[
    {
        "page": 1,
        "title": "S\u00cdNDROME DE INTESTINO IRRITABLE ",
        "body": "<p>\n\n\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n<meta name=\"ProgId\" content=\"Word.DocumentW\" \/>\n<meta name=\"Generator\" content=\"Microsoft Word 15\" \/>\n<meta name=\"Originator\" content=\"Microsoft Word 15\" \/>\n<link rel=\"File-List\n\" href=\"file:\/\/\/C:\/Users\/lucas\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_filelist.xml\" \/>\n<link rel=\"themeData\n\" href=\"file:\/\/\/C:\/Users\/lucas\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_themedata.thmx\" \/>\n<link rel=\"colorSchemeMapping\n\" href=\"file:\/\/\/C:\/Users\/lucas\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_colorschememapping.xml\" \/>\n<xml>\n \n  \n  \n   \n   \n   \n   \n   \n   \n   \n   \n   \n  \n  \n  \n   \n   \n   \n   \n   \n   \n   \n   \n   \n   \n   \n  \n<\/xml><xml>\n \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n \n<\/xml>\n<style>\n\n<\/style>\n\n<style>\n \/* Style Definitions *\/\n table.MsoNormalTable\n\t{mso-style-name:\"Tabla normal\";\n\tmso-tstyle-rowband-size:0;\n\tmso-tstyle-colband-size:0;\n\tmso-style-noshow:yes;\n\tmso-style-priority:99;\n\tmso-style-parent:\"\";\n\tmso-padding-alt:0cm 5.4pt 0cm 5.4pt;\n\tmso-para-margin:0cm;\n\tline-height:115%;\n\tmso-pagination:widow-orphan;\n\tfont-size:11.0pt;\n\tfont-family:\"Arial\",sans-serif;\n\tmso-ansi-language:EN;}\n<\/style>\n\n\n\n\n\n\n<h1 style=\"margin-top:24.0pt;page-break-after:auto\"><a name=\"_x04zqtd78l90\"><\/a><b><span style=\"font-size:23.0pt;line-height:115%\">S\u00cdNDROME DE INTESTINO IRRITABLE (IBS)<\/span><\/b><\/h1>\n\n<h2 style=\"margin-bottom:4.0pt;page-break-after:\nauto\"><a name=\"_cvs01upx8x7f\"><\/a><b><span style=\"font-size:17.0pt;line-height:115%\">Definici\u00f3n<\/span><\/b><\/h2>\n\n<p style=\"margin-top:12.0pt;margin-bottom:\n12.0pt\"><span>Trastorno funcional digestivo\ncaracterizado por dolor o malestar abdominal cr\u00f3nico, acompa\u00f1ado de alteraci\u00f3n\nde los h\u00e1bitos intestinales (diarrea, estre\u00f1imiento o ambos), sin anomal\u00edas\nestructurales evidentes. No existen biomarcadores diagn\u00f3sticos espec\u00edficos.<\/span><\/p>\n\n<h2 style=\"margin-bottom:4.0pt;page-break-after:\nauto\"><a name=\"_o2k25jjaf8lb\"><\/a><b><span style=\"font-size:17.0pt;line-height:115%\">Epidemiolog\u00eda<\/span><\/b><\/h2>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Prevalencia: 10\u201320% adultos y\nadolescentes.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Predomina en mujeres (2\u20133 veces\nm\u00e1s frecuente).<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>S\u00edntomas inician antes de los 45\na\u00f1os en la mayor\u00eda.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Alta superposici\u00f3n con otros\ntrastornos funcionales: fibromialgia, cefalea, s\u00edntomas genitourinarios.<br \/>\n<br \/>\n<\/span><\/p>\n\n<h2 style=\"margin-bottom:4.0pt;page-break-after:\nauto\"><a name=\"_cbwh7qxjkdcg\"><\/a><b><span style=\"font-size:17.0pt;line-height:115%\">Diagn\u00f3stico: Criterios de\nRoma IV<\/span><\/b><\/h2>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span style=\"font-family:&quot;Arial Unicode MS&quot;\">Dolor\nabdominal recurrente al menos 1 d\u00eda por semana durante los \u00faltimos 3 meses,\nasociado a \u22652 de los siguientes:<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:72.0pt;text-indent:-18.0pt\"><span><span>\u25cb<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Relacionado con la defecaci\u00f3n<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:72.0pt;text-indent:-18.0pt\"><span><span>\u25cb<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Asociado con cambios en la\nfrecuencia de evacuaciones<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:72.0pt;text-indent:-18.0pt\"><span><span>\u25cb<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Asociado con cambios en la forma\nde las heces<br \/>\n<span>&nbsp;<\/span><\/span><i><span style=\"font-family:&quot;Arial Unicode MS&quot;\">Inicio de s\u00edntomas\n\u22656 meses antes del diagn\u00f3stico.