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臨床履歴では,有機的消化不良と機能的消化不良を区別できますか?
Paul Moayyedi1, Nicholas J Talley, M Brian Fennerty
1Department of Medicine, McMaster University, Hamilton, Ontario, Canada. moayyep@mcmaster.ca
JAMA
|April 6, 2006
まとめ
有機性消化不良の正確な診断は,臨床医やコンピュータモデルにとって依然として困難です. いずれのアプローチも,内視鏡検査を受ける患者において,有機性疾患と機能性疾患を確実に区別することができない.
科学分野:
- 胃腸内科 胃腸内科
- 医療診断 医療診断
- 医療情報工学 医療情報工学
背景:
- 胃腸上部の症状は一般的で,人口の40%に影響します.
- 消化不良の正確な診断は,適切な調査と治療に不可欠です.
研究 の 目的:
- 主治医,胃腸科医,および有機性消化不良のコンピューターモデルの診断精度を体系的にレビューする.
- 臨床的意見とコンピュータモデルの有効性を評価し,有機的と機能的消化不良を区別する.
主な方法:
- 2003年12月まで発表された研究の体系的な文献レビュー.
- 上部胃腸内視鏡検査の結果と臨床医/コンピュータモデルの診断を比較する見通し研究を含む.
- 様々な診断アプローチの確率比 (LRs) のデータ抽出.
主要な成果:
- 11366人の患者を対象とした15件の研究が分析され,42%が有機性消化不良を患っていた.
- 臨床医とコンピュータモデルの診断では,同様の精度 (有機性消化不良のLR1.6) が示されました.
- 胃潰瘍病 (LR 2.2) と食道炎 (LR 2.4) のような特定の診断は,中程度の予測値を持っていた.
結論:
- 臨床的判断もコンピュータモデルも,有機的と機能的消化不良を適切に区別することができません.
- 患者データを含む現在の診断ツールには,内視鏡検査の前に病気の種類を区別する際の限界があります.
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