Medications for the treatment of irritable bowel syndrome
Irritable Bowel Syndrome Symptoms and Treatment
In medicine, the concept of a syndrome is a symptom complex, in which functional disorders of the intestine and abdominal discomfort are noted in the absence of organic diseases. What is irritable bowel syndrome? The manifestations and therapy of this disease we will consider today.
Symptoms of development of irritable bowel syndrome
In Russia, new standards for major gastroenterological diseases have been adopted, where under the irritable bowel syndrome should be understood as a disorder of motor and secretory functions of the intestine, predominantly of the large intestine, without structural changes. This confirms the three-month duration of the existence of the symptoms proposed in the Roman criteria. The concept of IBS is broader than the more usual term for dyskinesia of the intestines, as it explains not only the motor but also the secretory disorders of this part of the digestive system.
In the development of these criteria, it has become accepted to c
abdominal pain, relieved after defecation or accompanied by changes in the frequency or consistency of the stool,
violation of defecation for at least 25% of the time, consisting of 2 deviations from the norm and more,
violation of the frequency of defecation (more than 3 times a day or less 3 times a week),
consistency of stool (fragmented, liquid, watery),
Act of defecation (urge urgency, tension, feeling of incomplete emptying),The main symptoms of the disease:
- dyskinetic (with diarrhea)
- spastic (with constipation),
Features of Irritable Bowel Syndrome Treatment
The choice of the therapy program is determined by the interaction of several factors and depends on the leading symptom of irritable bowel syndrome (pain, flatulence, diarrhea, constipation), its severity and impact on the quality of life of the patient, as well as on the nature of the patient's behavior and his mental state. According to the standards of treatment, a diet is prescribed with the exception of certain products (milk, carbonated beverages, legumes, cabbage, alcohol).
Drug therapy depends on the type of functional disorders. With hypertension of the colon, M-holinoblokatory, antispasmodics; with hypotonia of the colon - prokinetics, with increased motility of the large intestine (diarrhea) - Loperamide, with reduced motility of the colon (constipation) - Lactulose, with excessive bacterial growth - eubiotics, as well as psychotherapy in combination with antidepressants or tranquilizers. More detailed medical treatment of the syndrome is described below.
Treatment with drugs in irritable bowel syndrome
Treatment includes psychotherapy, anxiolytics (Alprazolam, Xanax, Kassadan, Amolam), tranquilizers of benzo-diazepine series (Sibazon, Phenazepam, Elenium, Rudothel), phytopreparations of valerian, bloodworm of five-lobed and hawthorn blood-red, Novopassit, as well as antidepressants (Amitriptyline, Doxepin, Melipramine) with a predominant effect on serotonin receptors - Fluoxetine (Framamex), Fluvoxamine (Fevarin), Citalopram (Cipramil), Sertraline (Zoloft), Coaxyl.
Antibacterial agentsit is undesirable to apply not only for years and months, but also for weeks. Their long reception leads to the development of microbial resistance and an increase in the frequency of adverse reactions. They are unsuitable for use in the treatment of irritable bowel syndrome with constipation.
Biological preparations (Coli-bacterin, Bifidumbacterin, Bifikol, lactobacterin)do not meet the requirement "the way a spoon to dinner". Their effect, if it does, then weeks later. He is often not sufficiently expressed and unstable. Hence, biologics can be properly classified only as auxiliary means of treating irritable bowel syndrome. They take an hour before meals for 5-10 man-doses 2-3 times a day for 1-2 months.
Excessive popularity as a means of treatment of irritable bowel syndrome acquired in recent yearsenzyme preparations Penzinorm forte, Festal, Triferment, Mezim forte, Katazim forte, Digestal, Pankurmen.They are prescribed from 1 to 3 tablets 3 times a day. However, the scale of application of these funds far exceeds their effectiveness. The reason for this dissonance seems quite understandable. These drugs consist mainly of pancreatic enzymes, and some also contain pepsin and bile. Meanwhile, the symptoms of the syndrome are not related to their deficiency. With it, only clinically insignificant deviations in the external secretion of the pancreas are detected [Frolkis A. AT. 1981]. Under such conditions, the introduction of its enzymes from the outside loses justification. It can not be ruled out that their natural products are thereby suppressed. It is not enough reasoned and therapeutic use of the pepsin contained in some of the preparations. With achlorhydria, it remains ineffective, and if the stomach secrete hydrochloric acid, then, as a rule, pepsin.
Starting pathogenetic factors in IBS are disorders of intestinal motility and, in part, secretion, to which enzyme preparations do not exert influence in the treatment of irritable bowel syndrome. Meanwhile, they sometimes serve as a substitute for effective pharmacotherapy of IBS, while not providing the expected therapeutic success. Their place in the system of pharmacological treatment of irritable bowel syndrome can be defined as purely auxiliary. The main purpose of the mentioned enzyme means is treatment of insufficiency of external pancreatic secretion, which will be discussed in the corresponding section of the book.
Psychotherapeutic treatment of irritable bowel syndrome
Remission in the syndrome is relatively rare, and even during her stool is mostly unstable, periodically there are pain, flatulence. Since many patients have syndrome associated with neurosis, this type of disorder are perceived with excessive acuity, and sometimes dramatized, regarded as a sign of the impending catastrophe.
Thus, the tasks of supportive treatment include not only regulating the activity of the intestine and eliminating abdominal pain, but also, for the most part, mitigating neurotic manifestations. The most significant of these tasks is counteracting both constipation and, in particular, relaxation of the stool. It is this that serves as a sign of exacerbation of the disease, is more difficult for patients to perceive, and therefore requires a possible rapid elimination. From this perspective, medicamental agents that meet the objectives of maintenance treatment should be considered.
More specifically, the requirements for drugs for maintenance treatment of IBS are as follows:
relatively fast action,
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