Kang J Y, Ho K Y, Yeoh K G, Guan R
Department of Medicine, National University Hospital, Singapore.
J Gastroenterol Hepatol. 1996 Jun;11(6):515-9. doi: 10.1111/j.1440-1746.1996.tb01694.x.
The aim of the present study was to determine the degree of pain localization and frequency of nocturnal pain in duodenal ulcer and other causes of chronic upper abdominal pain. These parameters were prospectively recorded in a consecutive series of 1615 patients with chronic upper abdominal pain presenting to one gastroenterologist. The proportion of patients who were able to localize the site of their pain using a single finger was 13% for duodenal ulcer, 5% for gastric ulcer, 17% for biliary disease, 7% for functional dyspepsia and 8% for irritable bowel syndrome. The numbers of subjects with the above diagnoses who experienced nocturnal pain were 63, 63, 51, 41 and 58%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value for duodenal ulcer were 13, 92, 14 and 91%, respectively, for localized pain; 63, 50, 11 and 93%, respectively, for nocturnal pain occurrence; and 9, 96, 20 and 90%, respectively, if the pain was both localized and nocturnal. If the pain was neither localized nor nocturnal, the corresponding values for the absence of duodenal ulcer disease were 49, 68, 93 and 13%, respectively. The pain of duodenal ulcer was therefore more likely to be nocturnal and well localized compared with pain from other causes. However, while the absence of these features made duodenal ulcer unlikely, their presence was less helpful in the diagnostic process.
本研究的目的是确定十二指肠溃疡及其他慢性上腹部疼痛病因的疼痛定位程度和夜间疼痛频率。在一位胃肠病专家接诊的连续1615例慢性上腹部疼痛患者中，对这些参数进行了前瞻性记录。能够用单指定位疼痛部位的患者比例分别为：十二指肠溃疡患者占13%，胃溃疡患者占5%，胆道疾病患者占17%，功能性消化不良患者占7%，肠易激综合征患者占8%。上述诊断的患者中经历夜间疼痛的比例分别为63%、63%、51%、41%和58%。十二指肠溃疡定位疼痛的敏感性、特异性、阳性预测值和阴性预测值分别为13%、92%、14%和91%；夜间疼痛发生情况的相应值分别为63%、50%、11%和93%；如果疼痛既定位又为夜间疼痛，相应值分别为9%、96%、20%和90%。如果疼痛既不定位也不是夜间疼痛，十二指肠溃疡病不存在的相应值分别为49%、68%、93%和13%。因此，与其他病因引起的疼痛相比，十二指肠溃疡的疼痛更可能是夜间疼痛且定位良好。然而，虽然这些特征的缺失使十二指肠溃疡不太可能，但它们的存在在诊断过程中的帮助较小。
