Cuda Tahleesa, Gunnarsson Ronny, de Costa Alan
Cairns Clinical School, College of Medicine and Dentistry, James Cook University, 451 Draper Street, Cairns, QLD, 4870, Australia.
Department of Surgery, Cairns Private Hospital, Cairns, QLD, Australia.
BMC Gastroenterol. 2018 Jan 31;18(1):25. doi: 10.1186/s12876-018-0753-7.
Acquired Megacolon (AMC) is a condition involving persistent dilatation and lengthening of the colon in the absence of organic disease. Diagnosis depends on subjective radiological, endoscopic or surgical findings in the context of a suggestive clinical presentation. This review sets out to investigate diagnostic criteria of AMC.
The literature was searched using the databases - PubMed, Medline via OvidSP, ClinicalKey, Informit and the Cochrane Library. Primary studies, published in English, with more than three patients were critically appraised based on study design, methodology and sample size. Exclusion criteria were studies with the following features: post-operative; megarectum-predominant; paediatric; organic megacolon; non-human; and failure to exclude organic causes.
A review of 23 articles found constipation, abdominal pain, distension and gas distress were predominant symptoms. All ages and both sexes were affected, however, symptoms varied with age. Changes in anorectal manometry, histology and colonic transit are consistently reported. Studies involved varying patient numbers, demographics and data acquisition methods.
Outcome data investigating the diagnosis of AMC must be interpreted in light of the limitations of the low-level evidence studies published to date. Proposed diagnostic criteria include: (1) the exclusion of organic disease; (2) a radiological sigmoid diameter of ~ 10 cm; (3) and constipation, distension, abdominal pain and/or gas distress. A proportion of patients with AMC may be currently misdiagnosed as having functional gastrointestinal disorders. Our conclusions are inevitably tentative, but will hopefully stimulate further research on this enigmatic condition.
获得性巨结肠（AMC）是一种在无器质性疾病情况下，结肠持续扩张和延长的病症。诊断依赖于在提示性临床表现背景下的主观影像学、内镜或手术检查结果。本综述旨在研究AMC的诊断标准。
通过PubMed、经由OvidSP的Medline、ClinicalKey、Informit和Cochrane图书馆等数据库检索文献。对以英文发表的、患者超过3例的原发性研究，根据研究设计、方法和样本量进行严格评估。排除标准为具有以下特征的研究：术后；以巨直肠为主；儿科；器质性巨结肠；非人类；以及未排除器质性病因。
对23篇文章的综述发现，便秘、腹痛、腹胀和气促是主要症状。各年龄段和男女两性均受影响，然而，症状随年龄而异。一致报道了肛门直肠测压、组织学和结肠传输的变化。研究涉及不同的患者数量、人口统计学和数据采集方法。
鉴于迄今发表的低水平证据研究的局限性，对AMC诊断的结果数据必须加以解读。提议的诊断标准包括：（1）排除器质性疾病；（2）放射学检查显示乙状结肠直径约为10厘米；（3）以及便秘、腹胀、腹痛和/或气促。一部分AMC患者目前可能被误诊为功能性胃肠疾病。我们的结论不可避免地具有试探性，但有望激发对这种神秘病症的进一步研究。
