İrritabl Bağırsak Sendromunda Non-Farmakolojik Yaklaşımlar
Özet
İrritabl bağırsak sendromu (İBS), karın ağrısı, kramp, şişkinlik, dışkılama aciliyeti, dışkılama sırasında ağrı ve bağırsak alışkanlıklarında değişikliklerle karakterize kronik bir gastrointestinal sistem rahatsızlığıdır. En sık görülen fonksiyonel bağırsak bozukluklarından biri olan İBS hastaların günlük yaşam aktiviteleri üzerinde önemli bir etkiye sahiptir. Ayrıca toplum üzerinde de gereksiz ameliyatlar sonucunda artan ekonomik maliyetlerle birlikte önemli bir sağlık yükü oluşturmaktadır. İBS hastalarında diğer popülasyona kıyasla kolesistektomi, apendektomi, histerektomi ve sırt ameliyatlarının daha sık yapıldığı kaydedilmiştir.. İBS karmaşık yapısı nedeniyle, uzun süreli genel kabul görmüş tedaviler mevcut değildir. Bu yüzden tedavi semptom yönetim stratejilerine odaklanmıştır. İBS’de semptomların şiddeti çok hafiften iş göremezliğe kadar değişkenlik göstermektedir. İBS hastalarının semptom yönetiminde en sık kullandığı nonfarmakolojik yöntemler; düşük fermente edilebilir karbonhidratlar (düşük fermante edilebilir oligo-,di,monosakkaritler ve polioller) diyeti, glütensiz diyet, fiziksel aktivite ve egzersiz (yoga, yürüyüş/aerobik fiziksel aktivite, Tai Ji, dağcılık ve Baduanjin qigong gibi aktiviteler), bilişsel-davranışçı terapi, bağırsak odaklı hipnoterapi, yönlendirilmiş duygusal imgeleme, akupunltur, nane yağı, kurkumin, homeopati, öz yönetim müdahaleleridir.
Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder characterized by abdominal pain, cramping, bloating, urgency to defecate, pain during defecation and changes in bowel habits. As one of the most common functional bowel disorders, IBS has a significant impact on patients' daily life activities. It also creates a significant health burden on the society with increasing economic costs as a result of unnecessary surgeries. Cholecystectomy, appendectomy, hysterectomy and back surgeries have been reported to be performed more frequently in patients with IBS compared to the other population. Due to the complex nature of IBS, there are no generally accepted long-term treatments. Therefore, treatment has focused on symptom management strategies. The severity of symptoms in IBS varies from very mild to disabling. The most commonly used nonpharmacologic methods for symptom management in IBS patients are low fermentable carbohydrates (low fermentable oligo-, di, monosaccharides and polyols) diet, gluten-free diet, physical activity and exercise (activities such as yoga, walking/aerobic physical activity, Tai Ji, mountaineering and Baduanjin qigong), cognitive-behavioral therapy, gut-focused hypnotherapy, guided emotional imagery, acupuncture, peppermint oil, curcumin, homeopathy, self-management interventions.
Referanslar
Lacy BE, Xu Y, Taylor DCA, et al. Burden of illness and treatment attitudes among participants meeting Rome IV criteria for irritable bowel syndrome: A nationwide survey in the united states. Neurogastroenterology & Motility. 2024;doi:10.1111/nmo.14903.
Huang KY, Wang FY, Lv M, et al. Irritable bowel syndrome: epidemiology, overlap disorders, pathophysiology and treatment. World Journal of Gastroenterology. 2023;29(26):4120–4135. doi:10.3748/wjg.v29.i26.4120.
Chen J, Zhang Y, Barandouzi ZA, et al. The effect of self-management online modules plus nurse-led support on pain and quality of life among young adults with irritable bowel syndrome: A randomized controlled trial. International Journal of Nursing Studies. 2022;132:104278. doi:10.1016/j.ijnurstu.2022.104278.
