Al Snih Gad Mehanna, Bailey Kent R, Oblizajek Nicholas R, Bharucha Adil E
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota.
Clin Gastroenterol Hepatol. 2025 May 20. doi: 10.1016/j.cgh.2025.05.005.
BACKGROUND & AIMS: Widely used to identify constipation in clinical trials and epidemiologic studies, bowel questionnaires have not been adequately validated vs the gold standard approach, diaries. Constipation is associated with poor quality-of-life (QoL). However, the contribution of individual symptoms to QoL is unknown.
Bowel symptoms (questionnaires and 2-week bowel diaries), somatic symptom scores (range, 0-4), and bowel symptom-related QoL were evaluated in healthy women and women with constipation in the community and clinic.
The bowel variables were significantly correlated and not significantly different between the first and second weeks of the diary. Agreement between bowel symptoms assessed with questionnaires and diaries was significant (P < .001) but varied among symptoms. Of 73 participants who reported 0 to 2 stools/week on questionnaires, 63 (86%) recorded more frequent stools in a diary. Among participants with frequent (≥25% of the time) hard stools, straining, and incomplete evacuation on a questionnaire, respectively 32%, 49%, and 23% recorded these symptoms less frequently in a diary. Only 116 of 222 participants (52%) satisfied constipation criteria by questionnaires and diaries; the remainder satisfied either questionnaire or diary criteria. Stool form, excessive straining, incomplete evacuation, and somatic symptoms were independently associated with poor QoL. Each unit increase in the somatic symptom score was associated with an increased odds of poor QoL (odds ratio, 5.31; 95% confidence interval, 4.54-6.08).
Disparities exist between bowel symptoms recorded with questionnaires and diaries. Bowel diaries characterize constipation symptoms in a refined manner; only 52% of participants satisfied constipation symptom criteria on both instruments. Somatic symptoms overshadow the contribution of bowel symptoms to QoL.
肠道问卷在临床试验和流行病学研究中被广泛用于识别便秘，但与金标准方法（日记法）相比，尚未得到充分验证。便秘与生活质量（QoL）较差相关。然而，个体症状对生活质量的影响尚不清楚。
对社区和诊所中的健康女性和便秘女性进行肠道症状（问卷和为期2周的肠道日记）、躯体症状评分（范围为0 - 4）以及与肠道症状相关的生活质量评估。
肠道变量之间存在显著相关性，且在日记的第一周和第二周之间无显著差异。问卷和日记评估的肠道症状之间的一致性显著（P <.001），但不同症状之间存在差异。在问卷中报告每周排便0至2次的73名参与者中，63名（86%）在日记中记录的排便频率更高。在问卷中分别有频繁（≥25%的时间）硬便、排便费力和排便不尽的参与者中，在日记中记录这些症状的频率分别为32%、49%和23%。222名参与者中只有116名（52%）通过问卷和日记满足便秘标准；其余参与者仅满足问卷或日记标准。粪便形状、过度用力、排便不尽和躯体症状与生活质量差独立相关。躯体症状评分每增加一个单位，生活质量差的几率就增加（优势比，5.31；95%置信区间，4.54 - 6.08）。
问卷和日记记录的肠道症状存在差异。肠道日记能更精确地描述便秘症状；只有52%的参与者在两种工具上都满足便秘症状标准。躯体症状掩盖了肠道症状对生活质量的影响。
