{"id":64831,"date":"2024-11-27T10:00:34","date_gmt":"2024-11-27T13:00:34","guid":{"rendered":"https:\/\/nutritotal.com.br\/pro\/?post_type=materiais&#038;p=64831"},"modified":"2024-11-27T10:49:36","modified_gmt":"2024-11-27T13:49:36","slug":"sindrome-do-intestino-irritavel-caso-clinico","status":"publish","type":"parceiros","link":"https:\/\/nutritotal.com.br\/pro\/parceiros\/sindrome-do-intestino-irritavel-caso-clinico\/","title":{"rendered":"S\u00edndrome do Intestino Irrit\u00e1vel: condu\u00e7\u00e3o de caso cl\u00ednico"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_75 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Conte\u00fado<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Alternar tabela de conte\u00fado\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/nutritotal.com.br\/pro\/parceiros\/sindrome-do-intestino-irritavel-caso-clinico\/#Caso_clinico\" >Caso cl\u00ednico<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/nutritotal.com.br\/pro\/parceiros\/sindrome-do-intestino-irritavel-caso-clinico\/#Teste_seus_conhecimentos\" >Teste seus conhecimentos<\/a><\/li><\/ul><\/nav><\/div>\n<div id=\"attachment_64880\" style=\"width: 1160px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-64880\" class=\"wp-image-64880 size-full\" src=\"https:\/\/nutritotal.com.br\/pro\/wp-content\/uploads\/2024\/11\/portal-para-nutricionistas-sindrome-do-intestino-irritavel.png\" alt=\"S\u00edndrome do Intestino Irrit\u00e1vel\" width=\"1150\" height=\"460\" srcset=\"https:\/\/nutritotal.com.br\/pro\/wp-content\/uploads\/2024\/11\/portal-para-nutricionistas-sindrome-do-intestino-irritavel.png 1150w, https:\/\/nutritotal.com.br\/pro\/wp-content\/uploads\/2024\/11\/portal-para-nutricionistas-sindrome-do-intestino-irritavel-300x120.png 300w, https:\/\/nutritotal.com.br\/pro\/wp-content\/uploads\/2024\/11\/portal-para-nutricionistas-sindrome-do-intestino-irritavel-768x307.png 768w, https:\/\/nutritotal.com.br\/pro\/wp-content\/uploads\/2024\/11\/portal-para-nutricionistas-sindrome-do-intestino-irritavel-1024x410.png 1024w\" sizes=\"(max-width: 1150px) 100vw, 1150px\" \/><p id=\"caption-attachment-64880\" class=\"wp-caption-text\">Fonte: Canva<\/p><\/div>\n<p>A<strong> s\u00edndrome do intestino irrit\u00e1vel (SII)<\/strong> \u00e9 um dist\u00farbio funcional que pode afetar at\u00e9 22% da popula\u00e7\u00e3o geral. De acordo com os crit\u00e9rios de Roma IV, a SII \u00e9 caracterizada por dor abdominal recorrente e distens\u00e3o abdominal associada a altera\u00e7\u00f5es nos h\u00e1bitos intestinais, na aus\u00eancia de doen\u00e7a org\u00e2nica ou anormalidades bioqu\u00edmicas.<\/p>\n<p>A <strong>s\u00edndrome do intestino irrit\u00e1vel p\u00f3s-infecciosa (SII-PI)<\/strong> \u00e9 um tipo particular de SII, com in\u00edcio dos sintomas ap\u00f3s um epis\u00f3dio agudo de gastroenterite infecciosa, devido a infec\u00e7\u00e3o por bact\u00e9rias, protozo\u00e1rios ou v\u00edrus. Nesse sentido, a SII-PI \u00e9 mais prevalente ap\u00f3s infec\u00e7\u00f5es bacterianas, sendo as bact\u00e9rias mais comuns Campylobacter, Shigella, E. coli e Salmonella.