Irritable bowel syndrome medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

IBS is heterogeneous in its presentation and treatment of IBS is based on predominant symptoms in the patient. There are no strict guidelines for the treatment of IBS and treatment is symptom-based.

Medical Therapy

Medical therapy of IBS

  • The multimodal treatment regimen is preferred for Irritable Bowel Syndrome (IBS).[1][2][3][4][5]
  • IBS is heterogeneous in its presentation, which makes it difficult to treat.[6]
  • All subtypes of IBS
    • Preferred regimen (1): Dietary measures: Low FODMAP high fiber diet for six-eight weeks
    • Preferred regimen (2): Moderate-severe exercise: Exercise for 30-60 mins 3-5 days a week for 12 weeks
    • Preferred regimen (2): Psychiatric referral in all IBS patients
  • Diarrhea-predominant IBS
    • Preferred regimen (1):  Loperamide 2 mg 45 minutes prior to a meal, as needed
    • Alternative regimen (1): Ondansetron 4 mg for five weeks
    • Alternative regimen (2): Colesevelam 1.875 g q12h
    • Alternative regimen (3): Gluten free diet for 2 weeks
  • Constipation-predominant IBS
    • Preferred regimen (1): Psylium half-one tbsp q24h, titrated based on response to therapy
    • Preferred regimen (2):17 g of PEG powder dissolved in 8 ounces of water q24h, may be titrated upto 34 g daily
    • Preferred regimen(3) : Lubiprostone 8 micrograms q12h for 12weeks
    • Preferred regimen (4) : Linaclotide 266 micrograms q24h for 12 weeks
    • Alternative regimen (1): Tageserod
  • Pain-predominant IBS:
    • Preferred regimen (1): Dicyclomine 20 mg po q6h as needed
      • Alternative regimen (1): Hyoscyamine 0.125 to 0.25 mg po q6h as needed
      • Alternative regimen (2): Sustained release hyoscyamine 0.375 to 0.75 mg po q12 hours as needed
    • Preferred regimen (2): Amitriptyline, Nortriptyline, or Imipramine 10 to 25 mg hs as needed
      • Alternative regimen (1):  Desipramine 12.5 to 25 mg hs as needed
  • Refractory IBS:
    • Preferred regimen (1): Rifaximin 550 mg q8h for 2 weeks


Dietary Measures

  • General instructions:[7][8][9][10][11][12][13]
    • Careful dietary history must be taken
    • Caffeine and alcohol avoidance decreases anxiety in patients
    • Legume avoidance decreases symptoms of flatulence
    • Skipping entire meals may worsen IBS symptoms
    • Avoidance of large meals
    • Reduced fat intake
    • Elimination diets help remove the most common dietary allergens[14][15][16]
    • Judicious water intake for the constipation-predominant IBS patients to prevent stool dehydration
    • Fiber supplementation
    • Schedule times for bowel evacuations and ensure intake of stimulating substances such as coffee prior to the scheduled time
    • Individualized dietary recommendations are preferable
    • Avoidance of gluten as gluten sensitivity may manifest in a subset of IBS patients [17][18][19][20]

Exclusion of gas-producing foods:

  • Beans, onions, celery, carrots, raisins, bananas, apricots, prunes, cabbage, onions, brussels sprouts, wheat germ, pretzels, and bagels
  • Low FODMAP diet:
    • A diet low in fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) is preferred in IBS patients.[12]
    • Education consists of: [10][14]
      • Elimination of dietary FODMAPs for 6-8 weeks
      • Reintroduction of foods high in FODMAPs to determine individual tolerance to specific foods
    • High FODMAP foods include: [21][22]
      • honey, mangoes cherries, high-fructose corn syrup, apples, pears, or oligosaccharides such as wheat
      • mannitol, sorbitol, fructose, lactose, fructans, xylitol, and galactans
      • sugar-alcohols such as isomalt, maltitol, erythritol, lactitol, mannitol and xylitol
    • High FODMAP foods are poorly absorbed by the gut and are osmotically active short chain carbohydrates.
    • Rapid fermentation of high FODMAP foods results in symptoms of abdominal discomfort and flatulence.[10][22][23][24]
  • Lactose avoidance:
    • IBS patients have more subjective lactose intolerance complaints (flatulence and diarrhea) as compared to other individuals.[25][26]
    • Lactose ingestion leads to production of hydrogen gas.
    • Bacterial fermentation of the unabsorbed lactose causes symptoms of bloating and distension.
    • Lactose intolerance can be diagnosed using breath testing.[27]
    • IBS patients with lactose intolerance should be given a lactose-restricted diet.[16][28][29][30]
  • Fiber in the diet:
    • Dietary fiber decreases symptoms of bloating in IBS patients. [16][31][32][33][34][35]
    • Soluble fibers are preferred as compared to insoluble fibers for treating symptoms of constipation.[36]

Physical activity 

  • Exercise plays an important role in relieving IBS symptoms by the following mechanisms :[7][33][37][38][39][40][41][42]
    • Reduction of stress
    • Protection against GI symptom aggravation
    • Alleviation of flatulence
    • Maintenance of GI function
    • Elevation of sympathetic tone, which is found to be decreased in IBS-D patients

Psychological therapy and counseling

  • It is necessary to build a good physician patient rapport due to the following reasons:[2][43][44][21][45][46][47][48][49][50][51][52]
    • IBS has a remarkably high placebo response rate
    • Patient regimens need to be individualized in IBS patients
    • Appropriate goals need to be set with emphasis on the chronic nature of the syndrome
    • Patient counseling plays an important role
  • The 2009 American College of Gastroenterologists (ACG) states that a psychiatric referral must be considered in all IBS patients.
  • Patients may be given the following therapies for symptom control:[1]
    • Cognitive-behavioral therapy
    • Interpersonal psychotherapy
    • Dynamic psychotherapy
    • Hypnotherapy
    • Antidepressants: Selective Serotonin Reuptake Inhibitors (SSRIs) and Tricyclic antidepressants (TCAs)
    • Behavior modification used in conjunction with antidepressants[53]
    • Anxiolytics 
      • Used for short-term (less than two weeks) reduction of acute situational anxiety in IBS patients
      • Side effects:
        • Benzodiazepines may lower pain thresholds by stimulating gamma aminobutyric acid (GABA) receptors, thereby decreasing brain serotonin
        • Drug interactions
        • High risk of habituation
        • Rebound withdrawal

Adjunctive pharmacologic therapy

Pharmacologic therapy is only preferred in patients where symptoms of IBS are moderate-severe and impair the quality of life.

