The standard of treatment for irritable bowel syndrome

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Irritable Syndromeintestine (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) and IBS with constipation (code K 59.0).

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

ExaminationCompulsory laboratoryresearch

• General blood analysis

• General urine analysis

• Total bilirubin of blood

• Feces for dysbiosis

• Fecal analysis for latentblood

Compulsory instrumental research

• Ultrasound of the abdominal and pelvic organs

• Colonoscopy with biopsy

Obligatory consultation of the coloproctologist.

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

Characteristics of treatment activities

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

Medicinal treatmentwith excessive bacterial growth(microbial contamination, dysbacterios

is) 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 (ersefuryl), g3 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 colonprescribe drugs with spasmolytic and analgesic effect:

meteopsmyl 1 capsule 3 times a day for 2 weeks. or a deburred 100-200 mg 3 times a day for 2 weeks. less often - no-spawn or papaverine, 4 g, or buscopan 10 mg 3-4 times a day for 2 weeks.

With the prevalence of constipationalong with a diet containing dietary fiber and a sufficient amount of fluid, an additional laxative is prescribed:

lactulose 30-60 ml per dayor

Bisacodyl 1-3 dragees (, 05 15 g) once before bedtime, or

guttalax 10-12 drops beforesleep,or

caliphy (combined preparation) 1-2 tablespoons before bedtime, or

kafiol (combined preparation) 1 briquettes, etc.

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

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

Duration of inpatient treatment

Annual dispensary examination and examination in out-patient and polyclinic conditions.

Requirements for treatment outcomes

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 effecttreatment and follow-up inambulatory polyclinicconditions.

Order of the Ministry of Health of Russia on November 9 № 774н About the statement of the standard of the specialized medical aid at a syndrome of the irritated intestine (with a diarrhea)

Order of November 9 No. 774n

About the statement of the standard of specialized medical aid at
irritable bowel syndrome (with diarrhea)

Published: June 10, Russian Newspaper (special issue) No. 123/1 (6099/1).
The beginning of the document: 21.06. in

Registered by the Ministry of Justice of Russia on February 15
registration number 27118

Approve the standard for specialized medical care for irritable bowel syndrome (with diarrhea) according to the annex.

Minister V.I. Skvortsova

application
to the order of the Ministry of Health
Russian Federation
of November 9, No. 774n

The standard of specialized medical care for irritable bowel syndrome (with diarrhea)

Age category:adults
Floor:any
Phase:any
Stage:any
Complication:without complications
Type of medical care:specialized medical care
Condition of medical care:permanently
Form of medical care:planned, urgent
Average duration of treatment (number of days): 18

Code on the ICD X *
Nosological units

1 the probability of providing medical services or prescribing medicinal products for medical use (medical products) included in the standard of care that can take values ​​from 0 to 1, where 1 means that this event is carried out by 100% of patients, corresponding to this model, and figures less than 1 - the percentage of patients with appropriate medical indications.

2. Medical services for the treatment of disease, condition and control of treatment

Reception (examination, consultation) and supervision of a specialist doctor

Medical service code

Name of medical service

Average frequency of granting

The average index of the frequency of application

Daily examination by a gastroenterologist with supervision and care of the middle and junior medical staff in the hospital department

Daily examination by a physician-therapist with supervision and care of the average and junior medical staff in the department of the hospital

Laboratory methods of research

Medical service code

Name of medical service

Average frequency of granting

The average index of the frequency of application

Study of feces for occult blood

General (clinical) blood test

Blood analysis biochemical general therapeutic

Urinalysis total

3. The list of medicinal products for medical use registered in the territory of the Russian Federation, indicating the average daily and courseware doses

Name of medicinal product **

The averaged frequency of granting

Other drugs for the treatment of gastric ulcer and duodenal ulcer and gastroesophageal reflux disease

Search for new opportunities for treatment of irritable bowel syndrome with refractory course

I.D. Loranskaya, Yu.A. Kozlova

The article is devoted to the problem of treatment of the refractory form of irritable bowel syndrome (IBS) - functional pathology of the digestive system, which is one of the most common diseases in the gastroenterological practice. The results of the study of the effect of antidepressants from groups of tricyclic, tetracyclic and selective inhibitors of reuptake serotonin (SSRIs) on the main clinical manifestations of IBS in patients with refractory course of this pathology and the presence of a connection with the state psychoemotional sphere. The positive effect of antidepressants, especially SSRIs, on the symptomatology of IBS in this category of patients is shown.