<\/p>\n<p>Estima-se que a preval\u00eancia da SII-PI seja de 11,5% dos pacientes infectados. Assim, ocorre a persist\u00eancia de sintomas como diarreia e desconforto abdominal, mesmo ap\u00f3s a infec\u00e7\u00e3o causadora. As caracter\u00edsticas cl\u00ednicas da SII geralmente se desenvolvem de 6 a 18 meses ap\u00f3s o epis\u00f3dio de gastroenterite infecciosa.<\/p>\n<p>No artigo de hoje, iremos conduzir um caso cl\u00ednico que ilustra as nuances da <a href=\"https:\/\/nutritotal.com.br\/pro\/sindrome-do-intestino-irritavel-papel-da-dieta-e-microbiota-intestinal\/\">S\u00edndrome do Intestino Irrit\u00e1vel<\/a> (SII), abordando desde os sintomas iniciais at\u00e9 o manejo da condi\u00e7\u00e3o. Confira a seguir!<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Caso_clinico\"><\/span>Caso cl\u00ednico<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Paciente, 34 anos, refere que &#8211; h\u00e1 mais ou menos 40 dias &#8211; teve <strong>quadro s\u00fabito de dor abdominal difusa<\/strong>, tipo c\u00f3lica, acompanhada de diarreia, 6 a 8 evacua\u00e7\u00f5es l\u00edquidas, sem sangue, muco ou pus, com tenesmo e sensa\u00e7\u00e3o de evacua\u00e7\u00e3o incompleta. Nega febre, refere alguma n\u00e1usea, sem v\u00f4mitos.<\/p>\n<p>Foi ao Pronto Socorro (PS) onde foi hidratada, recebeu antiespasm\u00f3dicos com melhora parcial e teve alta ap\u00f3s algumas horas de observa\u00e7\u00e3o, com orienta\u00e7\u00f5es sobre hidrata\u00e7\u00e3o e uso de antiespasm\u00f3dico, se necess\u00e1rio.<\/p>\n<p>O quadro evoluiu favoravelmente, at\u00e9 cerca de 20 dias, quando iniciou <strong>quadro de dor abdominal, associada a distens\u00e3o abdominal e epis\u00f3dios isolados de diarreia pastosa, sem sangue, muco ou restos alimentares<\/strong>. Comenta que o quadro doloroso \u00e9 quase que di\u00e1rio com momentos de maior intensidade e, a distens\u00e3o que, ao longo do dia, se intensifica, incomoda muito a paciente: \u201cparece que estou gr\u00e1vida; e minha barriga, al\u00e9m de doer, faz muito barulho\u201d.<\/p>\n<p>Ao exame cl\u00ednico estava em<strong> bom estado geral, com desconforto \u00e0 palpa\u00e7\u00e3o abdominal,<\/strong> principalmente em mesog\u00e1strio e flanco esquerdo, ru\u00eddos a\u00e9reos aumentados e n\u00edtida distens\u00e3o abdominal, sem outros comemorativos.<\/p>\n<p>Em sua hist\u00f3ria pregressa, refere que <strong>j\u00e1 foi diagnosticada com SII, por apresentar quadros frequentes de dor abdominal e distens\u00e3o<\/strong>, principalmente ap\u00f3s estresse e ingest\u00e3o de alguns tipos de alimentos, tanto que foi orientada a retirar o gl\u00faten da dieta, sem muita melhora.<\/p>\n<p>J\u00e1 fez uso de v\u00e1rias medica\u00e7\u00f5es para o intestino que n\u00e3o sabe referir, pois n\u00e3o as utiliza mais, ou porque \u201cnada adiantou\u201d e \u201co m\u00e9dico n\u00e3o explica muita coisa sobre meu problema\u201d. Quando tem dor toma butilbrometo de escopolamina e tentava controlar a distens\u00e3o com dieta, sem maiores resultados. Acrescenta que \u201co que estou sentido atualmente \u00e9 muito pior do que sentia\u201d.<\/p>\n<p>Nega hist\u00f3ria familiar de c\u00e2ncer do aparelho digestivo e faz uso de medica\u00e7\u00e3o ansiol\u00edtica e antidepressiva h\u00e1 alguns anos, para tratamento de dist\u00farbio de <a href=\"https:\/\/nutritotal.com.br\/pro\/como-os-alimentos-agem-no-controle-da-ansiedade\/\">ansiedade e depress\u00e3o<\/a>.