Chloride channel activators

  • Mechanism of action:
    • Chloride channel activators are used for the constipation-predominant subtype of IBS and act by enhancing chloride-rich intestinal fluid secretions via guanylate cyclase activation.[51][54]
    • Chloride ion secretion is accompanied by the passive diffusion of water and sodium to maintain isotonicity.
  • Examples of chloride channel activators include:

5-hydroxytryptamine (serotonin) 3 receptor antagonists

  • 5-hydroxytryptamine-3 receptor (5HT-3) antagonists are useful in patients with severe refractory diarrhea-predominant IBS.[58][59][60][61][62]
  • The enteric neurons of the GI tract bear 5-HT3 receptors.
  • Stimulation of 5-HT3 receptors causes intestinal hyperactivity and hypersensitivity.
  • Alosetron (Lotronex): 5-hydroxytryptamine-3 receptor (5HT-3) antagonist[34][59][63][64]
    • Mechanism of action: Alosetron improves abdominal pain and diarrhea by affecting the visceral afferent activity of the GI tract leading to decreased colonic secretion and motility.

Side effects:

  • Ischemic colitis
  • Complications of severe constipation

5-hydroxytryptamine-4 (5-HT4) receptor agonists

  • 5HT4 receptor agonists are prokinetics or secretagogues used for constipation predominant cases of IBS.[65][66]
  • Mechanism of action:
    • Agonism of the 5-hydroxytryptamine-4 (5-HT4) receptor leads to increased motility of the colon
  • Tageserod: Partial 5-HT4 receptor agonist
    • Increased cardiovascular side effects

Antispasmodic agents [67][67][68][1][6]

  • Antispasmodic agents are of two types:
    • Mebeverine and Pinaverine directly affect intestinal smooth muscle relaxation.
      • Mechanism of action:
        • Antispasmodic agents cause selective inhibition of gastrointestinal smooth muscle, thereby reducing stimulated colonic motor activity [32]
      • Indication: IBS patients with post prandial abdominal pain, discomfort,distension and fecal urgency
      • Side effect: Constipation[1]
    • Anticholinergics
      • Mechanism of action: Anticholinergics decreased abdominal pain and fecal urgency by inhibing acetylcholine action at parasympathetic sites loacted in the secretory glands, smooth muscle and the CNS.
      • Examples of anticholinergic agents include:[64][67][69][70][71][72][73]
      • Dicyclomine hydrochloride (Bentyl)
        • Preferred dose : 20mg po q6h
      • Hyoscyamine sulfate (Levsin)
        •  0.125 to 0.25 mg po q12h
      • Side effects:
        • Urinary retention
        • Visual disturbances
        • Constipation
        • Dry mouth

Opioids

  • Mechanism of action: Nonabsorbable synthetic opioids act by the following mechanisms:[1][45][34][74][75][76]
    • Reduction in visceral nociception due to inhibition of the afferent pain pathway
    • Reduction in secretions via µ-opioid receptors in the periphery
    • Prolongation of GI transit time leading to improvement in stool consistency and reduction of stool frequency and volume
    • Inhibition of GI motility and peristalsis
  • Examples of opioids that act as effective antidiarrheal agents include:
    • Diphenoxylate hydrochloride (2.5 mg) with atropine sulfate (0.025 mg) (Lomotil):
      • Diphenoxylate is a meperidine congener that has a constipating effect.
      • The presence of atropine discourages abuse, due to anticholinergic side effects.
    • Loperamide (Imodium)- preferred as initial treatment for diarrhea in IBS patients
      • Preferred regimen:  2 mg 45 minutes before a meal on regularly scheduled doses
    • Eluxadoline (Viberzi): [77][78][79]
      • kappa opioid receptor agonist
      • mu opioid receptor agonist
      • delta opioid receptor antagonist
      • Side effects of Eluxadoline include:
        • Nausea
        • Constipation
        • Abdominal pain
        • Pancreatitis in a small fraction of patients
  • Side effects of opioids:
    • Addiction potential
    • Severe constipation

Bile acid sequestrants

  • 50 percent of patients with diarrhea predominant IBS have bile acid malabsorption. [80][81][82]
  • Stimulation of colonic motility and secretions by bile acids leads to diarrhea in patients.
  • Bile acid sequestrants are used as second-line therapy in diarrhea predominant IBS patients.
  • Examples:[34]
    • Cholestyramine
    •  Colestipol
    • Colesevelam
  • Side effects of bile acid sequestrants:
    • Flatulence
    • Abdominal discomfort
    • Constipation

Antidepressants

  • Antidepressants have analgesic and antidepressive effects and acts by the following mechanisms: [1][21][67][83][84][85][86][87][88][89][90]
    • Inhibition of serotonin which is the pain neuromodulator
    • Inhibition of norepinephrine which leads to stimulation of descending inhibitory pain pathways
    • Stimulation of endogenous endorphin release leading to mood improvement
    • Visceral analgesic effect by incresing pain threshold in the GI tract [91]
    • Tricyclic antidepressants cause slowing of intestinal transit time via anticholinergic properties thereby reducing abdominal pain, stool frequency and mucorrhea
  • In IBS patients with persistent pain in the abdomen despite use of antispasmodics, a trial of antidepressants is recommended.
  • Before increasing the dose of antidepressants, it is advised to wait for three to four weeks of therapy due to delayed onset of action.
  • Examples of antidepressants used for IBS include
    • Tricyclic antidepressants (TCAs): may be started at a dose of 10-25mg hs[92][93][94]
      • Amitriptyline (Elavil) [95][96]
      • Nortriptyline
      • Imipramine (Tofranil)
      • Desipramine 
    • In case of patient intolerance to a TCA agent, another drug may be administered.
  • Side effects of TCAs include:
    • Sedation
    • Constipation

Antibiotics

  • Routine antibiotic use is not recommended as benefit is transient in most IBS patients.
  • Post infectious IBS is due to the overgrowth of intestinal bacteria and may benefit from antibiotic use.
  • In moderate-severe refractory cases of IBS, a two week trial of antibiotics may be administered to patients. [97][98][99]
  • Rifaximin (Xifaxan): a semisynthetic Rifampin derivative[100][101]
  • Mechanism of action:
    • Binds beta-subunit of bacterial DNA-dependent RNA polymerase causing inhibition of transcription and thereby impairing bacterial protein synthesis
  • Preferred dose of Rifaximin: 550 mg PO q8h for 14 d [97][102]

Probiotics 

  •  Probiotics are not routinely recommended in IBS patients.
  • Probiotics have the following properties:[6][34][72][103][104][105][106]
  • Indications:
    • Abdominal pain
    • Bloating
    • Normalization of bowel habit in IBS patients

Bulk-Forming Laxatives

  • Bulk forming laxatives have the following properties:[6][45][35][67][107][108][109][110][111][112][113][114][115][116][117]
  • Composition:
    • Natural or semi-synthetic hydrophilic polysaccharides and cellulose derivatives.
  • Mechanism of action:
    • They facilitate intestinal passage and stimulate persistalsis by forming emolient gels in the water and increasing stool bulk.
  • Examples of some of the bulk-forming laxatives include:
    • Methylcellulose (Citrucel)
    • Psylium (Metamucil, Fiberall, Reguloid, Konsyl
    • Polyethylene glycol (PEG)- inexpensive and improves stool frequency in refractory cases [34][118]
    • Isapghula husk
    • Lactulose
    • Milk of magnesia  

