diagnosis of irritable bowel syndrome requires both chronic bowel symptoms that interfere with everyday life and the exclusion of relevant differential diagnoses. Its treatment is based on general therapeutic principles, dietary recommendations, psychological components, and symptomatic medication. Bulking agents, laxatives, spasmolytics, loperamide, and probiotic agents are recommended (with variable recommendation strengths), as are--for selected patients--antidepressants, 5-HT4 agonists, 5-HT3 antagonists, and topical antibiotics. CONCLUSION: The first German S3 guideline on irritable bowel syndrome translates up-to-date scientific knowledge as represented in current publications into concrete recommendations for diagnosis and treatment in clinical practice. In the future, it is likely that further causative pathophysiological mechanisms will be discovered; this should lead, in turn, to the development of new, causally directed treatments, which will supplement or replace the traditional, purely symptomatic treatments that are still in use today.
BACKGROUND:Irritable bowel syndrome is characterized by chronic abdominal symptoms and irregular bowel movements without any cause than can be revealed by routine diagnostic assessment. In recent years, its pathophysiology has come to be much better understood, and new therapeutic approaches have been developed. These advances were taken into consideration and assessed for their relevance to clinical practice in the framework of a new interdisciplinary S3 guideline. METHODS: A systematic search of the literature retrieved a total 5573 articles, from which 243 were selected on the basis of criteria relating to their form and content, individually assessed, and summarized in evidence tables. The recommendations formulated in this way were discussed in a Delphi procedure and a consensus conference, then accordingly modified and finalized. RESULTS: Variable symptom constellations are caused by disturbances of gastrointestinal regulation at multiple levels. The diagnosis of irritable bowel syndrome requires both chronic bowel symptoms that interfere with everyday life and the exclusion of relevant differential diagnoses. Its treatment is based on general therapeutic principles, dietary recommendations, psychological components, and symptomatic medication. Bulking agents, laxatives, spasmolytics, loperamide, and probiotic agents are recommended (with variable recommendation strengths), as are--for selected patients--antidepressants, 5-HT4 agonists, 5-HT3 antagonists, and topical antibiotics. CONCLUSION: The first German S3 guideline on irritable bowel syndrome translates up-to-date scientific knowledge as represented in current publications into concrete recommendations for diagnosis and treatment in clinical practice. In the future, it is likely that further causative pathophysiological mechanisms will be discovered; this should lead, in turn, to the development of new, causally directed treatments, which will supplement or replace the traditional, purely symptomatic treatments that are still in use today.
Authors: P Layer; V Andresen; C Pehl; H Allescher; S C Bischoff; M Classen; P Enck; T Frieling; S Haag; G Holtmann; M Karaus; S Kathemann; J Keller; R Kuhlbusch-Zicklam; W Kruis; J Langhorst; H Matthes; H Mönnikes; S Müller-Lissner; F Musial; B Otto; C Rosenberger; M Schemann; I van der Voort; K Dathe; J C Preiss Journal: Z Gastroenterol Date: 2011-02-01 Impact factor: 2.000
Authors: J Keller; T Wedel; H Seidl; M E Kreis; V Andresen; J C Preiss; P Layer; I van der Voort Journal: Z Gastroenterol Date: 2011-03-09 Impact factor: 2.000
Authors: Mark Pimentel; Anthony Lembo; William D Chey; Salam Zakko; Yehuda Ringel; Jing Yu; Shadreck M Mareya; Audrey L Shaw; Enoch Bortey; William P Forbes Journal: N Engl J Med Date: 2011-01-06 Impact factor: 91.245
Authors: Jeffrey M Johnston; Caroline B Kurtz; James E Macdougall; Bernard J Lavins; Mark G Currie; Donald A Fitch; Chris O'Dea; Mollie Baird; Anthony J Lembo Journal: Gastroenterology Date: 2010-08-27 Impact factor: 22.682
Authors: P Moayyedi; A C Ford; N J Talley; F Cremonini; A E Foxx-Orenstein; L J Brandt; E M M Quigley Journal: Gut Date: 2008-12-17 Impact factor: 23.059
Authors: Clare O'Leary; Peter Wieneke; Sarah Buckley; Paud O'Regan; Comeilius C Cronin; Eamonn M M Quigley; Fergus Shanahan Journal: Am J Gastroenterol Date: 2002-06 Impact factor: 10.864
Authors: Paul Enck; Qasim Aziz; Giovanni Barbara; Adam D Farmer; Shin Fukudo; Emeran A Mayer; Beate Niesler; Eamonn M M Quigley; Mirjana Rajilić-Stojanović; Michael Schemann; Juliane Schwille-Kiuntke; Magnus Simren; Stephan Zipfel; Robin C Spiller Journal: Nat Rev Dis Primers Date: 2016-03-24 Impact factor: 52.329
Authors: Philipp Romero; Stefanie Schmitteckert; Mira M Wouters; Lesley A Houghton; Bastian Czogalla; Gregory S Sayuk; Guy E Boeckxstaens; Patrick Guenther; Stefan Holland-Cunz; Beate Niesler Journal: BMC Med Genet Date: 2015-12-11 Impact factor: 2.103