Suvremeni dijagnostički i terapijski postupnici u bolesnika sa sindromom iritabilnog crijeva

master's thesis

• Title (english): Modern diagnostic and therapeutic algorithms for patients with irritable bowel syndrome
• Author: Ivan Petković
• Mentor: Žarko Babić (mentor)
• Committee member: Marko Banić (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Žarko Babić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Sindrom iritabilnog crijeva (SIC) stanje je u kojem bolesnici osjećaju bol i/ili nelagodu koji su povezani s promjenama učestalosti defekacije i konzistencije stolice bez jasnih organskih i strukturalnih promjena crijeva. Za postavljanje dijagnoze koriste se RIM IV kriteriji iz 2016. godine pri čemu je važno isključiti najčešće organske i strukturalne bolesti koje obilježavaju slični simptomi. Dijagnostički algoritam obuhvaća krvne pretrage, endokrinološke i mikrobiološke pretrage, endoskopiju s uzimanjem biopsija te čitav niz funkcionalnih pretraga kojima se između ostalog mogu identificirati neurološki i miopatski uzroci simptoma. Od funckionalnih pretraga najznačajniji su testovi pasaže crijeva (tranzit kapsula, RTG nepropusne pločice) i pretrage kontraktilnosti crijevne muskulature (anorektalna i kolonmanometrija, defekografija magnetnom rezonancom). Prema RIM IV kriterijima SIC se dijeli na 4 podtipa: s predominantnim proljevom, zatvorom, miješani i neodređeni tip. Ne postoje univerzalne terapijske smjernice, no mogućnosti su brojne i potrebno je pronaći optimalan pristup svakom pojedinom bolesniku. Pokazalo se kako su promjene načina života, a posebice prehrambenih navika, najučinkovitija terapijska metoda. Prehrana s niskim udjelom fermentabilnih oligo-, di-, monosaharida i poliola (low FODMAP) posebice se ističe. U farmakoterapiji koriste se brojni lijekovi koji utječu na crijevni motilitet, eliminaciju crijevnih plinova, crijevnu mikrofloru, a povoljan učinak mogu imati i psihofarmaci.

Abstract (english)

Irritable bowel syndrome (IBS) is a condition in which patients experience pain and/or discomfort associated with a change in bowel movements and stool consistency without clear organic or structural changes of the bowel. ROME IV criteria from 2016. are used for diagnosis whereby it is important to exclude the most common organic and structural pathology that is associated with similar symptoms. Diagnostic algorithm includes blood tests, endocrine and microbiology tests, endoscopy with biopsy and a battery of functional tests which can identify myopathies and neurological conditions capable of producing IBS symptoms. Most notable such tests are bowel transit tests (wireless motility capsule, radiopaque markers) and tests of peristalsis and muscle function (anorectal and colonic manometry, magnetic resonance defecography). According to ROME IV criteria IBS is divided into 4 subgroups; diarrhea predominant, constipation predominant, mixed and unspecified IBS. There are no universal therapeutic guidelines. However there is an abundance of available methods and the approach has to be tailored to the individual patient. Lifestyle interventions, particularly change of diet proved most effective. The low FODMAP (fermentable oligo-. di-, monosaccharides and polyols) diet is most widely helpful. Multiple drugs affecting bowel motility, gas elimination and gut microbiota can be used. Drugs conventionally used for treating mood disorders can also be effective.

• Keywords: Sindrom iritabilnog crijeva; dijagnostika; terapija; FODMAP
• Keywords (english): Irritable bowel syndrome; diagnosis; therapy; FODMAP
• Language: croatian
• URN:NBN: urn:nbn:hr:105:629967
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-01-27 10:16:55