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Huisarts en Wetenschap

, Volume 52, Issue 1, pp 17–20 | Cite as

Prikkelbaredarmsyndroom in de huisartsenpraktijk

  • René Bijkerk
Beschouwing
  • 126 Downloads

Samenvatting

In deze beschouwing worden aanbevelingen gegeven voor de diagnostiek en behandeling van PDS-patiënten. Huisartsen kunnen PDS-patiënten op basis van de symptomen met zekerheid identificeren. Bij alarmsymptomen is aanvullend onderzoek geïndiceerd. De diagnose PDS wordt in de huisartsenpraktijk tevens bepaald door het ‘patiëntenprofiel’. De karakteristieken daarvan zijn: een frequent consultatiepatroon, een verhoogde prevalentie van somatische en psychiatrische comorbiditeit en een voorgeschiedenis met lichamelijk onverklaarde klachten. De huisarts zou de behandeling moeten starten met het onderzoeken van de perceptie en verwachtingen van de patiënt. De volgende stap is het geven van uitleg en geruststelling, waarbij de goedaardige achtergrond van het syndroom wordt uitgelegd. Leefstijlaanpassing is onderdeel van de behandeling. PDS-patiënten met functionele of psychiatrische comorbiditeit hebben mogelijk baat bij psychologische interventies of medicamenteuze behandeling.

beschouwing prikkelbare darm diagnostiek 

Abstract

Irritable bowel syndrome (IBS) is a functional disorder in which abdominal pain or discomfort is associated with a change in bowel habit. IBS is a common disorder in primary care and patients have a high consultation frequency, as well for IBS as for other disorders. In this article we provide recommendations for the management of patients with IBS in primary care. GPs are able to identify IBS patients with confidence; additional investigations for diagnosing IBS are only recommended in case of alarm symptoms. In addition to symptoms the primary care diagnosis of IBS is guided by the ‘patient’s profile’. Characteristics that support this ‘IBS profile’ include high consultation patterns, increased prevalence of psychiatric and somatic comorbidity and a history of medically unexplained physical symptoms in the past. In clinical practice GPs’ management of IBS starts with exploring the patients perception and expectations. Counseling and reassurance is the next step, explaining pathophysiology and symptom generation of IBS, and the prognosis and benign background of the syndrome. The need for lifestyle adaption is part of the therapy. In IBS patients with functional or psychiatric comorbidity psychological treatment or psychotropic drugs could be considered.

