Recent advances in clinical practice: mastering the challenge—managing IBS symptoms in IBD

IF 23 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Gut Pub Date : 2024-11-12 DOI:10.1136/gutjnl-2024-333565
Judith Wellens, João Sabino, Tim Vanuytsel, Jan Tack, Séverine Vermeire
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Abstract

Many patients with IBD report persisting symptoms, despite resolution of the inflammatory process. Although by definition, a diagnosis of IBS cannot be made, the prevalence of ‘IBS in IBD’ surpasses the rate of IBS in the global population by fivefold. Because IBS-like symptoms are associated with a decreased quality of life and increased healthcare utilisation in IBD, diagnosis and treatment are necessary. In this review, we summarise the current knowledge on IBS-like symptoms in IBD. A pathophysiological common ground is present, which includes genetic susceptibility, environmental triggers, gut microbial dysbiosis, increased intestinal permeability, visceral hypersensitivity and involvement of brain–gut interaction. When symptoms persist after resolution of inflammation, other GI diseases should be excluded based on the chief complaint, considering any possible psychological co-morbidity early in the diagnostic work-up. Subsequent treatment should be initiated that is evidence-based and often multimodal, including classical and non-classical pharmacological agents as well as lifestyle and microbiota-based approaches, spanning the breadth of the gut, brain and its interaction. Treatment goals in this substantial part of the IBD population should be adapted to not only focus on treating the inflammation but taking care of the patient.
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临床实践的最新进展:应对挑战--处理 IBD 患者的肠易激综合征症状
许多 IBD 患者报告说,尽管炎症过程已经缓解,但症状依然存在。虽然根据定义,IBS 无法确诊,但 "IBD 中的 IBS "患病率是全球 IBS 患病率的五倍。由于类似 IBS 的症状与 IBD 患者生活质量下降和医疗费用增加有关,因此诊断和治疗是必要的。在这篇综述中,我们总结了目前有关 IBD 中 IBS 类症状的知识。病理生理学上存在一个共同点,包括遗传易感性、环境诱因、肠道微生物菌群失调、肠道通透性增加、内脏超敏和脑肠相互作用的参与。当炎症缓解后症状仍然存在时,应根据主诉排除其他消化道疾病,并在诊断工作的早期考虑任何可能的心理并发症。随后应启动循证治疗,通常是多模式治疗,包括经典和非经典药物治疗,以及基于生活方式和微生物群的方法,涵盖肠道、大脑及其相互作用的各个方面。这部分 IBD 患者的治疗目标应有所调整,不仅要重视治疗炎症,还要照顾好患者。
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来源期刊
Gut
Gut 医学-胃肠肝病学
CiteScore
45.70
自引率
2.40%
发文量
284
审稿时长
1.5 months
期刊介绍: Gut is a renowned international journal specializing in gastroenterology and hepatology, known for its high-quality clinical research covering the alimentary tract, liver, biliary tree, and pancreas. It offers authoritative and current coverage across all aspects of gastroenterology and hepatology, featuring articles on emerging disease mechanisms and innovative diagnostic and therapeutic approaches authored by leading experts. As the flagship journal of BMJ's gastroenterology portfolio, Gut is accompanied by two companion journals: Frontline Gastroenterology, focusing on education and practice-oriented papers, and BMJ Open Gastroenterology for open access original research.
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