Department of Radiology, Cork University Hospital and Alimentary Pharmabiotic Centre, University College Cork, Wilton, Cork, Ireland.
Radiology. 2012 Feb;262(2):485-94. doi: 10.1148/radiol.11110423. Epub 2011 Dec 9.
To critically evaluate the current literature in an effort to establish the current role of radiologic imaging (computed tomography, magnetic resonance imaging, ultrasonography [US], fluoroscopy, conventional film radiography) in irritable bowel syndrome (IBS).
The term "irritable bowel syndrome" was used to search Clinical Evidence, UpToDate, Cochrane Library, TRIP, and National Institute for Health and Clinical Excellence databases and the American College of Physicians Journal Club and Evidence-Based Medicine online. PubMed was searched by using medical subject headings ("irritable bowel syndrome;" "colonic diseases, functional;" "diagnosis;" "colonography;" "computed tomographic (CT)") and the dates January 1, 1985 to July 1, 2010. Appraisal was independently performed by two reviewers who followed the Oxford Centre for Evidence Based Medicine practice criteria.
No systematic review (SR) specifically examined radiologic imaging in IBS; however, in the secondary literature, five relevant SRs or guidelines partially addressed this topic. A PubMed search identified 1451 articles, 111 of which at least partially addressed radiologic imaging. Of these, seven valid articles (two SRs and five primary research articles) were identified. The five primary research articles examined either colonic investigations (colonoscopy and barium enema examination) (n=5) or US (n=2) or both (n=2). Structural disease found infrequently in patients with IBS-type symptoms included diverticulosis, colorectal cancer, celiac disease, inflammatory bowel disease, and ovarian cancer. The incidence of structural disease in patients with concerning symptoms was low.
Although widely used, there is a surprising paucity of evidence guiding radiologic imaging in IBS. Radiologic imaging may not be required in patients with IBS without potentially concerning symptoms but should be considered where such symptoms exist, and choice of imaging study should be influenced by predominant symptoms. Definitive recommendations must await further research.
批判性地评估当前文献，以确定放射影像学（计算机断层扫描、磁共振成像、超声、透视、常规胶片放射摄影）在肠易激综合征（IBS）中的当前作用。
使用术语“肠易激综合征”搜索 Clinical Evidence、UpToDate、Cochrane 图书馆、TRIP 和英国国家卫生与临床优化研究所数据库以及美国医师学会杂志俱乐部和循证医学在线。使用医学主题词（“肠易激综合征”；“结肠疾病，功能性”；“诊断”；“结肠造影术”；“计算机断层扫描（CT）”）在 PubMed 上进行搜索，日期为 1985 年 1 月 1 日至 2010 年 7 月 1 日。两名评审员独立进行评估，遵循牛津循证医学中心实践标准。
没有专门针对 IBS 放射影像学的系统评价（SR）；然而，在二级文献中，有五项相关的 SR 或指南部分涉及这一主题。在 PubMed 上搜索到 1451 篇文章，其中有 111 篇至少部分涉及放射影像学。其中，有 7 篇有效文章（两篇 SR 和五篇原始研究文章）被确定。这五篇原始研究文章分别检查了结肠检查（结肠镜检查和钡灌肠检查）（n=5）或 US（n=2）或两者（n=2）。在有 IBS 型症状的患者中，很少发现结构性疾病，包括憩室病、结直肠癌、乳糜泻、炎症性肠病和卵巢癌。有潜在症状的患者中结构性疾病的发生率较低。
尽管放射影像学广泛应用，但指导 IBS 放射影像学的证据却令人惊讶地缺乏。没有潜在症状的 IBS 患者可能不需要进行放射影像学检查，但如果存在这些症状，应考虑进行检查，并且应根据主要症状选择影像学检查。明确的建议必须等待进一步的研究。
