Irritable bowel syndromeK58.9; 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, histamine-containing or -liberating foods, if necessary Lactrase Tbl or also Daosin® in case of histamine intolerance. Herbal antidepressants such as lavender oil, valerian and hops, caraway and fennel oil in the case of foreground flatulence.

Curcurmin has been shown to inhibit inflammation, have antioxidant and spasmolytic effects, antiseptic, concomitant analgesic and lower cholesterol. Studies prove the re-epithelialization of the intestinal mucosa. Among other things, there is a decrease in TNF-alpha. It should be noted that turmeric root alone has little effect, only with the addition of piperine (bio-perine).

Additionally probiotics, see also S3- Guideline Irritable Bowel Syndrome.

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

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. 1 teaspoon of the drug is mixed with about 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 irritable bowel syndrome with chronic constipation, a combination preparation with lactulose is recommended; if diarrhea predominates, a combination preparation with peppermint in enteric-coated capsules is recommended.


Lini semen (flaxseed)

Directions: 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 flaxseed, 3 times a day 1 sachet before meals and 2 sachets before sleep.

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)

Couple preparations: Chiana® capsules enteric-coated, 3 x daily 1 capsule before meals; Medacalm® hard capsules enteric-coated, 3 x daily 1 capsule unchewed before meals.

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10. https://www.awmf.org/uploads/tx_szleitlinien/021-016l_S3_Definition-Pathophysiologie-Diagnostik-Therapie-Reizdarmsyndroms_2022-02.pdf
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