Lacy Brian, Ayyagari Rajeev, Guerin Annie, Lopez Andrea, Shi Sherry, Luo Michelle
Mayo Clinic, Division of Gastroenterology, 4500 San Pablo Boulevard, Jacksonville, FL 32224, USA.
Analysis Group Inc., Boston, MA, USA.
Therap Adv Gastroenterol. 2019 Jan 1;12:1756284818818326. doi: 10.1177/1756284818818326. eCollection 2019.
Irritable bowel syndrome (IBS) reduces quality of life and burdens healthcare systems. This study identified factors associated with frequent use of IBS diagnostic tests and procedures.
Using a United States claims database (2001-2012), tests and procedures in IBS patients occurring in the 2-year study period (12 months before/following the first IBS diagnosis) were analyzed: endoscopy, GI transit testing, anorectal procedures, and radiologic imaging. Patients were classified based on test/procedure frequency (3+, 1-2, or 0). Multivariate logistic regression identified factors associated with more frequent tests/procedures.
Among 201,322 IBS patients, 41.7% had 3+ tests/procedures, 35.1% had 1-2, and 23.3% had 0. Patients with more tests/procedures were older [mean age 50.6 (3+ group), more likely to be female and had more comorbidities, including anxiety, depressive disorders, and somatization. Dyspepsia [odds ratio (95% confidence interval): 1.80 (1.72-1.87)], interstitial cystitis [1.60 (1.45-1.77)], gastroesophageal reflux disease [1.59 (1.55-1.63)], constipation [1.50 (1.45-1.54)], and dyspareunia [1.38 (1.25-1.52)] were significantly associated with more tests/procedures (3+ 1-2), while anxiety, depressive disorders, and somatization were not. Patients with more frequent specialist visits [emergency department (ED; 1.10 (1.09-1.11)) and gastroenterologists (1.26 (1.26-1.27))] or at least one GI-related ED visit or inpatient admission [1.95 (1.86-2.04) and 3.67 (3.48-3.87), respectively] were more likely to have more tests/procedures (all < 0.05).
Test frequency in patients with IBS is strongly associated with demographic and clinical characteristics, especially comorbid conditions related to IBS. Presence of common overlapping comorbid conditions should increase clinicians' confidence in making the diagnosis of IBS, thus curtailing redundant testing and reducing healthcare costs.
肠易激综合征（IBS）会降低生活质量并给医疗保健系统带来负担。本研究确定了与频繁使用IBS诊断测试和程序相关的因素。
利用美国索赔数据库（2001 - 2012年），分析了在2年研究期内（首次IBS诊断前/后的12个月）IBS患者进行的测试和程序：内镜检查、胃肠转运测试、肛肠程序和放射影像学检查。根据测试/程序频率（3次及以上、1 - 2次或0次）对患者进行分类。多因素逻辑回归分析确定了与更频繁的测试/程序相关的因素。
在201,322例IBS患者中，41.7%进行了3次及以上测试/程序，35.1%进行了1 - 2次，23.3%进行了0次。进行更多测试/程序的患者年龄更大[平均年龄50.6岁（3次及以上组）]，更可能为女性，且有更多合并症，包括焦虑、抑郁障碍和躯体化障碍。消化不良[比值比（95%置信区间）：1.80（1.72 - 1.87）]、间质性膀胱炎[1.60（1.45 - 1.77）]、胃食管反流病[1.59（1.55 - 1.63）]、便秘[1.50（1.45 - 1.54）]和性交困难[1.38（1.25 - 1.52）]与更多的测试/程序（3次及以上对1 - 2次）显著相关，而焦虑、抑郁障碍和躯体化障碍则不然。就诊更频繁的患者[急诊科（ED；1.10（1.09 - 1.11））和胃肠病学家（1.26（1.26 - 1.27））]或至少有一次与胃肠相关的ED就诊或住院[分别为1.95（1.86 - 2.04）和3.67（3.48 - 3.87）]更可能进行更多的测试/程序（均P < 0.05）。
IBS患者的测试频率与人口统计学和临床特征密切相关，尤其是与IBS相关的合并症。存在常见的重叠合并症应增加临床医生对IBS诊断的信心，从而减少不必要的检查并降低医疗成本。