Other therapies 

  • Other therapies have been evaluated in patients with IBS but their role remains uncertain.
  • These therapies are as follows:  [105][106][119][120]
    • Herbal medicines
    • Tight-junction modulators: Larazotide may be used for patients with evidence of increased mucosal permeability or immune activation.
    • Mast cell stabilizers: Ketotifen prevents mast cell activation that contributes to visceral hypersensitivity. [121][122]
    • Apuncture:[123][124]
      • Acupuncture acts on serotonergic, cholinergic, and glutamatergic pathways and causes reductions in blood cortisol level [125][126]
    • Relaxation techniques [127][128]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, Talley NJ, Quigley EM (2009). "An evidence-based position statement on the management of irritable bowel syndrome". Am. J. Gastroenterol. 104 Suppl 1: S1–35. doi:10.1038/ajg.2008.122. PMID 19521341.
  2. ↑ 2.0 2.1 Drossman DA, Thompson WG (1992). "The irritable bowel syndrome: review and a graduated multicomponent treatment approach". Ann. Intern. Med. 116 (12 Pt 1): 1009–16. PMID 1586090.
  3. ↑ Weinberg DS, Smalley W, Heidelbaugh JJ, Sultan S (2014). "American Gastroenterological Association Institute Guideline on the pharmacological management of irritable bowel syndrome". Gastroenterology. 147 (5): 1146–8. doi:10.1053/j.gastro.2014.09.001. PMID 25224526.
  4. ↑ Camilleri M (2012). "Pharmacology of the new treatments for lower gastrointestinal motility disorders and irritable bowel syndrome". Clin. Pharmacol. Ther. 91 (1): 44–59. doi:10.1038/clpt.2011.261. PMID 22071696.
  5. ↑ Akehurst R, Kaltenthaler E (2001). "Treatment of irritable bowel syndrome: a review of randomised controlled trials". Gut. 48 (2): 272–82. PMC 1728206. PMID 11156653.
  6. ↑ 6.0 6.1 6.2 6.3 Jailwala J, Imperiale TF, Kroenke K (2000). "Pharmacologic treatment of the irritable bowel syndrome: a systematic review of randomized, controlled trials". Ann. Intern. Med. 133 (2): 136–47. PMID 10896640.
  7. ↑ 7.0 7.1 Kim YJ, Ban DJ (2005). "Prevalence of irritable bowel syndrome, influence of lifestyle factors and bowel habits in Korean college students". Int J Nurs Stud. 42 (3): 247–54. doi:10.1016/j.ijnurstu.2004.06.015. PMID 15708012.
  8. ↑ McKenzie YA, Alder A, Anderson W, Wills A, Goddard L, Gulia P, Jankovich E, Mutch P, Reeves LB, Singer A, Lomer MC (2012). "British Dietetic Association evidence-based guidelines for the dietary management of irritable bowel syndrome in adults". J Hum Nutr Diet. 25 (3): 260–74. doi:10.1111/j.1365-277X.2012.01242.x. PMID 22489905.
  9. ↑ Shepherd SJ, Parker FC, Muir JG, Gibson PR (2008). "Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence". Clin. Gastroenterol. Hepatol. 6 (7): 765–71. doi:10.1016/j.cgh.2008.02.058. PMID 18456565.
  10. ↑ 10.0 10.1 10.2 Ong DK, Mitchell SB, Barrett JS, Shepherd SJ, Irving PM, Biesiekierski JR, Smith S, Gibson PR, Muir JG (2010). "Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome". J. Gastroenterol. Hepatol. 25 (8): 1366–73. doi:10.1111/j.1440-1746.2010.06370.x. PMID 20659225.
  11. ↑ Austin GL, Dalton CB, Hu Y, Morris CB, Hankins J, Weinland SR, Westman EC, Yancy WS, Drossman DA (2009). "A very low-carbohydrate diet improves symptoms and quality of life in diarrhea-predominant irritable bowel syndrome". Clin. Gastroenterol. Hepatol. 7 (6): 706–708.e1. doi:10.1016/j.cgh.2009.02.023. PMC 2693479. PMID 19281859.
  12. ↑ 12.0 12.1 Rao SS, Yu S, Fedewa A (2015). "Systematic review: dietary fibre and FODMAP-restricted diet in the management of constipation and irritable bowel syndrome". Aliment. Pharmacol. Ther. 41 (12): 1256–70. doi:10.1111/apt.13167. PMID 25903636.
  13. ↑ Atkinson W, Sheldon TA, Shaath N, Whorwell PJ (2004). "Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial". Gut. 53 (10): 1459–64. doi:10.1136/gut.2003.037697. PMC 1774223. PMID 15361495.
  14. ↑ 14.0 14.1 Lea R, Whorwell PJ (2005). "The role of food intolerance in irritable bowel syndrome". Gastroenterol. Clin. North Am. 34 (2): 247–55. doi:10.1016/j.gtc.2005.02.005. PMID 15862933.
  15. ↑ Harris LR, Roberts L (2008). "Treatments for irritable bowel syndrome: patients' attitudes and acceptability". BMC Complement Altern Med. 8: 65. doi:10.1186/1472-6882-8-65. PMC 2633319. PMID 19099570.
  16. ↑ 16.0 16.1 16.2 Heizer WD, Southern S, McGovern S (2009). "The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review". J Am Diet Assoc. 109 (7): 1204–14. doi:10.1016/j.jada.2009.04.012. PMID 19559137.
  17. ↑ Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, Shepherd SJ, Muir JG, Gibson PR (2011). "Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial". Am. J. Gastroenterol. 106 (3): 508–14, quiz 515. doi:10.1038/ajg.2010.487. PMID 21224837.
  18. ↑ Biesiekierski JR, Peters SL, Newnham ED, Rosella O, Muir JG, Gibson PR (2013). "No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates". Gastroenterology. 145 (2): 320–8.e1–3. doi:10.1053/j.gastro.2013.04.051. PMID 23648697.
  19. ↑ Vazquez-Roque MI, Camilleri M, Smyrk T, Murray JA, Marietta E, O'Neill J, Carlson P, Lamsam J, Janzow D, Eckert D, Burton D, Zinsmeister AR (2013). "A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: effects on bowel frequency and intestinal function". Gastroenterology. 144 (5): 903–911.e3. doi:10.1053/j.gastro.2013.01.049. PMC 3633663. PMID 23357715.
