病歴と身体検査は,イライラ性腸症候群が,この患者の下部胃腸道症状の原因であることを確認するのに役立ちますか?
Alexander C Ford1, Nicholas J Talley, Sander J O Veldhuyzen van Zanten
1Gastroenterology Division, McMaster University Medical Centre, 1200 Main St W, Hamilton, ON L8N 3Z5, Canada. alexf12399@yahoo.com
JAMA
|October 16, 2008
まとめ
個々の症状は,刺激性腸症候群 (IBS) の診断に限られた精度を持っています. ローマI基準は一定の妥当性を示したが,マニングとクルーズの基準はIBSの診断に適度な正確さしかなかった.
科学分野:
- 胃腸内科 胃腸内科
- クリニカル診断とは
- 根拠に基づいた医学は,エビデンスに基づいた医療です.
背景:
- 下部消化器系症状は一般的であり,しばしば機能的条件に起因する.
- 刺激性腸症候群 (IBS) は,症状に基づく頻繁な診断です.
- 一部の患者は,IBSの診断の前にさらなる調査を必要とします.
研究 の 目的:
- IBSの個々の症状と症状の組み合わせの診断の正確性に関する文献を体系的にレビューする.
- IBSを特定する際のさまざまな診断基準の有効性を評価する.
主な方法:
- 2008年6月までのMEDLINEとEMBASEの体系的な文献検索.
- 下部消化器系症状を有する成人の患者に関する見通し研究を含む.
- 2人の著者による独立したデータ抽出と確率比 (LR) 推定.
主要な成果:
- 2355人の患者を含む10件の研究が分析され,IBSの罹患率は57%であった.
- 個々の症状は診断値が限られていた (陽性LRs 1.2-2.1).
- ローマI基準 (LR 4.8) とクルーズスコア (LR 8.6) は,マニング基準 (LR 2.9) よりも高い精度を示した.
結論:
- 個々の症状は,下部GI症状を有する患者のIBSの診断の正確性が低い.
- マニング基準とKruisのスコア付けシステムは,控えめな精度を示しました.
- ローマI基準のみが検証されており,IBSの診断方法を改善するためにさらなる研究が必要である.
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