Department of Surgery, Oncology and Gastroenterology (DISCOG), Gastroenterology Unit, University of Padova-Azienda Ospedaliera di Padova, Padova, Italy.
Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.
Am J Gastroenterol. 2021 Feb 1;116(2):362-371. doi: 10.14309/ajg.0000000000000946.
Irritable bowel syndrome (IBS) is a chronic functional bowel disorder, which follows a relapsing and remitting course. Little is known about how evolving definitions of IBS or treatment for the condition affect symptom stability. We conducted a 12-month longitudinal follow-up study of individuals who self-identified as having IBS to examine these issues.
We collected demographic, gastrointestinal symptom, mood, and psychological health data at baseline, and gastrointestinal symptom data at 12 months, from adults who self-identified as having IBS, registered with 3 organizations providing services to people with IBS. We applied the Rome III and Rome IV criteria simultaneously at baseline and 12 months and subtyped participants according to predominant stool form or frequency. We examined stability of a diagnosis of IBS, and stability of IBS subtype, for the Rome IV and III criteria separately and examined the effect of commencing new therapy on fluctuation of symptoms.
Of 1,375 individuals recruited at baseline, 784 (57.0%) provided data at 12 months. Of these, 452 met the Rome IV criteria for IBS at baseline, of whom 133 (29.4%) fluctuated to another functional bowel disorder at 12 months. In the remaining 319 (70.6%) who still met the Rome IV criteria for IBS, IBS subtype changed in 101 (31.7%) subjects, with IBS with mixed bowel habit (IBS-M) the least stable. Commencing a new treatment for IBS did not affect symptom stability. Among 631 who met the Rome III criteria at baseline responding at 12 months, 104 (16.5%) fluctuated to another functional bowel disorder. In the 527 (83.5%) who still met the Rome III criteria for IBS, IBS subtype fluctuated in 129 (24.5%), with IBS-M the most stable subtype. Again, commencing a new treatment for IBS did not affect symptom stability.
Fluctuation between functional bowel disorders and predominant stool subtype is common in people with IBS and does not appear to be influenced solely by treatment. Rome IV IBS appears less stable than Rome III IBS.
肠易激综合征（IBS）是一种慢性功能性肠病，具有反复发作和缓解的特点。目前对于 IBS 定义的演变或该疾病的治疗如何影响症状稳定性知之甚少。我们对自我诊断为 IBS 的个体进行了为期 12 个月的纵向随访研究，以探讨这些问题。
我们从通过 3 个为 IBS 患者提供服务的组织注册的成年人中收集了基线时的人口统计学、胃肠道症状、情绪和心理健康数据，以及 12 个月时的胃肠道症状数据。我们在基线和 12 个月时同时应用罗马 III 和罗马 IV 标准，并根据主要粪便形态或频率对参与者进行亚型分类。我们分别检查了罗马 IV 和罗马 III 标准下 IBS 诊断的稳定性以及 IBS 亚型的稳定性，并检查了开始新治疗对症状波动的影响。
在基线时招募的 1375 名个体中，784 名（57.0%）在 12 个月时提供了数据。其中，452 名符合罗马 IV IBS 标准，其中 133 名（29.4%）在 12 个月时波动为另一种功能性肠病。在其余 319 名（70.6%）仍符合罗马 IV IBS 标准的患者中，101 名（31.7%）患者的 IBS 亚型发生变化，其中混合肠型 IBS（IBS-M）最不稳定。开始新的 IBS 治疗并不影响症状稳定性。在基线时符合罗马 III 标准并在 12 个月时应答的 631 名患者中，104 名（16.5%）波动为另一种功能性肠病。在仍符合罗马 III IBS 标准的 527 名患者中，129 名（24.5%）的 IBS 亚型发生波动，其中 IBS-M 是最稳定的亚型。同样，开始新的 IBS 治疗并不影响症状稳定性。
IBS 患者中功能性肠病和主要粪便亚型之间的波动很常见，似乎不仅仅受治疗的影响。罗马 IV IBS 似乎不如罗马 III IBS 稳定。
