How is irritable bowel syndrome treated?

Therapeutic nutrition

The diet is selected individually depending on the leading clinical symptoms. Exclude hot spices, products rich in essential oils, raw vegetables, fruits, limit milk. The set of products is adjusted taking into account tolerance, the nature of motor disorders, the predominance of proteolytic (putrefactive) or saccharolytic (fermentative) microflora. Meals are fractional, 5-6 times a day.

In case of irritable bowel syndrome with predominant diarrhea, mechanically and chemically gentle diets No. 46 and 4b are recommended (depending on the clinical picture). Products containing little connective tissue are indicated - veal, lean pork, rabbit meat, white meat of turkey and chicken, lean fish.

In case of irritable bowel syndrome with predominance of constipation, dietary treatment is staged. For the first 2 weeks, diets No. 46 and 4b are recommended, enriched with products and dishes with a mild laxative effect. Well-boiled vegetables, ripe fruits after heat treatment, vegetable oil, low-acidity fermented milk drinks (more than 50-60° C), fruit and berry juices from ripe fruits of non-acidic varieties contribute to the normalization of intestinal motility. Then the child is transferred to diet No. 3 with the addition of wheat bran and mandatory adherence to a sufficient drinking regime.

Normalization of the motor-evacuation function of the intestine

For irritable bowel syndrome with predominant constipation and abdominal pain, antispasmodics and drugs that thin the intestinal contents are prescribed.

Drotaverine is an antispasmodic agent, an isoquinoline derivative, which acts directly on the smooth muscles of the gastrointestinal, biliary, urogenital and cardiovascular systems by inhibiting phosphodiesterase and disrupting the intracellular accumulation of cAMP, which leads to myocyte relaxation due to the inactivation of the light chain of myosin kinase. Children aged 1-6 years are prescribed 40-120 mg orally per day (2-3 times 1/2-1 tablet), over 6 years - 80-200 mg per day (2-5 times 1 tablet).

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

Dicycloverine is an M-anticholinergic, a quaternary amine. It has anticholinergic activity, causing 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 disadvantages of drotaverine and dicycloverine:

• non-selectivity of the effect on the muscular membrane of the colon;
• the presence of undesirable effects caused by the impact on the smooth muscles of other organs of the gastrointestinal tract;
• systemic anticholinergic effects (dry mouth, tachycardia, impaired sweating and urination).

Mebeverine has an antispasmodic effect, reducing the permeability of smooth muscle cells for sodium ions, reducing the outflow of potassium ions, as a result of which constant relaxation or hypotension does not occur. Children over 12 years old - the capsule should be swallowed whole with water. Prescribed 1 capsule (200 mg) 2 times a day 20 minutes before meals (morning and evening).

Trimebutine regulates gastrointestinal motility by acting on opioid receptors. The drug is administered orally, rectally and parenterally. The dosage regimen is individual. The daily dose for oral administration should not exceed 300 mg, for rectal administration - 100-200 mg. For intramuscular or intravenous administration, a single dose is 50 mg. The drug is allowed for children from the first year of life, the dose depends on age.

Hyoscine butylbromide is an M-cholinergic receptor blocker, has a relaxing effect on the smooth muscles of internal organs, does not have an anticholinergic effect on the central nervous system. Children over 6 years old are prescribed 10-20 mg 3 times a day orally with a small amount of water. Children aged 1 to 6 years - 5-10 mg orally or rectally - 7.5 mg 3-5 times a day; children under 1 year - orally 5 mg 2-3 times a day or rectally - 7.5 mg up to 5 times a day.

For children over 12 years of age, otilonium bromide and pinaverium bromide are permitted. 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 at 100 mg 3-4 times a day during meals, after acute symptoms subside, the maintenance dosage is 50 mg 3-4 times a day for 2 to 6 weeks.

Lactulose is widely used in everyday pediatric practice as an effective and safe laxative, many drugs are approved from birth, the dose is selected individually. The duration of administration is not limited, since addiction does not occur.

Macrogol is an isoosmotic laxative consisting of long linear polymers that hold water molecules by means of hydrogen bonds, liquefying fecal matter and facilitating its evacuation. The drug indirectly affects peristalsis without causing an irritating effect. It is not absorbed from the gastrointestinal tract, and begins to act 24-48 hours after administration.

