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Ross z gastroenterol gepatol koloproktol 2017; 27(5):76-93

Topic: Clinical guidelines

Diagnosis and treatment of the irritable bowel syndrome: clinical guidelines of the Russian gastroenterological association and Russian association of coloproctology



V.T. Ivashkin1, Yu.A. Shelygin2, Ye.K. Baranskaya1, Ye.A. Belousova3, A.G. Beniashvili4, S.V. Vasilyev5, A.O. Golovenko2, O.V. Golovenko6, Ye.G. Grigoryev7, N.V. Kostenko8, T.L. Lapina1, I.D. Loranskaya6, O.S. Lyashenko1, I.V. Mayev9, Ye.A. Poluektova1, V.G. Rumyantsev10, V.M. Timerbulatov11, A.S. Trukhmanov1, O.Yu. Fomenko2, I.L. Khalif2, E.Yu. Chashkova7, A.A. Sheptulin1, O.S. Shifrin1, V.V. Yanovoy12

1 Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, the Russian Federation
2 Federal government-financed institution Ryzhikh State Scientific Center of Coloproctology Ministry of healthcare of the Russian, Moscow, the Russian Federation
3 State government-financed healthcare institution of the Moscow region Vladimirsky Moscow regional research clinical institute, Moscow, the Russian Federation
4 Federal government-financed institution Mental Health Research Center of the Russian Academy of Medical Sciences, Moscow, the Russian Federation
5 State educational institution Saint Petersburg State Pavlov Medical University, Ministry of Healthcare of the Russian Federation, St. Petersburg, the Russian Federation
6 State educational government-financed institution of continuing professional education Institute of Postgraduate Medical Education Federal Medical-Biological Agency of Russia, Moscow, Russian Federation
7 Federal state government-financed scientific institution Irkutsk Scientific Center Of Surgery And Traumatology, Irkutsk, Russian Federation
8 Federal state government-financed educational institution of higher education Astrakhan State Medical University, Ministry of Healthcare of the Russian Federation, Astrakhan, the Russian Federation
9 Federal state government-financed educational institution of higher education Yevdokimov Moscow State
University of Medicine and Dentistry, Ministry of Healthcare of the Russian Federation, Moscow, the Russian Federation
10 LLC On-Clinic, Moscow, the Russian Federation
11 Federal state government-financed educational institution of higher education Bashkir State Medical University of Ministry of Healthcare of the Russian Federation, Ufa, the Russian Federation
12 Federal state government-financed educational institution of higher education Amur State Medical Academy of Ministry of Healthcare of the Russian Federation, Blagoveshchensk, the Russian Federation




Aim of publication. To present recent RGA evidencebased medicine centered guidelines on diagnosis, rational pharmacotherapy and management of irritable bowel syndrome (IBS).

Summary. IBS is a functional bowel disorder is manifested by recurrent abdominal pain that develops at least once per week and characterized by at least two of the following signs: it is related to bowel movements, associated to the change in stool frequency and/ or shape. These symptoms should be present in the patient for the last 3 months at overall duration of observation for six months or more. Similar to other functional gastrointestinal disorders, the diagnosis of IBS can be established at compliance of symptoms to Rome IV criteria and the absence of organic gastrointestinal diseases that could cause patients symptoms.
Due to complexity of differential diagnostics, IBS should be considered as diagnosis by exclusion that require following investigations: clinical and biochemical blood tests; IgA or IgG anti-tissue transglutaminase antibodies; thyroid hormone levels; fecal occult blood test; glucose or lactulose hydrogen breath test for bacterial overgrowth syndrome; stool test for coliform bacteria, stool test for Clostridium difficile toxins A and B; fecal calprotectin level; abdominal ultrasound; upper and lower endoscopies, at indications with biopsies.
IBS treatment requires diet and lifestyle modifications, intake of pharmacological agents and psychotherapy. Antispasmodic medications (e.g.: hyoscine butylbromide, pinaverium bromide, mebeverine) are recommended for abdominal pain relief. For diarrhea-predominant IBS such medications as loperamide hydrochloride, dioctaedric smectite, non-absorbable antibiotic rifaximin and probiotics may be prescribed. For treatment of IBS with constipation use of bulking agents (psyllium), osmotic laxatives (macrogol 4000, lactulose), laxatives stimulating intestinal motility (bisacodyl) may be applied. Enterokinetic agent prucalopride may be prescribed at inefficacy of laxatives. Peripheral opioid agonists (trimebutine maleate) normalizing intestinal motor activity via action on different subtypes of peripheral opioid receptors, combined plant-derived medication STW 5 are applied as well.

Conclusion. Implementation of clinical guidelines can determine timely diagnosis and treatment of various IBS types. The IBS is characterized by scalloping course with relapse periods that are provoked by psychoemotional stress and remissions. The risk of organic bowel diseases IBS patients is not higher, than in total population.


Key words:
irritable bowel syndrome, diarrhea, constipation, spasmolytics, loperamide hydrochloride, dioctaedric smectite, probiotics, laxatives, prucalopride, trimebutine maleate, STW5.

For citation:
Ivashkin V.T., Shelygin Yu.A., Baranskaya Ye.K., Belousova Ye.A., Beniashvili A.G., Vasilyev S.V., Golovenko A.O., Golovenko O.V., Grigoryev Ye.G., Kostenko N.V., Lapina T.L., Loranskaya I.D., Lyashenko O.S., Mayev I.V., Poluektova Ye.A., Rumyantsev V.G., Timerbulatov V.M., Trukhmanov A.S., Fomenko O.Yu., Khalif I.L., Chashkova E.Yu., Sheptulin A.A., Shifrin O.S., Yanovoy V.V.. Diagnosis and treatment of the irritable bowel syndrome: clinical guidelines of the Russian gastroenterological association and Russian association of coloproctology. Ross z gastroenterol gepatol koloproktol 2017; 27(5):76-93
DOI: 10.22416/1382-4376-2017-27-5-76-93


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