GI Motility Program, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
J Clin Gastroenterol. 2011 Oct;45(9):790-3. doi: 10.1097/MCG.0b013e3182053cea.
Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by alterations in bowel function, abdominal discomfort, and bloating. The symptoms of IBS vary widely between constipation and diarrhea predominance. In this study, we examine "constipation minus diarrhea" score (C-D) to account for the contribution of diarrhea and to create a reliable method for predicting constipation predominance in IBS.
A nested study was conducted in participants with IBS by Rome I criteria. After consent, they completed a daily stool diary for 1 week. This included recording frequency of bowel movements and describing consistency of stool using the Bristol stool scale. After submitting their diaries, participants rated their bowel symptoms using a visual analog score (VAS) scale from 0 to 100 mm, with 100 mm representing maximum severity. VAS scores for C, D, and C-D were subsequently compared with the true stool events of the previous week by stool diary to validate the potential usefulness of the simple C-D method.
Eighty-four participants with IBS completed stool diaries and VAS surveys for bowel symptoms, from which C-D scores were compiled. By correcting for the predominance of constipation compared with diarrhea, C-D scores predicted constipation based on the frequency of bowel movements and Bristol stool score. Furthermore, a second method was used to validate the C-D technique by comparing the mean C-D score in participants with constipation (≤3 d with bowel movement in previous week). In this case, the mean C-D score was 74.1 ± 3.8 compared with -3.0 ± 5.9 for patients with >3 days with bowel movement in that week (P<0.001). Although the constipation severity alone also distinguished these 2 groups, the difference was less impressive (P<0.01). In participants with mean Bristol stool scores of ≤2 in the preceding week, the C-D mean score was 25.4 ± 6.1 compared with participants having mean Bristol stool score of >2 where the C-D was -11.1 ± 5.9 (P<0.01). Using constipation severity by VAS alone, there was no significant difference between these same 2 Bristol stool categories (P=0.29).
IBS patients' self-assessment of constipation and diarrhea severity using the C-D score is an effective predictor of C-IBS and constipation severity. The C-D score may be a useful tool in future IBS constipation trials, as it seems to predict constipation and it correlates well with stool diaries.
肠易激综合征（IBS）是一种以肠道功能改变、腹部不适和腹胀为特征的慢性功能性胃肠道疾病。IBS 的症状在便秘和腹泻为主之间差异很大。在这项研究中，我们检查了“便秘减去腹泻”评分（C-D），以考虑腹泻的贡献，并创建一种可靠的方法来预测 IBS 中的便秘为主。
通过罗马 I 标准对 IBS 患者进行嵌套研究。同意后，他们完成了为期一周的日常粪便日记。这包括记录排便频率，并使用布里斯托尔粪便量表描述粪便的稠度。提交日记后，参与者使用视觉模拟评分（VAS）量表对肠道症状进行评分，范围从 0 到 100 毫米，100 毫米代表最大严重程度。随后，通过与前一周的粪便日记比较，比较 VAS 评分与 C、D 和 C-D 的真实粪便事件，以验证简单 C-D 方法的潜在有用性。
84 名 IBS 患者完成了粪便日记和 VAS 调查，以编制 C-D 评分。通过校正便秘与腹泻的优势，C-D 评分根据排便频率和布里斯托尔粪便评分预测便秘。此外，通过比较前一周排便次数≤3 天的参与者的平均 C-D 评分，用第二种方法验证了 C-D 技术。在这种情况下，平均 C-D 评分分别为 74.1±3.8 和 -3.0±5.9（P<0.001）。尽管便秘严重程度本身也能区分这两组，但差异不太明显（P<0.01）。在前一周平均布里斯托尔粪便评分≤2 的参与者中，C-D 的平均评分分别为 25.4±6.1，而平均布里斯托尔粪便评分>2 的参与者的 C-D 为 -11.1±5.9（P<0.01）。使用 VAS 单独评估便秘严重程度，在这两个相同的布里斯托尔粪便类别之间没有显著差异（P=0.29）。
IBS 患者使用 C-D 评分对便秘和腹泻严重程度的自我评估是预测 C-IBS 和便秘严重程度的有效指标。C-D 评分可能是未来 IBS 便秘试验的有用工具，因为它似乎可以预测便秘，并且与粪便日记相关性良好。
