Academic Unit of Gastroenterology & Department of Infection, Immunity and Cardiovascular Sciences, University of Sheffield, Sheffield, UK.
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, NC, USA.
Lancet Gastroenterol Hepatol. 2021 Feb;6(2):139-148. doi: 10.1016/S2468-1253(20)30212-0. Epub 2020 Nov 13.
Irritable bowel syndrome (IBS) is a common functional bowel disorder characterised by symptoms of recurrent abdominal pain associated with a change in bowel habit. This condition is one of the most frequent reasons to seek a gastroenterology consultation in primary and secondary care. The diagnosis of IBS is made by identifying characteristic symptoms, as defined by the Rome criteria, and excluding organic gastrointestinal diseases that might otherwise explain these symptoms. Organic conditions that can be mistaken for IBS include coeliac disease, inflammatory bowel disease (IBD), colorectal cancer, and, in those with diarrhoea-predominant symptoms, chronic gastrointestinal infections, microscopic colitis, and primary bile acid diarrhoea. The concept of small intestinal bacterial overgrowth being associated with IBS is shrouded with controversy and uncertainty, mainly because of invalid tests due to poor sensitivity and specificity, potentially leading to incorrect assumptions. There is insufficient evidence to link IBS-type symptoms with exocrine pancreatic insufficiency or with symptomatic uncomplicated diverticular disease, since both are hampered by conflicting data. Finally, there is growing appreciation that IBS can present in patients with known but stable organic gastrointestinal diseases, such as quiescent IBD or coeliac disease. Recognising functional gut symptoms in these individuals is paramount so that potentially harmful escalations in immunosuppressive therapy can be avoided and attention can be focused on addressing disorders of gut-brain interaction. This Review endeavours to aid clinicians who practise adult gastroenterology in recognising the potential overlap between IBS and organic gastrointestinal diseases and highlights areas in need of further research and clarity.
肠易激综合征（IBS）是一种常见的功能性肠病，其特征为反复发作的腹痛，伴有排便习惯改变。这种疾病是初级和二级保健中寻求胃肠病学咨询的最常见原因之一。IBS 的诊断是通过识别特征性症状来做出的，这些症状由罗马标准定义，并排除可能解释这些症状的其他胃肠道疾病。可能被误诊为 IBS 的器质性疾病包括乳糜泻、炎症性肠病（IBD）、结直肠癌，以及以腹泻为主症状的患者中的慢性胃肠道感染、显微镜下结肠炎和原发性胆汁酸腹泻。小肠细菌过度生长与 IBS 相关的概念存在争议和不确定性，主要是因为由于敏感性和特异性差，检测无效，可能导致错误的假设。没有足够的证据将 IBS 型症状与外分泌性胰腺功能不全或有症状的单纯性憩室病联系起来，因为这两种情况都受到相互矛盾的数据的阻碍。最后，越来越多的人认识到，IBS 可以在患有已知但稳定的器质性胃肠道疾病的患者中出现，如静止期 IBD 或乳糜泻。识别这些患者的功能性肠道症状至关重要，这样可以避免潜在的免疫抑制治疗升级，并将注意力集中在解决肠道-大脑相互作用障碍上。本综述旨在帮助从事成人胃肠病学实践的临床医生认识到 IBS 与器质性胃肠道疾病之间可能存在重叠，并强调需要进一步研究和明确的领域。
