Curtin Bryan, Jimenez Enoe, Rao Satish S C
Division of Gastroenterology and Hepatology, Digestive Health Center, Augusta University, Medical College of Georgia, Augusta, GA, USA.
J Neurogastroenterol Motil. 2020 Sep 30;26(4):423-436. doi: 10.5056/jnm20012.
Constipation, irritable bowel syndrome, fecal incontinence, abdominal pain, and anorectal pain are problems that affect 40% of the population. They commonly present with overlapping symptoms indicating that their pathophysiology affects multiple segments of the gut as well as brain and gut interactions. Clinically, although some conditions are readily recognized, dyssynergic defecation, fecal incontinence, and anorectal pain are often missed or misdiagnosed. Consequently, the assessment of lower gastrointestinal symptoms in patients with suspected colonic or anorectal motility disorder(s) remains challenging for most clinicians. A detailed history, use of the Bristol stool form scale, prospective stool diaries, ideally through a phone App, digital rectal examination, and judicious use of complementary diagnostic tests are essential. Additionally, it is important to evaluate the impact of these problems on quality of life and psychosocial issues, because they are intricately linked with these disorders. The Rome IV diagnostic questionnaire for functional gastrointestinal disorders can provide additional information often missed during history taking. Here, we discuss a systematic approach for the clinical evaluation of patients with suspected lower gastrointestinal problems, grouped under 4 common diagnostic categories. We describe how to take a detailed history, perform meticulous digital rectal examination, and use validated tools to supplement clinical evaluation, including assessments of quality of life and scoring systems for disease severity and digital Apps. These tools could facilitate a comprehensive plan for clinical management including diagnostic tests, and translate the patients' complaints into definable, diagnostic categories.
便秘、肠易激综合征、大便失禁、腹痛和肛门直肠疼痛是影响40%人口的问题。它们通常表现出重叠的症状，这表明它们的病理生理学影响肠道的多个节段以及脑肠相互作用。临床上，虽然有些病症很容易识别，但排便协同失调、大便失禁和肛门直肠疼痛常常被漏诊或误诊。因此，对于大多数临床医生来说，评估疑似结肠或肛门直肠动力障碍患者的下消化道症状仍然具有挑战性。详细的病史、使用布里斯托大便形态量表、前瞻性大便日记（理想情况下通过手机应用程序）、直肠指检以及合理使用辅助诊断测试至关重要。此外，评估这些问题对生活质量和心理社会问题的影响也很重要，因为它们与这些疾病有着复杂的联系。罗马IV功能性胃肠疾病诊断问卷可以提供病史采集过程中经常遗漏的额外信息。在此，我们讨论一种针对疑似下消化道问题患者的系统临床评估方法，这些问题分为4个常见诊断类别。我们描述了如何获取详细的病史、进行细致的直肠指检以及使用经过验证的工具来补充临床评估，包括生活质量评估、疾病严重程度评分系统和数字应用程序。这些工具可以促进包括诊断测试在内的临床管理综合计划，并将患者的主诉转化为可定义的诊断类别。
