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IBS, Irritable Bowel Syndrome

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Definition:
Funktionella magbesvär med buksmärtor kopplat till avföringsrubbning med perioder av diarré och/eller förstoppning.
Förekomst:
Cirka 5 % av befolkningen har IBS.
Symtom:
Tillståndet kännetecknas av buksmärtor som är relaterade till tarmperistaltiken, vilket kan innebära att smärtan förändras vid tarmtömning eller att tarmtömningsfrekvensen/konsistensen förändras i samband med smärta. Några har omväxlande diarré och förstoppning, medan andra har dominerande symtom av antingen diarré eller förstoppning. Uppblåsthetskänsla och tarmtömningssymtom som trängningar eller känsla av ofullständig tömning är vanligt förekommande.
Kliniska fynd:
Inga onormala kliniska fynd vid undersökning.
Diagnostik:
Det finns inga specifika tester som kan påvisa IBS.
Behandling:
Adekvat undersökning och information till patienten om tillståndet. Ändring av livsstilsfaktorer kan hjälpa. Beroende på symtombördan kan läkemedelsbehandling, kostbehandling eller psykologisk behandling bli aktuell.
  1. Palsson OS, Whitehead W, Törnblom H, Sperber AD, Simren M. Prevalence of Rome IV Functional Bowel Disorders Among Adults in the United States, Canada, and the United Kingdom. Gastroenterology. 2020;158(5):1262-1273.e3. PMID: 31917991 PubMed  
  2. Sperber AD, Bangdiwala SI, Drossman DA et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology. 2021 Jan;160(1):99-114.e3. doi: 10.1053/j.gastro.2020.04.014. Epub 2020 Apr 12. PMID: 32294476. PubMed  
  3. Chey WY, Jin HO, Lee MH, Sun SW, Lee KY. Colonic motility abnormality in patients with irritable bowel syndrome exhibiting abdominal pain and diarrhea. Am J Gastroenterol. 2001 May;96(5):1499-506. doi: 10.1111/j.1572-0241.2001.03804.x. PMID: 1137468 PubMed  
  4. Levy RL, Jones KR, Whitehead WE, et al. Irritable bowel syndrome in twins: heredity and social learning both contribute to etiology. Gastroenterology 2001;121:799-804. pmid: 11606493 PubMed  
  5. Bonfiglio F, Liu X, Smillie C, Pandit A et al. GWAS of stool frequency provides insights into gastrointestinal motility and irritable bowel syndrome. Cell Genom. 2021 Dec 8;1(3):None. doi: 10.1016/j.xgen.2021.100069. PMID: 34957435 PubMed  
  6. Margolis KG, Cryan JF, Mayer EA. The Microbiota-Gut-Brain Axis: From Motility to Mood. Gastroenterology. 2021 Apr;160(5):1486-1501. doi: 10.1053/j.gastro.2020.10.066. Epub 2021 Jan 22. PMID: 33493503 PubMed  
  7. Bharucha AE, Wouters MM, Tack J. Existing and emerging therapies for managing constipation and diarrhea. Curr Opin Pharmacol. 2017 Dec;37:158-166. doi: 10.1016/j.coph.2017.10.015. Epub 2017 Nov 21. PMID: 29172123 PubMed  
  8. Thabane M, et al. Systematic review and meta-analysis: the incidence and prognosis of post-infectious irritable bowel syndrome. Aliment Pharmacol Ther 2007; 26: 535-44. PubMed  
  9. Lawal A, Kern M, Sidhu H, et al. Novel evidence for hypersensitivity of visceral sensory neural circuitry in irritable bowel syndrome patients. Gastroenterology 2006; 130:26. Gastroenterology  
  10. Tillisch K, Mayer EA, Labus JS. Quantitative meta-analysis identifies brain regions activated during rectal distension in irritable bowel syndrome. Gastroenterology. 2011 Jan;140(1):91-100. doi: 10.1053/j.gastro.2010.07.053. Epub 2010 Aug 7. PMID: 20696168 PubMed  
  11. Whitehead WE, Crowell MD, Robinson JC, Heller BR, Schuster MM. Effects of stressful life events on bowel symptoms: subjects with irritable bowel syndrome compared with subjects without bowel dysfunction. Gut. 1992 Jun;33(6):825-30. doi: 10.1136/gut.33.6.825. PMID: 1624167 PubMed  
