Irritable Bowel Syndrome Treatment Protocol


Standards (protocols) for the diagnosis and treatment of digestive organs.
Irritable Bowel Syndrome

1. Irritable Bowel Syndrome (IBS). Cipher K 58

IBS - disorders of motor and secretory function of the intestine, mainly of the large intestine, without structural changes in organs. This includes: IBS with diarrhea (code K 58.0), IBS without diarrhea (code K 58.9) h CPK with constipation (cipher K 59.0).

This category includes diseases caused by functional bowel disorders lasting more than 3 months.

Compulsory laboratory tests (once):

  • General blood analysis
  • General urine analysis
  • Total bilirubin of blood
  • ЩФ, ГГТП
  • CoprogramCal to dysbiosis
  • Fecal occult blood test

Compulsory instrumental research (once):

  • Recto-Humanoscopy
  • Irrigoscopy
  • Ultrasound of the abdominal and pelvic organs
  • Electrocardiography
  • Esophagogastroduodenoscopy
  • Colonoscopy with biopsy

Obligatory consultation of the coloproctologist.

Consultation of specialists on indications:gynecologist, urologist, physiotherapist, neurologist.

Characteristics of treatmen

t activities

Psychotherapy and diet with the exception of intolerable foods and beverages.

Medicinal treatment with excess bacterial growth (microbial contamination, dysbacteriosis) consists in the appointment of three 5-7-day courses of intestinal antiseptics of a wide spectrum of action:

  • intetriks 2 capsules 3 times a day,
  • furazolidone, g 3 times a day,
  • nifuraksazid (ersefuril), g 3 times a day (caps. syrup)
  • sulgin, g 4 times a day,
  • Enterol 1-2 capsules or sachet 2 times a day.

With spastic dyskinesia of the colon, preparations with spasmolytic and analgesic effect are prescribed:

  • meteopsmyl 1 capsule 3 times a day for 2 weeks. or
  • debrideate 100-200 mg 3 times a day for 2 weeks. less often -
  • but-spawn or papaverine, 4 g, or
  • Buscopan 10 mg 3-4 times a day for 2 weeks.

With the prevalence of constipation, along with a diet containing dietary fiber and a sufficient amount of liquid, a laxative is additionally prescribed:

  • Lactulose 30-60 ml per day or
  • Bisacodyl 1-3 dragees (, 05 15 g) once before bedtime, or
  • guttalax 10-12 drops at bedtime, or
  • caliphy (combined preparation) 1-2 tablespoons before bedtime, or
  • kafiol (combined preparation) 1 briquettes, etc.

With hypomotor dyskinesia, course therapy with cisapride (co-ordinate, etc.) is justified. synonyms) inside 20 mg 2 times a day in combination with laminaride - 4 teaspoons of granules per day.

With diarrhea prescribe tsitomukoprotektor smect 1 package 3 times a day after meals, buffer aluminum-containing antacids (maalox, gastal, protab, etc.) 1 dose 3-4 times in day after 1 h after meals and antidiarrheal drugs that slow the peristalsis of the intestine - loperamide (imodium) from 2 mg to 4 mg pa intake (16 mg per day) until discontinuation diarrhea.

The duration of inpatient treatment is 14-21 days.

Annual check-up and examination in out-patient clinics.

Requirements for the results of treatment:

Coping pain and dyspeptic syndromes, normalization of stool and laboratory indicators (remission).

Improvement of well-being without significant positive dynamics of objective data (partial remission).

In the absence of the effect of treatment, continue therapy and follow-up in outpatient settings.

Irritable Bowel Syndrome

Irritable Bowel Syndrome(IBS) is a functional disruption of the bowel, in which abdominal pain or discomfort is associated with an act of defecation or changes in its pattern. The most frequent symptoms are flatulence and violation of the act of defecation.

A clear set of symptoms is not characteristic for diagnosisIrritable Bowel Syndrome. because any of them can be experienced by almost everyone. To distinguish it from transient intestinal symptoms, experts identified scales for chronic and recurrent types of the syndrome and proposed diagnostic criteria based on the frequency level development of symptoms.

The danger of this intestinal disease is its possible transitionatanother gastrointestinal disease (for example, with gastroesophageal reflux disease, dyspepsia and functional constipation).

Symptomsirritable bowel syndromecharacterized by what is observed in the patient for quite a long time and can:

  • occasionally
  • vary and depend on food intake - to disappear and exacerbate
  • to worsen the quality of life and social behavior in many patients, and also to manifest themselves during periods of significant stress.
In general, it can be noted that there are no general criteria for diagnosis of the syndrome; Many patients with symptomsirritable bowel syndromeDo not consult a doctor and do not have a formal diagnosis

Diagnosticsirritable bowel syndrome

  • At the first stage of diagnosis of any disease, at the therapist's appointment, an anamnesis is made, a physical examination, differential diagnosis - elimination of threatening symptoms, celiac disease, evaluation of psychological factors patient.
  • The second stage of the diagnosis of bowel diseases - laboratory diagnosis - the performance of a clinical blood test, assessment of sedimentation rate of erythrocytes or C-reactive protein, feces analysis (leukocytes, egg worm, parasites, latent blood)
  • The study of thyroid function, the determination of antibodies to tissue transglutaminase (tTG)
  • Colonoscopy and biopsy (according to indications)
  • Determination of inflammatory markers in feces (eg, calprotectin)
Attention! Not all patients need a colonoscopy - in particular, only patients with anxiety symptoms and signs, as well as persons over 50 years old. The need for further research and sigmoidoscopy should be determined by the characteristics of the patient (symptoms, age, etc.).


