Functional intestinal symptoms in patients with inflammatory bowel disease: recommendations of the American Gastroenterological Association (2019)
Journal Title: Сучасна гастроентерологія - Year 2019, Vol 0, Issue 4
Abstract
The paper presents overview of the latest recommendations of the American Gastroenterological Association on the management of patients with functional intestinal symptoms (FIS). It was noted that the prevalence of irritable bowel syndrome (IBS) in patients with inflammatory bowel disease (IBD) amounts up to 39 % at average and more often observed at Crohn’s disease (CD) than at ulcerative colitis. The level of fecal calprotectin should be considered as a sensitive marker, allowing differential diagnosis between functional and inflammatory changes in intestine. The monitoring of fecal calprotectin is performed once every 3 — 6 months. In case of its increase, one can predict the risk of IBD exacerbation. In cases of appropriate symptoms, and if the fecal calprotectin level is elevated or borderline, a colonoscopy with a biopsy and histological examination is mandatory. At suspicious fibrostenosing CD form or if fistula is present, CT enterocolography is performed. Among the pathophysiological mechanisms that are potentially capable to affect the persistence of FIS in patients with IBD, inflammatory-associated deviations from the axis «central nervous system -gastrointestinal tract» are considered, mechanisms non-specifically associated with IBD, changes in the structure and function of the digestive tract due to IBD, such as malabsorption of bile acids, syndrome of intestinal bacterial overgrowth, exocrine pancreatic insufficiency, carbohydrate malabsorption and others. In the treatment of FIS and IBD, both non-drug (diet, psychotherapy) and drug-based symptom-based treatment methods can be used with account of the pathophysiological mechanisms. It has been concluded that at FIS and IBD combination, the restrictive diets, psychotherapy, antispasmodics and antidepressants, antibiotics (rifaximin) and probiotics are potentially useful. The additional randomized controlled trials are needed to work out more personalized approach to the management of patients with this pathology, as well as the study of new methods of treatment, such as fecal microbial transplantation.
Authors and Affiliations
S. M. Tkach, A. E. Dorofeev, Yu. G. Kuzenko
Keywords
Related Articles
- EP ID EP670124
- DOI 10.30978/MG-2019-4-36
- Views 122
- Downloads 0
First experience of the study of prevalence of the Helicobacter pylori-negative peptic ulcer in Lviv Region
The prevalence of Helicobacter pylori-negative peptic ulcers of the stomach and duodenum in Ukraine has not been studied yet. The lack of accounting for such patients, lack of knowledge of risk factors for the developmen...
The mechanisms of development of irritable bowel syndrome and treatment of abdominal pain in the light of Rome IV criteria
Objective — to assess the clinical efficacy of Capsumen in patients with irritable bowel syndrome (IBS) with pain syndrome. Materials and methods. The investigation involved 17 patients (7 women and 10 men aged 19 to 52...
The place of domperidone in the treatment of comorbid pathology of esophagus and stomach (a clinical case)
It has been established that around 20 % of patients with gastroesophageal reflux disease (GERD) have clinical symptoms of the functional gastric dyspepsia, and 20 — 30 % of patients with predominantly non-erosive reflux...
Criteria of effective acid inhibition during antihelicobacter pharmacotherapy (according to the findings of express-gastro-pH-monitoring)
Objective — to establish the criteria of pH values of express-gastro-pH-monitoring for successful eradication of Helicobacter pylori). Materials and methods. The analysis has been performed for the results of express-ga...
Predictors of irritable bowel syndrome formation among students
Objective — to establish the role of the nervous system disorders in the formation of irritable bowel syndrome (IBS) among students. Materials and methods. Examination involved 32 students with IBS, aged 19 to 26 years....