Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.
Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.
Aliment Pharmacol Ther. 2021 May;53(10):1126-1137. doi: 10.1111/apt.16322. Epub 2021 Mar 11.
Conventionally, irritable bowel syndrome (IBS) is subgrouped using predominant stool form, yet it is a complex disorder, with multiple biopsychosocial contributors. We previously derived and validated a latent class model subgrouping people with IBS into seven clusters based on gastrointestinal and extraintestinal symptoms and psychological profile.
To conduct longitudinal follow-up examining the natural history and prognostic value of these clusters.
Participants completed a 12-month follow-up questionnaire. We applied our model to these data, comparing cluster membership between the two time points in those still meeting Rome IV criteria at follow-up, including stratifying the analysis by predominant stool pattern, and level of psychological burden, at baseline. We examined whether baseline cluster predicted the course of IBS, and whether starting new treatment was associated with changing cluster.
Eight hundred and eleven participants met Rome IV criteria for IBS at baseline, of whom 452 (55.7%) responded, and 319 (70.6%) still met Rome IV criteria for IBS at follow-up. Of these, 172 (53.9%) remained in the same IBS cluster as at baseline and 147 changed cluster. Cluster membership stratified according to psychological comorbidity was more stable; 84% of those in a cluster with high psychological burden at baseline remained in such a cluster at follow-up. People in clusters with high psychological burden at baseline had more severe symptoms (P < 0.001), received a higher mean number of subsequent treatments (P < 0.001), and were more likely to consult a doctor than people in clusters with low psychological burden (P < 0.001). There was no significant association between starting a new treatment and changing cluster at follow-up.
Longitudinal follow-up demonstrated little transition between clusters with respect to psychological burden, and these appeared to predict disease course. Directing treatment according to cluster, including earlier use of psychological therapies, and exploring how this approach influences outcomes in IBS, should be examined.
传统上，肠易激综合征（IBS）根据主要粪便形式进行亚组分类，但它是一种复杂的疾病，有多种生物心理社会因素。我们之前基于胃肠道和肠外症状以及心理特征，衍生并验证了一种潜在类别模型，将 IBS 患者分为七个亚群。
进行纵向随访，以检查这些亚群的自然史和预后价值。
参与者完成了为期 12 个月的随访问卷。我们将我们的模型应用于这些数据，比较了仍符合罗马 IV 标准的患者在两个时间点的聚类成员身份，包括在基线时根据主要粪便模式和心理负担水平进行分层分析。我们检验了基线聚类是否可以预测 IBS 的病程，以及开始新的治疗是否与改变聚类相关。
811 名参与者符合 IBS 的罗马 IV 标准，其中 452 名（55.7%）做出了回应，319 名（70.6%）在随访时仍符合 IBS 的罗马 IV 标准。其中，172 名（53.9%）与基线时的 IBS 聚类相同，147 名发生了聚类改变。根据心理共病情况分层的聚类成员更稳定；基线时处于高心理负担聚类的 84%在随访时仍处于该聚类中。基线时处于高心理负担聚类的患者症状更严重（P<0.001），接受的后续治疗平均数量更多（P<0.001），并且比低心理负担聚类的患者更有可能咨询医生（P<0.001）。在随访时开始新的治疗与改变聚类之间没有显著关联。
纵向随访显示，在心理负担方面，亚群之间的转变很少，而且这些亚群似乎可以预测疾病进程。根据聚类指导治疗，包括更早地使用心理疗法，并探讨这种方法如何影响 IBS 的结局，应该进行研究。