Makkawy EA, Abdulaal IE, Kalaji FR, et al. Prevalence, risk factors, and management of irritable bowel syndrome in Saudi Arabia: A systematic review. Cureus. 2023;doi:10.7759/cureus.47440.
Shah SL, Janisch NH, Crowell M, et al. Patients with irritable bowel syndrome are willing to take substantial medication risks for symptom relief. Clinical Gastroenterology and Hepatology. 2021;19(1):80–86. doi:10.1016/j.cgh.2020.04.003.
Ford AC, Moayyedi P, Chey WD, et al. American college of gastroenterology monograph on management of irritable bowel syndrome. American Journal of Gastroenterology. 2018;113:1–18. doi:10.1038/s41395-018-0084-x.
Di Rosa C, Altomare A, Terrigno V, et al. Constipation-predominant irritable bowel syndrome (IBS-C): Effects of different nutritional patterns on intestinal dysbiosis and symptoms. Nutrients. 2023;15(7):1647. doi:10.3390/nu15071647.
Alammar N, Wang L, Saberi B, et al. The impact of peppermint oil on the irritable bowel syndrome: A meta-analysis of the pooled clinical data. BMC Complementary and Alternative Medicine. 2019;19(1):21. doi:10.1186/s12906-018-2409-0.
Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of rome foundation global study. Gastroenterology. 2021;160(1):99-114.e3. doi:10.1053/j.gastro.2020.04.014.
Ionescu VA, Gheorghe G, Georgescu TF, et al. The latest data concerning the etiology and pathogenesis of irritable bowel syndrome. Journal of Clinical Medicine. 2024;13(17):5124. doi:10.3390/jcm13175124.
Enck P, Aziz Q, Barbara G, et al. Irritable bowel syndrome. Nature Reviews Disease Primers. 2016;2(1):16014. doi:10.1038/nrdp.2016.14.
Simrén M, Törnblom H, Palsson OS, et al. Management of the multiple symptoms of irritable bowel syndrome. The Lancet Gastroenterology & Hepatology. 2017;2(2):112–122. doi:10.1016/S2468-1253(16)30116-9.
Camilleri M, Boeckxstaens G. Dietary and pharmacological treatment of abdominal pain in IBS. Gut. 2017;66(5):966–974. doi:10.1136/gutjnl-2016-313425.
Cong X, Perry M, Bernier KM, et al. Effects of self-management interventions in patients with irritable bowel syndrome: Systematic review. Western Journal of Nursing Research. 2018;40(11):1698–1720. doi:10.1177/0193945917727705.
Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: management of irritable bowel syndrome. American Journal of Gastroenterology. 2021;116(1):17–44. doi:10.14309/ajg.0000000000001036.
Fukudo S, Okumura T, Inamori M, et al. Evidence-based clinical practice guidelines for irritable bowel syndrome 2020. Journal of Gastroenterology. 2021;56(3):193–217. doi:10.1007/s00535-020-01746-z.
Hawrelak JA, Wohlmuth H, Pattinson M, et al. Western herbal medicines in the treatment of irritable bowel syndrome: a systematic review and meta-analysis. Complementary Therapies in Medicine. 2020;48:102233. doi:10.1016/j.ctim.2019.102233.
Staudacher HM, Mahoney S, Canale K, et al. Clinical trial: a mediterranean diet is feasible and improves gastrointestinal and psychological symptoms in irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 2024;59(4):492–503. doi:10.1111/apt.17791.
National Institute for Health and Care Excellence (NICE). Irritable bowel syndrome in adults: diagnosis and management 2008. (15/09/2024 tarihinde https://www.nice.org.uk/guidance/cg61 adresinden ulaşılmıştır.)
Jent S, Bez NS, Haddad J, et al. The efficacy and real-world effectiveness of a diet low in fermentable oligo-, di-, monosaccharides and polyols in irritable bowel syndrome: a systematic review and meta-analysis. Clinical Nutrition. 2024;43(6):1551–1562. doi:10.1016/j.clnu.2024.05.014.
