[Therapeutic strategy in the irritable bowel syndrome]

Abstract

The irritable intestine is one of the most frequently encountered complaints in medical practice. Although treatment is generally difficult, a therapeutic strategy which can be used in most cases is proposed. Most patients with these symptoms do not seek medical attention. The motivation for medical consultation can however be of prime importance for adequate treatment. The attending physician must first establish the reality of disease by detailed history-taking, physical examination and sigmoidoscopy. Promoting factors such as dysentery, medications, alimentation, emotions or any other major event in the patient's life must be identified. The physician must reassure and console the patient accordingly. Bran-containing diets are reliable adjuvants for most patients. Follow-up is important to guarantee patient compliance and understanding. The essential risk in the irritable bowel syndrome is the doubtfulness which hovers over the disease entity and can be responsible for patient anxiety, or prompt expensive investigations, undesirable effects of medication or even unnecessary surgery. If the patient's complaints remain unchanged at the second medical visit, other diagnostics should be considered, thus avoiding unjustified investigations. Continued empathy with the patient is important. Medication, either for their placebo or specific symptomatic action (e. g. antidiarrheics) should be considered as well. The physician has to reassure and console the patient who does not improve. The patient can then be directed to a specialized unit, but only on the physician's specific orders.