Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Int J Colorectal Dis. 2011 Jul;26(7):935-40. doi: 10.1007/s00384-011-1163-2. Epub 2011 Mar 4.
The diagnosis of irritable bowel syndrome is symptom based, and colonoscopy is the most direct way to rule out organic colonic diseases. It is controversial on the necessity of colonoscopy for patients with suspected irritable bowel syndrome and lacking alarm features. This study was designed to verify the organic lesions and discuss the value of colonoscopy in this type of patients.
Colonoscopy of 3,332 patients with suspected irritable bowel syndrome and lacking warning signs from 2000 to 2009 were reviewed. One thousand five hundred eighty-eight patients under 50 years of age who underwent colonoscopy screening for health care in the same period were used as controls. The prevalence of different colonic organic lesions was compared between two groups.
Organic colonic lesions were found in 30.3% of the patients with suspected irritable bowel syndrome (1,010/3,332) and 39.0% of the controls (619/1,588). Compared with controls, patients with suspected irritable bowel syndrome had higher prevalence of noninflammatory bowel disease and noninfectious colitis and terminal ileitis, however, had lower prevalence of diverticular disease, adenomatous polyps, and non-adenomatous polyps (all P < 0.001).
The diagnostic sensitivity of symptom criteria on irritable bowel syndrome without colonoscopy is not more than 69.7% in patients with suspected irritable bowel syndrome lacking warning signs. Though the method of colonoscopy is hard to screen tumor in this type of patients, it is beneficial to uncover some other relevant organic lesions such as terminal ileitis. Colonoscopy should not be refused to suspected irritable bowel syndrome patients without warning signs.
肠易激综合征的诊断基于症状，结肠镜检查是排除结肠器质性疾病的最直接方法。对于疑似肠易激综合征且缺乏报警特征的患者，是否需要进行结肠镜检查存在争议。本研究旨在验证器质性病变，并探讨结肠镜检查在这类患者中的价值。
回顾性分析 2000 年至 2009 年期间 3332 例疑似肠易激综合征且缺乏报警特征的患者的结肠镜检查结果。同期对 1588 例因健康体检行结肠镜筛查且年龄＜50 岁的患者作为对照组。比较两组患者不同结肠器质性病变的发生率。
疑似肠易激综合征患者中发现器质性结肠病变的比例为 30.3%（1010/3332），对照组为 39.0%（619/1588）。与对照组相比，疑似肠易激综合征患者中炎症性肠病和感染性结肠炎及末端回肠炎的发生率较高，而憩室病、腺瘤性息肉和非腺瘤性息肉的发生率较低（均 P＜0.001）。
对于疑似肠易激综合征且缺乏报警特征的患者，不进行结肠镜检查的症状标准诊断敏感性不超过 69.7%。尽管结肠镜检查方法很难在这类患者中筛查出肿瘤，但它有利于发现其他一些相关的器质性病变，如末端回肠炎。对于疑似肠易激综合征且缺乏报警特征的患者，不应拒绝行结肠镜检查。
