功能性胃肠病罗马3.ppt

功能性胃肠病(FGIDs)  研究进展 姒健敏
FGIDs: 概念
The functional gastrointestinal disorders , defined as a bination of chronic or recurrent gastrointestinal symptoms not exp-
lained by structural or biochemical abnormalities.
Drossman DA, Rome I
IBS诊断
1#FGID
分类1990
1989
1994
Rome 1书
1992-1995
Rome 1
1999
Rome II
Gut增刊
2000
Rome II书
2006
胃肠病学增刊
+Rome书
功能性胃肠病的罗马标准演变
Rome III Functional Gastrointestinal Disorders
A Functional esophageal disorders
A1 Functional heartburn
A2 Functional chest pain of presumed esophageal origin
B Functional gastroduodenal disorders
B1 Functional dyspepsia
B1a postprandial distress syndrome
B1b epigastric pain syndrome
C Functional bowel disorders
C1 Irritable bowel syndrome
C2 Functional bloating
C3 Functional constipation
C4 Functional diarrhea
C5 Unspecified Functional bowel disorder
D Functional abdominal pain syndrome
E Functional gallbladder and Sphincter of Oddi disorders
F Functional anorectal disorders
G Functional disorders:neonates and toddlers
H Functional disorders:children and adolescents
H1 Vomiting and aerophagia
H2 Abodminal pain-related functional gastrointestinal disorders
H2a FD
H2b IBS
H2c Abdominal migraine
罗马III标准的变化
时间规定变化:症状持续至少6个月
近3个月病情活动(符合诊断标准)
分类发生变化:反刍从食道疾病(分类A)改胃肠疾病(分类B)
功能型腹痛单独分类
儿童细分类
标准变化:FD以餐后不适综合症 B1a 和上腹痛综合症 B1b替代动力型和溃疡型
IBS亚型重分:主张简单按照排便习惯分
IBS-C,IBS-D 和混合型
Oddi 括约肌功能障碍诊断标准更加严格基于症状发作时间(30’) 和排除条件。
The Functional Gastrointestinal Disorders and the Rome III Process
。
DROSSMAN DA, GASTROENTEROLOGY 2006;130:1377–1390
FGID的重叠现象
多数患者有多种症状群
FGID是一种或多种病症?
943例合格的受试者中657(69%)例做出了回复
年龄和性别分层的随机抽样,Olmsted Country,MN 年龄30-64岁
反流
IBS
便秘
Loche et al, Nerogastroenterol Motil 2005;17:
腹泻
消化不良
IBS患者上消化道症状的重叠
症状
C-IBS
(n=76)
D-IBS
(n=64)
症状数量

*
下腹痛(%)

**
上腹痛(%)


胀气(%)


消化不良(%)


恶心(%)


晨期饱胀感(%)


烧心感(%)


*P<; **P=
Talley et al, Am J Gastroenterol 2003; 98:2454
GERD
F