How is irritable bowel syndrome treated?

Health food

The diet is selected individually depending on the leading clinical symptoms. Exclude spicy seasonings, foods rich in essential oils, raw vegetables, fruits, restrict milk. The set of products is adjusted taking into account the tolerability, the nature of motor disorders, the predominance of proteolytic (putrefactive) or saccharolytic (fermenting) microflora. Nutrition is fractional, 5-6 times a day.

Irritable bowel syndrome with a predominance of diarrhea is recommended mechanically and chemically sparing diets № 46 and 4в (depending on the clinical picture). Products containing little connective tissue are shown - veal, lean pork, rabbit meat, white turkey meat and chicken, low-fat fish.

In irritable bowel syndrome with a predominance of constipation, dietary treatment is a step-wise treatment. For the first 2 weeks, diets Nos. 46 and 4c are recommended, enriched with foods and dishes with a mild, laxative effect. Normalization of the motor activity of the intestine is promoted by well-brewed vegetables, ripe fruits after cooking, vegetable oil, low-acid fermented milk (by more than 50-60 ° C), fruit and berry juices from ripe fruits of non-acid varieties. Then the child is transferred to diet number 3 with the addition of wheat bran and the mandatory observance of sufficient drinking regime.

Normalization of motor-evacuation function of the intestine

In irritable bowel syndrome with a predominance of constipation, abdominal pain is prescribed antispasmodics and drugs that dilute intestinal contents.

Drotaverin, a spasmolytic agent derived from isoquinoline, acts directly on the smooth muscles of the gastrointestinal, biliary, urogenital and cardiovascular systems by inhibiting phosphodiesterase and disrupting intracellular accumulation of cAMP, which results in the relaxation of myocytes due to the inactivation of the light chain of myosin kinase. Children 1-6 years inward appoint 40-120 mg per day (2-3 times for 1 / 2-1 tablet), over 6 years - 80-200 mg per day (2-5 times for 1 tablet).

Drotaverin forte for children over 6 years of age, the daily dose is 80-200 mg (1-2.5 tablets), single dose - 40 mg (1/2 tablet).

Dicycloverin - M-holinoblokator, quaternary amine. Has anticholinergic activity, causes relaxation of smooth muscles. Children aged 6 months to 2 years are prescribed 5 mg 3-4 times a day, over 2 years - 10 mg 3-4 times a day.

The main drawbacks of drotaverine and dicyclovir are:

• nonselectivity of influence on the muscular membrane of the large intestine;
• the presence of undesirable effects due to the effect on the smooth muscles of other organs of the gastrointestinal tract;
• systemic anticholinergic effects (dry mouth, tachycardia, impaired sweating and urination).

Mebeverin has an antispastic effect, reducing the permeability of smooth muscle cells for sodium ions, reducing the outflow of potassium ions, so that there is no permanent relaxation or hypotension. Children older than 12 years-the capsule should be swallowed whole, washed down with water. Assign 1 capsule (200 mg) 2 times a day for 20 minutes before meals (morning and evening).

Trimebutin regulates peristalsis of the gastrointestinal tract, affecting opioid receptors. Enter the drug inside, rectally and parenterally. Dosing regimen is individual. The daily dose for ingestion should not exceed 300 mg, for rectal administration - 100-200 mg. With intramuscular or intravenous administration, a single dose is 50 mg. For children, the drug is allowed from the first year of life, the dose depends on the age.

Hyoscine butyl bromide - blocker of M-cholinergic receptors, has a relaxing effect on the smooth muscles of internal organs, does not have anticholinergic effects on the central nervous system. Children over 6 years are prescribed 10-20 mg 3 times a day inward with a small amount of water. Children aged 1 year to 6 years - 5-10 mg orally or rectally - 7.5 mg 3-5 times a day; Children younger than 1 year - inside 5 mg 2-3 times per day or rectally - 7.5 mg to 5 times a day.

For children over 12 years of age, otilonium bromide and pinaverium bromide are allowed. Pinaverium bromide »blocks calcium channels of receptors located in the intestinal mucosa, and calcium channels of the smooth muscles of the intestinal wall; the drug is prescribed for 100 mg 3-4 times daily with meals, after the acute symptoms subsided, the maintenance dosage is 50 mg 3-4 times a day from 2 to 6 weeks.

Lactulose is widely used in everyday pediatric practice as an effective and safe laxative, many drugs are allowed from birth, the dose is selected individually. Duration of admission is not limited, as the addiction does not occur.

Macrogol is an isoosmotic laxative consisting of long linear polymers, through hydrogen bonds of the water-holding molecule, which dissolves stool masses and facilitates their evacuation. The drug indirectly acts on peristalsis, without causing an irritating effect. It is not absorbed from the digestive tract, it begins to function 24-48 hours after ingestion.

In Russia the children's dosage form of macrogol is registered - the transpreg. At the age of 1 year to 6 years, 1-2 sachets are prescribed per day (preferably in the morning). The maximum daily dose is 5.9 g (2 sachets at 2.95 g). The contents of the sachet should be dissolved in 50 ml of water. Children 6-12 years old are assigned 1-2 sachets per day (preferably in the morning). The maximum daily dose is 8.85 g (3 sachets at 2.95 g).

