RESUMO
ABSTRACT BACKGROUND: Irritable bowel syndrome (IBS) is a clinical disorder associated with high socioeconomic burden. Despite its importance, management of IBS remains difficult and several interventions have been hypothesized as beneficial for this condition. This study identified and summarized all Cochrane systematic reviews (SRs) about the effects of interventions for managing IBS patients. DESIGN AND SETTING: Review of systematic reviews, carried out in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: Review of Cochrane SRs addressing interventions for IBS. RESULTS: We included six SRs assessing acupuncture, bulking agents, antispasmodics, antidepressants, herbal medicines, homeopathy, hypnotherapy and psychological therapy for IBS. The certainty of evidence ranged from unknown to moderate, mainly due to imprecision in the estimates and high risk of bias from the primary studies included. There was moderate certainty of evidence that acupuncture had no important benefit regarding improvement of symptoms and quality of life, compared with sham acupuncture. There was also very low certainty of evidence that homeopathic asafoetida, used alone or in association with nux, was better than placebo regarding self-reported overall improvement. CONCLUSION: There was moderate certainty of evidence that acupuncture had no important benefit regarding improvement of symptoms and quality of life. Further well-designed and well-conducted randomized clinical trials are needed in order to reduce the uncertainties regarding the most commonly used interventions for patients with IBS.
Assuntos
Humanos , Gerenciamento Clínico , Síndrome do Intestino Irritável/terapia , Revisões Sistemáticas como Assunto , Psicoterapia/métodos , Resultado do Tratamento , Medicina Baseada em Evidências , Síndrome do Intestino Irritável/psicologiaRESUMO
Skill in the diagnosis and management of functional disorders is essential for anyone concerned with human disease. The main principie is to distinguish between organic clinical entities and functional disorders. The pathophysiologic mechanisms that generate the symptoms of the functional disorders are imper- fectly understood. The most important etiologic factors are rela- ted to stress such as mental, emotional, or physical tension, strain, or distress. The importance of the functional disorders in gastroenterology is due to their high prevalence in almost all peoples at some time of their lives. The treatment of the func- tional disorders try to be specific but is very difficult because the pathophysiologic mechanisms involved are unclear. On the other hand, nonpharmacologic strategies by the physician can be efficients, mainly establishing a therapeutic relationship with your patient.
Habilidade em diagnosticar e lidar com desordens funcionais é essencial a qualquer um que cuide de doenças humanas. É fundamental distinguir entre entidades clínicas orgânias e distúrbios funcionais. A fisiopatologia dos distúrbios funcionais nâo é bem compreendida. Os fatores etiológicos mais importantes relacionam-se ao estresse, tais como estados de tensâo mental, emocional ou física. O tratamento farmacológico tem limitações como inespecificidade e os altos índices de efeito placebo. Por outro lado, a adoção de estratégias não farmacológicas pelo médico pode ser eficiente, principalmente esta- belecendo um relacionamento terapêutico com seu paciente.