過敏性腸症候群診断クライテリア比較
2008年 10月 15日
ref.)下痢型過敏性腸症候群治療薬:イリボー 2008年 07月 17日
過敏症腸症候群も、過活動性膀胱と同じく、自覚症状をgolden standardとした病名
、故に、質問法により診断も変わる。今後も、機能的疾患群が増えていくのだろう・・・
過敏性腸症候群の診断クライテリアとしては、Kruis scoring systemが優秀そうだが・・・
・Manning criteria for diagnosing irritable bowel syndrome(Manning AP, Thompson WG, Heaton KW, et al. Towards positive diagnosis of the irritable bowel. BMJ 1978;2:653–4)
Diagnose irritable bowel syndrome if ≥ 3 are present:
* Abdominal pain
* Relief of pain on defecation
* Increased stool frequency with pain
* Looser stools with pain
* Mucus in stools
* Feeling of incomplete evacuation
"Red flag" signs
Evaluate further if the patient is aged > 50 or has:
* Weight loss
* Blood in stools
* Anaemia
* Fever
(参照:BMJ 2005;330:632 (19 March))
・Kruis scoring system(Kruis W, Thieme C, Weinzierl M, et al. A diagnostic score for the irritable bowel syndrome. Its value in the exclusion of organic disease. Gastroenterology 1984;87:1–7.)
(参考:http://media.wiley.com/product_data/excerpt/65/04708449/0470844965.pdf)
A. Questions to be completed by the patient Score
1. Are you here because of abdominal pain?
Do you suffer from flatulence?
Do you suffer from irregular bowel movements? +34
2. Have you suffered from your complaints for more
than two years? +16
3. How can your abdominal pain be described – burning,
cutting, very strong, terrible, feeling of pressure, dull,
boring, not so bad? +23
4. Have you noticed alternating constipation and
diarrhoea? +14
B. Checklist to be completed by the Doctor
1. Abnormal physical findings and/or history
pathogenic for any diagnosis other than IBS −47
2. ESR > 20 mm/2 hours −13
3. Leukocytosis >10 000/cm −50
4. Haemoglobin: female <12 g per cent, male <14 g per cent −98
5. History of blood in stool −98
A score of 44 or more indicates IBS with a predictive value of 94 per cent.
Rome III criteria for IBS.
(参考:http://media.wiley.com/product_data/excerpt/65/04708449/0470844965.pdf)
At least 12 weeks, which need to be consecutive, in the preceding 12 months
of abdominal discomfort or pain that has two of three features:
(1) relieved by defecation; and/or
(2) onset associated with a change in frequency of stool; and/or
(3) onset associated with a change in form (appearance) of stool.
The following symptoms cumulatively support the diagnosis of IBS
・Abnormal stool frequency (>3/day and <3/week) (more than three times
a day and less than three times a week).
・Abnormal stool form (lumpy/hard or loose/watery stool.)
・Abnormal stool passage (straining, urgency, or feeling of incomplete
evacuation).
・Passage of mucus.
・Bloating or feeling of abdominal distension.
Will the History and Physical Examination Help Establish That Irritable Bowel Syndrome Is Causing This Patient's Lower Gastrointestinal Tract Symptoms?
JAMA. 2008;300(15):1793-1805.
個々の症状項目陽性LRsは 、粘液直腸通過:1.2(95% 信頼区間[CI] 0.93-1.6)~腹痛発症時の軟便:2.1(95% CI,1.4-3.0)
陰性LRsは、下腹部症状がないこと:0.29(95%CI, 0.12-0.72)~直腸部粘液通過のないこと;0.88(95%CI 0.72-1.1)
・Manningクライテリアは、陽性尤度 2.9(95%CI, 1.3-6.4)で、陰性LR 0.29(95%CI 0.12-0.71)
・Rome Iクライテリアは、LR 4.8(95CI, 3.6-6.5)で、陰性LRは0.34 (95% CI, 0.29-0.41)
・Kruis scoring systemは、陽性LR 8.6(95% CI 2.9-26.0)で、陰性LRは0.26(95%CI, 0.17-0.41)
・Rome II と III criteria は検討されず
by internalmedicine | 2008-10-15 15:40 | 消化器