Alpers David H
Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA.
J Psychosom Res. 2008 Jun;64(6):567-72. doi: 10.1016/j.jpsychores.2008.02.023. Epub 2008 Apr 28.
The definition of irritable bowel syndrome (IBS) by Rome criteria was a major advancement in the nosology of the disease, but this goal was achieved by employing symptoms related to the gastrointestinal tract and by eliminating all symptoms that were nonspecific. The description of the course of the illness and response to treatment has been hampered by restrictions to the defining characteristics, abdominal pain and altered bowel habit. Other abdominal symptoms (e.g., bloating, nausea, and epigastric discomfort) and general somatic symptoms (e.g., fatigue, headache, and sleep disturbance) are not included in the Rome definition, yet are commonly reported by patients with IBS. This article addresses the following questions: Are comorbid conditions part of or distinct from the syndrome of IBS and other functional gastrointestinal disorders (FGIDs)? Are there overlapping abdominal or extra-abdominal symptoms confounding the definition of IBS? Are extra-abdominal somatic symptoms and/or syndromes part of the clinical presentation of IBS? Are "nondiagnostic" abdominal symptoms important in defining symptom burden in IBS? Is the concept of somatization related to IBS, and, if so, how? How can we better define the symptom burden in IBS and other FGIDs? In short, have we hampered the evaluation of IBS (and other FGIDs) by making the definitions too reductionist? While definite answers to the above questions are not possible at this time, this article proposes that the definitions of IBS or other FGIDs not be altered, but that in the process of evaluation of the clinical end points and/or severity of the diseases, consideration be given to the possibility of including other components of the symptom burden of these disorders.
罗马标准对肠易激综合征（IBS）的定义是该疾病分类学上的一项重大进展，但这一目标是通过采用与胃肠道相关的症状并排除所有非特异性症状来实现的。对疾病病程和治疗反应的描述受到定义特征（腹痛和排便习惯改变）的限制。其他腹部症状（如腹胀、恶心和上腹部不适）以及一般躯体症状（如疲劳、头痛和睡眠障碍）未被纳入罗马定义，但IBS患者经常报告这些症状。本文探讨以下问题：共病情况是IBS综合征及其他功能性胃肠疾病（FGIDs）的一部分还是与之不同？是否存在重叠的腹部或腹部外症状混淆了IBS的定义？腹部外躯体症状和/或综合征是否是IBS临床表现的一部分？“非诊断性”腹部症状在定义IBS的症状负担方面是否重要？躯体化概念与IBS是否相关，如果是，如何相关？我们如何更好地定义IBS和其他FGIDs的症状负担？简而言之，我们是否因定义过于简化而妨碍了对IBS（及其他FGIDs）的评估？虽然目前无法对上述问题给出确切答案，但本文建议IBS或其他FGIDs的定义不应改变，但在评估疾病的临床终点和/或严重程度时，应考虑纳入这些疾病症状负担的其他组成部分的可能性。
