Acil Serviste “Kronik” Karın Ağrısı: Fonksiyonel Bağırsak Hastalıkları ve İrritabl Bağırsak Sendromu
Özet
Acil servislere karın ağrısı şikayetiyle başvuran hastaların önemli bir kısmını, semptomları alevlenen fonksiyonel bağırsak hastalıkları (FBH) oluşturmaktadır. İrritabl Bağırsak Sendromu (IBS), organik bir neden olmaksızın karın ağrısı ve dışkılama alışkanlığında değişikliklerle seyreden kronik bir tablodur. Acil tıp pratiğinde temel zorluk, bu hastaların kronik ağrı zeminindeki akut alevlenmelerini, cerrahi müdahale gerektiren "akut karın" tablolarından ayırt etmektir. Bu bölümde, IBS patofizyolojisi, Roma IV tanı kriterleri, acil serviste alarm semptomlarının yönetimi, fonksiyonel dispepsi ile örtüşme (overlap) durumları ve güncel tedavi algoritmaları kanıta dayalı tıp ışığında ele alınmıştır. Klinisyenin gereksiz radyolojik görüntülemeden kaçınarak doğru semptomatik tedaviyi planlaması hedeflenmektedir.
A significant portion of patients presenting to the emergency department with abdominal pain consists of functional bowel diseases (FBD) with exacerbated symptoms. Irritable Bowel Syndrome (IBS) is a chronic condition characterized by abdominal pain and changes in bowel habits without an organic cause. The primary challenge in emergency medicine is to distinguish the acute exacerbations of these patients on the background of chronic pain from "acute abdomen" situations requiring surgical intervention. In this chapter, IBS pathophysiology, Rome IV diagnostic criteria, management of alarm symptoms in the emergency department, overlap situations with functional dyspepsia, and current treatment algorithms are discussed in the light of evidence-based medicine. It is aimed for the clinician to plan the correct symptomatic treatment by avoiding unnecessary radiological imaging.
Referanslar
Ford AC, Sperber AD, Corsetti M, Camilleri M. Irritable bowel syndrome. Lancet. 2020;396(10263):1675-1688. doi:10.1016/S0140-6736(20)31548-8.
Sperber AD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simrén M, Tack J, et al. Worldwide prevalence and burden of functional gastrointestinal disorders: results of the Rome Foundation Global Study. Gastroenterology. 2021;160(1):99-114. doi:10.1053/j.gastro.2020.04.014.
Lacy BE, Pimentel M, Brenner DM, Chey WD, Keefer LA, Long MD, et al. ACG clinical guideline: management of irritable bowel syndrome. Official journal of the American College of Gastroenterology| ACG. 2021;116(1):17-44. doi:10.14309/ajg.0000000000001036.
Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology. 2016;150(6):1262-1279.
Vasant DH, Paine PA, Black CJ, Houghton LA, Everitt HA, Corsetti M, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut. 2021;70(7):1214-1240.
Black CJ, Ford AC. Best management of irritable bowel syndrome. Frontline Gastroenterology, 2021;12(4), 303-315.
Simren M, Palsson OS, Whitehead WE. Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice. Current gastroenterology reports. 2017;19(4): 15.
Schmulson MJ, Drossman DA. What is new in Rome IV. Journal of neurogastroenterology and motility. 2017;23(2):151-163.
Ruepert L, Quartero AO, de Wit NJ, et al. Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. Cochrane database of systematic reviews. 2011;(8): CD003460.
Moayyedi P, Andrews CN, MacQueen G, et al. Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable Bowel Syndrome (IBS). Journal of the Canadian Association of Gastroenterology. 2019;2(1): 6-29.
Swierczynski M, Makaro A, Grochowska A, Salaga M. Pharmacological approaches to treat intestinal pain. Expert Review of Clinical Pharmacology. 2023; 16(4), 297-311.
Efskind PS, Bernklev T, Vatn MH. A double-blind placebo-controlled trial with loperamide in irritable bowel syndrome. Scandinavian journal of gastroenterology. 1996;31(5): 463-468.
Chapman RW, Stanghellini V, Geraint M, et al. Randomized clinical trial: macrogol/polyethylene glycol 3350 plus electrolytes for treatment of patients with constipation-associated irritable bowel syndrome. Official journal of the American College of Gastroenterology| ACG. 2013;37(2): 200-207.
