腹泻型肠易激综合征(IBS-D)和功能性腹泻(FDr)是以腹泻为特征的两种主要功能性肠病。尽管他们的患病率很高,IBS-D和FDr与主要不确定性相关,特别是关于他们的最佳诊断工作和管理。与来自10个欧洲国家的专家进行了Delphi共识,他们对31个陈述进行了文献总结和投票过程。使用建议的分级来评估证据质量,评估,发展,和评价标准。所有声明都达成了共识(定义为>80%的协议)。专家组同意IBS-D和FDr的潜在重叠。在诊断方面,共识支持基于症状的方法,也排除了警报症状,推荐全血细胞计数的评估,C反应蛋白,乳糜泻血清学,和粪便钙卫蛋白,并考虑诊断胆汁酸性腹泻。对于50岁以上且存在警报特征的患者,建议在右侧和左侧结肠进行随机活检的结肠镜检查。关于治疗,对于使用低可发酵的低聚糖饮食达成了强烈的共识,di-,单糖和多元醇,以肠道为导向的心理治疗,利福昔明,洛哌丁胺,还有伊洛沙多林.对抗痉挛药提出了弱或有条件的建议,益生菌,tryciclic抗抑郁药,胆汁酸螯合剂,5-羟色胺-3拮抗剂(即阿洛司琼,昂丹司琼,或雷莫司琼)。一个由欧洲专家组成的跨国小组总结了关于该定义的共识现状,诊断,以及IBS-D和FDr的管理。
Irritable bowel syndrome with diarrhoea (IBS-D) and functional diarrhoea (
FDr) are the two major functional bowel disorders characterized by diarrhoea. In spite of their high prevalence, IBS-D and
FDr are associated with major uncertainties, especially regarding their optimal diagnostic work-up and management. A Delphi consensus was performed with experts from 10 European countries who conducted a literature summary and voting process on 31 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation criteria.
Consensus (defined as >80% agreement) was reached for all the statements. The panel agreed with the potential overlapping of IBS-D and
FDr. In terms of diagnosis, the consensus supports a symptom-based approach also with the exclusion of alarm symptoms, recommending the evaluation of full blood count, C-reactive protein, serology for coeliac disease, and faecal calprotectin, and consideration of diagnosing bile acid diarrhoea. Colonoscopy with random biopsies in both the right and left colon is recommended in patients older than 50 years and in presence of alarm features. Regarding treatment, a strong consensus was achieved for the use of a diet low fermentable oligo-, di-, monosaccharides and polyols, gut-directed psychological therapies, rifaximin, loperamide, and eluxadoline. A weak or conditional recommendation was achieved for antispasmodics, probiotics, tryciclic antidepressants, bile acid sequestrants, 5-hydroxytryptamine-3 antagonists (i.e. alosetron, ondansetron, or ramosetron). A multinational group of European experts summarized the current state of consensus on the definition, diagnosis, and management of IBS-D and
FDr.