Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7080, USA.
Am J Gastroenterol. 2012 Feb;107(2):286-95. doi: 10.1038/ajg.2011.358. Epub 2011 Nov 8.
The objectives of this study were to determine how variable stool consistency is in patients with irritable bowel syndrome (IBS) and to assess the relationship between stool consistency and gastrointestinal symptoms.
Individuals with a physician diagnosis of IBS were recruited by advertisement. Enrollment questionnaires included the Rome III Diagnostic Questionnaire and IBS Symptom Severity Scale. Then, 185 patients meeting the Rome criteria for IBS rated the consistency (using the Bristol Stool Scale) of each bowel movement (BM) for 90 days and whether the BM was accompanied by pain, urgency, or soiling. Each night, they transferred BM ratings from a paper diary to an internet form and also reported the average daily intensity of abdominal pain, bloating, bowel habit dissatisfaction, and life interference of bowel symptoms. Only the longest sequence of consecutive days of diary data was used in the analysis (average of 73 days).
Patients were 89% females with average age 36.6 years. Among the patients, 78% had both loose/watery and hard/lumpy stools; the average was three fluctuations between these extremes per month. The proportion of loose/watery stools correlated r=0.78 between the first and second months and the proportion of hard/lumpy stools correlated r=0.85 between months. Loose/watery stools were associated with more BM-related pain, urgency, and soiling than hard/lumpy or normal stools; however, IBS-C patients had significantly more BM-unrelated abdominal pain, bloating, dissatisfaction with bowel habits, and life interference than IBS-D patients. Questionnaires overestimated the frequency of abnormal stool consistency and gastrointestinal symptoms compared with diaries.
Stool consistency varies greatly within individuals. However, stool patterns are stable within an individual from month to month. The paradoxical findings of greater symptom severity after individual loose/watery BMs vs. greater overall symptom severity in IBS-C implies different physiological mechanisms for symptoms in constipation compared with diarrhea. Daily symptom monitoring is more sensitive and reliable than a questionnaire.
本研究旨在确定肠易激综合征（IBS）患者粪便稠度的变化情况，并评估粪便稠度与胃肠道症状之间的关系。
通过广告招募经医生诊断为 IBS 的个体。入组问卷包括罗马 III 诊断问卷和 IBS 症状严重程度量表。然后，符合 IBS 罗马标准的 185 名患者对 90 天内的每次排便（BM）的稠度（使用布里斯托粪便量表）进行评分，并记录 BM 是否伴有疼痛、急迫感或弄脏衣物。每晚，他们将 BM 评分从纸质日记转移到互联网表格，并报告平均每日腹痛、腹胀、排便习惯不满和肠道症状对生活的干扰程度。分析中仅使用最长时间的连续日记数据（平均 73 天）。
患者中 89%为女性，平均年龄为 36.6 岁。在这些患者中，78%同时存在稀便和硬便；平均每月这两种极端情况各出现 3 次波动。首次和第二次排便之间稀便的比例呈 r=0.78 相关，硬便的比例呈 r=0.85 相关。稀便与更多的 BM 相关疼痛、急迫感和弄脏衣物相关，而硬便或正常便则较少出现这种情况；然而，与 IBS-D 患者相比，IBS-C 患者的 BM 无关腹痛、腹胀、排便习惯不满和生活干扰的程度显著更高。与日记相比，问卷高估了异常粪便稠度和胃肠道症状的频率。
个体内部的粪便稠度变化很大。然而，个体内部的粪便模式在每个月内是稳定的。与 IBS-C 相比，个别稀便后出现更严重症状的矛盾发现表明，便秘相关的症状可能存在不同的生理机制。与问卷相比，每日症状监测更敏感和可靠。
