刺激性肠综合征的诊断和治疗:一篇综述
1Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
JAMA
|March 2, 2021
概括
刺激性肠综合症 (IBS) 影响着数以百万计的人, 诊断依赖于症状. 先进的诊断可以改善那些对初始疗法没有反应的人的治疗.
科学领域:
- 胃肠病学
- 内部医学
- 功能性胃肠疾病
背景情况:
- 刺激性肠综合征 (IBS) 是美国普遍存在的胃肠疾病,影响7-16%的人口,每年直接成本超过10亿美元.
- 传统的IBS诊断依赖于识别腹,便秘,疼痛或胀气等症状集群,
- 这些功能障碍可能需要在没有反应常规第一线治疗的患者进行进一步评估.
研究的目的:
- 通过关注主要症状并排除警报信号来完善刺激性肠综合征 (IBS) 的诊断标准.
- 通过识别初始治疗不反应的特定潜在功能障碍来加强IBS的治疗.
- 探索各种IBS症状的先进诊断和治疗策略.
主要方法:
- 验证研究发现共识标准存在缺陷,有利于更简单的方法,重点关注腹痛,肠道功能障碍和膨胀,同时排除警报症状.
- 诊断增强包括详细的体形/心理疾病病史,体检和查测试 (血红蛋白,C反应蛋白) 以排除有机疾病.
- 最初的治疗包括患者教育,安慰和第一线治疗 (纤维,药,抗药,抗腹药);耐药病例可能需要检测特定的功能障碍.
主要成果:
- 通过专注于关键症状并排除警报特征,可以改善基于症状的IBS诊断.
- 对IBS的第一线治疗包括改变生活方式和针对特定症状的药物.
- 少数IBS患者可能需要进一步检查特定功能障碍,如直肠疏散障碍,结肠过渡异常或胆酸腹.
结论:
- 在IBS频谱内识别特定功能障碍的进展为改善诊断和症状管理提供了潜力.
- 虽然证据有限,但针对特定功能障碍的个性化治疗方法可能有利于不响应标准IBS疗法的人.
- 提高诊断能力可以为大多数IBS患者提供更有针对性,更有效的治疗策略.
相关概念视频
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