Patients withirritable bowel syndromeall over the world, many alternative / complementary therapies are often referred for help. In Israel and China, for example, are widely used medicinal homeopathic remedies, often used in the treatmentirritable bowel syndrome. Nevertheless, their effectiveness is difficult to assess, since the concentration of active ingredients varies considerably depending on the extraction process.

Drugs in treatmentirritable bowel syndrome

  • Antibiotics. Preliminary data onnonabsorbable antibiotics(for example, at a dose of 400 mg / day 3 times) are encouraging, but to date no studies have been done to obtain solid leads.
  • Spasmolytics. including peppermint oil. Certain antispasmodics (hyoscine, cimetropium, pinaverium and peppermint oil) can give a short-term relief of abdominal pain or discomfort whenirritable bowel syndrome .
  • Diet with fiber. means, causing an increase in the volume of intestinal contents and laxatives.
  • Hydrophilic mucilloid psilium (husk of isfagula) is moderately effective.
  • The only study showed improvement in patients with polycarbophil calcium.
  • Antidiarrheal agents.Loperamideis not more useful than placebo in relieving abdominal pain, flatulence and symptoms of IBS as a whole, but is effective in treating diarrhea, decreasing stool frequency and improving its character.
  • Probiotics. In studies on the effect of a single microorganism, lactobacilli did not show efficacy in patients withirritable bowel syndrome. Some efficacy was shown by bifidobacteria and certain combinations of probiotics.
  • Antidepressants. Tricyclic antidepressants and selective serotonin reuptake inhibitors are more effective than placebo in reducing overall symptomsirritable bowel syndromeand, probably, in the reduction of abdominal pain.

So, the options for drug treatmentirritable bowel syndromein Israel are different: from quite effective homeopathic remedies, along with a correct diet rich in fiber, you can be offered a number of medications for a fairly long period of treatment. After the completion of the course of treatment, you will receive individual recommendations for further monitoring by the gastroenterologist.

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Protocols for diagnosis and treatment of children with diseases of the digestive system (part 2).

Domperidone (motilium), cisapride (co-ordinate, pre-pulsed), trimebutin (debibrate)

Note: The ganglion block group is only applied topically by electrophoresis.

Appendix No. 3
Application of alginates in children's gastroenterology
With chronic diseases of the digestive system in children for the purpose of immunocorrection, enterosorption, membrane protection and the subsidization of a number of cations to the use may be recommended preparations of alginic acid (products of the Arkhangelsk algae plant, laboratory SevPIN-RO).

Alginates are used in the form of a gel (alginate K, Mg, Na) with esophagitis, gastroduodenitis, peptic ulcer, dyskinesia bile ducts; in the form of gel and candle with pathology of the intestine; as well as alginate Ca in the form of a powder in order to subsidize calcium during periods of increased need and against the background of long-term use of prednisolone. Drugs can be given to children aged 1 month by courses for 3 weeks 2-3 times a year.

Methods of appointment. Alginates K and Mg in the form of 4% or 2% of the gel is administered through the mouth, depending on the age from 1/2 tea to 1 tablespoon per reception. Multiplicity and time of reception are selected individually. Inside 30 minutes before meals with reduced acidity and 30 minutes after meals with increased acidity and at night. When using alginate once a day is prescribed at night before bedtime.

To obtain the gel from the powder, it is necessary to pour 1 powder (1 g) into a jar with a lid filled with boiled water at room temperature t 25-50 ml, without stirring, and leave to dissolve at room temperature for 3 hours. After complete dissolution (gel formation), the solution must be placed in the refrigerator, where it should be stored before use.

Rectal alginate K and Na are used in the form of candles (from, to, g to a candle) and in the form of microclyster of 4% gel. Official candles Alginatol.

Alginate Ca is given in the form of a powder of, g (powder, g contains from 500 to 700 mg of calcium) from 1 to 2 times a day by adding it to food (porridge, mashed potatoes).

There may be an increase in the pain syndrome with the use of Mg alginate (a dose reduction is necessary), as well as individual intolerance to alginates due to their taste qualities. It is not recommended to prescribe alginates for allergies to seafood.

Appendix No. 4
From the order of the Ministry of Education of Russia and the Ministry of Health and Social Affairs of Russia of July 18, 1994 No. 268/146


operations in connection with diseases of the organs of the gastrointestinal tract, esophagus, peritoneum, liver, gall bladder, pancreas for 3 months after discharge from the hospital at the conclusion of the surgeon
  • Crohn's disease (and NNC) constantly
  • One of the important parts of the pediatrician's work is the professional orientation of schoolchildren with chronic diseases of the digestive system. Contraindicated work associated with significant neuro-emotional and physical stress, with toxic substances, vibration, industrial noise, unfavorable meteorological conditions, with forced working posture, conveyor rhythm of work, frequent business trips and constant travel within and for limits of the city.


    ALT - alanine aminotransferase
    AST - aspartate aminotransferase
    HBO - hyperbaric oxygenation
    GGTP - gamma-glutamyl transpeptidase
    UHF - decimeter waves
    DN - a disaccharidase insufficiency
    CHF - cholelithiasis
    PPI - proton pump inhibitors
    NUK - ulcerative colitis
    P - pancreatitis
    PeMP - alternating magnetic field
    RE - reflux esophagitis
    SKL - sanatorium treatment
    SMT - sinusoidal modulated currents
    CRP - C-reactive protein
    IBS - irritable bowel syndrome
    Ultrasound - ultrasound
    FEGS - fibroesophagogastroduodenoscopy
    X - cholecystitis
    YaB - peptic ulcer
    HP - Helicobacter pylori
    5-ASA - preparations of 5-aminosalicylic acid
    AR - antireflux

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    Chronic gastroduodenitis
    Chronic enteritis
    Chronic Colitis
    Ulcerative Colitis Nonspecific

    Sources:,, d = 1415


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