Spiegel Brennan M R, Gralnek Ian M, Bolus Roger, Chang Lin, Dulai Gareth S, Naliboff Bruce, Mayer Emeran A
Division of Gastroenterology, VA Greater Los Angeles Healthcare System, CA 90073, USA.
Gastrointest Endosc. 2005 Dec;62(6):892-9. doi: 10.1016/j.gie.2005.08.016.
Although colonoscopy is rarely of clinical use in irritable bowel syndrome (IBS), it is, nonetheless, frequently performed in IBS. Proponents contend that a normal colonoscopy provides reassurance and improves health-related quality of life (HRQOL). However, no previous data have measured these effects. We sought to measure the association of a normal colonoscopy with reassurance and HRQOL in patients with IBS aged <50 years.
We retrospectively evaluated 458 patients with IBS, aged 18 to 49 years. Subjects completed a symptom questionnaire, the Symptom Checklist 90 (SCL-90) psychometric checklist, and the Short Form 36 (SF-36) Health Survey. The main outcomes were HRQOL as measured by the mental component score (MCS) and the physical component score (PCS) of the SF-36 and reassurance as operationalized by a negative response to the question: "Do you think there is something seriously wrong with your body?" The independent variable was presence or absence of a previous normal colonoscopy. We performed regression analysis to control for potential confounders, including timing of colonoscopy.
The unadjusted mean SF-36 PCS was 42 +/- 10 (0-100 scale: 0, worst) in patients with recent colonoscopy (<12 months), 45 +/- 11 in patients with distant colonoscopy (>12 months), and 45 +/- 10 in patients without colonoscopy (p = 0.78). The mean SF-36 MCS in the 3 groups were 42 +/- 13, 44 +/- 11, and 43 +/- 11 (p = 0.57). Colonoscopy did not impact the proportion reassured (69.3%, 67.2%, 66.6%; p = 0.85). There were no significant differences between groups for any outcomes when adjusting for potential confounders.
We found no independent association between a negative colonoscopy and reassurance or improved HRQOL in IBS patients aged <50 years. These results suggest that the role of colonoscopy in IBS may be limited but require confirmation in prospective trials.
尽管结肠镜检查在肠易激综合征（IBS）中很少有临床应用价值，但在IBS患者中仍经常进行。支持者认为，正常的结肠镜检查能让人安心，并改善健康相关生活质量（HRQOL）。然而，以前没有数据测量过这些影响。我们试图测量正常结肠镜检查与年龄小于50岁的IBS患者的安心程度和HRQOL之间的关联。
我们回顾性评估了458例年龄在18至49岁之间的IBS患者。受试者完成了一份症状问卷、症状自评量表90（SCL - 90）心理测量清单和简短健康调查问卷36（SF - 36）。主要结局是通过SF - 36的心理成分得分（MCS）和身体成分得分（PCS）测量的HRQOL，以及对“你认为你的身体有严重问题吗？”这个问题的否定回答所体现的安心程度。自变量是既往是否有正常的结肠镜检查。我们进行了回归分析以控制潜在的混杂因素，包括结肠镜检查的时间。
近期进行结肠镜检查（<12个月）的患者未调整的平均SF - 36 PCS为42±10（0 - 100分制：0为最差），远期进行结肠镜检查（> >12个月）的患者为45±11，未进行结肠镜检查的患者为45±10（p = 0.78）。三组患者的平均SF - 36 MCS分别为42±13、44±11和43±11（p = 0.57）。结肠镜检查对安心程度的比例没有影响（69.3%、67.2%、66.6%；p = 0.85）。在调整潜在混杂因素后，各组在任何结局方面均无显著差异。
我们发现年龄小于50岁的IBS患者中，结肠镜检查结果正常与安心程度或HRQOL改善之间没有独立关联。这些结果表明结肠镜检查在IBS中的作用可能有限，但需要在前瞻性试验中得到证实。