Roth B, Nseir M, Jeppsson H, et al. A starch- and sucrose-reduced diet has similar efficiency as low fodmap in IBS—A randomized non-inferiority study. Nutrients. 2024;16(17):3039. doi:10.3390/nu16173039.
Black CJ, Staudacher HM, Ford AC. Efficacy of a low fodmap diet in irritable bowel syndrome: Systematic review and network meta-analysis. Gut. 2022;71(6):1117–1126. doi:10.1136/gutjnl-2021-325214.
Hahn J, Choi J, Chang MJ. Effect of low fodmaps diet on irritable bowel syndromes: A systematic review and meta-analysis of clinical trials. Nutrients. 2021;13(7):2460. doi:10.3390/nu13072460.
van Lanen AS, de Bree A, Greyling A. Efficacy of a low-fodmap diet in adult irritable bowel syndrome: A systematic review and meta-analysis. European Journal of Nutrition. 2021;doi:10.1007/s00394-020-02473-0.
Varjú P, Farkas N, Hegyi P, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: a meta-analysis of clinical studies. Plos One. 2017;12(8):e0182942. doi:10.1371/journal.pone.0182942.
Pourmand H, Esmaillzadeh A. Consumption of a low fermentable oligo-, di-, mono-saccharides, and polyols diet and irritable bowel syndrome: A systematic review. International Journal of Preventive Medicine. 2017;8(1):104. doi:10.4103/ijpvm.IJPVM_175_17.
Altobelli E, Del Negro V, Angeletti P, et al. Low-fodmap diet improves irritable bowel syndrome symptoms: A meta-analysis. Nutrients. 2017;9(9):940. doi:10.3390/nu9090940.
Khalighi Sikaroudi M, Soltani S, Ghoreishy SM, et al. Effects of a low fodmap diet on the symptom management of patients with irritable bowel syndrome: A systematic umbrella review with the meta-analysis of clinical trials. Food & Function. 2024;15(10):5195–5208. doi:10.1039/D3FO03717G.
Van den Houte K, Colomier E, Routhiaux K, et al. Efficacy and findings of a blinded randomized reintroduction phase for the low fodmap diet in irritable bowel syndrome. Gastroenterology. 2024;167(2):333–342. doi:10.1053/j.gastro.2024.02.008.
Eswaran S, Chey WD, Jackson K, et al. A diet low in fermentable oligo-, di-, and monosaccharides and polyols improves quality of life and reduces activity impairment in patients with irritable bowel syndrome and diarrhea. Clinical Gastroenterology and Hepatology. 2017;15(12):1890-1899.e3. doi:10.1016/j.cgh.2017.06.044.
Peters SL, Yao CK, Philpott H, et al. Randomised clinical trial: the efficacy of gut‐directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 2016;44(5):447–459. doi:10.1111/apt.13706.
Aziz I, Trott N, Briggs R, et al. Efficacy of a gluten-free diet in subjects with irritable bowel syndrome-diarrhea unaware of their hla-dq2/8 genotype. Clinical Gastroenterology and Hepatology. 2016;14(5):696-703.e1. doi:10.1016/j.cgh.2015.12.031.
Vazquez–Roque MI, Camilleri M, Smyrk T, et al. A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: Effects on bowel frequency and intestinal function. Gastroenterology. 2013;144(5):903-911.e3. doi:10.1053/j.gastro.2013.01.049.
Biesiekierski JR, Peters SL, Newnham ED, et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology. 2013;145(2):320-328.e3. doi:10.1053/j.gastro.2013.04.051.
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Referanslar
Lacy BE, Xu Y, Taylor DCA, et al. Burden of illness and treatment attitudes among participants meeting Rome IV criteria for irritable bowel syndrome: A nationwide survey in the united states. Neurogastroenterology & Motility. 2024;doi:10.1111/nmo.14903.
Huang KY, Wang FY, Lv M, et al. Irritable bowel syndrome: epidemiology, overlap disorders, pathophysiology and treatment. World Journal of Gastroenterology. 2023;29(26):4120–4135. doi:10.3748/wjg.v29.i26.4120.
