Traitement de première ligne du syndrome de l'intestin irritable
Le syndrome de l'intestin irritable (SII) est une affection fonctionnelle intestinale courante, prise en charge principalement par des mesures de première ligne liées au mode de vie, à l'alimentation et à la pharmacologie. L'objectif clinique est la réduction des symptômes globaux du SII et de la douleur abdominale.
Cible clinique
Amélioration des symptômes globaux du SII et de la douleur abdominale.
Symptômes globaux du SII & douleur abdominale
Approche de première ligne
L'approche structurée de première ligne commence par des mesures liées au mode de vie et des conseils diététiques. Au-delà de ces fondements, plusieurs options fondées sur des preuves sont séquencées selon le choix du patient — avec des considérations spécifiques concernant le type de fibres, le moment d'administration et les agents à éviter. Le protocole complet précise quelles options essayer en premier, dans quel ordre, et quand réévaluer.
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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