Expert answer:
THE cure for irritable bowel syndrome is controversial. Many patients will have relapses of symptoms and some will have no more symptoms after some time. The evolution with treatment is unpredictable, but it is known that some factors bring worse prognosis:
- Persistence of a chronically stressful life;
- Psychiatric comorbidity;
- Long-standing symptoms;
- Excessive anxiety.
O treatment of irritable bowel syndrome should be individualized, according to the predominance of diarrheal symptoms or constipation. The treatment options are listed below:
- Psychological support: patients are usually anxious, tense, depressed and sometimes full of "phobias". A good doctor-patient relationship is critical to successful treatment. It is important to explain the diagnosis, both the functional and recurrent character of the disease, and its non-evolution for cancer. The main objective of the psychological approach is to make the person recognize his problem and the factors that caused it and to learn to deal with it. Antidepressants may be used, especially for the control of abdominal pain. Other techniques may be useful, such as psychotherapy, relaxation techniques and hypnosis;
- Food Orientation: one must adopt diet rich in fibers and avoid vegetables, cabbage, radish, coffee, soda and dairy products;
- Antidiarrheals: indicated when there is a predominance of diarrhea. Loperamide or diphenoxylate, one tablet orally every 6 hours or 8 hours, are the most indicated;
- Antispasmodics: include anticholinergics, calcium channel blockers, intestinal musculature relaxers without cholinergic action, and others that are useful in cases of exaggerated gastrocolic reflexes (desire to defecate shortly after meals);
- Pro-kinetics: include cisapride and domperidone and should be used in those patients in whom constipation predominates;
- Anti-inflammatory to control abdominal pain;
- Probiotics, as the strain Bifidobacterium infantile and Bifidobacterium lactis.
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The treatment should be prescribed by the doctor gastroenterologist.