<\/p>\n<p>Inicialmente, a paciente foi orientada a trocar o antiespasm\u00f3dico para otil\u00f4nio, 1 comprimido antes do almo\u00e7o e outro antes do jantar. Quando solicitados, os exames de rotina vieram todos sem altera\u00e7\u00f5es, entre eles:<\/p>\n<ul>\n<li>Hemograma;<\/li>\n<li>Prote\u00edna C-reativa;<\/li>\n<li>Velocidade de hemossedimenta\u00e7\u00e3o;<\/li>\n<li>Sorologia para Doen\u00e7a Cel\u00edaca;<\/li>\n<li>Ferro e magn\u00e9sio;<\/li>\n<li>Teste respirat\u00f3rio para supercrescimento bacteriano e ultrassom de abd\u00f4men.<\/li>\n<\/ul>\n<p>No retorno, os exames estavam todos normais, exceto o teste respirat\u00f3rio que confirmou o supercrescimento bacteriano. A paciente referiu melhora do quadro de dor e menos diarreia, embora ainda persistisse a distens\u00e3o abdominal \u201cque me deixa extremamente irritada e desesperan\u00e7osa com isso\u201d.<\/p>\n<p>O exame f\u00edsico mostrava melhor toler\u00e2ncia \u00e0 palpa\u00e7\u00e3o, e distens\u00e3o abdominal com ru\u00eddos aumentados. Assim, foi iniciado esquema antibi\u00f3tico com metronidazol 250 mg 6\/6 horas por 14 dias. Retorno em 30 dias.<\/p>\n<p>A paciente n\u00e3o retornou na data prevista, porque estava melhor, vindo a retornar ap\u00f3s 6 meses com recidiva do quadro. Exame f\u00edsico inalterado.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Teste_seus_conhecimentos\"><\/span>Teste seus conhecimentos<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>&nbsp;<\/p>\n<div class = \"hdq_quiz_wrapper\"><a href = \"https:\/\/nutritotal.com.br\/pro\/parceiros\/sindrome-do-intestino-irritavel-caso-clinico\/\" rel=\"noamphtml\" class = \"hdq_quiz_start hdq_button button\" role = \"button\">Iniciar teste<\/a><\/div>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>Refer\u00eancias<\/strong>:<\/p>\n<p>Sadeghi A, Biglari M, Nasseri Moghaddam S. <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC6663289\/\">Post-infectious Irritable Bowel Syndrome: A Narrative Review<\/a>. Middle East J Dig Dis 2019;11:69-75. doi:10.15171\/mejdd.2019.130.<\/p>\n<p>Lupu VV, Ghiciuc CM, Stefanescu G, Mihai CM, Popp A, Sasaran MO, Bozomitu L, Starcea IM, Adam Raileanu A, Lupu A. <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC10292139\/\">Emerging role of the gut microbiome in post-infectious irritable bowel syndrome: A literature review<\/a>. World J Gastroenterol. 2023 Jun 7;29(21):3241-3256. doi: 10.3748\/wjg.v29.i21.3241. PMID: 37377581; PMCID: PMC10292139.<\/p>\n<p>Maryam Soheilipour, Atefeh Chahichi, Hamid Mohajer, Niousha Ghomashi, Hamidreza Roohafza, Peyman Adibi, <a href=\"https:\/\/academic.oup.com\/ofid\/article\/11\/3\/ofae032\/7585183\">Risk Factors of Developing Postinfectious Irritable Bowel Syndrome in Shigellosis Patients, 5 Years After Hospitalization During the Outbreak<\/a>, Open Forum Infectious Diseases, Volume 11, Issue 3, March 2024, ofae032, https:\/\/doi.org\/10.1093\/ofid\/ofae032.<\/p>\n<p>Spiller, R., &amp; Garsed, K. (2009). <a href=\"https:\/\/www.gastrojournal.org\/article\/S0016-5085(09)00361-8\/fulltext#:~:text=Risk%20factors%20for%20developing%20PI,in%20the%20preceding%203%20months\">Postinfectious irritable bowel syndrome<\/a>. Gastroenterology, 136(6), 1979-1988.