Olden Kevin W
Department of Medicine, Division of Gastroenterology, Mayo Clinic Scottsdale, 13400 E. Shea Boulevard, Scottsdale, Arizona 85259, USA.
Gastroenterology. 2002 May;122(6):1701-14. doi: 10.1053/gast.2002.33741.
Irritable bowel syndrome (IBS) is the most common disorder seen in gastroenterology practice. It is also a large component of primary care practices. Although the classic IBS symptoms of lower abdominal pain, bloating, and alteration of bowel habits is easily recognizable to most physicians, diagnosing IBS remains a challenge. This is in part caused by the absence of anatomic or physiologic markers. For this reason, the diagnosis of IBS currently needs to be made on clinical grounds. A number of symptom-based diagnostic criteria have been proposed over the last 15 years. The most recent of these, the Rome II criteria, seem to show reasonable sensitivity and specificity in diagnosing IBS. However, the role of the Rome II criteria in clinical practice remains ill defined. A review of the literature shows that, in patients with no alarm symptoms, the Rome criteria have a positive predictive value of approximately 98%, and that additional diagnostic tests have a yield of 2% or less. Diagnostic evaluation should also include a psychosocial assessment specifically addressing any history of sexual or physical abuse because these issues significantly influence management strategies and treatment success.
肠易激综合征（IBS）是胃肠病学实践中最常见的疾病。它也是初级保健实践的重要组成部分。尽管大多数医生都很容易识别出肠易激综合征的典型症状，如下腹痛、腹胀和排便习惯改变，但诊断肠易激综合征仍然是一项挑战。部分原因是缺乏解剖学或生理学标志物。因此，目前肠易激综合征的诊断需要基于临床依据。在过去15年里，已经提出了一些基于症状的诊断标准。其中最新的罗马II标准在诊断肠易激综合征方面似乎显示出合理的敏感性和特异性。然而，罗马II标准在临床实践中的作用仍不明确。文献综述表明，在没有警示症状的患者中，罗马标准的阳性预测值约为98%，而额外的诊断测试的阳性率为2%或更低。诊断评估还应包括社会心理评估，特别关注任何性虐待或身体虐待史，因为这些问题会显著影响管理策略和治疗效果。
