Gijsbers Carolien F M, Benninga Marc A, Schweizer Joachim J, Kneepkens C M Frank, Vergouwe Yvonne, Büller Hans A
*Juliana Children's Hospital/Haga Teaching Hospital, The Hague †Emma Children's Hospital/Academic Medical Centre, Amsterdam ‡Willem-Alexander Children's Hospital/Leiden University Medical Centre, Leiden §VU University Medical Centre, Amsterdam ||Erasmus Medical Centre, Rotterdam, The Netherlands.
J Pediatr Gastroenterol Nutr. 2014 Jun;58(6):779-85. doi: 10.1097/MPG.0000000000000319.
Rome criteria were formulated to define functional gastrointestinal disorders (Rome III criteria, 2006) excluding organic diagnoses when alarm symptoms were absent. The aims of the study were to validate the Rome III criteria as to their capacity to differentiate between organic and functional abdominal pain and to assess the role of alarm symptoms in this differentiation.
During 2 years all of the patients (ages 4-16 years) presenting with recurrent abdominal pain (Apley criteria) and referred to secondary care were included. Clinical diagnoses were based on protocolized evaluation and intervention with 6-month follow-up. Alarm symptoms were registered. Rome III criteria for functional pain syndromes were assigned independently. Descriptive statistical analyses were performed.
In 200 patients (87 boys, mean age 8.8 years), organic (17%), functional (40%), combined organic and functional (9%), spontaneous recovery (27%), and other (8%) clinical diagnoses were established. Alarm symptoms were found in 57.5% (organic causes 56%, functional causes 61%). The evaluation for Rome symptom clusters revealed symptoms of irritable bowel syndrome in 27%, functional dyspepsia in 15%, functional abdominal pain in 28%, functional abdominal pain syndrome in 14.5%, and no pain syndrome in 15.5%. Rome diagnoses, based on symptoms and absence of alarm symptoms, predicted functional clinical diagnosis with sensitivity 0.35 (95% confidence interval 0.27-0.43), specificity 0.60 (0.46-0.73), positive predictive value 0.71 (0.61-0.82), and negative predictive value of 0.24 (0.17-0.32).
The Rome III criteria for abdominal pain are not specific enough to rule out organic causes. Alarm symptoms do not differentiate between organic and functional abdominal pain.
制定罗马标准以定义功能性胃肠疾病（2006年罗马Ⅲ标准），在无警示症状时排除器质性诊断。本研究的目的是验证罗马Ⅲ标准区分器质性和功能性腹痛的能力，并评估警示症状在这种区分中的作用。
纳入2年内所有因复发性腹痛（阿普雷标准）就诊于二级医疗机构的4至16岁患者。临床诊断基于规范化评估和干预，并进行6个月随访。记录警示症状。独立应用罗马Ⅲ功能性疼痛综合征标准。进行描述性统计分析。
200例患者（87名男孩，平均年龄8.8岁）确诊为器质性（17%）、功能性（40%）、器质性与功能性并存（9%）、自然缓解（27%）和其他（8%）临床诊断。57.5%的患者出现警示症状（器质性病因56%，功能性病因61%）。对罗马症状群的评估显示，27%的患者有肠易激综合征症状，15%有功能性消化不良，28%有功能性腹痛，14.5%有功能性腹痛综合征，15.5%无疼痛综合征。基于症状和无警示症状的罗马诊断对功能性临床诊断的预测敏感性为0.35（95%置信区间0.27 - 0.43），特异性为0.60（0.46 - 0.73），阳性预测值为0.71（0.61 - 0.82），阴性预测值为0.24（0.17 - 0.32）。
罗马Ⅲ腹痛标准特异性不足，无法排除器质性病因。警示症状不能区分器质性和功能性腹痛。
