Drossman Douglas A, Morris Carolyn B, Hu Yuming, Toner Brenda B, Diamant Nicholas, Leserman Jane, Shetzline Michael, Dalton Christine, Bangdiwala Shrikant I
UNC Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Room 1110 Burnett-Womack CB#7080, Chapel Hill, North Carolina 27599-7080, USA.
Gastroenterology. 2005 Mar;128(3):580-9. doi: 10.1053/j.gastro.2004.12.006.
BACKGROUND & AIMS: Irritable bowel syndrome (IBS) is subtyped as IBS with diarrhea (IBS-D) or IBS with constipation (IBS-C) based on Rome II guidelines. The remaining group is considered as having mixed IBS (IBS-M). There is no standard definition of an alternator (IBS-A), in which bowel habit changes over time. Our aim was to use Rome II criteria to prospectively assess change in bowel habit for more than 1 year to understand IBS-A.
Female patients (n=317) with IBS entering a National Institutes of Health treatment trial were studied at baseline with questionnaires and 2-week daily diary cards of pain and stool frequency and consistency. Studies were repeated at the end of treatment (3 months) and at four 3-month intervals for one more year. Algorithms to classify subjects into IBS-D, IBS-C, and IBS-M groups used diary card information and modified Rome II definitions. Changes in bowel habit at 3-month intervals were then assessed using these surrogate diary card measures.
At baseline, 36% had IBS-D, 31% IBS-M, and 34% IBS-C. Except for stool frequency, there were no differences between groups. While the proportion of subjects in each subgroup remained the same over the year, most individuals (more than 75%) changed to either of the other 2 subtypes at least once. IBS-M was the least stable (50% changed out by 12 weeks). Patients were more likely to transition between IBS-M and IBS-C than between IBS-D and IBS-M. Notably, only 29% switched between the IBS-D and IBS-C subtypes over the year.
While the proportion of subjects in each of the IBS subtypes stays the same, individuals commonly transition between subtypes, particularly between IBS-M and IBS-C. We recommend that IBS-A be defined as at least one change between IBS-D and IBS-C by Rome II criteria over a 1-year period.
根据罗马II标准，肠易激综合征（IBS）分为腹泻型肠易激综合征（IBS-D）或便秘型肠易激综合征（IBS-C）。其余类型则被视为混合型肠易激综合征（IBS-M）。对于肠道习惯随时间变化的交替型肠易激综合征（IBS-A），目前尚无标准定义。我们的目的是使用罗马II标准对肠道习惯变化进行超过1年的前瞻性评估，以了解IBS-A。
对317名参加美国国立卫生研究院治疗试验的IBS女性患者进行了研究，在基线时通过问卷调查以及疼痛、大便频率和大便稠度的2周每日记录卡进行调查。在治疗结束时（3个月）以及之后的一年中，每隔3个月重复进行研究。使用记录卡信息和修改后的罗马II定义，将受试者分类为IBS-D、IBS-C和IBS-M组的算法。然后使用这些替代记录卡测量方法评估每隔3个月的肠道习惯变化。
在基线时，36%的患者为IBS-D，31%为IBS-M，34%为IBS-C。除大便频率外，各组之间无差异。虽然各亚组受试者的比例在一年中保持不变，但大多数个体（超过75%）至少有一次转变为其他两种亚型之一。IBS-M最不稳定（到12周时50%发生转变）。患者从IBS-M转变为IBS-C的可能性高于从IBS-D转变为IBS-M。值得注意的是，一年中只有29%的患者在IBS-D和IBS-C亚型之间转变。
虽然IBS各亚型受试者的比例保持不变，但个体通常在各亚型之间转变，特别是在IBS-M和IBS-C之间。我们建议将IBS-A定义为根据罗马II标准在1年期间内IBS-D和IBS-C之间至少发生一次变化。
