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Irritabel tarm, årsaker

Innhold i artikkelen

Årsaken er ukjent, men det finnes mange teorier. Man antar ar det foreligger en økt følsomhet i tarmen for ytre påkjenninger. Den økte følsomheten gir seg utslag i økt muskelaktivitet i tarmveggen, og ofte uhensiktsmessig tarmaktivitet som fører til luftansamlinger, løs mage eller treg mage. Stress, bekymring, spenninger, angst og hverdagsproblemer vil hos mange utløse denne typen mageplager, men de regnes ikke som årsaker til plagene.

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Nyere kunnskap kan tyde på at tarmen kan reagere på visse typer karbohydrater i føden, og hos noen kan dette muligens være en av årsaksfaktorene. Det foreslås at pasienter med gjenstridige plager kan forsøke en kostendring. Les mer om FODMAP-dietten. 

Endret sammensetning av de normale tarmbakteriene kan også ha en betydning. 

I noen få tilfeller kan mageplagene skyldes en ikke-diagnostisert glutenintoleranse og/eller laktoseintoleranse.

Vil du vite mer

Dette dokumentet er basert på det profesjonelle dokumentet Irritabel tarm-syndrom . Referanselisten for dette dokumentet vises nedenfor

  1. Snyder N. Irritable bowel syndrome. BMJ Best Practice, last updated Mar 20, 2017. bestpractice.bmj.com
  2. Ford AC, Lacy BE, Talley NJ. Irritable bowel syndrome. N Engl J Med. 2017 Jun 29;376(26):2566-2578. PMID: 28657875.
  3. Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterology. 2006;130:1480-1491. PubMed
  4. Vandvik, P. O. and Lydersen S, Farup PG. Prevalence, impact and comorbidity of IBS in Norway. Scand J Gastroenterol 2006; 41: 650-6. PubMed
  5. Vandvik PO, Kristensen P, Aabakken L, Farup PG. Abdominal complaints in general practice. Scand J Prim Health Care 2004; 22: 157-62. PubMed
  6. Agrawal A, Houghton LA, Reilly B, et al. Bloating and distension in irritable bowel syndrome: the role of gastrointestinal transit. Am J Gastroenterol 2009; 104:1998. PubMed
  7. Lehrer JK. Irritable bowel syndrome. Medscape, last updated Apr 04, 2017. emedicine.medscape.com
  8. 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. PubMed
  9. Lawal A, Kern M, Sidhu H, et al. Novel evidence for hypersensitivity of visceral sensory neural circuitry in irritable bowel syndrome patients. Gastroenterology 2006; 130:26. Gastroenterology
  10. Dorn SD, Palsson OS, Thiwan SI, et al. Increased colonic pain sensitivity in irritable bowel syndrome is the result of an increased tendency to report pain rather than increased neurosensory sensitivity. Gut 2007; 56:1202. Gut
  11. Carroccio A, Mansueto P, Iacono G, et al. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol 2012; 107: 1898-906. PubMed
  12. Ford AC, Vandvik PO. Irritable bowel syndrome: dietary interventions. Systematic review 410. BMJ Clinical Evidence 2015.
  13. Rej A, Sanders DS. Gluten-free diet and its ‘cousins’ in irritable bowel syndrome. Nutrients. 2018 Nov; 10(11): 1727. www.ncbi.nlm.nih.gov
  14. Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology 2010; 25: 252-8. PubMed
  15. Berstad A, Valeur J, Lillestøl K, et al, Matoverfølsomhet – et paradigmeskifte?, Allergi i praksis, 1/2011.
  16. Melchior C, Gourcerol G, Dechelotte P, et al. Symptomatic fructose malasorption in irritable bowel syndrome: A prospective study. Un Eur Gastroenterol J 2014; 2: 131-7. doi: 10.1177/2050640614521124 DOI
  17. Gibson PR, Newnham E, Barrett JS, Shepherd SJ, Muir JG. Review article: fructose malabsorption and the bigger picture. Aliment Pharmacol Ther 2007; 25: 349-63. PubMed
  18. Thabane M, et al. Systematic review and meta-analysis: the incidence and prognosis of post-infectious irritable bowel syndrome. Aliment Pharmacol Ther 2007; 26: 535-44. PubMed
  19. Begtrup LM, Engsbro AL, Kjeldsen J, et al. A positive diagnostic strategy is noninferior to a strategy of exclusion for patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2013;11:956-62.e1. PMID: 23357491.
  20. Schmulson MJ, Drossman DA. What is new in Rome IV. J Neurogastroenterol Motil 2017; 23 (2): 151-63.
