학술논문
功能性便秘的新认识——罗马Ⅳ标准更新点解读 / Update of the Rome criteria for functional constipation
Document Type
Academic Journal
Source
中华胃肠外科杂志 / Chinese Journal of Gastrointestinal Surgery. 20(12):1334-1338
Subject
Language
Chinese
ISSN
1671-0274
Abstract
功能性胃肠病的罗马Ⅳ标准于2016年5月发布.基于脑-肠轴、肠道微生态、 药物基因组学以及社会心理学的发展,罗马Ⅳ标准对功能性便秘(FC)的定义、诊断标准、临床评估、病因及病理生理机制以及治疗等方面作出如下不同程度的修改:(1)定义:FC和便秘型肠易激综合征不再认为是两个疾病,两者以病理生理特征为联系存在于一个症状谱内,而这些特征则体现于每例患者临床表现不同.(2)诊断标准:罗马Ⅳ增加了Bristol粪便性状量表1～2型和每周自发排粪(SBM)两个指标,分别细化了粪便性状标准和排粪频率的评价.(3)临床评估:规范了FC的临床评估步骤,旨在排除器质性疾病,了解合并的解剖结构改变,判断分型指导治疗,减少不必要的检查以提高诊断效率.(4)病因及病理生理机制:在罗马Ⅲ基础上,罗马Ⅳ增加了大量篇幅阐述FC的病因及病理生理机制,包括危险因素及遗传学、结肠推进力不足和排粪障碍等.(5)治疗:提出了促分泌剂、胆汁酸转运抑制剂等新药物的循证医学证据,对新老药物的安全性作了评价.相比罗马Ⅲ标准,罗马Ⅳ对FC的诊断更加严谨、高效,治疗方案更加规范、合理.
The Rome Ⅳ criteria were released in May 2016. Based on the development of brain-intestinal axis theory, intestinal microecology, pharmacogenomics and social psychology, the Rome Ⅳ criteria revise the definition,diagnostic criteria, clinical evaluation process, and treatments of functional constipation (FC). The revisions are as follows:(1) Definition: FC and constipation-predominant irritable bowel syndrome are considered to be on a continuum rather than as independent entities. (2) Diagnostic criteria: the Bristol stool scale type 1, type 2 and spontaneous bowel movements are added in the diagnostic criteria, respectively, refining the criteria for stool consistency and frequency. (3) Clinical evaluation process: the Rome Ⅳ criteria specifies the clinical assessment procedure for FC. The aim is to exclude organic disease, to detect the structural changes of the combination, to determine the type of guidance therapy, and to reduce unnecessary checks to improve diagnostic efficiency. (4) Pathophysiologic mechanism: much more newly investigated mechanisms are added, including the risk factors, genetics, inadequate colonic propulsion and defecation disorder. (5) Treatment: the treatment regimen summarizes the evidence-based medical evidence of new drugs , such as secretagogues and bile acid transport inhibitors , and evaluates the safety of all the new and old drugs. Compared to the Rome Ⅲ standard, the diagnosis of FC will be more stringent and efficient, and the treatment options will be more standardized and reasonable with the Rome Ⅳ.
The Rome Ⅳ criteria were released in May 2016. Based on the development of brain-intestinal axis theory, intestinal microecology, pharmacogenomics and social psychology, the Rome Ⅳ criteria revise the definition,diagnostic criteria, clinical evaluation process, and treatments of functional constipation (FC). The revisions are as follows:(1) Definition: FC and constipation-predominant irritable bowel syndrome are considered to be on a continuum rather than as independent entities. (2) Diagnostic criteria: the Bristol stool scale type 1, type 2 and spontaneous bowel movements are added in the diagnostic criteria, respectively, refining the criteria for stool consistency and frequency. (3) Clinical evaluation process: the Rome Ⅳ criteria specifies the clinical assessment procedure for FC. The aim is to exclude organic disease, to detect the structural changes of the combination, to determine the type of guidance therapy, and to reduce unnecessary checks to improve diagnostic efficiency. (4) Pathophysiologic mechanism: much more newly investigated mechanisms are added, including the risk factors, genetics, inadequate colonic propulsion and defecation disorder. (5) Treatment: the treatment regimen summarizes the evidence-based medical evidence of new drugs , such as secretagogues and bile acid transport inhibitors , and evaluates the safety of all the new and old drugs. Compared to the Rome Ⅲ standard, the diagnosis of FC will be more stringent and efficient, and the treatment options will be more standardized and reasonable with the Rome Ⅳ.