Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Eur J Gastroenterol Hepatol. 2013 May;25(5):568-74. doi: 10.1097/MEG.0b013e32835d4ddd.
To determine to what extent the Rome III criteria for irritable bowel syndrome can contribute towards safely reducing unnecessary referrals for colonoscopy in primary care patients with lower gastrointestinal (GI) complaints.
Data from the CEDAR study were used: a cross-sectional study in 810 patients with lower GI complaints suggestive for organic bowel disease who were referred by their general practitioner for secondary care colonoscopy. Fulfilment of the Rome III criteria was ascertained by a questionnaire. General practitioners recorded the presence or absence of alarm symptoms. Outcome was determined by colonoscopy and histology.
Of 810 participants, 222 fulfilled the Rome III criteria [27%, 95% confidence interval (CI) 24-31%]. The majority of these patients presented with alarm symptoms. Only 39 participants fulfilled the Rome III criteria and lacked alarm symptoms (overall frequency 5%, 95% CI 4-7). Overall, organic bowel disease was diagnosed in 141 participants (17%). Participants who fulfilled the Rome III criteria had a significantly lower risk of organic bowel disease compared with participants who did not [12% (95% CI 8-17) vs. 20% (95% CI 17-23), P<0.01]. The lowest risk was observed in patients without alarm symptoms who fulfilled the Rome III criteria (3%, 95% CI 0-14).
A minority of referred primary care patients with lower GI complaints both fulfilled the Rome III criteria for irritable bowel syndrome and lacked alarm symptoms. Although organic bowel disease could be ruled out safely in this small group, application of the Rome III criteria is not likely to lead to a considerable reduction in unnecessary referrals for colonoscopy in these patients.
确定罗马 III 标准对肠易激综合征的诊断在多大程度上有助于安全减少初级保健患者因下胃肠道（GI）症状而下消化道内镜检查的不必要转诊。
使用 CEDAR 研究的数据：对 810 例因疑似器质性肠病而下消化道内镜检查的患者进行的横断面研究，这些患者由全科医生转诊至二级保健机构。通过问卷确定罗马 III 标准的满足情况。全科医生记录是否存在报警症状。通过结肠镜检查和组织学确定结果。
810 名参与者中，222 名符合罗马 III 标准[27%（95%可信区间 24-31%）]。这些患者大多数有报警症状。只有 39 名符合罗马 III 标准且无报警症状的患者（总体发生率 5%（95%可信区间 4-7%））。总体而言，141 名患者（17%）诊断为器质性肠病。符合罗马 III 标准的患者发生器质性肠病的风险显著低于不符合罗马 III 标准的患者[12%（95%可信区间 8-17%）比 20%（95%可信区间 17-23%），P<0.01]。无报警症状且符合罗马 III 标准的患者风险最低（3%（95%可信区间 0-14%））。
下胃肠道症状转诊的初级保健患者中，符合罗马 III 标准的肠易激综合征患者且无报警症状的患者为数较少。尽管在这个小群体中可以安全排除器质性肠病，但罗马 III 标准的应用不太可能导致这些患者下消化道内镜检查的不必要转诊大量减少。
