Longstreth G F
Department of Medicine, Kaiser Permanente Medical Care Program, San Diego, CA, USA.
Dig Dis Sci. 1997 Jun;42(6):1105-11. doi: 10.1023/a:1018864915375.
The common occurrence of irritable bowel syndrome underscores the importance of an accurate diagnostic evaluation without unnecessary expense. A preliminary diagnosis can usually be made with the Manning symptom criteria and additional history data in patients without warning signs of organic disease. A confident diagnosis can often be made with the addition of a physical examination and only limited laboratory and structural studies, such as a proctosigmoidoscopy and complete blood count. Tests that may be indicated in some patients include fecal examination for parasites and occult blood, dietary lactose exclusion or a lactose-hydrogen breath test, and a complete colon structural study. Other tests are occasionally indicated. Routine rectal biopsy and abdominal ultrasonography are unnecessary in patients with only typical symptoms, and large bowel motility testing is not useful. After a confident diagnosis, further testing for recurrent symptoms can be minimized. Investigation for psychosocial factors, while not necessary to diagnose irritable bowel syndrome, is important in treatment and may reduce medical costs. Misdiagnosis can result in unnecessary hysterectomy and other surgery, and it may be reduced by closer collaboration with gynecologists and general surgeons in the evaluation of patients.
肠易激综合征的常见性凸显了进行准确诊断评估且避免不必要费用的重要性。对于没有器质性疾病警示迹象的患者，通常可依据曼宁症状标准及额外的病史数据做出初步诊断。通过体格检查以及仅进行有限的实验室和结构检查，如直肠乙状结肠镜检查和全血细胞计数，往往能够做出确切诊断。某些患者可能需要进行的检查包括粪便寄生虫和潜血检查、饮食乳糖排除或乳糖-氢气呼气试验，以及完整的结肠结构检查。偶尔也需要进行其他检查。对于仅有典型症状的患者，常规直肠活检和腹部超声检查并无必要，大肠动力测试也没有用处。做出确切诊断后，对于复发症状的进一步检查可减至最少。对心理社会因素的调查虽非诊断肠易激综合征所必需，但在治疗中很重要，且可能降低医疗费用。误诊可能导致不必要的子宫切除术及其他手术，在对患者进行评估时，通过与妇科医生和普通外科医生更密切的合作，误诊情况可能会减少。
