Therapy irritable bowel syndrome
Chronic abdominal complaints that persist for more than 3 months, such as abdominal pain, flatulence and stool irregularities without pathological changes in the diagnosis suggest the diagnosis of irritable bowel syndrome.
The diagnosis is a so-called exclusion diagnosis, i.e, other diseases that can lead to gastrointestinal complaints must first be excluded, such as Crohn's disease, ulcerative colitis, celiac disease, gastrointestinal tumours, infectious intestinal diseases, disorders of the pancreas digestion of fats (exocrine pancreatic insufficiency) Food allergies, hyperthyroidism, circulatory disorders (mesenteric ischemia), functional disorders due to adhesions after surgery, diverticular disease, bacterial colonization of the small intestine, carbohydrate malabsorption (e.g., carbohydrate deficiency), and other diseases.B. lactose intolerance, fructose malabsorption), ovarian tumours. Gastroscopy, colonoscopy, H2 breath tests and C13 breath tests as well as ultrasound examination of the abdominal cavity, blood tests, stool tests for calprotectin and pathogenic germs and, if necessary, a contrast medium examination of the small intestine (MR Sellink) are part of the diagnosis of chronic abdominal complaints or stool irregularities. If there are no abnormal findings, the diagnosis of irritable bowel syndrome is likely.
The causes of irritable bowel syndrome include
- Bacterial enteritis (postinfectious irritable bowel syndrome), e.g. after severe salmonella infection or other infectious diseases of the intestinal mucosa
- Change in the intestinal flora, e.g. after antibiotic therapy
- Genetic predisposition
- Mental causes
- Changed motility
- Increased mucous membrane permeability (leaky good)
- immune cells in mucosal biopsies, e.g. intraepithelial T cells, mast cells
The therapy of irritable bowel syndrome is often very difficult and depends on the symptoms. It is important to stress that irritable bowel syndrome is a stressful but not dangerous or malignant disease.
For pain-oriented therapy, spasmolytics, e.g. mebeverine, buscopan, probiotics, e.g. E. coli Nissle, bifidobacteria, lactobacilli, Saccaromyces, soluble dietary fibres, such as pectins, hemicellulose, psyllium preparations, topical antibiotics if necessary and antidepressants, e.g. amitryptiline, if necessary are used.
Therapy for constipation includes fibre, laxatives such as PEG-electolytic solutions and lactulose, prokinetics such as prucalopride, probiotics, herbal medicines (phytotherapeutics), spasmolytics, e.g. mebeverine.
For diarrhoea, drugs such as loperamide, the temporary use of opium drops, colestyramine, probiotics, the temporary use of topical antibiotics, dietary fibre and, in therapy-resistant cases, tricyclic antidepressants are used.
For flatulence, the use of probiotics, simethicone, phytotherapeutics and, in refractory cases, the temporary use of topical antibiotics is recommended.
Tips on diet for irritable bowel syndrome
It makes sense to keep a nutrition diary for about 14 days, recording your eating habits (time, type and quantity of food and any complaints that may arise afterwards), in order to draw up an individual long-term nutrition plan.
A nutritional approach is the so-called low-FODMAP diet (fermentable oligosaccharides disaccharides, monosaccharides and polyols), which is limited for 4-6 weeks.
FODMAP's reduced diet can help to significantly reduce symptoms of bloating, bloating, cramps and / or diarrhea. Foodstuffs with high proportions of: Fructose, lactose, fructans (fructo-oligosaccharides), galactans and polyols. Polyols include sugar alcohols such as sorbitol, mannitol, isomalt and xylitol. These are found in some fruits, but especially in finished products and soft drinks. The diet should be carried out for a minimum of 4 and a maximum of 8 weeks. It is important that patients should strictly follow the diet during this period and not make any exceptions. Psychotherapeutic treatment can also be useful and considered if indicated.
Antimycotics are not indicated for RDS, even in the case of positive candida detection in stool, as there are no controlled studies that prove a causal relationship between fungal infection and irritable bowel syndrome. The treatment of a positive candida detection in stool with antifungal drugs with side effects should be avoided. Nutrition also seems to play a role in irritable bowel syndrome.