  20. ↑ Verdu EF, Huang X, Natividad J, Lu J, Blennerhassett PA, David CS, McKay DM, Murray JA (2008). "Gliadin-dependent neuromuscular and epithelial secretory responses in gluten-sensitive HLA-DQ8 transgenic mice". Am. J. Physiol. Gastrointest. Liver Physiol. 294 (1): G217–25. doi:10.1152/ajpgi.00225.2007. PMID 18006603.
  21. ↑ 21.0 21.1 21.2 Occhipinti K, Smith JW (2012). "Irritable bowel syndrome: a review and update". Clin Colon Rectal Surg. 25 (1): 46–52. doi:10.1055/s-0032-1301759. PMC 3348735. PMID 23449495.
  22. ↑ 22.0 22.1 Shepherd SJ, Lomer MC, Gibson PR (2013). "Short-chain carbohydrates and functional gastrointestinal disorders". Am. J. Gastroenterol. 108 (5): 707–17. doi:10.1038/ajg.2013.96. PMID 23588241.
  23. ↑ Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG (2014). "A diet low in FODMAPs reduces symptoms of irritable bowel syndrome". Gastroenterology. 146 (1): 67–75.e5. doi:10.1053/j.gastro.2013.09.046. PMID 24076059.
  24. ↑ Drisko J, Bischoff B, Hall M, McCallum R (2006). "Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics". J Am Coll Nutr. 25 (6): 514–22. PMID 17229899.
  25. ↑ Saberi-Firoozi M, Khademolhosseini F, Mehrabani D, Yousefi M, Salehi M, Heidary ST (2007). "Subjective lactose intolerance in apparently healthy adults in southern Iran: Is it related to irritable bowel syndrome?". Indian J Med Sci. 61 (11): 591–7. PMID 18025745.
  26. ↑ Gupta D, Ghoshal UC, Misra A, Misra A, Choudhuri G, Singh K (2007). "Lactose intolerance in patients with irritable bowel syndrome from northern India: a case-control study". J. Gastroenterol. Hepatol. 22 (12): 2261–5. doi:10.1111/j.1440-1746.2007.04986.x. PMID 17559357.
  27. ↑ Pimentel M, Chow EJ, Lin HC (2003). "Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. a double-blind, randomized, placebo-controlled study". Am. J. Gastroenterol. 98 (2): 412–9. doi:10.1111/j.1572-0241.2003.07234.x. PMID 12591062.
  28. ↑ Yang J, Deng Y, Chu H, Cong Y, Zhao J, Pohl D, Misselwitz B, Fried M, Dai N, Fox M (2013). "Prevalence and presentation of lactose intolerance and effects on dairy product intake in healthy subjects and patients with irritable bowel syndrome". Clin. Gastroenterol. Hepatol. 11 (3): 262–268.e1. doi:10.1016/j.cgh.2012.11.034. PMID 23246646.
  29. ↑ Zhu Y, Zheng X, Cong Y, Chu H, Fried M, Dai N, Fox M (2013). "Bloating and distention in irritable bowel syndrome: the role of gas production and visceral sensation after lactose ingestion in a population with lactase deficiency". Am. J. Gastroenterol. 108 (9): 1516–25. doi:10.1038/ajg.2013.198. PMID 23917444.
  30. ↑ Böhmer CJ, Tuynman HA (2001). "The effect of a lactose-restricted diet in patients with a positive lactose tolerance test, earlier diagnosed as irritable bowel syndrome: a 5-year follow-up study". Eur J Gastroenterol Hepatol. 13 (8): 941–4. PMID 11507359.
  31. ↑ Bijkerk CJ, Muris JW, Knottnerus JA, Hoes AW, de Wit NJ (2004). "Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome". Aliment. Pharmacol. Ther. 19 (3): 245–51. PMID 14984370.
  32. ↑ 32.0 32.1 Ford AC, Talley NJ, Spiegel BM, Foxx-Orenstein AE, Schiller L, Quigley EM, Moayyedi P (2008). "Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis". BMJ. 337: a2313. PMC 2583392. PMID 19008265.
  33. ↑ 33.0 33.1 Levy RL, Linde JA, Feld KA, Crowell MD, Jeffery RW (2005). "The association of gastrointestinal symptoms with weight, diet, and exercise in weight-loss program participants". Clin. Gastroenterol. Hepatol. 3 (10): 992–6. PMID 16234045.
  34. ↑ 34.0 34.1 34.2 34.3 34.4 34.5 Talley NJ (2003). "Pharmacologic therapy for the irritable bowel syndrome". Am. J. Gastroenterol. 98 (4): 750–8. doi:10.1111/j.1572-0241.2003.07306.x. PMID 12738451.
  35. ↑ 35.0 35.1 Francis CY, Whorwell PJ (1994). "Bran and irritable bowel syndrome: time for reappraisal". Lancet. 344 (8914): 39–40. PMID 7912305.
  36. ↑ Bijkerk CJ, de Wit NJ, Muris JW, Whorwell PJ, Knottnerus JA, Hoes AW (2009). "Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial". BMJ. 339: b3154. PMC 3272664. PMID 19713235.
  37. ↑ Johannesson E, Simrén M, Strid H, Bajor A, Sadik R (2011). "Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial". Am. J. Gastroenterol. 106 (5): 915–22. doi:10.1038/ajg.2010.480. PMID 21206488.
  38. ↑ Lustyk MK, Jarrett ME, Bennett JC, Heitkemper MM (2001). "Does a physically active lifestyle improve symptoms in women with irritable bowel syndrome?". Gastroenterol Nurs. 24 (3): 129–37. PMID 11847862.
  39. ↑ Daley AJ, Grimmett C, Roberts L, Wilson S, Fatek M, Roalfe A, Singh S (2008). "The effects of exercise upon symptoms and quality of life in patients diagnosed with irritable bowel syndrome: a randomised controlled trial". Int J Sports Med. 29 (9): 778–82. doi:10.1055/s-2008-1038600. PMID 18461499.
  40. ↑ Villoria A, Serra J, Azpiroz F, Malagelada JR (2006). "Physical activity and intestinal gas clearance in patients with bloating". Am. J. Gastroenterol. 101 (11): 2552–7. doi:10.1111/j.1572-0241.2006.00873.x. PMID 17029608.
  41. ↑ Taneja I, Deepak KK, Poojary G, Acharya IN, Pandey RM, Sharma MP (2004). "Yogic versus conventional treatment in diarrhea-predominant irritable bowel syndrome: a randomized control study". Appl Psychophysiol Biofeedback. 29 (1): 19–33. PMID 15077462.
  42. ↑ Kuttner L, Chambers CT, Hardial J, Israel DM, Jacobson K, Evans K (2006). "A randomized trial of yoga for adolescents with irritable bowel syndrome". Pain Res Manag. 11 (4): 217–23. PMC 2673138. PMID 17149454.
  43. ↑ Owens DM, Nelson DK, Talley NJ (1995). "The irritable bowel syndrome: long-term prognosis and the physician-patient interaction". Ann. Intern. Med. 122 (2): 107–12. PMID 7992984.
