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Inicio Medicina Clínica (English Edition) Irritable bowel syndrome: How to improve decision making in clinical practice
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Vol. 151. Issue 12.
Pages 489-497 (December 2018)
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Vol. 151. Issue 12.
Pages 489-497 (December 2018)
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DOI: 10.1016/j.medcle.2018.11.004
Irritable bowel syndrome: How to improve decision making in clinical practice
Síndrome del intestino irritable: cómo mejorar la toma de decisiones en la práctica clínica
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Fermín Mearina,
Corresponding author
mearin@dr.teknon.es

Corresponding author.
, Enrique Reyb, Cecilio Santanderc
a Servicio de Aparato Digestivo, Centro Médico Teknon, Barcelona, Spain
b Servicio de Aparato Digestivo, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
c Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Madrid, Spain
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Table 1. Guidelines to establish a doctor-patient therapeutic relationship.
Table 2. Basic and optional complementary tests in diarrhoea-predominant irritable bowel syndrome.
Table 3. Dietary recommendations of the National Institute for Health and Clinical Excellence (NICE) for irritable bowel syndrome.
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Abstract

Irritable bowel syndrome (IBS) is a highly prevalent functional disorder, characterised by the presence of recurrent abdominal pain associated with changes in bowel habits. Its physiopathology is complex, its clinical manifestations are diverse, and the therapeutic possibilities are multiple and not well known. In clinical practice, the diagnosis of IBS represents an important challenge; this means that in many cases the patients do not receive the proper diagnosis, which implies an absence of a targeted treatment, and therefore bad symptomatic control. In this article, the fundamental questions posed by the doctor when dealing with a patient with symptoms compatible with IBS are presented chronologically. The main objective is to provide clinical and eminently practical information that facilitates the management of patients with IBS, from both diagnostic and therapeutic points of view.

Keywords:
Irritable bowel syndrome
Diarrhoea
Constipation
Abdominal pain
Diagnosis
Treatment
Resumen

El síndrome de intestino irritable (SII) es un trastorno funcional muy prevalente, caracterizado por la presencia de dolor abdominal recurrente asociado a alteraciones del ritmo deposicional. Su fisiopatología es compleja, sus manifestaciones clínicas, diversas, y las posibilidades terapéuticas, múltiples y no bien conocidas. En la práctica clínica el diagnóstico del SII representa un reto importante, y ello hace que en muchas ocasiones los pacientes no reciban el diagnóstico adecuado, lo que comporta una ausencia de tratamiento dirigido y, por tanto, un mal control sintomático. En este artículo se plantean cronológicamente las preguntas fundamentales que se hace el médico cuando atiende a un paciente con síntomas compatibles con SII. El objetivo fundamental es proporcionar una información clínica y eminentemente práctica que facilite el manejo de los pacientes con SII, tanto desde el punto de vista diagnóstico como terapéutico.

Palabras clave:
Síndrome de intestino irritable
Diarrea
Estreñimiento
Dolor abdominal
Diagnóstico
Tratamiento

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