Literatuur

  1. 1.
    Cayley WE. Irritable bowel syndrome. BMJ 2005;330:632.Google Scholar
  2. 2.
    Ohman L, Simren M. New insights into the pathogenesis and pathophysiology of irritable bowel syndrome. Dig Liver Dis 2007;39:201-15.Google Scholar
  3. 3.
    Aziz Q, Thompson DG. Brain-gut axis in health and disease. Gastroenterology 1998;114:559-78.Google Scholar
  4. 4.
    Wilhelmsen I. Brain-gut axis as an example of the bio-psycho-social model. Gut 2000;47 Suppl 4:iv5-7.Google Scholar
  5. 5.
    Kamm MA. The role of psychosocial factors in functional gut disease. Eur J Surg Suppl 1998;:37-40.Google Scholar
  6. 6.
    Bijkerk CJ, De Wit NJ, Stalman WA, Knottnerus JA, Hoes AW, Muris JW. Irritable bowel syndrome in primary care: the patients' and doctors' views on symptoms, etiology and management. Can J Gastroenterol 2003;17:363-8.Google Scholar
  7. 7.
    Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Muller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut 1999;45 Suppl 2:II43-7.Google Scholar
  8. 8.
    Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology 2006;130:1480-91.Google Scholar
  9. 9.
    Bijkerk CJ. Irritable bowel syndrome in primary care. Utrecht: University Medical Center Utrecht, 2008.Google Scholar
  10. 10.
    Rubin G, de Wit NJ, Meineche-Schmidt V, Seifert B, Hall N, Hungin P. The diagnosis of IBS in primary care: consensus development using nominal group technique. Fam Pract 2006;23:687-92.Google Scholar
  11. 11.
    Koloski NA, Talley NJ, Huskic SS, Boyce PM. Predictors of conventional and alternative health care seeking for irritable bowel syndrome and functional dyspepsia. Aliment Pharmacol Ther 2003;17:841-51.Google Scholar
  12. 12.
    Drossman DA, McKee DC, Sandler RS, Mitchell CM, Cramer EM, Lowman BC, et al. Psychosocial factors in the irritable bowel syndrome. A multivariate study of patients and nonpatients with irritable bowel syndrome. Gastroenterology 1988;95:701-8.Google Scholar
  13. 13.
    Williams RE, Black CL, Kim HY, Andrews EB, Mangel AW, Buda JJ, et al. Determinants of healthcare-seeking behaviour among subjects with irritable bowel syndrome. Aliment Pharmacol Ther 2006;23:1667-75.Google Scholar
  14. 14.
    Vandvik PO, Wilhelmsen I, Ihlebaek C, Farup PG. Comorbidity of irritable bowel syndrome in general practice: a striking feature with clinical implications. Aliment Pharmacol Ther 2004;20:1195-203.Google Scholar
  15. 15.
    Van der Horst HE, Van Dulmen AM, Schellevis FG, Van Eijk JT, Fennis JF, Bleijenberg G. Do patients with irritable bowel syndrome in primary care really differ from outpatients with irritable bowel syndrome? Gut 1997;41:669-74.Google Scholar
  16. 16.
    Koloski NA, Talley NJ, Huskic SS, Boyce PM. Predictors of conventional and alternative health care seeking for irritable bowel syndrome and functional dyspepsia. Aliment Pharmacol Ther 2003;17:841-51.Google Scholar
  17. 17.
    Koloski NA, Talley NJ, Boyce PM. Epidemiology and health care seeking in the functional GI disorders: a population-based study. Am J Gastroenterol 2002;97:2290-9.Google Scholar
  18. 18.
    Locke GR, Weaver AL, Melton LJ, Talley NJ. Psychosocial factors are linked to functional gastrointestinal disorders: a population based nested case-control study. Am J Gastroenterol 2004;99:350-7.Google Scholar
  19. 19.
    Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology 2002;122:1140-56.Google Scholar
  20. 20.
    Jones J, Boorman J, Cann P, Forbes A, Gomborone J, Heaton K, et al. British Society of Gastroenterology guidelines for the management of the irritable bowel syndrome. Gut 2000 ;47 Suppl 2:ii1-19.Google Scholar
  21. 21.
    De Wit NJ, Van der Wind D, Schellevis FG, Van der Horst HE. Epidemiology and clinical management of irritable bowel syndrome in primary care; one year results from a nationwide database. Gut Suppl III 56, A40, 2007. Ref Type: Abstract.Google Scholar
  22. 22.
    Hamm LR, Sorrells SC, Harding JP, Northcutt AR, Heath AT, Kapke GF, et al. Additional investigations fail to alter the diagnosis of irritable bowel syndrome in subjects fulfilling the Rome criteria. Am J Gastroenterol 1999;94:1279-82.Google Scholar
  23. 23.
    Thompson WG. The treatment of irritable bowel syndrome. Aliment Pharmacol Ther 2002;16:1395-406.Google Scholar
  24. 24.
    Costa F, Mumolo MG, Bellini M, Romano MR, Ceccarelli L, Arpe P, et al. Role of faecal calprotectin as non-invasive marker of intestinal inflammation. Dig Liver Dis 2003;35:642-7.Google Scholar
  25. 25.
    Oberndorff-Klein Woolthuis AH, Brummer RJ, De Wit NJ, Muris JW, Stockbrugger RW. Irritable bowel syndrome in general practice: an overview. Scand J Gastroenterol Suppl 2004;241:17-22.Google Scholar
  26. 26.
    Cardol M, Van Dijk L, De Jong JD, De Bakker DH, Westert GP. Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijk. Huisartsenzorg: wat doet de poortwachter? Utrecht/Bilthoven: NIVEL/RIVM, 2004.Google Scholar
  27. 27.
    Van der Horst HE, Schellevis FG, Van Eijk JT, Bleijenberg G. Managing patients with irritable bowel syndrome in general practice. How to promote and reinforce self-care activities. Patient Educ Couns 1998;35:149-56.Google Scholar
  28. 28.
    Kennedy T, Jones R, Darnley S, Seed P, Wessely S, Chalder T. Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial. BMJ 2005;331:435.Google Scholar
  29. 29.
    Whorwell PJ, Prior A, Faragher EB. Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Lancet 1984;2:1232-4.Google Scholar
  30. 30.
    Drossman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review on irritable bowel syndrome. Gastroenterology 2002;123:2108-31.Google Scholar

Copyright information

© Bohn Stafleu van Loghum 2009

Authors and Affiliations

  1. 1.

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