  44. ↑ Drossman DA (1995). "Diagnosing and treating patients with refractory functional gastrointestinal disorders". Ann. Intern. Med. 123 (9): 688–97. PMID 7574225.
  45. ↑ 45.0 45.1 45.2 Brandt LJ, Bjorkman D, Fennerty MB, Locke GR, Olden K, Peterson W, Quigley E, Schoenfeld P, Schuster M, Talley N (2002). "Systematic review on the management of irritable bowel syndrome in North America". Am. J. Gastroenterol. 97 (11 Suppl): S7–26. PMID 12425586.
  46. ↑ Stewart AL, Hays RD, Ware JE (1988). "The MOS short-form general health survey. Reliability and validity in a patient population". Med Care. 26 (7): 724–35. PMID 3393032.
  47. ↑ Gralnek IM, Hays RD, Kilbourne A, Naliboff B, Mayer EA (2000). "The impact of irritable bowel syndrome on health-related quality of life". Gastroenterology. 119 (3): 654–60. PMID 10982758.
  48. ↑ Harvey RF, Mauad EC, Brown AM (1987). "Prognosis in the irritable bowel syndrome: a 5-year prospective study". Lancet. 1 (8539): 963–5. PMID 2882351.
  49. ↑ Kaptchuk TJ, Kelley JM, Conboy LA, Davis RB, Kerr CE, Jacobson EE, Kirsch I, Schyner RN, Nam BH, Nguyen LT, Park M, Rivers AL, McManus C, Kokkotou E, Drossman DA, Goldman P, Lembo AJ (2008). "Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome". BMJ. 336 (7651): 999–1003. doi:10.1136/bmj.39524.439618.25. PMC 2364862. PMID 18390493.
  50. ↑ Drossman DA, Whitehead WE, Camilleri M (1997). "Irritable bowel syndrome: a technical review for practice guideline development". Gastroenterology. 112 (6): 2120–37. PMID 9178709.
  51. ↑ 51.0 51.1 51.2 51.3 Ford AC, Talley NJ (2012). "Irritable bowel syndrome". BMJ. 345: e5836. PMID 22951548.
  52. ↑ Kaminski A, Kamper A, Thaler K, Chapman A, Gartlehner G (2011). "Antidepressants for the treatment of abdominal pain-related functional gastrointestinal disorders in children and adolescents". Cochrane Database Syst Rev (7): CD008013. doi:10.1002/14651858.CD008013.pub2. PMID 21735420.
  53. ↑ Labus J, Gupta A, Gill HK, Posserud I, Mayer M, Raeen H, Bolus R, Simren M, Naliboff BD, Mayer EA (2013). "Randomised clinical trial: symptoms of the irritable bowel syndrome are improved by a psycho-education group intervention". Aliment. Pharmacol. Ther. 37 (3): 304–15. doi:10.1111/apt.12171. PMC 3829380. PMID 23205588.
  54. ↑ Rey E, Mearin F, Alcedo J, Ciriza C, Delgado-Aros S, Freitas T, Mascarenhas M, Mínguez M, Santos J, Serra J (2017). "Optimizing the Use of Linaclotide in Patients with Constipation-Predominant Irritable Bowel Syndrome: An Expert Consensus Report". Adv Ther. 34 (3): 587–598. doi:10.1007/s12325-016-0473-8. PMC 5350198. PMID 28083815.
  55. ↑ Rao S, Lembo AJ, Shiff SJ, Lavins BJ, Currie MG, Jia XD, Shi K, MacDougall JE, Shao JZ, Eng P, Fox SM, Schneier HA, Kurtz CB, Johnston JM (2012). "A 12-week, randomized, controlled trial with a 4-week randomized withdrawal period to evaluate the efficacy and safety of linaclotide in irritable bowel syndrome with constipation". Am. J. Gastroenterol. 107 (11): 1714–24, quiz p.1725. doi:10.1038/ajg.2012.255. PMC 3504311. PMID 22986440.
  56. ↑ Chey WD, Lembo AJ, Lavins BJ, Shiff SJ, Kurtz CB, Currie MG, MacDougall JE, Jia XD, Shao JZ, Fitch DA, Baird MJ, Schneier HA, Johnston JM (2012). "Linaclotide for irritable bowel syndrome with constipation: a 26-week, randomized, double-blind, placebo-controlled trial to evaluate efficacy and safety". Am. J. Gastroenterol. 107 (11): 1702–12. doi:10.1038/ajg.2012.254. PMID 22986437.
  57. ↑ Drossman DA, Chey WD, Johanson JF, Fass R, Scott C, Panas R, Ueno R (2009). "Clinical trial: lubiprostone in patients with constipation-associated irritable bowel syndrome--results of two randomized, placebo-controlled studies". Aliment. Pharmacol. Ther. 29 (3): 329–41. doi:10.1111/j.1365-2036.2008.03881.x. PMID 19006537.
  58. ↑ Gershon MD, Tack J (2007). "The serotonin signaling system: from basic understanding to drug development for functional GI disorders". Gastroenterology. 132 (1): 397–414. doi:10.1053/j.gastro.2006.11.002. PMID 17241888.
  59. ↑ 59.0 59.1 Zighelboim J, Talley NJ, Phillips SF, Harmsen WS, Zinsmeister AR (1995). "Visceral perception in irritable bowel syndrome. Rectal and gastric responses to distension and serotonin type 3 antagonism". Dig. Dis. Sci. 40 (4): 819–27. PMID 7720476.
  60. ↑ Prior A, Read NW (1993). "Reduction of rectal sensitivity and post-prandial motility by granisetron, a 5 HT3-receptor antagonist, in patients with irritable bowel syndrome". Aliment. Pharmacol. Ther. 7 (2): 175–80. PMID 8387353.
  61. ↑ Gershon MD (2003). "Serotonin and its implication for the management of irritable bowel syndrome". Rev Gastroenterol Disord. 3 Suppl 2: S25–34. PMID 12776000.
  62. ↑ Garsed K, Chernova J, Hastings M, Lam C, Marciani L, Singh G, Henry A, Hall I, Whorwell P, Spiller R (2014). "A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea". Gut. 63 (10): 1617–25. doi:10.1136/gutjnl-2013-305989. PMC 4173656. PMID 24334242.
  63. ↑ Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, Whitehead WE, Janssens J, Funch-Jensen P, Corazziari E (1993). "U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact". Dig. Dis. Sci. 38 (9): 1569–80. PMID 8359066.
  64. ↑ 64.0 64.1 Drossman DA, Camilleri M, Mayer EA, Whitehead WE (2002). "AGA technical review on irritable bowel syndrome". Gastroenterology. 123 (6): 2108–31. doi:10.1053/gast.2002.37095. PMID 12454866.
