Bytzer P, Stokholm M, Andersen I, Klitgaard N A, Schaffalitzky de Muckadell O B
Department of Medical Gastroenterology, Odense University Hospital, Denmark.
Gut. 1989 Oct;30(10):1379-84. doi: 10.1136/gut.30.10.1379.
The costs and medical benefits of an early, routine laxative screening test in patients with diarrhoea of uncertain origin was evaluated. During a two year period 200 consecutive, unselected patients complaining of diarrhoea were considered for the study in whom a three day faecal collection was undertaken. Fifty four patients denying laxative consumption had diarrhoea (mean daily stool weight greater than 200 g) of uncertain origin at their initial visit of whom 47 were screened to detect ingestion of anthraquinones, bisacodyl, phenolphthalein, and magnesium salts. Seven patients had positive tests. No single clinical feature could have predicted the outcome of the test. The possible cost savings of the programme were estimated by not releasing the results of the test to the clinicians until the patient's investigations were complete. The seven patients with laxative abuse spent a total of 35 days in hospital and were seen on 29 occasions in the outpatient clinic after the laxative screening test was positive. The cost of the screening programme was cheaper than the costs of the diagnostic procedures in patients with laxative abuse. We recommend the use of a comprehensive, early laxative screening programme in all patients with diarrhoea of uncertain origin as a cost effective procedure.
对病因不明的腹泻患者进行早期常规泻药筛查试验的成本和医疗效益进行了评估。在两年期间，连续纳入200例未经挑选、主诉腹泻的患者进行研究，对其进行为期三天的粪便收集。54例否认服用泻药的患者在初次就诊时存在病因不明的腹泻（平均每日粪便重量超过200克），其中47例接受筛查以检测是否摄入蒽醌类、比沙可啶、酚酞和镁盐。7例检测结果呈阳性。没有单一临床特征能够预测检测结果。通过在患者检查完成之前不向临床医生公布检测结果，估算了该项目可能节省的费用。7例泻药滥用患者在泻药筛查试验呈阳性后共住院35天，门诊就诊29次。筛查项目的成本低于泻药滥用患者诊断程序的成本。我们建议对所有病因不明的腹泻患者采用全面的早期泻药筛查项目，作为一种具有成本效益的程序。
