miércoles, 12 de septiembre de 2007

Borrador de la guía NICE sobre el Síndrome del Intestino Irritable

El magnífico y, a veces atacado, National Institute for Clinical Excellence (NICE) ha publicado el borrador de su guía para el Síndrome del Intestino Irritable (IBS en inglés). Es de agradecer este tipo de documentos en las patología frecuentes y donde la actitud terapéutica es variopinta y poc estructurada. Este es un documento donde se aborda qué tipo de pruebas realizar y como ordenar los tratamientos a los pacientes.
El resumen terapéutico es el siguiente:

NICE has issued draft guidelines on irritable bowel syndrome (IBS) for consultation from 16th August to 11th October 2007.

Some of the preliminary recommendations with regards to treatment by primary care clinicians are as follows:

• Do not discourage people with IBS from trying specific probiotic products; if people with IBS choose to do this, it should be for at least 4 weeks, and they should monitor their effect.

• Discourage the use of aloe vera in the treatment of IBS.

• Consider prescribing antispasmodic agents, to be taken as required, alongside dietary and lifestyle advice.

• Laxatives should be considered for the treatment of constipation in people with IBS, but they should be actively discouraged from taking lactulose.

• Loperamide should be considered as first-line treatment for diarrhoea in people with IBS.

• Advise people with IBS how to adjust laxative or anti-motility agent doses according to clinical response; the dose should be titrated according to the stool consistency with the aim of achieving a soft well formed stool.

• Consider the benefit of prescribing tricyclics as second-line treatment for people with IBS; treatment should be initiated at a low starting dose (5–10 mg equivalent of amytriptyline), once at night, and should be reviewed regularly. The dose can subsequently be increased, but does not usually need to exceed 30 mg.

• Consider prescribing SSRIs only when tricyclics have been shown to be ineffective.• Consider reported side effects when prescribing tricyclics or SSRIs and follow up patient after 4 weeks and then at 6–12 monthly intervals thereafter.

• Consider referring for behavioural therapies people with IBS who do not respond to first line therapies after 12 months and who develop a continuing symptom profile (refractory IBS).

• Do not encourage the use of acupuncture or reflexology in the treatment of IBS

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