  65. ↑ Khoshoo V, Armstead C, Landry L (2006). "Effect of a laxative with and without tegaserod in adolescents with constipation predominant irritable bowel syndrome". Aliment. Pharmacol. Ther. 23 (1): 191–6. doi:10.1111/j.1365-2036.2006.02705.x. PMID 16393297.
  66. ↑ Scott LJ, Perry CM (1999). "Tegaserod". Drugs. 58 (3): 491–6, discussion 497–8. PMID 10493276.
  67. ↑ 67.0 67.1 67.2 67.3 67.4 Ruepert L, Quartero AO, de Wit NJ, van der Heijden GJ, Rubin G, Muris JW (2011). "Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome". Cochrane Database Syst Rev (8): CD003460. doi:10.1002/14651858.CD003460.pub3. PMID 21833945.
  68. ↑ Poynard T, Regimbeau C, Benhamou Y (2001). "Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome". Aliment. Pharmacol. Ther. 15 (3): 355–61. PMID 11207510.
  69. ↑ Zheng L, Lai Y, Lu W, Li B, Fan H, Yan Z, Gong C, Wan X, Wu J, Huang D, Wang Y, Mei Y, Li Z, Jiang Z, Liu X, Ye J, Yang Y, Huang H, Xiao J (2015). "Pinaverium Reduces Symptoms of Irritable Bowel Syndrome in a Multicenter, Randomized, Controlled Trial". Clin. Gastroenterol. Hepatol. 13 (7): 1285–1292.e1. doi:10.1016/j.cgh.2015.01.015. PMID 25632806.
  70. ↑ Page JG, Dirnberger GM (1981). "Treatment of the irritable bowel syndrome with Bentyl (dicyclomine hydrochloride)". J. Clin. Gastroenterol. 3 (2): 153–6. PMID 7016973.
  71. ↑ Cappello G, Spezzaferro M, Grossi L, Manzoli L, Marzio L (2007). "Peppermint oil (Mintoil) in the treatment of irritable bowel syndrome: a prospective double blind placebo-controlled randomized trial". Dig Liver Dis. 39 (6): 530–6. doi:10.1016/j.dld.2007.02.006. PMID 17420159.
  72. ↑ 72.0 72.1 Brenner DM, Moeller MJ, Chey WD, Schoenfeld PS (2009). "The utility of probiotics in the treatment of irritable bowel syndrome: a systematic review". Am. J. Gastroenterol. 104 (4): 1033–49, quiz 1050. doi:10.1038/ajg.2009.25. PMID 19277023.
  73. ↑ Merat S, Khalili S, Mostajabi P, Ghorbani A, Ansari R, Malekzadeh R (2010). "The effect of enteric-coated, delayed-release peppermint oil on irritable bowel syndrome". Dig. Dis. Sci. 55 (5): 1385–90. doi:10.1007/s10620-009-0854-9. PMID 19507027.
  74. ↑ Hovdenak N (1987). "Loperamide treatment of the irritable bowel syndrome". Scand. J. Gastroenterol. Suppl. 130: 81–4. PMID 3306904.
  75. ↑ Efskind PS, Bernklev T, Vatn MH (1996). "A double-blind placebo-controlled trial with loperamide in irritable bowel syndrome". Scand. J. Gastroenterol. 31 (5): 463–8. doi:10.3109/00365529609006766. PMID 8734343.
  76. ↑ Cann PA, Read NW, Holdsworth CD, Barends D (1984). "Role of loperamide and placebo in management of irritable bowel syndrome (IBS)". Dig. Dis. Sci. 29 (3): 239–47. PMID 6365490.
  77. ↑ Traynor K (2015). "Eluxadoline approved for irritable bowel syndrome with diarrhea". Am J Health Syst Pharm. 72 (13): 1078. doi:10.2146/news150043. PMID 26092951.
  78. ↑ Dove LS, Lembo A, Randall CW, Fogel R, Andrae D, Davenport JM, McIntyre G, Almenoff JS, Covington PS (2013). "Eluxadoline benefits patients with irritable bowel syndrome with diarrhea in a phase 2 study". Gastroenterology. 145 (2): 329–38.e1. doi:10.1053/j.gastro.2013.04.006. PMID 23583433.
  79. ↑ Lembo AJ, Lacy BE, Zuckerman MJ, Schey R, Dove LS, Andrae DA, Davenport JM, McIntyre G, Lopez R, Turner L, Covington PS (2016). "Eluxadoline for Irritable Bowel Syndrome with Diarrhea". N. Engl. J. Med. 374 (3): 242–53. doi:10.1056/NEJMoa1505180. PMID 26789872.
  80. ↑ Wedlake L, A'Hern R, Russell D, Thomas K, Walters JR, Andreyev HJ (2009). "Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome". Aliment. Pharmacol. Ther. 30 (7): 707–17. doi:10.1111/j.1365-2036.2009.04081.x. PMID 19570102.
  81. ↑ Fernández-Bañares F, Esteve M, Salas A, Alsina M, Farré C, González C, Buxeda M, Forné M, Rosinach M, Espinós JC, Maria Viver J (2007). "Systematic evaluation of the causes of chronic watery diarrhea with functional characteristics". Am. J. Gastroenterol. 102 (11): 2520–8. doi:10.1111/j.1572-0241.2007.01438.x. PMID 17680846.
  82. ↑ Odunsi-Shiyanbade ST, Camilleri M, McKinzie S, Burton D, Carlson P, Busciglio IA, Lamsam J, Singh R, Zinsmeister AR (2010). "Effects of chenodeoxycholate and a bile acid sequestrant, colesevelam, on intestinal transit and bowel function". Clin. Gastroenterol. Hepatol. 8 (2): 159–65. doi:10.1016/j.cgh.2009.10.020. PMC 2822105. PMID 19879973.
  83. ↑ Tabas G, Beaves M, Wang J, Friday P, Mardini H, Arnold G (2004). "Paroxetine to treat irritable bowel syndrome not responding to high-fiber diet: a double-blind, placebo-controlled trial". Am. J. Gastroenterol. 99 (5): 914–20. doi:10.1111/j.1572-0241.2004.04127.x. PMID 15128360.
  84. ↑ Tack J, Broekaert D, Fischler B, Van Oudenhove L, Gevers AM, Janssens J (2006). "A controlled crossover study of the selective serotonin reuptake inhibitor citalopram in irritable bowel syndrome". Gut. 55 (8): 1095–103. doi:10.1136/gut.2005.077503. PMC 1856276. PMID 16401691.
  85. ↑ Kuiken SD, Tytgat GN, Boeckxstaens GE (2003). "The selective serotonin reuptake inhibitor fluoxetine does not change rectal sensitivity and symptoms in patients with irritable bowel syndrome: a double blind, randomized, placebo-controlled study". Clin. Gastroenterol. Hepatol. 1 (3): 219–28. doi:10.1053/cgh.2003.50032. PMID 15017494.
  86. ↑ Vahedi H, Merat S, Rashidioon A, Ghoddoosi A, Malekzadeh R (2005). "The effect of fluoxetine in patients with pain and constipation-predominant irritable bowel syndrome: a double-blind randomized-controlled study". Aliment. Pharmacol. Ther. 22 (5): 381–5. doi:10.1111/j.1365-2036.2005.02566.x. PMID 16128675.
