Academic Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, United Kingdom; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.
Academic Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, United Kingdom.
Clin Gastroenterol Hepatol. 2022 Feb;20(2):334-341.e3. doi: 10.1016/j.cgh.2020.08.062. Epub 2020 Aug 31.
BACKGROUND & AIMS: There is little data on the diagnostic yield of colonoscopy in patients with symptoms compatible with functional bowel disorders (FBDs). Previous studies have only focused on diagnostic outcomes of colonoscopy in those with suspected irritable bowel syndrome using historic Rome I-III criteria, whilst having partially assessed for alarm features and shown markedly conflicting results. There is also no colonoscopy outcome data for other FBDs, such as functional constipation or functional diarrhea. Using the contemporaneous Rome IV criteria we determined the diagnostic yield of colonoscopy in patients with symptoms compatible with a FBD, stratified diligently according to the presence or absence of alarm features.
Basic demographics, alarm features, and bowel symptoms using the Rome IV diagnostic questionnaire were collected prospectively from adults attending out-patient colonoscopy in 2019. Endoscopists were blinded to the questionnaire data. Organic disease was defined as the presence of inflammatory bowel disease, colorectal cancer, or microscopic colitis.
646 patients fulfilled symptom-based criteria for the following Rome IV FBDs: IBS (56%), functional diarrhea (27%) and functional constipation (17%). Almost all had alarm features (98%). The combined prevalence of organic disease was 12%, being lowest for functional constipation and IBS-constipation (∼6% each), followed by IBS-mixed (∼9%), and highest amongst functional diarrhea and IBS-diarrhea (∼17% each); p = .005. The increased prevalence of organic disease in diarrheal versus constipation disorders was accounted for by microscopic colitis (5.7% vs. 0%, p < .001) but not inflammatory bowel disease (7.2% vs. 4.0%, p = .2) or colorectal cancer (4.2% vs. 2.3%, p = .2). However, 1-in-4 chronic diarrhea patients - conceivably at risk for microscopic colitis - did not have colonic biopsies taken. Finally, only 11 of 646 (2%) patients were without alarm features, in whom colonoscopy was normal.
Most patients with symptoms of FBDs who are referred for colonoscopy have alarm features. The presence of organic disease is significantly higher in diarrheal versus constipation disorders, with microscopic colitis largely accounting for the difference whilst also being a missed diagnostic opportunity. In those patients without alarm features, the diagnostic yield of colonoscopy was nil.
功能性肠病（FBD）患者的症状与结肠镜检查的诊断效果相关的数据较少。既往研究仅关注使用罗马 I-III 标准诊断疑似肠易激综合征患者的结肠镜检查结果，部分评估了警报特征，并得出了明显相互矛盾的结果。也没有其他 FBD（如功能性便秘或功能性腹泻）的结肠镜检查结果数据。我们使用最新的罗马 IV 标准，根据是否存在警报特征，对符合 FBD 症状的患者进行了结肠镜检查的诊断效果评估。
前瞻性收集 2019 年在门诊行结肠镜检查的成人的基本人口统计学数据、警报特征和罗马 IV 诊断问卷的肠道症状。内镜医师对问卷数据不知情。器质性疾病定义为炎症性肠病、结直肠癌或显微镜结肠炎。
646 例患者满足罗马 IV 功能性肠病的症状标准：肠易激综合征（56%）、功能性腹泻（27%）和功能性便秘（17%）。几乎所有患者均存在警报特征（98%）。器质性疾病的综合患病率为 12%，功能性便秘和肠易激综合征-便秘型（各约 6%）最低，其次是肠易激综合征-混合型（约 9%），功能性腹泻和肠易激综合征-腹泻型（各约 17%）最高；p =.005。腹泻性疾病比便秘性疾病中器质性疾病的患病率增加，这归因于显微镜结肠炎（5.7%比 0%，p <.001），而不是炎症性肠病（7.2%比 4.0%，p =.2）或结直肠癌（4.2%比 2.3%，p =.2）。然而，约 1/4 的慢性腹泻患者（可能有显微镜结肠炎风险）没有进行结肠活检。最后，在 646 例患者中，仅有 11 例（2%）无警报特征，结肠镜检查正常。
因 FBD 症状就诊并接受结肠镜检查的大多数患者均存在警报特征。腹泻性疾病比便秘性疾病中器质性疾病的患病率更高，其中显微镜结肠炎在很大程度上导致了这种差异，同时也错过了诊断机会。在无警报特征的患者中，结肠镜检查无诊断效果。