  12. Berens S, Banzhaf P, Baumeister D, Gauss A, Eich W, Schaefert R, Tesarz J. Relationship between adverse childhood experiences and illness anxiety in irritable bowel syndrome - The impact of gender. J Psychosom Res. 2020 Jan;128:109846. doi: 10.1016/j.jpsychores.2019.109846. Epub 2019 Oct 19. PMID: 31759196 PubMed  
  13. Park SH, Videlock EJ, Shih W, Presson AP, Mayer EA, Chang L. Adverse childhood experiences are associated with irritable bowel syndrome and gastrointestinal symptom severity. Neurogastroenterol Motil. 2016 Aug;28(8):1252-60. doi: 10.1111/nmo.12826. Epub 2016 Apr 8. PMID: 27061107 PubMed  
  14. Vandvik PO, Wilhelmsen I, Ihlebaek C, Farup PG. Comorbidity of irritable bowel syndrome in general practice: a striking feature with clinical implications. Aliment Pharmacol Ther 2004; 20: 1195-203. PubMed  
  15. Zamani M, Alizadeh-Tabari S, Zamani V. Systematic review with meta-analysis: the prevalence of anxiety and depression in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2019 Jul;50(2):132-143. doi: 10.1111/apt.15325. Epub 2019 Jun 3. PMID: 31157418 PubMed  
  16. Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology 2010; 25: 252-8. PubMed  
  17. Sun Q, Jia Q, Song L, Duan L. Alterations in fecal short-chain fatty acids in patients with irritable bowel syndrome: A systematic review and meta-analysis. Medicine (Baltimore). 2019 Feb;98(7):e14513. doi: 10.1097/MD.0000000000014513. PMID: 30762787 PubMed  
  18. Black CJ, Ford AC. Global burden of irritable bowel syndrome: trends, predictions and risk factors. Nat Rev Gastroenterol Hepatol. 2020 Aug;17(8):473-486. doi: 10.1038/s41575-020-0286-8. Epub 2020 Apr 15. PMID: 32296140 PubMed  
  19. Svensk Gastroenterologisk Förening. IBS – utredning och behandling. Sammanfattningsdokument. 2009. Hämtad 2021-11-01. svenskgastroenterologi.se  
  20. Lagerlöf E, Agreus L, Simrén M, Törnblom H. ABC om - IBS – irritabel tarm. Lakartidningen. 2018 Mar 7;115:EXDU. Swedish. PMID: 29533415 PubMed  
  21. Lacy BE, Patel NK. Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome. J Clin Med. 2017 Oct 26;6(11). PMID: 29072609 PubMed  
  22. Nationellt vårdprogram. Tjock- och ändtarmscancer. Hämtad 2020-05-15 kunskapsbanken.cancercentrum.se  
  23. Nationellt vårdprogram äggstockscancer, RCC 2015 www.cancercentrum.se  
  24. Waugh, N, Cummins, E, Royle, P, et al. Faecal calprotectin testing for differentiating amongst inflammatory and non-inflammatory bowel diseases: systematic review and economic evaluation. Health Technol Assess 2013: 17; xv-xix, 1–211. PMID: 24286461. PubMed  
  25. Robinson A, Lee V, Kennedy A, et al. A randomised controlled trial of self-help interventions in patients with a primary care diagnosis of irritable bowel syndrome. Gut 2006; 55: 643-8. PMID: 16099784 PubMed  
  26. Moayyedi P, Quigley EM, Lacy BE, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol. 2014 Sep;109(9):1367-74. PMID: 25070054 PubMed  
  27. Lösliga fibrer och bakterier kan lindra vid irritabel tarm. SBU 2015. www.sbu.se  
  28. Bijkerk CJ, de Wit NJ, Muris JWM, et al. Soluble og insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ 2009; 339: b3154. BMJ (DOI)  
  29. 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 Jul 19;13(7):2460. doi: 10.3390/nu13072460. PMID: 34371973 PubMed  
  30. 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. Eur J Nutr. 2021 Sep;60(6):3505-3522. doi: 10.1007/s00394-020-02473-0. Epub 2021 Feb 14. Erratum in: Eur J Nutr. 2021 Jun 28;: PMID: 33585949 PubMed  
  31. Nordin E, Brunius C, Landberg R, Hellström PM. FODMAPs, but not gluten, elicit modest symptoms of irritable bowel syndrome: a double-blind, placebo-controlled, randomized three-way crossover trial. Am J Clin Nutr. 2021 Oct 7:nqab337. doi: 10.1093/ajcn/nqab337. Epub ahead of print. PMID: 34617561 PubMed  
