Talley N J, Holtmann G, Agréus L, Jones M
Department of Medicine, University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia.
Am J Gastroenterol. 2000 Jun;95(6):1439-47. doi: 10.1111/j.1572-0241.2000.02075.x.
It is unknown whether distinct functional GI (GI) symptom groupings occur in the general population and whether these are similar across different cultures. Although symptom-based diagnostic criteria have been developed for upper and lower GI syndromes (the Rome criteria), the classification is controversial. We aimed to identify whether independent symptom-based subgroups exist in four countries consistent with the Rome criteria.
Random samples of the community were mailed a validated questionnaire based on the Bowel Disease Questionnaire in Rochester, MN (n = 2,220), in Sydney, Australia (n = 1,135), and in Essen, Germany (n = 500). A different validated questionnaire was mailed to a random sample in Osthammar, Sweden (n = 1,517). Only the common questions (n = 22) were used in the current analysis, and these were essentially identical in wording. The underlying structure of the item responses was examined using factor analysis. Initial factors were extracted using principal components analysis and then rotated using Varimax. Clustering of symptoms among individuals was examined though cluster analysis, using the factors as the basis for clustering.
Response rates varied from 64% to 80%; responders and nonresponders were similar sociodemographically. All four studies yielded similar factor structures. All countries reported symptom groupings consistent with the irritable bowel syndrome (IBS), dyspepsia and/or gastroesophageal reflux, and constipation; all except Sweden also had a diarrhea group. The cluster analysis yielded slightly more disparate results but a healthy group was present in all populations. All four populations had an IBS and/or bowel dysfunction cluster identified; a gastroesophageal reflux cluster was also present in all countries.
The similarity of factor and cluster structures found in these four nations suggest that patterns of GI symptoms and groupings of individuals are similar across these Western cultures. These results are consistent with the current international Rome classification for separate upper and lower functional GI disorders.
尚不清楚在普通人群中是否存在不同的功能性胃肠（GI）症状分组，以及这些分组在不同文化中是否相似。尽管已经针对上、下消化道综合征制定了基于症状的诊断标准（罗马标准），但该分类存在争议。我们旨在确定在四个符合罗马标准的国家中是否存在基于症状的独立亚组。
向明尼苏达州罗切斯特市（n = 2220）、澳大利亚悉尼市（n = 1135）和德国埃森市（n = 500）的社区随机样本邮寄一份基于明尼苏达州罗切斯特市肠道疾病问卷的有效问卷。向瑞典奥斯特哈马尔市的一个随机样本邮寄另一份有效问卷（n = 1517）。本次分析仅使用共同问题（n = 22），这些问题在措辞上基本相同。使用因子分析检查项目反应的潜在结构。最初的因子通过主成分分析提取，然后使用方差最大化进行旋转。通过聚类分析检查个体间症状的聚类情况，以这些因子作为聚类的基础。
回复率从64%到80%不等；回复者和未回复者在社会人口统计学方面相似。所有四项研究都产生了相似的因子结构。所有国家都报告了与肠易激综合征（IBS）、消化不良和/或胃食管反流以及便秘一致的症状分组；除瑞典外，所有国家都有腹泻组。聚类分析产生的结果略有不同，但所有人群中都有一个健康组。所有四个人群都识别出了一个IBS和/或肠道功能障碍聚类；所有国家也都存在胃食管反流聚类。
在这四个国家中发现的因子和聚类结构的相似性表明，在这些西方文化中，胃肠症状模式和个体分组是相似的。这些结果与当前国际上对功能性上、下消化道疾病的罗马分类一致。