  87. ↑ Creed F, Fernandes L, Guthrie E, Palmer S, Ratcliffe J, Read N, Rigby C, Thompson D, Tomenson B (2003). "The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome". Gastroenterology. 124 (2): 303–17. doi:10.1053/gast.2003.50055. PMID 12557136.
  88. ↑ Ladabaum U, Sharabidze A, Levin TR, Zhao WK, Chung E, Bacchetti P, Jin C, Grimes B, Pepin CJ (2010). "Citalopram provides little or no benefit in nondepressed patients with irritable bowel syndrome". Clin. Gastroenterol. Hepatol. 8 (1): 42–48.e1. doi:10.1016/j.cgh.2009.09.008. PMC 2818161. PMID 19765674.
  89. ↑ Bundeff AW, Woodis CB (2014). "Selective serotonin reuptake inhibitors for the treatment of irritable bowel syndrome". Ann Pharmacother. 48 (6): 777–84. doi:10.1177/1060028014528151. PMID 24651166.
  90. ↑ Xie C, Tang Y, Wang Y, Yu T, Wang Y, Jiang L, Lin L (2015). "Efficacy and Safety of Antidepressants for the Treatment of Irritable Bowel Syndrome: A Meta-Analysis". PLoS ONE. 10 (8): e0127815. doi:10.1371/journal.pone.0127815. PMC 4529302. PMID 26252008.
  91. ↑ Bueno L, Fioramonti J, Delvaux M, Frexinos J (1997). "Mediators and pharmacology of visceral sensitivity: from basic to clinical investigations". Gastroenterology. 112 (5): 1714–43. PMID 9136853.
  92. ↑ Gorard DA, Libby GW, Farthing MJ (1995). "Effect of a tricyclic antidepressant on small intestinal motility in health and diarrhea-predominant irritable bowel syndrome". Dig. Dis. Sci. 40 (1): 86–95. PMID 7821126.
  93. ↑ Ford AC, Talley NJ, Schoenfeld PS, Quigley EM, Moayyedi P (2009). "Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis". Gut. 58 (3): 367–78. doi:10.1136/gut.2008.163162. PMID 19001059.
  94. ↑ Clouse RE, Lustman PJ, Geisman RA, Alpers DH (1994). "Antidepressant therapy in 138 patients with irritable bowel syndrome: a five-year clinical experience". Aliment. Pharmacol. Ther. 8 (4): 409–16. PMID 7986966.
  95. ↑ Saps M, Youssef N, Miranda A, Nurko S, Hyman P, Cocjin J, Di Lorenzo C (2009). "Multicenter, randomized, placebo-controlled trial of amitriptyline in children with functional gastrointestinal disorders". Gastroenterology. 137 (4): 1261–9. doi:10.1053/j.gastro.2009.06.060. PMC 2827243. PMID 19596010.
  96. ↑ Bahar RJ, Collins BS, Steinmetz B, Ament ME (2008). "Double-blind placebo-controlled trial of amitriptyline for the treatment of irritable bowel syndrome in adolescents". J. Pediatr. 152 (5): 685–9. doi:10.1016/j.jpeds.2007.10.012. PMID 18410774.
  97. ↑ 97.0 97.1 Pimentel M, Lembo A, Chey WD, Zakko S, Ringel Y, Yu J, Mareya SM, Shaw AL, Bortey E, Forbes WP (2011). "Rifaximin therapy for patients with irritable bowel syndrome without constipation". N. Engl. J. Med. 364 (1): 22–32. doi:10.1056/NEJMoa1004409. PMID 21208106.
  98. ↑ Pimentel M, Park S, Mirocha J, Kane SV, Kong Y (2006). "The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial". Ann. Intern. Med. 145 (8): 557–63. PMID 17043337.
  99. ↑ Pimentel M, Chow EJ, Lin HC (2000). "Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome". Am. J. Gastroenterol. 95 (12): 3503–6. doi:10.1111/j.1572-0241.2000.03368.x. PMID 11151884.
  100. ↑ Menees SB, Maneerattannaporn M, Kim HM, Chey WD (2012). "The efficacy and safety of rifaximin for the irritable bowel syndrome: a systematic review and meta-analysis". Am. J. Gastroenterol. 107 (1): 28–35, quiz 36. doi:10.1038/ajg.2011.355. PMID 22045120.
  101. ↑ Sharara AI, Aoun E, Abdul-Baki H, Mounzer R, Sidani S, Elhajj I (2006). "A randomized double-blind placebo-controlled trial of rifaximin in patients with abdominal bloating and flatulence". Am. J. Gastroenterol. 101 (2): 326–33. doi:10.1111/j.1572-0241.2006.00458.x. PMID 16454838.
  102. ↑ Shanahan F, Quigley EM (2014). "Manipulation of the microbiota for treatment of IBS and IBD-challenges and controversies". Gastroenterology. 146 (6): 1554–63. doi:10.1053/j.gastro.2014.01.050. PMID 24486051.
  103. ↑ Moayyedi P, Ford AC, Talley NJ, Cremonini F, Foxx-Orenstein AE, Brandt LJ, Quigley EM (2010). "The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review". Gut. 59 (3): 325–32. doi:10.1136/gut.2008.167270. PMID 19091823.
  104. ↑ Kim HJ, Camilleri M, McKinzie S, Lempke MB, Burton DD, Thomforde GM, Zinsmeister AR (2003). "A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome". Aliment. Pharmacol. Ther. 17 (7): 895–904. PMID 12656692.
  105. ↑ 105.0 105.1 Spanier JA, Howden CW, Jones MP (2003). "A systematic review of alternative therapies in the irritable bowel syndrome". Arch. Intern. Med. 163 (3): 265–74. PMID 12578506.
  106. ↑ 106.0 106.1 Hussain Z, Quigley EM (2006). "Systematic review: Complementary and alternative medicine in the irritable bowel syndrome". Aliment. Pharmacol. Ther. 23 (4): 465–71. doi:10.1111/j.1365-2036.2006.02776.x. PMID 16441466.
  107. ↑ Gordon M, MacDonald JK, Parker CE, Akobeng AK, Thomas AG (2016). "Osmotic and stimulant laxatives for the management of childhood constipation". Cochrane Database Syst Rev (8): CD009118. doi:10.1002/14651858.CD009118.pub3. PMID 27531591.
  108. ↑ Michail S, Gendy E, Preud'Homme D, Mezoff A (2004). "Polyethylene glycol for constipation in children younger than eighteen months old". J. Pediatr. Gastroenterol. Nutr. 39 (2): 197–9. PMID 15269628.
  109. ↑ Loening-Baucke V, Krishna R, Pashankar DS (2004). "Polyethylene glycol 3350 without electrolytes for the treatment of functional constipation in infants and toddlers". J. Pediatr. Gastroenterol. Nutr. 39 (5): 536–9. PMID 15572895.