  21. Cristofori F, Fontana C, Magista A, et al. Increased prevalence of celiac disease among pediatric patients with irritable bowel syndrome. A 6-year prospective chort study. JAMA Pediatr 2014. doi:10.1001/jamapediatrics.2013.4984 DOI
  22. Carroccio A, Mansueto P, Iacono G, et al. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: Exploring a new clinical entity. Am J Gastroenterol, 2012. doi:10.1038/ajg.2012.236 DOI
  23. Rostom A, Dubé C, Cranney A, et al. The diagnostic accuracy of serologic tests for celiac disease: a systematic review. Gastroenterology 2005; 128 (4 Suppl 1): 38-46.
  24. Waugh N, Cummins E, Royle P, et al. Review: Calprotectin testing differentiates inflammatory bowel disease from the irritiable bowel syndrome. Ann Intern Med 2014; 160: JC13. doi:10.7326/0003-4819-160-8-201404150-02013 DOI
  25. Menees SB, Powell C, Kurlander J, et al. A Meta-Analysis of the Utility of C-Reactive Protein, Erythrocyte Sedimentation Rate, Fecal Calprotectin, and Fecal Lactoferrin to Exclude Inflammatory Bowel Disease in Adults With IBS. Am J Gastroenterol 2015; 110: 444-54. doi:10.1038/ajg.2015.6 DOI
  26. Maagaard L, Ankersen DV, Vegh Z, et al. Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet. World J Gastroenterol 2016; 22: 4009-19. pmid:27099444 PubMed
  27. NICE guideline. Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care. NICE guideline CG61, 2015.
  28. Ford AC, Moayyedi P. Meta-analysis: factors affecting placebo response rate in the irritable bowel syndrome. Aliment Pharmacol Ther 2010;32:144-158. PubMed
  29. El-Salhy M, Hatlebakk JG, Gilja OH et al. Efficacy of faecal microbiota transplantation for patients with irritable bowel syndrome in a randomised, double-blind, placebo-controlled study. Gut 2019. Epub ahead of print. pmid:31852769 PubMed
  30. Everitt HA, Landau S, O'Reilly G, et al. Assessing telephone-delivered cognitive–behavioural therapy (CBT) and web-delivered CBT versus treatment as usual in irritable bowel syndrome (ACTIB): a multicentre randomised trial. Gut, published online first: 10 April 2019. gut.bmj.com
  31. Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015;313(9):949-58. doi: 10.1001/jama.2015.0954 DOI
  32. Robinson A, Lee V, Kennedy A, et al. A randomised controlled trial of self-help interventions in patients with a primary care diagnosis of irritable bowel syndrome. Gut 2006; 55: 643-8. Gut
  33. Staudacher HM1, Whelan K, et.al. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet, Oct 2011; 24(5): 487-95.
  34. Halmos E, Power V, et.al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014; 146: 67-75. Gastroenterology
  35. Dionne J, Ford AC, Yuhong Y et al. A Systematic Review and Meta-Analysis Evaluating the Efficacy of a Gluten-Free Diet and a Low FODMAPs Diet in Treating Symptoms of Irritable Bowel Syndrome. Am J Gastroenterol 2018. pmid:30046155 PubMed
  36. Ford AC, Moayyedi P, Lacy BE, et al. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol 2014;109:Suppl 1:S2-S26. PMID: 25091148. PubMed
  37. Moayyedi P, Quigley EM, Lacy BE, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol. 2014 Sep;109(9):1367-74. PMID: 25070054 PubMed
  38. Bijkerk CJ, de Wit NJ, Muris JWM, et al. Soluble og insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ 2009; 339: b3154. BMJ (DOI)
  39. Moayyedi P, Ford AC, Talley NJ, et al.The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut 2010; 59: 325-32. Gut
  40. Rao S, Lembo AJ, Shiff SJ, et al. A 12-week, randomized, controlled trial with a 4-week randomized withdrawal period to evaluate the efficacy and safety of linaclotide in irritable bowel syndrome with constipation. Am J Gastroenterol 2012 Sep 18. pmid:22986440 PubMed
  41. Shah ED, Kim HM, Schoenfeld P. Efficacy and Tolerability of Guanylate Cyclase-C Agonists for Irritable Bowel Syndrome with Constipation and Chronic Idiopathic Constipation: A Systematic Review and Meta-Analysis. Am J Gastroenterol. 2018. PMID: 29380823 PubMed
