Caporaso N, Morisco F, Penagini R
Scuola di Specializzazione in Gastroenterologia, Università di Napoli Federico II, Napoli, Italia.
Minerva Gastroenterol Dietol. 2010 Jun;56(2):101-20.
The general practitioner is most likely to benefit from this "Opinion Paper" about the functional intestinal disorders, both as an update and as a tool to improve his/her relationship with patients. Four functional intestinal disorders have been described: irritable bowel syndrome, functional bloating, functional constipation and functional diarrhea. All such disorders are defined by non-specific symptoms, referred to the middle and/or lower gastrointestinal tract without evidence of any organic basis. Symptoms should have arisen at least six months earlier, and they should have recurred at least three times monthly over the last three months. Disorders of motility, visceral hypersensitivity, inflammatory and immune disorders, as well as psycho-social, genetic and environmental factors, have all been involved in the pathophysiology of functional intestinal disorders; disturbances of the colonic bacterial flora are also suggested to have a leading role and interventions to correct them are most useful. Functional intestinal disorders as described in the validated Rome III Criteria are possibly too much categorized, but such criteria still are the only useful tool for diagnosis and therapeutic choices. Clinical history is crucial for diagnosis, meaning when symptoms were first detected and how they evolve, alternate, and associate. A diagnostic diary to report symptoms, daily activities, and foods may also be helpful. Functional intestinal disorders persist over time, and they heavily interfere with quality of life; they also have a heavy impact on economical resources. However, intestinal functional disorders are not associated with dangerous sequelae or mortality. It is up to general practitioners to reassure patients and to prescribe first-level diagnostic exams appropriately.
全科医生很可能会从这篇关于功能性肠道疾病的“意见书”中受益，既可以作为一种更新知识的方式，也可以作为改善其与患者关系的工具。文中描述了四种功能性肠道疾病：肠易激综合征、功能性腹胀、功能性便秘和功能性腹泻。所有这些疾病都由非特异性症状所定义，这些症状涉及中、下消化道，且无任何器质性病变的证据。症状应至少在六个月前出现，且在过去三个月内每月至少复发三次。运动功能障碍、内脏高敏感性、炎症和免疫紊乱，以及心理社会、遗传和环境因素，都参与了功能性肠道疾病的病理生理过程；结肠菌群紊乱也被认为起主要作用，针对其进行的干预最为有效。经认可的罗马Ⅲ标准中所描述的功能性肠道疾病可能分类过于细致，但这些标准仍然是诊断和治疗选择的唯一有用工具。临床病史对诊断至关重要，即首次发现症状的时间以及症状如何演变、交替和关联。记录症状、日常活动和饮食的诊断日记可能也会有所帮助。功能性肠道疾病会长期存在，并严重干扰生活质量；它们还对经济资源有重大影响。然而，肠道功能紊乱与危险的后遗症或死亡率无关。让患者安心并适当安排一级诊断检查是全科医生的职责。
