متلازمة القولون العصبي مع الإمساك عندما لا تحقق الملينات زيادة كافية في حركات الأمعاء

References

DOI: 10.1136/gutjnl-2021-324598

• Patients are subgrouped according to their predominant stool pattern into IBS with diarrhoea (IBS-D), IBS with constipation (IBS-C), IBS with mixed bowel habits (IBS-M) or IBS unclassified (IBS-U), to direct therapy.
• Linaclotide, a guanylate cyclase-C agonist, is an efficacious second-line drug for IBS with constipation in secondary care. It is likely to be the most efficacious secretagogue available for IBS with constipation, although diarrhoea is a common side effect (recommendation: strong, quality of evidence: high).
• Lubiprostone, a chloride channel activator, is an efficacious second-line drug for IBS with constipation in secondary care. This secretagogue is less likely to cause diarrhoea than others. However, patients should be warned that nausea is a frequent side effect (recommendation: strong, quality of evidence: moderate).
• Plecanatide, another guanylate cyclase-C agonist, is an efficacious second-line drug for IBS with constipation in secondary care. Diarrhoea is a common side effect and is no less likely than with linaclotide or tenapanor. Although the drug is licensed for IBS with constipation in the USA, it is not yet available for this indication in many countries (recommendation: strong, quality of evidence: high).
• Tenapanor, a sodium-hydrogen exchange inhibitor, is an efficacious second-line drug for IBS with constipation in secondary care. Again, diarrhoea is a frequent side effect. Although the drug is licensed for IBS with constipation in the USA, it is not yet available for this indication in many countries (recommendation: strong, quality of evidence: high).
• Tegaserod, a 5-Hydroxytryptamine 4 receptor agonist, is an efficacious second-line drug for IBS with constipation in secondary care but is unavailable outside the USA. Diarrhoea is a common side effect (recommendation: strong, quality of evidence: moderate).