Journal List > Korean J Gastroenterol > v.73(2) > 1116845

Kim and Jee: Irritable Bowel Syndrome

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.

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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.
kjg-73-84f1.tif
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 criteriaa:
• 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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Sam Ryong Jee
https://orcid.org/0000-0002-7928-1153

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