Chen J, Zhang Y, Barandouzi ZA, et al. The effect of self-management online modules plus nurse-led support on pain and quality of life among young adults with irritable bowel syndrome: A randomized controlled trial. International Journal of Nursing Studies. 2022;132:104278. doi:10.1016/j.ijnurstu.2022.104278.
Makkawy EA, Abdulaal IE, Kalaji FR, et al. Prevalence, risk factors, and management of irritable bowel syndrome in Saudi Arabia: A systematic review. Cureus. 2023;doi:10.7759/cureus.47440.
Shah SL, Janisch NH, Crowell M, et al. Patients with irritable bowel syndrome are willing to take substantial medication risks for symptom relief. Clinical Gastroenterology and Hepatology. 2021;19(1):80–86. doi:10.1016/j.cgh.2020.04.003.
Ford AC, Moayyedi P, Chey WD, et al. American college of gastroenterology monograph on management of irritable bowel syndrome. American Journal of Gastroenterology. 2018;113:1–18. doi:10.1038/s41395-018-0084-x.
Di Rosa C, Altomare A, Terrigno V, et al. Constipation-predominant irritable bowel syndrome (IBS-C): Effects of different nutritional patterns on intestinal dysbiosis and symptoms. Nutrients. 2023;15(7):1647. doi:10.3390/nu15071647.
Alammar N, Wang L, Saberi B, et al. The impact of peppermint oil on the irritable bowel syndrome: A meta-analysis of the pooled clinical data. BMC Complementary and Alternative Medicine. 2019;19(1):21. doi:10.1186/s12906-018-2409-0.
Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of rome foundation global study. Gastroenterology. 2021;160(1):99-114.e3. doi:10.1053/j.gastro.2020.04.014.
Ionescu VA, Gheorghe G, Georgescu TF, et al. The latest data concerning the etiology and pathogenesis of irritable bowel syndrome. Journal of Clinical Medicine. 2024;13(17):5124. doi:10.3390/jcm13175124.
Enck P, Aziz Q, Barbara G, et al. Irritable bowel syndrome. Nature Reviews Disease Primers. 2016;2(1):16014. doi:10.1038/nrdp.2016.14.
Simrén M, Törnblom H, Palsson OS, et al. Management of the multiple symptoms of irritable bowel syndrome. The Lancet Gastroenterology & Hepatology. 2017;2(2):112–122. doi:10.1016/S2468-1253(16)30116-9.
Camilleri M, Boeckxstaens G. Dietary and pharmacological treatment of abdominal pain in IBS. Gut. 2017;66(5):966–974. doi:10.1136/gutjnl-2016-313425.
Cong X, Perry M, Bernier KM, et al. Effects of self-management interventions in patients with irritable bowel syndrome: Systematic review. Western Journal of Nursing Research. 2018;40(11):1698–1720. doi:10.1177/0193945917727705.
Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: management of irritable bowel syndrome. American Journal of Gastroenterology. 2021;116(1):17–44. doi:10.14309/ajg.0000000000001036.
Fukudo S, Okumura T, Inamori M, et al. Evidence-based clinical practice guidelines for irritable bowel syndrome 2020. Journal of Gastroenterology. 2021;56(3):193–217. doi:10.1007/s00535-020-01746-z.
Hawrelak JA, Wohlmuth H, Pattinson M, et al. Western herbal medicines in the treatment of irritable bowel syndrome: a systematic review and meta-analysis. Complementary Therapies in Medicine. 2020;48:102233. doi:10.1016/j.ctim.2019.102233.
Staudacher HM, Mahoney S, Canale K, et al. Clinical trial: a mediterranean diet is feasible and improves gastrointestinal and psychological symptoms in irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 2024;59(4):492–503. doi:10.1111/apt.17791.
National Institute for Health and Care Excellence (NICE). Irritable bowel syndrome in adults: diagnosis and management 2008. (15/09/2024 tarihinde https://www.nice.org.uk/guidance/cg61 adresinden ulaşılmıştır.)
