Tratamiento de primera línea del Síndrome del Intestino Irritable
El síndrome del intestino irritable (SII) es una afección funcional intestinal frecuente que se maneja principalmente mediante medidas de primera línea relacionadas con el estilo de vida, la dieta y la farmacología. El objetivo clínico es la reducción de los síntomas globales del SII y el dolor abdominal.
Objetivo clínico
Mejoría de los síntomas globales del SII y del dolor abdominal.
Síntomas globales del SII y dolor abdominal
Enfoque de primera línea
El enfoque estructurado de primera línea comienza con medidas de estilo de vida y orientación dietética. Más allá de estos fundamentos, varias opciones basadas en evidencia se secuencian según la elección del paciente, con consideraciones específicas en torno al tipo de fibra, el momento de administración y qué agentes evitar. El protocolo completo detalla qué opciones probar primero, en qué orden y cuándo reevaluar.
References
DOI: 10.1136/gutjnl-2021-324598
- All patients with IBS should be advised to take regular exercise (recommendation: strong, quality of evidence: weak).
- First-line dietary advice should be offered to all patients with IBS (recommendation: strong, quality of evidence: weak).
- Soluble fibre, such as ispaghula, is an effective treatment for global symptoms and abdominal pain in IBS, but insoluble fibre (eg, wheat bran) should be avoided as it may exacerbate symptoms. Soluble fibre should be commenced at a low dose (3–4 g/day) and built up gradually to avoid bloating (recommendation: strong; quality of evidence: moderate).
- Probiotics, as a group, may be an effective treatment for global symptoms and abdominal pain in IBS, but it is not possible to recommend a specific species or strain. It is reasonable to advise patients wishing to try probiotics to take them for up to 12 weeks, and to discontinue them if there is no improvement in symptoms (recommendation: weak, quality of evidence: very low).
- Certain antispasmodics may be an effective treatment for global symptoms and abdominal pain in IBS. Dry mouth, visual disturbance and dizziness are common side effects (recommendation: weak, quality of evidence: very low).
- Peppermint oil may be an effective treatment for global symptoms and abdominal pain in IBS. Gastro-oesophageal reflux is a common side effect (recommendation: weak, quality of evidence: very low).
- Otherwise, treatment should commence with dietary therapies or first-line drugs, according to patient choice, with second-line drugs reserved for those whose symptoms do not improve with these measures, due to a combination of the potential side effects, as well as the costs, of some of these agents to the health service.
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