<\/p>\n<p>Kligler B, Cohrssen A. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/19007054\/\">Probiotics<\/a>. Am Fam Physician. 2008;78(9):1073-8.<\/p>\n<p>Raskov H, Burcharth J, Pommergaard HC, Rosenberg J. <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC5687151\/\">Linking Gut Microbiota to Colorectal Cancer<\/a>. Gut Microbes. 2016;7:365-83.<\/p>\n<p>Ford AC, Harris LA, Lacy BE, Quigley EMM, Moayyedi P. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30294792\/\">Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome<\/a>. Aliment Pharmacol Ther. 2018;48(10):1044-60.<\/p>\n<p>Barbara G, Grover M, Bercik P, Corsetti M, Ghoshal UC, Ohman L, et al. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30009817\/\">Rome Foundation Working Team report on post-infection irritable bowel syndrome<\/a>. Gastroenterology. 2019;156:46\u201358.<\/p>\n<p>Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, et al. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27144627\/\">Bowel Disorders<\/a>. Gastroenterology. 2016;S0016-5085(16);00222-5.<\/p>\n<p>Berumen A, Edwinson AL, Grover M. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/34024451\/\">Post-infection Irritable Bowel Syndrome<\/a>. Gastroenterol Clin North Am. 2021;50(2):445\u20136.<\/p>\n<p>Downs IA, Aroniadis OC, Kelly L, Brandt LJ. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28885302\/\">Post-infection Irritable Bowel Syndrome: The Links Between Gastroenteritis,Inflammation, the Microbiome, and Functional Disease<\/a>. J Clin Gastroenterol. 2017;51:869\u201377.<\/p>\n<p>Pimentel M, Lembo A. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32026278\/\">Microbiome and Its Role in Irritable Bowel Syndrome<\/a>. Dig Dis Sci. 2020;65:829\u201339.<\/p>\n<p>Mari A, Abu Baker F, Mahamid M, Sbeit W, Khoury T. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32143424\/\">The Evolving Role of Gut Microbiota in the Management of Irritable Bowel Syndrome: An Overview of the Current Knowledge<\/a>. J Clin Med. 2020;9(3):685.<\/p>\n<p>Guslandi M. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17900396\/\">Probiotic Agents in the Treatment ofIrritable Bowel Syndrome<\/a>. The J Int Med Res. 2007;35(5):583-9.<\/p>\n<p><strong>Se voc\u00ea gostou deste artigo, leia tamb\u00e9m<\/strong>:<\/p>\n<ul>\n<li><a href=\"https:\/\/nutritotal.com.br\/pro\/material\/caso-clinico-lactosil\/\">Intoler\u00e2ncia \u00e0 lactose: condu\u00e7\u00e3o de caso cl\u00ednico<\/a><\/li>\n<li><a href=\"https:\/\/nutritotal.com.br\/pro\/sindrome-do-intestino-irritavel-papel-da-dieta-e-microbiota-intestinal\/\">S\u00edndrome do Intestino Irrit\u00e1vel: papel da dieta e microbiota intestinal<\/a><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Acompanhe a condu\u00e7\u00e3o de um caso cl\u00ednico de S\u00edndrome do Intestino Irrit\u00e1vel, incluindo manejo e estrat\u00e9gias n\u00e3o medicamentosas para melhorar a qualidade de vida do paciente.<\/p>\n","protected":false},"author":114981,"featured_media":64879,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"divisao":[2185,2193],"categorias_parceiros":[3585],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.5 - 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