<br \/>\n<br \/>\n<\/span><\/i><\/p>\n\n<h2 style=\"margin-bottom:4.0pt;page-break-after:\nauto\"><a name=\"_qqyeebt31r69\"><\/a><b><span style=\"font-size:17.0pt;line-height:115%\">Manifestaciones cl\u00ednicas<\/span><\/b><\/h2>\n\n<h3 style=\"margin-top:14.0pt;page-break-after:auto\"><a name=\"_5ysg466btbb1\"><\/a><b><span style=\"font-size:13.0pt;line-height:115%;color:black\">Dolor abdominal<\/span><\/b><\/h3>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Tipo c\u00f3lico, epis\u00f3dico, variable\nen intensidad y localizaci\u00f3n.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Se alivia con defecaci\u00f3n o\nexpulsi\u00f3n de gases.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Empeora con comidas, estr\u00e9s o\nmenstruaci\u00f3n.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>No provoca desnutrici\u00f3n ni\ninterfiere con el sue\u00f1o.<br \/>\n<br \/>\n<\/span><\/p>\n\n<h3 style=\"margin-top:14.0pt;page-break-after:auto\"><a name=\"_8qeg5dnvigy8\"><\/a><b><span style=\"font-size:13.0pt;line-height:115%;color:black\">Alteraciones del h\u00e1bito\nintestinal<\/span><\/b><\/h3>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Subtipos:<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:72.0pt;text-indent:-18.0pt\"><span><span>\u25cb<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>IBS-C (estre\u00f1imiento)<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:72.0pt;text-indent:-18.0pt\"><span><span>\u25cb<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>IBS-D (diarrea)<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:72.0pt;text-indent:-18.0pt\"><span><span>\u25cb<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>IBS-M (mixto)<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Alternancia frecuente entre\nsubtipos.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Diarrea: &lt;200 mL, sin sangre,\nno nocturna.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Estre\u00f1imiento: heces duras,\nsensaci\u00f3n de evacuaci\u00f3n incompleta.<br \/>\n<br \/>\n<\/span><\/p>\n\n<h3 style=\"margin-top:14.0pt;page-break-after:auto\"><a name=\"_1jes4ytoutqn\"><\/a><b><span style=\"font-size:13.0pt;line-height:115%;color:black\">Otros s\u00edntomas<\/span><\/b><\/h3>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Flatulencia, distensi\u00f3n abdominal,\nmoco en heces.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>25\u201350% reporta dispepsia, n\u00e1useas\no v\u00f3mitos.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Superposici\u00f3n frecuente con\ndispepsia funcional.<br \/>\n<br \/>\n<\/span><\/p>\n\n<h2 style=\"margin-bottom:4.0pt;page-break-after:\nauto\"><a name=\"_wcywx6x76euo\"><\/a><b><span style=\"font-size:17.0pt;line-height:115%\">Fisiopatolog\u00eda<\/span><\/b><\/h2>\n\n<p style=\"margin-top:12.0pt;margin-bottom:\n12.0pt\"><span>Multifactorial. Involucra alteraciones\nmotoras y sensoriales del tubo digestivo, disfunci\u00f3n del eje\nenc\u00e9falo-intestino, disbiosis, inflamaci\u00f3n subcl\u00ednica y factores psicol\u00f3gicos.<\/span><\/p>\n\n<h3 style=\"margin-top:14.0pt;page-break-after:auto\"><a name=\"_44tqk7vz5up2\"><\/a><b><span style=\"font-size:13.0pt;line-height:115%;color:black\">Principales mecanismos:<\/span><\/b><\/h3>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span>Anomal\u00edas motoras<\/span><\/b><span>: contracciones exageradas\npostprandiales, tr\u00e1nsito col\u00f3nico alterado.