Corazziari E, Attili A F, Angeletti C, De Santis A
Department of Clinical Science, University Sapienza, Rome, Italy.
Dig Liver Dis. 2008 Dec;40(12):944-50. doi: 10.1016/j.dld.2008.02.013. Epub 2008 Apr 10.
BACKGROUND: Subjects with irritable bowel syndrome may undergo an excess of cholecystectomy. It is not known, however, whether the cholecystectomy rate parallels an increased risk of gallstones. AIM: Aim was to assess the prevalence and the incidence of gallstones and cholecystectomy in subjects with irritable bowel syndrome symptoms. SUBJECTS AND METHODS: In this population-based study, 29,139 subjects (63.2% of 46,139 randomly selected subjects, age 30-69 years) underwent a physical examination, an interview on gastrointestinal symptoms and an upper abdominal ultrasonography. An identical survey was carried out 7.8+/-1.0 (M+/-S.D.) years later on 8460 gallstone-free subjects at the first survey. Prevalence and incidence of gallstones and cholecystectomy were assessed in subjects with (1) irritable bowel syndrome; (2) abdominal pain and normal bowel; (3) altered bowel and no abdominal pain and (4) asymptomatic controls; univariate and multivariate regression logistic models were used for statistical analysis. RESULTS: Prevalence odds of gallstones and cholecystectomy were significantly higher in irritable bowel syndrome and abdominal pain and normal bowel than in controls. Irritable bowel syndrome and abdominal pain and normal bowel subjects were more aware of gallstones than controls (p<0.001), and the prevalence of gallstones in irritable bowel syndrome subjects unaware of their gallbladder status was not significantly different from the controls. The incidence of gallstone disease in irritable bowel syndrome, abdominal pain and normal bowel, and altered bowel and no abdominal pain subjects did not differ from the controls. The incidence of cholecystectomy was higher in irritable bowel syndrome and abdominal pain and normal bowel groups than in controls and altered bowel and no abdominal pain group. CONCLUSIONS: Irritable bowel syndrome subjects have an increased risk of cholecystectomy that is not due to an increased risk of gallstones, but rather to abdominal pain, awareness of having gallstones, and inappropriate surgical indications.
背景：肠易激综合征患者可能接受胆囊切除术的比例过高。然而，尚不清楚胆囊切除术的发生率是否与胆结石风险增加平行。 目的：评估有肠易激综合征症状的患者中胆结石和胆囊切除术的患病率及发病率。 研究对象与方法：在这项基于人群的研究中，29139名受试者（46139名随机选取受试者中的63.2%，年龄30 - 69岁）接受了体格检查、胃肠道症状访谈以及上腹部超声检查。在首次调查7.8±1.0（均值±标准差）年后，对首次调查时无胆结石的8460名受试者进行了相同的调查。在患有（1）肠易激综合征；（2）腹痛且肠道正常；（3）肠道改变但无腹痛；（4）无症状对照的受试者中评估胆结石和胆囊切除术的患病率及发病率；采用单因素和多因素回归逻辑模型进行统计分析。 结果：肠易激综合征以及腹痛且肠道正常的患者中胆结石和胆囊切除术的患病几率显著高于对照组。肠易激综合征以及腹痛且肠道正常的受试者比对照组更了解胆结石（p<0.001），且未意识到自身胆囊状况的肠易激综合征患者中胆结石的患病率与对照组无显著差异。肠易激综合征、腹痛且肠道正常以及肠道改变但无腹痛的受试者中胆结石疾病的发病率与对照组无差异。肠易激综合征以及腹痛且肠道正常组的胆囊切除术发生率高于对照组以及肠道改变但无腹痛组。 结论：肠易激综合征患者胆囊切除术风险增加并非由于胆结石风险增加，而是由于腹痛、对患有胆结石的认知以及不恰当的手术指征。
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