The standard of treatment for irritable bowel syndrome
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
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.
Similar articles
Sources: http://therapy.narod.ru/kish_stand.htm, http://www.gastroscan.ru/literature/authors/6317, http://www.pharmateca.ru/ru/archive/article/8723
No comments yet!
Share your opinion