Irritable bowel syndrome K58.9; F45.32

Irritable bowel syndrome refers to a frequently occurring but not clearly defined clinical picture characterised by various abdominal complaints. It is often associated with psychosomatic diseases.

According to the S3 guideline "Irritable bowel syndrome", 3 criteria must be met:

• Complaints lasting for >3 months (e.g. abdominal pain, flatulence), which are related to the abdomen by the patient and doctor and are usually accompanied by changes in bowel movements.
• Relevant limitations of the quality of life
• There are no changes typical for other clinical pictures which are responsible for these symptoms.

Irritable bowel syndrome can be divided into 3 subtypes:

• diarrhoea (RDS-D)
• Constipation (RDS-O)
• Mixing type (RDS-M)

Irritable bowel syndrome affects 7-21% of the general population at some point in their lives (Soares RL 2014).

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Irritable bowel syndrome is caused by increased intestinal sensitivity and dysfunction of the autonomic nervous system in the intestinal area (abdominal brain).

The most significant causes of IBS are:

Stress and anger, food allergies or intolerances, increase of the enteric nervous system, intestinal infections, motility disorders of the intestine, disturbance of the intestinal flora, suppression of the intestinal immune system, micro-inflammations, in addition there is a genetic predisposition, increased serotonin release, possibly also hormonal influences.

The clinical picture of irritable bowel syndrome is characterized by cramping, burning or stabbing abdominal pain. In addition, there is a feeling of pressure in the lower abdomen or left colon, bloating, audible bowel sounds, constipation, flatulence, and diarrhea. Weight loss is usually not seen.

Depending on the symptoms in the foreground, a distinction is made between a diarrhea-dominant IBS and an obstipation-dominant IBS, whereby these can also alternate in phases.

In the case of irritable bowel syndrome, the following parameters should be within the normal range: BSG, CRP, liver and pancreatic enzymes, blood count, haemoccult test and calprotectin in the stool. Furthermore, the defecation should not contain any worm eggs.

For the diagnosis of irritable bowel syndrome, a medical history including clinical picture according to ROM III consensus criteria is taken. In addition, a sonography of the abdomen, a digital palpation of the colon and, if necessary, further diagnostics of the abdomen are performed.

If there is existing pain in the left lower abdomen,:

• Diverticulitis
• Inguinal hernia
• Adnexal diseases
• endometriosis
• other colonic diseases, colitis of different genesis, also ulcerative colitis-

should be excluded. In case of pain in the left upper abdomen, diseases of the spleen, pancreas, heart, stomach and esophagus should be excluded.
In addition, fructose and lactose intolerance, microscopic colitis, and sprue should be ruled out. Also food allergies and intolerances, pancreatic diseases, triggering medication intraabdominal brides.

There is no known therapy for the treatment of irritable bowel syndrome that is effective in the long term. Therapeutic measures focus on dietary measures and treatment of stress conditions.

Dietary measures: Numerous studies prove the positive effect of low-fodmap diet. In any case, omitting the foods that aggravate symptoms, smaller and more frequent meals. In irritable bowel syndrome, high-fiber diet with adequate fluid intake.

Probiotics have been shown to be a helpful therapeutic option in various larger studies (Didari T et al. 2015).

Symptomatic therapeutic approaches: For cramping pain - spasmolytics. For heartburn, nausea and constipation: prokinetics. For diarrhea: antidiarrheal agents.

Symptom-oriented: pain e.g. preparations with peppermint oil, e.g. ^Medacalm®, for constipation e.g. Flosamen, ^Laxatan® M, diarrhea: e.g. Myrrhinil ^Intest®.

Order therapy: avoidance of triggering foods, e.g. lactose, foods containing or releasing histamine, if necessary Lactrase Tbl or ^Daosin® for histamine intolerance. Herbal antidepressants such as lavender oil, valerian and hops, caraway and fennel oil if flatulence is the main problem.

Curcurmin has been shown to inhibit inflammation, has an antioxidant and spasmolytic effect, is antiseptic, analgesic and lowers cholesterol levels. Studies have shown a re-epithelialization of the intestinal mucosa. Among other things, there is a reduction in TNF-alpha. It should be noted that turmeric root alone has hardly any effect, only with the addition of piperine (Bio-Perine). Additionally probiotics, see also S3 guideline irritable bowel syndrome.

Psyllii semen (psyllium seeds) and Plantaginis ovatae semen (Indian psyllium seeds)

Application: The daily dose of psyllium seeds or Indian psyllium seeds/psyllium husks is 10 to 30 g or 12 to 20 g respectively. Psyllium seeds are taken before meals. To do this, 1 teaspoon of the drug is mixed with approx. 150 ml of cold water and consumed. Psyllium husks (1-2 tsp) are taken with soups or other liquids.

Preparations: ^Agiocur® granules, ^Flosine® balance granules, ^Mucofalk® apple/orange granules, ^Pascomucil® powder, Schoenenberger NatuPur, ^Medacalm®, ^{Enteroplant®}.

Combination preparations: In the case of irritable bowel syndrome with chronic constipation, a combination preparation with lactulose is recommended; if diarrhoea predominates, a combination preparation with peppermint in enteric-coated capsules is recommended.

Linisemen (linseed)

Application: Soak two to three tablespoons of crushed linseed in ¼ to ½ liter of water, then boil briefly, separate the linseed from the mucus and drink the mucus in sips.

Preparations: ^Linusit® Gold quality linseed, 3 x daily 1 sachet before meals and 2 sachets before bedtime.

Combination preparations: It is recommended to use in combination with chamomile flower extracts, but a ready-made combination is not available.

Menthae piperitae aetheroleum (peppermint oil)

Preparations: ^Chiana® capsules enteric-coated, 3 x daily 1 capsule before meals; Medacalm® hard capsules enteric-coated capsules, 3 x daily 1 capsule unchewed before meals

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