van Assen Tijmen, Boelens Oliver B, Kamphuis Jan T, Scheltinga Marc R, Roumen Rudi M
Department of Surgery, Máxima Medical Centre, Veldhoven, The Netherlands.
Frontline Gastroenterol. 2012 Oct;3(4):288-294. doi: 10.1136/flgastro-2012-100207. Epub 2012 Jul 26.
The irritable bowel syndrome (IBS) population is heterogeneous, harbouring a variety of abdominal symptoms. Therefore, IBS is often termed a 'diagnosis of exclusion'. Chronic abdominal wall pain (CAWP) is a poorly recognized entity, frequently caused by the anterior cutaneous nerve entrapment syndrome (ACNES). Some patients may be misdiagnosed because IBS and CAWP share symptoms. Aim of this study was to construct and validate a questionnaire to distinguish patients with CAWP (including ACNES) patients with IBS.
A questionnaire was designed of 17 ACNES characteristic items obtained from ACNES patients (n=33) and expert opinion of two specialized surgeons. Eleven IBS-related items ('Rome III' criteria) were added leading to a questionnaire containing 28 items. This was validated in a 'gold standard' ACNES group (successfully operated ACNES patients, n=68) and a 'prospective' IBS group (n=64) as well as in a 'prospective' ACNES group (n=47). Distinctive power of individual items was analyzed by χ. Reliability was tested with Crohnbach's α. ROC curve was used to determine cut-off values.
Eighteen of 28 items were significantly distinctive (p<0.01) between ACNES and IBS patients leading to an 18-point ACNES score with good internal consistency (α=0.85). Cut-off value of 10 points resulted in 94% sensitivity, 92% specificity and areas under the curve (AUC) of 0.98. Evaluation of the prospective ACNES group led to 85% sensitivity, 92% specificity and AUC 0.95 indicating high discriminative properties of the questionnaire.
This novel questionnaire may be useful and valid as a simple tool distinguishing patients harbouring a CAWP syndrome from those having IBS.
肠易激综合征（IBS）患者群体具有异质性，存在多种腹部症状。因此，IBS常被称为“排除性诊断”。慢性腹壁疼痛（CAWP）是一种认识不足的病症，常由前皮神经卡压综合征（ACNES）引起。一些患者可能会被误诊，因为IBS和CAWP有共同症状。本研究的目的是构建并验证一份问卷，以区分CAWP（包括ACNES）患者和IBS患者。
从ACNES患者（n = 33）处获取17项ACNES特征性条目，并结合两位专科外科医生的专家意见设计了一份问卷。添加了11项与IBS相关的条目（“罗马III”标准），形成了一份包含28个条目的问卷。在一个“金标准”ACNES组（成功接受手术的ACNES患者，n = 68）、一个“前瞻性”IBS组（n = 64）以及一个“前瞻性”ACNES组（n = 47）中对其进行了验证。通过χ分析单个条目的区分能力。用Cronbach's α检验可靠性。使用ROC曲线确定临界值。
28个条目中有18个在ACNES患者和IBS患者之间具有显著差异（p<0.01），得出一个18分的ACNES评分，具有良好的内部一致性（α = 0.85）。临界值为10分时，敏感性为94%，特异性为92%，曲线下面积（AUC）为0.98。对前瞻性ACNES组的评估得出敏感性为85%，特异性为92%，AUC为0.95，表明该问卷具有较高的鉴别性。
这份新问卷作为一种简单工具，可有效区分患有CAWP综合征的患者和患有IBS的患者，可能是有用且有效的。