  32. Ankersen DV, Weimers P, Burisch J. Whats 'App-ening': the help of new technologies in nutrition in digestive diseases. Curr Opin Clin Nutr Metab Care. 2017 Sep;20(5):426-431. PMID: 28768297 PubMed  
  33. Asha MZ, Khalil SFH. Efficacy and Safety of Probiotics, Prebiotics and Synbiotics in the Treatment of Irritable Bowel Syndrome: A systematic review and meta-analysis. Sultan Qaboos Univ Med J. 2020 Feb;20(1):e13-e24. doi: 10.18295/squmj.2020.20.01.003. Epub 2020 Mar 9. PMID: 32190365 PubMed  
  34. Behandling av IBS (irritabel tarm) med fibrer. SBU 2015. www.sbu.se  
  35. Behandling av IBS (irritabel tarm) och funktionell förstoppning med probiotika, prebiotika och synbiotika. SBU. 2015. www.sbu.se  
  36. Daley AJ, Grimmett C, Roberts L, Wilson S, Fatek M, Roalfe A, Singh S. The effects of exercise upon symptoms and quality of life in patients diagnosed with irritable bowel syndrome: a randomised controlled trial. Int J Sports Med 2008;29:778-82. PMID: 18461499. PubMed  
  37. Ruepert L, Quartero AO et al. Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. Cochrane database systematic review 2011. pmid:21833945 PubMed  
  38. Mueller-Lissner S, Tytgat GN, Paulo LG, Quigley EM, Bubeck J, Peil H, Schaefer E. Placebo- and paracetamol-controlled study on the efficacy and tolerability of hyoscine butylbromide in the treatment of patients with recurrent crampy abdominal pain. Aliment Pharmacol Ther. 2006 Jun 15;23(12):1741-8. doi: 10.1111/j.1365-2036.2006.02818.x. PMID: 16817918 PubMed  
  39. Ford AC, Lacy BE, Harris LA, Quigley EMM, Moayyedi P. Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-Analysis. Am J Gastroenterol. 2019 Jan;114(1):21-39. doi: 10.1038/s41395-018-0222-5. PMID: 30177784 PubMed  
  40. Everitt HA, Landau S, O'Reilly G, Sibelli A, Hughes S, Windgassen S, Holland R, Little P, McCrone P, Bishop F, Goldsmith K, Coleman N, Logan R, Chalder T, Moss-Morris R; ACTIB trial group. Assessing telephone-delivered cognitive-behavioural therapy (CBT) and web-delivered CBT versus treatment as usual in irritable bowel syndrome (ACTIB): a multicentre randomised trial. Gut. 2019 Sep;68(9):1613-1623. doi: 10.1136/gutjnl-2018-317805. Epub 2019 Apr 10. PMID: 30971419 PubMed  
  41. Brandt LJ, Bjorkman D, Fennerty MB, Locke GR, Olden K, Peterson W, Quigley E, Schoenfeld P, Schuster M, Talley N. Systematic review on the management of irritable bowel syndrome in North America. Am J Gastroenterol 2002;97:S7-26. pmid: 12425586 PubMed  
  42. Heymann-Monnikes I, Arnold R, Florin I, Herda C, Melfsen S, Monnikes H. The combination of medical treatment plus multicomponent behavioral therapy is superior to medical treatment alone in the therapy of irritable bowel syndrome. Am J Gastroenterol 2000;95:981-94. PMID: 10763948. PubMed  
  43. El-Salhy M, Hatlebakk JG, Gilja OH et al. Efficacy of faecal microbiota transplantation for patients with irritable bowel syndrome in a randomised, double-blind, placebo-controlled study. Gut 2019. Epub ahead of print. pmid:31852769 PubMed  
  44. Halkjær SI, Christensen AH, Lo BZS, et al Faecal microbiota transplantation alters gut microbiota in patients with irritable bowel syndrome: results from a randomised, double-blind placebo-controlled study Gut Published Online First: 06 July 2018.
  45. Canavan C, West J, Card T. The economic impact of the irritable bowel syndrome. Aliment Pharmacol Ther 2014;40:1023-1034. PubMed  
  • Susanna Walter, docent och specialist i gastroenterologi, Universitetssjukhuset i Linköping
  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet