Department of Biobehavioral Nursing and Health Systems, University of Washington, Box 357266, Seattle, WA 98195, USA.
Dig Dis Sci. 2011 Jul;56(7):2050-8. doi: 10.1007/s10620-011-1567-4. Epub 2011 Feb 3.
Irritable bowel syndrome (IBS) has traditionally been classified by stooling pattern (e.g., diarrhea-predominant). However, other patterns of symptoms have long been recognized, e.g., pain severity. Our objective was to examine the utility of subtyping women with IBS based on pain/discomfort severity as well as predominant bowel pattern.
Women (n = 166) with IBS completed interviews, questionnaires, and kept a diary for 28 days. Rome II questionnaire items eliciting the past year recall of hard and loose stools, and frequency and severity of abdominal pain or discomfort were used to classify participants into six subtypes-three bowel pattern categories by two pain/discomfort severity categories. Concordance of these subtypes with corresponding diary items was examined. Analysis of variance (ANOVA) tested the relationship of bowel pattern and pain categories to measures of quality of life and symptoms.
There is moderate congruence of the retrospective classification of bowel pattern and pain/discomfort severity subtypes with prospectively reported stool frequency and consistency and pain severity. Quality of life, impact of IBS on work and daily activities, and cognitive beliefs about IBS differed significantly based on abdominal pain/discomfort category but not on predominant bowel pattern. There is evidence of an interaction, with the effect of pain severity being strong in the IBS-diarrhea and IBS-mixed groups, but this was absent in the IBS-constipation group. Similar results hold for most diary symptoms, except for those directly related to bowel pattern.
Overall, the distress of IBS is more strongly related to the severity of abdominal pain/discomfort than is the predominant stool pattern in patients with IBS. Categorizing IBS patients by abdominal pain/discomfort severity in conjunction with predominant bowel pattern may be useful to clinicians and researchers in developing more effective management.
肠易激综合征（IBS）传统上按排便模式（例如腹泻为主）进行分类。然而，长期以来人们一直认识到其他症状模式，例如疼痛严重程度。我们的目的是检查基于疼痛/不适严重程度以及主要排便模式对 IBS 女性进行亚型分类的效用。
患有 IBS 的女性（n=166）完成了访谈、问卷调查，并记录了 28 天的日记。罗马 II 问卷项目引出过去一年回忆硬便和稀便的情况，以及腹痛或不适的频率和严重程度，用于将参与者分为六种子类型-两种疼痛/不适严重程度类别下的三种排便模式类别。检查这些子类型与相应日记条目的一致性。方差分析（ANOVA）检验了排便模式和疼痛类别与生活质量和症状测量的关系。
回溯性分类的排便模式和疼痛/不适严重程度亚型与前瞻性报告的粪便频率和一致性以及疼痛严重程度中度一致。生活质量、IBS 对工作和日常活动的影响以及对 IBS 的认知信念因腹痛/不适类别而有显著差异，但与主要排便模式无关。有证据表明存在相互作用，在 IBS-腹泻和 IBS-混合组中疼痛严重程度的影响较强，但在 IBS-便秘组中则不存在。对于大多数日记症状，除了那些直接与排便模式相关的症状外，结果也相似。
总体而言，IBS 的痛苦与 IBS 患者的腹痛/不适严重程度比主要排便模式更为密切相关。根据腹痛/不适严重程度与主要排便模式对 IBS 患者进行分类，可能对临床医生和研究人员制定更有效的管理方法有用。
