Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.
Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.
Neurogastroenterol Motil. 2022 Nov;34(11):e14391. doi: 10.1111/nmo.14391. Epub 2022 May 9.
Previously, we used latent class analysis (LCA) to identify novel subgroups in people with irritable bowel syndrome (IBS). There are four other functional bowel disorders that, although characterized as discrete disorders, overlap considerably with, and fluctuate to, IBS. These might instead be conceptualized as a milder form of IBS. We explored this hypothesis using LCA in a cohort of people with non-IBS functional bowel disorders.
We collected demographic, symptom, and psychological health data from 1375 adults in the community who self-identified as having IBS and identified individuals meeting Rome IV criteria for any non-IBS functional bowel disorder. We performed LCA to identify specific subgroups (clusters). We followed participants up at 12 months to reassess gastrointestinal and psychological heath and also gather data about healthcare utilization and impact of symptoms.
811 people met Rome IV criteria for IBS and 558 Rome IV criteria for another functional bowel disorder (76 (5.5%) functional constipation; 198 (14.5%) functional diarrhea; 129 (9.5%) functional abdominal bloating or distension; and 155 (11.4%) unspecified functional bowel disorder). LCA in these 558 people identified five clusters defined by a combination of gastrointestinal symptoms and the extent of psychological co-morbidity. However, correlation between these clusters and the Rome IV functional bowel disorder diagnoses was poor and 75% of people were classified as having mild IBS using our previous IBS-derived model. By 12 months, one-third of people had fluctuated and met criteria for IBS. Clusters with high psychological burden had a poorer prognosis, with higher rates of medical consultation, medication use, and greater impact of symptoms on daily life.
The functional bowel disorders may be better characterized as a spectrum of IBS rather than separate disorders. Adopting this pragmatic stance may help to simply diagnosis, treatment, and recruitment of patients to research trials.
此前，我们使用潜在类别分析（LCA）来识别肠易激综合征（IBS）患者中的新型亚组。还有其他四种功能性肠病，尽管它们被定义为离散性疾病，但与 IBS 有很大的重叠，并会波动到 IBS。这些疾病可能被认为是更轻微的 IBS 形式。我们在患有非 IBS 功能性肠病的患者队列中使用 LCA 来探索这一假设。
我们从社区中自我认同为患有 IBS 的 1375 名成年人中收集了人口统计学、症状和心理健康数据，并确定了符合罗马 IV 标准的任何非 IBS 功能性肠病患者。我们进行了 LCA 以确定特定的亚组（聚类）。我们在 12 个月时对参与者进行随访，重新评估胃肠道和心理健康状况，并收集有关医疗保健利用和症状影响的数据。
811 人符合罗马 IV 标准的 IBS 诊断，558 人符合罗马 IV 标准的另一种功能性肠病诊断（76 例（5.5%）功能性便秘；198 例（14.5%）功能性腹泻；129 例（9.5%）功能性腹部胀气或膨胀；155 例（11.4%）未指定的功能性肠病）。在这些 558 人中，LCA 确定了五个聚类，这些聚类由胃肠道症状和心理共病的程度组合定义。然而，这些聚类与罗马 IV 功能性肠病诊断之间的相关性较差，并且使用我们以前的 IBS 衍生模型，75%的人被归类为轻度 IBS。在 12 个月时，三分之一的人波动并符合 IBS 的标准。心理负担较高的聚类预后较差，就诊率、用药率较高，症状对日常生活的影响较大。
功能性肠病可能更好地描述为 IBS 的一个连续谱，而不是单独的疾病。采用这种务实的立场可能有助于简化诊断、治疗和招募患者参加研究试验。