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span>Hipersensibilidad visceral<\/span><\/b><span>: umbrales m\u00e1s bajos\npara distensi\u00f3n y dolor intestinal.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span>Disfunci\u00f3n del SNC<\/span><\/b><span>: activaci\u00f3n anormal del\nc\u00edngulo anterior y l\u00f3bulo prefrontal ante est\u00edmulos intestinales.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span>Factores psicol\u00f3gicos<\/span><\/b><span>: depresi\u00f3n, ansiedad,\nsomatizaci\u00f3n; antecedentes de abuso sexual aumentan riesgo.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span>IBS posinfeccioso<\/span><\/b><span>: 25% tras gastroenteritis\nbacteriana (Campylobacter, Salmonella, Shigella).<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span>Inflamaci\u00f3n de mucosa<\/span><\/b><span style=\"font-family:&quot;Arial Unicode MS&quot;\">:\ninfiltrado linfoc\u00edtico\/mastocitos, \u2191 IL-6, IL-18, TNF.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span>Disbiosis<\/span><\/b><span style=\"font-family:&quot;Arial Unicode MS&quot;\">:\n\u2193 Bifidobacterium y Lactobacillus, \u2191 relaci\u00f3n Firmicutes:Bacteroidetes.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span>Alteraci\u00f3n de serotonina<\/span><\/b><span style=\"font-family:\n&quot;Arial Unicode MS&quot;\">: \u2191 5-HT postprandial en IBS-D, polimorfismo TPH1 asociado.<br \/>\n<br \/>\n<\/span><\/p>\n\n<h2 style=\"margin-bottom:4.0pt;page-break-after:\nauto\"><a name=\"_kdtqsdr4wc67\"><\/a><b><span style=\"font-size:17.0pt;line-height:115%\">Diagn\u00f3stico diferencial<\/span><\/b><\/h2>\n\n<p style=\"margin-top:12.0pt;margin-bottom:\n12.0pt;margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>IBD (CU, Crohn), enfermedad\ncel\u00edaca, colon irritable posinfeccioso, hipertiroidismo, hipotiroidismo,\nintolerancia a lactosa, diverticulitis, SIBO, colelitiasis, c\u00e1ncer de colon o\np\u00e1ncreas.<br \/>\n<br \/>\n<\/span><\/p>\n\n<h3 style=\"margin-top:14.0pt;page-break-after:auto\"><a name=\"_ti4ps4c8qdmz\"><\/a><b><span style=\"font-size:13.0pt;line-height:115%;color:black\">Estudios complementarios\n(solo si hay signos de alarma):<\/span><\/b><\/h3>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Biometr\u00eda hem\u00e1tica, VSG, sangre\noculta en heces.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Coproparasitario.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Colonoscopia (si &gt;40 a\u00f1os o\ndiarrea cr\u00f3nica).<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Prueba de aliento (intolerancia a\nlactosa o SIBO).<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Serolog\u00eda para enfermedad cel\u00edaca\nen IBS-D.<br \/>\n<br \/>\n<\/span><\/p>\n\n<h2 style=\"margin-bottom:4.0pt;page-break-after:\nauto\"><a name=\"_ejpcpdf47e9f\"><\/a><b><span style=\"font-size:17.0pt;line-height:115%\">Tratamiento<\/span><\/b><\/h2>\n\n<h3 style=\"margin-top:14.0pt;page-break-after:auto\"><a name=\"_pryq6pfgcvf0\"><\/a><b><span style=\"font-size:13.0pt;line-height:115%;color:black\">Educaci\u00f3n y dieta<\/span><\/b><\/h3>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Tranquilizar al paciente.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Identificar alimentos\ndesencadenantes: cafe\u00edna, leguminosas, fructosa, sorbitol, col.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Dieta baja en FODMAP: eficaz en\n68% de los pacientes.<br \/>\n<br \/>\n<\/span><\/p>\n\n<h3 style=\"margin-top:14.0pt;page-break-after:auto\"><a name=\"_gddokr5ivynw\"><\/a><b><span style=\"font-size:13.0pt;line-height:115%;color:black\">Fibras<\/span><\/b><\/h3>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Psyllium preferido sobre salvado.