In Russia, a pediatric dosage form of macrogol, transipeg, is registered. For children aged 1 to 6 years, 1-2 sachets are prescribed per day (preferably in the morning). The maximum daily dose is 5.9 g (2 sachets of 2.95 g). The contents of the sachet should be dissolved in 50 ml of water. For children aged 6-12 years, 1-2 sachets are prescribed per day (preferably in the morning). The maximum daily dose is 8.85 g (3 sachets of 2.95 g).

In irritable bowel syndrome with a predominance of diarrhea caused by hyperkinetic intestinal dyskinesia, drugs are used that restore the intestinal mucosal barrier and provide increased protective factors.

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

De-nol is taken 30 minutes before meals; children aged 4-8 years need 8 mg/kg per day, this dose is divided into 2 doses; at 8-12 years old, give 1 tablet (120 mg) 2 times a day. Children over 12 years old are prescribed 1 tablet 4 times a day 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).

Dioctahedral smectite is prescribed to children under 1 year old at 1 sachet per day; from 1 year to 2 years - 2 sachets per day; over 2 years - 2-3 sachets per day. The contents of the sachet are dissolved in 50 ml of water and distributed into several doses during the day.

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

Restoration of normal intestinal biocenosis and chemistry of intestinal contents

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

• bacterial overgrowth in the small intestine (gut);
• ineffectiveness of previous treatment without the use of antibacterial agents.

If there are indications for antibacterial treatment, it is advisable to prescribe antiseptics orally. Nifuroxazide is prescribed to children over 1 month at 200-600 mg per day in 2-3 doses. Intetrix can be given from birth at a rate of 10 mg/kg per day 1-3 times a day.

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

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

Correction of psycho-emotional disorders

Treatment of psychoemotional disorders includes taking psychotropic drugs, psychotherapy, autogenic training, and therapeutic exercise under the supervision of a psychotherapist.

Approximate treatment regimen for patients with irritable bowel syndrome with predominant constipation:

• the diet includes warm, low-slag, non-irritating food, possibly adding dietary fiber (bran);
• prescription of antispasmodics (trimebutine, mebeverine, hyoscine butylbromide);
• stool correction (transipeg or lactulose preparations);
• prescribing psychotropic drugs (in the presence of psychoemotional disorders, after consultation with a neurologist);
• consultation with a physiotherapist, if necessary - physiotherapy treatment;
• ineffectiveness of treatment for 7 days (persistent flatulence, mucus discharge with feces) requires additional administration of an antibacterial drug (intetrix or nifuroxazide) for 7 days, followed by taking a probiotic for 2 weeks.

Approximate treatment regimen for patients with irritable bowel syndrome with predominant diarrhea:

• diet;
• antispasmodics (mebeverine, hyoscine butylbromide);
• dioctahedral smectite (sucralfate);
• loperamide;
• ineffectiveness or instability of the effect after 5-7 days of treatment requires additional administration of an antibacterial drug (intetrix or nifuroxazide) followed by taking a probiotic;
• psychotropic drugs, physiotherapy - if necessary, after consultation with a neurologist or physiotherapist.

Forecast

The prognosis of the disease is favorable. The course of the disease is chronic, recurrent, but not progressive. The risk of developing inflammatory bowel diseases, colorectal cancer in patients with irritable bowel syndrome is the same as in the general population, which determines the tactics of monitoring patients, so there is no need for frequent colonoscopic examinations.

The quality of life of patients with irritable bowel syndrome in terms of nutrition, sleep, rest, and active activity is reduced. According to the results of a population study among senior schoolchildren in Novosibirsk, it was found that 49% of schoolchildren with irritable bowel syndrome seek medical attention for the disease, and 21% of adolescents have undergone an endoscopic examination. 62% of adolescents with irritable bowel syndrome have missed school in the past year due to poor health.

Symptoms of irritable bowel syndrome (abdominal pain of constant localization, diarrhea, flatulence) often lead to nutritional deficiencies, gradual exclusion of an increasing number of food products from the diet. Usually, pathological symptoms persist for many years with only minor fluctuations in the severity of the condition. Exacerbations are often associated not with psychogenic, but with somatogenic factors (deviation from the nutritional stereotype, change in the usual pharmacotherapy regimen).

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