Department of Internal Medicine, University of Medicine and Pharmacy, Hochiminh, Vietnam.
Department of Gastroenterology, Gia-Dinh People's Hospital, Hochiminh, Vietnam.
J Gastroenterol Hepatol. 2018 Jan;33(1):150-155. doi: 10.1111/jgh.13821.
The Asia-Pacific Colorectal Screening (APCS) score has been validated in several populations but not yet in patients with irritable bowel syndrome (IBS). The aim of this study was to assess the performance of APCS score in stratifying risk of colorectal advanced neoplasms (CAN) in Vietnamese IBS patients.
Consecutive patients who fulfilled IBS diagnosis criteria according to the Rome III were prospectively enrolled and underwent colonoscopy. APCS score for each patient was calculated by summing the points attributed by risk factors. Three tiers of risk were defined: 0-1 "average risk" (AR); 2-3 "moderate risk" (MR); and 4-7 "high risk" (HR). Logistic regression analysis was performed to assess the relative risk of CAN in HR group and MR group compared with AR group.
There were 404 patients with excellent bowel preparation and complete colonoscopy. The mean age was 48.8 ± 11.2 years and male : female ratio was 1.2:1. Twenty-eight patients (6.9%) were diagnosed with CAN: 19 (4.7%) advanced adenoma and 9 (2.2%) invasive colorectal cancer. Patients in the MR and HR tiers had 5.6-fold (95% confidence interval 1.2 to 24.7, P = 0.012) and 12.1-fold (95% confidence interval 2.6 to 56.2, P < 0.001) increased rates of CAN compared with those in the AR tier, respectively. Three out of 9 patients with invasive colorectal cancer had no alarm features but had high sum APCS score (2 in MR tier and 1 in HR tier).
The APCS score is useful to identify IBS patients with high risk of CAN for colonoscopy priority.
亚太结直肠筛查（APCS）评分已在多个人群中得到验证，但尚未在肠易激综合征（IBS）患者中得到验证。本研究旨在评估 APCS 评分在分层越南 IBS 患者结直肠高级别瘤（CAN）风险中的作用。
连续符合罗马 III 标准的 IBS 诊断标准的患者前瞻性入组并接受结肠镜检查。每位患者的 APCS 评分通过将危险因素赋予的分数相加来计算。风险分为 3 个等级：0-1“平均风险”（AR）；2-3“中度风险”（MR）；和 4-7“高风险”（HR）。采用 logistic 回归分析评估 HR 组和 MR 组与 AR 组相比，CAN 的相对风险。
共有 404 例患者具有良好的肠道准备和完整的结肠镜检查。平均年龄为 48.8±11.2 岁，男女比例为 1.2:1。28 例（6.9%）诊断为 CAN：19 例（4.7%）高级腺瘤和 9 例（2.2%）侵袭性结直肠癌。MR 和 HR 组的患者与 AR 组相比，CAN 的发生率分别增加了 5.6 倍（95%置信区间 1.2 至 24.7，P=0.012）和 12.1 倍（95%置信区间 2.6 至 56.2，P<0.001）。9 例侵袭性结直肠癌患者中有 3 例无报警特征，但 APCS 评分较高（MR 组 2 例，HR 组 1 例）。
APCS 评分可用于识别 IBS 患者中结直肠 CAN 高危人群，以便优先进行结肠镜检查。