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Comenzar con 3\u20134 g\/d\u00eda y aumentar\ngradualmente hasta 20\u201330 g\/d\u00eda.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Efectiva especialmente en IBS-C.<br \/>\n<br \/>\n<\/span><\/p>\n\n<h3 style=\"margin-top:14.0pt;page-break-after:auto\"><a name=\"_nqpi1vb3njkg\"><\/a><b><span style=\"font-size:13.0pt;line-height:115%;color:black\">F\u00e1rmacos sintom\u00e1ticos<\/span><\/b><\/h3>\n\n<h4 style=\"margin-top:12.0pt;margin-bottom:2.0pt;page-break-after:auto\"><a name=\"_j3bnbydwveo5\"><\/a><b><span style=\"font-size:11.0pt;\nline-height:115%;color:black\">Antiespasm\u00f3dicos (anticolin\u00e9rgicos)<\/span><\/b><\/h4>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>\u00datiles para dolor abdominal y\nc\u00f3licos.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>M\u00e1s eficaces si se toman 30 min\nantes de comidas.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Ej: diciclomina (menos efectos\nadversos).<br \/>\n<br \/>\n<\/span><\/p>\n\n<h4 style=\"margin-top:12.0pt;margin-bottom:2.0pt;page-break-after:auto\"><a name=\"_z9mynb6rulsb\"><\/a><b><span style=\"font-size:11.0pt;\nline-height:115%;color:black\">Antidiarreicos<\/span><\/b><\/h4>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Loperamida: 2\u20134 mg c\/4\u20136 h, m\u00e1x.\n12 mg\/d\u00eda.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Colestiramina \u00fatil en malabsorci\u00f3n\nde \u00e1cidos biliares (hasta 30% de IBS-D).<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Mejor tomarlos antes de eventos de\nestr\u00e9s.<br \/>\n<br \/>\n<\/span><\/p>\n\n<h4 style=\"margin-top:12.0pt;margin-bottom:2.0pt;page-break-after:auto\"><a name=\"_8x1puacw69ii\"><\/a><b><span style=\"font-size:11.0pt;\nline-height:115%;color:black\">Antidepresivos<\/span><\/b><\/h4>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Tric\u00edclicos (imipramina,\ndesipramina): \u00fatiles en IBS-D por efectos anticolin\u00e9rgicos.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>ISRS (paroxetina, citalopram):\nmejoran IBS-C, aunque evidencia es limitada.<br \/>\n<br \/>\n<\/span><\/p>\n\n<h4 style=\"margin-top:12.0pt;margin-bottom:2.0pt;page-break-after:auto\"><a name=\"_twnafxabl4yn\"><\/a><b><span style=\"font-size:11.0pt;\nline-height:115%;color:black\">Flatulencia<\/span><\/b><\/h4>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Dieta baja en FODMAP.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Evitar bebidas carbonatadas,\nchicle.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Simeticona y carb\u00f3n activado:\nutilidad no comprobada.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Enzimas digestivas pueden ayudar\ntras comidas copiosas.<br \/>\n<br \/>\n<\/span><\/p>\n\n<h3 style=\"margin-top:14.0pt;page-break-after:auto\"><a name=\"_j5nev2udtmao\"><\/a><b><span style=\"font-size:13.0pt;line-height:115%;color:black\">Modulaci\u00f3n de la\nmicrobiota<\/span><\/b><\/h3>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span>Antibi\u00f3ticos<\/span><\/b><span>:<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:72.0pt;text-indent:-18.0pt\"><span><span>\u25cb<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Rifaximina (550 mg c\/12 h \u00d7 2\nsem): beneficios sostenidos en IBS-D.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span>Probi\u00f3ticos<\/span><\/b><span>:<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:72.0pt;text-indent:-18.0pt\"><span><span>\u25cb<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Lactobacillus, Bifidobacterium:\nreducen dolor y distensi\u00f3n (no modifican frecuencia o consistencia).