MORE ACCURATE DIAGNOSIS OF IRRITABLE-BOWEL-SYNDROME BY THE USE OF NONCOLONIC SYMPTOMATOLOGY
MORE ACCURATE DIAGNOSIS OF IRRITABLE-BOWEL-SYNDROME BY THE USE OF NONCOLONIC SYMPTOMATOLOGY
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DOI：
10.1136/gut.32.7.784
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发表时间：
1991-07-01
期刊：
影响因子：
24.5
通讯作者：
WHORWELL, PJ
中科院分区：
文献类型：
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作者：
MAXTON, DG;MORRIS, J;WHORWELL, PJ
目前用于区分肠易激综合征和器质性胃肠道疾病的标准几乎完全依赖于结肠起源的症状。然而，“非结肠”症状，由肠道其他部位或更普遍的性质引起，在肠易激综合征中很常见，甚至可能有更好的诊断潜力。对107例肠易激综合征患者和295例其他肠道疾病患者的非结肠特征的患病率进行了评估。胃肠型非结肠症状有助于区分肠易激综合征和炎症性肠病，但除早期饱腹感外，对胃-食管或胆道疾病没有帮助。更普遍的“非结肠”特征，如嗜睡和背痛，在肠易激综合征中比所研究的所有器质性胃肠道疾病更常见，并且具有良好的判别功能。多重逻辑回归分析确定了肠易激综合征具有特别显著独立风险的某些特征。这些因素包括嗜睡（相对危险度6.7）、不完全排空（相对危险度5.2）、年龄在40岁以下（相对危险度2.1）、背痛（相对危险度2.0）、早饱（相对危险度1.8）和排尿频率（相对危险度1.8）。当患者出现以上一种特征时，这些相对风险可以相乘得出总体风险。在诊断测试可用之前，可以通过识别具有良好判别功能的症状来获得更可靠的肠易激综合征诊断。本研究结果表明，肠易激综合征的非结肠特征可能在这方面特别有价值。
The criteria now used in an attempt to distinguish irritable bowel syndrome from organic gastrointestinal disease rely almost entirely on symptoms of colonic origin. 'Non-colonic' symptoms, however, arising either from elsewhere in the gut or of a more general nature, are common in irritable bowel syndrome and may have even better diagnostic potential. The prevalence of these non-colonic features was assessed in 107 patients with the irritable bowel syndrome and 295 subjects with other gut disorders. Gastrointestinal type non-colonic symptoms are useful in differentiating irritable bowel syndrome from inflammatory bowel disease but, with the exception of early satiety, are not helpful when there is gastro-oesophageal or biliary disease. More general 'non-colonic' features, such as lethargy and backache, are much commoner in irritable bowel syndrome than in all the organic gastrointestinal diseases studied and have good discriminant function. Multiple logistic regression analysis identified certain features that had a particularly significant independent risk for irritable bowel syndrome. These were lethargy (relative risk 6.7), incomplete evacuation (RR 5.2), age under 40 (RR 2.1), backache (RR 2.0), early satiety (RR 1.8), and frequency of micturition (RR 1.8). These relative risks can be multiplied together to give an overall risk when more than one of these features is present in a patient. Until a diagnostic test is available more confident diagnosis of irritable bowel syndrome can be achieved by identifying symptoms that have good discriminant function. The results of this study indicate that the non-colonic features of irritable bowel syndrome may be especially valuable in this respect.