Irritable Bowel Syndrome

Jae Hak Kim; Sam Ryong Jee

doi:10.4166/kjg.2019.73.2.84

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Kim and Jee: Irritable Bowel Syndrome

Review Article

Korean J Gastroenterol 2019;73(2):84-91.

Published online: 4 October 2019

DOI: https://doi.org/10.4166/kjg.2019.73.2.84

Irritable Bowel Syndrome

Jae Hak Kim, Sam Ryong Jee¹

Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Busan, Korea

¹Department of Internal Medicine, Inje University College of Medicine, Busan, Korea

Correspondence to: Sam Ryong Jee, Department of Internal Medicine, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea. Tel: +82-51-890-6536, Fax: +82-51-892-0273, E-mail: srjee@inje.ac.kr, ORCID: https://orcid.org/0000-0002-7928-1153

Received 28 December 2018 Revised 28 January 2019 Accepted 1 February 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. Its diagnosis is based on symptoms, and the Rome IV criteria are recognized as the gold diagnostic standard. The Korean Society of Neurogastroenterology and Motility (KSNM) recently updated their clinical practice guidelines for the treatment of IBS, which were last issued in 2011. In this updated edition, the KSNM defines IBS as a chronic, recurrent symptom complex that includes abdominal pain or discomfort, changes in bowel habits, and bloating for at least 6 months, which is somewhat broader than the previous definition. Four major topics have been changed in the updated version in-line with the results of recent studies, that is, colonoscopy; a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols; probiotics; and rifaximin. Herein, we review the 2017 revised edition of the KSNM with respect to recommended clinical practice guidelines for IBS and compare these with other guidelines.

Keywords: Irritable bowel syndrome, Practice guideline, Evidence-based practice

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Fig. 1.

Suggested diagnostic and therapeutic algorithms for irritable bowel syndrome. IBS, irritable bowel syndrome; FODMAP, fermentable oligosaccharides, disaccharides, monosaccharides, and polyols; GI, gastrointestinal.

Table 1.

Clinical Prac ctice Guidelines for Irritable Bowel Syndrome in Korea

Category	Statement	Grade of recommendation	Level of evidence	Vote in the revised edition
Colonoscopy	Colonoscopy may be considered in patients with alarm symptoms, e.g., rectal bleeding, unexplained weight loss, change in bowel habits persisting after age 50 years, or a family history of bowel cancer.	Weak	Moderate quality	Yes
Diet	A low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet, which restricts dietary short-chain carbohydrates, is effective in reducing the symptoms of irritable bowel syndrome.	Weak	Low quality	Yes
Physical activity	Physical activity may be helpful in improving the symptoms of irritable bowel syndrome.	Weak	Low quality	No
Bulking agents	Bulking agents can provide overall symptom relief in irritable bowel syndrome patients.	Weak	Moderate quality	No
Osmotic laxatives	Osmotic laxatives can increase stool frequency in constipation-dominant irritable bowel syndrome patients.	Weak	Moderate quality	No
Antispasmodic agents	Antispasmodics are effective in treating abdominal discomfort and pain in irritable bowel syndrome patients.	Strong	Moderate quality	No
Anti-diarrheal agents	Loperamide is recommended to improve stool consistency and decrease bowel frequency in diarrhea-dominant irritable bowel syndrome patients.	Strong	Low quality	No
Serotonin subtype 3 receptor antagonists	Ramosetron, a serotonin subtype 3 receptor antagonist, improves stool consistency, abdominal pain/bloating, and health-related quality of life in diarrhea-dominant irritable bowel syndrome patients.	Weak	High quality	No
Serotonin subtype 4 receptor agonists	Prucalopride, a serotonin subtype 4 receptor agonist, may improve stool consistency, abdominal pain/bloating, and health-related quality of life in constipation-dominant irritable bowel syndrome patients whose bowel symptoms are refractory to simple laxatives.	Weak	Low quality	No
Antibiotics	Rifaximin may be effective in reducing global symptoms of diarrhea-dominant irritable bowel syndrome.	Weak	Moderate quality	Yes
Probiotics	Probiotics may be considered to relieve global symptoms, bloating, and flatulence in irritable bowel syndrome patients.	Weak	Low quality	Yes
Antidpressants	Tricyclic antidepressants may be considered in patients with irritable bowel syndrome for abdominal pain relief and global symptom improvement.	Weak	High quality	No
	Selective serotonin reuptake inhibitors may be considered to improve the sense of well-being of patients with irritable bowel syndrome.	Weak	Moderate quality	No

Table 2.

Rome IV Criteria for Irritable Bowel Syndrome

Recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, associated with two or more of the following criteria^a:

• Related to defecation

• Associated with a change in frequency of stool

• Associated with a change in form (appearance) of stool

^a Criterion fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis.

Table 3.

High FODMAP Contained Food

	Relevant in Korea	Less relevant in Korea
Oligosaccharides	Kimchi, doenjang, gochujang, ssamjang, dumpling, ketchup, cream pasta source, tomato-based pasta sauce, energy bar, strawberry jam, dimsum, wasabi powder, fructooligosaccharides, peach, persimmon, watermelon, garlic, onion, peas, chicory, wheat, rye, barley, almonds, pistachios	Brussels sprout, artichokes, Thai curry paste, tomyum soup, inulin, leek, beetroot, fennel, legumes, chickpeas, lentils
Disaccharides	Milk, yogurt, ice cream	Custard, soft cheeses
Monosaccharides	Honey, apple, cherry, mango, pear, watermelon, asparagus	High-fructose corn syrup, artichokes, sugar snap, pickled onion
Polyols	Sorbitol, xylitol, apple, pear, cherry, apricot, nectarine, plum, avocado, mushroom, white cabbage	Mannitol, maltitiol, isomalt, blackberries, prune, cauliflower, snow peas

FODMAP, fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.

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ORCID iDs: Sam Ryong Jee
https://orcid.org/0000-0002-7928-1153
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