<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span>Prebi\u00f3ticos<\/span><\/b><span>: poco efectivos o incluso\nagravantes.<br \/>\n<br \/>\n<\/span><\/p>\n\n<h3 style=\"margin-top:14.0pt;page-break-after:auto\"><a name=\"_plxlerz2lbt\"><\/a><b><span style=\"font-size:13.0pt;line-height:115%;color:black\">F\u00e1rmacos dirigidos<\/span><\/b><\/h3>\n\n<h4 style=\"margin-top:12.0pt;margin-bottom:2.0pt;page-break-after:auto\"><a name=\"_rg4h45jyz803\"><\/a><b><span style=\"font-size:11.0pt;\nline-height:115%;color:black\">Antagonistas de 5-HT3 (alosetr\u00f3n)<\/span><\/b><\/h4>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>IBS-D grave en mujeres.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span style=\"font-family:&quot;Arial Unicode MS&quot;\">\u2193\ndolor y tr\u00e1nsito intestinal.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Riesgo: colitis isqu\u00e9mica (0.2%).\nReintroducido con programa de control estricto.<br \/>\n<br \/>\n<\/span><\/p>\n\n<h4 style=\"margin-top:12.0pt;margin-bottom:2.0pt;page-break-after:auto\"><a name=\"_3w6mzdj7xj3\"><\/a><b><span style=\"font-size:11.0pt;\nline-height:115%;color:black\">Agonistas de 5-HT4 (tegaserod)<\/span><\/b><\/h4>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>IBS-C.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Mejora tr\u00e1nsito y s\u00edntomas.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Retirado por eventos\ncardiovasculares.<br \/>\n<br \/>\n<\/span><\/p>\n\n<h4 style=\"margin-top:12.0pt;margin-bottom:2.0pt;page-break-after:auto\"><a name=\"_y2vpyrb9mh3y\"><\/a><b><span style=\"font-size:11.0pt;\nline-height:115%;color:black\">Lubiprostona<\/span><\/b><\/h4>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Activador de canales de cloro.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>8 \u00b5g c\/12 h.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>\u00datil en IBS-C, bien tolerado.<br \/>\n<br \/>\n<\/span><\/p>\n\n<h4 style=\"margin-top:12.0pt;margin-bottom:2.0pt;page-break-after:auto\"><a name=\"_tvevkvayjszj\"><\/a><b><span style=\"font-size:11.0pt;\nline-height:115%;color:black\">Linaclotida<\/span><\/b><\/h4>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Agonista de guanilato ciclasa C.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>290 \u00b5g\/d\u00eda.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span style=\"font-family:&quot;Arial Unicode MS&quot;\">Acelera\ntr\u00e1nsito, \u2193 dolor visceral.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Efecto adverso: diarrea (4.5%).<br \/>\n<br \/>\n<\/span><\/p>\n\n<h2 style=\"margin-bottom:4.0pt;page-break-after:\nauto\"><a name=\"_alpsm1ea7jct\"><\/a><b><span style=\"font-size:17.0pt;line-height:115%\">Enfoque terap\u00e9utico seg\u00fan\ngravedad<\/span><\/b><\/h2>\n\n<p style=\"margin-top:12.0pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span>Leve (70%)<\/span><\/b><span>: educaci\u00f3n, dieta, manejo en\natenci\u00f3n primaria.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span>Moderado (25%)<\/span><\/b><span>: f\u00e1rmacos sintom\u00e1ticos seg\u00fan\nsubtipo (IBS-C, IBS-D, gases).<br \/>\n<br \/>\n<\/span><\/p>\n\n<p style=\"margin-bottom:12.0pt;\nmargin-left:36.0pt;text-indent:-18.0pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span>Grave (5%)<\/span><\/b><span style=\"font-family:&quot;Arial Unicode MS&quot;\">:\ns\u00edntomas constantes, disfunci\u00f3n psicosocial \u2192 antidepresivos, psicoterapia,\ntratamiento en centros especializados.<br \/>\n<br \/>\n<\/span><\/p>\n\n<p class=\"MsoNormalM\"><span>&nbsp;<\/span><\/p>\n\n\n<br \/><\/p>",
        "footer": "P\u00e1gina 1"
    }
]