  42. Ford AC, Quigley EM, Lacy BE, et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: Systematic review and meta-analysis. Am J Gastroenterol 2014 Oct; 109:1547 doi:10.1038/ajg.2014.202 DOI
  43. Biekiesiekierski JR, Newbham ED, Irving PM, et al. Gluten causes gastrointetinal symptoms in subjects without celiac disease: a double-blind randomized placebo-contgrolled trial. Am J Gastroenterol 2011; 106: 508-14. PubMed
  44. Layer P, Stanghellini V. Linaclotide for the management of irritable bowel syndrome with constipation. Aliment Pharmacol Ther 2014; 39: 371-84. PubMed
  45. Chey WD, Lembo AJ, Lavins BJ, et al. Linaclotide for irritable bowel syndrome with constipation: a 26-week, randomized, double-blind, placebo-controlled trial to evaluate efficacy and safety. Am J Gastroenterol 2012 Sep 18. pmid:22986437 PubMed
  46. Brenner DM, Fogel R, Dorn SD, et al. Efficacy, safety, and tolerability of plecanatide in patients with irritable bowel syndrome with constipation: results of two phase 3 randomized clinical trials. Am J Gastroenterol 2018. pmid:29545635 PubMed
  47. Shin A, Camilleri M, Kolar G, et al. Systematic review with meta-analysis: highly selective 5-HT4 agonists (prucalopride, velusetrag or naronapride) in chronic constipation. Aliment Pharmacol Ther 2014; 39: 239-53. pmid: 24308797 PubMed
  48. Chey WD, Lembo AJ, Rosenbaum DP Efficacy of Tenapanor in Treating Patients With Irritable Bowel Syndrome With Constipation: A 12-Week, Placebo-Controlled Phase 3 Trial (T3MPO-1). Am J Gastroenterol. 2020. PMID: 31934897 PubMed
  49. Ruepert L, Quartero AO, de Wit NJ, et al. Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews 2011; 10: CD003460. Cochrane (DOI)
  50. Fukudo S, Kinoshita Y, Okumura T, et al. Ramosetron reduces symptoms of irritable bowel syndrome with diarrhea and improves quality of life in women. Gastroenterology. 2016: 150: 358-66. PMID: 26551550 PubMed
  51. Ford AC, Talley NJ, Schoenfeld PS, et al. Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. Gut 2009; 58: 367-78.
  52. Statens Legemiddelverk (SLV). Nye anbefalinger ved bruk av metoklopramid. Juli 2013.
  53. Liu JP, Yang M, Liu Y, Wei ML, Grimsgaard S. Herbal medicines for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004116. DOI: 10.1002/14651858.CD004116.pub2. DOI
  54. Garsed K, Chernova J, Hastings M, et al. A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea. Gut 2013 Dec 12.
  55. Song GH, Leng PH, Gwee KA, Moochhala SM, Ho KY. Melatonin improves abdominal pain in irritable bowel syndrome patients who have sleep disturbances: a randomised, double blind, placebo controlled study. Gut 2005; 54: 1402-7. Gut
  56. Tazzyman S, Richards N, Trueman AR, et al. Vitamin D associates with improved quality of life in participants with irritable bowel syndrome: outcomes from a pilot trial. BMJ Open Gastro 2015; 2:e000052 . doi:10.1136/bmjgast-2015-000052 DOI
  57. Kaptchuk TJ, Kelley JM, Conboy LA, et al. Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. BMJ 2008; 336: 999-1003. PubMed
  58. van der Veek PP, van Rood YR, Masclee AA. Clinical trial: short- and long-term benefit of relaxation training for irritable bowel syndrome. Aliment Pharmacol Ther 2007; 26: 943-52. PubMed
  59. Halkjær SI, Christensen AH, Lo BZS, et al Faecal microbiota transplantation alters gut microbiota in patients with irritable bowel syndrome: results from a randomised, double-blind placebo-controlled study Gut Published Online First: 06 July 2018.
  60. Longstreth GF, Yao JF. Irritable bowel syndrome and surgery: a multivariable analysis. Gastroenterology 2004; 126: 1665 - 73. Gastroenterology
  61. Canavan C, West J, Card T. The economic impact of the irritable bowel syndrome. Aliment Pharmacol Ther 2014;40:1023-1034. PubMed
  62. Biesiekierski JR, Peters SL, Newnham ED, et al. No effects of gluten in patients with self-reported non-celilac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroeneterology 2013; 145: 320-8. PubMed
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