Diagnosis and Treatment of Irritable Bowel Syndrome: Clinical Recommendations of the Russian Gastroenterological Association and Association of Coloproctologists of Russia
В. Т. Ивашкин, И. В. Маев, Yu. A. Shelygin, Е. К. Baranskaya, С. С. Белоус, Е. Д. Белоусова, А. Г. Бениашвили, Sergey Vasilyev, А. V. Veselov, Е. G. Grigoryev, Н. В. Костенко, В. Н. Кашников, Vladimir F. Kulikovskiy, I. D. Loranskaya, O. S. Lyashenko, Elena Poluektova, V. G. Rumyantsev, Timerbulatov Vm, O. Yu. Fomenko, Д. А. Хубезов, E. Yu. Chashkova, G. I. Chibisov, М. В. Шапина, А. А. Шептулин, О. С. Шифрин, А. С. Трухманов, О. П. Алексеева, S. A. Alekseenko, A. Yu. Baranovsky, O. Yu. Zolnikova, N. V. Korochanskaya, S. N. Mammayev, И. Б. Хлынов, В. В. Цуканов
Abstract
Aim . Current clinical recommendations accentuate current methods for the diagnosis and treatment of irritable bowel syndrome (IBS). Key points. IBS is a functional bowel disorder manifested with recurrent, at least weekly, abdominal pain with the following attributes (any two leastwise): link to defecation, its frequency or stool shape. The symptoms are expected to persist for at minimum three months in a total six-month follow-up. Similar to other functional gastrointestinal (GI) disorders, IBS can be diagnosed basing on the patient symptoms compliance with Rome IV criteria, provided the absence of potentially symptom-causative organic GI diseases. Due to challenging differential diagnosis, IBS can be appropriately established per exclusionem, with pre-examination as follows: general and biochemical blood tests; tissue transglutaminase IgA/IgG antibody tests; thyroid hormones test; faecal occult blood test; hydrogen glucose/ lactulose breath test for bacterial overgrowth; stool test for enteric bacterial pathogens and Clostridium difficile A/B toxins; stool calprotectin test; abdominal ultrasound; OGDS, with biopsy as appropriate; colonoscopy with biopsy. The IBS sequence is typically wavelike, with alternating remissions and exacerbations often triggered by psychoemotional stress. Treatment of IBS patients includes dietary and lifestyle adjustments, various-class drug agents prescription and psychotherapeutic measures. Conclusion . Adherence to clinical recommendations can facilitate timely diagnosis and improve medical aid quality in patients with different clinical IBS variants.