Irritabl Bağırsak Sendromu (IBS)
Özet
Irritabl bağırsak sendromu (IBS), tekrarlayan karın ağrısı ya da rahatsızlık hissiyle birlikte dışkılama alışkanlığında değişiklikle karakterize, organik nedeni saptanamayan kronik bir beyin-bağırsak etkileşimi bozukluğudur (DGBI). Roma V kriterlerine göre semptomların en az üç aydır sürmesi ve son altı ay içinde başlamış olması gerekir. IBS dört alt tipe ayrılır: kabızlık ağırlıklı (IBS-K), ishal ağırlıklı (IBS-İ), karışık (IBS-M) ve sınıflandırılamayan (IBS-S). Visseral aşırı duyarlılık, bağırsak motilite bozuklukları, mikrobiyota değişiklikleri, mukozal-immün işlev bozuklukları ve beyin-bağırsak iletişim değişiklikleri bir arada rol oynar. Klinik değerlendirmede alarm bulgularının ayırt edilmesi temel önceliktir: dışkıda kan, gece uykudan uyandıran ağrı, istemsiz kilo kaybı, demir eksikliği anemisi, ailede kolorektal kanser/İBH öyküsü ve 50 yaş sonrası yeni başlangıç organik hastalık araştırmasını gerektirir. Bu bölümün amacı, IBS'li hastalarda kanıta dayalı, Roma V ile uyumlu, damgalayıcı olmayan ve hasta merkezli bir yaklaşım sunmaktır.
Irritable bowel syndrome (IBS) is a chronic disorder of gut–brain interaction (DGBI) characterized by recurrent abdominal pain or discomfort associated with changes in bowel habits, without an identifiable organic cause. According to the Roma V criteria, symptoms must be present for at least three months and should have started within the previous six months. IBS is classified into four subtypes: constipation-predominant (IBS-C), diarrhea-predominant (IBS-D), mixed type (IBS-M), and unclassified IBS (IBS-U). Multiple mechanisms are involved simultaneously, including visceral hypersensitivity, abnormalities in gastrointestinal motility, alterations in the gut microbiota, mucosal-immune dysfunction, and changes in gut–brain communication. In clinical evaluation, identifying alarm features is the primary priority. Rectal bleeding, nocturnal pain that awakens the patient from sleep, unintentional weight loss, iron deficiency anemia, a family history of colorectal cancer or inflammatory bowel disease, and new-onset symptoms after the age of 50 warrant investigation for organic disease. The aim of this section is to provide an evidence-based, Roma V–compatible, non-stigmatizing, and patient-centered approach to the management of patients with IBS.
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