Read the article in
The Library of the Doctor

Literature

1. Ardatskaya M.D. Irritable bowel syndrome: the current state of the issue, standards for diagnosis and treatment / / Handbook of the polyclinic 2009. No. 3. FROM. 48-53.

2. Vyborny D.E. Kikta S.V. Treatment of depressions in gastroenterological practice // Clinical perspectives of gastroenterology, hepatology 2010. № 6. FROM. 21-8.

3. Holenko O.M. Modern standards of diagnosis and treatment of irritable bowel syndrome. A manual for doctors. M. 2007. 16 sec.

4. Loranskaya I.D. Lavrentieva OA A Systemic Approach to the Treatment of Irritable Bowel Syndrome. № 5. FROM. 758-60.

5. Marilov V.V. Psychosomatosis. Psychosomatic diseases of the gastrointestinal tract. M. 2010. 154 sec.

6. Osipenko M.D. Psychotropic drugs and pathology of the gastrointestinal tract // Health of Ukraine 2007. № 7. FROM. 50-1.

7. Parfenov A.I. Ruchkina I.N. Irritable bowel syndrome. A manual for doctors. M. 2008. 33 sec.

8. Poluektova E.A. Irritable bowel syndrome - from pathogenesis to treatment // South Russian Medical Journal 2009. № 4. FROM. 39-43.

9. Poluektova E.A. Ivashkin V.T. Sheptulin AA Yurmanova E.N. Substantiation of the use of psychotropic drugs in patients with irritable bowel syndrome // Consilium Medicum 2007. T. 9. № 7. FROM. 51-6.

10. Poroshina E.G. Psychopharmacotherapy in the clinic of internal diseases // Pharm-index-Practitioner 2004. № 6. FROM. 12-15.

11. Samsonov A. A. Baranova E.Yu. Plotnikova M.V. Krasnova N.G. Irritable bowel syndrome is a disease with many unknowns, some therapeutic aspects // The attending physician. № 2. FROM. 34-8.

12. Simanenkov V.I. Lutayenko E.A. Treatment of irritable bowel syndrome from the perspective of evidence-based medicine. A manual for doctors. St. Petersburg. 2008. 108 s.

13. Sprints A.M. Eryshev OF Shatova E.P. Filippova I.N. Psychotic and neurotic disorders in patients with somatic pathology. St. Petersburg. 2007.156 sec.

14. Crowell MD, Jones MP, Dineen TN, et al.Review Antidepres sants in the treatment of irritable bowel syndrome and visceral pain syndromes. Neurogastroent Motil 200; (7): 736-42.

15. Cushing G. The Life of Sir William Osler. Oxford. Clarendon Press 192;: 237.

16. Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut 200; 2 (11): 1623-29.

17. Hahn DA, Krichdorfer IJ, Fullerton S. Patient perceived severity of irritable bowel syndrome in relation to symptoms, resources utilization and quality of life. Aliment Pharmacol Ther 199;: 53-59.

18. Jones MP, Dilley JB, Drossman DA, Crowell MD. Brain-gut connections in functional disorders. Neurogastroent Motil 200;: 1-103.

19. Lea R, Haughton LA, Calvert EL, Larder S. Gut-focused hypnotherapy normalized disordered rectal sensitivity in patients with irritable bowel syndrome. Aliment Pharmacol Ther200; 7 (5): 635-42.

20. Mertz HR. Irritable bowel syndrome. N Engl J Med 200; 4: 136-46.

21. Palsson OS, Psy D. Irritable Bowel Syndrom (IBS)? 2008. http: // www.ibshypnosis.com/IBStreatmens.html

22. Prior A, Colgan SM, Whorwell PJ. Changes in rectal sensitivity after hypnotherapy in patiens with irritable bowel syndrome. Gut 199; 1:896-97.

23. Taeh Y, Martinez V, Million M, et al. Stress and the gastrointestinal tract III. Stress-related alterations of gut motor function: the role of braincorticotropin - releasing factor receptors. Am JGastrointest Liver Physiol 200; 8: 73-77.

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Sources: http://therapy.narod.ru/kish_stand.htm, http://www.gastroscan.ru/literature/authors/6317, http://www.pharmateca.ru/ru/archive/article/8723



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