Jent S, Bez NS, Haddad J, et al. The efficacy and real-world effectiveness of a diet low in fermentable oligo-, di-, monosaccharides and polyols in irritable bowel syndrome: a systematic review and meta-analysis. Clinical Nutrition. 2024;43(6):1551–1562. doi:10.1016/j.clnu.2024.05.014.
Roth B, Nseir M, Jeppsson H, et al. A starch- and sucrose-reduced diet has similar efficiency as low fodmap in IBS—A randomized non-inferiority study. Nutrients. 2024;16(17):3039. doi:10.3390/nu16173039.
Black CJ, Staudacher HM, Ford AC. Efficacy of a low fodmap diet in irritable bowel syndrome: Systematic review and network meta-analysis. Gut. 2022;71(6):1117–1126. doi:10.1136/gutjnl-2021-325214.
Hahn J, Choi J, Chang MJ. Effect of low fodmaps diet on irritable bowel syndromes: A systematic review and meta-analysis of clinical trials. Nutrients. 2021;13(7):2460. doi:10.3390/nu13072460.
van Lanen AS, de Bree A, Greyling A. Efficacy of a low-fodmap diet in adult irritable bowel syndrome: A systematic review and meta-analysis. European Journal of Nutrition. 2021;doi:10.1007/s00394-020-02473-0.
Varjú P, Farkas N, Hegyi P, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: a meta-analysis of clinical studies. Plos One. 2017;12(8):e0182942. doi:10.1371/journal.pone.0182942.
Pourmand H, Esmaillzadeh A. Consumption of a low fermentable oligo-, di-, mono-saccharides, and polyols diet and irritable bowel syndrome: A systematic review. International Journal of Preventive Medicine. 2017;8(1):104. doi:10.4103/ijpvm.IJPVM_175_17.
Altobelli E, Del Negro V, Angeletti P, et al. Low-fodmap diet improves irritable bowel syndrome symptoms: A meta-analysis. Nutrients. 2017;9(9):940. doi:10.3390/nu9090940.
Khalighi Sikaroudi M, Soltani S, Ghoreishy SM, et al. Effects of a low fodmap diet on the symptom management of patients with irritable bowel syndrome: A systematic umbrella review with the meta-analysis of clinical trials. Food & Function. 2024;15(10):5195–5208. doi:10.1039/D3FO03717G.
Van den Houte K, Colomier E, Routhiaux K, et al. Efficacy and findings of a blinded randomized reintroduction phase for the low fodmap diet in irritable bowel syndrome. Gastroenterology. 2024;167(2):333–342. doi:10.1053/j.gastro.2024.02.008.
Eswaran S, Chey WD, Jackson K, et al. A diet low in fermentable oligo-, di-, and monosaccharides and polyols improves quality of life and reduces activity impairment in patients with irritable bowel syndrome and diarrhea. Clinical Gastroenterology and Hepatology. 2017;15(12):1890-1899.e3. doi:10.1016/j.cgh.2017.06.044.
Peters SL, Yao CK, Philpott H, et al. Randomised clinical trial: the efficacy of gut‐directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 2016;44(5):447–459. doi:10.1111/apt.13706.
Aziz I, Trott N, Briggs R, et al. Efficacy of a gluten-free diet in subjects with irritable bowel syndrome-diarrhea unaware of their hla-dq2/8 genotype. Clinical Gastroenterology and Hepatology. 2016;14(5):696-703.e1. doi:10.1016/j.cgh.2015.12.031.
Vazquez–Roque MI, Camilleri M, Smyrk T, et al. A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: Effects on bowel frequency and intestinal function. Gastroenterology. 2013;144(5):903-911.e3. doi:10.1053/j.gastro.2013.01.049.
Biesiekierski JR, Peters SL, Newnham ED, et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology. 2013;145(2):320-328.e3. doi:10.1053/j.gastro.2013.04.051.
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