Center for Functional Gastrointestinal and Motility Disorders, and Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7080, USA.
Am J Gastroenterol. 2010 Apr;105(4):814-20; quiz 813, 821. doi: 10.1038/ajg.2010.56. Epub 2010 Feb 23.
This article reviews the evidence for validity of symptom-based criteria (Manning, Rome I, Rome II, and Rome III) for irritable bowel syndrome (IBS). Two kinds of validations are reported: (i) studies testing whether symptom criteria discriminate patients with structural disease at colonoscopy from patients without structural disease; and (ii) studies testing whether symptom criteria discriminate patients presumed to have IBS by positive diagnosis from healthy subjects or patients with other functional and structural disorders. The first study type addresses an important clinical management question but cannot provide meaningful information on the sensitivity or positive predictive value because IBS is defined only by exclusion of structural disease. Specificity is modest (about 0.7) but can be improved to 0.9 by the addition of red flag signs and symptoms. The second type of study judges validity by whether the symptom criteria consistently perform as predicted by theory. Here, factor analysis confirms consistent clusters of symptoms corresponding to IBS; symptom-based criteria agree reasonably well (sensitivity, 0.4-0.9) with clinical diagnoses made by experienced clinicians; and patients with a clinical diagnosis of IBS who fulfill Rome II criteria have greater symptom severity and poorer quality of life than patients with a clinical diagnosis of IBS who do not fulfill Rome criteria. There are no consistent differences in sensitivity or specificity between Manning, Rome I, and Rome II. Both study types support the validity of symptom-based IBS criteria. Tests of Rome III are needed.
本文回顾了基于症状的标准（曼宁、罗马 I、罗马 II 和罗马 III）对肠易激综合征（IBS）的有效性证据。报告了两种验证方法：（i）研究测试症状标准是否可以区分结肠镜检查中存在结构疾病的患者与无结构疾病的患者；（ii）研究测试症状标准是否可以区分通过阳性诊断假定患有 IBS 的患者与健康受试者或患有其他功能性和结构性疾病的患者。第一种研究类型解决了一个重要的临床管理问题，但由于 IBS 仅通过排除结构性疾病来定义，因此无法提供有关敏感性或阳性预测值的有意义信息。特异性适中（约为 0.7），但通过添加红色标志和症状，特异性可提高到 0.9。第二种研究类型通过症状标准是否按照理论预测一致地表现来判断有效性。在这里，因子分析证实了与 IBS 一致的症状簇；基于症状的标准与经验丰富的临床医生做出的临床诊断相当吻合（敏感性为 0.4-0.9）；符合罗马 II 标准的临床诊断为 IBS 的患者的症状严重程度和生活质量比不符合罗马标准的患者更差。曼宁、罗马 I 和罗马 II 的敏感性或特异性没有一致差异。两种研究类型均支持基于症状的 IBS 标准的有效性。需要对罗马 III 进行测试。
