IBS 患者亚组的特点是具有特定的、可重复的胃肠道和非胃肠道症状谱,并报告在医疗保健利用方面存在差异:一项基于人群的研究。

Subgroups of IBS patients are characterized by specific, reproducible profiles of GI and non-GI symptoms and report differences in healthcare utilization: A population-based study.

机构信息

Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina.

出版信息

Neurogastroenterol Motil. 2019 Jan;31(1):e13483. doi: 10.1111/nmo.13483. Epub 2018 Nov 4.

Abstract

BACKGROUND

In a previous clinical sample of IBS patients, subgroups characterized by profiles of GI and non-GI symptoms were identified. We aimed to replicate these subgroups and symptom associations in participants fulfilling IBS diagnostic criteria from a population-based study and relate them to healthcare utilization.

METHODS

An Internet-based health survey was completed by general population adults from United States, Canada, and UK. Respondents fulfilling IBS diagnosis (Rome III and IV) were analyzed for latent subgroups using Gaussian mixture model analysis. Symptom measures were derived from validated questionnaires: IBS-related GI symptoms (Rome IV), extraintestinal somatic symptoms (PHQ-12), and psychological symptoms (SF-8).

KEY RESULTS

A total of 637 respondents fulfilled Rome III criteria (average age 46 years, range 18-87, 66% females) and 341 Rome IV criteria (average age 44, range 18-77, 64% female) for IBS. Seven subgroups were identified in the Rome III cohort, characterized by profiles of GI symptoms (constipation-related, diarrhea-related, and mixed, respectively), and further distinguished by the presence or absence of non-GI comorbidities. The Rome IV cohort showed five similar but less distinct subgroups with a preponderance of mixed symptom profiles. Higher severity of non-GI comorbidities was associated with more frequent healthcare visits and medication usage.

CONCLUSIONS AND INFERENCES

In line with previous findings in a clinical IBS cohort, we were able to identify population-based subgroups characterized by a combination of GI symptoms with the additional distinction made by varying severity of non-GI symptoms and with differences in healthcare utilization.

摘要

背景

在之前的 IBS 患者临床样本中,确定了以 GI 和非 GI 症状特征为特征的亚组。我们旨在复制这些亚组和症状关联在满足 IBS 诊断标准的来自人群研究的参与者中,并将其与医疗保健的利用相关联。

方法

美国、加拿大和英国的一般人群成年人完成了一项基于互联网的健康调查。对符合 IBS 诊断标准(Rome III 和 IV)的患者进行潜在亚组分析,采用高斯混合模型分析。症状测量来自于验证过的问卷:IBS 相关的胃肠道症状(Rome IV)、肠外躯体症状(PHQ-12)和心理症状(SF-8)。

主要结果

共有 637 名患者符合 Rome III 标准(平均年龄 46 岁,范围 18-87 岁,66%为女性),341 名符合 Rome IV 标准(平均年龄 44 岁,范围 18-77 岁,64%为女性)。在 Rome III 队列中确定了 7 个亚组,其特征是胃肠道症状的特征(分别是便秘相关、腹泻相关和混合性),并且进一步由是否存在非胃肠道合并症来区分。Rome IV 队列显示了五个类似但不太明显的亚组,混合症状特征更为突出。非胃肠道合并症的严重程度较高与更频繁的医疗保健就诊和药物使用相关。

结论和推断

与之前在临床 IBS 队列中的发现一致,我们能够识别以胃肠道症状组合为特征的基于人群的亚组,同时还可以通过非胃肠道症状的严重程度和医疗保健利用的差异来进行额外区分。

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