Varney J, Barrett J, Scarlata K, et al. FODMAPs: food composition, defining cutoff values and international application. Journal of gastroenterology and hepatology. 2017;32, 53-61.
Moayyedi P, Quigley EM, Ferry LY, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Official journal of the American College of Gastroenterology| ACG. 2014;109(9): 1367-1374.
Mayer EA, Knight R, Mazmanian SK, et al. Gut microbes and the brain: paradigm shift in neuroscience. Journal of Neuroscience. 2014;34(46): 15490-15496.
Enck P, Aziz Q, Barbara G, et al. Irritable bowel syndrome. Nature Reviews Disease Primers. 2016;2(1): 16014.
Barbara G, Feinle-Bisset C, Ghoshal UC, et al. The Intestinal Microenvironment and Functional Gastrointestinal Disorders. Gastroenterology. 2016;150(6): 1305-1318.
Mearin F, Lacy BE, Chang L, et al. Bowel Disorders. Gastroenterology. 2016;150(6): 1393-1407.
Referanslar
Ford AC, Sperber AD, Corsetti M, Camilleri M. Irritable bowel syndrome. Lancet. 2020;396(10263):1675-1688. doi:10.1016/S0140-6736(20)31548-8.
Sperber AD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simrén M, Tack J, et al. Worldwide prevalence and burden of functional gastrointestinal disorders: results of the Rome Foundation Global Study. Gastroenterology. 2021;160(1):99-114. doi:10.1053/j.gastro.2020.04.014.
Lacy BE, Pimentel M, Brenner DM, Chey WD, Keefer LA, Long MD, et al. ACG clinical guideline: management of irritable bowel syndrome. Official journal of the American College of Gastroenterology| ACG. 2021;116(1):17-44. doi:10.14309/ajg.0000000000001036.
Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology. 2016;150(6):1262-1279.
Vasant DH, Paine PA, Black CJ, Houghton LA, Everitt HA, Corsetti M, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut. 2021;70(7):1214-1240.
Black CJ, Ford AC. Best management of irritable bowel syndrome. Frontline Gastroenterology, 2021;12(4), 303-315.
Simren M, Palsson OS, Whitehead WE. Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice. Current gastroenterology reports. 2017;19(4): 15.
Schmulson MJ, Drossman DA. What is new in Rome IV. Journal of neurogastroenterology and motility. 2017;23(2):151-163.
Ruepert L, Quartero AO, de Wit NJ, et al. Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. Cochrane database of systematic reviews. 2011;(8): CD003460.
Moayyedi P, Andrews CN, MacQueen G, et al. Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable Bowel Syndrome (IBS). Journal of the Canadian Association of Gastroenterology. 2019;2(1): 6-29.
Swierczynski M, Makaro A, Grochowska A, Salaga M. Pharmacological approaches to treat intestinal pain. Expert Review of Clinical Pharmacology. 2023; 16(4), 297-311.
Efskind PS, Bernklev T, Vatn MH. A double-blind placebo-controlled trial with loperamide in irritable bowel syndrome. Scandinavian journal of gastroenterology. 1996;31(5): 463-468.
Chapman RW, Stanghellini V, Geraint M, et al. Randomized clinical trial: macrogol/polyethylene glycol 3350 plus electrolytes for treatment of patients with constipation-associated irritable bowel syndrome. Official journal of the American College of Gastroenterology| ACG. 2013;37(2): 200-207.
Varney J, Barrett J, Scarlata K, et al. FODMAPs: food composition, defining cutoff values and international application. Journal of gastroenterology and hepatology. 2017;32, 53-61.
Moayyedi P, Quigley EM, Ferry LY, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Official journal of the American College of Gastroenterology| ACG. 2014;109(9): 1367-1374.
Mayer EA, Knight R, Mazmanian SK, et al. Gut microbes and the brain: paradigm shift in neuroscience. Journal of Neuroscience. 2014;34(46): 15490-15496.
Enck P, Aziz Q, Barbara G, et al. Irritable bowel syndrome. Nature Reviews Disease Primers. 2016;2(1): 16014.
Barbara G, Feinle-Bisset C, Ghoshal UC, et al. The Intestinal Microenvironment and Functional Gastrointestinal Disorders. Gastroenterology. 2016;150(6): 1305-1318.
Mearin F, Lacy BE, Chang L, et al. Bowel Disorders. Gastroenterology. 2016;150(6): 1393-1407.