In irritable bowel syndrome with prevalence of diarrhea caused by hyperkinetic dyskinesia of the intestine, drugs that restore the mucosal barrier of the intestine and provide increased protection factors.

Sucralfate for children over 4 years of age is prescribed for 0.5-1 g 4 times a day (for 1 hour before meals and at bedtime) from the calculation of 40-80 mg / kg body weight for 4 doses.

De-nol is taken 30 minutes before meals; children 4-8 years need 8 mg / kg per day, this dose is divided into 2 receptions; in 8-12 years give 1 tablet (120 mg) 2 times a day. Children over 12 years are prescribed 1 tablet 4 times a day for 30 minutes before breakfast, lunch and dinner, the last time before bedtime, or 2 tablets 2 times a day. The tablet is washed down with a few sips of water (not milk).

Smectite dioctahedral for children younger than 1 year is prescribed 1 packet per day; from 1 year to 2 years - 2 sachets per day; over 2 years - 2-3 bags per day. The contents of the sachet are dissolved in 50 ml of water and distributed over several doses throughout the day.

Loperamide is used as a symptomatic agent. Children older than 5 years are prescribed 1 capsule (0.002 g) 1-5 times a day. Children 1-5 years of age, the drug is given as a solution containing 0.2 mg / ml of 1 teaspoonful (5 ml) per 10 kg of body weight 2-3 times a day. Children younger than 1 year of the drug is not prescribed.

Restoration of normal intestinal biocoenosis and intestinal chemical chemistry

To normalize the composition of the intestinal microflora, probiotics and prebiotics are used, many patients need antibacterial treatment. Indications for the prescription of antibacterial drugs:

• excess bacterial growth in the intestine (small intestine);
• inefficiency of previous treatment without the use of antibacterial agents.

In the presence of indications for antibacterial treatment, it is advisable to prescribe antiseptic agents inside. Nifuroxazide is prescribed for children older than 1 month at 200-600 mg per day in 2-3 doses. Intetriks can be given from birth at the rate of 10 mg / kg per day 1-3 times a day.

Carry out 1-2 courses of treatment lasting 5-7 days with a change of the drug before the next course.

After antibacterial treatment, probiotics are necessary - preparations containing a normal intestinal microflora.

Correction of psychoemotional disorders

Treatment of psychoemotional disorders includes the use of psychotropic drugs, psychotherapy, autogenous training, therapeutic exercise under the supervision of a psychotherapist.

An approximate scheme of treatment of patients with irritable bowel syndrome with a predominance of constipation:

• the diet provides a warm, slightly malodorous, non-irritating food, possibly the addition of dietary fiber (bran);
• administration of antispasmodics (trimebutin, mebeverin, hyoscine butyl bromide);
• correction of stool (transpag or lactulose preparations);
• the appointment of psychotropic drugs (in the presence of psychoemotional disorders, after consulting a psychoneurologist);
• consultation of the physiotherapist, if necessary - physiotherapy treatment;
• ineffectiveness of treatment for 7 days (the preservation of flatulence, the release of mucus with feces) requires an additional appointment of an antibacterial drug (intetriks or nifuroxazide) for 7 days followed by a probiotic for 2 weeks.

An approximate scheme of treatment of patients with irritable bowel syndrome with predominance of diarrhea:

• diet;
• antispasmodics (mebeverin, hyoscine butyl bromide);
• smectite dioctahedral (sucralfate);
• loperamide;
• ineffectiveness or instability of the effect after 5-7 days of treatment requires an additional prescription of an antibacterial drug (inte- trix or nifuroxazide) followed by a probiotic;
• psychotropic drugs, physiotherapy - if necessary, after consulting a psychoneurologist or a physiotherapist.

Forecast

The prognosis of the disease is favorable. The course of the disease is chronic, relapsing, but not progressive. The risk of developing inflammatory bowel disease, colorectal cancer in patients with irritable bowel syndrome is the same. As in the general population, which determines the tactics of patient observation, so there is no need for frequent colonoscopy studies.

The quality of life of patients with irritable bowel syndrome in relation to nutrition, sleep, rest, active activity is reduced. According to the results of a population study among senior school students in Novosibirsk, it was found that 49% of school children with irritable bowel syndrome are being treated for the disease to a doctor, 21% of teenagers underwent endoscopy. 62% of teenagers with irritable bowel syndrome missed school in the last year because of poor health.

Symptoms of irritable bowel syndrome (abdominal pain unchanged localization, diarrhea, flatulence) often lead to nutritional deficiencies, the gradual elimination of more and more foods from the diet. Usually, pathological symptoms persist for many years with only minor variations in the severity of the condition. Exacerbations are more often associated not with psychogenic, but with somatogenic factors (a deviation from the stereotype of nutrition, a change in the usual scheme of pharmacotherapy).

[1], [2], [3], [4], [5], [6], [7], [8]