  110. ↑ Loening-Baucke V (2002). "Polyethylene glycol without electrolytes for children with constipation and encopresis". J. Pediatr. Gastroenterol. Nutr. 34 (4): 372–7. PMID 11930092.
  111. ↑ Gremse DA, Hixon J, Crutchfield A (2002). "Comparison of polyethylene glycol 3350 and lactulose for treatment of chronic constipation in children". Clin Pediatr (Phila). 41 (4): 225–9. doi:10.1177/000992280204100405. PMID 12041718.
  112. ↑ Chapman RW, Stanghellini V, Geraint M, Halphen M (2013). "Randomized clinical trial: macrogol/PEG 3350 plus electrolytes for treatment of patients with constipation associated with irritable bowel syndrome". Am. J. Gastroenterol. 108 (9): 1508–15. doi:10.1038/ajg.2013.197. PMID 23835436.
  113. ↑ Dupont C, Leluyer B, Maamri N, Morali A, Joye JP, Fiorini JM, Abdelatif A, Baranes C, Benoît S, Benssoussan A, Boussioux JL, Boyer P, Brunet E, Delorme J, François-Cecchin S, Gottrand F, Grassart M, Hadji S, Kalidjian A, Languepin J, Leissler C, Lejay D, Livon D, Lopez JP, Mougenot JF, Risse JC, Rizk C, Roumaneix D, Schirrer J, Thoron B, Kalach N (2005). "Double-blind randomized evaluation of clinical and biological tolerance of polyethylene glycol 4000 versus lactulose in constipated children". J. Pediatr. Gastroenterol. Nutr. 41 (5): 625–33. PMID 16254521.
  114. ↑ Thomson MA, Jenkins HR, Bisset WM, Heuschkel R, Kalra DS, Green MR, Wilson DC, Geraint M (2007). "Polyethylene glycol 3350 plus electrolytes for chronic constipation in children: a double blind, placebo controlled, crossover study". Arch. Dis. Child. 92 (11): 996–1000. doi:10.1136/adc.2006.115493. PMC 2083581. PMID 17626140.
  115. ↑ Loening-Baucke V, Pashankar DS (2006). "A randomized, prospective, comparison study of polyethylene glycol 3350 without electrolytes and milk of magnesia for children with constipation and fecal incontinence". Pediatrics. 118 (2): 528–35. doi:10.1542/peds.2006-0220. PMID 16882804.
  116. ↑ Wang Y, Wang B, Jiang X, Jiang M, Xu C, Shao C, Jia L, Huang Z, Xu X, Liu H, Shang L (2012). "Polyethylene glycol 4000 treatment for children with constipation: A randomized comparative multicenter study". Exp Ther Med. 3 (5): 853–856. doi:10.3892/etm.2012.491. PMC 3438798. PMID 22969980.
  117. ↑ Alper A, Pashankar DS (2013). "Polyethylene glycol: a game-changer laxative for children". J. Pediatr. Gastroenterol. Nutr. 57 (2): 134–40. doi:10.1097/MPG.0b013e318296404a. PMID 23591910.
  118. ↑ Ford AC, Moayyedi P, Lacy BE, Lembo AJ, Saito YA, Schiller LR, Soffer EE, Spiegel BM, Quigley EM (2014). "American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation". Am. J. Gastroenterol. 109 Suppl 1: S2–26, quiz S27. doi:10.1038/ajg.2014.187. PMID 25091148.
  119. ↑ Liu JP, Yang M, Liu YX, Wei M, Grimsgaard S (2006). "Herbal medicines for treatment of irritable bowel syndrome". Cochrane Database Syst Rev (1): CD004116. doi:10.1002/14651858.CD004116.pub2. PMID 16437473.
  120. ↑ Yoon SL, Grundmann O, Koepp L, Farrell L (2011). "Management of irritable bowel syndrome (IBS) in adults: conventional and complementary/alternative approaches". Altern Med Rev. 16 (2): 134–51. PMID 21649455.
  121. ↑ Klooker TK, Braak B, Koopman KE, Welting O, Wouters MM, van der Heide S, Schemann M, Bischoff SC, van den Wijngaard RM, Boeckxstaens GE (2010). "The mast cell stabiliser ketotifen decreases visceral hypersensitivity and improves intestinal symptoms in patients with irritable bowel syndrome". Gut. 59 (9): 1213–21. doi:10.1136/gut.2010.213108. PMID 20650926.
  122. ↑ Zhou EH, Liu HR, Wu HG, Shi Y, Wang XM, Tan LY, Yao LQ, Zhong YS, Jiang Y, Zhang LL (2009). "Suspended moxibustion relieves chronic visceral hyperalgesia via serotonin pathway in the colon". Neurosci. Lett. 451 (2): 144–7. doi:10.1016/j.neulet.2008.12.026. PMID 19114087.
  123. ↑ Lembo AJ, Conboy L, Kelley JM, Schnyer RS, McManus CA, Quilty MT, Kerr CE, Drossman D, Jacobson EE, Davis RB (2009). "A treatment trial of acupuncture in IBS patients". Am. J. Gastroenterol. 104 (6): 1489–97. doi:10.1038/ajg.2009.156. PMC 2694961. PMID 19455132.
  124. ↑ Tian SL, Wang XY, Ding GH (2008). "Repeated electro-acupuncture attenuates chronic visceral hypersensitivity and spinal cord NMDA receptor phosphorylation in a rat irritable bowel syndrome model". Life Sci. 83 (9–10): 356–63. doi:10.1016/j.lfs.2008.06.027. PMID 18694764.
  125. ↑ Schneider A, Weiland C, Enck P, Joos S, Streitberger K, Maser-Gluth C, Zipfel S, Bagheri S, Herzog W, Friederich HC (2007). "Neuroendocrinological effects of acupuncture treatment in patients with irritable bowel syndrome". Complement Ther Med. 15 (4): 255–63. doi:10.1016/j.ctim.2006.12.002. PMID 18054727.
  126. ↑ Ma XP, Tan LY, Yang Y, Wu HG, Jiang B, Liu HR, Yang L (2009). "Effect of electro-acupuncture on substance P, its receptor and corticotropin-releasing hormone in rats with irritable bowel syndrome". World J. Gastroenterol. 15 (41): 5211–7. PMC 2773902. PMID 19891022.
  127. ↑ van der Veek PP, van Rood YR, Masclee AA (2007). "Clinical trial: short- and long-term benefit of relaxation training for irritable bowel syndrome". Aliment. Pharmacol. Ther. 26 (6): 943–52. doi:10.1111/j.1365-2036.2007.03437.x. PMID 17767479.
  128. ↑ Gaylord SA, Palsson OS, Garland EL, Faurot KR, Coble RS, Mann JD, Frey W, Leniek K, Whitehead WE (2011). "Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial". Am. J. Gastroenterol. 106 (9): 1678–88. doi:10.1038/ajg.2011.184. PMID 21691341.

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