Clinical Evaluation of a Patient With Symptoms of Colonic or Anorectal Motility Disorders.
Clinical Evaluation of a Patient With Symptoms of Colonic or Anorectal Motility Disorders.
复制标题
结肠或肛门直肠动力障碍症状患者的临床评价。
DOI：
10.5056/jnm20012
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发表时间：
2020-09-30
影响因子：
3.4
通讯作者：
Rao SSC
中科院分区：
文献类型：
--
作者：
Curtin B;Jimenez E;Rao SSC
便秘、肠易激综合症、大便失禁、腹痛和肛门直肠疼痛影响着 40% 的人口。它们通常表现出重叠的症状，表明它们的病理生理学影响肠道的多个部分以及大脑和肠道的相互作用。临床上，虽然某些病症很容易识别，但排便失调、大便失禁和肛门直肠疼痛经常被漏诊或误诊。因此，对于大多数临床医生来说，评估疑似结肠或肛门直肠运动障碍患者的下消化道症状仍然具有挑战性。详细的病史、布里斯托大便形式量表的使用、未来的大便日记（最好通过手机应用程序）、直肠指检以及明智地使用补充诊断测试都是必不可少的。此外，评估这些问题对生活质量和心理社会问题的影响也很重要，因为它们与这些疾病有着错综复杂的联系。功能性胃肠道疾病罗马 IV 诊断问卷可以提供在病史采集过程中经常遗漏的额外信息。在这里，我们讨论了对疑似下消化道问题患者进行临床评估的系统方法，分为 4 个常见诊断类别。我们描述了如何获取详细的病史，进行细致的直肠指检，并使用经过验证的工具来补充临床评估，包括生活质量评估和疾病严重程度的评分系统和数字应用程序。这些工具可以促进包括诊断测试在内的临床管理的全面计划，并将患者的投诉转化为可定义的诊断类别。
Constipation, irritable bowel syndrome, fecal incontinence, abdominal pain, and anorectal pain are problems that affect 40% of the population. They commonly present with overlapping symptoms indicating that their pathophysiology affects multiple segments of the gut as well as brain and gut interactions. Clinically, although some conditions are readily recognized, dyssynergic defecation, fecal incontinence, and anorectal pain are often missed or misdiagnosed. Consequently, the assessment of lower gastrointestinal symptoms in patients with suspected colonic or anorectal motility disorder(s) remains challenging for most clinicians. A detailed history, use of the Bristol stool form scale, prospective stool diaries, ideally through a phone App, digital rectal examination, and judicious use of complementary diagnostic tests are essential. Additionally, it is important to evaluate the impact of these problems on quality of life and psychosocial issues, because they are intricately linked with these disorders. The Rome IV diagnostic questionnaire for functional gastrointestinal disorders can provide additional information often missed during history taking. Here, we discuss a systematic approach for the clinical evaluation of patients with suspected lower gastrointestinal problems, grouped under 4 common diagnostic categories. We describe how to take a detailed history, perform meticulous digital rectal examination, and use validated tools to supplement clinical evaluation, including assessments of quality of life and scoring systems for disease severity and digital Apps. These tools could facilitate a comprehensive plan for clinical management including diagnostic tests, and translate the patients’ complaints into definable, diagnostic categories.
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影响因子：
29.4
作者：
EVERHART, JE;RENAULT, PF
通讯作者：
RENAULT, PF
影响因子：
29.4
作者：
Chiarioni, Giuseppe;Nardo, Adriana;Whitehead, William E.
通讯作者：
Whitehead, William E.
影响因子：
--
作者：
Lee, Yeong Yeh;Annamalai, Chandramouli;Rao, Satish S C
通讯作者：
Rao, Satish S C
影响因子：
1.9
作者：
Frank, L;Kleinman, L;Miner, P
通讯作者：
Miner, P
影响因子：
3.9
作者：
HILL, J;CORSON, RJ;KIFF, ES
通讯作者：
KIFF, ES