Institution of Clinical and Experimental Medicine (IKE), Division of Gastroenterology, Linköping University, Linköping, Sweden.
Dig Dis Sci. 2011 May;56(5):1444-51. doi: 10.1007/s10620-010-1468-y. Epub 2010 Nov 10.
Diagnostic criteria for irritable bowel syndrome (IBS) have not been validated by prospective symptom diary. We investigated the bowel patterns in community subjects with and without non-organic abdominal pain, and compared the symptoms with subjects fulfilling the Rome II criteria (IBS).
From the Swedish population register, a random sample completed an abdominal symptom questionnaire. Responders were subsequently invited for a clinical evaluation and offered a colonoscopy regardless of whether they had abdominal symptoms or not. A total of 268 subjects underwent colonoscopy, clinical evaluation by gastroenterologist, laboratory investigations, and completed the Rome questionnaire and prospective gastrointestinal (GI) symptom diaries for 1 week. Twenty-three subjects of 268 were excluded due to organic GI disease.
Subjects recorded 2,194 bowel movements and 370 abdominal pain episodes on 1,504 days. Subjects with pain in the diary (n = 81) had higher stool frequency (P = 0.01), more urgency (P = 0.0002), feelings of incomplete evacuation (P = 0.0002), nausea (P = 0.0009), and abdominal bloating (P = 0.0005) than subjects without pain (n = 151). Twenty-eight subjects (12%) fulfilled the Rome II criteria for IBS. Together, they had 96 pain episodes but only 4% were improved by defecation; 29% of the pain episodes started or worsened after a meal. Subjects with IBS and other subjects with non-organic abdominal pain (n = 64) exhibited no differences in terms of the proportions of pain episodes improved by defecation, bloating, stool frequency, consistency, or defecatory symptoms.
Current criteria for IBS that rely on recall of the relationship between abdominal pain and bowel disturbance may overcall this association when measured prospectively.
目前还没有通过前瞻性症状日记来验证肠易激综合征（IBS）的诊断标准。我们调查了有无非器质性腹痛的社区人群的肠道模式，并将症状与符合罗马 II 标准（IBS）的人群进行了比较。
从瑞典人口登记处随机抽取了一组人群，完成了腹部症状问卷。随后，对应答者进行了临床评估，并为他们提供了结肠镜检查，无论他们是否有腹部症状。共有 268 名患者接受了结肠镜检查、胃肠病学家的临床评估、实验室检查，并完成了罗马问卷和为期一周的前瞻性胃肠道（GI）症状日记。由于存在器质性胃肠道疾病，268 例中有 23 例被排除在外。
患者在 1504 天中记录了 2194 次排便和 370 次腹痛发作。日记中有疼痛的患者（n=81）的排便频率更高（P=0.01），更急迫（P=0.0002），有不完全排空的感觉（P=0.0002），恶心（P=0.0009）和腹部胀气（P=0.0005），而无疼痛的患者（n=151）则无上述症状。28 名患者（12%）符合罗马 II 诊断 IBS 的标准。他们共有 96 次疼痛发作，但只有 4%的疼痛发作通过排便得到缓解；29%的疼痛发作在餐后开始或加重。IBS 患者和其他非器质性腹痛患者（n=64）在排便改善、腹胀、排便频率、粪便稠度或排便症状方面，疼痛发作的比例无差异。
目前基于回忆腹痛与肠道紊乱之间关系的 IBS 诊断标准，在前瞻性测量时可能会过高估计这种关联。
